O objetivo do presente trabalho consistiu na análise das ferramentas utilizadas pelo Direito para a proteção do meio ambiente. Para a sua consecução, estudou-se doutrina, legislação, jurisprudência e dados fáticos disponíveis em veículos de mídia digital ou impressa e sítios eletrônicos oficiais. Foram, também, conduzidas entrevistas com autoridades públicas do Estado de São Paulo e visitas a proprietários de imóveis rurais. As constatações revelaram a pluralidade de ângulos sob os quais a temática da proteção do meio ambiente pode ser encarada. As principais contribuições desta pesquisa consistiram na demonstração da insuficiência do sistema de sanções negativas para a proteção do meio ambiente, sendo indispensável a criação de incentivos positivos às práticas favoráveis ao meio ambiente. Os principais temas desta dissertação foram tratados em capítulos próprios e puderam ser assim elencados: (i) o Direito Positivo e as normas jurídicas comentários quanto à positivação do Direito e a importância das normas ; (ii) a evolução do Direito Ambiental no Brasil e a sua finalidade tendências do Direito Ambiental no Brasil e a busca da proteção ambiental ; (iii) o regime de sanções negativas maneira como as sanções negativas são aplicadas e seus resultados ; (iv) o regime de incentivos maneira como os incentivos positivos são aplicados atualmente e propostas de utilização em outros casos ; (v) experiência brasileira na concessão de incentivos ambientais as previsões normativas já existentes e os resultados alcançados no Brasil ; e (vi) o Direito Internacional Ambiental e a experiência dos países na concessão de incentivos comentários sobre tratados internacionais e normas internas de outros países que utilizam incentivos positivos para a proteção do meio ambiente. Foi apresentado um conjunto de reflexões críticas com base no material analisado e no diálogo com autoridades públicas, acadêmicos e cidadãos brasileiros na vivência profissional do pesquisador. / The scope of this work was to study the tools provided by the Law for the protection of the environment. For this purpose, this work analyzed the following material: doctrine, legislation, jurisprudence and factual data available on digital or printed media channels, as well as official websites. Interviews with public authorities of the State of São Paulo and visits to rural properties were also carried out. The findings disclosed various points of view regarding environmental protection. The main contributions of this research consisted in demonstrating the failure of the system based on negative sanctions for the protection of the environment, reason why positive incentives for environmentally friendly practices must be created. This dissertation discoursed on the following main themes: (i) the Positive Law and the legal rules comments on the positivation of the Law and the importance of statutes ; (ii) the evolution of the Environmental Law in Brazil and its goal tendencies of the Environmental Law in Brazil and the pursuit of environmental protection ; (iii) the sanctions regime how penalties are applied and what are their results ; (iv) the incentives regime how positive incentives are currently applied and proposals for enforcement ; (v) the Brazilian experience in the enactment of environmental incentives the legal rules currently applicable and the results observed in Brazil ; and (vi) the International Environmental Law and the experience of countries in the giving of incentives comments on international treaties and domestic rules of countries that enacted positive incentives for the protection of the environment. The study formulated critical findings based on the material analyzed and on discussions held with public authorities, students and citizens during the professional experience of the researcher.

This qualitative study examines middle school teachers and their thoughts and attitudes when working with gender roles and equality – both in social studies, but also as a part of schools´ core values.    The purpose of the study is to show how this work is done, both through different examples and also through understanding how these teachers look at their responsibility as teachers regarding gender roles and equality. The empiric material of the study consists of five semi-structured interviews with middle school teachers. The participants of the study had various experiences of working as teachers, which contributed to making the results and analysis interesting since they work in such a similar way with gender equality in their classrooms.    The results show that all the participants work actively with gender roles and equality in different ways. The participants say that they can use current events and ongoing discussions in society as a foundation for this work. They all see the connection between the core content in the social studies syllabus and the school’s basic values.    However, the participants have different views on their responsibilities as social studies’ teachers in relation to other teachers. On one hand, three of the participants claim that their responsibility is bigger as they are meant to teach the conceptions and their meaning within their subject. On the other hand, two of the participants say that the most important part of working with equality and gender roles lies within the school’s basic principles, and that it is the responsibility of everyone working in school to follow them.                           Keywords: gender rules, gender equality, middle school teachers and science teachers / Den här kvalitativa studien undersöker mellanstadielärares syn på och tankar kring arbetet med könsroller och jämställhet i både samhällskunskap och skolans värdegrundsuppdrag. Syftet med studien är dels att belysa hur arbetet går till genom olika exempel och dels genom att förstå hur samhällskunskapslärare ser på sitt uppdrag. Fem semistrukturerade intervjuer med behöriga mellanstadielärare har gjort den här studien möjlig. Lärarna har olika antal verksamma år, vilket har gjort resultatet och analysen intressant då de arbetar på så pass liknade sätt med könsroller och jämställdhet i sina klassrum.    I resultatet framkommer att alla lärarna jobbar mycket med könsroller och jämställdhet, på olika sätt. De menar att de allmänna diskussionerna och aktuella händelserna är bra som underlag. Alla ser kopplingen mellan det centrala innehållet i samhällskunskap och skolans allmänna värdegrundsuppdrag. Lärarna ser något olika på sitt uppdrags omfattning i förhållande till alla som arbetar i skolan. Tre av respondenterna menar att deras uppdrag som samhällskunskapslärare är något större då de i sitt arbete även ska undervisa om begreppen könsroller och jämställdhet och dess innebörd. Två av respondenterna menar att det är de som lärare som visar eleverna hur vi är mot varandra som är det viktigaste, alltså det uppdraget som finns i värdegrundsuppdraget som alla som arbetar i skolan har.                                   Nyckelord: könsroller, genus, jämställdhet, mellanstadielärare och samhällskunskapslärare

[pt] A dissertação analisa o processo de criação do primeiro tratado de saúde pública internacional, a Convenção-Quadro para o Controle do Tabaco (CQCT), assinada em 2003, e em vigência desde 2005. A hipótese defendida é a de que as décadas anteriores à criação da CQCT coincidem com o estágio de emergência da norma internacional de controle do tabaco – uma denominação avançada pelo presente trabalho na tentativa de sintetizar sob um único conceito analítico uma miríade de ideias, entendimentos, e prescrições internacionais relativas ao controle do tabaco desenvolvidas ao longo das últimas cinco décadas. Nesta perspectiva, a criação da CQCT corresponderia à institucionalização da norma de controle do tabaco a nível internacional. Ainda, tal institucionalização representaria um ponto de ruptura no processo mais amplo de evolução da norma internacional de controle do tabaco, delimitando o início de uma nova fase, caracterizada pela dinâmica de socialização da norma, bem como pela ocorrência de um efeito cascata, em que mais países passam a adotá-la, e de maneira mais rápida. No intuito de analisar o processo de internalização da norma internacional em questão, o trabalho seleciona o caso brasileiro, atentando para como as particularidades domésticas dos países tanto ditam o passo da evolução desta norma, como determinam suas futuras possibilidades. / [en] The scope of this study is to analyze the creation process of the first international public health treaty, the Framework Convention on Tobacco Control (FCTC); which was signed in 2003 and came into force in 2005. The hypothesis is that the previous decades, before the creation of FCTC, overlap with the stage of emergence of an international norm on tobacco control – a denomination used in this present analysis as an attempt to synthesize, under a single analytical concept, the myriad of ideas, understandings, and international prescriptions about tobacco control; which has been developed during the last five decades. In this perspective, the creation of FCTC would correspond to the institutionalization of tobacco control norms at the international level. Furthermore, this institutionalization would represent a tipping point in the whole evolution process of the international norm on tobacco control. This would set the limits of the beginning of a new stage, characterized by the dynamic of socialization of the norm; as well by the occurrence of a cascade effect, where more countries start to adopt the norm and do it in a faster way. With the purpose of analyzing the internalization process of the international norm in question, the present study selects the Brazilian case; emphasizing how domestic particularities of different countries dictate the speed in which this norm evolves, and also determine future possibilities.

O Brasil tem grande experiência no desenvolvimento de tecnologias para a cadeia produtiva do algodão, sendo um player mundial importante nesse segmento atualmente. O avanço da cotonicultura no Cerrado brasileiro impulsionou e viabilizou uma produção altamente tecnificada, eficiente e lucrativa, elevando o país da condição de importador de fibra de algodão na década de 70 a um dos principais exportadores atualmente. Embora a cadeia do algodão tenha atingido um alto nível tecnológico, há ainda muitos desafios e problemas a serem vencidos, uma vez que nos últimos anos tem-se verificado uma estagnação na produtividade, apesar do aporte cada vez maior de tecnologias como cultivares transgênicas, máquinas, insumos e gestão de dados mais eficientes. Nesse contexto as técnicas de mineração de dados oferecem excelente oportunidade de se avaliar esse problema, uma vez os dados desse setor são bem organizados, como é o caso do Banco de Dados organizado pelo Instituto Matogrossense do Algodão (IMAmt) e que foi disponibilizado para esse estudo. Problema: O problema alvo desse trabalho é entender as causas da estagnação da produtividade do algodoeiro, os seja, dos fatores que estão influenciando negativamente na produção de algodão no cerrado no estado de Mato Grosso. Solução: A solução proposta é se utilizar técnicas de mineração de dados em um BD complexo, contendo informações da produtividade e fatores do sistema de produção que influenciam na produção, para a extração de conhecimento e geração de recomendações para os cotonicultores do Estado. Objetivo: Aplicar técnicas de Mineração de Dados, mais especificamente classificação baseada em regras em um BD de produção de algodão no estado de Mato Grosso para identificar os principais fatores, como as práticas de manejo, as variáveis do solo e a incidência de doenças, que estão afetando a produtividade do algodão e consequentemente limitando o aumento da produtividade. Estado-da-arte e Método proposto: Diferentemente de outros trabalhos baseados em classificação de regras de associação que tem foco no resultado preditivo (acurácia), nesse trabalho a ênfase é da extração de regras de associação que tenham relevância prática e que possam auxiliar o agricultor na tomada de decisão. Na etapa de pré-processamento realizou-se a seleção e transformação de atributos e identificação de outliers. Os atributos numéricos foram discretizados utilizando 4 métodos, sendo 3 automáticos (técnica de Kononenko, Better Encoding e a combinação das duas) e um manual. Na etapa de modelagem de classificação, os algoritmos de regras utilizados foram o PART e o JRip e a conversão binária de atributos foi também avaliada. O desempenho foi avaliado pela precisão, revocação, custo e a combinação delas no índice IFC (100*F/Log2 custo). Resultados: A avaliação das métricas indicou o melhor desempenho para o classificador PART, com a discretização pela técnica de Kononenko combinada com Better Encoding, seguida pela conversão binária. A análise das regras, com auxílio de especialistas da área, possibilitou a seleção daquelas mais relevantes e dos atributos que mais impactam na produtividade. Dentre esses atributos, destacam-se: a cultivar de algodão, o tempo da abertura e de início do cultivo de algodão na área, o sistema de plantio e de preparo do solo. Os principais atributos físico-químicos do solo foram os micronutrientes zinco, ferro e boro e os macronutrientes cálcio e magnésio e a resistência do solo à penetração. A ausência do fungo fusarium impactou positivamente na produtividade. Em geral, os atributos relacionados ao Manejo do algodoeiro apresentaram maior relevância na composição das regras de classificação, seguidos dos atributos Químicos e Físicos do Solo e dos atributos relacionados à doenças. / Brazil has great experience in developing technologies for the cotton sector, becoming an important world player presently. The cotton production has spread in the Brazilian cerrado stimulating and making viable a highly technical, efficient and profitable production, and leading the country from a condition of importer to a major exporter, currently. Although the cotton productive chain has reached a high technological level, there are many challenges and problems to be overcome, since the productivity is stagnant despite the use of more efficient transgenic cultivars, machines, agrochemicals and data management. In this context data mining offers excellent opportunities to evaluate this problem, since data in this sector is very well organized, as is the case of the Data Base (DB) of the Mato Grosso Cotton Institute, which is available for this study. Problem: The target problem of this study is to understand the causes of such productivity stagnation, that is, the factors influencing negatively the Mato Grosso cerrado cotton production. Solution: The proposed solution is to apply data mining to a complex DB, having productivity information and the factors that influences production, for extracting knowledge and generate recommendations for the cotton farmers in the State. Purpose: Apply data mining technique, more specifically the classification based on rules, in a DB of cotton production in the State of Mato Grosso to identify the main factors, as management practices, soil variables and diseases that are affecting cotton productivity and limiting the productivity increasing. State-of-Art and Proposed Method: Unlike other works based in classification based on rules with focus in prediction (accuracy) this work has emphasis in association rules with practical relevance to help farmers in decision-making. In the pre-processing step, it was performed selection, transformation and outliers identification. Numerical attributes were discretized using 4 methods, 3 automatic (techniques of Kononenko, Better Encoding and the combination of both) and one manual. In the classification step, the rule algorithms used were PART and JRip and binary split was also evaluated. The performance was evaluated by precision, recall, cost and the combination of them in an index called IFC (100*F/Log2 cost). Results: The evaluation of these metrics has indicated the best performance for the classifier PART, with discretization by the technique of Kononenko combined wit Better Encoding, and using binary split. The rules were analyzed with the aid of specialists for the selection of the most relevant ones and select the attributes that mostly impact the productivity. Among these attributes are: the cotton cultivar, time of opening the area and beginning of cotton cultivation, soil and growing system used. The main soil physico-chemical attributes were the micronutrients zinc, iron, bore, the macronutrients calcium and magnesium, and soil penetration resistance. The absence of the fungi fusarium has impacted positively in productivity. In general, attributes related to cotton management were more relevant in the classification rules composition, followed by soil Chemical and Physical attributes and lastly the ones related to diseases.

Postgraduate tutors have an important role to play in teaching and learning in higher education. There has been substantial research conducted in this area - much of it is orientated towards improving the quality of the methods of instruction and classroom practice. Far less research has been focused on the postgraduate tutors as producers of content. This research is based on an intervention that tasked five postgraduate tutors with planning two tutorials and designing an assessment task: activities that fell outside the scope of their usual work and roles. The aim of the research is to discover more about how postgraduate tutors, who typically have extensive and expert content knowledge, but very little pedagogical knowledge, develop pedagogical content knowledge. The study tracks the decision making process and the knowledge reservoirs that the participants emphasise in their planning and design in order learn about the teaching beliefs and priorities of these novice teachers. The analysis goes on to explore the criteria for legitimation that the postgraduate tutors establish and/ or entrench. The study finds that the participants are highly sensitive to the many kinds of constraints that circulate and that they in turn re-circulated. It goes on to suggest that postgraduate tutors are likely to reproduce the regulative rules that they find in operation and the cumulative messages of what is valued in terms of student and teacher performance in a given context.

Figure éminente du groupe des Fantaisistes, Tristan Derème (1889-1941) est surtout connu pour sa production poétique. Y réduire son œuvre serait, cependant, faire fi d’une masse de livres (Le Quatorze juillet ou petit art de rimer quand on manque de rimes, Le Poisson Rouge, L’Onagre Orangé, La Libellule Violette, parmi beaucoup d’autres) qui constituent, sous la forme spéciale d’une réflexion à plusieurs voix, autant d’essais sur un très grand nombre de questions, surtout d’ordre formel, touchant la poésie française.Il s’agit d'abord de voir en quoi et comment ce massif ignoré de la littérature du XXe siècle se situe au carrefour d’une tradition très classique, qu’il prolonge, et des perspectives les plus modernes, qu’il préfigure, aussi bien à travers son « dit » (les conceptions et positions développées, qui font l'objet d'une première partie), qu’à travers son « faire » (les créations, avec diverses contraintes inédites d'écriture et de réécriture, analysées dans un deuxième temps). Cette réflexion polylogale, menée dans un salon littéraire fictif, interroge de façon essentielle la théorie littéraire. La forme ludique et originale de ce « dire » occupe la troisième et dernière partie de l'étude, avec pour horizon une perspective métathéorique : et si une poétique de la poésie ne pouvait s'écrire que dans la fantaisie ? / An eminent figure in the group of French writers known as the « Fantaisistes », Tristan Derème (1889-1941) is best known for his poetical works. However, limiting Derème’s achievement to his poetry implies putting aside a considerable number of books (Le Quatorze Juillet ou petit art de rimer quand on manque de rimes, Le Poisson rouge, L’Onagre orangé, La Libellule Violette, to name but a few) which constitute a series of essays employing multiple voices to explore a wide range of questions relating to French poetry, particularly its formal properties.This thesis first explores the ways and means by which this little-commented opus of twentieth century literature operates at a theoretical crossroads, extending an undoubtedly classical tradition whilst anticipating strikingly modern perspectives. Consideration is given both to the substance of Derème’s writing (the conceptions and positions which he develops, which are the subject of the first part of the thesis) and do the literary form of his work (his formal innovations, experimenting with diverse writing and re-writing constraints, which are analyzed in the second part). Set in a fictional literary salon, Derème’s polyvocal reflections raise fundamental questions concerning literary theory. The ludic and original form of these reflections is the subject of the last part of the study, which opens up a meta-theoretical perspective: what if a poetics of poetry could only be written as fantasy ?

[pt] Sobre a teoria constitucional desenvolvida na segunda metade do século XX (a teoria pós-1945) está assentada a produção teórico- dogmática hegemônica no direito constitucional brasileiro. Quer na sua matriz valorativa quer naquela direcionada por princípios e procedimentos é pressuposto que as constituições detêm uma espécie de normatividade autônoma capaz de regular a vida, harmonizando, pela via da reciprocidade, a tensão entre norma e realidade. Num momento de globalização, risco, estado de guerra, Império e neoliberalismo, entretanto, o consenso teórico alcançado com a tese da normatividade autônoma da constituição acha-se desestabilizado. Necessária sua reestruturação. A isso se propõe Exceção Permanente: introdução a uma categoria para a teoria constitucional no século XXI. A categoria exceção permanente, apresentada nesta dissertação em suas linhas introdutórias, aponta, ao invés da reciprocidade, em direção à imanência entre norma e vida, bem assim a um âmbito de indiscernibilidade em que o discurso jurídico- constitucional é redimensionado, abrindo horizontes à ação emancipatória e a uma nova compreensão da própria normatividade. Ilumina a difícil e obscura equação entre constituição e vida, encontrando-se nela chave adequada para compreender o processo histórico contemporâneo, diretivas teóricas e mecanismo para articular questões centrais da teoria constitucional, v.g., constituição, direitos fundamentais, hermenêutica constitucional e jurisdição constitucional. / [en] The constitutional theory developed in the second half of the XX century (the theory of post-1945) bounds the hegemonic theoretic- dogmatic tradition in the constitutional Brazilian Law. Whether in the valued matrix or in the one guided by principles and procedures is based on the assumption of the Constitution`s autonomous normativity that is able to regulate life, harmonizing, by the way of reciprocity, the tension between norm and reality. However, in a period of globalization, risk, war state, Empire and neo- liberalism, the theoretic consensus achieved by the autonomous normativity theory of the constitution is non-stabilized. Urging a new structure. It is the aim of Exceção Permanente: introdução a uma categoria para a teoria constitucional no século XXI. Instead of the reciprocity post-1945 theory, the permanent exception category introduce in this dissertation points in the direction to the immanence between norm and life, and to a space of indiscernability whose legal- constitutional speech is redimensioned opening new horizons to the emancipatory action and to a new comprehension of the normativity. Clarify the difficult and obscure equation between the constitution and life. As a consequence of that, it is found inside this permanent exception category an appropriated key to comprehend the contemporaneous historical process, theorical directives and mechanism to articulate central questions of the constitutional theory, v.g., constitution, fundamental rights, constitutional hermeneutic and constitutional jurisdiction.

Ur ett samhällsperspektiv är revision en viktig funktion där syftet är att kvalitetssäkra ekonomisk information samt skapa trygghet gentemot allmänheten. Digitaliseringens framväxt har skapat goda förutsättningar för att få fram relevant information där ett samspel mellan parterna är avgörande i säkerställandet. Studiens problemformulering lyder, på vilka sätt kan rotationsreglerna påverka revisorernas möjlighet att bedöma och hur bidrar revisorer till utveckling av informationskvaliteten. Syftet är att skapa förståelse om hur informationskvalitet har påverkats efter införandet av rotationsreglerna, samt hur revisorerna bidrar till att utveckla och upprätthålla god kvalitet. Den teoretiska- och praktiska referensramen baseras på tidigare forskning och litteratur om informationskvalitet samt relationerna mellan parterna och revisionsprocessen. Undersökningen har genomförts genom fyra telefonintervjuer samt av tre strukturerade intervjuer med skriftliga svar vars innehåll är identiska och bygger på den teoretiska samt praktiska referensramen. Slutligen kopplades den empiriska delen samman med den teoretiska och praktiska vilket resulterade i en klar analys och utförlig slutsats.   Studien bevisar att det inte föreligger nämnvärda skillnader i informationskvaliteten efter rotationsreglernas införande men däremot påvisas bedömningen av kvaliteten bero på hur väl kommunikationen fungerar. Genom att upprätthålla en god kommunikation och samspel mellan parterna säkerställer detta en god kvalitet. Ytterligare faktorer där bedömningen samt upprätthållandet av kvaliteten uppnås är genom noggrann planering där vikten ligger på att prioritera uppdragen korrekt. Vidare förbättras även kvaliteten på informationen genom revisorernas individuella utveckling där kontinuerliga internutbildningar ges. Förståelsen kring reglerna är av stor vikt för att upprätthålla en god informationskvalitet eftersom det bygger på att ha vetskapen om hur och varför processen ska genomföras. I samband med detta skapar det förutsättningar till att utföra en utförlig och noggrann bedömning och granskning av revisionen. / The purpose of this thesis is to give insight on the effects of the quality of information due to the initiation of rotation rules. Furthermore, it also presents accountants contribution in developing and maintaining a good quality of information. The theoretical as well as practical framework is based on previous research and literature on information quality, the relations between parties and the audit process. The study shows that the initiation of rotation rules have made no difference in terms of information quality. However, to maintain high quality of information good communication between parties is of essence. The maintenance of information quality requires proper planning, prioritizing of assignments and development generated by continuous education. Furthermore, understanding of current rules is essential in maintaining good information quality and implementing a thorough assessment of the audit.

Contexte: Le pronostic des neutropénie fébrile (NF) post-chimiothérapie de l’enfant a été amélioré par une antibiothérapie à large spectre systématique. Cependant des infections sévères ne surviennent que dans 15-25% des cas. Il a été recommandé en 2012 de faire évoluer la prise en charge en tenant compte du risque infectieux en utilisant des règles de décision clinique (RDC). Nous avions montré que les outils publiés pour distinguer ce risque étaient peu performants, non validés ou non applicables sur notre population. Une nouvelle RDC (score) permettant de distinguer les épisodes de NF à bas risque d’infection sévère a été construite. Cette RDC a été validée en interne. Compte tenu des différences mises en évidence dans les populations de tumeurs solides et d’hémopathies, il pourrait être pertinent d’utiliser un arbre de décision clinique pour classer le risque infectieux dont la première division serait le type de cancer et de valider cette nouvelle RDC.L’objectif de ce travail était de calibrer cette RDC sous forme d’arbre et de la valider sur un échantillon multicentrique pour distinguer les enfants avec NF à bas risque d’infection sévère. Méthodes: La première étape a été d’évaluer la méthodologie de développement des RDC déjà publiées pour identifier d’éventuelles limites méthodologiques. Ensuite, nous avons décrit les différences entre les hémopathies ou avec les tumeurs solides. Puis, la nouvelle RDC a été calibrée sous forme d’un arbre de décision à l’aide du logiciel Sipina. Sa performance a été évaluée en termes de sensibilité (Se), spécificité (Sp), et rapport de vraisemblance négatif (RVN).En parallèle, un protocole de validation multicentrique prospectif a été monté, avec pour objectif une Se proche de 100% et un RVN inférieur à 0,1. Il a été validé par le CCTIRS et par la CNIL. Il a été financé par la Ligue Contre le Cancer (72 000 euros). Trente et un centres ont été recrutés. La RDC n’a été appliquée qu’a posteriori ; la prise en charge de cette population n’a donc pas été modifiée. La performance de la RDC entre la population de validation et construction a été analysée en termes de Se, Sp, RVN. L’évaluation des pratiques de prise en charge des NF post-chimiothérapie de l’enfant a été faite en parallèle sous la forme d’une enquête nationale, dans la perspective d’une étude d’impact ultérieure.Résultats: L’étude de la méthodologie des RDC déjà publiées a montré que les critères de développement d’une RDC étaient respectés dans 71% des cas (médiane). Une RDC avait atteint le plus haut niveau d’évidence, mais sa population de construction était différente de la nôtre et cette RDC n’était pas reproductible sur notre population. Il existait 2 à 3 fois plus d’infection sévère chez les patients atteints d’une hémopathie maligne. Deux arbres de décision ont donc été construits pour différencier le risque d’infection sévère. Pour les patients avec une tumeur solide il avait des Se de 96%, Sp de 59% et RVN à 0,07, pour ceux avec une hémopathie maligne, il avait des Se de 99%, Sp de 52% et RVN à 0,03. Les inclusions de la validation multicentrique se sont déroulées de janvier 2012 à mai 2016. 1806 épisodes ont été inclus (333 infections sévères, 18,4%). L’application de la RDC a été faite a posteriori(en cours). L’enquête nationale menée en parallèle sur la prise en charge faite en pratique dans les centres français a montré une grande variabilité de prise en charge notamment dans les définitions de la neutropénie et de la fièvre. Un travail doit être initié avec la Société Française des Cancers de l’Enfant pour uniformiser la prise en charge des NF et déterminer le type d’allègement thérapeutique à proposer en vue de l’étude d’impact, en utilisant cette RDC. Conclusion: Les étapes de construction et de validation de cette nouvelle RDC ont été réalisées en respectant les standards méthodologiques. Une étude d’évaluation de l’impact de la RDC devra être mise en place pour atteindre le plus haut niveau d’évidence. / Purpose: Chemotherapy-induced febrile neutropenia (FN) is known to be a risk for severe infection and death in the absence of prompt and appropriate antibiotic therapy. Immediate hospitalization for rapid institution of empirical broad-spectrum intravenous antibiotic therapy has led to reduce the mortality. However, documented or severe infections occur in only 15-25% of cases. In 2012 paediatric guidelines suggested to adapt the management of FN episodes to the infectious risk. In a previous work, none of the published clinical decision rules (CDRs) to rule out severe infections have been validated and have only rarely been tested in an external set of children. The methodological standards used to derive and validate these CDRs were a real concern. A new CDR was previously derived as a scoring system in Lille to classify the patients at high or low risk of severe infection, with a dataset collected in 2 centers in Lille, in following methodological standards. Differences between solid tumours and blood cancers were observed in children with FN for numbers and types of infections. As a result, we considered relevant to build a decision tree model to predict the low risk for severe infection with a first division that could be the type of cancer. This new decision rule was already validated in an internal set of data, but required an external validation.The aim of this project was to calibrate the CDR as a decision tree and validate its performance a posteriori in an external set of patients, using prospectively collected data from multiple centers.Methods: the methodological standards of available CDRs were first analysed. The new CDR derived on a bicentric dataset was reused to calibrate the CDR as a decision tree, using Sipina software. A prospective multicentric observational protocol funded by 72000€ provided by “la Ligue Contre le Cancer” was developed for an external validation of the CDR to expect near 100% sensitivity (Se) and a negative likelihood ratio (LR) below 0.1. The ethical regulation was followed. Thirty-one centers were recruited in France (27/30 referent centers for management of children with cancer, and 4 proximity centers fit to manage children with FN). The CDR was not applied to the included patients, and remained confidential. The data were collected on an e-CRF “capture system”. The data were captured by an assistant of clinical research and controlled by a physician researcher after the monitoring of the data in all centers. The CDR was a posteriori applied on the dataset. The performance of the CDR between validation and derivation sets of patients was analysed in terms of Se, specificity (Sp) and negative LR.Results: the methodological standards of development of a CDR were not always followed for the development of the published CDR predicting infection for FN in children. Only one CDR followed all criteria and reached the highest level of evidence, but this CDR was built in a very different population from our and was not reproducible. A decision tree model of the CDR was built to distinguish children with FN at low risk of severe infection. For children with solid tumours, the CDR had 96% Se, 59% Sp, and a negative LR at 0.07. For children with blood cancers, the CDR had 99% Se, 52% Sp, and a negative LR at 0.03.For external validation, inclusions started in 2012 until May 2016. Of the 31 centers, 23 included 1806 cases (333 severe infections [18.4%]). The retrospective application of the CDR on all included case in ongoing. A national survey was also conducted as the same time to analyse the real management of children with FN in France in order to determine the type of management that could be proposed for low risk patients when the CDR will be tested in an impact study.Conclusion: the different steps for the construction and validation of the new CDR were conducted following standards. This CDR is in progress to reach the highest level of evidence.

A alta disponibilidade de informações em saúde por meio de sistemas de informação só pode ser proporcionada com a utilização de sistemas que sejam capazes de trocar dados de forma segura e consistente. Para isso, estes sistemas necessitam ser interoperáveis, capazes de trocar informações. Uma das características mais importantes de tais sistemas é a utilização de terminologias em saúde, permitindo a codificação dos termos clínicos de maneira robusta e consistente. Algumas das terminologias mais conhecidas e utilizadas são: SNOMED-CT, ICD-CM, ICD, LOINC, NANDA, TUSS, CBHPM, Tabela de Procedimentos SUS, entre outras. Quando os sistemas não se utilizam de uma mesma terminologia para codificação de um mesmo conceito é necessário a realização de mapeamentos e traduções entre as terminologias. O mapeamento entre terminologias consiste em estabelecer as associações pertinentes às terminologias para que cada termo pertencente a uma possa ser associado a algum termo da outra. Este mapeamento, geralmente, é criado por especialistas de domínio, que atuam analisando as duas terminologias em questão e estabelecendo manualmente estas associações. Neste trabalho, propomos uma metodologia que visa facilitar a realização deste tipo de mapeamento, por meio da utilização de dois recursos: Regras de Associação, para extração das associações preexistentes entre as terminologias em registros clínicos; e Busca Textual, para pareamento entre conceitos das duas terminologias baseado na identificação de termos comuns. O auxílio à criação destes mapeamentos é proporcionado por meio de sugestões de relações existentes entre as terminologias. Como resultado deste trabalho obtivemos uma metodologia genérica de mapeamento entre terminologias capaz de auxiliar com sucesso os especialistas. Em aproximadamente 40% dos casos os especialistas concordaram com uma das sugestões apresentadas. De forma complementar, obtivemos o mapeamento parcial entre duas terminologias: a ICD9-CM e a TUSS, utilizadas como caso de uso para validação da metodologia. / The high availability of health information through information systems can be provided only with the use of systems that are able to exchange data securely and consistently. To this end, these systems need to be interoperable, capable of exchanging information that is understood both at one end as the other. One of the most important characteristics of such systems is the use of terminologies in health, allowing the coding of clinical terms in a robust and consistent manner. Some of the most known and used terminologies are: SNOMED-CT, ICD-CM, ICD, LOINC, NANDA, TUSS, CBHPM, and SUS Procedures Table, among others. When systems do not use the same terminology for encoding the same concept, it is necessary to perform mappings and translations between the terminologies. The mapping between terminologies consists on establishing the relevant associations present in terminologies, so that each term belonging to one can be associated unambiguously to the terms belonging to another. This mapping is typically created by domain experts who work analyzing the two terms in question and manually setting these associations. In this paper, we propose a methodology that aims to facilitate this type of mapping, through the use of two frameworks: Association Rules, for the extraction of preexisting associations between the terminologies in clinical records; and Textual Search, for pairing between the two terminologies concepts based on the identification of common terms. The creation of these mappings by experts is aided by the method suggesting links between the terminologies through the Association Rules or Textual Search. As a result of this work we obtained a generic methodology for mapping between terminologies able to successfully assist the experts. In approximately 40% of cases the experts agreed with the suggestions. As a complement, we obtained a partial mapping between two specific terminologies for coding surgical procedures: the ICD9-CM and TUSS, used as use case to validate the methodology.