A maioria dos edifícios de concreto pré-moldado, construídos no Brasil e no exterior, é constituída por lajes alveolares. Este trabalho considera o estudo da continuidade dessas lajes. No cálculo desses elementos, a prática comum é considerá-los como simplesmente apoiados. Para melhorar o desempenho, é possível promover a continuidade nos apoios intermediários. Isso pode ser feito colocando armadura na região tracionada da ligação, no interior da capa, ou através de barras concretadas dentro dos alvéolos. O objetivo deste trabalho é investigar o comportamento de pavimentos formados por lajes alveolares com continuidade, com armadura na capa. Para isso, foi realizado um estudo envolvendo análise teórica e experimental em três modelos. Esses modelos, em escala real, foram submetidos a um carregamento transversal, distribuído de forma linear. Os estudos teóricos consideraram uma simulação numérica com elementos de viga e a fórmula de Branson para descrever o comportamento não linear físico do material. Além disso, foram avaliadas as expressões dos principais códigos nacionais e internacionais, no que diz respeito à ruptura por cisalhamento da seção transversal e da interface laje-capa. Os resultados da análise experimental indicaram que o modelo 1 rompeu por cisalhamento da seção transversal, com o mecanismo de tração diagonal do concreto. O modelo 2 apresentou ruptura por cisalhamento da interface. No modelo 3, a ruptura foi por flexão. O comportamento dos modelos ensaiados foi governado pela fissuração da capa na região de momento negativo. A análise teórica com elementos de barra representou de forma satisfatória o comportamento dos modelos ensaiados. As únicas formulações que apresentaram resultados coerentes com os três ensaios foram: EUROCODE 2:2004, para o cálculo da resistência ao cisalhamento da interface, e FIB MODEL CODE 2010, para o cálculo da resistência ao cisalhamento da seção transversal. Conclui-se que a continuidade melhora o desempenho das lajes alveolares, uma vez que reduz os deslocamentos no meio do vão e aumenta a capacidade de carga. / Most buildings of precast concrete built in Brazil and abroad consist of hollow core slabs. This paper considers the study of the continuity of these slabs. In design of these elements the common practice is to consider them as simply supported. To improve the performance it is possible to promote the continuity in the intermediate supports. This can be done by placing reinforcement in the tensioned region of the connection, inside the topping, or by bars concreted inside the voids. The aim of this work is to investigate the behavior of hollow core floors with continuity, with reinforcement in the topping. For this, a study involving theoretical and experimental analysis was conducted in three models. The full-scale models were subjected to a transverse loading distributed linearly. The theoretical studies have considered a numerical simulation with beam elements and the Branson formula to describe the physical nonlinear behavior of the material. Furthermore, the specifications of the major Brazilian and international codes were evaluated, with respect to failure by shear of the cross section and the slab-topping interface. The results of the experimental analysis indicated that the model 1 failed by shear of the cross section with the mechanism of diagonal tension of the concrete. Model 2 presented shear failure of the interface. In model 3, the failure was by flexure. The behavior of the tested models was ruled by cracking of the topping in region of negative bending moment. Theoretical analysis with beam elements represented satisfactorily the behavior of the tested models. The only formulations that presented consistent results with the three tests were: EUROCODE 2:2004, to calculate the shear strength of the interface, and FIB MODEL CODE 2010, for calculating of the shear strength of the cross section. It is concluded that the continuity improves the performance of the hollow core slabs, as it reduces the displacements at mid-span and increases the bearing capacity.

L’objectif de nos travaux de thèse était de mieux comprendre les troubles de l’identité dans la schizophrénie, et en particulier les perturbations du sentiment de continuité de soi dans le temps. Dans ce but, nos recherches ont consisté en une analyse exhaustive de la cohérence narrative de récits de vie recueillis auprès de patients schizophrènes stabilisés. Nos résultats mettent en évidence un défaut de raisonnement autobiographique au sein des récits de patients accompagné de perturbations de la cohérence temporelle. Ces altérations sont liées aux déficits exécutifs des patients d’une part et à la diminution de leur sentiment subjectif de cohérence personnelle d’autre part. Nos résultats vont dans le sens d’une dysconnexion entre le self et la mémoire autobiographique dans la schizophrénie conduisant à une perturbation du sentiment de continuité de soi dans le temps. Nous concluons notre travail en développant des applications cliniques et thérapeutiques en vue d’aider les patients à recréer un récit cohérent de leur vie et tenter de renforcer leur sentiment de continuité de soi. / The purpose of this project was to better understand disorders of the self in schizophrenia, and more particularly impairments of the sense of self-continuity observed in these patients. In order to do so, we deeply investigated narrative coherence of stabilized patients’ life stories. Our analyses showed a lack of autobiographical reasoning within patients’ narratives and a decreased of temporal coherence. Those impairments were related to patients’ executive dysfunction and to their subjective feeling of less coherent life. Our results suggest a disconnection between the self and autobiographical memory in schizophrenia leading to an impoverishment of the sense of self-continuity across time in those patients. To go further, clinical and therapeutic applications could ensue from our work. Indeed, it would be possible to help patients creating new and more coherent life stories through psychotherapy and by this way help them to retrieve a sense of self-continuity.

Enterprises during their operation are impacted many threats and risks that could dramatically affect their business. Business Continuity Management has evolved to provide resistance against the eternal operational risks. BCM aims to ensure business continuity in case of its danger. The goal of this thesis is to apply the selected methods of the BCM into emergency planning, which is regulated by legislatively for businesses in the Czech Republic.

A cirurgia de terceiro molar é um dos procedimentos mais realizados na área de cirurgia e traumatologia bucomaxilofaciais. A evolução pós-cirúrgica era baseada em evidência clínica. No nosso trabalho, propusemos acompanhar a evolução pós-cirúrgica através da utilização do eletromiografia de superfície. Realizamos quatro tomadas, no pré-operatório, normalizando, e três no pós-operatório, 7, 14, 21 dias, em amostra de 30 pacientes. Observamos, no vigésimo primeiro dia, recuperação próxima da normalização no gênero feminino e ainda aquém no gênero masculino. Constatamos que a eletromiografia de superfície é sensível para controle da evolução pós-cirúrgica, demonstrando ser um método eficaz e seguro. / The third molar surgery is one of the most frenquently performed procedures in the buccal-maxillary-facial traumatology and surgery areas, whereas the post-surgery evolution has been based on the clinical evidence until now. In our study, we proposed to analyze the post-surgery clinical evolution through the use of electromyograph of surface. We have made four takes, on the presurgery, normalizing, and three on the 7, 14 and 21 postoperative days, in a sample of 30 patients. We observed, in the twentieth-first day, a recovery close to normalization on women, but men did not reach normalization. The electromyograph of surface is sensitive to the post-surgery evolution control, and is an efficient and safe method.

La gestion de la continuité des opérations est un cadre complet visant à éviter que les événements perturbateurs n’affectent les opérations commerciales, à rétablir rapidement les activités et à réduire les dommages potentiels correspondants pour les systèmes énergétiques, tels que les centrales nucléaires. Cette thèse propose des discussions sur les aspects suivants: développement de méthodes appropriées d'évaluation des risques afin d'intégrer les données de surveillance de l'état et les données d'inspection pour une mise à jour et des pronostics robustes et en temps réel du profil de risque. Pour tenir compte de l'incertitude des données de surveillance de l'état, un modèle de mélange gaussien de Markov caché est développé pour modéliser les données de surveillance de l'état. Un réseau bayésien est appliqué pour intégrer les deux sources de données. Pour améliorer l'applicabilité de la continuité des opérations dans la pratique, les variables variant dans le temps considèrent l'indice de continuité des opérations, par ex. la dégradation des composants, les revenus en fonction du temps, etc. sont pris en compte dans le processus de modélisation de la continuité des activités. Sur la base de l'indice de continuité d'activité proposé, une méthode d'optimisation conjointe prenant en compte toutes les mesures de sécurité dans le processus d'évolution des événements, y compris les étapes de prévention, d'atténuation, d'urgence et de récupération, est développée pour améliorer la continuité des opérations du système avec des ressources limitées. Les méthodologies proposées sont appliquées aux centrales nucléaires contre les événements perturbateurs. / Business continuity management is a comprehensive framework to prevent the disruptive events from impacting the business operations, quickly recovering business and reducing the corresponding potential damages for energy system, such as nuclear power plants (NPPs). This dissertation provides discussions on the following aspects: developing appropriate risk assessment methods in order to integrate condition monitoring data and inspection data for a robust and real-time risk profile updating and prognostics. To account for the uncertainty of condition monitoring data, a hidden Markov gaussian mixture model is developed to model the condition monitoring data. A Bayesian network is applied to integrate the two data sources. For improving applicability of business continuity in practice, time-variant variables regard business continuity index, e.g. component degradation, time-dependent revenue, etc are taken into consideration in the business continuity modelling process. Based on the proposed business continuity index, a joint optimization method considering all the safety measures in event evolvement process including prevention stage, mitigation stage, emergency stage and recovery stage is developed to enhance system business continuity under limited resources. The proposed methodologies are applied to NPP against disruptive event.

L’amélioration du pronostic des pathologies chroniques à début pédiatrique s’est accompagnée d’un nombre grandissant de patients atteignant l’âge adulte. Cependant, l’adolescence et l’entrée dans la vie adulte est une période de multiples changements et de crises, pouvant être à l’origine de rupture avec le système de soins et de complications médicales. Dans cette thèse, j’ai tout d’abord décrit les hospitalisations et la mortalité des jeunes ayant été déclarés en affection de longue durée (ALD) avant 14 ans (N=1752), en comparaison à des jeunes sans pathologie chronique (N=52346). Pour cela, une cohorte rétrospective (2005-2014) a été reconstruite à partir de l’échantillon généraliste des bénéficiaires de l’Assurance maladie. Environ 3% des jeunes de 14 ans avaient déjà été déclarés en ALD. Les profils de mortalité par sexe et les tendances par âge de l’incidence des hospitalisations étaient différents de ceux de la population générale du même âge, en particulier après 18 ans, où l’on observait une chute de l’incidence des hospitalisations. Ensuite, à partir de ces mêmes données, j’ai montré que le pronostic de ces jeunes malades, y compris la mortalité, était associé à la précarité sociale, mesurée par la couverture maladie universelle complémentaire, montrant ainsi que la gratuité des soins à laquelle ces jeunes ont droit dans le système de santé français ne permettait pas de compenser les inégalités sociales dans cette population. Enfin, à un moment ou un autre, ces jeunes sont transférés vers un service d’adultes. Ce passage est un moment crucial dans leur suivi, qui peut être à l’origine d’une discontinuité du suivi médical. Des programmes de transition sont mis en place progressivement pour préparer et accompagner ce transfert. J’ai réalisé une revue systématique de la littérature (23 études) qui a montré qu’il existait deux aspects de la continuité des soins au moment de ce transfert : l’engagement (premier contact) et le maintien dans le suivi en service d’adultes. Cette analyse a également mis en exergue la pauvreté des études existant actuellement pour évaluer les programmes de transition en termes de continuité des soins. Finalement, ces résultats soulèvent de nombreuses questions, notamment les stratégies d’adaptation de ces jeunes vis-à-vis des situations à haut risque et le rôle du transfert en service d’adultes sur le comportement des patients, le pronostic et les pratiques cliniques. Des études incluant largement l’ensemble des jeunes atteints d’une pathologie chronique, intégrant notamment des facteurs liés à l’organisation des soins, liés à la pathologie, individuels et familiaux, devraient être encouragées. / The prognosis of childhood-onset chronic conditions has improved, such that more patients now reach adulthood. However, adolescence and entry into adulthood is a critical period that may be associated with poor outcomes, including gaps in care continuity and medical complications. Here, I first described hospitalization and mortality rates in youths registered for a long-term disease (LTD) before the age of 14 (N=1,752), relative to those with no LTD (N=52,346). A retrospective cohort (2005-2014) was built from a sample of the French national health insurance database, called Echantillon généraliste des Bénéficiaires. Approximately 3% of 14-year-old youths had been registered for a LTD. The mortality patterns by gender and the trend in hospitalization rates by age were different from those in the general population of the same age, especially after reaching the age of 18, which was followed by a fall in hospitalization rates. Then, using the same data, I showed that the prognosis of these youths living with a chronic disease, including mortality, was associated with low socio-economic level, as measured by being covered by Couverture Maladie Universelle Complementaire, a public complementary health insurance offering free access to care, delivered on the basis of very low househould incomes. Hence, overcoming financial barriers did not offset social health inequalities in this population. At last, one day, these youths have to be transferred to adult care. Moving to adult care is a critical time in patients’ follow-up that may lead to discontinuity in medical care. Transition programs are being gradually implemented, to prepare and smooth the transfer and support youths during this period. I performed a systematic review of literature (23 studies) that highlighted two aspects of continuity of care during transfer: engagement (first contacts) and retention in adult care once the first contact has been established. This review also emphasized the paucity of knowledge to evaluate transition programs in terms of care continuity. Finally, the results of this PhD raises many issues that need to be addressed, including coping strategies of young patients with high risk situations, and the role of transfer to adult care on patient behavior, prognosis and clinical practices. Studies involving patients with a large spectrum of severe chronic diseases, including factors related to healthcare organization, related to the disease, individual and familial, should be encouraged.

Having the Swedish northern village Vittangi as its field, this thesis asks what it is that makes Vittangi feel like home to its inhabitants and, further, how the sense of home motivate its inhabitants to participate in its place-making, i.e., in making it their home. Home is, in the thesis, understood as a subjective experience of rootedness. The ethnographic chapters therefore investigate, by focusing on the experience of everyday life in the village, how the sense of home is expressed through the inhabitants’ activities and movements in, to and through the village. Considering that the thesis’ focus is both on the sense of home and the making of home, its over-all aim is to examine the relationship between being and making home. Moreover, great attention is given to the values existing in the village, referring both to values created by global processes of economics, politics, and social activity, as well as values that are based in the experience of everyday life. In the end, the thesis argues that it is the experience-based values of Vittangi which makes it home to its inhabitants, and that it is these values which motivates inhabitants to partake in its place-making. Further, it is argued that the experience-based values cannot be separated from global processes of economics and politics, but that it is through the form they take in the locality which makes them valuable.

A reactive system is a system that continuously interacts with its environment. The environment provides an input signal, to which the system reacts with an output signal, and so on ad infinitum. In reactive synthesis, the goal is to automatically generate an implementation from a specification of the reactive and non-terminating input/output behaviours of a system. In the classical setting, the set of signals is assumed to be finite. however, this assumption is not realistic to model systems which process sequences of signals accompanied with data from a possibly infinite set (e.g. a client id, a sensor value, etc.), which need to be stored in memory and compared against each other.The goal of this thesis is to lift the theory of reactive system synthesis over words on a finite alphabet to data words. The data domain consists in an infinite set whose structure is given by predicates and constants enriched with labels from a finite alphabet. In this context, specifications and implementations are respectively given as automata and transducers extended with a finite set of registers that they use to store data values. To determine the transition to take, they compare the input data with the content of the registers using the predicates of the domain.In a first part, we consider both the bounded and unbounded synthesis problem; the former additionally asks for a bound on the number of registers of the implementation, along with the specification. We do so for different instances, depending on whether the specification is a nondeterministic, universal (a.k.a. co-non-deterministic) or deterministic automaton, for various domains.While the bounded synthesis problem is undecidable for non-deterministic specifications, we provide a generic approach consisting in a reduction to the finite alphabet case, that is done through automata-theoretic constructions. This allows to reprove decidability of bounded synthesis for universal specifications over (ℕ,=), and to obtain new ones, such as the case of a dense order, or the ability of data guessing, all with a 2-ExpTime complexity.We then move to the unbounded synthesis problem, which is undecidable for specifications given by non-deterministic and universal automata, but decidable and ExpTime-complete for deterministic ones over (ℕ,=) and (ℚ,<). We also exhibit a decidable subclass in the case of (ℕ,<), namely one-sided specifications.In a second part, we lift the reactivity assumption, considering the richer class of implementations that are allowed to wait for additional input before reacting, again over data words. Specifications are modelled as non-deterministic asynchronous transducers, that output a (possibly empty) word when they read an input data. Already in the finite alphabet case, their synthesis problem is undecidable.A way to circumvent the difficulty is to focus on functional specifications, for which any input sequence admits at most one acceptable output. Targeting programs computed by input-deterministic transducers is again undecidable, so we shift the focus to deciding whether a specification is computable, in the sense of the classical extension of Turing-computability to infinite inputs. We relate this notion with that of continuity for the Cantor distance, which yields a decidable characterisation of computability for functional specifications given by asynchronous register transducers over (ℕ,=) and for the superseding class of oligomorphic data domains, that also encompasses $(ℚ,<)$. The study concludes with the case of (ℕ,<), that is again decidable. Overall, we get PSpace-completeness for the problems of deciding computability and refined notions, as well as functionality. / Option Informatique du Doctorat en Sciences / info:eu-repo/semantics/nonPublished

Syfte: Att beskriva barnmorskors inställning till vårdmodellen caseload midwifery. Metod: En webbaserad enkätundersökning med kvalitativ ansats som analyserades med induktiv innehållsanalys. Resultat: Totalt besvarade 58 barnmorskor enkäten varav fyra exkluderades. Av svaren utvecklades sex stycken kategorier: “Kontinuitet kan ge tryggare vård”, “Etablerad relation kan leda till stöd”, “Kan påverka patientsäkerheten”, “Kan påverka kompetensen”, “Ett alternativ för framtiden” och “Behov vid implementering”. Dessa skapade två teman: “Kontinuerlig kontakt kan medföra trygghet och utmaningar” och “Framtidsvision för ett hållbart yrkesliv”. Det framkom att caseload midwifery kan skapa trygghet genom kontinuerlig relation men det är även en modell som möter flertalet utmaningar. Caseload midwifery kan vara ett alternativt tillägg till mödrahälsovårdens standardmodell. Den kan ses som en framtidsvision som baseras på hållbarhet genom tillfredsställande arbetsmiljö om goda arbetsvillkor tillmötesgås. Slutsatser: Majoriteten av barnmorskorna är positiva till caseload midwifery då modellen kan leda till många lösningar men den möter också flertalet utmaningar. Införandet av vårdmodellen kan vara en hållbar lösning för framtiden eftersom det är en attraktiv och efterlängtad modell. / Aim: To describe the attitudes towards caseload midwifery amongst midwives. Method: A web-based questionnaire based on a qualitative approach and analyzed through an inductive content analysis. Result: In total 58 midwives answered the questionnaire of which four were excluded. Six categories developed in total: “Continuity can lead to safer care”, “An established relationship can lead to trust and support”, “It can affect the patient safety”, “It can affect the competence”, “An alternative for the future” and “Needs for implementation”. All together these categories developed two themes: “A contact made continuously could lead to safety and challenges” and “A vision for the future based for a sustainability professional career”. Caseload midwifery can create safety through a continuous relationship nonetheless it is also a model that faces several challenges. Caseload midwifery can be an alternative model which would fit well as an addition to the standard model of maternal health care. It can be seen as a vision for the future based on sustainability throughout a more satisfactory working atmosphere, but only if good conditions are met. Conclusions: The majority of the midwives were positive towards caseload midwifery because the model might lead to solutions but it also leads to adversities. An implement of the model of care could be a sustainable solution for the future since it is attractive and longed for.

The objectives for this study were to develop a continuity of care scale, to assess the mean level of continuity of care, to assess association between demographic variables and clinical variables with continuity of care, and to assess association between continuity of care and medication adherence among Medicare beneficiaries. A retrospective cohort study was conducted to achieve the objectives using data from the 2015 to 2017 Medicare Current Beneficiaries Survey (MCBS). To be included in the sample, beneficiaries had to have a hyperlipidemia diagnosis, be continuously enrolled in Medicare Part D for six months from start of medication adherence, be continuously enrolled in Medicare Part A and Part B in the preceding year, and had to have at least two prescription claims for hyperlipidemia medications. Beneficiaries were excluded if they had a proxy responder, had an Alzheimer’s disease or dementia diagnosis, were enrolled in Medicare due to end-stage renal disease or disability, or were residing in a long-term care facility. Among 2,120 beneficiaries that met sample selection criteria, 57 percent were aged 75 years or older, 57 percent were female, and 87 percent were White. An overall continuity of care scale was developed using MCBS items that asked respondents about their care experience. Exploratory factor analysis was used to determine subscales of continuity of care using a randomly selected 60 percent of the sample, which yielded three subscales of continuity of care: relational continuity (Factor 1), informational continuity (Factor 2), and management continuity (Factor 3). Confirmatory factor analysis conducted using the remaining 40 percent of the sample validated factor structure of the continuity of care scale. The mean level of overall continuity of care among Medicare beneficiaries was 3.26 out of 4. Medication adherence was assessed using proportion of days (PDC) covered for anti-hyperlipidemia medications. Beneficiaries with a PDC of 80 percent or more were considered medication adherent. Approximately, 81 percent of beneficiaries were adherent to prescribed hyperlipidemia medications. Association between demographic variables and clinical variables with overall continuity of care was assessed using multivariable logistic regression based on purposeful selection of variables method. Older age, low perceived health status, and lower number of prescribed medications were associated with low overall continuity of care. Race and marital status were found to have interaction effect on overall continuity of care. Among non-white beneficiaries, married beneficiaries reported higher overall continuity of care than not-married beneficiaries. Among married beneficiaries, whites reported lower overall 12 continuity of care than non-whites. Association between overall continuity of care and medication adherence was assessed using multivariable logistic regression with purposeful selection of variables method. There was no association found between overall continuity of care and medication adherence.