Évaluer la sécurité des patients hospitalisés constitue un enjeu majeur de la gestion des risques pour les services de santé. Le développement d'indicateurs destinés à mesurer les événements indésirables liés aux soins (EIS) est une étape cruciale dont le défi principal repose sur la performance des données utilisées. Le développement d'indicateurs de la sécurité des patients - les Patient Safety Indicators (PSIs) - par l'Agency for Healthcare Research and Quality (AHRQ) aux Etats Unis, utilisant des codes de la 9ème révision (cliniquement modifiée) de la Classification Internationale des Maladies (CIM) présente des perspectives intéressantes. Nos travaux ont abordé cinq questions fondamentales liées au développement de ces indicateurs : la définition du cadre nosologique, la faisabilité de calcul des algorithmes et leur validité, la qualité des données pour coder les diagnostics médicaux à partir de la CIM et leur performance pour comparer plusieurs pays, et la possibilité d'établir une valeur de référence pour comparer ces indicateurs. Certaines questions demeurent cependant et nous proposons des pistes de recherche pour améliorer les PSIs : une meilleure définition des algorithmes et l'utilisation d'autres sources de données pour les valider (i.e., données de registre), ainsi que l'utilisation de modèles d'ajustement utilisant l'index de Charlson, le nombre moyen de diagnostics codés et une variable de la valeur prédictive positive, afin de contrôler les variations du case-mix et les différences de qualité du codage entre hôpitaux et pays.

Évaluer la sécurité des patients hospitalisés constitue un enjeu majeur de la gestion des risques pour les services de santé. Le développement d’indicateurs destinés à mesurer les événements indésirables liés aux soins (EIS) est une étape cruciale dont le défi principal repose sur la performance des données utilisées. Le développement d’indicateurs de la sécurité des patients – les Patient Safety Indicators (PSIs) – par l’Agency for Healthcare Research and Quality (AHRQ) aux Etats Unis, utilisant des codes de la 9ème révision (cliniquement modifiée) de la Classification Internationale des Maladies (CIM) présente des perspectives intéressantes. Nos travaux ont abordé cinq questions fondamentales liées au développement de ces indicateurs : la définition du cadre nosologique, la faisabilité de calcul des algorithmes et leur validité, la qualité des données pour coder les diagnostics médicaux à partir de la CIM et leur performance pour comparer plusieurs pays, et la possibilité d’établir une valeur de référence pour comparer ces indicateurs. Certaines questions demeurent cependant et nous proposons des pistes de recherche pour améliorer les PSIs : une meilleure définition des algorithmes et l’utilisation d’autres sources de données pour les valider (i.e., données de registre), ainsi que l’utilisation de modèles d’ajustement utilisant l’index de Charlson, le nombre moyen de diagnostics codés et une variable de la valeur prédictive positive, afin de contrôler les variations du case-mix et les différences de qualité du codage entre hôpitaux et pays. / Assessing safety among hospitalized patients is a major issue for health services. The development of indicators to measure adverse events related to health care (HAE) is a crucial step, for which the main challenge lies on the performance of the data used for this approach. Based on the limitations of the measurement in terms of reproducibility and on the high cost of studies conducted using medical records audit, the development of Patient Safety Indicators (PSI) by the Agency for Healthcare Research and Quality (AHRQ) in the United States, using codes from the clinically modified 9th revision of the International Classification of Diseases (ICD) shows interesting prospects. Our work addressed five key issues related to the development of these indicators: nosological definition; feasibility and validity of codes based algorithms; quality of medical diagnoses coding using ICD codes, comparability across countries; and possibility of establishing a benchmark to compare these indicators. Some questions remain, and we suggest several research pathways regarding possible improvements of PSI based on a better definition of PSI algorithms and the use of other data sources to validate PSI (i.e., registry data). Thus, the use of adjustment models including the Charlson index, the average number of diagnoses coded and a variable of the positive predictive value should be considered to control the case-mix variations and differences of quality of coding for comparisons between hospitals or countries.

Devido à mudança de paradigma originada pela evolução das redes elétricas inteligentes (Smart Grid), surgiram novos requisitos em automação de subestações de distribuição, sobretudo envolvendo operação, monitoramento, controle e proteção. Um nível mais avançado de automação é esperado na rede de distribuição com implementações do conceito de Smart Grid. O objetivo dos próximos sistemas de automação da distribuição é aperfeiçoar o uso dos recursos computacionais disponíveis, objetivando aumentar a disponibilidade do sistema elétrico, a qualidade da energia e a eficiência das concessionárias. E nessa nova realidade, a troca de informação entre os vários sistemas de informação de uma empresa do setor elétrico não é apenas desejada, mas, na maioria dos casos, necessária. Nesse contexto, se propõe uma arquitetura computacional capaz de transferir todas as informações geradas a partir da implementação de funcionalidades \"inteligentes\" na subestação, envolvendo as funções de supervisão, controle, monitoramento e proteção das subestações de distribuição, para o centro de controle da concessionária (COS), o que não está previsto nos protocolos normalmente utilizados, como DNP, ICCP, e IEC 61850. Para atingir esse objetivo é feita a investigação sobre o uso dos padrões internacionais propostos na arquitetura de referência do IEC para realizar tal integração, mostrando a necessidade de modificação nos objetos de dados definidos. Com o intuito de avaliar a viabilidade da arquitetura proposta foi desenvolvido um protótipo dentro do programa de Pesquisa e Desenvolvimento (P&D) regulado pela ANEEL (Agência Nacional de Energia Elétrica), em parceria com a CPFL (Companhia Paulista de Força e Luz). Nesse protótipo foram desenvolvidos módulos com funcionalidades \"inteligentes\" que promovem a migração de funções do centro de controle para a subestação. Além disso, o protótipo também implementa serviços web (Web Services) que são responsáveis pela integração da informação, tornando a troca de informação independentemente da plataforma onde os serviços são implementados. O texto contempla as anotações que refletem os passos dessa implementação do protótipo, bem como o registro dos testes exigidos pelos trabalhos, os quais compreenderam a implementação das novas funcionalidades, com a obtenção e tratamento dos dados, e seu posterior envio ao centro de controle. / Due to the paradigm shift caused by the evolution of the power grids, resulting in a new concept of Smart Grid, new requirements in automation of distribution substations emerged, especially those involving the operation, monitoring, control and protection. A more advanced level of automation is expected in the distribution network with implementations of the concepts related to Smart Grid. The goal of the next distribution automation systems is to optimize the use of available resources, intending to increase the availability of the power system, the power quality and the efficiency of the utilities. In this new context, the exchange of information between the various information systems of an electrical utility is not only desired, but in most cases, necessary. In this context, it is proposed a computational architecture capable of transferring all the information generated from the implementation of \"smart\" functions in the substation, involving supervisory, control, monitoring and protection of distribution substations, to the utility control center (COS), which is not provided for in the protocols commonly used by the utility, such as DNP, ICCP, and IEC 61850. Research on the use of international standards proposed in the IEC reference architecture to achieve such integration is also performed, revealing the necessity of modifying the defined data model. A prototype was developed in a partnership with CPFL (Companhia Paulista de Força e Luz), in order to assess the feasibility of the proposed architecture, within the R&D program regulated by ANEEL (Brazilian Electric Power Agency). Modules have been developed with the \"smart\" features that promote migration of some control center functions to the substation. In addition, the prototype also implements web services that are responsible for the data integration, with the information being exchanged regardless of the platform where the services are implemented. The text includes notes reflecting the steps of this prototype implementation, as well as the tests required to validate the model, which comprised the implementation of those new features, obtaining and processing the data, and subsequent sending to the utility control center (DMS).

Devido à mudança de paradigma originada pela evolução das redes elétricas inteligentes (Smart Grid), surgiram novos requisitos em automação de subestações de distribuição, sobretudo envolvendo operação, monitoramento, controle e proteção. Um nível mais avançado de automação é esperado na rede de distribuição com implementações do conceito de Smart Grid. O objetivo dos próximos sistemas de automação da distribuição é aperfeiçoar o uso dos recursos computacionais disponíveis, objetivando aumentar a disponibilidade do sistema elétrico, a qualidade da energia e a eficiência das concessionárias. E nessa nova realidade, a troca de informação entre os vários sistemas de informação de uma empresa do setor elétrico não é apenas desejada, mas, na maioria dos casos, necessária. Nesse contexto, se propõe uma arquitetura computacional capaz de transferir todas as informações geradas a partir da implementação de funcionalidades \"inteligentes\" na subestação, envolvendo as funções de supervisão, controle, monitoramento e proteção das subestações de distribuição, para o centro de controle da concessionária (COS), o que não está previsto nos protocolos normalmente utilizados, como DNP, ICCP, e IEC 61850. Para atingir esse objetivo é feita a investigação sobre o uso dos padrões internacionais propostos na arquitetura de referência do IEC para realizar tal integração, mostrando a necessidade de modificação nos objetos de dados definidos. Com o intuito de avaliar a viabilidade da arquitetura proposta foi desenvolvido um protótipo dentro do programa de Pesquisa e Desenvolvimento (P&D) regulado pela ANEEL (Agência Nacional de Energia Elétrica), em parceria com a CPFL (Companhia Paulista de Força e Luz). Nesse protótipo foram desenvolvidos módulos com funcionalidades \"inteligentes\" que promovem a migração de funções do centro de controle para a subestação. Além disso, o protótipo também implementa serviços web (Web Services) que são responsáveis pela integração da informação, tornando a troca de informação independentemente da plataforma onde os serviços são implementados. O texto contempla as anotações que refletem os passos dessa implementação do protótipo, bem como o registro dos testes exigidos pelos trabalhos, os quais compreenderam a implementação das novas funcionalidades, com a obtenção e tratamento dos dados, e seu posterior envio ao centro de controle. / Due to the paradigm shift caused by the evolution of the power grids, resulting in a new concept of Smart Grid, new requirements in automation of distribution substations emerged, especially those involving the operation, monitoring, control and protection. A more advanced level of automation is expected in the distribution network with implementations of the concepts related to Smart Grid. The goal of the next distribution automation systems is to optimize the use of available resources, intending to increase the availability of the power system, the power quality and the efficiency of the utilities. In this new context, the exchange of information between the various information systems of an electrical utility is not only desired, but in most cases, necessary. In this context, it is proposed a computational architecture capable of transferring all the information generated from the implementation of \"smart\" functions in the substation, involving supervisory, control, monitoring and protection of distribution substations, to the utility control center (COS), which is not provided for in the protocols commonly used by the utility, such as DNP, ICCP, and IEC 61850. Research on the use of international standards proposed in the IEC reference architecture to achieve such integration is also performed, revealing the necessity of modifying the defined data model. A prototype was developed in a partnership with CPFL (Companhia Paulista de Força e Luz), in order to assess the feasibility of the proposed architecture, within the R&D program regulated by ANEEL (Brazilian Electric Power Agency). Modules have been developed with the \"smart\" features that promote migration of some control center functions to the substation. In addition, the prototype also implements web services that are responsible for the data integration, with the information being exchanged regardless of the platform where the services are implemented. The text includes notes reflecting the steps of this prototype implementation, as well as the tests required to validate the model, which comprised the implementation of those new features, obtaining and processing the data, and subsequent sending to the utility control center (DMS).

Salmonella Choleraesuis é o agente causador de um quadro septicêmico em suínos que pode apresentar altas taxas de mortalidade nos animais infectados. No presente estudo foram avaliadas 93 estirpes de S. Choleraesuis provenientes de suínos com sinais clínicos de infecção. Foram avaliadas estirpes originadas de sete granjas localizadas nos Estados de São Paulo, Paraná, Santa Catarina e Minas Gerais obtidas durantes os anos de 2015, 2016 e 2017. As estirpes de Salmonella foram submetidas a reação em cadeia pela polimerase para confirmação do sorovar pela amplificação do gene fliC, em seguida foram caracterizadas quanto ao perfil de resistência a antimicrobianos e a caracterização genotípica pelo polimorfismo do comprimento de fragmentos amplificados (AFLP). A determinação do perfil de resistência a antimicrobianos revelou que as 93 estirpes foram resistentes a penicilina, doxiciclina, sulfadimetoxina, clindamicina, tilosina, tilmicosina e tiamulina, sendo, portanto, todas multirresistentes. Os antimicrobianos com menores taxas de resistência foram cefitiofur (0%), marbofloxacina (1,1%), neomicina (10,8%) e enrofloxacina (18,3%). As estirpes foram discriminadas em 17 perfis de resistência diferentes, o perfil mais frequente reuniu 39 estirpes (42%) resistentes a penicilina, ampicilina, doxiciclina, oxitetraciclina, florfenicol, sulfadimetoxina, gentamicina, tulatromicina, tilosina, tilmicosina, tiamulina e clindamicina. A análise das estirpes pelo AFLP indicou todas as 93 estirpes foram agrupadas em um único perfil com mais de 94% de similaridade. A partir dos dados obtidos é possível verificar que as estirpes de S. Choleraesuis isoladas de suínos apresentaram baixa variabilidade genética e alta frequência de resistência aos antimicrobianos mais usados em suinocultura. / Salmonella Choleraesuis is the causative agent of septicemia in pigs and may present high mortality rates in infected animals. In the present study, 93 strains of S. choleraesuis from pigs with clinical signs of infection were evaluated. Strains from seven farms located in the states of São Paulo, Paraná, Santa Catarina and Minas Gerais obtained during the years 2015, 2016 and 2017 were evaluated. Salmonella strains were submitted to polymerase chain reaction for confirmation of serovar by amplification of the fliC gene were then characterized for antimicrobial resistance profile and genotype characterization by amplified fragment length polymorphism (AFLP). The determination of the antimicrobial resistance profile revealed that the 93 strains were resistant to penicillin, doxycycline, sulfadimethoxine, clindamycin, tylosin, tilmicosin and tiamulin, and were therefore multiresistant. The antimicrobials with the lowest resistance rates were cefitiofur (0%), marbofloxacin (1.1%), neomycin (10.8%) and enrofloxacin (18.3%). The strains were discriminated in 17 different resistance profiles, the most frequent profile consisted of 39 strains (42%) resistant to penicillin, ampicillin, doxycycline, oxytetracycline, florfenicol, sulfadimetoxin, gentamicin, tulathromycin, tylosin, tilmicosin, tiamulin and clindamycin. Analysis of the strains by AFLP indicated that all 93 strains were grouped into a single profile with more than 94% similarity. From the data obtained it is possible to verify that the strains of S. Choleraesuis isolated from pigs presented low genetic variability and high frequency of resistance to the antimicrobials most used in swine production systems.

Dentre as espécies conhecidas do gênero Arcobacter, as espécies A. butzleri, A. cryaerophilus e A. skirrowii são consideradas potecialmente zoonóticas, podendo ser transmitidas por alimentos de origem animal. O presente estudo teve como objetivos isolar e caracterizar fenotipica e genotipicamente cepas de Arcobacter spp. provenientes de carcaças de suínos e amostras de ambiente de abatedouro localizado no Estado de São Paulo. As cepas isoladas foram submetidas a reação em cadeia pela polimerase para a identificação e detecção de um grupo de genes de virulência. A concentração inibitória mínima frente a nove antimicrobianos usados para o controle da infecção pelo agente foi determinada e as cepas foram analisadas através do PFGE e pelo AFLP. Dentre as 30 carcaças avaliadas, 25 foram positivas para o agente e 70 cepas foram selecionadas e identificadas como Arcobacter spp. As espécies isoladas foram A. butzleri (n=61), A. cryaerophilus (n=7) e A. skirrowii (n=2). A frequência dos possíveis genes de virulência encontrada variou de 71,4% a 100% para os genes tlyA, pldA, cj1349, ciaB, cadF e mviN. Não foram detectados os genes hecA, hecB e irgA. O perfil de virulência ciaB/ cj1349/ mviN/ cadF/ pldA/ tlyA foi o mais frequente e detectado em 66% das cepas. Todas as cepas foram sensíveis à gentamicina e tetraciclina e 77,1% foram multirresistentes, dentre estas o perfil mais frequente foi de resistência a azitromicina/ florfenicol/ ácido nalidíxico/ telitromicina/ clindamicina Houve grande diversidade genotípica entre as cepas através do PFGE e do AFLP, e ambas a técnicas apresentaram o mesmo poder discriminatório na análise das cepas isoladas. / Among the known species of the genus Arcobacter, the species A. butzleri, A. cryaerophilus and A. skirrowii are considered potentially zoonotic and can be transmitted by food of animal origin. This study aimed to isolate and characterize phenotypically and genotypically strains of Arcobacter spp from swine carcasses and slaughterhouse environment samples located in the State of São Paulo. The isolated strains were subjected to polymerase chain reaction for identification and detection of a group of putative virulence genes. The minimum inhibitory concentration was determined against nine antimicrobials indicated for the control of infection by the agent and the strains were analyzed by PFGE and by AFLP. Among the 30 carcasses evaluated, 25 were positive for the agent and 70 strains were selected and identified as Arcobacter spp. The isolated species were A. butzleri (n = 61), A. cryaerophilus (n = 7) and A. skirrowii (n = 2). The frequency of virulence genes found ranged from 71.4 % to 100 % for genes tlyA , pldA , cj1349 , ciaB , cadF and mviN . The genes hecA, hecB and irgA were not detected. The virulence profile ciaB/ cj1349/ mviN/ cadF/ pldA/ tlyA was the most frequent and detected in 66 % of the strains. All strains were susceptible to gentamicin and tetracycline and 77.1% were multirresistant, among these the most common profile of resistance was azithromycin/ florfenicol/ nalidixic acid/ telithromycin/ clindamycin There were large genotypic diversity among strains by PFGE and AFLP and both techniques showed the same discriminatory power in the analysis of the isolated strains.

Les pullulations de « papillon cendre » du genre Hylesia, appartenant à la famille des Saturniidae, constituent un problème récurrent de santé publique en Guyane et au Venezuela. En effet, pour protéger ses oeufs des prédateurs, la femelle possède des soies détachables extrêmement urticantes qu’elle est susceptible de libérer dans l’atmosphère. L’augmentation des sources de lumière artificielle depuis la fin du 19ème siècle liée à l’urbanisation croissante attire ces papillons nocturnes vers les villes et les villages, où la libération des soies urticantes est susceptible d’affecter l’Homme en générant une douloureuse affection de peau, la « papillonite ». Malgré les enjeux sociaux et économiques liés à la présence récurrente de ces papillons en zones urbaines, leur biologie et leur écologie reste peu connue. Les pullulations de « papillon cendre » attribuées à l’espèce H. metabus constituent un problème récurrent de santé publique en Guyane et au Venezuela. La définition de méthodes spécifiques de régulation des populations s’avère donc très urgente mais nécessitait au préalable de vérifier que seule l’espèce H. metabus est impliquée dans ces épisodes d’urtication et de préciser la structure des populations de ces insectes. Il était également important de préciser les mécanismes de reconnaissance des partenaires sexuels chez cette même espèce. Ces questions ont été les objectifs principaux de cette thèse. L’utilisation d’outils moléculaires a permis de montrer que seule l’espèce Hylesia metabus était impliquée dans les récents épisodes d’urtication en Guyane et au Venezuela. L’étude a également démontré que les populations guyanaises de cette espèce se distinguaient au plan génétique des populations du Vénézuela, et surtout qu’elles se structuraient en 2 sousensembles génétiques distincts entre la côte et l’intérieur de la Guyane. Tous les insectes collectés durant les épisodes de pullulation appartenaient au sous-ensemble côtier. Une approche basée sur l’étude du comportement de reproduction a été utilisée afin de préciser la temporalité d’émission de la phéromone sexuelle et ouvre de nouvelles perspectives pour l’identification de cette phéromone. / The genus Hylesia (Lepidoptera Saturniidae) are moths of human health importance in Venezula and French Guiana, inducing epidemic outbreaks of lepidopterism, a puriginous dermatitis caused by the urticating properties of the females’ abdominal setae. Adult female releases extremely urticating setae in the surrounding air, causing itchy dermatitis known as ‘papillonite’. Hylesia are attracted by artificial light source which are increasing since the end of the 19th century due to urbanization resulting in serious invasion event in towns and villages. Despite of the impact on human health, many aspects of the biology and their ecology remain unclear. The definition of specific methods of population regulation is thus very urgent but it was necessary first of all to verify that only the species H. metabus is involved in these episodes of urtication and to specify the population structure of these insects. It was also important to clarify the mechanisms for recognizing sexual partners in this same species. These questions were the mainobjectives of this thesis.The use of molecular tools has shown that a single species, Hylesia metabus, was involved in recent episodes ofurtication in Guyana and Venezuela. The study also demonstrated that the Guyanese populations of this species aregenetically distinct from the Venezuelan populations, and especially that they are structured in 2 distinct genetic subgroupsbetween the coast and the interior of French Guiana. All insects collected during outbreaks belonged to thecoastal subset. An approach based on the study of reproductive behavior has been used to clarify the temporality ofemission of the sex pheromone and opens new perspectives for the identification of this pheromone

Der Einsatz von Digital Mock-Up-Techniken (DMU-Techniken) ermöglicht es, die Produktentwicklung effizienter und effektiver zu gestalten. Das Ergebnis der Promotion stellt ein Quality Function Deployment-gestütztes methodisches Verfahren dar, mit dessen Hilfe DMU-Techniken in die Produktentwicklungsprozesse der Automobilindustrie eingeführt werden können. Das methodische Verfahren wurde innerhalb eines großen deutsch-amerikanischen Automobilunternehmens entwickelt. Vorteile des Einführungsverfahrens sind die geringeren Aufwendungen bei der Implementierung von DMU-Techniken. Weitere Vorteile des Einführungsverfahrens sind die strukturierte Dokumentation des Einführungsprozesses, die stringente Verwendung der Kundenanforderungen, die Konzentration des Expertenwissens auf einige wenige Visualisierungstechniken (House of Quality).

<p>The paper deals with the development of a remote management solution for embedded audio devices. The creation of a development environment for the embedded ARM target is discussed as well as several available solutions for remote system management. The creation of a service for stream and system management using SNMP is discussed as well as several changes to the SNMP standard to improve performance using multicast. The implementation of a proof-of-concept cross-platform user interface for the client side is described as well.</p>

Thesis (doctoral)--Hochschule St. Gallen für Wirtschafts-, Rechts- und Sozialwissenschaften, 1990.