<p>HIV/AIDS is the largest and most serious global epidemic in the recent times. To date, the epidemic has affected approximately 40 million people (range 33 &ndash / 46 million) of whom 67%, that is, an estimated 27 million people are in the Sub Saharan Africa. The Sub Saharan Africa is also reported to have the highest regional prevalence of 7.2% compared to an average of 2% in other regions. A medical cure for HIV/AIDS remains elusive but use of antiretroviral therapy (ART) has resulted in improvement of quality and quantity of life as evidenced by the reduction of mortality and morbidity associated with the infection, hence longer and good quality life for HIV/AIDS patients on ART.</p>

The two longitudinal case studies that make up this dissertation sought to explain and predict the relationship between usability and clinician acceptance of a health information system. The overall aim of the research study was to determine what role usability plays in the acceptance or rejection of systems used by clinicians in a healthcare context. The focus was on the end users (the clinicians) rather than the views of the system designers and managers responsible for implementation and the clients of the clinicians. A mixed methods approach was adopted that drew on both qualitative and quantitative research methods. This study followed the implementation of a community health information system from early beginnings to its established practice. Users were drawn from different health service departments with distinctly different organisational cultures and attitudes to information and communication technology used in this context. This study provided evidence that a usability analysis in this context would not necessarily be valid when the users have prior reservations on acceptance. Investigation was made on the initial training and post-implementation support together with a study on the nature of the clinicians to determine factors that may influence their attitude. This research identified that acceptance of a system is not necessarily a measure of its quality, capability and usability, is influenced by the user’s attitude which is determined by outside factors, and the nature and quality of training. The need to recognise the limitations of the current methodologies for analysing usability and acceptance was explored to lay the foundations for further research.

Made available in DSpace on 2014-12-17T14:55:40Z (GMT). No. of bitstreams: 1 WilmaMCM.pdf: 1186058 bytes, checksum: 6e290882faed8cfbcd44afc878b5d7b0 (MD5) Previous issue date: 2009-04-24 / The sharing of knowledge and integration of data is one of the biggest challenges in health and essential contribution to improve the quality of health care. Since the same person receives care in various health facilities throughout his/her live, that information is distributed in different information systems which run on platforms of heterogeneous hardware and software. This paper proposes a System of Health Information Based on Ontologies (SISOnt) for knowledge sharing and integration of data on health, which allows to infer new information from the heterogeneous databases and knowledge base. For this purpose it was created three ontologies represented by the patterns and concepts proposed by the Semantic Web. The first ontology provides a representation of the concepts of diseases Secretariat of Health Surveillance (SVS) and the others are related to the representation of the concepts of databases of Health Information Systems (SIS), specifically the Information System of Notification of Diseases (SINAN) and the Information System on Mortality (SIM) / O compartilhamento de conhecimentos e integra??o de dados ? um dos maiores desafios da ?rea da sa?de e essencial para contribui??o de melhoria da qualidade da assist?ncia em sa?de. Uma vez que a mesma pessoa recebe atendimento em diversas institui??es de sa?de ao longo de sua vida, suas informa??es ficam distribu?das em diferentes sistemas de informa??o que s?o executados em plataformas de hardware e software heterog?neas. Este trabalho prop?e um Sistema de Informa??o em Sa?de Baseado em Ontologias (SISOnt) para compartilhamento de conhecimento e integra??o de dados em sa?de, que permite inferir novas informa??es a partir de bases de dados e da base de conhecimento. Para esse fim foram criadas tr?s ontologias representadas atrav?s dos padr?es e conceitos propostos pela Web Sem?ntica. A primeira ontologia prov? a representa??o dos conceitos de agravos da Secretaria de Vigil?ncia em Sa?de (SVS) e as demais est?o relacionadas ? representa??o dos conceitos das bases de dados dos Sistemas de Informa??o em Sa?de (SIS), especificamente do Sistema de Informa??o de Agravos de Notifica??o (SINAN) e do Sistema de Informa??es sobre Mortalidade (SIM)

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2017-07-17T11:52:47Z No. of bitstreams: 1 PDF - Júlia Cibelle Freire de Queiroz Arnaud.pdf: 23071946 bytes, checksum: 1107c01b26b40906b0869fa7c2cee053 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2017-07-20T12:23:22Z (GMT) No. of bitstreams: 1 PDF - Júlia Cibelle Freire de Queiroz Arnaud.pdf: 23071946 bytes, checksum: 1107c01b26b40906b0869fa7c2cee053 (MD5) / Made available in DSpace on 2017-07-20T12:23:22Z (GMT). No. of bitstreams: 1 PDF - Júlia Cibelle Freire de Queiroz Arnaud.pdf: 23071946 bytes, checksum: 1107c01b26b40906b0869fa7c2cee053 (MD5) Previous issue date: 2017-03-31 / The number of health information systems is increasing in quantity and complexity, and their quality is essential to improve the quality of the services delivered to the population. Normally, the development of medical device software presents requirements that normally are not addressed by the traditional software development of non-safety critical industry. In this sense, projects of health information systems start to face new challenges imposed by regulators, society and suppliers since they start to interact with medical devices, personal health devices and diagnostic solutions. Requirements engineering processes are very important for the reduction of the involved risks in the development of these systems. Most agile processes used by several companies, although following well established activities for software development, have some gaps in the requirements engineering activities, turning the way in which requirements are developed in the context for health often incomplete. Health system development should be supported by an appropriate requirements engineering process, which in addition to guiding the development process, also fits in the treatment of specific requirements that these software products need. This work proposes the definition of a requirements engineering process that enables the development and management of requirements in a traceable way, while at the same time aligning with the agile development process. The process defines activities, inputs, outputs and guidelines that, in an integrated way and guides the requirements engineering in an effective way. Finally, an experimental study is presented in the context of health information systems to evaluate the viability of the proposed process. / O número de sistemas de informação em saúde está aumentando em quantidade e complexidade, e sua qualidade é essencial para melhorar a qualidade dos serviços prestados à população. O desenvolvimento de software para dispositivo médico apresenta requisitos que normalmente não são abordados pelo desenvolvimento de software tradicional. Neste sentido, os projetos de sistemas de informação de saúde começam a enfrentar novos desafios impostos pelos reguladores, sociedade e fornecedores, uma vez que começam a interagir com os dispositivos médicos, dispositivos pessoais de saúde e soluções de diagnóstico. Os processos de engenharia de requisitos são muito importantes para a redução dos riscos envolvidos no desenvolvimento destes sistemas. Muitos dos processos ágeis utilizados por várias empresas, apesar de seguir um ciclo de atividades para o desenvolvimento do software, apresentam algumas lacunas nas atividades da engenharia de requisitos, tornando a forma com que os requisitos são desenvolvidos no contexto para saúde muitas vezes incompleta. O desenvolvimento de sistemas na área da saúde deve ser apoiado por um processo de engenharia de requisitos apropriado, que além de guiar processo de desenvolvimento, também se encaixe no tratamento de requisitos específicos que estes produtos de software necessitam. Este trabalho propõe a definição de um processo de engenharia de requisitos que possibilite o desenvolvimento e gerenciamento dos requisitos de maneira rastreável, ao mesmo tempo que se alinha ao processo de desenvolvimento ágil. O processo define atividades, entradas, saídas e diretrizes que de forma integrada, orientam a engenharia de requisitos de maneira eficaz. Finalmente é apresentado um estudo experimental no contexto de sistemas de informação em saúde para avaliar a viabilidade do processo proposto.

Esta pesquisa investigou o emprego da informação no sistema de trabalho das Equipes Saúde da Família (EqSF), nas Unidades Básicas de Saúde (UBS), visando identificar que fatores interferem no emprego da informação em um ambiente de alta complexidade, de difícil controle e descentralizado. Para responder essa questão, foram identificados o processo de tratamento e o uso das informações. Tem como objetivo também compreender a discrepância entre a intenção do uso e o uso efetivo das informações e suas causas. Foi utilizado o método de estudo de casos múltiplos e, para isso, foram estudadas sete EqSF que fazem parte de três UBS, gerenciadas por uma Organização Social (OS), a Fundação da Faculdade de Medicina da USP, na região oeste do município de São Paulo. As EqSF são grupos multiprofissionais que promovem a atenção básica e a prevenção à saúde para os pacientes de determinado território. Buscou-se compreender como, nesse contexto, são feitos a captura, o registro, a disponibilização e o emprego das informações, já que elas são recursos relevantes para a produção de serviço desses profissionais e são coletadas tanto no domicílio do paciente quanto na UBS. Para realizar o atendimento dentro dos níveis de qualidade previsto pela OS e Secretaria Municipal de Saúde (SMS), os profissionais criam diversos sistemas de informação paralelos (cadernos, planilhas, etc.) de uso individual, uma vez que os sistemas eletrônicos da SMS e do Ministério da Saúde não atendem suas necessidades e as informações que contém nem sempre são usadas. Isso acontece devido ao não alinhamento entre os sistemas de informação e a infraestrutura disponível (BOSTROM; HEINEN, 1997a), requisito que é superado por meio de esforços individuais e coletivos. Essa situação corrobora as considerações de DeLone e McLean (1992, 2002, 2003) que afirmam haver uma relação entre o uso da informação e a satisfação do usuário com a qualidade do sistema, a qualidade da informação e a qualidade do serviço informacional. Os profissionais costumam memorizar dados para registro posterior, possibilitando redundância, erros e perdas de detalhes. As informações são registradas de acordo com o interesse do profissional e não há um sistema estruturado para a consolidação das informações. / This research investigated the use of information in the work of the Family Health Teams (EqSF), the Basic Health Units (UBS), to identify factors that interfere with the use of information in an environment of high complexity, difficult to control and decentralized. To answer this question, it was identified the treatment process and use information. It aims also to understand the discrepancy between the intended use and effective use of information and its causes. We used the method of multiple case study and, therefore, we studied seven EqSF three that are part of UBS, managed by a Social Organization (OS), the Foundation of the Faculty of Medicine, USP, in the western region of São Paulo. The EqSF are multidisciplinary groups that promote primary and preventive health care for patients of the territory. We sought to understand how, in this context, are made to capture, registration, delivery and use of information resources as they are relevant to the production of professional service and are collected in both the patient\'s home and in UBS. To perform the service within the quality standards set by the OS and the Municipal Health Secretariat (SMS), professionals create several parallel information systems (notebooks, spreadsheets, etc.). Individual use, since the electronic systems of SMS and Ministry of Health did not meet their needs and the information it contains are not always used. This is due to non-alignment between information systems and infrastructure available (BOSTROM; HEINEN, 1997a), a requirement which is overcome through individual and collective efforts. This situation confirms the considerations of Delone and McLean (1992, 2002, 2003) who claim to be a relationship between information use and user satisfaction with system quality, information quality and service quality of information. Professionals tend to store data backlog, enabling redundancy, errors and loss of detail. Information is recorded according to the interest of professional and there is no structured system for the consolidation of information.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-08T15:33:17Z No. of bitstreams: 2 Dissertação - Raphael Brandão Pereira - 2014.pdf: 5605844 bytes, checksum: 196cfb8206d12ce4391303dcba120f92 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-08T15:37:31Z (GMT) No. of bitstreams: 2 Dissertação - Raphael Brandão Pereira - 2014.pdf: 5605844 bytes, checksum: 196cfb8206d12ce4391303dcba120f92 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-08T15:37:31Z (GMT). No. of bitstreams: 2 Dissertação - Raphael Brandão Pereira - 2014.pdf: 5605844 bytes, checksum: 196cfb8206d12ce4391303dcba120f92 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-09-29 / The information and communication technologies havebeen increasingly incorporated to nursing practices, to support the use and the record of nursing process, demanding the monitoring of its results achieved and intervenient factors on a continuous basis. The present study had the objective of providing an analysis of record of nursing process supported by communication and information technologies and the intervenient factors intervenient factors in the nurses’ perception. It is a study of a single integrated case, carried out at the neonatal intensive care unit of a university hospital, located at the Midwest region of the country, from January to April 2014. The new technologies consisted of a data collection/nursing development protocol, specific for a neonatal intensive care unit, and the use of support software to the diagnostic steps, health care planning (target, objective and prescription statements), implementation and evaluation. The data collection was held through the application of a questionnaire and data collected from nurses’ records at patients’ medical files. The study integrated unit consisted of seven nurses, who worked in the section before (from September to November 2010) and after (from September to November 2012) the implementation of the communication and information technologies to support the use and record of the nursing process. The level of application of the nursing process (NAPE) was classified from 1 to 5, according to its accuracy. The records number in each stage of the nursing process was calculated for each day of nursing attendance during the study period. The quantitative data was analyzed through descriptive statistics. The nurses’ statements on intervenient factors were analyzed using the Donabedian health assessment model (1984). There was an increase of records units by nursing service delivery days (UR/DAY), during data collection stages from 55.2 UR/DAE to 80.4% UR/DAE, new nursing diagnostic records to 0.3 UR/DAE, of targets and objectives (1.0 UR/DAE), and of nursing evaluation (0.2 UR/DAE). The stage of nursing prescription had a decrease from 2.1 UR/DAE to 1.9% UR/DAE and the implementation from 4.4 UR/DAE to 3.1 UR/DAE. It was possible to identify the record of more stages of the nursing process if compared with the period before the new technologies started to be used. Nevertheless this increase was not so significant. Among the intervenient factors, time availability was considered enough for the nursing process (PE) application, and besides that, the record remained incipient. Nurses that reported receiving satisfactory or very satisfactory training on the PE or on the use of new communication and information technologies, also reported more stages of the PE. Considering the strategic relevance of adequate record of nursing service delivery and of the legal and ethical requirement of the nursing process, even small improvements may be relevant. However, in general, it is possible to conclude that the insertion of new technologies associated to the training process did not have a significant impact in the stages of the nursing process at the context of the study. / Tecnologias de comunicação e informação de diferentes tipos estão sendo empregadas na enfermagem para apoiar o uso e o registro do processo de enfermagem, gerando a necessidade de análise contínua dos resultados alcançados e dos fatores intervenientes. Esse estudo teve como objetivo analisar o registro do processo de enfermagem apoiado por tecnologias de informação e comunicação e os fatores intervenientes na percepção dos enfermeiros. Trata-se de um estudo de caso único integrado, realizado na UTI neonatal de um hospital de ensino da região centro-oeste do Brasil, de janeiro a abril de 2014. As novas tecnologias consistiram em um protocolo de coleta de dados/evolução de enfermagem, específico para o cenário de UTI neonatal, e um software de apoio ao uso das etapas de diagnóstico, planejamento (declaração de metas, objetivos, prescrições) e implementação e avaliação da assistência. Realizou-se coleta de dados mediante aplicação de questionário e extração de dados das anotações das enfermeiras nos prontuários. As unidades integradas do estudo de caso foram sete enfermeiras, que atuaram no setor antes (setembro a novembro de 2010) e após (setembro a novembro de 2012) a implantação das novas tecnologias de informação e comunicação para apoio ao uso e registro do processo de enfermagem. O nível de aplicação do processo de enfermagem (NAPE) foi classificado de 1 até 5, de acordo com sua completude. O número de registros de cada etapa do processo de enfermagem foi calculado para cada dia de atendimento de enfermagem no período estudado. Os dados quantitativos foram analisados por meio de estatística descritiva. Os depoimentos dos enfermeiros sobre os fatores intervenientes foram analisados à luz do modelo de avaliação em saúde de Donabedian (1984). Verificou-se aumento das unidades de registro por dias de atendimento de enfermagem (UR/DIA) na etapa de coleta de dados de 55,2 UR/DAE para 80,4 UR/DAE, surgimento de registros de diagnóstico de enfermagem para 0,3 UR/DAE, das metas e objetivos (1,0 UR/DAE), e da avaliação de enfermagem (0,2 UR/DAE). A etapa de prescrições de enfermagem apresentou diminuição de 2,1 UR/DAE para 1,9UR/DAE e a implementação de 4,4 UR/DAE para 3,1 UR/DAE. Verificou-se o registro de mais etapas do processo de enfermagem em comparação com o período em que as novas tecnologias não eram utilizadas. Contudo esse incremento foi pouco expressivo. Entre os fatores intervenientes, disponibilidade do tempo foi considerada suficiente para aplicação do PE e apesar disso,o registro permaneceu incipiente. Enfermeiras que relataram ter recebido capacitaçãosatisfatória ou muito satisfatória em PE e no uso das novas tecnologias de comunicação e informação registraram mais etapas do PE.Tendo em vista a importância estratégica do registro adequado do atendimento de enfermagem e da exigência ético legal do uso do processo de enfermagem, pequenos avanços podem ser relevantes, contudo, de modo geral, conclui-se que a inserção das novas tecnologias associada ao processo de capacitação não obteve impacto expressivo no registro das etapas do processo de enfermagem no cenário estudado.

Medication prescriptions constitute an important type of clinical intervention. Medication adherence is the degree to which a patient consumes their medication as agreed upon with a prescriber. Despite many years of research, medication non-adherence continues to be a problem of note, partially due to its multi-faceted in nature. Numerous interventions have attempted to improve adherence but none have emerged as definitive. A significant sub-problem is the lack of consensus regarding definitions and measurement of adherence. Several recent reviews indicate that discrepancies in definitions, measurement techniques, and study methodologies make it impossible to draw strong conclusions via meta-analyses of the literature. Technological interventions aimed at improving adherence have been the subject of ongoing research. Due to the increasing prevalence of the Internet of Things, technology can be used to provide a continuous stream of data regarding a patient's behaviour. To date, several researchers have proposed interventions that leverage data from the Internet of Things, however none have established an acceptable means of analyzing and acting upon this wealth of data. This thesis introduces a computational definition for adherence that can be used to support continued development of technological adherence interventions. A central part of the proposed definition is a formal language for specifying prescriptions that uses fuzzy set theory to accommodate imprecise concepts commonly found in natural language medication prescriptions. A prescription specified in this language can be transformed into an evaluation function which can be used to score the adherence of a given medication taking behaviour. Additionally, the evaluator function is applied to the problem of scheduling medication administrations. A compiler for the proposed language was implemented and had its breadth of expression and clinical accuracy evaluated. The results indicate that the proposed computational definition of adherence is acceptable as a proof of concept and merits further works. / Graduate

Magister Public Health - MPH / HIV/AIDS is the largest and most serious global epidemic in the recent times. To date, the epidemic has affected approximately 40 million people (range 33 - 46 million) of whom 67%, that is, an estimated 27 million people are in the Sub Saharan Africa. The Sub Saharan Africa is also reported to have the highest regional prevalence of 7.2% compared to an average of 2% in other regions. A medical cure for HIV/AIDS remains elusive but use of antiretroviral therapy (ART) has resulted in improvement of quality and quantity of life as evidenced by the reduction of mortality and morbidity associated with the infection, hence longer and good quality life for HIV/AIDS patients on ART. / South Africa

Magister Public Health - MPH / Background: The Provincial Government Western Cape (PGWC) Department of Health identified a lack of data on inpatient diagnoses and procedures in a form suitable to use for operational, strategic as well as financial health care planning. The only format in which diagnostic and procedure data was available was a paper based one encompassing individual patient notes in folders and discharge summaries. Making the data available in a coded format within an electronic database would facilitate storage, analysis and utilisation of that data for health service planning. Recognising the lack of availability of such coded data, this study was undertaken to evaluate different coding systems for their ability to code data in order to assist in deciding which coding systems best fit the need to facilitate easy and accurate recording of data on diagnoses and procedures from patient records. The identification of the most appropriate coding system for the context in which the PGWC Department of health functions should facilitate the easy recording, storage and retrieval of data that is accurate, reliable and useful for management decision making and would support optimal patient care. Aim: The aim of the study was to evaluate a selection of potentially suitable coding systems in order to determine which would be best able to code public sector district and regional hospital diagnostic and procedure data in the Western Cape Province. Method: A cross sectional analytical study design was used. Discharge diagnosis and procedure data were extracted from 342 patient folders from 3 district and 3 regional public hospitals in the Western Cape. This yielded 221 different diagnostic concepts and 126 different procedure concepts. The diagnostic concepts were further grouped into “all” diagnostic concepts recorded, diagnostic concepts recorded as “symptoms only” and diagnostic concepts recorded as “proper diagnoses”. The diagnostic coding systems evaluated were ICD-10 (International Classification of Diseases), ICPC-2 (International Classification of Primary Care 2nd edition) and ICD-10 Condensed Morbidity List. The procedure coding systems evaluated were CCSA-2001 (Current Procedure Terminology for South Africa) ICD-9-CM (International Classification of Diseases Clinical Modification 9th revision) and ICPC-2. The diagnoses and procedures were then coded in all of the coding systems being evaluated. Each diagnosis and procedure concept was matched with its representing concept in the coding system and scored according to the ability of the coding system to provide an “exact” match which was scored as (3) or a “partial” match scored as (2) or a “poor” match scored as (1) or “no” match scored as (0). Results: ICD-10 was better able to code diagnoses obtained from district and regional hospitals in the Western Cape compared to ICPC-2 and ICD-10 Condensed Morbidity list. For all recorded diagnostic concepts, ICD-10 was able to score 82% of the concepts as either an “exact” or a “partial” match compared to 79% in ICPC-2 and 30% in ICD-10-CL. ICD-10 consistently performed best across different stratification of diagnostic concepts namely concepts recorded as “proper diagnoses”, concepts recorded from regional hospitals only, concepts recorded from district hospitals only, concepts designated as “common diagnoses” and for concepts designated as “very common diagnoses”. In addition ICD-10 had zero diagnostic concepts for which “no match” could be found. CCSA -2001 proved to be the best coding system for coding procedures across all hospitals with an overall percentage of “exact” and “partial” matches of 83% compared to 65% for ICD-9-CM and 39% for ICPC-2 and also proved to be best across all strata. Conclusion: There were striking differences between the evaluated coding systems with regard to their ability to code diagnoses and procedures in the evaluated district and regional hospitals in the Western Cape Province. ICD-10 covers the scope of clinical diagnoses in more accurate and specific detail than ICPC-2 and ICD-10 CL. Though ICPC-2 is simpler and easier to use than ICD-10, it is not as detailed and specific as the latter but it proved ideal for symptoms rather than for specific diagnoses. ICD-10 Condensed Morbidity List was shown to be inadequate for coding diagnoses. However the difference between the two, although statistically significant were not very large and given the ease of use of ICPC-2, it could be recommended for use. As for procedures CCSA-2001 was assessed as being the most appropriate for coding procedures recorded in this setting compared to the other coding systems. ICPC-2 performed poorest for coding procedures across all evaluated settings and thus would be inappropriate to use. ICD-10 in most comparisons performed second best to ICPC-2 in terms of coding ability for diagnoses and could be considered for recommendation as a diagnostic coding tool.

The adoption of Health Information Systems (HIS) by primary care clinics and practitioners has become a standard in the healthcare industry. This increase in HIS utilization enables the informatization and automation of many paper-based clinical workflows, such as clinical referrals, through systems interoperability. The healthcare industry defines several interoperability standards and mechanisms to support the exchange of data among HIS. For example, the health authorities, Interior Health and Northern Health, created the CDX system to provide interoperability for HIS across British Columbia using SOAP Web Services and HL7 Clinical Document Architecture (CDA) interoperability standards. The CDX interoperability allows HIS such as Electronic Medical Record (EMR) systems to exchange information with other HIS, such as patients clinical records, clinical notes and laboratory testing results. In addition, to ensure the EMR systems adhere to the CDX specification, these health authorities conduct conformance testing with the EMR vendors to certify the EMR systems. However, conformance testing can only cover a subset of the systems' specifications and a few use cases. Therefore, systems properties that are not closely associated with the systems (i.e. emergent properties) are hard, or even impractical, to assure using only conformance testing. System safety is one of these properties that are particularly significant for EMR systems because it deals with patient safety. A well-known approach for improving systems safety is through hazard analysis. For scenarios where the human factor is an essential part of the system, such as EMR systems, the System-Theoretic Process Analysis (STPA) is more appropriate than traditional hazard analysis techniques. In this work, we perform a hazard analysis using STPA on the CDX conformance profile in order to evaluate and improve the safety of the CDX system interoperability. In addition, we utilize and customize a tool named FASTEN to support and facilitate the analysis. To conclude, our analysis identified a number of new safety-related constraints and improved a few other already specified constraints. / Graduate