Trata-se de uma pesquisa descritiva cujo propósito é o de observar, descrever e explorar aspectos de uma situação, utiliza-se de uma abordagem qualitativa. Investiga o uso do computador no desenvolvimento de atividades administrativo-burocráticas de enfermagem relacionados com o gerenciamento da assistência. Procurou-se também desvelar estratégias de implantação de sistemas informatizados nos processos de trabalho do enfermeiro. O recurso metodológico usado foi a análise de conteúdo, na modalidade de análise temática de BARDIN. Os resultados são analisados e discutidos em 05 categorias e respectivos núcleos de significados. Constatamos que o ensino da informática, em tempos de informação e mudanças aceleradas na aquisição de novos conhecimentos, não pode ser conseguido sem o uso de computadores na ciência da enfermagem e, em assim sendo o curso de enfermagem deve incluir no seu currículo o computador e o gerenciamento de informações. Os estudantes de enfermagem devem buscar o conhecimento no uso da tecnologia informacional e entenderem como ela faz interface com os vários sistemas de saúde. O desenvolvimento de atitudes tidas como positivas em relação a aplicação do computador na enfermagem, ainda na formação do futuro enfermeiro é essencial para que venha a envolver-se no planejamento e implantação de projetos informatizados. Já na prática o que se constatou foi um déficit significativo teórico e prático no manuseio do computador nos processos de trabalho. A Central de Processamento de Dados não ofereceu treinamento e informação suficiente para o “staff” de enfermagem. Percebeu-se ainda durante a fase de coleta de dados e no discurso dos entrevistados a despreocupação, da instituição em manter os enfermeiros bem treinados no manuseio da informática. Pode-se mesmo afirmar que o pouco da habilidade aprendido deu-se após inúmeras tentativas de acertos e erros. No entanto, o que mais chamou a atenção foi a grande preocupação dos enfermeiros em manifestar o interesse em buscar a informação, conhecimentos e cursos de especialização, manter-se atualizado. Eles estão ansiosos em encontrar meios para continuar a estudar. Constatou-se que o uso de grandes bancos de dados computadorizados para armazenar e administrar informações é um importante aliado na tomada de decisões no cuidado ao paciente. O uso do computador torna o trabalho do enfermeiro mais evidente, pois ao refletir seu trabalho, justifica largamente sua existência e seus custos operacionais. Muitas oportunidades que os enfermeiros têm para desenvolverem estratégias pessoais na sua prática podem viabilizar a introdução de sistemas informáticos nos processos de trabalho. A conclusão mais importante na análise dessas estratégias é que a formação de pelo menos um reduzido grupo de enfermeiros especializados em sistemas de informação computadorizados para fins de enfermagem seria uma estratégia admirável. Quanto as tendências profissionais na enfermagem moderna espera-se que os enfermeiros tenham uma ação mais destacada no desenvolvimento, seleção e implementação de Sistemas de Informação Hospitalar Computadorizado. Finalmente com relação a (in) satisfação do enfermeiro no trabalho verificou-se que a maioria das razões apontadas pelos enfermeiros como fatores de insatisfação podem ser evitada ou em muito amenizada com a informatização. O desgaste físico e psicológico decorrente com a demanda de tempo em atividades tidas como repetitivas e burocráticas em sua maioria podem ser substituídas na íntegra com programas de computadores que podem ser operados por um escriturário bem treinado. A sobrecarga de trabalho seria então bastante aliviada ou mesmo deixar de sê-lo, dando a oportunidade ao profissional de enfermagem de estar mais próximo dos seus pacientes. / It is a descriptive research aiming to observe, to describe and to explore aspects of a situation, using a qualitative approach to investigate the use of computer in the development of nursing administrative and bureaucratic activities related to assistance. It was tried to search for strategies of computerized systems in the nursing work processes. The used methodological resource was the content analyses in the modality of thematic analyses of Bardin. The results were analyzed and discussed in five (05) categories and respective nuclei of meanings. It was verified that the teaching of computer science in times of information and accelerated changes in the acquisition of new knowledge can not be done without the application of computer in the nursing science, so the nursing course must include in its curriculum the computer science and its use in the administration of information. The nursing student should become sophisticated with the use of information technology and to understand how it interfaces with the various health systems. The development of positive attitudes concerned with the application of computer in the nursing activities during the under graduation course is essential to make the future professional involved in the planning and implantation of computerized projects. It was verified that in the professional field there were a significant theoretical and practical deficit in handling computers in the nursing work processes. One should ask: why is that so? The simple answer is that the Data Processing Center did not give sufficient training and information to the nursing staff. It was still noticed during the phase of data collecting and interviewees´ speech the easiness of the Institution in maintaining the nurse staff well trained in handling computers. One can affirm that the little knowledge was learned after countless attempts of successes and mistakes. However, what most got attention was the great concern of the nurses in manifesting the interest in looking for information, knowledge and specialization courses to stay up dated. They are eager to find means to continue studying. It was verified that the use of large computerized data bases to store and administer information is an important ally to reach a decision in the care of patients. The use of computers make the nursing job more evident, because when considering carefully the job, justifies largely its existence as well as the operational costs. A lot of opportunities that nurses have to develop personal strategies in practical activities can make possible the introduction of computerized systems in the work process. The most important conclusion in the analysis of those strategies is that the formation of a reduced number of nurses specialized in computerized information systems for nurses issues would be an admirable strategy. Concerning professional tendencies in the modern nursing it is wanted that nurse have a more outstanding participation in the development, selection and implementation of hospital computerization information systems. Finally it was considered the nursing satisfaction or dissatisfaction in the work. It was verified that the most of pointed out reasons for dissatisfactions can be avoided or softened with the computerization. The physical or psychological waste related to time consuming demands in activities considered repetitive and bureaucratic can be successfully substituted by computers software operated by a well trained clerk. The work overload would be quite alleviated or even leave of being. It means better opportunities for nurses to be closer of their patients.

INTRODUÇÃO: A terapia antirretroviral (TARV) reduziu a mortalidade e a morbidade por aids, melhorou a qualidade de vida das pessoas vivendo com HIV/aids (PVHA) e, recentemente, foi reconhecida pelo seu papel como instrumento para redução da transmissão do HIV. Entretanto, a efetividade da TARV depende da manutenção de altas taxas de adesão à mesma. Tipo de tratamento, características individuais dos pacientes, barreiras de acesso ao serviço e à informação, falta de regularidade no comparecimento às consultas e às retiradas de medicamentos podem associar-se negativamente à adesão. Do ponto de vista da gestão, a falta à consulta agendada é um problema para os serviços de saúde que pode ser traduzido em custos para a sociedade. O presente estudo tem como objetivo analisar o perfil dos pacientes com HIV/aids que faltaram a consultas médicas agendadas de infectologia em um serviço especializado no atendimento de PVHA adultos, utilizando uma base de dados secundários gerados por um sistema administrativo destinado ao monitoramento da produção e ao faturamento. MÉTODOS: Foram incluídas PVHA em acompanhamento no Serviço de Extensão ao Atendimento de Pacientes HIV/Aids (SEAP HIV/Aids) com registro de pelo menos uma consulta agendada de infectologia em 2006 e 2007. Excluídos os sujeitos com discordância nas informações sobre sexo e data de nascimento, gestantes e com registro de óbito ou de transferência de serviço antes da primeira consulta de infectologia em 2007. Através do Sistema de Informação e Gestão Hospitalar (SIGH) foram obtidos dados do cadastro dos pacientes, registros de consultas e atendimentos em especialidades médicas e disciplinas de saúde, de internações hospitalares no ICHCFMUSP e de retiradas de medicamentos. A variável desfecho foi falta em consulta agendada de infectologia em 2007. As variáveis independentes incluíram características sócio-demográficas dos sujeitos, consultas e atendimentos em especialidades e disciplinas disponíveis no SEAP HIV/Aids, internações no ICHCFMUSP; tipo de médico infectologista que acompanhou o sujeito: se assistente ou residente, mudança de médico e retirada de antirretrovirais (ARV), em 2007. Na análise foram utilizados os testes do qui-quadrado de Pearson e t de Student. RESULTADOS: Sob o olhar da qualidade de informação, observou-se baixa frequência de registros de consultas e atendimentos em duplicidade. Embora a completitude e a acessibilidade tenham sido consideradas adequadas para grande parte dos dados, as variáveis cor, ocupação e endereço, não foram analisadas devido à baixa consistência dos dados referentes às mesmas. Entre os 3075 sujeitos incluídos 38,9% (1195) faltaram em pelo menos uma consulta de infectologia e a taxa de faltas às consultas de infectologia foi de 13,9%; 70,1% (2157) dos sujeitos eram do sexo masculino e não foi observada associação entre sexo e falta em consulta (p=0,32). A proporção de sujeitos que faltaram diminuiu à medida em que aumentou a idade (p<0,001) e a média de idade dos que faltaram foi menor do que a dos que não faltaram (p<0,001). Os sujeitos que faltaram agendaram 33,3% mais consultas em infectologia (p<0,001) e compareceram a menos consultas (p<0,001) quando comparados aos que não faltaram. A falta foi associada a maior comparecimento em consulta sem agendamento (p<0,001) e em atendimento de serviço social (p<0,001), a internação hospitalar no ICHCFMUSP (p<0,001), a assistência feita por médico residente e a troca de médico (p=0,02), e a menor comparecimento em consultas de ginecologia (p<0,001) e de proctologia (p=0,00). Sujeitos em uso de TARV faltaram em menor proporção (p<0,001). A média de retiradas de ARV entre os sujeitos que faltaram foi menor quando comparados aos que não faltaram (p<0,001). A organização do serviço de saúde é um fator relevante para o comparecimento dos pacientes em consulta. No contexto da atenção à saúde de PVHA, acesso a mais modalidades de assistência, atendimento em horário marcado, e uma gestão que tenha por objetivo diminuir as barreiras de acesso ao tratamento podem contribuir para elevar a qualidade da assistência ofertada. A elaboração e acompanhamento de indicadores de qualidade tais como acompanhamento de taxas de faltas e de retiradas de ARV pode contribuir para a redução de taxas de faltas às consultas. Embora ainda necessite de melhorias, o SIGH revelou-se um instrumento útil para a elaboração de indicadores relacionados à qualidade da atenção à saúde de PVHA / BACKGROUND: The highly active antiretroviral therapy (HAART) reduced AIDS morbidity and mortality in HIV/AIDS patients, improved their quality of life and, was recognized as prevention to HIV transmission. However, the success of antiretroviral therapy (ART) depends on high levels of adherence to it. Treatment regimens, patient individual characteristics, access barriers, missing scheduled appointments and not taking ART drugs can be associated with low adherence. For managers, a missed appointment could be translated in costs. Our goal is to characterize HIV/AIDS patients who missed scheduled medical appointments, according to SIGH, an electronic administrative database. METHODS: Adults HIV/AIDS patients followed at a public outpatient clinic specialized in HIV/AIDS attached to the Clinics Hospital of the São Paulo University Medicine School who had at least one scheduled appointment with an infectious disease physician in 2006 and 2007 were included. Patients with uncertain age and gender registry, pregnant or who were transferred or died before first scheduled appointment in 2007 were excluded. The outcome was missed scheduled medical appointment with an infectious diseases physician in 2007. Data on sociodemographic characteristics (age, gender, color/race, occupation, and address), appointments with physicians and health care providers care available in the clinic, hospitalization at Central Institute of Clinics Hospital of the São Paulo University Medicine School and ART withdrawal from the pharmacy in 2007 were obtained from a computerized administrative database; besides, the sort of infectious disease physician (assistant or resident) who cared for the patient, physician changing and number of changes were other independent variables included. Chi-square and Student-t test were used on analysis. RESULTS: We observed few duplicities of registry of appointments. Although the database showed a good completeness and accessibility for most variables, color/race, occupation and address had low consistency and were not analyzed. The study included 3075 subjects, 38.9% (1195) of them missed at least 1 scheduled medical appointment with an infectious disease physician in 2007; 13.9% of all medical appointments were missed. Subjects who missed medical appointments scheduled 33.3% more (p<0.001) and had less medical consultations (p<0.001) compared with those who did not miss medical visits. Seventy one percent (2157) of the subjects were men and we found no association between gender and missing medical appointment (p=0.32). Missing medical appointment was associated with younger age (p<0.001), unscheduled medical (p<0.001) and social worker visits (p<0.001), hospitalization (p<0.001), assistance by resident (p=0.04), change of physician (p=0.02), lower attendance to gynecologist (p<0.001) and proctologist (p=0.00); besides, not be on HAART was associated to missing medical appointment (p<0.001) and subjects who missed medical visits withdrew few ART drugs from the pharmacy (p<0.001). The organization of the health service is relevant for improving patient attendance to it. Access to more medical specialties and health disciplines, scheduled medical visits, reduction of barriers to access are all management instruments to increase the quality of health services. The use of quality indicators, like rate of missed medical appointments and withdrawal of drugs from the pharmacy, may increase the adherence of HIV/aids patients to the treatment. The performance of SIGH was satisfactory when it was used for quality indicators, although some improvement is still necessary

Dû aux différents défis de la Santé Publique dans le monde contemporain, aux inadéquations des autorités en raison du manque de cohésion dans la mise en oeuvre des différents programmes de santé publique et des authentiques besoins de la population, nous reconnaissons la légitimité de remettre en question la place accordée aux Fonctions Essentielles de Santé Publique dans le processus d’élaborations des Plans Nationaux de Santé. Par une analyse documentaire, nous comptons scruter les plans nationaux de santé de la République d’Haïti et du Brésil, respectivement intitulé Plano Nacional de Saúde (PNS) 2012-2015 et Plan Directeur de Santé (PDS) 2012-2022, en ayant comme cadre d’analyse12 Fonctions Essentielles de Santé Publique définies par l’Organisation Panaméricaine de la Santé (OPS). Notre objectif est de déterminer si les fonctions ont été prises en compte dans le processus d’élaboration des plans, mais également de dégager les particularités structurelles des 2 plans, l’existence d’indicateurs et d’objectifs définis et surtout de mettre en évidence les similitudes et différence d’approches des FESP rencontrées. Structurellement, les deux plans laissent entrevoir certaines divergences. Les douze fonctions considérées pour l’analyse ont été identifiées dans les deux plans, l’une abordée plus profondément que l’autre. Haïti, en dehors du fait qu’il aspire au renforcement de la gouvernance de l’autorité nationale, mise surtout sur la mise en place d’un système national d’information sanitaire en adéquation avec les FESP abordant la thématique de analyse de la situation de santé et veille sanitaire. Le Brésil pour sa part démontre un intérêt particulier pour la réduction des inégalités à travers les différentes actions prévues dans le PNS surtout celles en lien avec les soins de santé primaire et en misant la qualité des soins qui épousent en partie certaines idées véhiculées par les FESP. Parfois dans le PDS on dénote une absence d’indicateurs ou des objectifs frisant l’utopie. Le PNS pour être un document à portée nationale sous l’obédience du gouvernement central projette certaines actions en dehors de son champ d’activité légalement défini. / Frente aos diferentes desafios da saúde pública na contemporaneidade, do desafinamento das autoridades dada a falta de coesão na execução dos diferentes programas em saúde pública e as necessidades reais da população, reconhecemos a importância de questionar o lugar dado às Funções Essenciais da Saúde Pública (FESP) na elaboração dos planos nacionais de saúde. Neste trabalho, mediante uma análise de documentos, utilizando uma metodologia descritiva, foram examinados os Planos Nacionais de Saúde do Haiti e do Brasil, respectivamente denominados Plano Nacional de Saúde (PNS) 2012-2015 e Plan Directeur de Santé (PDS) 2012-2022, usando como referencial as Funções Essenciais de Saúde. O objetivo é de determinar se no processo de elaboração dos dois planos foram consideradas as FESP. Foram levantadas as particularidades estruturais dos planos, a existência de metas e de indicadores e ressaltadas as semelhanças e diferenças de cada um. Os dois planos têm estruturas diferentes: o do Haiti abrange mais anos e maior quantidade de páginas. As doze FESP consideradas para análise foram identificadas nos dois planos. Houve diferença substancial na forma de sua abordagem. Haiti aposta muito na implementação de um Sistema de Informação Sanitária para reforçar as duas funções que abordam o tema de análise da situação de saúde e a vigilância em saúde. O Brasil demonstra um interesse especial em melhorar a Atenção Básica a Saúde, através de equipe multidisciplinar, aprimorando o processo de trabalho e diminuindo as inequidades que existem na atenção ao cidadão, ações que abarcam várias FESP. No PDS em alguns momentos não foi possível identificar os indicadores e algumas metas um pouco fora de alcance. O Plano Nacional de Saúde por ser um documento de abrangência nacional pautou algumas ações que não cabem dentro da esfera de responsabilidade do Governo Federal. / Due to the different challenges of public health in the contemporary world, to the inadequacies of the authorities due to the lack of cohesion in the implementation of the various public health programs and the genuine needs of the population, we recognize the legitimacy of questioning the place accorded to the Essential Public Health Functions in the process of drawing up National Health Plans. Through a literature review, we intend to scrutinize the National Health Plans of the Republic of Haiti and Brazil, respectively Plano Nacional de Saúde (PNS) 2012-2015 and Plan of Health (PDS) 2012-2022, using as framework of analysis the 12 Essential Public Health Functions as defined by the Pan American Health Organization (PAHO). Our objective is to determine whether the functions have been taken into account in the planning process, but also to identify structural features of the plans, existence of defined indicators and objectives and above all highlight similarities and differences in the approaches of the EPHF’s encountered. Structurally, both plans point to some divergences. The twelve functions considered for analysis were identified in the two plans, one approach deeper than the other. Haiti, apart from the fact that it aspires to strengthen the governance of the national authority, relies above all on the establishment of a national health information system in line with the EPHF’s addressing the issue of health situation analysis and health surveillance. Brazil, for its part, demonstrates a particular interest in reducing inequalities through the various actions provided for in the PNS, especially those related to primary health care, and by focusing on the quality of care that partly espouses certain ideas conveyed by EPHF’s. Sometimes in the PDS there is a lack of indicators or some objectives bordering on fantasy. The PNS to be a document of national scope under the obedience of the federal government projects certain actions outside its field of activity legally defined.

Hydrogen fuel cells, and notably the polymer electrolyte fuel cell (PEFC), present an important opportunity to reduce greenhouse gas emissions within a range of sectors of society, particularly for transportation and portable products. Despite several decades of research and development, there exist three main hurdles to full commercialisation; namely infrastructure, costs, and durability. This thesis considers the latter of these. The lifetime target for an automotive fuel cell power plant is to survive 5000 hours of usage before significant performance loss; current demonstration projects have only accomplished half of this target, often due to PEFC stack component degradation. Health management techniques have been identified as an opportunity to overcome the durability limitations. By monitoring the PEFC for faulty operation, it is hoped that control actions can be made to restore or maintain performance, and achieve the desired lifetime durability. This thesis presents fault detection and diagnosis approaches with the goal of isolating a range of component degradation modes from within the PEFC construction. Fault detection is achieved through residual analysis against an electrochemical model of healthy stack condition. An expert knowledge-based diagnostic approach is developed for fault isolation. This analysis is enabled through fuzzy logic calculations, which allows for computational reasoning against linguistic terminology and expert understanding of degradation phenomena. An experimental test bench has been utilised to test the health management processes, and demonstrate functionality. Through different steady-state and dynamic loading conditions, including a simulation of automotive application, diagnosis results can be observed for PEFC degradation cases. This research contributes to the areas of reliability analysis and health management of PEFC fuel cells. Established PEFC models have been updated to represent more accurately an application PEFC. The fuzzy logic knowledge-based diagnostic is the greatest novel contribution, with no examples of this application in the literature.

A garantia do acesso dos usuários do Sistema Único de Saúde (SUS) em todos os níveis de atenção em tempo adequado e a criação de fluxos de assistência à saúde que opere de forma sincronizada são uns dos grandes desafios do SUS. O HCFMRP-USP oferta serviços de nível terciário dentro do sistema, sendo referência dentro de sua Regional de Saúde trabalha para otimizar suas vagas ofertadas aos Departamentos Regionais de Saúde e absorver o maior número possível de pacientes que necessitam de atendimento terciário. Objetivo: Avaliar o aproveitamento das vagas de consultas para novos pacientes ofertadas pelo HCFMRP - USP aos Departamentos Regionais de Saúde de sua região de abrangência, no período de 2006 a 2014. Metodologia: Foi realizado um estudo descritivo com dados secundários do banco de dados do HCFMRP-USP, a partir das informações do Serviço de Agendamento e Controle de Pacientes Ambulatoriais. Foram calculadas no período de 2006 até 2014, a Taxa de Agendamento, Taxa de Falta, Taxa de adequação da Referência e Taxa de Aproveitamento Global. Resultados: A taxa geral de agendamento foi 76%, a taxa de falta de pacientes novos teve a média de 17%, a Taxa média de Adequação da Referência foi de 92%. A taxa de aproveitamento global foi 57%, ano de 2014 das 37.830 vagas disponibilizadas pelo HCRP apenas 21.170 foram efetivamente aproveitadas. CONCLUSÕES: As iniciativas para o HCFMRP-USP se consolidar como um hospital terciário vem sendo gradativamente concretizadas, todas as taxas avaliadas tiveram uma melhora significativa se compararmos com o estudo anteriormente realizado que avaliou os anos de 2000-2005, mas ainda existem muitos desafios. Os gestores precisam avaliar os dados e buscarem mudanças em suas práticas de gestão, sendo necessários investimentos na formação recursos humanos e na integração entre gestores para que seja possível o integral aproveitamentos das vagas disponibilizadas. / Ensuring access of users of the Unified Health System (UHS) at all levels of care in a timely manner and the creation of health care flows that operate synchronously are one of the great challenges of UHS. The HCFMRP-USP offers tertiary services within the system, being a reference within its Regional Health activity to optimize their vacancies offered to the Regional Health Departments and the largest possible number of patients who need tertiary care. Objective: Evaluate the use of vacancies consultations for new patients offered by HCFMRP - USP to Regional Departments of Health within the respective coverage area in the period 2006-2014. Methodology: A descriptive study of secondary data from HCFMRP- USP database was conducted from information of the Scheduling and Ambulatory Patient Control Service. There were calculated in the period of 2006 until 2014: the Schedule Rate, Lack Rate, Adequacy Rate Reference and Global Utilization Rate. Results: The overall Schedule Rate was 76%, the Lack Rate of new patients had an average of 17%, the average Reference Adequacy Rate 92%. The Global Utilization Rate was 57%, in the year of 2014 37,830 vacancies provided by HCFMRP-USP only 21,170 were actually utilized. Conclusions: The initiatives for HCFMRP-USP consolidate as a tertiary hospital has been gradually implemented, all measured rates had a significant improvement when compared to the previously conducted study that evaluated the years 2000-2005, but there are still many challenges. Managers need to evaluate the data and seek changes in their management practices and the necessary investments in training human resources and integration of managers for the full exploitations of available vacancies is possible.

El colectivo enfermero español no redacta de forma generalizada ningún Informe de Cuidados de Enfermería al Alta (ICEA) tras la atención hospitalaria del paciente que permita la continuidad de los cuidados. Desde que el Ministerio de Sanidad, Política Social e Igualdad presentara el Plan de Calidad para el Sistema Nacional de Salud (2006) donde se enmarcó el proyecto Historia Clínica Digital, diferentes grupos de trabajo han definido los Informes del Conjunto Mínimo de Datos, entre los que se incluye el Informe de Cuidados de Enfermería. Tomando una muestra aleatoria de enfermeras de los hospitales correspondientes a las nueve áreas de salud de la Región de Murcia, se analizan las capacidades científicas, las capacidades tecnológicas, el nivel de conocimientos y el acceso a la formación continuada que tienen sobre el contenido del ICEA. Los datos muestran que es necesaria una importante consolidación teórica y metodológica de las enfermeras hospitalarias más veteranas de la Región de Murcia, en diagnósticos NANDA, intervenciones recogidas en las NIC y medición de resultados enfermeros (NOC) que les permita redactar el ICEA. / The Spanish nursing profession does not write any report widely to Alta Care Nurse after the patient's hospital care will allow for continuity of care. Since the Ministry of Health, Social Affairs and Equal submit the Quality Plan for the National Health System (2006) which framed the Medical Records project, various working groups have defined the reports of the Minimum Data Set, among which are included, the Nursing Care Report. We taking a random sample of nurses from hospitals for the nine health areas in the region of Murcia, discusses the scientific, technological capabilities, the level of knowledge and access to ongoing training with the nurses on the content of the discharge nurse. These data show that consolidation needs major theoretical and methodological most senior hospital nurses in the region of Murcia, in matters of NANDA diagnoses, interventions included in the NIC and measurement of nursing outcomes (NOC) to allow them to draft the Report of High Nursing.

As a consequence of the recent deregulation in the electrical power production industry, there has been a shift in the traditional ownership of power plants and the way they are operated. To hedge their business risks, the many new private entrepreneurs enter into long-term service agreement (LTSA) with third parties for their operation and maintenance activities. As the major LTSA providers, original equipment manufacturers have invested huge amounts of money to develop preventive maintenance strategies to minimize the occurrence of costly unplanned outages resulting from failures of the equipments covered under LTSA contracts. As a matter of fact, a recent study by the Electric Power Research Institute estimates the cost benefit of preventing a failure of a General Electric 7FA or 9FA technology compressor at $10 to $20 million. Therefore, in this dissertation, a two-phase data analytics approach is proposed to use the existing monitoring gas path and vibration sensors data to first develop a proactive strategy that systematically detects and validates catastrophic failure precursors so as to avoid the failure; and secondly to estimate the residual time to failure of the unhealthy items. For the first part of this work, the time-frequency technique of the wavelet packet transforms is used to de-noise the noisy sensor data. Next, the time-series signal of each sensor is decomposed to perform a multi-resolution analysis to extract its features. After that, the probabilistic principal component analysis is applied as a data fusion technique to reduce the number of the potentially correlated multi-sensors measurement into a few uncorrelated principal components. The last step of the failure precursor detection methodology, the anomaly detection decision, is in itself a multi-stage process. The obtained principal components from the data fusion step are first combined into a one-dimensional reconstructed signal representing the overall health assessment of the monitored systems. Then, two damage indicators of the reconstructed signal are defined and monitored for defect using a statistical process control approach. Finally, the Bayesian evaluation method for hypothesis testing is applied to a computed threshold to test for deviations from the healthy band. To model the residual time to failure, the anomaly severity index and the anomaly duration index are defined as defects characteristics. Two modeling techniques are investigated for the prognostication of the survival time after an anomaly is detected: the deterministic regression approach, and parametric approximation of the non-parametric Kaplan-Meier plot estimator. It is established that the deterministic regression provides poor prediction estimation. The non parametric survival data analysis technique of the Kaplan-Meier estimator provides the empirical survivor function of the data set comprised of both non-censored and right censored data. Though powerful because no a-priori predefined lifetime distribution is made, the Kaplan-Meier result lacks the flexibility to be transplanted to other units of a given fleet. The parametric analysis of survival data is performed with two popular failure analysis distributions: the exponential distribution and the Weibull distribution. The conclusion from the parametric analysis of the Kaplan-Meier plot is that the larger the data set, the more accurate is the prognostication ability of the residual time to failure model.

Introduction The beggars are one the most vulnerable and stigmatized groups in the European society and are determined to live in substandard conditions, characterized by lack of sanitation and overcrowdings, and bare the harsh weather conditions to earn their living. Often, they have limited access to healthcare and their lifestyle has a great impact upon their health. However, little is known about their own perceptions of their health and their strategies to keep it. Aim The aim was to explore the Romanian beggars’ perceptions of their health prior to and during begging, the perceived consequences of begging on their health, and their coping strategies to maintain health while begging in Uppsala, Sweden. Method Data was collected from 8 semi-structured interviews in Uppsala, Sweden during March 2015. The collected data was then analysed using manifest qualitative content analysis. Findings The Romanian beggars in Uppsala perceived their health status to be affected through their activity. Physical consequences involved developing new illnesses and conditions, but also aggravating previous health conditions, and mental consequences included degrading and marginalizing effects of begging, but also harassment from passersby. Access to healthcare in Sweden was limited and determined the beggars to develop alternative strategies for health management or to return to Romania for treatment.     Conclusion The health status was found to be both negatively and positively affected through complex interactions between the individual and the surrounding levels: social network, community, institutions and society. More attention should be given to this group from all levels to improve their health status.

Η διατριβή αναφέρεται στην ανάπτυξη μίας Μεθοδολογίας Ενοποίησης Εργαλείων Διοίκησης (Μ.Ε.Δ.Δ.) για την επίλυση προβλημάτων που παρουσιάζονται στον τομέα της υγείας, τα οποία αναφέρονται αφενός στη χωροθέτηση μονάδων υγείας και αφετέρου στην οργάνωση και διαχείρισή τους. Η καινοτομία της διατριβής αυτής είναι ότι αντιμετωπίζει τα προβλήματα αυτά σαν προβλήματα της μορφής ‘αιτία-κατάσταση-αντιμετώπιση’, δηλαδή προτείνει την ανάλυση των αιτιών (για παράδειγμα ανάλυση παραγόντων κινδύνου για τη δημιουργία Οξέος Στεφανιαίου Συνδρόμου) που οδηγούν σε μία κατάσταση (Οξύ Στεφανιαίο Σύνδρομο) και μετά χρησιμοποιεί αυτή την ανάλυση για την αντιμετώπιση των καταστάσεων (χωροθέτηση, οργάνωση και διαχείριση μονάδων καρδιαγγειακών νοσημάτων). Η Μ.Ε.Ε.Δ. βασίζεται στην ενοποίηση μεθόδων από τα πεδία της Επιχειρηματικής Νοημοσύνης (Business Intelligence), της Επιχειρησιακής Έρευνας και της Κοστολόγησης, με σκοπό αρχικά την εξαγωγή κανόνων για την εύρεση αιτιών που δημιουργούν μία κατάσταση, στη συνέχεια την αντιμετώπιση αυτής της κατάστασης με βάση τους εξορυγχθέντες κανόνες και τέλος την οργάνωση των λειτουργικών μονάδων που δημιουργήθηκαν για την αντιμετώπιση της κατάστασης. Αρχικά, χρησιμοποιούνται τρεις μέθοδοι του επιστημονικού πεδίου Εξόρυξης από Δεδομένα (data mining): οι κανόνες συσχέτισης (association rules), ταξινόμησης (classification rules) και ομαδοποίησης (clustering rules) ως τεχνικές εύρεσης ισχυρών κανόνων, δηλαδή αιτιών που δημιουργούν την κατάσταση. Στη συνέχεια, χρησιμοποιείται η ανάλυση χωροθέτησης (location analysis) από το πεδίο της επιχειρησιακής έρευνας, προκειμένου να χωροθετηθούν λειτουργικές μονάδες. Η τεχνική της προσομοίωσης (simulation) εφαρμόζεται, προκειμένου να εξετάσει σενάρια σχετικά με τη δομή και τους απαιτούμενους πόρους των μονάδων. Κατόπιν, η τεχνική της κοστολόγησης με βάση τις δραστηριότητες (Activity-based costing) χρησιμοποιείται για την κοστολόγηση των υπηρεσιών της μονάδας, ενώ η μέθοδος OLAP (On-line analytical processing) εφαρμόζεται για την παρακολούθηση της λειτουργίας της μονάδας και για τη λήψη στρατηγικών αποφάσεων και διορθωτικών μέτρων. Η εργασία αυτή προτείνει την οργάνωση των μεθόδων που αναφέρθηκαν με μία συγκεκριμένη ροή, ώστε κανείς να οδηγείται σε μία ολοκληρωμένη λύση τέτοιων πολύπλοκων προβλημάτων. / The thesis is concerned with the development of a methodology for solving a variety of problems in healthcare management, which refer to the location of health units, as well as their organization and management. The proposed methodology deals with these kinds of problems as problems of the form ‘cause-state-treatment’, which means that it proposes the analysis of the causes (for example risk factors associated with cardiovascular disease) which result in a state (cardiovascular disease) and then it uses this analysis to deal (treat) with the state (situation) (location, organization and management of Heart Disease Centers). The proposed methodology is based on the integration of various methods and techniques from the fields of Business Intelligence, Data Mining, Operational Research and Costing. Initially, the methodology extracts rules, which represent the causes that create a state, then it tackles the state (situation) based on the extracted rules, and finally it organizes the operational units, which are developed in order to deal with the state (situation). Thus, at the fist stage three data mining techniques are used: association rule mining, classification rules and clustering, as techniques for discovering strong rules in databases, that is, causes that lead to a state. Following, location analysis is used, intending to locate operational units, based on the quantitative results of the first stage. Simulation is used with the aim to examine alternative scenarios regarding the structure and the required resources (human resources as well as technology requirements) of the units. Then, activity-based costing is used to assess the efficiency of the health care technology. Finally, OLAP (On-line analytical processing) is applied in order for the health care managers to monitor the operations of the unit, as well as undertake corrective measures and finally aid decision making. The thesis proposes the organization of the aforementioned methods with a particular flow, so as the decision maker is led to an integrated solution of such complex health care management problems.

Research into the use of information by health care professionals has generally been conducted in countries dominated by the biomedical model. In these contexts, illness is considered to have a scientifically identifiable physical cause, and treatment practices within the formal health care sector are prescribed and managed in accordance with this definition. Yet there are also contexts where other belief systems inform and guide the way that people think about their health. In comparison to the biomedical model, these contexts have contributed very little to our understanding of how health professionals develop their knowledge. This research investigates how primary health care workers (PHCWs) in one such context, Papua New Guinea (PNG), develop their knowledge about the health services they provide. In order to discover and understand the differing views of these PHCWs, 69 semi-structured interviews were conducted in three culturally and geographically diverse regions of PNG. In explaining the diagnostic and treatment practices they use, these participants provided insights into not only how PHCWs engage with information but also how it informs their professional practice. These data were analysed, interpreted and discussed using a framework consisting of four, primary but interconnecting aspects: the context in which information was provided, the interactions with the sources of information, the processes by which information was understood, and the outcomes realized as a result of the information being used. Findings indicated that the majority of participants in this study acknowledged, if not incorporated, information pertaining to biomedicine, Christianity and Indigenous belief systems into their diagnostic and treatment practices. Even when these belief systems clearly contradicted each other, PHCWs did not in general feel the need to make a conscious choice between them. From their comments it would appear that four factors contributed to this ability to incorporate diverse and often conflicting ideas into the way that patients were cared for. First, all of the belief systems were considered legitimate by at least one group of people connected to the community in which the PHCW worked. Second, although varying in degrees of availability and accessibility, members of these groups were able to disseminate information pertaining to the belief system they supported. Third, the PHCW had no particular affiliation with any one of these groups but instead regularly interacted with a range of different people. Lastly, the PHCW worked in situations where health practices were not generally well supervised by their employers and therefore they were relatively free to choose between various diagnostic and treatment practices. The qualitative interpretive approach adopted in this thesis contributes to the field of human information behavior by affirming that conflict is in the eye of the beholder. When a number of belief systems coexist and all are considered legitimate, information about them is freely available, and the recipients actions are neither constrained by their own dogma, nor imposed upon by others, individuals may quite comfortably embrace diverse beliefs. These findings may also contribute to a better understanding of health management practices in developing countries by suggesting that health professionals are not merely personifications of a biomedical model. Instead, the study demonstrates that multiple belief systems can be combined by PHCWs, and that in turn this benefits the formal health care sector through increased treatment options that are both appropriate and effective in such circumstances.