published_or_final_version / Biological Sciences / Doctoral / Doctor of Philosophy

This research aims to integrate mathematical water quality models with Bayesian inference techniques for obtaining effective model calibration and rigorous assessment of the uncertainty underlying model predictions. The first part of my work combines a Bayesian calibration framework with a complex biogeochemical model to reproduce oligo-, meso- and eutrophic lake conditions. The model accurately describes the observed patterns and also provides realistic estimates of predictive uncertainty for water quality variables. The Bayesian estimations are also used for appraising the exceedance frequency and confidence of compliance of different water quality criteria. The second part introduces a Bayesian hierarchical framework (BHF) for calibrating eutrophication models at multiple systems (or sites of the same system). The models calibrated under the BHF provided accurate system representations for all the scenarios examined. The BHF allows overcoming problems of insufficient local data by “borrowing strength” from well-studied sites. Both frameworks can facilitate environmental management decisions.

A qualidade dos exames mamográficos é uma preocupação constante do sistema de saúde mundial que se vê diante do desafio da detecção precoce do câncer de mama. As organizações responsáveis implementaram protocolos internacionais que consistem em testes de aceitação dos equipamentos mamográficos e de tomossíntese da mama, os quais estabelecem um padrão de qualidade nos serviços radiográficos. Porém, essas diretrizes têm como base o uso de objetos simuladores de mamas com espessuras e composições padrões, que muitas vezes não condizem com os perfis populacionais dos centros de diagnóstico. Neste trabalho, foi desenvolvido um sistema automatizado de rastreamento e gerenciamento de dados, que extrai as informações referentes ao processo de aquisição da mamografia digital e armazena-as em um servidor DICOM SCP (Service Class Provider). Após armazenadas, o sistema correlaciona os fatores de exposição das imagens, de forma a avaliar os níveis de referência em dose de radiação fornecidos pelos equipamentos. Como resultados, foi verificado que o perfil mamário dos centros institucionais de diagnóstico estudados não segue os valores de referência apresentados na literatura em termos de espessura e densidade mamária. Enquanto a mama padrão dos testes de garantia de qualidade é composta por 50 mm de espessura e 50% de densidade (50-50), a população estudada apresentou mamas comprimidas com média de 60 mm de espessura, com baixo percentual de tecido fibroglandular (menor que 25%). Portanto, o uso o sistema desenvolvido pode direcionar os testes de conformidade dos equipamentos para perfis mamários específicos. Esse direcionamento pode auxiliar na determinação de doses ótimas de radiação para melhoria da qualidade da imagem, produzindo valores de referência de grande utilidade para a qualidade dos serviços radiográficos. / Image quality assessment in mammography represents one of the greatest challenges that health services face in order to detect breast cancer early. The world health organization recommends quality assurance guidelines, which consist of acceptance tests for digital mammography (DM) and digital breast tomosynthesis (DBT), to standardize the radiological services. However, these guidelines are based on test objects widely used to simulate standard breasts in terms of composition and thickness, which often do not match with the demographic profiles in the breast care centers. In this thesis work, an automated system for tracking and data management was developed to extract the metadata (DICOM header) from the image acquisition process and to store it into a custom DICOM Service Class Provider (SPC). The developed system correlates the exposure factors\' info in order to evaluate the references for patient radiation dose provided by the manufacturers. As result of the data correlations, the reference required by the international guidelines for standard breasts are not a feasible representation for the demographic profile in the breast care center evaluated in terms of breast density and thickness. While the standard for quality assurance testing consists of breasts with 50 mm of thickness and 50% of density, the demographic population presented compressed breast thickness of approximately 60 mm and low fibroglandular tissue (less than 25%). Therefore, using the developed system should guide the quality assurance in digital mammography to specific breast profiles. This guidance may assist in determining optimal radiation doses to improve the image quality, producing useful benchmarks for the quality of radiological services.

Apesar dos avanços nos índices de coleta e tratamento de esgotos no Estado de São Paulo, ainda existem incertezas sobre a efetividade dos sistemas de tratamento existentes, uma vez que são escassas as informações sobre o desempenho das ETEs em operação no país. Por meio da aquisição e análise de dados de desempenho do sistema, é possível a avaliação do cumprimento da legislação ambiental e a melhoria das condições operacionais, reduzindo, efetivamente, o impacto do lançamento sobre os recursos hídricos. Nesse sentido, o presente trabalho teve como objetivo avaliar estatisticamente o desempenho de lagoas de estabilização - tecnologia de tratamento mais utilizada no Estado de São Paulo - localizadas na UGRHI 12 - Baixo Pardo/Grande, todas com vazão de projeto inferior a 300 L/s, utilizando dados de automonitoramento fornecidos pelos prestadores de serviço. A avaliação compreendeu um período de 10 anos (2005 a 2014) e abrangeu desde os projetos das lagoas até a caracterização dos dados afluentes e efluentes das ETEs, incluindo também o impacto do lançamento dos esgotos tratados nos corpos receptores e a qualidade dos corpos d\'água em escala de bacia hidrográfica, utilizando os dados da rede de monitoramento da CETESB na UGRHI 12. O desempenho das ETEs foi avaliado quanto aos parâmetros DBO, DQO, CT, E. coli, SS, N-amoniacal e P-total, considerando tanto as faixas típicas apontadas na literatura, como o atendimento aos padrões de lançamento e qualidade. Os dados disponibilizados foram bastante heterogêneos, apresentando, em sua maioria, periodicidades de amostragem variáveis e interrupções no monitoramento, o que impediu, em alguns casos, a realização de uma análise mais consistente. As concentrações afluentes de matéria orgânica foram mais elevadas do que os valores usuais expressos na literatura, sendo a causa mais provável o baixo consumo de água aliado ao tipo de amostragem praticado (amostragem simples). De maneira geral, o desempenho das lagoas, considerando as eficiências médias de remoção de DBO e DQO, ficou dentro do esperado, o que não foi suficiente, contudo, para garantir percentuais elevados de conformidade com a legislação do estado de São Paulo, os quais resultaram abaixo de 80% na maioria das ETEs. Quanto às concentrações nos esgotos tratados, o desempenho ficou aquém do esperado, o que implicou no lançamento de efluentes com concentrações elevadas de matéria orgânica, embora de acordo com os padrões de lançamento pelo critério da eficiência de remoção. A avaliação do corpo receptor mostrou que, mesmo se tratando de vazões relativamente baixas, tais lançamentos foram capazes de impactar os cursos d\'água, notadamente aqueles com baixas razões de diluição. Finalmente, em escala de bacia hidrográfica, verificou-se que, nos corpos d\'água da UGRHI 12, ainda permanecem percentuais elevados de desconformidade para P-total e E. coli, contribuindo para esse cenário tanto as fontes de poluição pontuais como as difusas. / Despite advances in wastewater collection and treatment indicators in São Paulo state, there are still uncertainties about the effectiveness of existing treatment systems, since they is little information on the performance of WTPs operating in the country. Throughout the acquisition and analysis of system performance data, it is possible to evaluate the compliance with environmental legislation and improve operating conditions, effectively reducing the impact of the discharge on water resources. In this sense, the present study aimed to evaluate statistically the performance of stabilization ponds - wastewater treatment technology most widely used in São Paulo state - located in UGRHI 12 - Baixo Pardo/Grande, all of them with design flow rates below 300 L/s, using self-monitoring data given by the service providers. The evaluation comprised a period of 10 years (2005-2014), including from the projects of the ponds to the characterization of WTPs influent and effluent data, also incorporating the impact of treated wastewater release in receiving bodies and the quality of water bodies in watershed scale, using the data from CETESB\'s monitoring network in UGRHI 12. The performance of the WTPs was evaluated for BOD, COD, total coliforms, E. coli, suspended solids, ammonia and total phosphorus, considering the typical ranges mentioned in the literature and compliance with discharge and water quality standards. The provided data were quite heterogeneous, most of them presenting variable sampling periodicities and interruptions in monitoring, sometimes hindering a more consistent analysis. The influent\'s concentrations of organic matter were higher than the usual values expressed in the literature, which was most likely caused by low water consumption combined with the type of sampling practiced (single sampling). In general, the ponds\' performance, considering the average BOD and COD removal efficiencies, was as expected, however, such values weren\'t enough to ensure high percentage of compliance with São Paulo\'s environmental legislation, since the percentages were below 80% in most WTPs. Regarding the concentrations in treated wastewater, the performance was less than expected, which resulted in the discharge of effluents with high concentrations of organic matter, even though they were in compliance with discharge standards by the removal efficiency criterion. The evaluation of the receiving stream showed that, even consisting of relatively low flow rates discharges, such releases were able to impact the water bodies, especially those with low dilution ratio. Finally, in watershed scale, it was found that, in UGRHI 12 water bodies, there are still high percentages of non-conformity for total phosphorus and E. coli, contributing to this scenario both point and non-point sources of pollution.

A qualidade dos exames mamográficos é uma preocupação constante do sistema de saúde mundial que se vê diante do desafio da detecção precoce do câncer de mama. As organizações responsáveis implementaram protocolos internacionais que consistem em testes de aceitação dos equipamentos mamográficos e de tomossíntese da mama, os quais estabelecem um padrão de qualidade nos serviços radiográficos. Porém, essas diretrizes têm como base o uso de objetos simuladores de mamas com espessuras e composições padrões, que muitas vezes não condizem com os perfis populacionais dos centros de diagnóstico. Neste trabalho, foi desenvolvido um sistema automatizado de rastreamento e gerenciamento de dados, que extrai as informações referentes ao processo de aquisição da mamografia digital e armazena-as em um servidor DICOM SCP (Service Class Provider). Após armazenadas, o sistema correlaciona os fatores de exposição das imagens, de forma a avaliar os níveis de referência em dose de radiação fornecidos pelos equipamentos. Como resultados, foi verificado que o perfil mamário dos centros institucionais de diagnóstico estudados não segue os valores de referência apresentados na literatura em termos de espessura e densidade mamária. Enquanto a mama padrão dos testes de garantia de qualidade é composta por 50 mm de espessura e 50% de densidade (50-50), a população estudada apresentou mamas comprimidas com média de 60 mm de espessura, com baixo percentual de tecido fibroglandular (menor que 25%). Portanto, o uso o sistema desenvolvido pode direcionar os testes de conformidade dos equipamentos para perfis mamários específicos. Esse direcionamento pode auxiliar na determinação de doses ótimas de radiação para melhoria da qualidade da imagem, produzindo valores de referência de grande utilidade para a qualidade dos serviços radiográficos. / Image quality assessment in mammography represents one of the greatest challenges that health services face in order to detect breast cancer early. The world health organization recommends quality assurance guidelines, which consist of acceptance tests for digital mammography (DM) and digital breast tomosynthesis (DBT), to standardize the radiological services. However, these guidelines are based on test objects widely used to simulate standard breasts in terms of composition and thickness, which often do not match with the demographic profiles in the breast care centers. In this thesis work, an automated system for tracking and data management was developed to extract the metadata (DICOM header) from the image acquisition process and to store it into a custom DICOM Service Class Provider (SPC). The developed system correlates the exposure factors\' info in order to evaluate the references for patient radiation dose provided by the manufacturers. As result of the data correlations, the reference required by the international guidelines for standard breasts are not a feasible representation for the demographic profile in the breast care center evaluated in terms of breast density and thickness. While the standard for quality assurance testing consists of breasts with 50 mm of thickness and 50% of density, the demographic population presented compressed breast thickness of approximately 60 mm and low fibroglandular tissue (less than 25%). Therefore, using the developed system should guide the quality assurance in digital mammography to specific breast profiles. This guidance may assist in determining optimal radiation doses to improve the image quality, producing useful benchmarks for the quality of radiological services.

This research aims to integrate mathematical water quality models with Bayesian inference techniques for obtaining effective model calibration and rigorous assessment of the uncertainty underlying model predictions. The first part of my work combines a Bayesian calibration framework with a complex biogeochemical model to reproduce oligo-, meso- and eutrophic lake conditions. The model accurately describes the observed patterns and also provides realistic estimates of predictive uncertainty for water quality variables. The Bayesian estimations are also used for appraising the exceedance frequency and confidence of compliance of different water quality criteria. The second part introduces a Bayesian hierarchical framework (BHF) for calibrating eutrophication models at multiple systems (or sites of the same system). The models calibrated under the BHF provided accurate system representations for all the scenarios examined. The BHF allows overcoming problems of insufficient local data by “borrowing strength” from well-studied sites. Both frameworks can facilitate environmental management decisions.

The work deals with the holistic concept of comprehensive home care. First, it deals with different characteristic aspects of home care, who provides the care, the extend to which care is provided, principles to be followed when caring, attention is paid to the needs of clients and a good communication with them. Because home care often provide religious charitable organizations, it is also dealt with the Caritas Czech Republic. The last chapter of the first part deals with the common problem of workers in the helping professions, the burnout syndrome. For the implementation of quality health and social care were developed in the society quality standards, that are binding in providing care and assistance which can evaluate the quality of care provided. Our question is, how can theology contribute to the quality of home care. To implement certain elements of quality are in this work offered theological impulses, that can assist in providing quality holistic home care to clients.

The dissertation focuses on the topic of fulfilment of selected quality standards for social services in care homes for the elderly. The theoretical part of the piece of work deals with defining the terms pertaining to the quality standards of social services in care homes for the elderly. These are the terms ?old age?, ?need?, ?care home for the elderly?, ?social services?, ?quality standards?, and ?client?. The aim of the dissertation was to map the fulfilment and realisation of selected quality standards in care homes for the elderly. Partial aims were to determine the extent of fulfilment of quality standards from the point of view of the client and to compare the individual levels of application of the quality standards for social services. Two care homes were chosen for the study, the Care Home for the Elderly Tep in Veselí nad Lužnicí and the Care Home for the Elderly in Horní Stropnice. Two hypotheses were established. Quantitative research was chosen to facilitate reaching the aims and verifying the hypotheses, utilising questioning methods, interviewing techniques and questionnaire enquiry. Furthermore, analysing the data was accomplished using secondary document analysis. The research file contained the clients and staff of both selected care homes for the elderly. Following the evaluation of the results I believe that the aims of the dissertation were fulfilled. Selected quality standards are realised well in both care homes for the elderly and the essential criteria of individual quality standards are fulfilled as well. In addition, the research study proved both hypotheses to be correct. Selected quality standards are fulfilled from the point of view of the clients and at the same time applied in accordance with their needs. The dissertation can provide the selected care homes for the elderly with feedback regarding the fulfilment and realisation of selected quality standards of social services. It can also equally serve as guidance for potential clients in choosing their social services provider.

Background: Due to increased demands that staffing companies should be quality certified according to ISO, the concept of quality has gotten a whole new meaning. This has resulted in customer satisfaction being the primary focus in the staffing industry. The discussion lies in how staffing companies guarantee satisfied customers when quality requirements are also higher for the manning industry's customers than in any other industry. Aims: This study aims to achieve a deeper understanding why and how a staffing & recruitment agency implements ISO-quality standards and how their coworkers perceive said standards.  Theory: The study is based on institutional theory, new institutional theory and Rövik's description of administrative reforms as well as the tool perspective and the symbol perspective. The chapter ends with the theory of total quality management.  Methods: A qualitative approach in which interviews with three quality managers and three operational staff at a staffing company were conducted to collect data for the study. Conclusion: The study shows that staffing & recruitment agencies implements quality assurance systems, more specifically ISO, to survive the competition. This is due to that the agencies have to adapt to current norms and values in their social context to be seen as legitimate. Among today's norms are the environmental- and quality-certificates ISO 9001 and ISO 14001. / Bakgrund: På grund av ökade krav på att bemanningsföretag ska vara kvalitetscertifierade enligt ISO har begreppet kvalitet fått en helt ny innebörd. Detta har resulterat i att kundnöjdhet är det primära fokuset i bemanningsbranschen. Diskussionen ligger i hur bemanningsföretag garanterar nöjda kunder när kvalitetskraven dessutom är högre hos bemanningsbranschens kunder än i någon annan bransch. Syfte: Syftet med denna studie är att djupare förstå varför och hur ett bemanningsföretag inför ISO-kvalitetsstandarder, samt hur medarbetares uppfattning är av dessa standarder. Teori: Studien grundar sig i Institutionell teori, Nyinstitutionell teori och Röviks beskrivning av administrativa reformer samt verktygsperspektivet och symbolperspektivet. Teorikapitlet avslutas med teorin om total kvalitetsstyrning. Metod: En kvalitativ ansats där intervjuer med tre kvalitetschefer och tre operativt anställda på ett bemanningsföretag har utförts för att samla in data till studien. Slutsatser: Studien har visat att Bemanningsföretag implementerar kvalitetssäkringssystem, specifikt ISO, för att ha en chans att överleva på marknaden. Detta som ett resultat av att bemanningsföretag måste bland annat anpassa sig till normer och värderingar i samhället för att vara legitima. Bland dagens normer ingår miljö-och kvalitetscertifikaten ISO 9001 & ISO 14001.

The aim of my thesis is the comparison of demands for the quality in social work and health care required by legislation and expert sources. This thesis deals with quality standards in these professions, which, nowadays, represent a necessary component for the execution of these fields. Both disciplines endeavour to increase the quality of patient´s life in various ways. Furthermore, health care highlights a sanitary component.