Risk assessment models developed from administrative and clinical databases are used for clinical decision making. Since these models are derived from a database, they have an inherent limitation of being as good as the data they are derived from. Many of these models under or overestimate certain clinical outcomes particularly mortality in certain group of patients. Undeniably, there is significant variability in all these models on account of patient population studied, the statistical analysis used to develop the model and the period during which these models were developed. This review aims to shed light on development and application of risk assessment models for cardiac surgery with special emphasis on risk stratification in severe aortic stenosis to select patients for transcatheter aortic valve replacement.

L’entrée des polluants gazeux du sol (Radon, COV,…) dans les environnements intérieurs peut occasionner des risques sanitaires significatifs. Or les modèles d’évaluation de risques sanitaires liés à ces polluants gazeux du sol contiennent beaucoup d’incertitudes qui peuvent conduire à une mauvaise appréciation des risques. Dans un premier temps, cette thèse contribue à l’amélioration des modèles d’évaluation des risques. Dans un second temps, elle propose le développement d’un modèle de dimensionnement des Systèmes de Dépressurisation du Sol (SDS) passifs utilisés pour protéger les bâtiments des pollutions gazeuses venant du sol. L’amélioration des modèles a porté sur la prise en compte des principaux phénomènes de convection et diffusion à l’interface entre le sol et le bâtiment, en tenant compte des différentes typologies de soubassement. La première contribution porte sur le développement de modèles analytiques fournissant les débits d’air dus à la convection à travers le sol pour différents types de soubassement : dallage indépendant, dalle portée, vide sanitaire et cave. Les bâtiments avec des murs enterrés et les soubassements avec un lit de gravier sous le plancher bas sont également traités. Une méthodologie permettant la prise en compte de la fissuration et des points singuliers du plancher bas est aussi proposée. La deuxième contribution porte sur la prise en compte du transfert couplé des polluants des sols par convection et diffusion auprès des fondations. Une étude numérique a permis une meilleure compréhension du comportement des polluants à l’interface sol/bâtiment. Sur la base de cette compréhension, des lois semi-empiriques d’estimation des flux d’entrée de polluant dans les bâtiments sont proposées. Les différents modèles développés ont été validés numériquement avec un modèle CFD et expérimentalement avec des données issues de la littérature. La confrontation de ces modèles avec ceux existants a montré les améliorations apportées. L’impact de la typologie du soubassement sur le transfert de polluants gazeux des sols a été constaté. Une première application des modèles est illustrée par leur intégration dans un code de simulation thermo-aéraulique multizone afin de pouvoir étudier l’impact de ces polluants sur la qualité de l’air intérieur. Ce travail se termine par le développement d’un modèle de dimensionnement des Systèmes de Dépression du Sol (SDS) passifs. Ce modèle aéraulique de dimensionnement des SDS a été validé par des mesures effectuées au CSTB dans une maison expérimentale. Les premières applications du modèle de dimensionnement portent notamment sur l’impact de la météorologie (vent et tirage thermique) sur le fonctionnement du SDS passif et sur l’impact des stratégies de ventilation du bâtiment sur le fonctionnement du SDS passif. On voit ainsi l’intérêt de l’utilisation d’un tel modèle pour tester l’aptitude de ce système de protection des bâtiments dans des situations environnementales données. / Transfer of soil gas pollutants (Radon, VOC) into buildings can cause significant health risks. However, analytical models used today to estimate health risks associated with these pollutants contain many uncertainties which can lead to poor risk assessment. Initially, the main objective of this thesis is to contribute to the improvement of these models for risk assessment. Secondly, we propose the development of air flow model for passive Sub slab Depressurization Systems (SDS) design used to protect buildings. The improvement of models focused on the inclusion of the main phenomena of convection and diffusion at building/soil interface, taking into account different types of building substructures. The first improvement concerns the assessment of convection phenomenon through the development of analytical models to quantify air flow rates entering through many kinds of building substructures: floating slab, bearing slab, crawl space and basement. Buildings with buried walls and substructures with a sub slab gravel layer are also treated. A methodology taking into account the presence of cracks, holes and singular leakages of the slab is also proposed. The second improvement of the models is the inclusion of coupled transfer of convection and diffusion near foundations. A numerical study allowed a better understanding of the behavior of pollutants at soil / building interface. Based on this understanding, semi-empirical laws for estimating soil gas pollutants entry rate into buildings are proposed. The various models developed have been validated numerically using a CFD model and experimentally with data from the literature when available. The impact of building substructure on pollutant transfer has been highlighted. A first application of the model is illustrated by their integration into a multizone simulation code to study the impact of these transfers on indoor air quality. Finally, the work ends with the development of a model for designing passive sub slab depressurization systems. The design model developed is validated with in situ experimental data. Preliminary applications using this model focused at first on the impact of meteorological conditions (stack effect, wind) on the sub slab system running. At second, the impact of ventilation strategies on sub slab depressurization performance is studied. Thus, we see the potential interest of this model to test the effective running of passive sub slab depressurization systems in given configuration.

The gap between demand and supply for antibiotics in the healthcare sector has seen a steady growth over the past decades, further increasing the risk of antibiotic resistance and unavailability in the Swedish healthcare sector and market. The thesis is part of the work of the multisectoral platform, PLATINEA, which is working towards better availability of antibiotics. This study focuses on analysing the supply structure of antibiotics and pharmaceutical supply chains using a risk assessment model. A literature review of previous research has been done to identify risk factors, understand their importance and develop the risk assessment model. The risk assessment model uses these risk factors to assess the supply risk of an antibiotic. The study is designed in a quantitative manner, where the antibiotics are classified as very high, high, medium, and low risk of shortage using risk scores. Expert opinions were collected using a self-completion questionnaire, in which experts allocate weights that measure the importance of said risk factors. Weights were used to measure value of risk for antibiotics using MCDA process. The outcomes of the study are (1). the weights of risk factors given by industry experts, (2). the developed multi-criteria risk assessment model, (3). ranking of selected 39 antibiotics from high to low supply risk, based on re-assessed risk scores.

企業為有效提高生產效率、降低成本與找尋最佳解決方案，促成專業高效率、有彈性與低成本合作夥伴遍及全球各地的現象。而當前產業趨勢為專業化分工、企業全球化，此情況也使企業、顧客與供應商等合作夥伴形成關係極為複雜的全球化供應鏈網路，但伴隨而來是發生機率大幅提高之供應鏈風險等相關問題。2011年3月日本發生芮氏規模8.9地震，且併發如海嘯等災害造成日本企業減產停工、並出現供應鏈中斷的情況，使蘋果公司產品i-Devices、波音七八七客機、美國汽車廠商都受其影響。2011年7月泰國發生水災，除造成電腦產業硬碟短缺，亦造成相關電腦資訊產業鉅額損失。近年來關於供應鏈風險管理文獻研究也指出，全球化使供應鏈網路錯綜複雜，使供應鏈網路更容易受政治及經濟變化影響而出現混亂、崩潰，進而產生更大的風險。因此對企業而言供應鏈風險管理議題是非常重要的。有鑑於此，本研究將針對「如何有效減低供應鏈風險發生之衝擊」為主要議題進行研究。 本研究使用陳有慶(2013)相互影響關聯之供應鏈風險因子表，且從文獻蒐集相關風險因子之供應鏈風險管理策略，並運用系統動態模擬方法(System Dynamics; SD)建立以SCOR流程模式為整體框架基礎架構的供應鏈風險管理策略評估模擬模式。藉由此模擬模式可評估測試供應鏈風險管理策略對不同風險因子的影響，驗證各策略降低風險的有效性，並觀察不同策略對各風險因子的控制及降低對供應鏈衝擊的效果，最後針對各風險因子策略彙整並分析出對應之最佳風險管理策略。 / To reduce cost, increase productivity enterprises, and find the best solution. Enterprises cooperate with professional efficiency, flexible, and low-cost partners all over the world. Industry specialization, corporate globalization is the current trend of the times. The phenomenon also contributed to the enterprise, customers and suppliers, and other partners to form a highly complex relationship between global supply chain networks, it is accompanied by the occurrence of risk related issues. The earthquake happened on Japan in March 2011, it caused related subsequent disaster also caused Japanese companies cut downtime or the disruption of supply chain situation. In recent years, research on risk management of the supply chain literature also prove that the globalization cause the supply chain network complexity, and it have a greater risk happen because of political and economic environment changes. Therefore this research concentrates on a topic: how to effectively mitigate risk impacts in supply chain. About the topic, the System Dynamics (SD) method and the risk factor framework of supply chains by Chen&Lin (2013) will be used to construct a risk management strategy evaluation simulation model to evaluate the performance of risk management strategies. The risk management strategies will be examined by the proposed simulation model, and the proper strategy for each risk factor will be found. The risk assessment and risk management strategy evaluation simulation model proposed in this research could be as useful tools for managers to assess risks and to select proper risk management strategies in supply chains.