Die klinische Obduktion erfüllt heutzutage vor allem Aufgaben in der Qualitätssicherung. Trotz eines hohen individuellen und gesundheitspolitischen Stellenwertes fällt die Zahl der tatsächlich durchgeführten Sektionen seit Jahrzehnten weltweit. Die Gründe für das Absinken sind multifaktoriell. In der vorliegenden Arbeit wird die Rolle des zuletzt behandelnden Arztes untersucht, der bei der Initialisierung des Vorganges (Arztgespräch mit den Angehörigen, Dokumentation, Anmeldung der Obduktion) eine wichtige Rolle spielt. Zu diesem Zweck wurden die von 2005 bis 2012 am Ev. Diakonissenkrankenhaus Leipzig durchgeführten 194 Obduktionen ausgewertet. Durch krankenhausweite, arzt-zentrierte Mittel der Hilfestellung, Schulung und Formalisierung im Jahr 2009 gelang es, die Autopsierate am akademischen Lehrkrankenhaus der Regelversorgung von 3,3% auf 26% zu steigern. Im Rahmen der Untersuchung wurden klinisch vermutete und autoptisch nachgewiesene Todesursachen verglichen und die Ergebnisse in Fehlerklassen eingeteilt. Im Kontrollzeitraum vor dem Maßnahmenpaket wurde eine Gesamt-Fehlerrate von 54% in den Todesursachen (davon 18,8 % prognoserelevante Fehler) festgestellt. Nach Intervention konnte ein Absinken der Gesamt-Fehlerrate auf 27,9% (davon 11,6% prognoserelevante Diskrepanzen) gemessen werden. Nach Gruppierung der autoptisch erhobenen Todesursachen wurden „einfache“ und „schwierige“ Diagnosen erarbeitet. Dabei zeigten sich Lungenembolien (45,5% Fehleinschätzung), Infektionen (13,7% Fehleinschätzung) und akut dekompensierte Herzinsuffizienzen (8,8% Fehleinschätzung) als am häufigsten klinisch verkannte todesursächliche Krankheiten. Eine Sektionsfrequenz von ca. 30% wird als ausreichende epidemiologische Datengrundlage zur Validierung der Todesursachenstatistik angesehen (Bundesärztekammer 2005). In Deutschland beträgt die Rate aktuell etwa 4%. Bemüht man sich um eine Steigerung der Obduktionsrate, ist die Rolle des zuletzt behandelnden Arztes hervorzuheben. In der vorliegenden Arbeit konnte durch einfache Mittel der Beseitigung von Unsicherheiten, Schulung und Formalisierung (SOP) eine deutliche Steigerung der Rate an Sektionen ermöglicht werden. In Konsequenz wurde ein Absinken der Diagnose-Diskrepanzrate und der Anzahl an prognoserelevanten Irrtümern (18,8% auf 11,6%) in den Todesursachen festgestellt. Ob dies allein einen didaktischen Erfolg der vermehrten Behandlungsnachschau darstellt, oder statistische Effekte (verringerter Selektionsbias) beinhaltet, muss offen bleiben. Auffällig ist die Schlüsselstellung der Intensivtherapiestation. Da hier aufgrund der Erkrankungsschwere die höchste Patientensterblichkeit im Krankenhaus vorliegt (25% der pro Jahr Versterbenden), ist eine positive Einstellung der ärztlichen Kollegen gegenüber der Obduktion von entscheidender Bedeutung. Das Maßnahmenpaket ist auf andere Einrichtungen übertragbar und ein für Ärzteschaft und Geschäftsführung lohnender Aufwand, da neben sämtlichen individuellen Vorteilen für Angehörige und Mediziner die Ergebnisse einer solchen Auswertung als globale Qualitätsindikatoren für ein Krankenhaus dienen können.

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I denna studie så ville AstraZenecas dispenseringsfunktion, som arbetar med att finfördelamaterial från sin bulkförpackning undersöka hur och med vilka frekvenser kalibreringar ochfunktionskontroller för deras vågar bör göras. Detta i hopp om att harmonisera en uppdateradoch förbättrad standard mellan siterna Gärtuna och Snäckviken. Standarder inom mätningslära är inget som läkemedelsföretag själva investerar resurser i, utanföljer det som farmakopéerna världen över publicerar i sina böcker. Däri återfinns allt som kantänkas behövas för tillverkning och utformning av läkemedel. Syftet med att kalibrera ochgenomföra funktionskontroller så ofta som AstraZeneca gör i dagsläget är för att vara förenligamed regelverk för att bli godkända vid inspektioner. Däremot finns risken attfunktionskontroller och kalibreringar genomförs med högre eller lägre frekvens än vad de bordegöras samt att irrelevanta tester vid dessa kontroller får alltför hög prioritering för att påvisa envågs förmåga att fungera som den ska. För att undersöka detta genomfördes det en kartläggning av hur AstraZeneca arbetar idag medvågkalibreringar och funktionskontroller. Denna behandlade både hur arbetet sker internt viaegna funktioner, men också externt via vågtillverkaren och valideringsfirmor. Dennainformation tillsammans med vad farmakopéerna och vågtillverkaren själva påstår är korrektarbetssätt blev ett tydligt och effektivt sätt att sålla bort överflödiga och i vissa fall irrelevantametoder som används på AstraZeneca idag. Utöver dessa finns det fenomen såsommätosäkerhet och störningselement som kan påverka varje vägning till den grad där resultatenär fullständigt missvisande, och i läkemedelsindustrins fall är dessa oacceptabla. Vid studiens slut kunde flera systematiska brister identifieras och rekommendationer för attmotverka eller lösa dessa gavs i enlighet med syftet om att nå god praxis för våganvändningen isamband med dispenseringsprocessen. Framtida förbättringsarbeten hade förenklats ocheffektiviserats till stor del om en fullständig digitalisering och övervakning avstörningselementen möjliggörs. / In this study that was commissioned by AstraZeneca's dispensing function that worksmainly by sub-dividing materials from its bulk packaging. They wanted to investigatehow and with what frequencies calibrations and routine testing for their balances shouldbe performed. This, with the purpose of harmonizing an updated and improvedstandard between the sites Gärtuna and Snäckviken. Measurement theory standards are not something that pharmaceutical companiesthemselves invest resources in but rather follow what pharmacopoeias around the worldpublish in their books. The books contain everything that may be needed for themanufacturing and design of medicines. The purpose of calibrating and performingroutine testing as often as AstraZeneca does today is to comply with regulations to beapproved during inspections. However, there is a risk that routine testing andcalibrations are performed at a higher or lower frequency than they should be, and thatirrelevant tests at these routine tests are given too high a priority to demonstrate abalances ability to function properly. To investigate this, a survey was conducted of how AstraZeneca works today withbalance calibrations and routine testing. The survey considered both how the work isdone internally via AstraZeneca’s own employees, but also externally via the balancemanufacturer and validation companies. This information, in combination with whatthe pharmacopoeias and the balance manufacturer themselves claim is the correct wayof operating, became a clear and effective way of sifting away superfluous and in somecases irrelevant methods used in AstraZeneca today. In addition to these, there arephenomena such as measurement uncertainty and external disturbance elements thatcan affect any weighing to the extent that the results are completely misleading, and inthe case of the pharmaceutical industry, such results would be unacceptable. At the end of the study, several systematic flaws or shortcomings could be identified andrecommendations to counteract or solve these were given in accordance with the aim ofachieving best practice for the use of balances in connection with the dispensingprocess. Future improvement work would have been greatly simplified and streamlinedif complete digitization and monitoring of the disturbance elements were made possible.

Worms have been improved and a range of sophisticated techniques have been integrated, which make the detection and response processes much harder and longer than in the past. Therefore, in this thesis, a STAKCERT (Starter Kit for Computer Emergency Response Team) model is built to detect worms attack in order to respond to worms more efficiently. The novelty and the strengths of the STAKCERT model lies in the method implemented which consists of STAKCERT KDD processes and the development of STAKCERT worm classification, STAKCERT relational model and STAKCERT worm apoptosis algorithm. The new concept introduced in this model which is named apoptosis, is borrowed from the human immunology system has been mapped in terms of a security perspective. Furthermore, the encouraging results achieved by this research are validated by applying the security metrics for assigning the weight and severity values to trigger the apoptosis. In order to optimise the performance result, the standard operating procedures (SOP) for worm incident response which involve static and dynamic analyses, the knowledge discovery techniques (KDD) in modeling the STAKCERT model and the data mining algorithms were used. This STAKCERT model has produced encouraging results and outperformed comparative existing work for worm detection. It produces an overall accuracy rate of 98.75% with 0.2% for false positive rate and 1.45% is false negative rate. Worm response has resulted in an accuracy rate of 98.08% which later can be used by other researchers as a comparison with their works in future.

A obrigatoriedade e responsabilidade pelo gerenciamento de resíduos de serviços de saúde atribuídas a todo gerador é legitimada pelo impacto advindo da periculosidade dos mesmos à saúde humana e ao ambiente. Esse fato impõe que o gerador elabore seu plano de gerenciamento de resíduos e crie instrumentos de prevenção de acidentes e de gestão desses resíduos. Escolheu-se como objeto deste estudo a Faculdade de Saúde Pública da Universidade de São Paulo, para análise do gerenciamento dos resíduos com foco, principalmente, na segurança ocupacional. O objetivo foi desenvolver modelo de Procedimento Operacional Padrão (POP), da geração ao descarte de cada grupo de resíduos gerados pelos laboratórios de ensino e pesquisa em saúde, na instituição estudada, como instrumento de gestão auxiliar e complementar ao respectivo plano de gerenciamento de resíduos de serviços de saúde, contemplando a normativa vigente relativa a resíduos, saúde, ambiente e segurança dos trabalhadores. O método envolveu a seleção de dois laboratórios para o estudo de caso, considerando os resíduos gerados. Para ambos foram realizados: a) identificação dos resíduos gerados e práticas utilizadas nas diferentes etapas do gerenciamento; e b) identificação dos riscos ocupacionais, por meio de revisão documental e entrevista com funcionários, com registro de campo e fotográfico. Os dados obtidos foram confrontados com a legislação e normas vigentes. Houve ainda participação em reuniões da Comissão de Gerenciamento de Resíduos e busca de informações junto a funcionários da instituição e do serviço de limpeza terceirizados. A análise possibilitou a proposição de um caderno contendo 11 POPs para 9 distintos tipos de RSS, para os resíduos gerados nos laboratórios estudados, que contempla todos os tipos de resíduos gerados nos diversos laboratórios da instituição, além de dois POPs adicionais que tratam um da segurança e saúde do trabalhador e outro das disposições gerais relativas ao gerenciamento dos RSS. O conjunto de POPs proposto agregou as exigências normativas de interface vigentes e padronizou as práticas, rotinas e procedimentos nas diversas etapas do gerenciamento interno. O resultado do estudo nos dois laboratórios mais complexos possibilitou a elaboração de um caderno contendo POPs a serem aplicados a todos os 18 laboratórios da instituição. Os procedimentos organizados em um POP institucional para o setor contribuirá para a qualidade no processo de gerenciamento para reduzir a descontinuidade de práticas advindas da rotatividade de funcionários e a minimização dos riscos ocupacionais, melhorando a saúde e segurança do trabalhador do setor / The obligation and responsibility for the waste management from health services by every generating entity are validated by the impact proceeding from their hazardous effects on human health as well as the environment. Consequently, there is a demand for the generating entity to create tools for both accident prevention and management of such residues. The object being chosen for such case study is Faculdade de Saúde Pública da Universidade de São Paulo (Public Health Faculty, USP) for the analysis of the management of such residues with main focus on occupational safety. The objective was to develop a model of Standardized Operational Procedure, SOP, from the phases of generation to discard of each of the groups of residues generated by educational and health research laboratories, in the institution studied, as a management tool aiming to aid, and complement the respective management plan of residues from health services, enforced by the law, which contemplates not only the obligations determined by the effective norm relative to the residues but also those relative to health, environment and safety of workers involved in the various phases of such management. The Method consisted on the selection of two laboratories in the institution studied, taking into account the residues they generated. For both laboratories it was carried out: a) identification of the residues generated and the practices used in the various phases of the management; and b) identification of the occupational risks, by means of documentation revision and queries with the personnel, with field and photographic records. The findings were compared with the legislation and effective norms. In addition, there were meetings with the participation of The Waste Management Committee and collection of information from the institution personnel and outsourced cleaning service workers. The analysis enabled the elaboration of a notebook which contains 11 SOPs for 9 distinctive types of RSS for the residues generated in the studied laboratories - which contemplate all the types of residues generated in several laboratories of the institution; as well as two additional SOPs, whereby one focuses on safety and workers health, and the other on the general dispositions relative to the management of RSSs. The set of proposed SOPs added the effective norm interface requirements and standardized the practices, routines and procedures in the various phases of the internal management. The result of the study in the two most complex laboratories enabled the elaboration of a notebook which contains SOPs to be applied in all 18 laboratories of the institution. The procedures organized in an institutional SOP for the sector will contribute to the quality in the management process in order to reduce the discontinuity of practices originated in the turnover of worker, as well as to the diminishing of occupational risks, improving the health and safety of the workers of the sector

La thèse questionne le devenir du " contrat implicite " qui lie un salarié à une entreprise. L'extrême variabilité des conditions économiques et sociales mais aussi la révision conséquente des configurations organisationnelles conduisent chacun des acteurs à devoir opérer une redéfinition plus ou moins profonde de ses attentes à l'égard de l'entreprise. D'aucun ne peut faire l'économie d'une interrogation de " ce " qui fonde sa relation d'emploi... pas même le manager. La recherche questionne l'épreuve subjective imposée par les modifications organisationnelles sur la relation d'emploi par un regard théorique pluridisciplinaire (gestion/management et psychanalyse) sur les perceptions de brèche et de violation du contrat psychologique et par la mise en œuvre d'une approche méthodologique exploratoire mixte (quantitative et qualitative) et longitudinale. Elle vise à la fois à comprendre les résistances éventuelles à toutes formes de changement, les réactions attitudinales, comportementales et psycho-sociales conséquentes ou encore, les moyens dont dispose l'entreprise pour intégrer cette dimension subjective dans ses pratiques.

Wireless communications have been an indispensable aspect of everyday life, and there is an increasing consumer demand for accessing several wireless communication technologies from a single, compact, mobile device. System-on-package (SOP) technology is an advanced packaging technology that has been proven to realize the convergence of multiple functions into miniaturized, high-performance systems to meet this demand. With the advancements in the SOP technology, the miniaturization of the front-end module has been achieved using embedded passives in multilayer packages. However, the integration of the antenna directly on the module package is still the barrier to achieve a fully-integrated, high-performance RF SOP system. The main reason for this missing link is that integrating the antenna on the package requires miniaturizing the antenna, which is a difficult task. The focus of this dissertation is to design high-performance antennas along with developing techniques for miniaturization and system-on-package (SOP) integration of these antennas to achieve fully-integrated SOP systems using advanced multilayer organic substrates and thin-film magneto-dielectric materials. The targeted spectrum for the antenna designs are 2.4/5 GHz WLAN/WiMAX and 60 GHz WPAN bands. Several novel antenna designs and configurations to integrate the antenna on the package along with the module are discussed in this dissertation. The advanced polymers used in this research are Liquid Crystalline Polymer (LCP), RXP, and thin-film magneto-dielectrics.

A obrigatoriedade e responsabilidade pelo gerenciamento de resíduos de serviços de saúde atribuídas a todo gerador é legitimada pelo impacto advindo da periculosidade dos mesmos à saúde humana e ao ambiente. Esse fato impõe que o gerador elabore seu plano de gerenciamento de resíduos e crie instrumentos de prevenção de acidentes e de gestão desses resíduos. Escolheu-se como objeto deste estudo a Faculdade de Saúde Pública da Universidade de São Paulo, para análise do gerenciamento dos resíduos com foco, principalmente, na segurança ocupacional. O objetivo foi desenvolver modelo de Procedimento Operacional Padrão (POP), da geração ao descarte de cada grupo de resíduos gerados pelos laboratórios de ensino e pesquisa em saúde, na instituição estudada, como instrumento de gestão auxiliar e complementar ao respectivo plano de gerenciamento de resíduos de serviços de saúde, contemplando a normativa vigente relativa a resíduos, saúde, ambiente e segurança dos trabalhadores. O método envolveu a seleção de dois laboratórios para o estudo de caso, considerando os resíduos gerados. Para ambos foram realizados: a) identificação dos resíduos gerados e práticas utilizadas nas diferentes etapas do gerenciamento; e b) identificação dos riscos ocupacionais, por meio de revisão documental e entrevista com funcionários, com registro de campo e fotográfico. Os dados obtidos foram confrontados com a legislação e normas vigentes. Houve ainda participação em reuniões da Comissão de Gerenciamento de Resíduos e busca de informações junto a funcionários da instituição e do serviço de limpeza terceirizados. A análise possibilitou a proposição de um caderno contendo 11 POPs para 9 distintos tipos de RSS, para os resíduos gerados nos laboratórios estudados, que contempla todos os tipos de resíduos gerados nos diversos laboratórios da instituição, além de dois POPs adicionais que tratam um da segurança e saúde do trabalhador e outro das disposições gerais relativas ao gerenciamento dos RSS. O conjunto de POPs proposto agregou as exigências normativas de interface vigentes e padronizou as práticas, rotinas e procedimentos nas diversas etapas do gerenciamento interno. O resultado do estudo nos dois laboratórios mais complexos possibilitou a elaboração de um caderno contendo POPs a serem aplicados a todos os 18 laboratórios da instituição. Os procedimentos organizados em um POP institucional para o setor contribuirá para a qualidade no processo de gerenciamento para reduzir a descontinuidade de práticas advindas da rotatividade de funcionários e a minimização dos riscos ocupacionais, melhorando a saúde e segurança do trabalhador do setor / The obligation and responsibility for the waste management from health services by every generating entity are validated by the impact proceeding from their hazardous effects on human health as well as the environment. Consequently, there is a demand for the generating entity to create tools for both accident prevention and management of such residues. The object being chosen for such case study is Faculdade de Saúde Pública da Universidade de São Paulo (Public Health Faculty, USP) for the analysis of the management of such residues with main focus on occupational safety. The objective was to develop a model of Standardized Operational Procedure, SOP, from the phases of generation to discard of each of the groups of residues generated by educational and health research laboratories, in the institution studied, as a management tool aiming to aid, and complement the respective management plan of residues from health services, enforced by the law, which contemplates not only the obligations determined by the effective norm relative to the residues but also those relative to health, environment and safety of workers involved in the various phases of such management. The Method consisted on the selection of two laboratories in the institution studied, taking into account the residues they generated. For both laboratories it was carried out: a) identification of the residues generated and the practices used in the various phases of the management; and b) identification of the occupational risks, by means of documentation revision and queries with the personnel, with field and photographic records. The findings were compared with the legislation and effective norms. In addition, there were meetings with the participation of The Waste Management Committee and collection of information from the institution personnel and outsourced cleaning service workers. The analysis enabled the elaboration of a notebook which contains 11 SOPs for 9 distinctive types of RSS for the residues generated in the studied laboratories - which contemplate all the types of residues generated in several laboratories of the institution; as well as two additional SOPs, whereby one focuses on safety and workers health, and the other on the general dispositions relative to the management of RSSs. The set of proposed SOPs added the effective norm interface requirements and standardized the practices, routines and procedures in the various phases of the internal management. The result of the study in the two most complex laboratories enabled the elaboration of a notebook which contains SOPs to be applied in all 18 laboratories of the institution. The procedures organized in an institutional SOP for the sector will contribute to the quality in the management process in order to reduce the discontinuity of practices originated in the turnover of worker, as well as to the diminishing of occupational risks, improving the health and safety of the workers of the sector

Masters of Science / The aim of this study was to develop a Stock Control Assessment Tool for use in the public health care sector and then to apply it to identify problems in the stock control system. This would help authorities to optimize the system. The advantages experienced with such a dynamic Assessment Tool were many: The Tool was quick and easy to apply; it was user friendly; it provided an immediate SWOT analysis of a particular facility; it is in line with the SA NDP directives and it provides an indication of which structures are in place and whether they are functioning properly. Furthermore; it could determine the increase or decrease in performance of a facility (therefore identify trends within the functional status of a system) when data is collected over a period of time; and finally, it could also be used to prioritize drug policy directives. The following steps were established in the development of the Tool: A literature review of pharmaceutical stock control and Drug Supply Management was addressed to provide the background information for the motivation of this study and to identify the various elements that could influence stock control at a facility level. Observational studies were applied at selected private and public facilities to observe the impact of these identified stock control elements. An 'ideal' stock control system was then generated from the literature review and observational assessment. A structured questionnaire was developed and surveyed at these facilities to generate key areas of concern of a stock control system. A study and adaptation of the indicator methods used by the World Health Organization (WHO) to monitor drug use in health facilities resulted in the formulation of a practical Stock Control Assessment Tool based on 11 key indicators and a number of sub-indicators, all of which were objectively defined. The Tool was then applied at selected public facilities and the results were analyzed quantitatively, qualitatively and subjectively. Each of the indicators was then applied and results examined closely with a view to possible refinements of the indicator. The refinements were made and the Tool was re-applied at two selected facilities. These two facilities were randomly selected from the original six facilities included for the testing of the Tool. Final conclusions and specific recommendations were generated to improve the stock control systems at the selected public health care facilities.