L'objectif principal de ce travail est d’étudier en profondeur certaines techniques biostatistiques avancées en recherche évaluative en chirurgie cardiaque adulte. Les études ont été conçues pour intégrer les concepts d'analyse de survie, analyse de régression avec “propensity score”, et analyse de coûts. Le premier manuscrit évalue la survie après la réparation chirurgicale de la dissection aigüe de l’aorte ascendante. Les analyses statistiques utilisées comprennent : analyses de survie avec régression paramétrique des phases de risque et d'autres méthodes paramétriques (exponentielle, Weibull), semi-paramétriques (Cox) ou non-paramétriques (Kaplan-Meier) ; survie comparée à une cohorte appariée pour l’âge, le sexe et la race utilisant des tables de statistiques de survie gouvernementales ; modèles de régression avec “bootstrapping” et “multinomial logit model”. L'étude a démontrée que la survie s'est améliorée sur 25 ans en lien avec des changements dans les techniques chirurgicales et d’imagerie diagnostique. Le second manuscrit est axé sur les résultats des pontages coronariens isolés chez des patients ayant des antécédents d'intervention coronarienne percutanée. Les analyses statistiques utilisées comprennent : modèles de régression avec “propensity score” ; algorithme complexe d'appariement (1:3) ; analyses statistiques appropriées pour les groupes appariés (différences standardisées, “generalized estimating equations”, modèle de Cox stratifié). L'étude a démontrée que l’intervention coronarienne percutanée subie 14 jours ou plus avant la chirurgie de pontages coronariens n'est pas associée à des résultats négatifs à court ou long terme. Le troisième manuscrit évalue les conséquences financières et les changements démographiques survenant pour un centre hospitalier universitaire suite à la mise en place d'un programme de chirurgie cardiaque satellite. Les analyses statistiques utilisées comprennent : modèles de régression multivariée “two-way” ANOVA (logistique, linéaire ou ordinale) ; “propensity score” ; analyses de coûts avec modèles paramétriques Log-Normal. Des modèles d’analyse de « survie » ont également été explorés, utilisant les «coûts» au lieu du « temps » comme variable dépendante, et ont menés à des conclusions similaires. L'étude a démontrée que, après la mise en place du programme satellite, moins de patients de faible complexité étaient référés de la région du programme satellite au centre hospitalier universitaire, avec une augmentation de la charge de travail infirmier et des coûts. / The main objective of this work is to study in depth advanced biostatistical techniques in adult cardiac surgery outcome research. The studies were designed to incorporate the concepts of survival analysis, regression analysis with propensity score, and cost analysis. The first manuscript assessed survival, and cardiovascular specific mortality, following surgical repair of acute ascending aortic dissection. The statistical analyses included survival analyses with multiphase parametric hazard regression and other parametric (exponential, Weibull), semi-parametric (Cox) or non-parametric models (Kaplan Meier), comparison with the survival of a matched cohort for age, gender and race using State lifetables, and modelization with bootstrapping and multinomial logit models. The study showed that the early and late survival following surgical repair has improved progressively over 25 years in association with noticeable changes in surgical techniques and preoperative diagnostic testing. The second manuscript focused on outcomes following isolated coronary artery bypass grafting in patients with a history of percutaneous coronary intervention. The statistical analyses included multivariable regression models with propensity score, complex matching algorithm (1:3) and appropriate statistical analyses for matched groups (standardized differences, generalized estimating equations, and survival analyses with stratified proportional hazards models). The study showed that remote prior percutaneous coronary intervention more than 14 days before coronary artery bypass grafting surgery was not associated with adverse outcomes at short or long-term follow-up. The third manuscript evaluated the financial consequences and the changes in case mix that occurred at an academic medical center subsequent to the implementation of a satellite cardiac surgery program. The statistical analyses included two-way ANOVA multivariable regression models (logistic, linear or ordinal), propensity score, and cost analyses using Log-Normal parametric models. “Survival” analyses models were also explored, using “cost” instead of “time” as the outcome of interest, and led to similar conclusions. The study showed that, after implementation of the satellite cardiac surgery program, fewer patients of lower complexity came to the academic medical center from the satellite program area, with a significant increase in nursing workload and costs.

Le facteur le plus important de pronostic de l'asthme professionnel (AP) est la durée des symptômes avant le retrait de lʼexposition à lʼagent causant lʼAP. La qualité de vie réduite, la détresse psychologique et les maladies psychiatriques sont des conditions souvent associées à l'AP. Notre objectif était d'identifier les facteurs, incluant le statut socioéconomique, qui ont une influence sur lʼintervalle de temps nécessaire pour présenter une requête à une agence médicolégale à la suite de lʼapparition de symptômes dʼasthme et de confirmer qu'un tel délai est associé à un moins bon pronostic respiratoire et à des coûts directs plus élevés. En outre, nous avons examiné la relation entre les variables cliniques et socio-économiques dʼune part et leur influence sur les facteurs psychologiques et économiques dʼautre part chez des travailleurs atteints d'AP. Ensuite, nous avons voulu évaluer si les individus souffrant de détresse psychologique (DP) et de morbidité psychiatrique pourraient être identifiés en utilisant un instrument mesurant la qualité de vie (QV). Lʼétude a été effectuée auprès dʼindividus ayant déposé des demandes d'indemnisation pourʼAP auprès du Commission de la sécurité et de la santé du travail du Québec (CSST). Les données ont été recueillies au moment de la réévaluation, soit environ deux ans et demi après le diagnostic. Outre la collecte des marqueurs cliniques de l'asthme, les individus ont été soumis à une évaluation générale de leur histoire sociodémographique et médicale, à une brève entrevue psychiatrique (évaluation des soins primaires des troubles mentaux, PRIME-MD) et à un ensemble de questionnaires, incluant le Questionnaire sur la qualité de vie - AQLQ(S), le Questionnaire respiratoire de St. George (SGRQ) et le Psychiatric Symptom Index (PSI).Soixante personnes ont été incluses dans l'étude. Etre plus âgé, avoir un revenu supérieur à 30 000$ CA etêtre atteint dʼAP dû à un allergène de haut poids moléculaire ont une association positive avec le nombre dʼannées dʼexposition avec symptômes avant le retrait. Au cours de la période de suivi, le nombre dʼannées dʼexposition avec symptômes était plus grand chez les individus ayant une hyperréactivité bronchique persistante. Par ailleurs, la présence de symptômes au poste de travail pendant moins d'un an est associée à une réduction des coûts directs. Les paramètres de QV et de DP avaient des corrélations modérées avec les marqueurs cliniques de lʼAP. Les plus fortes associations avec ces variables ont pu être observées dans les cas de la sévérité de l'asthme, des statuts dʼemploi et matrimonial, du revenu et de la durée de la période de travail avec l'employeur. Un seuil de 5,1 au niveau de la sous-échelle de la fonction émotionnelle de lʼAQLQ(S) sʼest avéré avoir la meilleure valeur discriminante pour distinguer les individus avec ou sans détresse psychiatrique cliniquement significative selon le PSI. Nous avons été en mesure d'identifier les variables socio-économiques associées à un intervalle plus long dʼexposition professionnelle en présence de symptômes dʼasthme. De même, une plus longue période d'exposition a été associée à un moins bon pronostic de la maladie et à des coûts de compensation plus élevés. Ces résultats s'avèrent utiles pour la surveillance de lʼAP qui pourrait cibler ces sous-groupes d'individus. La QV et la PS sont fréquemment réduites chez les individus atteints d'AP qui perçoivent une compensation. Elles sont associées à des marqueurs cliniques de lʼasthme et à des facteurs socio-économiques. En outre, nos résultats suggèrent que le questionnaire de lʼAQLQ(S) peut être utilisé pour identifier les individus avec un niveau de détresse psychologique potentiellement significatif. / The most important factor in the prognosis of occupational asthma (OA) is the length of exposure with symptoms prior to removal from exposure. Impaired quality of life, psychological distress and psychiatric disease are conditions frequently associated with OA. Our goal was to identify factors, including socio-economic status, that can influence the delay in submitting a claim to a medicolegal agency after the onset of asthmatic symptoms, and to confirm that such a delay is associated with a worse respiratory prognosis and higher direct costs. Further, we examined the association between clinical and socio-economic variables and their influence on psychological and cost outcomes in individuals with OA. Next, we wanted to evaluate whether individuals with clinically significant psychological distress (PD) and psychiatric morbidity could be identified by using a quality of life (QOL) measurement instrument. This is a study of individuals who filed claims for compensation for occupational asthma from the Workersʼ Compensation Board of Quebec (the CSST). Data were collected at re-evaluation, approximately two and a half years after diagnosis. Besides collecting clinical markers of asthma, individuals underwent a general socio-demographic and medical history evaluation, a brief psychiatric interview (Primary Care Evaluation of Mental Disorders, PRIME-MD) and completed a battery of questionnaires, including the Asthma Quality of Life Questionnaire - AQLQ(S), the St. Georgeʼs Respiratory Questionnaire (SGRQ), and the Psychiatric Symptoms Index (PSI). Sixty individuals were included in the study. Being older, having a revenue of >$30,000 Can. (CAD$) and having OA due to high- molecular- weight agents were all positively associated with the number of years of exposure with symptoms before removal from exposure. Individuals with persistent airway hyperresponsiveness at follow-up had a higher number of years with symptoms. Experiencing symptoms in the workplace for less than one year generated lower direct costs. QOL and PD parameters had moderate correlations with clinical markers of OA. Asthma severity, employment and marital status, income and length of employment with the employer showed the strongest associations with QOL and PD. More impaired QOL was associated with higher direct costs for compensation. A cut-off of 5.1 on the AQLQ(S) emotional function subscale had the best discriminative value to distinguish individuals with or without clinically significant psychological distress according to the PSI. We were able to identify socio-economic variables that were associated with a longer interval during which individuals remained symptomatic in the workplace before being removed from exposure. This longer exposure time was associated with worse disease outcomes and higher compensation costs. These findings could prove to be useful in surveillance programs that could be preferentially targeted for these subgroups of individuals. Impaired QOL and PD are frequent among individuals with OA receiving compensation and are associated with clinical markers of OA and socio-economic factors. Further, our findings suggest that the AQLQ(S) questionnaire could be used to identify individuals with potentially clinically significant levels of psychological distress.

Fine grained sediment deposition in urban environments during natural hazard events can impact critical infrastructure and properties (urban terrain) leading to reduced social and economic function and potentially adverse public health effects. Therefore, clean-up of the sediments is required to minimise impacts and restore social and economic functionality as soon as possible. The strategies employed to manage and coordinate the clean-up significantly influence the speed, cost and quality of the clean-up operation. Additionally, the physical properties of the fine grained sediment affects the clean-up, transport, storage and future usage of the sediment. The goals of the research are to assess the resources, time and cost required for fine grained sediment clean-up in an urban environment following a disaster and to determine how the geotechnical properties of sediment will affect urban clean-up strategies. The thesis focuses on the impact of fine grained sediment (<1 mm) deposition from three liquefaction events during the Canterbury earthquake sequence (2010-2011) on residential suburbs and transport networks in Christchurch. It also presents how geotechnical properties of the material may affect clean-up strategies and methods by presenting geotechnical analysis of tephra material from the North Island of New Zealand. Finally, lessons for disaster response planning and decision making for clean-up of sediment in urban environments are presented. A series of semi-structured interviews of key stakeholders supported by relevant academic literature and media reports were used to record the clean-up operation coordination and management and to make a preliminary qualification of the Christchurch liquefaction ejecta clean-up (costs breakdown, time, volume, resources, coordination, planning and priorities). Further analysis of the costs and resources involved for better accuracy was required and so the analysis of Christchurch City Council road management database (RAMM) was done. In order to make a transition from general fine sediment clean-up to specific types of fine disaster sediment clean-up, adequate information about the material properties is required as they will define how the material will be handled, transported and stored. Laboratory analysis of young volcanic tephra from the New Zealand’s North Island was performed to identify their geotechnical properties (density, granulometry, plasticity, composition and angle of repose). The major findings of this research were that emergency planning and the use of the coordinated incident management system (CIMS) system during the emergency were important to facilitate rapid clean-up tasking, management of resources and ultimately recovery from widespread and voluminous liquefaction ejecta deposition in eastern Christchurch. A total estimated cost of approximately $NZ 40 million was calculated for the Christchurch City clean-up following the 2010-2011 Canterbury earthquake sequence with a partial cost of $NZ 12 million for the Southern part of the city, where up to 33% (418 km) of the road network was impacted by liquefaction ejecta and required clearing of the material following the 22 February 2011 earthquake. Over 500,000 tonnes of ejecta has been stockpiled at Burwood landfill for all three liquefaction inducing earthquake events. The average cost per kilometre for the event clean-up was $NZ 5,500/km (4 September 2010), $NZ 11,650/km (22 February 2011) and $NZ 11,185/km (13 June 2011). The duration of clean-up time of residential properties and the road network was approximately two to three months for each of the three liquefaction ejecta events; despite events volumes and spatial distribution of ejecta. Interviews and quantitative analysis of RAMM data revealed that the experience and knowledge gained from the Darfield earthquake (4 September 2010) clean-up increased the efficiency of the following Christchurch earthquake induced liquefaction ejecta clean-up events. Density, particle size, particle shape, clay content and moisture content, are the important geotechnical properties that need to be considered when planning for a clean-up method that incorporates collection, transport and disposal or storage. The geotechnical properties for the tephra samples were analysed to increase preparedness and reaction response of potentially affected North Island cities from possible product from the active volcanoes in their region. The geotechnical results from this study show that volcanic tephra could be used in road or construction material but the properties would have to be further investigated for a New Zealand context. Using fresh volcanic material in road, building or flood control construction requires good understanding of the material properties and precaution during design and construction to extra care, but if well planned, it can be economically beneficial.

Thesis (Master of Business Administration) -- Naval Postgraduate School, 2005. / Title from title screen (viewed Aug. 26, 2008). "December 2005." The original document contains color images. "ADA443358"--URL. Includes bibliographical references (p. 85-91). Also issued in paper format.

Äldre flerbostadshus står för en stor del av Sveriges totala energianvändning som behöver sänkas föratt minska klimatpåverkan och klara regeringsmålet om effektivare energianvändning. Examensarbetets syfte är därför att bidra till en ökad kunskap om energieffektivisering genom åtgärder i äldre byggnaders klimatskärm, och om hur åtgärder kan värderas genom energisimulering och livscykelkostnadsanalys. Målet är att identifiera vilka åtgärder som är ekonomiskt och arkitektoniskt lämpliga för äldre flerbostadshus med intresse av att bevara deras karaktär. Det är även att bedöma vilken energibesparing och livscykelkostnad de utvalda åtgärderna genererar. Ett flerbostadshus i centrala Luleå valdes ut som referensbyggnad. Byggnaden är genom sin konstruktion och design representativ för tidseran. Intressanta åtgärder samt åtgärdspaket i dess klimatskal valdes ut. Sedan utfördes en bred litteraturgenomgång om bostadsbyggandet i Sverige 1945–1964, byggnadens energianvändning, energieffektivisering av klimatskalet, de utvalda åtgärderna samt metoderna energisimulering och livscykelkostnadsanalys. Referensbyggnaden dokumenterades och en energisimuleringsmodell byggdes i programvaran IDA ICE. Den nuvarande utformningen av byggnaden simulerades och kalibrerades mot senast uppmätt normalårskorrigerad energianvändning. Sedan utfördes simuleringar för de utvalda åtgärderna och åtgärdspaketen vilka bestämts till tilläggsisolering av vindsbjälklag, byte av fönster till lågenergifönster och tätning av otätheter runt dessa, en kombination av båda tidigare åtgärder (åtgärdspaket 1), tilläggsisolering av fasad och fönsterbyte, samt en kombination av alla tre åtgärder (åtgärdspaket 2). Livscykelkostnaderna för nuläget och för implementering av de olika åtgärderna beräknades genom nuvärdeskostnadsmetoden. Även återbetalningstider beräknades genom simple-payback-metoden. Byggnadens nuvarande utformning gav efter kalibrering en simulerad energianvändning på 136,2 kWh/(m2Atemp,år); 2,9 % över det senast uppmätta normalårskorrigerade värdet. Nuvärdeskostnaden för att inte utföra någon åtgärd beräknades till ca 2 727 tkr. Åtgärderna genererade energibesparingar på 3,5–14,6 %, nuvärdeskostnader på 2 685-5 880 tkr och återbetalningstider på 7-105 år. För varje adderad åtgärd i klimatskalet ökade energibesparingen. Tilläggsisolering av vindsbjälklag visade sig vara den enda lönsamma åtgärden, då den har en nuvärdeskostnad som är lägre än att inte utföra någon åtgärd. En känslighetsanalys utfördes för kostnadsberäkningarna där diskonteringsräntan höjdes och sänktes med 2 % och energipriset höjdes med 10 %. Tilläggsisoleringav vindsbjälklag kvarstod dock som den enda lönsamma åtgärden. Åtgärderna hade kunnat generera högre procentuell energibesparing för en annan liknande byggnad. Referensbyggnaden innehåller ett stort renoverat kontor vilket ger en lägre nuvarande energianvändning och lägre procentuell energibesparing för åtgärder än om endast den äldre bostadsdelen studerats. Då Luleå har Sveriges lägsta energipris är åtgärder med hög investeringskostnad ekonomiskt svårmotiverade. Detta beror på att kostnadsbesparingarna genom minskad energianvändning blir små i förhållande till åtgärdernas investeringskostnader. Tilläggsisolering av fasad kan inte rekommenderas då åtgärden både är mycket olönsam och förändrar byggnadens uttryck väsentligt. Slutsatsen är att tilläggsisolering av vindsbjälklag är den lämpligaste åtgärden för äldre flerbostadshus, av de undersökta åtgärderna för energieffektivisering i klimatskalet. Den är arkitektoniskt lämplig med hänsyn till bevarandet av byggnaden då den inte förändrar byggnadens utseende. Den är även ekonomiskt lämplig då den har en livscykelkostnad som är lägre änalternativet att inte utföra någon åtgärd. För fortsatta studier föreslås bl.a. att undersöka hur åtgärder kan göras mer attraktiva för fastighetsägare, att kartlägga fastigheter från tidseran (skick, energianvändning, resultat av åtgärder, möjligheter) samt att utvärdera potentialen av ny teknik. / Old multifamily houses stand for a large part of Sweden’s total energy usage, which must decrease to minimize our environmental impact and to accomplish the government goal of more efficient energy usage. The aim of this master thesis is therefore to contribute to an increased knowledge on energy optimization through building envelope improvements in older buildings, and how energy efficiency measures can be evaluated through building energy simulation and life cycle cost analysis. The goal is to identify which measures that are economically and architecturally appropriate for old multifamily houses with interest in retaining their character. It is also to evaluate which energy saving and life cycle cost the selected measures generate. A multifamily house in central Luleå was selected as reference building. The building is by its construction and design representative for the era. Interesting energy efficiency measures in the building envelope were chosen. Then a wide literature study was carried out on house building in Sweden 1945-1964, building energy usage, energy efficiency through building envelope measures, the selected measures and the methods building energy simulation and life cycle cost analysis. The reference building was documented and an energy simulation model was built in the software IDA ICE. A present version of the building was simulated and calibrated to better match the latest normalised annual value. After that, simulations were performed for the selected measures; additional attic insulation, change to low energy windows and weather stripping these, a combination of both previous measures, additional facade insulation and change of windows, and a combination of all three measures. The life cycle costs of the present situation and for implementation of the different measures were calculated through the net present cost method. Also, payback times were calculated through the simple payback method. The building in its original state showed a post-calibration energy usage of 136,2 kWh/(m2Atemp,year); 2,9 % above the surveyed value. The net present cost for not performing any energy conservation measures was calculated to about 2 727 SEK. The measures generated energy savings of 3,5-14,6 %, net present costs of 2 685 -5 880 SEK and payback times of 7-105 years. For each added measure in the building envelope, the energy saving increased. Additional insulation of the attic turned out to be the only profitable measure, since its net present cost is lower than for not performing any energy conservation measure. A sensitivity analysis was performed for the cost analyses where the discount rate was raised and lowered by 2 % and the energy price raised by 10 %. However, the additional attic insulation remained as the only profitable measure. The energy conservation measures could have generated greater energy savings for a similar building. The reference building contains a large retrofitted office which lowers the present energy usage and the percental energy savings for measures compared to if only the dwelling part had been studied. Since Luleå has Sweden’s lowest energy prices, measures with high investment costs become difficult to give grounds for. This is because the cost savings achieved by their energy savings are low compared to their investment costs. Additional facade insulation cannot be recommended since it both is very unprofitable and highly changes the appearance of the building. The conclusion is that additional attic insulation is the most appropriate energy conservation measure for old multifamily houses, of selected measures in the building envelope. It can be regarded as architecturally appropriate since it does not change the building appearance. It is also economically appropriate since its life cycle cost is lower than for not performing any measure. Suggested future research includes analyzing how energy efficiency measures can be made more attractive for real estate owners, charting real estate from the era (condition, energy usage, results from measures, opportunities) and evaluating the potential of new technology within the field.

Les structures de génie civil, en particulier les ponts en béton armé, doivent être conçues et gérées pour assurer les besoins de transport et de communication dans la société. Il est indispensable de garantir un fonctionnement convenable et sécuritaire de ces structures, puisque les défaillances peuvent conduire à des perturbations du transport, des pertes catastrophiques de concessions et des pertes de vies humaines, avec des impacts économiques, sociétaux et environnementaux graves, à court et à long termes. Les gestionnaires entreprennent diverses activités pour maintenir la performance et le fonctionnement adéquat à long terme, tout en satisfaisant les contraintes financières et sécuritaires. Idéalement, ils peuvent recourir à des techniques d'optimisation pour établir les compromis entre la réduction du coût du cycle de vie (LCC) et la maximisation de la durée de vie. Cela nécessite le développement de l’analyse du cycle de vie, de l’analyse de fiabilité et de l'optimisation structurale.Les approches actuelles pour la conception et la gestion des structures s’appuyant sur l’analyse du coût de cycle de vie, montrent les besoins suivants : (1) une approche intégrée et systématique pour modéliser de façon cohérente les processus de dégradation, les charges de trafic, le vieillissement et les conséquences directes et indirectes de la défaillance, (2) une considération complète des dépendances économiques, structurales et stochastiques entre les différents éléments de l’ouvrage, (3) une approche permettant de modéliser efficacement un système structural formé de plusieurs éléments interdépendants, (4) une évaluation des conséquences de la dégradation et de la redistribution des charges entre les éléments en tenant compte de la redondance du système et de la configuration de l’ouvrage, (5) une méthode d'optimisation de la conception et de la maintenance qui préserve l’exigence de fiabilité tout en considérant la robustesse de la décision. L'objectif global de cette thèse est de fournir des procédures améliorées qui peuvent être appliquées à la conception et à la gestion fiabilistes et robustes des ouvrages en béton armé, en réduisant les coûts supportés par les gestionnaires et les utilisateurs, tout en tenant compte des dépendances entre les éléments. Dans la première partie de cette thèse, une synthèse bibliographique concernant les procédures de la conception et de la maintenance basée sur des calculs fiabilistes est présentée, et les différents composants du LCC sont développés. Ensuite, une approche est proposée pour la conception des ouvrages en tenant compte du coût aux usagers et en intégrant dans la fonction du coût de cycle de vie. Le modèle couplé corrosion-fatigue est aussi considéré dans l’optimisation de la conception. La planification de la maintenance des ouvrages est ensuite développée, en considérant les différents types d'interaction entre les éléments, en particulier les dépendances économiques, structurales et stochastiques. Ce modèle utilise l'analyse de l'arbre de défaillance et les probabilités conditionnelles pour tenir compte des dépendances dans la planification de la maintenance. Les conséquences de la dégradation et de la redistribution des charges sont prises en compte dans l'approche proposée. Par ailleurs, une méthode pratique de calcul de la fiabilité d'un système formé de plusieurs composantes interdépendantes est proposée, à travers un facteur de redondance calculé par la modélisation mécanique. Enfin, une nouvelle procédure d'optimisation est proposée, permettant de tenir compte des incertitudes dans le système et la capacité structurale de s'adapter aux variabilités intrinsèques. La procédure proposée tient compte des incertitudes et de la variabilité dans une formulation cohérente, validée au moyen des applications numériques. (...) / Civil engineering structures, particularly reinforced concrete bridges, should be designed and managed to ensure the society needs. It is crucial to assure that these structures function properly and safely as damage during the service life can lead to transport disturbance, catastrophic loss of property, causalities, as well as severe economic, social, and environmental impacts, in addition to long term consequences. Decision-makers adopt various activities to maintain adequate long-term performance and functionality while satisfying financial constraints. Ideally, they may employ optimization techniques to identify the trade-offs between minimizing the life-cycle cost (LCC) and maximizing the expected service life. This requires the development of three challenging chores: life cycle analysis, reliability analysis and structural optimization. The current approaches for the design and management of structures through a Life-cycle cost analysis (LCCA) highlight the following needs: (1) an integrated and systematic approach to model coherently the deterioration processes, the increasing traffic loads, the aging and the direct and indirect consequences of failure, (2) a mutual consideration of economic, structural and stochastic dependencies between the elements of a structural system, (3) an adequate approach for the deterioration dependencies and load redistribution between the elements, (4) an improvement of system reliability computation as a function of the structural redundancy and configuration that can take into account the dependencies between the elements, (5) a consideration of design and maintenance optimization procedures that focus coherently on the robustness of the management decision and on the satisfaction of reliability requirements.The overall objective of this study is to provide improved LCCA and procedures that can be applied to select optimal and robust design and maintenance decisions regarding new and existing reinforced concrete structures, by minimizing both manager and user costs, while providing the required safety along the structure lifetime, taking into account the most severe degradation processes and the dependencies between structural elements. In the first part of this thesis, a literature review concerning the current probabilistic design and maintenance procedures is presented, and the LCC components are discussed. Then, a new approach is developed to evaluate the user delay costs on a reinforced concrete bridge structure, based on direct and indirect costs related to degradation and failure, and to integrate it to the life cycle cost function, in order to allow for probabilistic design. In addition,the coupled corrosion-fatigue model is considered in the design optimization. Afterward, a structural maintenance planning approach is developed to consider the three types of interactions, namely economic, structural and stochastic dependencies. The proposed model uses fault tree analysis and conditional probabilities to reflect the dependencies in the maintenance planning. The consequences of degradation are evaluated and a method is proposed to account for the load redistribution. Moreover, a practical formulation for quantifying the reliability of a system formed of interrelated components is proposed, by the mean of a redundancy factor that can be computed by finite element analysis. Finally, a new optimization procedure is proposed, by taking into account the uncertainties in the analysis, and the structural ability to adapt to variability, unforeseen actions or deterioration mechanisms. The proposed procedure takes account of uncertainties andvariability in one consistent formulation, which is shown through numerical applications. (...)

Klimatförändringarna blir allt mer omfattande i takt med att jordens befolkning ökar. Den negativa miljöpåverkan bottnar till stor del i användandet av råvaror och energiförbrukning vid skapandet av materiella ting. Enligt energimyndigheten (2015) står byggsektorn för ca 40 % av Sveriges totala energianvändning. För att minska energianvändningen har mål både på nationell och internationell nivå skapats. Målen är tänkta att skapa större förståelse av ett mer energieffektivt byggt samhälle för samtliga aktörer inom byggbranschen. En hållbar utveckling av husbyggandet kräver förutom att värna om miljön en beaktning av de ekonomiska och sociala aspekterna.   I det här examensarbetet har det undersökts om två specifika standardhus från en småhusleverantör kan utvecklas till passivhus med bevarad arkitektonisk karaktär. Studien syftar delvis till att undersöka om begreppet passivhus kan fungera som ett hållbart koncept för byggandet av enfamiljshus. Begreppet hållbar utveckling har begränsats och en förenkling har applicerats i arbetet. Den ekologiska aspekten representeras av energiberäkningar och eventuella åtgärder för att standardhusen ska uppnå kraven för passivhus. Den ekonomiska aspekten representeras av en livscykelkostnadsanalys med hjälp av nuvärdesmetoden och återbetalningsmetoden. Den sociala aspekten representeras av en utvärdering av förändring i boendekvaliteter vid utveckling från ett standardhus till passivhus. Studien presenterar även en alternativ utformning av ett passivhus med avsikt att främja positiva boendekvaliteterna.   Standardhusen tillhör en småhusproducent, Intressanta hus, som har sitt huvudsäte i Västerås. Husen utgörs av en villa på 147 m2 i ett plan med pulpettak samt en villa på 151 m2 i två plan med sadeltak. Med anledning av Intressanta hus geografiska läge har Västerås klimat använts som utgångspunkt vid energiberäkningarna. För att addera ytterligare en utmaning har även möjligheter för utveckling till passivhus undersökts för standardhusen i ett subarktiskt klimat i Kiruna. Västerås representerar därmed klimatzon III och Kiruna klimatzon I.   Resultaten avslöjade att det är möjligt att utveckla standardhuset i två plan med sadeltak till passivhus och samtidigt bevara den arkitektoniska karaktären i de båda klimatzonerna. Standardhuset med ett plan och pulpettak är endast möjligt att anpassa till passivhus i klimatzon III med bevarad arkitektonisk karaktär. Livscykelkostnadsanalysen visar med hjälp av nuvärdesmetoden att det är ekonomiskt fördelaktigt att investera i passivhus som ett koncept för en kalkylperiod på 50 år. Den boendekvalitet som främst förändras är bostadens ljusinsläpp och för passivhuset i ett plan är skillnaden av ljusinsläpp markant i klimatzon I.   Studiens slutsats är att konceptet passivhus är en metod av husbyggnation som främjar den hållarbara utvecklingen i förenklad form. Resultaten är framförallt positiva för klimatzon III men om byggnaden har låg formfaktor kan konceptet fungera bra även i kallare klimat som återfinns i klimatzon I. / The climate changes increases as the population increases. The negative environmental impact is mostly based on the use of raw materials and energy consumption in the production of various products. According to Energimyndigheten (2015), the building sector is the cause of about 40 % of Sweden's total energy use. In order to reduce the energy use goals have been created at both national and international levels. The goals are intended to create a greater understanding of a more energy efficient society for all actors within the construction industry. In addition to create a sustainable development of the building sector one needs to also take in account the social and economic aspects.   This master thesis examined whether two specific standard houses from a small house producer can be adapted to passive houses with a preserved architectural character. The purpose of the study is partly to investigate whether the concept of passive houses can serve as a sustainable concept of building single family houses. The concept of sustainable development has been simplified. The ecological aspect is represented by the energy calculations and possible actions that the standard houses need to achieve in order to meet the requirements for passive houses. The economic aspect is represented by a life cycle cost analysis using the Net Present Value method and the Simple Payback method. The social aspect is represented by an evaluation of changes in living qualities as the standard houses develops to passive houses. The study also presents an alternative design of a passive house with the purpose of improving the accommodation qualities.   The standard houses belong to a small-house-producer, Intressanta hus, who has their main market in Västerås. The houses is represented by a 147m2 villa with one floor and a pulpit roof and a 151m2 villa with two floors and a pitched roof. Due to Intressanta hus geographic location, the typical climate for Västerås has been used in the energy calculations. To add another dimension, opportunities for developing the standard houses to passive houses have also been investigated for the typical climate in Kiruna. Therefore Västerås represents climate zone III and Kiruna represents climate zone I.   The results revealed that it is possible to adapt the standard house with two floors and a pitched roof to a passive house while preserving the architectural character in both climate zones. The standard house with one floor and a pulpit roof is only possible to adjust to a passive house in climate zone III with a preserved architectural character. The life cycle cost analysis using the Net Present Value showed that it is an economical advantage to invest in a passive house in a period of 50 years. The accommodation quality that changes the most is the incident light in the houses and for the passive house with one floor the difference of light is remarkably high in climate zone I.

The diploma thesis deals with the proposal to increase labor productivity and economic evaluation in the company EKOSTAVBY Brno. The introductory section describes the theoretical background, the following analysis of the company. The work is based on the current status in the company, focusing mainly on the centre of mechanization and transport. The aim of this paper is to propose certain changes and measures, which would lead to a reduction in the loss rate of the centre.

This book focuses on an evaluation of technical, economical, and personal aspects of e-learning deployment in a theoretical plane and in the specific environment of the bank ČSOB, a. s. The thesis begins by an introduction of the term e-learning and a brief description of main properties and characteristics of this new trend in a field of not only corporate education. Special attention is devoted to an assessment of business benefits and cots of education; every aspect is analyzed and compared both for the classical brick and mortar classroom instructor led education and for the e-learning. The thesis introduces two mathematical models for assessing an effectiveness of e-learning deployment. Theoretical concepts are applied to data from a real course which was run in one of the main Czech banks ČSOB, a. s. Last part briefly examines the concepts and benefits of SCORM standard package and its support in the SAP LS 600 system.

In der Behandlung der zervikalen Dystonie wird die Therapie mit Botulinumtoxin (BTX) erfolgreich angewendet. Neben dieser Therapie werden von Patienten oft alternative Therapien (CAM [Complementary and Alternative Medicine]) angesprochen und ausprobiert. Diese Studie geht der Frage nach, wie häufig CAM-Therapien genutzt werden, wie deren Wirkung bewertet wird und ob es Prädiktoren für die Therapiewahl gibt. Zur Datenerhebung wurden 265 Fragebögen von zwei Patientengruppen ausgewertet. Gruppe 1 (n=101) bestand aus Patienten der Botulinumtoxinsprechstunde des Universitätsklinikums Leipzig und der Paracelsus Klinik Zwickau. Gruppe 2 (n=165) wurde aus Mitgliedern des Selbsthilfeverbandes Bundesverband-Torticollis e.V. rekrutiert. Bei 86% der Patienten wurde die Therapie mit BTX angewendet. Von den Therapiemöglichkeiten der CAM wurden am häufigsten physikalische Therapien (Massagen n=171) genannt. Am besten bewertet wurden jedoch, neben der BTX-Therapie, spezielle physiotherapeutische sowie psychotherapeutische Verfahren. Die CAM-Therapien wurden häufig in Kombination mit der BTX-Therapie angewendet und von Patienten, deren Erkrankung einen langen chronischen Verlauf vorwies (>10 Jahre). Als Prädiktoren für die Wahl einer CAM-Therapie zeigten sich eine Zugehörigkeit zur Gruppe 2, aufgetretene Nebenwirkungen im Rahmen der BTX-Therapie, männliches Geschlecht und erhöhter Stress bei den Erkrankten. Außerdem fand sich ein signifikanter Unterschied zu einem höheren Bildungsabschnitt und Arbeit in gehobeneren Berufsgruppen bei Patienten, die vermehrt CAM Therapie anwenden. Zusammenfassend wurden CAM-Therapien, neben der Behandlung mit BTX, häufig von den Befragten angewendet. Hohe Zufriedenheitswerte erzielte eine Kombination mit physiotherapeutischen Verfahren oder Psychotherapie. Die Wahl von CAM-Therapien ist von der Erkrankungsdauer, Bildungslage und finanziellen Ressourcen abhängig.:1 EINLEITUNG 5 2 STAND DER FORSCHUNG 6 2.1 Definitionen 6 2.2 Epidemiologie 7 2.3 Pathologie 8 2.4 Klinisches Bild 11 2.5 Therapie 13 3 FRAGESTELLUNG UND HYPOTHESEN 24 4 STICHPROBE UND METHODE 25 4.1 Stichprobe 25 4.2 Erhebungsinstrument 26 4.3 Statistische Auswertung 28 5 ERGEBNISSE 30 5.1 Soziodemographische Daten 30 5.2 Krankheitsbezogene Merkmale 33 5.3 Therapie 35 5.4 Prädiktoren für die Therapiewahl 42 6 DISKUSSION 45 6.1 Das Patientenkollektiv 45 6.2 Diskussion der Botulinum-Toxin-Therapie 47 6.3 Diskussion der alternative Therapien 48 6.4 Diskussion der Prädiktoren für die Therapiewahl 54 6.5 Kritik 58 6.6 Schlussfolgerungen und Empfehlungen 59 7 ZUSAMMENFASSUNG 61 8 LITERATURVERZEICHNIS 64 9 ANLAGEN 72 9.1 Tabellen- und Abbildungsverzeichnis 9.2 Fragebogen 9.3 Erklärung der eigenständigen Abfassung der Arbeit 9.4 Curriculum Vitae 9.5 Veröffentlichungen und Vorträge 9.6 Danksagung