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Information System (IS) effectiveness assessment is an important issue for the organizations as IS have become critical for their survival. With the incorporation of Internet technologies into the business environment, it is now more difficult to measure IS effectiveness, because Internet provides a borderless, non-stop, flexible communication medium. Assessing the effectiveness of web-based information systems (WIS) is vital for survival and competitive advantage which is a complicated subject since there are several interacting factors to consider. In the literature there are several methods proposed for IS assessment. However, those studies have been far from providing a broad, comprehensive evaluation framework for any type of web-based IS independent of its domain. In this study, a generic WIS effectiveness assessment framework is proposed. The framework is applied in case studies consisting of four organizations in e-commerce and e-banking domains.

This thesis presents health care organizations as heterogenic and highly complex in nature with particular normative structures underpinning their formal rational structures. It seeks to explore the evolution of organization structure as applied to a medical corporation in Qatar and to examine the nature of organizational culture and multi professional cohesiveness. In doing so it assesses a range of models on organizational design and change. The three hospitals that compose the corporation are investigated through triangulated interpretative qualitative and quantitative methodologies and the application of the Competing Values Framework. The comprehensive approach of the investigation resulted in a series of conclusions on the evolution of hospital organizational structures, the link between life cycle and structure, forms of organizing health services, characertistics of professional structures, the nature and success of change management strategies, coordination mechanisms, organizational and professional cultures, and health service, organizational and team effectiveness assessment. Findings demonstrated that autonomous and sometimes conflicting professions worked in harmony and cohesiveness as a consequence of shared core values and the human relations focus of health organizations. In examining organizational design it showed that coordination mechanisms were preferred to integration mechanisms with the former playing an important role in conflict resolution and human relations. Finally, findings indicated that when organizational design has shortcomings, the organization substitutes through other mechanisms.

Ziel dieser Arbeit ist es, robuste und performante Algorithmen für die Fusion von polizeilichen Unfalldaten zur Testszenariengenerierung im Rahmen der Absicherung automatisierter Fahrfunktionen zu generieren. In dieser Arbeit werden dabei Methoden zur Datenfusion in Kombination mit generativen und Klassifikationsmodellen untersucht. Eine spezifische Variable vom Empfänger wird während des Datenfusionsverfahrens im Voraus entfernt. Ein Spender mit den gemeinsamen Variablen wird verwendet, um die Vorhersage für die fehlende spezifische Variable im Empfänger zu erhalten. Als Methode werden Ensembles aus Distance-Hot-Deck und Machine-Learning Verfahren für die Vorhersage verwendet. Nach der Vorhersage werden die Ergebnisse anhand ausgewählter Bewertungsmetriken bewertet. Darüber hinaus werden zwei generative Modelle eingeführt, um Datensätze unterschiedlicher Qualität zu synthetisieren. Ziel ist es, die Robustheit der Ensembles mit den synthetisierten „Rauschdaten“ zu testen und die Performance von Ensembles mit den synthetisierten Daten hoher Qualität zu verbessern. Schließlich können Erkenntnisse darüber gewonnen werden, welche Ensembles die besten Ergebnisse für die Datenfusion liefern.:1. Einleitung 2. Grundlagen 3. Randbedingungen 4. Vorgehensweise 5. Ergebnisse 6. Diskussion & Ausblick

Objective: With the overall goal to harmonize prospective effectiveness assessment of active safety systems, the specific objective of this study is to identify and evaluate sources of variation in virtual precrash simulations and to suggest topics for harmonization resulting in increased comparability and thus trustworthiness of virtual simulation-based prospective effectiveness assessment. Methods: A round-robin assessment of the effectiveness of advanced driver assistance systems was performed using an array of state-of-the-art virtual simulation tools on a set of standard test cases. The results were analyzed to examine reasons for deviations in order to identify and assess aspects that need to be harmonized and standardized. Deviations between results calculated by independent engineering teams using their own tools should be minimized if the research question is precisely formulated regarding input data, models, and postprocessing steps. Results: Two groups of sources of variations were identified; one group (mostly related to the implementation of the system under test) can be eliminated by using a more accurately formulated research question, whereas the other group highlights further harmonization needs because it addresses specific differences in simulation tool setups. Time-to-collision calculations, vehicle dynamics, especially braking behavior, and hit-point position specification were found to be the main sources of variation. Conclusions: The study identified variations that can arise from the use of different simulation setups in assessment of the effectiveness of active safety systems. The research presented is a first of its kind and provides significant input to the overall goal of harmonization by identifying specific items for standardization. Future activities aim at further specification of methods for prospective assessments of the effectiveness of active safety, which will enhance comparability and trustworthiness in this kind of studies and thus contribute to increased traffic safety.

The primary purpose of this study is to develop a methodology that can be used to assess IS effectiveness in the Turkish Army. This study starts with the review of the information system effectiveness and assessment paradigms. Afterwards, influences of the characteristics of the Turkish Army on IS effectiveness assessment techniques are investigated. Observations and interviews are determined as the favorable data collection techniques. A user perceived effectiveness assessment instrument for semi-structured interviews is developed. Then a case study is applied to assess IS effectiveness in one of the units of the Turkish Army. At the end of the thesis, a qualitative assessment methodology based on maturity and key determinants of a successful IS are proposed for the Turkish Army.

Introdução: As comunicações interatriais do tipo ostium secundum (CIA-OS) são tratadas por fechamento percutâneo (FP) ou intervenção cirúrgica (IC). Estudos comparando ambos métodos são escassos e avaliações de custo-efetividade inexistem na literatura nacional. Objetivos: Realizar uma avaliação da segurança e eficácia (ASE) clínica seguida de uma análise de custo-efetividade (ACE) incremental comparando o FP e IC sob a perspectiva do Sistema Único de Saúde (SUS). Materiais e métodos: ASE - Estudo observacional, não randomizado de 2 coortes de crianças e adolescentes < 14 anos com CIA-OS tratadas por FP ou IC. A coleta dos dados foi prospectiva no FP e retrospectiva no IC. ACE - Realizada revisão sistemática de estudos clínicos disponíveis no MEDLINE e a Cochrane Central. Estudos com mais de 50 pacientes e com idade média abaixo de 14 anos foram incluídos. A análise foi baseada em uma árvore de decisão computando os custos e consequências no longo prazo de ambas as opções. Foi utilizado valor da prótese de R$ 16.000 e estipulado valor de honorário médico de R$ 2.355. A efetividade foi estimada em anos de vida. A avaliação utilizou uma taxa de desconto de 5% ao ano e uma disposição a pagar de 3 vezes o PIB per capita no Brasil (63.000). Análises de limiares também foram conduzidas. Resultados: ASE - De Abr/09 a Out/11 foram alocados 75 pacientes (pts) no FP e entre Jan/06 e Jan/11 105 pts na IC. A idade e o peso foram maiores no FP e o diâmetro da CIA foi semelhante entre os grupos. Sucesso técnico foi observado em todos os procedimentos e não houve óbitos. Complicações (a maioria menores) foram encontradas em 68% na IC e em 4% do FP (p<0,001). As taxas de fluxo residual não significativo ou de oclusão total do defeito foram semelhantes nos 2 grupos. A mediana de internação foi de 1,2 dias após o FP e 8,4 dias após a IC (p< 0,001). ACE - A estratégia de busca retornou 2.957 referências, das quais 34 foram incluídas. A taxa de mortalidade foi semelhante nos 2 grupos. O FP teve discreta maior efetividade, menor taxa de complicações moderadas/graves e menor tempo de internação, mas com maior probabilidade de um segundo procedimento. A relação de custo-efetividade incremental (RCEI) do tratamento percutâneo foi de R$ 230.641 por ano de vida salvo. Considerando-se este cenário, seria necessário que o custo indireto associado à cirurgia fosse de R$ 4.960, ou que o valor pago pelo dispositivo percutâneo sofresse redução de R$ 4.960 para que o FP se tornasse aceitável do ponto de vista econômico. Conclusões: Ambos tratamentos são seguros e eficazes com ótimos desfechos, porém o FP apresenta menor morbidade e tempo de internação. Usando os valores diretos estipulados neste estudo, a RCEI foi elevada limitando a incorporação do FP pelo SUS neste momento. Estudos considerando também os custos indiretos são necessários para a adequada ACE de ambas estratégias. / Introduction: Atrial septal defects of the secundum type (ASD-OS) are treated by percutaneous closure (PC) or surgical intervention (SI). Comparative studies are scarce and there is no cost-effectiveness assessment in the Brazilian literature. Objectives: To perform a clinical safety and efficacy (ASE) assessment followed by an incremental cost-effectiveness (CEE) analysis comparing PC and SI under the Brazilian Unified Health System perspective. Materials and methods: ASE - Observational, non-randomized study of two cohorts of children and adolescents under 14 years with ASD-OS treated by PC or SI. Data was collected prospectively in PC and retrospectively in SI. CEE - A systematic review of clinical studies available in MEDLINE and Cochrane Central was performed. Studies with more than 50 patients and mean age under 14 years were included. Analysis was based on a decision tree that took into account costs and consequences during long-term follow-up for both options. The cost of the device and medical honorarium were estimated at R$ 16.000 and R$ 2.355, respectively. Effectiveness was estimated in years of life. Assessment was performed using a discount tax of 5% and a willingness to pay of 3 times the GID in Brazil (63.000). Threshold analyses were also conducted. Results: ASE - From Apr/09 to Oct/11 75 patients (pts) were enrolled in PC and from Jan/06 to Jan/11 105 pts in SI. Age and weight were greater in PC and the ASD diameter was similar. Technical success was achieved in all procedures and there were no deaths. Complications (most minor) occurred in 68% of SI and 4% of PC (p<0,001). The rate of total occlusion or non-significant residual shunts was similar in both groups. Median hospitalization time was 1.2 days in PC and 8.4 days in SI (p<0,001). CEE - Search strategy returned 2957 references and 35 were included. Mortality was similar in both groups. PC was associated with slightly better effectiveness, lower rates of moderate/severe complications and reduced hospital stay despite a higher probability of a second procedure. Incremental cost-effectiveness ratio (ICER) was R$ 230.641 for life-year gained. In this scenario, PC would be acceptable from the economic point of view if the indirect costs of the SI was R$ 4.960 or the cost of the device was reduced by R$ 4.960. Conclusions: Both methods are safe and effective with excellent outcomes, however PC is associated with less morbidity and in-hospital time. Using the direct costs stipulated in this study, the ICER was high limiting the incorporation of PC by the Brazilian Unified Health System (SUS) at this moment. Studies also considering the indirect costs should be performed for better CEE assessment of both strategies.

Tecnologias como cateter nasoentérico, equipo de infusão, bomba infusora e dieta enteral são constantemente substituídas por novos produtos, ou por atualizações, sem que haja avaliação da efetividade das mesmas. O objetivo principal desta pesquisa é delinear o cenário em que a incorporação e utilização das tecnologias de Terapia Nutricional Enteral (TNE) acontece em um hospital geral de grande porte, no Município do Rio de Janeiro. Atualmente, elas são avaliadas na fase de incorporação, de forma superficial, e na fase de utilização, somente em caso de intercorrências, quando é feita a crítica de material, negativa ao produto. A pesquisa foi realizada de setembro a dezembro de 2009, no Hospital Federal do Andaraí (HFA). Responderam à pesquisa, quarenta e três enfermeiros de setores com Terapia Nutricional Enteral (TNE), sete nutricionistas da Comissão de Avaliação e Suporte Nutricional Enteral e Parenteral (CASNEP), e quatro Chefias de Serviços, envolvidas com a incorporação dessas tecnologias. Os profissionais entrevistados confirmaram a pouca influência de suas opiniões técnicas na aquisição e interrupção do uso dessas tecnologias, mas acreditam na importância do monitoramento das mesmas. As entrevistas, com questionários semi-estruturados possibilitaram a identificação do fluxo de incorporação existente, que não é padronizado para todas as tecnologias. Foi proposta a inserção de um impresso, criado a partir dos resultados da pesquisa, como ferramenta de avaliação da efetividade das tecnologias de TNE. O instrumento deverá ser introduzido no fluxo de incorporação e difusão destas tecnologias. A utilização da gestão participativa na avaliação da efetividade das tecnologias utilizadas em TNE, por sistema fechado no HFA, será fundamental na normatização do atendimento ao paciente com desnutrição protéico-calórica, assistido pela CASNEP, e poderá servir como modelo para outras comissões multidisciplinares assistenciais / Technologies such nasoenteric catheter, infusion set and pump and enteral nutrition formulas are constantly replaced by new products or updates without evaluation of their effectiveness. They are currently assessed superficially at the incorporation phase, only in case of complications, through criticism of negative material to product. The use of participatory management in evaluating the effectiveness of advanced nutrition through a closed system in the Andaraí Federal Hospital (an important hospital in Rio de Janeiro), where this research happened, is fundamental to the standardization of care for patients with protein-energy malnutrition. Nurses of the sectors responsible for 90% of enteral nutritional support in addition to dietitians of the enteral nutrition team (CASNEP) and service managers involved in the incorporation and diffusion responded to the survey. The professionals confirmed the low influence of their expert opinions on the acquisition and cessation of use of technologies in Enteral Nutrition Therapy. (ENT), but they believe in the importance of their monitoration. Now, we will create a form for evaluating the effectiveness of the technologies to be introduced in the flow of incorporation and use. Although they represent a vision of a group of professionals, the results can improve the quality of enteral nutrition therapy inside a closed system, and may serve as a mirror for the management of other technologies used by the multidisciplinary team care

Tecnologias como cateter nasoentérico, equipo de infusão, bomba infusora e dieta enteral são constantemente substituídas por novos produtos, ou por atualizações, sem que haja avaliação da efetividade das mesmas. O objetivo principal desta pesquisa é delinear o cenário em que a incorporação e utilização das tecnologias de Terapia Nutricional Enteral (TNE) acontece em um hospital geral de grande porte, no Município do Rio de Janeiro. Atualmente, elas são avaliadas na fase de incorporação, de forma superficial, e na fase de utilização, somente em caso de intercorrências, quando é feita a crítica de material, negativa ao produto. A pesquisa foi realizada de setembro a dezembro de 2009, no Hospital Federal do Andaraí (HFA). Responderam à pesquisa, quarenta e três enfermeiros de setores com Terapia Nutricional Enteral (TNE), sete nutricionistas da Comissão de Avaliação e Suporte Nutricional Enteral e Parenteral (CASNEP), e quatro Chefias de Serviços, envolvidas com a incorporação dessas tecnologias. Os profissionais entrevistados confirmaram a pouca influência de suas opiniões técnicas na aquisição e interrupção do uso dessas tecnologias, mas acreditam na importância do monitoramento das mesmas. As entrevistas, com questionários semi-estruturados possibilitaram a identificação do fluxo de incorporação existente, que não é padronizado para todas as tecnologias. Foi proposta a inserção de um impresso, criado a partir dos resultados da pesquisa, como ferramenta de avaliação da efetividade das tecnologias de TNE. O instrumento deverá ser introduzido no fluxo de incorporação e difusão destas tecnologias. A utilização da gestão participativa na avaliação da efetividade das tecnologias utilizadas em TNE, por sistema fechado no HFA, será fundamental na normatização do atendimento ao paciente com desnutrição protéico-calórica, assistido pela CASNEP, e poderá servir como modelo para outras comissões multidisciplinares assistenciais / Technologies such nasoenteric catheter, infusion set and pump and enteral nutrition formulas are constantly replaced by new products or updates without evaluation of their effectiveness. They are currently assessed superficially at the incorporation phase, only in case of complications, through criticism of negative material to product. The use of participatory management in evaluating the effectiveness of advanced nutrition through a closed system in the Andaraí Federal Hospital (an important hospital in Rio de Janeiro), where this research happened, is fundamental to the standardization of care for patients with protein-energy malnutrition. Nurses of the sectors responsible for 90% of enteral nutritional support in addition to dietitians of the enteral nutrition team (CASNEP) and service managers involved in the incorporation and diffusion responded to the survey. The professionals confirmed the low influence of their expert opinions on the acquisition and cessation of use of technologies in Enteral Nutrition Therapy. (ENT), but they believe in the importance of their monitoration. Now, we will create a form for evaluating the effectiveness of the technologies to be introduced in the flow of incorporation and use. Although they represent a vision of a group of professionals, the results can improve the quality of enteral nutrition therapy inside a closed system, and may serve as a mirror for the management of other technologies used by the multidisciplinary team care

Introdução: As comunicações interatriais do tipo ostium secundum (CIA-OS) são tratadas por fechamento percutâneo (FP) ou intervenção cirúrgica (IC). Estudos comparando ambos métodos são escassos e avaliações de custo-efetividade inexistem na literatura nacional. Objetivos: Realizar uma avaliação da segurança e eficácia (ASE) clínica seguida de uma análise de custo-efetividade (ACE) incremental comparando o FP e IC sob a perspectiva do Sistema Único de Saúde (SUS). Materiais e métodos: ASE - Estudo observacional, não randomizado de 2 coortes de crianças e adolescentes < 14 anos com CIA-OS tratadas por FP ou IC. A coleta dos dados foi prospectiva no FP e retrospectiva no IC. ACE - Realizada revisão sistemática de estudos clínicos disponíveis no MEDLINE e a Cochrane Central. Estudos com mais de 50 pacientes e com idade média abaixo de 14 anos foram incluídos. A análise foi baseada em uma árvore de decisão computando os custos e consequências no longo prazo de ambas as opções. Foi utilizado valor da prótese de R$ 16.000 e estipulado valor de honorário médico de R$ 2.355. A efetividade foi estimada em anos de vida. A avaliação utilizou uma taxa de desconto de 5% ao ano e uma disposição a pagar de 3 vezes o PIB per capita no Brasil (63.000). Análises de limiares também foram conduzidas. Resultados: ASE - De Abr/09 a Out/11 foram alocados 75 pacientes (pts) no FP e entre Jan/06 e Jan/11 105 pts na IC. A idade e o peso foram maiores no FP e o diâmetro da CIA foi semelhante entre os grupos. Sucesso técnico foi observado em todos os procedimentos e não houve óbitos. Complicações (a maioria menores) foram encontradas em 68% na IC e em 4% do FP (p<0,001). As taxas de fluxo residual não significativo ou de oclusão total do defeito foram semelhantes nos 2 grupos. A mediana de internação foi de 1,2 dias após o FP e 8,4 dias após a IC (p< 0,001). ACE - A estratégia de busca retornou 2.957 referências, das quais 34 foram incluídas. A taxa de mortalidade foi semelhante nos 2 grupos. O FP teve discreta maior efetividade, menor taxa de complicações moderadas/graves e menor tempo de internação, mas com maior probabilidade de um segundo procedimento. A relação de custo-efetividade incremental (RCEI) do tratamento percutâneo foi de R$ 230.641 por ano de vida salvo. Considerando-se este cenário, seria necessário que o custo indireto associado à cirurgia fosse de R$ 4.960, ou que o valor pago pelo dispositivo percutâneo sofresse redução de R$ 4.960 para que o FP se tornasse aceitável do ponto de vista econômico. Conclusões: Ambos tratamentos são seguros e eficazes com ótimos desfechos, porém o FP apresenta menor morbidade e tempo de internação. Usando os valores diretos estipulados neste estudo, a RCEI foi elevada limitando a incorporação do FP pelo SUS neste momento. Estudos considerando também os custos indiretos são necessários para a adequada ACE de ambas estratégias. / Introduction: Atrial septal defects of the secundum type (ASD-OS) are treated by percutaneous closure (PC) or surgical intervention (SI). Comparative studies are scarce and there is no cost-effectiveness assessment in the Brazilian literature. Objectives: To perform a clinical safety and efficacy (ASE) assessment followed by an incremental cost-effectiveness (CEE) analysis comparing PC and SI under the Brazilian Unified Health System perspective. Materials and methods: ASE - Observational, non-randomized study of two cohorts of children and adolescents under 14 years with ASD-OS treated by PC or SI. Data was collected prospectively in PC and retrospectively in SI. CEE - A systematic review of clinical studies available in MEDLINE and Cochrane Central was performed. Studies with more than 50 patients and mean age under 14 years were included. Analysis was based on a decision tree that took into account costs and consequences during long-term follow-up for both options. The cost of the device and medical honorarium were estimated at R$ 16.000 and R$ 2.355, respectively. Effectiveness was estimated in years of life. Assessment was performed using a discount tax of 5% and a willingness to pay of 3 times the GID in Brazil (63.000). Threshold analyses were also conducted. Results: ASE - From Apr/09 to Oct/11 75 patients (pts) were enrolled in PC and from Jan/06 to Jan/11 105 pts in SI. Age and weight were greater in PC and the ASD diameter was similar. Technical success was achieved in all procedures and there were no deaths. Complications (most minor) occurred in 68% of SI and 4% of PC (p<0,001). The rate of total occlusion or non-significant residual shunts was similar in both groups. Median hospitalization time was 1.2 days in PC and 8.4 days in SI (p<0,001). CEE - Search strategy returned 2957 references and 35 were included. Mortality was similar in both groups. PC was associated with slightly better effectiveness, lower rates of moderate/severe complications and reduced hospital stay despite a higher probability of a second procedure. Incremental cost-effectiveness ratio (ICER) was R$ 230.641 for life-year gained. In this scenario, PC would be acceptable from the economic point of view if the indirect costs of the SI was R$ 4.960 or the cost of the device was reduced by R$ 4.960. Conclusions: Both methods are safe and effective with excellent outcomes, however PC is associated with less morbidity and in-hospital time. Using the direct costs stipulated in this study, the ICER was high limiting the incorporation of PC by the Brazilian Unified Health System (SUS) at this moment. Studies also considering the indirect costs should be performed for better CEE assessment of both strategies.