Les recommandations de l’OMS sur la prise en charge des enfants nés de mères infectées par le VIH évoluent en fonction des nouvelles données scientifiques souvent issues d’essais thérapeutiques. Leur application en routine, surtout dans les pays à ressources limitées, devrait prendre en compte les contraintes opérationnelles locales pour guider les pratiques. Ce travail de thèse a été développé dans cette optique, avec pour objectif d’évaluer l’ensemble du processus de prise en charge de ces enfants avant l’âge de sept mois, depuis le dépistage précoce de l’infection VIH jusqu’à la mise en œuvre du traitement antirétroviral (ARV) systématiquement proposé dès le diagnostic de l’infection VIH, et leurs réponses aux vaccins administrés dans le Programme Elargi de Vaccination (PEV). Ce travail est issu de l’analyse des données collectées dans deux enquêtes : la cohorte ANRS-PEDIACAM initiée en 2007 et toujours en cours, menée dans trois hôpitaux urbains du Cameroun, et l’enquête transversale ACIP-EPIPEV, menée de novembre 2004 à Mai 2005 dans cinq hôpitaux du Cameroun et de la République Centrafricaine. Nos résultats ont montré que le diagnostic précoce du VIH et l’initiation des ARV chez les nourrissons étaient faisables et largement acceptés en routine dans les services de pédiatrie urbains. Parmi les nourrissons nés de mères séropositives inclus dans PEDIACAM, 89,7% ont été ramenés pour le test VIH à un âge médian de 1,5 mois (IQ : 1,4-1,6) et 83,9% ont complété le processus de diagnostic en revenant chercher les résultats du test avant l’âge de 7 mois. Les facteurs associés au processus incomplet reflétaient plus la qualité des soins prénataux et l’urgence du contexte obstétrical que les conditions environnementales. Parmi les nourrissons infectés par le VIH, 83,5% ont initié les ARV avant l’âge de 7 mois. Mais le processus d’initiation précoce des ARV a été considéré comme suboptimal chez environ un tiers d’entre eux. Les facteurs associés à ce retard étaient liés au système de soins, à la gestion des prélèvements et des résultats du test VIH. Enfin, dans l’étude EPIPEV, nous avons observé des proportions plus faibles de réponses vaccinales adéquates chez les enfants infectés que non infectés par le VIH, nés de mères séropositives. Cette différence était plus marquée pour le vaccin contre la rougeole (20% vs 60%). Le niveau de réponse observé chez les enfants non infectés nés de mères séropositives était néanmoins faible par rapport à celui attendu chez les enfants en population générale. Ce dernier résultat suggérerait que l’exposition au VIH pendant la grossesse pourrait entrainer un dysfonctionnement immunologique, même en l’absence de transmission du VIH à l’enfant. L’ensemble de ces travaux nous ont permis de cibler certains aspects pour améliorer le processus de prise en charge précoce des nourrissons exposés au VIH, portant sur l’organisation des sites, l’application effective des recommandations établies et la mise en place d’une coordination active. / The world health organization (WHO) recommendation updates regarding care of HIV-infected children reflects new scientific findings in clinical trials. Their implementation in routine practice, especially in resource-limited countries, should consider local operational constraints in order to direct good clinical practice guidelines. We put in place this work in order to evaluate the early care process of HIV-exposed infants aged less than 7 months including: early diagnosis of HIV, initiation of antiretroviral therapy (ART), and immune responses to vaccines administered by the Expanded Program on Immunization (EPI). Our data were collected from two surveys: the current ANRS-PEDIACAM cohort which started in 2007, in three urban hospitals located in Cameroon, and the ACIP-EPIPEV cross sectional study conducted from November 2004 to May 2005, in five urban hospitals based in Cameroon and the Central African Republic. Our results strongly suggested that both early HIV diagnosis and initiation of ART in infants were feasible and well accepted in “real pediatric world urban settings”. Among HIV-exposed infants enrolled in the PEDIACAM study, 89.7% were tested for HIV at a median age of 1.5 months and 83.9% completed the process by returning for the result before 7 months of age. Incomplete process was associated to factors related to the quality of antenatal care and obstetrical emergency than environmental ones. Among HIV-infected infants identified, 83.5% started ART before 7 months of age. However, ART initiation was considered as suboptimal in approximately one third of them. Risk factors associated with this delay were related to the care delivery system, including delays in sample collection and turn around procedures. Finally, the EPIPEV study showed that antibody levels to EPI vaccines in HIV-uninfected children born to HIV-infected mothers were higher compared to levels in HIV-infected children (60% vs 20% concerning measles vaccine), but lower than the levels described for children born to HIV-uninfected mothers. This result suggested an immunological dysfunction of HIV-exposed children which occurred during pregnancy and could affect their survival. Overall, our studies contributed in providing findings that could help in improving early care in HIV-exposed infants. These include the structural and functional organization of health structures, the effective implementation of current recommendations, and of active coordination.

Encontrar soluções para a problemática dos resíduos e, em virtude da crescente demanda por energia, diminuir a dependência dos combustíveis fósseis têm constituído grandes desafios para os pesquisadores. O setor hospitalar é um potencial gerador dos chamados Resíduos de Serviços de Saúde (RSS) que também apresenta um alto consumo de energia em decorrência do seu período de funcionamento e de equipamentos que necessitam de infraestrutura adequada. Apesar de representarem uma pequena parcela perante o montante dos Resíduos Sólidos Urbanos (RSU), no Brasil, nem todos os geradores se preocupam com seu tratamento e destinação final. O emprego de tecnologias desenvolvidas para o tratamento desses resíduos com a possibilidade de recuperação energética deve ser avaliado. O Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HC-FMRP-USP) gera cerca de 1,9 ton/dia de RSS. Nesse contexto, o objetivo geral desta pesquisa foi avaliar a viabilidade legal, ambiental e econômico-financeira da implantação de um sistema próprio de tratamento de RSS no HCFMRP- USP para geração de energia. A metodologia foi estruturada em pesquisa exploratória, coleta de dados por meio de entrevistas semi-estruturadas com responsáveis pelo setor dos RSS no hospital, com pesquisadores da área da saúde, de escolas de engenharia, órgãos técnicos e indústrias fabricantes dos equipamentos; levantamento bibliográfico e análise de conteúdo. Para a avaliação econômico-financeira, foi empregada a avaliação custoefetividade. Estudos comparativos sobre os tipos de tratamento disponíveis e utilizados nacionalmente foram considerados. Assim, o processo que melhor se adequou ao sistema proposto foi o da incineração com tecnologia de gaseificação e combustão combinadas (GCC). Os resultados demonstraram que o sistema proposto está sob a égide da lei contemplando, inclusive, a Política Nacional de Resíduos Sólidos (PNRS), desde que mediante anuência do Conselho Gestor do campus da USP e de sua Comissão de Meio Ambiente, além do devido processo de licenciamento ambiental junto à CETESB e pré-análise dos RSS. Contudo, sob o aspecto ambiental há questões públicas e políticas sobre a aceitação de sua implantação no complexo hospitalar. Embora haja o emprego de avançada tecnologia, o equipamento avaliado necessita de instalação, manutenção e monitoramento adequados por profissionais capacitados para operá-los, a fim de se evitar possíveis danos às pessoas e ao meio-ambiente, para isso, os envolvidos devem agir com responsabilidade. Por fim, sob o aspecto econômico-financeiro houve um empate técnico entre os custos do tratamento realizado atualmente e os da proposta do investimento. Assim, esse último aspecto avaliado incidiu sobre o benefício implícito da decisão de se implantar ou não o processo. Portanto, considera-se a viabilidade da implantação de um sistema próprio para tratamento de RSS no HCFMRP-USP para geração de energia sob os três aspectos: legal, ambiental e econômicofinanceiro. / Finding solutions to the waste problem and reducing dependence on fossil fuels due to the growing demand for energy have become big challenges for researchers to deal with. Hospitals are large producers of Medical waste (MW) and also big energy consumers due to their long running hours and the running of equipment that demands adequate infrastructure. Despite accounting for a small share of all the Municipal Solid Waste (MSW) not all producers, in Brazil, are concerned about waste treatment and its final destination. The use of technologies developed with the aim of treating such waste in order to generate energy has to be assessed. The Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP) generates around 1.9 tons of waste per day. In this context, the general aim of this research program was to assess the legal, environmental and economic-financial feasibility of the implementation of a private system of biomedical waste treatment at HCFMRP-USP in order to generate energy. The method was structured in exploratory research, data gathering by means of semi-structured interviews with MW department staff at the hospital, with Health researchers, with Engineering College researchers, technical organizations and equipment manufacturers, besides bibliographic referencing and content analysis. Cost-effectiveness analysis was used for the economic-financial analysis. Comparative studies of the types of treatment available and used nationwide were taken into consideration. Thus, the process which best suited the proposed system was that of incineration by means of Gasification Combined Cycle (GCC). Results showed that the proposed system is under the support of Law and it also takes into consideration the National Policy for Solid Waste (NPSW), provided that it has the approval of the Director Council of the Administration of the campus of USP and of its Environment Committee as well as appropriate environmental licenses granted by CETESB and pre-analysis of MW. However, under the environmental aspect, there are public and political issues regarding the acceptance of this implementation in the hospital premises. Although there is the use of advanced technology, the equipment which was assessed needs to be installed, maintained and monitored adequately by professionals trained to operate it so as to avoid possible damage to humans and the environment. Staff involved must be responsible. Finally, under the economic-financial aspect there was a draw between the costs of the treatment conducted at present and those of the proposed investment. Therefore, this last aspect assessed prevailed over the implicit benefit of the decision on whether to implement the process or not. However, the feasibility of the implementation of a private MW treatment system at HC-FMRP-USP in order to generate energy is to be considered under the legal, environmental and economicfinancial aspects.

Wind energy technologies are considered to be among the most promising types of renewable energy sources, which have since attracted broad considerations through recent years due to the soaring oil prices and the growing concerns over climate change and energy security. In Kuwait, rapid industrialisation, population growth and increasing water desalination are resulting in high energy demand growth, increasing the concern of oil diminishing as a main source of energy and the climate change caused by CO2 emissions from fossil fuel based energy. These demands and challenges compelled governments to embark on a diversification strategy to meet growing energy demand and support continued economic growth. Kuwait looked for alternative forms of energy by assessing potential renewable energy resources, including wind and sun. Kuwait is attempting to use and invest in renewable energy due to the fluctuating price of oil, diminishing reserves, the rapid increase in population, the high consumption of electricity and the environment protection. In this research, wind energy will be investigated as an attractive source of energy in Kuwait.

Esta dissertação analisa a viabilidade técnico-econômica de pequenas centrais de cogeração a gás natural no setor terciário do estado de São Paulo, os estudos de cogeração foram baseados em casos reais de estabelecimentos comerciais dos principais segmentos do setor terciário com demanda elétrica e térmica compatível ao balanço energético para a configuração de cogeração. A análise dos resultados inclui o fator de utilização de energia (FUE), investimentos iniciais, economia operacional (fluxo de caixa), retorno dos investimentos (Payback), taxa interna de retorno (TIR) e valor presente líquido (VPL). As tecnologias empregadas nos estudos foram gerador do tipo Motor a Combustão Interna (MCI) e Microturbina (TG), resfriador de líquido por absorção (ABS) e resfriador de líquido elétrico convencional. Foi realizada análise do potencial de mercado para aplicação de cogeração através do mapeamento dos principais segmentos do setor terciário e realizado o levantamento do estado da arte. Foram estudadas as legislações brasileiras tanto no que se refere à cogeração qualificada como geração distribuída, realizado análise de emissões com destaque ao comparativo entre emissão de CO2 das centrais de cogeração e a emissão de CO2 das termelétricas a gás natural. Foi realizado estudo do cenário energético brasileiro do ponto de vista geração e distribuição de energia elétrica, cenário da oferta de gás natural no Brasil e a sua estrutura de distribuição no estado de São Paulo e, por fim, foram destacados os benefícios e barreiras da cogeração no Brasil. Os resultados alcançados apontam para um revés na viabilidade financeira da cogeração devido aos consecutivos aumentos no preço da tarifa de gás natural, apesar de bastante racional e com benefícios diretos ao meio ambiente e ao país, fazem-se necessários incentivos específicos relacionados à tarifa do gás natural para o crescimento da aplicação de cogeração no setor terciário do estado de São Paulo. / This dissertation examines the technical and economic feasibility of small cogeneration plants powered by natural gas in the tertiary sector of the state of São Paulo. Cogeneration studies were based on real cases of commercial facilities of the main segments of the tertiary sector with electrical and thermal demands compatible for energy usage in cogeneration configuration. The analysis results include energy utilization factor (EUF), initial investments, operational savings (cash flow), return on investment (payback), internal rate of return (IRR) and net present value (NPV). The technologies investigated in the study were Internal Combustion Engine (ICE) and Microturbine (TG) generator, absorption chiller (ABS) and conventional electrical chiller. It was carried out an analysis of the potential market for application of cogeneration by mapping the main segments of the tertiary sector and conducted a survey of the state of the art. Brazilian laws were studied both with regard to qualified cogeneration and distributed generation, performed emissions analysis with emphasis on the comparative between CO2 emission from cogeneration plant and CO2 emission from power plants by natural gas. It was made a study of Brazilian energy scenario from the viewpoint of generating and distributing of electricity, scenario of supply of natural gas in Brazil and its distribution structure in the São Paulo state and, finally, it was appointed the benefits and barriers of cogeneration in Brazil. The results indicate a setback on the financial viability of cogeneration due to consecutive increases in the price of natural gas, although quite rational and with direct benefits to the environment and the country, it\'s necessary specific incentives related to the natural gas price for the growth of the application of cogeneration in the tertiary sector of the state of São Paulo.

The aim of this thesis is to evaluate different repowering alternatives from the viewpoint of increasing power production from existing offshore wind farms (OWF), as some of the first commissioned OWFs are approaching the end of their expected lifetime. The thesis presents a literature review of components and financial aspects that are of importance for repowering of OWFs. In the literature review, risks and uncertainties regarding repowering are also lifted and analysed. The thesis contains a case study on Horns Rev 1 OWF, where three different repowering scenarios are evaluated by technical and financial performance, aiming to compare the cost of repowering alternatives. The design of the case study is based around previous studies of offshore repowering having focused mainly on achieving the lowest possible levelized cost of energy (LCoE) and highest possible capacity factor, often resulting in suggested repowering utilizing smaller wind turbines than the existing ones. In order to evaluate the financial viability of repowering alternatives, the software RETScreen Expert was used to estimate the annual energy production (AEP) after losses and calculate the net present value (NPV) and LCoE for lifetime extension and full repowering utilizing different capacity wind turbines. Input values from the literature as well as real wind resource measurements from the site was utilized to achieve as accurate results as possible. The result of the case study shows that repowering of OWFs have the possibility of providing a very strong business case with all scenarios resulting in a positive NPV as well as lower LCoE than the benchmarked electricity production price. Although the initial investment cost of the different repowering alternatives presented in this thesis still are uncertain to some extent, due to the lack of reliable costs for repowering alternatives, this thesis provides a base for further research regarding the repowering of OWFs.

Type 1 diabetes affects a person’s life on many levels in terms of quality of life, health, and socioeconomic costs both for the patients but also their families. As of now there is no therapy that targets the underlying mechanism of the disease. Intralymphatic administration of Diamyd® is being evaluated in a phase IIb clinical trial, DIAGNODE-2. The aim was to examine if the intralymphatic administration is feasible for both patients and medical professionals, and to identify any aspects of the procedure that can be improved. This feasibility study is based on interviews and answers received from questionnaires. The medical professionals that were selected were radiologists and study nurses that are involved in the DIAGNODE-2 trial. The radiologists were the prime focus and were thus interviewed through face-to-face/skype or phone and answered a questionnaire. Study nurses, having more contact with the patient, answered a survey in order to gain additional insights into the patient perspective.   The results show that the radiologists has a positive view towards the administration procedure, which was described as easy and safe. According to the study nurses the patients accept the procedure and they agreed that the patients understand the injection procedure once they received the information. In terms of the emotional state of the patients they were a bit nervous, but they became calmer after receiving the first injection. Based on the above-mentioned findings the intralymphatic injection procedure is described as feasible and has the potential to become a part of the standard clinical routine.

[pt] O mercado brasileiro de energia elétrica ainda não encontrou um modelo de mercado e de formação de preço que garanta a expansão auto-sustentada da oferta. Investigando em detalhe o modelo atual de despacho da geração e formação do preço, demonstramos a sua pouca eficácia na atração de investimentos, e identificamos a causa dessa falha como sendo a miopia do modelo de despacho, uma vez os estados críticos do sistema só aprecem de forma significativa quando o sistema já estiver degradado. São estudados três modelos alternativos que modificam a função-objetivo ou a regra de formação do preço, ajustados de modo a viabilizar e tornar suficientemente atrativos os investimentos na expansão da oferta. Finalmente, estes modelos são então comparados entre si e com o modelo atual, quanto ao valor para o investidor e quanto ao custo para o sistema e para o consumidor. Um mercado é dito completo se permite aos agentes alocar livremente seus recursos e demandas quando estiverem disponíveis e/ou forem necessários e permite que os agentes condicionem estes recursos / demandas ao estado (preço) do mercado. Estas funcionalidades são implementadas através dos derivativos financeiros, negociados no mercado futuro. Neste trabalho fazemos uma análise conceitual do mercado futuro de energia elétrica, indicando a diferença em relação ao de outras commodities e apresentando um modelo da oferta e demanda por contratos futuros de energia elétrica. / [en] The Brazilian Market of Electrical Energy has not yet found a stable market and price model that ensues the feasibility and makes attractive a self-sustained investment for the expansion of electrical energy generation. Researching the current generation dispatch and spot price model, we show that it is ineffective to attract investments because the model is myopic, since the range of critical system states that is foreseen at the current state is not significant until the system is already too degraded. Stemming from this conclusion, we develop three alternative models, modifying the dispatch model objective and the price formation rule. These alternative models are tuned to make the investments in generation expansion feasible and attractive. The models are compared regarding their value to the investor and the cost to the system and to the consumer. A complete market allows the economic agents to freely allocate their resources and requirements whenever they are available and/or required. A complete market also allows conditional settlement, i.e., to condition the resource availability and/or requirement to a particular market state (price). These features are realized by financial derivatives, in the, so called, futures market. We present a conceptual analysis of the electrical energy s future market, pointing the differences to other commodities future markets that are due to economical unfeasibility of storing electricity. We also present an equilibrium model for the forward electrical energy contracts.

千年以來，人類不斷遭遇各種疫病的侵襲，流行速度更勝戰火蔓延，影響整體人類重大，然而隨著醫學知識的進步與衛生環境的改善，許多傳染病已經受到控制乃至根絕，但是生活周遭仍然面臨諸多威脅生命健康的潛藏危機，如果稍有疏失或不慎，傳染病不僅對於人體造成傷害，甚至恐將危害社會、經濟和政治層面，而近年的SARS、H1N1等流行病毒皆造成全球恐慌。 防疫工作重點在於及早掌握疫情趨勢以利制定相關因應政策，目前各國對於傳染病的掌握主要透過層層監測系統與歷史平均，藉以判斷該年特定傳染病流行與散佈程度。這些方法受到各種人為與環境因素影響，導致推估疫情成效有限之外，同時所得資料無法直接反應未來疫情，因此導致各國相關單位逐漸嘗試其他預測方法。 近年應用預測市場機制預測疫情模式引起公衛領域的重視，相關學術期刊與著名雜誌相繼介紹此一新興模式，同時肯定其在預測傳染病方面的成效與貢獻，而美國和台灣政府部門先後透過此項機制改善現有防疫體系的不足。那麼，預測市場用以預測疫情的成效是否確實如同其在眾多領域取得的成效一樣出眾？鑑於前述問題，本研究分別透過質化與量化的方式發掘公衛、醫學或流病學等其他領域對於「傳染病預測市場」是否能夠成為有效的預測機制或是成為常規的參考方法，結果證實使用的疾管局人員與參與的專業醫事人員認為「傳染病預測市場」確實可以應用於我國疫情預測的層面，但是兩者意見具有程度的差異。 / For centuries, the spread of various diseases damage countless human beings, which surpass wars in the world. Those diseases not only endanger people’s life, but also invade the other dimensions, including society, economic and politics. With the advancement of medical knowledge and the improvement of public health, many infectious diseases have been brought under control and even eradicated. But humans still face and experience threats from pandemic viruses such as SARS and H1N1 constantly. Epidemic prevention work focuses on understanding the variation of situation as soon as possible. Then governments can set up suitable decisions and policies based on epidemic situation. Though the monitoring system and the historical average are the mainstream to control the trends of infections for related departments, scientists believe that the two methods are subject to humans and environmental factors. In other words, it is difficult to draw effective information and direct response of the future trends from present methods. And it leads to national units gradually try other epidemic forecasting methods. In recent years, using prediction markets to predict flu causes the attention of public health. Thus academic journals and well-known magazines not only introduce this application but approve its effectiveness and contribution in predicting infectious diseases. The departments of US and Taiwan have tried to improve the deficiencies of the existing prevention system through prediction markets. Is this application really as successful as PM in many issues and fields? To response the question, this research intends to through qualitative and quantitative ways respectively to explore the evaluations on Epidemic Prediction Markets behind public health, medical, epidemiology, etc. The result confirms that CDC staff and health workers identify the feasibility of Epidemic Prediction Markets, but with the degree of variation.

The thesis outlined in this report has been done as a sub-project in cooperation between the municipalities Borlänge in Sweden and Chisinau in Moldova. The project aimed to explore the region's economic and environmental opportunities for waste incineration with energy recovery, also known as Waste to Energy. At present, the solution to the waste situation is unmonitored landfills with smaller sorting operations. Environmentally, this is a poor solution and although there are plans for change, no specific strategy has been presented. Another important issue is Moldova's dependence on foreign produced energy. The country's energy system is dependent on imported natural gas, and only a small part of the country's electrical energy is produced domestically. What makes the waste to energy so interesting for this region is that it contributes to an improvement in both of these issues by using the waste as fuel to reduce energy dependency. The study has been done without specific waste composition data for the Chisinau region. With this in mind a dynamic model in several steps has been made, designed to obtain new results depending on what waste composition is specified. The results of this study show that implementation of a waste incineration plant in the Chisinau energy system is economically and environmentally feasible, given the current conditions. The proposed plant is designed to annually handle 400,000 tonnes of waste, and would with the assumed waste composition deliver 560 GWh of district heat and 260 GWh of electric energy. This production provides an annual profit of 31.6 M €, which gives a positive net present value after the project amortization. Compared with the city's current solution with landfills and gas turbines, the project also provides a significant environmental improvement. During the plant's design lifetime, greenhouse gas emissions are 53.9%, and only 6.8% with the assumption that only a portion of the carbon content of the waste is of fossil origin.

No description available.