Subjects: This diploma thesis is dedicated to the topic of time management in nursing - it deals with four generations of time management and with its different techniques. Furthermore it describes functions and roles of a manager. Objectives: The main objective of this thesis is to analyse time management issues that concern nurse managers working in intensive care. The main goal of the research is to answer following question: How do nurse managers in intensive care use and organise their working time? Secondary goals are: to name priorities of nurse managers on an ordinary working day, to find out which timekeeping devices do nurse managers use for direct measuring of time consumption, to analyze managerial strategies used by nurse managers for their time management, to sum up the most frequent tasks postponed by nurse managers for a later time and find the reasons of procrastination. Methodology: Data were gained through a combined quantitative and qualitative research design. Quantitative research was done through the use of a time frame of a working day and a working week of nurse managers. Results were presented in boxes and charts to provide a better overview. Data for qualitative analysis were gained through semi-structured interviews in three focus groups. Qualitative data were processed...

Background: Many processes play a critical role in making non-manufacturing operations work as optimal as possible. One of these processes that is an important part of these activities is the goods flow process. If this process does not function effectively, this can affect the entire business, which in turn will lead to huge costs and lead times. It is therefore important that the flow of goods in the terminal works well because customers nowadays require that goods that they place an order have to be delivered as soon as possible. Purpose: The aim of the study is to find solutions for streamlining flow of incoming and outgoing goods, which will reduce unnecessary transport distances between goods reception and delivery ports, as well as finding a solution for lack of surface. Methodology: All necessary information has been collected by using qualitative and quantitative data and with the help of various types of interviews: semi-structured and unstructured, as well as participating in observations to initiate process mapping and find new terminal design. Subsequently, cost savings were achieved by comparing the new and old terminal design, after that calculations were performed to see how much surface use was made more efficient with movement of LKM stock. Conclusion: By analyzing incoming goods flow and changing port usage in the terminal, in other words by increasing the number of ports for a department and by distributing goods flow between ports in an optimal manner, goods flow efficiency can be achieved. Non-manufacturing operations work can improve its productivity by optimizing floor space usage and eliminating waste and defects which effect goods handling. / Bakgrund: Många processer spelar kritisk roll för att icke-tillverkande verksamheter ska fungera så optimalt som möjligt. En av dessa processer som utgör en viktig del i sådana verksamheter är godsflödeprocessen. Om denna process inte fungerar på ett effektivt sätt kan det påverka hela verksamheten som i sin tur kommer att leda till stora kostnader och ledtider. Det är därför viktigt att godsflödet i terminalen fungerar väl eftersom kunder nuförtiden ställer höga krav på att gods som de lägger en beställning på skall levereras så snabbt så möjligt. Syfte: Studiens syfte är att hitta lösningar för att effektivisera flödet av in- och utgående gods som i sin tur kommer att minska onödiga truckkörningar mellan godsmottagning och utleverans portar, samt att optimera golvyta användning i terminalen. Metod: All nödvändig information har samlats in genom att använda kvalitativa och kvantitativa data och med hjälp av olika typer intervjuer: semi-strukturerade och ostrukturerade, samt genom deltagande observationer för att initiera processkartläggning och designa ny terminallayout. Därefter räknades kostnadsbesparingen fram som uppnåddes genom att jämföra den nya och gamla terminaldesignen, efter detta utfördes beräkningar för att se hur mycket användning av golvyta effektiviserades med LKM lager förflyttning. Slutsats: Genom att analysera inkommande godsflöde och ändra portanvändning i terminalen, det vill säga utöka antal portar för en avdelning samt genom att fördela godsflöde mellan portar på ett optimalt sätt kan godsflödeeffektivisering åstadkommas. Icke-tillverkande verksamhet kan förbättra sin produktivitet genom att optimera golvyta användning och eliminering av slöserier och brister i godshanteringen.

A partir do trabalho para implantação do Sistema de Informações para Habitação Social - Habisp, este estudo se propõe a apresentar as fontes teóricas que sustentam o problema: é preciso ter método para planejar a ação pública e estabelecer prioridades de atendimento. E reflexiona sobre a importância e eficiência dos indicadores sociais e dos sistemas de informações no apoio à tarefa. Tem por objetivo geral avaliar os rebatimentos do Habisp e do seu sistema de priorização - um painel de indicadores físicos e sociais para a investigação e análise da situação física e social dos assentamentos precários da cidade de São Paulo - na política habitacional no município. Parte-se da hipótese que o Habisp e seu sistema de priorização contribuíram para que a municipalidade da cidade de São Paulo formulasse uma política de intervenções urbanísticas e socioambientais calcada na \"territorialização\" da precariedade, com ganhos em relação à capacidade de decisão, otimização de recursos e governança. / Based on the study for the implementation of the Social Housing Information System - Habisp, this study aims to present the theoretical sources which sustain the problem: a method is required to plan a public action and establish the service priorities, reflecting upon the relevance and the efficiency of the social indicators and the information systems which support the task. It aims to evaluate the folding tool of Habisp and its prioritization system - a panel of physical and social indicators for investigation and analysis of the physical and social situation of the precarious settlements in the city of São Paulo - in the housing policy of the municipality. It is assumed that Habisp and its prioritization system contributed to the municipality of the city of São Paulo to formulate a policy of urban and socio environmental interventions in accordance with the \"territorialisation\" of precariousness, with gains against decision making capacity, optimization of resources and governance.

A partir do trabalho para implantação do Sistema de Informações para Habitação Social - Habisp, este estudo se propõe a apresentar as fontes teóricas que sustentam o problema: é preciso ter método para planejar a ação pública e estabelecer prioridades de atendimento. E reflexiona sobre a importância e eficiência dos indicadores sociais e dos sistemas de informações no apoio à tarefa. Tem por objetivo geral avaliar os rebatimentos do Habisp e do seu sistema de priorização - um painel de indicadores físicos e sociais para a investigação e análise da situação física e social dos assentamentos precários da cidade de São Paulo - na política habitacional no município. Parte-se da hipótese que o Habisp e seu sistema de priorização contribuíram para que a municipalidade da cidade de São Paulo formulasse uma política de intervenções urbanísticas e socioambientais calcada na \"territorialização\" da precariedade, com ganhos em relação à capacidade de decisão, otimização de recursos e governança. / Based on the study for the implementation of the Social Housing Information System - Habisp, this study aims to present the theoretical sources which sustain the problem: a method is required to plan a public action and establish the service priorities, reflecting upon the relevance and the efficiency of the social indicators and the information systems which support the task. It aims to evaluate the folding tool of Habisp and its prioritization system - a panel of physical and social indicators for investigation and analysis of the physical and social situation of the precarious settlements in the city of São Paulo - in the housing policy of the municipality. It is assumed that Habisp and its prioritization system contributed to the municipality of the city of São Paulo to formulate a policy of urban and socio environmental interventions in accordance with the \"territorialisation\" of precariousness, with gains against decision making capacity, optimization of resources and governance.

A necessidade de investimento em saneamento no Brasil é essencial, pois está vinculada à melhoria da qualidade de vida da sociedade. Os projetos de saneamento exigem altos investimentos e, para garantir a prestação dos serviços, é necessário um sistema complexo de infraestrutura. Os elevados custos envolvidos e a limitação de recursos financeiros fazem com que seja preciso estabelecer prioridades para execução de projetos de saneamento. Com efeito, o objetivo desta pesquisa é propor um modelo multicritério de decisão para apoiar decisões de hierarquia de projetos de abastecimento de água e esgotamento sanitário. A pesquisa abordada tem enfoque qualitativo, sendo também vista como metodológica, pois sua finalidade é envolver métodos e procedimentos adotados como científicos. Assim, traz como escopo apoiar e estruturar o processo de decisão em que são definidos: os elementos (intervenientes, alternativas potenciais, critérios, problemática); tipos de decisão em grupo; escolha dos métodos multicritérios (PROMETHEE II & GAIA e ELECTRE IV); modelagem de preferência; sistemas de apoio à decisão (D-SIGHT e ELECTRE III-IV); avaliação de resultados e análise de sensibilidade. Procura-se garantir que a pesquisa tenha caráter prático, razão por que foi realizada a aplicação numérica do modelo no contexto da bacia dos rios Piracicaba, Capivari e Jundiaí, região sudeste do Brasil. / The need of investment in water supply and sewage projects in Brazil is substantial to improve the quality of life. These projects require high investments and, mostly, to ensure the provision of these services it is necessary a complex infrastructure. Due to the high costs associated with the lack of resources, it is relevant to prioritize projects. Thus, the purpose of this research is to propose a multicriteria decision model to support decisions hierarchy of water supply and sewage projects. This work has a qualitative and methodological approach; the goal is to inquire a scientific procedure. The object is to structure the decision-making process defined by its main concepts (actors, potential alternatives, criteria, problems), group decision making; selection of multiple criteria methods (PROMETHEE II & GAIA, ELECTRE IV); preference modeling, decision support systems (D-SIGHT and ELECTRE III-IV), evaluation and sensitivity analysis. This study seeks a practical purpose, so the proposed model, is applied in the basin of Piracicaba, Capivari e Jundiaí. The contribution here to aid similar situations where is necessary to establish priorities of sanitation projects.

Contexte : Pour les patients atteints d’une polyarthrite rhumatoïde débutante (PARD), l’utilisation de médicaments antirhumatismaux à longue durée d’action améliore les résultats pour les patients de manière significative. Les patients traités par un rhumatologue ont une plus grande probabilité de recevoir des traitements et donc d’avoir de meilleurs résultats de santé. Toutefois, les délais observés entre le début des symptômes et une première visite avec un rhumatologue sont souvent supérieurs à la recommandation de trois mois énoncée par les guides de pratiques. Au Québec, le temps d’attente pour voir un rhumatologue à la suite d’une demande de consultation est généralement long et contribue aux délais totaux. Objectifs : Nous avons évalué la capacité d’un programme d’accès rapide avec un triage effectué par une infirmière à correctement identifier les patients avec PARD et à réduire leur temps d’attente, dans le but d’améliorer le processus de soin. Méthodes : Une infirmière a évalué tous les nouveaux patients référés en 2009 et 2010 dans une clinique de rhumatologie située en banlieue de Montréal. Un niveau de priorité leur a été attribué sur la base du contenu de la demande de consultation, de l’information obtenue à la suite d’une entrevue téléphonique avec le patient et, si requis, d’un examen partiel des articulations. Les patients avec PARD, avec une arthrite inflammatoire non différentiée, ou atteints d’une autre pathologie rhumatologique aiguë étaient priorisés et obtenaient un rendez-vous le plus rapidement possible. Les principales mesures de résultat étudiées étaient la validité (sensibilité et spécificité) du triage pour les patients atteints de PARD ainsi que les délais entre la demande de consultation et la première visite avec un rhumatologue. Résultats : Parmi les 701 patients nouvellement référés, 65 ont eu un diagnostic final de PARD. Le triage a correctement identifié 85,9% de ces patients et a correctement identifié 87,2% des patients avec l’une des pathologies prioritaires. Le délai médian entre la demande de consultation et la première visite était de 22 jours pour les patients atteints de PARD et de 115 pour tous les autres. Discussion et conclusion : Ce programme d’accès rapide avec triage effectué par une infirmière a correctement identifié la plupart des patients atteints de PARD, lesquels ont pu être vus rapidement en consultation par le rhumatologue. Considérant qu’il s’agit d’un programme qui requiert beaucoup d’investissement de temps et de personnel, des enjeux de faisabilités doivent être résolus avant de pouvoir implanter un tel type de programme dans un système de soins de santé ayant des ressources très limitées. / Background : In patients with early rheumatoid arthritis (ERA), use of disease-modifying anti-rheumatic drugs substantially improves patient outcomes. Patients treated by rheumatologists are more likely to receive these treatments and to have better disease outcomes. However, delays from symptoms onset to first rheumatologist visit often exceed the guideline recommendations of 3 months. Waiting time to see a rheumatologist after a referral is made, is generally long in Quebec and contributes to those delays. Objectives : We evaluated the ability of a nurse-led triage and rapid access program to identify patients with ERA and reduce their waiting time, in order to improve process of care. Methods : A nurse assessed all new referrals received between 2009 and 2010, in a suburban Montreal rheumatology clinic. Priority level was assigned based on the written content of the referral, a telephone interview with the patient and, if needed, an partial joint examination. Patients with ERA, including undifferentiated inflammatory arthritis, and other acute rheumatologic conditions were prioritized and given an appointment as early as possible. The main outcome measures were validity (sensibility and specificity) of the priority level for patients with ERA and delay from referral to first visit with rheumatologist. Results : Of 701 newly referred patients, 65 had a final diagnosis of ERA. The triage correctly identified 85.9% of patients with ERA and 87.2% of patients with other high priority conditions. The median delay between referral date and first visit was 22 days for patients with ERA and 115 days for all others. Discussion and implications : This nurse led triage and rapid access program correctly identified most patients with ERA and resulted in rapid consultation for these patients. Since this is a labor intensive program, feasibility issues need to be resolved before implementing this type of triage in a resource constrained healthcare system.

L’arthrite est l’une des causes principales de douleur et d’incapacité auprès de la population canadienne. Les gens atteints d’arthrite rhumatoïde (AR) devraient être évalués par un rhumatologue moins de trois mois suivant l’apparition des premiers symptômes et ce afin de débuter un traitement médical approprié qui leur sera bénéfique. La physiothérapie et l’ergothérapie s’avèrent bénéfiques pour les patients atteints d’ostéoarthrite (OA) et d’AR, et aident à réduire l’incapacité. Notre étude a pour but d’évaluer les délais d’attente afin d’obtenir un rendez-vous pour une consultation en rhumatologie et en réadaptation dans le système de santé public québécois, et d’explorer les facteurs associés. Notre étude est de type observationnel et transversal et s’intéresse à la province de Québec. Un comité d’experts a élaboré trois scénarios pour les consultations en rhumatologie : AR présumée, AR possible, et OA présumée ; ainsi que deux scénarios pour les consultations en réadaptation : AR diagnostiquée, OA diagnostiquée. Les délais d’attente ont été mesurés entre le moment de la requête initiale et la date de rendez-vous fixée. L’analyse statistique consiste en une analyse descriptive de même qu’une analyse déductive, à l’aide de régression logistique et de comparaison bivariée. Parmi les 71 bureaux de rhumatologie contactés, et pour tous les scénarios combinés, 34% ont donné un rendez-vous en moins de trois mois, 32% avaient une attente de plus de trois mois et 34% ont refusé de fixer un rendez-vous. La probabilité d’obtenir une évaluation en rhumatologie en moins de trois mois est 13 fois plus grande pour les cas d’AR présumée par rapport aux cas d’OA présumée (OR=13; 95% Cl [1.70;99.38]). Cependant, 59% des cas d’AR présumés n’ont pas obtenu rendez-vous en moins de trois mois. Cent centres offrant des services publics en réadaptation ont été contactés. Pour tous les scénarios combinés, 13% des centres ont donné un rendez-vous en moins de 6 mois, 13% entre 6 et 12 mois, 24% avaient une attente de plus de 12 mois et 22% ont refusé de fixer un rendez-vous. Les autres 28% restant requéraient les détails d’une évaluation relative à l’état fonctionnel du patient avant de donner un rendez-vous. Par rapport aux services de réadaptation, il n’y avait aucune différence entre les délais d’attente pour les cas d’AR ou d’OA. L’AR est priorisée par rapport à l’OA lorsque vient le temps d’obtenir un rendez-vous chez un rhumatologue. Cependant, la majorité des gens atteints d’AR ne reçoivent pas les services de rhumatologie ou de réadaptation, soit physiothérapie ou ergothérapie, dans les délais prescrits. De meilleures méthodes de triage et davantage de ressources sont nécessaires. / Arthritis is a leading cause of pain and disability in Canada. Persons with rheumatoid arthritis (RA) should be seen by a rheumatologist within three months of symptom onset to begin appropriate medical treatment and improve health outcomes. Early physical therapy (PT) and occupational therapy (OT) are beneficial for both osteoarthritis (OA) and RA and may prevent disability. The objectives of the study are to describe wait times from referral by primary care provider to rheumatology and rehabilitation consultation in the public system of Quebec and to explore associated factors. We conducted a cross-sectional study in the province of Quebec, Canada whereby we requested appointments from all rheumatology practices and public rehabilitation departments using case scenarios that were created by a group of experts. Three scenarios were developed for the rheumatology referrals: Presumed RA; Possible RA; and Presumed OA and two scenarios for the rehabilitation referrals: diagnosed RA and diagnosed OA. Wait times were evaluated as the time between the initial request and the appointment date provided. The statistical analysis consisted primarily of descriptive statistics as well as inferential statistics (bivariate comparisons and logistic regression). Seventy-one rheumatology practices were contacted. For all scenarios combined, 34% were given an appointment with a rheumatologist within three months of referral, 32% waited longer than three months and 34% were refused services. The odds of getting an appointment with a rheumatologist within three months was 13 times greater for the Presumed RA scenario versus the Presumed OA scenario (OR=13; 95% Cl[1.70;99.38]). However, 59% of the Presumed RA cases did not receive an appointment within three months. One hundred rehabilitation departments were also contacted. For both scenarios combined, 13% were given an appointment within 6 months, 13% within 6 to 12 months, 24% waited longer than 12 months and 22% were refused services. The remaining 28% were told that they would require an evaluation appointment based on functional assessment prior to being given an appointment. There was no difference with regards to diagnosis, RA versus OA, for the rehabilitation consultation. RA is prioritized over OA when obtaining an appointment to a rheumatologist in Quebec. However, the majority of persons with RA are still not receiving rheumatology or publicly accessible PT or OT intervention in a timely manner. Better methods for triage and increased resource allocation are needed.

The budding yeast Saccharomyces cerevisiae has been an invaluable model organism in contributing to the current understanding of cellular biology, owing mainly to its highly tractable genetic system and the completion of its genome sequencing in 1996. Indeed, these bolstered the development of novel methods that have provided great insights into genetic and protein networks in human cells. With the large collection of datasets, S. cerevisiae also became an ideal platform for investigating the mechanism of action of novel compounds. The first part of my thesis uses a validated chemogenomic assay to investigate the mechanism of action of structurally related novel DNA-damaging agents, delineating valuable structure-activity relationship in the process. The second part describes the development of a method that uses drug-induced wild-type growth dynamic to characterize novel compounds, which, in combination with the chemogenomic assay, may complement existing high throughput screening experiments to improve the current drug development process.

The budding yeast Saccharomyces cerevisiae has been an invaluable model organism in contributing to the current understanding of cellular biology, owing mainly to its highly tractable genetic system and the completion of its genome sequencing in 1996. Indeed, these bolstered the development of novel methods that have provided great insights into genetic and protein networks in human cells. With the large collection of datasets, S. cerevisiae also became an ideal platform for investigating the mechanism of action of novel compounds. The first part of my thesis uses a validated chemogenomic assay to investigate the mechanism of action of structurally related novel DNA-damaging agents, delineating valuable structure-activity relationship in the process. The second part describes the development of a method that uses drug-induced wild-type growth dynamic to characterize novel compounds, which, in combination with the chemogenomic assay, may complement existing high throughput screening experiments to improve the current drug development process.

Major accidents in the process industries occurred mostly as an outcome of multiple failures in different safety barriers and their interrelation with unsafe acts by frontline operators. This has become the reason why safety analyses in terms of plant technical aspects cannot be performed independently from analysing human response to the changing technology. Unsafe acts and errors by operators must be seen as a symptom of system insufficiencies and underlying problems, rather than as the cause of an accident. With this paradigm, the need to optimally configure the system and the whole working condition to understand human’s limitation and requirements becomes very evident. It is too naive to desire that human operators make zero error by asking them to change their behaviour and to perfectly adapt to the system. Human Factors (HF) attempts to cope with the need to understand the interrelation between human operators, the technology they are working with and the management system, with the aim to increase safety and efficiency. In achieving this goal, HF must be incorporated into the whole plant lifecycle, from the earliest design stage to plant operation and modifications. Moreover, HF analysis must comprise all kinds of operators’ activities and responsibilities in operating process plants, which can include manual works in field and supervisory control conducted remotely from a control centre/room. This work has developed techniques that provide systematic way to incorporate HF into process plant lifecycle. The new HF analysis technique, PITOPA-Design, in a combination with the classic PITOPA, is applicable for an implementation during design and operation of a plant. With the awareness that safety analysis and HF cannot be performed separately, an interconnection with HAZOPs is made possible by means of this new technique. Moreover, to provide a systematic analysis of operators’ work in control room, an additional technique, the PITOPA-CR was also developed. This HF technique can as well be integrated into a general HF analysis both during design phase and plant operation. In addition to it, results coming from PITOPA-CR will provide information required to optimally configure control and alarm system, as well as the whole alarm management system to better understand the limitation and requirements of control room operators. The structure of the development can be described as follows: i) Development of HAZOPA (the Hazards and Operator Actions Analysis), which provides the interconnection between HF analysis and HAZOPs, ii) Development of PITOPA-Design, a technique to incorporate HF consideration into design phase, which is differentiated into 3 stages to comprise the conceptual design, the basic engineering and the detail engineering phase, iii) Development of PITOPA-CR, a technique for HF analysis in control room, iv) Integration of PITOPA-CR into alarm management system, development of a technique for alarm prioritization. / Schwere Unfälle in der Prozessindustrie erfolgen meist aus einem Zusammenspiel mehrerer verschiedener Fehler und der gleichzeitigen Wechselwirkung mit falschem menschlichem Handeln. Dabei sind diese Fehlhandlungen nicht als Unfallursache anzusehen, sondern sie resultieren aus Fehlern, die in dem System selbst zu finden sind. Aus diesem Grund kann bei der Sicherheitsanalyse die technische Analyse nicht unabhängig von der Betrachtung des Human Factors (HF) durchgeführt werden. Um eine Reduzierung der Fehlhandlungen zu erreichen, müssen das Anlagendesign, die Bedienbarkeit und die Arbeitsumgebung an die menschlichen Fähigkeiten angepasst werden. Human Factors (HF) betrachtet die Interaktion zwischen menschlichen, technischen und organisatorischen Aspekten einer Anlage, mit dem Ziel die Sicherheit und Effektivität der Anlage zu optimieren. Dafür ist eine Einbindung von HF in den gesamten Lebenszyklus einer Anlage notwendig. So müssen HF- Analysen nicht nur während des Betriebs einer Anlage und bei Prozessmodifikationen durchgeführt werden, sondern auch während des gesamten Design- Prozesses, da gerade in den frühen Design-Phasen das Optimierungspotential besonders hoch ist. Eine solche Analysemethode muss alle Aufgaben eines Operators erfassen, so dass zwischen manueller Arbeit und der Arbeit in der Leitwarte unterschieden werden muss. In dieser Arbeit wurden Analysentechniken entwickelt, die einen systematischen Ansatz zur Berücksichtigung des HF über den gesamten Lebenszyklus einer verfahrenstechnischen Anlage darstellen. Mit Hilfe der neuen Analysemethode, PITOPA-Design, können Untersuchungen sowohl während der Designphase als auch während des Betriebs einer Anlage durchgeführt werden. Da solche HF-Analyse immer in Verbindung mit einer klassischen Sicherheitsanalyse erfolgen muss, bindet die neue Methode die HAZOP-Analyse direkt ein. Darüber hinaus wurde ein weiterer Ansatz für die Analyse von Operatorhandlungen in einer Messwartenarbeit entwickelt. Diese neue Analysentechnik, PITOPA-CR, bildet die Grundlage für Verbesserungen im Alarmsystem und wird in das Alarmmanagementsystem eingebunden. Die Arbeit ist wie folgt strukturiert: i) Entwicklung von HAZOPA (the Hazards and Operator Actions Analysis). Diese Methode stellt die Einbindung der HF-Analyse in HAZOP dar. ii) Entwicklung von PITOPA-Design, zur HF-Analyse während des gesamten Designprozesses einer verfahrenstechnischen Anlage. Die Methode wurde in 3 Teile eingeteilt, um die drei Designsphasen Conceptual-, Basic-, und Detail-Design zu erfassen. iii) Entwicklung von PITOPA-CR, zur HF-Analyse in der Messwarte. iv) Einbindung von PITOPA-CR in das Alarmmanagementsystem und Entwicklung einer Technik zur Alarmpriorisierung.