A partir dos dados coletados pelo Programa de Defesa da Vida dos Lactentes da Secretaria de Higiene e Saúde do Município de Bauru no período de 11 de maio de 1986 a 10 de novembro de 1987, avaliou-se a capacidade de elementos clínicos e sociais, de fácil obtenção no momento do parto, predizer a mortalidade e internação de crianças entre O e 6 meses. O critério diagnóstico com maior sensibilidade para discriminar um grupo de crianças que devem receber uma atenção especial nos períodos de O a 6 dias e de 7 dias a 6 meses foram: - O a 6 dias: peso do recém nascido abaixo de 2500 gr, mãe menor de 18 anos e malformação congênita. - 7 dias a 6 meses: peso ao nascer abaixo de 2750 gr, renda familiar per capita abaixo de 0.75 salário mínimo, e malformação congênita. Outros critérios diagnósticos são apresentados e comparados com estes, entre os quais o do Programa de Defesa da Vida dos Lactentes, calculando-se as respectivas sensibilidades, especificidades e percentual de crianças classificadas como de risco. O mesmo critério diagnóstico proposto para prevenir a mortalidade entre 7 dias e 6 meses foi utilizado para calcular a sensibilidade quando o desfecho e a internação. / According to the data of the \"Infant Life Defense Program\" of the Public Health Office of the \"Municipallity of Bauru during the period of may 11, 1986 to november 10, 1987, we tried to evaluate the capacity of clinical and social characteristics which are obtained at the moment of birth for predicting mortality and hospitalization of children until 6 monthes of life. The diagnostic criterion with more sensitivity to choose a percentage of children to require special care between the first 7 days and betwen 7 days to 6 months of life: - O to 6 days: birth weight less than 2500 g., adolescent pregnancy and congenital malformations. - 7 d. to 6 m.: birth weight less than 2750 g., family revenue less than $27 per capita in a month and congenital malformations. Other diagnostic criteria have been shown and compared by the sensitivity and specificity to the proposals above in which the \"Infant Life Defense Program\" was included. The same diagnostic criteria was used to evaluate the sensitivity for hospitalization.

Safety analysis is a process involving several techniques.The purpose of this thesis is to test and develop methodssuitable for the safety analysis of railway risks and railwaysafety measures. Safety analysis is a process comprisingproblem identification, risk estimation, valuation of safetyand economic analysis. The main steps are described in separatechapters, each of which includes a discussion of the methodsand a review of previous research, followed by the contributionof this author. Although the safety analysis proceduredescribed can be used for analysing railway safety, it has suchgeneral foundations that it can be used wherever safety isimportant and wherever safety measures are evaluated. Itcombines cost benefit analysis with criteria for thedistribution and the absolute levels of risk. Risks are estimated with both statistical and risk analysismethods. Historical data on railway accidents are analysed andstatistical models fitted to describe trends in accident ratesand consequences. A risk analysis model is developed usingfault tree and event tree techniques, together with Monte Carlosimulation, to calculate risks for passenger train derailments.The results are compared with the statistical analysis ofhistorical data. People's valuation of safety in different contexts isanalysed, with relative values estimated in awillingness-to-pay study. A combination of focus groups andindividual questionnaires is used. Two different methods areused to estimate the value of safety and the results arecompared. Comparisons are also made with other studies. Different approaches for safety analysis and methods foreconomic analysis of safety are reviewed. Cost-benefit analysisas a decision criterion is discussed and a study on theeconomic effectsof a traffic control system is presented. There are several results of the work. Historical data showsa decrease in the accident rate. The average consequence ofeach accident has not changed over time. The risk analysismodel produces comparable results and enables analysis ofvarious safety measures. The valuation study shows that peopleprefer the prevention of small-scale accidents over theprevention of larger, catastrophic accidents. There are onlysmall differences in the valuation of safety in differentcontexts.

<p>Safety analysis is a process involving several techniques.The purpose of this thesis is to test and develop methodssuitable for the safety analysis of railway risks and railwaysafety measures. Safety analysis is a process comprisingproblem identification, risk estimation, valuation of safetyand economic analysis. The main steps are described in separatechapters, each of which includes a discussion of the methodsand a review of previous research, followed by the contributionof this author. Although the safety analysis proceduredescribed can be used for analysing railway safety, it has suchgeneral foundations that it can be used wherever safety isimportant and wherever safety measures are evaluated. Itcombines cost benefit analysis with criteria for thedistribution and the absolute levels of risk.</p><p>Risks are estimated with both statistical and risk analysismethods. Historical data on railway accidents are analysed andstatistical models fitted to describe trends in accident ratesand consequences. A risk analysis model is developed usingfault tree and event tree techniques, together with Monte Carlosimulation, to calculate risks for passenger train derailments.The results are compared with the statistical analysis ofhistorical data.</p><p>People's valuation of safety in different contexts isanalysed, with relative values estimated in awillingness-to-pay study. A combination of focus groups andindividual questionnaires is used. Two different methods areused to estimate the value of safety and the results arecompared. Comparisons are also made with other studies.</p><p>Different approaches for safety analysis and methods foreconomic analysis of safety are reviewed. Cost-benefit analysisas a decision criterion is discussed and a study on theeconomic effectsof a traffic control system is presented.</p><p>There are several results of the work. Historical data showsa decrease in the accident rate. The average consequence ofeach accident has not changed over time. The risk analysismodel produces comparable results and enables analysis ofvarious safety measures. The valuation study shows that peopleprefer the prevention of small-scale accidents over theprevention of larger, catastrophic accidents. There are onlysmall differences in the valuation of safety in differentcontexts.</p>

A partir dos dados coletados pelo Programa de Defesa da Vida dos Lactentes da Secretaria de Higiene e Saúde do Município de Bauru no período de 11 de maio de 1986 a 10 de novembro de 1987, avaliou-se a capacidade de elementos clínicos e sociais, de fácil obtenção no momento do parto, predizer a mortalidade e internação de crianças entre O e 6 meses. O critério diagnóstico com maior sensibilidade para discriminar um grupo de crianças que devem receber uma atenção especial nos períodos de O a 6 dias e de 7 dias a 6 meses foram: - O a 6 dias: peso do recém nascido abaixo de 2500 gr, mãe menor de 18 anos e malformação congênita. - 7 dias a 6 meses: peso ao nascer abaixo de 2750 gr, renda familiar per capita abaixo de 0.75 salário mínimo, e malformação congênita. Outros critérios diagnósticos são apresentados e comparados com estes, entre os quais o do Programa de Defesa da Vida dos Lactentes, calculando-se as respectivas sensibilidades, especificidades e percentual de crianças classificadas como de risco. O mesmo critério diagnóstico proposto para prevenir a mortalidade entre 7 dias e 6 meses foi utilizado para calcular a sensibilidade quando o desfecho e a internação. / According to the data of the \"Infant Life Defense Program\" of the Public Health Office of the \"Municipallity of Bauru during the period of may 11, 1986 to november 10, 1987, we tried to evaluate the capacity of clinical and social characteristics which are obtained at the moment of birth for predicting mortality and hospitalization of children until 6 monthes of life. The diagnostic criterion with more sensitivity to choose a percentage of children to require special care between the first 7 days and betwen 7 days to 6 months of life: - O to 6 days: birth weight less than 2500 g., adolescent pregnancy and congenital malformations. - 7 d. to 6 m.: birth weight less than 2750 g., family revenue less than $27 per capita in a month and congenital malformations. Other diagnostic criteria have been shown and compared by the sensitivity and specificity to the proposals above in which the \"Infant Life Defense Program\" was included. The same diagnostic criteria was used to evaluate the sensitivity for hospitalization.

The aim of this thesis is analysis and resolution of the decision-making problem "selection of merchandising and gifts supplier in an international company" using multi-criteria decision process while respecting risk. The goal of this thesis is to select a suitable supplier and offer recommendation to company's management for solving similar decision processes. The theoretical part of the thesis describes the knowledge base of methods and procedures of decision analysis that are later applied in the practical part of the thesis on the specific project with aim to optimize the decision-making process and identify the best variant. The conclusion of the thesis provides recommendations for solving similar problem in the future.

Made available in DSpace on 2014-07-29T15:29:13Z (GMT). No. of bitstreams: 1 Dissertacao Suelene Brito do Nascimento Tavares.pdf: 1452329 bytes, checksum: 6d86236e3c08daf9227c6b9f207128b7 (MD5) Previous issue date: 2007-09-06 / Cytopathology is an effective method of screening for cervical cancer; however, this method has high rates of false-negative results (FNR). To reduce FNR, routine measures of internal and external quality control are required in laboratories. The 10% random review of negative smears (R-10%) is the most commonly used method; however, it is not effective in reducing FNR. Nevertheless, there is evidence that the review of smears selected according to clinical risk factors (RCRF) and rapid prescreening (RPS) of all smears present good results. This study evaluated the performance of RPS, R-10% and RCRF as methods of internal quality control of cervical smear testing. The sample was composed of a total of 6,135 cervical smears from women who had attended Basic Health Clinics in Goiânia Goiás between March 2006 and March 2007. The cytopathological results were classified according to the 2001 Bethesda System. Initially, 6,135 smears were submitted to RPS followed by routine scrutiny (RS). Following RS, smears classified as negative were selected on the basis of clinical risk criteria, while 10% of all the smears were selected randomly, both sets then being submitted to the respective reviews. Four cytologists were responsible for RPS, RS, R-10% and RCRF, and three for reviewing the abnormal and discordant smears from any of the reviews. The smears classified as negative in RPS, RS, R-10% and RCRF were considered to have a final diagnosis (FD) of negative. Smears considered suspect or unsatisfactory at RPS were analyzed separately by two other cytologists. Smears considered abnormal or unsatisfactory at RS, R-10% and/or RCRF were likewise reviewed. When the two reviewing cytologists reached concordant diagnoses, these were considered the FD. Discordant results were analyzed by a third cytologist and a consensus meeting was held to define the FD. All stages of the study were performed blinded except for the consensus meeting. Smears classified as negative at RS, which were suspect at RPS and/or considered abnormal at R-10% and RCRF and confirmed abnormal in the FD, were considered FN results. Of the 6,135 smears, 5,522 were classified as negative, 84 as unsatisfactory and 529 as abnormal in the FD. Sensitivity of RPS was 63.0% for all abnormalities and 96.7% for high-grade squamous intraepithelial lesion (HSIL) compared to RS. The sensitivity of RPS was 74.9% for all abnormalities and 95.0% for HSIL compared to FD. The sensitivity of R-10% was 53.8% for all abnormalities when compared to FD. R-10% failed to detect any cases of HSIL. The sensitivity of RCRF was 64.0% for all abnormalities and 75.0% for HSIL compared to the FD. RPS identified an additional 132 (2.15%) abnormal smears, whereas R-10% and RCRF identified an additional 7 (0.11%) and 32 (0.52%), respectively. In conclusion, RPS is an effective method of internal quality control and has better sensitivity than R-10% and RCRF for the detection of FN results. It also allows the FN rate of the laboratory to be monitored and permits continuous evaluation of the prescreening cytologist and the routine screening cytologist. / O exame citopatológico é um método eficiente para prevenir o câncer do colo do útero, no entanto, apresenta altas taxas de resultados falso-negativos (RFN). Para reduzir os RFN, são necessárias medidas de controle interno e externo da qualidade na rotina dos laboratórios. O método de revisão aleatória de 10% dos esfregaços negativos (R-10%) é o mais utilizado, no entanto, não é eficiente para reduzir os RFN. Porém, há evidências de que a revisão dos esfregaços selecionados por critérios clínicos de risco (RCCR) e o pré-escrutínio rápido (PER) apresentam bons resultados. Esse estudo comparou o desempenho do PER, R-10% e RCCR como métodos de controle interno da qualidade dos esfregaços cervicais. A casuística foi constituída por 6.135 esfregaços citopatológicos cervicais de mulheres atendidas nas Unidades Básicas de Saúde de Goiânia GO, no período de março de 2006 a março de 2007. Os resultados citopatológicos foram classificados de acordo com o Sistema de Bethesda 2001. Inicialmente 6.135 esfregaços foram submetidos ao PER e em seguida ao escrutínio de rotina (ER). Após o ER os esfregaços classificados como negativos foram selecionados com base em critérios clínicos de risco e aleatoriamente 10% do total de esfregaços e submetidos às respectivas revisões. Quatro citologistas foram responsáveis pelo PER, ER, R-10% e RCCR e três pelas revisões dos esfregaços alterados e discordantes em qualquer revisão. Os esfregaços com resultados negativos no PER, ER, R-10% e RCCR foram considerados diagnóstico final (DF). Os esfregaços com resultados suspeitos ou insatisfatórios, pelo PER, foram analisados separadamente por dois outros citologistas. Também os esfregaços cujos resultados foram considerados alterados ou insatisfatórios pelo ER, R-10% e/ou RCCR foram igualmente revisados. Quando os dois citologistas revisores emitiram diagnósticos concordantes estes foram considerados DF. Os resultados discordantes foram analisados por um terceiro citologista e em uma reunião de consenso foi definido o DF. Todas as etapas do estudo foram realizadas às cegas, exceto na reunião de consenso. Os esfregaços classificados como negativos pelo ER que foram suspeitos pelo PER e/ou alterados nas R-10% e RCCR e confirmados pelo DF foram considerados RFN. Dos 6.135 esfregaços, 5.522 foram classificados como negativos, 84 como insatisfatórios e 529 como alterados pelo DF. A sensibilidade do PER foi de 63,0% para todas as anormalidades e de 96,7% para lesão intra-epitelial escamosa de alto grau (HSIL) quando comparado ao ER. A sensibilidade do PER foi de 74,9% para todas as anormalidades e de 95,0% para HSIL quando comparado ao DF. A sensibilidade da R-10% foi de 53,8% para todas as anormalidades quando comparado ao DF e não detectou nenhuma HSIL, enquanto a sensibilidade da RCCR foi de 64,0% para todas as anormalidades e de 75,0% para HSIL quando comparado ao DF. O PER acrescentou 132 (2,15%) esfregaços alterados, enquanto que a R-10% e a RCCR acrescentaram sete (0,11%) e 32 (0,52%), respectivamente. Enfim, o PER é uma alternativa eficiente de controle interno da qualidade, apresentando maior sensibilidade que as R-10% e RCCR na detecção de RFN. Permite, ainda, monitorar a taxa de RFN do laboratório, assim como avaliar continuamente o desempenho tanto do pré-escrutinador quanto do escrutinador de rotina.