Dissertationen zum Thema „Estimation de l’état de santé“
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El, Hayek Antoine. „Analyse de vieillissement, estimation de la durée de vie et méthode de surveillance de l’état de santé des condensateurs électrolytiques“. Thesis, Lyon, 2020. http://www.theses.fr/2020LYSE1037.
Der volle Inhalt der QuelleWith the emergence of new technologies, we are witnessing the development of techniques to improve dependability and in particular the maintainability of static energy converters and their components. In these conversion systems, the electrolytic capacitors, ensuring a stable DC network, represent an important element in the AC / DC and / or DC / AC electrical energy conversion chain. In operation, they are subject to electrical and environmental constraints (ambient temperature, current ripple, applied voltage, humidity, vibrations, etc.). These capacitors undergo redox reactions, which consume and evaporate electrolyte. The lifetime of the capacitor is thus affected. Therefore, it is interesting to estimate the state of health of these components in order to be able to schedule maintenance operations. It is therefore useful to develop tools for applying conditional monitoring. In the context of this work, the objective is to propose a system for monitoring the state of health of the electrolytic capacitors. We have therefore developed evolution models of their aging indicators which are the variations of the equivalent series resistance ESR and equivalent capacity C. The prediction algorithm is based on the evolution of these indicators to estimate the state remaining life of the capacitor module. The real-time monitoring system developed does not include additional sensors to those already existing in the energy converters considered and does not require prior accelerated aging tests. In this manuscript, we first detail the experimental procedure for accelerated aging, the different stages of characterization, the aging process and the associated results. We propose a simple and effective method to identify ESR and C aging indicators in real time. The proposed algorithm is based on time scaling and on a reference frame of temperature and voltage constraints. Subsequently, the results of the simulation of the surveillance system and the forecast of the selected state of health are presented. Experimental tests have been carried out on capacitors integrated into an industrial speed controller with a power of 15 kW. The algorithms implemented and their respective implementation constraints, for a real-time application, are detailed
Arnaud, Amandine. „Evaluation de l’état de santé et des conditions de vie des personnes sans domicile à partir d’enquêtes épidémiologiques : difficultés méthodologiques et pratiques“. Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS384/document.
Der volle Inhalt der QuelleSince the 80’s, many surveys have been carried to count and describe homeless people, and to understand the exclusion’s phenomenon to advice French public assistance policies. However, only a few surveys have been done ensuring representativeness and even fewer attempted in assessing the health status of homeless people in an objective way, whereas housing deprivation (homelessness) is known to have a durable impact on health. This can be explained by the fact that this population is difficult to define, as it is very heterogeneous and constantly evolving (number and profile wise). The homeless are also scattered and highly mobile within the Ile-de-France territory, and also between streets and different forms of accommodation. These particularities are all constraints to epidemiological surveys among homeless people, and the generalization of their results.This PhD thesis presents the state of knowledge on homelessness and what has been done in order to give support to this population between 2007 and 2016. It compiles knowledge on the health status and living conditions of homeless people in Ile-de-France based on epidemiological surveys carried out by the Observatoire du Samusocial de Paris focusing on mental health, ectoparasites or anemia. It details the main methodological and practical obstacles encountered during these investigations, the solutions chosen to overcome them and concludes by affirming that reasonable and reliable estimates of prevalence can be produced in the field of health
Rochefort, Claire. „Analyse du vieillissement, estimation de la durée de vie et méthode de surveillance de l’état de santé des condensateurs à film métallisé“. Electronic Thesis or Diss., Lyon 1, 2024. http://www.theses.fr/2024LYO10183.
Der volle Inhalt der QuelleWidely used, the metallized film capacitors are a common cause of electronic system failure. Some of their failures can lead to serious accidents and severe damage to their surroundings, such as explosions or fires. In addition to these safety issues, the failures analysis is justified by the economic issues related to the maintenance of these systems. The objective is to estimate the remaining useful lifetime and to prevent the sudden failures. Nowadays, the most used ageing laws require performing preliminary ageing tests to identify their parameters and enable their extrapolation. These parameters strongly depend on the series and the manufacturer of the capacitor itself. For these reasons, these ageing laws are costly to use and not robust. Other types of laws based on stochastic processes and related to failure mechanisms are emerging. However, their robustness and predictive capability need to be evaluated. Finally, even if measures are implemented to reduce the occurrence of catastrophic failures, risks persist. There is a need to prevent these types of failures without solely relying on the internal characteristics and the background of the capacitors. To address these issues, this work was carried out in collaboration with Schneider Electric as part of a CIFRE contract. Several accelerated ageing tests were carried out on a total of 111 capacitors from different manufacturers. The first test campaign focused on ageing under fixed conditions of alternating voltage and temperature, while the second added the additional constraint of humidity. Post-mortem analysis revealed that the different ageing campaigns led to the prevalence of a specific type of failure mechanism. The first campaign highlighted the effects of self-healing, and the second, those of corrosion. Based on these results, models of the capacitance evolution according to these two mechanisms were established. These were validated by the data in comparison to some existing laws. A first model based on the metallization resistance degradation due to self-healing effects was also proposed. Simultaneously, a large number of thermal runaways on capacitors were observed. Through real-time health indicator measurements, an in-depth study of the process was conducted. Early signs of thermal breakdown were identified. These results enable the early detection of thermal runaway and the implementation of damage prevention measures. Based on this principle, a generic method for preventing the risk of thermal breakdown was proposed. Its feasibility has been demonstrated and experimentally evaluated
Dbeiss, Mouhannad. „Mission Profile-Based Accelerated Ageing Tests of SiC MOSFET and Si IGBT Power Modules in DC/AC Photovoltaic Inverters“. Thesis, Université Grenoble Alpes (ComUE), 2018. http://www.theses.fr/2018GREAT020/document.
Der volle Inhalt der QuelleIn the case of photovoltaic installations, the DC/AC inverter has the highest failure rate, and the anticipation of its breakdowns is still difficult, while few studies have been done on the reliability of this type of inverter. The aim of this PhD is to propose tools and methods to study the ageing of power modules in this type of application, by focusing on ageing phenomena related to thermo-mechanical aspects. As a general rule, the accelerated ageing of power modules is carried out under aggravated conditions of current (Active Cycling) or temperature (Passive Cycling) in order to accelerate the ageing process. Unfortunately, when applying this type of accelerated ageing tests, some failure mechanisms that do not occur in the real application could be observed, while inversely, other mechanisms that usually occur could not be recreated. The first part of the PhD focuses on the implementation of an accelerated ageing method of the semiconductor devices inside photovoltaic inverters. This is accomplished by analyzing the mission profiles of the inverter’s output current and ambient temperature, extracted over several years from photovoltaic power plants located in the south of France. These profiles are used to study photovoltaic current dynamics, and are introduced into numerical models to estimate losses and junction temperature variations of semiconductors used in inverters, using the cycle counting algorithm “Rainflow”. This method is then performed in two experimental test benches. In the first one, the devices under test are IGBT modules, where the accelerated ageing profile designed is implemented using the opposition method. Moreover, an in-situ setup for monitoring ageing indicators (thermal impedance and dynamic resistance) is also proposed and evaluated. The second bench is devoted to study the ageing of SiC MOSFET power modules. The accelerated ageing test is carried out under the same conditions as for the IGBT modules with more monitored electrical indicators, but this time by disconnecting the semiconductor devices from the inverter. The results obtained allowed to determine several potential ageing indicators of IGBTs and SiC MOSFETs used in a photovoltaic inverter
Breuneval, Romain. „Surveillance de l’état de santé des actionneurs électromécaniques : application à l'aéronautique“. Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE1313.
Der volle Inhalt der QuelleThe aeronautics industry is facing three major challenges: the reduction of its environmental impact, the absorption to the air traffic increase and a high level of safety for increasing complex systems, for equivalent costs. Predictive maintenance allows answering to these issues. Systems, for which the life can be predicted, can be used for a longer time. This reduces the number of components used in the lifetime of an aircraft. To predict failures also allow increasing the availability of aircrafts by avoiding unplanned downtime. Finally, monitoring the ageing of the aircraft allows to optimize maintenance and so to reduce costs. In the 2000s, these methodologies were applied to turbojets. It starts, now, to be generalized to others avionics systems. Therefore, this work deal with predictive maintenance methodologies for electromechanical actuator (EMA) for flight controls systems. Problems and constraints (computation time, memory quantities…) related to this subject are detailed. In a first part, fault feature computation methodologies are investigated. A first method is proposed for screw/nut systems. This method is based on the identification of a friction model. A second method, based on current analysis, is presented. This method uses a combination of empirical mode decomposition and independent component analysis. The two methods are tested on data from a non-operational profile. This data are from a simulation model which represents the EMA in the aircraft environment. The simulations performed represent virtual trials on a population of EMA. From these simulations, fault features are computed. Then, performances metrics are evaluated. Diagnosis by pattern recognition is then studied. An algorithm based on support vector machine and fuzzy membership functions is proposed. This algorithm can estimate the severity of a fault. It can also detect unknown observations, which can represent unknown faults or combined faults. The architecture of a global diagnosis system, based on the proposed algorithm, is detailed. Experimental validation of fault features computation and diagnosis algorithm is performed. These validations are based on three data bases. The first one is based on trials performed on a healthy EMA on a representative bench. The second consists in an induction motor at constant speed for different types of faults. The last one is from trials on a permanent magnet synchronous machine, of aeronautics type, for different kinds of short – circuit fault severities. The respect of the aeronautics constraints is verified. At last, elements for prognosis process are given. This process is detailed. Only a part of this process is treated, on a roller bearings benchmark database. First, the clustering for prognosis is studied. A metric, which allows verifying that the obtained clusters are coherent regarding time, and thus, checks the constraints for prognosis, is given. Then the proposed diagnosis algorithm is validated on the clustered data. This brought to perform two kinds of validation, a diagnosis oriented one and a prognosis oriented one. A method to normalize data for the prognosis oriented validation, based on sigmoid function, is given. The prediction of the features in the future is studied. A regression algorithm based on support vector regression is used. Finally, the diagnosis algorithm is applied to the predicted data. This allows to estimate the end of life, and so the remaining useful life for a given time. These estimations are evaluated regarding different kinds of performance metrics and regarding the constraints of the aeronautics applicative field
Wang, Yuqi. „Suivi de l’état de santé des réseaux de distribution de chaleur“. Thesis, Lille, 2019. http://www.theses.fr/2019LIL1I016.
Der volle Inhalt der QuelleCompanies managing district heat networks, provide energy services to customers. Faced with rising energy costs and increasingly stringent regulatory and societal pressures, these energy service companies are seeking to control the system energy efficiency, aiming at improving their competitiveness and social image. In this context, the industrial needs to monitor the energy efficiency of the energy distribution system and its health state, in order to perform maintenance operations in case of problems. Due to the large amount of data and the desired short reaction time, it is necessary to develop methods to support the operator in the health state monitoring and in the maintenance decision-making process. These methods aim at providing appropriate health indicators of system's components, whose evolutions are easy to be interpreted by operators. Behavioral models of heat networks are used on the one hand to generate these indicators, and on the other hand to establish the links between component faults and their impacts on energy efficiency of the network. These links are analyzed to search for monitorable subsystems, i.e. to verify whether the faults to be monitored are structurally detectable, and to guide the indicators generation. Static models are retained for their genericity, simplicity of development, of calculation and of interpretation. Indicators generated using static models must be calculated when the system is operating in steady state. For this reason, we propose a method to determine the steady state time-windows. The computed indicators are then analyzed to give to the operator an information on the system's health state. Structural analysis shows that an indicator can be sensitive to different faults, and that a fault can influence the values of several indicators. The evolutions of these indicators can therefore be correlated. In order to use the information of the correlation between the indicators to isolate the fault,indicators values are analyzed in the space of indicators. We propose a dynamic clustering method to help the operator to monitor the health state of the network.The proposed approach is applied on a heat network plant managed by Veolia, the industrial partner of this thesis, using the data recorded during two months. The results show the efficiency of the proposed tools and methods
Bagot, Mathieu. „Plateforme adaptative pour le suivi de l’état de santé de patients mobiles“. Thesis, Lorient, 2020. http://www.theses.fr/2020LORIS560.
Der volle Inhalt der QuelleThe combination of portable sensors and wireless transmission technologies offers interesting prospects for mobile health applications. With such applications, the health status of a fragile patient can be continuously monitored, even as the patient continues to go about his or her normal activities rather than being confined to a home or hospital. However, the development of fully operational applications for this type of monitoring remains a challenge, firstly because not all conditions require the same sensors or the same processing of the data collected, and secondly because mobility leads to particular requirements in terms of the autonomy of the monitoring device, and resilience to transmission hazards. In this thesis we identify the characteristics required of a monitoring system that meets these needs, and propose technical solutions to meet them. We then present a platform combining these solutions. This platform can be adapted to various conditions thanks to a plugin mechanism that makes it both modular and extensible. In addition, it can be adapted to the context, according to a strategy that may depend on the patient's condition, the current health status, and the resources available to collect and transmit data related to that health status
Li, Huan. „Energy consumption minimization strategy for fuel cell hybrid electric vehicles“. Thesis, Bourgogne Franche-Comté, 2018. http://www.theses.fr/2018UBFCA034/document.
Der volle Inhalt der QuelleGlobal warming, environment pollution and exhaustion of petroleum energies have risen their attention of the humanity over the world. Fuel cell hybrid electric vehicle (FCHEV) taking hydrogen as fuel and have zero emission, is thought by public and private organisms as one of the best ways to solve these problems. This PhD dissertation consider a FCHEV with three power sources: fuel cell, battery and supercapacitor, which increases the difficult to design an energy management strategy (EMS) to split the power between the different power sources.Among the EMS available in the current literature, the Equivalent consumption minimization strategy (ECMS) was selected because it allows a local optimization without rely on prior knowledge of driving condition while giving optimal results.Due to low energy density of supercapacitor, its equivalent hydrogen consumption is neglected in most bibliographic references, which not only counter to the aim of minimizing whole hydrogen consumption but also increase the complication of EMS due to the need of an additional EMS to calculate supercapacitor power demand. Thus, a sequential quadratic programming ECMS (SECMS) strategy is proposed to consider energy cost of all three power sources into the objective function. A rule based control strategy (RBCS) and hybrid strategy (HEOS) are also designed in order to to be compared with SECMS. Degradation of energy sources represents a major challenge for the stability of the developed SECMS system. So, based on online estimating state of heath of fuel cell and battery, an adaptive ECMS (AECMS) has been designed through adjusting the equivalent factor and dynamical change rate of fuel cell. The simulation results show that the AECMS can ensure the charge sustenance of battery and the increase of fuel cell durability.To validate the proposed energy management algorithms and the numerical models an exerimental test bench has been built around the real time interface DSPACE. The comparison of the simulation and experimental results showed that the proposed SECMS is operated at around maximum efficiency, supercapacitor supplies peak power, battery works as the energy buffer. It has been proved that the neglect of supercapacitor equivalent hydrogen consumption in ECMS leads to not optimal operation. Compared with RBCS and HEOS, SECMS has least hydrogen consumption and most stable fuel cell current
Blondel, Pierre. „Estimation de l’état interne d’une batterie lithium-ion à l’aide d’un modèle électrochimique“. Thesis, Université de Lorraine, 2019. http://www.theses.fr/2019LORR0008/document.
Der volle Inhalt der QuelleDeveloped in the nineties, lithium batteries have colonized our environment in less than thirty years and they keep spreading faster and faster. Powerful, efficient, light and compact, this technology remains hazardous. In order to limit the danger and slow the aging of lithium cells, most of such batteries embed a management system. The latter needs to access some internal states, which are not directly measurable. This thesis intends to estimate these variables using a nonlinear observer, which is based on an electrochemical model. The behavior of the battery is driven by the transportation phenomenon of its main electrochemical species. We therefore built a finite dimensional electrochemical model of these adapted to estimation. It relies on the spatial discretization of the partial differential equations, which describe these transportation phenomena. It also formulates some assumptions, such as the fact that an electrode globally behaves like a single particle of its active material. The obtained state space model has affine dynamics and a nonlinear output. Among the existing observers for such systems that we are aware of, none can be applied directly to the developed model. Hence, we developed new ones whose stability is guaranteed provided a linear matrix inequality holds, which is used to construct the observation gain. We then confront these observers to experimental data acquired on commercialized batteries. The obtained results are encouraging and the observer seems to be a fair compromise between physical meaning and numerical complexity
Blondel, Pierre. „Estimation de l’état interne d’une batterie lithium-ion à l’aide d’un modèle électrochimique“. Electronic Thesis or Diss., Université de Lorraine, 2019. http://www.theses.fr/2019LORR0008.
Der volle Inhalt der QuelleDeveloped in the nineties, lithium batteries have colonized our environment in less than thirty years and they keep spreading faster and faster. Powerful, efficient, light and compact, this technology remains hazardous. In order to limit the danger and slow the aging of lithium cells, most of such batteries embed a management system. The latter needs to access some internal states, which are not directly measurable. This thesis intends to estimate these variables using a nonlinear observer, which is based on an electrochemical model. The behavior of the battery is driven by the transportation phenomenon of its main electrochemical species. We therefore built a finite dimensional electrochemical model of these adapted to estimation. It relies on the spatial discretization of the partial differential equations, which describe these transportation phenomena. It also formulates some assumptions, such as the fact that an electrode globally behaves like a single particle of its active material. The obtained state space model has affine dynamics and a nonlinear output. Among the existing observers for such systems that we are aware of, none can be applied directly to the developed model. Hence, we developed new ones whose stability is guaranteed provided a linear matrix inequality holds, which is used to construct the observation gain. We then confront these observers to experimental data acquired on commercialized batteries. The obtained results are encouraging and the observer seems to be a fair compromise between physical meaning and numerical complexity
Iugulescu, Lestrade Raluca. „Des recompositions institutionnelles de l’État par l'agencification : le cas des agences régionales de santé au prisme de la « veille sanitaire »“. Thesis, Toulouse 1, 2017. http://www.theses.fr/2017TOU10056.
Der volle Inhalt der QuelleThis thesis deals with the study of the process of agencification, illustrated by regional health agencies (ARS), and analyzed as a form of institutionalization. We are interested in the sanitary surveillance, one of the missions carried out by ARS, which we have taken as an example of the broader change of agencification. Based on several first-hand and second-hand sociological data sources, collected in two separate periods and using an ethnographic approach, the thesis proposes to clarify the setting up of the "ARS common houses " as desired by the political-administrative powers as to explore how they manage to "form an institution". As such, we study in three steps the recompositions implied by the ARSs' creation. First, by the study of the ARS's genesis: from a project to the recruitment of personnel, we show how the representations the agents have of the ARS shape it. Secondly, the professional, hierarchical and statutory recompositions imposed by the creation of the agencies, as well as the study of an intermediary role - the department manager- account for the evolution within the ARS of the profession of health surveillance, as a bureaucratic practice and the establishment of ARSs as institutions. It is the traditional public health professions, the technical bodies of the State, but also some new figures, more "fuzzy" and neo-managerial, which allow us to grasp here the "prudential" character of the profession of health watch. And it is in an "ethos" of public health as form of resilience, acquired in School and on the field, that allow them to "form a body" together, but in an ephemeral way. Finally, the study of a third source of recomposition, which is inseparable from the establishment of ARS, namely the digitization of exchanges in administrative life, reveals to us the institution even more. Nowadays, through the screens and the electronic network of which they are the terminals of bureaucratic practices, authority is intensified, revealing increased forms of institutional docility, impacting roles, memory and bureaucratic routines. Our study shows that beyond the regionalization by the ARS, the agencification and the professional, hierarchical and statutory recompositions that it generates, it is a whole system of practices and representations of agents that is quietly transformed, allowing us to observe the new" at a distance bureaucratic practices that mergers and agencifications of all kinds spread. However, our study reveals at the same time places where institution still succeeds in "forming a body" with its agents. The generalists of the "public issue" protect and still keep watch on Public Health in the ARS
Hébert, Maude. „Processus de transition des perceptions de l’état de santé de femmes atteintes d’un cancer du sein“. Thèse, Université de Sherbrooke, 2016. http://hdl.handle.net/11143/8166.
Der volle Inhalt der QuelleAbstract : This study aims to propose a theoretical model of the transition process perceptions of health status of women diagnosed with breast cancer in a nursing perspective. Although the experience of living with a diagnosis of breast cancer has been an increasing number of studies over the past two decades, it still raises many conceptual questions. Thus, the transition between being healthy, being diagnosed with breast cancer overnight without experiencing systemic symptoms and being healthy again was the subject of this thesis. Considering the current state of the literature and the purpose of research, the author has used a Grounded Theory methodology (Strauss & Corbin, 1998) to guide this study because it emphasizes the study processes and social interactions. Thus, to reach diversity of women, the author uses three settings: a tertiary hospital, a secondary hospital and a university. Collection and data analysis were carried out from 32 semi-structured interviews with women at different times in the course of chronic disease (n = 30), healthy women carrying the BRCA1 gene and a woman without health history of breast cancer in her family. From the conceptualization emerged three broad categories or concepts defined by their attributes and articulated in an explanatory model. These categories are: a) perceptions of health and disease before the transition, b) transition and c) perceptions of health and illness after the transition. The first category of perceptions of health and disease before the transition is divided according to the concepts of invulnerability, opposite to the disease perceptions of health and death, fear and doubt if heredity. The transition begins at the moment of the diagnosis and lasts up to one year following the end of treatments. React emotionally to deal with the situation, develop a new conception of life and respond to representations of cancer are circular stages of transition process. The central category of the transition is defined by not feeling sick. The personal, interpersonal and social factors influence these perceptions. Then, once the chemotherapy and radiotherapy are completed, women are in a state of health change. The changing perceptions of health and illness after the transition begins is characterized by perception of health that are more holistic and valuable. Cancer is now a surmountable event that nobody is immune. The salient point emerging from this research is to learn to live with a sword of Damocles over the head when the participants find themselves in a state of health changed.
Carbajal, Rosas Katherine. „Évaluation de l’état de santé bucco-dentaire à différents stades de la maladie d’Alzheimer : étude observationnelle longitudinale prospective“. Master's thesis, Université Laval, 2020. http://hdl.handle.net/20.500.11794/66793.
Der volle Inhalt der QuellePeople suffering from Alzheimer’s disease suffer from cognitive declines which deteriorate their general and oral health. We frequently observe dental cavities, periodontal disease and tooth loss among these people. In that respect, we wanted to establish a health and oral evolutionary curve throughout Alzheimer’s disease. To that end, we conducted a prospective observational study that includes a transverse and longitudinal component. The participants had to have Alzheimer’s disease at different stages, have teeth and live in the province of Quebec. Combative, bedridden people, and those who were diagnosed with bacterial endocarditis or who had heart valve prostheses were excluded from this research. The data corresponding to the variable responses (number of visible and missing teeth, obturations, cavities, retained dental roots and loose teeth, plaque index and gingival bleeding) and explanatory variables (age, gender, education level, resulting score to the Folstein Mini-Mental State Examination, co-morbid conditions, quantity of saliva and the use of dental care) have been provided through a medical examination form. We recruited participants (n = 46) from six Quebec health facilities between May 2016 and October 2017. This study showed that as Alzheimer’s disease progresses, dental plaque (p = 0,05) and gingival bleeding (p = 0,01) increase and the number of teeth (p < 0,0001) and fillings (p = 0,04) decreases. Also, the number of cavities, retained dental roots and loose teeth, seem to increase with the progression of the disease. The probability of having a cavity drastically increases as the cognitive decline progresses (p = 0,023). In conclusion, oral health deteriorates with the development of Alzheimer’s disease, and this from the moderate stage of the disease.
Mauduit, Florian. „Evaluer l’état de santé des poissons : la pierre angulaire manquante dans l'évaluation et la gestion des risques écologiques“. Thesis, Brest, 2017. http://www.theses.fr/2017BRES0033/document.
Der volle Inhalt der QuelleGrowth of human population and associated intensification of human activities is putting considerable pressure on coastal marine ecosystems. To assess anthropogenic impact on these ecosystems, substantial efforts have been devoted to the development of biomarkers. Despite a potential for a broad application range, most commonly used biomarkers target effects at sub-organismal organizational level (molecules, cells or tissues) and very few are liable to indicate impacts at organism or higher organizational levels. On the other hand, although too far removed from causal events to constitute early warning signals of environmental stress, high-level organizational biomarkers are of considerable relevance to human activities, economy and well-being. They are indeed the integrative result of the environmental history of an organism and, at the same time, reflect their vulnerability and resilience to changes in their living conditions. This view is corroborated by the recent revision of the concept of animal health, which nowadays incorporates the latent effects of past living conditions, the consequences of past exposures and experiences and the cumulative consequences of these effects. The joint use of high organizational levels markers and the concept of health could help overcome the failure of current biomarkers to provide ecologically relevant information. In this context, the objectives of my thesis were 1) to develop a methodology to assess fish health; 2) to investigate the underlying mechanisms and confounding factors of the performances measured and 3) to verify the applicability of our approach through two case studies.Throughout these researches, we demonstrated that hypoxia tolerance, temperature susceptibility and swimming performances are promising biomarkers of fish health. Their responses are stable over time, predictive of fish survival in the field and sensitive to an exposure to dispersant-treated oil. Also, application of this methodology to case studies demonstrated that our approach is generalizable to different contexts and that it provides operational information easily transferable to socio-economic sectors and general public
Gautier, Amandine. „Douleurs en chaîne : une approche multi-niveaux de la santé au travail des agents de l’État en abattoir“. Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE2141.
Der volle Inhalt der QuelleThis thesis considers the occupational health of public officials in slaughterhouses in its multi-dimensionality. It provides an analysis of work in the public sector, not only from its institutional framework, but also from the many interactions, often interdependent, between the activity, the organizations and the trajectory of food safety policy. It undermines both the presumption of quality at work in the public sector and the strong tightness of this sector. It shows how pain is negotiated, between daily activity and occupational disease reporting and reclassification schemes. From the 2000s, a growing proportion of officials in slaughterhouses suffered from musculoskeletal disorders. MSDs are an opportunity for middle management to negotiate with slaughterhouses, but also to state the "real work" of slaughterhouse agents. The agenda setting of the occupational health of the agents affected in the slaughterhouses arises in the context of redefining the missions of the State and the evolutions of the food safety policy contribute sometimes to make emerge health at work, to overshadow it by leaving aside the question of the future of those officials whose missions evolve and whose profession is liable to disappear. At the crossroads between the sociology of professions, occupational health and the sociology of public action, the analysis framework proposes to articulate the regulations related to health and working conditions to those of the activity and the profession of inspector himself
Eddahech, Akram. „Modélisation du vieillissement et détermination de l’état de santé de batteries lithium-ion pour application véhicule électrique et hybride“. Thesis, Bordeaux 1, 2013. http://www.theses.fr/2013BOR14992/document.
Der volle Inhalt der QuelleIn this thesis, we focus on the reliability of lithium batteries used for automotive applications. For this purpose, electric and thermal characterization methodologies as well as aging tests under several modes (calendar, power cycling, calendar/power cycling) are carried out.In a first part of the work, battery modeling and battery state estimation (state-of-charge and state-of-health) are considered.Then, based on periodic characterization from electrochemical impedance spectroscopy, calendar aging is investigated. Next, we proposed an original process for precise battery state-of-health determination that exploits a full recharge and mainly constant-voltage charge step which allows easily its integration within a battery management system. Our experimental results, up to two years real-life data, confirm effectiveness of our technique.Finally, we study the capacity recovery phenomenon occurring due to combined battery aging (calendar/power cycling). This final part is almost dedicated to introduce strategies for battery use presenting at the same time a thermal behavior study
Wang, Tinghong. „Commande robuste pour une gestion énergétique fonction de l’état de santé de la batterie au sein des véhicules hybrides“. Thesis, Grenoble, 2013. http://www.theses.fr/2013GRENT038/document.
Der volle Inhalt der QuelleIn the recent years, growing public concern has been given both on the energy problem and on the environment problem resulted from dramatically increased vehicles equipped with Internal Combustion Engine (ICE). Subsequently, intensive contributions have been made by the automotive industries and research institutes on vehicles that depend less on the fossil fuels, and introduce less pollutant emissions. This has led to the emergence of environment-friendly and energy-saving vehicles such as the Hybrid Electric Vehicle (HEV) that is usually equipped with one or more additional electric motors and the associated power battery compared with the Conventional vehicles (CVs) propelled solely by the ICE. The key point of an HEV is to design a proper Energy Management Strategy (EMS) that decides how to split the demanded power between the engine and the motor (battery). As the most important and expensive part of an HEV, it is important to take into account battery states, such as battery State of Charge (SOC) and battery ageing, aiming at maintain the optimality of the achieved EMS, as well as prolonging the battery life. In this dissertation, an HEV of parallel structure, which is equipped with a Lithiumion battery is considered. This dissertation is focused on accounting for battery related items, i.e. battery SOC and SOH indicated by battery parameters, in the EMS developments leading to a kind of fault tolerant EMS. Some brief introduction on the control methods and realization approaches involved in this work is presented first, followed by two big parts: the first part is focused on the battery modeling and estimation, while the second part is concerned by the vehicle modeling and few kinds of EMS development methods
Gentil, Lia. „L’effet de l’état de santé mentale sur l’adhésion à la pharmacothérapie chez les patients âgés diabétiques ou hypertendus et l’impact sur les coûts des services de santé au Québec“. Thèse, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/10507.
Der volle Inhalt der QuelleHervé, de Beaulieu Martin. „Identification et pronostics de l’état de santé des systèmes non linéaires par apprentissage profond. Application à la maintenance prévisionnelle des avions d’affaires“. Electronic Thesis or Diss., Université de Lorraine, 2023. http://www.theses.fr/2023LORR0227.
Der volle Inhalt der QuelleState-of-Health prognostics is a major challenge in the predictive maintenance domain, and has been the subject of numerous studies in recent years, with particular emphasis on the use of Artificial Intelligence (AI) to improve prediction performance. However, few realistic approaches have been proposed so far that take into account the real industrial constraints, and in particular the lack of data under degradation. The aim of this PhD work is to propose an AI-based prognostics approach as realistic as possible, addressing in particular the problem of the absence of degradation data, and leveraging the available a priori knowledge. A global prognostics approach in the absence of measured degradation data is proposed. It is divided into three main stages. First of all, a hybrid data augmentation phase based on system identification coupled with the injection of a physics-based degradation model is used to generate both nominal data and degradation data. Next, an unsupervised Health Index (HI) extraction method, using the reconstruction error of an autoencoder, is used to obtain a HI from the sensor data collected on the system. Finally, a long-term HI prediction process leads to Remaining Useful Life (RUL) predictions. Some stages are first validated on an academic dataset (C-MAPSS), then the overall method is applied to a real industrial case thanks to a partnership with Dassault Aviation. The research conducted highlights the need for approaches that are realistic from an industrial point of view, taking account of real-life constraints, and the results obtained open up new opportunities for the practical use of AI in predictive maintenance
Estaquio, Carla. „Scores nutritionnels : méthodes, aspects socio-économiques et association avec l’état nutritionnel et la morbidité dans la cohorte SU.VI.MAX“. Thesis, Paris, CNAM, 2011. http://www.theses.fr/2011CNAM0782/document.
Der volle Inhalt der QuelleThe actions implemented in the French National Program on Nutrition and Health (PNNS) raise expectations and questions in terms of efficiency. It is therefore useful to provide information about the general public adherence and demonstrate the potential for improving the health status of the population when PNNS nutritional guidelines are followed. Adherence was measured through the construction of two a priori nutritional scores based on the public health goals (FSIPO) or PNNS recommendations (PNNS-GS). A better compliance with recommendations or public health goals was associated with better nutritional status. Subjects with a high score (PNNS-GS or FSIPO) reported healthier lifestyle (tobacco, alcohol, physical activity) than those with lower scores. A 36% reduction in the risk of chronic disease (death, cancer and cardiovascular disease) was observed after eight years of follow up, among men with high FSIPO. Despite some limitations, validation of a priori nutritional scores is essential to convince both the public health authorities and the general public that the adherence to the PNNS is useful at an individual and collective level
Jésus, Pierre. „Impact de l’état et de la prise en charge nutritionnels dans les maladies neurodégénératives : Approche neuroépidémiologique“. Thesis, Limoges, 2014. http://www.theses.fr/2014LIMO0071/document.
Der volle Inhalt der QuelleNeurodegenerative diseases (NDD) mainly concern neuromuscular diseases, including amyotrophic lateral sclerosis (ALS), dementia, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, Huntington's disease. Due to the multiplicity of factors inducing a weight loss, the NDD are at risk of malnutrition, which can alter the evolution of these diseases and the quality of life of patients. The purpose of this work was to assess the nutritional status and / or the effect of treatment of patients with ALS and cognitive disorders (dementia and / or mild cognitive impairment [MCI]) in France with a health network, but also in Central Africa. The health network Limousin Nutrition (LINUT) realizes assessments and nutritional interventions in ALS patients at home and in residents of nursing homes (NH). The first evaluation by the network of ALS patients found more swallowing disorders than specialized consultation (60.0% vs. 47.5%) and taste disorders (43.8%), not further described in ALS. Improvements of practices were proposed. The network assessed also residents in NH, with or without dementia, initially and after a 4 months follow-up. Malnutrition affected more often demented patients (56.1% vs. 46.4% p=0.004), and energy intakes of all residents (26.4 ± 8.8 kcal/kg/d) were below the recommendations. The network intervention improved the nutritional status of patients with dementia (+0.29 ± 0.07 point of MNA®/month, p=0.003) and energy intake of all residents at 4 months. Two studies named
Seconda, Louise Lucie. „Identification de nouveaux profils alimentaires : Estimation des impacts environnementaux et individuels“. Electronic Thesis or Diss., Paris 13, 2019. http://www.theses.fr/2019PA131072.
Der volle Inhalt der QuelleIn order to not exceed the environmental planetary boundaries and ensure a good life for future generations, the food systems have to be sustainable. This thesis proposes to assess the sustainability of dietary patterns by integrating environmental, economic or socio-cultural and nutrition indicators.This thesis is based on data from the NutriNet-Santé cohort and those collected in the BioNutriNet project. In particular, during the BioNutriNet project data on the environmental impacts of food production by distinguishing between organic and conventional production methods, as well as food prices by also distinguishing production methods and places of purchase were collected. We proposed three approaches to evaluate the sustainability of dietary patterns within the cohort: an approach based on greenhouse gas emissions related to the production of diets, a more exploratory approach leading to a typology and finally an a priori approach consisting of creating an index to assess the sustainability of French diets. In a second step, we assessed the associations between diets identified as sustainable and the risk of obesity, overweight, cancer and/or cardiovascular disease and with body weight gain. Finally, from the data, we proposed more or less conservative solutions for sustainable diets using optimization.We were able to identify different dietary patterns according to their sustainability. The approach chosen has little impact on the structure of the most sustainable diets. The proportion of food groups in these most sustainable diets were almost 50% fruit and vegetables, 15% starch, 10% dairy products, 3% meat and 2% fish, and 4% soybean products. The most important difference between the three approaches relies on the contribution of organic foods to diets. We have observed a decrease in the risk of obesity, overweight and cancer for those who adopted the most sustainable dietary patterns. Finally, solutions from the optimization showed that from the least to the most disruptive scenarios, the contributions of fruits, vegetables, starch and soybean increase while those of animal foods and fatty and sweet foods decrease. Trends were independent of the level of vegetal-based food in the initial diets. Several solutions could be found to meet environmental challenges, while remaining economically accessible and covering the main nutritional needs. The choice of scenarios will have to be discussed in the light of the effort that we want to make on food in relation to other areas.Finally, the work carried out during this thesis showed that it is possible to identify and propose diets on good nutritional quality and to meet in part to environmental and public health emergencies while trying to ensure their economic accessibility and acceptability. In the context of unsustainable food systems and an increasing prevalence of chronic diseases, these results may be of major interest to justify the integration of sustainability into agricultural and public health policies
Benioudaki, Anna. „Le droit de la discrimination fondée sur le handicap et l’état de santé et sa contribution à la lutte contre la discrimination multiple“. Thesis, Toulouse 1, 2017. http://www.theses.fr/2017TOU10019.
Der volle Inhalt der QuelleNowadays, the issue of labour discrimination is a complex and living subject matter that raises questions about the adaptedness of the rights that are specifically protected by labour legislation to the situation experienced by employees. Legal writing and case-law in this field are constantly evolving. In the first part of this study, we have considered disability and health condition as prohibited grounds of discrimination. Thus, we first analyzed the social construction of disability. Indeed, contrary to the medical model, the social one moves the problem away from the individual person and places it in the social processes that are linked to human diversity. We have examined the statutory duty of reasonable accommodation provided to persons with disabilities and its implementation by case-law, positive actions and their role against disability based discrimination as well as the explanation of the differences in treatment based on disability. We have studied the United Nations Convention on the Rights of Persons with Disabilities, of 13 December 2006. This Convention has indeed become the core of European legislation and policy on disability, underlining its innovations. Furthermore, beyond the concept of “disability”, we have considered the issue of whether illness and unfitness are sufficient to justify a termination or if they are grounds of discrimination. The European legislator does not seem eager to include them in the prohibited discrimination grounds. Our study of the legislation that is protecting against discrimination based on disability has led us to conclude that it has brought solutions in cases where protection against discrimination based on health condition is not regulated. The second part of our study is dedicated to the analysis of multiple discrimination. We have highlighted the ineffectiveness of the European legislation and, thus, that of the majority of legislations of the European Union Member States in fighting against it. We have noted that what should be questioned is the legal categorization system itself. Indeed, it is absolutely inappropriate and does not allow to identify the real sense of the persons’ identity or, consequently, to identify discrimination based on more than one grounds that are interacting in such a manner that makes them totally indissociable. On this matter, we have concluded that the protection scheme against discrimination based on disability could also lead to solutions on the issue of identification of multiple discrimination and protection against it, thanks to the individual approach and to the context evaluation it requires. As a last step, the present study aims at supporting the introduction of the concept of “multiple discrimination” both in the European Union legislation and in that of the Member States. This would give a new impulse to the fight against discriminations and would allow to address the existing legislative deficiencies
Casagranda, Léonie. „Évaluation de l’impact d’une consultation médicale de suivi à long terme sur l’état de santé de jeunes adultes guéris d’un cancer pédiatrique (hors leucémie)“. Thesis, Saint-Etienne, 2015. http://www.theses.fr/2015STET003T/document.
Der volle Inhalt der QuelleIntroduction - What is the model of long-term follow-up adapted to the expectations and needs of youngadults cured of a childhood cancer? Method – The aim of this study was to estimate the impact of a long-term follow-up care (LTFU) associated self-questionnaire and medical consultation, on the health of young adult survivors of childhood cancer. Young adults with childhood cancer between 1987 and 1992 in Rhône-Alpes-Auvergne were seen during a LTFU medical and psychological consultation (SALTO), which was preceded and followed by a self-questionnaire. Furthermore, the capacity of adaptation of their autonomous nervous system (ANS) was estimated to determine the characteristics of the subjects whose ANS was altered. Results - 207 young adults completed a questionnaire before consultation and 197 of them declared having sequalae, on average each self-reported 3.4 late effects, which was confirmed by a medical observation made at 150 consultations (mean 2.6 observed late effects/subject). After the consultation, about 70 % of the subjects modified their number of self-reported late effects. No particular characteristic was clearly highlighted in people with an altered capacity of ANS regulation but a significant relationship was established between altered ANS and cardiovascular complication (P=0,049). A satisfaction survey showed a very favorable opinion about the SALTO consultation. Approximately 80% of the subjects presenting a psychiatric disorder at the time of the consultation had received no psychological follow-up at this time. Conclusion - Long-term follow-up of young adult survivors of a childhood cancer is necessary, feasible and answers a real need
Geanta, Ioana. „Contribution à un cadre de modélisation de gestion intégrée de l'état de santé de véhicules : proposition d'un module générique de gestion de la santé suport à l'intégration du diagnostic et du pronostic“. Thesis, Université de Lorraine, 2014. http://www.theses.fr/2014LORR0212/document.
Der volle Inhalt der QuelleSpherea (formerly Cassidian Test & Services), initiator of the PhD thesis, is a leading provider of Automatic Test Equipment (ATE) solutions for aerospace and military vehicles’ maintenance. The company’s interest in Integrated Vehicle Health Management (IVHM) research is motivated by occurrence of No Fault Found (NFF) events detected by ATE, and determining superfluous maintenance activities and consequently major wastes of time, energy and money. IVHM, through its advanced diagnostics and prognostics capabilities, and integration at enterprise level of vehicle health management could solve NFF events occurring during operational-level maintenance. Nevertheless, IVHM systems proposed so far are most of the times developed and matured empirically, for specific vehicle systems, founded on proprietary concepts, and lacking of consensual structuring principles. This results in a lack of consensus in both the structuring principles of IVHM systems and their Systems Engineering. Today, the challenge is to provide an IVHM modelling framework independent from the type of supported system and usable for IVHM Systems Engineering. Towards such framework, the main contributions developed in this thesis progressively build the foundation and pillars of an IVHM modelling framework. The notion of system of systems drives our first proposal of defining principles of an overall IVHM system. From this system vision, the focus of the thesis is oriented on the vehicle centric function of IVHM as catalyst of maintenance decisions at operational level, having the ability to solve the industrial problems at the genesis of the thesis. The key structuring principles of this function are analysed upon three dimensions (functional dimension, a dimension of abstraction, and distribution between the on-board /on-ground segment), setting the basis of the proposal of a generic modelling framework IVHM, considering both vehicle and enterprise centric functions. This framework is built following a Model-based Systems Engineering (MBSE) approach, supported by SysML. The major contribution of the thesis is the modelling, within the framework of IVHM, of the generic Health Management Module (gHMM), support for integration of diagnostics and prognostics, key processes of health management. The gHMM formalization enables to integrate diagnostics and prognostics not only in the conventional way: from diagnosis to prognosis, but also in an original one: from prognostics to diagnostics with the purpose of reducing ambiguity groups; the latter is backed-up through the proposal of an algorithm for one elementary activities of the gHMM. The gHMM MBSE engineering thus leads to a generic modelling framework, which, by a principle of instantiation, allows the construction of an IVHM system designed for the health management of individual vehicle systems. Towards such particularization, the thesis investigates characteristics impacting selection of appropriate supporting algorithms. This analysis enables to identify ten generic macro-criteria, which are further formalized based on ontologies and used within a multi-criteria based methodology suited for selecting diagnostics and prognostics algorithms for vehicle health management. Finally, the validation protocol of the scientific contributions is proposed, and applied at different scales of implementation in the field of wind turbine and UAV health management
Leveque, Cedric. „La gouvernementalité aux marges de l’État : la lutte contre le paludisme en Casamance (sénégal)“. Thesis, Bordeaux, 2015. http://www.theses.fr/2015BORD0320/document.
Der volle Inhalt der QuelleThis thesis consists in a Senegalese State analysis in its works and its governmentality process deployed in Casamance. Through the combat against malaria as an ethnographic field of investigation, this work analyses the fabrication of the State legitimacy in a region where it is challenged. It's about the investigation into the relations between the political apparatus (ideological and coercive), the government collaborators and communities through the State works. The structural adjustment of the 80's which has led to the decentralization and the community apparatus setting up, contributed to deteriorate the State's image for the people. A crisis of the legitimacy of the State rooted in a social conflict, exacerbated this deterioration in a Casamance context. This conflict appeared because the people felt that the State was a looter and was unable to provide for their well-being. Today, the imaginary of a State which has "given up" the region still goes on when Casamance still knows a weakened conflict. Consequently, how does the State build its legitimacy when it mainly reveals itself to the Casamances through its violent prerogatives? How does it appear by its benevolent forms allowing to legitimate its presence when its coercive apparatus are so obvious (military control and legitimate police)? Thus, this thesis questions, through an analysis of the deployment of the bio-powerand through the setting up of the policies to combat malaria, the fabrication of the State in Casamance. This research constitutes in this way a political anthropology
Duchene, Pierre. „Caractérisation non destructive des matériaux composites en fatigue : diagnostic de l’état de santé et pronostic de la durée de vie résiduelle par réseaux de neurones“. Thesis, Ecole nationale supérieure Mines-Télécom Lille Douai, 2018. http://www.theses.fr/2018MTLD0008.
Der volle Inhalt der QuelleThis research work consists in a new approach for non-destructive characterisation of damage in composite materials (carbon/epoxy) subjected to fatigue during self-heating tests (increasing load blocks). This approach is based on the use of several non-destructive techniques applied in-situ, in real time or delayed, whose analysis is either redundant or complementary. Six techniques were used (acoustic emission, infrared thermography, digital image correlation, acousto-ultrasound, C-scan ultrasound and lamb waves) and their post-processed results were merged using algorithms based on neural networks. The results obtained made it possible to assess and locate the damage of the material and to estimate its residual life. In doing so, several scientific advances have been obtained by, for example, carrying out a 2D localization of acoustic events using only two sensors with millimetric precision, or the development of a new pictorial acousto-ultrasonic technique allowing an control of the state of material damage at free stress conditions, ... and finally, the prognosis of the residual lifetime of the material based on a data fusion by neural networks
Thiam, Adji Mbayang. „Effet de l’accès à un médecin de famille sur la perception de l’état de santé des individus âgés de 15 ans et plus dans les provinces de Terre-Neuve et Labrador, Nouveau-Brunswick et Colombie-Britannique“. Mémoire, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/11870.
Der volle Inhalt der QuelleIllivi, Frederic. „Genèse et mise en œuvre du plan « sport, santé, bien-être » : acteurs, savoirs, territoires et instruments, une sociologie de l’état en recomposition : le cas de la région Nouvelle-Aquitaine“. Thesis, Bordeaux, 2018. http://www.theses.fr/2018BORD0145.
Der volle Inhalt der QuelleThe regional Health Agencies (ARS) and the regional Directorates for Youth, Sports and social cohesion (DRJSCS) are invited by their Ministry of Guardianship to implement the plan "Sport, health and well-being", the objectives of which have been adopted by The central state. With the recognition of physical activity as a determinant of health enabled by the accumulation of knowledge, its institutionalization also follows the mobilization of many cause entrepreneurs. The analysis of the conditions of its territorialisation in the new-Aquitaine region from a perspective of instrumentation of public action, gives to see the effects of this plan in many ambivalent points. The use of public and private operators, their remotely-controlled competition by incentive-type instruments, the separation between sponsor and provider, are included in the processes leading to the establishment of a quasi-market of the " Health sport in this region. The forms of Labour Division observed reflect a tangible shift that appears to be gradually confining the health and sports associations to the rank of functional operators. They also accelerate the mechanisms of diversifying the associative sports supply within a field long refractory to this type of evolution. All these dynamics allow, more generally, to participate in the analytical debates on the recomposition of relations between the State and the territories
Geanta, Ioana. „Contribution à un cadre de modélisation de gestion intégrée de l'état de santé de véhicules : proposition d'un module générique de gestion de la santé suport à l'intégration du diagnostic et du pronostic“. Electronic Thesis or Diss., Université de Lorraine, 2014. http://www.theses.fr/2014LORR0212.
Der volle Inhalt der QuelleSpherea (formerly Cassidian Test & Services), initiator of the PhD thesis, is a leading provider of Automatic Test Equipment (ATE) solutions for aerospace and military vehicles’ maintenance. The company’s interest in Integrated Vehicle Health Management (IVHM) research is motivated by occurrence of No Fault Found (NFF) events detected by ATE, and determining superfluous maintenance activities and consequently major wastes of time, energy and money. IVHM, through its advanced diagnostics and prognostics capabilities, and integration at enterprise level of vehicle health management could solve NFF events occurring during operational-level maintenance. Nevertheless, IVHM systems proposed so far are most of the times developed and matured empirically, for specific vehicle systems, founded on proprietary concepts, and lacking of consensual structuring principles. This results in a lack of consensus in both the structuring principles of IVHM systems and their Systems Engineering. Today, the challenge is to provide an IVHM modelling framework independent from the type of supported system and usable for IVHM Systems Engineering. Towards such framework, the main contributions developed in this thesis progressively build the foundation and pillars of an IVHM modelling framework. The notion of system of systems drives our first proposal of defining principles of an overall IVHM system. From this system vision, the focus of the thesis is oriented on the vehicle centric function of IVHM as catalyst of maintenance decisions at operational level, having the ability to solve the industrial problems at the genesis of the thesis. The key structuring principles of this function are analysed upon three dimensions (functional dimension, a dimension of abstraction, and distribution between the on-board /on-ground segment), setting the basis of the proposal of a generic modelling framework IVHM, considering both vehicle and enterprise centric functions. This framework is built following a Model-based Systems Engineering (MBSE) approach, supported by SysML. The major contribution of the thesis is the modelling, within the framework of IVHM, of the generic Health Management Module (gHMM), support for integration of diagnostics and prognostics, key processes of health management. The gHMM formalization enables to integrate diagnostics and prognostics not only in the conventional way: from diagnosis to prognosis, but also in an original one: from prognostics to diagnostics with the purpose of reducing ambiguity groups; the latter is backed-up through the proposal of an algorithm for one elementary activities of the gHMM. The gHMM MBSE engineering thus leads to a generic modelling framework, which, by a principle of instantiation, allows the construction of an IVHM system designed for the health management of individual vehicle systems. Towards such particularization, the thesis investigates characteristics impacting selection of appropriate supporting algorithms. This analysis enables to identify ten generic macro-criteria, which are further formalized based on ontologies and used within a multi-criteria based methodology suited for selecting diagnostics and prognostics algorithms for vehicle health management. Finally, the validation protocol of the scientific contributions is proposed, and applied at different scales of implementation in the field of wind turbine and UAV health management
Seydou, Hassane Ramatou. „Contribution au développement des techniques ensemblistes pour l’estimation de l’état et des entrées des systèmes à temps continu : application à la détection de défauts“. Thesis, Bordeaux 1, 2012. http://www.theses.fr/2012BOR14669/document.
Der volle Inhalt der QuelleThis thesis deals with the problem of a dynamical system observation and the estimation of its characteristic variables; the latter point constitutes the core element in many engineering science fields. The final aim is to build a general framework for integrity control and fault detection of such systems within a bounded error context. The developments offered herein make use of parity relations, sliding mode differentiators, interval observers and constraint satisfaction problems. Input reconstruction techniques are developed for a general class of nonlinear continuous-time systems. Domains are reconstructed for the input values which are consistent with the measurements using interval analysis and constraint satisfaction techniques. It is shown that time-varying or invariant coordinate changes may relax the applicability conditions (stability/cooperativity) of the interval observer design methods. Sliding mode differentiators were also used to enhance interval observer accuracy. The proposed approaches are illustrated through computer simulations and they have been applied to aircraft servo loop control surface for robust and early detection of abnormal positions
Laboudi, Khaled. „Contribution à la détection et à l'estimation des défauts pour des systèmes linéaires à commutations“. Thesis, Reims, 2017. http://www.theses.fr/2017REIMS030/document.
Der volle Inhalt der QuelleThis work deals with the problem of estimation of fault and hybrid state for a classof switched linear systems. The objective is to develop a method to synthesize anobserver and an estimator dedicated respectively to the estimation of the hybridstate and the faults. After presenting a state of the art for estimation, stabilityand diagnostic techniques for switched linear systems, the report is divided intotwo parts. The first part proposes a method for estimating the continuous stateand the faults in the case where the discrete state of the system is known. Basedon a coordinate transformation which decouples a subset of the state of the systemof faults, we first synthesized a hybrid observer to estimate the continuous stateof the system and, in a second step, an estimator allowing the reconstructionof faults. The proposed fault estimator depends on the derivative of the systemoutput. For this reason, a robust and accurate differentiator based on sliding modetechniques is used. In the second part of this paper, the discrete state of the systemis assumed unknown. An algebraic approach is proposed to estimate the switchingtimes between the different subsystems. Thereafter, the estimation of the hybridstate (continuous and discrete state) and of the faults is considered in the casewhere the discrete state of the system is unknown. The latter is reconstructedfrom the estimated switching times and on a known switching sequence. Thecontinuous state of the system is estimated using a pole placement method allowingimprove the performances of the transient phase. Finally, by exploiting the resultsfound in the first part, the estimation of the faults is considered by estimatingthe output of the system with an algebraic differentiator. This differentiator givesmore interesting results at the noise compared to the differentiator based on thesliding mode techniques used in the first part
Untas, Aurélie. „Facteurs prédisant l’observance thérapeutique, l’état anxio-dépressif et la qualité de vie chez des patients mis en dialyse : mise en perspective d’une approche transactionnelle et d’une approche systémique en psychologie de la santé“. Bordeaux 2, 2009. http://www.theses.fr/2009BOR21623.
Der volle Inhalt der QuelleIntroduction : Dialysis initiation is a major life event for patients, but also for relatives. The aim of the present study was to better understand family and relatives influence on patients’ adjustment to dialysis. Method: We conducted a study on a sample of 120 patients, of whom 61 dyads (patient-relative). We measured socio-demographic, medical, familial, psychological and transactional variables one month after dialysis initiation, and then six and twelve months later. The criterions chosen were adherence, anxiety and depression states and quality of life. Results : Perceived stress and seek for social support decreased over time during the first year of dialysis whereas patients’ physical quality of life increased. Family conflict and perceived stress were the main variable explaining patients’ adherence, anxiety and depression states and quality of life. The influence of family relations on patients’ adjustment was confirmed by cluster analysis revealing three profiles: conflict, expressive and conventional families. Patients belonging to conflict families seemed especially a risk of developing symptoms. Dyadic analysis based on the Actor and Partner Interaction Model pointed out the importance of patients’ optimism and problem focused coping on relatives’ emotional adjustment to dialysis. Conclusion : These results show the importance of using a family approach in health psychology for patients confronted to dialysis initiation and suggest future psychosocial interventions
Van, Cauteren Dieter. „Estimation de la morbidité des infections d’origine alimentaire en France“. Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLS148/document.
Der volle Inhalt der QuelleThe objective of this work was to produce population-based estimates of the burden of foodborne infections in France for the 2008-2013 period.Number if illnesses and hospitalisations were estimated for 21 pathogens (10 bacteria, 3 viruses and 8 parasites).The burden of foodborne infections remains substantial with 1 to 2,5 million of cases and 14000 to 21000 hospitalisations occurring each year. As in other industrialized countries Norovirus, Campylobacter spp. and Salmonella spp. are the leading pathogens and account for the majority of cases and hospitalisations.We estimate for the first time the foodborne burden related to Hepatitis E Virus (HEV). HEV appears to be one of the key pathogens in France, with annually around 50 000 foodborne cases and 500 hospitalisations.Our estimates cannot be compared with prior crude estimates in France to assess illness trends as different methodologies were used. These results are useful to food safety policymakers for the prevention and control of foodborne pathogens. They can inform education campaigns for consumers and provide information for additional research including health states and cost estimates
Izambert, Caroline. „Soigner les étrangers ? L’État et les associations pour la couverture maladie des pauvres et des étrangers en France des années 1980 à nos jours“. Thesis, Paris Sciences et Lettres (ComUE), 2018. http://www.theses.fr/2018PSLEH127.
Der volle Inhalt der QuelleIn France, the healthcare costs of undocumented foreign nationals are covered by a specific welfare benefitcalled State Medical Aid (Aide médicale d’État). This benefit was created in 2000, as part of the law onUniversal Medical Insurance (Couverture médicale universelle) which enables French nationals andundocumented foreign nationals to benefit from the state health insurance scheme (Assurance maladie) as longas they are resident in France. This thesis explores the origins of a measure created exclusively for people whosepresence on French territory is judged illegal and the impact of the existence of this particular healthcarecoverage.The approach brings together a history of public policy and an ethnography of care settings and reception centresfor undocumented foreign nationals.Part One retraces the stages involved in opening up access to the state health insurance scheme from the mid-1980s onwards. It focuses on the way in which a distinction progressively emerged between the public healthissue of undocumented people accessing healthcare, and that of poor people accessing healthcare. The role ofhumanitarian associations, notably Doctors without Borders and Doctors of the World, who opened freehealthcare centres in France from 1986 onwards, is underscored, as are their links with movements defending therights of foreigners. These processes are located within a longer history of debates about access to welfare forthe poorest going back to the nineteenth century, and the subordination of social policy to the objectives ofcontrolling migratory flows.Part Two, based on research carried out in a hospital and in a health rights organization, analyses theconsequences of the introduction of immigration administrative categories into the healthcare system as well asthe emergence of a degraded form of social citizenship for people living illegally in France
Belazi, Nader. „Estimation de l'état de charge (SOC) et de l'état de santé (SOH) d'une batterie Lithium-Ion utilisée pour les voitures électriques“. Mémoire, École de technologie supérieure, 2012. http://espace.etsmtl.ca/967/1/BELAZI_Nader.pdf.
Der volle Inhalt der QuelleBochard, Nicolas. „Effet de halo santé : une explication en termes de fausse attribution affective“. Thesis, Université Grenoble Alpes (ComUE), 2018. http://www.theses.fr/2018GREAS043/document.
Der volle Inhalt der QuelleLabels on food products can lead to unwarranted inferences: organic and fair-trade products are perceived as containing fewer calories. This effect is described in the literature as the health halo effect. In this thesis, we argue that an affective misattribution mechanism can partially explain this effect. We present 11 studies testing empirically this hypothesis.Among our main results, we show that this effect still occurs even if participants did not mention that they used the label in their evaluation (Study 3) and when they are under cognitive load, hindering a deliberate reasoning (Studies 4 and 5). By using an affective misattribution procedure, we also show that when a neutral stimulus is preceded by an organic label (vs. a control picture), this stimulus is then evaluated more positively (Studies 6, 7, and 8). Finally, we observed a systematic congruency between the valence of the prime (i.e., the label) and the valence of the evaluation of a neutral stimulus (i.e., the caloric content of a food product; Studies 9, 10, and 11). Taken together, these studies suggest that this cognitive bias is a robust phenomenon, involving a few inferences and mainly driven by the valence of the label (whether positive or negative)
Lizé, Emmanuel. „Détection d'endommagement sans état de référence et estimation de la température pour le contrôle santé intégré de structures composites par ondes guidées“. Thesis, Paris, ENSAM, 2018. http://www.theses.fr/2018ENAM0058/document.
Der volle Inhalt der QuelleThis thesis work concerns the Structural Health Monitoring (SHM) of aeronautical composite structures by guided waves with piezoelectric transducers (PZT). Conventional detection methods are based on the comparison of signals from the inspected structure in the current state with those measured in a healthy state (the baseline). Temperature significantly alters the measured signals and the associated diagnosis if its influence is not considered in the baseline. Also, the acquisition of the baseline is very constraining for the deployment of SHM systems in real conditions. The first contribution of this thesis is the estimation of the temperature field from the PZT measurements (modal frequency shift and static capacity), which allows to compensate the effect of temperature in the baseline without adding dedicated sensors. The second contribution of this thesis concerns baseline free methods. The detection performance of four methods are compared (reciprocity principle, amplitude variation, Lamb mode analysis and instantaneous baseline) on a numerical model and experimental cases of damages at different temperatures on a highly anisotropic composite plate. The results obtained show that the decomposition of Lamb wave modes in signals measured via dual PZTs (PZTs consisting of two concentric electrodes - a ring and a disk - on their upper side) significantly improves the detection performance of these methods. A dimensioning process for the deployment of these methods on complex anisotropic structures is proposed. These results open up promising opportunities that potentially contribute to the transfer of SHM technologies from laboratories to industry
Kacki, Sacha. „Influence de l’état sanitaire des populations anciennes sur la mortalité en temps de peste : contribution à la paléoépidémiologie“. Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0058/document.
Der volle Inhalt der QuelleFrom the 6th century onwards, plague caused recurring mortality crises in the Western world. Such epidemics hadprofound biological, cultural, economic and political impacts on European societies. Some aspects of the history ofplague epidemics are currently well known, but many questions remain unanswered, such as the preciseepidemiological pattern of the disease in ancient times. It is unclear whether plague killed people indiscriminately orwhether this disease was selective with respect to age, sex and health. This research contributes to this debate.It consists of an anthropological and paleopathological study of skeletal remains of 1090 individuals, including plaguevictims from four medieval and post-medieval burial grounds, and individuals from two parochial cemeteries in useduring periods of normal mortality. Results from the four plague-related assemblages reveal a peculiar demographicsignature. Age and sex distribution differs clearly from what is expected in non-epidemic periods, when it is shown tocorrespond closely to the demographic structure of the living population. Moreover, the study of various non-specificskeletal stress markers shows that plague victims were in a better health before they passed away than people who diedin non-epidemic periods. The results demonstrate that individuals who suffered stress and disease had a reducedchance of survival in non-epidemic periods, whereas they were not at a higher risk to die during plague epidemics.This study provides evidence that plague was not selective, and that it killed regardless of sex, age, and pre-existing health
Meng, Jianwen. „Battery fault diagnosis and energy management for embedded applications“. Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPAST003.
Der volle Inhalt der QuelleIn order to cope with environmental problems and climate change, electric vehicles (EVs) gain the ever booming development in recent years. From the point of view of energy storage, because of their high energy / power density and their extended lifespan, it is essentially the lithium-ion battery (LIB) technology which is the most used power unit for EVs. Doubtlessly, the reliability of LIBs is of vital importance for the development of EVs. To this end, this thesis is dedicated to the algorithmic development of battery state and parameter estimation as well as incipient short-circuit diagnosis. The battery state and parameter estimation, which can also be termed as battery monitoring, is a critical part in the so-called health conscious energy management strategy for electric or hybrid electric vehicle. Premature aging can be avoided through the accurate battery state estimation such as state of charge (SOC) and state of health (SOH). Furthermore, as the thermal runaway (TR) can be ultimately attributed to short-circuit (SC) electrical abuse, therefore, effective battery incipient SC detection can give an early warning of TR. The main contribution of this thesis lies in the theoretical and methodological aspects in the domain of battery monitoring and incipient SC diagnosis
Pras, Maxime. „Influence de l’état de dispersion de nanotubes de carbone sur leur relargage et aérosolisation lors de la sollicitation tribologique de nanocomposites MWNT/polymère“. Thesis, Lyon, INSA, 2013. http://www.theses.fr/2013ISAL0020/document.
Der volle Inhalt der QuelleCarbon nanotubes (CNT) reinforced polymer-based composites represent a significant opportunity in terms of mechanical reinforcement and electrical and thermal conductivity improvements. However specific issues for nanotubes and related composites on human health are still under studied. It is strongly expected that standards and regulations on carbon nanotubes and on carbon nanotubes composites should appear soon. Due to their high aspect ratio they could migrate into breathing apparatus (because of their small diameter) and remain stuck to the walls (due to their length) causing damages like pulmonary fibrosis or cancer. Exposition of human people to carbon nanotubes must be controlled and an occupational exposure limit must be defined. That is why suppliers of carbon nanotubes have large interest to predict rules in controlling carbon nanotube release during the use of materials prepared from nanotubes, especially under abrasion or other cyclic mechanical solicitations. A key point is to check if a good dispersion state is a required condition to decrease isolated carbon nanotubes release. As the dispersion state of carbon nanotubes in polymer-based nanocomposites was known and controlled, standardized abrasion tests were performed in a glove box in order to simulate the wear use of a nanocomposite during its lifecycle, i.e. to generate particles. Released particles were collected on TEM grids and by particle sizing devices and these ones were analyzed in term of number, size and nature thanks to different characterization methods. Granulometric data, TEM micrographs and EDX measurements were all performed and founded to be influenced by several parameters amongst which the carbon nanotubes dispersion state. Carbon nanotubes were found in the abraded particles but never isolated from other polymer particles but could be linked to released polymer particles via Van der Waals interactions and physical entanglement. It clearly appears that the dispersion state of CNT has an influence on the shape and the aspect of released particles
Marec, Anne. „Contrôle de santé des matériaux hétérogènes par émission acoustique et acoustique non linéaire : discrimination des mécanismes d’endommagement et estimation de la durée de vie restante“. Le Mans, 2008. http://cyberdoc.univ-lemans.fr/theses/2008/2008LEMA1012.pdf.
Der volle Inhalt der QuelleLocal damage in glass/epoxy and glass/polyester composite materials is investigated with the analysis of the signals of acoustic emission (AE). Unsupervised pattern recognition analyses (fuzzy c-means clustering) associated with a principal component analysis are the tools used for the classification of the monitored AE events. A cluster analysis of AE data is achieved and the resulting clusters are correlated to the damage mechanisms of the material under investigation. The proposed method also shows the time evolution of different damage mechanisms till the global failure. Thus the most critical damage mechanisms are identified. After being validated on model samples composed of unidirectional composites, this method is applied to actual composites such as cross-ply composites, sheet molding compound (SMC) and polymer concretes damaged with tensile, creep and three-point bending tests. Furthermore, AE signals generated by heterogeneous materials are not stationary. Thus, continuous and discrete wavelet transforms are applied on typical damage mechanisms AE signals such as matrix cracking, debonding, fiber failure. Time-scale descriptors are defined from these wavelets and are introduced in the classification process. They provide a better discrimination of damage mechanisms than some time-based descriptors for more complex composite materials. Finally, gradually damaged SMC composite materials are experimented with nonlinear slow dynamics tests. Nonlinear slow dynamics have been found to be very sensitive to damage evolution. Clustering of AE signals enables to understand the contribution of the different damage mechanisms to the evolution of the nonlinear behavior of damaged SMC
Audureau, Etienne. „Etude des déterminants géographiques et spatiaux de la qualité de vie liée à la santé en France“. Phd thesis, Université René Descartes - Paris V, 2012. http://tel.archives-ouvertes.fr/tel-00800664.
Der volle Inhalt der QuelleFachehoun, Richard Coovi. „Estimation de l'exposition au plomb reliée à l'ingestion de viande de gros gibiers chez les chasseurs de cervidés du Québec“. Master's thesis, Université Laval, 2015. http://hdl.handle.net/20.500.11794/26128.
Der volle Inhalt der QuelleCorman, Maya. „Approche psychologique des personnes atteintes d'hémopathies et inscrites dans un processus de greffe de cellules souches hématopoiétiques (CSH) : identification des facteurs socio-psychologiques impliqués dans l’état de santé mentale et physique aux différents stades du processus et développement d’un programme d’intervention adapté“. Thesis, Université Clermont Auvergne (2017-2020), 2020. http://www.theses.fr/2020CLFAL015.
Der volle Inhalt der QuelleHematopoietic stem cells allograft, or bone marrow transplantation, is one of the treatments proposed to stop the course of hematopoietic malignancies such as acute leukemia. This procedure consists of replacing the cells in the diseased blood with healthy cells from a compatible donor to maximize the chances of success. Although injecting the graft appears to be a relatively simple procedure, it is nonetheless part of a whole process that begins well before the procedure and has consequences in the months and even years following the allograft. Thus, the patient's care pathway can be divided into three stages: the pre-transplant, hospitalization in a protected sector, and the post-transplant period with the return home. At these different stages, an alteration in quality of life, the presence of symptoms of psychological distress and even a state of post-traumatic stress disorder (PTSD) can be observed. However, these psychological consequences may differ from one individual to another, suggesting that certain factors, other than medical ones, could influence both the physical and psychological consequences of the allograft. It is in this perspective and based on the Transactional Integrative and Multidimensional Model of Bruchon-Schweitzer and Boujut (2014) and the Complete State Health Approach of Keyes and Lopez (2002) that four studies were conducted in this thesis work in health psychology. The objective was to highlight the different protective and deleterious psychological factors at the different stages of allograft on the mental and physical health of patients, focusing on factors little explored to date and from the third wave of cognitive and behavioural therapies such as acceptance and commitment therapy. After validating a French version of the AFQ scale (article 1), the first study found that the level of happiness before the transplant contributes to a better quality of life before the procedure (article 2). The second highlighted the prospective effect of anxious preoccupations during hospitalization on the occurrence of post-traumatic stress disorder and the positive effect of fighting spirit on the level of resilience and happiness five months post-transplant (article 3). The third one revealed that the more people tended to be in experiential avoidance, the more likely they were to develop symptoms of PTSD, while patients with high non-judgmental scores (a facet of mindfulness) were less likely to develop such symptomatology (article 4). Finally, the fourth study shows that the experience of positive life changes in patients' lives after transplantation is far from systematic. Rather, patients show a decline in their psychological health that is related to a low level of acceptance (article 5). All of these results led us to reflect and propose an intervention adapted to the needs of patients (i.e. a digital platform) based on effective interventions in psycho-oncology and web-based therapies. In this perspective, a first device (i.e. DESP task) aimed at remedying the attentional biases involved in anxiety and depression has been developed and tested (article 6). The DESP has been the subject of a declaration of invention (declaration of invention n°0487-UCADESPTASK). Proposing a continuity of care and trying to overcome the obstacles inherent to the specificities of the allograft course is essential to improve the care of patients and accompany them during this pathway
Boudet, Céline. „Exposition du citadin aux particules fines en suspension : estimation de la part attribuable aux émissions automobiles : contribution à l'évaluation du risque sanitaire“. Université Joseph Fourier (Grenoble), 1999. http://www.theses.fr/1999GRE18003.
Der volle Inhalt der QuelleNdour, Cheikh. „Modélisation statistique de la mortalité maternelle et néonatale pour l'aide à la planification et à la gestion des services de santé en Afrique Sub-Saharienne“. Phd thesis, Université de Pau et des Pays de l'Adour, 2014. http://tel.archives-ouvertes.fr/tel-00996996.
Der volle Inhalt der QuelleMosallam, Ahmed. „Remaining useful life estimation of critical components based on Bayesian Approaches“. Thesis, Besançon, 2014. http://www.theses.fr/2014BESA2069/document.
Der volle Inhalt der QuelleConstructing prognostics models rely upon understanding the degradation process of the monitoredcritical components to correctly estimate the remaining useful life (RUL). Traditionally, a degradationprocess is represented in the form of physical or experts models. Such models require extensiveexperimentation and verification that are not always feasible in practice. Another approach that buildsup knowledge about the system degradation over time from component sensor data is known as datadriven. Data driven models require that sufficient historical data have been collected.In this work, a two phases data driven method for RUL prediction is presented. In the offline phase, theproposed method builds on finding variables that contain information about the degradation behaviorusing unsupervised variable selection method. Different health indicators (HI) are constructed fromthe selected variables, which represent the degradation as a function of time, and saved in the offlinedatabase as reference models. In the online phase, the method estimates the degradation state usingdiscrete Bayesian filter. The method finally finds the most similar offline health indicator, to the onlineone, using k-nearest neighbors (k-NN) classifier and Gaussian process regression (GPR) to use it asa RUL estimator. The method is verified using PRONOSTIA bearing as well as battery and turbofanengine degradation data acquired from NASA data repository. The results show the effectiveness ofthe method in predicting the RUL
Laanani, Moussa. „Étude des relations entre l’état de santé, sa prise en charge et le décès par suicide à partir du Système national des données de santé Contacts with Health Services During the Year Prior to Suicide Death andPrevalent Conditions A Nationwide Study Collider and Reporting Biases Involved in the Analyses of Cause of Death Associations in Death Certificates: an Illustration with Cancer and Suicide“. Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASR016.
Der volle Inhalt der QuelleSuicide is a major public health problem in France, with nearly 10,000 premature deaths each year. Studying the determinants of suicide is complex. It is a multi-factorial phenomenon, which can be influenced by personal and/or environmental, biomedical and/or socio-economic factors. The presence of diseases (psychiatric or physical) in the individual plays an important role. Psychiatric pathologies can be complicated by suicidal processes (suicidal ideation, which may be followed by suicidal behaviour and then death by suicide). For physical diseases, the disease can have a significant impact on the quality of life of the individual, favouring suicidal processes, and thus death by suicide. Psychiatric disorders can thus worsen physical illnesses and be a step towards the occurrence of suicidal processes. Physical diseases can also occur in individuals suffering from psychiatric disorders, and can trigger suicidal processes. For both psychiatric and physical diseases, suicidal processes can also be the consequence of adverse effects of drug treatments. In such cases, it is often difficult to disentangle the role of the treatment and that of the pathology being treated. The aim of this thesis was to study the complex relationships between diseases and suicide death, using data from the French National Health Data System (SNDS)
Motrunich, Anastasiia. „Estimation des paramètres pour les séquences de Markov avec application dans des problèmes médico-économiques“. Thesis, Le Mans, 2015. http://www.theses.fr/2015LEMA1009/document.
Der volle Inhalt der QuelleIn the first part of this dissertation we consider several problems of finite-dimensional parameter estimation for Markov sequences in the asymptotics of large samples. The asymptotic behavior of the Bayesian estimators and the estimators of the method of moments are described. It is shown that under regularity conditions these estimators are consistent and asymptotically normal. We show that the Bayesian estimator is asymptotically efficient. The one-step and two-step maximum likelihood estimator-processes are studied. These estimators allow us to construct the asymptotically efficient estimators based on some preliminary estimators, say, the estimators of the method of moments or Bayes estimator and the one-step maximum likelihood estimator structure. We propose particular non-linear autoregressive processes as examples and we illustrate the properties of these estimators with the help of numerical simulations. In the second part we give theapplications of Markov processes in health economics. We compare homogeneous and non-homogeneous Markov models for cost-effectiveness analysis of routine use of transparent dressings containing a chlorhexidine gluconate gel pad versus standard transparent dressings. The antimicrobial dressing protects central vascular accesses reducing the risk of catheter-related bloodstream infections. The impact of the modeling approach on the decision of adopting antimicrobialdressings for critically-ill patients is discussed