Simple training tool is insufficient for appropriate diagnosis and treatment of malnutrition: A pre-post intervention study in a tertiary center.

OBJECTIVES To improve malnutrition awareness and management in our department of general internal medicine; to assess patients' nutritional risk; and to evaluate whether an online educational program leads to an increase in basic knowledge and more frequent nutritional therapies. METHODS A prospective pre-post intervention study at a university department of general internal medicine was conducted. Nutritional screening using Nutritional Risk Score 2002 (NRS 2002) was performed, and prescriptions of nutritional therapies were assessed. The intervention included an online learning program and a pocket card for all residents, who had to fill in a multiple-choice questions (MCQ) test about basic nutritional knowledge before and after the intervention. RESULTS A total of 342 patients were included in the preintervention phase, and 300 were in the postintervention phase. In the preintervention phase, 54.1% were at nutritional risk (NRS 2002 ≥3) compared with 61.7% in the postintervention phase. There was no increase in the prescription of nutritional therapies (18.7% versus 17.0%). Forty-nine and 41 residents (response rate 58% and 48%) filled in the MCQ test before and after the intervention, respectively. The mean percentage of correct answers was 55.6% and 59.43%, respectively (which was not significant). Fifty of 84 residents completed the online program. The residents who participated in the whole program scored higher on the second MCQ test (63% versus 55% correct answers, P = 0.031). CONCLUSIONS Despite a high ratio of malnourished patients, the nutritional intervention, as assessed by nutritional prescriptions, is insufficient. However, the simple educational program via Internet and usage of NRS 2002 pocket cards did not improve either malnutrition awareness or nutritional treatment. More sophisticated educational systems to fight malnutrition are necessary.

Clinical Diagnosis and Staging of Intrahepatic Cholangiocarcinoma.

Intrahepatic cholangiocarcinomas are the second most common primary liver malignancies with an increasing incidence over the past decades. Due to a lack of early symptoms and their aggressive oncobiological behavior, the diagnostic approach is challenging and the outcome remains unsatisfactory with a poor prognosis. Thus, a consistent staging system for a comparison between different therapeutic approaches is needed, but independent predictors for worse survival are still controversial. Currently, four different staging systems are primarily used, which differ in the way they determine the 'T' category. Furthermore, different nomograms and prognostic models have been recently proposed and may be helpful in providing additional information for predicting the prognosis and therefore be helpful in approaching an adequate treatment strategy. This review will discuss the diagnostic approach to intrahepatic cholangiocarcinoma as well as compare and contrast the most current staging systems and prognostic models.

Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi's sarcoma in five countries across sub-Saharan Africa.

BACKGROUND Survival after diagnosis is a fundamental concern in cancer epidemiology. In resource-rich settings, ambient clinical databases, municipal data and cancer registries make survival estimation in real-world populations relatively straightforward. In resource-poor settings, given the deficiencies in a variety of health-related data systems, it is less clear how well we can determine cancer survival from ambient data. METHODS We addressed this issue in sub-Saharan Africa for Kaposi's sarcoma (KS), a cancer for which incidence has exploded with the HIV epidemic but for which survival in the region may be changing with the recent advent of antiretroviral therapy (ART). From 33 primary care HIV Clinics in Kenya, Uganda, Malawi, Nigeria and Cameroon participating in the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortia in 2009-2012, we identified 1328 adults with newly diagnosed KS. Patients were evaluated from KS diagnosis until death, transfer to another facility or database closure. RESULTS Nominally, 22% of patients were estimated to be dead by 2 years, but this estimate was clouded by 45% cumulative lost to follow-up with unknown vital status by 2 years. After adjustment for site and CD4 count, age <30 years and male sex were independently associated with becoming lost. CONCLUSIONS In this community-based sample of patients diagnosed with KS in sub-Saharan Africa, almost half became lost to follow-up by 2 years. This precluded accurate estimation of survival. Until we either generally strengthen data systems or implement cancer-specific enhancements (e.g., tracking of the lost) in the region, insights from cancer epidemiology will be limited.

The utility of rapid participatory appraisal for community assessment, diagnosis, and policy development

The selection of a model to guide the understanding and resolution of community problems is an important issue relating to the foundation of public health practice: assessment, policy development, and assurance. Many assessment models produce a diagnosis of community weaknesses, but fail to promote planning and interventions. Rapid Participatory Appraisal (RPA) is a participatory action research model which regards assessment as the first step in the problem solving process, and claims to achieve assessment and policy development within limited resources of time and money. Literature documenting the fulfillment of these claims, and thereby supporting the utility of the model, is relatively sparse and difficult to obtain. Very few articles discuss the changes resulting from RPA assessments in urban areas, and those that do describe studies conducted outside the U.S.A. ^ This study examines the utility of the RPA model and its underlying theories: systems theory, grounded theory, and principles of participatory change, as illustrated by the case study of a community assessment conducted for the Texas Diabetes Institute (TDI), San Antonio, Texas, and subsequent outcomes. Diabetes has a high prevalence and is a major issue in San Antonio. Faculty and students conducted the assessment by informal collaboration between two nursing and public health assessment courses, providing practical student experiences. The study area was large, and the flexibility of the model tested by its use in contiguous sub-regions, reanalyzing aggregated results for the study area. Official TDI reports, and a mail survey of agency employees, described policy development resulting from community diagnoses revealed by the assessment. ^ The RPA model met the criteria for utility from the perspectives of merit, worth, efficiency, and effectiveness. The RPA model best met the agencies' criteria (merit), met the data needs of TDI in this particular situation (worth), provided valid results within budget, time, and personnel constraints (efficiency), and stimulated policy development by TDI (effectiveness). ^ The RPA model appears to have utility for community assessment, diagnosis, and policy development in circumstances similar to the TDI diabetes study. ^

Near infra-red-activatable nanocarriers for selective cancer diagnosis and treatment

Standard treatment strategies for cancer patients include surgery, radiation therapy, and chemotherapy. Although these strategies have been proven effective, they also have associated limitations. An attractive and innovative approach that can be used alone or in combination with the above modalities is based on the systemic or topical administration of a nanomaterial-based photoactive compound. Interaction with light in the near infrared (NIR) region results in either emission of fluorescence, which can be used for photodetection, or absorption of light which results in phototherapy. Nanomaterials have the advantage of providing multi-functional and unique properties in a single device that cannot be readily acquired with conventional small molecular weight compounds. ^ In this study, three different novel nanocarrier systems were designed and evaluated in mediating photodetection and phototherapy in the NIR. The first compound synthesized was a dual-labeled magnetic resonance/optical imaging agent for sentinel lymph node mapping and biopsy. This dual-labeled agent combines the high resolution of magnetic resonance imaging with the highly sensitive detection of optical imaging. The second imaging agent was an activatable optical imaging agent used to monitor cathepsin B activity in vivo and to probe the degradation of poly(L-glutamic acid). This polymeric nanocarrier offers highly sensitive technique for the detection of enzymatic activity, with is not yet possible with small molecular weight compounds. The third agent was a C225-conjugated hollow nanoshell that is targeted to epidermal growth factor receptors. This targeting agent has been demonstrated to mediate photothermal therapy both in vitro and in vivo. ^ These nanocarrier systems are an invaluable tool for the detection of cancer and many other diseases. With improved targeted delivery of these agents, the ability to diagnose diseases will become more sensitive and more specific. Finally, when designed properly, these agents would allow concurrent diagnosis and treatment of patients of various diseases. ^

PROJECTION OF HEALTH DEMAND IN TERMS OF HOSPITAL ADMISSIONS FOR SELECTED DIAGNOSES IN HEALTH SYSTEMS AGENCY SERVICE AREAS

The National Health Planning and Resources Development Act of 1974 (Public Law 93-641) requires that health systems agencies (HSAs) plan for their health service areas by the use of existing data to the maximum extent practicable. Health planning is based on the identificaton of health needs; however, HSAs are, at present, identifying health needs in their service areas in some approximate terms. This lack of specificity has greatly reduced the effectiveness of health planning. The intent of this study is, therefore, to explore the feasibility of predicting community levels of hospitalized morbidity by diagnosis by the use of existing data so as to allow health planners to plan for the services associated with specific diagnoses.^ The specific objectives of this study are (a) to obtain by means of multiple regression analysis a prediction equation for hospital admission by diagnosis, i.e., select the variables that are related to demand for hospital admissions; (b) to examine how pertinent the variables selected are; and (c) to see if each equation obtained predicts well for health service areas.^ The existing data on hospital admissions by diagnosis are those collected from the National Hospital Discharge Surveys, and are available in a form aggregated to the nine census divisions. When the equations established with such data are applied to local health service areas for prediction, the application is subject to the criticism of the theory of ecological fallacy. Since HSAs have to rely on the availability of existing data, it is imperative to examine whether or not the theory of ecological fallacy holds true in this case.^ The results of the study show that the equations established are highly significant and the independent variables in the equations explain the variation in the demand for hospital admission well. The predictability of these equations is good when they are applied to areas at the same ecological level but become poor, predominantly due to ecological fallacy, when they are applied to health service areas.^ It is concluded that HSAs can not predict hospital admissions by diagnosis without primary data collection as discouraged by Public Law 93-641. ^

Self-learning of fault diagnosis identification

A good and early fault detection and isolation system along with efficient alarm management and fine sensor validation systems are very important in today¿s complex process plants, specially in terms of safety enhancement and costs reduction. This paper presents a methodology for fault characterization. This is a self-learning approach developed in two phases. An initial, learning phase, where the simulation of process units, without and with different faults, will let the system (in an automated way) to detect the key variables that characterize the faults. This will be used in a second (on line) phase, where these key variables will be monitored in order to diagnose possible faults. Using this scheme the faults will be diagnosed and isolated in an early stage where the fault still has not turned into a failure.

Distributed Fault Diagnosis Using Bayesian Reasoning in MAGNETO

Many of the emerging telecom services make use of Outer Edge Networks, in particular Home Area Networks. The configuration and maintenance of such services may not be under full control of the telecom operator which still needs to guarantee the service quality experienced by the consumer. Diagnosing service faults in these scenarios becomes especially difficult since there may be not full visibility between different domains. This paper describes the fault diagnosis solution developed in the MAGNETO project, based on the application of Bayesian Inference to deal with the uncertainty. It also takes advantage of a distributed framework to deploy diagnosis components in the different domains and network elements involved, spanning both the telecom operator and the Outer Edge networks. In addition, MAGNETO features self-learning capabilities to automatically improve diagnosis knowledge over time and a partition mechanism that allows breaking down the overall diagnosis knowledge into smaller subsets. The MAGNETO solution has been prototyped and adapted to a particular outer edge scenario, and has been further validated on a real testbed. Evaluation of the results shows the potential of our approach to deal with fault management of outer edge networks.

Fault Tolerance Analysis and Self-Healing Strategy of Autonomous, Evolvable Hardware Systems

This paper presents an analysis of the fault tolerance achieved by an autonomous, fully embedded evolvable hardware system, which uses a combination of partial dynamic reconfiguration and an evolutionary algorithm (EA). It demonstrates that the system may self-recover from both transient and cumulative permanent faults. This self-adaptive system, based on a 2D array of 16 (4×4) Processing Elements (PEs), is tested with an image filtering application. Results show that it may properly recover from faults in up to 3 PEs, that is, more than 18% cumulative permanent faults. Two fault models are used for testing purposes, at PE and CLB levels. Two self-healing strategies are also introduced, depending on whether fault diagnosis is available or not. They are based on scrubbing, fitness evaluation, dynamic partial reconfiguration and in-system evolutionary adaptation. Since most of these adaptability features are already available on the system for its normal operation, resource cost for self-healing is very low (only some code additions in the internal microprocessor core)

A multi-agent system with distributed bayesian reasoning for network fault diagnosis

In this paper, an innovative approach to perform distributed Bayesian inference using a multi-agent architecture is presented. The final goal is dealing with uncertainty in network diagnosis, but the solution can be of applied in other fields. The validation testbed has been a P2P streaming video service. An assessment of the work is presented, in order to show its advantages when it is compared with traditional manual processes and other previous systems.

Behaviour Driven Development for Multi-Agent Systems

This paper presents a testing methodology to apply Behaviour Driven Development (BDD) techniques while developing Multi-Agent Systems (MAS), so called BEhavioural Agent Simple Testing (BEAST) methodology. It is supported by the developed open source framework (BEAST Tool) which automatically generates test cases skeletons from BDD scenarios specifications. The developed framework allows testing MASs based on JADE or JADEX platforms and offers a set of configurable Mock Agents which allow the execution of tests while the system is under development. BEAST tool has been validated in the development of a MAS for fault diagnosis in FTTH (Fiber To The Home) networks.

An integrated framework for office information systems design and management

Information Technologies are complex and this is true even in the smallest piece of equipment. But this kind of complexity is nothing comparejwith the one that arises when this technology interact with society. Office Automation has been traditionally considered as a technical field but there is no way to find solutions from a technical point of view when the problems are primarily social in their origin. Technology management has to change its focus from a pure technical perspective to a sociotechnical point of view. To facilitate this change, we propose a model that allows a better understanding between the managerial and the technical world, offering a coherent, complete and integrated perspective of both. The base for this model is an unfolding of the complexity found in information Technologies and a matching of these complexities with several levels considered within the Office, Office Automation and Human Factors dimensions. Each one of these domains is studied trough a set of distinctions that create a new and powerful understanding of its reality. Using this model we build up a map of Office Automation to be use^not only by managers but also by technicians because the primaty advantage of such a framework is that it allows a comprehensive evaluation of technology without requhing extensive technical knowledge. Thus, the model can be seen as principle for design and diagnosis of Office Automation and as a common reference for managers and specialist avoiding the severe limitations arising from the language used by the last

Safety and health in forest harvesting operations. Diagnosis and preventive actions. A review

Aim of study: to review the present state of the art in relation to the main labour risks and the most relevant results of recent studies evaluating the safety and health conditions of the forest harvesting work and better ways to reduce accidents. Area of study: It focuses mainly on developed Countries, where the general concern about work risks prevention, together with the complex idiosyncrasy of forest work in forest harvesting operations, has led to a growing interest from the forest scientific and technical community. Material and Methods: The main bibliographic and Internet references have been identified using common reference analysis tools. Their conclusions and recommendations have been comprehensively summarized. Main results: Collection of the principal references and their most important conclusions relating to the main accident risk factors, their causes and consequences, the means used towards their prevention, both instrumental as well as in the aspects of training and business management, besides the influence of the growing mechanization of logging operations on those risks. Research highlights: Accident risk is higher in forest harvesting than in most other work sectors, and the main risk factors such as experience, age, seasonality, training, protective equipment, mechanization degree, etc. have been identified and studied. The paper summarizes some relevant results, one of the principal being that the proper entrepreneurial risk management is a key factor leading to the success in minimizing labour risks..

Distributed control strategies for photovoltaic systems in urban environments

Este trabajo es una contribución a los sistemas fotovoltaicos (FV) con seguimiento distribuido del punto de máxima potencia (DMPPT), una topología que se caracteriza porque lleva a cabo el MPPT a nivel de módulo, al contrario de las topologías más tradicionales que llevan a cabo el MPPT para un número más elevado de módulos, pudiendo ser hasta cientos de módulos. Las dos tecnologías DMPPT que existen en el mercado son conocidos como microinversores y optimizadores de potencia, y ofrecen ciertas ventajas sobre sistemas de MPPT central como: mayor producción en situaciones de mismatch, monitorización individual de cada módulo, flexibilidad de diseño, mayor seguridad del sistema, etc. Aunque los sistemas DMPPT no están limitados a los entornos urbanos, se ha enfatizado en el título ya que es su mercado natural, siendo difícil una justificación de su sobrecoste en grandes huertas solares en suelo. Desde el año 2010 el mercado de estos sistemas ha incrementado notablemente y sigue creciendo de una forma continuada. Sin embargo, todavía falta un conocimiento profundo de cómo funcionan estos sistemas, especialmente en el caso de los optimizadores de potencia, de las ganancias energéticas esperables en condiciones de mismatch y de las posibilidades avanzadas de diagnóstico de fallos. El principal objetivo de esta tesis es presentar un estudio completo de cómo funcionan los sistemas DMPPT, sus límites y sus ventajas, así como experimentos varios que verifican la teoría y el desarrollo de herramientas para valorar las ventajas de utilizar DMPPT en cada instalación. Las ecuaciones que modelan el funcionamiento de los sistemas FVs con optimizadores de potencia se han desarrollado y utilizado para resaltar los límites de los mismos a la hora de resolver ciertas situaciones de mismatch. Se presenta un estudio profundo sobre el efecto de las sombras en los sistemas FVs: en la curva I-V y en los algoritmos MPPT. Se han llevado a cabo experimentos sobre el funcionamiento de los algoritmos MPPT en situaciones de sombreado, señalando su ineficiencia en estas situaciones. Un análisis de la ventaja del uso de DMPPT frente a los puntos calientes es presentado y verificado. También se presenta un análisis sobre las posibles ganancias en potencia y energía con el uso de DMPPT en condiciones de sombreado y este también es verificado experimentalmente, así como un breve estudio de su viabilidad económica. Para ayudar a llevar a cabo todos los análisis y experimentos descritos previamente se han desarrollado una serie de herramientas software. Una siendo un programa en LabView para controlar un simulador solar y almacenar las medidas. También se ha desarrollado un programa que simula curvas I-V de módulos y generador FVs afectados por sombras y este se ha verificado experimentalmente. Este mismo programa se ha utilizado para desarrollar un programa todavía más completo que estima las pérdidas anuales y las ganancias obtenidas con DMPPT en instalaciones FVs afectadas por sombras. Finalmente, se han desarrollado y verificado unos algoritmos para diagnosticar fallos en sistemas FVs con DMPPT. Esta herramienta puede diagnosticar los siguientes fallos: sombras debido a objetos fijos (con estimación de la distancia al objeto), suciedad localizada, suciedad general, posible punto caliente, degradación de módulos y pérdidas en el cableado de DC. Además, alerta al usuario de las pérdidas producidas por cada fallo y no requiere del uso de sensores de irradiancia y temperatura. ABSTRACT This work is a contribution to photovoltaic (PV) systems with distributed maximum power point tracking (DMPPT), a system topology characterized by performing the MPPT at module level, instead of the more traditional topologies which perform MPPT for a larger number of modules. The two DMPPT technologies available at the moment are known as microinverters and power optimizers, also known as module level power electronics (MLPE), and they provide certain advantages over central MPPT systems like: higher energy production in mismatch situations, monitoring of each individual module, system design flexibility, higher system safety, etc. Although DMPPT is not limited to urban environments, it has been emphasized in the title as it is their natural market, since in large ground-mounted PV plants the extra cost is difficult to justify. Since 2010 MLPE have increased their market share steadily and continuing to grow steadily. However, there still lacks a profound understanding of how they work, especially in the case of power optimizers, the achievable energy gains with their use and the possibilities in failure diagnosis. The main objective of this thesis is to provide a complete understanding of DMPPT technologies: how they function, their limitations and their advantages. A series of equations used to model PV arrays with power optimizers have been derived and used to point out limitations in solving certain mismatch situation. Because one of the most emphasized benefits of DMPPT is their ability to mitigate shading losses, an extensive study on the effects of shadows on PV systems is presented; both on the I-V curve and on MPPT algorithms. Experimental tests have been performed on the MPPT algorithms of central inverters and MLPE, highlighting their inefficiency in I-V curves with local maxima. An analysis of the possible mitigation of hot-spots with DMPPT is discussed and experimentally verified. And a theoretical analysis of the possible power and energy gains is presented as well as experiments in real PV systems. A short economic analysis of the benefits of DMPPT has also been performed. In order to aide in the previous task, a program which simulates I-V curves under shaded conditions has been developed and experimentally verified. This same program has been used to develop a software tool especially designed for PV systems affected by shading, which estimates the losses due to shading and the energy gains obtained with DMPPT. Finally, a set of algorithms for diagnosing system faults in PV systems with DMPPT has been developed and experimentally verified. The tool can diagnose the following failures: fixed object shading (with distance estimation), localized dirt, generalized dirt, possible hot-spots, module degradation and excessive losses in DC cables. In addition, it alerts the user of the power losses produced by each failure and classifies the failures by their severity and it does not require the use of irradiance or temperature sensors.

Distributed control strategies for photovoltaic systems in urban environments : Versión definitiva

Este trabajo es una contribución a los sistemas fotovoltaicos (FV) con seguimiento distribuido del punto de máxima potencia (DMPPT), una topología que se caracteriza porque lleva a cabo el MPPT a nivel de módulo, al contrario de las topologías más tradicionales que llevan a cabo el MPPT para un número más elevado de módulos, pudiendo ser hasta cientos de módulos. Las dos tecnologías DMPPT que existen en el mercado son conocidos como microinversores y optimizadores de potencia, y ofrecen ciertas ventajas sobre sistemas de MPPT central como: mayor producción en situaciones de mismatch, monitorización individual de cada módulo, flexibilidad de diseño, mayor seguridad del sistema, etc. Aunque los sistemas DMPPT no están limitados a los entornos urbanos, se ha enfatizado en el título ya que es su mercado natural, siendo difícil una justificación de su sobrecoste en grandes huertas solares en suelo. Desde el año 2010 el mercado de estos sistemas ha incrementado notablemente y sigue creciendo de una forma continuada. Sin embargo, todavía falta un conocimiento profundo de cómo funcionan estos sistemas, especialmente en el caso de los optimizadores de potencia, de las ganancias energéticas esperables en condiciones de mismatch y de las posibilidades avanzadas de diagnóstico de fallos. El principal objetivo de esta tesis es presentar un estudio completo de cómo funcionan los sistemas DMPPT, sus límites y sus ventajas, así como experimentos varios que verifican la teoría y el desarrollo de herramientas para valorar las ventajas de utilizar DMPPT en cada instalación. Las ecuaciones que modelan el funcionamiento de los sistemas FVs con optimizadores de potencia se han desarrollado y utilizado para resaltar los límites de los mismos a la hora de resolver ciertas situaciones de mismatch. Se presenta un estudio profundo sobre el efecto de las sombras en los sistemas FVs: en la curva I-V y en los algoritmos MPPT. Se han llevado a cabo experimentos sobre el funcionamiento de los algoritmos MPPT en situaciones de sombreado, señalando su ineficiencia en estas situaciones. Un análisis de la ventaja del uso de DMPPT frente a los puntos calientes es presentado y verificado. También se presenta un análisis sobre las posibles ganancias en potencia y energía con el uso de DMPPT en condiciones de sombreado y este también es verificado experimentalmente, así como un breve estudio de su viabilidad económica. Para ayudar a llevar a cabo todos los análisis y experimentos descritos previamente se han desarrollado una serie de herramientas software. Una siendo un programa en LabView para controlar un simulador solar y almacenar las medidas. También se ha desarrollado un programa que simula curvas I-V de módulos y generador FVs afectados por sombras y este se ha verificado experimentalmente. Este mismo programa se ha utilizado para desarrollar un programa todavía más completo que estima las pérdidas anuales y las ganancias obtenidas con DMPPT en instalaciones FVs afectadas por sombras. Finalmente, se han desarrollado y verificado unos algoritmos para diagnosticar fallos en sistemas FVs con DMPPT. Esta herramienta puede diagnosticar los siguientes fallos: sombras debido a objetos fijos (con estimación de la distancia al objeto), suciedad localizada, suciedad general, posible punto caliente, degradación de módulos y pérdidas en el cableado de DC. Además, alerta al usuario de las pérdidas producidas por cada fallo y no requiere del uso de sensores de irradiancia y temperatura. ABSTRACT This work is a contribution to photovoltaic (PV) systems with distributed maximum power point tracking (DMPPT), a system topology characterized by performing the MPPT at module level, instead of the more traditional topologies which perform MPPT for a larger number of modules. The two DMPPT technologies available at the moment are known as microinverters and power optimizers, also known as module level power electronics (MLPE), and they provide certain advantages over central MPPT systems like: higher energy production in mismatch situations, monitoring of each individual module, system design flexibility, higher system safety, etc. Although DMPPT is not limited to urban environments, it has been emphasized in the title as it is their natural market, since in large ground-mounted PV plants the extra cost is difficult to justify. Since 2010 MLPE have increased their market share steadily and continuing to grow steadily. However, there still lacks a profound understanding of how they work, especially in the case of power optimizers, the achievable energy gains with their use and the possibilities in failure diagnosis. The main objective of this thesis is to provide a complete understanding of DMPPT technologies: how they function, their limitations and their advantages. A series of equations used to model PV arrays with power optimizers have been derived and used to point out limitations in solving certain mismatch situation. Because one of the most emphasized benefits of DMPPT is their ability to mitigate shading losses, an extensive study on the effects of shadows on PV systems is presented; both on the I-V curve and on MPPT algorithms. Experimental tests have been performed on the MPPT algorithms of central inverters and MLPE, highlighting their inefficiency in I-V curves with local maxima. An analysis of the possible mitigation of hot-spots with DMPPT is discussed and experimentally verified. And a theoretical analysis of the possible power and energy gains is presented as well as experiments in real PV systems. A short economic analysis of the benefits of DMPPT has also been performed. In order to aide in the previous task, a program which simulates I-V curves under shaded conditions has been developed and experimentally verified. This same program has been used to develop a software tool especially designed for PV systems affected by shading, which estimates the losses due to shading and the energy gains obtained with DMPPT. Finally, a set of algorithms for diagnosing system faults in PV systems with DMPPT has been developed and experimentally verified. The tool can diagnose the following failures: fixed object shading (with distance estimation), localized dirt, generalized dirt, possible hot-spots, module degradation and excessive losses in DC cables. In addition, it alerts the user of the power losses produced by each failure and classifies the failures by their severity and it does not require the use of irradiance or temperature sensors.