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Submitted by Luis Guilherme Macena (guilhermelg2004@gmail.com) on 2013-04-08T12:33:46Z No. of bitstreams: 1 Melissa_Dissertação.pdf: 389612 bytes, checksum: ab23a920bbb76b9e01c6b056791e7adb (MD5) / Made available in DSpace on 2013-04-08T12:33:46Z (GMT). No. of bitstreams: 1 Melissa_Dissertação.pdf: 389612 bytes, checksum: ab23a920bbb76b9e01c6b056791e7adb (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / Objetivo: avaliar a associação entre os níveis séricos de 25-hidroxivitamina D (25 OHD) e câncer de mama no climatério. Métodos: trata-se de um estudo do tipo casocontrole com mulheres de 45 a 70 anos atendidas nos ambulatórios de mastologia e ginecologia geral do hospital materno-infantil Instituto Fernandes Figueira, localizado no município do Rio de Janeiro. Foram selecionados 39 casos incidentes de câncer de mama e 60 controles. As participantes foram submetidas à entrevista para o preenchimento de um questionário estruturado e em seguida foi realizado a coleta de sangue para a dosagem de 25 OHD. Resultados: foi observada uma prevalência de 80,8% de hipovitaminose D (< 30ng/mL) entre as participantes do estudo. Em relação à estimativa de risco para carcinoma mamário, o grupo com níveis suficientes de 25 OHD não apresentou diferença com significância estatística do grupo com hipovitaminose D. Porém, na análise das estimativas de risco conforme o status menopausal, houve menor chance de exposição e desenvolvimento de câncer de mama nas mulheres pósmenopausadas com níveis suficientes de 25 OHD (OR* 0.53; IC 95%, 0.12-2.41) que as na pré-menopausa com níveis normais de vitamina D (OR* 0.97; IC 95%, 0.13-8.35) quando comparadas ao grupo com hipovitaminose D. Conclusão: Os resultados desse estudo sugerem que a hipovitaminose D entre mulheres pós-menopausadas seja um fator de risco para o câncer de mama durante o climatério. Todavia, ainda são necessários mais estudos que também confirmem essa associação. / Purpose: to evaluate the association between the plasma levels of 25-hydroxyvitamin D and the breast cancer in the climacteric. Methods: it is a kind of case-control study with women between 45 until 70 years old attended in clinics of mastology and ginecology of the maternal-infantile hospital Fernandes Figueira, localized in Rio de Janeiro city. Thirdy-nine incident cases of breast cancer and 60 controls were selected. The participants were submitted to an interview for filling out of a structured questionnaire and forthwith it was made the swab blood for the dosage of 25 OHD. Results: a prevalence of 80,8% of vitamin D deficiency was spotted among the participants of the study. In relation to the estimate of risk for breast cancer, the group with sufficient levels of 25 OHD did not present difference with significance statistic of the group with vitamin D deficiency. Nevertheless, during the analysis of the estimate of risk according to menopausal status, there were less chance of exposition and development of the breast cancer in postmenopaused women with sufficient levels of 25 OHD (OR* 0.53; IC 95%, 0.12-2.41) than the premenopaused women with normal levels of vitamin D (OR* 0.97; IC 95%, 0.13-8.35) when compared to the group with vitamin D deficiency. Conclusion: the results of this study suggests that the vitamin D deficiency among postmenopaused women is a factor of risk for the breast cancer during the climacteric. However, more studies are still necessary to confirm this association.

Dans cette thèse, nous étudions trois catégories de problèmes : les d-extensibles, les d-bloqueurs et les d-transversaux.Les d-extensibles de stables optimaux sont des ensembles de sommets d'un graphe G tels que tout stable de cardinal d du sous-graphe induit par un d-extensible peut être étendu à un stable optimal de G à l'aide de sommets qui n'appartiennent pas au d-extensible. Nous étudions les d-extensibles de cardinal maximal de stables dans les graphes bipartis. Nous démontrons quelques propriétés structurelles puis nous déterminons une borne inférieure du cardinal maximal d'un d-extensible. Nous étudions quelques classes de graphes dans lesquelles déterminer un d-extensible optimal de stables est un problème polynomial. Nous nous intéressons ensuite aux d-extensibles de stables dans les arbres. Nous prouvons plusieurs propriétés structurelles, déterminons une autre borne inférieure du cardinal maximal d'un d-extensible et étudions quelques classes d'arbres dans lesquelles déterminer un d-extensible optimal de stables est un problème polynomial.Les d-bloqueurs de stables sont des ensembles de sommets d'un graphe G tels que, si on retire les sommets d'un d-bloqueur, le cardinal maximal d'un stable du graphe induit par les sommets restants est inférieur d'au moins d au cardinal maximal d'un stable du graphe initial. Nous nous intéressons ici aux d-bloqueurs de coût minimal de stables dans les arbres. Après avoir prouvé une caractérisation des d-bloqueurs de stables dans les arbres, nous démontrons que déterminer un d-bloqueur de coût minimal de stable est un problème polynomial dans une classe d'arbres particulière.Soit Pi un problème d'optimisation sur un ensemble d'éléments fini. Un d-transversal de Pi est un ensembles d'éléments tel que l'intersection entre le d-transversal et toute solution optimale au problème Pi est de cardinal supérieur égal à d. Nous proposons ici une approche de génération de contraintes pour déterminer des d-transversaux de cardinal maximal de problèmes modélisés par des programmes mathématiques en variables binaires. Nous étudions deux variantes de cette approche que nous testons sur des instances de graphes générés aléatoirement pour déterminer des d-transversaux de stables optimaux et des d-transversaux de couplages optimaux / In this thesis, we study three types of problems : the d-extensibles sets, the d-blockers and the d-transversals.In a graph G, a d-extensible set of maximum independent sets is a subset of vertices of G such that every stable set of cardinality d in the subgraph restricted to the d-extensible set can be extented to a maximum stable set of G using only vertices that do not belong to the d-extensible set. We study d-extensible sets of mxaimum cardinality of stable sets in bipartite graphs. We show some structural properties and we determine a lower bound of the maximum cardinality of a d-extensible set. We consider some classes of graph where finding an optimum d-extensible set can be done in polynomial time. Then, we study the d-extensibles sets of stable sets in trees. We prove some properties on the structures of the d-extensibles sets and we determine another lower bound of the maximum cardinality of a d-extensible set. Finaly, we study somme classes of tree where a d-extensible sets of maximum cardinality can be done in polynomial time.In a graph G, a d-blocker is a subset of vertices such that, if removed, a maximum stable set of the resulting subgraph is of cardinality at most the cardinality of a maximum stable set of G minus d. We study d-blocker of minimal cost of stable sets in tree.We prove a caracterisation of d-blockers in tree and we study a particular classe of trees where computing a d-blocker of minimal cost of stable sets can be done in polynomial time.Let Pi be an optimisation problem on a finite set of elements. A d-transversal of Pi is a subset of elements such that the intersection between the d-transversal and every optimal solution of Pi contains at lest d elements. We propose an approach to compute d-transversal of any optimisation problem modelised by mathematical program with binary variables. We use a contraints generation approach. We compare two variations of this approach on randomly generated graph by computing d-transversals of stables sets and d-transversals of matching

In Geoffrey Chaucer's Troilus and Criseyde, the main character Troilus depicts the overt and covert ideology of Boethius's The Consolation of Philosophy. Clearly, Troilus meets with the Boethian question of free will, views it from the perspective of a Boethian universe, and closes with Boethius's suggestion to serve God. Less apparently, Troilus shows that in order to discern the ultimate Boethian position on free will, the conflict between reason and passion must also be resolved. Because he succumbs to passion and loses his ability to reason, Troilus appears illogical and negative when he discusses free will. In heaven, though, Troilus experiences the ultimate Boethian state and acclaims the final Boethian pronouncement that results from the resolution of not only the free will-necessity question but also the reason passion issue. Perceiving his situation intuitively and thus circumventing the deductive process, Troilus rejects a life given to following "blynde lust" and commends one dedicated to God. In doing so, he illustrates both the apparent and the obscure of Boethian philosophy.

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Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Type-2 diabetes is a nationally growing health concern. Previous literature has implicated that vitamin D deficiency and type-2 diabetes are interconnected. At this time there are no guidelines in place to guide the evaluation or treatment of vitamin D deficiency in type-2 diabetic patients. In order to create up to date guidelines for the treatment and evaluation of vitamin D deficiency in type-2 diabetic patients an integrative literature review was conducted using EMBASE, PubMed, and CINAHL. The literature review resulted in 44 articles that met the inclusion and exclusion criteria. The literature review resulted in the creation of five clinical recommendations. The most significant change to current clinical standards includes screening all type-2 diabetic patients for vitamin D deficiency. Vitamin D supplementation is not recommended for use in treating type-2 diabetes, diabetic complications, or preventing the progression from prediabetes to diabetes. However, type-2 diabetic patients with vitamin D deficiency should be treated with vitamin D supplementation to improve indirect health outcomes and prevent morbidity and mortality.

A hipovitaminose D hoje é considerada uma pandemia suas causas e consequências tem sido muito estudadas. Quando a população atendida é de pessoas vivendo com HIV/Aids as comorbidades parecem ser abreviadas tanto pela infecção viral como pela introdução da TARV. A Infecção Pelo HIV, apesar da terapia antirretroviral aumentar a expectativa de vida dos portadores do vírus, novos desafios se impõe no manejo clínico dos pacientes, tais como alterações neurológicas, distúrbios metabólicos como dislipidemias, lipodistrofia, resistência à insulina e osteopenia e osteoporose.. O objetivo foi avaliar a eficácia da suplementação de vitamina D em pacientes infectados pelo HIV, a despeito de tudo que é sabido de complicações e comorbidades advindas da infecção e dos efeitos adversos da terapia antirretroviral. Realizou-se um ensaio clínico controlado, randomizado, duplo cego, onde metade da coorte de 36 PVHA foram suplementadas com vitamina D (grupo 1) por 06 meses e 37 PVHA (grupo 2) com placebo. Como resultado verificou-se que a suplementação de colecalciferol (vitamina D3) foi eficaz, 80% dos pacientes tiveram níveis sanguíneos normalizados em seis meses de uso. Importante destacar a significância que houve em relação aos níveis de vitamina D e fumo, além disso o grupo que suplementou com vitamina teve resultado significativo(p<0,001) em relação ao aumento dos linfócitos TCD4. O Efavirenz pode influir de maneira negativa nos níveis de vitamina D e que a suplementação se faz necessária como um provável coadjuvante na melhora do CD4 e a dosagem adequada resulta na eficácia do tratamento. / Hypovitaminosis D today is considered a pandemic its causes and consequences have been much studied. When the population served is people living with HIV / AIDS, the comorbidities seem to be shortened by both viral infection and the introduction of ART. HIV infection, although antiretroviral therapy increases the life expectancy of HIV patients, new challenges are imposed in the clinical management of patients, such as neurological changes, metabolic disorders such as dyslipidemia, lipodystrophy, insulin resistance and osteopenia and osteoporosis. The aim of this study was to evaluate the efficacy of vitamin D supplementation in HIV-infected patients, despite the known complications and comorbidities of the infection and the adverse effects of antiretroviral therapy. A double-blind, randomized, controlled clinical trial was conducted in which half of the cohort of 36 PLHA were supplemented with vitamin D (group 1) for 6 months and 37 PLHA (group 2) with placebo. As a result cholecalciferol (vitamin D3) supplementation was found to be effective, 80% of patients had normalized blood levels at six months of use. It is important to highlight the significance of vitamin D and smoking levels, and the group that supplemented with vitamin had a significant result (p <0.001) in relation to the increase in CD4 T lymphocytes. Efavirenz may have a negative effect on vitamin D levels and that supplementation is necessary as a likely adjunct to CD4 enhancement and adequate dosing results in treatment efficacy.