In June 2012, the Supreme Court of the United States decided the fate of the Patient Protection and Affordable Care Act in a case called National Federation of Independent Business v. Sebelius. While initially the decision seemed favorable to supporters of the bill, Chief Justice Roberts’ majority opinion could likely render the bill ineffective in implementation and it creates more Constitutionally confusing precedent than it resolves. Among the questions that now rise to the surface are: will Congress be able to raise the tax to a level where it will become effective? What is now mandatory for states to adopt into their Medicaid programs? Where is the line for the federal government with regards to coercion? What are the definitions of direct and indirect taxes? And, how binding is the Origination Clause of the Constitution?

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-11-22T21:30:08Z No. of bitstreams: 1 IvanDanielBezerraNogueira_TESE.pdf: 1922078 bytes, checksum: 3cdd07333d51eaea2368fef5ab71548c (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-11-24T22:26:23Z (GMT) No. of bitstreams: 1 IvanDanielBezerraNogueira_TESE.pdf: 1922078 bytes, checksum: 3cdd07333d51eaea2368fef5ab71548c (MD5) / Made available in DSpace on 2017-11-24T22:26:23Z (GMT). No. of bitstreams: 1 IvanDanielBezerraNogueira_TESE.pdf: 1922078 bytes, checksum: 3cdd07333d51eaea2368fef5ab71548c (MD5) Previous issue date: 2017-09-01 / Introdu??o: A insufici?ncia card?aca (IC) ? um dos mais importantes desafios cl?nicos atuais na ?rea da sa?de mundial, com perfil epid?mico em progress?o. Nesse sentido, a sa?de autorreferida (SAR), bem como o exerc?cio f?sico (EF), t?m sido utilizados como medidas de monitora??o do estado de sa?de e tratamento dessa enfermidade, respectivamente. A SAR ? um preditor de morbimortalidade e para an?lise ? categorizada em sa?de autorreferida boa (SAR B) e prec?ria (SAR P). Por outro lado, o EF surgiu como um dos pilares no manejo da IC, mas apesar das elevadas evid?ncias sobre seus benef?cios, a ader?ncia a essa pr?tica estima-se que ? baixa no Brasil. Objetivo: Estimar a preval?ncia de IC e associa??o com SAR e pr?tica de EF no Brasil. M?todos: Estudo transversal que utilizou dados da Pesquisa Nacional de Sa?de (PNS) realizada em 2013, com dados v?lidos para 59.655 adultos (? 18 anos). A preval?ncia de IC, avaliada pela pergunta ?Algum m?dico j? lhe deu o diagn?stico de IC??, relacionou-se ?s caracter?sticas sociodemogr?ficas, percep??o do estado de sa?de (SAR, percep??es de sa?de f?sica e mental), diagn?stico de depress?o, pr?tica de EF e as barreiras ao EF. Foram realizadas as an?lises descritiva, bivariada e multivariada. O modelo final da associa??o entre IC e SAR P foi testado pela regress?o de Poisson com vari?ncia robusta. Para a pr?tica de EF utilizou-se o comando svy, a fim de considerar os pesos amostrais e expandir os resultados para a popula??o brasileira. Resultados: O diagn?stico de IC foi referido por 1,1% dos entrevistados. Observou-se que ter o diagn?stico m?dico de IC aumenta em quatro vezes a chance de ter pior percep??o de sa?de (OR = 4,17; IC95% 3,65?4,76), contudo essa medida reduz para menos da metade, quando ajustado por faixa et?ria e percep??o da sa?de f?sica (OR = 1,78; IC95% 1,52?2,08). Os indiv?duos com IC tiveram mais de 80% de chance de n?o praticar EF nos ?ltimos 3 meses. Os aposentados praticaram mais EF que os n?o aposentados (2,77 %; IC95% 1,51?4,04). Quanto ? participa??o dos indiv?duos com IC em um programa p?blico de EF, a preval?ncia dos que n?o participaram foi 15% maior em rela??o aos indiv?duos que participaram desse programa. Observou-se que a principal barreira foi a de sa?de/incapacidade, seguida da barreira f?sica e posteriormente, da barreira comportamental. Conclus?o: A associa??o entre IC e SAR P revela a forma como essa doen?a influencia a qualidade de vida dos brasileiros com tal mol?stia. Destaca-se a baixa preval?ncia da pr?tica de EF e, dentre os que praticaram, os aposentados s?o a maioria. Observou-se que a principal barreira neste estudo foi a de problemas de sa?de/incapacidade. / Background: Heart failure (HF) is one of the most important current clinical challenges in the area of global health, with epidemic profile in progress. In this sense, self-rated health (SRH), as well as physical exercise (PE), have been used as measures of health monitoring and treatment of this disease, respectively. SRH is a predictor of morbidity and mortality and to analysis is categorized into good self-rated health (SRH G) and poor (SRH P). On the other hand, PE emerged as one of the pillars in the handling of the HF, but despite the high evidence on their benefits, the adherence to this practice estimated that is low in Brazil. Objective: To estimate the prevalence of HF and association with SRH and PE practice in Brazil. Methods: Cross-sectional study that used data from the National Health Survey (NHS) held in 2013, with valid data to 59,655 adults (? 18 years). The prevalence of HF, assessed by question "Some doctor gave you the diagnosis of HF?", related to sociodemographics, health perception (SRH, perceptions of physical and mental health), diagnosis of depression, practice of PE and PE barriers. Descriptive analyses were performed, bivariate and multivariate. The final model of the association between HF and SRH P was tested by Poisson regression with robust variance. For PE svy command was used, in order to consider the sample weights and expand the results for the brazilian population. Results: The diagnosis of HF was referenced by 1.1% of respondents. It was observed that having the medical diagnosis of HF increases by four times the chance of having worse perception of health (OR = 4.17; 95%CI 3.65?4.76), however this measure reduces to less than half, when adjusted for age and perception of physical health (OR = 1.78; 95%CI 1.52?2.08). Individuals with HF have had over 80% chance of not practicing PE in the last 3 months. Retirees have done more PE than non-retirees (2.77%; 95%CI 1.51?4.04). On the participation of individuals with HF in a public program of PE, the prevalence of which did not participate in was 15% higher in relation to individuals who participated in this program. It was observed that the main barrier to health/disability, followed by the physical barrier and the behavioral barrier.

Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-01-04T13:53:16Z No. of bitstreams: 2 lidiane_guedes_oliveira.pdf: 705674 bytes, checksum: 7f2a8cdcec73417a5a58f7784fffca1d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-01-04T13:53:48Z (GMT) No. of bitstreams: 2 lidiane_guedes_oliveira.pdf: 705674 bytes, checksum: 7f2a8cdcec73417a5a58f7784fffca1d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-01-04T13:53:48Z (GMT). No. of bitstreams: 2 lidiane_guedes_oliveira.pdf: 705674 bytes, checksum: 7f2a8cdcec73417a5a58f7784fffca1d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2014 / Funda??o de Amparo ? Pesquisa do estado de Minas Gerais (FAPEMIG) / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (Capes) / Evid?ncias cient?ficas cumulativas sugerem que os ?cidos graxos monoinsaturados (MUFAs) diet?ticos reduzem fatores de risco para o desenvolvimento de desordens metab?licas, as quais causam muitas doen?as cr?nicas n?o transmiss?veis (DCNT), tais como o diabetes n?o insulinodependente e as cardiovasculares. O ?leo de pequi (Caryocar brasiliense) apresenta em sua composi??o predom?nio de ?cidos graxos monoinsaturados e carotenoides antioxidantes, os quais t?m sido tamb?m relacionados ? redu??o do risco para DCNT. Entretanto, ainda s?o escassos na literatura estudos que avaliem efeitos fisiol?gicos do ?leo de pequi dentro da perspectiva de alimento funcional, ou seja, associado ? dieta usual e h?bitos saud?veis de vida, dentre os quais se destaca o exerc?cio f?sico regular. Diante desse contexto, o objetivo deste estudo foi pesquisar a influ?ncia da ingest?o do ?leo de pequi associada ao exerc?cio f?sico aer?bio regular (EFAR), sobre vari?veis relacionadas ao crescimento, ao metabolismo e par?metros cardiovasculares de ratos, desde est?gios iniciais de vida (p?s-desmame) at? o in?cio da vida adulta (20 semanas de vida). O protocolo experimental consistiu de quatro grupos (n=8) de ratos Wistar machos: CS - animais que receberam ra??o; CT - receberam ra??o e EFAR; OS - receberam ra??o suplementada com ?leo de pequi (2,25/100g = +50% do conte?do lip?dico da ra??o) e OT - receberam ra??o suplementada com ?leo de pequi e EFAR. O EFAR foi realizado em piscina, em intensidades e cargas progressivas, e a dieta fornecida ad libitum durante 15 semanas. A ingest?o alimentar e o peso corporal foram monitorados durante o per?odo experimental para os c?lculos da ingest?o alimentar e cal?rica, do ganho de peso, do coeficiente de efici?ncia alimentar (CEA%) e do ?ndice de massa corporal (IMC). A press?o arterial sist?lica (PAS) e a frequ?ncia card?aca (FC) foram aferidas no in?cio e na ?ltima semana do experimento. No ?ltimo dia, os animais foram eutanasiados, as cavidades abdominais e tor?cicas foram abertas para coleta de amostras. Os cora??es foram retirados e o ?ndice de contratilidade (+dP/dt) e relaxamento (-dP/dt) card?aco foram analisados pela t?cnica de cora??o isolado. Foram determinados: (a) o comprimento da t?bia esquerda; (b) os pesos absolutos e relativos do f?gado, p?ncreas e cora??o e de toda a gordura das regi?es epididimal e retroperitoneal; (c) as concentra??es plasm?ticas de colesterol (COL), lipoprote?na de alta densidade (HDL), triglicer?deos (TG), glicose, insulina, o ?ndice HOMA e a raz?o COL/HDL; (d) as concentra??es hep?ticas de COL e TG. Observou-se que a associa??o do ?leo de pequi ao EFAR n?o influenciou de maneira significativa par?metros relacionados ao crescimento (ingest?o alimentar e cal?rica, peso corporal, CEA, peso de ?rg?os, comprimento da t?bia), a PAS e FC, a glicemia e a raz?o COL/HDL. No entanto, foi essencial para evitar o ac?mulo de gordura na regi?o visceral, a eleva??o nos n?veis de insulina plasm?tica e no ?ndice HOMA-IR provocados pela ingest?o isolada do ?leo de pequi. Por outro lado, a associa??o da ingest?o do ?leo de pequi ao EFAR melhorou a capacidade de contra??o e relaxamento card?acos. Assim, podemos inferir que a ingest?o do ?leo de pequi, quando associada ? pr?tica regular de exerc?cios aer?bios, pode favorecer, sobretudo, a fun??o card?aca sem exercer efeitos delet?rios no crescimento e em vari?veis relacionadas ao metabolismo lip?dico e glic?dico. / Disserta??o (Mestrado) ? Programa Multic?ntrico de P?s-gradua??o em Ci?ncias Fisiol?gicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2014. / ABSTRACT Cumulative evidence suggests that dietary monounsaturated fatty acids (MUFAs) reduce risk factors for metabolic disorders, which lead to many chronic non-communicable diseases (NCDs), such as cardiovascular and non-insulin-dependent diabetes. Pequi oil (Caryocar brasiliense) is high in monounsaturated fatty acids and antioxidant carotenoids, which have also been associated to reduced risk for NCDs. However, there is lacking of studies evaluating pequi oil physiological effects from the perspective of being a functional food, which means, associated to a usual diet and a healthy lifestyle, being the regular physical exercise a part of it. In this context, the aim of this study was to investigate the influence of pequi oil intake, associated to regular aerobic physical exercise (RAPE) on variables related to growth, metabolism and on cardiovascular parameters of rats, from early stages of life (post weaning) to early adulthood (20 weeks old). The experimental protocol consisted of four groups (n = 8) of male Wistar rats: CS - animals fed chow; CT - received chow and RAPE; OS - received chow added pequi oil (2.25 / 100g =+50% of the chow lipid content) and OT - received chow added pequi oil and RAPE. The RAPE was held in a pool at intensities and progressive loading, and the diets were fed ad libitum for 15 weeks. Food intake and body weight were monitored throughout the experimental period to determine food and caloric intake, weight gain, feed efficiency ratio (FER%) and body mass index (BMI). Systolic blood pressure (SBP) and heart rate (HR) were measured at baseline and in the last week of the experiment. On the last day, animals were euthanized and the abdominal and thoracic cavities were opened for sampling. Hearts were removed and the contractility (+dP/dt) and relaxation (-dP/dt) indexes were analyzed by the isolated heart technique. It were determined: (a) The left tibia length (b) the relative liver, pancreas and hearts weights and the retroperitoneal and epididimal fat pad weights; (c) plasma concentrations of cholesterol (COL), high density lipoprotein (HDL), triglycerides (TG), glucose, insulin, HOMA-IR index and COL/HDL ratio; (d) hepatic TG and COL levels. The association of pequi oil intake to RAPE did not influence significantly growth (food and caloric intake, body weight, FER%, organ weights, tibia length), SBP and HR, blood glucose and COL/HDL ratio. However, it prevented fat accumulation in the visceral region and plasma insulin and HOMA-IR increases caused by the pequi oil intake solely. Moreover, the pequi oil intake associated to RAPE improved the heart contraction and relaxation ability. Thus, we can infer that pequi oil intake, when associated to RAPE can improve mainly cardiac function without exerting deleterious effects on growth and on glucose and lipid metabolism.

Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-01-04T16:31:23Z No. of bitstreams: 2 nayara_rayane_cesar.pdf: 2602002 bytes, checksum: c844463923756f76132f0190a6617bd5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-01-04T16:31:46Z (GMT) No. of bitstreams: 2 nayara_rayane_cesar.pdf: 2602002 bytes, checksum: c844463923756f76132f0190a6617bd5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-01-04T16:31:46Z (GMT). No. of bitstreams: 2 nayara_rayane_cesar.pdf: 2602002 bytes, checksum: c844463923756f76132f0190a6617bd5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015 / Funda??o de Amparo ? Pesquisa do estado de Minas Gerais (FAPEMIG) / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (Capes) / O padr?o diet?tico ocidental, caracterizado pelo alto consumo de gordura saturada e carboidratos refinados, favorece o ac?mulo de tecido adiposo e o surgimento de v?rias doen?as cardiometab?licas (DCM). Atualmente, tem-se considerado que n?o apenas a quantidade, mas o perfil das gorduras ingeridas pode exercer forte influ?ncia sobre o desenvolvimento dessas doen?as. Nesse contexto, v?rios estudos t?m demonstrado que o consumo de alimentos fontes de ?cidos graxos monoinsaturados (MUFA) est? associado a um menor risco para o desenvolvimento de DCM. Al?m disso, t?m sido tamb?m identificados muitos compostos bioativos presentes nos alimentos vegetais, os quais t?m sido associados a efeitos ben?ficos na redu??o do risco e, ou, no tratamento de DCM. Dentre esses compostos est?o os carotenoides, que apresentam atividade antioxidante. Nessa perspectiva, o ?leo do pequi apresenta-se como um potencial alimento funcional, dado que os MUFA representam aproximadamente 60% dos seus ?cidos graxos, e possui ainda um teor elevado de carotenoides totais. Considerando que o padr?o de consumo alimentar ocidental favorece o desenvolvimento das DCM, e que o ?leo do pequi ? um potencial alimento protetor, mas ainda n?o foi explorado nesse contexto, o objetivo deste estudo foi avaliar os efeitos da substitui??o parcial da banha de porco (rica em ?cidos graxos saturados - SFA) por ?leo de Caryocar brasiliense ? pequi (rico em MUFA e carotenoides) em uma dieta de padr?o ocidental, sobre o metabolismo, a fun??o card?aca e o estado redox celular de ratos. Ap?s uma semana de adapta??o, os animais rec?m-desmamados foram distribu?dos em tr?s grupos (n=12) e tratados durante 12 semanas. Os grupos foram identificados conforme a dieta que receberam: CTRL ? controle, dieta AIN93G; HFS ? dieta alta em gordura e sacarose; HFS-OP ? dieta alta em gordura e sacarose, com substitui??o parcial da banha de porco por ?leo de pequi (27%). O peso corporal e a ingest?o alimentar foram monitorados durante todo o per?odo experimental; a press?o arterial sist?lica (PAS) e a frequ?ncia card?aca (FC) foram aferidas na 3? e 10? semanas; as fezes das ?ltimas 72 horas foram coletadas para avalia??o das concentra??es de colesterol e triglicer?deos (TG) e, ao final do experimento, os animais foram eutanasiados por decapita??o. As cavidades abdominais e tor?cicas foram abertas para coleta de amostras: (A) cora??es: foram retirados imediatamente para avalia??o da fun??o card?aca ex vivo; posteriormente foram avaliados os n?veis de peroxida??o lip?dica e capacidade antioxidante total; (B): tecido adiposo das regi?es epididimal e retroperitoneal, que foi pesado e posteriormente utilizado para avalia??es da adiposidade e histol?gicas; (C) soro: para determina??o das concentra??es de glicose, colesterol e TG; (D) plasma: para determina??o das concentra??es de insulina, leptina e adiponectina, peroxida??o lip?dica e capacidade antioxidante total; (E) f?gados: para avalia??o das concentra??es de colesterol e TG, an?lises histopatol?gicas e peroxida??o lip?dica, capacidade antioxidante total e atividade enzim?tica (super?xido dismutase, catalase e glutationa peroxidase). Observou-se que os pesos corporais dos animais HFS-OP e HFS foram mais elevados que CTRL (p<0,05), no entanto, a deposi??o de gordura na regi?o visceral em resposta ao consumo das dietas ocidentais foi atenuada pela substitui??o da banha de porco por ?leo de pequi (p<0,05). A menor sobrecarga reduziu a deposi??o de TG no tecido hep?tico o que pode estar associado ao retardo do desenvolvimento do diabetes. De um modo geral, a fun??o card?aca foi prejudicada pelas dietas ocidentais em compara??o ao CTRL. Nas avalia??es in vivo n?o foram observados efeitos diferenciais da substitui??o parcial da banha de porco por ?leo de pequi, contudo, quando a fun??o card?aca foi avaliada ex vivo, a ingest?o do ?leo atenuou os danos ? fun??o card?aca (p<0,05), sugerindo que, ainda que modestamente, o ?leo do pequi exerceu um efeito protetor sobre as estruturas card?acas intr?nsecas. Al?m disso, foi observada uma atenua??o da peroxida??o lip?dica no tecido hep?tico para HFS-OP em rela??o ? HFS (p<0,05), sugerindo que o ?leo do pequi pode ter favorecido a incorpora??o dos MUFA e de carotenoides nas membranas dos cardiomi?citos, o que exerceu um efeito protetor. Devido ao papel prim?rio do f?gado no controle metab?lico de todo o organismo, esse efeito de prote??o contra a peroxida??o lip?dica n?o p?de ser observado nos hepat?citos. Contudo, a presen?a dos carotenoides na dieta HFS-OP fortaleceu o sistema antioxidante ex?geno, evitando que a atividade das enzimas super?xido dismutase e glutationa peroxidase fosse prejudicada em HFS-OP como observado para HFS (p<0,05). Essas adapta??es sugerem que a substitui??o parcial da banha de porco por ?leo de pequi foi capaz de atenuar alguns efeitos delet?rios da dieta ocidental sobre o metabolismo lip?dico, a fun??o card?aca e o estado redox celular de ratos. / Disserta??o (Mestrado) ? Programa Multic?ntrico de P?s-gradua??o em Ci?ncias Fisiol?gicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2015. / ABSTRACT The Western diet pattern, which means a high saturated fat and refined carbohydrates intake, leads to body fat accumulation and several cardiometabolic diseases (CMD). Currently, it has been considered that, not only the amount, but the fat quality, can exert a strong influence in the development of those diseases. In this context, several studies have shown that consuming foods high in monounsaturated fatty acids (MUFA) is associated with lower risk for CMD. Moreover, it has also been identified many bioactive compounds in plant foods which are associated with beneficial effects in reducing the risk, or treating DCM. Among these compounds are carotenoids, which have strong antioxidant activity. In this perspective, pequi oil is a potential functional food, since MUFA represent approximately 60% of its fatty acids content, and it is also high in several antioxidant carotenoids. So, considering that western diet pattern promotes CMD development, and pequi oil is a potential functional food, but it has not been explored in this context, the aim of this study was to evaluate the effects of a partial replacement of lard (high in SFA) by pequi oil (high in MUFA and carotenoids), into a Western diet model, on metabolism, cardiac function and cellular redox status of rats. The animals were divided into three groups (n = 12) and treated during 12 weeks: CTRL - control, AIN93G diet; HFS ? high in saturated fat and sucrose; HFS-OP - high in saturated fat and sucrose, with partial replcement of lard by pequi oil (27%). Body weight and food intake were monitored throughout the experimental period; systolic blood pressure (SBP) and heart rate (HR) were measured at the 3rd and 10th weeks; faeces from the last 72 hours were collected for evaluation of cholesterol and triglycerides (TG). At the end of the experiment, all animals were killed by decapitation, the abdominal and thoracic cavities were opened for collection of samples: (A) hearts were taken immediately to evaluate the ex vivo cardiac function; levels of lipid peroxidation and total antioxidant capacity; (B): epididymal and retroperitoneal adipose tissues were harversted, weighed and subsequently used for adiposity and histological evaluations; (C) serum: for glucose, cholesterol and TG determination; (D) plasma: for insulin, leptin and adiponectina determinations, lipid peroxidation, total antioxidant capacity; (E) livers: for cholesterol and TG levels, histopathological analyzes, lipid peroxidation, total antioxidant capacity and enzyme activities. Body weights from HFS-OP and HFS animals were equally higher than CTRL (p<0.05); however, visceral fat deposition in response to consumption of the Western diet was attenuated by replacing lard by pequi oil and it also led to less TG deposition in the liver (p<0.05). In general, cardiac function was impaired by Western diet, promoting a higher blood pressure and heart rate in vivo and a lower cardiac contractility and relaxation efficiency ex vivo (p<0,05). However, although there were no differential effects from the partial replacement of lard by pequi oil on blood pressure and heart rate in vivo, this replacement attenuated the damage to cardiac function compared to HFS (p<0.05), suggesting that, eventhough modestly, pequi oil exerted a protective effect on intrinsic cardiac structures. In addition, the partial replacement of lard by pequi oil reduced lipid peroxidation in cardiomyocytes (p<0.05) compared to HFS, which was not observed in hepatocytes. Moreover, in the hepatocytes, there were an increasing in total antioxidant capacity and catalase and glutathione peroxidase activities compared to HFS (p<0.05). These adaptations suggest that the partial replacement of lard by pequi oil mitigated some deleterious effects of the Western diet on lipid metabolism, cardiac function and cellular redox status of rats.

Made available in DSpace on 2014-12-17T14:13:41Z (GMT). No. of bitstreams: 1 DaniellaCB_TESE.pdf: 1456295 bytes, checksum: daf0a0f4cae3c76b4bf08c373b4a9fa4 (MD5) Previous issue date: 2011-07-13 / Introduction: Chagas Disease is a serious public health problem, with 5 million infected individuals in Brazil. Of these, approximately 30% develop chronic Chagas cardiomyopathy (CCC), where the main symptoms are fatigue and dyspnea. Objective: To correlate maximal exercise capacity with pulmonary function, inspiratory muscle strength and quality of life in patients with CCC. Methodology: Twelve individuals suffering from CCC were evaluated (7 men), with a mean age of 54.91? 8.60 years and the following inclusion criteria: functional class II and III according to the New York Heart Association (NYHA); left ventricle ejection fraction below 45%; clinical stability (> 3 months); symptom duration > 1 year, body mass index (BMI) < 35Kg/m2 and non-smokers or ex-smokers with a history of smoking <10 packs/day. All subjects were submitted to spirometry, manometer testing, maximal cardiopulmonary exercise testing (CPX) and a quality of life questionnaire (Minnesota). Results: A negative correlation was observed between VO2m?x and MLHFQ scores (r=-0.626; p=0.03) and a positive association with MIP (r=0.713; p=0.009). Positive correlations were also recorded between MIP and spirometric variables [FEV1(r=0.825;p=0.001 ), FVC(r=0.66;p=0.01 and FEF25-75%(r=0.639;p=0.02)]. Conclusion: The present study demonstrated that in patients with CCC: VO2MAX is directly related to inspiratory muscle strength and quality of life, while deteriorating lung function is directly associated with respiratory muscle weakness / O treinamento muscular inspirat?rio (TMI) realizado por meio do exerc?cio com limiar de carga inspirat?ria ? utilizado na reabilita??o de indiv?duos com insufici?ncia card?aca cr?nica (ICC). Este trabalho ser? apresentado em tr?s artigos. O primeiro artigo teve como objetivo comparar a cinem?tica ventilat?ria de pessoas saud?veis em rela??o a pacientes com ICC associada ? cardiomegalia e a fraqueza diafragm?tica; o segundo artigo teve como objetivo avaliar os dados funcionais de pacientes com ICC ap?s serem submetidos a programa de TMI e o terceiro e ?ltimo artigo teve como objetivo analisar um subgrupo de pacientes chag?sicos (CCC) durante o exerc?cio m?ximo. Foi observado que a presen?a da cardiomegalia e da fraqueza muscular inspirat?ria s?o comuns em pacientes com ICC. Mecanismos exatos de a??o destes dois fatores associados ou isolados na determina??o dos sintomas respirat?rios nestes pacientes ainda s?o desconhecidos. De acordo com este primeiro estudo, uma menor ventila??o na regi?o diafragm?tica levaria a uma maior percep??o da dispn?ia durante o exerc?cio subm?ximo nesta popula??o. Al?m disso, as mudan?as observadas no padr?o de distribui??o regional da ventila??o nos pacientes com ICC em rela??o aos indiv?duos saud?veis podem servir como base para outros estudos prospectivos utilizando o TMI. O segundo artigo original demonstrou que o TMI para pacientes portadores de ICC mostrou-se eficaz para melhora na for?a muscular, capacidade funcional e qualidade de vida para esta popula??o. Este trabalho tamb?m observou o comportamento da distribui??o dos volumes pulmonares para o sistema t?raco-abdominal nesta popula??o, elucidando que maiores volumes nos compartimentos da caixa tor?cica abdominal e abdominal podem refletir em uma maior efetividade da contra??o diafragm?tica. Concluindo, o terceiro e ?ltimo artigo trouxe elucida??es para os pacientes portadores de CCC: o VO2M?X est? diretamente relacionado com a for?a dos m?sculos inspirat?rios e a qualidade de vida nestes doentes, enquanto que a deterioriza??o da fun??o pulmonar sugere refletir em uma fraqueza dos m?sculos da inspira??o

Made available in DSpace on 2014-12-17T14:44:19Z (GMT). No. of bitstreams: 1 JasonAM_DISSERT.pdf: 1206570 bytes, checksum: 6ff0e9d810dfe142512fa532ed9d6df2 (MD5) Previous issue date: 2014-02-21 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Introduction: The emergence of High Active Antiretroviral Therapy (HAART) increase the life expectancy of the persons living with HIV/AIDS (PLHIV), therefore the prolonged use cause metabolic implications and influences on body fat distribution and increase the cardiovascular diseases prevalence. Aims: Evaluate the effect of resistance training on heart rate variability, biochemical parameters and somatotype on PLHIV. Methods: Participated this study seven sedentary men, with age above 25 years old, living with HIV/AIDS, under HAART use. Were submitted a 16 week intervention with resistance training. Evaluated the heart rate variability, biochemical parameters and somatotype, before, after 8 weeks and 16 weeks, all in paired form. It was found the data normality by Shapiro-Wilk test and conducted the Anova one way combined with Tukey post hoc to samples in each evaluate moment, adopting significance level p<0,05. Also were calculated percentage change deltas. For somatotype was used the somatotype spatial distance (DES), obeying the significance value DES&#8805;1. Results: Was found significance differences only in variable final heart rate delta 60s (p=0,01), however, is not showed changes on heart rate variability, biochemical parameters and somatotype components. Conclusion: 16 weeks of resistance training showed improvement on heart rate recovery after submaximal effort and, despite is not enough to produce significance differences on biochemical parameters and somatotype components, could be realize improvement on average value of fasting glucose and lipid profile, as well as reducing the endomorphic component / Introdu??o: O surgimento da terapia antirretroviral altamente ativa (HAART) aumentou a expectativa de vida das pessoas vivendo com HIV/AIDS (PVHIV), por?m o seu uso prolongado ocasiona implica??es metab?licas e influencia na redistribui??o de gordura corporal e aumento da preval?ncia de doen?as cardiovasculares. Objetivo: Avaliar o efeito do treinamento resistido na variabilidade da frequ?ncia card?aca, par?metros bioqu?micos e somatotipo de PVHIV. M?todos: Participaram do estudo 7 homens sedent?rios, com idade acima de 25 anos, vivendo com HIV/AIDS, sob uso de HAART. Foram submetidos a uma interven??o de 16 semanas com treinamento resistido. Avaliou-se a variabilidade da frequ?ncia card?aca, par?metros bioqu?micos e o somatotipo, inicialmente e ap?s 8 e 16 semanas de interven??o. Todos eles de forma pareada. Constatou-se a normalidade dos dados pelo teste de Shapiro-Wilk e realizou-se uma Anova one way combinado ao post hoc de Tukey para as amostras em cada momento de avalia??o adotando um valor de p<0,05. Tamb?m foram calculados deltas de mudan?as percentual. Para o somatotipo utilizou-se a dist?ncia espacial dos somatotipos (DES), obedecendo um valor de signific?ncia de DES&#8805;1. Resultados: Encontrou-se diferen?a significativa, somente para a vari?vel delta da frequ?ncia card?aca final de 60s (p=0,01), no entanto, n?o foram observadas modifica??es na variabilidade de frequ?ncia card?aca, vari?veis bioqu?micas e componentes do somatotipo. Conclus?o: 16 semanas de treinamento resistido demonstrou melhoria na recupera??o da frequ?ncia card?aca ap?s um esfor?o subm?ximo e, apesar de n?o ser suficiente para produzir diferen?as significativas nos par?metros bioqu?micos e nos componentes do somatotipo, p?de-se perceber melhoria nos valores m?dios de glicemia e perfil lip?dico, assim como redu??o do componente de endomorfia

Made available in DSpace on 2014-12-17T15:16:11Z (GMT). No. of bitstreams: 1 GeorgesWSO_DISSERT.pdf: 1009426 bytes, checksum: 8893e2a5a8e365ecfa26bba101b66dcf (MD5) Previous issue date: 2010-08-31 / INTRODUCTION: Cardiac and pulmonary manifestations of the Chagas disease (CD) affect between 20-30% of the infected subjects. The chronic Chagas cardiomyopathy (CCC) has some peculiarities such as arrhythmias and, especially heart failure (HF) and is potentially lethal due to left ventricular dysfunction. How respiratory disorders, patients get progressive loss of functional capacity, which contributes to a poor quality of life related to disease. Measurements of lung volume by the movement of the chest wall surface are an alternative evaluation of lung function and kinematics of complex thoracoabdominal for these patients. OBJECTIVE: evaluate the kinematics of the thoracoabdominal complex through the regional pulmonary volumes and to correlate with functional evaluation of the cardiorrespiratory system in patients with Chagas disease at rest. MATERIALS AND METHODS: a cross-section study with 42 subjects had been divided in 3 groups, 15 composed for patients with CCC, 12 patients with HF of different etiologies and 15 healthful presented control group. An optoelectronic plethysmography (POE), Minnesota questionnaire, six minute walk test, spirometer and manovacuometer was used. RESULTS: It was observed in the 6MWT where group CRL presented greater distance 464,93?44,63m versus Group HF with 399,58? 32,1m (p=0,005) and group CCC 404?68,24m (p=0,015), both the groups presented difference statistics with regard to Group CRL. In the manovacuometer 54,59?19,98; of the group CCC and 42,11?13,52 of group IC found group CRL presented 81,31?15,25 of the predicted versus, presenting in relation to group CRL. In the POE it observed a major contribution in abdominal compartment in patients with IC if compared like CCC and control groups. On the basis of the questionnaire of quality of life of Minessota, verified a low one groups CCC and IC 43,2?15,2 and 44,4?13,1, respectively (p<0,05) when compared with the control group (19,6?17,31). CONCLUSION: it seems that the patients with CCC possess same functional and respiratory characteristics, observed for the POE, 6MWT, manovacuometer and spirometer to the patients of group HF, being able to consider similar interventions for this complementary group as therapeutical of this neglected disease / INTRODU??O: As manifesta??es pulmonares e card?acas da Doen?a de Chagas (DC) afetam entre 20 a 30% dos indiv?duos infectados. A Cardiomiopatia Chag?sica Cr?nica (CCC) possui algumas particularidades tais como arritmias e, principalmente a Insufici?ncia Card?aca (IC), sendo potencialmente letal devido a disfun??o ventricular esquerda. Como altera??es respirat?rias, os pacientes adquirem progressivo preju?zo da capacidade funcional, o que contribui para uma pobre qualidade de vida relacionada ? doen?a. As medidas dos volumes pulmonares atrav?s do movimento da superf?cie caixa tor?cica surgem como alternativa de avalia??o da fun??o pulmonar e da cinem?tica do complexo t?raco-abdominal para estes pacientes. OBJETIVO: analisar a cinem?tica do complexo t?raco-abdominal atrav?s dos volumes pulmonares regionais e correlacionar com avalia??o funcional do sistema cardiorrespirat?rio em pacientes com Doen?a de Chagas durante o repouso. MATERIAIS E M?TODOS: estudo transversal com 42 sujeitos que foram alocados em 3 grupos, sendo 15 composta por pacientes com CCC, 12 pacientes com IC de diferentes etiologias e 15 idosos saud?veis. Foi utilizado um pletism?grafo opto eletr?nico (POE), question?rio de Minessota, teste de caminhada 6 minutos, espirometria e manovacuometria. RESULTADOS: Observou-se no TC6min onde o grupo idosos apresentou maior dist?ncia percorrida 464,93?44,63m vs Grupo IC com 399,58? 32,1m (p=0,005) e grupo CCC 404?68,24m (p=0,015), ambos os grupos apresentam diferen?a estat?stica com rela??o ao Grupo Idosos. Na manovacuometria o grupo idosos apresentou 81,31%?15,25 do predito vs 54,59%?19,98 do grupo CCC e 42,11%?13,52 do grupo IC, apresentando (p<0,05) em rela??o ao grupo Idosos. Na POE observou-se uma maior contribui??o do compartimento abdominal no grupo IC o que n?o aconteceu com os grupos CCC e controle. Com base no question?rio de qualidade de vida de Minessota, verificou-se um baixo escore nos grupos CCC e IC 43,2?15,2 e 44,4?13,1, respectivamente (p<0,05) quando comparados ao grupo controle (19,6?17,31). CONCLUS?O: os dados sugerem que os pacientes com CCC possuem mesmas caracter?sticas funcionais e respirat?rias, observadas pela POE, TC6min, manovacuometria e espirometria aos pacientes do grupo IC, a capacidade funcional apresentou-se diminu?da, podendo considerar interven??es semelhantes para esse grupo como terap?utica complementar dessa doen?a negligenciada

This Master Thesis was conducted at Octapharma AB in Stockholm. Anticomplementary activity (ACA) is a measure of the product’s abilities to activate the complement system. IgG aggregates are mainly responsible for this activation. Two different performances of a method for determination of ACA in Octagam® are available. The two performances are based on the reference method for test of ACA in immunoglobulins in the European Pharmacopoeia Commission Guideline 6.0 (chapter 2.6.17). The method is carried out either in test tubes or on microtiter plates. The test tube method can be performed either in a manual manner or modified, being more automated. The latter performance has been applied in this study. The plate method is more automated than both of the tube methods. The plate method and the manual tube method have earlier seemed to result in different outcomes, which was the basis for this thesis. The plate method and the modified test tube method have been compared and robustness parameters have been studied in order to see which factors influence on the end result. The adequacy of using Human Biological Reference Preparation (human BRP) as a control for the ACA method in general has also been investigated. Samples of the product are outside the scope of this thesis and have not been investigated. According to this study, the plate method and the modified tube method are not comparable with regard to complement titration results and to ACA of the BRP control. A higher precision is gained with the plate method. This in combination with the higher degree of automation makes the plate method advantageous in several aspects. When it comes to the robustness of the ACA method in general, the sheep red blood cells (SRBC) used are critical. Haemolysin dilution and complement activity seem to be critical as well. Human BRP is, according to this study more adequate as a reference for the plate method than for the tube method. An In house control is believed to be more representative to the ACA method in general as it is of the same nature as the samples analysed, in contrast to the human BRP.

Cette thèse porte sur la modélisation et l’analyse de la propagation électromagnétique dans un milieu forestier dans les bandes VHF et UHF. L’objectif principal est le développement d’un modèle numérique "full-wave" tridimensionnel de diffusion par la forêt permettant de caractériser l’interaction d’une onde électromagnétique avec un milieu forestier. Un tel modèle s’avère, actuellement, un outil indispensable à l’analyse des mesures radar pour l’étude des paramètres caractéristiques de la forêt tels que la biomasse forestière, la hauteur des arbres et leur densité. La complexité numérique de ce modèle a limité son domaine d’application à de petites parcelles de forêt et aux basses fréquences. Pour pouvoir traiter de larges zones forestières tout en montant en fréquence, et s’approcher ainsi des besoins et exigences des utilisateurs potentiels de notre modèle, nous avons intégré à ce modèle une méthode numérique efficace dédiée à l’analyse de larges problèmes électromagnétiques. La méthode en question,connue sous le nom de Characteristic Basis Function Method (CBFM) était récemment développée dans le laboratoire de Communication et Electromagnétisme de l’université PennState dirigé par le Professeur Mittra. Après une optimisation et une adaptation au problème d’intérêt, la CBFM réalise d’excellentes performances et nous permet une diminution considérable du temps de calcul et des besoins en espace mémoire sans pour autant dégrader la qualité des résultats obtenus ou altérer la fidélité du modèle à la réalité du problème électromagnétique traité. / A 3-D full-wave model, based on the integral representation of the electric field and dedicatedto the analysis of bi-static scattering mechanisms by a forest in the VHF and UHF bands wasefficiently enhanced. In order to overcome the limitation of a previous 3D model to small simulationsscenes and low frequencies, we have developed, during this research work, a new model using basis functionsadapted to the problem of interest, in the context of the Characteristic Basis Function Method(CBFM) and we investigated the suitability of this direct method for computing the electromagneticfields inside and outside three-dimensional dielectric objects representing the tree trunks and branches.The CBFM has shown great performances, when applied to the forest scattering modeling, both interms of CPU time and memory resources needed. Once properly set, the CBFM-E is so efficient thatit is able to treat in few minutes electromagnetic problems totally intractable with the classical MoM.Consequently, we have developed a powerful 3D forest electromagnetic scattering tool which allows ustoday to compute large forest electromagnetic problems in few minutes without worrying about theaccuracy of the solution. On the other hand, we have demonstrated the efficiency and accuracy of theCBFM-E when applied to 3D dielectric objects in the context of the electric volumetric integral equation,and have consolidated thus its leading position in the computational electromagnetics, especiallyagainst the iterative solvers based numerical methods.

Semestral thesis deals with fractional-order frequency filters. There is descripe proposal of the filter, their simulations and practical realizations. The first part is focused at the introduction to a frequency filters. The following is chapter which explore various proposals fractional-order frequency filters. The next chapter describes used activ elements in this thesis. Then there is briefly described a method of the signal flow graphs. The following is a description of the theoretical design of lowpass and highpass frequency filter, where order of the filter is between the first and second. Another part deal with the design and simulation of the four circuits. There are two curcuits consists of transconductance amplifiers (BOTA) and two curcuist consists of current followers. The last part of the thesis deals with practical realization of the two fractional-order filters.