Background: Knowledge of the incidence of tuberculosis (TB) and hospitalization postpartum could reduce maternal morbidity and mortality. TB infections are prevalent in pregnant women living with Human immunodeficiency virus (HIV) compared to women not living with HIV in South Africa. Adherence to Antiretroviral Therapy (ART) is poor among pregnant and postpartum women living with HIV (WLHIV), thus making WLHIV at a higher risk of hospitalization postpartum, due to the increased risk of Cesarean delivery (CD) and obstetric conditions as a result of HIV. The prevalence of TB among pregnant and postpartum women is poorly defined including in high prevalence TB and HIV locations, indicating limited evidence. The aim is to explore the incidence of TB and hospitalization within four years postpartum among WLHIV, including associated risk factors. Methodology: The study population is from phase 2 of the Maternal and Child HealthAntiretroviral Therapy (MCH-ART) study. It is a single-arm observational cohort study of 628 WLHIV who attended antenatal care (ANC). Enrolment into phase 1 began in March 2013, the final deliveries from phase 2 were in December 2014, and the final follow-up visits were completed in 2016. MCH-ART is an ongoing study with global approval examining strategies for providing HIV care and treatment to HIV-infected women who initiate ART during pregnancy and their HIV-exposed infants. This study took place at the Midwife-Obstetric Unit (MOU) at Gugulethu Community Health Centre, Western Cape South Africa. It consists of three connected study designs and three phases through the antenatal and postnatal periods. Phase 1 is a cross-sectional study, phase 2 is a cohort study and phase 3 is a randomized trial. Kaplan-Meier survival analysis was used to assess the incidence of TB and hospitalization over time among ix WLHIV up to four years postpartum and Cox regression was used to measure the effect of risk factors on the incidence of TB and hospitalization. Results: Thirty-five (35) WLHIV developed TB postpartum at a total person-time of 2365.1 woman-years. The incidence rate (IR) of developing TB among WLHIV postpartum was 1.48 (95% CI=1.03-2.06) cases per 100 woman-years from 2013 to 2018. Twenty-three (23) WLHIV was hospitalized postpartum and a total person-time of 552.8 woman-years was spent. The IR of hospitalization among WLHIV postpartum was 4.16 (95% CI=2.64-6.24) cases per 100 womanyears from 2013 to 2018. The IR of TB and hospitalization among WLHIV postpartum is statistically significant. Adjusting, for other risk factors, the history of diabetes at ANC, the history of TB at ANC and CD4 count (200 - <500) cells/mm3 at ANC also significantly increases the incidence of TB postpartum, whereas, obstetric reasons is associated with the hospitalization of WLHIV.

No description available.

The focus of this thesis is an investigation of ways to detect weak dependence between two random variables X and Y. Our approach is to design tests for correlation rather than testing for dependence directly, since X and Y are not independent if they are not uncorrelated. We examined the magnified Pearson correlation after the Box-Cox transformation to determine whether X and Y are dependent. The results indicated that our approach not only has the potential to detect and evaluate the weak dependence cases that have previously been intractable, but also is conceptually simple and easy to implement.

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

No description available.

The catalytic decomposition of methane offers an interesting route to obtain a stream of pure COx-free hydrogen and carbon materials in the solid phase with potential applications to improve the viability of the process. In this work, we have studied the kinetics of this process using a silica-supported nickel catalyst in a packed bed reactor. In order to ensure the intrinsic kinetic regime, the effects of external and mass transfer on the overall kinetics were examined at relevant reaction conditions. The external mass transfer was found to affect the kinetics at 500 ⁰C and a space velocity of 80 h–1. The internal mass transfer was found to not limit the kinetics when a catalyst particle size in the range of 1000-2000 µm was used. Within the intrinsic kinetic regime, we found that the reaction order with respect to methane is in the range of 0.77-0.94, the activation energy is 110 kJ mol–1 and the rate determining step is the dissociation of the first C-H bond. In addition, the kinetics of the catalyst deactivation follows a first-order behavior with respect to the activity of the catalyst, with an activation energy of 125 kJ mol–1. At the end of the study, a mathematical model for the best-fit model was found using MATLAB. With the whole set of data, the best fit is obtained with a Langmuir-Hinshelwood type rate law.

Un essai clinique est une recherche biomédicale pratiquée sur l'Homme dont l'objectif est la consolidation et le perfectionnement des connaissances biologiques ou médicales. Le nombre de sujets nécessaire (NSN) est le nombre minimal de patients à inclure dans l'essai afin d'assurer au test statistique une puissance donnée pour observer un effet donné. Pour ce faire plusieurs centres investigateurs sont sollicités. La période entre l'ouverture du premier centre investigateur et le recrutement du dernier patient est appelée période de recrutement que l'on souhaite modéliser. Les premières modélisations remontent à presque 50 ans avec les travaux de Lee, Williford et al. et Morgan avec l'idée déjà d'une modélisation de la dynamique de recrutement par des processus de Poisson. Un problème émerge lors de recrutement multicentriques du fait du manque de caractérisation de l'ensemble des sources de variabilité agissant sur les différentes dynamiques de recrutement. Le modèle dit Poisson-gamma basé sur un processus de Poisson dont les intensités par centre sont considérées comme un échantillon de loi gamma permet l'étude de variabilité. Ce modèle est au coeur de notre projet. Différents objectifs ont motivés la réalisation de cette thèse. Le premier questionnement porte sur la validité de ces modèles. Elle est établie de façon asymptotique et une étude par simulation permet de donner des informations précises sur la validité du modèle. Par la suite l'analyse de bases de données réelles a permis de constater que lors de certaines phases de recrutement, des pauses dans le recrutement sont observables. Une question se pose alors naturellement : comment et faut-il prendre en compte ces informations dans le modèle de dynamique de recrutement ? Il résulte d'études par simulation que la prise en compte de ces données n'améliore pas les performances prédictives du modèle lorsque les sources d'interruptions sont aléatoires mais dont la loi est inchangée au cours du temps. Une autre problématique observable sur les données et inhérente au problème de recrutement de patients est celle des dites sorties d'étude. Une technique Bayésienne empirique analogue à celle du processus de recrutement peut être introduite pour modéliser les sorties d'étude. Ces deux modélisations se couplent très bien et permettent d'estimer la durée de recrutement ainsi que la probabilité de sorties d'étude en se basant sur les données de recrutement d'une étude intermédiaire, donnant des prédictions concernant le processus de randomisation. La dynamique de recrutement possède de multiples facteurs autre que le temps de recrutement. Ces aspects fondamentaux couplés au modèle Poisson-gamma fournissent des indicateurs pertinents pour le suivi des essais. Ainsi est-il possible d'ajuster le nombre de centres au cours de l'essai en fonction d'objectifs prédéfinis, de modéliser et prévoir la chaîne d'approvisionnement nécessaire lors de l'essai et de prévoir l'effet de la randomisation des patients par région sur la puissance du test de l'essai. Il permet également d'avoir un suivi des patients après randomisation permettant ainsi de prévoir un ajustement du nombre de patients en cas de pertes significative d'effectif, ou d'abandonner un essai si les résultats préliminaires sont trop faibles par rapport aux risques connus et observés. La problématique de la dynamique de recrutement peut être couplée avec la dynamique de l'étude en elle-même quand celle-ci est longitudinale. L'indépendance des deux processus permet une estimation facile des différents paramètres. Le résultat est un modèle global du parcours du patient dans l'essai. Deux exemples clés de telles situations sont les données de survie - la modélisation permet alors d'estimer la durée d'un essai quand le critère d'arrêt est le nombre d'événements observés et les modèles de Markov - la modélisation permet alors d'estimer le nombre de patients dans un certain état au bout d'un certain temps. / A clinical trial is a biomedical research which aims to consolidate and improve the biological and medical knowledges. The number of patients required il the minimal number of patients to include in the trial in order to insure a given statistical power of a predefined test. The constitution of this patients' database is one of the fundamental issues of a clinical trial. To do so several investigation centres are opened. The duration between the first opening of a centre and the last recruitment of the needed number of patients is called the recruitemtn duration that we aim to model. The fisrt model goes back 50 years ago with the work of Lee, Williford et al. and Morgan with the idea to model the recruitment dynamic using Poisson processes. One problem emerge, that is the lack of caracterisation of the variabliity of recruitment between centers that is mixed with the mean of the recruitment rates. The most effective model is called the Poisson-gamma model which is based on Poisson processes with random rates (Cox process) with gamma distribution. This model is at the very heart of this project. Different objectives have motivated the realisation of this thesis. First of all the validity of the Poisson-gamma model is established asymptotically. A simulation study that we made permits to give precise informations on the model validity in specific cases (function of the number of centers, the recruitement duration and the mean rates). By studying database, one can observe that there can be breaks during the recruitment dynamic. A question that arise is : How and must we take into account this phenomenon for the prediction of the recruitment duration. The study made tends to show that it is not necessary to take them into account when they are random but their law is stable in time. It also veered around to measure the impact of these breaks on the estimations of the model, that do not impact its validity under some stability hypothesis. An other issue inherent to a patient recruitment dynamic is the phenomenon of screening failure. An empirical Bayesian technique analogue to the one of the recruitment process is used to model the screening failure issue. This hierarchical Bayesian model permit to estimate the duartion of recruitment with screening failure consideration as weel as the probability to drop out from the study using the data at some interim time of analysis, giving predictions on the randomisation dynamic. The recruitment dynamic can be studied in many different ways than just the duration of recruitment. These fundamental aspects coupled with the Poisson-gamma model give relevant indicators for the study follow-up. Multiples applications in this sense are computed. It is therefore possible to adjust the number of centers according to predefined objectives, to model the drug's supply chain per region or center and to predict the effect of the randomisation on the power of the test's study. It also allows to model the folow-up period of the patients by means of transversal or longitudinal methods, that can serve to adjust the number of patients if too many quit during the foloww-up period, or to stop the study if dangerous side effects or no effects are observed on interim data. The problematic of the recruitment dynamic can also be coupled with the dynamic of the study itself when it is longitudinal. The independance between these two processes allows easy estimations of the different parameters. The result is a global model of the patient pathway in the trail. Two key examples of such situations are survival data - the model permit to estimate the duration of the trail when the stopping criterion is the number of events observed, and the Markov model - the model permit to estimate the number of patients in a certain state for a given duartion of analysis.

Diversos mecanismos celulares estão associados à patogênese do Carcinoma Epidermoide de Cabeça e Pescoço (CECP). Algumas dessas alterações envolvem proteínas pertencentes à via de sinalização do Akt, e o fator de transcrição NF-kB, o qual têm importante papel na fisiologia normal e no câncer. A proteína COX-2, descrita em processos inflamatórios, também participa da carcinogênese e está associada com a via de sinalização do Akt e com o NF-kB. Dendrímeros são uma forma única de nanotecnologia, surgindo como nanotransportadores com a capacidade de penetrar na célula tumoral liberando drogas quimioterápicas em seu interior. Os benefícios desta tecnologia são o aumento da eficicácia do princípio ativo utilizado e a redução dos seus efeitos secundários tóxicos. O Celecoxibe, antiinflamatório não esteroidal, inibidor seletivo da COX-2, tem se mostrado um importante agente anticarcinogênico, no entanto seu mecanismo de ação no CECP não é totalmente compreendido. Neste trabalho, um Dendrímero de Poliglicerol associado ao Celecoxibe (PGLD-celecoxibe) foi sintetizado e caracterizado por técnicas de espectroscopia ¹H-RMN, ¹³C-RMN, Maldi-Tof, TLC e DSC. Além disso, o conjugado foi testado in vitro em três linhagens celulares de CECP. O PGLD-Celecoxibe foi sintetizado com sucesso e promoveu a redução da dose capaz de inibir a proliferação celular, reduzindo o IC 50 do Celecoxibe de forma significativa em todas as linhagens celulares, se aproximando da dose sérica alcançada por este medicamento, resultado corroborado pelo Ensaio de Migração Celular. O mecanismo de morte celular observado foi a apoptose, associada a diminuição significativa da expressão de COX-2 ou por uma via alternativa independente. Alguns dos grupos tratados apresentaram alteração na expressão das proteínas pAkt e NF-kB. / Several cellular mechanisms are associated with the pathogenesis of Head and Neck Squamous Cell Carcinoma (HNSCC). Some of these alterations involve proteins in the Akt signaling pathway and the transcription factor NF-kB, which plays an important role in normal physiology and in cancer. COX-2 protein, described in inflammatory processes, and also involved in the carcinogenesis is associated with the Akt signaling pathway and the NF-kB. Dendrimers are a unique form of nanotechnology, emerging as nanocarriers with the ability to penetrate the tumor cell releasing chemotherapeutic. This technology increases the active substance efficiency and reduces its toxic side effects. Celecoxib, a nonsteroidal anti-inflammatory, selective inhibitor of COX-2 has been shown to be an important anticancer agent, but its action mechanism in HNSCC is not fully understood. A polyglycerol dendrimer linked to celecoxib (PGLD-Celecoxibe) was synthesized and characterized by NMR spectroscopy ¹H-NMR, ¹³C-NMR,TLD, DSC and Maldi-Tof techniques. In addition, in vitro assays were performed in three HNSCC cell lines The PGLD-Celecoxibe was successfully synthesized and provided a decrease in the dose able to inhibit cell proliferation reducing the IC 50 index of Celecoxib significantly in all cell lines, approaching to the serum dose achieved for this product, result supported by Wound Healing Assay. The cell death mechanism observed was apoptosis, which can be associated with significant reduction of expression of COX-2 also may be occurring by a COX-2 independent pathway. Some of the treated groups showed alterations in pAkt and NF-kB proteins expression.

Diante da importância do sistema financeiro para a economia de um país, faz-se necessária sua constante fiscalização. Nesse sentido, a identificação de problemas existentes no cenário bancário apresenta-se fundamental, visto que as crises bancárias ocorridas mundialmente ao longo da história mostraram que a falta de credibilidade bancária e a instabilidade do sistema financeiro geram enormes custos financeiros e sociais. Os modelos de previsão de insolvência bancária são capazes de identificar a condição financeira de um banco devido ao valor correspondente da sua probabilidade de insolvência. Dessa forma, o presente trabalho teve como objetivo identificar os principais indicadores característicos da insolvência de bancos privados no Brasil. Para isso, foi utilizada a técnica de análise de sobrevivência em uma amostra de 70 bancos privados no Brasil, sendo 33 bancos insolventes e 37 bancos solventes. Foi possível identificar os principais indicadores financeiros que apresentaram-se significativos para explicar a insolvência de bancos privados no Brasil e analisar a relação existente entre estes indicador e esta probabilidade. O resultado deste trabalho permitiu a realização de importantes constatações para explicar o fenômeno da insolvência de bancos privados no Brasil, bem como, permitiu constatar alguns aspectos característicos de bancos em momentos anteriores à sua insolvência. / The financial system is very important to the economy of a country, than its supervision is necessary. Accordingly, the identification of problems in the banking scenario is fundamental, since the banking crisis occurring worldwide throughout history have shown that and instability of the financial system generates huge financial and social costs. The banking failure prediction models are able to identify the financial condition of a bank based on the value of its probability of insolvency. Thus, this study aimed to identify the main financial ratios that can explain the insolvency of private banks in Brazil. For this, it was used the survival analysis to analize a sample of 70 private banks in Brazil, with 33 solvent banks and 37 insolvent banks. It was possible to identify the key financial indicators that were significantly to explain the bankruptcy of private banks in Brazil and it was possible to examine the relationship between these financial ratios and the probability of bank failure. The result of this work has enabled the achievement of important findings to explain the phenomenon of the bankruptcy of private banks in Brazil, and has seen some characteristic of banks in times prior to its insolvency.

Introdução: O excesso de peso em adultos jovens está associado ao desenvolvimento de doenças crônicas não transmissíveis (DCNT) e à diminuição da qualidade de vida e ao aumento da mortalidade precoce. A transição da adolescência para a fase adulta é o período de maior risco para a incidência da obesidade. Objetivo: Estimar o efeito o índice de massa corpora (IMC) aos 20 anos sobre a incidência de DCNT em adultos brasileiros com idade entre 30 a 49 anos. Métodos: Foram selecionados 12.079 indivíduos de 30 a 49 anos da Pesquisa Nacional de Saúde (PNS), realizada no ano de 2013. O modelo adotado para determinação das DCNT foi aquele proposto pela Organização Mundial de Saúde. A incidência das DCNT (hipertensão, doenças cardiovasculares, diabetes e câncer, entre outras), informada pela data do diagnóstico, foi modelada como função do IMC aos 20 anos. Os indivíduos sem a doença até o presente foram considerados como censura. As estimativas de sobrevida foram calculadas com o método de Kaplan-Meier (KM) para cada uma das doenças, estratificada por sexo e ajustada por escolaridade. A análise dos fatores de risco para as doenças foi feita utilizando-se o modelo de riscos proporcionais de Cox. Resultados: Nas curvas de sobrevida KM, indivíduos com IMC >=25kg/m² apresentaram incidência mais elevada e precoce de DCNT, principalmente hipertensão, diabetes e depressão. A idade mediana para incidência do diabetes em obesos foi de 47 anos para homens e 48 anos para mulheres. A incidência da hipertensão arterial foi 4,2 por mil com sobrevida mediana de 48 e 44 anos em mulheres com excesso de peso e obesidade, respectivamente. Dentre os fatores de risco associados as DCNT, o tabagismo em idade precoce foi associado à incidência de depressão. Conclusão: O excesso de peso em adultos jovens aumenta a incidência precoce de DCNT, com efeitos negativos na qualidade de vida, lazer e produtividade, além de aumentar a demanda por serviços de saúde. Torna-se necessário que a intervenção para redução dessas doenças seja direcionada para o período da infância e adolescência com ações que promovam a redução da exposição desses indivíduos à alimentação de má qualidade e incentivo a prática de atividade, não uso do tabaco e consumo moderado de álcool. / Introduction: Overweight in young adults is associated with the development of chronic noncommunicable diseases (NCDs) and decreased quality of life and increased early mortality. The transition from adolescence to adulthood is the period of greatest risk for the incidence of obesity. Objective: To estimate the effect of the corpora mass index (BMI) at age 20 on the incidence of NCDs in Brazilian adults aged 30-49 years. Methods: We selected 12 079 individuals 30-49 years of the National Health Research (PNS) held in 2013. The model adopted for determining the NCD was that proposed by the World Health Organization The incidence of NCDs (hypertension, diseases. cardiovascular, diabetes and cancer, among others), informed by the date of diagnosis, and modeled as a function of BMI at age 20. Individuals without the disease to date have been considered as censorship. Survival estimates calculated with the Kaplan-Meier (KM) for each of the diseases, stratified by gender and adjusted for schooling. The analysis of risk factors for the disease made using the model of Cox proportional hazards. Results: In the survival curves KM, individuals with BMI> = 25 kg / m² presented higher and early incidence of NCDs, particularly hypertension, diabetes and depression. The median age for incidence of diabetes in obese was 47 years for men and 48 years for women. The incidence of hypertension was 4.2 per thousand with a median survival of 48 and 44 years in women with excess weight and obesity respectively. Among the risk factors associated with the NCD, smoking at an early age was associated with the incidence of depression. Conclusion: Being overweight in young adults increases the early incidence of NCDs, with negative effects on quality of life, leisure and productivity, and increase the demand for health services. It is necessary that the intervention to reduce these diseases directed to the period of childhood and adolescence with actions that promote a reduction in exposure of these individuals to the poor quality of food and encouraging the practice of activity, no tobacco use and moderate consumption alcohol.