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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
591

An Assessment of Community Capacity for Sustainable Watershed Management in the Lower Kaskaskia River Watershed

Slemp, Christopher Thomas 01 December 2009 (has links)
Sprawling low density housing and retail developments characterize the growth patterns of many communities nationally. These patterns of development have been associated with impairments in ecosystem services that are critical to the functioning of social and natural systems. In response to the negative implications of these patterns, watershed initiatives are taking place across the U.S. These initiatives are characterized by participatory decision making processes involving diverse community interest groups. Studies have indicated that leadership and social capital contribute to the success of these initiatives. A qualitative assessment of community capacity for sustainable watershed management was conducted in two Lower Kaskaskia River watersheds. The study communities of Belleville and O'Fallon, Illinois are located in the eastern metropolitan region of St. Louis, MO. The primary concerns of community managers and planners are related to managing growth and its negative impacts on economic, social, and natural capitals. Six research questions drove this capacity assessment: (1) How do diverse community managers and residents define community health, (2) What role does the natural environment play in perceptions of community health, (3) What are the perceived effects of urbanization on the study communities, (4) What are community stakeholders' beliefs about the level of environmental protection within their communities, (5) What are stakeholders' perceptions of their communities' ability to solve problems and (6) What are critical indicators of community capacity to engage in sustainable watershed management. Study findings suggest that healthy natural environments are an essential element of healthy communities. Indicators of community capacity for watershed management were identified by participants. This list of indicators can be used as a tool by residents that have identified a need for a watershed initiative in their community. Key findings suggest that developing a sustainable vision, networking between groups, and leadership play important roles in the successful implementation of community based watershed initiatives.
592

Capacity Constraints for Air Traffic Flow Development

Petersen, Rebecca January 2018 (has links)
In aviation, the demand for air traffic grows at a higher rate than the capacity. As the demand is predicted to continue to grow also in the future, so is the problem of capacity shortage. If the capacity cannot match the demand, it will result in congestion and delay. There are numerous factors that limit the capacity both on airside and landside, for example the runway capacity, noise restrictions, the environment surrounding the airport etc. Actors such as airlines, ground service companies, ICAO and IATA also affect and are affected by the available capacity. When planning opening of new airports or in case of changes in the location and size of the airports, the requirement for, as well as the currently available capacity must be examined. Previous studies regarding key limiting factors to air traffic capacity, address different constraints, but lack a comprehensive view. A compilation of air traffic constraints would therefore be a valuable tool in airport planning when capacity demand changes. The aim of this thesis was to identify key limiting factors and see how they affect air traffic. This thesis analyses the importance of different limiting factors in respect to the level of significance to which previous research has acknowledged the different constraints. To compliment the literature review, professionals in airport planning were interviewed. The result from the literature review as well as the interviews showed that the major limiting factor to air traffic capacity is the runway. The runway was also the factor that was affecting as well was affected by other limiting factors. Previous literature considered wake vortex to be the second most important constraint whereas the interviewees considered stands to be the runner up limiting factor. In conclusion, this thesis showed that the runway is the most important limiting factor to air traffic capacity. The thesis also showed that different limiting factors are closely linked to each other. For an overall understanding of air traffic capacity constraints and how these constraints affect air traffic flow, it is essential to understand the interaction between the limiting factors.
593

A Knowledge Perspective on Needs as a Foundation for Organisational Learning Processes

Kragulj, Florian 06 July 2016 (has links) (PDF)
Needs are crucial in organisational learning processes, but yet not formally conceptualised as a distinct type of knowledge. In this conceptual paper, I establish a knowledge perspective on needs and the transformation process from needs towards need satisfaction. Based on an ontology clarifying the concept of need and its means of satisfaction, I introduce need-based solution knowledge consisting of three distinct capacities to act. I argue why these capacities should be made explicit in group settings and point at possible leverage points for organisational practice.
594

Sorption properties of natural zeolites for the removal of ammonium and chromium ions in aqueous solution

Ndayambaje, Guillaume January 2011 (has links)
>Magister Scientiae - MSc / There are huge amount of natural clinoptilolite available in South Africa which can be utilised for wastewater treatment of ammonia and chromium if their characteristics are properly known. However, these deposits have not been well characterised but in this study, the untreated clinoptilolite materials were fully characterised using techniques such as SEM-EDS, HRTEM-SAED, XRD, XRF, FTIR and BET. After acid pretreatment with several extractions, the pretreated samples were again characterised using the above mentioned techniques. These pretreated materials were used for NH₄⁺ and Cr³⁺ adsorption of wastewater. The three natural South African clinoptilolite samples used in this study were from ECCA Holdings (ESC and EHC samples) and Pratley (PC sample) deposits obtained from Western Cape and KwaZulu-Natal Province respectively. This study revealed that the chemical composition and mineral phases of South African clinoptilolites vary considerably from site to site, even clinoptilolite mined from the same deposit sites. The XRD analyses showed that Pratley clinoptilolite (PC) was the most pure clinoptilolite sample (81.41 %) compared to the purity of EHC (67.88 %) and ESC (44.0 %) sample. The ECCA Holdings untreated clinoptilolite samples contained dense phases such as quartz which was not found in Pratley sample. Quartz was found to be the most dominant impurity in both ECCA Holding sample. The cation exchange capacity (CEC) of ESC, EHC and PC samples were found to be 1.23, 1.81 and 2.90 meq/g respectively and these results were compared to that of XRF analyses. The acid solutions of 0.02 and 1.0 M HCl were used to pretreat natural clinoptilolite to determine the optimum acid concentration and number of extractions required to fully replace the exchangeable cations. The pretreatment results showed that 0.02 M HCl was the optimum acid concentration for acid pretreatment of clinoptilolite samples. Between 7 and 22 extractions were required to remove Na⁺, K⁺, Ca²⁺ and Mg²⁺ without causing much dealumination of the framework. Sodium ion was found to be weakly bound cation in the clinoptilolite framework, since it could be completely exchanged by H⁺ after 7 extractions with 0.02 M HCl acid solution. Potassium ion was found to be strongly bound in the clinoptilolite framework since it could not be completely exchanged during the acid pretreatment process even after 22 extractions. The HRTEM-SAED and BET results showed that ESC, EHC and PC were all polycrystalline and microporous materials respectively. It was found that the adsorption capacity of the treated Pratley clinoptilolite sample was increased by 36 % for NH₄⁺ removal, compared to that of the untreated PC sample. The adsorption study results showed that the pretreatment of clinoptilolite samples using 150 mL volumes of 0.02 M HCl with 7 acid extractions at 25 °C for ESC pretreated and EHC pretreated. The pretreatment of PC sample at 22 extractions could remove high percentage of NH₄⁺ (98.11 %) within a short contact time of 10 min. The pretreated Pratley clinoptilolite sample was found to be the best NH₄⁺ adsorbent (98.11 % NH₄⁺ removal) compared to EHC treated (93.89 % NH₄⁺ removal) and ESC treated (75.00 % NH₄⁺ removal) clinoptilolite samples. However, acid-pretreated Pratley clinoptilolite did not sufficiently remove Cr³⁺ (16.10 %) from synthetic wastewater showing that it is not a good adsorbent for this particular metal ion removal. Despite several studies that have been conducted on clinoptilolite, no study has been carried out on the pretreatment and comparison of sorption capacity of different South African clinoptilolites for the removal of NH₄⁺ from wastewater. This study has been able improve on the acid-pretreatment procedure for clinoptilolite. This study demonstrated that it is not only the acid concentration that is important but also the number of extractions needed to remove all the exchangeable cations from the clinoptilolite framework. This study has also been able to prove that South African clinoptilolite can treated ammonia from wastewater.
595

The Role of Evaluation Policy in Organizational Capacity to Do and Use Evaluation

Al Hudib, Hind 14 September 2018 (has links)
Despite the recent calls made by scholars in the evaluation field regarding the importance of evaluation policy and its influence on evaluation practice, there remains a lack of empirical evidence pertaining to the relationship between evaluation policy and evaluation capacity building (ECB). This study sought to explore the role of evaluation policy in building, or in impeding, organizational capacity to do and use evaluation. Through three interconnected studies—a review of an extensive sample of evaluation policies; interviews with scholars and practitioners from Canada, the United States, and Europe; and focus groups held with evaluation community members in Jordan and Turkey—the research identified a set of 10 categories of evaluation policy and proceeded to develop and validate an ecological framework depicting the relationship between evaluation policy and organizational capacity to do and use evaluation. The findings suggest that the role of evaluation policy in building organizational capacity for evaluation is moderated by a number of variables operating at the contextual, organizational and individual levels and that an in-depth understanding of the dynamic, unfolding and ongoing connections between ECB, on the one hand, and the broader social, economic, political and cultural systems associated with an organization, on the other, is essential in focusing ECB efforts. While the findings reveal that the role of evaluation policy in leveraging organizational evaluation capacity has been limited, they also show some evidence that if an evaluation policy is carefully designed to privilege learning as a central and desirable function of evaluation it will be more likely to have a positive influence on the organizational capacity to do and use evaluation. The investigation helps to advance understanding of these connections and provides some insight into the components of evaluation policies and the role that they might play in shaping the future of evaluation practice. This thesis makes an important contribution to the body of knowledge on organizational evaluation capacity. Although much has been published in the evaluation literature on ECB, its relationship to evaluation policy has not been explored or described based on empirical data. The main practical implication of the research is the possibility for organizations seeking to develop evaluation policies that are ECB-oriented to use the ecological framework and the set of evaluation policy categories as guides. Similarly, organizations that are seeking to review and update their current policies to make them more ECB-friendly stand to benefit in this way. Future research may focus on expanding the scope of the framework and its applicability for different types of organizations in different contexts. Finally, it is argued that the development of policies designed to promote learning is a necessary step towards the advancement of evaluation practice.
596

Impacto da prescrição de exercício físico regular na qualidade de vida e função ventricular de pacientes com doença falciforme

Araujo Jr, Jonas Alves January 2018 (has links)
Orientador: Meliza Goi Roscani / Resumo: Introdução: Doença falciforme (DF) refere-se a um grupo de entidades nosológicas hemolíticas hereditárias, decorrentes da mutação da hemoglobina, com padrão de hemoglobina S. A polimerização das moléculas de hemoglobina S desoxigenada causa falcização dos eritrócitos, podendo levar à oclusão dos vasos sanguíneos e isquemia de múltiplos órgãos, implicando em redução da capacidade funcional e cardiovascular, crises dolorosas frequentes, inflamação crônica, insuficiência de órgãos e prejuízo na qualidade de vida. O efeito benéfico do exercício físico na qualidade de vida e na capacidade funcional é bem descrito nos pacientes com doença cardiovascular, no entanto, estudos conclusivos são necessários sobre o efeito da prescrição de exercício físico regular nos pacientes com doença falciforme. Ainda é controverso se o estresse físico pode desencadear crises de falcização e piora do quadro clínico. Objetivo: Avaliar o impacto da prescrição de exercício físico regular na sintomatologia, no VO2 de pico, na função cardiovascular e na qualidade de vida de pacientes com doença falciforme. Metodologia: Foi realizado ensaio clínico não randomizado em pacientes com doença falciforme em seguimento ambulatorial e livres de crises de falcização há, pelo menos, 30 dias antes da data de inclusão, divididos em dois grupos pareados por idade e sexo: Grupo Exercício (EXE): composto por 14 pacientes, submetidos à prescrição de exercício físico regular aeróbio 3 vezes por semana, com duração de 1 hor... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Sickle cell disease (SCD) refers to a group of heritable hemolytic nosological entities, arising from the hemoglobin mutation, with hemoglobin S pattern. Polymerization of deoxygenated hemoglobin S molecules causes erythrocyte sickling, which can lead to blood vessel occlusion and multiple organ ischemias, leading to reduced functional and cardiovascular capacity, frequent painful crises, chronic inflammation, organ failure, and life quality injury. The profitable effect of physics exercises in life quality and in the functional capacity is well descript on patients with cardiovascular diseases, however, conclusive researchers are necessary about the effect on the prescription of regular physics exercises for patients with sickle cell diseases. Still controversial if the physics stress could trigger the sickling crises and worsening the clinical conditions. Objective: To evaluate the impact in the prescription of regular physics exercises on VO2 peak on cardiovascular function and on life quality of patients with sickle cell diseases. Methodology: A prospective study of non-randomized intervention with sickle cell disease patients in outpatients’ follow-up and free of sickle cell crises 30 days before the inclusion, divided into two groups matched for age and sex: Exercise Group (EG) composed by 14 patients, submitted to regular aerobics physics exercises prescription three times a week 1 hour period per eight weeks; Control Group (CG, n=13): without prescriptio... (Complete abstract click electronic access below) / Doutor
597

Organizational Structure and Institutional Support for USDA Forest Service Partnerships

Barrow, Lori Ann 01 December 2012 (has links)
AN ABSTRACT OF THE THESIS OF LORI A. BARROW, for the Master of Science degree in FORESTRY, presented on October 18, 2012 at Southern Illinois University Carbondale TITLE: ORGANIZATIONAL STRUCTURE AND INSTITUTIONAL SUPPORT FOR USDA FOREST SERVICE PARTNERSHIPS MAJOR PROFESSOR: Dr. Erin Seekamp and Dr. Andrew Carver In an era of constrained appropriations and increasingly complex social and environmental challenges, partnerships have become an essential tool for public land management agencies, such as the USDA Forest Service (USFS), to accomplish critical tasks, meet management goals, and enhance service delivery. Despite the growing practice and reliance on partnerships as an alternative management strategy, few empirical assessments of this management approach have been conducted, and knowledge is limited regarding the structure and function of these relationships. Therefore, the goals of this study were to expand the established partnership knowledge base by systematically examining the institutional characteristics necessary to foster a vibrant partnership culture, uncovering and documenting the various partnership structural types being utilized, and determining whether or not institutional characteristics or external environment characteristics are related to the partnership approach utilized by USFS personnel. To explore these partnership characteristics, and assess whether differences existed between administrative levels and between national forest, an online questionnaire was administered to agency personnel on 13 randomly selected forests during the fall of 2011. Forests were randomly selected from three stratum of internal commitment from all 155 national forests' "Working Together" webpage. Of the 1584 respondent sample, 611 completed the questionnaire (40% response rate). Data collected clearly document a steady increase in the reliance of partnerships as a management strategy in recreation and resource service delivery. While the findings reveal diverse partnership support networks, respondents reported few incentives to cultivate partnerships and limited recognition for their partnership work. Furthermore, this study confirms that agency personnel work with multiple types of volunteer or partnering groups on a fairly regular basis, and make strategic choices when selecting and cultivating partnerships based on the types of work typically performed and their access and proximity to different partnering groups. Moreover, a mixed-method cluster analysis provided further insight into agency-partner interactions by identifying and defining partnership structural types and exposing variation in personnel's capacity to engage partners based on the level of internal support received, the extent of the national forest's partnership dependency, and type of external environment that categorizes the communities adjacent to the national forest (i.e., urban or rural). As the partnership phenomenon continues to be espoused by the USFS as an innovative and alternative management strategy, this thesis provides agency personnels' depiction of the agency's capacity to engage and support partnerships at multiple administrative levels and on different national forests, and helps build the foundation for managing national forests through partnerships.
598

BEARING CAPACITY OF SHALLOW FOUNDATION USING GEOGRID REINFORCED DOUBLE LAYERED SOIL

Tiwari, Dipak 01 December 2011 (has links)
Since the last three decades, several studies have been conducted related to improvement in bearing capacity of pavements, embankments, and shallow foundations resting on geosynthetic reinforced soil. Most of the work has been carried out on single layer soil e.g., sand or clay layer only. Very few studies are available on a double layer soil system; but no study is available on the local soil of Carbondale, Illinois. The present study investigates the physical and engineering properties of a local soil and commonly available sand and improvement in the bearing capacity of a local soil for a rectangular footing by replacing top of the local soil with sand layer and placing geogrids at different depths. Seven tests on the model footing were performed to establish the load versus settlement curves of unreinforced and reinforced soil supporting a rectangular foundation. The improvement in bearing capacity is compared with the bearing capacity of the local soil and double layer unreinforced soil system. The test results focus on the improvement in bearing capacity of local soil and double layer unreinforced soil system in non-dimensional form i.e., BCR (Bearing Capacity Ratio). The results obtained from the present study show that bearing capacity increases significantly with the increasing number of geogrid layers. The bearing capacity for double layer soil increases, by placing three inch sand layer at the top of local soil, was not significant. The bearing capacity of the local soil increased at an average of 7% with three inches sand layer. The bearing capacity for the double layer soil increases with an average of 16.67% using one geogrid layer at interface of soils (i.e., local soil and sand) with u/B equal to 0.67. The bearing capacity for the double layer soil increases with an average of 33.33% while using one geogrid in middle of sand layer having u/B equal to 0.33. The improvement in bearing capacity for double layer soil maintaining u/B equal to 0.33 and h/B equal to 0.33; for two, three and four number geogrid layer were 44.44%, 61.11%, 72.22%, respectively. The results obtained from this research work may be useful for the specific condition or similar type of soil available anywhere to improve the bearing capacity of soil for foundation and pavement design.
599

Avaliação da capacidade funcional motora em pacientes esquizofrênicos

Szortyka, Michele Fonseca Vieira January 2014 (has links)
Introdução: A esquizofrenia é um transtorno mental grave e debilitante, que afeta o paciente tanto na sua saúde física como na diminuição de sua capacidade funcional, causando um grande comprometimento ao longo da vida. Apesar de ser possível que o prejuízo em motricidade e prejuízo cognitivo possam representar expressão de um mesmo processo inflamatório sistêmico, pouco se sabe sobre a relação entre motricidade e esquizofrenia. Objetivos: Avaliar a capacidade funcional motora em pacientes esquizofrênicos correlacionando com marcadores inflamatórios, gravidade de doença e tratamento medicamentoso. Métodos: Estudo transversal, por amostra de conveniência, aprovado pelo comitê de ética do Hospital de Clínicas de Porto Alegre (HCPA). Foram recrutados 40 indivíduos com esquizofrenia estabilizada, em tratamento no ambulatório do HCPA. Foi avaliada a capacidade funcional motora através do Teste de Caminhada de 6 Minutos. O nível de significância adotado foi de 5% para todas as variáveis e as análises foram realizadas no programa Statistical Package for the Social Sciences (SPSS, versão 21.0). Resultados: A amostra foi estratificada por anos de doença através do percentil 25, onde apresentou significância no estado civil apresentando uma maior frequência de solteiros e separados em pacientes com o maior tempo de doença (p=0.022). As médias das variáveis funcionais e clínicas laborais que comparadas com médias populacionais apresentaram significância foram: frequência cardíaca (p=0.004), pressão arterial diastólica e sistólica (p=0.001 e p<0.001), frequência respiratória (p<0.001), Proteína C reativa (p=0.015), borg (p<0.001) e Tc6m em homens e mulheres (p<0.001 e p=0.024). No desempenho funcional e dispneia houve uma correlação com a proteína C reativa (r=-0,369 e r= 0,535). Conclusão: O presente estudo mostrou a associação entre o prejuízo funcional com marcadores inflamatórios, principalmente com níveis elevados de PCR. Alterações clínicas foram associadas como reações adversas a utilização de antipsicóticos, apesar de não ser possível descartar também mecanismos inflamatórios antecedendo ambas as alterações. O prejuízo na capacidade funcional associado com aumento da PCR sugere um paciente com sinais de deterioração maior. Todos achados deste estudo apresentam uma contribuição para o entendimento do processo psicótico e abrem caminho para novas intervenções terapêuticas. / Introduction: Schizophrenia is a severe, debilitating mental disorder that affects both the physical health and the functional capacity of patients, causing great impairment throughout the life course. Although physical and cognitive impairments may represent different expressions of a single systemic inflammatory process, little is known about the relationship between motor function and schizophrenia. Objective: To evaluate physical functional capacity in patients with schizophrenia and ascertain whether it correlates with markers of inflammation, disease severity, and pharmacotherapy. Methods: Cross-sectional study using a convenience sampling strategy. Forty patients with stable schizophrenia, undergoing treatment, were recruited from the outpatient psychiatry clinic of Hospital de Clínicas de Porto Alegre (HCPA), a tertiary referral center in Southern Brazil. The 6-minute walk test (6MWT) was used to assess physical functional capacity. The significance level was set at 5% for all variables, and all statistical analyses were carried out in SPSS 21.0. The study was approved by the HCPA Research Ethics Committee. Results: The sample was homogeneous and normally distributed. Subjects were stratified by disease duration, which was significantly associated only with marital status (p=0.022). Comparison of mean functional and clinical variables to population averages showed significant differences in heart rate (p=0.004), diastolic (p=0.001) and systolic (p<0.001) blood pressure, respiratory rate (p<0.001), C-reactive protein levels (p=0.015), Borg Scale of Perceived Exertion scores (p<0.001), and 6MWT distances in men (p<0.001) and women (p=0.024). Conclusion: The present study detected an association between functional impairment and markers of inflammation, especially elevated CRP levels, in patients with schizophrenia. Clinical changes were associated with adverse reactions to antipsychotics, although underlying inflammatory mechanisms could not be ruled out. The loss of functional capacity associated with increased CRP suggests a patient with signs of deterioration increased. The findings of this study contribute to current understanding of the psychotic process and may pave the way for novel therapeutic interventions.
600

Impacto da prescrição de exercício físico regular na qualidade de vida e função ventricular de pacientes com doença falciforme / Impact of exercise prescription on the quality of life and ventricular function of patients with sickle cell disease

Araujo Jr, Jonas Alves 02 March 2018 (has links)
Submitted by Jonas Alves De Araujo Junior (xonasxr@hotmail.com) on 2018-09-21T19:11:31Z No. of bitstreams: 1 Tese de Doutorado 2018 Final - Jonas Alves de Araujo Junior.pdf: 4183055 bytes, checksum: 06cbdf04fea3452cbd7071ec719a0674 (MD5) / Rejected by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: problema 1: Financiamento recebido No formulário de submissão consta o CNPq como financiador do seu projeto mas, no arquivo submetido, não localizei nos agradecimentos referência a este. Caso tenha recebido o apoio favor incluí-lo nos agradecimentos. PORTARIA Nº 206, DE 4 DE SETEMBRO DE 2018 Dispõe sobre obrigatoriedade de citação da CAPES Art. 1º Os trabalhos produzidos ou publicados, em qualquer mídia, que decorram de atividades financiadas, integral ou parcialmente, pela CAPES, deverão, obrigatoriamente, fazer referência ao apoio recebido. Assim que tiver efetuado a correção submeta o arquivo, em PDF, novamente. Agradecemos a compreensão. on 2018-09-25T12:51:57Z (GMT) / Submitted by Jonas Alves De Araujo Junior (xonasxr@hotmail.com) on 2018-10-02T01:46:12Z No. of bitstreams: 1 Tese de Doutorado 28 set 2018 Final - Jonas Alves de Araujo Junior.pdf: 2989656 bytes, checksum: a4df1baef8b7326aa87d9d8872bd6889 (MD5) / Rejected by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: problema 1: Financiamento recebido No formulário de submissão consta a Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) como financiador do seu projeto mas, no arquivo submetido, o agradecimento incluído foi para “ À fundação de Amparo à Pesquisa do Estado de São Paulo, pelo apoio financeiro”. De qual agência você recebeu o financiamento: CAPES ou FAPESP???. Se FAPESP altere a agência indicada no formulário; Se das duas agências então inclua também um agradecimento à CAPES. Assim que tiver efetuado a correção submeta o arquivo, em PDF, novamente. Agradecemos a compreensão. on 2018-10-02T13:01:06Z (GMT) / Submitted by Jonas Alves De Araujo Junior (xonasxr@hotmail.com) on 2018-10-04T14:34:50Z No. of bitstreams: 1 Tese de Doutorado 03 out 2018 Final - Jonas Alves de Araujo Junior.pdf: 2988851 bytes, checksum: f80bd8ac54f4136cc1ef58ab3ce87adf (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-10-04T15:53:23Z (GMT) No. of bitstreams: 1 araujojunior_ja_dr_bot.pdf: 2988851 bytes, checksum: f80bd8ac54f4136cc1ef58ab3ce87adf (MD5) / Made available in DSpace on 2018-10-04T15:53:23Z (GMT). No. of bitstreams: 1 araujojunior_ja_dr_bot.pdf: 2988851 bytes, checksum: f80bd8ac54f4136cc1ef58ab3ce87adf (MD5) Previous issue date: 2018-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: Doença falciforme (DF) refere-se a um grupo de entidades nosológicas hemolíticas hereditárias, decorrentes da mutação da hemoglobina, com padrão de hemoglobina S. A polimerização das moléculas de hemoglobina S desoxigenada causa falcização dos eritrócitos, podendo levar à oclusão dos vasos sanguíneos e isquemia de múltiplos órgãos, implicando em redução da capacidade funcional e cardiovascular, crises dolorosas frequentes, inflamação crônica, insuficiência de órgãos e prejuízo na qualidade de vida. O efeito benéfico do exercício físico na qualidade de vida e na capacidade funcional é bem descrito nos pacientes com doença cardiovascular, no entanto, estudos conclusivos são necessários sobre o efeito da prescrição de exercício físico regular nos pacientes com doença falciforme. Ainda é controverso se o estresse físico pode desencadear crises de falcização e piora do quadro clínico. Objetivo: Avaliar o impacto da prescrição de exercício físico regular na sintomatologia, no VO2 de pico, na função cardiovascular e na qualidade de vida de pacientes com doença falciforme. Metodologia: Foi realizado ensaio clínico não randomizado em pacientes com doença falciforme em seguimento ambulatorial e livres de crises de falcização há, pelo menos, 30 dias antes da data de inclusão, divididos em dois grupos pareados por idade e sexo: Grupo Exercício (EXE): composto por 14 pacientes, submetidos à prescrição de exercício físico regular aeróbio 3 vezes por semana, com duração de 1 hora por 8 semanas; Grupo Controle (CON, n=13): sem prescrição e supervisão da prática regular de exercício físico. Os dois grupos foram submetidos, antes e após intervenção, às avaliações: clínica, do VO2 pico (avaliação física e teste ergométrico), da qualidade de vida (questionário SF-36), do grau de sedentarismo (IPAQ), da função ventricular (ecocardiograma transtorácico) e medida da espessura médio-intimal (EMIC) por ultrassonografia de carótidas. As comparações entre grupos foram realizadas por meio de Análise de Variância (ANOVA) de dois fatores, considerando os fatores tempo e grupo. As correlações entre as variáveis do mesmo grupo foram realizadas por meio de regressão linear para distribuição normal e correlação de Pearson para distribuição não normal, com nível de significância p<0,05. Resultados: Os resultados mostraram que as características basais (M0) dos grupos não apresentaram diferenças significativas. Os grupos foram comparados no momento inicial (M0) e final (M2). Foi observada melhora significativa no VO2 pico (p=0,03), Resumo 2  função sistólica do VE avaliada por fração de ejeção pelo Simpson (p=0,01) e na função diastólica avaliada pela onda E’ do Doppler tecidual mitral (p=0,04). Houve melhora da qualidade de vida no quesito aspectos físicos no grupo EXE (p=0,01). Os pacientes no M0 que não faziam uso de hidroxiureia apresentaram maior infradesnivelamento do segmento ST (p=0,04), e, embora não significante, grande parte desses pacientes apresentou desaparecimento do infradesnivelamento do segmento ST após terem sido submetidos à prática de atividade física (p=0,07). Não houve necessidade de interrupção do exercício por indução de crises de falcização ou piora dos sintomas em pacientes com DF. Conclusão: Os resultados corroboram a hipótese de que a prescrição de exercício físico regular controlado e supervisionado causa impacto favorável na capacidade funcional, função cardiovascular sistólica e diastólica e qualidade de vida dos pacientes com DF. Os pacientes em uso de hidroxiureia também parecem apresentar menos sinais de isquemia do que os pacientes com DF que não fazem uso dessa medicação. / Introduction: Sickle cell disease (SCD) refers to a group of heritable hemolytic nosological entities, arising from the hemoglobin mutation, with hemoglobin S pattern. Polymerization of deoxygenated hemoglobin S molecules causes erythrocyte sickling, which can lead to blood vessel occlusion and multiple organ ischemias, leading to reduced functional and cardiovascular capacity, frequent painful crises, chronic inflammation, organ failure, and life quality injury. The profitable effect of physics exercises in life quality and in the functional capacity is well descript on patients with cardiovascular diseases, however, conclusive researchers are necessary about the effect on the prescription of regular physics exercises for patients with sickle cell diseases. Still controversial if the physics stress could trigger the sickling crises and worsening the clinical conditions. Objective: To evaluate the impact in the prescription of regular physics exercises on VO2 peak on cardiovascular function and on life quality of patients with sickle cell diseases. Methodology: A prospective study of non-randomized intervention with sickle cell disease patients in outpatients’ follow-up and free of sickle cell crises 30 days before the inclusion, divided into two groups matched for age and sex: Exercise Group (EG) composed by 14 patients, submitted to regular aerobics physics exercises prescription three times a week 1 hour period per eight weeks; Control Group (CG, n=13): without prescription or supervision on the practice of regular physic exercise. Both groups were submitted, before and after intervention to the clinic, of VO2 peak (physic evaluation and ergonometric test), of life quality (questionnaire SF – 36), of sedentarism level (IPAQ), of ventricular function (transthoracic echocardiogram) and measure of intimal-medial thickness (EMIC) by carotid ultrasonography. The comparisons between groups were performed by Variance Analysis (ANOVA) of two factors, considering factors of time and group. The correlations between variables of the same group were performed using linear regression for normal distribution and Person’s correlation for non-normal distribution with significance level p<0,05. Results: The results showed that the basal characteristics (M0) of the groups who did not present significant differences between the studied groups. The groups Abstract 6 were compared at initial moment (M0) and final (M2). There was a significant improvement in VO2 peak (p=0.03), VE systolic function assessed by ejection fraction by Simpson (p=0.01) and diastolic function assessed by mitral tissue E’ of Doppler wave (p=0.04). There was improvement in life quality about physics aspects on the EXE group (p=0.01). Patients in the M0 who did not use hydroxyurea presented higher segment depression ST (p=0.04) and many patients showed disappearance of ST segment depression after having undergone physical activity (p=0.07). There was no need to withdraw participants from the study protocol due to induction of sickle cell crises or worsening of the patients’ symptom. Conclusion: The results corroborate the hypothesis that the prescription of controlled and supervised regular physical exercises has a favorable impact on functional capacity, systolic and diastolic cardiovascular function and life quality of SCD patients

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