The purpose of this research has been to investigate the relationships between team building, salutogenesis and performance. Team building was investigated by focusing on the directive and interactive dimensions of • climate • supervisory support • team work. Salutogenesis was investigated by focusing on the concepts of • sense of coherence • locus of control • self-efficacy. Work performance was investigated by focusing on • performance measurement criteria • self-appraisal as a cognitive mediator between performance and salutogenesis. In the literature survey a performance model was postulated to explain the relationships between team building, salutogenesis and performance. The personality profile of the optimal functioning individual in the context of the performance model was compiled from the personality profiles of the optimal functioning team member, the optimal functioning individual and the optimal performing individual. In the empirical investigation a sample (N = 245) of mine employees completed a battery of questionnaires using computerised data collection. The battery was subjected to item-test correlations, Cronbach alpha coefficient measurements and factor analyses, to establish the reliability and structure of each questionnaire. lntercorrelations were calculated and analysed to test the relationships between the dimensions, and concepts. Following this, the factor analysis of a five factor model established the relationships between the dimensions and concepts of team building, salutogenesis and performance. Finally, LISREL-analyses were performed to test the conceptual structure of the relationships. The empirical findings indicate that team building forms a construct based on directive and interactive dimension of climate, supervisory support and team work. Salutogenesis forms a construct and it includes the incorporation of work performance as a concept of salutogenic orientations. The relationship between the constructs was confirmed using LIS REL-analysis, thus validating the integration of the dimensions and properties within each construct into the properties of a performance model; and the personality profiles within each construct into the personality profile of the optimal functioning individual. The empirical results were integrated with the literature review. Team building and salutogenic orientations are integrated into a performance model which explains the relationships between the work environment, the behaviour of the individual and his/her performance within the context of the work environment. / Industrial and Organisational Psychology / D.Litt. et Phil. (Industrial Psychology)

The study constituted an investigation for concept images and mathematical reasoning of Grade 11 learners on the concepts of reflection, translation and stretch of functions. The aim was to gain awareness of any conceptions that learners have about these transformations. The researcher’s experience in high school and university mathematics teaching had laid a basis to establish the research problem. The subjects of the study were 96 Grade 11 mathematics learners from three conveniently sampled South African high schools. The non-return of consent forms by some learners and absenteeism during the days of writing by other learners, resulted in the subsequent reduction of the amount of respondents below the anticipated 100. The preliminary investigation, which had 30 learners, was successful in validating instruments and projecting how the main results would be like. A mixed method exploratory design was employed for the study, for it was to give in-depth results after combining two data collection methods; a written diagnostic test and recorded follow-up interviews. All the 96 participants wrote the test and 14 of them were interviewed. It was found that learners’ reasoning was more based on their concept images than on formal definitions. The most interesting were verbal concept images, some of which were very accurate, others incomplete and yet others exhibited misconceptions. There were a lot of inconsistencies in the students’ constructed definitions and incompetency in using graphical and symbolical representations of reflection, translation and stretch of functions. For example, some learners were misled by negative sign on a horizontal translation to the right to think that it was a horizontal translation to the left. Others mistook stretch for enlargement both verbally and contextually. The research recommends that teachers should use more than one method when teaching transformations of functions, e.g., practically-oriented and process-oriented instructions, with practical examples, to improve the images of the concepts that learners develop. Within their methodologies, teachers should make concerted effort to be aware of the diversity of ways in which their learners think of the actions and processes of reflecting, translating and stretching, the terms they use to describe them, and how they compare the original objects to images after transformations. They should build upon incomplete definitions, misconceptions and other inconsistencies to facilitate development of accurate conceptions more schematically connected to the empirical world. There is also a need for accurate assessments of successes and shortcomings that learners display in the quest to define and master mathematical concepts but taking cognisance of their limitations of language proficiency in English, which is not their first language. Teachers need to draw a clear line between the properties of stretch and enlargement, and emphasize the need to include the invariant line in the definition of stretch. To remove confusion around the effect of “–” sign, more practice and spiral testing of this knowledge could be done to constantly remind learners of that property. Lastly, teachers should find out how to use smartphones, i-phones, i-pods, tablets and other technological devices for teaching and learning, and utilize them fully to their own and the learners’ advantage in learning these and other concepts and skills / Mathematics Education / D.Phil. (Mathematics, Science and Technology Education)

No description available.

Nous présentons une nouvelle approche pour la modélisation d'objets 3D de haute qualité à partir de séquences d'images en rotation partiellement calibrées. L'algorithme est capable: de calibrer la caméra (la pose et la longueur focale), de reconstruire la géométrie 3D et de créer une carte de texture. Par rapport à d'autres méthodes plus classiques, le calibrage est réalisé à partir d'un ensemble de silhouettes comme seule source d'information. Nous développons le concept de cohérence d'un ensemble de silhouettes généré par un objet 3D. Nous discutons d'abord la notion de cohérence de silhouettes et définissons un critère pratique pour l'estimer. Ce critère dépend à la fois des silhouettes et des paramètres des caméras qui les ont générées. Ces paramètres peuvent être estimés pour le problème de modélisation 3D en maximisant la cohérence globale des silhouettes. La méthode de reconstruction 3D est fondée sur l'utilisation d'un modèle déformable classique, qui définit le cadre dans lequel nous pouvons fusionner l'information de la texture et des silhouettes pour reconstruire la géométrie 3D. Cette fusion est accomplie en définissant deux forces basées sur les images: une force définie par la texture et une autre définie par les silhouettes. La force de texture est calculée en deux étapes: une approche corrélation multi-stéréo par décision majoritaire, et une étape de diffusion du vecteur gradient (GVF). En raison de la haute résolution de l'approche par décision majoritaire, une version multi-résolution du GVF a été développée. En ce qui concerne la force des silhouettes, une nouvelle formulation de la contrainte des silhouettes est dérivée. Elle fournit une manière robuste d'intégrer les silhouettes dans l'évolution du modèle déformable. A la fin de l'évolution, cette force fixe les contours générateurs du modèle 3D. Finalement, une carte de texture est calculée à partir des images originales et du modèle 3D reconstruit.

<p>Cilj ovog istraživanja je bio da se utvrdi da li postoji razlika u debljini makule kod pacijenata sa glaukomom otvorenog ugla (POAG) u odnosu na zdravu populaciju i u zavisnosti od stepena progresije bolesti, kao i da se utvrdi da li postoji povezanost između promene debljine makule i stepena o&scaron;tećenja vidnog polja i debljine peripapilarnog sloja nervnih vlakana u zavisnosti od stepena progresije bolesti. Materijal i metode: U ovu kliničku prospektivnu studiju je uključeno 186 pacijenata. Na osnovu kliničkog nalaza formirane su tri grupe. Prva grupa (kontrolna &ndash; grupa zdravih): 68 pacijenata bez očnih oboljenja, sa najboljom korigovanom vidnom o&scaron;trinom &ge; 0.9, intraokularnim pritiskom (IOP) &le; 21 mmHg, normalnim odnosom ekskavacije i povr&scaron;ine glave vidnog živca i normalnim nalazom vidnog polja. Druga grupa (rani glaukom): 78 pacijenata sa klinički dijagnostikovanim primarnim glaukomom otvorenog ugla (sa karakterističnim o&scaron;tećenjem glave vidnog živca i sloja nervnih vlakana retine i kod kojih je srednja vrednost devijacije standardne automatske perimetrije MD &gt; -6 dB, prema Hodap klasifikaciji), bez drugih očnih ili sistemskih oboljenja, koja bi imala uticaj na nastanak glaukoma i sa najboljom korigovanom vidnom o&scaron;trinom &ge; 0.5. Treća grupa (glaukom srednjeg stepena): 40 pacijenata sa klinički dijagnostikovanim primarnim glaukomom otvorenog ugla (sa karakterističnim o&scaron;tećenjem glave vidnog živca i sloja nervnih vlakana retine i kod kojih je srednja vrednost devijacije standardne automatske perimetrije -6 dB &gt; MD &gt; -12 dB, prema Hodap klasifikaciji), bez drugih očnih ili sistemskih oboljenja, koja bi imala uticaj na nastanak glaukoma i sa najboljom korigovanom vidnom o&scaron;trinom &ge; 0.5. Svim pacijentima je bio urađen kompletan oftalmolo&scaron;ki pregled, kompjuterizovano vidno polje (Humphrey Field Analyzer, Carl Zeiss Meditec, Jena, Germany, SITA Standard, test C 24-2) i optička koherentna tomografija sloja nervnih vlakana peripapilarno i u predelu makule (SOCT Copernicus HR, Optopol Tech. SA, Zawiercie, Poland). Rezultati: Perifovea i parafovea, pokazuju statistički značajno smanjenje debljine i zapremine sloja nervnih vlakana u odnosu na stepen progresije glaukoma otvorenog ugla, pri čemu je ono nagla&scaron;enije u perifovei (p&lt;0,05). U svim segmentima makule (TPeriF, IPeriF, SPeriF, NPeriF, TParaF, SParaF, IParaF i NParaF) dolazi do smanjenja debljine i zapremine sloja nervnih vlakana sa progresijom bolesti (p&lt;0,05). Segmenti makule TPeriF, IPeriF, a potom i SPeriF, prema navedenom redosledu, predstavljaju segmente sa najvećim potencijalom za predikciju ranih glaukomskih o&scaron;tećenja s obzirom na uočeno najveće smanjenje debljine i zapremine nervnih vlakana (p&lt;0,05). Segmenti makule SParaF i NParaF predstavljaju segmente sa najvećim potencijalom za predikciju napredovanja glaukomskih o&scaron;tećenja srednjeg stepena s obzirom na uočeno najveće smanjenje debljine i zapremine nervnih vlakana (p&lt;0,05). Debljina RNFL glave vidnog živca se statistički značajno smanjuje sa progresijom bolesti u svim posmatranim segmentima (p&lt;0,05). Međusobni odnos između grupe zdravih i grupe pacijenata sa ranim glaukomom ukazuje da je statistički značajno smanjenje debljine RNFL prisutno u svim segmentima osim u segmentima P3 i P4 (p&gt;0,05). Merenja debljine RNFL u segmentu P6 imaju najbolji potencijal za predikciju ranog glaukoma s obzirom na najizraženije smanjenje debljine nervnih vlakana upravo u ovom segmentu (p&lt;0,05). Merenja debljine RNFL u segmentu P1 ima najbolji potencijal za predikciju dalje progresije bolesti. Debljina sloja nervnih vlakana makule srazmerna je smanjenju debljine RNFL na glavi vidnog živca, pri čemu je ona uočljivija na nivou segmenata koji su okarakterisani kao dobri prediktori za nastanak, odnosno progresiju bolesti (P6 sa IPeriF i TPeriF, odnosno P1 sa SPeriF), &scaron;to dodatno nagla&scaron;ava njihovu važnost u dijagnostici glaukoma otvorenog ugla. Debljina makule kod pacijenata sa glaukomom otvorenog ugla je opisana umerenom do dobrom povezano&scaron;ću sa stepenom o&scaron;tećenja vidnog polja, pri čemu je ona najjača kod TPeriF, IPeriF i SPeriF segmenata i srazmerna je stepenu o&scaron;tećenja vidnog polja. Koeficijenti korelacije između vrednosti srednje devijacije vidnog polja i debljine RNFL, odnosno&nbsp; sloja nervnih vlakana makule, pokazuju snažniju povezanost u odnosu na parametre dobijenog smanjenja debljine nervnih vlakana u makuli, &scaron;to otvara mogućnost za dalja istraživanja. Segmenti glave vidnog živca i makule, koji su pokazali najbolju diskriminaciju u smislu predikcije nastanka POAGa, kao i oni koji sugeri&scaron;u na njegovu progresiju, sme&scaron;teni su na lokacijama koje su međusobno povezane opisanim prirodnim tokom nervnih vlakana.&nbsp; Zaključak: Optička koherentna tomografija makule je važna pomoćna metoda u dijagnostici glaukoma kojom je moguće izdvojiti pacijente sa ranim glaukomom u odnosu na zdravu populaciju, odnosno utvrditi progresiju glaukoma otvorenog ugla.</p> / <p>All patients underwent complete ophthalmologic examination, SAP (Humphrey Field Analyzer, Carl Zeiss Meditec, Jena, Germany, SITA Standard, test C 24-2) and optical coherent tomography scans of RNFL and macula (SOCT Copernicus HR, Optopol Tech. SA, Zawiercie, Poland). Results: Perifoveal and parafoveal nerve fiber layer have shown significant reduction of thickness and volume compared to stage of POAG progression, where perifovea showed higher significance (p&lt;0,05). All macular segments (TPeriF, IPeriF, SPeriF, NPeriF, TParaF, SParaF, IParaF i NParaF) showed reduction in thickness and volume compared to disease progression (p&lt;0,05). Macular segments TPeriF, IPeriF, as well as SPeriF, represent segments with highest potential to predict early glaucomatous damage according to the most significant reduction of nerve fiber layer thickness and volume (p&lt;0,05). Macular segments SParaF and NParaF represent segments with highest potential to predict progression of POAG according to the most significant reduction of nerve fiber layer thickness and volume (p&lt;0,05). Optic nerve head (ONH) RNFL thickness showed reduction compared to POAG progression in all segments (p&lt;0,05). All ONH segments except P3 and P4 showed significant reduction of RNFL comparing control group to early glaucoma group patients (p&gt;0,05). ONH segment P6 was found to be the highly specific for early glaucoma prediction according to the most significant reduction of RNFL thickness (p&lt;0,05), while segment P1 was found to have highest potential for POAG progression. Macular nerve fiber layer thickness reduction follows ONH RNFL thickness reduction and there is mutual relation between both macular and ONH segments (P6 to IPeriF and TPeriF, P1 to SPeriF) with highest specificity for early defects and POAG progression. It was shown that macular thickness changes have moderate to good correlation with visual filed changes and it was highest in TPeriF, IPeriF and SPeriF segments. This correlation was found to be higher in macula then in ONH RNFL thickness changes, compared to visual field changes. Both macular and ONH RNFL segments, which were found to have highest specificity to POAG prediction and progression, are located in areas which mutually connect following natural course of nerve fiber layer between them. Conclusion: Optical coherence tomography of macula represents important ancillary method in POAG diagnosis and follow up, allowing to differentiate between early glaucoma patients and healthy individuals, as well as to determine progression of glaucomatous disease.</p>

<p>Cilj ovog istraživanja je da se ispita uticaj centralne debljine makularne regije (CMT) i prisustva subretinalne tečnosti na vidnu o&scaron;trinu (VA) kod pacijenata obolelih od dijabetesnog makularnog edema, kao i uticaj očuvanosti kontinuiteta spoja spolja&scaron;njeg i unutra&scaron;njeg segmenta fotoreceptora (IS/OS &ndash; kompleks) i spolja&scaron;nje granične membrane (ELM) kao prognostičkih faktora u pobolj&scaron;anju vidne o&scaron;trine nakon primenjene terapije kod pacijenata obolelih od dijabetesnog makularnog edema (DME). Materijal i metode: u ovu retrospektivno prospektivnu kliničku studiju nasumično je uključeno 100 pacijenata koji su podeljeni u dve grupe. Grupu A &ndash; prospektivni deo studije je činilo 50 pacijenata (50 očiju) kod kojih je dijagnostikovan dijabetesni makularni edem i kod kojih je inidikovana primena terapije, laserftotkogaulacije i/ili anti-VEGF terapije (bevacizumab). Grupu B &ndash; retrospektivnu grupu je činilo 50 pacijenata (58 očiju) koji su prethodno lečeni od dijabetesnog makularnog edema primenom laserfotokoagulacije i/ili anti-VEGF terapije (bevacizumab). Nakon kompletnog oftalmolo&scaron;kog pregleda koji se sastojao od određivanja vidne o&scaron;trine (optotipima po Snellenu), biomikroskopije, merenja intraokularnog pritiska i pregleda očnog dna &ndash; fundusa primenom panfundoskopa izvr&scaron;ena je optička koherentna tomografija u svih pacijenata (primenom aparata Stratus&reg; OCT, Carl Zeiss, Meditec i Copercnicus&reg; Optopol). Analiza OCT snimka, je obuhvatila određivanje centralne debljine makule (CMT), prisustva subretinalne tečnosti kao i procenu stanja očuvanosti kontinuiteta spoja spolja&scaron;enjeg i unutra&scaron;njeg segmenta fotoreceptora (IS/OS kompleks) i očuvanost kontinuiteta spolja&scaron;nje granične membrane (ELM). CMT je izračunat primenom softvera OCT aparata i izražen kao srednja vrednost za svih 9 ETDRS polja. Prisutvno subretinalne tečnosti je klasifikovano kao pozitivno ukoliko je identifikovano makar u jednom preseku OCT tomograma .Očuvanost kontinuiteta IS/OS kompleksa i ELM je analizirana u svakom pojedinačnom snimku i podeljena u 3 kategorije. Prva &ndash; ukoliko je očuvano u svim presecima, druga &ndash; ukoliko je očuvano samo u pojedinim presecima i treća &ndash; ukoliko se IS/OS kompleks i ELM nisu mogli identifikovati na nalazu OCT tomograma. Rezultati ukazuju da prisustvo subretinalne tečnosti pre primenjene terapije nema statistički značajnog uticaja na pobolj&scaron;anje vidne o&scaron;trine nakon primenjene terapije u pacijenata grupe A (pA=0,915), a statistička značajnost nije potvrđena ni kod pacijenata koji su prethodno tretirani od DME &ndash; grupa B (pB=0,772). Srednja vrednosti CMT i VA u pacijaneta grupe A iznosila je 474&mu;m&plusmn;140,67&mu;m odnosno 0.25&plusmn;0.20. Nakon primenjene terapije srednja vrednost vidnih o&scaron;trina iznosila je 0.41&plusmn;0.25, dok su vrednosti srednje vrednosti CMT iznosile 343.68&mu;m&plusmn;99.03&mu;m. Potvrđeno je statistički značajno pobolj&scaron;anje vidne o&scaron;trine nakon primenjene terapije (pVA=0,0001) i statistički značajno smanjenje centralne debljine makule (pCMT=0,0001). Korelacija VA sa vrednostima CMT pre primenjene terapije pokazuje statističku značajnost sa negativnom korelacijom (r=-0,391; p=0,005) dok se nakon primenjene terapije ne uočava statistički značajna korelacija (r=-0,047; p=0,746). Analizom vrednosti CMT pre primenjene terapije sa vrednostima VA nakon terapije se uočava statistički značajna negativna korelacija, odnosno veće vrednosti CMT pre primenjene terapije ograničavaju pobolj&scaron;anje vidne o&scaron;trine nakon primenjene terapije (r=-0,393; p=0,005). Evaluacija OCT tomograma, pre primenjene terapije, u pacijenata grupe A utvrđen je u potpunosti očuvan kontinuitet IS/OS kompleksa i ELM u svim presecima u 23 odnosno 27 očiju, u pojedinim presecima u 18 odnosno 16 očiju, i nije mogao biti identifikovan u 9 odnosno 7 očiju. U pacijenata grupe A nakon primenjene terapije uočava se statistički značajno pobolj&scaron;anje vrednosti VA u zavisnosti od očuvanosti kontinuiteta IS/OS kompleksa (F=5,550, p=0,007) i ELM (F=5,428, p=0,008). Univarijantna odnosno multivarjiantna analiza podataka za granične vrednosti vidnih o&scaron;trina od 0,1 i koraka pobolj&scaron;anja od 0,1 ukazuje na statističku značajnost prediktora IS/OS kompleksa (p=0,012 i p=0,032) i ELM (p=0,003 i p=0,018) u pobolj&scaron;anju vrednosti vidnih o&scaron;trina nakon primenjene terapije. Pacijenti sa očuvanim kontinuitetom IS/OS kompelsa u svim presecima imaju 9,5 puta (OR=9,500 ) veću &scaron;ansu za pobolj&scaron;anje VA nakon primenjene terapije u odnosu na pacijente gde kontinuitet IS/OS kompleksa nije uočljiv. Pacijenti sa očuvanim kontinuitetom IS/OS kompleksa u pojedinim presecima imaju 7 puta veću &scaron;ansu (OR=7,000) za pobolj&scaron;anje vidne o&scaron;trine nakon terapije u poređenju sa onima kod kojih IS/OS nije uočljiv. Pacijenti sa očuvanim kontinuitetom ELM u svim presecima imaju 34,5 puta (OR=34,500 ) veću &scaron;ansu za pobolj&scaron;anje vidne o&scaron;trine u odnosu na pacijente gde ELM nije uočljiv. Pacijenti sa očuvanim kontinuitetom ELM u pojedinim presecima imaju 18 puta veću &scaron;ansu (OR=18,000) za pobolj&scaron;anje VA nakon terapije u odnosu na one kod kojih ELM nije uočljiv. Pored statistički značajnog uticaja očuvanosti kontinuiteta IS/OS kompleksa i ELM na pobolj&scaron;anje vrednosti vidnih o&scaron;trina nakon primenjene terapije, uočava se i pozitvna korelacija između vidnih o&scaron;trina pre i nakon terapije (r=0,869; p=0,0001). U pacijenata grupe B srednja vrednost CMT odnosno VA iznosila je 253,72&mu;m&plusmn;75,27&mu;m odnosno 0,68&plusmn;0,29. Postoji statistički značajna razlika u vrednostima VA u odnosu na očuvanost kontinuiteta IS/OS kompleksa (F=107,913, p=0,0001) i ELM (F=25,619, p=0,0001). Poređenjem vrednosti parametara za obe posmatrane grupe uočava se statistički značajna razlika u vrednostima CMT koje su bile manje u grupi B (t=5,355, p=0,0001) i srednjim vrednostima VA ( t=5,137, p=0,0001) koje su bile veće u grupi B. Analizom očuvanosti kontinuiteta IS/OS kompleksa (&chi;2=0,119, p=0,730) i ELM (&chi;2=2,957, p=0,085) ne uočava se statistički značajna razlika. Zaključak: Odnos vidnih o&scaron;trina sa centralnom debljinom makule prikazuje različite vrednosti vidnih o&scaron;trina za iste vrednosti centralne debljine makule. Značajan uticaj na vidnu o&scaron;trinu pacijenata obolelih od DME ima očuvanost integriteta spolja&scaron;nje granične membrane (ELM) i spoja unutra&scaron;njeg i spolja&scaron;njeg segmenta fotoreceptora (IS/OS kompleks) evaluiranih na osnovu OCT snimka &ndash; tomograma. Očuvanost integriteta ELM i IS/OS kompleksa u svim presecima na OCT tomogramu pre primenjene terapije u pacijenta sa DME se mogu smatrati pozitivnim prognostičkim faktorom u pobolj&scaron;anju vidne o&scaron;trine nakon primenjene terapije. U pacijenata kod kojih je kontinuitet ELM i IS/OS kompleksa očuvan u svim pravcima vrednost CMT pre primenjene terapije nema uticaj na pobolj&scaron;anje vidne funkcije nakon terapije. Integritet IS/OS kompleksa i ELM ima pozitivnu korelaciju sa vidnom o&scaron;trinom bez obzira na vrstu primenjene terapije, anti-VEGF odnosno laserfotokoagulacije. Prisustvo subretinalne tečnosti ne utiče na vidnu o&scaron;trinu pacijenata obolelih od DME. Vrednosti VA pre terapije utiču na pobolj&scaron;anje vidne o&scaron;trine nakon terapije.</p> / <p>The aim of this study was to investigate the influence of the central macular thickness (CMT) and the presence of sub retinal fluid on visual acuity (VA) in patients with diabetic macular edema, as well as the impact of preservation and continuity of the photoreceptor inner/outer segment junction (IS / OS - complex ) and external limiting membrane (ELM) as a prognostic factor in improving visual acuity after the applied therapy in patients with diabetic macular edema (DME). Materials and Methods: this retrospective - prospective randomized clinical study included 100 patients who were divided into two groups. Group A - a prospective part of the study, consisted of 50 patients (50 eyes), with the diagnosis of diabetic macular edema in which laser photocoagulation and / or anti-VEGF therapy (bevacizumab) was indicated. Group B - retrospective group, consisted of 50 patients (58 eyes), who were previously treated for diabetic macular edema either with laser photocoagulation and / or anti-VEGF therapy (bevacizumab). After complete ophthalmologic examination, which consisted of the determination of visual acuity (measured with Snellen charts), biomicroscopy, intraocular pressure measurement and inspection of the fundus, optical coherence tomography was performed in all patients (using the Stratus&reg; OCT, Carl Zeiss Meditec and Copercnicus&reg; Optopol). Analysis of OCT image, included the determination of the central macular thickness (CMT), presence of sub retinal fluid, as well as an assessment of the preservation of the continuity of the photoreceptor inner/outer segment junction (IS/OS - complex) and external limiting membrane (ELM). CMT is calculated using software of the OCT apparatus and expressed as the mean value for all 9 ETDRS fields. Presence of sub retinal fluid is classified as positive if it is identified in at least one cross-section of OCT tomogram. Preserved continuity of IS / OS complex and ELM is analyzed in each individual OCT cross-section image and divided into 3 categories. First - if it is preserved in all cross sections images, the second - if it is preserved only in certain sections and the third - if the IS / OS complex and ELM were not able to identify in OCT tomograms. The results indicate that the presence of sub retinal fluid before the applied therapy has no statistically significant effect on improving visual acuity after the applied therapy in patients of group A (pA = 0.915), and statistical significance was not also confirmed in any of the patients who were previously treated by DME - Group B (pB = 0.772). Mean CMT and VA values of patients in group A was 474&mu;m &plusmn; 140,67&mu;m and 0.25 &plusmn; 0.20. After receiving therapy mean visual acuity was 0.41 &plusmn; 0.25, while the value of the mean CMT was 343.68&mu;m&plusmn; 99.03&mu;m. Significant improvement in visual acuity was achieved after the treatment in group A (pVA = 0.0001) together with statistically significant reduction in central macular thickness (pCMT = 0.0001). Correlation of VA with the values of CMT before applied therapy shows statistically significant negative correlation (r = -0.391; p = 0.005), while after the applied therapy statistical significance was not observed (r = -0.047; p = 0.746). Analyzing the values of CMT before the applied therapy with the values of VA after the treatment statistically significant negative correlation was observed, higher values of CMT before the applied therapy restrict visual acuity improvement after the applied therapy (r = -0.393; p = 0.005). Analyzing OCT tomograms in the patients in group A, before the applied therapy, fully preserved continuity of IS/OS complex and ELM in all the sections was found in 23 and 27 of the eyes, in certain sections in 18 and 16 of the eyes, and could not be identified in 9 and 7 eyes. Statistically significant improvement in VA, after the applied therapy, in patients in group A is observed, depending on the preservation of continuity of IS/OS complex (F = 5.550, p = 0.007) and ELM (F = 5.428, p = 0.008). Univariate and multivariate analysis with cut off VA value of 0.1 and step improvements of 0.1 points to statistically significant predictor of IS/OS complex (p = 0.012 and p = 0.032) and ELM (p = 0.003 and p = 0.018) in improving the VA after the applied therapy. Patients with preserved continuity of IS/OS complex in all sections are 9.5 times (OR = 9.500) more likely to improve the VA after receiving therapy compared to patients where continuity of IS/OS complex is not noticeable. Patients with preserved continuity of IS/OS complex in the some sections are 7 times more likely (OR = 7.000) for the improvement of visual acuity after treatment compared to those in which the IS/OS is not detectable. Patients with preserved continuity of ELM in all sections are 34.5 times (OR = 34,500) a greater chance to improve visual acuity compared to patients where ELM is not apparent. Patients with preserved continuity of ELM in the some sections are 18 times more likely (OR = 18,000) to improve the VA after treatment compared to those in which the ELM is not apparent. In addition to statistically significant impact of preservation of continuity of IS/OS complex and ELM for VA improvement after the treatment, statistically significant positive correlation between visual acuity before and after treatment (r = 0.869; p = 0.0001) was observed. In Group B patients, the mean CMT and VA value was 253,72&mu;m&plusmn;75,268&mu;m and 0.68 &plusmn; 0.29. There is a statistically significant difference in the VA values compared to the preservation of continuity of IS/OS complex (F = 107.913, p = 0.0001) and ELM (F = 25.619, p = 0.0001). Comparing the values of parameters for both groups, statistically significant difference in CMT values and mean VA was observed. CMT values were lower (t = 5.355, p = 0.0001) while VA values were higher (t = 5.137, p = 0.0001), in group B. The analysis of preservation of continuity of IS/OS complex (&chi;2 = 0.119, p = 0.730) and ELM (&chi;2 = 2.957, p = 0.085) did not show a statistically significant difference. Conclusion: The relationship of visual acuity with central macular thickness shows the different levels of visual acuity for the same value of the central macular thickness. A significant impact on VA in patients with DME has maintained integrity of the external limiting membrane (ELM) and the photoreceptors inner/outer segments junction (IS/OS complex) evaluated on the basis of OCT - tomograms. Preservation of the integrity of the ELM and IS/OS complex in all sections of the OCT tomogram before applied therapy in patients with DME can be considered a positive prognostic factor in improving visual acuity after receiving therapy. In patients with preserved continuity of ELM and IS/OS complex in all sections before applied therapy the CMT value has no effect on the improvement of visual function after treatment. Regardless of the type of applied therapy, anti-VEGF and/or laser photocoagulation preserved integrity of IS/OS complex and ELM has a positive correlation with visual acuity. The presence of sub retinal fluid does not affect the visual acuity in patients with DME. The values of VA before treatment influence the improvement of visual acuity after treatment.</p>

Le Nicaragua connaît un déficit en logement très préoccupant. Celui-ci est du en grande partie à l’incapacité du secteur financier à satisfaire la demande des familles à faible revenu. De nombreuses initiatives ont été mises en place par des organismes provenant des trois sphères sociétales pour pallier ce problème. Certains l’ont fait avec succès d’autres sans. Aujourd’hui bien que ces initiatives aient comme objectif de répondre au problème existant, le déficit continu de se creuser. Ce mémoire propose une analyse des causes du problème afin de comprendre pourquoi les initiatives mises en place ne fonctionnent pas comme elles le devraient. Il met en avant le manque de coordination qui existe enter les acteurs et démontre que l’ensemble du secteur fonctionne selon une organisation « en silo » révélatrice d’un manque de cohérence des politiques de financement du logement. Enfin il analyse les origines possibles d’une telle organisation et des incohérences politiques qui l’ont amenée. Par cette analyse, il tente de déterminer la part de responsabilité relative imputable à l’État nicaraguayen et à l’Aide Publique au Développement qui est la principale source de fonds de tous ces programmes. / Nicaragua suffers of a very important housing deficit. The bulk of it is due to the inability of the finance sector to attend low income families. Numerous initiatives were implemented by organization from the three societal sectors to alleviate this problem. Some were successful, others were not. Today, although the objectives set by these initiatives seems to respond the existing problem, the deficit keeps on deepening. This thesis offers to analyse the causes of the problem and to understand why the implemented initiatives are not functioning as they should. It emphasizes the lack of coordination existing and demonstrates that the whole sector functions in accordance with a silo approach which is itself indicative of a lack of housing finance policy coherence. Finally, it analyses the possible origin of such an organization and of the policy incoherence that brought it. Through this analysis it attempts to clarify the respective accountability of the Nicaraguan State and the ODA which is the main financing source of these programs.

L’augmentation de la population âgée dans la société indique que les systèmes de soins de la santé font face à de nouveaux défis. Les hauts niveaux d’incapacité qui en résultent peuvent être réduits par les nouvelles technologies, la promotion de la santé ainsi que des stratégies de prévention. Les écrits scientifiques récents soulignent la supériorité des prothèses dentaires implanto-portées par rapport aux prothèses conventionnelles en termes de satisfaction et de qualité de la vie des patients. Cependant, il n'est toujours pas clair si ces avantages ont des effets positifs à long terme sur la santé orale et générale ainsi que sur la qualité de vie des populations âgées. Objectifs, Hypothèses : Notre but était de mesurer l’impact des prothèses mandibulaires retenues par 2 implants sur la qualité de vie associée à la santé bucco-dentaire et générale ainsi que sur la santé orale et la qualité du sommeil des aînés édentés. Nous avons évalué les hypothèses nulles suivantes : il n'y a aucune différence entre les individus portants des prothèses mandibulaires retenues par 2 implants (IODs) et ceux qui portent des prothèses conventionnelles (CDs), par rapport à la qualité de vie reliée à la santé bucco-dentaire et générale, la santé orale et la qualité du sommeil, un an après avoir reçu leurs nouvelles prothèses. Méthodes : Dans cette étude randomisée contrôlée, 255 aînés ont reçu au hasard IODs ou les CDs, les deux types de prothèses étant opposés à des prothèses maxillaires conventionnelles. La qualité de la vie reliée à la santé bucco-dentaire (OHRQoL) et la santé générale subjective ont été mesurées avec les questionnaires Oral Health Impact Profile (OHIP-20) et Short Form-36 (SF-36) en condition pré-traitement et après un an. La qualité du sommeil et la somnolence diurne ont été mesurées à l’aide du questionnaire Qualité de Sommeil de Pittsburg et de l'Échelle de Somnolence Epworth. La santé orale a été évaluée par un examen clinique. Les variables indépendantes étaient le sens de cohérence et le type de prosthèse, ainsi que des variables socio-démographiques. En utilisant des analyses statistiques bi et multi-factorielles, des comparaisons à l’intérieur d’un même groupe et entre deux groupes ont été effectuées. Résultats : Les différences pré et post traitement pour les cotes OHIP étaient significativement plus grandes pour le groupe IOD que le groupe CD (p<0.05). Le type de traitement et la cote pré-traitement étaient des facteurs significatifs à OHRQoL (p < 0.0001). Dans le groupe CD, il y avait une diminution significative par rapport aux cotes de «Physical Component Scores (PCS)», le fonctionnement physique, le rôle physique et la douleur physique entre les données pré-traitement et un an après le traitement, ce qui indique une diminution au niveau de la santé générale subjective. Dans le groupe IOD, une diminution statistiquement non significative a été remarquée par rapport à toutes les cotes des sous-échelles de SF-36, sauf pour la douleur physique. Le modèle final de régression a démontré qu’après ajustement pour les variables âge, sexe, statut marital et type de traitement, la cote totale finale d’OHIP et les données de bases de PCS prédisaient la cote finale de PCS (p < 0.0001). Aucune corrélation significative entre sens de cohérence et OHRQoL n'a été détectée (r =-0.1; p > 0.05). Les aînés porteurs des prothèses conventionnelles avaient presque 5 fois plus de chance d’avoir une stomatite prothétique que ceux portant des prothèses mandibulaires hybrides retenues par 2 implants (p < 0.0001). Les aînés ayant subjectivement une mauvaise santé générale avaient une qualité de sommeil moins bonne que ceux avec une meilleure santé générale subjective (p < 0.05). Les personnes qui avaient une OHRQoL moins bonne étaient presque 4 fois plus somnolentes pendant le jour que celles avec une meilleure OHRQoL (p=0.003, χ2; OR =3.8 CI 1.5 to 9.8). L'analyse de régression a montré que la santé générale subjective et OHRQoL prévoient la qualité du sommeil (p=0.022 et p=0.001, respectivement) et la somnolence diurne (p=0.017 et p=0.005, respectivement). Conclusions: Les résultats de cette étude suggèrent que, chez les aînés édentés, des prothèses mandibulaires hybrides retenues par deux implants amènent une amélioration significative de la qualité de vie reliée à la santé bucco-dentaire et maintiennent la sensation d’une meilleure santé physique. Des prothèses hybrides implanto-portées peuvent contribuer à la santé orale en réduisant les traumatismes infligés à la muqueuse orale et en contrôlant la stomatite prothétique. Les aînés édentés dont le niveau de qualité de vie reliée à la santé bucco-dentaire est bas, peuvent aussi avoir des troubles de qualité du sommeil. / The global greying of society indicates that health care systems face new challenges. High levels of disability can be reduced through new technologies, health promotion and preventive strategies. Recent literature has underlined the superiority of mandibular implant overdentures over conventional dentures for patient satisfaction and quality of life. However, it is still not clear whether this benefit has any long-term positive effects on oral and general health, as well as on the quality of life of elderly populations. Objectives, Hypotheses: We aimed to measure the impact of mandibular two-implant overdentures on the general and oral health quality of life, as well as on oral health and sleep quality of edentulous elders. We tested the null hypothesis that there is no difference in the general and oral health quality of life, as well as, on oral health and sleep quality of those wearing mandibular two-implant overdentures (IODs) and those who wear conventional dentures (CDs), one year following prosthesis delivery. Methods: In this randomized controlled trial, 255 elders randomly received IODs or CDs, both opposed by conventional maxillary dentures. OHRQoL and perceived general health were measured with the Oral Health Impact Profile (OHIP-20) and the Short Form-36 (SF-36) at baseline and after one year. Sleep quality and daytime sleepiness were measured with the Pittsburg Sleep Quality global score and the Epworth Sleepiness Scale. Clinical exams were conducted to evaluate oral health. Independent variables included sense of coherence and prosthesis type, as well as socio-demographic variables. Between and within group comparisons were performed using bivariate and multivariate statistical tests. Results: Pre/post treatment differences in OHIP scores were significantly greater for the IOD than the CD group (p<0.05). Type of treatment and pre-treatment scores were significant contributors to OHRQoL (p<0.0001). In the CD group, there was a statistically significant decrease in physical component scores (PCS), physical functioning, role physical and bodily pain from baseline to one year follow up, indicating decreased perceived general health. In the IOD group, no statistically significant decrease was seen in SF-36 subscale scores from baseline to one year, except for bodily pain. The final regression model demonstrated that, after controlling for age, sex, marital status and type of treatment, the OHIP total final and the PCS baseline scores predict PCS final scores (p<0.0001). No significant correlation between sense of coherence and OHRQoL was detected (r= -0.1; p> 0.05). Elders wearing conventional dentures were almost 5 times more likely to have denture stomatitis than those wearing mandibular two-implant retained overdentures (p < 0.0001). Elders with low perceived general health had poorer sleep than those with high perceived general health (p<0.05). Those with low oral health related quality of life were almost 4 times sleepier during the day than those with high OHRQoL (p=0.003, χ2; OR =3.8 CI 1.5 to 9.8). Regression analysis showed that perceived general health and OHRQoL predict sleep quality (p=0.022 and p=0.001, respectively) and daytime sleepiness (p=0.017 and p=0.005, respectively). Conclusions: The results of this study suggest that, in edentulous elders, mandibular two-implant overdentures provide significant improvement in oral health related quality of life and maintain perceived physical health. Implant overdentures may contribute to oral health by reducing oral mucosa trauma and control denture stomatitis. Edentulous elders whose oral health related quality of life is low may also have poor sleep quality.

Cette thèse porte sur l’étude de l’anatomie de la cornée après 3 techniques de greffe soient, la greffe totale traditionnelle (GTT) et des techniques de greffe lamellaire postérieur (GLP) telles que la greffe lamellaire endothéliale profonde (DLEK) et la greffe endothélium/membrane de Descemet (EDMG) pour le traitement des maladies de l’endothélium, telles que la dystrophie de Fuchs et de la kératopathie de l’aphaque et du pseudophaque. Dans ce contexte, cette thèse contribue également à démontrer l’utilité de la tomographie de cohérence optique (OCT) pour l’étude de l’anatomie des plaies chirurgicales la cornée post transplantation. Au cours de ce travail nous avons étudié l'anatomie de la DLEK, avant et 1, 6, 12 et 24 mois après la chirurgie. Nous avons utilisé le Stratus OCT (Version 3, Carl Zeiss, Meditec Inc.) pour documenter l’anatomie de la plaie. L'acquisition et la manipulation des images du Stratus OCT, instrument qui à été conçu originalement pour l’étude de la rétine et du nerf optique, ont été adaptées pour l'analyse du segment antérieur de l’oeil. Des images cornéennes centrales verticales et horizontales, ainsi que 4 mesures radiaires perpendiculaires à la plaie à 12, 3, 6 et 9 heures ont été obtenues. Les paramètres suivants ont été étudiés: (1) Les espaces (gap) entre les rebords du disque donneur et ceux du receveur, (2) les dénivelés de surface postérieure (step) entre le les rebords du disque donneur et ceux du receveur, (3) la compression tissulaire, (4) le décollement du greffon, 6) les élévations de la surface antérieure de la cornée et 7) la pachymétrie centrale de la cornée. Les mesures d’épaisseur totale de la cornée ont été comparées et corrélées avec celles obtenues avec un pachymètre à ultra-sons. Des mesures d’acuité visuelle, de réfraction manifeste et de topographie ont aussi été acquises afin d’évaluer les résultats fonctionnels. Enfin, nous avons comparé les données de DLEK à celles obtenues de l’EDMG et de la GTT, afin de caractériser les plaies et de cerner les avantages et inconvénients relatifs à chaque technique chirurgicale. Nos résultats anatomiques ont montré des différences importantes entre les trois techniques chirurgicales. Certains des paramètres étudiés, comme le sep et le gap, ont été plus prononcés dans la GTT que dans la DLEK et complètement absents dans l’EDMG. D’autres, comme la compression tissulaire et le décollement du greffon n’ont été observés que dans la DLEK. Ceci laisse entrevoir que la distorsion de la plaie varie proportionnellement à la profondeur de la découpe stromale du receveur, à partir de la face postérieure de la cornée. Moins la découpe s’avance vers la face antérieure (comme dans l’EDMG), moins elle affecte l’intégrité anatomique de la cornée, le pire cas étant la découpe totale comme dans la GTT. Cependant, tous les paramètres d’apposition postérieure sous-optimale et d’élévation de la surface antérieure (ce dernier observé uniquement dans la GTT) finissent par diminuer avec le temps, évoluant à des degrés variables vers un profil topographique plus semblable à celui d’une cornée normale. Ce processus paraît plus long et plus incomplet dans les cas de GTT à cause du type de plaie, de la présence de sutures et de la durée de la cicatrisation. Les valeurs moyennes d’épaisseur centrale se sont normalisées après la chirurgie. De plus, ces valeurs moyennes obtenues par OCT étaient fortement corrélées à celles obtenues par la pachymétrie à ultra-sons et nous n’avons remarqué aucune différence significative entre les valeurs moyennes des deux techniques de mesure. L’OCT s’est avéré un outil utile pour l’étude de l’anatomie microscopique des plaies chirurgicales. Les résultats d’acuité visuelle, de réfraction et de topographie des techniques de GLP ont montré qu’il existe une récupération visuelle rapide et sans changements significatifs de l’astigmatisme, contrairement à la GTT avec et sans suture. La GLP a permis une meilleure conservation de la morphologie de la cornée, et par conséquence des meilleurs résultats fonctionnels que la greffe de pleine épaisseur. Ceci nous permet d’avancer que la GLP pourrait être la technique chirurgicale à adopter comme traitement pour les maladies de l’endothélium cornéen. / This thesis aims to study the anatomy of the corneal wound following 3 techniques of corneal graft: traditional penetrating keratoplasy (PK) and two techniques of posterior lamellar keratoplasy (PLK) which are deep lamellar endothelial keratoplasy (DLEK) and Endothelial-Descemet’s Membrane Graft (EDMG) for the treatment of the endothelial corneal diseases, such as Fuch’s dystrophy and aphakic and pseudopakic bullous keratopathy. In this context, this thesis also contributes to show the utility of the time domain optical coherence tomography (TD-OCT) for studying the anatomy of surgical wounds after corneal transplantation. In this work we studied the anatomy of DLEK, before and 1,6,12 and 24 months after surgery. We used the Stratus OCT. (Version 3, Carl Zeiss, Meditec Inc.) to document the anatomy of the wound. The acquisition and the handling of the images of the Stratus OCT, an instrument originally designed for the study of the retina and the optic nerve, were adapted to analyse the anterior segment of the eye. Vertical and horizontal central images of the cornea, in addition to 4 radial measurements perpendicular to the wound at 12, 3, 6 and 9 hours were obtained. The following parameters were studied: (1) the gap between the edges of the donor disc and those of the recipient, (2) posterior surface mismatch (step) between the edges of the disc donor and those of the recipient, (3) tissue compression, (4) graft detachment, 6) elevations of the anterior corneal surface and 7) the central pachymetry of the cornea. Measurements of the total thickness were compared and correlated with those obtained with an ultrasound pachymeter. Measurements of visual acuity, manifest refraction and topography were also acquired in order to evaluate the functional results. Lastly, we compared the data of DLEK with those obtained from the EDMG and the PK, in order to characterize the wounds and to highlight the advantages and disadvantages relative to each surgical technique.Our anatomical results showed important differences between the three surgical techniques. Some of the studied parameters, like the step and the gap, were more pronounced in PK than in DLEK and completely absent in the EDMG group. Others, like tissue compression and graft detachment were observed only in the DLEK group. This let us predict that the distortion of the wound varies proportionally with the depth of recipient posterior stromal dissection. The less dissection towards the anterior surface (as in EDMG), the less it affects the anatomical integrity of the cornea, the worst case being full thickness trephination as in PK. However, all the parameters of sub-optimal posterior surface apposition and anterior surface elevation (this last only observed in PK) ended up decreasing with time, evolving with variable degrees to a topographic profile more similar to that of a normal cornea. This process appears longer and more incomplete in the cases of PK because of the type of wound, the presence of sutures and the longer healing period. The mean values of central thickness were normal after surgery. Moreover, these mean values obtained by OCT. were strongly correlated with those obtained by ultrasound pachymetry and we did not notice any significant difference between the mean values of the two measurement techniques. OCT proved to be a useful tool for the study of the microscopic anatomy of the corneal surgical wounds. The results of vision, refraction and topography of the techniques of posterior lamellar grafts showed that there was a fast visual recovery and without significant changes in astigmatism, contrary to PK with and without sutures. Posterior lamellar grafts allowed a better conservation of the morphology of the cornea, and consequently better functional results than PK. This enabled us to conclude that posterior lamellar corneal grafts could be the surgical technique of choice for the treatment of corneal endothelial diseases.

Résumé : La coordination entre les politiques d'urbanisme et de transport, dans un nouveau contexte façonné par la montée en puissance des préoccupations environnementales et des enjeux du développement durable, est plus que jamais recherchée afin d'assurer une meilleure cohérence entre ces deux domaines. Ce travail a pour objectif d'analyser la place des politiques de mobilités urbaines au sein d'une politique plus globale de développement urbain durable.Beaucoup d'innovations et de bonnes pratiques dans le domaine du transport, proposant des modes alternatifs de déplacement, ont été adoptées pour répondre aux exigences du développement durable et surtout pour tenter de diminuer la place de la voiture particulière. Pour ce faire, des actions technologiques et organisationnelles doivent être insérées au sein de formes urbaines alternatives favorisant la ville à courte distance et la mixité et renforçant l'accessibilité (une des facettes du lien entre transport et urbanisme). De ce fait, la coordination et la complémentarité entre les politiques d'urbanisme, d'habitat et de transport ainsi qu'entre les acteurs aux échelles urbaine et interurbaine, doivent être renforcées.Cette recherche trouve son originalité dans l'étude comparative des quatre principales agglomérations de la région Champagne-Ardenne (Reims, Troyes, Charleville-Mézières et Châlons-en-Champagne), agglomérations de taille moyenne qui ont moins été étudiées que les grandes agglomérations. Elle examine comment les questions des déplacements et des mobilités ont été prises en compte dans les documents de planification stratégique de transport (SCoT et PDU). Alors que le lien entre transport et urbanisme se présente comme un des objectifs prônés par la loi SRU, qu'en est-il vraiment de la cohérence entre ces deux domaines en Champagne-Ardenne ? / Abstract : Mobility planning and urban sustainable development in Champagne-Ardenne. Analytical approach of the four main cities of Champagne-ArdenneCoordination between urbanism and transportation policies is more and more demanded in a new context characterized by an increasing concern for environmental issues and sustainable development. This research aims to analyse the role of urban mobility policies within more global sustainable development policies. Many innovative practices have been adopted in order to limit the importance of private cars and to foster alternative modes of mobility. This supposes to integrate technological and organisational actions into alternative urban forms favouring short distance, mixity and accessibility, which needs a better coordination between urbanism, dwelling and transportation policies at both urban and interurban scales.This research takes its originality from a comparative survey of the four main cities in Champagne-Ardenne, Reims, Troyes, Charleville-Mézières and Châlons-en-Champagne, i.e. mid-size cities that have been less studied than greater cities. It appreciates how mobility issues have been taken into account in strategic planning documents (SCOT, PDU). Since the link between mobility and city planning is one of the main objectives of the Solidarity and Urban Renewal act implemented in 2000, how far goes the coherence between these two fields of action ?Key-words : Strategic planning – Mobility planning policies – Urban mobility plans (PDU) – Master plans (SCOT) – Coherence between transport and urbanism – Champagne-Ardenne – Mid-size cities.