This dissertation evaluates the feasibility of extending restorative justice to school disciplinary action in South African schools. It considers developments in education and identifies relevant shortcomings before addressing them. The extension of restorative justice to school disciplinary action establishes a new way of thinking that has, until recently, not been applied to civil law. In Dikoko v Mokhatla (2007 (1) BCLR 1 (CC)) honourable justice Sachs ruled that any remedy applied in civil law must aim for the restitution of relationships, rather than punishment of the guilty party. Children are often on unequal footing compared to adults when it comes to prosecution or punishment and consequently they are exposed to excessive punitive measures, as illustrated by the Dey saga (Le Roux and Others v Dey 2011 (3) SA 274 (CC)). The implementation of restorative justice as an alternative to current school disciplinary action may result in limiting these excessive punishments. Because of the universal nature of the subject a comparison will be made to the successful implementation of restorative justice programs in the United Kingdom, Australia and New Zealand. The various departments of education in these countries have developed proactive strategies for managing students' behaviour. In New Zealand, schools place particular emphasis on the use of restorative practices, rather than suspension, to ensure the establishment of beneficial learning environments. Furthermore, parents’ and community members' involvement is encouraged by inter alia the National Safe Schools Framework, which has been implemented in Australia since 2003. These countries have long been regarded as leaders in the field of restorative justice. It is of the utmost importance to consider international trends due to the guidance that it can offer school governing bodies in South Africa. The principle of restorative justice has received extensive international support due to various practical tools that have been developed by the above-mentioned countries. Therefore, these tools are considered in order to assist governing bodies in determining the way forward in South African schools. / LLM (Comparative Child Law), North-West University, Potchefstroom Campus, 2015

A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the factors that predispose children to be in conflict with the law and to develop guidelines to support these children. The data-collection techniques were individual semi-structured interviews and field notes. The sample consisted of eight (8) children who volunteered to be interviewed. The theme that emerged during data collection and analysis was the factors that predispose children to break the law. Five categories were identified in this theme, namely * Personal factors * Family factors * Community factors * Police service factors and * Education factors It is recommended that all the institutions involved in the provision and maintenance of the child's mental health be involved in the implementation of the guidelines. / Health Studies / M.A. (Health Studies)

Em diálogo com o contexto nacional e internacional de encarceramento em massa e de crise do sistema de justiça penal, os Juizados Especiais Criminais (Jecrims) surgem no Brasil com a dupla tarefa de em um contexto de redemocratização reduzir a complexidade no processamento de conflitos de pequena gravidade, sem deixar de puni-los ainda que levemente. Caracterizados por procedimentos de intervenção mais horizontalizados e flexíveis nos quais se estabelece, em tese, uma troca de interesses entre a justiça penal e as partes em conflito, em favor de uma resposta rápida para a vítima e menos dolorosa para o infrator, esse modo de fazer justiça tem sido chamado de justiça negocial. A partir da etnografia dos Juizados Especiais Criminais de São Bernardo do Campo, a pesquisa buscou compreender os sentidos de punição mobilizados nessas situações de negociação. Constatou-se que essas situações são influenciadas por processos de afirmação de identidades profissionais no campo da justiça, sobretudo a do promotor cujo protagonismo nessas cortes lhes confere uma dinâmica centrada na punição do infrator em detrimento da mediação do conflito. A abordagem etnográfica das audiências também permitiu verificar a predominância de um sistema de atribuição de sanções fortemente marcado por estratégias gestionárias, mas também por finalidades clássicas da pena. Nesse jogo de influências predominam sanções de cunho monetário e a tímida recorrência do trabalho comunitário como forma de punição. Com o intuito de melhor compreender as razões dessa timidez, a pesquisa teve um segundo momento etnográfico dedicado à Central de Penas e Medidas Alternativas de São Bernardo do Campo. Lá foi possível verificar que a reticência em relação a essa modalidade punitiva relaciona-se aos desafios de tornar o serviço comunitário obrigatório uma punição credível para promotores e juízes. Desse modo, conclui-se que o sistema de sanções mobilizado na justiça negocial, uma justiça em princípio alternativa, guarda, mesmo que de maneira leve, uma tradicional semântica do sofrimento. / In dialogue with the national and international contexts of mass imprisonment and criminal justice systems crisis, the Juizados Especiais Criminais (Special Criminal Courts) emerge in Brazil with two scopes: reducing the complexity of minor crimes procedure without stop punishing minor crime even in a soft way. By using horizontal and flexible intervention procedures in which it creates, theoretically, an exchange of interests between criminal justice and conflict parts, favoring a quickly and less painful answer for both parts, this kind of doing justice has been called by bargaining justice. Through ethnography of the Special Criminal Courts of Sao Bernardo do Campo, the research aimed to understand the meanings of punishment mobilized on these bargaining situations. The research revealed that these situations are influenced by the process of affirmation of professional identities in the justice field, especially the prosecutor\'s identity which leadership in these special courts creates a particular dynamic centered on the criminal punishment and not on the conflict mediation. The ethnographic approach of the special courts hearings also made possible verifying the predominance of a system of sanctions attribution characterized substantially by management strategies and also by classical theories of punishment. In this influence play, the forms of punishment that prevail are mainly monetary sanctions and only barely community service. To understand the reasons for the lack of community service application, the research had a second ethnographic moment at the Center of Alternative Punishments and Measures of Sao Bernardo do Campo. Thus, it was possible to verify that the lack of confidence about this kind of punishment is related to the challenges of making the community service mandatory, a reliable punishment for prosecutors and judges. The dissertation concludes that the sanction system mobilized in the bargaining justice, theoretically an alternative justice, keeps a traditional semantic of suffering even in a soft way.

Made available in DSpace on 2016-04-26T20:48:31Z (GMT). No. of bitstreams: 1 Augusto de Pinho Rodrigues.pdf: 1059393 bytes, checksum: 78b0c9acddd97bef15d3a78fd2aa1ff8 (MD5) Previous issue date: 2010-11-08 / Instituto de Pesquisa Econômica Aplicada / This research aims to study the advantages of the economic integration for two countries of MERCOSUL: Brazil and Argentina. From this perspective, is observed the trade creation, the exports low competitiveness and some evidences showing that the two biggest economies of Latin America are specialized in export commodities shift and share analyses and the regional evolution of the commerce, all those points are highlighted in this work. Trying to value the real advantages of the agreement of MERCOSUL, this search aims to provide a discussion if regional integration can help increasing the world competitiveness from those economies external sector, according to the international economics theory. How would be the best strategy: regional integration or commercial multilateralism? It will discuss theories and arguments from economic thoughts trying to explain the consequences from the integration between countries considering a trade flow analysis. In addition, it considers an individual analysis of the main MERCOSUL members Brazil and Argentina and their advantages related to the regional integration. Several empirical indices were examined in order to measure if the expected integration advantages can be really seen / Este trabalho se propõe a estudar as vantagens da integração econômica para os países do MERCOSUL, Brasil e Argentina. Dos efeitos percebidos, na perspectiva recente deste bloco econômico, destacam-se a criação de comércio, a pouca competitividade das exportações, as diferenças de competitividade entre commodities e manufaturas e o relativo aumento do comércio regional, que são foco da análise da presente dissertação. Visando avaliar as vantagens conseguidas a partir da efetivação do MERCOSUL, o trabalho pretende contribuir para a discussão relativa à adoção de uma estratégia de integração regional em opção à abertura comercial multilateral, à luz das teorias do comércio internacional. Será considerada a análise individual do Brasil e da Argentina e suas respectivas vantagens advindas como consequência da adesão ao bloco, advindas de variações nos fluxos comerciais, aumento da competitividade do ponto de vista estrutural diferencial, de preços relativos e aqueles provenientes dos ganhos estáticos. Além disso, abordaremos debates teóricos entre escolas de pensamento econômico, relativos à economia internacional, na tentativa de explicar as consequências que a integração entre países acarretaria. Serão analisados diversos indicadores empíricos objetivando visualizar se as vantagens previstas na teoria da integração já se efetivaram

Introdução: A obesidade é uma afecção com alta prevalência no Brasil e no mundo. É fator de risco para comorbidades como Diabetes tipo 2 (DM2), Hipertensão Arterial Sistêmica (HAS), Dislipidemia, Apneia Obstrutiva do Sono (AOS), entre outras. Seu tratamento é complexo e a cirurgia bariátrica, executada por diferentes técnicas, tem sido uma das opções. Objetivo: Analisar os resultados publicados na literatura em relação às técnicas cirúrgicas de Banda Gástrica Ajustável (BGA), Gastrectomia Vertical (GV), Gastroplastia com derivação em Y de Roux (GDYR) e Derivação Biliopancreática (DBP) - técnica de \"Scopinaro\" e de \"Duodenal Switch\" quanto às complicações operatórias, à mortalidade, à perda do excesso de peso (PEP) e ao reganho, e a resolução das comorbidades após a operação. Método: Foram analisados 116 estudos selecionados na base de dados MEDLINE por meio da PubMed publicados na Língua Inglesa entre 2003 e 2014. Para comparar as diferentes técnicas cirúrgicas (BGA, GV, GDYR e DBP), realizou-se estudo estatístico por meio da análise de variância (ANOVA) aplicando os testes de Duncan e de Kruskal Wallis avaliando: complicações pós-operatórias (fístula, sangramento e óbito); perda e reganho do excesso de peso, e resolução das comorbidades. Resultados: A ocorrência de sangramento foi de 0,6% na média entre todos os estudos, sendo 0,44% na BGA; 1,29% na GV; 0,81% na GDYR e 2,09% na DBP. Já a ocorrência de fístulas foi de 1,3% na média entre todos os estudos, 0,68% para BGA; 1,93% para GV; 2,18% para GDYR e 5,23% para DBP. A mortalidade nos primeiros 30 dias pós-operatórios foi de 0,9% na média entre todos os estudos, 0,05% na BGA; 0,16% na GV; 0,60% na GDYR e 2,52% na DBP. A PEP após cinco anos na média entre todos os estudos foi de 63,86%, especificamente na BGA, foi de 48,35%; 52,7% na GV; 71,04% na GDYR e 77,90% na DBP. A taxa de DM2 resolvida foi de 76,9% na média entre todos os estudos, sendo 46,80% na BGA; 79,38% na GV; 79,86% na GDYR e 90,78% na DBP. A taxa de Dislipidemia resolvida após a operação foi de 74,0% na média de todo o estudo, sendo 51,28% na BGA; 58,00% na GV; 73,28% na GDYR e 90,75% na DBP. A taxa de HAS resolvida após a operação foi de 61,80% na média de todo o estudo, sendo 54,50% na BGA; 52,27% na GV; 68,11% na GDYR e 82,12% na DBP. A taxa de AOS resolvida após a operação foi de 75,0% na média de todo o estudo, sendo 56,85% na BGA; 51,43% na GV; 80,31% na GDYR e 92,50% na DBP. Conclusão: quando analisadas e comparada as quatro técnicas observa-se que nos primeiros 30 dias pós-operatório a taxa de sangramento é superior nos pacientes submetidos à DBP e taxa de fístula inferior nos pacientes da BGA. Quanto à mortalidade observou-se taxa mais pronunciada nos pacientes submetidos à DBP e menos nos submetidos à BGA. Quanto à PEP observou-se uma uniformidade entre os pacientes submetidos à GV, GDYR E DBP até o terceiro ano. Após esse período observa-se reganho de peso nos submetidos à GV até o quinto ano de seguimento. Já nos pacientes submetidos à BGA observou-se taxas de PEP menos pronunciadas em relação às demais desde o início do seguimento. Quanto à resolução das comorbidades observou-se taxas de resolução de DM2 inferiores nos pacientes submetidos à BGA, e não houve diferença entre nenhuma técnica quanto à resolução das demais comorbidades: HAS, AOS e dislipidemia / Introduction: Obesity is a disease with high prevalence in Brazil and worldwide. It is a risk factor for comorbidities such as type 2 diabetes (T2D), hypertension, dyslipidemia, obstructive sleep apnea, among others. Treatment is complex and bariatric surgery, performed by different techniques, has been one of the options. Objective: To analyze the surgical the results presented in the literature related to techniques of Adjustable Gastric Banding (AGB), Sleeve Gastrectomy(SG), Roux-en-Y Gastric Bypass(RYGB) and Biliopancreatic Diversion(BPD) - (\"Scopinaro\" and \"Duodenal Switch\" procedures) as to the postoperative complications, mortality, excess weight loss (EWL) and regain, and resolution of the comorbidities after surgery. Method: 116 studies were selected in MEDLINE through PubMed published in the English language between 2003 and 2014. To compare the different surgical techniques (AGB, SG, RYGB, BPD), statistical analysis was performed by analysis of variance applying Duncan and Kruskal Wallis tests assessing: postoperative complications (leak, bleeding and death); EWL and regained, and resolution of comorbidities after surgery. Results: The incidence of bleeding was in average 0.6% from all studies; 0.44% in AGB; 1.29% for SG; 0.81% RYGB and 2.09% for BPD. The average incidence of leaks was 1.3% in all studies; 0.68% for AGB; 1.93% in SG; 2.18% RYGB and 5.23% for BPD. Average mortality in the first 30 postoperative days was 0.9% in all studies; 0.05% for AGB; 0.16% in SG; 0.60% in RYGB and 2.52% in BPD. The average percentage of EWL after five years in all studies was 63.86%, specifically in AGB it was 48.35%; 52.7% in SG; 71.04% in RYGB and 77.90% in BPD. The rate of T2D resolved was in average 76.9% across all studies, 46.80% for AGB; 79.38% for SG; 79.86% RYGB and 90.78% for BPD. The rate of dyslipidemia resolved was in average 74.00% across all studies, 51.28% for AGB; 58.00% for SG; 73.28% RYGB and 90.75% for BPD. The rate of hypertension resolved was in average 61.80% across all studies, 54.50% for AGB; 52.27% for SG; 68.11% for RYGB and 82.12% for BPD. The rate of apnea resolved was in average 75.00% across all studies, 56.85% for AGB; 51.43% for SG; 80.31% for RYGB and 92.50% for BPD. Conclusion: After analyzing and comparing the four techniques it was observed that in the first 30 postoperative days the bleeding rate is higher in patients undergoing BPD and lower fistula rate in patients undergoing AGB. Regarding mortality was observed higher rate in patients undergoing BPD and smaller in patients undergoing AGB. As for EWL there was uniformity among patients submitted to SG, RYGB and BPD until the third year. After this period there has been regained weight in the patients submitted to SG until the fifth year. The patients undergoing AGB have lower rates of EWL. As for the resolution of comorbidities, observed T2D resolution rates were lower in patients undergoing AGB, and there was no difference between the techniques regarding: hypertension, dyslipidemia and obstructive sleep apnea

INTRODUÇÃO: Os pacientes oncológicos exigem um olhar diferenciado da equipe multiprofissional que o assiste. O câncer provoca um estresse de longo prazo. Fora a preocupação imediata com a morte, o medo relacionado à dor e às deformidades físicas deixam os pacientes em total quadro de ansiedade e muitas vezes, quadros depressivos se instalam no diagnóstico e se prolongam após o tratamento. Para o tratamento do câncer de bexiga é realizada a cistectomia total, desta forma torna-se necessária a utilização de técnicas de derivação urinária (Bricker ou neobexiga), ambas tem seus benefícios e empecilhos que irão influenciar diretamente na qualidade de vida desses pacientes. OBJETIVO: Comparar as alterações de qualidade de vida em pacientes submetidos às técnicas de reconstrução urinária por neobexiga ortotópica ou derivação urinária a Bricker em pacientes submetidos à cistectomia radical. MÉTODO: Foi realizado estudo qualitativo, transversal de 67 pacientes submetidos à cistectomia radical, divididos em dois grupos: 1) Neobexiga e 2) ureteroileostomia cutânea (Bricker) operados no período de Julho/2005 a Outubro/2010, pela mesma equipe cirúrgica, no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram utilizados para entrevista a ficha Sócio- Demográfica, a Escala de Ansiedade e Depressão e o Questionário SF36. RESULTADOS: Observamos que a média de idade do grupo Bricker é significativamente maior que a do grupo com neobexiga (p = 0,036). Não foram encontradas diferenças significativas nas proporções de sexo entre os dois grupos (p = 0,963). Quanto às demais adaptações pós-operatórias, como retorno ao trabalho, sono e repouso, nível de ansiedade e depressão, em nosso estudo não foi encontrada diferença significativa entre as técnicas. CONCLUSÃO: Não houve diferença significativa, com relação a qualidade de vida pós operatória, entre os pacientes submetidos a derivação urinária por neobexiga ortotópica ou Bricker / INTRODUCTION: Cancer patients require a different view of the multidisciplinary team because cancer may cause long-term stress. The concern with death, fear related to pain and physical deformities leave patients in complete of anxiety and depression settle in the diagnosis and continue after treatment. Physical and mental distress is common while living with cancer illness. Patients commonly suffer because the concern with death, fear related to pain and physical deformities. For the treatment of bladder cancer a radical cystectomy is performed and the choice of transposed intestinal segment surgery ranges from incontinent urinary diversion through an abdominal stoma (ileal conduit diversion) to continent urinary diversion to orthotopic bladder replacement (orthotopic neobladder), both have their benefits and drawbacks that will directly influence the quality of life of these patients. OBJECTIVE: We compared health-related quality of life between patients who underwent orthotopic neobladder or an ileal conduit urinary diversion following radical cystectomy. METHOD: The study included 67 patients who underwent radical cystectomy for bladder cancer, divided into two groups: 1) Neobladder; 2) Ileal conduit diversion (Bricker). Health related quality of life was evaluated using the Short Form-36 survey, a patient demographic sheet and the anxiety and depression scale. RESULTS: When compared the mean age, we found that the mean age of the Bricker group is significantly higher than in the neobladder group (p = 0.036). There were no significant differences in sex ratios between the two groups (p = 0.963). There was no significant difference in any scale scores between the neobladder and ileal conduit groups. Conclusion: No significant postoperative differences were observed in the QOL associated with the urinary diversion.

Dans cette thèse, une solution de caoutchouc de styrène-butadiène (SBR) réticulé avec du peroxyde organique, a été transformé en un gel autodégradable par l’ajout d’hydropéroxyde comme agent de dégradation. La formulation a été caractérisée en rhéologie dynamique. Les spectres de temps de relaxation ont été calculés à partir des modules dynamiques de cisaillement, par une nouvelle méthode développée dans ces travaux présentée avec une revue complète de méthodes pour le calcul des spectres de relaxation à partir de données de rhéométrie de cisaillement. Des expériences in-situ et ex-situ ont été réalisées afin d’évaluer l’évolution de les réactions de réticulation et dégradation. Les changements de la structure du réseau polymérique sont mises en évidence dans les spectres de temps de relaxation. La cinétique de la dégradation de la solution de SBR a été étudiée dans des conditions anaérobies et caractérisée par diffusion de la lumière multi-angles couplée à la chromatographie d’exclusion stérique (SEC-MALS). En utilisant des équations de bilan de populations, nous avons pu calculer les constantes cinétiques de dégradation thermique et thermo-oxydative. Différentes formulations de ces gels auto-dégradables à base d’huile ont été évaluées en tant que potentiels agents de dérivation pour des opérations de traitement de puits. Le comportement rhéologique de ces gels a été mesuré en fonction du temps, pour vérifier la réticulation du polymère, la force de gel, et la dégradation ; ces variables peuvent être ajustées aux nécessités de l’opération de traitement en jouant sur la formulation. Des tests d’écoulement dans carotte simples ont été réalisés pour évaluer la résistance à la pression en fonction de la force du gel et de sa dégradation. Des tests d’écoulement dans carottes parallèles ont également été menés, afin d’évaluer l’efficacité de la dérivation et la restauration de mobilité. / In this work, a solution of peroxide crosslinked styrene-butadiene rubber (SBR) has been transformed to a self-degradable gel system by adding hydroperoxide as a degradation agent to the formulation. Dynamic rheometry was employed to calculate the relaxation time with a new method presented along with a full review of methods for calculation of the relaxation time spectrum from oscillatory rheometry. In-situ and ex-situ experiments were performed to evaluate the evolution of crosslinking and degradation reactions. Structural changes in the polymer network were visible within the relaxation time spectra. The degradation kinetics of styrene butadiene rubber (SBR) in solution was studied in anaerobic conditions and the characterization was performed by multiangle light scattering coupled to size exclusion chromatography (SEC-MALS). Using population balance equations, it was possible to calculate the kinetic constants for thermal and thermooxidative degradation. Different formulations of these oil-based self-degradable gels have been evaluated as possible diverting agents during oil wells operations. The time dependent rheological behavior of the gels was measured to verify polymer crosslinking, maximum gel strength and gel degradation, all of which can be adjusted by varying formulation depending on operation needs. Single core tests were performed to evaluate pressure resistance as a function of gel strength and gel degradation. Parallel cores tests were also carried out to validate diversion efficiency and mobility restoration.

Obesity is the fifth leading cause of global deaths. The efficacy and safety of obesity treatment is still controversial. The objective of the thesis is to evaluate the efficacy and safety of bariatric surgery, through a systematic review of the current evidence and meta- analysis of important outcomes. Nineteen (19) randomized controlled trials (RCTs) with 1346 participants were included. Bariatric surgery resulted in greater weight loss when compared to non-surgical treatment. Weight loss was also associated with resolution and/or improvement of obesity related comorbidites such as diabetes, hypertension, hyperlipidemia, and sleep apnea. Weight loss and safety varied across the surgical procedures. Biliopancreatic diversion/duodenal switch had the greatest weight loss, followed by sleeve gastrectomy and Roux-en-Y gastric bypass, purely restrictive procedures such as vertical banded gastroplasty and adjustable gastric banding resulted in the least weight loss. Long term, high quality, and adequately powered trials are still needed to support the available evidence

Η χολοπαγκρεατική εκτροπή αποτελεί την πιο αποτελεσματική μέθοδο της βαριατρικής χειρουργικής όσο αφορά την απώλεια του βάρους και την υποχώρηση του σακχαρώδους διαβήτη τύπου 2, συνοδεύεται όμως συχνά από σημαντική έλλειψη θρεπτικών συστατικών. Η επιμήκης γαστρεκτομή είναι μια σχετικά νέα επέμβαση, η οποία σύμφωνα με μελέτες προκαλεί σημαντικού βαθμού απώλεια βάρους και υποχώρηση του σακχαρώδους διαβήτη τύπου 2. Σκοπός: Η προοπτική εκτίμηση και σύγκριση της επίδρασης της χολοπαγκρεατικής εκτροπής μακρών ελίκων και της λαπαροσκοπικής επιμήκους γαστρεκτομής στην υποχώρηση του σακχαρώδους διαβήτη τύπου 2, της υπέρτασης και της δυσλιπιδαιμίας, καθώς επίσης και στα επίπεδα ινσουλίνης, γλυκαγόνης, γκρελίνης, PYY και GLP-1( σε νηστεία αλλά και μετά από τη λήψη γλυκόζης ) σε ασθενείς με κλινικά σοβαρή παχυσαρκία και σακχαρώδη διαβήτη τύπου2. Μέθοδος: Δώδεκα ασθενείς (ΔΜΣ 57.6±9.9 kg/m2) υποβλήθηκαν σε χολοπαγκρεατική εκτροπή μακρών ελίκων και δώδεκα (ΔΜΣ 43.7±2.1 kg/m2 ) σε λαπαροσκοπική επιμήκη γαστρεκτομή. Όλοι οι ασθενείς παρουσίαζαν σακχαρώδη διαβήτη τύπου 2 και μελετήθηκαν προεγχειρητικά και σε 1, 3 και 12 μήνες μετά το χειρουργείο. Σε όλους τους χρόνους υποβλήθηκαν σε από του στόματος δοκιμασία ανοχής γλυκόζης. Αποτελέσματα: Το σωματικό βάρος σημείωσε σημαντική και αναλόγου μεγέθους μείωση και στις δύο ομάδες (Ρ<0.001). Στους 12 μήνες η ποσοστιαία απώλεια του υπερβάλλοντος σωματικού βάρους ήταν παρόμοια στις δύο ομάδες (Ρ=0.8) και ο σακχαρώδης διαβήτης είχε υποχωρήσει σε όλους τους ασθενείς. Η γλυκόζη, η ινσουλίνη και η αντίσταση στη δράση της παρουσίαζαν σημαντική μείωση έπειτα και από τις δύο επεμβάσεις, όμως η ευαισθησία στην ινσουλίνη ενισχύθηκε περισσότερο έπειτα από τη χολοπαγκρεατική εκτροπή (Ρ=0.003). Η αρτηριακή πίεση, η ολική και η LDL χοληστερόλη μειώθηκαν σημαντικά έπειτα από τη χολοπαγκρεατική εκτροπή (Ρ<0.001), όχι όμως και μετά την επιμήκη γαστρεκτομή. Τα τριγλυκερίδια μειώθηκαν σημαντικά και στις δύο ομάδες, ενώ η HDL χοληστερόλη παρουσίασε σημαντική αύξηση μόνο μετά την επιμήκη γαστρεκτομή (Ρ<0.001). Τα επίπεδα γκρελίνης νηστείας δεν μεταβλήθηκαν σημαντικά μετά τη χολοπαγκρεατική εκτροπή (Ρ=0.2), ενώ σημείωσαν σημαντική μείωση μετά την επιμήκη γαστρεκτομή (Ρ<0.001). Η απόκριση των ΡΥΥ και GLP-1 ενισχύθηκε σημαντικά και στις δύο ομάδες ασθενών (Ρ=0.001). Συμπεράσματα: Η λαπαροσκοπική επιμήκης γαστρεκτομή οδήγησε σε αναλόγου βαθμού απώλεια σωματικού βάρους και υποχώρηση του σακχαρώδη διαβήτη τύπου 2 με τη χολοπαγκρεατική εκτροπή μακρών ελίκων. Η χολοπαγκρεατική εκτροπή όμως ήταν περισσότερο αποτελεσματική όσο αφορά τη βελτίωση της ευαισθησίας στην ινσουλίνη, της δυσλιπιδαιμίας και της αρτηριακής υπέρτασης. / Biliopancreatic diversion (BPD) is the most effective bariatric procedure in terms of weight loss and remission of diabetes type 2 (DM2) but it is accompanied by nutrient deficiencies. Sleeve gastrectomy (SG) is a relatively new restrictive operation that has shown promising results concerning DM2 resolution and weight loss. Objective: To evaluate and compare prospectively the effects of BPD long limb (BPDLL) and SG on remission of DM2, hypertension and dyslipidemia and also on fasting, and glucose-stimulated insulin, glucose, glucagon, ghrelin, PYY and glucagon-like peptide-1 (GLP-1) levels in morbidly obese patients with DM2. Methods: Twelve patients (BMI 57.6±9.9 kg/m2) underwent BPDLL and 12 (BMI 43.7±2.1 kg/m2) underwent SG. All patients had DM2 and were evaluated before and 1, 3 and 12 months after surgery. Oral glucose tolerance test and blood sampling were carried out after an overnight fast and 30, 60 and 120 minutes after glucose ingestion. Results: Body weight decreased markedly in both groups (P<0.001); excess weight loss was similar in both groups at 12 months (P=0.08) and DM2 resolved in all patients. Glucose, insulin and insulin resistance decreased significantly after both procedures, but the BPDLL group had higher insulin sensitivity than the SG group at 1 year (P=0.003). Blood pressure, total and LDL cholesterol decreased markedly after BPDLL (P<0.001) but not after SG. Triglycerides decreased significantly after both operations but HDL increased significantly after SG only (p<0.001). Fasting ghrelin did not change significantly after BPDLL (P=0.2), but decreased markedly after SG (P<0.001). Fasting GLP-1 and PYY increased significantly after BPDLL only (P=0.01), however GLP-1 and PYY responses to glucose were significantly enhanced in both groups (P=0.001). Conclusion: SG results in weight loss and resolution of DM2 comparable to BPDLL, but BPDLL is more effective in terms of dyslipidemia resolution and blood pressure reduction.

This thesis details the hydrodynamic research conducted at Delta Marsh as part of the Restoring the Tradition marsh rehabilitation project. Research has indicated that the hydraulic and hydrologic controls on the marsh can have considerable impacts on its ecological function, but the impacts of these controls had not previously been studied. Field hydrography and two-dimensional numerical modelling (using MIKE 21) provided insight into many aspects of the physical behaviour of Delta Marsh. Eighty five percent of the inflow to Delta Marsh from Lake Manitoba passes through Clandeboye Channel, and these discharge signals propagate as far west as Cadham Bay. Inflow to the marsh disperses quickly, and accounts for a small fraction of the water that exits the marsh during subsequent outflow. Thus, Portage Diversion water that enters the marsh through the lake can remain there even if there is a net loss in marsh volume over the season. Wind friction across Lake Manitoba has the greatest impact on short-term fluctuations in marsh volume and on the composition of marsh water, followed by the Portage Diversion and the natural inflows to Lake Manitoba. Expansions to flood diversion infrastructure will considerably impact the composition of Delta Marsh waters. Three methods of wetland discharge estimation were developed and tested. The most promising method was the regressed slope Manning method (RSMM), which estimates two-directional channel discharge as a function of the water surface elevations at both ends of a channel. When used in conjunction with the velocity index method, the RSMM can multiply the amount of reliable discharge data collected per research dollar. Thanks to its simple formulation, the RSMM is likely applicable outside of wetland settings, as well. / February 2016