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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.
41

Vers une performance globale et durable de la micro-entreprise en phase de post-naissance – l’impact des compétences de l’entrepreneur / Towards a comprehensive and sustainable performance of the post-birth micro-enterprise – the impact of skills of the entrepreneur

Rouveure, Thomas 29 November 2017 (has links)
Les fondements de l’entrepreneuriat placent l’entrepreneur comme l’acteur incontournable du processus entrepreneurial : c’est lui qui impulse la saisie d’opportunités, qui crée et développe une organisation et qui favorise le degré d’innovation dans l’entreprise, pour espérer créer de la valeur (Aldrich, 2005 ; Verstraete & Fayolle, 2005). En raison de la forte diversité de ses champs d’actions, nous avons fait le choix de cibler spécifiquement notre recherche sur la micro-entreprise (MIC) à une période précise du processus de création : la post-naissance. Quelles sont les activités constitutives du rôle de l’entrepreneur et les difficultés qu’il rencontre dans son entreprise ? Pourquoi seulement 4% des entreprises pérennes à 5 ans créent des emplois (Taugourdeau & Verdier, 2013) ? Cette recherche répond à des enjeux socio-économiques tels que : susciter l’esprit d’entreprendre, créer les emplois de demain et accroître le dynamisme du tissu économique (Assises de l’entrepreneuriat, 2013).Le cadre théorique s’appuie sur trois théories qui, par leur complémentarité, offrent une perspective novatrice à cette recherche. A partir d’une approche structurée de la performance globale et durable de l’entreprise, issue de la Théorie Socio-Economique (TSE) (Savall, 1974 ; Savall & Zardet, 1987), nous proposons de construire une Architecture Dysfonctionnelle de la Micro-Entreprise (ADME) qui permet une analyse approfondie de son environnement interne. Par la suite, nous l’expérimentons et mesurons les répercussions financières des dysfonctionnements pour ces MIC. La TSE, par sa méthodologie d’intervention, ambitionne une volonté de changement dans l’entreprise et révèle le besoin de développement de compétences et d’évolution des comportements professionnels (Savall et al., 2015). Ainsi, nous nous rapprochons du champ de la cognition entrepreneuriale, observé à partir de la notion d’ « attitude ». Ces attitudes, accumulées, forment notre conception de la Configuration Stratégique Cognitive de l’Entrepreneur (CSCE), inspirée de la Théorie du Comportement Planifié (TCP) (Ajzen, 1987, 1991), puis élargie à partir du champ de la cognition entrepreneuriale (Grazzini & Boissin, 2013; Mitchell et al., 2002, 2007;Shapero & Sokol, 1982).La CSCE offre un approfondissement sur les structures de croyances à partir desquelles l’entrepreneur prend ses décisions et agit (Grazzini & Boissin, 2013). Elle permet d’expliquer dans quelle mesure l’intervention socio-économique agit sur l’intention de changement, puis, sur le comportement de l’entrepreneur. Par ailleurs, une relation peut se tisser entre la TCP et l’approche par les compétences à partir des attitudes de l’entrepreneur. La théorie de la compétence, adaptée au champ de l’entrepreneuriat (Bird, 1995 ; Chandler & Jansen, 1992 ; Lans et al., 2010 ; Man & Lau, 2000 ; Toutain & Fayolle, 2008), reconnaît le tryptique :connaissance (savoir), pratiques (savoir-faire) et attitudes (savoir-être). La CSCE peut représenter un cadre d’analyse du savoir-être qui approfondit les caractéristiques d’influence d’actions de l’entrepreneur. Enfin, la relation établie avec la TSE est proposée à partir du modèle de coût-valeur des activités (Savall & Zardet, 2008) qui connecte la compétence à une activité. Nous proposons et expérimentons la nomenclature d’activités de l’entrepreneur, représentative des pratiques et savoirs qui lui sont nécessaires, tous intégrés dans trois rôles : entrepreneurial, gestionnaire et technico-fonctionnel (Chandler & Jansen, 1992).La recherche empirique s’est déroulée en deux étapes. La première étape, exploratoire, comprend 43 répondants, acteurs divers de l’entrepreneuriat. La seconde est une recherche-intervention menée auprès de 16 MIC en phase de post-naissance. Ainsi, la problématique centrale de cette recherche est la suivante: Comment instaurer une méthodologie d’accompagnement visant à modifier l’intention de l’entrepreneur quant aux actions qu’il réalise dans son entreprise? / Foundations in entrepreneurship place the entrepreneur as the essential actor in the entrepreneurial process: he is the one who promotes the identification of opportunities, creates and develops an organization and promotes the degree of innovation in the company, hoping to create the value (Aldrich, 2005 ; Verstraete & Fayolle, 2005). Due to the wide diversity of its action fields, we have chosen to specifically target our micro-enterprise research (MIC) at a specific time in the creative process: post-birth. What activities constitute the role of the entrepreneur and the difficulties he encounters in his business? Why only 4% of 5-year-old companies create jobs (Taugourdeau & Verdier, 2013)? This research responds to socio-economic issues such as: fostering the entrepreneurial spirit, creating the jobs of tomorrow and increasing the dynamism of the economic fabric (Assises de l’entrepreneuriat, 2013).The theoretical framework is based on three theories which, by their complementarity, offer an innovative perspective to this research. Based on a structured approach to the overall and sustainable performance of the company, based on Socio-Economic Theory (TSE) (Savall, 1974 ; Savall & Zardet, 1987), we propose to construct a Dysfunctional Architecture Micro-Enterprise (ADME), which allows a thorough analysis of its internal environment. We then experiment and measure the malfunctioning financial implications of these MICs. The TSE, through its intervention methodology, aims at a wish for change in the company and reveals the need for skills development and changes in professional behavior (Savall et al., 2015). Thus, we approach the field of entrepreneurial cognition, observed from the notion of "attitude". The set of different kinds of attitudes can form our conception of the Cognitive Strategic Configuration of the Entrepreneur (CSCE), inspired by the Theory of Planned Behavior (TCP) (Ajzen, 1987, 1991) and then expanded from the field of entrepreneurial cognition (Grazzini & Boissin, 2013 ; Mitchell et al., 2002, 2007 ; Shapero & Sokol, 1982). The CSCE offers a deeper insight into the belief structures from which the entrepreneur takes decisions and acts (Grazzini & Boissin, 2013). It explains the extent to which socio-economic intervention influences the intention of change and then the entrepreneur behavior. In addition, a relationship can be forged between the TCP and the competency approach based on the entrepreneur's attitudes. The theory of competence, adapted to the field of entrepreneurship (Bird, 1995 ; Chandler & Jansen 1992;Lans et al., 2010;Man & Lau 2000 ; Toutain & Fayolle, 2008) recognizes the tripod: knowledge, practices (know-how) and attitudes. The CSCE can represent a know-how analysis framework that deepens the characteristics that can influence the entrepreneurial actions. Finally, the relation established with the TSE is proposed on the basis of the cost-value activities model (Savall & Zardet, 2008) which connects competence to an activity. We propose and experiment the entrepreneurial activities nomenclature, representative of the practices and knowledge which are necessary for the entrepreneurial process, all integrated into three roles: entrepreneurial, managerial and technical-functional (Chandler & Jansen, 1992).Empirical research was conducted in two stages. The first stage, exploratory, comprises 43 people interviewed, different actors of entrepreneurship. The second is an intervention–research with 16 MICs in the post-birth phase. Thus, the research central problem was: How to implement a methodology of accompanying to modify the intention of the entrepreneur with the actions that he carry out in the company?
42

Qualidade de vida e função sexual de mulheres submetidas ao tratamento para o câncer do colo do útero

Corrêa, Camila Soares Lima 19 February 2014 (has links)
Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-26T14:19:31Z No. of bitstreams: 1 camilasoareslimacorrea.pdf: 2489508 bytes, checksum: e12b749f06936dc865a6f6dea87eb4cf (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-27T11:03:59Z (GMT) No. of bitstreams: 1 camilasoareslimacorrea.pdf: 2489508 bytes, checksum: e12b749f06936dc865a6f6dea87eb4cf (MD5) / Made available in DSpace on 2016-01-27T11:03:59Z (GMT). No. of bitstreams: 1 camilasoareslimacorrea.pdf: 2489508 bytes, checksum: e12b749f06936dc865a6f6dea87eb4cf (MD5) Previous issue date: 2014-02-19 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A alta curabilidade do câncer do colo do útero (CCU), quando detectado precocemente associada aos recentes avanços científicos na terapêutica da doença têm contribuído para uma maior sobrevida das pacientes. Porém, seu tratamento pode levar a efeitos adversos tardios importantes, como disfunções sexuais, que comprometem de forma significativa a qualidade de vida (QV). Desta forma, torna-se essencial investigar a QV e a função sexual de sobreviventes ao CCU, visando verificar, de forma holística, as reais necessidades dessas pacientes e guiar as ações de equipes inter e multidisciplinares. E, com isso, oferecer um cuidado adequado, humanizado e que atenda a todas essas necessidades, pois não basta aumentar a sobrevida, é necessário ter qualidade nesta sobrevivência. Dentro deste contexto, o objetivo principal desta pesquisa foi avaliar a QV e a função sexual de mulheres submetidas ao tratamento para o CCU e comparar com um grupo controle de mulheres sem história de câncer. Trata-se de estudo epidemiológico observacional, analítico, do tipo caso-controle com amostra total de 74 mulheres divididas em grupo câncer - GCa (mulheres submetidas a tratamento para o CCU há, pelo menos três meses - n=37) e grupo controle de base populacional - GCo (mulheres sem história de câncer - n=37). Foram aplicados três questionários: um de caracterização geral da amostra; um questionário de avaliação da qualidade de vida, desenvolvido pela Organização Mundial da Saúde (WHOQOL-bref); e um instrumento de avaliação da função sexual (Índice de Função Sexual Feminina – FSFI). O grupo controle apresentou maior frequência de mulheres vivendo com companheiro (GCo=73%; GCa=51,4%; p=0,05) e de mulheres que consideravam o relacionamento com este como bom ou muito bom (GCo=93,1%; GCa=63,2%; p=0,02). As seguintes variáveis, que no GCa poderiam estar associadas a efeitos adversos do tratamento, foram diferentes entre os grupos (p ˂ 0,05), sendo mais frequentes no GCa: menopausa (GCo=59,5%; GCa=100%; p˂0,01); sangramento durante ou após a relação sexual (GCo=0; GCa=36,8%; p˂0,01); aumento da frequência (GCo=0; GCa=37,8%; p˂0,01), urgência (GCo=16,2%; GCa=37,8%; p=0,03), incontinência (GCo=10,8%; GCa=35,1%; p=0,02) e retenção urinárias (GCo=2,7%; GCa=21,6%; p=0,02); diarréia (GCo=0; GCa=43,2%; p˂0,01), urgência (GCo=0; GCa=37,8%; p˂0,01) e incontinência fecais (GCo=0; GCa=21,6%; p˂0,01); dor (GCo=0; GCa=21,6%; p˂0,01) e muco anais (GCo=0; GCa=18,9%; p=0,01); enterorragia (GCo=0; GCa=24,3%; p˂0,01) e linfedema em membros inferiores (GCo=0; GCa=35,1%; p˂0,01). Além disto, o grupo câncer apresentou piores resultados quanto a variáveis relacionadas à função sexual: 64,9% relataram vagina estreita ou curta demais; a maioria não era sexualmente ativa (59,5%) e, das mulheres que tinham relação sexual, 80% apresentavam disfunção. Foi encontrada diferença estatisticamente significativa entre os grupos nos domínios “Físico” e “Relações Sociais” do WHOQOL-bref, sendo que a média destes domínios foi superior no grupo controle. As médias do grupo câncer foram estatisticamente inferiores às do grupo controle em todos os domínios do FSFI e também no escore total do instrumento. Diante dos resultados encontrados, conclui-se que há impacto negativo do tratamento para o CCU na QV e função sexual das sobreviventes. A partir disto, pode-se contribuir para dar maior visibilidade a estes aspectos na prática clínica, buscando guiar as intervenções de forma a atender todas as necessidades destas pacientes, contribuindo para uma melhor qualidade de vida na sobrevivência. / The high curability of cervical cancer (CC), when detected early, coupled with the latest scientific advances in the treatment of disease, has contributed to increased survival of patients. However, its treatment can lead to significant late adverse effects such as sexual dysfunctions that compromise significantly the quality of life (QoL). Thus, it becomes essential to investigate the QoL and sexual function of survivors at the CC in order to verify, holistically, the real needs of these patients and guide the actions of inter and multidisciplinary teams. And with that, provide a convenient and humanizing care that meets all these requirements, it is not enough to increase survival, it is necessary to have this quality survival. Within this context, the main objective of this research was to assess quality of life and sexual function in women submitted to treatment for cervical cancer, and compare with a control group of women without a history of cancer. It is, analytical, observational, epidemiological study of case-control sample with a total of 74 women divided into cancer group - CaG (women submitted to treatment for cancer of the cervix for at least three months - n = 37) and population-based control group - CoG (women without a history of cancer - n = 37). Three questionnaires were applied: a general characterization of the sample, a survey for evaluating the quality of life, developed by the World Health Organization (WHOQOL-BREF), and an instrument for assessment of sexual function (Female Sexual Function Index - FSFI). The control group had a higher frequency of women living with a partner (CoG = 73%; CaG = 51.4%, p = 0.05) and women who considered the relationship even as good or very good (CoG = 93 1%; CaG = 63.2%, p = 0.02). The following variables related to potential adverse effects of treatment were more frequent in the cancer group: menopause (CoG = 59.5%; CaG = 100%, p ˂ 0.01), bleeding during or after intercourse (CoG = 0; CaG = 36.8%, p ˂ 0.01) increase in the frequency (CoG = 0; CaG = 37.8%, p ˂ 0.01), urgency (CoG = 16.2%; CaG = 37.8 %, p = 0.03), incontinence (CoG = 10.8%; CaG = 35.1%, p = 0.02) and urinary retention (CoG = 2.7%; CaG = 21.6%, p = 0.02), diarrhea (CoG = 0; CaG = 43.2%, p ˂ 0.01), urgency (CoG = 0; CaG = 37.8%, p ˂ 0.01) and fecal incontinence (CoG = 0; CaG = 21.6%, p ˂ 0.01), pain (CoG = 0; CaG = 21.6%, p ˂ 0.01) and anal mucus (CoG = 0; CaG = 18.9% p = 0.01), rectal bleeding (CoG = 0; CaG = 24.3%, p ˂ 0.01) and lower limb lymphedema (CoG = 0; CaG = 35.1%, p ˂ 0.01). Moreover, the cancer group had worse results as related to sexual function variables: 64.9% reported narrow or too short vagina most were not sexually active (59.5%) and women who had sexual intercourse, 80 % dysfunctional. Statistically significant difference between groups in the fields "Physical" and "Social Relations" WHOQOL-BREF was found, while the average of these areas was higher in the control group. The averages of cancer group were statistically lower than the control group in all domains of FSFI, and total score of the instrument. Considering the results, it is concluded that there is negative impact of treatment for CC in QoL and sexual function of survivors. From this, one can contribute to giving greater visibility to these issues in clinical practice, seeking to guide interventions in order to attend all the needs of these patients, contributing to a better quality of life in survivors.
43

Sexuelle Dysfunktionen und sexuelle Zufriedenheit bei Patientinnen mit posttraumatischer Belastungsstörung

Haase, Angelika, Boos, Anne, Schönfeld, Sabine, Hoyer, Jürgen January 2009 (has links)
Hintergrund: Sexuelle Dysfunktionen sind ein häufiges Problem bei Patientinnen mit posttraumatischer Belastungsstörung (PTB). Kaum untersucht ist, ob ein Zusammenhang zwischen der Art des Traumas (sexuell vs. nichtsexuell) und der Häufigkeit sexueller Dysfunktionen bzw. Zufriedenheit besteht und welche Rolle komorbide Depressionen dabei spielen. Zudem wurden verschiedene Störungsbilder (PTB, Angst, Depression) in Bezug auf sexuelle Funktions-/Zufriedenheitsbeeinträchtigungen vergleichend untersucht (klinische Spezifität). Patientinnen und Methoden: Nach der standardisierten klinischen Diagnostik wurden 351 ambulante Psychotherapiepatientinnen folgenden 3 Gruppen zugeteilt: Patientinnen mit PTB (n = 89), mit anderen Angststörungen (n = 157) und mit depressiven Störungen (n = 105). Informationen zur sexuellen Zufriedenheit und Funktionsfähigkeit wurden mit dem Kurzfragebogen für Sexualität (KFS) erhoben. Die Art des Traumas (sexuell vs. nichtsexuell) wurde per Interview erfasst; Depressivität mit dem Beck-Depressions-Inventar (BDI). Ergebnisse: Sexuell traumatisierte PTB-Patientinnen haben ein 4-fach höheres Risiko, Beeinträchtigungen der sexuellen Funktionsfähigkeit zu erleben als PTB-Patientinnen mit nichtsexuellem Trauma. Bei Vorliegen einer depressiven Störung zusätzlich zur PTB steigt das Risiko für sexuelle Dysfunktionen um das 3-fache gegenüber PTB-Patientinnen ohne komorbide Depression. Mit der sexuellen Zufriedenheit hängt die Art des Traumas hingegen nicht zusammen. Während drei Viertel der PTB- und Depressionspatientinnen sexuelle Dysfunktionen berichten, gilt dies nur für jede zweite Angstpatientin (außer PTB). Diskussion: Sowohl die Art des Traumas als auch komorbide Depressionen stehen im Zusammenhang mit sexuellen Dysfunktionen bei PTB-Patientinnen. Insbesondere bei Patientengruppen mit einem erhöhten Risiko für Beeinträchtigungen der sexuellen Funktionen ist es wichtig, die Thematik bei therapeutischen Interventionen zu berücksichtigen. / Background: Sexual dysfunctions are a common problem in female patients with posttraumatic stress disorder (PTSD). However, only few studies have investigated the incidence of sexual dysfunctions in PTSD patients accounting for the type of traumatisation (sexual vs non-sexual), the role of co-morbid depression as well as the comparison to other psychiatric disorders (clinical specification). Patients and Methods: In this study, 351 female outpatients were tested with a standardised clinical diagnostic instrument and assigned to the following 3 groups: patients with PTSD (n = 89), with other anxiety disorders (n = 157) and with depressive disorders (n = 105). Information about aspects of sexual satisfaction und sexual functioning was assessed by a short questionnaire (‘Kurzfragebogen für Sexualität’, KFS). The type of trauma was assessed by interview, and the level of depressive symptoms with the Beck Depression Inventory (BDI). Results: The risk of suffering from sexual dysfunctions was 4 times higher for sexually compared to non- sexually traumatised patients, and 3 times higher in the case of co-morbid depression compared to PTSD patients without co-morbid depression. Yet, there was no association between sexual satisfaction and type of trauma. Only half of the patients with anxiety disorder (except PTSD) suffer from sexual dysfunctions compared to 3 out of 4 patients with depression or PTSD. Discussion: Both the type of trauma and co-morbid depression are related to sexual dysfunction in patients with PTSD. Especially with patient groups that hold an increased risk of developing sexual dysfunctions, it is important to consider this topic during therapeutic interventions. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
44

Nuove indagini sul metabolismo e la risposta immunitaria dalla messa in asciutta all'avvio di lattazione / NEW INSIGHT ON METABOLISM AND THE IMMUNE RESPONSE FROM DRY-OFF TO EARLY LACTATION

MEZZETTI, MATTEO 03 April 2019 (has links)
Il sistema immunitario è costituito da una varietà di cellule, molecole e processi biologici che interagiscono per prevenire le invasioni microbiche, riconoscere le molecole estranee ed eliminare le fonti esistenti di lesioni cellulari, ripristinando le normali funzioni tissutali una volta risolto il problema. L'immunità innata è la prima linea di difesa contro le invasioni di agenti patogeni. Nelle vacche da latte, il suo funzionamento subisce gravi alterazioni durante il periodo di transizione (TP). In questa fase è stata segnalata una compromissione delle funzioni delle cellule polimorfonucleate (PMN) correlate alla produzione di metaboliti reattivi dell'ossigeno (ROM), all’attività della mieloperossidasi (MPO), alla chemiotassi e alla fagocitosi. I PMN bovini hanno un alterata espressione dei geni codificanti per tali funzioni tra -1 e 2 settimane dal parto, rispetto al livello rilevato 4 settimane dopo il parto per gli stessi geni. La causa esatta delle disfunzioni immunitarie che si verificano nel periparto non è mai stata chiaramente identificata. In esse possono contribuire diversi fattori, principalmente imputati alle alterazioni metaboliche tipiche del periparto (cambiamenti nell’assetto ormonale, limitazione della risposta immunitaria materna al fine di mantenere la gravidanza, alterazioni nel bilancio energetico e stato di stress ossidativo). Tuttavia, la durata e l’entità delle disfunzioni immunitarie può aumentare qualora subentri uno stato di squilibrio fisiologico (PI). In tali condizioni, le alterazioni metaboliche del periparto sfuggono al controllo dei meccanismi omeostatici e omeoretici, ed una infiammazione sistemica è la conseguenza frequente di questo squilibrio. Lo stato infiammatorio sistemico è scatenato da un aumento dei livelli di citochine proinfiammatorie (PIC), che è collegato ad un aumento della temperatura corporea al parto, e che tipicamente inficia le funzionalità epatiche, modificando le priorità anaboliche dell'organo in fase di inizio lattazione. A seguito di tale slittamento, il fegato produce più α-globuline, note come proteine positive di fase acuta (+APP), cioè aptoglobina, ceruloplasmina e siero amiloide alfa (SAA). Al contrario, riduce la sintesi di albumina, retinol binding protein (RBP), paraoxonasi (PON) e lipoproteine, note come proteine negative di fase acuta (-APP), e sequestra minerali, quali zinco e ferro, dal flusso ematico. L'infiammazione porta all'attivazione dei PMN, mentre la ridotta competenza immunitaria comunemente riportata in TP è stata associata ad un effetto opposto sui leucociti. Pertanto, questi dovrebbero essere considerati come due fenomeni distinti, ma lo stato di PI potrebbe essere considerato un denominatore comune, direttamente correlato al rischio di patologie in avvio di lattazione. Le strategie nutrizionali per ottimizzare l'immunità delle vacche da latte durante il TP dovrebbero quindi essere focalizzate sulla riduzione del grado di PI correlato al parto. Tra tali strategie nutrizionali, dovrebbe essere presa in considerazione la corretta gestione delle fonti energetiche per adattarle alle variazioni dei fabbisogni. Inoltre, il profilo degli acidi grassi delle fonti lipidiche può contribuire nel modificare le funzioni immunitarie. Infine, la somministrazione di prodotti supplementari con attività antiossidanti o antinfiammatorie, così come di specie donatrici di gruppi metilici, potrebbero essere strategie utili a favorire la funzionalità immunitaria delle bovine durante il TP. In una prospettiva più ampia, sebbene strategie nutrizionali e supplementi possano talora mitigare le alterazioni immunitarie, possiamo concludere che l'adozione di pratiche volte a minimizzare il PI durante il periodo di transizione sia la strategia più efficace per prevenire le disfunzioni. Al fine di chiarire il legame tra le alterazioni che si verificano nel periparto e le disfunzioni immunitarie delle bovine da latte sono stati condotti tre esperimenti. Bovine di razza frisona sono state alloggiate in poste individuali a stabulazione fissa e monitorate regolarmente per le condizioni corporee (BCS), il peso (BW), l'assunzione di alimenti (DMI), la produzione di latte (MY) e il tempo di ruminazione. Campioni di sangue sono stati raccolti regolarmente per valutare un ampio profilo ematochimico e per testare le funzioni dei globuli bianchi mediante stimolazioni ex-vivo. Inoltre, la diapedesi dei PMN è stata testata in vivo mediante test della carragenina e sono stati raccolti campioni di rumine a 30 giorni dal parto (DFC). Il primo esperimento era volto a chiarire le cause dei cambiamenti metabolici che si verificano al momento della messa in asciutta, ed il contributo del livello produttivo in tali alterazioni. Infatti, i profondi cambiamenti nell’alimentazione, gli adattamenti gastrointestinali, del metabolismo e dei parametri immunitari che si verificano nelle bovine alla messa in asciutta sono note scatenare il rilascio di cortisolo, indurre segnali di infiammazione sistemica ed alterare il bilancio redox. Produzioni di latte elevate al momento della messa in asciutta hanno un ruolo nell'aggravare tali condizioni. Nel nostro studio, un gruppo di 13 bovine è stato asciugato a 55 giorni dalla data prevista per il parto. Gli animali sono stati divisi in due gruppi in base alla produzione media dell'ultima settimana di lattazione, assumendo un cut-off di 15 kg * d-1: bassa (LM; 6 animali) e alta produzione (HM; 7 animali). I dati sono stati sottoposti ad ANOVA utilizzando un modello per misure ripetute, assumendo il livello produttivo al termine della lattazione, il tempo e la loro interazione come effetti fissi. L'aumento delle quantità di fibra nella razione di asciutta ha ridotto la DMI e aumentato il tempo di ruminazione. La migrazione dei leucociti nella ghiandola mammaria per contribuire alla fase di involuzione ha ridotto la loro abbondanza nel sangue e aumentato la loro attività. Tale attivazione dei leucociti nella mammella ha aumentato l'abbondanza di specie reattive dell’azoto nel plasma e innescato un'infiammazione sistemica in tutti gli animali (aumento delle +APP e riduzione delle -APP). Tale infiammazione ha compromesso le funzioni epatiche (aumento delle concentrazioni di gamma-glutamil transferasi -GGT- bilirubina e fosfatasi alcalina -ALP-). Sia la produzione di specie dell’azoto che lo stato infiammatorio sistemico hanno contribuito all'esaurimento degli antiossidanti circolanti (gruppi tiolici -SHp-, tocoferolo, β-carotene, potere antiossidante ferrico riducente -FRAP- e capacità antiossidante contro specie reattive dell'ossigeno -ORAC-). Gli animali con una produzione più elevata alla messa in asciutta hanno mostrato la peggiore condizione, probabilmente per i più profondi cambiamenti metabolici che hanno affrontato dopo l'interruzione delle mungiture, e per la fase involutiva verosimilmente più dispendiosa. Questo studio evidenzia la messa in asciutta come una fase critica per gestire la salute delle vacche da latte, e suggerisce un potenziale legame della messa in asciutta con le alterazioni delle funzioni immunitarie che si verificano nel periparto. Nel secondo esperimento si sono cercati di identificare i cambiamenti del sistema immunitario che precedono l'insorgenza della chetosi, al fine di chiarire il loro ruolo nella comparsa della malattia. Pertanto, 13 bovine sono state monitorate tra -48 e 35 DFC e suddivise in due gruppi sulla base dei loro livelli plasmatici di beta idrossibutirrato (BHB): inferiore (CTR, 7 animali) o superiore a 1,4 mMol / L (KET; 6 animali). I dati sono stati sottoposti ad ANOVA utilizzando un modello per misure ripetute, assumendo lo stato di salute, il tempo e la loro interazione come effetti fissi. Le vacche KET hanno avuto una maggiore attivazione del sistema immunitario prima del parto (maggiori concentrazioni plasmatiche di PIC, MPO e specie ossidanti e maggiori produzione di interferone gamma in risposta alla stimolazione con Mycobacterium avium) alterazioni della funzionalità epatica (più alta concentrazione sanguigna di GGT) e minori minerali plasmatici. Elevati livelli plasmatici di NEFA, BHB e glucosio nelle vacche KET suggeriscono uno stato di insulinoresistenza e una marcata mobilizzazione del grasso corporeo durante il periodo di asciutta. Tali andamenti dei parametri relativi al metabolismo energetico durante l’asciutta sono stati associati alla riduzione della DMI al momento del parto e al peggioramento del bilancio energetico negativo ad avvio lattazione. Ciò ha causato a sua volta una riduzione di MY e accresciuto ulteriormente la mobilizzazione dei grassi in avvio di lattazione. Compromissione della funzionalità epatica e attivazione dei leucociti durante il periodo di asciutta hanno determinato una marcata risposta infiammatoria di fase acuta nelle vacche KET dopo il parto (maggiori concentrazioni di +APP minori concentrazioni di RBP), ed ulteriormente compromesso la funzionalità epatica (maggiori concentrazioni di glutammato-ossalacetato transaminasi -AST-GOT- e bilirubina). I leucociti delle vacche KET hanno mostrato ridotte funzioni infiammatorie dopo stimolazione ex-vivo con lipopolisaccaridi batterici (minore produzione di PIC e maggiore produzione di lattato). Queste alterazioni potrebbero essere guidate dall'azione combinata dei metaboliti legati alla mobilizzazione dei lipidi e delle azioni antinfiammatorie volte a prevenire un'infiammazione eccessiva. Ciò suggerisce che le alterazioni dei parametri immunitari osservate prima del parto siano altamente correlate con la probabilità di sviluppare chetosi in avvio di lattazione. Nel terzo esperimento è stato somministrato un prodotto immunostimolante dalla comprovata efficacia nel migliorare le funzioni leucocitarie degli animali immunodepressi e nel ridurre l'incidenza delle malattie infettive delle bovine ad inizio lattazione. La sua modalità di azione non è mai stata chiarita, e un’indagine approfondita sul suo effetto metabolico potrebbe evidenziarne l’efficacia anche nei confronti dei disordini metabolici del periodo di transizione. Pertanto, un gruppo di10 bovine è stato monitorato da -62 a 42 DFC. Il gruppo trattato (TRT, 5 animali) ha ricevuto 32,5 g di Omnigen-AF® (Phibro Animal Health Corporation) due volte al giorno (65 g d-1), mentre il gruppo di controllo (CTR, 5 animali) non ha ricevuto alcun supplemento. I dati sono stati sottoposti ad ANOVA utilizzando un modello per misure ripetute, assumendo il trattamento, il tempo e la loro interazione come effetti fissi. La somministrazione dell’immunostimolante alla messa in asciutta non ha influenzato BW, BCS, MY, composizione del latte e del fluido ruminale e nemmeno modificato la concentrazione di neutrofili del sangue. Tuttavia, ha aumentato il tempo di ruminazione e migliorato il metabolismo energetico dopo il parto (concentrazioni di NEFA e BHB inferiori). Le bovine TRT avevano maggiori concentrazioni ematiche di linfociti e i loro leucociti avevano una maggiore efficienza nel rispondere alla stimolazione con lipopolisaccaridi batterici (produzione di lattato inferiore e minore consumo di glucosio). Nonostante questi effetti positivi sulle cellule immunitarie, l'immunostimolante non ha influenzato le concentrazioni di +APP dopo il parto. Inoltre, l’immunostimolante ha ridotto le concentrazioni di albumina, PON e antiossidanti dopo il parto, suggerendo la compromissione di alcune funzioni epatiche negli animali trattati. Tuttavia, la mancanza di qualsiasi effetto sui biomarcatori di funzionalità (bilirubina) e danno epatico (GGT, AST-GOT, ALP) smentisce una reale compromissione delle attività epatiche a seguito del trattamento. Gli effetti positivi nel favorire il recupero delle funzioni del rumine, riducendo la mobilizzazione dei grassi corporei dopo il parto, suggeriscono che l'immunostimolante sia una strategia efficace nella prevenzione dei disturbi metabolici del periodo di transizione. / Immune system is made of a variety of cells, molecules and biological processes that interacts to prevent microbial invasions, recognize foreign molecules and eliminate existing sources of cellular injuries to restore tissues to their normal functions once problem has been solved. Innate immunity is the primary defense line against pathogens invasions. Its functioning typically undergoes severe alterations during transition period (TP) of dairy cows. An impairment of polymorphonuclear cells (PMN) functions related to reactive oxygen metabolites (ROM) production, myeloperoxidase (MPO) activity, chemotaxis and phagocytosis has been reported in this phase. Bovine PMN have an altered abundance in mRNA transcripts encoding for such functions between -1 and 2 weeks from calving, in comparison to the level found at 4 weeks after calving for the same genes. The exact cause of immune dysfunctions occurring in peripartum has never been clearly identified. Reduced immune competence could arise from the interaction of different factors affected from the typical peripartum trends (i.e. changes in endocrine asset, limitations of maternal immune responses against the allogeneic conceptus, alterations in energy balance and oxidative stress status). Nevertheless, its duration could be modified when peripartal changes exceed the control of homeorhetic and homeostatic mechanisms, leading to the physiological imbalance (PI) condition. Such a condition could also trigger the inflammatory-like status. It consists in a prepartal raise of pro-inflammatory cytokines (PICs) levels, that is linked to a raise in body temperature at calving, and that typically affects liver metabolism, implying severe losses in hepatic functions and a shift of anabolic priority of the organ in early lactation. The liver produces more α-globulins, known as positive acute phase proteins (APP), i.e. haptoglobin, ceruloplasmin and serum amyloid alpha (SAA). Conversely, it reduces the synthesis of albumin, retinol binding protein, paraoxonase (PON) and lipoproteins, known as negative APP and sequesters minerals, as zinc and iron, from blood flow. Inflammation lead to the activation of PMN, while the reduced immune competence commonly reported in TP has been associated to an opposite effect on leukocytes. Thus, these should be considered as two distinct phenomena, but they could arise from a common cause with a different magnitude and duration. Nutritional strategies to optimize dairy cow’s immunity during TP should be focused on reducing the PI degree related to calving, as this condition could be referred as a common denominator between immune dysfunction and diseases causes. Among such nutritional strategies, the correct management of energy sources to fit with altered requirements should be considered. Furthermore, fatty acids profile of lipid sources administered could also modify immune functions. Finally, the administration of supplementary products exerting antioxidant or anti-inflammatory activities, as well as methyl donors species, could be beneficial for dairy cows immunity in TP. In a wider perspective, although feed additives and nutritional strategy could be effective in mitigate immune alterations, we can conclude that adoption of proper management practices aimed to avoid PI condition in peripartal period of dairy cows could be the most effective strategy to prevent dysfunctions. Three experiments have been designed to elucidate the linkage between sudden changes occurring in peripartum and immune alterations in dairy cows. Throughout such experiments Holstein dairy cows were housed in tied stalls and monitored regularly for body condition score (BCS), body weight (BW), dry matter intake (DMI), milk yield (MY) and rumination time. Blood samples were collected regularly to assess a wide hematochemical profile and to test white blood cell functions through ex-vivo challenges. Furthermore, PMN diapedesis has been tested in-vivo through a carrageenan-skin test and rumen samples were collected at 30 days from calving (DFC). The first experiment was aimed in investigate the main causes of metabolic changes occurring at dry-off and the contribution of MY in such alterations. In fact, dry-off is related to deep changes in feeding behavior, gastro intestinal adaptations, metabolism and immune parameters in high-yielding cow’s career. Indeed, the release of cortisol, signals of systemic inflammation and altered redox balance have been reported immediately after milking interruption, and high MY have a role in aggravating such conditions. In our study, a group of 13 Holstein dairy cows were dried off at 55 days from expected calving day, and regularly monitored from -7 to 34 days from dry-off (DFD). Animals were retrospectively divided in two groups according to their average MY in the last week of lactation, assuming a cut-off of 15 kg*d-1: low MY (6 cows) and high MY (7 cows). Data were submitted to ANOVA using a mixed model for repeated measures including MY at dry-off, time and their interaction as fixed effects. Increased fiber amounts of dry ration reduced DMI and increased rumination time. Leukocytes migration into mammary gland to contribute in the involution phase decreased their abundance in blood at dry-off, and their activity. Such activation of leukocytes at mammary site increased the abundance of nitrogen species in plasma and triggered a systemic inflammation in all the animals, as reflected from increased concentrations of positive and reduced concentrations of negative APPs. Such inflammation impaired liver functions, as suggested from the increased gamma-glutamyl transferase (GGT), bilirubin and alkaline phosphatase (ALP) concentrations. Both the production of nitrogen species and the systemic inflammatory status contributed in the depletion of antioxidant system in blood (thiol groups -SHp-, tocopherol, β-carotene, ferric reducing antioxidant power -FRAP- and oxygen reactive antioxidant capacity -ORAC-). Animals with higher MY at dry-off showed the worst condition, likely for the deeper metabolic changes they faced at milking interruption, and to the greater amount of mammary parenchyma to be reabsorbed. This study highlights the dry-off as a thorny point to manage dairy cows’ health and depose for a relationship between dry-off and immune alteration that typically occurs at calving. The second experiment was aimed in investigate changes occurring in the immune system prior to ketosis onset to elucidate their role in disease occurrence. Thus, a group of 13 Holstein dairy cows were monitored from -48 to 35 DFC and retrospectively divided into 2 groups basing on their plasma BHB levels: lower (CTR; 7 cows) or higher than 1.4 mMol/L (KET; 6 cows). Data were submitted to ANOVA using a mixed model for repeated measures including health status, time and their interaction as fixed effects. KET cows had a greater activation of the immune system prior to calving (higher plasma concentrations of PICs, myeloperoxidase and oxidant species, and greater interferon gamma responses to Mycobacterium avium) impaired liver functions (higher blood concentration of GGT) and lower plasma minerals. High plasma NEFA, BHB and glucose levels in KET cows suggest an insulin resistance status and a marked mobilization of body fat occurring during dry period. They were also associated to reduced DMI around calving and worse negative energy balance in early lactation. This caused in turn reduced MY and increased fat mobilization in early lactation. Impairment of liver function and activation of leukocytes during the dry period accentuated the acute phase response in KET cows after calving (greater concentrations of positive APPs and lower concentration of retinol binding protein), further impairing liver function (higher blood concentrations of glutamate-oxaloacetate transaminase -AST-GOT- and bilirubin). Leukocytes of KET cows had reduced inflammatory functions after an ex vivo stimulation assay (lower production of PICs and greater production of lactate). These alterations on WBC could be driven by the combined action of metabolites related to the mobilization of lipids and of anti-inflammatory actions aimed to prevent over exuberant inflammation. This suggests that prepartal trends of immune parameters be highly related with the likelihood of developing diseases in early lactation. The third experiment consisted in the administration of Omnigen-AF (OAF), an immune stimulant that is effective in increasing leukocytes functions in immunosuppressed animals and in reducing incidence of infectious diseases in early lactating dairy cows. Its mode of action has never been elucidated, and a wider perspective of its metabolic effect could highlight its effectiveness in facing metabolic disorders of transition period also. Thus, a group of 10 Holstein dairy cows were divided into 2 groups: treated group (TRT; 5 cows) received 32.5 g of Omnigen-AF® (Phibro Animal Health Corporation) twice a day (65 g d-1) as top-dress on the morning and afternoon feeds, while control group (CTR; 5 cows) did not receive any supplementation. From -62 to 42 DFC animals were monitored regularly. Data were submitted to ANOVA using a mixed model for repeated measures including treatment, time and their interaction as fixed effects. Administration of OAF at dry-off did not affect BW, BCS, milk yield, milk and rumen fluid composition, and neither affected blood neutrophils concentrations. Nevertheless, it increased rumination time and improved the energy metabolism after calving (lower NEFA and BHB concentrations). TRT cows had an increased lymphocytes abundance at blood level, and their leukocytes had greater efficiency in facing biological stressors during the peripartum (lower lactate production and lower glucose consumption after a challenge with bacterial lipopolysaccharides). Despite these positive effects on immune cells, OAF did not affect the positive APPs concentrations after calving. A reduced abundance of albumin, PON and antioxidants also occurred with OAF after calving, suggesting some impairment of hepatic functions to occur. Nevertheless, the lack of any effect on main biomarkers related to liver function (bilirubin) and liver damage (GGT, AST-GOT, ALP) dismisses a real impairment of liver activities to occur with OAF. Positive effects in favoring the recovery of rumen functions, reducing mobilization of body fats after calving suggest OAF to be an effective strategy in preventing metabolic disorders of transition period.
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Etude de la dysfonction cellulaire et moléculaire du syndrome mitochondrial MELAS. / Study of cellular and molecular dysfunction of mitochondrial MELAS syndrom

Geffroy, Guillaume 29 September 2017 (has links)
Chaque mitochondrie contient son propre génome en de multiples copies d’ADN. Les mutations de l'ADN mitochondriales (ADNmt) sont responsables de sévères dysfonctions de la chaîne respiratoire. Le ratio entre la proportion de copies sauvages et mutantes, qualifiée d'hétéroplasmie, détermine la sévérité de la pathologie. Une des mutations les plus répandues de l'ADNmt est la mutation m.3243A>G, affectant l'ARN de transfert de la leucine. Ce variant est à l'origine du syndrome mitochondrial MELAS. Il n’existe à l’heure actuelle aucun traitement curatif pour ce syndrome. Nous avons développé une série de cybrides neuronaux porteurs de la mutation m.3243A>G a différents taux d’hétéroplasmie. Nous avons mis en évidence que de fort taux de mutations sont responsables de sévères dysfonctions de la chaîne respiratoire, d’un défaut d’assemblage précoce du complexe I ainsi qu’une réduction du renouvellement mitochondrial. Différentes stratégies métaboliques ont été employées pour compenser ces déficits. L’exposition des cellules a une restriction glucidique ou à la diète cétogène associant réduction glucidique et ajout de corps cétoniques, améliore significativement les fonctions mitochondriales après 4 semaines. Ces effets passent notamment par une restauration de l’assemblage et de l’activité du complexe I médiée ces interventions métaboliques. Par ailleurs, l’administration de la diète cétogène à un patient atteint du syndrome MELAS a déjà montré des résultats encourageants. De telles approches pourraient alors, constituées des stratégies thérapeutiques futures dans le traitement du syndrome MELAS et des maladies mitochondriales. / Each mitochondrion contains its own genome in multiple copies. Mitochondrial DNA (mtDNA) mutations are responsible for respiratory chain defects. The ratio of mutant to normal mtDNA, a condition known as heteroplasmy, may determine the disease severity. The m.3243A>G mutation, which affects the leucine tRNA, is one of the most common mtDNA mutation. This variant is responsible for the MELAS syndrome, a neurodegenerative disease, characterized by pseudostrokes. Unfortunately there are no curative treatments for MELAS syndrome. We have developed series of cybrid neuronal cells lines carrying the m.3243A>G mutation with different mutant loads, within the same nuclear background. High mutation load is associated to severe respiratory chain dysfunction, an early complex I assembly defect and a mitochondrial turn-over deficit. Different strategies were used to compensate the defects in the mutant cells. Cell exposure to low glucose or ketogenic diet, combining glucose reduction and the addition of ketone bodies, greatly improves mitochondrial functions after 4 weeks. Those effects are linked to a significant increase of complex I assembly and activity mediated by those metabolic interventions. In addition, a MELAS patient treated with ketogenic diet showed significant clinical improvement. Thus, metabolic approaches may constitute promising therapeutic strategies against MELAS syndrome and mitochondrial disorders.
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Fatores associados à qualidade de vida relacionada à saúde em pacientes em diálise : o foco deve ser o humor? / Factors associated with health related quality of life on dialysis patients : mood should be the focus?

Motta, Douglas Rafanelle Moura de Santana 30 May 2016 (has links)
Chronic kidney disease (CKD) patients have compromised health related quality of life (HRQOL) by several reasons. This study aimed to evaluate HRQOL on hemodialysis (HD) and peritoneal dialysis (PD) patients and to identify HRQOL associated factors. Methods: We conducted a transversal study with 215 patients on HD and 58 on PD between July and September 2013, in Sergipe, Brazil. HRQOL was assessed using the Kidney Disease Quality of Life Short Form Instrument- 1.3 (KDQOL-SF), consisting of two cores: specific (KDCS) and generic (RAND-36). Additionally demographic and clinical variables directly related to CKD, factors such as mood, sleep disorders and sexual dysfunction were evaluated through specific instruments. Results: Patients had a mean age of 51 years (SD ± 15.4), mostly men (62%), with low educational (72%) and economic (95%) levels. There was no difference related to HRQOL among dialysis modalities, only PD patients felt more stimulated by caring staff than that on HD (p<0.01). The prevalence of depressive (29%) and anxiety (30%) symptoms, poor quality of sleep (56%), excessive daytime sleepiness (43%) and male (48%) and female (76%) sexual dysfunction were high. Multiple linear regression showed that depressive (R= -0.39 p<0.01, R= -0.48 p<0.01) and anxiety (R = -0.41 p <0.01, R = -0.27 p <0.01) symptoms were independently associated with KDCS and RAND-36. Confirmatory factorial analysis models confirmed the association of mood disorders with low HRQOL. High prevalence of anxiety (30%) and depressive symptoms (29%) were revealed. Conclusion: Patients on HD and PD showed no differences in HRQOL. Mood disorders are independently associated with low HRQOL, with high prevalence of anxiety and depressive symptoms in dialysis patients. / Portadores de doença renal crônica (DRC) possuem comprometimento da qualidade de vida relacionada à saúde (QVRS) por diversas razões. Este estudo objetivou avaliar QVRS de pacientes em hemodiálise (HD) e diálise peritoneal (DP) e identificar fatores a ela associados. Casuística e Método: Estudo transversal realizado entre julho e setembro de 2013 com 215 pacientes em HD e 58 em DP, em Sergipe, Brasil. Avaliou-se a QVRS através do questionário Kidney Disease Quality of Life Instrument- Short Form 1.3 (KDQOL-SF), composto por dois núcleos: específico (KDCS) e genérico (RAND-36). Além de variáveis demográficas e clínicas diretamente relacionadas a DRC, foram avaliados fatores como distúrbios de humor, sono e disfunções sexuais através de instrumentos específicos. Resultados: Os pacientes possuíam em média 51 anos (desvio-padrão±15,4), eram na maioria homens (62%), com níveis educacional (72%) e econômico (95%) baixos. Não se evidenciaram diferenças relacionadas à QVRS entre as modalidades dialíticas, apenas pacientes em DP se sentiram mais estimulados pela equipe cuidadora que os em HD (p<0,01). As prevalências de sintomas depressivos (29%), sintomas ansiosos (30%), baixa qualidade de sono (56%), sonolência diurna excessiva (43%) e disfunções sexuais masculina (48%) e feminina (76%) foram altas. Análise por regressão linear múltipla mostrou que sintomas depressivos (R= -0,39 p<0,01; R= -0,48 p<0,01) e ansiosos (R= -0,41 p<0,01; R= -0,27 p<0,01) foram fatores independentemente associados aos núcleos KDCS e RAND-36. Modelos de análise fatorial corroboraram a associação dos distúrbios de humor com baixa QVRS. Evidenciou-se alta prevalência de sintomas ansiosos (30%) e depressivos (29%). Conclusão: Pacientes em HD e DP não apresentaram diferenças na percepção de QVRS. Os distúrbios de humor foram fatores independentemente associados à baixa QVRS, com alta prevalência de sintomas ansiosos e depressivos em pacientes em diálise.
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La place du renforcement musculaire dans la rééducation des dysfonctions musculaires de l'insuffisance cardiaque chronique / Role of strength training in the rehabilitation of muscle dysfunctions due to chronic heart failure

Feiereisen, Patrick 06 February 2014 (has links)
L’insuffisance cardiaque chronique est une maladie systémique où des dysfonctions périphériques viennent s’ajouter à l’incapacité du cœur à assurer un débit cardiaque adéquat aux tissus métabolisants. Parmi des dysfonctions périphériques, l’atrophie ainsi que la perte de force et d’endurance musculaire jouent un rôle primordial et contribuent largement à la genèse des symptômes majeurs de l’insuffisance cardiaque chronique, c’est à dire la fatigue, la dyspnée et l’intolérance à l’effort.<p>Ce n’est que depuis le début des années 1990 que des études ont montré que le réentraînement à l’effort pouvait être bénéfique pour le patient insuffisant cardiaque chronique; auparavant, il était considéré comme contre-indiqué.<p>La méthodologie d’entraînement proposée à cette époque aux patients était un entraînement de l’endurance cardio-vasculaire, le renforcement musculaire n’y avait pas sa place car on craignait que l’impact hémodynamique de ce type d’entraînement risquerait de détériorer la fonction cardiaque encore plus. Des études menées sur des contractions musculaires de type isométrique montraient en effet une diminution de la fonction cardiaque pendant l’entraînement. Cependant, les contraintes imposées pendant les exercices de renforcement musculaire dynamique (encore appelés « résistifs ») ne correspondent nullement à celles du renforcement isométrique. Des études sur des personnes saines ont montré que le renforcement musculaire est plus adapté à induire des améliorations du volume et de la force musculaire que l’entraînement de l’endurance cardio-vasculaire.<p>Le but de nos travaux a donc été de vérifier si l’introduction du renforcement musculaire, en complément de l’entraînement cardio-vasculaire ou bien comme entraînement à part entière, pouvait apporter un bénéfice supplémentaire chez l’insuffisant cardiaque chronique par son aptitude, du moins théorique, à mieux corriger certains aspects des dysfonctions musculaires.<p><p><p>Il s’agissait, dans les différentes études que nous avons menées, de vérifier qu’un entraînement composé de renforcement musculaire (au moins partiellement) chez le patient insuffisant cardiaque chronique:<p>-\ / Doctorat en Sciences de la motricité / info:eu-repo/semantics/nonPublished
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La politique d'arabisation, enjeu multidimensionnel de pouvoir en Algérie : l'exemple du système éducatif de 1962 à 2000 / The arabization policy, a multidimensional power issue in Algeria : the example of educational system from 1962 to 2000.

Ait Hamou, Sarah 10 June 2016 (has links)
La politique d’arabisation commune aux trois pays du Maghreb,a été beaucoup plus problématique en Algérie.En effet,le cas algérien attire particulièrement l’attention dans la mesure où l’équation sociolinguistique demeure irrésolue. Les récentes évolutions en matière linguistique à l’exemple de la reconnaissance de la langue berbère,Tamazight,comme langue officielle, montrent en effet que la question linguistique n’est pas un acquis, mais aussi que celle-ci est fortement liée au pouvoir politique.C’est dans ce cadre que nous avons choisi d’appréhender la politique d’arabisation algérienne de 1962 à 2000 en tant qu’enjeu multidimensionnel,avec pour exemple l’arabisation du système éducatif algérien afin d’en mesurer les conséquences sur l’ensemble du système algérien.Cette thèse s’articule autour de deux parties.La première partie pose les jalons de la construction de l’Etat algérien,à travers une rétrospective historique allant de l’Algérie précoloniale à l’Algérie contemporaine.Dans cette partie, deux chapitres sont abordés,le premier portant sur la genèse du système politique algérien à travers lequel sont analysés les principes et fondements de l’Etat algérien et sa formation nationale;et le second est consacré à la construction identitaire algérienne autour de la politique d’arabisation et particulièrement de la généralisation de l’utilisation de la langue arabe, et dans lequel a été questionné le rapport entre politique d’arabisation et édification nationale et identitaire.D’autre part, dans une deuxième partie traitant des usages politiques de l’arabisation en Algérie,un premier chapitre empirique a été traité afin de cerner la politique d’arabisation de façon plus pragmatique, notamment à travers son application dans l’enseignement algérien; et enfin dans un second et dernier chapitre,c’est la politique d’arabisation au cœur du pouvoir algérien et la mise en exergue des dynamiques, des enjeux et des luttes de pouvoir que cette politique a fait naître qui sont étudiés. Dans cette perspective, nous nous sommes interrogés sur le rôle et la fonction de la politique d’arabisation dans la construction nationale et étatique algérienne, et plus globalement dans l’édification du système politique algérien. En d’autres termes, il s’agit de déconstruire les liens entre une politique dite linguistique et le pouvoir qui l’a mise en place en retraçant l’évolution historique de la politique d’arabisation algérienne depuis l’indépendance du pays en 1962 jusqu’en 2000.L’on verra ainsi comment cette politique est présentée d’abord comme une politique linguistique, puis comme une politique identitaire et idéologique pour enfin se révéler être une politique de pouvoir et véritable enjeu de luttes entre les différentes factions au pouvoir.Ainsi,d’un point de vue strictement théorique,nous avons utilisé une approche constructiviste, de construction nationale mais aussi identitaire,en nous appuyant sur des théoriciens tels qu’Anthony D.Smith,Ernest Gellner,Benedict Anderson,Adrian Hastings,ou encore Juan Linz. Du point de vue idéologique,la politique d’arabisation relève clairement de l’idéologie arabo-musulmane dans laquelle s’inscrit explicitement l’aile conservatrice du parti unique FLN (Front de libération nationale) qui l’a instaurée.A partir de là,nous avons questionné le rapport de la politique d’arabisation à l’idéologie arabo-musulmane.Ce sont donc tous ces éléments, politiques, idéologiques et identitaires qui donnent naissance à la mise en place d’une succession importante de lois d’arabisations.Parmi elles,la principale est la loi n°91-05 portant généralisation de l’utilisation de la langue arabe qui a connu de nombreux bouleversements.Tout cela montre à quel point,la politique d’arabisation a été un processus lent,discontinu,parfois fragile,mais surtout qu’elle a été davantage au cœur de luttes de pouvoir,en servant ce dernier qu’une politique linguistique à proprement parler servant la langue arabe et la population arabophone. / The arabization policy is a common policy to the three countries of Maghreb,Morocco,Tunisia and Algeria.However,it has been more problematical in Algeria than in the two other countries. Actuallly,the algerian case is interesting to study because of the fact that the linguistic equation is still challenging and remain unresolved.The latest evolutions in the linguistic field,as the example of the recognition of the berber language,Tamazight,as an official language,show that this topic cannot be considered as an acquis,and above all that it’s an issue that is very much tied to political power.In that context,we’ve chosen to discuss the arabization policy from 1962 to 2000 as a multidimensionnal issue,with the example of the educational system in order to give a more valid measure of its impact on the algerian system as a whole,the political,social and economic system as well as the ideological,linguistic and cultural one.This thesis is structured around two parts.The purpose of the first part is to establish the foundations of the construction of the algerian state,through an historical retrospective from the pre-colonial period to the post-colonial one.In this part,two chapters are submited.The first one deals with the algerian political system’s genesis into which the principles and foundations of the algerian state and its national formation;the second chapter focuses on the algerian identity building around the arabization policy and especially the generalization of the utilization of the arabic language,it questions the link between arabizaion policy and national and identitary building.On the other hand,the second part is about the political purposes of the arabization policy in Algeria in which the first chapter is empirical in order to get a clear understanding of the pratical side of the arabization policy,particularly in the educational system;and finally the second and last chapter is about arabization and power,it comes to include arabization policy in the heart of the algerian power and to point out the dynamics,the issues,concerns and struggles that are involved by such a policy.When we look at that perspective,we have questioned the role and function of the arabization policy in the algerian state and national building,and more generally in the edification of the algerian system and its particular characteristics.In other words,it is about deconstructing the links between a policy known as linguistic and the power that established it,by tracing the historical evolution of the arabization policy since Algeria’s independance in 1962 to 2000.Thus,we have seen how the arabization policy has been first presented as a linguistic policy,then as an identity policy and finally has proven to be a power policy and a real power game and struggle.In this way, from a strict theorical point of you,we’ve first presented a constructivist approach of a national building and identity building,by using theorists’ references such as those of Anthony D.Smith,Ernest Gellner,Benedict Anderson, Adrian Hastings,and Juan Linz.From an ideological point of view,arabization policy goes to arab-islamic ideology into which explicitly fit the conservative faction of the single party NLF(National Liberation Front)which has initiated it.The arab-muslim orientation is begining to dawn at the first sign of algerian nationalism.From there,the relation between arabization policy and arab-muslim ideology has been questioned.All these facts,political,ideological and identity ones set up a series of arabization laws. Amongst them,the main one is the law n°91-05 on the generalization of the utilization of the arabic language which has experienced difficulties.All of this points out how much arabization policy has been a very long process,discontinuous,and fragile.But especially,we have proved that arabization policy has been more a power issue serving the algerian political regime than a linguistic policy serving arabic language and population.
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Executive Function Deficits in Seriously Ill Children—Emerging Challenges and Possibilities for Clinical Care

Bluschke, Annet, von der Hagen, Maja, Novotna, Barbara, Roessner, Veit, Beste, Christian 12 June 2018 (has links)
The past years have seen an incredible increase in the quality and success rates of treatments in pediatric medicine. One of the resulting major challenges refers to the management of primary or secondary residual executive function deficits in affected children. These deficits lead to problems in the ability to acquire, understand, and apply abstract and complex knowledge and to plan, direct, and control actions. Executive functions deficits are important to consider because they are highly predictive of functioning in social and academic aspects of daily life. We argue that current clinical practice does not sufficiently account for the complex cognitive processes in this population. This is because widely applied pharmacological interventions only rarely account for the complexity of the underlying neuronal mechanisms and do not fit well into possibly powerful “individualized medicine” approaches. Novel treatment approaches targeting deficits in executive functions in seriously ill children could focus on neuronal oscillations, as these have some specific relations to different aspects of executive function. Importantly, such treatment approaches can be individually tailored to the individuals’ deficits and can be transferred into home-treatment or e-health solutions. These approaches are easy-to-use, can be easily integrated into daily life, and are becoming increasingly cost-effective.
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Mundgesundheitsstatus und Untersuchungen zur Auswirkung einer Botulinumtoxin-Injektionstherapie bei oromandibulären Dysfunktionen auf das stomatognathe System / Oral health status and studies on the effect of botulinum toxin injection therapy on oromandibular dysfunction on the stomatognathic system

Ziebolz, Holger 28 October 2019 (has links)
No description available.

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