Waste, that is any matter whether gaseous, liquid or solid or any combination thereof, originating from any residential, commercial or industrial area identified as undesirable or superfluous by-product, emission, residue or remainder of any process or activity tends to be a hazard to the environment. Waste is generated in all processes which transform materials from one state, form or medium to another. The management of waste in the Sedibeng District Municipality is a very complex problem. There are many reasons for this and these include: the diverse and voluminous waste stream; progressive accumulation of waste in the environment; large numbers of unpermitted waste disposal sites; the severe shortage of hazardous waste disposal sites and shortage of personnel in local municipalities qualified to implement existing legislation. The accumulation of waste in the district not only poses a serious and growing threat to health and quality of life, but also causes infrastructural damage such as the blocking of storm water drains and sewer by litter which ultimately leads to costly road and pavement destruction and increase in maintenance costs. The objective of the study was to investigate waste management activities in the Sedibeng District Municipality and to explore best practices as strategies for recommendations. The Sedibeng District Municipality comprises three local municipalities namely the Emfuleni, Lesedi and Midvaal Local Municipalities. Due to the fact that the Municipality forms part of the industrial hub of the Gauteng Province, there has been an excessive influx of the people into the district and, as a result, more houses had to be built and more normal urban services such as electricity, sanitation, water and waste, had to be provided. The study intended to investigate different waste management strategies that are employed by the three local municipalities that could help reduce the impacts and volumes of waste that are generated by residents before such waste could pollute the environment. A further objective was to explore possible waste reduction mechanisms such as recycling that can help reduce waste volumes before they reach the disposal site. Arising from the problem statement on waste management for this study, it is important that the locus of this study be directed towards the solution of the problem on waste management activities in the Sedibeng District Municipality The following hypothesis was accordingly formulated: Waste management strategies and practices as currently practised in the Sedibeng District Municipality are obsolete, outdated and inadequate to attain a cleaner environment and as a result, there is a need to explore the development of more cost effective strategies in waste management. Comparative study of the different strategies that are employed in the three local municipalities as well as the challenges they face when providing the required service, were made. Similar study was applied to the achievements that are recorded as findings of the study. The challenges and success stories highlighted in the study were found through the use of questionnaires that were distributed to respondents in the three local municipalities. Questionnaires for the study were compiled for both councilors and municipal officials. The research instruments for the study included questionnaires, interviews and consultations with members of the community. Further technique was participant observation, the researcher being responsible for the provision of refuse removal services to the Evaton and Sebokeng communities. Amongst others, it was found that: discrepancies existed in the waste management processes and these include the following: • There was a serious problem of personnel shortage in municipalities as a result of financial constraints that led to nonreplacement of personnel who went on retirement, resigned or died; • Existing equipment do not compliment the growing population figures as well as the sizes of the municipality and as a result, residents opted to dump waste at their backyards as an alternative procedure for disposal of waste from their homes, and • Problems attributed to illegal dumping increase each day and their resolution will be a function of implementation of compliance with legislation. • Community awareness of refuse collection schedule is at minimum, a situation which leads to illegal dumping of waste, and • Tariff on refuse removal is deemed to be prohibitive to African residential areas. The study ends with recommendations for management action on waste, and for further research. / Thesis (Ph.D. (Public Management and Administration))--North-West University, Vaal Triangle Campus, 2010.

Waste, that is any matter whether gaseous, liquid or solid or any combination thereof, originating from any residential, commercial or industrial area identified as undesirable or superfluous by-product, emission, residue or remainder of any process or activity tends to be a hazard to the environment. Waste is generated in all processes which transform materials from one state, form or medium to another. The management of waste in the Sedibeng District Municipality is a very complex problem. There are many reasons for this and these include: the diverse and voluminous waste stream; progressive accumulation of waste in the environment; large numbers of unpermitted waste disposal sites; the severe shortage of hazardous waste disposal sites and shortage of personnel in local municipalities qualified to implement existing legislation. The accumulation of waste in the district not only poses a serious and growing threat to health and quality of life, but also causes infrastructural damage such as the blocking of storm water drains and sewer by litter which ultimately leads to costly road and pavement destruction and increase in maintenance costs. The objective of the study was to investigate waste management activities in the Sedibeng District Municipality and to explore best practices as strategies for recommendations. The Sedibeng District Municipality comprises three local municipalities namely the Emfuleni, Lesedi and Midvaal Local Municipalities. Due to the fact that the Municipality forms part of the industrial hub of the Gauteng Province, there has been an excessive influx of the people into the district and, as a result, more houses had to be built and more normal urban services such as electricity, sanitation, water and waste, had to be provided. The study intended to investigate different waste management strategies that are employed by the three local municipalities that could help reduce the impacts and volumes of waste that are generated by residents before such waste could pollute the environment. A further objective was to explore possible waste reduction mechanisms such as recycling that can help reduce waste volumes before they reach the disposal site. Arising from the problem statement on waste management for this study, it is important that the locus of this study be directed towards the solution of the problem on waste management activities in the Sedibeng District Municipality The following hypothesis was accordingly formulated: Waste management strategies and practices as currently practised in the Sedibeng District Municipality are obsolete, outdated and inadequate to attain a cleaner environment and as a result, there is a need to explore the development of more cost effective strategies in waste management. Comparative study of the different strategies that are employed in the three local municipalities as well as the challenges they face when providing the required service, were made. Similar study was applied to the achievements that are recorded as findings of the study. The challenges and success stories highlighted in the study were found through the use of questionnaires that were distributed to respondents in the three local municipalities. Questionnaires for the study were compiled for both councilors and municipal officials. The research instruments for the study included questionnaires, interviews and consultations with members of the community. Further technique was participant observation, the researcher being responsible for the provision of refuse removal services to the Evaton and Sebokeng communities. Amongst others, it was found that: discrepancies existed in the waste management processes and these include the following: • There was a serious problem of personnel shortage in municipalities as a result of financial constraints that led to nonreplacement of personnel who went on retirement, resigned or died; • Existing equipment do not compliment the growing population figures as well as the sizes of the municipality and as a result, residents opted to dump waste at their backyards as an alternative procedure for disposal of waste from their homes, and • Problems attributed to illegal dumping increase each day and their resolution will be a function of implementation of compliance with legislation. • Community awareness of refuse collection schedule is at minimum, a situation which leads to illegal dumping of waste, and • Tariff on refuse removal is deemed to be prohibitive to African residential areas. The study ends with recommendations for management action on waste, and for further research. / Thesis (Ph.D. (Public Management and Administration))--North-West University, Vaal Triangle Campus, 2010.

X-linked myopathy with excessive autophagy (XMEA) is a skeletal muscle disorder inherited in recessive fashion, affecting boys and sparing carrier females. Onset is in childhood with weakness of the proximal muscles of the lower extremities, progressing slowly to involve other muscle groups. Pathological analysis of skeletal muscle biopsies shows no inflammation, necrosis or apoptosis. Instead, forty to 80% of fibers exhibit giant autophagic vacuoles with heterogeneous degradative content. Numerous critical functions of all cells are compartmentalized in particular pH environments established by the intracellular transmembrane V-ATPase proton pump complex. Assembly of this complex, directed by the Vma21p chaperone, is well-studied in yeast but completely unknown in other organisms. The aim of my project was a better understanding of XMEA pathogenesis, with a focus on finding the disease-causing gene. In this thesis, I identify mutations in XMEA patients in a novel, previously uncharacterized gene, which we name VMA21. Most of the mutations are located in splicing-relevant positions and decrease splicing efficiency. After establishing that XMEA is caused by hypomorphic alleles of the VMA21 gene, I show that VMA21 is the diverged human orthologue of the yeast Vma21p protein, and that like Vma21p, it is an essential assembly chaperone of the V-ATPase. Decreased VMA21 reduces V-ATPase activity, resulting in altered lysosomal pH and a blockage at the degradative step of autophagy. Towards understanding disease pathogenesis, I show evidence of compensatory autophagy upregulation consecutive to the impaired clearance. Accumulated autolysosomes due to increased autophagy continue to face the degradative block and are slow to disappear. Instead, they merge to each other and form the characteristic giant XMEA vacuoles. These results uncover a novel mechanism of disease, namely macroautophagic overcompensation leading to cell vacuolation and tissue atrophy. This work describes the clinical outcome at the cusp of tolerable reduction in V-ATPase, with implications on common diseases like osteoporosis and cancer metastasis, where increased V-ATPase activity is an important component. Our XMEA patients show that the safety margin of reducing V-ATPase activity in humans is wide, increasing the potential to utilize chemical or biological V-ATPase inhibitors as possible therapies.

Submitted by Timbo Noeme (noeme.timbo@metodista.br) on 2016-08-09T17:10:01Z No. of bitstreams: 1 LeonardoMMuniz2.pdf: 1320890 bytes, checksum: e1d55ac3650fd4a9ee03b53c73b61a12 (MD5) / Made available in DSpace on 2016-08-09T17:10:01Z (GMT). No. of bitstreams: 1 LeonardoMMuniz2.pdf: 1320890 bytes, checksum: e1d55ac3650fd4a9ee03b53c73b61a12 (MD5) Previous issue date: 2015-12-15 / The internet is part of every people daily life and becomes increasingly accessible through different types of devices. Several studies have been conducted in order to assess the consequences of their excessive use in personal, academic and professional life. This paper aimed to identify if the concentration and social isolation are some of the reflections by the excessive use of instant messaging applications in the workplace. Some of the variables that assess aspects of excessive use of instant messaging are diminished impulse control, loneliness, social comfort, and digital distraction. Through a quantitative research approach, it was used scales applied to a sample of 283 people, the data was analyzed by multivariate techniques like Exploratory Factor Analysis and Multiple Linear Regression. The results of this study confirm that the excessive use of instant messaging is positive related to loss of concentration and the variable digital distraction exerts a greater influence than the diminished impulse control. However, according to the results, loneliness and social comfort cannot be said that there is a relationship in increasing social isolation due to lack of significance of the relationship. / A Internet está inserida no cotidiano do indivíduo, e torna-se cada vez mais acessível por meio de diferentes tipos de dispositivos. Com isto, diversos estudos foram realizados com o intuito de avaliar os reflexos do seu uso excessivo na vida pessoal, acadêmica e profissional. Esta dissertação buscou identificar se a perda de concentração e o isolamento social são alguns dos reflexos individuais que o uso pessoal e excessivo de aplicativos de comunicação instantânea podem resultar no ambiente de trabalho. Entre as variáveis selecionadas para avaliar os aspectos do uso excessivo de comunicadores instantâneos tem-se a distração digital, o controle reduzido de impulso, o conforto social e a solidão. Através de uma abordagem de investigação quantitativa, utilizaram-se escalas aplicadas a uma amostra de 283 pessoas. Os dados foram analisados por meio de técnicas estatísticas multivariadas como a Análise Fatorial Exploratória e para auferir a relação entre as variáveis, a Regressão Linear Múltipla. Os resultados deste estudo confirmam que o uso excessivo de comunicadores instantâneos está positivamente relacionado com a perda de concentração, e a variável distração digital exerce uma influência maior do que o controle reduzido de impulso. De acordo com os resultados, não se podem afirmar que a solidão e o conforto social exercem relações com aumento do isolamento social, devido à ausência do relacionamento entre os construtos.

L'efficacité de la technique NSM dans la réparation et renforcement des structures est fortement dépendante de la performance d’adhérence entre les joncs de carbone et le béton. De nombreuses études récentes ont été réalisées pour quantifier d’adhérence sur des éprouvettes saines en raison de la complexité de ce problème. Par contre, le comportement des éléments réparés peut être affecté, d’une part, selon les conditions de pré-chargement, et d’autre part, selon l’endommagement spécifique, qui pourraient être rencontrés dans les structures existantes. En effet, un endommagement dans le béton ou dans les armatures peut modifier le comportement global des éléments réparés en réduisant la capacité portante.Tout d’abord, des essais à grande échelle en flexion ont été réalisés pour étudier le comportement des poutres en béton armé. D’une part, différents types d’endommagements ont été considérés tels que la corrosion des aciers et les charges excessives. D’autre part, différentes conditions de pré-chargement incluant les maintiens du chargement à l’heure de la mise en oeuvre de la réparation ont été étudiées. Le comportement de la poutre témoin renforcée se distingue par son côté fragile qui s’accompagne d’une ruine soudaine par pull-out du jonc de carbone de la résine suivie d’éclatement de morceaux de béton dans la zone de béton d’enrobage et d’un écrasement du béton comprimé. Par contre, la ruine de la poutre corrodée et réparée intervient par séparation (délamination) du béton d’enrobage dans la zone tendue au niveau à l’insertion du jonc de carbone, qui a commencé entre deux fissures de flexion dans la zone centrale et s’est propagé vers l’appui. Ensuite, afin de comprendre l’origine du mode de ruine de la poutre corrodée et réparée, et d'étudier le comportement global, la rigidité, la ductilité, le mode de ruine, et la capacité portante, des essais expérimentaux ont été réalisés en faisant varier les paramètres relatifs aux conséquences de la corrosion (perte généralisée de la section d’acier tendu, éclatement du béton d’enrobage, détérioration de l’adhérence acier-béton). Cependant, la ruine par la séparation du béton d’enrobage entre deux fissures adjacentes observé sur la poutre corrodée et réparée n’a jamais été obtenue. Pour nos simulations : La ruine a eu lieu par Pull-out du jonc de carbone. Dans tous les cas, la capacité portante mesurée des poutres endommagées puis réparées était supérieure à celle de la poutre témoin (non-renforcée)Finalement, puisque les structures nécessitant de la réparation par application de matériaux composites ne sont pas de récentes, et par conséquent, qui ont déjà subi un certain nombre d’endommagements dus aux contraintes mécaniques (surcharge maintenue à long-terme, charge accidentelle à court-terme), une partie expérimentale s’est intéressée à l'utilisation des joncs de carbone pour la réparation des éléments endommagés par une charge excessive, puis réparés sous ou sans charge maintenue. Un endommagement est capable de réduire légèrement la capacité portante des poutres réparées (moins de 8% par rapport à la poutre témoin renforcée). La réparation des poutres sous charge maintenue a une influence non-significative en diminuant la capacité portante entre 5% et 6% par rapport aux poutres endommagées réparées sans charge maintenue. La ruine des poutres pré-chargées puis réparées a été par l’arrachement du jonc de carbone de la résine « Pull-out » à cause des fissures longitudinales développées dans la résine qui conduit à la perte d'adhérence entre le jonc de carbone et le matériau de scellement en réduisant légèrement leur capacité portante. Par contre, les poutres endommagées par chargement excessif puis réparées ont montré un mode de ruine différent (par écrasement du béton comprimé) mais avec une réduction significative leur capacité portante / The effectiveness of the NSM technique for repairing or strengthening the RC structures is highly dependent on the bond strength behavior between CFRP rods and concrete. Many recent studies have been conducted to evaluate bond strength on undamaged concrete specimens because of the complexity of this problem. On the contrary, the behavior of repaired specimens may be affected, first, by pre-loading conditions, and the other, depending on specific damage that could be encountered in the existing structures. Indeed, damage in concrete or in reinforcement can change the global behavior of repaired elements by reducing the bearing capacity.First, large-scale bending tests were carried out to study the behavior of reinforced concrete beams. On the one hand, various types of damage were considered such as the steel corrosion and excessive loads. On the one hand, different pre-loading conditions including sustaining loads at the time of implementation repair were studied. The behavior of the beam strengthened control is distinguished by its fragile side which is accompanied by sudden failure due to pull-out of the CFRP NSM rod, followed by splitting of concrete pieces in the concrete cover and a crushing of concrete in compressive zone. On the other hand, the failure mode of corroded repaired beam occurred by concrete cover delamination in the tension zone at the level of insertion of CFRP NSM rod that started between two bending cracks in the central area and has spread to the support. Then, in order to understand the origin of the failure mode, global behavior, stiffness, ductility, and bearing capacity of repaired corroded beam, an experimental tests were performed by varying the parameters relating to the consequences of corrosion (such as generalized loss of bottom steel section, concrete cover delamination failure and bond strength failure between concrete and reinforcing steel). However, the failure occurred by the concrete cover delamination between two adjacent bending cracks was never obtained on the repaired corroded beam. For our simulations: The failure was due to pull-out of CFRP rod. In all cases, the bearing capacity measured for repaired damaged beams was greater than that of control beam (non-repaired).Finally, since the structures requiring repair by applying composite materials are not recent, and consequently, number of damages occurred due to mechanical stress (long-term sustained overloading, short term accidental load), an experimental part was interested in the use of CFRP NSM rods to repair of beams damaged by excessive load, and then repaired under or without sustained load. A damage can slightly reduce the bearing capacity of the repaired beams (less than 8% compared to the strengthened control beam). The repair of beams under sustained load has a non-significant effect by reducing the bearing capacity between 5% and 6% compared to the damaged beams repaired without sustained load. The damages of the pre-loaded RC beams repaired with NSM failed by the tearing of the carbon rod "pull-out" due to the longitudinal cracks developed in the epoxy resin volume, which leads to loss of adhesion between the CFRP rod and the sealing material by slightly reducing their bearing capacity. While, the RC beams damaged by overloading which were repaired showed a different mode of failure (crushing of concrete in compression) with also a significant reduction in their ultimate bearing capacity values

Made available in DSpace on 2015-06-17T19:34:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-12-19. Added 1 bitstream(s) on 2015-06-18T12:46:47Z : No. of bitstreams: 1 000825194.pdf: 3080507 bytes, checksum: 998e2764a5077af643f8bbbd26ffa1e3 (MD5) / Introdução: A Síndrome de Apneia Obstrutiva do Sono (SAOS) se caracteriza pela obstrução parcial e/ou completa intermitente da via aérea superior, causada pelo colabamento da musculatura faríngea, levando à cessação ou diminuição do fluxo aéreo respiratório e consequentemente à hipóxia intermitente e hipercapnia. A manifestação diurna mais comum de SAOS é a sonolência diurna, relatada já há mais de 2000 anos. A obesidade é o fator causal reversível mais frequente associado à SAOS, sendo a atividade física importante componente para o seu tratamento. A hipótese levantada neste estudo foi que pacientes com SAOS apresentariam alterações na sua qualidade do sono, com maior sonolência diurna e menor disposição de realização de atividade física, além de alterações na componente FEF25%-75% da espirometria, sendo essa a componente relacionada à fração expiratória involuntária sem interferência da musculatura respiratória. Nestes pacientes, o uso adequado do CPAP com pressão terapêutica poderia melhorar essas alterações, mesmo em curto prazo. Objetivo: Avaliar parâmetros da qualidade do sono, sonolência diurna, disposição para atividade física e da função pulmonar em pacientes com SAOS, antes e após o uso de CPAP. Métodos: Trata-se de estudo randomizado, duplo cego, com aprovação pelo comitê de Ética em Pesquisa local (protocolo nº41/2013. Foram convidados pacientes de ambos os gêneros, em acompanhamento no ambulatório de ventilação não invasiva, com idade entre 30 a 75 anos, com diagnóstico polissonográfico de SAOS. Os pacientes foram randomizados por sorteio pelo orientador sem conhecimento dos fisioterapeutas e foram alocados em dois grupos, sendo o Grupo I composto por pacientes em uso de CPAP em pressão mínima de 4 cmH2O e o Grupo II por pacientes em uso de CPAP na pressão terapêutica ideal. Todos pacientes receberam o equipamento de CPAP disponibilizado pelo serviço de ... / Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is characterized by the complete or partial intermittent obstruction of the upper airway due to colapse of the pharyngeal muscles, causing the cessation or reduction of the respiratory airflow and, consequently, intermittent hypoxia and hipercapnia. The most common daytime symptom is excessive daytime sleepiness, reported already as long as 2000 years ago. Obesity is the most frequent reversibel causal fator, being physical activity an important component for its treatment. We hypothezised that OSA patients would show disordered sleep quality, higher daytime sleepiness and lower disposal for physical activity, beside changes at the spyrometric fraction FEF25%-75%, as being the componente related to unvoluntary expiration phase without interference of the expiration muscles. The adequate use o of nighttime CPAP would improve these conditions, even after a short period of intervention. Aims: To study the parameters for sleep quality, excessive daytime sleepiness, diposal for physical activity and of spirometry in OSA patients, before and after CPAP therapy. Methods: This double-blind, randomized study was approved by the local Ethics Comission. There were invited patients at follow-up at the ambulatory for non-invasive ventilation, aged 30 to 75 years old, both genders, all diagnosed OSAS by full-night polysomnography. They were randomized for two groups without the knowledge ot the physical therapeut, Group I receiving the CPAP with minimal pressure at 4 cmH2O and Group II at ideal therapeutic pressure. An equipment with blinded visor was disposed to all patients, thus, nor the patients, neither the physical therapeut had access to the ventilatory data. At two moments, before and after 7 days of CPAP treatment, all patients answered the questionnaires for daytime sleepiniess (Epworth Sleepiniess Scale), sleep quality (Pittsburgh questionnaire) and disposal for physical activity ...

INTRODUÇÃO: A empatia representa um dos domínios centrais das habilidades sociais e de comunicação e é frequentemente associada a melhores resultados diagnósticos e terapêuticos. Por esse motivo, as habilidades empáticas dos profissionais da área da saúde têm sido amplamente investigadas no contexto da educação médica. Nosso objetivo foi avaliar a empatia do estudante de medicina e sua associação com qualidade de vida, esgotamento profissional e sonolência diurna. MÉTODOS: Estudo transversal randomizado de abrangência nacional, com a utilização de questionários de autorrelato validados para a avaliação de empatia (Escala Multidimensional de Reatividade Interpessoal de Davis - EMRI), qualidade de vida (The Whoqol Quality of Life Assessment - WHOQOL-BREF e Questionário para avaliar a qualidade de vida do estudante e residente da área da saúde - Veras-q), esgotamento profissional (Maslach Burnout Inventory - MBI) e sonolência diurna excessiva (Escala de Sonolência Diurna de Epworth - ESS) em uma plataforma eletrônica desenvolvida para o estudo - a plataforma VERAS. RESULTADOS: Dos 1.650 estudantes randomizados, 1.350 (81,8%) completaram todos os questionários da plataforma VERAS. Observamos importantes diferenças de gênero nos domínios consideração empática e angústia pessoal da EMRI, com maiores escores para o grupo do sexo feminino (p<0,05; d>0,5). Estudantes dos diversos ciclos do curso de medicina apresentaram diferenças pouco expressivas das disposições empáticas (p<0,05; f<0,25). A percepção de qualidade de vida no curso foi muito menor do que a percepção de qualidade de vida em geral entre os estudantes de medicina (p<0,001; d>0,8). Estudantes do sexo feminino apresentaram menores escores de qualidade de vida nos domínios físico, psicológico e uso do tempo (p<0,05; d<0,5). A percepção de qualidade de vida relacionada ao ambiente de ensino também foi discretamente menor entre estudantes dos últimos anos do curso (p<0,001; f<0,25). Em relação aos escores de esgotamento profissional, estudantes do sexo feminino apresentaram maior exaustão emocional e menor despersonalização do que estudantes do sexo masculino (p<0,001; d<0,5). Estudantes dos últimos anos do curso apresentaram escores discretamente maiores de exaustão emocional, despersonalização e realização pessoal (p<0,05; f<0,25). Os escores de sonolência diurna foram discretamente maiores entre estudantes do sexo feminino (p<0,001; d<0,5) e não diferiram entre os ciclos do curso. Aproximadamente 56% dos estudantes apresentaram sonolência diurna excessiva. Os escores de sonolência diurna apresentaram correlações fracas com os domínios da EMRI. Entre os estudantes do sexo masculino, realização pessoal (beta= -0,22; p<0,001) e qualidade de vida no domínio psicológico (beta= -0,19; p<0,001) contribuíram para menor angústia pessoal. Entre o grupo do sexo feminino, realização pessoal contribuiu significativamente para maior consideração empática (beta= 0,23; p<0,001) e tomada de perspectiva (beta= 0,30; p<0,001). Escores de despersonalização contribuíram para menor disposição empática nesses domínios (beta= -0,29; p<0,001 para consideração empática e beta= -0,17; p<0,001 para tomada de perspectiva). CONCLUSÕES: Estudantes do sexo feminino apresentaram maior disposição para consideração empática e para angústia pessoal do que estudantes do sexo masculino. As diferenças das disposições empáticas dos estudantes de diferentes ciclos do curso de medicina foram inexpressivas. Dentre as variáveis estudadas, realização pessoal apresentou a maior contribuição para menor angústia pessoal entre estudantes do sexo masculino. Maior realização pessoal e menor despersonalização também contribuíram para maior disposição empática entre estudantes do sexo feminino / INTRODUCTION: Empathy is one of the main domains of social and communication skills. It is often associated to better diagnostic and therapeutic outcomes. For this reason, it has been extensively investigated among health professionals. We aimed to assess medical students\' empathic disposition and its association with quality of life, burnout and daytime sleepiness. METHODS: Cross-sectional multi-centric randomized study with the use of validated self-report questionnaires of empathy (the Interpersonal Reactivity Index - IRI), quality of life (The Whoqol Quality of Life Assessment - WHOQOL-BREF and the Health Professionals and Students\' Life Questionnaire - Veras-q), burnout (the Maslach Burnout Inventory - MBI) and daytime sleepiness (the Epworth Excessive Sleepiness Scale - ESS). Questionnaires were available to students on an electronic platform designed for the study - the VERAS platform. RESULTS: From the total of 1,650 randomized students, 1,350 (81.8%) completed all questionnaires. We observed important gender differences on students\' dispositional empathic concern and personal distress. Female students had higher scores on these domains than their male counterparts (p<0.05; d>0.5). Students from different phases of medical training had minor differences on empathic dispositions (p<0.05; f<0.25). Students\' perception of quality of life related to medical school was quite lower than their perception of quality of life in general (p<0.001; d>0.8). Female students had slightly lower scores on physical, psychological and time management domains of quality of life compared to male students (p<0.05; d<0.5). Perceptions of quality of life on the learning environment were also slightly lower among students in the final years of medical school (p<0.001; f<0.25). Female students had higher scores on emotional exhaustion and lower scores on depersonalization than their male counterparts (p<0.001; d<0.5). Students at the final years of medical school had slightly higher scores on emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Daytime sleepiness scores were slightly higher among female students (p<0.001; d<0.5). Sleepiness scores did not differ according to phases of medical school. Approximately 56% of students had suggestive scores of excessive daytime sleepiness. Daytime sleepiness scores yielded weak correlations with empathy domains. Among male students, personal accomplishment (beta= -0.22; p<0.001) and psychological quality of life (beta= -0.19; p<0.001) contributed to lower personal distress. Among female students, personal accomplishment had a significant contribution to higher empathic concern (beta= 0.23: p<0.001) and perspective taking (beta= 0.30; p<0.001). Depersonalization scores contributed to lower empathic disposition on these domains (beta= -0.29: p<0.001 for empathic concern domain and beta= -0.17; p<0.001 for perspective taking domain). CONCLUSIONS: Female students had higher disposition on empathic concern and personal distress than their male counterparts. Differences on students\' empathic dispositions across phases of medical school were quite small. Among all study variables, personal accomplishment had higher contributions to lower personal distress among male students. Higher personal accomplishment and lower depersonalization also contributed to higher empathic disposition among female students

Made available in DSpace on 2015-09-25T12:19:58Z (GMT). No. of bitstreams: 1 Johnnatas Mikael Lopes.pdf: 1466778 bytes, checksum: 5046b57d301d6c9c6f495adbb993d925 (MD5) Previous issue date: 2012-09-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Objective: To determine the prevalence of Excessive Daytime Sleepiness (EDS) in the elderly and its relationship with socio-demographic characteristics of sleep, depression, nutritional status and cardiovascular risk (CR). Materials and Methods: This crosssectional elderly population study conducted in 2010-2011 in the city of Campina Grande-PB. It was estimated sample of 205 seniors, selected randomly in the health districts. The EDS was diagnostic by Epworth Sleepiness Scale. Also investigated were: anthropometric measurements, depression, nutritional status, quality of sleep, snoring, insomnia and physical activity. Results: They were 168 elderly participants, age 72.34±7.8 years, 122 (72.6%) of women. The EDS was diagnostic in 53 (31.5%) participants (95%CI: 27.94%-35.06%). Men (43.5%) were the most affected (p<0.04). The snoring was associated with SED (x2=8.49, p=0.04). Seniors aged over 80 are three times more likely to have SED than the elderly aged 60-69 years (95% CI: 1.08 to 9.24, p=0.03). Elderly obese (42.6%) and high waist circumference (88.5%) had more EDS (p=0.04). Depression (78.6%, p=0.0005) and high waist circumference is associated with EDS in men (57.1%, p=0.02). Only in women, obesity was related to the SED (42.1%, p=0.01). Conclusion: There is high prevalence of SED among the elderly population studied. The high age, men and snoring predict the SED. Obesity, depression and RC s factors present association with SED. The male is a key variable in this relationship. / Objetivo: Determinar a prevalência de Sonolência Excessiva Diurna (SED) em idosos e sua relação com fatores sócio-demográficos, características do sono, depressão, estado nutricional e risco cardiovascular (RC). Materiais e Métodos: Pesquisa transversal de base populacional realizada de 2010-2011 com idosos da cidade de Campina GrandePB. Foi estimada amostra de 205 idosos, selecionada aleatoriamente nos distritos sanitários. A SED foi diagnóstica através da Escala de Sonolência de Epworth. Foram também investigados: medidas antropométricas, depressão, estado nutricional, qualidade do sono, ronco, insônia e atividade física. Resultados: Participaram da pesquisa 168 idosos, idade de 72,34 ±7,8 anos, 122 (72,6%) de mulheres. A SED foi diagnóstica em 53 (31,5%) participantes (IC95%: 27,94%-35,06%). Os homens (43,5%) foram os mais acometidos (p<0,04). O ronco foi associado à SED (x2=8,49; p=0,04). Idosos com idade igual ou superior a 80 anos têm três vezes mais probabilidade de apresentar SED do que os idosos com idade entre 60-69 anos (IC95%: 1,08-9,24; p=0,03). Idosos obesos (42,6%) e com elevada circunferência abdominal (88,5%) apresentaram mais SED (p=0,04). Depressão (78,6%; p=0,0005) e circunferência abdominal elevada está associada à SED nos homens (57,1%; p=0,02). Apenas nas mulheres a obesidade mostrou-se relacionada com a SED (42,1%; p=0,01). Conclusão: Existe alta prevalência de SED na população idosa estudada. A idade elevada, homens e roncar predizem a SED. A obesidade, depressão e fatores que favorecem RC apresentam associação com a SED. O sexo masculino é uma variável determinante desta relação.

A presente dissertação tem como tema central a onerosidade excessiva na revisão e extinção dos contratos no direito civil brasileiro. Ela aborda as hipóteses de rompimento do princípio do equilíbrio econômico contratual na fase de execução dos contratos em virtude da superveniência de fatos extraordinários e imprevisíveis que interrompem sua originária relação de equivalência. O presente estudo divide-se em seis grandes partes. Em primeiro lugar, fazem-se necessárias uma introdução e uma descrição da problemática relacionada ao tema. Em seguida, apresenta-se a origem histórica da revisão e da extinção contratual a partir do exame da cláusula rebus sic stantibus. Feito isso, são relatadas as teorias que as fundamentam pela doutrina e pela jurisprudência antes do advento do texto legal expresso que trata da matéria. Concluída essa fase histórica, analisa-se o direito positivo brasileiro vigente, primeiramente, por questões cronológicas, a revisão por onerosidade excessiva no Código de Defesa do Consumidor. Posteriormente, as disposições legais inseridas no Código Civil que possibilitam a revisão e resolução dos contratos por onerosidade excessiva, com uma análise dogmática dos pressupostos positivos e negativos necessários à aplicação dos arts. 317 e 478 do Código Civil. Em seguida, o estudo procura analisar algumas questões pontuais relacionadas à aplicação dos dois artigos, tais como: (i) quem tem legitimidade e interesse para requerer a revisão e resolução dos contratos, de acordo com os arts. 317 e 478 do Código Civil, respectivamente; (ii) qual é o papel do juiz na revisão e resolução dos contratos, de acordo com os arts. 317 e 478 do Código Civil, respectivamente; e (iii) se há concorrência na aplicação desses artigos ou deve ser observado um procedimento sequencial em atenção ao princípio da preservação dos contratos. Finalmente, o trabalho apresenta breve síntese e conclusões. / This dissertation brings at its core the topic of excessive burden on the revision and termination of contracts pursuant to Brazilian Civil Law. Accordingly, this study discusses the hypothesis of breaking the principle of contractual economic balance in the execution phase of contracts, due to the supervenience of extraordinary and unpredictable facts, which interrupts its original equivalence relation. The current study is divided into six major parts. It is necessary at first to consider the introduction and delimitation of the core subject. Ensuingly, the historical origin regarding the revision and termination of contracts is presented, pursuant to the contemplation of the rebus sic stantibus clause. Subsequently, the theories used as grounds are laid down, through Brazilian doctrine and case law, prior to the upcoming of the express legal text dealing with the subject. Upon the conclusion of the historical phase, the Civil Code the current ruling positive law is analyzed, as to explain the concept of excessive burden present in the Consumer Code. Sequentially, the legal dispositions inserted in the Civil Code, which enable the revision and resolution of contracts through excessive burden, bearing a dogmatic analysis of the positive and negative assumptions necessary to the application of articles 317 and 478 of the Civil Code. Certain correlated topics are then also dealt with, complementing the understanding and analysis of the aforementioned articles of the Civil Code, such as: (i) who possesses the legitimacy and interest in requesting the revision and resolution of contracts, pursuant to articles 317 and 478 of the Civil Code, respectively; (ii) what exactly is the role of the judge in the revision and resolution of contracts, according to articles 317 and 478 of the Civil Code, respectively; and (iii) whether said articles in anyway clash in their application or if a sequential procedure directed at the preservation of contracts must be observed. Finally, the study presents a brief summary and conclusions.

Orientador: Maria Filomena Ceolim / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-25T05:55:57Z (GMT). No. of bitstreams: 1 Andrechuk_CarlaRenataSilva_M.pdf: 2366527 bytes, checksum: 832d736fa468c155251f5062be71b5c4 (MD5) Previous issue date: 2014 / Resumo: Este estudo teve como objetivo avaliar a evolução clínica de pacientes com infarto agudo do miocárdio (IAM) internados em um hospital público de grande porte do interior do estado de São Paulo, em função de: qualidade do sono habitual; grau de sonolência diurna; estratificação de risco para apneia obstrutiva do sono (alto ou baixo). Trata-se de um estudo descritivo, correlacional e de corte transversal. Foram incluídos 113 pacientes (média de idade 59,7 anos ±12,3, 70,8% do sexo masculino) hospitalizados na unidade coronariana e enfermaria de cardiologia. Aplicou-se um instrumento para caracterização sociodemográfica e clínica, previamente submetido a juízes para avaliação de conteúdo; o Índice de Qualidade de Sono de Pittsburgh (PSQI); a Escala de Sonolência Epworth (ESE) e o Questionário de Berlim (QB). O escore médio do PSQI foi 8,1 (±3,8) e da ESE 8,9 (±4,5). A prevalência de má qualidade do sono, sonolência diurna excessiva (SDE) e alto risco para a síndrome da apneia obstrutiva do sono (SAOS) foi de 71,7%, 29,2% e 60,2%, respectivamente. A evolução clínica com piora durante a hospitalização foi observada em 12,4% (n=14) dos participantes. À análise de regressão logística múltipla, o escore final obtido no PSQI mostrou-se associado de forma independente a esse desfecho, sendo que o aumento de um ponto correspondeu à chance 26% maior de apresentar piora clínica (OR 1,26, IC95% 1,08-1,48). O escore final da ESE foi significativamente associado ao desfecho de piora apenas na análise univariada (OR 1,13, IC95% 1,01-1,27). O alto risco para SAOS foi identificado em 17,7% dos pacientes com piora clínica e em 4,4% daqueles com melhora (p<0,05 ao teste Exato de Fisher). A má qualidade do sono, SDE e o alto risco para SAOS foram frequentes nos pacientes acometidos por IAM e repercutiram de forma negativa no desfecho durante a hospitalização. Identificar os sujeitos com sono de má qualidade e distúrbios associados ao sono deve constituir parte da atuação rotineira dos profissionais de saúde visando a prevenção das doenças cardiovasculares / Abstract: The goal of this study was to assess the clinical evolution of patients with acute myocardial infarction (AMI) admitted at a large public hospital in the State of São Paulo, with respect to: usual sleep quality; degree of daytime sleepiness; and obstructive sleep apnea risk stratification (high or low). This is a descriptive, correlational and cross-sectional study. It included 113 patients (male individuals with average age of 59.7 years ±12.3, 70.8%) admitted at the coronary care unit and the cardiology ward. The tools used were: an instrument, previously submitted to judges for content evaluation, for sociodemographic and clinical characterization; the Pittsburgh Sleep Quality Index (PSQI); the Epworth sleepiness scale (ESS); and the Berlin questionnaire (BQ). The average PSQI score was 8.1 (±3.8) and the average ESS score was 8.88 (±4.5). The prevalence of poor sleep quality, excessive daytime sleepiness (EDS), and high risk of obstructive sleep apnea syndrome (OSAS) was 71.7%, 29.2%, and 60.2%, respectively. Clinical picture worsening during hospitalization was observed in 12.4% of the participants (n=14). In the multiple logistic regression analysis, the final score obtained in the PSQI was independently associated with this outcome, and the increase of one point corresponded to the 26% higher chance of presenting clinical worsening (OR, 1.26; 95% CI: 1.08-1.48). The final score in the ESS was significantly associated with the worsened outcome only according to the univariate analysis (OR, 1.13; 95% CI: 1.01-1.27). The high risk of OSAS was identified in 17.7% of the patients with clinical worsening and in 4.4% of those with improvement (p<0.05 according to Fisher's exact test). Poor sleep quality, EDS, and the high risk of OSAS were frequent in patients affected by AMI and they had a negative impact on the outcome during hospitalization. Identifying the individuals with poor sleep quality and sleep-related disorders should be part of health professionals' routine performance aiming at the prevention of cardiovascular diseases / Mestrado / Enfermagem e Trabalho / Mestra em Enfermagem