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Operational transconductance amplifier and capacitor (OTA-C) filters have outstood among different types of filter due to high frequency and low power capabilities in the main stream digital CMOS technology. They have been widely used in computer hard disk drive (HDD) and wireless communication transceivers. OTA-C filters based on cascade and passive ladder simulation are well-known. However, multiple loop feedback (MLF) OTA-C filters which have certain advantages still have the scope for further research. So far there have been no explicit formulas for current-mode leapfrog (LF) filter design and performance evaluation of current-mode MLF OTA-C filters are still lacking. From application viewpoints, read channels for computer hard disk drives require very high frequency continuous-time filters. This automatically disqualifies active- RC/MOSFET-C filters and OTA-C filters become the only solution. In wireless communications, active-RC/MOSFET-C filters have been proved useful for mobile systems whose baseband frequency falls below a few MHz. However, for wireless LANs with the frequency of several tens of MHz, OTA-C filters are a strong candidate. Whilst in HDD read channels, cascaded OTA-C architectures have been most utilized and in wireless receivers, OTA-C structures based on ladder simulation have been popular, MLF OTA-C filters have not been practically used in either of the applications. This thesis describes some novel designs and applications of multiple loop feedback OTA-C filters with extensive CMOS simulations. Analogue filters for computer hard disk drive systems are first reviewed; the state of the art and design considerations are provided. Three VHF linear phase lowpass OTA-C filters are then designed, which include a seventh-order and a fifth-order current-mode filter based on the follow-the-leader-feedback (FLF) structure and a seventh-order voltage-mode filter using the inverse FLF (IFLF) configuration. These filters all have very low power consumption. The synthesis and design of general current-mode LF OTA-C filters are conducted next. Iterative design formulas for both all-pole and finite-zero functions are derived and explicit formulas for up to sixth-orders are given. These formulas are very easy to use for designing any type of characteristics. Subsequently, linear phase lowpass OTA-C filter design for HDD read channels using LF structures are investigated in details. A current-mode filter and a voltage-mode filter using the fifth-order LF structure are presented. The two filters can operate up to 800MHz and have very small passband phase ripple. Analogue filters for wireless communication baseband applications are also reviewed thoroughly in this thesis, where the design of a fourth-order current-mode FLF Butterworth lowpass OTA-C filter for multi-standard receivers is presented. Then two fifth-order current-mode elliptic lowpass OTA-C filters based on respective LF and FLF structures for wireless communication baseband are designed. Fifth-order voltage-mode IFLF and LF elliptic lowpass filters are also presented. All these MLF baseband filters designed can operate up to 40MHz to cover all important wireless and mobile standards. Simulations show that the LF structures have better dynamic range and stopband attenuation performances than the FLF and IFLF configurations.

OBJECTIVES The aim of this analysis was to assess the 7-year long-term safety and effectiveness of a randomized comparison of percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of isolated proximal left anterior descending lesions. BACKGROUND Long-term follow-up data comparing PCI by SES and MIDCAB surgery for isolated proximal left anterior descending lesions are sparse. METHODS Patients were randomized either to PCI with SES (n ¼ 65) or MIDCAB (n ¼ 65). Follow-up data were obtained after 7 years with respect to the primary composite endpoint of death, myocardial infarction, and target vessel revas- cularization. Angina was assessed by the Canadian Cardiovascular Society classification and quality of life with Short Form 36 and MacNew quality of life questionnaires. RESULTS Follow-up was conducted in 129 patients at a median time of 7.3 years (interquartile range: 5.7, 8.3). There were no significant differences in the incidence of the primary composite endpoint between groups (22% PCI vs. 12% MIDCAB; p ¼ 0.17) or the endpoints death (14% vs. 17%; p ¼ 0.81) and myocardial infarction (6% vs. 9%, p ¼ 0.74). However, the target vessel revascularization rate was higher in the PCI group (20% vs. 1.5%; p < 0.001). Clinical symptoms and quality of life improved significantly from baseline with both interventions and were similar in magnitude between groups. CONCLUSIONS At 7-year follow-up, PCI by SES and MIDCAB in isolated proximal left anterior descending lesions yielded similar long-term outcomes regarding the primary composite clinical endpoint and quality of life. Target vessel revascularization was more frequent in the PCI group. (Randomied Comparison of Minimally Invasive Direct Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention With Drug-Eluting Stents in Patients With Proximal Stenosis of the Left Anterior Descending Coronary Artery; NCT00299429) (J Am Coll Cardiol Intv 2014;-:-–-) © 2014 by the American College of Cardiology Foundation.

Made available in DSpace on 2016-03-22T17:27:18Z (GMT). No. of bitstreams: 1 taiane.pdf: 500923 bytes, checksum: bb4a10bbb2a2448b84aceb8f2e29daa6 (MD5) Previous issue date: 2013-01-17 / Introduction: The literature indicates high occurrence of anxiety symptoms in people who have depression, this index simultaneously suggests the importance of studying the impact of anxiety symptoms in treatment for depression. Objective: To evaluate the impact of anxiety symptoms in remission of depressive symptoms in brief psychotherapies for depression at follow-up six months. Methods: Randomized clinical trial with youth of 18 to 29 years old who met diagnostic criteria for depression assessed by the Structured Clinical Interview for DSM (SCID). Depressive symptoms were assessed using the Hamilton Depression Scale (HAM-D), while the anxiety symptoms were assessed using the Hamilton Anxiety Scale (HAM-A). The protocols of psychotherapy used were: Cognitive Narrative Psychotherapy (CNP) and Cognitive Behavioral Psychotherapy (CBP), both with seven sessions. At the end of treatment and at follow-up six months an evaluation was made with the HAM-D and HAM-A. Results: The sample included 97 patients divided evenly between the protocols of psychotherapy. There was a significant positive moderate correlation between the severity of anxiety symptoms at baseline and remission of depressive symptoms at post-intervention (r = 0.444 p <0.001), while at follow-up six months not there was a significant correlation (r = 0.181 p = 0.164). There was remission of anxiety symptoms (8.69 ± 7.93) and depressive symptoms (6.38 ± 5.4o) after the brief psychotherapies. The remission of anxiety symptoms remained at follow-up of six months (7.59 ± 8.31, p = 0,228) and the same was true for the remission if depressive symptoms (6.48 ± 5.04, p = 0,879). Conclusion: The severity of anxiety symptoms contributed to greater remission of depressive symptoms after brief psychotherapies in the short term. However, in long term, the severity of the anxiety symptoms has no impact on the remission of the depressive symptoms. The brief psychotherapies for depression demonstrate efficacy in the remission of depressive and anxious symptoms / Introdução: A literatura aponta alta ocorrência de sintomas ansiosos em indivíduos que apresentam depressão, este índice simultâneo sugere a importância de se estudar o impacto dos sintomas ansiosos no tratamento para depressão. Objetivo: Avaliar o impacto dos sintomas ansiosos na remissão de sintomas depressivos em psicoterapias breves para depressão no follow-up de seis meses. Método: Ensaio clínico randomizado com jovens de 18 à 29 anos que preencheram critério diagnóstico de depressão avaliado através da Structured Clinical Interview for DSM (SCID). Os sintomas depressivos foram avaliados através da Hamilton Depression Scale (HAM-D), enquanto os sintomas ansiosos foram avaliados através da Hamilton Anxiety Scale (HAM-A). Os protocolos de psicoterapia utilizados foram: Psicoterapia Cognitiva Narrativa (PCN) e Psicoterapia Cognitivo Comportamental (PCC), ambos com sete sessões. Ao fim do tratamento, bem como, no follow-up de seis meses foi realizada uma avaliação com as escalas HAM-D e HAM-A. Resultados: A amostra total contou com 97 pacientes distribuídos homogeneamente entre os protocolos de psicoterapia. Houve uma correlação moderada positiva significativa entre a severidade dos sintomas ansiosos no baseline e a remissão de sintomas depressivos no pós-intervenção (r=0,444 p<0,001), no entanto, no follow-up de seis meses a correlação não foi estatisticamente significativa (r=0,181 p=0,164). Houve remissão de sintomas ansiosos (8,69±7,93) e de sintomas depressivos (6,38±5,40) após as psicoterapias breves. A remissão dos sintomas ansiosos manteve-se no follow-up de seis meses (7,59±8,31; p=0,228) e o mesmo ocorreu para a remissão se sintomas depressivos (6,48±5,04; p=0,879). 47 Conclusão: A severidade dos sintomas ansiosos contribuiu para maior remissão de sintomas depressivos após psicoterapias breves em curto prazo. Contudo, a longo prazo, a severidade dos sintomas ansiosos não apresenta impacto sobre a remissão dos sintomas depressivos. As psicoterapias breves para depressão demonstram eficácia na remissão de sintomas ansiosos e depressivos

Made available in DSpace on 2016-04-04T18:29:32Z (GMT). No. of bitstreams: 1 Regina Celia Furigo.pdf: 8832692 bytes, checksum: 54938673017ec631e8aa17d399c05061 (MD5) Previous issue date: 2006-12-05 / The purpose of the present study was to analyze the Psychologic Attention available on the Emergency Psychological Attendance to the users of a Universitary Clinicschool generated from the experiences of emergency psychologists, patients, and Supervisor-researcher. The used methodology was based on a phenomenologic research from the study of ten cases in clinic attendance of individuals who spontaneously sought the cited service. It is important to note that the emergency attendance was offered for free by a convenant between the cited University and the Brasilian Public Heath System (SUS). The cases were treated and analyzed in the light of Jungian referencial. The attendance was carried out by six emergency psychologists previously selected and with a minimum of one year experience in clinical attendance. Three sessions were carried out for each patient and also a follow-up interview, was performed a month after the end of the Emergengy psychological attendance process. The group of emergency psychologists had a weekly supervision during the six month the research was performed. A detailed report of the clinical work as well as the personal perceptions of the emergency psychologists was delivered for each case of the program. The same has occurred with the supervisor-researcher who was responsible for the follow up interviews which reflected the patients feelings about the research. As a result, it was generated pool of ten reports from the psychologists about the attended patients?processes, ten follow-up interviews and ten perception reports from the supervisor-researcher about her personal understanding of the process as a whole. The emergency psychologists? reports, as well as the data obtained on the follow-up interview were divided in unities of significate which possibilitate the elaboration of specific syntheses, both from the emergency psychologist and the patient and from the supervisor-researcher. Thus, it was obtained three general syntheses refering to the lived element related to the research focus. The main results obtained show that, when the Emergency Psychological Attendance empathizes with the patient who needs psychological care, in the exact moment of his (her) crysis, treats with different times: one internal ( the patient time) and other external (the chronological time) and thus reaches such relevant results as to the contention of anguish in a brief time. Both Emergency Psychologists and patients experience a highly rich moment for their psyche, which makes viable the archetype of the wounded physician which, when constelating, assists the patient to recapture the hability to carry out his (her) autocure. Therefore, it is considered that Intervention Model used in the Emergency Psychological Attendance arises as an enormous hope of speeding and dinamizing the clinical services delivered by Psychology, enhancing the resources of this science for people who needs it within the health care field. / O presente estudo teve como objetivo analisar a Aten??o Psicol?gica disponibilizada no Servi?o de Plant?o Psicol?gico, aos usu?rios de uma Clinica-Escola Universit?ria, a partir das experi?ncias de Plantonistas, Clientes e Supervisora-Pesquisadora. Quanto ? quest?o metodol?gica, foi conduzida uma pesquisa fenomenol?gica a partir do estudo do atendimento cl?nico de dez casos referentes a pessoas que recorreram ao Servi?o de forma espont?nea. Ressalte-se que o acompanhamento foi oferecido de forma gratuita pelo conv?nio estabelecido entre a Universidade em quest?o e o SUS. Os casos foram atendidos e analisados ? luz de referencial junguiano. O atendimento foi realizado por seis plantonistas previamente selecionados e com no m?nimo um ano de experi?ncia em interven??es dessa natureza. Ocorreram tr?s sess?es por paciente mais uma entrevista de follow up, realizada um m?s ap?s o t?rmino do processo do Plant?o. O grupo de plantonistas foi supervisionado semanalmente durante os seis meses de realiza??o da pesquisa. Entregou relat?rio pormenorizado do seu trabalho cl?nico bem como de suas percep??es pessoais sobre o significado do Plant?o para cada caso. O mesmo ocorreu com a supervisora pesquisadora, encarregada das entrevistas de follow up, que no caso constituiu-se na voz do paciente dentro da pesquisa. Gerou-se ent?o um conjunto de dez relatos dos plantonistas sobre os processos dos clientes atendidos, dez entrevistas de follow up e dez relatos de percep??o da supervisora pesquisadora sobre seu entendimento pessoal daquele processo como um todo. Os relatos dos plantonistas, assim como os dados obtidos na entrevista de follow up foram divididos em unidades de significado que possibilitaram a elabora??o de s?nteses espec?ficas, tanto do plantonista, como do paciente e da supervisora pesquisadora. Obteve-se desse modo tr?s s?nteses gerais referentes ao elemento vivido, em rela??o ao foco da pesquisa. Os principais resultados foram que o Plant?o Psicol?gico ao colocar-se ao lado do paciente que necessita de atendimento psicol?gico no exato momento de sua crise lida com tempos diferentes: um interno (o tempo do paciente) e outro externo (o cronol?gico) e por isso consegue resultados t?o relevantes em termos de conten??o de ang?stias em um breve tempo. Plantonistas e Pacientes vivenciam um momento de encontro altamente fecundo para a psique de ambos, o que viabiliza a constela??o do arqu?tipo do curador ferido que, ao constelar-se, ajuda o paciente na retomada de sua capacidade de se autocurar, entre outros. Considera-se ent?o que o Modelo de Interven??o utilizado no Servi?o de Plant?o Psicol?gico desponta como uma grande esperan?a de agiliza??o e dinamiza??o dos servi?os cl?nicos prestados pela Psicologia, vindo a contribuir com uma gama maior de recursos que esta Ci?ncia pode colocar a servi?o de quem dela precisa dentro da ?rea da Sa?de.

<p>Enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of mild-to-moderate obstructive sleep apnea syndrome (OSAS) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. In more severe cases, the patients are generally treated with nasal continuous positive airway pressure (CPAP). However, many patients do not satisfactorily tolerate CPAP as a result of frequent side-effects. Consequently, there is a need for an alternative treatment. Reports on the beneficial effects of mandibular advancement appliances in the treatment of mild-to-moderate OSA exist in the form of short–term evaluations.</p><p>One of the aims of the present thesis was to compare treatment effects with a mandibular advancement appliance and UPPP in patients with OSA with follow-up after one and four years. Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index, AI >5 and <25) were randomised to treatment with a dental appliance or UPPP. Sleep studies were performed before and one and four years after intervention. According to the criteria for normalisation (AI<5 and apnea hypopnea index, AHI<10), 78% of the patients in the dental appliance group and 51% of the patients in the UPPP group had normalised after one year (p<0.05). Still after four years of treatment, 63% of the patients in the dental appliance group and 33% of the patients in the UPPP group were normalised. The dental appliance group had a higher normalisation rate than the UPPP group, but the efficacy was partly invalidated by the compliance rate of 62%.</p><p>Quality of life assessments in the dimensions of vitality, contentment and sleep improved in both groups at the one-year follow-up after treatment. There was no difference between the groups in terms of vitality and sleep. The UPPP group, however, reported a higher degree of contentment than the dental appliance group, even though the somnographic values were superior in the latter group. </p><p>Another aim was to conduct a randomised study to test the hypothesis that severe OSA patients will benefit from more pronounced mandibular advancement (MA) compared with a shorter advancement. Eighty-six males with severe OSA (AI>20) were randomly allocated to either 75% or 50% MA for a six-month treatment period. Treatment with a more pronounced mandibular advancement yielded a 20% higher normalisation rate than a shorter advancement. A mean normalisation rate of 45% was found for patients in this category with few side-effects, good patient satisfaction and a compliance of 92% after 6 months. </p><p>The overall conclusion is that dental appliance treatment is effective in patients with mild to moderate OSA and even for patients with severe OSA. The efficacy in terms of normalisation in patients with mild to moderate OSA was higher after the dental appliance treatment with a 50% degree of advancement than after the UPPP treatment. However, severe OSA patients might benefit from more pronounced advancement (75%) compared with a shorter degree of advancement (50%). QOL improved significantly after both dental appliance and UPPP treatment. </p>

Enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of mild-to-moderate obstructive sleep apnea syndrome (OSAS) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. In more severe cases, the patients are generally treated with nasal continuous positive airway pressure (CPAP). However, many patients do not satisfactorily tolerate CPAP as a result of frequent side-effects. Consequently, there is a need for an alternative treatment. Reports on the beneficial effects of mandibular advancement appliances in the treatment of mild-to-moderate OSA exist in the form of short–term evaluations. One of the aims of the present thesis was to compare treatment effects with a mandibular advancement appliance and UPPP in patients with OSA with follow-up after one and four years. Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index, AI &gt;5 and &lt;25) were randomised to treatment with a dental appliance or UPPP. Sleep studies were performed before and one and four years after intervention. According to the criteria for normalisation (AI&lt;5 and apnea hypopnea index, AHI&lt;10), 78% of the patients in the dental appliance group and 51% of the patients in the UPPP group had normalised after one year (p&lt;0.05). Still after four years of treatment, 63% of the patients in the dental appliance group and 33% of the patients in the UPPP group were normalised. The dental appliance group had a higher normalisation rate than the UPPP group, but the efficacy was partly invalidated by the compliance rate of 62%. Quality of life assessments in the dimensions of vitality, contentment and sleep improved in both groups at the one-year follow-up after treatment. There was no difference between the groups in terms of vitality and sleep. The UPPP group, however, reported a higher degree of contentment than the dental appliance group, even though the somnographic values were superior in the latter group. Another aim was to conduct a randomised study to test the hypothesis that severe OSA patients will benefit from more pronounced mandibular advancement (MA) compared with a shorter advancement. Eighty-six males with severe OSA (AI&gt;20) were randomly allocated to either 75% or 50% MA for a six-month treatment period. Treatment with a more pronounced mandibular advancement yielded a 20% higher normalisation rate than a shorter advancement. A mean normalisation rate of 45% was found for patients in this category with few side-effects, good patient satisfaction and a compliance of 92% after 6 months. The overall conclusion is that dental appliance treatment is effective in patients with mild to moderate OSA and even for patients with severe OSA. The efficacy in terms of normalisation in patients with mild to moderate OSA was higher after the dental appliance treatment with a 50% degree of advancement than after the UPPP treatment. However, severe OSA patients might benefit from more pronounced advancement (75%) compared with a shorter degree of advancement (50%). QOL improved significantly after both dental appliance and UPPP treatment.

Fear is an innate emotion and an adaptive response to provide protection from potential harm. When fear is excessive and out of proportion in relation to the confronted situation, it can lead to the development of an anxiety disorder. Many individuals feel anxious at some point, but not all experience clinical anxiety or meet the diagnostic criteria of an anxiety disorder. Still, anxiety disorders are the most prevalent form of psychiatric disorder in the general population. More often than not people suffering from one anxiety disorder also present other psychiatric conditions. As of today, cognitive and behavioural treatments have been tested and found to positively affect anxiety disorders, making them the treatment of choice. Nevertheless, many patients do not seek or receive adequate treatment. One common critique of the research trials from which the recommendations for treatments stem is the use of a single protocol targeting only one diagnosis. This is because many people suffer from comorbidities. Another problem connected to the recommendation that cognitive behavioural therapy (CBT) should be the treatment of choice for anxiety disorders is the lack of therapists with adequate training. One possible way of dealing both with the shortcoming of therapists and making CBT more accessible is the use of the Internet. Internet-based CBT (ICBT) has been tested in numerous trials during the last 15 years, showing positive outcomes for a large variety of disorders. Many ICBT trials also make use of a single protocol. Another way of dealing with comorbidities might be to tailor the treatment to let characteristics and preferences of the patient guide the design of the protocol. Little is known about possible effects of tailoring the ICBT, the effects of therapeutic relationships in ICBT, and the effectiveness and cost-effectiveness of these treatments. This thesis is based on three studies on two separate randomized controlled trials (RCTs) using the same set of modules accessible for the tailored protocol. Study I was an RCT investigating treatment effects up to two-year after completion, showing favourable outcomes of the treatment in a self-recruited sample at all measure points. Study II was a secondary analysis exploring possible relations between working alliance and treatment outcome for participants in the treatment group recruited for Study I indicating that working alliance predict outcome in this tailored treatment. The second RCT was an effectiveness trial (Study III) analysing treatment effects and cost-effectiveness of the treatment up to one year post treatment in a primary-care population. This study showed positive treatment effects both regarding symptom reduction and cost-effectiveness, and that effects were sustained at one year post treatment. Conclusions drawn from these studies are that individually tailored ICBT seems to be a feasible approach for patients with anxiety disorders regardless of comorbidities, and a responsible choice in terms of societal costs. / Rädsla är en medfödd känsla och en adaptiv respons för att skydda organismen från potentiell skada. När rädslan blir överdriven och oproportionerlig i relation till den konfronterade situationen, kan det leda till utvecklandet av ångestsyndrom. Många personer upplever någon gång ångest, men inte alla upplever klinisk ångest eller uppfyller de diagnostiska kriterierna för något ångestsyndrom. Trots detta är ångest det vanligaste psykiatriska tillståndet i befolkningen i stort och oftast uppfyller personer som lider av ett ångestsyndrom även andra  psykiatriska tillstånd. Till dags dato har både kognitiva och beteendeinriktade behandlingar testats och visat sig verksamma vid ångestproblem, vilket gjort dem till de behandlingar som rekommenderas för dessa tillstånd. Trots god effekt av behandling söker många patienter ändå inte hjälp, alternativt erhåller inte adekvat behandling. En vanlig kritik mot den forskning från vilka behandlingsrekommendationerna för ångestsyndrom stammar är att många använt en manual eller ett protokoll som riktar sig mot bara en diagnos. Detta på grund av den stora komorbiditeten. Ett annat problem kopplat till rekommendationerna att kognitiv beteendeterapi (KBT) ska vara förstahandsval vid behandling av ångest är bristen på behandlare med adekvat utbildning. Ett möjligt sätt att göra KBT mer tillgängligt är att använda Internet. Internet- förmedlad KBT (IKBT) har prövats i ett stort antal studier de senaste 15 åren dessa har visat positiva resultat vid ett stort antal psykiatriska tillstånd. Flertalet av dessa studier har dock använt ett enda behandlingsprotokoll. En annan möjlighet att hantera komorbiditet kan vara att skräddarsy behandlingen för att låta patientens egenskaper och preferenser vara med och styra utformningen av behandlingsprotokollet. Möjliga effekter av att skräddarsy IKBT är relativt lite undersökt, likaså effekterna av terapeutiska relationer i IKBT samt klinisk effektivitet och kostnadseffektiviteten för dessa behandlingar. Denna avhandling bygger på tre studier från två randomiserade kontrollerade studier med samma uppsättning av moduler tillgängliga för att skräddarsy behandlingsprotokollen. I Studie I undersöktes behandlingseffekter upp till två år efter avslutad behandling i en självrekryterad grupp patienter. Studie II var en sekundäranalys av behandlingsgruppen från Studie I där eventuella samband mellan arbetsallians och behandlingsresultat undersöktes. Den andra randomiserade kontrollerade studien var en prövning av huruvida denna behandling var effektiv för en klinisk population (Studie III) rekryterad via primärvården. Förutom behandlingseffekter undersöktes även kostnadseffektiviteten upp till ett år efter behandlingsavslut. De slutsatser som dras utifrån dessa studier är att skräddarsydd IKBT verkar vara en framkomlig väg för patienter med ångest oavsett komorbiditet, att arbetsalliansen kan vara en faktor som påverkar utfallet, samt att det är ett ansvarsfullt val vad gäller samhälleliga kostnader.

Les sources transitoires sont souvent associées aux phénomènes les plus violents de l’Univers, où l’accélération de hadrons peut avoir lieu. Parmi ces sources, les sursauts gamma, les noyaux actifs de galaxie ou encore les supernovae à effondrement de coeur sont des candidats prometteurs pour la production de rayons cosmiques et de neutrinos de haute énergie. Le télescope ANTARES, situé au fond de la Méditerranée, a pour but de détecter ces neutrinos, qui pourraient révéler la présence d’une source de rayons cosmiques. Cependant, pour augmenter la sensibilité aux sources transitoires, une méthode basée sur le suivi multi-longueur d’onde d’alertes neutrino a été développée au sein de la collaboration ANTARES. Ce programme, TAToO, permet de déclencher un réseau de télescopes optiques et l’instrument XRT du satellite Swift seulement quelques secondes après la détection d’un neutrino par ANTARES. Les télescopes commencent un programme d’observation de la région du ciel correspondante pour tenter de détecter une contrepartie optique ou X à l’évènement neutrino. Les travaux présentés dans cette thèse portent sur le développement et la mise en place d’un programme d’analyse d’images optiques, ainsi que sur l’analyse de données optiques et X obtenues lors des observations par les différents télescopes, pour identifier des sources transitoires rapides, telles que les émissions rémanentes de sursauts gamma, ou lentes, telles que les supernovae à effondrement de coeur. / Transient sources are often associated with the most violent phenomena in the Universe, where the acceleration of hadrons may occur. Such sources include gamma-ray bursts (GRBs), active galactic nuclei (AGN) or core-collapse supernovae (CCSNe), and are promising candidates for the production of high energy cosmic rays and neutrinos. The ANTARES telescope, located in the Mediterranean sea, aims at detecting these high energy neutrinos, which could reveal the presence of a cosmic ray accelerator. However, to enhance the sensitivity to transient sources, a method based on multi-wavelength follow-up of neutrino alerts has been developed within the ANTARES collaboration. This program, denoted as TAToO, triggers a network of robotic optical telescopes and the Swift-XRT with a delay of only few seconds after a neutrino detection. The telescopes start an observation program of the corresponding region of the sky in order to detect a possible electromagnetic counterpart to the neutrino event. The works presented in this thesis cover the development and implementation of an optical image analysis pipeline, as well as the analysis of optical and X-ray data to search for fast transient sources, such as GRB afterglows, and slowly varying transient sources, such as CCSNe.

Background: Prophylactic mastectomies in carriers of mutations in BRCA1 or BRCA2 are becoming increasingly more accepted. We investigated the outcome after prophylactic mastectomy, especially regarding satisfaction with the procedure, in a monocenter study. Methods: BRCA1/2 mutation carriers and non-carriers with elevated pedigree-based cancer risk were followed prospectively in a structured surveillance program between 2000 and 2017. A retrospective telephone survey was conducted among all patients with documented prophylactic mastectomy. Complications and satisfaction with the decision for prophylactic mastectomy were recorded. Results: 39 patients who opted for a prophylactic mastectomy (38 BRCA1/2 mutation carriers and 1 noncarrier) were interviewed. Mostly nipple-sparing mastectomy with reconstruction was performed (87%). Half of the patients (22/39; 56.4%) had a history of unilateral breast cancer. The median time since prophylactic mastectomy was 5.6 years. While 61.5% did not report any complications, flap loss was seen in 15% (3/20) and moderate limitations in everyday life were present in 20% (7/35). An improvement in quality of life was noticed by 82% after prophylactic mastectomy and no patient expressed regret with regard to the decision. Conclusions: Prophylactic mastectomy is a procedure with risk for long-term complications in some cases. Our results confirm high satisfaction with the decision and improved quality of life.