INTRODUÇÃO: Pacientes em terapia anti-retroviral podem apresentar escapes transitórios de viremia plasmática (blip), porém os preditores desse evento e seu impacto sobre a incidência de falência virológica são ainda controversos na literatura. Neste estudo de coorte estimou-se a incidência de blip e de falência virológica e investigaram-se possíveis preditores de tais desfechos. Blip foi definido como carga viral superior a 50 cópias/mL com subseqüente supressão da viremia plasmática e falência virológica como duas medidas consecutivas de carga viral plasmática superiores a 50 cópias/mL. Adicionalmente, pesquisou-se, por ocasião desses eventos, a presença de mutações genotípicas de HIV capazes de conferir resistência aos anti-retrovirais e as concentrações plasmáticas de inibidores não nucleosídicos da transcriptase reversa e inibidores da protease, comparando-as com o relato dos participantes sobre adesão à medicação. MÉTODOS: 350 participantes infectados pelo HIV (250 homens e 100 mulheres) foram selecionados no Serviço de Extensão ao Atendimento de Pacientes com HIV/Aids Casa da Aids do Hospital das Clínicas da FMUSP, São Paulo, Brasil. Na admissão ao estudo e trimestralmente, ao longo de 78 semanas, foram coletadas informações sobre dados sóciodemográficos, forma presumida de aquisição do vírus, uso de e adesão a medicações anti-retrovirais, ocorrência de outras comorbidades, bem como uso de álcool e de drogas ilícitas. Investigaram-se fatores potencialmente associados à incidência dos desfechos de interesse, tais como ocorrência de outras doenças, exposição a imunizações e falha na adesão a práticas de sexo mais seguro. Amostras de sangue periférico foram coletadas a cada visita para determinação de carga viral plasmática por RT-PCR ultrassensível, e contagem de linfócitos T CD4+ por citometria de fluxo. Nos indivíduos que apresentaram os desfechos de interesse do estudo, procedeu-se ao seqüenciamento dos genes da transcriptase reversa e da protease de HIV e à dosagem plasmática dos anti-retrovirais por método de Cromatografia Líquida de Alta Performance. As incidências de blip e falência virológica foram estimadas e os fatores associados a ambos investigados em modelo de regressão logística múltipla. RESULTADOS: As incidências de blip e falência virológica foram 9,4 e 4,2/100 pessoas-ano, respectivamente. Três indivíduos apresentaram falência virológica precedidos por blip. À análise multivariada, a não adesão às praticas de sexo mais seguro no mês precedente se mostrou independentemente associada à ocorrência de blip (OR 24,64, IC 95% 4,40 137,88, p<0,001) e de falência virológica (OR 24,69, IC 95% 4,20 145,18, p<0,001). Adicionalmente, observou-se que a exposição prévia a maior número de esquemas anti-retrovirais foi preditora dos eventos blip (OR 1,82, IC 95% 1,41 2,36, p<0,001) e falência virológica (OR 1,67, IC 95% 1,19 2,35, p=0,003). A ocorrência de blip não se associou ao desenvolvimento posterior de falência virológica. Um maior número de mutações conferidoras de resistência medicamentosa foi identificado no momento de falência virológica, quando comparado ao momento de blip, com predomínio de mutações no gene da transcriptase reversa, refletindo o maior uso desses fármacos. Das 122 concentrações plasmáticas de anti-retrovirais analisadas em 120 amostras, 84 estavam em níveis terapêuticos adequados. Porém, tais resultados apresentaram apenas 69% de concordância com a adesão auto-referida à medicação. Este estudo mostra que apresentar blip em uma medida isolada pode ser um evento benigno; por outro lado, falência virológica pode ser conseqüente a acúmulo de mutações conferidoras de resistência a pelo menos um dos anti-retrovirais em uso, podendo comprometer a eficácia do esquema terapêutico utilizado. Ambos os desfechos mostraram-se mais incidentes na população multiexperimentada à terapêutica, que, portanto, merece atenção particular. Uma importante contribuição deste estudo foi a avaliação da dosagem plasmática dos antiretrovirais, método simples e de baixo custo, que, implantado na rotina laboratorial, pode contribuir para o monitoramento da adesão aos antiretrovirais e reduzir a demanda por testes genotípicos / BACKGROUND: HIV-1-infected patients under antiretroviral therapy may present intermittent viremia (blip); however, predictors of this outcome and its influence on the incidence of virologic failure remain controversial in the literature. The aim of this study is to estimate the incidence of blip and virologic failure in a cohort of patients under stable antiretroviral therapy and to investigate their associated factors. Blip was defined as a plasma HIVRNA load above 50 copies/mL followed by a subsequent value below 50 copies/mL. Virologic failure was defined as two consecutives measures of viral load above 50 copies/mL. Moreover, at time of occurrence of these outcomes, HIV genotyping assays were performed in search of drug resistance-associated mutations, and plasma concentrations of nonnucleoside reverse transcriptase and protease inhibitors assessed and compared with self-reported adhrence to therapy. METHODS: 350 subjects (250 male and 100 female) were enrolled at the HIV Clinic, School of Medicine, University of São Paulo, Brazil and followed for 78 weeks. At baseline and in 3-month interval follow-up visits we collected sociodemographic data and information on presumed mode of HIV acquisition, use of and adherence to antiretrovirals, comorbidities and use of alcohol and illicit drugs. Additionally, patients were questioned about potential predictors of the outcomes, including occurrence of other diseases, immunizations and risky sexual behavior. Blood samples were drawn for assessment of HIV plasma viral loads, using ultrasensitive RT-PCR, and T CD4+ cell counts by flow cytometry. Individuals who presented blip and/or virologic failure were submitted to HIV genotyping assays and assessment of antiretroviral plasma concentrations by high-performance liquid chromatography. Incidences of blip and virological failure were estimated and associated factors investigated, using a multiple logistic regression model. RESULTS: The incidence of blip and of virologic failure were 9.4/100 and 4.2/100 person-years, respectively. Three individuals presented virologic failure after blip episodes. On multivariate analysis, non-adherence to safer sex measures in the previous month was shown independently associated with the occurrence of blip (OR 24.64, 95%CI 4.40 137.88, p<0.001) and virologic failure (OR 24.69, 95%CI 4.20 145.18, p<0.001). In addition, history of multiple exposures to antiretroviral regimens was also a predictor of blip (OR 1.82, 95%CI 1.41 2.36, p<0.001) and virologic failure (OR 1.67, 95%CI 1.19 2.35, p<0.001). Blips were not predictive of virologic failure. A larger number of HIV mutations were identified at time of virologic failure, as compared to blip episodes, with mutations detected predominantly in the reverse transcriptase (RT) gene, probably due to larger exposure to RT inhibitors. Eighty-four out of 122 assessments of antiretroviral plasma concentrations analyzed in 120 samples resulted in the therapeutic range. However, these results were concordant with self-reported adherence to therapy in 69% of cases only. This study shows that a single blip episode may be considered benign, whereas virologic failure could result from accumulation of HIV drug resistance-associated mutations that may impair the efficacy of therapy. Both study outcomes occurred more frequently among patients with larger exposure to antiretrovirals, and therefore they should be monitored in this regard. An important contribution of this study concerns the assessment of antiretroviral plasma concentrations, a simple and low cost laboratory tool. Incorporated routinely in patient follow-up, it would help monitoring adherence to therapy and reduce the need for HIV genotyping assays

O principal objetivo deste trabalho consistiu em avaliar o desempenho de um sistema experimental para pós-tratamento de reatores anaeróbios. Foram testados reator microaerado e reator com aeração intermitente, seguidos de flotação por ar dissolvido. Foram avaliadas condições para se obter nitrificação, desnitrificação e remoção de fósforo, em reator com baixa concentração de OD e em reator em que se alternaram fases aeróbia e anaeróbia. O trabalho foi desenvolvido em duas etapas distintas: a Etapa I constituiu de ensaios preliminares, utilizando instalação em escala de laboratório, alimentados com efluente de reator anaeróbio compartimentado, composta de sistema de aeração com quatro reatores em paralelo, com capacidade de 11,5 L cada, operando em regime hidráulico contínuo, com concentrações de OD na faixa de 0,2 a 0,9 mg/L, em temperatura controlada de 30±2°C. Na Etapa I também foram operados reatores com aeração intermitente. Na Etapa II, empregou-se instalação para tratamento aeróbio, com capacidade de 100 L, seguida de flotador, em temperatura ambiente de 25±6°C, sendo operado um reator microaerado e outro com aeração intermitente; ambos foram alimentados com efluente de um reator anaeróbio de leito expandido. O sistema com aeração intermitente (&#952h: 6 h) mostrou-se estável, apresentando elevada remoção média de DQO (92%), de P-PO4-3 (90%) e de nitrogênio (sem utilização de fonte externa de carbono; apenas com recirculação adequada do lodo). Para &#952h médio de 8 h, nos ensaios com ciclos alternados de 2 h, com aeração e 4 h, sem aeração, foi obtida remoção máxima de P-PO4-3, de 95% para as amostras brutas e 97% para as amostras filtradas, com remoção média de 84%, e 88%, respectivamente. Considerando apenas os valores médios, registrou-se ligeira queda de remoção de P-PO4-3, e de DQO em relação ao período com &#952h médio de 6 h. Os resultados com aeração intermitente foram sensivelmente melhores em relação aos obtidos com microaeração. / The aim of this research the performance evaluation of a pilot system for post treatment of anaerobic reactors. Microaeration and intermittent aeration reactors, followed by dissolved air flotation (DAF) were examined. It was assessed the conditions to obtain nitrification, denitrification and phosphorus removal, in reactor operated with low concentration of OD and in a reactor operated were alternated aerobic and anaerobic phases were used. The research was developed in two different stages. The first one, constituted of preliminary test, using installation in laboratory scale, fed with effiuent of compartment anaerobic reactor. This system was composed of aeration system with four reactors in parallel, with 11,5 L each, operating in continuous flow, with concentrations of DO between 0.2 to 0.9 mg/L, in controlled temperature of 30±2 ºC. The reactors were also operated with intermittent aeration. In the second stage, an installation with 100L was used for aerobic treatment, followed by DAF, in room temperature of 25±6°C. One reactor was operated under microaeration and another with intermittent aeration. Both were fed with effiuent of an expanded bed anaerobic reactor. The system with intermittent aeration (&#952h: 6 h) shown stable, presenting high COD removal of (92%) and phosphorus removal (90%), without use of external carbon source; just with adapted recirculation of the sludge. For an average hydraulic retention time of 8 h, in the test with alternate cycles of 2 h with aeration and 4 h without aeration, it was obtained a maximum removal of P-PO4-3 equal 95% for the raw samples and 97% for the filtered samples, with average removal of 84%, and 88%, respectively. The results with intermittent aeration were significantely better in relation to the obtained with microaeration.

INTRODUÇÃO: A literatura tem postulado que a ventilação por pressão positiva não invasiva (VNI) pode facilitar o desmame de um grupo específico de pacientes. O objetivo deste estudo foi comparar a utilização da VNI como método alternativo na supressão da ventilação mecânica no pós-operatório de cirurgia cardíaca. MÉTODOS: Neste estudo prospectivo controlado e randomizado, foram estudados 100 pacientes submetidos a cirurgia de revascularização do miocárdio ou cirurgia valvar. Os pacientes foram admitidos na Unidade de Terapia Intensiva (UTI), sob ventilação mecânica e randomizados posteriormente em grupo estudo (n= 50), que utilizou VNI com dois níveis pressóricos após extubação, e grupo controle (n= 50), que utilizou a técnica convencional de supressão da ventilação mecânica. Foram analisados os tempos correspondentes à anestesia, cirurgia, circulação extracorpórea e ventilação mecânica na UTI. As variáveis gasométricas, hemodinâmicas e radiológicas foram avaliadas antes e após a extubação. RESULTADOS: Os grupos controle e estudo apresentaram comportamento semelhante quanto ao tempo de desmame ventilatório e as outras variáveis estudadas não apresentaram diferença estatística. A utilização da VNI por 30\' após a extubação, nos pacientes com atelectasias, promoveu diferença significativa na PaCO2 no grupo coronariano e na PaO2 no grupo submetido à cirurgia valvar. CONCLUSÃO: O tempo para supressão da ventilação mecânica foi similar nos grupos. Fatores extrísecos interferiram na evolução do desmame. O uso da VNI por 30 minutos após extubação apresentou diferença estatisticamente significante nas variáveis gasométricas em pacientes com atelectasias / INTRODUCTION: It was postulated that noninvasive positive pressure ventilation (NPPV) could facilitate ventilatory weaning in specific patients. The aim was to compare NPPV as alternative ventilatory weaning method with a standard ventilatory weaning protocol in the immediate postoperative period of cardiac surgery. METHODS: One hundred consecutive patients submitted to coronary artery bypass grafting or valvar surgery were addmitted in the Intensive Care Unit (ICU) and mechanicanically ventilated. They were randomly assigned to a study group (n=50) wich use NPPV witn bilevel presssure in the airways and a control group (n=50) witch used the conventional weaning thecnique. The outcome measures were anestesie, surgery, cardiopulmonar bypass and mechanical ventilation time. Arterial blood gases, hemodynamics and chest X-rays were assessed pre and post extubation. RESULTS: Weaning times were similar in both groups, and no differences were found in the studied variables. There were statistic significance considering PaCO2 in coronary and PaO2 in valvar group using NPPV 30\' after extubation, when atelectasis was detected. CONCLUSION: The ventilatory weaning time was similar in both groups. Extrinsics factors had interfered in weaning evolution. NPPV use during 30\' after extubation had statistical significance in gasometric variables in patients with athelectasis

A opção por sistemas biológicos prevalece para o tratamento do esgoto sanitário. Nas décadas recentes, sistemas que possuem regiões e/ou zonas anaeróbia, anóxica e aeróbia têm-se mostrado como alternativas atraentes para remoção simultânea de matéria orgânica, nitrogênio e fósforo. No entanto, os aspectos operacionais ainda merecem ser objeto de estudo para alcançar desempenho otimizado. Nesse cenário, com intuito de comparar alternativas para a operação das unidades de tratamento de esgoto, o presente trabalho propôs-se a estudar estratégias operacionais associadas ao monitoramento, em tempo real, sem adição de fonte externa de carbono, para um reator aerado não compartimentado com crescimento suspenso e fluxo contínuo precedido de reator anaeróbio. O sistema experimental, em escala de bancada, era constituído de um reator anaeróbio, com volume útil de 43,54 L, e reator aerado, com volume útil de 68,07 L; sendo que este era formado por sete setores, em série, sem separação física. O estudo foi dividido em duas etapas: I - estudo da variação dos volumes da região aerada e da não aerada; II - estudo da aeração intermitente com ciclo de aeração/agitação pré-fixado e controlado em tempo real por sistema informatizado. Em todas as Etapas do estudo ocorreu elevada remoção de DBO e conversão de NTK para nitrato, contudo não se conseguiu obter desnitrificação em nível desejado. O uso de reatores com setores sequenciais sem divisão física (Etapa I) dificultou a obtenção de regiões distintas predominantemente anóxica e aeróbia, comprometendo a remoção de nitrogênio (principalmente a desnitrificação). A maior eficiência média de remoção de nitrogênio alcançada no reator aerado foi de 35,6% (Etapa II), quando o reator era operado com aeração intermitente sendo o ciclo de aeração/agitação controlado em tempo real. A estratégia de operação com aeração intermitente, estudada na Etapa II, favoreceu a remoção de nitrogênio. A aeração intermitente demonstrou ser uma opção promissora comparada à aeração contínua em setores específicos do reator. O controle automatizado e informatizado em tempo real dos ciclos de aeração/agitação pode ser aplicado no aperfeiçoamento da operação dos sistemas de tratamento de esgoto sanitário. / The option of biological systems prevails for the treatment of sewage waste and in recent decades, systems that have anaerobic, anoxic, aerobic regions and / or zones have proven attractive for simultaneous removal of organic matter, nitrogen and phosphorus. However, the operational aspects still deserve to be studied in order to achieve the optimized performance of these systems. In this scenario, in order to compare alternatives for the operation of sewage treatment plants, the present work aimed to study operational strategies associated with monitoring, in real time, without the addition of external carbon source, for a non-compartmentalized aerated reactor with growth suspended and continuous flow preceded by anaerobic reactor. The experimental system in bench scale consisted of an anaerobic reactor, with a volume of 43.54 L and an aerated reactor, with a volume of 68.07 L; consisting of seven sectors, in series, without physical separation. The study was divided into two stages: I - study of the variation of the volume of the aerated and non-aerated regions; II - study of intermittent aeration with cycle of aeration/agitation controlled by a pre-fixed time interval; and controlled in real time by a computerized system. In all Stages of the study high BOD removal and conversion of TKN to nitrate occurred, but were unable to obtain denitrification at desired level. The use of reactors with sequential sectors without physical division (Stage I) made it difficult to obtain predominantly distinct anoxic and aerobic regions, compromising the removal of nitrogen (mainly the denitrification). The highest average removal efficiency of nitrogen attained in aerated reactor was 35.6% when the reactor was operated with intermittent aeration with aeration cycle controlled in real time. The operation strategy with intermittent aeration, studied in Stage II, favored the removal of nitrogen. The intermittent aeration proved to be a promising option compared to continuous aeration in specific sectors of the reactor. The automated and computerized control in real-time of the aeration / agitation cycles can be applied in improving the operation of sewage waste treatment systems.

O objetivo deste trabalho é apresentar o teste de esforço com o dinamômetro isocinético na avaliação objetiva da isquemia funcional da doença arterial oclusiva de membros superiores (DAOMS). Reuniu-se 23 pacientes com DAOMS unilateral, no grupo 1. Sete pacientes, sem DAOMS foram selecionados como o grupo controle (grupo 2). Os membros testados sem DAOMS do grupo 1 e do grupo 2 não apresentaram diferença estatística. A comparação de cada membro dos pacientes do grupo 1, com e sem DAOMS mostrou que os membros com DAOMS apresentaram desempenho significativamente menor que os membros sem lesão. Este teste permite a avaliação objetiva da limitação causada pela DAOMS de forma segura e objetiva / The objective of this work is to present the results of a stress test using an isokinetic dynamometer in patients with occlusive arterial disease in upper limbs (OADUL). Group 1 has 23 patients with unilateral subclavian occlusive disease. Seven patients, without OADUL, were included in a control group (group 2). No statistically difference was found in all parameters studied between limbs without OADUL in groups 1 and 2. So, each arm in group 1 (with and without OADUL) were tested. For all these parameters, the SOD limbs presented significantly lower values than the control limbs. This test gives an objective grade of limitation of the muscle function in patients with OADUL

Orientador: Sérgio Nascimento Bordalo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica e Instituto de Geociências / Made available in DSpace on 2018-08-22T17:35:33Z (GMT). No. of bitstreams: 1 OchoaLara_IsmaelOrlando_M.pdf: 12454353 bytes, checksum: de02a7be086b8fd068a57b93d2f5270a (MD5) Previous issue date: 2013 / Resumo: Apesar dos avanços alcançados, alguns aspectos da operação do gas-lift intermitente (GLI) convencional permanecem inexplorados ou pouco estudados até o presente, como por exemplo, a concomitância de etapas do ciclo apresentada por Carvalho (2004), ou a estabilidade de ciclos em função da temporização da válvula motora e do ajuste da válvula operadora. Ao mesmo tempo, o bombeio pneumático de Zadson (BPZ) tem apresentado bons resultados em sua aplicação em campos no Brasil, motivando-se estudos para se desenvolverem simuladores computacionais para o projeto e análise destes sistemas. Neste trabalho, foi construído um simulador físico para os métodos GLI convencional e BPZ, para validar simuladores numéricos propostos anteriormente por outros autores. O aparato laboratorial é constituído por quatro conjuntos operacionais: o primeiro conjunto representa a coluna de produção do GLI convencional, o segundo conjunto representa a coluna do BPZ, o terceiro conjunto representa o acoplamento poço-reservatório e o quarto conjunto representa a injeção de gás comprimido. Para a medição, há transdutores de pressão localizados em vários pontos do aparato e tanques de medição do volume produzido. O sistema de aquisição de dados e atuação das válvulas operadora e motora é operado por uma placa micro-controlada. Testes foram realizados alterando-se as variáveis operacionais dos métodos. Como conclusões do trabalho foram identificadas a concomitância das etapas do ciclo GLI, avaliado o fallback para várias condições operacionais, estudada a estabilidade dos ciclos de GLI, e desenhado um mapa operacional das condições de um ciclo GLI regular. Além disso, foi testado o funcionamento de três modos de operação do BPZ / Abstract: Despite the advances achieved so far, some important aspects of the operation of the conventional intermittent gas-lift (IGL) remain unexplored or poorly studied, as for instance, the concurrency of cycle stages, as presented by Carvalho (2004), or the stability of cycles due to motor valve timing and adjustment of the gas-lift valve. At the same time, the Zadson pneumatic pump (ZPP) has presented good results in Brazilian fields, motivating studies to develop computational simulators for the design of this method. In the course of the present work, a physical simulator was built for the IGL and ZPP, to validate numerical simulators proposed by previous authors. The laboratory apparatus consists of four operational sets; the first set is the production column of conventional IGL, the second set is the column of ZPP, the third set represents the well-reservoir coupling and the fourth set is the injection of compressed gas. For measurement, there are pressure transducers located at various points of the apparatus and tanks for measuring the produced volume. The system of data acquisition and actuation of gas-lift and motor valves are operated by a microcontroller board. Tests were performed by changing the operating variables of the gas lift methods. The results of the study are: the identification of the concurrent stages during the IGL cycle, the fallback for various operating conditions, the stability of IGL cycles, and an operating map for the conditions of a stable IGL cycle. In addition, the operation of three lifting modes of the ZPP were tested / Mestrado / Explotação / Mestre em Ciências e Engenharia de Petróleo

La pandémie de maladies cardiovasculaires, actuellement en hausse, pose un problème majeur de santé publique. Malgré les progrès remarquables de la médecine au cours des précédentes décennies, les maladies cardiovasculaires constituent à l’heure actuelle la première cause de mortalité et de morbidité dans le monde. Parmi ces maladies, l’insuffisance cardiaque occupe une place assez importante. Les recherches réalisées au cours de ces dernières années ont permis d’établir que de nombreux facteurs de risque cardiovasculaire comme l’hypertension artérielle, le diabète, l’hyperlipidémie, l’obésité et le tabagisme s’accompagnent d’une dysfonction endothéliale précoce, caractérisée par la diminution de la biodisponibilité du monoxyde d’azote, et d’une rigidité artérielle. La DE semble être le dénominateur commun aux lésions microvasculaires, résultant d’une augmentation du stress oxydatif et d’une activation des voies de l’inflammation. Les conséquences fonctionnelles de ces lésions sont une altération de la capacité de la vasodilatation en réponse aux stimuli physiologiques, une augmentation de la rigidité artérielle et une ischémie tissulaire relative.Pour ce faire, nous avons étudié l’effet des différents facteurs affectant la fonction endothéliale microvasculaire et la biodisponibilité endothéliale du NO chez le sujet sain et pathologique, à l’aide d’une technique non invasive et reproductible appelée « laser Doppler imaging ».Nous avons dès lors démontré que le jeûne intermittent améliore la fonction endothéliale microvasculaire, produit une augmentation de la biodisponibilité du NO chez des sujets masculins en surcharge pondérale par rapport au groupe contrôle, de même qu’il exerce un effet favorable sur la tension artérielle et les paramètres biologiques.Dans un deuxième temps, nous avons examiné les effets des assistances ventriculaires à flux continu centrifuge sur les patients insuffisants cardiaques au stade terminal. Ainsi, nous avons pu montré que ces pompes, n’altèrent pas la dysfonction endothéliale existante chez les patients non assistés, et qu’elles sont respectueuses de la production du vWF, et permettent ainsi de diminuer l’incidence des hémorragies sans pour autant induire de thromboses. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Abstract Community assembly results from a combination of deterministic and stochastic mechanisms, whose relative effects can vary in response to environmental heterogeneity, connectivity, disturbance regimes and anthropogenic stressors. Understanding how community assembly mechanisms vary in response to environmental changes and connectivity is crucial for the management and conservation of river ecosystems. In this thesis, I tested the effects of connectivity and natural flow disturbances on riverine invertebrate communities by assessing assembly mechanism changes in response to (I) habitat connectivity, (II) seasonal flow intermittency and (III) inter–annual hydrological variability. I also conducted a field experiment to test for (IV) the effects of human–induced nutrient enrichment on community assembly of microorganisms (diatoms and aquatic fungi) and stream ecosystem functioning under different environmental settings. Invertebrate community assembly changed gradually with habitat connectivity. While limited dispersal resulted in higher community variability in the most isolated streams, mass effects caused community homogenization in the most connected ones. Natural and human induced disturbances lead to changes in the relative importance of deterministic and stochastic factors but often through different, or even opposite, mechanisms depending on the natural background of the ecosystem and organism type considered. For instance, seasonal drying and high–flow periods in intermittent Mediterranean rivers promoted deterministic and stochastic assembly processes respectively, whereas environmental sorting and stochastic processes respectively dominated during high and low flow years in boreal streams. Diatom and fungal communities responded differently to nutrient enrichment, with detrital processes and fungal communities responding more in naturally acidic than in circumneutral streams. The results of this thesis highlight the complexity of community assembly mechanisms: they tend to be highly context dependent and temporally variable. Therefore, stream bioassessment and conservation will benefit from explicitly incorporating connectivity and natural disturbance regimes. Assessing the interactive effects of connectivity and disturbances at the river network scale would provide a greater understanding of community assembly mechanisms and river ecosystem functioning. / Tiivistelmä Eliöyhteisöjen koostumus heijastelee determinististen ja stokastisten mekanismien vuorovaikutusta. Niiden suhteellinen merkitys vaihtelee suhteessa yhteisöjen kytkeytyneisyyteen sekä luontaisiin ja ihmisen aiheuttamiin häiriöihin. Yhteisöjen säätelymekanismit vaihtelevat jokiverkoston eri osissa ja tietoa tästä vaihtelusta tarvitaan jokiekosysteemien hoidon kehittämiseksi. Tässä tutkielmassa testasin elinympäristöjen kytkeytyneisyyden ja luontaisten häiriöiden (virtaamavaihtelut) vaikutuksia jokien selkärangatonyhteisöihin. Suoritin myös kenttäkokeen, jossa testattiin ihmisen aiheuttaman rehevöitymisen vaikutuksia mikro–organismeihin (piilevät, mikrobit) ja ekosysteemitoimintoihin erilaisissa ympäristöoloissa (luontaisesti happamat vs. neutraalit purot). Selkärangattomien yhteisökoostumus muuttui asteittain jokiverkostossa. Yhteisökoostumuksen vaihtelu oli suurinta eristäytyneimmissä latvapuroissa, kun taas isommissa, uomaston keskivaiheilla sijaitsevissa koskissa voimakas levittäytyminen eri suunnista (ns. massatekijät) aiheutti yhteisöjen rakenteen homogenisoitumista. Kuivuusjaksot ja niitä seuraavat korkean virtaaman jaksot edistivät determinististen prosessien merkitystä Välimeren alueen joissa, kun taas boreaalisissa puroissa Pohjois–Suomessa äärevät virtaamaolot, erityisesti poikkeuksellisen kuivat kesät, edistivät satunnaismekanismien vaikutusta. Perustuottajat (piilevät) ja hajottajat (akvaattiset sienet) vastasivat eri tavoin ravinnelisäykseen. Sienten hajotustoiminta nopeutui ravinnelisäyksen myötä, mutta vain luontaisesti happamissa puroissa. Tämän opinnäytetyön tulokset korostavat yhteisön kokoonpanomekanismien monimutkaisuutta: ne ovat usein erittäin tilanneriippuvaisia ja ajallisesti vaihtelevia. Siksi jokien ekologisen tilan arvioinnissa tulisi huomioida tutkimuspaikkojen kytkeytyneisyys jokimaisemassa.

Background: The prevalence of diabetes and obesity has been on the rise for many years and the search for new and effective dietetic solutions aiming at reducing calories, reducing body mass and improving diabetes has been ongoing. Currently, the intermittent fasting diet - the practice of alternating periods of eating and fasting - is gaining popularity. One of them is Time-restricted feeding (TRF), which time-limits energy intake within a defined window of time up to 10 hours per day without necessarily altering diet quality or quantity. A reduction in calorie intake, bodyweight, blood pressure, oxidative stress, inflammation biomarkers and triglycerides are evident with TRF studies conducted so far. Aim: The aim of the thesis is to investigate the effects of time-restricted feeding on glycemic biomarkers in human studies. Methods: A literature study is conducted with six chosen experimental studies which are primarily randomized controlled trials or randomized crossover trials with a TRF window of maximum 10 hours per day and predominantly with participants with overweight/obesity, prediabetes, type 2 diabetes and metabolic syndrome. Results: Compared to either baseline and/or control group, fasting glucose was reduced in 3 out of 6 TRF studies, while fasting insulin was reduced in 3 out of 5 TRF studies and HbA1C was decreased in 1 out of 2 TRF studies. For postprandial response, 1 out of 2 TRF studies found a reduction in glucose and likewise for insulin. Mean glucose levels were reduced in 1 out of 3 TRF studies. Insulin resistance was reduced in 3 out of 4 TRF studies while insulin sensitivity was reduced in the one study measuring this. Beta cell function improved in 2 out of 2 TRF studies compared to the control group or baseline. Conclusion: There are indications that TRF has an effect on glycemic biomarkers and thus potentially being able to reduce the risk and/or improve the treatment of type 2 diabetes. But in order to give a more definite answer more studies need to be conducted. In general, these studies should preferably have more participants and be methodologically stronger when it e.g. comes to the control of the dietary regimen.

Cette étude s’intéresse à la conception systémique intégrant simultanément les questions de dimensionnement et de gestion optimale de l'énergie. Le système étudié concerne un procédé de pompage intégrant un processus de dessalement d’eaux saumâtres alimenté par des sources de puissance hybrides renouvelable incluant un minimum de stockage électrochimique. Ce cas d’étude appartient à une classe typique de systèmes autonomes alimentés par des sources intermittentes dont profil de puissance a une forme "donnée" : « selon les conditions climatiques (ensoleillement, vent), avec un minimum de stockage d’électricité, la puissance offerte doit être convertie ou stockée hydrauliquement sous peine d’être gaspillée ». L'influence des conditions d'environnement et la robustesse du processus d’optimisation est enfin aussi discutée dans cette thèse. Deux types de modèles mathématiques, dynamiques et quasi-statiques, sont mis en œuvre pour décrire l'ensemble du dispositif. Le système est tout d’abord modélisé dynamiquement par Bond Graphs. Pour une simulation plus rapide, plus adaptée à l’optimisation globale du système, un modèle quasi-statique est créé pour être simulé dans l'environnement Matlab. Pour de tels dispositifs, étant donné une certaine puissance offerte au fil du vent et du soleil, trouver le point optimal de fonctionnement à chaque période consiste en un partage de puissance entre les sous systèmes de pompage et de traitement de l’eau : ce processus est plutôt complexe compte tenu des non linéarités (courbes rendement – puissance) et de la présence de nombreuses contraintes relatives aux limitations de puissance des pompes, aux conditions de niveau des réservoirs, ainsi qu’aux limitations de pression et de débit dans les processus hydrauliques (pompes osmoseur). Nous montrerons qu’il n’est pas si trivial de choisir une fonction objectif qui assure simultanément la performance et la robuste du système vis-à-vis des conditions d’environnement : une fonction objectif robuste quel que soit le profil de puissance des sources est ainsi proposée pour mettre en œuvre une gestion optimale de l’énergie. Le problème d’optimisation étant posé sous forme standard, consistant en la maximisation d’une fonction objectif sous contraintes, des approches d’optimisation efficaces par programmation non linéaire sont employées. La question du dimensionnement et son couplage à la gestion énergétique est finalement étudiée. En particulier, l’intérêt de la modularité des systèmes, considérant plusieurs pompes connectées en parallèle pour la même fonction, est investigué. / This study focuses on systemic design, integrating simultaneously issues of sizing and optimal energy management. The system under study consists of a pumping process including a brackish water desalination system fed by hybrid renewable power sources with minimum electrochemical storage. Such a device belongs to the class of “autonomous systems” supplied by intermittent sources whose power profile has a “given” waveform: “with minimum electrical storage, power has to be converted, stored in water tanks, or wasted following climatic (sun, wind) conditions”. Influence of environment conditions and robustness of the optimization process is then also discussed in this thesis. Both dynamic and quasi static models are implemented for representing the whole system. The device is firstly modeled dynamically by Bond Graph methodology. For faster simulations, which are more suitable for system optimization, a quasi static model is created to be simulated in the Matlab environment. For such systems, given a certain source power, finding optimal operation point at each period consists of a power sharing between all pumping devices: it is a complex process with huge nonlinearities (efficiency vs power curves) and with many constraints as for the limitation of pump powers, tank level conditions, or pressure and flow limitations in hydraulic network and pumping devices. It is not so trivial to define an objective function which ensures system performance and robustness versus environment conditions: a convenient objective function, whatever the input power profile, is then proposed to implement the optimal management. The optimization problem being mathematically expressed, consisting of objective function maximization under constraints, efficient optimization methods by non linear programming are implemented. The issue of sizing and its coupling with system management efficiency is finally studied. In particular, the interest of modular operation with several pumps connected in parallel is also concerned in this research.