Ce projet de recherche envisage la construction de l’histoire du réseau mondial de surveillance de la grippe de l’OMS à partir de sa création en 1947 et jusqu'à présent. La problématique est divisée en cinq axes. Le premier porte sur l’étude de la mise en place et de l’évolution du réseau en soulignant son rôle de programme global de santé publique dans la prévention et le contrôle des épidémies et des pandémies grippales. Le deuxième analyse le réseau en tant que programme innovateur et en évolution constante devant faire face aux urgences de santé publique imposées par l’émergence continue des nouveaux virus et par les pandémies et les menaces des pandémies grippales. Le troisième examine la puissance et les limites du réseau du point de vue de la globalisation et de son effectivité comme système de surveillance. Le quatrième étudie les enjeux concernant la relation entre ce réseau et la production des vaccins contre la grippe pandémique et saisonnière. Le cinquième traite des problèmes concernant la circulation des souches virales, des savoirs et des techniques au sein du réseau mondial de surveillance de la grippe. Mots-clés : grippe, surveillance, innovation, circulation, santé publique, vaccins, OMS / This dissertation traces the history of the WHO global influenza surveillance network between 1947 and 1997. This international public health system is responsible for the continuous monitoring of influenza virus mutations and the transfer of strains to the pharmaceutical industry for the production of vaccines. This story explores the various strategies employed by WHO in order to ensure the constitution and the globalization of the influenza network: development, standardization and dissemination of laboratory techniques and epidemiological surveillance methods; production and free distribution of reagents; certification and dissemination of scientific and epidemiological information on influenza; development of regulatory standards concerning the circulation and sharing of strains, epidemiological information and knowledge inside and outside of the influenza surveillance network. This analysis addresses the relationship between science, economics and international politics involved in the creation and the growth of this program. Furthermore, this story examines the challenges posed by the globalization of the influenza surveillance system, including the difficulties faced by developing countries – not producing influenza vaccine – to collaborate in the influenza surveillance. The involvement of WHO into the regulation of the production and the control of influenza vaccine and the relationship established by WHO with the industries producing the vaccine is also considered in the present study.

Made available in DSpace on 2014-06-12T22:57:42Z (GMT). No. of bitstreams: 2 arquivo3045_1.pdf: 893604 bytes, checksum: dcb29f02762a14a1b36ddf5bdf7632cb (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2011 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A desnutrição grave diminui a imunocompetência e com isso, aumenta a mortalidade infantil. Com o intuito de minimizar a morbimortalidade hospitalar, a OMS publicou diretrizes específicas para o tratamento de crianças com desnutrição grave. Portanto, supõe-se que na alta hospitalar os pacientes apresentem melhora da resposta imunológica. Esta dissertação originou o artigo intitulado Resposta imune de crianças desnutridas graves tratadas segundo o protocolo da OMS na fase hospitalar, atualmente submetido para publicação, e que está apresentado às páginas 25-42. O objetivo foi comparar reposta imune inata de crianças desnutridas graves internadas, tratadas segundo o protocolo da OMS, no momento da admissão e alta hospitalar. Para tal, foi realizado estudo experimental realizado com crianças menores de dois anos de idade, sendo 10 com desnutrição grave, e 10 crianças do grupo controle. O grupo desnutrido foi composto por pacientes internados no Instituto Materno Infantil Professor Fernando Figueira (IMIP) e submetidas ao protocolo da OMS. Foram excluídas as crianças portadoras do vírus HIV e aquelas reinternadas no período do estudo. Foi coletada uma amostra sanguínea na admissão e outra na alta hospitalar, sendo realizada análise do perfil leucocitário, índice de aderência, capacidade fagocitária e a produção de radicais livres (superóxido e óxido nítrico). Os pacientes com desnutrição grave apresentaram na admissão redução significativa da atividade fagocítica e produção de radicais oxidantes. Na alta hospitalar, foi observado melhora da função fagocitária e da liberação de óxido nítrico e superóxido, em relação à admissão hospitalar (p<0,005), entretanto, quando comparados ao grupo controle, os pacientes apresentaram valores reduzidos de linfócitos, assim como diminuição na produção de radicais livres. A partir destes resultados, foi observado que o tempo de hospitalização mostrou-se eficaz em restabelecer a atividade fagocitária, porém insuficiente em restaurar a atividade microbicida e o número de linfócitos

Dans la première partie de mon travail, j'ai préparé quatre catalyseurs différents à base d'oxydes de manganèse: une perovskite (LaMnO3), par voie sol-gel; un oxide simple (Mn2O3), par méthode rapide et un tamis moléculaire octahedrique (OMS-2) par deux méthodes de préparation différentes, via l'état solide (OMS) et la méthode hydrothermale (OMSh). Les propriétés physicochimiques de ces catalyseurs ont été caractérisées par diffraction des rayons X (DRX), adsorption-désorption de N2, analyses thermogravimétriques (ATD/ATG), analyses chimiques (ICP-OES) et réduction en température programmée (H2-RTP). Leurs performances catalytiques ont été évaluées dans la réaction d’oxydation du toluène. Trois cycles catalytiques consécutifs ont été réalisés pour chaque catalyseur afin de confirmer les performances. Afin d'évaluer la stabilité des catalyseurs dans des conditions réactionnelles, les performances catalytiques ont été étudiées sur des expériences de longue durée à température constante, pendant 24 h à 25% de conversion du toluène. Des tests d'oxydation du toluène sur un catalyseur de référence, type Pd/Al2O3 contenant 0,78% en poids de Pd, ont également été effectués à des fins de comparaison. Les caractéristiques cristallines détectées dans les modèles DRX sont bien compatibles avec la formation des structures désirées. Sur la base de leur surface spécifique et de leur réductibilité à basse température, les catalyseurs ont été classés comme suit : OMSs > Mn2O3 > OMS > LaMnO3. Cette tendance est en bon accord avec les performances observées dans l'élimination catalytique du toluène. Un modèle cinétique a été proposé et un bon accord a été obtenu lors de l'ajustement avec les données expérimentales. Dans la seconde partie de mon travail, des catalyseurs LaMnO3 (LM) avec un rapport molaire acide citrique (CA) sur nitrates métalliques (Mn et La) allant de 0,5 à 2 (LM 0,5 à LM 2) ont été synthétisés par méthode sol-gel citrate, afin d'étudier l'effet du rapport de l'acide citrique sur les propriétés physico-chimiques et les performances catalytiques. Les propriétés physicochimiques de ces catalyseurs ont été caractérisées par diffraction des rayons X (DRX), adsorption-désorption de N2 et par spectroscopie d'émission atomique de plasma à couplage inductif (ICP-AES). Sur des échantillons sélectionnés, des caractérisations supplémentaires par analyse thermogravimétrique et thermique différentielle (ATD/ATG), une réduction programmée en température par de l'hydrogène (H2-TPR) et une spectroscopie de photoélectrons X (XPS) ont été réalisées. Les résultats montrent que le rapport molaire acide citrique sur nitrates métalliques influence significativement le profil obtenu en ATD/ATG des solides non calcinés ainsi que les propriétés physico-chimiques des catalyseurs. Les caractéristiques cristallines détectées par DRX sont bien compatibles avec la formation de la phase perovskite LaMnO3. De petites caractéristiques de Mn2O3 ont été détectées dans les diagrammes de diffraction de tous les catalyseurs LM, à l'exception du rapport molaire élevé des nitrates CA / (Mn + La) (1,9 et 2,0). Inversement, des pics La2O3 sont observés pour des valeurs allant de 1,6 à 2, l'intensité la plus élevée étant détectée au rapport molaire égal à 2. Les performances catalytiques ont été évaluées dans l'oxydation du toluène en réalisant trois cycles catalytiques consécutifs pour atteindre des performances stables. Afin d'évaluer la stabilité des catalyseurs dans des conditions de réaction, des expériences à température constante ont été effectuées pendant 24 h à 17% de conversion du toluène. Les catalyseurs LM1.2, LM1.3 et LM1.5 ont montré les meilleures performances catalytiques en oxydation totale du toluène, tandis que LM1 et LM1.7 présentaient un comportement intermédiaire et LM0.8 était peu actif / In the first part of my work, I have prepared four different catalysts based on manganese oxides: a perovskite (LaMnO3), via sol-gel method; a simple oxide (Mn2O3), by rapid method and an Octahedral Molecular Sieve (OMS-2) by two different preparation methods, via solid state (OMSs) and hydrothermal method (OMSh). The physicochemical properties of these catalysts were characterized by X-ray diffraction (XRD), N2 adsorption–desorption, TGA/DTA, ICP-OES and H2-TPR. Their catalytic performances were evaluated in the oxidation of toluene. Three consecutive catalytic cycles were performed for each catalyst in order to reach steady state performances. In order to assess the stability of the catalysts under reaction conditions, the catalytic performances were studied upon long-term experiments running for 24 h at 25% of toluene conversion. Tests of toluene oxidation over a typical industrial catalyst, such as a commercial Pd/Al2O3 catalyst containing 0.78 wt% Pd, were also performed for comparison purposes. The crystalline features detected in the XRD patterns are well consistent with the formation of the desired structures. Based on their specific surface area and their low-temperature reducibility, the catalysts were ranked as follows: OMSs> Mn2O3> OMSh> LaMnO3. This trend was in good agreement with the performances observed in the catalytic removal of toluene. A kinetic model was proposed and a good agreement was obtained upon fitting with the experimental data. In the second part of my work, LaMnO3 (LM) catalysts with molar ratio of citric acid (CA) to metal nitrates (Mn and La) ranging from 0.5 to 2 (LM 0.5 to LM 2) were synthesized by citrate sol–gel method, in order to study effect of citric acid ratio on the physico-chemical properties and the catalytic performances. The physicochemical properties of these catalysts were characterized by X-ray diffraction (XRD), N2 adsorption–desorption and by inductively coupled plasma atomic emission spectroscopy (ICP-AES). Over selected samples, additional characterizations by thermogravimetric and differential thermal analysis (TGA/DTA), temperature-programmed reduction by hydrogen (H2-TPR) and X-ray photoelectron spectroscopy (XPS) were carried out. The results show that the molar ratio of citric acid to metal nitrates significantly influenced the TGA/DTA profile of gels along with the physico-chemical properties of the catalysts. The crystalline features detected by XRD are well consistent with the formation of LaMnO3 perovskite phase. Small features of Mn2O3 were detected in the diffraction patterns of all LM catalysts except for high CA/Mn+La nitrates molar ratio (1.9 and 2.0). Conversely, La2O3 peaks appeared for values ranging from 1.6 to 2, the highest intensity being detected at molar ratio equal to 2. The catalytic performances were evaluated in the oxidation of toluene, performing three consecutive catalytic cycles in order to reach steady-state performances. In order to assess the stability of the catalysts under reaction conditions, long-term experiments running for 24 h at 17 % of toluene conversion were carried out. The catalysts LM1.2, LM1.3 and LM1.5 showed the best catalytic performances in terms of toluene conversion, LM0.8 was poor performing, while LM1 and LM1.7 exhibited an intermediate behaviour

Os riscos de poluição ao meio ambiente envolvendo petróleo envolvem, não só o seu transporte, como também seu refino. O prejuízo causado por um derramamento de petróleo vai além de danos à fauna e flora, pois envolvem também questões sociais. A emissão de óxidos de enxofre, denominadas SOx, durante o refino de petróleo através do craqueamento catalítico em leito fluidizado (FCC) também é uma das preocupações ambientais, já que esses óxidos estão relacionados com o a formação de chuva ácida e problemas respiratórios. Os hidrocarbonetos provenientes de um derramamento podem ser degradados em produtos menos agressivos ao meio ambiente, por oxidação química, por exemplo. Já as emissões de enxofre na unidade de FCC podem ser minimizadas por diversos processos, como por exemplo, o uso de aditivos nas unidades de FCC. Nesse trabalho óxidos de manganês dos tipos OMS-1 e OMS-2 foram sintetizados em presença e ausência de biomassa e óxidos OMS-2 foram dopados com os metais cobre, vanádio e ferro. Possíveis alterações em suas propriedades, suas atividades catalíticas em oxidação de hidrocarbonetos e em testes de captura de enxofre em condições de temperatura similares à unidade de FCC foram investigadas. Constatou-se uma diminuição na área superficial, tamanho e volume de poros nos óxidos sintetizados em presença de biomassa, através de uma análise de adsorção e dessorção de N2 (ASAP), porém seus difratogramas em uma análise de difração de raio X de pó (DRX) revelaram a obtenção de estruturas do criptomelano em todos os OMS-2. Os óxidos OMS-2 testados na oxidação do cicloexano, não sofreram modificações em sua estrutura após seu uso como catalisador, mas a presença da biomassa na síntese não aumentou sua atividade catalítica. Nos testes DeSOx, o óxido dopado com ferro apresentou o melhor desempenho e testes em ciclos mostraram ser possível sua reutilização / The risk of pollution to the environment involving oil involve not only the transport, as well as its refining. The damage caused by an oil spill goes beyond damage to fauna and flora, they also involve social issues. The emission of sulfur oxides, SOx called during the refining of oil through the fluidized catalytic cracking (FCC) is also an environmental concern, since these oxides are related to the the formation of acid rain and respiratory problems. The hydrocarbons from a spill can be degraded into less harmful products for the environment by chemical oxidation, for example. Since sulfur emissions in the FCC unit can be minimized by various methods, for example, the use of additives in FCC units. In this work manganese oxides types of OMS-1 and OMS-2 are synthesized in the presence and absence of biomass and OMS-2 oxide was doped with the metals copper, vanadium and iron. Possible changes in their properties, their catalytic activities in the oxidation of hydrocarbons and sulfur capture in conditions similar to the FCC unit were investigated temperature tests. Found a decrease in the surface, size and volume of pores in the oxides synthesized in the presence of biomass area, through an analysis of N2 adsorption and desorption (ASAP), but their diffraction patterns on an analysis of X-ray diffraction powder (XRD) revealed the structures of obtaining criptomelano in all OMS-2. The OMS-2 oxides tested in the oxidation of cyclohexane, have not changed in its structure following its use as a catalyst, but the presence of biomass synthesis did not increase its catalytic activity. In Desox tests, the iron oxide doped showed the best performance and testing cycles proved possible reuse

Os riscos de poluição ao meio ambiente envolvendo petróleo envolvem, não só o seu transporte, como também seu refino. O prejuízo causado por um derramamento de petróleo vai além de danos à fauna e flora, pois envolvem também questões sociais. A emissão de óxidos de enxofre, denominadas SOx, durante o refino de petróleo através do craqueamento catalítico em leito fluidizado (FCC) também é uma das preocupações ambientais, já que esses óxidos estão relacionados com o a formação de chuva ácida e problemas respiratórios. Os hidrocarbonetos provenientes de um derramamento podem ser degradados em produtos menos agressivos ao meio ambiente, por oxidação química, por exemplo. Já as emissões de enxofre na unidade de FCC podem ser minimizadas por diversos processos, como por exemplo, o uso de aditivos nas unidades de FCC. Nesse trabalho óxidos de manganês dos tipos OMS-1 e OMS-2 foram sintetizados em presença e ausência de biomassa e óxidos OMS-2 foram dopados com os metais cobre, vanádio e ferro. Possíveis alterações em suas propriedades, suas atividades catalíticas em oxidação de hidrocarbonetos e em testes de captura de enxofre em condições de temperatura similares à unidade de FCC foram investigadas. Constatou-se uma diminuição na área superficial, tamanho e volume de poros nos óxidos sintetizados em presença de biomassa, através de uma análise de adsorção e dessorção de N2 (ASAP), porém seus difratogramas em uma análise de difração de raio X de pó (DRX) revelaram a obtenção de estruturas do criptomelano em todos os OMS-2. Os óxidos OMS-2 testados na oxidação do cicloexano, não sofreram modificações em sua estrutura após seu uso como catalisador, mas a presença da biomassa na síntese não aumentou sua atividade catalítica. Nos testes DeSOx, o óxido dopado com ferro apresentou o melhor desempenho e testes em ciclos mostraram ser possível sua reutilização / The risk of pollution to the environment involving oil involve not only the transport, as well as its refining. The damage caused by an oil spill goes beyond damage to fauna and flora, they also involve social issues. The emission of sulfur oxides, SOx called during the refining of oil through the fluidized catalytic cracking (FCC) is also an environmental concern, since these oxides are related to the the formation of acid rain and respiratory problems. The hydrocarbons from a spill can be degraded into less harmful products for the environment by chemical oxidation, for example. Since sulfur emissions in the FCC unit can be minimized by various methods, for example, the use of additives in FCC units. In this work manganese oxides types of OMS-1 and OMS-2 are synthesized in the presence and absence of biomass and OMS-2 oxide was doped with the metals copper, vanadium and iron. Possible changes in their properties, their catalytic activities in the oxidation of hydrocarbons and sulfur capture in conditions similar to the FCC unit were investigated temperature tests. Found a decrease in the surface, size and volume of pores in the oxides synthesized in the presence of biomass area, through an analysis of N2 adsorption and desorption (ASAP), but their diffraction patterns on an analysis of X-ray diffraction powder (XRD) revealed the structures of obtaining criptomelano in all OMS-2. The OMS-2 oxides tested in the oxidation of cyclohexane, have not changed in its structure following its use as a catalyst, but the presence of biomass synthesis did not increase its catalytic activity. In Desox tests, the iron oxide doped showed the best performance and testing cycles proved possible reuse

After the seminal works by Freeze and Harlan (1969), the scientific community realized that groundwater and vadose zone equation were breaking up. Hydrologists split into three communities following the motto “you are my boundary condition”: groundwater people, vadose zone scientists and surface water hydrologists. This compartmentalization of the scientific community fostered a deepening of knowledge in single branches, allowing to break things down into simple parts. However, this division represented an obstacle to the comprehension of the complexity that characterises the interactions between them. Eventually, this separation of the communities continued into software code. As a matter of fact, the boundary conditions were hard-wired, but they offered a poor representation of the physics in the interaction between different domains. Recently, there has been a renewed interest in studying the big picture, the interactions between different domains. This it is evident in the development of a new research field named the Earth’s Critical Zone (CZ). It is defined as the “ heterogeneous, near surface environment in which complex interactions involving rock, soil, water, air, and living organism regulate the natural habitat and determine the availability of life-sustaining resources” (National Research Council, 2001). Further interest in the studying the CZ is given by the ever-increasing pressure due to the growth in human population, wealth, and climatic changes. This thesis focuses on the CZ while recognising the central role of having a solid set of tools for modeling the water movements in all conditions. Recently, Prentice et al. (2015) identified Reliable, Robust, and Realistic, the three R’s, as the three characteristics that numerical models should have. Soil moisture is one of the key components to simulate the processes in the critical zone. The governing equation to describe the water flow in a porous material is know as the Richards equation and it dates back to 1931.The numerical solution of the Richards equation is far from trivial because of its mildly nonlinearity and it is often discarded in favour of more empirical models. After the pioneering work by Celia et al. (1990), a lot of work has been done in this direction and several model, for instance Hydrus, GEOtop, Cathy, Parflow adopted variants of the Newton algorithm to allows global convergence. Since Casulli and Zanolli (2010), anticipated by Brugnano and Casulli (2008), a new method called nested Newton has been found to guarantee convergence in any situation, even under the use of large time steps and grid sizes. The research presented in this thesis used this integration algorithm. Besides the numerical aspect, another issue was the correct definition of the boundary condition at the soil surface. As a matter of fact, the definition of the surface boundary condition is necessary to capture the generation of surface run-off. In the literature several approaches were proposed to couple surface and subsurface flow, and in this work the approach presented by Gugole (2016) has been used. The novelty regarded the discretization of the shallow water equation and the Richards equation in an unique algebraic system that was solved in a conservative manner. Richards equation was criticized from many points of view, but it is difficult to criticize its core mass conservation. The definition of the hydraulic properties of the soil, including both the soil water retention function (SWRC) and the hydraulic conductivity models, often uses simplified representation of the pore system describing it as bundle of cylindrical capillaries where the largest ones drain first and are filled last. As pointed out by Bachmann et al. (2002), “physical effects, like surface water film adsorption, capillary condensation and surface flow in liquid films, as well as volumetric changes of the pore space are often ignored”. Thus, the capillary bundle concept is a rough, even if still useful approximation of soil reality. From these observations, during the research the code has been designed to offer the opportunity to easily implement new soil water hydraulic models that might be proposed in the future. The Richards’ equation alone is not anymore sufficient to model the water flow in soils. In fact, soil temperature affects the water flow in soils. This is evident in cold regions where soil water is subject to freezing and thawing processes, but also in unfrozen soil, where temperature modifies water properties such as viscosity, the surface tension, and the contact angle. These microscopic variations of the water physical properties have significant impacts in the mass and energy budget within the CZ. For instance, it has been observed that the infiltration rates between the stream and the vadose zone show a clear diurnal pattern: infiltration rates are highest in late afternoon, when stream temperature is greatest, and they are lowest in early morning when stream temperature is least. In cold regions the run-off production is strongly affected by the presence of ice with the soil. Nonetheless, soil moisture modifies the thermal properties of the soil: water is characterised by a high thermal inertia and the thermal conductivity of ice is almost four times larger than that of liquid water, and water flow carries a significant amount of sensible heat. These aspects come under one the R of realistic. Hence, the Richards’ equation has been coupled with the energy equation for the unfrozen case. Moreover, the research developed a model to study the heat transfer considering the phase change of water. In both cases robust numerical schemes have been used. There are few models that already coupled the equations. One of these models is GEOtop that was conceived and built in the research group where this work was carried out. Such models have some limitations. One of the main limitations regards their implementations. In fact, these models were built as a monolithic code and this turns in difficulties in maintaining and developing existing codes. In this work the codes have been developed by using Design Patterns. As a result, the codes are easy to maintain, to extend, and to reuse. Considering the CZ, these aspects are of crucial importance. Researchers should have a model that can be extended to include more processes, i.e. increase its complexity and avoiding the code to become too complicated. The models were integrated in the Object Modelling System v3 (OMS3) framework. The system provides various components for precipitation treatment, radiation estimation in complex terrain, evaporation and transpiration that can be connected to each other’s for generating inputs and outputs. Due to the modularity of the system, whilst the components were developed and can be enhanced independently, they can be seamlessly used at run time by connecting them with the OMS3 DSL language based on Groovy. OMS3 provides the basic services and, among them, tools for calibration and implicit parallelization of component runs. In sum, the thesis analyses the relevant literature to date. It presents a detailed description of the physical processes related to the water flow and the energy budget within the soil. Then, it describes the numerical method used to solve and coupled the equations. It also provides the informatics behind WHETGEO 1D (Water HEat Tracers in GEOframe). Finally, the work focuses on the WHETGEO extension for the bidimensional case by showing how the code can be designed to store grid information.

A síndrome mielodisplásica primária (SMD) compreende um grupo de doenças hematopoéticas clonal de célula tronco pluripotente cacacterizada por vários graus de pancitopenia e alterações morfológica das células hematopoeticas e risco aumentado de transformação para leucemia mielóide aguda. A citogenética e a morfologia da medula óssea desempenham um papel fundamental para o diagnóstico e o prognóstico desses pacientes. Alterações cromossômicas são encontradas em aproximadamente 30-50% dos casos. Devido à importância da análise desses fatores para escolha terapêutica, torna-se necessário definir as alterações morfológicas e citogenéticas que possam contribuir para o prognóstico. Esse trabalho visa correlacionar as características morfológicas e citogenéticas da medula óssea em pacientes com SMD primária com as classificações OMS e FAB e com o IPSS. Foram estudados 32 pacientes com SMD primária diagnosticados entre 2000 e 2009 no HUPE-UERJ. As características clínicas foram analisadas através do levantamento de prontuários. A análise citogenética foi feita pela técnica de bandeamento GTG em células da medula ossea. A análise morfológica da biópsia de medula óssea e do mielograma foram realizadas através da revisão de lâminas. Vinte e três pacientes foram classificados em estágios iniciais da doença (22 AR, 1 ARSA) e 9 em estágio avançado AREB de acordo com a FAB. Alterações cromossômicas foram detectadas em 16 pacientes (50%). As mais frequentes foram: del(11)(q23) e del(17p). Dos pacientes com doença avançada, seis (66%) apresentaram aumento significativo da relação M:E (p=0,003) e sete (77%) possuíam alterações arquiteturais acentuadas (p<0,001) em comparação ao grupo de doença inicial. Pacientes classificados como intermediário 2 e alto risco pelo IPSS tiveram importante perda arquitetural (p<0,001), número significativamente maior de micromegacariócitos (p=0,017) e seis (85%) sofreram transformação leucêmica (p=0,006). ALIP foi significantemente aumentada nos pacientes de pior prognóstico (p=0,0 1) e naqueles com doença avançada (p=0,001). Nossos resultados apresentaram implicações potenciais para o diagnóstico e o prognóstico da SMD primária. As alterações morfológicas foram associadas com as classificações FAB, OMS e com os grupos de risco segundo o IPSS. / The primary myelodysplastic syndrome (MDS) comprises a heterogeneous group of clonal bone marrow disorders characterized by varying degrees of pancytopenia and morphological abnormalities of hematopoietic cells, and an increased risk of transformation into acute myeloid leukemia. The morphology and the cytogenetic of bone marrow play a key role in the diagnosis and the prognosis. Chromosomal abnormalities are found in 30-50% of cases. Due to the importance of analyzing these factors for therapeutic choice, it becomes necessary to define the morphological and the cytogenetic changes which could contribute to the prognosis.The aim of this study was to analyze the morphological and cytogenetic features of bone marrow and their correlations with FAB and WHO clasification and IPSS. We studied 32 patients with primary MDS between 2000 - 2009. The clinical data was recovered from medical records. Morphological characteristics were analyzed through a review of bone marrow biopsies and mielogram slides. Cytogenetic analysis was performed by GTG banding from bone marrow cells. The patients were classified according to FAB in initial stages: RA (22 patients) and RARS (1 patient) and nine in advanced stages - RAEB. Chromosomal abnormalities were detected in 16 patients (50%). The most frequent abnormalities were: del(11)(q23) and del(17p). Patients with advanced disease, six (66%) had significant increased M:E ratio (p=0.003) and seven patients (77%) had increased architectural changes (p<0.001). Patients classified as intermediary 2 and high risk according IPSS had important architectural loss (p<0.001), presence of micromegakaryocyte was considered significant higher (p=0.017) and six patients (85%) underwent leukemia transformation (p=0.006). ALIP was significant higher in the patients with a worse prognosis (p=0.021) and advanced stage of disease (p=0.001). Our results showed potential implications for diagnosis and prognosis of MDS. The morphological findings in this study were associated with FAB and WHO groups and prognostic risk (IPSS).

The objective of this thesis is to update the outage management system (OMS) in Taipower by verifying the phasing of distribution transformers and the connectivity of customers served by each distribution transformer. The GPS based phase measurement unit (PMU) is used to measure the voltage phasing of the transformer. The power line carrier (PLC) based identifier has been developed to support the identification of distribution transformer and all the customers served. In the thesis, four practical distribution feeders in Fengshan District of Taipower are selected for the update of distribution transformer phasing of OMS system for the update of distribution transformer phasing of OMS system. After correcting the phasing of distribution transformer in the OMS database, the attributes of distribution components are retrieved for the OMS system. The network configuration of distribution feeders is identified by exacting the topology process and node reduction to prepare the input data for load flow analysis. With the monthly energy consumption of customer from the customer information system (CIS) and the typical load patterns of various customer classes, the hourly loading of each transformer can be derived. By retrieving the actual power data of test feeders from the distribution dispatch control center (DDCC), the three phase load flow analysis is executed to solve the three phase currents of trunk line sections, laterals and distribution transformers. The three phase currents solved can therefore be applied to derive the strategy of three phase balancing of distribution feeders.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Direito, Curso de Pós-Graduação em Direito, 2017. / Submitted by Raquel Almeida (raquel.df13@gmail.com) on 2017-07-27T15:56:20Z No. of bitstreams: 1 2017_PatríciaRamosBarros.pdf: 2113522 bytes, checksum: b866a0261dbb702ca59715fd8dae8c74 (MD5) / Approved for entry into archive by Raquel Viana (raquelviana@bce.unb.br) on 2017-08-31T18:31:18Z (GMT) No. of bitstreams: 1 2017_PatríciaRamosBarros.pdf: 2113522 bytes, checksum: b866a0261dbb702ca59715fd8dae8c74 (MD5) / Made available in DSpace on 2017-08-31T18:31:18Z (GMT). No. of bitstreams: 1 2017_PatríciaRamosBarros.pdf: 2113522 bytes, checksum: b866a0261dbb702ca59715fd8dae8c74 (MD5) Previous issue date: 2017-08-31 / Este trabalho pretende investigar o sentido, as implicações e as contradições da noção de saúde global a partir da análise das condutas da Organização Mundial da Saúde (OMS) em situação de emergência sanitária. Busca-se, em especial, avaliar se o papel exercido pelo direito internacional no campo da saúde global, contribui para a manutenção de desigualdades históricas e de assimetrias socioeconômicas no Terceiro Mundo. Sob uma perspectiva historiográfica, o direito internacional é apresentado como uma técnica discursiva hegemônica, que emergiu do encontro colonial e que reproduz até os dias atuais padrões de dominação do norte sobre o sul global. Nesse sentido, a saúde global constitui palco do confronto de diversos interesses e do exercício de poder pelos atores internacionais. O discurso sanitário possui importantes vínculos coloniais, que transparecem na governança contemporânea da saúde global. A atuação da OMS na condução da resposta a uma emergência sanitária, por meio da aplicação do Regulamento Sanitário Internacional (RSI), evidencia reminiscências históricas e incoerências das medidas tomadas em relação às demandas terceiro-mundistas. Há um descompasso entre a propalada saúde global e a priorização dos destinatários das medidas sanitárias emergenciais. Assim, o direito internacional pode ser aplicado para sustentar a lógica colonial de perpetuação de desigualdades histórico-sociais na periferia do sistema internacional. Nesse contexto, faz-se imprescindível o olhar crítico dos internacionalistas a fim de que os países e os povos prejudicados tenham voz, sejam ouvidos e sejam atendidos em suas reivindicações. A saúde global não pode funcionar como simples rótulo. / This work intends to investigate the meaning, the implications and the contradictions of the notion of global health based on the analysis of the World Health Organization (WHO) procedures in a health emergency situation. In particular, it seeks to assess whether the role played by international law in the field of global health contributes to the maintenance of historical inequalities and socioeconomic asymmetries in the Third World From a historiographical perspective, international law is presented as a hegemonic discursive technique that emerged from the colonial encounter and which reproduces up to the present days patterns of domination from the north to the global south. In this sense, global health a is a battlefield of different interests and of the exercise of power by international actors. The sanitary discourse hás important colonial ties, which are reflected in the contemporary global health governance. The role of the WHO in the management of the response to a health emergency, through the application of the International Health Regulations (IHR), reveals historical reminiscences and inconsistencies with the measures taken in relation to third-world demands. There is a mismatch between the so-called global health and the prioritization of the recipients of emergency health measures. Thus, international law can be applied to support the colonial logic of perpetuating historical and social inequalities on the periphery of the international system. In this context, the critical view of the international lawyers is indispensable for Third World countries and peoples to have voice, to be heard and be heeded in their demands. Global health cannot work as a simple label.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, 2015. / Submitted by Fernanda Percia França (fernandafranca@bce.unb.br) on 2016-02-26T14:16:17Z No. of bitstreams: 1 2015_CláudiaRodriguesMafra.pdf: 1636459 bytes, checksum: a9bccdb632fd2b155c44483104dde49c (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2016-04-12T15:04:15Z (GMT) No. of bitstreams: 1 2015_CláudiaRodriguesMafra.pdf: 1636459 bytes, checksum: a9bccdb632fd2b155c44483104dde49c (MD5) / Made available in DSpace on 2016-04-12T15:04:15Z (GMT). No. of bitstreams: 1 2015_CláudiaRodriguesMafra.pdf: 1636459 bytes, checksum: a9bccdb632fd2b155c44483104dde49c (MD5) / INTRODUÇÃO: O procedimento cirúrgico tem a intenção de salvar vidas. Muitas vezes torna-se a única indicação de tratamento com intervenção de mudança, como por exemplo, o transplante renal. As cirurgias são cada vez mais complexas e, por conseguinte, expõe a potenciais riscos. O tema segurança do paciente tem estimulado organizações de saúde a implementar medidas de segurança a fim de minimizar falhas no processo do cuidado que possam vir a causar incidentes indesejáveis. Estudos evidenciam que mais da metade são evitáveis, portanto, a aplicação de medidas preventivas é necessária, como a utilização da lista de verificação de cirurgia segura, que tem como base o Programa Cirurgia Segura Salvam Vidas da Organização Mundial de Saúde (OMS). OBJETIVO: Analisar a aplicabilidade da lista de verificação para cirurgia segura em transplante renal de doador falecido, averiguando a conformidade e não conformidades de segurança cirúrgica. MÉTODO: Trata-se de uma pesquisa não experimental, descritiva e quantitativa, associada à observação direta/participante, tendo como foco a efetividade da aplicação do protocolo de cirurgia segura da OMS adaptado, desenvolvida em um Centro Cirúrgico de Hospital Universitário, em Brasília, Distrito Federal. A amostra foi composta pela equipe de trabalho multidisciplinar que participou do procedimento transplante renal de doador falecido, além do paciente adulto submetido ao procedimento operatório. Quantos aos itens da lista de verificação de segurança cirúrgica foram checados antes do início do procedimento, antes da indução anestésica, antes da incisão (pausa cirúrgica) e antes de o paciente sair da sala operatória. RESULTADOS: Dos 16 pacientes submetidos ao transplante, 75% eram do sexo masculino (n=12), tinha idade média 51,9 anos (DP: 14,6), 56,3% (n=9) situação conjugal, casados. Em relação ao nível de escolaridade, 31,2% (n=5) tinham ensino fundamental incompleto e quanto à ocupação laboral 50% (n=8) eram aposentados. As caracterizações da equipe cirúrgica dos profissionais da saúde participantes da pesquisa (n=62) a maioria era composta por jovens adultos (20 a 30 anos), com tempo de experiência em procedimento cirúrgico transplante renal de 1 a 2 anos (n=40,2%), constituído por médicos urologistas e anestesiologistas, médicos residentes, enfermeiros e técnicos de enfermagem, majoritariamente do sexo feminino (n=35; 56,5%), e metade da equipe 50% (n=31) possui outro vínculo empregatício. Dos itens analisados obteve-se um percentual de 100,0% da lateralidade não estava demarcada, 87,5% da equipe desconheciam se o paciente tinha algum tipo de alergia, 93,8% da profilaxia antimicrobiana não foi administrada dentro do 60 minutos preconizados e 100,0% da equipe cirúrgica não analisam os pontos importantes na recuperação pós- anéstesica e pós operatória.O percentual da LVCS 58,6% estava em conformidade e em algumas etapas a não conformidade atingiu 41,4%. CONCLUSÃO: Os resultados revelaram que os passos da lista de verificação aplicados em transplante renal de doador falecido não são efetivamente praticados. Portanto, a implementação de ações recomendadas é necessária, para que a lista seja aplicada de forma efetiva e, dessa forma, o processo de trabalho da equipe promova a melhoria da segurança cirúrgica e a qualidade dos cuidados prestados. / INTRODUCTION: The surgical procedure is intended to save lives. Often becomes the only indication of treatment with intervention of change, such as renal transplantation. The surgeries are increasingly in complexity and therefore present potential hazards. The patient safety issue has encouraged health organizations to implement security measures in order to minimize failures in the care process which might cause untoward incidents. Studies show that more than half are preventable, so the application of preventive measures is required, such as using the safe surgery checklist, which is based on the Safe Surgery Saves Lives program of the World Health Organization (WHO). OBJECTIVE: Analyze the applicability of the checklist for safe surgery in renal transplant deceased donor, checking compliance and non-surgical safety compliance. METHOD: This is a non-experimental, descriptive and quantitative research, combined with direct/participant observation, focusing on the effectiveness of the application of the safe surgery protocol adapted from the WHO, developed in a Surgical Center of a University Hospital in Brasilia, Distrito Federal. The sample was composed by a multidisciplinary team that participated in the procedure of deceased donor kidney transplantation, besides the adult patient submitted to the surgical procedure. About to items of surgical safety checklist, they have been checked before the start of the procedure, before induction of anesthesia, before skin incision (surgical pause) and before the patient leaves the operating room. RESULTS: Of the 16 patients undergoing transplantation, 75% were male (n=12), mean age was 51.9 years (SD: 14.6), 56.3% (n=9) married. In relation to scholarity, 31.2% (n=5) had incomplete primary education and on the labor occupancy 50% (n=8) were retired. The characterizations of the surgical team of health professionals participating in the study (n=62) show that the majority consists of young adults (20 to 30 years), with time of experience in kidney transplantation surgery from 1 to 2 years (n=40 2%) consisting of urologists and anesthesiologists, medical residents, nurses and nursing technicians, mostly female (n=35; 56.5%), and half the team 50% (n=31) has another link employment. Of the analyzed items obtained a percentage of 100.0% laterality was not demarcated, 87.5% of the team know whether the patient had any allergies, 93.8% of antimicrobial prophylaxis was not administered within the recommended 60 minutes and 100.0% of the surgical team did not analyze the important points in the post-anesthetic recovery and postoperative The percentage of LVCS 58.6% was in line or in a few steps to noncompliance reached 41.4%. CONCLUSION: The findings of the study revealed that the steps of the checklist of verification applied in deceased donor kidney transplantation are not effectively practiced. Therefore, the implementation of recommended actions is required for the list to be applied effectively and thus the team work process promotes the improvement of surgical safety and quality of care. / Introducción: El procedimiento quirúrgico está destinado a salvar vidas. A menudo se convierte en la única indicación de tratamiento como intervención de cambio, tales como el trasplante de riñón. Las cirugías son cada vez más complejas y por lo tanto presenta peligros potenciales. El tema seguridad del paciente ha estimulado las organizaciones de salud para implementar medidas de seguridad a fin de minimizar las fallas en el proceso de atención que pueden provocar incidentes adversos. Estudios muestran que más de la mitad son evitables, por lo que es necesaria la aplicación de medidas de prevención, como el uso de la lista de verificación de cirugía segura, que se basa en el programa Cirugía Segura Salva Vidas, de la Organización Mundial de la Salud (OMS). Objectivo: Analizar la aplicabilidad de la lista de verificación para la cirugía segura en trasplante renal de donante fallecido, revisando el cumplimiento y el cumplimiento de la seguridad no quirúrgico. Método: Se trata de una investigación no experimental, descriptiva y cuantitativa, asociada con la observación directa/participante, tiendo como foco la efectividad de aplicación del protocolo de cirugía segura adaptado OMS, desarrollado en un Quirófanos de un Hospital Universitario de Brasilia, Distrito Federal. La muestra fue compuesta por un equipo multidisciplinario que participó en el procedimiento de trasplante de riñón de donante fallecido, además de los pacientes adultos sometidos a la intervención quirúrgica. Como elementos de lista de verificación de seguridad quirúrgica se han comprobado antes del inicio del procedimiento, antes de la inducción de la anestesia, antes de la incisión de la piel (pausa quirúrgica) y antes de que el paciente sale del quirófano Resultados: De los 16 pacientes sometidos a trasplante, 75% eran del sexo masculino (n=12), con una media de edad de 51,9 años , 56,3% (n=9) son casados. En relación a la escolaridad, 31,2% (n=5) tienen educación primaria incompleta y cuanto a la ocupación 50% (n=8) son retirados. Las caracterizaciones del equipo quirúrgico de profesionales de salud que participan en el estudio (n=62) muestran que la mayoría se compone de adultos jóvenes (20 a 30 años), con experiencia en la cirugía de trasplante de riñón de 1 a 2 años (54,8%), constituido por urólogos y anestesiólogos, médicos residentes, enfermeras y técnicos de enfermería, en su mayoría mujeres (n=35; 56,5%), y la mitad del personal 50% (n=31) tiene otro empleo. Cuanto a los ítems de la lista de verificación de seguridad quirúrgica fueron checados antes del inicio del procedimiento, antes de la inducción de la anestesia, antes de la incisión (pausa quirúrgica) y antes de que el paciente salir del quirófano. De los elementos analizados obtiene un porcentaje del 100,0% lateralidad no fue demarcada, el 87,5% del equipo saber si el paciente tuvo algún tipo de alergia, el 93,8% de la profilaxis antimicrobiana no se administró dentro de los 60 minutos recomendados y 100,0% del equipo quirúrgico no analizó los puntos importantes en la recuperación postanestésica y post operatória. La LVCS porcentaje de 58,6% se encontraba en la línea y en unos pocos pasos a incumplimiento alcanzó el 41,4%.Conclusión: Los resultados del estudio muestran que los pasos de la lista de verificación aplicados en trasplante de riñón de donante fallecido no son practicados de manera efectiva. Por lo tanto, la implementación de acciones recomendadas es necesaria, para que la lista sea aplicada de forma efectiva y, de esa forma, el proceso de trabajo da equipo promueve la mejoría de la seguridad quirúrgica y la calidad de los cuidados prestados.