Concrete which is manufactured in a mixing plant to be delivered to construction site in unhardened and plastic stage is called ready-mixed concrete. Because of technical and economical reasons, many mineral and chemical admixtures are used in ready-mixed concrete production. As a result of extra mixing and delayed placing of ready-mixed concrete (especially at hot weather conditions), there can be many problems about concrete, like slump loss. Addition of water for retempering concrete is the usual procedure, but addition of water without proper adjustment in mixture proportions, adversely affects compressive strength. During this study, effects of prolonged mixing and retempering with superplasticizer on properties of fresh and hardened concrete at hot weather conditions are observed. Some of the properties of concrete inspected are compressive strength, splitting tensile strength, slump and air content. All mixes contain air entrainer and water reducer at a standard amount. The difference between mixes comes from kind and amount of mineral admixture which cement is replaced by. During the study, fly ash, blast furnace slag, ground clay brick and natural pozzolan are used at amounts, 25% and 50% of cement. Also, a mixture of pure cement is prepared as control concrete. 15 cm initial slump is planned in the experimental work. After five minutes and at the end of first, second, third and fourth hours of mixing process, if needed retempering process is proceeded with superplasticizer and samples are taken. As a result of retempering with superplasticizer, the aimed slump values are obtained. The effects are than, observed. As a result of this study, it has been observed that replacing Portland cement with certain mineral admixtures, especially fly ash at certain amounts, can be a solution for slump loss problem, by retarding the slump loss effect of prolonged mixing. Also it has been seen that ground clay brick causes better performance for slump values at lateral stages of mixing with respect to pure Portland cement. Another important observation has been about the increase in the amount of air caused by air entraining admixtures in fresh concrete based on prolonged mixing at hot weather conditions.

Base teórica: O avanço no conhecimento e a introdução de tecnologias mais sofisticadas para o cuidado do paciente crítico trouxeram importante incremento na sobrevida deste grande grupo de pacientes. Por outro lado, existe um estrato de pacientes que sobrevivem à condição crítica aguda, porém permanecem dependentes de algum tipo de suporte de manutenção da vida por longos períodos. A doença crítica crônica (DCC) como é conhecida, apesar de descrita desde a década de 80, ainda não possui um critério de definição claro, levando a divergências nos resultados de estudos e prejudicando o avanço em pesquisas que investigam estratégias de tratamento. Objetivo: Avaliar a sobrevida e fatores associados à DCC em uma população de pacientes críticos comparando dois critérios de diagnóstico desta condição. Metodologia: Coorte histórica com avaliação de variáveis clínicas e desfechos durante a internação hospitalar em uma população de doentes críticos de uma única unidade de tratamento intensivo (UTI). Os pacientes foram alocados em três grupos, dois com critérios de DCC definidos por ≥14 ou ≥21 dias de ventilação mecânica (VM) e um terceiro grupo de pacientes críticos agudos (< 14 dias de VM). Recrutamento e alocação foram feitos através de um banco de dados institucional e dos registros hospitalares das internações ocorridas de janeiro de 2007 a dezembro de 2010. Resultados: No período analisado ocorreram 3.023 internações na UTI, 2.783 apresentavam os critérios de inclusão e compuseram a análise final. Em relação ao tempo de VM, 163 pacientes apresentaram ≥14 dias e 89 ≥21 dias. A mortalidade hospitalar e na UTI foi inferior no grupo de pacientes críticos agudos quando comparado com os dois grupos de DCC (≥14 e ≥21 dias de VM) (16.3% versus 55.8% e 58.4% p<0.001; 10.6% versus 47.3% e 53.9% p<0.001 respectivamente). Quando comparados os dois grupos de DCC (≥14 e ≥21 dias de VM), não houve diferença estatisticamente significativa para mortalidade hospitalar e na UTI (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18 respectivamente). O pequeno número de pacientes em cada grupo pode ter limitado o poder das análises. Ambos os grupos de DCC tiveram escores de gravidade mais altos, desenvolveram mais complicações na UTI, apresentaram maior tempo de internação hospitalar e mortalidade quando comparados aos críticos agudos. Conclusão: O estudo não mostrou diferença estatisticamente significativa quanto às características e desfechos clínicos entre as duas definições de DCC. Por outro lado, mostrou que os dois grupos de DCC apresentaram desfechos piores quando comparados com os pacientes críticos agudos. Estes resultados justificam o uso do critério de ≥14 dias de VM para a identificação mais precoce dos doentes críticos crônicos. / Theoretical basis: Progress in knowledge and the introduction of more advanced technologies for critical patient care brought about an important increase in the survival of this large group of patients. On the other side, there exists a subset of patients who survive their acute critical illness, but they remain dependent on some kind of life support for long periods. Despite being described since the 1980s, the chronic critical illness (CCI) has still not been clearly defined. This situation led to divergent studies’ results and jeopardized the progress in research focused on treatment strategies for CCI. Objective: To assess the survival and CCI-associated factors in a population of critically ill patients comparing two diagnostic criteria of this condition. Methodology: Historical cohort study assessing clinical variables and outcomes during hospital stay, in a population of critically ill patients of a single intensive care unit (ICU). The patients were divided into three groups, two of these with different criteria of CCI, defined by ≥14 or ≥21 days of mechanical ventilation (MV), and a third group with acutely critically ill patients (less than 14 days of MV). The recruitment and allocation were carried out through an institutional database and medical records of admissions occurred from January 1, 2007 to December 31, 2010. Results: In the study period 3,023 ICU admissions occurred, 2,783 met the inclusion criteria and made part of the final analysis. As far as MV days are concerned, 163 patients had ≥14 days and 89 ≥21 days. Hospital and ICU mortality were lower in the group of acutely critically ill patients compared with the two CCI groups (≥14 days and ≥21 MV days) (16.3% versus 55.8% and 58.4% p<0.001; 10.6% versus 47.3% and 53.9% p<0.001 respectively). The comparative analysis between the two CCI groups (≥14 days and ≥21 MV days, respectively) was not statistically significant for hospital and ICU mortality (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18, respectively). The small number of patients in the two groups may have limited the power of analyzes. Both CCI groups had higher severity scores, developed more ICU complications, showed higher hospital length of stay and mortality when compared with the acutely critically ill patients. Conclusion: This study did not show significant difference between the two CCI definitions regarding characteristics and clinical outcomes. However, it showed that both groups had worse outcomes when compared with the acutely critically ill patients. This result justifies the use of the CCI criteria of ≥14 days of MV for earlier identification of this subset of patients.

Base teórica: O avanço no conhecimento e a introdução de tecnologias mais sofisticadas para o cuidado do paciente crítico trouxeram importante incremento na sobrevida deste grande grupo de pacientes. Por outro lado, existe um estrato de pacientes que sobrevivem à condição crítica aguda, porém permanecem dependentes de algum tipo de suporte de manutenção da vida por longos períodos. A doença crítica crônica (DCC) como é conhecida, apesar de descrita desde a década de 80, ainda não possui um critério de definição claro, levando a divergências nos resultados de estudos e prejudicando o avanço em pesquisas que investigam estratégias de tratamento. Objetivo: Avaliar a sobrevida e fatores associados à DCC em uma população de pacientes críticos comparando dois critérios de diagnóstico desta condição. Metodologia: Coorte histórica com avaliação de variáveis clínicas e desfechos durante a internação hospitalar em uma população de doentes críticos de uma única unidade de tratamento intensivo (UTI). Os pacientes foram alocados em três grupos, dois com critérios de DCC definidos por ≥14 ou ≥21 dias de ventilação mecânica (VM) e um terceiro grupo de pacientes críticos agudos (< 14 dias de VM). Recrutamento e alocação foram feitos através de um banco de dados institucional e dos registros hospitalares das internações ocorridas de janeiro de 2007 a dezembro de 2010. Resultados: No período analisado ocorreram 3.023 internações na UTI, 2.783 apresentavam os critérios de inclusão e compuseram a análise final. Em relação ao tempo de VM, 163 pacientes apresentaram ≥14 dias e 89 ≥21 dias. A mortalidade hospitalar e na UTI foi inferior no grupo de pacientes críticos agudos quando comparado com os dois grupos de DCC (≥14 e ≥21 dias de VM) (16.3% versus 55.8% e 58.4% p<0.001; 10.6% versus 47.3% e 53.9% p<0.001 respectivamente). Quando comparados os dois grupos de DCC (≥14 e ≥21 dias de VM), não houve diferença estatisticamente significativa para mortalidade hospitalar e na UTI (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18 respectivamente). O pequeno número de pacientes em cada grupo pode ter limitado o poder das análises. Ambos os grupos de DCC tiveram escores de gravidade mais altos, desenvolveram mais complicações na UTI, apresentaram maior tempo de internação hospitalar e mortalidade quando comparados aos críticos agudos. Conclusão: O estudo não mostrou diferença estatisticamente significativa quanto às características e desfechos clínicos entre as duas definições de DCC. Por outro lado, mostrou que os dois grupos de DCC apresentaram desfechos piores quando comparados com os pacientes críticos agudos. Estes resultados justificam o uso do critério de ≥14 dias de VM para a identificação mais precoce dos doentes críticos crônicos. / Theoretical basis: Progress in knowledge and the introduction of more advanced technologies for critical patient care brought about an important increase in the survival of this large group of patients. On the other side, there exists a subset of patients who survive their acute critical illness, but they remain dependent on some kind of life support for long periods. Despite being described since the 1980s, the chronic critical illness (CCI) has still not been clearly defined. This situation led to divergent studies’ results and jeopardized the progress in research focused on treatment strategies for CCI. Objective: To assess the survival and CCI-associated factors in a population of critically ill patients comparing two diagnostic criteria of this condition. Methodology: Historical cohort study assessing clinical variables and outcomes during hospital stay, in a population of critically ill patients of a single intensive care unit (ICU). The patients were divided into three groups, two of these with different criteria of CCI, defined by ≥14 or ≥21 days of mechanical ventilation (MV), and a third group with acutely critically ill patients (less than 14 days of MV). The recruitment and allocation were carried out through an institutional database and medical records of admissions occurred from January 1, 2007 to December 31, 2010. Results: In the study period 3,023 ICU admissions occurred, 2,783 met the inclusion criteria and made part of the final analysis. As far as MV days are concerned, 163 patients had ≥14 days and 89 ≥21 days. Hospital and ICU mortality were lower in the group of acutely critically ill patients compared with the two CCI groups (≥14 days and ≥21 MV days) (16.3% versus 55.8% and 58.4% p<0.001; 10.6% versus 47.3% and 53.9% p<0.001 respectively). The comparative analysis between the two CCI groups (≥14 days and ≥21 MV days, respectively) was not statistically significant for hospital and ICU mortality (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18, respectively). The small number of patients in the two groups may have limited the power of analyzes. Both CCI groups had higher severity scores, developed more ICU complications, showed higher hospital length of stay and mortality when compared with the acutely critically ill patients. Conclusion: This study did not show significant difference between the two CCI definitions regarding characteristics and clinical outcomes. However, it showed that both groups had worse outcomes when compared with the acutely critically ill patients. This result justifies the use of the CCI criteria of ≥14 days of MV for earlier identification of this subset of patients.

Le contenu de ce travail de recherche est une analyse comparative des interactions en classe d’espagnol langue étrangère (quatrième et terminale). Il est essentiellement axé sur les productions verbales enseignants/apprenants des classes de quatrième et de terminale, dans des établissements situés à Libreville, capitale du Gabon. Cette analyse prétend répondre à un questionnement sur le déroulement d’une classe de langue espagnole. Applique-t-il les règles préconisées par les institutions gabonaises ? Ce déroulement est-il le même selon les niveaux d’apprentissage des élèves (quatrième-terminale) ? Quels types d’activités sont pratiqués en classe ? Ces types d’activités favorisent-ils l’interaction comme moyen d’échanges et de communication ? Comment coexistent gestion d’interaction, de classe et du cours ? Quel est rôle de chaque interactant (enseignants/apprenants) pour une interaction pluridirectionnelle ? Quelles sont les adoptées stratégies dans la construction des énoncés pour faciliter compréhension des élèves ? Dans une démarche quelque peu sociolinguistique mais fortement didactique, ce travail s’inscrit dans l’enseignement des langues étrangères avec une approche interactionniste. Elle oriente de façon générale la formation des enseignants dans la gestion de la classe. En effet, en Europe comme en Afrique, il se pose, de façon permanente, ce problème de gestion des classes et des effectifs en classe de langue étrangère. Nos résultats montrent que l’enseignant emploie régulièrement les phénomènes langagiers tels que : la reformulation, la répétition et l’allongement syllabique, comme stratégies énonciatifs, afin de solliciter l’attention et la participation des élèves. Il arrive ainsi à assurer la gestion de la classe, des séquences du cours, du matériel et des élèves aussi bien en classe de quatrième qu’en classe de terminale. / A comparative analysis of interactions in Spanish classes at high school level (8th and 12th grade is the basis of this research. Indeed, it provides an insight into the interactions between teachers and students in Libreville-based high schools. So the on-ground research was done in Libreville, Gabon's capital city. This analysis is an attempt at answering questions on the teaching of Spanish as a second language. Does this teaching comply with the rules worked out by the Gabonese Ministry of Education? Is it similar for all grades? What are the various activities during Spanish classes? Do these activities foster interactions as a means of communication and exchange? How does the teacher handle interactions, students' behaviour and the class? How do the teacher and the student contribute to an intense interaction during the class? How do educators do to render their Spanish classes comprehensible for their pupils? By adopting both a sociolinguistic and above all didactic method this work is focused on the teaching of foreign languages. Its objective is to help educators better understand the mechanisms to handle a grade. Handling a grade is more and more complex both in western countries and developing ones due to the ever-growing number of students in language classes. Our findings show that the teacher steadily employs a wide range of teaching strategies like rephrasing, repetition and the prolonged pronunciation of syllables to get students' attention and participation. Thanks to this panoply of teaching techniques, the teacher succeeds in handling the class and students at 8th and 12th grade level.

Base teórica: O avanço no conhecimento e a introdução de tecnologias mais sofisticadas para o cuidado do paciente crítico trouxeram importante incremento na sobrevida deste grande grupo de pacientes. Por outro lado, existe um estrato de pacientes que sobrevivem à condição crítica aguda, porém permanecem dependentes de algum tipo de suporte de manutenção da vida por longos períodos. A doença crítica crônica (DCC) como é conhecida, apesar de descrita desde a década de 80, ainda não possui um critério de definição claro, levando a divergências nos resultados de estudos e prejudicando o avanço em pesquisas que investigam estratégias de tratamento. Objetivo: Avaliar a sobrevida e fatores associados à DCC em uma população de pacientes críticos comparando dois critérios de diagnóstico desta condição. Metodologia: Coorte histórica com avaliação de variáveis clínicas e desfechos durante a internação hospitalar em uma população de doentes críticos de uma única unidade de tratamento intensivo (UTI). Os pacientes foram alocados em três grupos, dois com critérios de DCC definidos por ≥14 ou ≥21 dias de ventilação mecânica (VM) e um terceiro grupo de pacientes críticos agudos (< 14 dias de VM). Recrutamento e alocação foram feitos através de um banco de dados institucional e dos registros hospitalares das internações ocorridas de janeiro de 2007 a dezembro de 2010. Resultados: No período analisado ocorreram 3.023 internações na UTI, 2.783 apresentavam os critérios de inclusão e compuseram a análise final. Em relação ao tempo de VM, 163 pacientes apresentaram ≥14 dias e 89 ≥21 dias. A mortalidade hospitalar e na UTI foi inferior no grupo de pacientes críticos agudos quando comparado com os dois grupos de DCC (≥14 e ≥21 dias de VM) (16.3% versus 55.8% e 58.4% p<0.001; 10.6% versus 47.3% e 53.9% p<0.001 respectivamente). Quando comparados os dois grupos de DCC (≥14 e ≥21 dias de VM), não houve diferença estatisticamente significativa para mortalidade hospitalar e na UTI (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18 respectivamente). O pequeno número de pacientes em cada grupo pode ter limitado o poder das análises. Ambos os grupos de DCC tiveram escores de gravidade mais altos, desenvolveram mais complicações na UTI, apresentaram maior tempo de internação hospitalar e mortalidade quando comparados aos críticos agudos. Conclusão: O estudo não mostrou diferença estatisticamente significativa quanto às características e desfechos clínicos entre as duas definições de DCC. Por outro lado, mostrou que os dois grupos de DCC apresentaram desfechos piores quando comparados com os pacientes críticos agudos. Estes resultados justificam o uso do critério de ≥14 dias de VM para a identificação mais precoce dos doentes críticos crônicos. / Theoretical basis: Progress in knowledge and the introduction of more advanced technologies for critical patient care brought about an important increase in the survival of this large group of patients. On the other side, there exists a subset of patients who survive their acute critical illness, but they remain dependent on some kind of life support for long periods. Despite being described since the 1980s, the chronic critical illness (CCI) has still not been clearly defined. This situation led to divergent studies’ results and jeopardized the progress in research focused on treatment strategies for CCI. Objective: To assess the survival and CCI-associated factors in a population of critically ill patients comparing two diagnostic criteria of this condition. Methodology: Historical cohort study assessing clinical variables and outcomes during hospital stay, in a population of critically ill patients of a single intensive care unit (ICU). The patients were divided into three groups, two of these with different criteria of CCI, defined by ≥14 or ≥21 days of mechanical ventilation (MV), and a third group with acutely critically ill patients (less than 14 days of MV). The recruitment and allocation were carried out through an institutional database and medical records of admissions occurred from January 1, 2007 to December 31, 2010. Results: In the study period 3,023 ICU admissions occurred, 2,783 met the inclusion criteria and made part of the final analysis. As far as MV days are concerned, 163 patients had ≥14 days and 89 ≥21 days. Hospital and ICU mortality were lower in the group of acutely critically ill patients compared with the two CCI groups (≥14 days and ≥21 MV days) (16.3% versus 55.8% and 58.4% p<0.001; 10.6% versus 47.3% and 53.9% p<0.001 respectively). The comparative analysis between the two CCI groups (≥14 days and ≥21 MV days, respectively) was not statistically significant for hospital and ICU mortality (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18, respectively). The small number of patients in the two groups may have limited the power of analyzes. Both CCI groups had higher severity scores, developed more ICU complications, showed higher hospital length of stay and mortality when compared with the acutely critically ill patients. Conclusion: This study did not show significant difference between the two CCI definitions regarding characteristics and clinical outcomes. However, it showed that both groups had worse outcomes when compared with the acutely critically ill patients. This result justifies the use of the CCI criteria of ≥14 days of MV for earlier identification of this subset of patients.

Animals rely on lipids as a major fuel for endurance exercise because they pack more joules per gram than any other fuel. However, in contrast to mammals, information on how the mobilization of lipids from endogenous stores is managed to meet the needs of energy metabolism in swimming fish is sparse. Information on in vivo rates of lipid mobilization in swimming fish has been limited to relatively low exercise intensities and has only been investigated in a single species. Therefore, the goal of my thesis was to address this paucity of information by quantifying lipolytic rate in rainbow trout during graded exercise and fatty acid mobilization in Atlantic salmon during prolonged endurance exercise. In the first part of my work, I hypothesized that like mammals, rainbow trout stimulate lipolysis above resting levels to a peak with increasing work intensity, but subsequently lower its rate at high intensities when ATP production from carbohydrates becomes dominant. To test this hypothesis, I measured the rate of appearance of glycerol (Ra glycerol) in the blood (resulting from the breakdown of triacylglycerol (TAG)) of trout at rest (control) and during graded exercise from rest to Ucrit. Results showed that Ra glycerol in trout averaged 1.24 ± 0.10 µmol kg -1 min-1 and that this rate was unaffected by exercise of any intensity. These experiments revealed that rainbow trout do not modulate lipolysis during exercise. Furthermore, I calculated that baseline lipolytic rate was much higher in trout than in mammals and that this rate is in constant excess of the requirements of energy metabolism. My second investigation focused on measuring fatty acid mobilization in Atlantic salmon. To date, the majority of studies on energy metabolism in salmonids have used rainbow trout as the ubiquitous model for salmonids. I postulated that domesticated rainbow trout may be far less impressive athletes than their wild anadromous form and other salmonids. In this regard, I proposed that studying energy metabolism in Atlantic salmon (even those from aquaculture) may help to deepen our understanding of the physiology of true long-distance migrant fish. To study the effects of prolonged endurance exercise on the mobilization of fatty acids from endogenous stores in these fish, I monitored the rate of appearance of fatty acids (Ra NEFA calculated from Ra Palmitate) in the blood during 72 hours of sustained swimming. I found that contrary to what has been previously described in rainbow trout, Ra Palmitate (and by proxy, Ra NEFA) is reduced by approximately 64% (from 0.75 ± 0.12 µmol kg-1min-1 to 0.27 ± 0.06 µmol kg-1min-1 and from 19.3 ± 7.8 µmol kg-1min-1 to 6.9 ± 2.0 µmol kg-1min-1 for Ra Palmitate and Ra NEFA, respectively) during prolonged endurance exercise in Atlantic salmon. However, like in trout, even this reduced rate of fatty acid mobilization exceeds the requirements of energy metabolism at rest and during swimming. While further experiments will be necessary, I speculated that this reduction in Ra NEFA may be caused by a partial inhibition of lipolysis to reduce the energetic cost of TAG:FA cycling and optimize fuel budgets during prolonged endurance exercise. This thesis provides the first in vivo measurements of lipolysis during graded exercise in salmonids and the first in vivo measurements of fatty acid mobilization in Atlantic salmon. From the results mentioned above, I concluded that salmonids mobilize lipids in constant excess of the requirements for energy metabolism, possibly to allow for rapid reorganization of membrane phospholipids in response to changing environmental conditions. However, more anadromous and migratory phenotypes may rely on a tighter control of lipolysis to minimize the costs of substrate cycling and conserve energy on limited fuel stores.

Orientador: Maria Ines Tiraboschi Ferro / Resumo: Períodos prolongados de seca têm se tornado mais frequentes em algumas regiões do Brasil. Além disso, a expansão da cultura de cana-de-açúcar para regiões com deficiência hídrica prolongada torna a produção sucroenergética limitada nestes locais. A melhor forma de contornar esse problema é utilizar cultivares tolerantes a este estresse. Neste trabalho, o perfil de expressão gênica da cana-de-açúcar foi avaliado, a partir de duas cultivares com respostas contrastantes ao déficit hídrico: uma delas com comportamento considerado tolerante (SP81-3250), e a outra altamente exigente em água (RB855453), considerada sensível. Ambas foram submetidas a três potenciais hídricos do solo (controle (sem estresse hídrico), déficit hídrico moderado e déficit hídrico severo) a partir de 60 dias após o plantio. Essas plantas foram avaliadas molecular e fisiologicamente em três épocas distintas: 30, 60 e 90 dias após a aplicação dos tratamentos, sendo este um dos poucos estudos realizados até o momento sobre a resposta de plantas de cana-de-açúcar sob déficit hídrico prolongado, estresse esse que foi realizado no período conhecido como fase de formação da cana-de-açúcar, compreendendo o período mais crítico por demanda de água. A análise global da expressão gênica através da tecnologia de RNA-Seq mostrou alterações significativas em resposta ao déficit hídrico entre as duas cultivares. Os transcritos do genótipo tolerante apresentaram uma maior capacidade de reação das plantas frente ao déficit... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Extended periods of drought have become more frequent in some regions of Brazil. In addition, the expansion of sugarcane cultivation to regions with prolonged water deficiency makes sugarcane production limited at these locations. The best way around this problem is to use stress-tolerant cultivars. In this work, the sugarcane gene expression profile was evaluated from two cultivars with contrasting responses to water deficit: one of them with tolerant behavior (SP81-3250), and the other highly demanding in water (RB855453 ), considered sensitive. Both were submitted to three soil water potentials (control (without water stress), moderate water deficit and severe water deficit) from 60 days after planting. These plants were evaluated molecularly and physiologically at three different times: 30, 60 and 90 days after the application of the treatments. This is one of the few studies carried out so far on the response of sugarcane plants under prolonged water deficit. This stress was realized during the period known as sugarcane formation phase, comprising the most critical period by water demand. The overall analysis of gene expression through RNA-Seq technology showed significant changes in response to water deficit between the two cultivars. The transcripts of the tolerant genotype showed a higher reaction capacity of the plants to prolonged water deficit, while in the sensitive genotype, several plant survival mechanisms were repressed. The tolerant cultivar presented inducti... (Complete abstract click electronic access below) / Mestre

Magister Chirurgiae Dentium (MChD) / Occupational hazards are common among many professions and dentistry is no exception. Occupational hazards include percutaneous injuries, inhalation of noxious chemicals, noise and musculoskeletal disorders (MSD). Despite the fact that MSD have been documented to be very prevalent among dentists in various countries, there is a paucity of literature from South Africa. Aim The aim of the present study was to determine the prevalence of musculoskeletal disorders among the dentists in KwaZulu-Natal (KZN), South Africa and to identify risk factors associated with it. The study was a cross-sectional, descriptive one and questionnaires were used to elicit information regarding socio-demographic details, medical history, work history and work-related posture information from dentists based in KwaZulu-Natal. A convenience sample of all qualified dentists in this region who were registered members of the South African Dental Association (SADA) was used. Results One hundred and nine dentists responded to the questionnaire. The response rate was 31%. The majority were male; a third aged between 30 - 39 years and the ratio of females to males was 1:3. Almost all the dentists reported pain in the neck, lower back and shoulder. Less than a quarter of the dentists in KZN reported hand pain, numbness in the hands and a tingling sensation in the hands. More than three quarters reported that they had no negative effects when performing restorative work and scaling and polishing, but 3.1% reported having extreme levels of pain. The most common working position reported was the 2 0' clock position. Nearly three quarters rotated their necks while performing clinical dentistry and a third tilted their shoulders towards their dominant hand. There was no relationship between Body Mass Index (BMI) and whether respondents treated patients while seated or standing and neither was there a relationship between pain in the lower back and BMI. There was a strong association between pain in the neck while performing clinical work and the number of years in practice confounded by age. When compared to other countries the prevalence of MSD is very high. The highest occurrence was for neck, back and shoulder pain. Avoiding these injuries is critical and self-recognition is important in either preventing further injuries or in increasing severity of the condition. The findings of this study suggests that it may be valuable to include ergonomic work practice in the training of dentists and dentists should be involved in a proper exercise routine which should include stretching and weight training to prevent injuries. Regular breaks should be taken to perform stretching exercises in-between the management of patients in order to reduce the risk of MSD.

La chirurgie est le traitement principal du cancer colorectal (CCR). Une durée d'hospitalisation prolongée peut augmenter le risque de complications et d'inactivité physique, entraînant un déclin de la fonction physique. L'objectif de cette étude est de déterminer si la celle-ci peut prédire l’hospitalisation prolongée chez les patients atteints de CCR. Un total de 459 patients provenant de 7 cohortes a été analysé. Une régression logistique a été utilisée pour déterminer le risque d'hospitalisation prolongée (>3 jours) et une courbe ROC a été tracée pour établir la sensibilité/spécificité. Les variables sélectionnées comprenaient l'âge, le sexe, l'IMC, la présence de comorbidités, le statut ASA, le site tumoral, l'approche chirurgicale, la force de préhension, le test Timed-Up and Go, le test assis-debout de 30 secondes, le test de flexion des coudes de 30 secondes, le test de marche de 6 minutes (6MWT), le questionnaire CHAMPS et le SF-36. Les résultats démontrent que les patients atteints d'une tumeur rectale ont un risque 2,7 fois plus élevé d'appartenir au groupe d'hospitalisation prolongée que ceux atteints d'une tumeur du côlon (O.R. 2,7 ; C.I. 1,3-5,7, p=0,01). Pour chaque augmentation de 20 mètres dans le 6MWT, il y a une diminution de 9% du risque d'être dans le groupe d'hospitalisation prolongée (C.I. 1.03-1.17, p=0.00). Un seuil de 431 m peut prédire 70% des patients dans le groupe d'hospitalisation prolongée (AUC 0,71, C.I. 0,63-0,78, p=0,00). L'utilisation du 6MWT comme outil de dépistage de l'hospitalisation prolongée devrait être intégrée dans le parcours chirurgical préopératoire. / Surgery is the primary treatment for colorectal cancer. A prolonged Length of Stay (pLOS) can increase risk of complications and physical inactivity, leading to a decline in physical function. While promising results were seen from preoperative exercise training and post-operative functional recovery, the predictive potential of preoperative physical function has not yet been investigated. The objective of this study is to determine if preoperative physical function can predict pLOS in patients with for colorectal cancer. A total of 459 patients from 7 cohorts were analyzed. Logistic regression was used to determine risk of pLOS (>3 days), and ROC curve was plotted to establish sensitivity/specificity. Selected variables included age, sex, BMI, comorbidity, ASA status, tumor site, surgical approach, handgrip strength, Timed-Up and Go, 30-second Sit-to-Stand, 30-second Arm Curl Test, 6-Minute-Walking Test (6MWT), CHAMPS Physical Activity Questionnaire for Older Adult and 36-Item Short Form Survey. The results showed that patients with rectal tumor are 2.7x more at risk to be in the pLOS group compared to those with colon tumor (O.R. 2.7; C.I. 1.3-5.7, p=0.01). For every increment of 20 meters in 6MWT, there is a decreased risk of 9% of being in pLOS group (C.I. 1.03-1.17, p=0.00). A cut-off of 431m can predict 70% of patients in pLOS group (AUC 0.71 C.I 0.63-0.78, p=0.00). Tumor site (rectal) and 6MWT were significant predictors of pLOS. Using the 6MWT as a screening tool for pLOS with cut-off of 431 m should be implemented in the preoperative surgical pathway.

Introduction. L’exposition à la douleur répétée pendant la période néonatale a des effets nocifs sur le développement neurologique des nouveau-nés prématurés et peut contribuer à une douleur prolongée. Une taxonomie précise de la douleur néonatale est absente due à l’existence d’une terminologie ambigüe qui persiste en néonatologie. Par conséquent, l’évaluation et la gestion de ce type de douleur dans le milieu clinique sont sous-optimales. Objectif. Établir la portée, l'étendue et la nature des écrits scientifiques liées à la douleur prolongée des nouveau-nés prématurés hospitalisés dans l’unité de soins intensifs néonatals (USIN), par le biais d’une revue de la portée. Méthodologie. La revue de la portée suit les lignes directrices du Joanna Briggs Institute (JBI). Une stratégie de recherche a été effectuée dans les bases de données CINAHL, PubMed, Medline, Web of Science, Google Scholar, GeryLit.org et Grey Source Index. Résultats. La revue de la portée a identifié 78 articles pertinents qui abordaient des définitions (n=25), des indicateurs (n=37), des contextes de soins (n=47), des outils d’évaluation (n=49), des conséquences (n=29) et des interventions (n=21) pour soulager la douleur prolongée néonatale. La revue soutien que les contextes de soins des nouveau-nés prématurés devraient toujours être considérés indépendamment de la présence ou non d’indicateurs de la douleur prolongée afin de guider l’évaluation et le soulagement de la douleur prolongée. Conclusion. Ce mémoire a recensé les éléments essentiels de la douleur prolongée et a permis d’émettre des recommandations pour la pratique, la formation, la gestion et le recherche infirmière, guidé par le cadre théorique de Huth et Moore (1998). / Introduction. Exposure to repetitive pain during the neonatal period has been shown to have important long-term effects on the neurodevelopment of the premature neonate and can contribute to experienced prolonged pain. Since a uniform taxonomy of neonatal prolonged pain is still lacking to this day in neonatology, prolonged pain management remains suboptimal in neonatal intensive care units (NICU). Aim. This master’s thesis aims to determine the scope, extent, and nature of the available literature on prolonged pain in premature neonates hospitalized in the NICU by way of a scoping review. Methodology. An electronic search was conducted in the databases of CINAHL, PubMed, Medline, Web of Science, GeryLit.org and Grey Source Index. This scoping review follows the JBI guidelines for scoping reviews. Results. A total of 78 articles were included in the scoping review which identified key elements of neonatal prolonged pain such as definitions (n=25), indicators (n=37), contexts (n=47), pain scales (n=49), consequences (n=29) and possible interventions (n=21) for prolonged pain management. The contexts of care were identified as being more indicative of prolonged pain and should guide pain evaluation and management. Conclusion. This master’s thesis contributes to the foundation of growing knowledge in neonatal prolonged pain and sheds light on the ambiguity that currently exists on this topic in the scientific literature and informs nursing prolonged pain management in NICU with the ultimate goal of improving developmental outcomes of premature neonates.