Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-24T12:33:27Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) RUBENS RODRIGUES TELES.pdf: 8256916 bytes, checksum: 343eb874fab58d245a7825e979a6bfef (MD5) / Made available in DSpace on 2017-07-24T12:33:27Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) RUBENS RODRIGUES TELES.pdf: 8256916 bytes, checksum: 343eb874fab58d245a7825e979a6bfef (MD5) Previous issue date: 2015-12-18 / CNPQ / Neste trabalho foram estudados parâmetros anisotrópicos de Ressonância Magnética Nuclear, como o acoplamento dipolar residual (do inglês, Residual Dipolar Coupling – RDC) e anisotropia do deslocamento químico residual (do inglês, Residual Chemical Shift Anisotropy), com a finalidade de refinar a elucidação estrutural molecular. A molécula teste escolhida para realização deste estudo foi a α-Santonina, um produto natural com quatro estereocentros, portanto oito diastereoisômeros. Inicialmente, os sinais dos espectros de RMN 1H e 13C foram atribuídos, com auxílio de experimentos uni e bidimensionais. Foram realizados cálculos de mecânica molecular para determinação do espaço conformacional de todos os diastereoisômeros, usando o campo de força MMFF94. As estruturas obtidas, numa janela de 5 kcal/mol foram refinadas com cálculos mecano-quânticos ao nível DFT/B3LYP/6-31G*. As anisotropias do deslocamento químico, foram derivadas do cálculo do tensor de blindagem química calculado com o método GIAO/PBE0/pcS-1. Os meios de alinhamento utilizados foram baseados na metodologia dos géis indutores de alinhamento (do inglês, strain-induced alignment in a gel – SAG), sendo avaliada a eficiência de três meios de alinhamento diferentes: poliacrilonitrila (PAN), poliacrilamida (PH) em DMSO-d6, e polimetilmetacrilato (PMMA) em CDCl3. O experimento realizado com o gel PAN forneceu onze valores de RDC na faixa entre –3,2 e +5,9 Hz. O ajuste dos valores experimentais com as estruturas otimizadas permitiu a determinação da configuração relativa correta da α-Santonina, (5a(S/R), 9b(S/R), 3a(S/R), 3(S/R)), bem como realizar a atribuição dos deslocamentos químicos dos hidrogênios pró-quirais do carbono-5. O experimento usando o gel PH forneceu seis valores de RDC, na faixa de –25,5 a +12,7 Hz. A baixa qualidade dos dados não possibilitou a determinação da configuração relativa da α-Santonina. Por fim, os experimentos com o gel PMMA permitiram a determinação da configuração relativa e da atribuição completa dos sinais de RMN 1H, inclusive dos hidrogênios diastereotópicos H4α, H4β, H5α e H5β que ainda não haviam sido atribuídos na literatura. Foram realizadas medidas de RCSA da molécula teste no gel PMMA. Os valores obtidos ficaram na faixa de –0,05 a +0,01ppm. Com estes dados não foi possível determinar a configuração relativa da mesma. Entretanto, foi realizado um tratamento associando os valores de RDC e RCSA, na qual obteve-se sucesso, chegando à correta configuração relativa com um fator Q igual a 0,606. Nesta amostra foram observados dois sinais para cada carbono, sendo um atribuído à molécula dentro do gel e outro fora do gel. Para estudar esta observação foram realizadas medidas do tempo de relaxação longitudinal, T1, medidas do coeficiente de difusão, bem como imagens de ressonância magnética do tubo de RMN contendo o gel. Foram realizados diferentes cálculos de química quântica para verificar a influência destes no resultado dos valores de RDCs e RCSAs calculados. Para a otimização da geometria foram testadas três classes de métodos, totalizando vinte e oito cálculos. Deste total foram realizados vinte cálculos DFT, quatro cálculos Hartree-Fock e quatro cálculos Semi-empírico. Observou-se que a qualidade da otimização da estrutura não apresentou grande impacto no ajuste dos dados de RDC. Entretanto, a qualidade do ajuste obtido quando foram usados os métodos Semi-empírico foi levemente inferior. Em relação ao RCSA foram testados três níveis de cálculo, PBE0, MP2 e B3LYP, usando sempre o método GIAO. Foi verificada também a importância da inclusão da solvatação implícita com clorofórmio, totalizando nove cálculos. Os resultados mostram que a escolha do método DFT ou MP2 é relevante para os valores calculados de RCSA, por outro lado, a escolha da base e a inclusão da solvatação exerce menor efeito. / In this work we studied the application of anisotropic parameters of Resonance Magnetic Nuclear, namely Residual Dipolar Coupling (RDC) and Residual Chemical Shift Anisotropy (RCSA), to the refinement of molecular structure elucidation. The test molecule chosen for this study was α-Santonin, a natural product with four stereogenic carbons and therefore eight possible diastereoisomeric structures. In the first step, the 1H and 13C NMR spectra were fully assigned by a combination of 1D and 2D experiments. The conformational space of each possible diastereoisomer was explored by means of molecular mechanics computations using the MMFF94 force field. The obtained structures, in an energy window of 5 kcal/mol, were refined at the DFT /B3LYP/6-31G* level method. Chemical shielding anisotropies were derived from chemical shift tensor computations at the DFT GIAO/PBE0/pcS-1 level on the previous B3LYP structures. The alignment media employed in this work used were based on the methodology of straininduced alignment in a gel (SAG). We evaluated the performance of three different gels: polyacrylonitrile (PAN), polyacrylamide (PH) in DMSO-d6, and polymethyl methacrylate (PMMA) in CDCl3. The experiment carried out in PAN gel provided eleven RDC values in the range of –3.2 and +5.9 Hz. Fitting of this experimental values to the computed structures allowed us to determine the correct relative configuration of αSantonin as (5a(S/R), 9b(S/R), 3a(S/R), 3(S/R)), as well as the assignment of chemical shifts of the prochiral hydrogens from carbon-5. The experiment using PH gel provided six RDC values in the range of –25,5 a +12,7 Hz. The lower quality of these data did not allow an unambiguous determination of the relative configuration of α-Santonin. Finally, experiments using the PMMA gel allowed to attribute the relative configuration and the complete assignment of NMR signals, including the diastereotopics hydrogens H4α, H4β, H5α e H5β, that were not assigned before in the literature. We performed RCSA measurements of the test molecule in PMMA gel. The values obtained were in the range of -0,05 a +0,01ppm. It was not possible however to select the correct configuration of αSantonin by fitting these RCSAs to the computed chemical shielding tensors. Nevertheless, when RDC and RCSA values were fitted together the correct structure was selected, arriving to the correct structure with a Q factor equal to 0.606. In this sample was observed two signals for each carbon, being assigned to the molecule within the gel and outside the gel. To further study this behavior were performed measurements of the longitudinal relaxation time (T1), diffusion coefficient and magnetic resonance imaging experiments of the gel. Different methods of quantum chemistry calculations were carried out to evaluate their influence on the outcome of the RDC and RCSA backcalculated values. For the geometry optimization were tested three classes of methods, totaling twenty-eight calculations, twenty DFT based, four Hartree-Fock and four Semiempirical. It was observed that the quality of the structure optimization does not have a strong impact on the fitting of the RDC data. Nevertheless, slightly worse fittings were consistently obtained when using Semiempirical geometries. Regarding the RCSAs we tested three classes of GIAO methods: PBEO, MP2 and B3LYP. It was also evaluated the importance of the inclusion of implicit solvation, totaling nine calculations. The results shown that the choice of DFT or MP2 method is relevant to the RCSA back-calculated values, on the other hand the choice of the basis set or the inclusion of solvation have small effects.

In diesem Beitrag wird die Effizienz von Walzenverdichtern mit unrunder Bandagegeometrie diskutiert. Diese Technologie hat aufgrund seiner höheren Fahrgeschwindigkeit großes Potential zur Rekultivierung großflächiger Tagebauinnenkippen. Die Verdichtung erfolgt durch einen Stoßprozess, welcher durch die eingetragene Energie und den Impuls beschrieben wird. Diese Größen sind abhängig von der Geometrie der Bandage. Für eine Geometrie wird exemplarisch die Kinematik und die davon abhängigen Zustandsgrößen berechnet. Der Einfluss des Bodens auf die Kinematik der Bandage wird mit einem numerischen Modell analysiert und im Kontext der theoretischen Ergebnisse diskutiert. Es zeigt sich, dass für eine Geometrie die Zuggeschwindigkeit und die statische Masse des Verdichters maßgeblich die eingetragene Energie und den Impuls bestimmen. Mit dem Wissen um die wesentlichen Wirkgrößen ist es möglich Verdichtungsprozessen effizienter zu gestalten, z.B. durch die Wahl des entsprechenden Zuggerätes oder die Applikation zusätzlicher Masse.

l’onchocercose et examine les principaux défis liés à l'élimination de l'onchocercose. Pour atteindre nos objectifs, 3 études rétrospectives ainsi que 3 études prospectives ont été réalisées. Ainsi, nous avons constaté que la maladie est présente dans les 26 provinces du pays, celle-ci est méconnue de la population et la participation communautaire au TIDC est faible à cause des effets secondaires du médicament dans les zones coendémiques et l’absence de l’éducation à la santé. Nonobstant les 18 années d’intervention pour contrôler et éliminer l'onchocercose en RDC, l’interruption de la transmission et ou de la prolifération du parasite dans différentes communautés y reste d’actualité. Bien que les stratégies y soient passées de la lutte contre la maladie à son élimination d'ici 2025 selon les projections de l’OMS, elles demeurent tout de même difficiles à atteindre à ce jour en RDC. Plusieurs actions sont encore indispensables pour faciliter l’éradication de la transmission de l’onchocercose en RDC comme :l’épandage aérien d’insecticide, les campagnes d’éducation pour la santé, les formations des distributeurs communautaires et d’agents de santé et la cartographie de toutes les zones de transmission et des zones endémiques à statut inconnu. Il est impérieux de souligner que la lutte contre la maladie est confrontée à certains défis tels que :la coendémicité de l'onchocercose et de la loase, la résistance à l'Ivermectine, la réticence de certaines populations au sein des communautés à adhérer au TIDC, les conflits et troubles civils, les difficultés de mise en œuvre du programme d’ordre technique et financier. Ainsi, nous recommandons :la mise au point d’une cartographie complète de l'élimination, l’adoption d'une approche différente de distribution des médicaments, l’instauration d’une surveillance et évaluation de routine du traitement de masse et le renforcement des partenariats en vue d’une coordination d’activités plus pérenne et d’un financement continu. Le Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapies Préventives (PNLMTN-CTP) doit planifier, coordonner et évaluer régulièrement ses interventions en RDC. Par conséquent, identifier les facteurs empêchant l'interruption de la transmission du parasite et prendre des mesures correctives pour éliminer la maladie en s’inspirant notamment des celles prises en Amériques, s’avèrent indispensables. Par ailleurs, la mise en œuvre des stratégies alternatives de traitement pour accélérer le processus d’élimination de l’onchocercose reste également une priorité.Mots-clés :Onchocercose, Ivermectine, stratégies, mesures, lutte, défis, RDC / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

Introduction :Les pays à bas et moyens revenus (PBMR) traversent une phase de transition nutritionnelle qui s’accompagne d’un accroissement rapide des pathologies cardio-métaboliques et de leurs facteurs de risque, à l’instar de l’obésité chez l’adulte, alors que la sous-nutrition prédomine encore largement chez l’enfant dans ces régions. Ce double fardeau de malnutrition constitue un problème majeur de santé publique. D’après la théorie des origines développementales des maladies chroniques non transmissibles (MNT), ces 2 fardeaux seraient étroitement liés de manière causale. L’objectif de notre étude était de retracer ses sujets avec antécédents de malnutrition aiguë sévère (MAS) durant l’enfance, d’évaluer leur devenir à long terme sur le plan socio-économique, cognitif et sanitaire, et enfin de rechercher les différents marqueurs cardio-métaboliques des MNT. Tout cela en vue d’établir une association entre MAS durant l’enfance et différentes MNT (Hypertension, diabète, obésité, dyslipidémies et composition corporelle) ainsi qu’avec le statut sociodémographique et économique à l’âge adulte, dans un contexte sans transition nutritionnelle.Méthodologie :Les dossiers de sujets admis pour MAS entre 1988 et 2007 ont été extraits des archives de l'hôpital pédiatrique de Lwiro (HPL), au Sud-Kivu, en République Démocratique du Congo (RDC). Entre décembre 2017 et avril 2019, nous avons entrepris d'identifier ces sujets dans les zones de santé de Miti-Murhesa et Katana. Les sujets d’étude ont été identifiés à partir de la base de données de l'HPL. Ils ont ensuite été recherchés dans leurs villages d’origine. Ils ont alors été répartis en quatre catégories (vivant dans le village ou ses environs, décédé, déplacé ou perdu de vue). Pour chaque ancien malnutri retrouvé, un non-exposé communautaire a été choisi de manière aléatoire pour une comparaison. Nos résultats d’intérêt étaient prioritairement les MNT incluant le syndrome métabolique, l’hypertension artérielle, l’obésité globale, l’obésité viscérale, le diabète sucré, les dyslipidémies ainsi que la composition corporelle évaluées par leurs différents marqueurs cliniques et biologiques et, accessoirement, l’atteinte rénale à travers le taux de créatinine sérique. Secondairement, nous avons évalué le capital humain à travers le niveau socio-économique (déduit à partir de la scolarité, la profession et les conditions de vie), l’estime de soi, les troubles cognitifs ainsi que les incapacités quotidiennes sur le plan relationnel et fonctionnel liés à l’état de santé. Il est signalé cependant qu’au moment de la reconstitution de la cohorte, nous avons récolté des données relatives à la survie (et son corolaire la mortalité et ses causes) ainsi que l’état nutritionnel à long terme.Résultats :Un total de 1981 dossiers des sujets admis pour MAS de 1988 à 2007 a été extrait des archives de l’HPL. L’âge médian à l’admission était de 41 mois. Six cents sujets ont été retrouvés et 201 sujets sont décédés. Soixante-cinq virgule six pourcents des sujets décédés avaient ≤10 ans lors de leur mort. Cinquante-neuf virgule deux pourcents de décès sont survenus dans les 5 ans ayant suivi la sortie de l’hôpital. Les principales causes de décès étaient le paludisme (14,9%), le kwashiorkor (13,9%), les infections respiratoires (10,4%) et les maladies diarrhéiques (8,9%). Comparés aux non exposés, les exposés avaient un faible poids (-1,7 kg, p=0,001), une petite taille [assise (-1,3 cm, p=0,006) et debout (-1,7 cm, p=0,003)], une longueur moindre des jambes (-1,6 cm, p=0,002) et un petit périmètre brachial (-3,2 mm, p= 0,051). Aucune différence n’a été observée en termes d’indice de masse corporelle (IMC), de longueur thoracique, et de périmètre crânien ou thoracique entre les 2 groupes.En termes de composition corporelle, les exposés, comparés aux non exposés, avaient une masse maigre réduite [-1,56 kg (-2,93, -0,20) ;p=0,024] mais cette observation était plus marquée chez les hommes (45,4 5,4 vs. 48,26,9 kg, p=0,01) que chez les femmes. En revanche, aucune différence entre exposés et non exposés n'a été observée en termes de masse grasse. Enfin, en ajustant pour la taille, l’index de masse maigre et l’index de masse grasse n’a montré aucune différence dans les deux groupes indépendamment du sexe.Sur le plan capital humain, comparés aux non exposés communautaires, la proportion avec niveau d’études et niveau socio-économique (NSE) élevés d’anciens malnutris était diminuée [niveau études (35,2 vs 46,4 ;p  0.) ;NSE (3,0 vs 6,7 ;p= 0,007)]. En plus, sur le plan cognitif et estime de soi, comparés aux non-exposés, les anciens malnutris avaient des scores inférieurs aux tests cognitifs [25.6 vs 27.8, p = 0.001 [Mini Mental State Examination (MMSE)] et 22.8 vs 26.3, p < 0.001(MMSE-I)] et avaient une moindre estime d’eux-mêmes (20,3% vs 12,3% ;p = 0.003). Néanmoins, en termes d’incapacités liées à l’état de santé, ces derniers avaient moins d’incapacités au plan relationnel (28,6 vs 31,5 ;p = 0.034) que la population générale, quoiqu’aucune différence n’ait été observée au plan des activités quotidiennes (5,8 vs 9,1 ;p = 0.322)En termes de MNT, comparés aux non exposés communautaires, les anciens malnutris avaient un tour de taille majoré [+1.2 (0.02,2.3) cm, p=0.015] et ratio tour de taille/taille debout supérieur [0.01 (0.01, 0.02) cm; p0.001]. Par contre, ils avaient un tour de hanches diminué [-1.5 (-2.6, -0.5) cm; p=0.021], et une force musculaire réduite. Concernant les marqueurs cardio-métaboliques de MNT, hormis une HbA1c plus élevée [+0.4 (0.2, 0.6)%; p0.001], aucune différence n’a été mise en évidence concernant la pression artérielle, la glycémie à jeun, la créatinine, le profil lipidique et l’albuminémie chez les exposés par rapport aux non exposés. En comparaison des non exposés, les exposés avaient une prévalence accrue de syndrome métabolique [Odds Ratio (OR) 2.35 (1.22, 4.54); p=0.010], d’obésité viscérale [OR ajusté 1.44 (1.09, 1.89); p=0.001] et de maigreur [OR ajusté 1.92 (1.03, 3.57)]. En revanche, la prévalence d’hypertension, de diabète, de surpoids et de dyslipidémie était similaire dans les deux groupes.Conclusion :Une MAS durant l’enfance expose les survivants à un risque élevé de MNT et à une diminution du capital humain à l’âge adulte, même en l’absence de transition nutritionnelle subséquente. Les décideurs politiques et les bailleurs de fonds souhaitant lutter contre l'expansion mondiale des MNT chez l’adulte pourraient considérer le bénéfice à long terme de la réduction de la MAS dans l’enfance en tant que mesure préventive de réduction du fardeau attribuable aux MNT au plan socio-économique. / Introduction: Low- and middle-income countries are going through a nutritional transition phase that is accompanied by a rapid increase in cardio-metabolic diseases and their risk factors, such as obesity in adults, while undernutrition still predominates in children in these regions. This double burden of malnutrition constitutes a major public health problem. According to the theory of developmental origins of chronic noncommunicable diseases (NCDs), these 2 burdens would be closely causally linked. The objective of our study was to trace subjects with a history of severe acute malnutrition (SAM) in childhood, to assess their long-term socioeconomic, cognitive, and health outcomes, and finally to investigate the different cardiometabolic markers of NCDs. All this was done in order to establish an association between SAM during childhood and different chronic non-communicable diseases (hypertension, diabetes, obesity, dyslipidemias and body composition) as well as with socio-demographic and economic status in adulthood, in a context without nutritional transition.Methodology: Records of subjects admitted for SAM between 1988 and 2007 were retrieved from the archives of Lwiro Hospital, South Kivu, Democratic Republic of Congo (DRC). Between December 2017 and April 2019, we undertook to identify these subjects in the Miti-Murhesa and Katana health zones. Study subjects were identified from the Lwiro Pediatric Hospital (LPH) database. They were then traced to their home villages. They were then divided into four categories (living in or near the village, deceased, displaced, or lost to follow-up). For each former malnourished found, a community non-exposed was randomly selected for comparison. Our outcomes of interest were primarily NCDs including primarily metabolic syndrome, arterial hypertension, global obesity, visceral obesity, diabetes mellitus, dyslipidemias as well as body composition assessed by their different clinical and biological markers and, secondarily, renal impairment through serum creatinine level. Secondly, we evaluated the human capital through the socio-economic level (deduced from the education, the profession and the living conditions), the self-esteem, the cognitive disorders as well as the daily disabilities on the relational and functional level related to the health condition. It should be noted, however, that at the time of reconstitution of the cohort, we collected data on survival (and its corollary, mortality and its causes) and long-term nutritional status.Results: A total of 1981 records of subjects admitted for SAM from 1988 to 2007 were retrieved from the archives of the LPH. The median age at admission was 41 months. Six hundred subjects were found and 201 subjects died. 65.6% of the deceased subjects were ≤10 years of age at death. 59.2% of deaths occurred within 5 years of hospital discharge. The leading causes of death were malaria (14.9%), kwashiorkor (13.9%), respiratory infections (10.4%), and diarrheal diseases (8.9%). Compared to the unexposed, the exposed had low weight (-1.7 kg, p=0.001), short stature [sitting (-1.3 cm, p=0.006) and standing (-1.7 cm, p=0.003)], shorter leg length (-1.6 cm, p=0.002), and small brachial circumference (-3.2 mm, p= 0.051). There were no differences in BMI, chest length, and head or chest circumference between the 2 groups.In terms of BC, exposed, compared to unexposed, had a reduced FFM [-1.56 kg (-2.93, -0.20); p=0,024] but this observation was more marked in exposed males (45.4  5.4 vs. 48.2 6.9 kg, p=0.01) than females compared to unexposed. However, no difference between exposed and unexposed was observed in terms of FM. Finally, adjusting for height, FFMI and FMI show no difference in either sex.In terms of human capital, compared to the community unexposed, the proportion with high education and socioeconomic status (SES) of formerly malnourished was decreased [study (35.2 vs. 46.4; p 0.); SES (3.0 vs. 6.7; p= 0.007)]. In addition, in terms of cognition and self-esteem, compared to the non-exposed, the formerly malnourished had lower scores on cognitive tests [25.6 vs 27.8, p = 0.001 (MMSE) and 22.8 vs 26.3, p < 0.001 (MMSE-I)] and had lower self-esteem (20.3% vs 12.3%; p = 0.003) Nevertheless, in terms of health-related disabilities, they had less disability in relationships (28.6 vs. 31.5; p = 0.034) than the general population, although no difference was observed in daily activities (5.8 vs. 9.1; p = 0.322).In terms of NCDs, compared to the community unexposed, the malnourished elders had an increased waist circumference [+1.2 (0.02, 2.3) cm, p=0.015] and a higher waist/standing height ratio [0.01 (0.01, 0.02) cm; p0.001]. On the other hand, they had a decreased hip circumference [-1.5 (-2.6, -0.5) cm; p=0.021], and reduced muscle strength. Regarding cardiometabolic markers of NCDs, apart from a higher HbA1c [+0.4 % (0.2, 0.6); p0.001], no differences were found in blood pressure, fasting blood glucose, creatinine, lipid profile and albumin levels in the exposed compared to the unexposed. Compared to unexposed individuals, exposed individuals had an increased prevalence of metabolic syndrome [Odds Ratio (OR) 2.35 (1.22, 4.54); p=0.010], visceral obesity [adjusted OR 1.44 (1.09, 1.89); p=0.001] and leanness [adjusted OR 1.92 (1.03, 3.57)]. In contrast, the prevalence of hypertension, diabetes, overweight and dyslipidemia was similar in both groups.Conclusion: SAM in childhood puts survivors at high risk for NCDs and reduced human capital in adulthood, even in the absence of subsequent nutritional transition. Policymakers and funders interested in combating the global expansion of NCDs in adults might consider the long-term benefit of reducing SAM in childhood as a preventive measure to reduce the socioeconomic burden attributable to NCDs. / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

Si l’explosion du système Est-Ouest marque la fin de l’idée de confrontation globale en tant que modèle de la guerre depuis la fin du second conflit mondial, on doit plus fondamentalement s’interroger sur les changements intervenus depuis les années 90 en ce qui concerne le statut de la guerre elle-même et sur le rôle des opérations de paix dans les relations internationales. Les crises politiques découlant de conflits internes sont des sources de déstabilisation et de fragilisation des institutions locales qui subissent le tumulte et affaiblissent la capacité des acteurs à sortir d’une telle situation politique. La nécessité de renforcer les capacités locales pendant cette période charnière afin d’éviter les crises récurrentes se traduit par la présence de la Communauté internationale qui déploie une multitude de stratégies. Il existe en effet, dans la grammaire des Nations Unies, un continuum de modes de gestion des crises qui va des formes les plus réservées de la persuasion à certaines modalités de diplomatie coercitive, impliquant un usage limité de la violence. Lorsqu’on examine les opérations de paix en RDC, un ensemble dynamique de tensions et de liaisons, oscillant entre ordre et désordre dans ses expressions institutionnelles, le constat qui se dégage est que la question de la paix exige une analyse qui prenne en compte plusieurs facteurs. D’où le recours à une approche interdisciplinaire, mobilisant des courants critiques au sein des relations internationales tout en alliant la sociologie des relations internationales. Notre approche interdisciplinaire qui est au centre de cette thèse peut aussi être d’un grand intérêt dans le renforcement de l’approche polémologique, elle-même fort utile pour appréhender les modalités de gouvernance par les groupes politico-militaires. Notre étude s’attache à évaluer la pertinence et la cohérence des pratiques et conduites des acteurs internationaux pour mieux dégager les contours axiologiques et idéologiques de la gestion des crises itératives. / If the explosion of the East/West system marks the end of the idea of global confrontation as model of the war since the end of the second world conflict, we more fundamentally have to wonder about the changes which took place since the 90s as regards the status of the very war and about the role of the peace operations in the international relations. The political crises ensuing from internal conflicts are sources of destabilization and weakening of the local institutions which undergo the tumult and weaken the capacity of the actors to go out of such a political situation. The necessity of strengthening the local capacities during this pivotal period to avoid the recurring crises is translated by the presence of the international community which spreads a multitude of strategies. There is indeed in the grammar of United Nations a continuum in the modes of crises’ management which goes the most reserved forms of the persuasion to certain modalities of coercive diplomacy, implying a use limited by the violence. When we examine the peace operations in RDC, dynamic set tensions and connections, oscillating between order and disorder in its institutional expressions, the report which gets free is that the question of the peace requires an analysis which takes into account several factors. Hence the use of an interdisciplinary approach, involving both critical currents in international relations (critical constructivism) while combining the sociology of international relations. Our study attempts to estimate the relevance and the coherence of the practices and the conducts of the international actors in a better way axiological and ideological outlines of the management of the iterative crises.

No description available.

Concerning the importance and the necessity of fitting food services to actual lawmaking and knowing the difficulty found in it, the present paper aimed to systemize a Tool (Evaluation List, Plan of Action and Touching Collaborators) to support Good Practices. The present study was realized in twenty three, 23, downtown food services, in Santa Maria, Rio Grande do Sul, through a proportional stratified sample of eight restaurants, eleven snack bars and four bakeries. A List of Evaluation of Good Practices for Food Services (LEGPFS) was made, specific for RDC 21604 ANVISA. This list was applied for a professional technician and for the company, in March and October, respectively. After that, a simple Plan of Action to facilitate the process of fitting was suggested. Samples of swabs to verify Staphylococcus coagulase positive and total count of mesophyll aerobics microorganisms and were collected from manipulators and from surfaces after hygiene, before and after the use of the tool. All collaborators were invited to participate of a touching concerning microbiological analysis and formulary applied to participants, evaluated by the results of LEGPFS. The results showed a significant difference (p<0,05) after the application of LEGPFS such for the technician as to the company, according to the fitting percentage. It was observed a significant improve (p<0,05) in following lawmaking after the use of the tool. The touching was considered efficient and there was a fitting to the process of hands and surfaces hygiene. In conclusion, the tool elaborated was valid to support food services in fitting actual lawmaking. / Tendo em vista a importância e a necessidade de adequação dos serviços de alimentação à legislação vigente e sabendo-se da dificuldade encontrada, objetivou-se, com este trabalho, sistematizar uma Ferramenta (Lista de Avaliação, Plano de Ação e Sensibilização de colaboradores) de apoio às Boas Práticas. O presente estudo foi realizado em 23 serviços de alimentação do Bairro Centro, da cidade de Santa Maria-RS, a partir de uma amostra estratificada proporcional de 8 restaurantes, 11 lanchonetes e 4 padarias/ confeitarias. Elaborou-se uma Lista de Avaliação de Boas Práticas para Serviços de Alimentação (LABPSA), específica para RDC 216/04 - ANVISA. Ela foi aplicada por profissional técnico e pela empresa, em março e outubro de 2006, respectivamente. Após a aplicação da LABPSA, sugeriu-se um modelo simples de Plano de Ação para facilitar o processo de adequação. Realizaram-se coletas de swabs nas mãos dos manipuladores e nas superfícies, após a higienização, para verificação de Staphylococcus coagulase positiva e contagem total de microrganismos aeróbios mesófilos, antes e após o uso da Ferramenta. Todos os colaboradores foram convidados a participar de uma sensibilização, avaliada pelos resultados da LABPSA, das análises microbiológicas e de formulário aplicado aos participantes. Constatou-se diferença significativa (p< 0,05) após a aplicação da LABPSA tanto técnica quanto pela empresa, de acordo com o percentual de adequação. Houve também uma melhora significativa (p< 0,05) no atendimento à legislação após a utilização da ferramenta. A sensibilização foi considerada eficaz e houve adequação no processo de higienização das mãos e superfícies. Em suma, a ferramenta elaborada foi válida para apoiar os serviços de alimentação nas adequações exigidas pela legislação atual.

This study quantifies the mandibular movements of opening and close, laterotrusion and protrusion, obtained from 20 healthy subjects and 20 TMD subjects subdivided into 10 individuals with myopathy and 10 individuals with arthropaty, selected by Research Diagnostic Criteria (RDC) protocols. These movements of all subjects were captured and measured at maximum length, medium velocity and acceleration and deviation during your trajectories, were captured by three infrared cameras and measured by a computational system previously developed by the University Federal of Uberlândia, which, in this research was named Jaw Capture. This system receives images simultaneously from nine reflective markers and send and process this data to a computer using a firewire system through a mathematical approach to analyze and quantify in 3D (at X, Y and Z axis), the marker trajectories. The reflective markers were positioned by supporting systems fixed on vestibular face of lower incisives and skin surface of face. The movement ranges are similar among all individuals, meanwhile the deviation and the medium velocity and acceleration are very different between target and control group after statistical analysis. This system being proves reliable and efficient. / Este estudo quantifica os movimentos mandibulares de abertura e fechamento, lateralidade e protrusão, de 20 indivíduos saudáveis, e 20 indivíduos com DTM, sendo, 10 indivíduos portadores de miopatia e 10 indivíduos portadores de artropatia, triados segundo o protocolo de Research Diagnostic Criteria (RDC). Os movimentos mandibulares, de cada um deles, foram capturados e medidos em suas amplitudes máximas, velocidade e aceleração médias, bem como os desvios durante os mesmos, por um sistema de reconstrução de imagens, desenvolvido na Universidade Federal de Uberlândia, o qual foi chamado neste trabalho de Jaw Capture. O sistema recebe imagens simultâneas de nove marcadores de alta refletividade, capturadas por três câmeras de infravermelho, conectadas a um computador pelo sistema firewire, através de uma abordagem matemática para analisar e quantificar as trajetórias dos marcadores em três dimensões (3D), nos eixos X, Y e Z. Os sensores foram posicionados em suportes afixados nos incisivos inferiores e na pele do rosto, sem considerar os movimentos das cabeças da mandíbula. A amplitude dos movimentos em todos os indivíduos mostrou-se semelhante, entretanto os desvios e a velocidade e aceleração médias foram muito diferentes, após a análise estatística. O método provou ser confiável e eficiente. / Doutor em Ciências

Il ne nous appartient pas dans cette étude de traiter des seuls problèmes occasionnés par l’exportation coercitive du modèle politique occidental en Afrique, la question a déjà fait l’objet de remarquables travaux. Il convient cependant de souligner que force est de constater le manque d’études concernant l’ethnie en tant qu’ontologie intrinsèque en relations internationales et en polémologie en particulier. Dans le cadre de notre étude, il s’agit d’une part de mettre en évidence l’aspect central et fondamental de la manipulation multiforme du concept d’ethnie dans la survenance de certains conflits post 2nde Guerre Mondiale. En effet, outre les deux bombardements nucléaires d’Hiroshima et de Nagasaki en 1945, les puissances nucléaires se sont livrées à un jeu macabre de chantage stratégique sans pour autant faire usage de l’arme prétorienne et ultime qu’est le feu nucléaire, reléguant les études concernant le phénomène nucléaire à de vaines spéculations sur l’emploi d’une arme devenue de fait obsolescente. Il va sans dire qu’eut égard aux nombreuses victimes civiles et militaires, directes et indirectes des conflits que nous décrivons et que nous analysons en l’espèce dans le cadre de cette étude ; l’ethnie qui est maintes fois convoquée, galvaudée joue un rôle non négligeable dans ces conflits. A cet effet les conflits étudiés en l’espèce appartiennent à la catégorie des conflits identitaires. La multiplicité des conflits à caractère ethnique en Afrique noire et les violences indicibles qui en résultent comme au Rwanda, nous incline à penser pour schématiser prosaïquement que l’ethnie tue plus que l’atome ; autrement dit les conflits ethniques auxquels un nombre limité d’études est consacré sont beaucoup plus violents et plus meurtriers que les spécialistes ne veulent le faire croire. Ainsi marginaliser, caricaturer ou analyser sans consistance scientifique, sans profondeur épistémologique les conflits identitaires et ethniques reviendrait à les exclure progressivement du champ d’étude des relations internationales et de la polémologie. L’ethnie appert de ce fait comme une ontologie intéressant de plus en plus les relations internationales eu égard à la multiplicité des conflits ethniques et identitaires essaimant en Afrique depuis la chute du Mur de Berlin. Depuis cette période symbolique les Etats forts bâtis sur le modèle jacobin importé et cimenté par les partis et pensées uniques ont fait place à une multitude de revendications, au pluralisme politique ainsi qu’à la résurgence des identités ethniques. Dans le cas congolais, l’ethnie devient une ontologie transnationale, elle sert non plus à diviser mais à unir des alliés. L’ethnie ne devient donc plus un facteur de repli identitaire mais une source de la constitution de grands ensembles politiques transnationaux. Pour ce faire, l’histoire est mobilisée et manipulée à dessein afin de servir de ferment de légitimation. / It is not up to us in this study to treat only problems caused by the coercive export of Western political model in Africa, the question has already been remarkable treated. It should however be noticed that it is clear the lack of studies on ethnicity as an integral ontology in international relations and conflict studies in particular. In our study, it is firstly to highlight the central and fundamental aspect of the multifaceted manipulation of the concept of ethnicity in the occurrence of certain post WW2 conflicts. Indeed, besides the two atomic bombings of Hiroshima and Nagasaki in 1945, the nuclear powers have engaged in a macabre game of strategic blackmail without making use of the ultimate weapon and Praetorian what the nuclear fire, relegating studies on nuclear phenomenon of idle speculation about the use of a weapon is now obsolescent.Needless to say, What would the light of numerous civilian and military casualties, direct and indirect conflicts we describe and we analyze the case in this study, the ethnic group that has repeatedly called, plays a hackneyed significant role in these conflicts. To this end the conflicts in the studied species belong to the category of identity conflicts. The multiplicity of ethnic conflicts in sub-Saharan Africa and the unspeakable violence that result as in Rwanda, we tend to think to map prosaically as ethnicity kills more than the atom, ie the ethnic conflicts which a limited number of studies are devoted much more violent and deadly than the experts do not want to believe. And marginalize, caricature or analysis without scientific consistency without deep epistemological identity and ethnic conflicts would be to progressively exclude the study of international relations and war studies.The ethnicity appears thus as interesting ontology increasingly international relations with respect to the multiplicity of ethnic and identity conflicts swarming in Africa since the fall of the Berlin Wall. Since this symbolic period strong states built on the Jacobin model imported cemented by single parties and thoughts have been replaced by a multitude of claims to political pluralism as well as the resurgence of ethnic identities. In the Congolese case, ethnicity becomes a transnational ontology, it is no longer to divide but to unite allies. The ethnic therefore becomes a factor of isolationism but a source of the formation of large transnational political groups. To do this, the story is mobilized and manipulated on purpose to serve as a leaven of legitimation.

Após décadas de afastamento, o farmacêutico busca retornar ao seu local primeiro de atuação, a farmácia. Esse retorno apresenta-se como tendência em muitos países, e também no Brasil. Entidades governamentais e profissionais esforçam-se para revalorizar a atuação do farmacêutico junto às atividades assistenciais, e uma contribuição significativa ocorreu com a publicação, pela Agência Nacional de Vigilância Sanitária (ANVISA), da Resolução de Diretoria Colegiada - RDC 44, em 17/08/2009. A Resolução estabelece critérios e condições mínimas para o cumprimento das Boas Práticas Farmacêuticas, e dá respaldo a vários Serviços Farmacêuticos no ambiente das farmácias e drogarias. Diante da tendência de retorno do farmacêutico à assistência, do crescimento dos cursos de Farmácia no país e do grande número de recém-formados que ingressam no segmento de farmácias e drogarias a cada ano, justifica-se verificar com se desenvolve o trabalho desses profissionais. O objetivo do presente trabalho consistiu em avaliar o perfil e a atuação dos farmacêuticos na vigência da Resolução 44/2009, em farmácias e drogarias do município de São Paulo. O estudo descritivo transversal desenvolveu-se junto às farmácias e drogarias do município de São Paulo, com aplicação de questionário ao farmacêutico. Abordou características gerais desse profissional e do estabelecimento, conhecimento do mesmo sobre a Resolução 44/2009, atividades assistenciais, relacionamento com os componentes da equipe de trabalho, aspectos de documentação, e a visão do farmacêutico, tanto de sua atividade como de si mesmo. As respostas foram testadas estatisticamente, e procurou-se verificar se a Resolução 44/2009 tem provocado mudanças em sua atuação, em relação aos Serviços Farmacêuticos (SF). Buscou-se identificar os principais fatores que se apresentam como obstáculos para o retorno do farmacêutico ao seu papel de agente de saúde. Os resultados indicaram que os farmacêuticos das farmácias e drogarias do município de São Paulo são jovens, formaram-se principalmente em instituições privadas, estão familiarizados com o termo \"atenção farmacêutica\", mas nem todos conhecem as condutas que esta prática envolve. Foram observados aspectos positivos, como a percepção dos profissionais de que a Resolução 44/2009 valorizou seu trabalho e que tem havido reconhecimento crescente de sua atuação. Existe inclinação para a prática assistencial, mas os farmacêuticos não desenvolvem plenamente os SF da Resolução 44/2009. Há, no entanto, muitas barreiras para a efetivação da atenção farmacêutica e demais serviços, o que dificulta a inserção do farmacêutico nas práticas assistenciais. Dentre as mais citadas estão a falta de tempo para tais práticas, formação deficiente ou inadequada, falta de autonomia e autoridade dos farmacêuticos, e a resistência dos empresários em considerar os serviços farmacêuticos como um diferencial de atendimento e possibilidade de ganhos financeiros. / After decades of absence the pharmacist seeks to return to his first workplace, the pharmacy. This return is shown as a trend in many countries, and also in Brazil. Government and professional entities strive to revalue the pharmacist\'s care activities, and in Brazil, a valuable contribution in this direction came with the publication of Collegiate Board Regulation RDC 44, in August 2009, by the National Agency of Sanitary Surveillance (ANVISA). This regulation establishes minimum conditions for Good Pharmaceutical Practices and gives legal backing to several pharmaceutical services in pharmacies. The trend of return to pharmaceutical care, the growth of Pharmacy courses in our country and the large number of new professionals who enter the pharmacy segment every year justify checking how this professional activity develops. The purpose of this study was to evaluate the profile and acting of pharmacists in the presence of Regulation 44/2009, in pharmacies of São Paulo. Data were collected through cross-sectional study with a questionnaire to pharmacists, including general characteristics of pharmacists and pharmacies, checking about the knowledge of Regulation 44/2009 and assistencial activities, documentation aspects (in the context of this Regulation), relationship with other components of the working team, and the vision of the community pharmacist, of himself and of his work. The answers were tested statistically, to check if Regulation 44/2009 has changed the performance of the pharmacists in relation to services listed therein, and which has been the main obstacles to its application. We attempted to identify the most relevant factors that stand out as obstacles to pharmacists on returning to their role as a health agent. The results showed that pharmacists in São Paulo are young, formed mainly in private institutions, are familiar with the term \"pharmaceutical care\", but not all knew about the practices involved. Positive aspects were observed, such as the Regulation 44/2009 valued pharmacist´s job, and there was an increasing recognition of him by the population. There is a tendency to care practice, but pharmacists do not develop, in a regular way, the SF of Regulation 44/2009. Several barriers were identified, however, for the effectiveness of pharmaceutical care and other services: the most cited were lack of appropriate working environment, poor training of pharmacists, lack of autonomy and authority for them, and the vision of businessmen, who show resistance in considering the pharmaceutical services as a differential in attendance.