La fibrillation auriculaire (FA) est la forme la plus fréquente d'arythmie cardiaque chez l’Homme. L'isolement des veines pulmonaires (VP) par radiofréquence (RF) est le traitement de référence pour les patients atteints de fibrillation auriculaire paroxystique (FAP) réfractaire symptomatique malgré le traitement médicamenteux. L’isolation des VP fonctionne très bien pour traiter les FA paroxystiques mais elle a un rôle limité dans le traitement des patients atteints de FA persistante (FAPs). La FA persistante est en effet plus complexe, en raison du développement dans l'oreillette gauche (OG) d’un substrat arythmogène résultant d’un remodelage électrique et anatomique. Ce substrat maintient la FA et nécessite donc des ablations supplémentaires dans l’OG (en dehors des veines pulmonaires). Les récidives de fibrillation auriculaire sont principalement dues à la reconnexion électrique des veines pulmonaires. C’est un phénomène fréquent, qui limite le succès de la procédure à long terme. Certaines séries rapportent de 20 à 50% de récidive, avec un impact important pour le patient, et pour le système de santé puisque générant des hospitalisations et des procédures répétées. L'ablation point par point utilisant un cathéter d’ablation à électrode unique peut être techniquement complexe. De ce fait, les lésions transmurales, contiguës et pérennes sont parfois difficiles et longues à réaliser, expliquant pour une part les taux élevés de reconnexion. Par conséquent, de nouveaux types de cathéters d’ablation ont été développés. On citera par exemple : les cathéters ballons de cryoablation, les cathéters d’ablation circulaire à électrodes multiples (PVAC et nMARQ), sont maintenant disponibles et ont pour but la création de lésions complètes et continues. Cependant, le ballon de cryoablation a des limites, notamment dans sa capacité à s'adapter à la variabilité anatomique des VP et pour l'ablation des sites extra-veineux. La conséquence est qu’un cathéter d’ablation supplémentaire doit être utilisé pour l’ablation des sites extra-veineux ce qui rend la procédure plus complexe et coûteuse. L’absence d'irrigation du cathéter PVAC augmente sans doute le risque de complications thromboemboliques. Le cathéter nMARQ en revanche est un cathéter circulaire irrigué qui, en plus de son rôle dans l’isolation des VP, permet l'ablation de substrat en dehors des veines pulmonaires. Par ailleurs, les outils de cartographie et d'imagerie cardiaques sont de plus en plus couramment utilisés pour planifier et guider l'ablation de FA. On citera la cartographie électroanatomique invasive (Carto®3) et non invasive (ECVUETM), la tomodensitométrie (TDM) et l'imagerie par résonance magnétique (IRM). Nous avons émis l'hypothèse que différentes stratégies et technologies pourraient améliorer la procédure et les résultats de l’isolation des VP en produisant de meilleures lésions et en permettant une visualisation directe des lésions. Nous avons donc évalué le rôle du cathéter circulaire irriguée pour la cartographie et l’ablation (nMARQ) dans la FAP et la FAPs avec ou sans guidage non invasif par ECGi. Nous nous sommes également intéressés à l’analyse en IRM des lésions produites par ce cathéter lors de l’isolation des veines pulmonaires. À cette fin, les données de l’isolation des VP ont été obtenues et traitées de manière aiguë et à 3 mois. Le suivi clinique a été évalué à 1 an. La thèse se compose de 3 parties : Partie 1 : Comment améliorer l'isolation des veines pulmonaires chez les patients atteints de fibrillation auriculaire paroxystique ? Partie 2 : Cathéter circulaire multiélectrodes et ablation de fibrillation auriculaire persistante. Partie 3 : Rôle de l'imagerie par résonance magnétique dans l'évaluation de la reconnexion des veines pulmonaires après l'isolement des veines pulmonaires ? / Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in Humans. Pulmonary vein isolation (PVI) by radiofrequency (RF) ablation is the mainstay treatment for patients with symptomatic and drug refractory paroxysmal atrial fibrillation (PAF) as ectopic beats (triggers) from pulmonary veins (PVs) initiate AF, however PVI alone had limited role in treating patients with persistent atrial fibrillation (PsAF), due to additional involvement in left atrium (LA) by electrical and anatomical remodeling, creating more complex substrate (fibrosis) that maintain AF and therefore necessitate non-PV sites ablation to modify the arhythmogenic substrate. Atrial fibrillation recurrence mainly due to pulmonary vein (PV) electrical reconnection is common and remains the current issue that limits long term procedural success and generates extra costs due to repeated hospital admissions and repeated procedures. Point by point ablation using single tip catheter can be challenging, complex and time consuming, enhancing electrical reconnection as stable lesions are difficult to achieve. To overcome these limitations, new type of catheters such as balloon (cryoablation) and multi-electrode circular ablation catheters like PVAC and nMARQ, are now available. However, cryoablation balloon is limited by inability to adapt to anatomic PV variability and to ablate non-PV sites. This means that an additional ablation catheter has to be used for non-PV targets, and it certainly adds to the costs. The PVAC catheter lacks of irrigation increases the risk of thromboembolic complications. On contrary, nMARQ is an irrigated circular ablation catheter which in addition to its role in PVI, allows for non-PV/LA substrate ablation. Cardiac mapping and imaging tools are now commonly used to plan and guide AF ablation, such as invasive (Carto 3) and noninvasive (ECVUE) electroanatomic mapping (EAM), computed tomography (CT) and magnetic resonance imaging (MRI), respectively. We hypothesized that different strategies and technologies could improve PVI procedure and outcome by producing better lesions and by allowing for direct visualization of lesions. We therefore, assessed the role of circular, irrigated mapping and ablation catheter (nMARQ) in PAF and PsAF with or without noninvasive ECGi guidance, and advanced imaging technologies (MRI) after PVI. For that purpose, PVI data were obtained and processed acutely and at 3 months. Clinical follow up was evaluated at 1 year. The thesis consists of 3 parts: Part 1: How to improve pulmonary vein isolation lesion formation in patients with paroxysmal atrial fibrillation? Part 2: Circular catheter and persistant atrial fibrillation ablation. Part 3: The role for magnetic resonance imaging in assessing pulmonary vein reconnection after pulmonary vein isolation?

Made available in DSpace on 2016-04-26T20:26:11Z (GMT). No. of bitstreams: 1 Eliane Ramos Oltramari.pdf: 697503 bytes, checksum: 2595d1a012142184eaec3430024ea38d (MD5) Previous issue date: 2007-11-28 / The present dissertation s study objective is the social reality and paradigmatic crisis of knowledge contained in the cultural constellation alongside, as well as its perceived effects in the legal universe. Because of its practical ends it culminates in proposing to the jurist a (re)connection of knowledge to provide a more appropriate source in understanding and solving social problems. In order to do so, our work contemplates basically three parts: in the first part, which comprises chapters 1 to 3, we have recorded the historical unfolding of modern times and its consequences. In the second part, which comprises chapter 4, a field research is presented, where the social perception of issues surveyed has been gauged. At the end, chapters 6 and 7, we examined the Law s predominant characteristics, and studied a proposal of knowledge convergence that could aid the development of a critical view for the existing model, envisioning the recovery of an ethical dimension in the legal universe / A presente dissertação tem como objeto de estudo a realidade social e a crise paradigmática do saber contida em sua constelação cultural que a acompanha, bem como os efeitos percebidos no universo jurídico. Porque tem fins práticos culmina por propor ao jurista uma (re)ligação dos saberes a fim de que se possa obter uma fonte mais adequada para a compreensão e solução dos problemas sociais. Para tanto, nosso trabalho contempla basicamente três partes: na primeira, que compreende os capítulos 1 a 3, fica registrado o desenrolar histórico da modernidade e suas conseqüências. Na segunda parte, que compreende o capítulo 4, foi apresentada uma pesquisa de campo, onde foram aferidas a percepção social das questões levantadas. Ao final, nos capítulos 6 e 7, foram examinadas as características dominantes do Direito, e estudada uma proposta de convergência de saberes que auxiliasse no desenvolvimento de uma visão crítica do modelo existente, com vistas ao resgate da dimensão ética do universo jurídico

Made available in DSpace on 2016-04-28T19:58:50Z (GMT). No. of bitstreams: 1 CristianeTavares.pdf: 728835 bytes, checksum: a536d6e9eba6491b3bb4e3c91c994f1f (MD5) Previous issue date: 2005-10-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The purpose of the present research is to capture the aesthetic project underlying Adélia Prado s poetics, starting from the analysis of three compositional elements in her work: metalanguage, metaphor and rhythm. The hypothesis that supports the research is based on the understanding that metalanguage, metaphor and rhythm are for Adelia Prado s poetry analogical to what the celebration of the Christian initiation sacraments (such as Baptism and Eucharist) mean for Catholicism. These are essential elements in both experiences, that is, they render the very existence of these experiences possible. It is through this aspect that the sacred and the non sacred, the immanent and the transcendent, the ascendant and the descendent are ultimately reconnected, so that both experiences, the poetic and the religious one merge: the poetic language aims at reuniting the name to the named thing, in the same way as the liturgical celebration accomplishes the fusion between the being and the Other Being. In Prado s poetry, as both dimensions merge into a single one, the word is retied to the being, the finite nature of the human experience is transcended and a reconnection between man and his ultimate otherness becomes possible / A presente pesquisa tem como objetivo deflagrar o projeto estético subjacente à poética de Adélia Prado, a partir da análise de três elementos composicionais presentes em sua obra: metalinguagem, metáfora e ritmo. A hipótese que sustenta a pesquisa parte do entendimento de que a metalinguagem, a metáfora e o ritmo estão para a poesia adeliana, assim como a celebração dos sacramentos de iniciação cristã (batismo e eucaristia) está para a religião católica. São elementos fundantes em ambas as experiências, ou seja, fazem possível sua existência. É no aspecto de religação entre o sagrado e o dessacralizado, o imanente e o transcendente, o ascendente e o descendente que as experiências poética e religiosa se encontram: a linguagem poética busca religar nome e coisa nomeada, assim como a celebração litúrgica dos sacramentos busca religar o ser e o Outro Ser. Na poesia adeliana, à medida que ambas as experiências se encontram, religa-se a palavra ao ser, expandem-se as fronteiras da finitude humana e permite-se a religação do homem com sua outridade recôndita

<p>This thesis discusses the reasons for space exploration and space science. Space plasma physics is identified as an essential building block to understand the space environment and it is argued that observation and analysis of space plasma waves is an important approach.</p><p>Space plasma waves are the main actors in many important processes. So-called broadband waves are found responsible for much of the ion heating in the auroral region. We investigate the wave properties of broadband waves and show that they can be described as a mixture of electrostatic wave modes. In small regions void of cold electrons the broadband activity is found to be ion acoustic waves and these regions are also identified as acceleration regions. The identification of the wave modes includes reconstructions of the wave distribution function. The reconstruction technique allow us to determine the wave vector spectrum, which cannot be measured directly. The method is applied to other wave events and it is compared in some detail with a similar method.</p><p>Space plasma wave are also sensitive tools for investigations of both the fine-structure and the dynamics of space plasmas. Studies of whistler mode waves observed in the boundary layer on the magnetospheric side of the magnetopause reveal that the plasma is organized in tube-like structures moving with the plasma drift velocity. The perpendicular dimension of these tubes is of the order of the electron inertial length. We present evidence that each tube is linked to a reconnection site and argue that the high density of tube-like structures indicates patchy reconnection.</p>

<p>Magnetic reconnection is a universal process occurring at boundaries between magnetized plasmas, where changes in the topology of the magnetic field lead to the transport of charged particles across the boundaries and to the conversion of electromagnetic energy into kinetic and thermal energy of the particles. Reconnection occurs in laboratory plasmas, in solar system plasmas and it is considered to play a key role in many other space environments such as magnetized stars and accretion disks around stars and planets under formation. Magnetic reconnection is a multi-scale plasma process where the small spatial and temporal scales are strongly coupled to the large scales. Reconnection is initiated rapidly in small regions by microphysical processes but it affects very large volumes of space for long times. The best laboratory to experimentally study magnetic reconnection at different scales is the near-Earth space, the so-called Geospace, where Cluster spacecraft <i>in situ</i> measurements are available. The European Space Agency Cluster mission is composed of four-spacecraft flying in a formation and this allows, for the first time, simultaneous four-point measurements at different scales, thanks to the changeable spacecraft separation. In this thesis Cluster observations of magnetic reconnection in Geospace are presented both at large and at small scales. </p><p>At large temporal (a few hours) and spatial (several thousands km) scales, both fluid and kinetic evidence of reconnection is provided. The evidence consist of ions accelerated and transmitted across the Earth’s magnetopause. The observations show that component reconnection occurs at the magnetopause and that reconnection is continuous in time. </p><p>The microphysics of reconnection is investigated at smaller temporal (a few ion gyroperiods) and spatial (a few ion gyroradii) scales. Two regions are important for the microphysics: the X-region, around the X-line, where reconnection is initiated and the separatrix region, away from the X-line, where most of the energy conversion occurs. Observations of a separatrix region at the magnetopause are shown and the microphysics is described in detail. The separatrix region is shown to be highly structured and dynamic even away from the X-line.</p><p>Finally the discovery of magnetic reconnection in turbulent plasma is presented by showing, for the first time, <i>in situ</i> evidence of reconnection in a thin current sheet found in the turbulent plasma downstream of the quasi-parallel Earth’s bow shock. It is shown that turbulent reconnection is fast and that electromagnetic energy is converted into heating and acceleration of particles in turbulent plasma. It is also shown that reconnecting current sheets are abundant in turbulent plasma and that reconnection can be an efficient energy dissipation mechanism.</p>

This thesis discusses the reasons for space exploration and space science. Space plasma physics is identified as an essential building block to understand the space environment and it is argued that observation and analysis of space plasma waves is an important approach. Space plasma waves are the main actors in many important processes. So-called broadband waves are found responsible for much of the ion heating in the auroral region. We investigate the wave properties of broadband waves and show that they can be described as a mixture of electrostatic wave modes. In small regions void of cold electrons the broadband activity is found to be ion acoustic waves and these regions are also identified as acceleration regions. The identification of the wave modes includes reconstructions of the wave distribution function. The reconstruction technique allow us to determine the wave vector spectrum, which cannot be measured directly. The method is applied to other wave events and it is compared in some detail with a similar method. Space plasma wave are also sensitive tools for investigations of both the fine-structure and the dynamics of space plasmas. Studies of whistler mode waves observed in the boundary layer on the magnetospheric side of the magnetopause reveal that the plasma is organized in tube-like structures moving with the plasma drift velocity. The perpendicular dimension of these tubes is of the order of the electron inertial length. We present evidence that each tube is linked to a reconnection site and argue that the high density of tube-like structures indicates patchy reconnection.

Magnetic reconnection is a universal process occurring at boundaries between magnetized plasmas, where changes in the topology of the magnetic field lead to the transport of charged particles across the boundaries and to the conversion of electromagnetic energy into kinetic and thermal energy of the particles. Reconnection occurs in laboratory plasmas, in solar system plasmas and it is considered to play a key role in many other space environments such as magnetized stars and accretion disks around stars and planets under formation. Magnetic reconnection is a multi-scale plasma process where the small spatial and temporal scales are strongly coupled to the large scales. Reconnection is initiated rapidly in small regions by microphysical processes but it affects very large volumes of space for long times. The best laboratory to experimentally study magnetic reconnection at different scales is the near-Earth space, the so-called Geospace, where Cluster spacecraft in situ measurements are available. The European Space Agency Cluster mission is composed of four-spacecraft flying in a formation and this allows, for the first time, simultaneous four-point measurements at different scales, thanks to the changeable spacecraft separation. In this thesis Cluster observations of magnetic reconnection in Geospace are presented both at large and at small scales. At large temporal (a few hours) and spatial (several thousands km) scales, both fluid and kinetic evidence of reconnection is provided. The evidence consist of ions accelerated and transmitted across the Earth’s magnetopause. The observations show that component reconnection occurs at the magnetopause and that reconnection is continuous in time. The microphysics of reconnection is investigated at smaller temporal (a few ion gyroperiods) and spatial (a few ion gyroradii) scales. Two regions are important for the microphysics: the X-region, around the X-line, where reconnection is initiated and the separatrix region, away from the X-line, where most of the energy conversion occurs. Observations of a separatrix region at the magnetopause are shown and the microphysics is described in detail. The separatrix region is shown to be highly structured and dynamic even away from the X-line. Finally the discovery of magnetic reconnection in turbulent plasma is presented by showing, for the first time, in situ evidence of reconnection in a thin current sheet found in the turbulent plasma downstream of the quasi-parallel Earth’s bow shock. It is shown that turbulent reconnection is fast and that electromagnetic energy is converted into heating and acceleration of particles in turbulent plasma. It is also shown that reconnecting current sheets are abundant in turbulent plasma and that reconnection can be an efficient energy dissipation mechanism.

Magnetized planets, such as Earth, are strongly influenced by the solar wind. The Sun is very dynamic, releasing varying amounts of energy, resulting in a fluctuating energy and momentum exchange between the solar wind and planetary magnetospheres. The efficiency of this coupling is thought to be controlled by magnetic reconnection occurring at the boundary between solar wind and planetary magnetic fields. One of the main tasks in space physics research is to increase the understanding of this coupling between the Sun and other solar system bodies. Perhaps the most important aspect regards the transfer of energy from the solar wind to the terrestrial magnetosphere as this is the main source for driving plasma processes in the magnetosphere-ionosphere system. This may also have a direct practical influence on our life here on Earth as it is responsible for Space Weather effects. In this thesis I investigate both the global scale of the varying solar-terrestrial coupling and local phenomena in more detail. I use mainly the European Space Agency Cluster mission which provide unprecedented three-dimensional observations via its formation of four identical spacecraft. The Cluster data are complimented with observations from a broad range of instruments both onboard spacecraft and from groundbased magnetometers and radars. A period of very strong solar driving in late October 2003 is investigated. We show that some of the strongest substorms in the history of magnetic recordings were triggered by pressure pulses impacting a quasi-stable magnetosphere. We make for the first time direct estimates of the local energy flow into the magnetotail using Cluster measurements. Observational estimates suggest a good energy balance between the magnetosphere-ionosphere system while empirical proxies seem to suffer from over/under estimations during such extreme conditions. Another period of extreme interplanetary conditions give rise to accelerated flows along the magnetopause which could account for an enhanced energy coupling between the solar wind and the magnetosphere. We discuss whether such conditions could explain the simultaneous observation of a large auroral spiral across the polar cap. Contrary to extreme conditions the energy conversion across the dayside magnetopause has been estimated during an extended period of steady interplanetary conditions. A new method to determine the rate at which reconnection occurs is described that utilizes the magnitude of the local energy conversion from Cluster. The observations show a varying reconnection rate which support the previous interpretation that reconnection is continuous but its rate is modulated. Finally, we compare local energy estimates from Cluster with a global magnetohydrodynamic simulation. The results show that the observations are reliably reproduced by the model and may be used to validate and scale global magnetohydrodynamic models.

No description available.

Observations of the surface of the Sun reveal multi-scaled, mixed magnetic features that carpet the entire solar surface. Not surprisingly, the global magnetic fields extrapolated from these observations are highly complex. This thesis explores the topology of the Sun's global coronal magnetic fields. The magnetic skeleton of a magnetic field provides us with a way of examining the magnetic field and quantifying its complexity. Using specialised codes to find the magnetic skeletons which were written during the course of this work, we first examine potential field extrapolations of the global solar coronal magnetic field determined from observed synoptic magnetograms from the Heliospheric Magnetic Imager on the Solar Dynamics Observatory. The resolution of the PFSS models is found to be very important for discovering the true nature of the global magnetic skeleton. By increasing the maximum number of harmonics used in the potential field extrapolations and, therefore, the grid resolution, 60 times more null points may be found in the coronal magnetic field. These high resolution fields also have a large global separator network which connects the coronal magnetic field over large distances and involves between 40 % and 60 % of all the null points in the solar atmosphere. This global separator network exists at both solar minimum and solar maximum and has separators that reach high into the solar atmosphere (> 1R☉) even though they connect null points close to the solar surface. These potential field extrapolations are then compared with magnetohydrostatic (MHS) extrapolations of the coronal magnetic field which also provide us with information about the plasma in the corona. With a small component of electric current density in the direction perpendicular to the radial direction, these MHS fields are found to have a plasma beta and pressure typical of the corona. As this small component of electric current density grows, the heliospheric current sheet is warped significantly and the magnetic field, plasma beta and pressure become unphysical. Torsional spine reconnection is also studied local to a single null point. First using a dynamical relaxation of a spiral null point under non-resistive magnetohydrodynamics (MHD) to a MHS equilibrium is form in which a current layer has built up around the spine lines. Then the reconnection under resistive MHD in this current sheet is studied. The current about the spine lines is dissipated and the magnetic energy is mainly converted into heat directly as the field lines untwist about the spine line.