Thesis (M.M. (Finance & Investment))--University of the Witwatersrand, Faculty of Commerce, Law and Management, Graduate School of Business Administration, 2014. / Corporate Risk management has become very important for firms who are exposed to markets risks. A firm that manages the market risks it is exposed to efficiently can ensure it remains solvent in times of extreme market volatility. This paper looks at the hedging activities of South African Airways over a 10 year period where the airline experienced significant losses due to volatility in the Rand Exchange Rate and Crude Oil prices.

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<p>Pre-clinical imaging has provided pulmonary researchers with a number of valuable tools for studying both the lung and lung disease. A greater understanding of the structure/function relationships within the rodent lung would help to bridge the gap between functional images of the lung and its underlying anatomy.</p> <p>The objectives of this work were to visualize and measure the components of rodent lung anatomy. Contrast-enhanced microCT images were used to visualize the airways and major blood vessels from both the Sprague-Dawley rat and the BALB/c mouse. These observations and measurements were used in the development of a pulmonary lung model containing both the conducting airways and blood vessels. The model can be applied to unenhanced images of the rodent lung to facilitate the regionalization of functional imaging data (SPECT/PET). The model has been used to simulate bronchoconstriction and deposition patterns of inhaled particles. Extensive validation revealed that the model was unable to fully reproduce the rodent lung and that further refinement is necessary.</p> <p>The finer structure of the rodent lung, which could not be resolved using our microCT system, was measured using histological sections of the rodent lung. Software was developed and validated to automatically quantify the increases in airspace size that are associated with several respiratory conditions.</p> <p>Together, this work sheds light on the underlying anatomy of the rodent lung that is present in both anatomical and functional images. The knowledge will help researchers to understand some of the structural changes that are occurring with the development of lung disease.</p> / Doctor of Philosophy (PhD)

Bakgrund: Att hantera luftvägen hos en patient i samband med anestesi är en av anestesisjuksköterskans huvuduppgifter. Då en oväntat svår luftväg uppstår så ställs det höga krav kompetensmässigt på anestesisjuksköterskan. Tidigare forskning har i liten utsträckning fokuserat på anestesisjuksköterskans erfarenheter kring denna komplexa situation. Det är därför önskvärt att utföra ytterligare studier inom detta ämne med fokus på erfarenheter. Syfte: Syftet med studien var att belysa anestesisjuksköterskans erfarenheter av den oväntat svåra luftvägen i samband med anestesi. Metod: Studien genomfördes utifrån kvalitativ ansats. Data samlades in genom semistrukturerade intervjuer med tio anestesisjuksköterskor anställda på två olika operationsavdelningar i Sverige. Intervjuerna transkriberades och analyserades med innehållsanalys. Resultat: I analysen framkom fyra kategorier som beskriver anestesisjuköterskornas erfarenheter av oväntat svår luftväg i samband med anestesi; upplevelser av att arbeta under press, att samarbeta i team, betydelsen av att känna sig trygg i sin yrkesroll samt värdet av reflektion. Slutsats: Anestesisjuksköterskornas delade erfarenheter tyder på en samstämmighet om att när en oväntat svår luftväg uppstår så efterfrågades mer träning tillsammans. Detta dels för att underlätta samarbetet och för att kunna ta del av andras erfarenheter och strategier för att lösa liknande situationer i framtiden. Nyckelord: Anestesisjuksköterska, oväntat svåra luftvägar, erfarenheter, känslor, upplevelser. / Background: Managing the airway of a patient during anesthesia is one of anesthesia nurse's main tasks. When an unexpected difficult airway occurs, the high demands in terms of competence of the nurse anesthetist. Previous research has small extent focused on the nurse anesthetist experiences of this complex situation. It is therefore desirable to perform further studies on this subject, focusing on experience. Aim: The aim was to illustrate anesthetic nurses experiences of the unexpected difficult airway associated with anesthesia. Method: The study was conducting using qualitative approach. Data were collected through semi-structured interviews with ten anesthetic nurses employed in two different surgical departments in Sweden. The interviews were transcribed and analyzed by content analysis. Result: The analysis revealed four categories that describe anesthetic nurses experiences of the unexpected difficult airway associated with anesthesia; experiences of working under pressure, to work in teams, the importance of feeling safe in their professional capacity and the value reflection Conclusion: Anesthetic nurses shared experiences suggest a consensus that when these situations occur they requested more training together. This is partly to facilitate cooperation and also to take advantage of others' experiences and strategies to solve similar situations in the future. Keywords: Nurse anesthetist, unexpected difficult airways, experiences, feelings.

Dans les nouveaux protocoles thérapeutiques par voie inhalée, le dosage des particules actives reste un problème complexe qui dépend de trois principaux facteurs : leur taille, la dynamique des flux et les variations de calibre bronchique. La solution nécessite de disposer d'un modèle de distribution des gaz et aérosols administrés dans les poumons. Ventilation pulmonaire et effets du cycle respiratoire sur la dynamique des fluides deviennent deux enjeux clés de la pratique clinique.<br /><br />Dans ce contexte, le projet RNTS RMOD a pour objectif de développer un simulateur morpho-fonctionnel des voies respiratoires pour l'aide au diagnostic, au geste médico-chirurgical et à l'administration de médicaments par inhalation.<br /><br />Contribuant au projet RMOD, la recherche développée dans cette thèse propose une modélisation in-silico de la structure des voies aériennes supérieures (VAS) et proximales (VAP) à partir d'examens tomodensitométriques (TDM). L'investigation morphologique et la simulation fonctionnelle bénéficient alors de géométries 3D réelles, adaptées au patient et spécifiques des pathologies rencontrées.<br /><br />La modélisation développée fait coopérer des méthodes originales de segmentation, de construction de surface maillée et d'analyse morpho-fonctionnelle.<br /><br />La segmentation des VAP est obtenue par un schéma diffusif et agrégatif gouverné par un modèle markovien, dont l'initialisation repose sur l'opérateur de coût de connexion sous contrainte topographique. De cette segmentation, l'axe central de l'arbre bronchique est extrait de manière robuste et précise en combinant information de distance, propagation de fronts, et partition conditionnelle locale. Cet axe central est représenté sous forme d'une structure hiérarchique multivaluée synthétisant caractéristiques topologiques et géométriques de l'arbre bronchique. Une surface maillée est ensuite construite en appliquant une procédure de Marching Cubes adaptative, les paramètres des différents filtres mis en jeu étant automatiquement ajustés aux caractéristiques locales du réseau bronchique conditionnellement aux attributs de l'axe central.<br /><br />La segmentation des VAS repose sur une propagation markovienne exploitant les variations locales de densité. L'initialisation combine morphologie mathématique et information de contour afin de garantir la robustesse à la topologie. Une procédure de type triangulation de Delaunay restreinte à une surface fournit ensuite la représentation maillée des VAS. Il est établi que la topologie et la géométrie des structures complexes composant les VAS sont effectivement préservées.<br /><br />Pour permettre aux médecins de valider les modèles maillés ainsi construits, un environnement virtuel 3D convivial et interactif a été réalisé. En outre, la morphologie des voies aériennes exo- et endo-luminale est analysée de façon automatique à partir de simulations d'écoulement pour des géométries réelles.<br /><br />Enfin, une modélisation unifiée des VAP et VAS est obtenue pour la première fois. Elle démontre la pertinence des approches développées. Elle ouvre la voie à la construction de modèles in-silico complets de l'appareil respiratoire ainsi qu'aux études fonctionnelles prenant en compte les paramètres morphologiques susceptibles d'influer localement ou globalement sur la dynamique des écoulements.

Många patienter med obstruktivt sömnapnésyndrom (OSAS) som behandlas med Continuous Positive Airways Pressure (CPAP) avbryter sin behandling i ett tidigt skede. Att inte vara följsam behandlingen kan innebära olika hälsorisker för patienten som kan få allvarliga konsekvenser. Kommunikationssituationen vid det initiala utprovningsbesöket kan därför påverka huruvida patienten inte blir följsam och fullföljer behandlingen. Syftet med denna studie var att belysa hur vårdpersonal beskriver sina erfarenheter av kommunikationssituationen vid det initiala utprovningsbesöket av CPAP. En kvalitativ intervjustudie genomfördes med 23 personer som alla möter denna grupp av patienter.  Som analysmetod användes induktiv innehållsanalys. Vid analysen av materialet framkom tre kategorier; Bygga en relation, Inta ett pedagogiskt förhållningssätt samt Stödja patientens delaktighet. Dessa tre kategorier mynnade ut i ett tema som visade på hur kommunikationssituationen beskrevs Skapa förutsättning för lärande hos patienten. Studien belyser vikten av en samskapande vård och ett personcentrerat förhållningssätt där patienten ses som en partner i de beslut som tas samt hur vårdpersonalens pedagogiska förhållningssätt påverkar kommunikations-situationen på olika sätt. Erfarenheterna som beskrevs i studien upplevdes påverka patientens möjligheter till lärande i situationen för en ökad följsam till sin CPAP-behandling. / Many patients with obstructive sleep apnea syndrome (OSAS) treated with Continuous Positive Airways Pressure (CPAP) interrupt their treatment at an early stage. Not having adherence to the treatment implies various health risks for the patient that can have serious consequences. Therefore, the communicationsituation at the initial testing visit may affect whether the patient does not follow up and completes the treatment. The purpose of this study was to illustrate how healthcare professionals describe their experiences of the communicationsituation at the initial visit testing CPAP. A qualitative interview study was conducted with 23 people who all meet this group of patients. As an analytical method, inductive content analysis was used. In the analysis of the material three categories was revealed; Build a Relationship, Take an Educational Approach and Support the Patient's Participation. These three categories emerged in a theme that demonstrated how the communication situation was described as Creating a prerequisite for learning for the patient. The study highlights the importance of a person-centered approach, a co-productive care where the patient is seen as a partner in the decisions and how the healthcare professionals' pedagogical approaches affect the communicationsituation in different ways. The experiences described in the study were perceived to affect the patient's ability to learn in the situation for an increased adherence to the CPAP treatment.

Mulheres asmáticas na pós-menopausa podem apresentar piora dos sintomas, portanto neste trabalho investigamos o papel dos hormônios sexuais femininos (HSF) sobre a inflamação alérgica pulmonar. A re-exposição ao antígeno exacerbou a inflamação alérgica pulmonar e a liberação de mediadores no pulmão dos animais alérgicos ovariectomizados (OVx). O valor da reatividade traqueal foi semelhante ao observado nos animais alérgicos Sham/OVx. O tratamento com estrógeno exacerbou a inflamação pulmonar, mas atenuou a reatividade das vias aéreas. O tratamento com progesterona não alterou o número de células do lavado broncoalveolar e atenuou a reatividade das vias aéreas, apesar acentuar a produção de muco e de colágeno. O tratamento com estrógeno em associação com a progesterona atenuou a inflamação pulmonar aos valores encontrados nos animais alérgicos Sham/OVx. Nossos estudos apontam para uma possível dissociação entre os efeitos moduladores dos HSF sobre a resposta inflamatória, notadamente no recrutamento celular e as alterações de mecânica respiratória. / Asthmatic postmenopausal women may experience worsening of symptoms, so in this work we investigated the role of female sex hormones (HSF) on pulmonary allergic inflammation. The re-exposure to antigen exacerbated allergic lung inflammation and release of mediators in the lungs of ovariectomized allergic mice (OVX ) . The value of tracheal reactivity was similar to that observed in allergic Sham/OVx . Treatment with estrogen exacerbated pulmonary inflammation but attenuated airways reactivity. Treatment with progesterone did not alter the number of cells in bronchoalveolar lavage and attenuated airways reactivity, although enhance mucus production and collagen. Treatment with estrogen in combination with progesterone attenuated lung inflammation to the values found in allergic animals Sham/OVx. Our studies point to a possible dissociation between the modulatory effects of HSF on the inflammatory response, especially on cell recruitment and alterations in respiratory mechanic.

The thesis begins with a theoretical part containing a general description of artificial pulmonary ventilation, invasive pulmonary ventilation and a detailed description of non-invasive pulmonary ventilation and chronic obstructive pulmonary disease. This section also focuses on a detailed description of non-invasive pulmonary ventilation in patients with chronic obstructive pulmonary disease. The aim of this thesis is to find out the real usability and success of non-invasive pulmonary ventilation in patients with chronic obstructive pulmonary disease received in 2018 at the department of ARO in the Hospital Jindřichův Hradec. The data was obtained from the patient documentation for 2018 from the ARO department and subsequently entered in the tables. The research found that in 2018, 162 patients had undergone the selected department, of whom 63 patients suffered from chronic obstructive pulmonary disease. Noninvasive pulmonary ventilation was used in 75 patients. Of the total number of non-invasive pulmonary ventilation applications, 30 were used in patients with chronic obstructive pulmonary disease. The success of non-invasive pulmonary ventilation in chronic patients reached 90 %. The main benefit is the fact that the number of patients with chronic obstructive pulmonary disease is increasing and that indeed chronic obstructive pulmonary disease is aggravated in the winter months. Another benefit is the finding that the success and true utility of non-invasive pulmonary ventilation in patients with chronic obstructive pulmonary disease is very good.

Introdução: Poucos estudos têm sido direcionados às mudanças histopatológicas nas pequenas vias áreas e seu possível papel no processo de remodelamento, nas pneumonias intersticiais idiopáticas. Objetivos: Estudar aspectos morfológicos, morfométricos e de imunohistoquímica das pequenas via aéreas na Fibrose Pulmonar Idiopática/ Pneumonia Intersticial Usual (FPI/ UIP) e Pneumonia Intersticial Não-específica (NSIP). Métodos: Foram estudadas as pequenas vias aéreas em biópsias pulmonares de 29 pacientes com FPI/ UIP e 08 com NSIP. As biópsias foram comparadas com 13 pacientes com Bronquiolite Constritiva Crônica (BC) - como controle positivo - e 10 pulmões controles normais de autópsia. Foram analisados semi e quantitativamente aspectos arquiteturais, inflamatórios, estruturais das vias aéreas, além da expressão de TGF-&#946;, MMP -2, -7, -9, e seus inibidores (TIMP-1, -2). Resultados: Comparados com os controles, pacientes com FPI/ UIP, NSIP e BC apresentaram inflamação bronquiolar, inflamação e fibrose peribronquiolar aumentadas e áreas luminais diminuídas. Pacientes com FPI/ UIP tiveram paredes das vias aéreas mais espessadas, devido ao aumento de todos os compartimentos. Pacientes com NSIP apresentaram área do epitélio aumentada, enquanto pacientes com BC tiveram maior lâmina própria. Todos os grupos estudados demonstraram expressão epitelial bronquiolar aumentada de MMP-7 e -9 comparados ao controle. Conclusão: As pequenas vias aéreas são patologicamente alteradas e podem fazer parte do processo de remodelamento nas pneumonias intersticiais idiopáticas. / Background: Few studies have addressed small airway (SA) histopathological changes, and their possible role in the remodeling process, in idiopathic interstitial pneumonias. Objectives: To study morphological, morphometrical and immunohistochemical features of SA in Idiopathic Pulmonary Fibrosis (Usual Interstitial Pneumonia - UIP) and Non-Specific Interstitial Pneumonia (NSIP). Methods: We analyzed SA pathology in lung biopsies of 29 patients with UIP and of 8 with NSIP. Biopsies were compared with lung tissue of 13 patients with Constrictive Bronchiolitis (CB) - as a positive control - and 10 normal autopsied control lungs. We analyzed, semi-quantitatively, SA structure, inflammation, architectural features and the bronchiolar epithelial immunohistochemical expression of TGF-&#946;, MMP -2, -7, -9, and their tissue inhibitors (TIMP-1, -2). Results: Compared to controls, patients with UIP, NSIP and CB presented increased bronchiolar inflammation, peribronchiolar inflammation and fibrosis and decreased luminal areas. UIP patients had thicker walls, due to an increase in most airway compartments. NSIP patients presented increased epithelial areas, whereas patients with CB had larger inner wall areas. All of the groups studied presented increased bronchiolar expression of MMP-7 and MMP-9, compared to the controls. Conclusion: We conclude that SA are pathologically altered and may take part in the lung remodeling process in idiopathic interstitial pneumonias.

Os softwares de avaliação em três dimensões revolucionaram os planejamentos da cirurgia ortognática. Com eles é possível realizar desde simulações dos movimentos cirúrgicos, até avaliação das vias aéreas superiores (VAS) em volume e área, o que não era possível nas radiografias bidimensionais. Muitos pacientes recorrem à cirurgia ortognática com finalidade de melhorar a oclusão e a estética. Dependendo da movimentação cirúrgica, o espaço aéreo pode aumentar ou diminuir. O presente trabalho tem como objetivo avaliar as alterações de área e de volume do espaço aéreo faríngeo em pacientes submetidos à cirurgia ortognática de avanço bimaxilar. Foi realizada a análise da área axial mínima e do volume aéreo superior pré-operatório (T0) e pós-operatório (T1) de 50 pacientes, sendo 17 do sexo masculino e 33 do sexo feminino, com média de idade de 36,6 (±12,1) anos. As avaliações foram feitas através de tomografia computadorizada de feixe cônico, utilizando o Programa Nemoceph 3DOS. Foi utilizado o teste ´´t`` pareado para comparar os dados pré e pós-operatórios de volume e o teste de Wilcoxon para comparar os dados pré e pós-operatório de área axial mínima. Todos os testes foram realizados com o programa Statistica, adotando um nível de significância de 5%. No estudo do erro do método, não houve erro casual nem sistemático entre a primeira e a segunda aferição das variáveis (p > 0,05 em todas as medidas). A cirurgia de avanço bimaxilar apresentou uma média de 70,46% (59,38) de aumento volumétrico e uma mediana de 61,27% de aumento na área axial mínima, onde a mesma variou de -22,50% à 659,06%. Com este trabalho, conclui-se que o avanço bimaxilar proporciona um aumento significativo de volume e área axial mínima das vias aéreas superiores, porém este ganho não é homogêneo em todos os pacientes. / Software in three dimensions has come to revolutionize the orthognathic surgery planning. With them it is possible to perform from simulations of the surgical movements, until evaluation of the upper airways in volume and area, which wasnt possible in two dimensions software. Many patients resort to orthognathic surgery in order to improve occlusion and facial profile. Depending of the surgical movements, the airway space may increase or decrease. The aim of the study is to evaluate the changes in the area and volume of the pharyngeal airway space in patients submitted to bimaxillary advancement in orthognathic surgery. It was analyzed the minimum axial area and the volume of the pharyngeal airway space preoperative (T0) and postoperative (T1) air volumes of 50 patients, which 17 were male and 33 were female, with a mean age of 36.6 (± 12.1) years. The evaluations were done using Cone-beam computed tomography in Nemoceph 3D-OS Program. It was used the paired t test to compare the pre and postoperative volume data and the Wilcoxon test to compare the pre and postoperative data of the minimal axial area. All the tests were performed with the Statistica program, adopting a level of significance of 5%. In the study of the method error, there was no casual or systematic error between the first and second measurements of the variables (p> 0.05 in all measurements). The bimaxillary advancement surgery presented a mean of 70.46% (59.38) of volumetric increase and a median increase of 61.27% in the minimum axial area, that varied from -22.50% to 659.06%. In this study, it was concluded that bimaxillary advancement provides a significant increase in volume and minimum axial area of the upper airways, but the increase it isnt homogeneous in all patients.