Colonic ischaemia (CI), Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are devastating complications after abdominal aortic aneurysm (AAA) surgery. The aims of this thesis were to study the incidence and clinical consequences of IAH/ACS and the association between CI and intra-abdominal pressure (IAP) among patients undergoing OR for ruptured AAA (rAAA), to compare extraluminal pHi monitoring, with standard intra-luminal monitoring among patients operated on for AAA, and to study the frequency and clinical consequences of IAH/ACS after endovascular repair (EVAR) for rAAA. The incidence of ACS was 26% in a retrospective study of 27 patients undergoing OR for rAAA. Consensus definitions on IAH/ACS were appropriate for patients after OR for rAAA: 78% (7/9) of patients with IAH grade III or IV developed organ failure and all patients who developed CI had some degree of IAH. Active fluid resuscitation treating hypovolaemia to avoid CI may partly cause IAH. The association between CI and IAP was investigated in a prospective study on 29 patients operated on for rAAA, 86% (25/29) were treated for hypovolaemia and ten (34%) had both IAH and CI. Since monitoring colonic perfusion is very important and there is no ideal method, a new technique, extraluminal colonic tonometry to detect colonic perfusion was compared with standard intraluminal tonometry. Although, this new method was not able to determine the severity of ischaemia it may serve as a screening test. EVAR of rAAA is feasible and patients may benefit from this less invasive procedure. Of 29 patients treated with this technique, 10% developed ACS, and all patients except one with preoperative shock developed some degree of IAH. In conclusion, IAP/ACS is common after both OR and EVAR for rAAA, and is associated with adverse outcome. Monitoring IAP and colonic perfusion with timely intervention may improve outcome.

This study is about 1-3-year-old children and their meeting with the documentation made available to them by preschool teachers. Eight preschool teachers in seven different preschools were interviewed. These interviews were combined with observations of the preschool environments to be able to view the documentation that was made available to the children. In this study we examine what happens in the meeting between children and material objects in documentation practises. We also sought to understand how material objects play a role in children’s participation in documentation practises. In this study we therefore use Karen Barads (2007) theory of agential realism to analyse the relationship between humans and the material environment. Basing the analysis on agential realism by viewing material objects as active agents instead of passive, we were able to gain insight into how photographs of children taking part in earlier activities or pictures of insects played a part in the activities and negotiations around the documentation. The youngest children’s handling of the documentation made available to them did not always coincide with the expectations of the preschool teachers. The documentations hanging on the wall would be worn out or taken down by the youngest children. Understanding the potential meaning behind the worn-out corners was made possible by using an agential realist approach where the child is seen as entangled in a constant intra-action with the human and non-human environment. We found that an agential realist approach has the potential to contribute to a versatile understanding of documentation practices with preschools youngest children.

Ce travail de thèse étudie l’improvisation socio-motrice, entre deux personnes. Nos capacités d’improvisation reflètent notre faculté à interagir avec autrui en adaptant nos réponses comportementales à celles de l’autre. Deux paramètres rendent compte de ces capacités : la créativité motrice, c’est-à-dire la richesse des mouvements, et la coordination interpersonnelle. Bien que fondamentaux dans le succès de nos interactions sociales, leur investigation conjointe, jamais réalisée, semble nécessaire. Le but de cette thèse était donc d’investiguer les comportements moteurs inter- et intra-personnels en situation d’improvisation. Pour cela, nous avons d’abord : (i) recueilli et défini les méthodes d’analyse de la créativité motrice et de la coordination, (ii) analysé les capacités d’improvisation et leur acquisition, (iii) mesuré l’effet de l’improvisation sur l’organisation posturale de chacun, et finalement (iv) évalué les capacités d’improvisation en présence d’un déficit d’interaction sociale (associé à la schizophrénie). Pris ensemble, nos résultats indiquent que l’improvisation socio-motrice est un bon témoin de nos interactions sociales. Nous montrons précisément que les capacités d’improvisation permettent de discriminer un individu sain d’un individu souffrant de déficit social. La coordination interpersonnelle semble jouer un rôle fondamental, aussi bien dans l’acquisition de l’improvisation que dans la stabilité posturale qui la sous-tend. Ces résultats sont discutés à travers l’approche des patrons dynamiques de coordination. Nous proposons un modèle simplifié de l’improvisation intégrant la coordination et la créativité. Nos conclusions offrent des perspectives permettant de mieux comprendre et améliorer nos interactions sociales, en présence ou non de désordres sociaux. / This work investigates the socio-motor improvisation that occurs between two people. Improvisation capacities rely on our ability to interact with others by adapting our own behavioral answers to those of the other. Two parameters display these capacities: motor creativity (i.e., the richness of our movements) and interpersonal coordination. Although these two parameters are fundamental in the success of social interaction, they were never investigated jointly. This was the goal of our thesis. We aimed to explore intra- and interpersonal motor behaviors during improvisation. To do so, (i) we reviewed existing methods analyzing creativity and coordination, and proposed new ones, (ii) we measured improvisation capacities and their possible acquisition, (iii) we evaluated the influence of improvisation on postural organization of each person and (iv) we assessed the ability to improvise in presence of social deficits (associated with schizophrenia). Taken together, our results demonstrate that socio-motor improvisation is a good candidate to capture our social interactions. More precisely, we show that such capacities could discriminate healthy people from patients suffering from social deficits. Interpersonal coordination seems fundamental since it improves improvisation capacities and postural stability during social interaction. These results are discussed in the conceptual framework of the dynamical approach to movement coordination. We propose a simplified model of socio-motor improvisation including creativity and coordination. Finally, our conclusions offer new perspectives for the understanding and the improvement of social interactions, in presence or not of social disorders.

Cette thèse étudie la polysémie du pronom on dans une perspective contrastive français-arabe. L’objectif de cette étude consiste à résoudre le problème de l’irrégularité dans la traduction arabe de on. Ce problème provient d’une variété d’emplois contradictoires de on en français, d’où sa polysémie. La polysémie de on a été examinée d’après le modèle interprétatif de la psychomécanique du langage de Gustave Guillaume complété par une approche énonciative. Ce cadre théorique a révélé comment, par une remontée vers l’ontogénèse de on, ce dernier est devenu un pronom intra-verbal malgré son origine substantivale. Par ailleurs, il est fait usage du Tenseur Binaire Radical (TBR) qui représente le signifié de puissance de on en langue. Ce signifié de puissance est illustré par un double mouvement qui va d’une pluralité indéfinie à une pluralité indéterminée, le point de transition étant moi-locuteur. Ainsi, le signifié de puissance de on a permis d’identifier et d’ordonner 13 signifiés d’effet, en tenant compte de la catégorie du nombre et de la notion de personne. Ces critères permettent de distinguer entre les valeurs de la 3e personne, celles de la personne 4 et les valeurs discursives d’un côté, et les effets de sens de l’autre. Mais pour traduire on, l’analyse contrastive du corpus bilingue a révélé que les traducteurs privilégient plutôt les effets de sens véhiculés par ce pronom. L’étude se termine donc par une proposition d’un ensemble de correspondants arabes pour chacun des 13 signifiés d’effet de on. Enfin, pour que la traduction de ce pronom soit adéquate, il faut que le groupe on + verbe soit considéré comme une unité de traduction. / This dissertation examines the polysemy of the pronoun on from a contrastive, French-Arabic perspective. The objective of the study is to resolve a problem of irregularity in most Arabic translations of on. This problem seems to be rooted in the variety of contradictory usage of on in French which reflects its polysemy. The polysemy of on was examined through Gustave Guillaume’s interpretative model of psychomechanics of language. Then, an enunciative approach was employed to complement the theoretical framework. As a result, the ontogenesis of on revealed how the pronoun became intra-verbal, despite its substantive etymology. Moreover, the study employed the Radical Binary Tensor that represents the potential meaning of on in tongue. This potential meaning is illustrated by a double movement: from an indefinite plurality to an indeterminate plurality, where the point of transition is moi-locuteur. Further, the obtained potential meaning facilitated the identification, and ordination, of 13 effective meanings for on by taking into consideration the notion of person and the category of number. Those criteria distinguish between the values of the 3rd person, person 4, and the discursive values on one hand, and the expressive effects on the other. The contrastive analysis of a bilingual corpus revealed a preference on the part of translators to deal with on based on its expressive effects. Finally, the study proposed a set of Arabic correspondents to each of on’s 13 effective meanings. Ultimately, the research concluded that an accurate translation of on can only be possible by considering the group on + verb as a unit of translation.

Cette thèse porte sur l’évaluation du leadership par une approche multi-évaluateurs (dite à 360 degrés). Tout d'abord les différents modèles du leadership, allant d'une conception unitaire, à une conception interractionniste puis à une définition en termes d'effet, sont détaillés. Puis en étudiant la question de la mesure, on met en évidence qu'avec la popularité croissante de leurs modèles, certains outils d'évaluation sont devenus des questionnaires psychométriques à part entière. Pourtant, du fait des limites de l’auto-évaluation, une nouvelle approche du leadership à vu le jour: l'évaluation à 360°. Elle évalue les qualités d'un manager en interrogeant les personnes travaillant avec lui (subordonnés, collègues, supérieurs...) et en comparant leurs évaluations avec la propre évaluation du manager. Un des points central de notre recherche a été d’étudier les apports et les limites de cette méthode. Tout d'abord on a vérifié dans quelle mesure les caractéristiques souvent utilisées pour expliquer la variabilité entre les catégories d'observateurs permettaient réellement de comprendre les écarts observés. Ces analyses ont montré que malgré des résultats significatifs, ces variables n’expliquent que très partiellement la variance existante. De par ces conclusions l’accent a été mis, non plus sur les différences inter-groupes, mais sur l'accord et le désaccord au sein des groupes d'observateurs. Enfin, la dernière partie revient aux bases méthodologiques et théoriques de la mesure en cherchant à proposer un modèle psychométriques qui conviendrait aux résultats de questionnaires à 360°, permettant de donner un cadre conceptuel au recours à des évaluateurs multiples. / This thesis is centered on leadership assessment through multi-rater evaluation, commonly known as 360 degrees assessment. First, leadership models were presented, and then, we discussed the measurement aspects of leadership, wherein we observed that some tools became full fledged psychometric assessments owning to the growing popularity of their underlying theory. Nevertheless, the concerns over the inherent limitations of self-report measures continued to be a major challenge in leadership assessment. This led to a new assessment approach called 360 degrees in which the characteristics of leaders are assessed by people working with them (subordinates, colleagues, superiors...) and compared with the leaders' self-appraisals. The focal point of this thesis was to study the advantages as well as the limitations of this approach. The study started with examining how well the variables which are supposed to explain the inter-rater variability were actually helpful in understanding the observed variance among observers. Those analysis yielded significant results despite the fact that those variables could explain only a very limited amount of variance. Following these observations, the study switched its focus from inter-group differences to intra-group / inter-rater agreement and disagreement. Finally, the last part of this thesis gets back to methodological and theoretical basics of measurement theory and proposes a psychometric model that would suit the 360 degrees assessments followed by a conceptual framework for the studies using multi-rater techniques.

p. 1-204 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-02T19:30:43Z No. of bitstreams: 1 999999999999999999.pdf: 821652 bytes, checksum: a675e81264e0276fcd87b509e674c613 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:40:30Z (GMT) No. of bitstreams: 1 999999999999999999.pdf: 821652 bytes, checksum: a675e81264e0276fcd87b509e674c613 (MD5) / Made available in DSpace on 2013-05-04T17:40:30Z (GMT). No. of bitstreams: 1 999999999999999999.pdf: 821652 bytes, checksum: a675e81264e0276fcd87b509e674c613 (MD5) Previous issue date: 2007 / Fatores associados ao retardo no crescimento intra-uterino ainda não foram totalmente esclarecidos. Recém-nascidos (RN) pequenos para a idade gestacional (PIG) apresentam alterações nos valores hematológicos comparados aos RN adequados para a idade gestacional (AIG) e pré-termos. Persistem também limitações metodológicas inerentes a acurácia dos métodos de determinação da idade gestacional. Objetivos: Determinar os fatores associados ao RCIU, as características hematológicas dos recém nascidos portadores do RCIU e avaliar a acurácia dos métodos da avaliação da idade gestacional utilizados no diagnóstico antropométrico desses recém-nascidos. Metodologia: Estudo envolvendo puérperas e 564 RN em 2 maternidades públicas da cidade de Salvador. Foram classificados de AIG, RN com o peso ≥10th e <90th, de PIG aqueles com peso <10th, avaliados pela curva de Williams; e pré-termo, aqueles com <37 semanas de gestação. Os dados foram coletados utilizando-se de questionário padronizado. Foram tomadas as medidas antropométricas da criança e da puérpera e coletou-se o sangue do cordão umbilical. A idade gestacional foi calculada pelos métodos da data da última menstruação, ultrassonografia e físico de Capurro. Estudo 1 de desenho caso-controle. Estudos 2 e 3 de desenhos de corte transversal. Análise estatística: No estudo 1, utilizou-se a regressão logística não condicional para testar a associação entre a variável dependente e as preditoras e Odds Ratio foi adotado como medida de associação. No estudo 2, a média e seu respectivo DP, valor máximo e mínimo foram usados para descrever os valores hematológicos do cordão umbilical. Para o estudo 3, realizou-se a diferença entre as medianas da idade gestacional segundo os métodos, utilizando-se do teste não paramétrico “Wilcoxon Signed Rank Test”. A correlação entre as idades gestacional estimadas pelo DUM, USG e Capurro e entre estes métodos e o peso ao nascer foi realizada utilizando-se do coeficiente de correlação de Pearson. Utilizou-se o Coeficiente Kappa para avaliar a concordância entre os métodos na estimação do estado antropométrico do recém-nascido. A validade dos métodos na estimação da idade gestacional foi avaliada por meio do cálculo da sensibilidade, especificidade, VPP, VPN e pela curva ROC. Foram utilizados os pacotes estatístico SPSS.11 e o Stata 8, aceitando-se a significância de 5% nas estimativas de interesse. Resultados: Com o estudo 1, identificou-se que a primeira gestação (OR:2,85; 1,73-4,71), o hábito de fumar (OR: 2,65; 1,35-5,19) e a gestação anterior desfavorável (OR:2.10; 1,21-3,64) se comportaram como fatores de risco para retardo no crescimento intra-uterino. Os resultados do estudo 2 indicaram que valores mais altos de hemácias (4,21×1012/l±0,48), hemoglobina (14,50 g/dl ±1,42), hematócrito (43,50%±4,36), ferritina (162,61 µg/l ±100,10); RDW (13,34±0,85%) e leucócitos (12,82 109/l ±3,39) foram identificados nos RN PIG, quando comparados com aqueles dos AIG a termo e pré-termos. Os RN AIG pré-termos apresentaram valores mais altos de VGM e HGM. Os valores médios das plaquetas foram mais altos nos RN AIG a termo. A partir dos resultados do estudo 3, observou-se que o método de Capurro incrementou a idade gestacional em intervalos menores de 39 semanas e a USG a aumentou a partir deste patamar, em relação ao método DUM. Os métodos DUM e USG apresentaram maior correlação entre a estimativa da idade gestacional e o estado antropométrico para o conjunto dos RN (r=0,668) e para a identificação do RN AIG (r=0,685). Considerando a idade gestacional estimada pelo DUM e a relação com o peso ao nascer, o coeficiente de correlação foi mais elevado (r=0,609) na identificação dos RN PIG’s. Na predição de RN PIG’s, maior sensibilidade foi observada para a USG (96,6%) e maior especificidade para o Capurro (75,5%). Acurácia mais elevada na estimativa da idade gestacional foi observada para a USG na 41ª, tomando como referencia o DUM (ROC=77%). Conclusão: O RCIU associou-se à primeira gestação, à gestação anterior desfavorável e ao hábito de fumar. RN portadores de RCIU apresentaram valores ematológicos mais elevados em relação os RN AIG e pré-termos e o método físico de Capurro apresentou pior desempenho na identificação de RCIU. / Salvador

Le risque individuel de rupture des anévrismes cérébraux est un enjeu majeur dans la prise en charge clinique des anévrismes asymptomatiques. La rupture anévrismale se produit lorsque la contrainte intra-pariétale dépasse la contrainte à rupture du matériau composant la paroi. Notre étude a pour objectif d'être un pas vers une nouvelle mesure biomécanique du risque individuel de rupture des anévrismes cérébraux. Dans un premier temps, une étude expéri- mentale fut menée pour caractériser le comportement biomécanique de la paroi anévrismale sur 16 échantillons d'anévrismes prélevés chirurgicalement. L'expérimentation sur les échan tillons de poche anévrismale a permis de dégager trois grandes classes de tissus pour chaque sexe (homme et femme) : souple, rigide et intermédiaire. Il apparaît que tous les anévrismes non rompus appartiennent à la catégorie rigide ou intermédiaire et que tous les anévrismes rompus correspondent à la catégorie souple. Ceci permet de mettre en évidence une corrélation entre le risque de rupture et les propriétés du matériau composant la paroi anévrismale. Dans un deuxième temps, des simulations d'interaction fluide/structure (FSI) ont été réalisées pour comparer les déformations d'un anévrisme " patient spécifique " constitué d'un matériau dégradé et non dégradé. Les résultats montrent que les propriétés du matériaux ont un impact majeur sur l'ampleur de la variation de volume anévrismale diastolosystolique. Les changements en terme de variations de volume en fonction des caractéristiques du tissu sont potentiellement visualisables à l'aide de l'imagerie médicale. Une analyse des incertitudes des paramètres est aussi présentée et montre la robustesse des résultats aux incertitudes des données d'entrée. Il a ensuite été démontré sur 12 cas " patient-spécifique " d'anévrismes différents (forme, taille, localisation et conditions aux limites différentes) qu'il existe toujours une différence significative en terme de variation de volume au cours du cycle cardiaque entre un anévrisme dont la paroi est composé d'un matériau rigide et d'un matériau souple. Cette étude suggère donc que la variation de volume anévrismale pourrait être utilisée comme une base pour une évaluation individuelle du risque de rupture des anévrismes cérébraux. / The individual risk of rupture of cerebral aneurysm is a major stake in the clinical treatment. The aneurismal rupture occurs when the intra-parietal stress exceeds the rupture stress of the material of the aneurismal wall. The goal of our study is to be a step toward a new biomechanical measure of an individual risk of rupture of cerebral aneurysm. First, an experimental study was performed to characterize the biomechanical behavior of the aneurismal wall on 16 samples of aneurysms removed by neurosurgery. The experimentation on the samples allowed us to reach three main categories of tissues for each sex (female and male): soft, intermediate and stiff. All the unruptured aneurysms belong to the stiff category or the intermediate category and all the ruptured aneurysms belong to the soft category. This is allowed us to give prominence to the correlation between the risk of rupture and the properties of the material of the aneurismal wall. Then, Fluid/Structure interaction computations (FSI) were performed to compare the strain of a “patient-specific” aneurysm composed of a degraded and undegraded material. The results show that the properties of the material have a major impact on the scope of the aneurismal volume variation over the cardiac cycle. The volume variation changes depending on the properties of the tissue are potentially viewable by medical imaging. A study of the uncertainties of the parameters is also proposed and shows the robustness of the results. We also demonstrated on 12 cases of “patient-specific” aneurysms that a significant difference stiff exists in terms of volume variation over the cardiac cycle between an aneurysm composed of a stiff and a soft material. This study suggests that the aneurismal volume variation could be used as a basis for an evaluation of the individual risk of rupture of cerebral aneurysms.

Submitted by ANA CAROLINA DOS SANTOS DEMARCHI null (carol_demarchi@hotmail.com) on 2016-04-02T14:54:57Z No. of bitstreams: 1 Tese_Repositório_Unesp_AnaCarolinaDemarchipdf.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-05T14:52:16Z (GMT) No. of bitstreams: 1 demarchi_acs_dr_bot.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) / Made available in DSpace on 2016-04-05T14:52:16Z (GMT). No. of bitstreams: 1 demarchi_acs_dr_bot.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) Previous issue date: 2016-02-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundamentação. A presença de Hipertensão Abdominal é condição frequente em pacientes de UTI com importante impacto sobre a mortalidade. Tais pacientes contam com diversos fatores de risco para aumento da pressão abdominal, entre eles ventilação mecânica e balanço hídrico positivo. Um discreto aumento da pressão abdominal pode levar a disfunções orgânicas, entre elas a Lesão Renal Aguda, complicação bastante prevalente, que acomete pacientes internados em terapia intensiva, com importante impacto sobre a mortalidade. Pacientes de terapia intensiva e em ventilação mecânica são diariamente submetidos a técnicas de fisioterapia respiratória, entretanto não foram localizados estudos que demonstrassem os efeitos das técnicas mais utilizadas em terapia intensiva sobre a pressão intra-abdominal e função renal destes pacientes. Objetivos. Avaliar a influência de diferentes técnicas de fisioterapia respiratória sobre a pressão intra-abdominal de pacientes de terapia intensiva, bem como o comportamento da função renal e hemodinâmica abdominal com a aplicação destas técnicas. Casuística e Método. Foi realizado ensaio clínico, randomizado, controlado, cruzado, no período de março de 2013 a dezembro de 2014, no Serviço de Terapia Intensiva da Faculdade de Medicina de Botucatu-SP. Os pacientes foram randomizados para receberem três possíveis sequências de técnicas que incluíam: Compressão Torácica Expiratória, Hiperinsuflação Manual e Bag-Squeezing. Todos os pacientes foram submetidos às três técnicas, em dias diferentes e consecutivos. Para análise das técnicas os dados foram reagrupados de acordo com as intervenções realizadas e comparados entre si. Foram avaliados parâmetros hemodinâmicos e pressão intra-abdominal antes, após e nas duas horas seguintes às intervenções. A função renal foi avaliada por meio do clearance de creatinina, clearance de uréia e fração de excreção de sódio e a pressão intra-abdominal avaliada pelo método original de Kron nos mesmos momentos. Resultados. Foram avaliados 31 pacientes, 17 do gênero masculino com idade média de 58,1 ±17,6 anos. A Pressão intra-abdominal diminuiu de forma estatisticamente significante com a utilização das três técnicas e nos dois momentos em que foram avaliadas. Imediatamente após a técnica Hiperinsuflação Manual, houve aumento estatisticamente significante do gradiente de filtração glomerular e com a técnica Bag-Squeezing, observou-se aumento do gradiente de filtração glomerular imediatamente após e nas duas horas seguintes à intervenção. Foi observado aumento da pressão de perfusão abdominal imediatamente após e nas duas horas seguintes à aplicação da referida técnica. O clearance de uréia apresentou aumento após a aplicação da técnica Bag-Squeezing e também foi observado aumento da fração de excreção de sódio com as técnicas Hiperinsuflação Manual e Bag-Squeezing. Conclusões. Técnicas de fisioterapia respiratória reduziram a pressão e melhoraram a hemodinâmica intra-abdominais de pacientes de terapia intensiva. As técnicas Hiperinsuflação Manual e Bag-Squeezing aumentaram a fração de excreção de sódio e apenas a última o clearance de uréia. De maneira geral, as técnicas empregadas se associaram a melhora dos parâmetros de avaliados. / Rationale: The presence of Abdominal Hypertension is a frequent condition in ICU patients with a significant impact on mortality. Critical patients have several risk factors for increased abdominal pressure, including mechanical ventilation and positive water balance. A slight increase in abdominal pressure can lead to organ dysfunction, including the Acute Renal Injury, which is a prevalent complication affecting patient in intensive care with a significant impact on mortality. Patients submitted mechanical ventilation are daily undergoing respiratory therapy techniques, however there aren’t studies demonstrating the effects of the techniques used in intensive care on intra-abdominal pressure and renal function in these patients. Objective: To evaluate the influence of different techniques of respiratory physiotherapy on intra-abdominal pressure on critical patients as well as the behavior of renal function and abdominal hemodynamic by implementing these techniques. Patients and Methods: Clinical trial conducted randomized, controlled, crossover, from March 2013 to December 2014 in the Intensive Care Unit at Hospital of São Paulo State University (UNESP-HC) (Botucatu, Brazil). Patients were randomized to receive three sequences of techniques that included: Chest Compression Expiratory, Hyperinflation and Manual Bag-Squeezing. All patients were submitted to three techniques in different consecutive days. Analysis of the technical data were grouped according to the measures carried out and compared among each other. Hemodynamic parameters were evaluated and intra-abdominal pressure before, after and within two hours after the intervention. Renal function was assessed by creatinine clearance, urea clearance and sodium excretion fraction and the intra-abdominal pressure assessed by the original method of Kron at the same moments. Results: We evaluated 31 patients, 17 males with a mean age of 58.1 ± 17.6 years. Intra-abdominal pressure decreased in a statistically significant way with the use of three techniques and two different times that were evaluated. Immediately after the Manual Hyperinflation technique there was a statistically significant increase in glomerular filtration gradient and the Bag-Squeezing technique, there was also an increase in glomerular filtration gradient immediately after and in two hours of intervention. There was an increase of abdominal perfusion pressure immediately at the end and two hours after application of this technique. The urea clearance showed an increase after the implementation of the Bag-Squeezing technique and increased sodium excretion fraction to the technical Manual Hyperinflation and Bag-Squeezing also were observed. Conclusions: Respiratory therapy techniques reduced pressure and improved intra-abdominal hemodynamic in critical care patients. Technical Manual Hyperinflation and Bag-Squeezing increased sodium excretion fraction, and only the last technique increase the clearance of urea. In general, the techniques employed were associated with improvement of the evaluated parameters.

Submitted by JOÃO FERNANDO RAMOS RAYMUNDO null (joao.fernando.hcb@gmail.com) on 2016-05-02T21:19:47Z No. of bitstreams: 1 Dissertação 02.05.16 - Versão FINAL.pdf: 1041129 bytes, checksum: ad2ccace3d485aa4b02d54a59ec72153 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-05-04T19:45:09Z (GMT) No. of bitstreams: 1 raymundo_jfr_me_bot.pdf: 1041129 bytes, checksum: ad2ccace3d485aa4b02d54a59ec72153 (MD5) / Made available in DSpace on 2016-05-04T19:45:09Z (GMT). No. of bitstreams: 1 raymundo_jfr_me_bot.pdf: 1041129 bytes, checksum: ad2ccace3d485aa4b02d54a59ec72153 (MD5) Previous issue date: 2016-03-04 / A pressão intra-abdominal (PIA) pode ser definida como, a pressão exercida pelos componentes intra-abdominais em relação à parede abdominal. Sua mensuração pode ser de forma direta ou indireta, através da pressão retal, gástrica ou vesical. A elevação da PIA é considerada uma complicação da cirurgia abdominal, sendo escassas as informações sobre esta variável em pacientes submetidos à cirurgia abdominal oncológica (CAO). Entre os fatores relacionados à elevação da PIA, podemos destacar a cirurgia abdominal, o estado nutricional dos pacientes e o balanço hídrico acumulado. O aumento da PIA pode acarretar à Hipertensão Intra-abdominal (HIA) - PIA maior ou igual a 12 mmHg, e até mesmo a Síndrome do Compartimento Abdominal (SCA) - PIA maior que 20 mmHg sustentada, quando associada a nova disfunção orgânica. Estas condições estão associadas à alta mortalidade. Objetivo: Analisar o valor da PIA em pacientes admitidos na UTI de um Hospital Oncológico submetidos à cirurgias abdominal, bem como verificar o desfecho clínico dos pacientes acometidos por HIA e SCA. Material e Método: Trata-se de um estudo observacional de coorte, com coleta retrospectiva, realizado na Unidade de Terapia Intensiva (UTI) do Hospital de Câncer de Barretos, Brasil. Os dados foram obtidos em um período de três meses, através de análises de prontuários. O objeto de estudo foi o valor da pressão intra-abdominal (PIA) em pós-operatório de cirurgias abdominais oncológicas (CAO), para detectar a ocorrência de hipertensão intra-abdominal (HIA). Foram incluídos pacientes admitidos na UTI, em pós-operatório imediato de CAO, ou casos de pós-operatórios de CAO recentes (até 2 semanas), encaminhados à UTI por indicações clínicas. A PIA e outras diversas variáveis fisiológicas foram analisadas, em três momentos - admissão na UTI, no registro do maior valor de PIA durante a internação e o último valor mensurado antes da retirada da sonda vesical, por não ser mais necessária, por alta ou óbito. Variáveis sócio demográficas também foram incluídas no estudo. Para a análise da relação entre a HIA e as variáveis foi utilizado a Analise Linear Multivariada (modelo reduzido). Resultado: Foram incluídos no estudo 50 pacientes, com idade média de 63 anos (± 10.8); 27 homens (54%); raça branca 38 (76%); obesos ou sobrepeso 33 pacientes (66%). A permanência média na UTI foi de 3,24 (± 4.56) dias. As especialidades médicas com maior número de cirurgias incluídas no estudo foi a equipe de Digestivo Alto com 22 pacientes (44%). Foram 49 cirurgias eletivas (98%), sendo 30 cirurgias por laparotomia (60%), 13 laparoscópicas (26%) das quais uma por metodologia robótica e 3 pacientes necessitaram de peritoniostomia. A prevalência de HIA (momento um) foi de 52% apresentando associação com a especialidade cirúrgica (p. 022). A frequência de HIA (maior elevação da PIA - momento dois) foi de 96% apresentando relação com a variável estado nutricional (p.0,027). No momento três (última mensuração), houve HIA em 62% dos pacientes, observando-se relação com as variáveis: Estado nutricional (p. 0,028), HAS (p. 0,048) e tipo de cirurgia (p. 0,023). Não foi observada relação entre o balanço hídrico acumulado e a presença de HIA em nenhum momento. Síndrome Compartimental Abdominal ocorreu em 10% dos pacientes. O desfecho em 30 dias após a Cirurgia Abdominal Oncológica foi analisado, sendo evidenciado 8% de mortalidade geral neste período. Conclusão: Os resultados obtidos neste estudo, sugerem que tanto elevação da Pressão Intra-Abdominal quanto a Hipertensão Intra-Abdominal são frequentes em pacientes submetidos à cirurgia abdominal oncológica. Foram identificadas outras variáveis que podem influenciar na elevação da PIA. A Síndrome Compartimental abdominal é uma entidade clínica presente no público estudado, porém não apresentou associação direta no desfecho em 30 dias. / The intra-abdominal pressure (IAP) can be defined as the pressure exerted by the intra- abdominal components in relation to the abdominal wall. Its measurement can be directly or indirectly, by rectal pressure, stomach or bladder. The elevation of the PIA is considered a complication of abdominal surgery, with little information on this variable in patients undergoing oncological abdominal surgery (OAS). Among the factors related to the increase in IAP, we can highlight abdominal surgery, the nutritional status of patients and the cumulative fluid balance. IAP increase may lead to intra-abdominal hypertension (IAH) - IAP greater than or equal to 12 mmHg, and even the Abdominal Compartment Syndrome (ACS) - IAP greater than 20 mmHg sustained when associated with new organ dysfunction. These conditions are associated with high mortality. Objective: To analyze the change in the value of IAP in patients admitted to the ICU of a Oncological Hospital undergoing abdominal surgery, as well as verify the clinical outcome of patients affected by IAH and ACS. Materials and Methods: This was an observational cohort study with retrospective collection, held in the Intensive Care Unit (ICU) of the Barretos Cancer Hospital, Brazil. Data were collected over a period of three months by chart analysis. The object of study was the amount of intra-abdominal pressure (IAP) in postoperative oncological abdominal surgery (OAS), to detect the occurrence of intra-abdominal hypertension (IAH). Admitted patients were included in the ICU, in OAS immediately after surgery, or cases of postoperative recent OAS (up to 2 weeks), admitted to the ICU for clinical indications. IAP and several other physiological variables were analyzed in three stages - ICU admission, the record of the highest value of IAP during hospitalization and the last value measured prior to catheter removal, for not being more necessary for discharge or death. Sociodemographic variables were also included in the study. Results: The study included 50 patients with a mean age of 63 years (s. d 10.8); 27 men (54%); 38 Caucasians (76%); obese or overweight 33 patients (66%). The average ICU stay was 3.24 (s.d 4:56) days. Medical specialties with the highest number of surgeries included in the study was the Digestive High team with 22 patients (44%). 49 were elective surgery (98%), 30 surgical laparotomy (60%), laparoscopic 13 (26%) of which a methodology for robotics and 3 patients required peritoneostomy. The prevalence of IAH (minute) was 52% with respect to the surgical specialty (p. 022). The incidence of IAH (highest elevation of IAP - times two) was 96% with respect to the variable nutritional status (p.0,027). At the moment three (last measurement), there IAH in 62% of patients, observing relationship with the variables: nutritional status (p 0.028.), Hypertension (p.0,048) and type of surgery (p 0.023.). To analyze the relationship between IAH and the variables we used the Analysis Multivariate Linear (scale model). No relationship was found between the accumulated water balance and the presence of IAH in no time. Abdominal Compartment syndrome was observed in 10% of the population. The outcome at 30 days after Abdominal Surgery Oncology was analyzed, being evidenced 8% overall mortality in this period. Conclusion: The results shown in this study suggest that both elevated intra-abdominal pressure as the Intra-Abdominal Hypertension is common in patients undergoing abdominal cancer surgery and other variables can influence the increase in IAP. Abdominal Compartment syndrome is a clinical entity present in the studied public, but has no direct influence on the outcome within 30 days.

1 Value added tax from the perspective of Czech and European law Abstract The Value Added Tax (hereinafter referred to as "VAT") is a general consumption tax assessed on the value added to goods and services. Since it applies to almost all goods and services which are sold and bought in the EU, it can be considered the most important indirect tax. Historically, it was introduced in order to replace sales tax and avoid the cascade effect of it. VAT is the first harmonised tax in the EU. The basic framework for EU VAT was introduced in the Sixth Directive 77/388/EC which was subsequently replaced by its "recast" - Directive 2006/112/EC. All member states' legislation must therefore comply with the provisions of the VAT Directive. Although the name of my thesis is "Value Added Tax from the perspective of Czech and European law", this area of law is so wide that it was necessary to focus on a specific topic. The main purpose of the thesis is to analyse the functioning of VAT in respect of intra Community acquisition of goods. Since VAT is the first harmonised tax in the EU and the European legislation is very important and influences the national legislation on VAT, I focused the thesis on intra Community trade. The original aim of the common VAT system was to apply the origin principle which means that the tax...