Orientadores: Ricardo Barini, Cleisson Fábio Andrioli Peralta / Dissertação (Mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T20:27:06Z (GMT). No. of bitstreams: 1 Tavares_NelsileneMotaCarvalho_M.pdf: 1623700 bytes, checksum: 57e06ff429364aff34689dd52216eeb9 (MD5) Previous issue date: 2012 / Resumo: Objetivos: Determinar intervalos de referência condicionais (longitudinais) para os valores de índices de pulsatilidade (IP) nos fluxos da artéria umbilical (AU), cerebral média (ACM), ducto venoso (DV) e IP médio das artérias uterinas (AUT), por meio da avaliação de gestantes de baixo risco de uma amostra da população brasileira. Métodos: Estudo observacional descritivo longitudinal realizado de fevereiro de 2010 a maio de 2012, no Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM-UNICAMP). Exames ultrassonográficos quinzenais foram realizados para obtenção dos IP das AU, AUT, ACM e IP venoso do DV em gestantes de baixo risco da 18ª a 40ª semana de gravidez. Análise estatística: Modelos lineares mistos foram usados para elaboração de intervalos de referência longitudinais (percentis 5, 50 e 95) dos IP dos vasos mencionados. Variáveis maternas e perinatais foram descritas com o uso de medianas e limites (variáveis contínuas), frequências absolutas e relativas (variáveis categóricas). Os IP das porções placentária e abdominal do cordão umbilical foram comparados por meio do teste T para amostras independentes. Valores de p menores do que 0,05 foram considerados significativos. Resultados: Duzentas e três gestantes de baixo risco foram incluídas no estudo. Cento e sessenta e quatro gestantes concluíram o estudo, sendo realizados 1242 exames ultrassonográficos, com mediana de oito exames por paciente (limites de 4 a 12). Houve redução significativa dos IP de todos os vasos estudados com a idade gestacional (IG). As equações obtidas para predição das medianas foram: IP-AU = 1,5602786 - (0,020623 x IG); Logaritmo do IP-ACM = 0,8149111 - (0,004168 x IG) - [0,002543 x (IG - 28,7756)2]; Logaritmo do IP-DV = 0,26691- (0,015414 x IG); IP-AUt = 1,2362403 - (0,014392 x IG). Houve diferença significativa entre os IP-AU obtidos nas extremidades placentária e abdominal fetal (p < 0,001). Conclusões: Foram estabelecidos intervalos de referência condicionais (longitudinais) dos principais parâmetros dopplervelocimétricos gestacionais em uma amostra da população brasileira. Estes podem ser mais adequados para o acompanhamento das modificações hemodinâmicas maternofetais em gestações normais ou não, a partir de uma validação / Abstract: Purpose: To determine longitudinal reference intervals of pulsatility index (PI) of the umbilical artery (UA), middle cerebral artery (MCA), uterine arteries (UTA) and ductus venosus (DV) in low risk pregnancies of the a Brazilian cohort. Methods: Longitudinal observational study performed from February 2010 to May 2012. Obstetric scans were performed fortnightly for the measurements of the PI of the UA, UTA, MCA, DV in low-risk pregnant women between 18-40 weeks of gestation. Statistical analysis: Linear mixed models were used for the elaboration of longitudinal reference intervals (5th, 50th and 95th centiles) of these measurements. Maternal and perinatal variables were described using median and range (continuous variables), absolute and relative frequencies (categorical variables). The PI obtained at the placental and abdominal portions of the umbilical artery were compared using independent samples T test. P values of less than 0,05 were considered statistically significant. Results: Two hundred and three low-risk pregnancies were included in the study. One hundred sixty four pregnant women completed the study and underwent 1242 scans. There was a significant decrease in the PI values of all studied vessels with gestational age (GA). The equations obtained for the prediction of the medians were as follows: PI-AU = 1,5602786 - (0,020623 x GA); Logarithm of the PI-MCA = 0,8149111 - (0,004168 x GA) - [0,002543 x (GA - 28,7756)2]; Logarithm of the PI-DV = - 0,26691- (0,015414 x GA); PI-UtA = 1,2362403 - (0,014392 x GA). There was a significant difference between the PI-UA obtained at the abdominal and placental ends of the umbilical cord (p < 0,001). Conclusions: Longitudinal reference intervals for the main gestational Doppler parameters were obtained from a Brazilian cohort. These intervals could be more adequate for the follow-up of materno-fetal haemodynamic modifications in normal and abnormal pregnancies, which still requires further validation / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

Dans le cadre de l’utilisation de plus en plus courante des BFUP dans des structures techniquement ou architecturalement complexes et de la recherche d’optimisation de la quantité de matériau mis en œuvre, cette thèse s’intéresse au fonctionnement des jonctions en BFUP. Son objectif principal est de mettre en évidence les phénomènes physiques qui interviennent dans la jonction et de mieux les retranscrire dans les méthodes de calcul afin de mieux en maîtriser la sécurité et d’optimiser la matière mise en oeuvre.Le travail de thèse s’articule en quatre étapes :- Une étude bibliographique a permis d’établir les bases de connaissances permettant de dimensionner les campagnes expérimentales et de proposer une structure de modélisation des jonctions âme-membrure.- Le développement d’un modèle analytique avancé permettant de prédire le comportement d’une poutre en Té soumise à une sollicitation combinée de flexion longitudinale (et donc de cisaillement longitudinal dans la table) et de flexion transversale.- L’étude expérimentale, à l’échelle du matériau, du comportement des BFUP sous sollicitation de cisaillement pur. Cette étude permet d’enrichir les connaissances sur le comportement des BFUP (données encore indisponibles dans la carte d’identité des différents matériaux) et constitue également une donnée d’entrée pour la compréhension quantitative des phénomènes qui interviennent dans la jonction, à l’échelle de la structure, lorsqu’elle est sollicitée en cisaillement longitudinal.- Enfin, l’essai à rupture de 6 poutres en Té à l’échelle 1 a permis d’étudier le comportement expérimental des jonctions soumises à des sollicitations de cisaillement longitudinal. Les résultats expérimentaux de cette étude ont été comparés aux différentes prédictions analytiques possibles, y compris le modèle proposé.Ces travaux de thèse ont permis d’apporter de nouveaux outils de dimensionnement (notamment dans le cadre de l’étude de la résistance des jonctions en BFUP sous sollicitation de cisaillement pur). Ils mériteraient d’être complétés par des essais de poutres soumis à une sollicitation concomitante de flexion longitudinale et de flexion transversale, pour mieux conforter les méhodes d’analyse proposées / Ultra-high performance fiber-reinforced concrete (UHPFRC) are increasingly used for technically or architecturally complex structures and research is going on to optimize design and save implemented material quantities. In this context, this thesis focuses on the mechanical behavior of junctions in UHPFRC structures. The main goal is to highlight physical phenomena occurring in the junctions in order to optimally transpose them into calculation methods. In this way, both safety and cost-efficience should be better controlled.This thesis is divided in four steps :- A literature review enabled to establish the background knowledge allowing to design the experimental campaigns and to suggest a modeling for web-flange junctions.- An advanced analytical model was developed in order to predict the behavior of a T-beam subjected to combined longitudinal bending (and therefore longitudinal shear in the table) and transverse bending.- The expérimental study, at the material scale, of UHPFRC behavior under pure shear stress, allowed enriching the knowledge in this field (data still unavailable in the identity card of current UHPFRC mixes). It also constituted an input for the quantitative understanding of the phenomena occuring in the junction, at the structure scale, when it is loaded in longitudinal shear.- Finally, the test of 6 full scale T-beams up to failure made it possible to study the experimental behavior of the junctions subjected to longitudinal shear stresses. The experimental results were compared with the various analytical predictions, including the proposed model.A new approch has thus been proposed to design junctions under longitudinal shear. It should be completed with experiments on T-beams under combined longitudinal and transverse bending to further validate the proposed analysis methods

M.A. / In accordance with literature indications that have established the need for psychotherapeutic outcome assessment instruments to determine the effects of psychotherapy, an exploratory and comparative study was conducted with anxiety disorder clients in private practice settings. The purpose of the study was to verify the recommendations made in the literature for the use of an idiographic method of outcome assessment (the Dyad Grid), as opposed to typically applied normative methods (the IPAT Anxiety Scale). The nature of the suggestions concerning the application of an idiographic method of outcome assessment, required the development of a theoretical framework which integrated the assessment procedure in an explanatory manner. To this end, the personal construct psychology view of anxiety was discussed in relation to repertory grid technique and prior outcome assessment research conducted with the Dyad Grid. On the basis of the personal construct approach to anxiety, a pre-test post-test research design was used to establish the utility of the Dyad Grid to discriminate between beneficial and nonbeneficial psychotherapy outcomes with anxiety disorder clients. The outcome results of the Dyad Grid assessments were compared with the results obtained from the IPAT Anxiety Scale, in conjunction with qualitative post-therapeutic ratings of benefit, or a lack of benefit, made by the client and therapist. The findings obtained on the basis of 14 case-studies are encouraging. The Dyad Grid displayed a statistically significant level of agreement with the client and therapist ratings of therapeutic outcome (onetailed, p = 0,05), whereas the IPAT Anxiety Scale did not. Though limited to a sample of convenience, and subject to an idiographic methodological bias, the discussion of the results indicated that the study provides support for the use of idiographic procedures as an alternative to nomothetic methods of outcome assessment. It is concluded that the initial success of the Dyad Grid in assessing psychotherapy outcome as beneficial or non-beneficial warrants further investigation with a large sample research design.

With the influx of high-dimensional data there is an immediate need for statistical methods that are able to handle situations when the number of predictors greatly exceeds the number of samples. One such area of growth is in examining how environmental exposures to toxins impact the body long term. The cytokinesis-block micronucleus assay can measure the genotoxic effect of exposure as a count outcome. To investigate potential biomarkers, high-throughput assays that assess gene expression and methylation have been developed. It is of interest to identify biomarkers or molecular features that are associated with elevated micronuclei (MN) or nuclear bud (Nbud) frequency, measures of exposure to environmental toxins. Given our desire to model a count outcome (MN and Nbud frequency) using high-throughput genomic features as predictors, novel methods that can handle over-parameterized models need development. Overdispersion, when the variance of a count outcome is larger than its mean, is frequently observed with count response data. For situations where overdispersion is present, the negative binomial distribution is more appropriate. Furthermore, we expand the method to the longitudinal Poisson and longitudinal negative binomial settings for modeling a longitudinal or clustered outcome both when there is equidispersion and overdispersion. The method we have chosen to expand is the Generalized Monotone Incremental Forward Stagewise (GMIFS) method. We extend the GMIFS to the negative binomial distribution so it may be used to analyze a count outcome when both a high-dimensional predictor space and overdispersion are present. Our methods were compared to glmpath. We also extend the GMIFS to the longitudinal Poisson and longitudinal negative binomial distribution for analyzing a longitudinal outcome. Our methods were compared to glmmLasso and GLMMLasso. The developed methods were used to analyze two datasets, one from the Norwegian Mother and Child Cohort study and one from the breast cancer epigenomic study conducted by researchers at Virginia Commonwealth University. In both studies a count outcome measured exposure to potential genotoxins and either gene expression or high-throughput methylation data formed a high dimensional predictor space. Further, the breast cancer study was longitudinal such that outcomes and high-dimensional genomic features were collected at multiple time points during the study for each patient. Our goal is to identify biomarkers that are associated with elevated MN or NBud frequency. From the development of these methods, we hope to make available more comprehensive statistical models for analyzing count outcomes with high dimensional predictor spaces and either cross-sectional or longitudinal study designs.

The purpose of this thesis is to identify typical patterns of career destinations for young women and men in relation to their high school science preparedness. This is an empirical structural study that documents the way high school academic capital is turned (or not) into human capital for science and engineering professions. The study uses ten years of longitudinal data on educational and career paths of British Columbia high school graduates of the Class of '88. Correspondence analysis and other descriptive statistics provide a picture of students' participation in mathematics and science senior high school courses and post-secondary academic programs. School course choices, post-secondary educational attainment, specialization fields are correlated to respondents' high school science preparedness, parental education and gender. A major finding of this study is that high school science preparedness opens greater opportunity for students to attend and succeed along abroad range of post-secondary pathways. Still, thesis findings confirm the existence of a "leaking" phenomenon along the physical sciences and engineering post-secondary pipeline, especially for women as well as men with non-university educated parents. Equity in access and outcomes is discussed in relation to respondents' possession of cultural and academic capital, and in relation to gender inequality that persists within school and post-secondary institutions, the science community and society at large. Implications for further research emerge from the literature review and the interpretation of thesis findings. Longitudinal research needs to explore more directly the reasons why many young women and men who excelled in science at the high school level depart from the science pipeline sooner or later. A major conclusion is that the "critical mass" approach that directs attention toward creating a large supply pool to feed the science pipeline by encouraging more young women to enter the field of science is still a unilateral numerical strategy, and more has to be done to improve the retention and advancement of talented women interested in science. This thesis reinforces the need for an analysis of the culture of the science community and a revision of the leaking science pipeline concept that should be replaced by a more open non-linear model of science careers. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

Longitudinal methods have become an improved and essential means of measuring intra-individual change over time. Yet one of the greatest and most hazardous drawbacks studying participants over multiple sessions can be the loss of participants over time. This study attempts to illuminate the problem of attrition in longitudinal research by estimating the mean effect sizes for participant loss across 57 studies published in 13 prestigious journals which regularly use older participants. Results estimate overall attrition to be around 34% of the original sample. The subsequent break down of attrition into its subtypes yield mean effect sizes for attrition due to Refusal (8%), Loss of contact (10%), Illness (6%), and Death (14%) in studies sampling from adults 50 years or older. Analyses were then conducted via meta-analytic one-way ANOVA and weighted regression to identify possible moderators of overall attrition and their four subtypes.

En 2011, en France, plus de 147 525 hommes et femmes sont morts d’un cancer. Cette pathologie ne touche pas seulement les personnes les plus âgées : 41 000 décès prématurés, survenant avant 65 ans sont dus au cancer (FRANCIM, InVS, CIRC). Ce sont autant de personnes qui vivaient potentiellement en couple. En cas de décès, des bouleversements plus ou moins pérennes vont toucher le conjoint, sur un plan psychique, physique et social. Les proches du patient cancéreux constituent l’une de ses premières sources de soutien tout au long de sa maladie. Différentes recherches menées ces dernières années ont souligné la vulnérabilité psychique de ces « aidants-soignants », notamment en termes de symptômes anxio-dépressifs. Les facteurs de risque sociodémographiques identifiés (comme le fait d’être une femme, d’être plus âgé, et l’existence de deuils antérieurs) ne prennent pas en compte le fonctionnement psychique et affectif des conjoints : les relations de l’aidant au malade, sa personnalité, ni même son vécu subjectif de la maladie et de la fin de vie. Lorsque l’issue du cancer est fatale, il semble que parmi les proches, ce soient les conjoints des patients qui rencontrent le plus de difficultés pour faire face au décès : le risque de deuil compliqué (Prolonged Grief Disorder, Prigerson et al, 2009) serait plus important dans cette population. A l’heure actuelle, l’existence de cette catégorie nosographique fait encore débat et les données empiriques longitudinales font défaut pour spécifier le caractère pathologique du deuil dans le champ du cancer. Les propositions de soutien psychologique pour ces personnes si intensément sollicitées restent finalement méconnues, à la fois par les conjoints endeuillés, qui y ont rarement recours, et par certains professionnels du soin. ObjectifsCette recherche a pour objectif d’identifier et de comprendre les déterminants des processus de deuil chez les conjoints, amorcés dès la fin de vie de la personne atteinte de cancer en phase palliative, et déployés à moyen et long terme. Cette étude vise également à décrire la phénoménologie ‘normale’ du deuil, ainsi que ses manifestations pathologiques. La proposition d’outils de réflexion favorisant la mise en place de dispositifs de soutien adaptés aux conjoints endeuillés, constitue le dernier objectif de cette recherche.MéthodesDeux études ont été réalisées. L’étude 1, quantitative, utilise une batterie psychométrique évaluant la détresse émotionnelle, l’ajustement social, le développement post-traumatique, les styles d’attachement et de coping, et enfin la personnalité des conjoints. Cette étude propose un suivi de cohorte durant la phase palliative (N=60)/6 mois après le décès (N=36) où l’on met en relation des données personnelles initiales avec l’ajustement ultérieur des conjoints de patients. L’étude 2, qualitative, propose une exploration de l’expérience personnelle de dix conjoints confrontés à la perte et de leurs processus de mise en sens à l’aide de l’Interpretative Phénoménological Analysis (IPA, Smith, Flowers, & Larkin, 2009). Résultats Les analyses quantitatives ont montré que la grande majorité des conjoints présentaient pendant la phase palliative une symptomatologie dépressive et souffraient d’un fardeau lié à la prise en charge du malade, tandis que leur adaptation sociale semble globalement préservée. Après la mort du patient, l’intensité des symptômes dépressifs augmente pour la majorité des conjoints endeuillés (53%), tandis qu’une minorité (13%) souffre d’un trouble du deuil prolongé. La détresse des conjoints endeuillés est avant tout prédite par leur niveau de dépression mesurée avant le décès, et peu par les variables liées à la maladie ou au décès lui-même. Les styles d’attachement permettent d’autre part d’identifier des profils adaptatifs chez les conjoints.... / In 2011, in France, more than 147 525 men and women died through cancer. This disease doesn’t affect only the oldest: 41 000 untimely deaths, before 65 years, are caused by cancer (FRANCIM, InVS, CIRC). All these persons were supposed to live with a partner. Faced with the patient’s death, more or less sustainable psychological, physical or social upheavals will affect the spouse.The cancer patient’s relatives and family constitute one of the patient’s main sources of support throughout the disease, but this support is not always recognized by physicians. Over recent years, several studies have emphasized the psychological vulnerability of these caregivers especially in terms of anxiety and depression patterns. However, identified sociodemographic risk factors (e.g. being a woman, being older, and having experienced previous grief) do not take into account the socio-affective and cognitive functioning of the patient’s spouse. The relationship with the patient, the caregiver’s personality, or the subjective experience of illness and end of life are considered to be critical by clinicians, but are largely ignored in empirical research. When the outcome of cancer is fatal, among the patient’s family and friends, the spouse appears to encounter the greatest difficulties to cope with her/his grief: the risk of complicated grief is more considerable among this population. Currently, the existence of this disorder (Prolonged Grief Disorder, Prigerson et al, 2009) still remains in debate and the lack of empirical longitudinal data to specify the pathological aspect of grief in the field of cancer, hinders any scientific consensus.Psychological support provided to these intensely requested persons remains poorly known, both by bereaved spouses, who have rarely resort to support facility, and by some healthcare professionals. AimsThis study aims at identifying and understanding the predictors of grief among bereaved spouses of cancer patients, induced from end of life to the mid- and long- term grief period. We also want to describe the “normal” phenomenology of grief, and its complicated manifestations. Finally this research aims at providing reflection tools facilitating the implementation of adapted support programs for bereaved spouses.MethodsTwo complementary studies were conducted. Study 1, a quantitative study, uses a psychometric battery assessing the distress, the social adjustment, the post-trauamtic growth, the styles of attachment and of coping, as well as the personality in spouses of cancer patients. This study consists of following-up of a cohort during the palliative period (N=60)/6 months after death (N=36), to capture correlations between initial personal data and subsequent adjustment. Study 2 is a qualitative study, which provides an investigation of ten spouses’ experience facing the loss of their loved one. This experience and their making sense processes were studied with the Interpretative Phénoménological Analysis (IPA, Smith, Flowers & Larkin, 2009)ResultsThe quantitative analyses showed that the vast majority of the spouses reported during the palliative phase a depressive symptomatology and feelings of burden associated with the caregiving of the patient. Their social adaptation is globally preserved. After the death of the patient, the intensity of the depressive symptoms increase for the majority of the bereaved spouses (53%), while a minority (13%) meet the criteria for a Prolonged Grief Disorder. Above all, the distress of the latter is predicted by their levels of depression assessed before the death. The factors linked to the disease or to the death itself hardly constitute good predictors of the condition of the bereaved spouses. The attachment styles allow us to identify adaptative profiles in this population.....

Investigations into the speech of normal children have indicated that disfluencies are common. It is important for the Speech Language Pathologist to have knowledge of normal disfluencies for differential diagnosis, parent counseling, and in order to plan strategies for intervention. The purpose of this study was to compare the frequency of disfluencies in 4 year old and 6 year old normal male children to the frequency of disfluencies when they were 3 years old and 5 years old respectively.

No description available.

Chemotherapy is a method used to treat cancer but it has a number of side-effects. Research conducted by the Department of Chemical Engineering at BYU involves a new method of administering chemotherapy using ultrasound waves and water-soluble capsules. The goal is to reduce the side-effects by localizing the delivery of the medication. As part of this research, a two-factor experiment was conducted on rats to test if the water-soluble capsules and ultrasound waves by themselves have an effect on tumor growth or patient survival. Our project emphasizes the usage of Bayesian Hierarchical Models and Win-BUGS to jointly model the survival data and the longitudinal data—mass. The results of the joint analysis indicate that the use of ultrasound and water-soluble microcapsules have no negative effect on survival. In fact, there appears to be a positive effect on the survival since the rats in the ultrasound-capsule group had higher survival rates than the rats in other treatment groups. From these results, it does appear that the new technology involving ultrasound waves and microcapsules is a promising way to reduce the side-effects of chemotherapy. It is strongly advocated that the formulation of a joint model for any longitudinal and survival data be performed. For future work for the ultrasound-microcapsule data it is recommended that joint modeling of the mass, tumor volume, and survival data be conducted to obtain additional information.