En dépit des taux élevés de mortalité infantile dans les populations du passé, les sujets décédés en période périnatale ont longtemps été délaissés dans les travaux anthropologiques et paléoanthropologiques. Alors que les analyses biologiques portant sur les individus adultes intègrent l’étude de la variabilité comme une composante majeure, rares sont celles permettant de replacer un individu décédé en période périnatale dans le cadre de la variabilité individuelle ou populationnelle de cette classe d’âge. Le présent travail se propose ainsi d’investir le sujet de la diversité métrique et non-métrique des sujets décédés entre 22 et 48 semaines d’aménorrhée à partir de l’étude biologique de 116 sujets de trois collections archéologiques (une kerma et deux médiévales et modernes) et d’une collection actuelle virtuelle comportant 364 individus. Un premier axe de recherche caractérise la variabilité des corpus dans ses composantes intra-individuelles, inter-individuelles, populationnelles, ainsi que du point de vue des corrélations à l’âge au décès. Un second axe de recherche vise à identifier des caractères permettant d’estimer l’état de morbidité et de vitalité à la naissance de l’individu, donnée déterminante pour le statut du sujet dans la société. Pour le premier axe, l’étude révèle des différences de conformation selon l’âge au décès et les groupes populationnels, de même que l’existence d’asymétries directionnelles et fluctuantes. Les résultats vont ensuite dans le sens d’une forte proximité biologique pour le groupe kerma, traduisant potentiellement une certaine endogamie, au contraire du groupe médiéval et moderne dont la diversité plus importante pourrait refléter des facteurs socio-géographiques ou séculaires. Le second axe de recherche a permis de souligner que la mécano-sensibilité des régions d’insertion musculaire apparaît comme un nouveau paramètre à considérer pour discerner les sujets ayant survécu à la naissance. L’étude de la collection kerma livre également la première identification en contexte archéologique d’un critère de morbidité spécifique, la côte surnuméraire cervicale. Enfin, le croisement des analyses biologiques et des données archéologiques de la nécropole 8B-51 de l’île de Saï, permet d’appréhender et de discuter les traitements funéraires dévolus à la classe d’âge périnatale au Kerma classique. / Despite the high rates of child mortality in past populations, subjects deceased in perinatal period were often neglected in bioarchaeological and paleoanthropology studies. Unlike biological analysis on adults, investigations on newborns rarely include individual or populational variability comparisons as a major component. In the present work, we will focus on metrical and non-metrical diversity of subject deceased between 22 and 48 amenorrhea weeks, based on the biological study of 116 subjects from three archaeological collections (one kerma and two medieval and modern) and one current virtual collection with 364 individuals. The first research axis characterizes the intra-individual, inter-individual and populational variability, and differences by age at death in both samples. The second line of research aims to identify criteria making it possible to estimate individual morbidity and live birth on dry bones, informations that are needed to understand the child’s position in society. Biological studies reveal for the first research axis shape differences by age at death and populations, as well as the existence of directional and fluctuating asymmetries. Results provide evidences of strong biological proximity in the kerma group, potentially indicating of endogamy. On the contrary, the diversity of the medieval and modern group appears broader and could reflect socio-geographical factors or secular trends. The second line of research reveals the mechanical sensitivity of muscular insertions as a key parameter for tracking of live-born subjects. The study of the kerma collection provides the first archaeological identification of the supernumerary cervical rib, detected as a morbidity criterion in perinatal period. Lastly, crossing of biological and archaeological data on the 8B-51 necropolis provides an interpretative framework for funerary treatments dedicated to the perinatal age group in Classic Kerma.

Made available in DSpace on 2016-01-26T12:51:35Z (GMT). No. of bitstreams: 1 fabioaugustoselig_dissert.pdf: 852758 bytes, checksum: 966b17099569a3dd4e20f70a9e415ad8 (MD5) Previous issue date: 2010-08-06 / The role of Autonomic Nervous System and its components sympathic and parassympathic in the regulation of the interaction between different parts of human body has been exhaustibly discussed in scientific literature. These studies demonstrated the applicability of the Chaos Theory in different situations, diseases and ages. Objective: Apply the concepts of nonlinear dynamics and Chaos Theory to evaluate premature newborns (PT), analyzing their heart rate variability (HRV) and comparing them with healthy term newborns (TN). Methods: By using a Polar Advanced S810, 59 PT born with different gestational ages had their HRV obtained and analyzed in time (SDNN, RMSSD, SD1/SD2), frequency (VLF, LF, HF and LF/HF) and chaos domain (TAU, Lyapunov Exponent, Entropy and Hurst Exponent) variables. The premature were compared to 78 healthy term newborns. The comparison were made applying Kruskal-Wallis statistic method and their graphic demonstration made by using Box-plots. Results: All time, frequency and chaos domain variables demonstrated statistic difference comparing term and preterm newborns except Hurst Exponent. Conclusion: Preterm newborn follow the rules of chaos theory and have more linear behavior when compared with term newborn. / : Vários trabalhos publicados nos últimos anos demonstram a importância do Sistema Nervoso Autônomo por meio dos componentes Simpático e Parassimpático na gerência da interação entre as diferentes partes do todo, fornecendo padrão caótico ao organismo humano. Estes estudos aplicaram a Teoria do Caos em diferentes situações, doenças e faixas etárias. Objetivo: Aplicar os conhecimentos da Teoria do Caos e da dinâmica não-linear na avaliação de recém-natos prematuros (PT), analisando sua Variabilidade da Frequência Cardíaca (VFC) e comparando-os com recém-natos de termo (RNT) saudáveis. Casuística e Método: 59 recém-natos prematuros com diferentes idades gestacionais tiveram seus batimentos cardíacos captados com auxílio do equipamento Polar Advanced S810 e sua VFC obtida pelo registro dos intervalos RR. A VFC foi analisada nos Domínios do Tempo (SDNN, RMSSD, SD1/SD2), da Frequência (VLF, LF, HF e a relação LF/HF) e do Caos (TAU e sua normalização [TAU(n]], Expoente de Lyapunov, Entropia e o expoente de Hurst). Os recém-natos prematuros foram comparados com um grupo de 78 recém-natos de termo saudáveis e sem intercorrências perinatais. O teste estatístico utilizado para comparação entre os grupos foi o teste não-paramétrico de Kruskal-Wallis com comparações múltiplas e sua demonstração gráfica feita com auxílio do gráfico tipo Box-plots. Resultados: Detectou-se diferença estatisticamente significativa entre os grupos para todas as variáveis estudadas (nos domínios do tempo, da frequência e do caos) sendo única exceção o Expoente de Hurst. Conclusão: Recém-natos prematuros obedecem às regras da Teoria do Caos e tendem a ter comportamento menos complexo, ou seja, mais linear, quando comparados com recém-natos de termo.

1 ABSTRACT The issue of births outside a medical facility is currently a controversial topic between specialists as well as in the public sector. While the specialists concur in refusing home births, the society is divided. There are voices that refuse home births but there are also plenty of people who support the right of mothers to give birth outside of a medical facility. Very sensitive topic is the legal and ethical aspects of the protection of unborn children and the issue of a safely conducted delivery. In the last decades, the life value of an unborn child has been seen as an ethical problem. The right to life is one of the fundamental human rights, which is enshrined in the constitutional system of the Czech Republic and also in the international human rights conventions. Because there are different opinions regarding this issue, it is necessary to establish a view that is widely accepted so that legal standards can be approved provided that the opinions of minorities are being respected. The main objective of this presented dissertation was to ascertain why are people losing confidence in a doctor's role during delivery and what is the reason for some of the mothers being unsatisfied with current institutional system of obstetrics. On the basis of these factual findings, which emerged during the...

Le sepsis tardif, défini comme une infection systémique chez les nouveaux nés âgés de plus de 3 jours, survient chez environ 7% à 10% de tous les nouveau-nés et chez plus de 25% des nouveau-nés de très faible poids de naissance qui sont hospitalisés dans les unités de soins intensifs néonatals (USIN). Les apnées et bradycardies (AB) spontanées récurrentes et graves sont parmi les principaux indicateurs précoces cliniques de l'infection systémique chez les prématurés. L'objectif de cette thèse est de déterminer si la variabilité du rythme cardiaque (VRC), la respiration et l'analyse de leurs relations aident au diagnostic de l'infection chez les nouveaux nés prématurés par des moyens non invasifs en USIN. Par conséquent, on a effectué l'analyse Mono-Voie (MV) et Bi-Voies (BV) sur deux groupes sélectionnés de nouveau-nés prématurés: sepsis (S) vs. non-sepsis (NS). (1) Tout d'abord, on a étudié la série RR non seulement par des méthodes de distribution (moy, varn, skew, kurt, med, SpAs), par les méthodes linéaire: le domaine temporel (SD, RMSSD) et dans le domaine fréquentiel (p_VLF, p_LF, p_HF), mais aussi par les méthodes non–linéaires: la théorie du chaos (alphas, alphaF) et la théorie de l'information (AppEn, SamEn, PermEn, Regul). Pour chaque méthode, nous étudions trois tailles de fenêtre 1024/2048/4096, puis nous comparons ces méthodes afin de trouver les meilleures façons de distinguer S de NS. Les résultats montrent que les indices alphaS, alphaF et SamEn sont les paramètres optimaux pour séparer les deux populations. (2) Ensuite, la question du couplage fonctionnel entre la VRC et la respiration nasale est adressée. Des relations linéaires et non-linéaires ont été explorées. Les indices linéaires sont la corrélation (r²), l'indice de la fonction de cohérence (Cohere) et la corrélation temps-fréquence (r2t,f) , tandis que le coefficient de régression non-linéaire (h²) a été utilisé pour analyser des relations non-linéaires. Nous avons calculé les deux directions de couplage pendant l'évaluation de l'indice h2 de régression non-linéaire. Enfin, à partir de l'ensemble du processus d'analyse, il est évident que les trois indices (r2tf_rn_raw_0p2_0p4, h2_rn_raw et h2_nr_raw) sont des moyens complémentaires pour le diagnostic du sepsis de façon non-invasive chez ces patients fragiles. (3) Après, l'étude de faisabilité de la détection du sepsis en USIN est réalisée sur la base des paramètres retenus lors des études MV et BV. Nous avons montré que le test proposé, basé sur la fusion optimale des six indices ci-dessus, conduit à de bonnes performances statistiques. En conclusion, les mesures choisies lors de l'analyse des signaux en MV et BV ont une bonne répétabilité et permettent de mettre en place un test en vue du diagnostic non invasif et précoce du sepsis. Le test proposé peut être utilisé pour fournir une alarme fiable lors de la survenue d'un épisode d'AB tout en exploitant les systèmes de monitoring actuels en USIN. / Late-onset sepsis, defined as a systemic infection in neonates older than 3 days, occurs in approximately 10% of all neonates and in more than 25% of very low birth weight infants who are hospitalized in Neonatal Intensive Care Units (NICU). Recurrent and severe spontaneous apneas and bradycardias (AB) is one of the major clinical early indicators of systemic infection in the premature infant. Various hematological and biochemical markers have been evaluated for this indication but they are invasive procedures that cannot be repeated several times. The objective of this Ph.D dissertation was to determine if heart rate variability (HRV), respiration and the analysis of their relationships help to the diagnosis of infection in premature infants via non-invasive ways in NICU. Therefore, we carried out Mono-Channel (MC) and Bi-Channel (BC) Analysis in two selected groups of premature infants: sepsis (S) vs. non-sepsis (NS). (1) Firstly, we studied the RR series not only by distribution methods (moy, varn, skew, kurt, med, SpAs), by linear methods: time domain (SD, RMSSD) and frequency domain (p_VLF, p_LF, p_HF), but also by non-linear methods: chaos theory (alphaS, alphaF) and information theory (AppEn, SamEn, PermEn, Regul). For each method, we attempt three sizes of window 1024/2048/4096, and then compare these methods in order to find the optimal ways to distinguish S from NS. The results show that alphaS, alphaF and SamEn are optimal parameters to recognize sepsis from the diagnosis of late neonatal infection in premature infants with unusual and recurrent AB. (2) The question about the functional coupling of HRV and nasal respiration is addressed. Linear and non-linear relationships have been explored. Linear indexes were correlation (r²), coherence function (Cohere) and time-frequency index (r2t,f), while a non-linear regression coefficient (h²) was used to analyze non-linear relationships. We calculated two directions during evaluate the index h2 of non-linear regression. Finally, from the entire analysis process, it is obvious that the three indexes (r2tf_rn_raw_0p2_0p4, h2_rn_raw and h2_nr_raw) were complementary ways to diagnosticate sepsis in a non-invasive way, in such delicate patients.(3) Furthermore, feasibility study is carried out on the candidate parameters selected from MC and BC respectively. We discovered that the proposed test based on optimal fusion of 6 features shows good performance with the largest Area Under Curves (AUC) and the least Probability of False Alarm (PFA). As a conclusion, we believe that the selected measures from MC and BC signal analysis have a good repeatability and accuracy to test for the diagnosis of sepsis via non-invasive NICU monitoring system, which can reliably confirm or refute the diagnosis of infection at an early stage.