Personer med kognitiva nedsättningar tillhör en av de största grupperna av funktionsnedsatta personer. Premium Comai är ett hjälpmedel för att hjälpa personer med kognitiva nedsättningar att bli mer självständiga i deras vardag. Denna målgrupp har framförallt svårigheter med de exekutiva funktionerna så till exempel att minnas saker de ska genomföra eller att uppfatta hur lång tid aktiviteter tar. Denna studie undersöker hur användandet av en digital kalender som hjälpmedel för personer med kognitiva nedsättningar ser ut och hur användare av upplever hjälpmedlet, om de upplever att det hjälper dem planera sin tid och att komma ihåg. För att undersöka detta intervjuades användare av Premium Comai, där intervjutekniken var semistrukturerade intervjuer. Användare upplever att hjälpmedlet är enkelt att använda och att det hjälper dem planera sin tid. Premium Comai skapar trygghet. / People with cognitive impairments belong to one of the largest groups of disabled persons. Premium Comai is a tool to help people with cognitive impairments to become more independent in their daily lives. These peoples have particular difficulties with the executive functions such as remembering things or to perceive the time an activity will take. This study examines how the use of a digital calendar that is accessible for people with cognitive impairments, how users perceive the means, if they feel it helps them manage their time and to remember. To examine this, users of Premium Comai were interviewed, using semi-structured interviews. Users perceive that the device is easy to use and it helps them to plan their time. Premium Comai makes users feel safe.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Balancing sustainable development with high productivity is a major current challenges, especially regarding the search for alternatives and technologies focused on devising processes and products that do not generate or reduce damage to the environment. In this sense, the use of tools such as Cleaner Production (CP) can contribute to increased efficiency in the use of raw materials, water and energy by not-generation, minimization or recycling of waste and by products from the production process. Thus, the objective is to analyze CP parameters used by companies in the metal-mechanic sector of the central region of Rio Grande do Sul state, participants Productive Extension Center and Innovation (NEPI), aiming to propose future scenarios resulting from the Theory of inventing problem solving (TRIZ). From this perspective, it was found that the surveyed companies adopt CP practices although no regulation. However, there are many potential to be developed by local entrepreneurs regarding environmental issues, which also depends on public politics, society and market. / Conciliar desenvolvimento sustentável com alta produtividade é um dos grandes desafios atuais, principalmente no que tange a busca por alternativas e tecnologias focadas em idealizar processos e produtos que não gerem ou reduzam passivos ambientais. Nesse sentido, o uso de ferramentas como a Produção mais limpa (PML) pode contribuir para o aumento da eficiência no uso de matérias-primas, água e energia através da não-geração, minimização ou reciclagem de resíduos do processo produtivo. Com isso, objetivou-se analisar parâmetros de PML utilizados por empresas do setor metalmecânico da região central do estado do Rio Grande do Sul, participantes do Núcleo de Extensão Produtiva e Inovação (NEPI), visando a proposição de cenários prospectivos resultantes da Teoria inventiva de solução de problemas (TRIZ). Nessa perspectiva, verificou-se que as empresas pesquisadas adotam práticas de PML, apesar de não haver sua regulamentação. Contudo, há muitas potencialidades a serem desenvolvidas pelos empresários locais no que tange as questões ambientais, o que depende também das políticas públicas, sociedade e mercado.

Este estudo teve por objetivo avaliar a influência da terapia hormonal sobre a pressão ocular de mulheres na pós-menopausa. A amostra foi constituída por 58 olhos de 58 pacientes no período da pós-menopausa, com indicação de terapia hormonal, com idade entre 41 e 65 anos, que não tenham utilizado hormônio nos últimos três meses. As pacientes foram randomizadas (por sorteio) em dois grupos: terapia hormonal contínua (n=32) com comprimidos de estradiol 2 mg e acetato de noretisterona 1 mg, diário durante três meses e grupo controle placebo (n=26). O estudo foi realizado de forma cega pela investigadora principal. As pacientes foram avaliadas quanto à pressão ocular, paquimetria, ceratometria e dosagens dos hormônios sexuais pré e pós-tratamento. A média de idade foi de 54,21 anos ± 4,95, sendo 53,66 anos ± 5,60 no grupo com terapia hormonal e de 54,88 anos ± 4,01 no grupo placebo. Não houve diferença significativa entre os grupos com relação a idade (p= 0,352), índice de massa corporal (p= 0,818), pressão ocular (p=0,697), ceratometria (p > 0,05), paquimetria central (p=0,580), e dosagens dos hormônios sexuais (p>0,05) no pré-tratamento. A pressão ocular média pré-tratamento foi de 14,08 mmHg ± 1,96 no grupo terapia hormonal e de 13,81 mmHg ± 3,28 no grupo placebo. Houve redução significativa da pressão ocular média entre o pré e o pós-tratamento (p=0,0009) no grupo terapia hormonal e redução não significativa no grupo placebo (p=0,108). Na avaliação entre os grupos, não houve diferença estatística nos valores de pressão ocular média no pós-tratamento. Na avaliação entre os grupos, não houve diferença estatisticamente significativa para os valores de paquimetria e ceratometria. O grupo com terapia hormonal apresentou aumento significativo dos níveis hormonais de estradiol e redução significativa nas dosagens hormonais médias de LH e FSH no pós-tratamento com 30, 60 e 90 dias (p=0,000). As dosagens hormonais no grupo placebo não apresentaram variação estatisticamente significante. No grupo terapia hormonal, houve correlação diretamente proporcional entre as pressões oculares médias e níveis hormonais de LH e FSH, e correlação inversamente proporcional com níveis hormonais de estradiol. Em resumo, houve redução da pressão ocular média no grupo terapia hormonal entre o pré e o pós-tratamento e os níveis pressóricos neste grupo se correlacionaram com os níveis hormonais de LH, FSH e estradiol / This trial aimed to assess the influence of hormonal therapy on intraocular pressure in post-menopausal women. The sample had 58 eyes of 58 patients during menopause period, indicated for hormonal therapy, they were between the age of 41 and 65 years, who have not taken hormone in the past three months. Patients were randomized (raffle) in two groups: continuous hormonal therapy (n=32) with 2 mg of estradiol and 1 mg daily of norethisterone acetate for three months and controlled placebo group (n=26). It was a blind study carried out by the main investigator. Patients were assessed regarding ocular pressure, pachymetry, keratometry and sex hormone\'s dosages, pre and post treatment. The average was 54.21 years old ± 4.95, where 53.66 years old ± 5.60 in the group with hormonal therapy and 54.88 years old ± 4.01 in the placebo group. There was no significant difference between the groups regarding age (p= 0.352), body mass index (p= 0.818), ocular pressure (p=0.697), keratometry (p > 0.05), central pachymetry (p=0.580), and sex hormone dosages (p>0.05) during pre treatment. The average pre treatment pressure was 14.08 mmHg ± 1.96 in the hormonal therapy group and 13.81 mmHg ± 3.28 in the placebo group. There was a significant reduction in the average ocular pressure between the pre and post treatment (p=0.0009) in the hormonal therapy group and not a significant reduction in the placebo group, (p=0.108). There was no statistically difference between the groups in the average ocular pressure values after treatment. There were no statistically significant differences between the two groups in the values of pachymetry and keratometry. The hormonal therapy group showed a significant increase in estradiol hormonal levels and a significant reduction in the average hormonal dosages of LH e FSH in the post treatment after 30, 60 and 90 days (p=0.000). The hormonal dosages in the placebo group no showed significant changed. In the hormonal group, there was a direct and proportional relation between the average ocular pressure and LH and FSH hormonal levels and a proportional contrariwise correlation with estradiol hormonal levels. In summary, there was a reduction in the ocular pressure average in the hormonal therapy group between the pre and post treatment and the pressure levels in this group were correlated with the hormonal levels of LH, FSH and estradiol

Introdução: As modificações evolutivas e o impacto clínico da composição da aterosclerose coronária em pacientes sob prevenção secundária permanecem pouco conhecidos. O ultrassom intravascular com histologia virtual (VH-IVUS) permite caracterizar in vivo tais componentes. Os objetivos desse estudo foram avaliar o papel prognóstico da composição da aterosclerose da árvore coronária proximal, bem como descrever o comportamento dinâmico da placa, explorando a relação entre seus componentes e as alterações geométricas do vaso. Métodos: Conduziu-se um estudo prospectivo, observacional e unicêntrico, que incluiu pacientes encaminhados para intervenção coronária percutânea. Durante essa intervenção, realizou-se VH-IVUS tipo \"artéria inteira\" das três coronárias principais para mensurar os parâmetros geométricos do vaso (luz, membrana elástica externa, placa+média e volume percentual do ateroma) e os componentes das placas (fibrótico, fibrolipídico, núcleo necrótico e cálcio denso). Calculou-se o volume indexado de cada parâmetro por paciente, artéria e subsegmento arterial. Avaliou-se a influência dos volumes indexados da árvore coronária proximal (por paciente), sem considerar a categorização fenotípica das placas, na ocorrência de eventos cardíacos adversos maiores (MACE), definidos como óbito, infarto agudo do miocárdio e revascularização miocárdica não planejada, após 4 anos de seguimento. Em um subgrupo de pacientes, VH-IVUS volumétrico seriado foi realizado para estudar variações do ateroma nas artérias e em seus subsegmentos, testando correlações entre componentes da placa e variações geométricas do vaso. Resultados: Foram incluídos 67 pacientes com idade média de 58,9 ± 9,2 anos, 66% do sexo masculino, 42% diabéticos, 69% multiarteriais e 45% com síndrome coronária aguda recente. Obtiveram-se imagens de VH-IVUS para 255 artérias. As médias dos volumes indexados basais da árvore coronária proximal, em escala de cinza, foram: luz 8,8±2,5mm3/mm, membrana elástica externa 15,4±3,5mm3/mm e placa+média 6,6±2,0mm3/mm, com percentual de volume do ateroma de 42,8±8,9%. Quanto aos componentes do ateroma, predominou o fibrótico 2,1 ± 1,0mm3/mm (61,8 ± 6,6%), seguido por núcleo necrótico 0,6±0,4mm3/mm (16,6±6,7%), fibrolipídico 0,5±0,3mm3/mm (14,1±6,0%) e cálcio denso 0,3±0,2mm3/mm (7,6 ± 4,6%). Após 4,9 anos (intervalo interquartil: 4,5 - 5,1 anos) sob prevenção secundária, ocorreram MACE em 18 pacientes, a maioria por reestenose. Não houve correlação entre os volumes indexados basais da árvore coronária proximal e a ocorrência de MACE. VH-IVUS seriado, após 20,6 meses (intervalo interquartil: 9,1 - 23,8 meses), foi realizado em 52 pacientes. Nas artérias desses pacientes, houve redução no volume indexado de luz, redução no volume indexado de membrana elástica externa, sem alteração no volume indexado de placa+média ou no percentual de volume do ateroma. Modificações na composição da placa foram observadas, com incremento absoluto e relativo dos componentes cálcio denso (0,09±0,21mm3/mm p < 0,01; 2,2±7,1% p < 0,01) e núcleo necrótico (0,13±0,47mm3/mm p < 0,01; 3,0 ± 10,9% p < 0,01), redução relativa do componente fibrolipídico (-0,05 ± 0,81mm3/mm p=0,37; -3,7 ± 10,3% p < 0,01) sem variação do componente fibrótico (-0,04 ± 1,00mm3/mm p=0,62; -1,6 ± 13,3% p=0,12). Nos subsegmentos arteriais, a composição basal da placa correlacionou-se com a resposta de remodelamento do vaso. A quantidade total de volume indexado basal dos componentes não calcificados correlacionou-se positivamente com a resposta de remodelamento constrictiva do vaso, que ocorreu menos frequentemente em diabéticos e associou-se a maior incremento do componente cálcio denso durante a evolução. Conclusão: Em coronarianos sob prevenção secundária, a composição média da aterosclerose na árvore coronariana proximal não se associou a ocorrência de eventos cardíacos adversos maiores. O comportamento dinâmico do ateroma foi compatível com estabilização da doença, ocorrendo variação não significativa na quantidade de placa, redução luminal associada a remodelamento negativo do vaso e modificação nos constituintes da placa com desvio de um \"perfil fibrolipídico para um mais calcificado\". A quantidade basal de componentes não calcificados da placa modulou as alterações geométricas direcionadas para o remodelamento constrictivo do vaso / Background: Clinical impact of coronary atherosclerosis composition and their modifications related to secondary prevention remains not well known. Virtual histology intravascular ultrasound (VH-IVUS) allows in vivo characterization of atherosclerotic plaque components. The aim of this study was to evaluate the prognostic value of atherosclerotic plaque composition of proximal coronary tree and to describe the variations in atherosclerotic plaques, exploring the relations of theirs components with geometric modifications of the vessel. Methods: It was conducted a prospective observational single center study, including patients referred to percutaneous coronary intervention. During the interventional procedure, volumetric three vessel \"whole artery\" VH-IVUS was performed to measure geometric vessel (lumen, elastic external membrane, plaque+media, percent atheroma volume) and atheroma compositional parameters (fibrotic, fibrolipid, necrotic core, and dense calcium). It was computed the volumetric index of each parameter in patient, artery, and arterial subsegment level. It was tested the prediction value of the volumetric indexes of proximal coronary tree (patient level), disregarding the phenotypical categorization of plaques, in the occurrence of major adverse cardiac events (MACE) defined by death, acute myocardial infarction, and unplanned myocardial revascularization, after 4 years of follow-up. In a subgroup of patients, serial volumetric VH-IVUS was performed to evaluate the modifications of the atheroma in arteries and their subsegments, testing the correlations between plaque components and geometric variations of the vessel. Results: It was included 67 patients with mean age of 58.9 ± 9.2 yearsold, 66% male, 42% with diabetes, 69% with multivessel coronary disease, and 45% with recent acute coronary syndrome. VH-IVUS was obtained for 255 arteries. The average of volumetric indexes of proximal coronary tree was: lumen 8.8±2.5mm3/mm; elastic external membrane 15.4 ± 3.5mm3/mm; placa+media 6.6 ± 2.0mm3/mm and percent atheroma volume 42.8±8.9%. In terms of composition, the predominant component was fibrotic 2.1 ± 1,0mm3/mm (61.8 ± 6.6%), followed by necrotic core 0.6 ± 0.4mm3/mm (16.6 ± 6.7%), fibrolipid 0.5 ± 0.3mm3/mm (14.1 ± 6.0%) and dense calcium 0.3 ± 0.2mm3/mm (7.6 ± 4.6%). After a 4.9- year (interquartile interval: 4.5 - 5.1) follow-up, MACE occurred in 18 patients, mainly motivated by stent reestenosis. There was no correlation between baseline volumetric indexes of proximal coronary tree and the occurrence of MACE. Serial VH-IVUS, after 20.6 months (interquartile interval: 9.1 - 23.8 months), was performed in 52 patients. In arterial level, there was decrease in lumen index volume, reduction in elastic external membrane index volume, with no variation in placa+media index volume and percent atheroma volume. Changes in plaque composition were observed, with increase in absolute and relative dense calcium (0.09 ± 0.21mm3/mm p < 0.01; 2.2 ± 7.1% p < 0.01) and necrotic core (0.13 ± 0.47mm3/mm p < 0.01; 3.0 ± 10.9% p < 0.01), relative decrease in fibrolipid (-0.05 ± 0.81mm3/mm p=0.37; - 3.7 ± 10.3% p < 0.01), and no modification in fibrotic component (-0.04 ± 1.00mm3/mm p=0.62; -1.6 ± 13.3% p=0.12). In arterial subsegment level, baseline plaque composition correlated with remodeling response of the vessel. Total index volume of non-calcified plaque components positively correlated with a trend toward constrictive remodeling of the vessel, which occurred less frequently in diabetic patients and was associated with greater increase in dense calcium component. Conclusion: In patients with coronary artery disease treated with secondary prevention strategies, mean atherosclerotic plaque composition of the proximal coronary tree was not able to predict major adverse cardiac events. Dynamic behavior of atheroma in these patients was compatible with disease stabilization, related to quantitative plaque steadiness, lumen reduction associated with constrictive remodeling of the vessel, and modifications of plaque components with shifting from \"fibrolipid to more calcified profile\". Total non-calcified plaque components modulated geometric modifications toward constrictive remodeling of the vessel

O objetivo desse estudo foi avaliar os efeitos da administração prévia de antibiótico na incidência de complicações infecciosas em procedimentos de estimulação cardíaca artificial. Os pacientes foram selecionados em um estudo duplo-cego e randomizado (1:1). Grupo I Cefazolina (1,0g dose única) versus grupo II placebo. O comitê de segurança interrompeu o estudo após a inclusão de 649 pacientes devido à diferença entre os grupos (group I 314; grupo II 335 pacientes) em favor do uso de antibiótico: 2 infectados (0,63%) versus 11 infectados no grupo placebo (3,28%); p=0,016. Marcadores identificados por análise univariada: não uso de antibiótico; procedimentos de implantes (versus trocas); hematoma pós-operatório e duração do procedimento. O não uso de antibiótico e hematoma pós-operatório foram significantes em análise multivariada / The objective of this study was to evaluate the effects of the previous venous antibiotic administration in the incidence of infectious complications in cardiac stimulation surgical procedures. Patients were selected in a double blind, randomized (1:1) trial. Group I Cefazolin (1,0g one dose) versus group II placebo. The security committee interrupted the trial after inclusion of 649 patients due to differences between groups (group I 314; group II 335 patients) in favor of the antibiotic arm: 2 infected patients (0,63%) versus 11 infected patients in the placebo arm (3,28%); p=0,016. Markers identified by univariate analysis: non-use of preventive antibiotic; implant procedures (versus replacement); post-operative haematoma and procedure duration. The non-use of antibiotic and the post-operative haematoma were independent predictors of infection in multivariate analysis

The diploma thesis is focused on the basics of legal awareness of pupils. Its aim is to examine children's conceptions of responsibility and the processes associated with it in pupils at the beginning of the secondary school, to identify gaps and misconceptions with which pupils come to teaching and to propose recommendations for teaching. The theoretical part introduces the concept of responsibility, especially from the point of view of law, the psychological foundations of children's concepts and research devoted to children's concepts in the field of law. The practical part consists of a probe into children's conceptions of responsibility. The probe is implemented on pupils before the transition to the secondary school and on pupils in the 6th grade. The probe is based on two situations, which pupils can meet in their daily lives. The situations take place in two familiar environments - school and park. We focused on these situations in semi-structured interviews, which were then qualitatively evaluated. Based on the probe, it was found that students at the beginning of the 2nd grade understand responsibility, but have difficulty identifying the rules according to which it is attributed and do not understand the relationships and powers of the institutions associated with responsibility. Also...

Background: Community acquired pneumonia (CAP) is a high incidence disease resulting in about 260,000 hospital admissions per year in Germany, more than myocardial infarction or stroke. Worldwide, CAP is the most frequent infectious disease with high lethality ranging from 1.2 % in those 20–29 years old to over 10 % in patients older than 70 years, even in industrial nations. CAP poses numerous medical challenges, which the PROGRESS (Pneumonia Research Network on Genetic Resistance and Susceptibility for the Evolution of Severe Sepsis) network aims to tackle: Operationalization of disease severity throughout the course of disease, outcome prediction for hospitalized patients and prediction of transitions from uncomplicated CAP to severe CAP, and finally, to CAP with sepsis and organ failure as a life-threatening condition. It is a major aim of PROGRESS to understand and predict patient heterogeneity regarding outcome in the hospital and to develop novel treatment concepts. Methods: PROGRESS was designed as a clinical, observational, multi-center study of patients with CAP requiring hospitalization. More than 1600 patients selected for low burden of co-morbidities have been enrolled, aiming at a total of 3000. Course of disease, along with therapy, was closely monitored by daily assessments and long-term follow-up. Daily blood samples allow in depth molecular-genetic characterization of patients. We established a well-organized workflow for sample logistics and a comprehensive data management system to collect and manage data from more than 50 study centers in Germany and Austria. Samples are stored in a central biobank and clinical data are stored in a central data base which also integrates all data from molecular assessments. Discussion: With the PROGRESS study, we established a comprehensive data base of high quality clinical and molecular data allowing investigation of pressing research questions regarding CAP. In-depth molecular characterization will contribute to the discovery of disease mechanisms and establishment of diagnostic and predictive biomarkers. A strength of PROGRESS is the focus on younger patients with low burden of co-morbidities, allowing a more direct look at host biology with less confounding. As a resulting limitation, insights from PROGRESS will require validation in representative patient cohorts to assess clinical utility. Trial registration: The PROGRESS study was retrospectively registered on May 24th, 2016 with ClinicalTrials.gov: NCT02782013

Background: To assess the long-term course of the feasibility and safety of orally administered heroin [diacetylmorphine (DAM)] tablets in substitution treatment of severely addicted opioid users. Design: Open-label, prospective cohort study with 2 non-randomly assigned treatment arms: DAM tablets only (n = 128) or DAM tablets combined with injected DAM and/or other opioids (n = 237). The average duration of the observation period was 62 months. Study endpoints were the time to discharge from treatment and the number of serious adverse events. Results: Both patient groups had a higher than 70% retention rate after the first 48 months of treatment, with similar long-term retention rates (after 8 years both groups had retention over 50%). The physician-verified rate of serious adverse events was 0.01 events per application year among the exclusively oral substitution group (intention-to-treat analysis) during the last year of observation, and 0.005 events per application year in the other group. Conclusions: Because of their feasibility and safety over years, DAM tablets may be a valuable long-term therapeutic alternative. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Dans le contexte du réchauffement climatique global, les institutions académiques et internationales comme GIEC et de nombreux pays ont proposé des objectifs de réduction des émissions de CO2. L'objectif de cette thèse est d'évaluer ces objectifs gouvernementaux en les comparants avec les objectifs globaux à l'aide de différentes méthodes d'allocations lesquelles correspondent à différents principes d'équité en matière d'émissions carbones.Afin d'évaluer les feuilles de route technologique permettant d'obtenir les réductions d'émission de CO2 nécessaires, un modèle qualifié de flexible est proposé à destination des décideurs. Notre modèle permet d'éviter les opérations informatiques complexes et peut être personnalisé en fonction de différents besoins. Les simulations sont réalisées jusqu'à l'horizon 2050 lequel est souvent considéré comme un pivot dans les habitudes de consommation d'énergies notamment. Dans cette thèse, des feuilles de route technologique pour les différents objectifs gouvernementaux en matières d'émissions de CO2 sont étudiées pour trois pays : la Chine, la France et les États-Unis. Le modèle couvre les principaux secteurs responsables des émissions de CO2 et étudie l'influence de différentes technologies sur le mix énergétique. Diverses méthodes et approches sont utilisées dans notre modélisation. L'identité IPAT est utilisée pour la décomposition des émissions dans les secteurs de l'énergie. Le modèle STIRPAT permet quant à lui d'évaluer l'évolution des émissions de CO2 dans les scénarios Business-as-Usual. Le modèle SVR est utilisé dans le cadre des projections de production d'électricité. Enfin, l'indice de Theil est employé pour mesurer les inégalités d'émissions de CO2 par tête. A la différence des modèles plus classiques en économie de l'énergie, notre modèle propose des feuilles de route technologiques selon différents critères, comme par exemple avec le développement « équilibré » de la technologie entre les secteurs, ou le critère de disponibilité des ressources énergétiques. Par ailleurs, l'équité carbone, avec la convergence des technologies dans les secteurs à long terme, peut être mise en œuvre dans notre modèle et joue, dans ce cas, comme une contrainte supplémentaire dans l'optimisation multi-objectifs.Nos résultats montrent que les objectifs gouvernementaux en France et aux États-Unis sont « très stricts » car, pour les atteindre, tous les secteurs doivent réaliser des efforts importants de réduction de CO2. En revanche, l'objectif gouvernemental de la Chine s'avère « plus facile » à réaliser car les progrès dans les technologies qui sont nécessaires sont moins exigeants.Plus précisément, si on prévoit que le mix énergétique reste inchangé en Chine et aux États-Unis, le CSC deviendra indispensable dans le secteur de l'énergie. Pour la France, 80% des voitures devront être remplacées par des véhicules électriques afin d'atteindre son objectif en matière de CO2.Toutefois, en considérant l'équité carbone entre secteurs, la combustion du charbon est censée être réduite de deux tiers en Chine et devra être pratiquement éliminée aux États-Unis. Par contre, le gaz peut être encouragé dans son utilisation dans le secteur de l'énergie en particulier aux États-Unis. Concernant le secteur du transport, plus de 60 % des véhicules doivent être remplacés par des véhicules électriques en Chine. Cette part serait d'environ 90 % en France et aux États-Unis.Enfin, la sensibilité des paramètres du modèle a été testée pour simulations, à chaque étape du travail, et pour toutes les roadmaps technologiques. Les résultats des tests de sensibilité montrent que la production d'électricité et l'intensité d'émissions sont les deux paramètres dont l'influence est la plus importante sur les émissions futures de CO2. Ainsi l'amélioration de l'efficacité de la combustion du charbon et de l'efficacité énergétique de l'électricité joueront un rôle central dans la réductions des émissions de CO2. / In the context of global warming, academic institutes, international institutions such as the IPCC, and governments of numerous countries have proposed global objectives of reducing CO2 emissions and announced national targets. The purpose of this thesis is to assess the governmental targets in comparing with the global objectives of various allocation methods, which correspond to different carbon equity principles.In order to evaluate the technology roadmaps which are necessary to achieve these reductions of CO2 emissions, a flexible modeling framework is proposed for policy makers. Our sectoral model avoids the complex computing operations. It can be customized according to different requirements and situations. We simulate the model up to the horizon 2050, which is often seen as a turning point in energy use patterns worldwide – forced by the probable decline in hydrocarbons extraction.In the thesis, the technology roadmaps for the governmental targets on CO2 emissions are studied for three typical countries: China, France, and the United States. The model covers the sectors responsible for the greatest part of CO2 emissions: power, transport, residence and industry sector, in studying the impacts of the principle energy technologies, such as energy mix, Carbon Capture and Storage (CCS), electric vehicles and energy efficiency.Various methods and approaches are used in our modeling. IPAT identity - which assumes the environment Impact is the results of Population, Affluence and Technology - is employed in the power sector emission decomposition. Besides STIRPAT - for Stochastic Impacts by Regression on Population, Affluence and Technology - model is used for the projection of CO2 emissions in the Business-as-Usual scenario. Then SVR - for Support Vector Regression - is used to forecast electricity production. Finally, the Theil index is employed as the measurement of per capita CO2 emission inequality. Different from classic cost-effective energy system models, our model provides the technology pathways for different criteria, such as balanced development of energy technology across sectors, availability of energy resources, etc. Besides, the carbon equity is employed as one of the constraints in the multi-objective optimization, under the consideration of the convergence of technologies in sectors in the long-term.Our results show that the governmental targets in France and the United States prove very strict, as they require all sectors to make large efforts in reducing CO2 emissions. In contrast, the governmental target in China seems more easily achievable, as the necessary advances of technologies are less demanding. More precisely: if the energy mix is expected to be kept unchanged in China and in the United States of America, the CCS prove indispensable in the power sector. In France, 80% of automobiles are required to be changed into electric vehicles, in order to get the target of CO2 emissions.However, under the sectoral carbon equity consideration, coal combustion is projected to be reduced by two thirds in China, and it will have to be almost eliminated in the United States to achieve their CO2 reduction target. But gas is encouraged to be used in the power sector, especially in the United States. Regarding the transport sector, more than 60% of vehicles should be replaced to electric vehicles in China, and this share will be about up to 90% in France and the United States.Finally the sensitivity of parameters in the model is tested for a robust simulation, at each step of the work, and for all technology roadmaps. The results of the sensitivity tests show that electricity production and the emission intensity of production are the two parameters with the most important influence on CO2 emissions. Thus improving the efficiency of coal combustion and the energy efficiency of electricity will play an important role in the CO2 emission reductions.

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: To examine the effect of a collaborative care program for late-life depression on risk of diabetes among depressed, older adults. Method: We conducted a 9-year follow-up study of 160 older, primary care patients with a depressive disorder but without diabetes enrolled at the Indiana sites of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial. Results: Surprisingly, the rate of incident diabetes in the collaborative care group (22/80 = 27.5%) was twice the rate observed in the usual care group (11/80 = 13.7%). Cox proportional hazards models adjusted for randomization status (HR = 1.94, p = .076), demographic factors (HR = 1.94, p = .075), and additionally for diabetes risk factors (HR = 1.73, p = .157) indicated that the risk of incident diabetes did not differ between the collaborative care and usual care groups, with collaborative care patients remaining at a nonsignificant increased risk. Conclusions: Our novel findings suggest that depression may not be a casual risk factor for diabetes and that depression treatment may be insufficient to reduce the excess diabetes risk of depressed, older adults.