<p>Uvod: Akutni apendicitis predstavlja jedno od najče&scaron;ćih abdominalnih hirur&scaron;kih oboljenja u dečjem uzrastu. Lečenje je operativno, primenom otvorene hirurgije ili primenom minimalno invazivne hirurgije tj. laparoskopske apendektomije. Iako je laparoskopska apendektomija, zbog svojih prednosti, stekla popularnost kod mnogih hirurga, jo&scaron; uvek nije &scaron;iroko primenjena metoda na na&scaron;im prostorima. Prednost izvođenja laparoskopske apendektomije u odnosu na otvorenu metodu u dečjem uzrastu je i dalje nedovoljno definisana i predmet je mnogih istraživanja. Cilj istraživanja je da se utvrdi da li je dužina hospitalizacije kod dece operisane laparoskopski zbog akutnog apendicitisa kraća u odnosu na otvorenu metodu, kao i da se utvrdi da li postoji razlika u pojavi postoperativnih komplikacija između ove dve hirur&scaron;ke metode. Pored toga, cilj istraživanja je i da se utvrdi uticaj obe metode lečenja na kvalitet života i brzinu uspostavljanja svakodnevnih aktivnosti. Metodologija: Na Klinici za dečju hirurgiju, Instituta za zdravstvenu za&scaron;titu dece i omladine Vojvodine, sprovedena je prospektivna, kontrolisana randomizirana studija, u trajanju od deset meseci, u koju su bili uključeni svi pacijenti sa akutnim apendicitisom, kod kojih je planirana apendektomija, a čiji roditelji su dali pismeni pristanak za uče&scaron;će u istraživanju. Svi ispitanici su podeljeni u dve osnovne grupe u odnosu na operativnu tehniku: otvorena i laparoskopska apendektomija. Potom su svi ispitanici podeljeni u tri podgrupe, u zavisnosti od stepena upaljenosti crvuljka (negativni, nekomplikovani i komplikovani apendicitis). Svaki ispitanik je imao svoj individualni protokol istraživanja gde su preoperativno zabeleženi: uzrast, pol, simptomi (vrsta i dužina), fizikalni pregled, laboratorijske analize (broj leukocita, hematokrit), ultrazvučni nalaz, procena op&scaron;teg stanja, udružena oboljenja, vreme od prijema do operacije, preoperativna antibiotska terapija. Intraoperativno je analizirano: vrsta hirurgije, nalaz na apendiksu, prisustvo peritonitisa, udružena patologija, dužina operacije i trajanje pneumoperitoneuma (kod laparoskopske apendektomije), patohistolo&scaron;ki nalaz apendiksa, bakteriolo&scaron;ki bris abdomena. Postoperativno su analizirani: antibiotska terapija (vrsta i dužina), započinjanje peroralnog unosa, utvrđivanje postoperativnog bola, febrilnost, uspostavljanje peristaltike creva, izgled rane, postoperativne komplikacije (infekcija rane, intraabdominalni apscesi, ileus) i dužina hospitalizacije. Posebno su analizirani kvalitet života pacijenata nakon operacije pomoću modifikovanog upitnika SF 10 za dečji uzrast, kao i uspostavljanje svakodnevnih aktivnosti pomoću Activity Assessment Scale (AAS), modifikovane za dečji uzrast, nakon svakog postoperativnog dana, prvih sedam dana, nakon mesec dana, tri i &scaron;est meseci od operacije. Svi pacijenti su operisani u uslovima op&scaron;te anestezije. Klasična, otvorena apendektomija je vr&scaron;ena kroz naizmenični rez u desnoj ilijačnoj jami. Po otvaranju peritoneuma, cekum je izvučen i načinjena je klasična apendektomija. Laparoskopska apendektomija je vr&scaron;ena kroz tri 5 mm porta. Pneumoperitoneum je kreiran otvorenom metodom po Hasson-u, kroz infraumbilikalnu inciziju, a preostala dva porta su postavljena desno i levo ilijačno. Mezenteriolum je zbrinut pomoću ultrazvučnih makaza. Postavljene su intrakorporalne ligature i apendiks je odstranjen kroz desni port. Rezultati: Tokom perioda od deset meseci operisano je ukupno 125 pacijenata uzrasta od 2 do 18 godina, zbog akutnog apendicitisa. Laparoskopskom tehnikom je operisano 60 pacijenata (48%), a otvorenom metodom 61 (48,8%). Kod 4 pacijenta je načinjena konverzija, tj. promena operativne tehnike iz laparoskopske u otvorenu metodu. Nije bilo statistički značajne razlike između terapijskih grupa u odnosu na stepen upaljenosti apendiksa, vrstu i dužinu trajanja simptoma, u dijagnostičkim procedurama, kao ni u vremenu proteklom od prijema u bolnicu do operacije. Srednje operativno vreme je iznosilo 65 minuta (25-185 min) za laparoskopsku grupu i 45,49 minuta (25-90 min) za otvorene apendektomije (razlika je statistički značajna, p&lt;0,001). Crevna peristaltika, kao i započinjanje peroralnog unosa, se statistički značajno ranije uspostavljaju u grupi laparoskopsko operisanih. U grupi laparoskopskih apendektomija, postoperativne komplikacije (infekcija rana i formiranje intraabdominalnih apscesa) su se javile kod 8,33% ispitanika (5/60), a u otvorenoj grupi kod 4.91%, (3/61), &scaron;to nije bilo statistički značajno (c2 = 0,152; df = 1; p = 0,696). Dužina hospitalizacije kod dece operisane laparoskopski je iznosila 5,95 } 1,21 dana, a otvoreno 6,43 } 1,09 dana, &scaron;to je statistički značajna razlika (t = -2,206; p = 0,029). Rezultati Man-Vitnijevog U testa su pokazali statistički značajno bolji ukupni skor svakodnevnih aktivnosti za grupu laparoskopskih apendektomija (Z = -7,608; p = 0,000). U svim ispitivanim indikatorima kvaliteta života, deca laparoskopske grupe su imala veći skor. Deca sa akutnim apendicitisom operisana laparoskopski značajno ranije postižu visok stepen kvaliteta života (t = 2,407; p = 0,018). Zaključak: Prednost minimalno invazivne hirurgije u terapiji akutnog apendicitisa u dečjem uzrastu ogleda se u bržem uspostavljanju ponovnog funkcionisanja gastrointestinalnog trakta, kraćoj hospitalizaciji, a samim tim i bržem sveukupnom oporavku, vraćanju svakodnevnim aktivnostima i dobrom kvalitetu života. Postoperativne komplikacije se podjednako javljaju, kako kod otvorene, tako i kod laparoskopske operativne tehnike.</p> / <p>Introduction: Acute appendicitis is one of the most common abdominal surgical diseases in children. Operative treatment means open surgery or minimally invasive surgery (laparoscopic appendectomy). Although laparoscopic appendectomy, gained popularity among many surgeons, it is still not widely accepted in our region. The advantage of laparoscopic appendectomy compared to the open method in children is still not sufficiently defined and is the subject of further research. The aim of the research was to determine whether the length of hospital stay after laparoscopic surgery in children with acute appendicitis is shorter compared to the open method, as well as to determine whether there is a difference in the occurrence of postoperative complications after these two operative techniques. In addition, the aim of the research was to determine the effect of both methods of treatment on quality of life and everyday functioning. Methodology: This prospective, randomized controlled study was performed at the Clinic for Pediatric Surgery, Institute of Children and Youth Healthcare of Vojvodina, during a period of ten months. All patients with acute appendicitis, whose parents have given written consent, were included in research. All patients were divided into two basic groups, in relation to the surgical technique: open or laparoscopic appendectomy. Then, all of them were divided into three groups, depending on the degree of appendicitis (negative, uncomplicated and complicated appendicitis). Each participant had their own individual research protocol where we recorded preoperatively: age, sex, symptoms (type and length), physical examination, laboratory tests (white blood cell count, hematocrit), ultrasound finding, general state (ASA classification), associated diseases, time from admission to surgery, preoperative antibiotic therapy. During the operation we analyzed: type of surgery, degree of the appendicitis, the presence of peritonitis, associated pathology, length of surgery and duration of pneumoperitoneum (in laparoscopic appendectomy), hystopathologic findings of the appendix, a bacteriology. Postoperatively we analyzed: antibiotic therapy (type and length), oral intake, postoperative pain, fever, establishing peristalsis, the appearance of postoperative complications (wound infections, intra-abdominal abscesses, ileus) and length of hospitalization. Especially, we analyzed the quality of life of patients after surgery using the modified questionnaire SF 10 for children; and the establishment of daily activities using Activity Assessment Scale (AAS), modified for children; after each postoperative day, the first seven days, one month, three and six months after surgery. All patients were operated under general anesthesia. Open appendectomy was performed through incision in the right iliac fossa. Peritoneum was opened, the cecum was pulled out and classic appendectomy was made. Laparoscopic appendectomy is performed through three 5 mm ports. Pneumoperitoneum was created by the Hasson techique, through the infraumbilical incision, and the remaining two ports are set at right and left iliac region. Mezenteriolum was ligated by ultrasonic scissors. After putting intracorporal ligature, appendix was removed through the right port. Results: Over a period of ten months we operated 125 patients , aged 2 to 18 years, due to acute appendicitis. Laparoscopic technique was performed in 60 patients (48%), and the open method in 61 (48,8%). In 4 patients the conversion was made (operative technique changed from laparoscopic to open method). There were no statistically significant differences between the treatment groups with respect to the degree of appendix inflammation, the type and duration of symptoms, the diagnostic procedures, as well as the time from hospital admission to the surgery. Medium operative time was 65 minutes (25-185 min.) for laparoscopic group and 45,49 minutes (25-90 min.) for open appendectomy (the difference is statistically significant, p&lt;0,001). Intestinal peristalsis, as well as the initiation of oral intake was significantly sooner established in the laparoscopic group. Postoperative complications (wound infections and intra-abdominal abscess formation In laparoscopic appendectomy) occurred after laparoscopy in 8,33% of patients (5/60), and in the open group in 4,91% (3/61), which was not statistically significant (c2 = 0,152, df = 1; p = 0,696). Length of hospital stay in children operated by laparoscopy was 5,95 } 1,21 days and by open technique 6,43 } 1,09 days, which is significantly longer (t = -2,206; p = 0,029). Results of the Mann-Whitney U test showed significantly better overall record of daily activities for a group of laparoscopic appendectomy (Z = -7,608; p = 0,000). In all tested indicators of quality of life, children from laparoscopic group had a higher score. Children with acute appendicitis treated by laparoscopic surgery achieved a high level of quality of life, significantly earlier (t = 2,407; p = 0,018). Conclusion: The advantage of minimally invasive surgery in the treatment of acute appendicitis in children is reflected in the faster re-establishment of functioning of the gastrointestinal tract, shorter hospitalization and therefore, a faster overall recovery, resuming normal activities and a good quality of life. Postoperative complications occur equally in both, open as well as in laparoscopic operative techniques.</p>

<p>Акутни панкреатитис је ензиматско инфламаторно оболење панкреаса, са инциденцијом око 17/100000 становника. Најчешћи етиолошки чиниоци који се везују за ово стање су билијарна калкулоза (45%) и конзумација алкохолних пића (35%). Ређи узроци су одређени лекови, хипертриглицеридемија, хиперкалијемија, траума, урођени чиниоци, и идиопатски панкреатитис (20%). По међународној Атланској (Atlanta) класификацији, акутни панкреатитис се може манифестовати у умереној, умерено тешкој и тешкој форми. Умерене форме панкреатитиса се јављају у 80%, карактеришу се едемом органа и имају благ и краткотрајан клинички ток, са стопом морталитета од 1%. Основни циљ лечења болесника са акутним панкреатитисом у прва 24 сата хоспитализације јесте олакшавање тегоба, утврђивање узрока панкреатитиса и процена тежине обољења. Акутни панкреатитис билијарне етиологије узрокован је калкулозом жучне кесе и/ или жучних путева. Препоручени третман билијарне калкулозе, у циљу превенције поновног атака умерене форме билијарног панкреатитиса , подразумева уклањање жучне кесе лапароскопском холецистектомијом са интраоперативном холангиографијом. Уколико се дијагностикује калкулоза жучних канала ради се ендоскопска ретроградна холангиопанкреатографија (ЕРЦП) са ендоскопском папилотомијом (ЕПТ) и уклањем__ калкулуса и детритуса уз жучних водова, са циљем обезбеђивања нормалног протока жучи у дванаестопалачно црево. Циљ овог истраживања је оптимализација редоследа примене ЛХ и ЕРЦП са ЕПТ, идентификацијом предикционих показатеља холедохолитијазе, ради скраћења дужине хоспитализације болесника са умереном формом акутног билијарног панкреатитиса. У спроведеној проспективној анамнестичкој студији, учествовало је 100 болесника лечених од умерене форме акутног билијарног панкреатитиса, у Ургентном центру Клиничког центра Војводине, од 2011. до 2015.године, од којих је код 80 урађена само ЛХ, а код 20 ЛХ и ЕРЦП са ЕПТ. Анализом клиничких, ултразвучних и лабораторијских налаза, идентификовано је 5 статистички значајних предиктора холедохолитијазе; директни и укупни билирубин, алкална фосфатаза (АФ), гама глутирил транспепдидаза (гама ГТ) и це реактивни протеин (ЦРП), на основу којих је омогућено креирање математичког модела за предикцију холедохолитијазе, коришћењем теорије потпорних вектора (СВМ). Установљено је да патолошки налази ових параметара значајно указују на холедохолитијазу, те да је ЛХ препоручена као метода првог избора, код болесника код којих налази предиктора холедохолитијазе нису патолошки. Овако лечени болесници су имали значајно краће време хоспитализације. Поред тога, уколико се интраоперативном холангиографијом (ИОХ) при ЛХ установи холедохолитијаза, ЕРЦП са ЕПТ се може урадити без одлагања.</p> / <p>Akutni pankreatitis je enzimatsko inflamatorno obolenje pankreasa, sa incidencijom oko 17/100000 stanovnika. Najčešći etiološki činioci koji se vezuju za ovo stanje su bilijarna kalkuloza (45%) i konzumacija alkoholnih pića (35%). Ređi uzroci su određeni lekovi, hipertrigliceridemija, hiperkalijemija, trauma, urođeni činioci, i idiopatski pankreatitis (20%). Po međunarodnoj Atlanskoj (Atlanta) klasifikaciji, akutni pankreatitis se može manifestovati u umerenoj, umereno teškoj i teškoj formi. Umerene forme pankreatitisa se javljaju u 80%, karakterišu se edemom organa i imaju blag i kratkotrajan klinički tok, sa stopom mortaliteta od 1%. Osnovni cilj lečenja bolesnika sa akutnim pankreatitisom u prva 24 sata hospitalizacije jeste olakšavanje tegoba, utvrđivanje uzroka pankreatitisa i procena težine oboljenja. Akutni pankreatitis bilijarne etiologije uzrokovan je kalkulozom žučne kese i/ ili žučnih puteva. Preporučeni tretman bilijarne kalkuloze, u cilju prevencije ponovnog ataka umerene forme bilijarnog pankreatitisa , podrazumeva uklanjanje žučne kese laparoskopskom holecistektomijom sa intraoperativnom holangiografijom. Ukoliko se dijagnostikuje kalkuloza žučnih kanala radi se endoskopska retrogradna holangiopankreatografija (ERCP) sa endoskopskom papilotomijom (EPT) i uklanjem__ kalkulusa i detritusa uz žučnih vodova, sa ciljem obezbeđivanja normalnog protoka žuči u dvanaestopalačno crevo. Cilj ovog istraživanja je optimalizacija redosleda primene LH i ERCP sa EPT, identifikacijom predikcionih pokazatelja holedoholitijaze, radi skraćenja dužine hospitalizacije bolesnika sa umerenom formom akutnog bilijarnog pankreatitisa. U sprovedenoj prospektivnoj anamnestičkoj studiji, učestvovalo je 100 bolesnika lečenih od umerene forme akutnog bilijarnog pankreatitisa, u Urgentnom centru Kliničkog centra Vojvodine, od 2011. do 2015.godine, od kojih je kod 80 urađena samo LH, a kod 20 LH i ERCP sa EPT. Analizom kliničkih, ultrazvučnih i laboratorijskih nalaza, identifikovano je 5 statistički značajnih prediktora holedoholitijaze; direktni i ukupni bilirubin, alkalna fosfataza (AF), gama glutiril transpepdidaza (gama GT) i ce reaktivni protein (CRP), na osnovu kojih je omogućeno kreiranje matematičkog modela za predikciju holedoholitijaze, korišćenjem teorije potpornih vektora (SVM). Ustanovljeno je da patološki nalazi ovih parametara značajno ukazuju na holedoholitijazu, te da je LH preporučena kao metoda prvog izbora, kod bolesnika kod kojih nalazi prediktora holedoholitijaze nisu patološki. Ovako lečeni bolesnici su imali značajno kraće vreme hospitalizacije. Pored toga, ukoliko se intraoperativnom holangiografijom (IOH) pri LH ustanovi holedoholitijaza, ERCP sa EPT se može uraditi bez odlaganja.</p> / <p>Acute pancreatitis is an enzymatic inflammatory disease of the pancreas, with an incidence of around 17/100000 inhabitants. The most common etiological factors that are associated with this condition are biliary calculi (45%) and consumption of alcoholic beverages (35%). Less common causes include certain medications, hypertriglyceridemia, hyperkalemia, trauma, congenital factors and idiopathic pancreatitis (20%). According to the Atlanta International classification, acute pancreatitis can be manifested in a moderate, moderately severe and severe forms. Moderate forms of pancreatitis occur in 80%, characterized by pancreatic edema and have mild and short clinical course, with a mortality rate of 1%. The main goal of treatment of patients with acute pancreatitis in the first 24 hours of hospitalization is to facilitate complaints, determining the cause of pancreatitis and assessment of severity of the disease. Acute biliary pancreatitis is caused by calculosis of the gallbladder and / or bile ducts. The recommended treatment of biliary calculi, in order to prevent repeated attacks of moderate biliary pancreatitis, involves the removal of the gallbladder thru laparoscopic cholecystectomy with intraoperative cholangiography. If presence of bile duct calculi is established, an endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic papillotomy (EPT) and removes stones and detritus along the bile ducts is indicated, with the aim of ensuring the normal flow of bile into the duodenum. The aim of this study is the optimization of the order of application LH and ERCP with EPT, the identification of predictable indicators of choledocholithiasis, in order to shorten the length of hospitalization of patients with a moderate form of acute biliary pancreatitis. We conducted prospective case control study, with 100 patients involved, treated for moderate forms of acute biliary pancreatitis in the Emergency Center of the Clinical Center of Vojvodina, from 2011 to 2015, of which 80 made only with LH and 20 with LH at and ERCP with EPT . The analysis of clinical, ultrasound and laboratory findings identified 5 significant predictors of choledocholithiasis; direct and total bilirubin, alkaline phosphatase (AF), gamma glutiril transpepdidase (gamma GT) and C reactive protein (CRP), under which enabled the creation of a mathematical model for predicting choledocholithiasis, using the Support vector machines (SVM). It was found that pathological findings of these parameters indicate a significant choledocholithiasis, and LH is recommended as the first choice in patients in whom there are not present pathological predictors of choledocholithiasis. Thus treated patients had a significantly shorter hospital stay. In addition, if the intraoperative cholangiography (IOH) during LH show choledocholithiasis, ERCP with the EPT can be done without delay.</p>

Bien que les chercheurs fassent état de l ’importance croissante de l ’individualisme en droit québécois de la famille, il n ’est pas clair que ces conclusions soient fondées sur une définition constante du phénomène. Il est primordial de comprendre la dynamique mouvante de cette tendance, ses caractéristiques ainsi que son lien avec le droit. Au moyen d ’une approche socio-juridique, le présent mémoire décrit ce phénomène et définit trois indicateurs pour explorer si et comment le droit social et privé québécois de la famille s ’individualise autour de la mère au foyer. Au final, le mémoire démontre que le droit de la famille vise, reconnaît et supporte concrètement très peu la mère au foyer. L ’observation de ce cas a plutôt mis en lumière une tendance à la diminution de mesures ou services qui la supportent, tendance qui est notamment liée à la fiscalisation, la contractualisation et l ’octroi d ’une large discrétion judiciaire. / Although researchers have given much attention to the growing importance of individualism in Quebec family law, it is unclear whether these conclusions refer to the same definition of the phenomenon. It is essential to understand the dynamic quality of this tendency, its characteristics as well as its relationship with the law. Using a socio- juridical approach, this thesis explores the phenomenon through three indicators. Specifically, we have undertaken to examine the individualization of Quebec ’s social family law and private family law in the case of the stay-at-home mother. Our analysis reveals that Quebec family law aims, acknowledges and concretly supports the autonomy of the stay-at-home mother very little. Our observations have rather highlighted a decrease in mesures and services that support her, a tendency that is related to the fiscalization, the contractualization and the important judiciary discretion characteristic of contemporary family law.

Introduction: La réinstitution de l’alimentation entérale en deçà de 24h après une chirurgie digestive semble a priori conférer une diminution du risque d’infections de plaie, de pneumonies et de la durée de séjour. Le but de cette étude est de vérifier l’effet de la reprise précoce de l’alimentation entérale sur la durée de séjour hospitalier suite à une chirurgie colique. Méthodes: Il s’agit d’une étude prospective randomisée dans laquelle 95 patients ont été divisés aléatoirement en deux groupes. Dans le groupe contrôle, la diète est réintroduite lorsque le patient passe des gaz ou des selles per rectum, et qu’en plus il n’est ni nauséeux ni ballonné. Les patients du groupe expérimental reçoivent pour leur part une diète liquide dans les 12 heures suivant la chirurgie, puis une diète normale aux repas subséquents. L’objectif primaire de cette étude est de déterminer si la réinstitution précoce de l'alimentation entérale post chirurgie colique diminue la durée de séjour hospitalier lorsque comparée au régime traditionnel de réintroduction de l’alimentation. Les objectifs secondaires sont de quantifier l’effet de la réintroduction précoce de la diète sur les morbidités periopératoires et sur la reprise du transit digestif. Résultats: La durée de séjour hospitalier a semblé être légèrement diminuée dans le groupe expérimental (8,78±3,85 versus 9,41±5,22), mais cette difference n’était pas statistiquement significative. Des nausées ou des vomissements furent rapportés chez 24 (51%) patients du bras experimental et chez 30 (62.5%) patients du groupe contrôle. Un tube nasogastrique a du être installé chez un seul patient du groupe experimental. La morbidité périopératoire fut faible dans les deux groupes. Conclusion: Il semble sécuritaire de nourrir précocément les patients suite à une chirurgie colique. Cependant cette étude n’a pu démontrer un impact significatif de la reintroduction précoce de l alimentation per os sur la durée de séjour hospitalier. / Introduction: of early feeding within 24 hours of intestinal surgery seems advantageous in terms of reduction of wound infection, pneumonia and length of hospital stay. The aim of the study is to evaluate the impact of early enteral nutrition in length of hospital stay in comparison to traditional postoperative feeding regimen. Method: This prospective study enrolled 95 patients randomized in two groups: control group patients receive enteral feeding in absence of nausea or vomiting, abdominal distension and after passage of flatus or stools, while patients in experimental group were fed a liquid diet within 12 hours of surgery, followed by a regular diet at the next meal. The primary endpoint was the impact of early oral feeding on hospital length of stay. The secondary endpoint was to measure the impact of the diet reintroduction modality on the incidence of early postoperative morbidity and return of bowel function. Result: Length of hospital stay was slightly diminished in the experimental group compared to control (8,78±3,85 versus 9,41±5,22), but the difference was not statistically significant. Postoperative nausea and vomiting were reported in 24 (51,0%) patients in experimental group and 30 (62,5%) in control group. Only one patient required nasogastric tube insertion. The majority of patients did not demonstrate any postoperative morbidity in both groups. Conclusion: Early enteral nutrition is safe after intestinal surgery. However we did not demonstrate that early enteral feeding diminished length of hospital stay or hastened the return of bowel function.

Ce mémoire a pour objectif de comprendre l'impact de la justice distributive et de la justice procédurale sur l'intention de rester via l'effet médiateur de l'engagement organisationnel. Pour étudier cette question, nous avons émis trois hypothèses basées sur les études empiriques et certaines théories. La première hypothèse stipule que la justice distributive est positivement et indirectement liée à l'intention de rester via l'engagement organisationnel. La deuxième hypothèse suggère que la justice procédurale est positivement et indirectement associée à l'intention de rester en passant par l'engagement organisationnel. La dernière hypothèse indique que la justice procédurale a un impact plus important sur l'intention de rester que la justice distributive via l'engagement organisationnel. Les données utilisées pour cette étude longitudinale ont été colligées dans le cadre d'une enquête portant sur « les liens entre la rémunération, la formation et le développement des compétences avec l’attraction et la rétention des employés clés ». Ces données proviennent d'une entreprise internationale du secteur des technologies de l'information et des communications (TIC) à Montréal. Les participants de l'étude sont les travailleurs nouvellement embauchés durant la période du 1er avril 2009 au 30 septembre 2010. À la suite de l'analyse des données, les résultats confirment toutes les hypothèses. Ces résultats indiquent que la justice distributive et la justice procédurale sont indirectement et positivement associées à l'intention de rester par l'effet médiateur de l'engagement organisationnel. De plus, les résultats des analyses multivariées longitudinales montrent que la justice procédurale affecte davantage l'intention de rester que la justice distributive via l'engagement organisationnel. Le travail sous supervision et le soutien organisationnel perçu ont également un impact considérable sur l'intention de rester des travailleurs. Finalement, la conclusion du mémoire indique en quoi cette recherche permet de guider les gestionnaires dans l'insertion de pratiques de fidélisation du personnel. / The purpose of this thesis is to understand the impact of distributive justice and procedural justice on workers' intent to stay via the organizational committment. In order to procede, we emited three hypothesis based on empirical researches and some theories. The first hypothesis suggests that distributive justice is positively and indirectly linked to workers' intent to stay when mediated by the organizational committment. The second hypothesis states that procedural justice stays positively and indirectly associated to workers's intent to stay via organizational committment. The last hypothesis stipulates that procedural justice has more impact on workers' intent to stay than distributive justice when mediated by the organizational committment. The data used for this study were collected for a larger research on “ the links between compensation, training and skills development with attracting and retaining key employees “. These data come from an international organization, operating in information technologies and communications, located in Montreal. Participants of the study were workers newly hired during the period of April 1st 2009 to September 30th 2010. Consequently to the the data analysis, the results confirm all hypothesis. These results indicate that distributive justice and procedural justice are indirectly and positively linked to workers' intent to stay by the mediating effet of organizational commitment. Moreover, the results of longitudinal multivariate analysis show that procedural justice has a greater effet on workers' intent to stay via organizational commitment. Working under supervision and perceived organizational support also affect considerably workers' intent to stay. Finally, the conclusion of the thesis helps human resources and industrial managers in the implementation of fidelity employment practices.

The objective of this thesis is to understand the impact of satisfaction with innovative benefits on the intention to stay of the information and communications technology industry (ICT) workers. In order to investigate this question, a general research hypothesis was presented based on a literature review and on Blau’s social exchange theory (1964) and Maslow’s theory of needs (1943). The general research hypothesis states that satisfaction with innovative benefits increases intention to stay through time. The data used in this thesis were collected as part of a larger research on the relationships between compensation, training and skills development and attracting and retaining key employees. The longitudinal data come from an office located in Montreal of a major international company from the ICT sector. The study population consists of workers newly hired between April 1st, 2009 and September 30th, 2010. The results confirm the research hypothesis showing that satisfaction with innovative benefits increase intention to stay through time. Among the various innovative benefits studied, the results indicate that it is the satisfaction with the gym at work that best predicts intention to stay of workers. Other innovative benefits significantly related to intention to stay are the games library, the lounge, the medical clinic and the library in the workplace. Also, longitudinal analyses reveal that it is mainly the differences between the individual characteristics of the employees who best explain intention to stay than the differences across time of the same worker. This thesis concludes by discussing the best way for industrial relations managers to use the results in order to retain their employees. Then, the limits of the study and some directions for further research are also presented. / L’objectif de ce mémoire est de comprendre l’impact de la satisfaction envers les avantages sociaux novateurs sur l’intention de rester des travailleurs du secteur des technologies de l’information et des communications (TIC). Pour étudier cette question, une hypothèse générale de recherche a été émise basée sur la revue de littérature ainsi que sur les théories de l’échange social de Blau (1964) et de la théorie des besoins de Maslow (1943). L’hypothèse générale de recherche soutient que la satisfaction envers les avantages sociaux novateurs fait augmenter l’intention de rester des travailleurs dans le temps. Les données utilisées dans ce mémoire ont été recueillies dans le cadre d’une enquête portant sur les relations entre la rémunération, la formation et le développement des compétences avec l’attraction et la rétention des employés clés. De nature longitudinale, les données proviennent du bureau situé à Montréal d’une entreprise d’envergure internationale du secteur des TIC. L’échantillon est composé d’employés embauchés entre le 1er avril 2009 et le 30 septembre 2010. Les résultats confirment l’hypothèse générale de recherche voulant que la satisfaction envers les avantages sociaux novateurs fait augmenter l’intention de rester des employés dans le temps. Parmi les différents avantages sociaux novateurs étudiés, les résultats indiquent que c’est la satisfaction envers le gym au travail qui prédit le mieux l’intention de rester des travailleurs. Les autres avantages sociaux novateurs trouvés significatifs en lien avec l’intention de rester sont la ludothèque, le lounge/salle de repos, la clinique médicale et la bibliothèque sur les lieux du travail. De plus, les analyses longitudinales révèlent que ce sont surtout les différences entre les caractéristiques individuelles des employés qui expliquent le mieux l’intention de rester et non les différences à travers le temps chez un même travailleur. Ce mémoire se termine en discutant de la meilleure façon pour les gestionnaires en relations industrielles d’utiliser les résultats dans le but de retenir leurs employés performants. Puis, les limites de l’étude et certaines pistes de recherches futures sont également présentées.

R I G H T T O R E S P E C T F O R P R I V A T E A N D F A M I L Y L I F E I N T H E C A S E - L A W O F T H E E U R O P E A N C O U R T O F H U M A N R I G H T S Abstract The aim of the thesis is to explain wording and application of the Article 8 of the European Convention for the Protection of Human Rights and Fundamental Freedoms (the Convention) from the perspective of the European Court of Human Rights (the ECHR). The scope of Article 8, which guarantees the right to respect for private and family life, is very broad. For this reason the thesis especially deals with the issue of the right of the child to know his/her origin and information about his/her early childhood. In particular it attempts to outline the way how the ECHR deals with the conflict of the right to know one's origin with the right of the parent to stay anonymous. The thesis is divided into five chapters which illustrate the particular aspects of the application of Article 8. These chapters are linked through the judgements Gaskin, Mikulić, Odiévre, Jäggi and Phinirikadou which are related to the right of the child to know his/her origin. Chapter 1 provides with the general introduction to the protection of human rights at the European level and also analyses the Convention and the ECHR. The goal of chapter 2 is to outline the inner...

The aims of this work were 1) to assess whether sorghum (Sorghum bicolor (L.) Moench) genotypes originating from the India can be grown and analyzed in the climatic conditions of central Europe and 2) to find out the utilization potential of selected non- destructive and destructive methods based mostly on the chlorophyll a fluorescence measurements and the determination of photosynthetic pigments' content for the differentiation of sorghum genotypes based on their presumed drought tolerance. Field experiments made during 2 years compared 15 genotypes of this species (2 stay-green parental lines, 2 senescent parental lines and 11 introgression lines with stay-green loci), 2 of these genotypes were further analyzed in greenhouse conditions where the water deficit was induced by a cessation of watering for 12 days. The field-grown plants showed some differences between individual genotypes in all measured parameters; however, for the majority of the genotypes these differences were not statistically significant. The stay-green parental genotype B35 differred the most from the other ones in both field seasons, but the other stay-green genotypes usually did not differ from the senescent genotypes. No significant differences between both greenhouse-tested genotypes (presumably contrasting in their...

Sous l’effet d’une concurrence de plus en plus forte et d’un nouveau système de tarification, les cliniques privées de court séjour françaises sont confrontées à des contraintes économiques de plus en plus nombreuses auxquelles elles tentent de s’adapter. Cette recherche a pour objet d’identifier quels sont les déterminants organisationnels et stratégiques de la performance financière des cliniques privées. Une revue de littérature française et étrangère conduite sur la performance des établissements de santé a révélé la présence de nombreux déterminants de la performance financière. Pour identifier les facteurs influençant celle des cliniques privées, une étude statistique a été réalisée sur la totalité des cliniques privées françaises de court séjour dont les données sont exploitables, soit 463 établissements. Les résultats des statistiques montrent que la performance financière des cliniques privées, mesurée par un score financier et par les ratios financiers le composant, subit l’impact de variables que les directeurs d’établissements peuvent influencer à moyen et à long terme. Le volume et la productivité de la masse salariale employée par les établissements, le volume d’activité, la présence d’un projet stratégique bien défini et dont la mise en œuvre est effective, ainsi que la qualité des soins, celle-ci étant mesurée par les résultats des cliniques privées sur les différentes démarches d’amélioration de la qualité des soins, sont des facteurs qui présentent un fort impact sur la performance financière. / Private short-stay clinics are confronted with increasing economic constraints, to which they are trying to adapt, due to stronger competition and a new system of pricing. This research identifies which are the organizational determinents and financial performance strategies of private clinics. A review of French and foreign literature pertaining to the performance of these health establishments revealed the presence of numerous determinents of the financial performance. To identify the factors influencing the private clinics, a statistical study was performed on 463 French short-term clinics, where the relevent data was available. The results of these statistics indicated that the financial performance of these clinics, as measured by financial scores and ratios, underwent an influential impact in the short and long term. The productivity of the paid employees, the volume of activity, the presence of a well-defined and effective strategic project, so that the quality of the care given, as measured by the results of these clinics on different steps towards improvement on the quality of care, are the factors which presented a strong impact on the financial performance.

<p>Uvod: Povezanost dijabetesa melitusa i&nbsp; tuberkuloze je odavno primećena i bila je predmet ispitivanja mnogih studija. Dijagnoza &scaron;ećerne bolesti pre otkrića insulina značila je smrtni ishod u roku od pet godina, a najče&scaron;ći uzrok smrti su bile infekcije, uključujući tuberkulozu. Poslednjih godina incidenca tuberkuloze je u padu, ali je i dalje prisutan značajan broj obolelih od tuberkuloze u zemljama u razvoju. Sa druge strane incidenca dijabetes melitusa je u porastu, pre svega zbog tendencije porasta broja gojaznih osoba. Procenjeno je da će prevalencija obolelih od dijabetes melitusa dostići 438 miliona obolelih do 2030, a 80% svih slučajeva će biti stanovnici zemalja u razvoju gde je i dalje visoka prevalencija tuberkuloze. Kao rezultat ovakve epidemiolo&scaron;ke situacije ove dve bolesti će se sve če&scaron;će javljati uporedo, modifikujući tok jedna drugoj. Preduslov za uspe&scaron;no lečenje dijabetičara obolelih od tuberkuloze je postizanje zadovoljavajuće metaboličke regulisanosti &scaron;ećerne bolesti. smrtni ishod u roku od pet godina, a najče&scaron;ći uzrok smrti su bile infekcije, uključujući tuberkulozu. Poslednjih godina incidenca tuberkuloze je u padu, ali je i dalje prisutan značajan broj obolelih od tuberkuloze u zemljama u razvoju. Sa druge strane incidenca dijabetes melitusa je u porastu, pre svega zbog tendencije porasta broja gojaznih osoba. Procenjeno je da će prevalencija obolelih od dijabetes melitusa dostići 438 miliona obolelih do 2030, a 80% svih slučajeva će biti stanovnici zemalja u razvoju gde je i dalje visoka prevalencija tuberkuloze. Kao rezultat ovakve epidemiolo&scaron;ke situacije ove dve bolesti će se sve če&scaron;će javljati uporedo, modifikujući tok jedna drugoj. Preduslov za uspe&scaron;no lečenje dijabetičara obolelih od tuberkuloze je postizanje zadovoljavajuće metaboličke regulisanosti &scaron;ećerne bolesti. Cilj istraživanja: Cilj rada je bilo ispitivanje uticaja dijabetesa melitusa na tok plućne tuberkuloze, prvenstveno na bakteriolo&scaron;ki status, radiolo&scaron;ku prezentaciju bolesti, dužinu terapijskog režima i učestalost recidiva bolesti. Materijal i metode: Ispitivanjem su obuhvaćene dve grupe od po pedeset bolesnika koji su hospitalizovani u Institutu za plućne bolesti Vojvodine. Prvu grupu činili su bolesnici sa plućnom tuberkulozom i pridruženom &scaron;ećernom bole&scaron;ću, a drugu grupu bolesnici sa plućnom tuberkulozom bez pridružene &scaron;ećerne bolesti. Svi bolesnici su analizirani po sledećim karakteristikama: starost, pol, klinička slika, bakteriolo&scaron;ki status, radiolo&scaron;ka prezentacija, prisustvo neželjenih efekata antituberkulotika, prisustvo rezistencije M. tuberculosis na lekove, trajanje terapijskog režima, ishod lečenja, pojava recidiva i dužina hospitalizacije. Oboleli od &scaron;ećerne bolesti bili su dodatno analizirani prema: tipu bolesti, dužini trajanja bolesti, metaboličkoj regulisanosti bolesti i prisustvu komplikacija. Svi bolesnici obuhvaćeni ispitivanjem bili su podvrgnuti standardnom dijagnostičkom algoritmu koji obuhvata: anamnezu i fizikalni pregled, direktnu mikroskopiju sputuma, kultivaciju sputuma, radiogram grudnog ko&scaron;a, CT grudnog ko&scaron;a u slučaju postavljenih kliničkih indikacija. Invazivna dijagnostika će se sprovesti kod bolesnika kod kojih dijagnoza nije mogla biti postavljena prethodno sprovedenom neinvazivnom dijagnostikom. Terapijski režim će biti započet tokom hospitalizacije u Institutu za plućne bolesti Vojvodine, a nastavljen ambulantno pod kontrolom Dispanzera za plućne bolesti. Po zavr&scaron;etku terapijskog režima predviđena je kontrola u Institutu za plućne bolesti Vojvodine koja obuhvata procenu kliničke slike, bakteriolo&scaron;kog statusa, radiolo&scaron;kog nalaza i eventualnu potrebu za produženjem terapijskog režima. Rezultati: Istraživanje je pokazalo da je u grupi obolelih od tuberkuloze bez pridruženog dijabetes melitusa bio sličan broj bolesnika mu&scaron;kog i ženskog pola, a veći broj ispitanika se nalazio u starosnim kategorijama do 50 godina starosti, dok je u grupi obolelih od tuberkuloze sa dijabetes melitusom bio značajno vi&scaron;e zastupljen mu&scaron;ki pol i značajno vi&scaron;e ispitanika se nalazilo u starosnim kategorijama preko 50 godina starosti. Beleži se statistički značajno veći broj recidiva u grupi obolelih od tuberkuloze sa dijabetes melitusom (p=0,001). Između ispitvanih grupa se ne beleži statistički značajna razlika u kliničkoj prezentaciji bolesti. U grupi obolelih od tuberkuloze sa dijabetes melitusom, statistički značajno je veći broj direktno pozitivnih nalaza sputuma (p=0,046). Utvrđeno je postojanje statistički značajne razlike u prosečnoj dužini vremena potrebnoj za direktnu konverziju sputuma (p=0,000) i prosečnoj dužini vremena potrebnoj za konverziju kulture sputuma (p=0,000). U oba slučaja je grupa obolelih od tuberkuloze sa pridruženim dijabetes melitusom imala duže prosečno vreme potrebno za konverziju. U grupi obolelih od tuberkuloze sa pridruženim dijabetes melitusom bilo je statistički značajno vi&scaron;e bolesnika sa prisustvom kaverne (p=0,006) i lokalizacijom promena u sva tri režnja (p=0,000). Nije zapažena statistički značajna razlika u trajanju terapijskog režima, ispoljavanju neželjenih efekata lekova, pojavi rezistencije na lekove i ishodu lečenja između dve ispitivane grupe. Grupa obolelih od tuberkuloze sa pridruženim dijabetesom imala je statistički značajno veći broj bolničkih dana (p=0,000). Poređenjem grupa obolelih od tuberkuloze sa pridruženim zadovoljavajuće regulisanim dijabetesom i grupe obolelih od tuberkuloze sa lo&scaron;e regulisanim dijabetesom uočeno je statistički značajno duže trajanje terapijskog režima kod dijabetičara sa lo&scaron;e regulisanom bole&scaron;ću (p=0,018). Nije bilo statistički značajne razlike u zastupljenosti recidiva, kliničke prezentacije bolesti, bakteriolo&scaron;kog i radiolo&scaron;kog statusa, ispoljavanju neželjenih efekata lekova, pojavi rezistencije na lekove, ishoda lečenja i broja bolničkih dana između dve ispitivane grupe. Dodatnim poređenjem grupa (oboleli od tuberkuloze bez pridruženog dijabetesa, oboleli od tuberkuloze sa pridruženim zadovoljavajuće regulisanim dijabetesom i oboleli od tuberkuloze sa pridruženim lo&scaron;e regulisanim dijabetesom) primećeno je da je grupi bolesnika obolelih od tuberkuloze sa lo&scaron;e regulisanim dijabetesom potrebno najduže vreme za direktnu konverziju i konverziju kultura sputuma na MT i da imaju najveći broj bolničkih dana. U grupi obolelih od tuberkuloze sa pridruženim lo&scaron;e regulisanim dijabetesom je bilo statistički značajno veći broj bolesnika koji su lečeni osam meseci u odnosu na druge dve grupe (p=0,011). Poređenjem grupa obolelih od tuberkuloze sa tipom 1 dijabetesa tipom 2 dijabetesa nije uočena statističk značajna razlika između grupa po svim ispitivanim varijablama. U grupi dijabetičara sa dobro regulisanim dijabetesom nalazi se veći broj onih koji imaju tip 2 bolesti, u odnosu na grupu bolesnika sa lo&scaron;e regulisanim dijabetesom. Grupa dijabetičara sa lo&scaron;e regulisanom bolesti ima statistički značajno veći broj komplikacija &scaron;ećerne bolesti. Zaključak: Dokazano je da &scaron;ećerna bolest značajno utiče na bakteriolo&scaron;ki status, radiolo&scaron;ku prezentaciju, dužinu terapijskog režima, učestalost recidiva tuberkuloze i broj bolničkih dana obolelih od tuberkuloze,kao i da je regulisanost &scaron;ećerne bolesti imala značajan uticaj na dužinu terapijskog režima.</p> / <p>Introduction: The association of diabetes mellitus and tuberculosis has long been observed and has been the subject of many studies. The diagnosis of diabetes before the discovery of insulin meant death within five years, a leading cause of death were infections, including tuberculosis. Last years the incidence of tuberculosis has declined, but there is still a significant number of TB patients in developing countries. On the other hand, the incidence of diabetes is on the rise, primarily due to the tendency of an increasing number of obese people. It is estimated that the prevalence of patients with diabetes will reach 438 million sufferers by 2030, and 80% of all cases will be people in developing countries where it is still a high prevalence of tuberculosis. As a result of the epidemiological situation, these two diseases will increasingly occur in parallel, modifying the current one another. Aim: The aim of this study was to investigate the influence of diabetes mellitus on the course of pulmonary tuberculosis, primarily in the bacteriological status, radiological presentation of disease, duration of the treatment regimen and the frequency of disease relapse. Materials and Methods: The study included two groups of fifty patients who were hospitalized at the Institute for pulmonary diseases. The first group consisted of patients with pulmonary tuberculosis and concomitant diabetes mellitus, a second group consisted of patients with pulmonary tuberculosis without associated diabetes. All patients were analyzed by the following characteristics: age, gender, clinical picture, bacteriological status, radiological presentation, the presence of side effects of antituberculosis drugs, the presence of M. tuberculosis resistant to the drugs, the duration of the therapeutic regimen, treatment outcome, recurrence and length of hospitalization. Diabetics were further analyzed with respect to: the type of disease, duration of disease, a metabolic disease and the regulation for the presence of a complication. All patients completed this study were subjected to a diagnostic algorithm comprising: history and physical examination, direct microscopy of sputum, cultivation of sputum, radiographs of the chest, chest CT scan in case positioned on clinical indications. Invasive diagnostic will be performed in patients in whom the diagnosis could not be set previously conducted noninvasive diagnostics. The treatment regimen will be started during the hospitalization in the Institute of pulmonary diseases and is set under the control of ambulatory pulmonary dispensaries. Results: The study showed that in the group of TB patients without concomitant diabetes mellitus was a similar number of patients male and female, a greater number of respondents was in the age groups up to the age of 50, while in the group of TB patients with diabetes mellitus was significantly more frequent male half and significantly more respondents were in the age groups over 50 years of age. Significantly higher number of relapses is recorded in a group of TB patients with diabetes mellitus (p = 0,001). Between the two study groups was not significant difference in the clinical presentation of the disease. In the group of TB patients with diabetes mellitus, is statistically significant higher number of smear positive findings (p = 0,046). There is a statisticaly significant difference in the average length of time required for the smear conversion (p = 0,000) and average length of time needed for the conversion of sputum cultures (p = 0,000). In both cases, the group of TB patients with associated diabetes mellitus had a longer average time needed for the conversion. In the group of patients with tuberculosis associated with diabetes mellitus was statistically significantly more patients with the presence of the cavern (p = 0,006), and the localization of the pulmonary changes in all three lobes (p = 0,000). Between the two study groups was not observed a statistically significant difference in duration of the treatment regimen, the expression of adverse drug effects, develop resistance to the drugs, and the outcome of the treatment. Group of patients with tuberculosis associated with diabetes had a statistically significantly greater number of hospital days (p = 0,000). Between the groups of patients with tuberculosis associated with satisfactory controlled diabetes and the group of TB patients with poorly controlled diabetes was statistically significantly longer duration of the therapeutic regimen in diabetic patients with poor regulation of the disease (p = 0,018). There was no significant difference in the appearance of relapses, the clinical presentation of disease, the bacteriological status, radiology, the expression of adverse drug effects, develop resistance to the drugs, outcome of the treatment, number of hospital days between the two study groups. Comparing the three groups (tuberculosis without associated diabetes mellitus, TB patients with associated satisfactorily controlled diabetes and TB patients with associated poorly controlled diabetes), it was observed that the group of patients suffering from tuberculosis with poorly controlled diabetes takes the longest time to smear conversion and conversion of sputum culture and to have the highest number of hospital days. In the group of patients with tuberculosis associated with poorly controlled diabetes was significantly greater number of patients who were treated for eight months compared to the other two groups (p = 0,011). Comparing the group of TB patients with type 1 diabetes and type 2 diabetes is not a statistically significant difference between the groups in all variables. In the group of diabetic patients with satisfactorily controlled diabetes, there are a large number of those with type 2 disease, in comparison to the group of patients with poorly controlled diabetes. Group of diabetics with poorly regulated disease has a significantly greater number of diabetes comlications. Conclusion: It has been shown that diabetes mellitus has a significant effect on the bacteriological status, radiological presentation, the length of the treatment regimen, the frequency of recurrence of tuberculosis and the number of hospital days of patients with tuberculosis, and that the adjustment of diabetes had a significant effect on the length of the treatment regimen.</p>