27 resultados para Resolution of moral conflicts

em Repositório Institucional UNESP - Universidade Estadual Paulista "Julio de Mesquita Filho"


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Pós-graduação em Psicologia - FCLAS

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Post-traumatic complications occasionally lead to tooth loss as well as the need for future implants. However, rehabilitation with endosseous osseointegrated implants does not protect the patient from the risk of suffering a new trauma. Implant fracture and the damage of the hexagon are post-traumatic complications that guide the clinician to preparing a more intricate treatment plan. The authors present a clinical case of a recurrent trauma of maxillary implant fracture. The treatment plan was to remove the implants followed by autogenous bone grafting to correct the defect. Two titanium implants were replaced, followed by connective tissue graft after allowing complete the healing process of the bone graft to occur. In the postoperative period of 6 months, satisfactory results have been shown as regards soft and hard tissues wound healing.

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We investigate and solve in the context of general relativity the apparent paradox which appears when bodies floating in a background fluid are set in relativistic motion. Suppose some macroscopic body, say, a submarine designed to lie just in equilibrium when it rests (totally) immersed in a certain background fluid. The puzzle arises when different observers are asked to describe what is expected to happen when the submarine is given some high velocity parallel to the direction of the fluid surface. on the one hand, according to observers at rest with the fluid, the submarine would contract and, thus, sink as a consequence of the density increase. on the other hand, mariners at rest with the submarine using an analogous reasoning for the fluid elements would reach the opposite conclusion. The general relativistic extension of the Archimedes law for moving bodies shows that the submarine sinks. As an extra bonus, this problem suggests a new gedankenexperiment for the generalized second law of thermodynamics.

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Minimization of a differentiable function subject to box constraints is proposed as a strategy to solve the generalized nonlinear complementarity problem (GNCP) defined on a polyhedral cone. It is not necessary to calculate projections that complicate and sometimes even disable the implementation of algorithms for solving these kinds of problems. Theoretical results that relate stationary points of the function that is minimized to the solutions of the GNCP are presented. Perturbations of the GNCP are also considered, and results are obtained related to the resolution of GNCPs with very general assumptions on the data. These theoretical results show that local methods for box-constrained optimization applied to the associated problem are efficient tools for solving the GNCP. Numerical experiments are presented that encourage the use of this approach.

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The effects of time averaging on the fossil record of soft-substrate marine faunas have been investigated in great detail, but the temporal resolution of epibiont assemblages has been inferred only from limited-duration deployment experiments. Individually dated shells provide insight into the temporal resolution of epibiont assemblages and the taphonomic history of their hosts over decades to centuries. Epibiont abundance and richness were evaluated for 86 dated valves of the rhynchonelliform brachiopod Bouchardia rosea collected from the inner shelf. Maximum abundance occurred on shells less than 400 yr old, and maximum diversity was attained within a century. Taphonomic evidence does not support models of live-host colonization, net accumulation, or erasure of epibionts over time. Encrustation appears to have occurred during a brief interval between host death and burial, with no evidence of significant recolonization of exhumed shells. Epibiont assemblages of individually dated shells preserve ecological snapshots, despite host-shell time averaging, and may record long-term ecological changes or anthropogenic environmental changes. Unless the ages of individual shells are directly estimated, however, pooling shells of different ages artificially reduces the temporal resolution of their encrusting assemblages to that of their hosts, an artifact of analytical time averaging. © 2006 by The University of Chicago. All rights reserved.

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Evidence is provided for the inner-sphere mechanism with actual metal coordination of the racemic amine in the crucial hydrogen transfer step promoted by Shvo's catalyst of the chemoenzymatic dynamic kinetic resolution (DKR) of amines. Key intermediates involved in this H-transfer step were intercepted and continuously monitored by electrospray ionization mass spectrometry (ESI-MS) and characterized by their dissociation chemistries via ESI-MS/MS. © 2013 The Royal Society of Chemistry.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Aim: To report a possible case of tremor fluoxetine-induced treated as Parkinson’s disease in an elderly female patient noncompliant with the pharmacotherapy, with uncontrolled hypertension and using fluoxetine to treat depression. Presentation of Case: Patient complained of sleepiness in the morning, agitation, anxiety, insomnia and mental confusion. Her greatest concern was about bilateral hand tremors which, in her view became, worse after biperiden was prescribed. Therefore, she stopped taking it. The initial medication was: omeprazole, losartan, biperiden, fluoxetine, atenolol + chlorthalidone, acetylsalicylic acid, atorvastatin and diazepam. Pharmacotherapeutic follow up was performed in order to check the necessity, safety and effectiveness of treatment. Discussion: During the analysis of pharmacotherapy, the patient showed uncontrolled blood pressure and had difficulty complying with the treatment. Thus, in view of the complaints expressed by the patient, our first hypothesis was a possible serotonin syndrome related to fluoxetine use. We proposed a change in the fluoxetine regime and discontinuation of biperiden. As tremors persisted, we suggested the replacement of fluoxetine by sertraline, since a possible tremor fluoxetine-induced could explain the complaint. This approach solved the drug-related problem identified. Conclusion: Tremors reported by the patient was identified as an iatrogenic event related to fluoxetine, which was solved by management of serotonin-reuptake inhibitors.

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There are few published papers about group psychotherapy for patients with obsessive-compulsive disorder (OCD), and usually restricted psychoeducational, support or cognitive-behavioral approaches. This article describes the experience of group psychotherapy for OCD patients started in 1996 in Botucatu Medical School - Unesp, São Paulo, Brazil. The two-hour sessions occur once a month, with 6 to 10 female patients, and are based on psychodramatic techniques. Psychotropic prescriptions are given after the sessions. In the beginning, aggressive obsessions were more prominent and were reported with much anguish and shame. Gradually, the themes changed from OCD specific issues (symptoms, pharmacological treatment, outcome, need of exposure and response prevention) to deeper and more personal psychodynamic aspects. The psychodramatic approach (techniques of double, mirror, role inversion, search for prymary scenes) has mostly shown: difficulty in accepting their own human mistakes or negative emotions due to excessive personal demands. This seems to generate guilt, low self-esteem, idealization of others, difficulty in enjoying pleasant situations, fear of taking responsibilities and of losing control (madness/aggressiveness). The group has been considered very important by the patients, since sharing experiences helps to diminish feelings of isolation, shame and guilt, stimulates the exposure to feared situations and enhances self-esteem. The fact that all participants have the same disorder favors group cohesion and provides relief, as they see in the others some of their afflictions and are able to share similar feelings and experiences. Many times the burden of the symptoms are dealt with humor. The confidence in such therapeutic setting is helping the identification and resolution of personal conflicts and contributing to the adherence to pharmacological treatment. The group also provides valuable training experiences for resident physicians in psychiatry.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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In managing an Inpatient unit, nurses face the need to make decisions involving agents in the institution’s internal and external environments, and all these measures are influential, regardless of how beneficial they may be. Hence, ethical issues constitute an important dimension of nursing management. This study aimed at identifying measures and/or interventions adopted by managing nurses at Inpatient Units in the Botucatu School of Medicine University Hospital - UNESP with the purpose to analyze professional ethics. The study involved nurses holding technicalsupervision positions in sectors related to the Nursing Division, comprising a total number of 20. The exploratory method was used by means of taped interviews with a qualitative approach based on the Collective Subject Discourse. Human resources deficit was observed as nurses’ major concern in relation to nursing care provision. The managers seek the nursing staff’s development by means of educational activities in their own unit at the same time that they adopt those offered by the hospital. When ethical violations occur, they resort to measures ranging from individual strategies for violators’ orientation to legal intervention. The resolution of ethical conflicts by nursing managers generally occurs in a gradual fashion by taking into account their compromising level, whether in relation to the patient or to the multiprofessional team. Educational activities are focused on the development of technical skills aiming at preventing physical damage to patients although educational activities targeted at the development of professionals’ ethical awareness were not mentioned