Therapeutic Project at Extra-Hospital Mental Health Services: a critical reflection on the elaboration and management of services' therapeutic projects

Based on a study conducted in Ribeirao Preto, SP, Brazil in extra-hospital mental health services that addressed the organization of these services, therapeutic projects and the inclusion of psychosocial rehabilitation in health actions available, a theoretical-critical reflection concerning the development process of the therapeutic projects by the services' teams is presented. The qualitative study was conducted in an outpatient clinic and a Psychosocial Care Center. Data were collected through semi-structured interviews and focal groups. Data analysis was based on the hermeneutic dialectic philosophy of Jurgen Habermas according to the techniques of reconstruction and interpretation. Data analysis revealed that professionals have difficulty developing and managing therapeutic projects. Health actions are made available without being concretely supported by a proposal guiding the service's practical activities. The therapeutic projects are referred by professionals as the result of guidelines provided by management levels or technical orientations inherent to each profession but not as an activity that represents a philosophy of work of the health team. When the therapeutic project is focused on as a type of consensus that results from a communicative action directed to a mutual and intersubjective understanding among the members of the mental health extra-hospital team, the difficulties of the services' team dialogically organizing themselves to collectively construct the therapeutic project is evidenced.

The contribution of HGAL/GCET2 in immunohistological algorithms: a comparative study in 424 cases of nodal diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma can be subclassified into at least two molecular subgroups by gene expression profiling: germinal center B-cell like and activated B-cell like diffuse large B-cell lymphoma. Several immunohistological algorithms have been proposed as surrogates to gene expression profiling at the level of protein expression, but their reliability has been an issue of controversy. Furthermore, the proportion of misclassified cases of germinal center B-cell subgroup by immunohistochemistry, in all reported algorithms, is higher compared with germinal center B-cell cases defined by gene expression profiling. We analyzed 424 cases of nodal diffuse large B-cell lymphoma with the panel of markers included in the three previously described algorithms: Hans, Choi, and Tally. To test whether the sensitivity of detecting germinal center B-cell cases could be improved, the germinal center B-cell marker HGAL/GCET2 was also added to all three algorithms. Our results show that the inclusion of HGAL/GCET2 significantly increased the detection of germinal center B-cell cases in all three algorithms (P<0.001). The proportions of germinal center B-cell cases in the original algorithms were 27%, 34%, and 19% for Hans, Choi, and Tally, respectively. In the modified algorithms, with the inclusion of HGAL/GCET2, the frequencies of germinal center B-cell cases were increased to 38%, 48%, and 35%, respectively. Therefore, HGAL/GCET2 protein expression may function as a marker for germinal center B-cell type diffuse large B-cell lymphoma. Consideration should be given to the inclusion of HGAL/GCET2 analysis in algorithms to better predict the cell of origin. These findings bear further validation, from comparison to gene expression profiles and from clinical/therapeutic data. Modern Pathology (2012) 25, 1439-1445; doi: 10.1038/modpathol.2012.119; published online 29 June 2012

Work and Inter-subjectivity: a theoretical reflection on its dialectics in the field of health and nursing

This theoretical reflection intends to show the inter-subjective relationship that takes place in health and nursing practices under the following theoretical perspectives: Institutional Analysis, Psychodynamics of Labor and the Theory of Communicative Action, with an emphasis on the latter. Linking these concepts to the Marxist approach to work in the field of health emerges from recognizing the need for its continuous reconstruction-in this case, with a view to understand the interaction and communication intrinsic to work in action. The theory of Communicative Action seeks to consider these two inextricable dimensions: work as productive action and as interaction. The first corresponds to instrumental action based on technical rules with a production-guided rationale. The second refers to the interaction that takes place as communicative action and seeks understanding among subjects. We assume that adopting this theoretical perspective in the analysis of health and nursing practices opens new possibilities for clarifying its social and historical process and inter-subjective connections.

SEARCH FOR POINT-LIKE SOURCES OF ULTRA-HIGH ENERGY NEUTRINOS AT THE PIERRE AUGER OBSERVATORY AND IMPROVED LIMIT ON THE DIFFUSE FLUX OF TAU NEUTRINOS

The surface detector array of the Pierre Auger Observatory can detect neutrinos with energy E-nu between 10(17) eV and 10(20) eV from point-like sources across the sky south of +55 degrees and north of -65 degrees declinations. A search has been performed for highly inclined extensive air showers produced by the interaction of neutrinos of all flavors in the atmosphere (downward-going neutrinos), and by the decay of tau leptons originating from tau neutrino interactions in Earth's crust (Earth-skimming neutrinos). No candidate neutrinos have been found in data up to 2010 May 31. This corresponds to an equivalent exposure of similar to 3.5 years of a full surface detector array for the Earth-skimming channel and similar to 2 years for the downward-going channel. An improved upper limit on the diffuse flux of tau neutrinos has been derived. Upper limits on the neutrino flux from point-like sources have been derived as a function of the source declination. Assuming a differential neutrino flux k(PS) . E-nu(-2). from a point-like source, 90% confidence level upper limits for k(PS) at the level of approximate to 5x10(-7) and 2.5x10(-6) GeV cm(-2) s(-1) have been obtained over a broad range of declinations from the searches for Earth-skimming and downward-going neutrinos, respectively.

Structural properties and energetics of diffuse Rb-87 clusters in three-dimension

A correlated two-body basis function is used to describe the three-dimensional bosonic clusters interacting via two-body van der Waals potential. We calculate the ground state and the zero orbital angular momentum excited states for Rb-N clusters with up to N = 40. We solve the many-particle Schrodinger equation by potential harmonics expansion method, which keeps all possible two-body correlations in the calculation and determines the lowest effective many-body potential. We study energetics and structural properties for such diffuse clusters both at dimer and tuned scattering length. The motivation of the present study is to investigate the possibility of formation of N-body clusters interacting through the van der Waals interaction. We also compare the system with the well studied He, Ne, and Ar clusters. We also calculate correlation properties and observe the generalised Tjon line for large cluster. We test the validity of the shape-independent potential in the calculation of the ground state energy of such diffuse cluster. These are the first such calculations reported for Rb clusters. (C) 2012 American Institute of Physics. [http://dx.doi.org/10.1063/1.4730972]

Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis

Objective: To evaluate the clinical outcomes of multivisceral transplantation (MVT) in the setting of diffuse thrombosis of the portomesenteric venous system. Background: Liver transplantation (LT) in the face of cirrhosis and diffuse portomesenteric thrombosis (PMT) is controversial and contraindicated in many transplant centers. LT using alternative techniques such as portocaval hemitransposition fails to eliminate complications of portal hypertension. MVT replaces the liver and the thrombosed portomesenteric system. Methods: A database of intestinal transplant patients was maintained with prospective analysis of outcomes. The diagnosis of diffuse PMT was established with dual-phase abdominal computed tomography or magnetic resonance imaging with venous reconstruction. Results: Twenty-five patients with grade IV PMT received 25 MVT. Eleven patients underwent simultaneous cadaveric kidney transplantation. Biopsy-proven acute cellular rejection was noted in 5 recipients, which was treated successfully. With a median follow-up of 2.8 years, patient and graft survival were 80%, 72%, and 72% at 1, 3, and 5 years, respectively. To date, all survivors have good graft function without any signs of residual/recurrent features of portal hypertension. Conclusions: MVT can be considered as an option for the treatment of patients with diffuse PMT. MVT is the only procedure that completely reverses portal hypertension and addresses the primary disease while achieving superior survival results in comparison to the alternative options.

Size-induced diffuse behavior in Pb0.89La0.11Zr0.40Ti0.60O3 nanocrystalline ferroelectric ceramics

The Pb1-xLaxZryTi1-yO3 system is a perovskite ABO(3) structured material which presents ferroelectric properties and has been used as capacitors, actuators, transducers and electro-optic devices. In this paper, we describe the synthesis and the characterization of Pb0.89La0.11Zr0.40Ti0.60O3 (PLZT11) nanostructured material. The precursor polymeric method and the spark plasma sintering technique were respectively used to prepare ceramic samples. In order to compare the effect of grain size, microcrystalline PLZT11 ceramic samples were also prepared. PLZT11 samples were characterized by X-ray diffraction technique which results show a reduction on the degree of tetragonality as the average grain size decreases. Moreover, the grain size decrease to a nanometer range induces a diffuse behavior on the dielectric permittivity curves as a function of the temperature and a reduction on the dielectric permittivity magnitude. Furthermore, the large number of grain boundaries due to the nanometer size gives rise to a dielectric anomaly. (C) 2012 Elsevier Masson SAS. All rights reserved.

Pathophysiology and molecular aspects of diffuse large B-cell lymphoma

Diffuse large B-Cell lymphoma is the most common subtype of non-Hodgkin lymphoma in the West. In Brazil, it is the fifth cause of cancer, with more than 55,000 cases and 26,000 deaths per year. At Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HCFMUSP, diffuse large B-Cell lymphoma represents 49.7% of all non-Hodgkin lymphoma cases. Initially, the classification of non-Hodgkin lymphoma was based on morphology, but advances in immunology and molecular medicine allowed the introduction of a biological classification for these diseases. As for other cancers, non-Hodgkin lymphoma involves patterns of multi factorial pathogenesis with environmental factors, as well as genetic, occupational and dietary factors, contributing to its development. Multiple lesions involving molecular pathways of B-cell proliferation and differentiation may result in the activation of oncogenes such as the BCL2, BCL6,and MYC genes and the inactivation of tumor suppressor genes such as p53 and INK4, as well as other important transcription factors such as OCT-1 and OCT-2. A dramatic improvement in survival was seen after the recent introduction of the anti-CD20 monoclonal antibody. The association of this antibody to the cyclophosphamide, hydroxydaunorubicin, oncovin and prednisolone (CHOP) regimen has increased overall survival of diffuse large B-Cell lymphoma and follicular lymphoma patients by 20%. However, 50% of all diffuse large B-Cell lymphoma patients remain incurable, creating a demand for more research with new advances in treatment. Thus, it is important to know and understand the key factors and molecular pathways involved in the pathogenesis of diffuse large B-Cell lymphoma.

Primary diffuse large B-cell lymphoma or lymphomatoid granulomatosis grade 3: a still-puzzling diagnosis in autopsy

Primary lung lymphoma is a rare entity accounting for approximately 0.3% of all primary neoplasia of the lung and includes diffuse large B-cell lymphoma (DLBL) and lymphomatoid granulomatosis (LYG). Considering that clinical features may be similar, whereas epidemiology, morphology, and radiological features are different, the authors report a case of a middle-aged man who presented multiple pulmonary nodules in the lower lobes and groundglass opacities scattered bilaterally on computed tomography. Clinically, he presented a consumptive syndrome with respiratory failure and pleurisy, which progressed until death. The autopsy findings were consistent with lymphomatoid granulomatosis (LYG) grade 3/ diffuse large B-cell lymphoma (DLBL). The authors call attention to the difficulty of establishing an accurate diagnosis, mainly when the demonstration of EBV-infected atypical B-cells fails.

Progettare l'ospitalità: turismi e turisti della città contemporanea

La ricerca si pone come obbiettivo principale quello di individuare gli strumenti in grado di controllare la qualità di una progettazione specifica che risponde alle forti richieste della domanda turistica di un territorio. Parte dalle più semplici teorie che inquadrano una costante condizione dell’uomo, “il VIAGGIARE”. La ricerca si pone come primo interrogativo quello definire una “dimensione” in cui le persone viaggiano, dove il concetto fisico di spazio dedicato alla vita si è spostato come e quanto si sposta la gente. Esiste una sorta di macroluogo (destinazione) che comprende tutti gli spazi dove la gente arriva e da cui spesso riparte. Pensare all'architettura dell’ospitalità significa indagare e comprendere come la casa non è più il solo luogo dove la gente abita. La ricerca affonda le proprie tesi sull’importanza dei “luoghi” appartenenti ad un territorio e come essi debbano riappropriarsi, attraverso un percorso progettuale, della loro più stretta vocazione attrattiva. Così come si sviluppa un’architettura dello stare, si manifesta un’architettura dello spostarsi e tali architetture si confondono e si integrano ad un territorio che per sua natura è esso stesso attrattivo. L’origine terminologica di nomadismo è passaggio necessario per la comprensione di una nuova dimensione architettonica legata a concetti quali mobilità e abitare. Si indaga pertanto all’interno della letteratura “diasporica”, in cui compaiono le prime configurazioni legate alla provvisorietà e alle costruzioni “erranti”. In sintesi, dopo aver posizionato e classificato il fenomeno turistico come nuova forma dell’abitare, senza il quale non si potrebbe svolgere una completa programmazione territoriale in quanto fenomeno oramai imprescindibile, la ricerca procede con l’individuazione di un ambito inteso come strumento di indagine sulle relazioni tra le diverse categorie e “tipologie” turistiche. La Riviera Romagnola è sicuramente molto famosa per la sua ospitalità e per le imponenti infrastrutture turistiche ma a livello industriale non è meno famosa per il porto di Ravenna che costituisce un punto di riferimento logistico per lo scambio di merci e materie prime via mare, oltre che essere, in tutta la sua estensione, caso di eccellenza. La provincia di Ravenna mette insieme tutti i fattori che servono a soddisfare le Total Leisure Experience, cioè esperienze di totale appagamento durante la vacanza. Quello che emerge dalle considerazioni svolte sul territorio ravennate è che il turista moderno non va più in cerca di una vacanza monotematica, in cui stare solo in spiaggia o occuparsi esclusivamente di monumenti e cultura. La richiesta è quella di un piacere procurato da una molteplicità di elementi. Pensiamo ad un distretto turistico dove l’offerta, oltre alla spiaggia o gli itinerari culturali, è anche occasione per fare sport o fitness, per rilassarsi in luoghi sereni, per gustare o acquistare cibi tipici e, allo stesso tempo, godere degli stessi servizi che una persona può avere a disposizione nella propria casa. Il percorso, finalizzato a definire un metodo di progettazione dell’ospitalità, parte dalla acquisizione delle esperienze nazionali ed internazionali avvenute negli ultimi dieci anni. La suddetta fase di ricerca “tipologica” si è conclusa in una valutazione critica che mette in evidenza punti di forza e punti di debolezza delle esperienze prese in esame. La conclusione di questa esplorazione ha prodotto una prima stesura degli “obbiettivi concettuali” legati alla elaborazione di un modello architettonico. Il progetto di ricerca in oggetto converge sul percorso tracciato dai Fiumi Uniti in Ravenna. Tale scelta consente di prendere in considerazione un parametro che mostri fattori di continuità tra costa e città, tra turismo balneare e turismo culturale, considerato quindi come potenziale strumento di connessione tra realtà spesso omologhe o complementari, in vista di una implementazione turistica che il progetto di ricerca ha come primo tra i suoi obiettivi. Il tema dell’architettura dell’ospitalità, che in questo caso si concretizza nell’idea di sperimentare l’ALBERGO DIFFUSO, è quello che permette di evidenziare al meglio la forma specifica della cultura locale, salvandone la vocazione universale. La proposta progettuale si articola in uno studio consequenziale ed organico in grado di promuovere una riflessione originale sul tema del modulo “abitativo” nei luoghi di prossimità delle emergenze territoriali di specifico interesse, attorno alle quali la crescente affluenza di un’utenza fortemente differenziata evidenzia la necessità di nodi singolari che si prestino a soddisfare una molteplicità di usi in contesti di grande pregio.

Lingue meno diffuse e corpora: studio empirico sulla terminologia amministrativa ladina

This study aims to the elaboration of juridical and administrative terminology in Ladin language, actually on the Ladin idiom spoken in Val Badia. The necessity of this study is strictly connected to the fact that in South Tyrol the Ladin language is not just safeguarded, but the editing of administrative and normative text is guaranteed by law. This means that there is a need for a unique terminology in order to support translators and editors of specialised texts. The starting point of this study are, on one side the need of a unique terminology, and on the other side the translation work done till now from the employees of the public administration in Ladin language. In order to document their efforts a corpus made up of digitalized administrative and normative documents was build. The first two chapters focuses on the state of the art of projects on terminology and corpus linguistics for lesser used languages. The information were collected thanks to the help of institutes, universities and researchers dealing with lesser used languages. The third chapter focuses on the development of administrative language in Ladin language and the fourth chapter focuses on the creation of the trilingual Italian – German – Ladin corpus made up of administrative and normative documents. The last chapter deals with the methodologies applied in order to elaborate the terminology entries in Ladin language though the use of the trilingual corpus. Starting from the terminology entry all steps are described, from term extraction, to the extraction of equivalents, contexts and definitions and of course also of the elaboration of translation proposals for not found equivalences. Finally the problems referring to the elaboration of terminology in Ladin language are illustrated.

Trasmission and Reflection (ATR)Far-Infrared Spectroscopy Applied in the Analysis of Cultural Heritage Materials

FIR spectroscopy is an alternative way of collecting spectra of many inorganic pigments and corrosion products found on art objects, which is not normally observed in the MIR region. Most FIR spectra are traditionally collected in transmission mode but as a real novelty it is now also possible to record FIR spectra in ATR (Attenuated Total Reflectance) mode. In FIR transmission we employ polyethylene (PE) for preparation of pellets by embedding the sample in PE. Unfortunately, the preparation requires heating of the PE in order to produces at transparent pellet. This will affect compounds with low melting points, especially those with structurally incorporated water. Another option in FIR transmission is the use of thin films. We test the use of polyethylene thin film (PETF), both commercial and laboratory-made PETF. ATR collection of samples is possible in both the MIR and FIR region on solid, powdery or liquid samples. Changing from the MIR to the FIR region is easy as it simply requires the change of detector and beamsplitter (which can be performed within a few minutes). No preparation of the sample is necessary, which is a huge advantage over the PE transmission method. The most obvious difference, when comparing transmission with ATR, is the distortion of band shape (which appears asymmetrical in the lower wavenumber region) and intensity differences. However, the biggest difference can be the shift of strong absorbing bands moving to lower wavenumbers in ATR mode. The sometimes huge band shift necessitates the collection of standard library spectra in both FIR transmission and ATR modes, provided these two methods of collecting are to be employed for analyses of unknown samples. Standard samples of 150 pigment and corrosion compounds are thus collected in both FIR transmission and ATR mode in order to build up a digital library of spectra for comparison with unknown samples. XRD, XRF and Raman spectroscopy assists us in confirming the purity or impurity of our standard samples. 24 didactic test tables, with known pigment and binder painted on the surface of a limestone tablet, are used for testing the established library and different ways of collecting in ATR and transmission mode. In ATR, micro samples are scratched from the surface and examined in both the MIR and FIR region. Additionally, direct surface contact of the didactic tablets with the ATR crystal are tested together with water enhanced surface contact. In FIR transmission we compare the powder from our test tablet on the laboratory PETF and embedded in PE. We also compare the PE pellets collected using a 4x beam condenser, focusing the IR beam area from 8 mm to 2 mm. A few samples collected from a mural painting in a Nepalese temple, corrosion products collected from archaeological Chinese bronze objects and samples from a mural paintings in an Italian abbey, are examined by ATR or transmission spectroscopy.