MANEJO TÉCNICO DO ATENDIMENTO PSICOLÓGICO EM AMBULATÓRIO DE REPRODUÇÃO HUMANA ASSISTIDA

O presente estudo teve por objetivos: descrever o manejo técnico do atendimento psicológico, ilustrado pelo caso de uma paciente infértil de um ambulatório de reprodução humana assistida; descrever as vicissitudes no campo analítico nestes atendimentos; e sistematizar esse manejo técnico em intervenções ambulatoriais em que se privilegia a compreensão das relações transferenciais. O instrumento utilizado para a coleta de dados foram os próprios atendimentos, ou entrevistas psicológicas, baseadas no método clínico de abordagem psicanalítica. A análise e a discussão dos resultados se basearam na apresentação de um único caso, que ilustrou a técnica que se objetivou sistematizar e descrever. É apresentado o caso da Sra. S., uma mulher de 41 anos, com parceiro em união estável há cinco anos, que realizava tratamento de infertilidade no ambulatório de reprodução humana. A paciente foi atendida pela psicóloga no próprio ambulatório durante o período da segunda tentativa de gravidez. Foram realizados efetivamente três (3) atendimentos e, no período de dois meses, a paciente não compareceu a três (3) sessões. Foram criadas cinco (5) categorias de análise: 1) Escuta; 2) Configuração de Queixa Psicológica; 3) Manejo dos Conflitos; 4) Manejo da Transferência; e 5) Enquadre. Estas categorias representaram elementos do atendimento. A divisão do atendimento em categorias teve propósito didático, no entanto, a sistematização do manejo deu-se a partir do desenvolvimento destas categorias, mas não numa ordem pré-estabelecida. A Escuta refere-se à capacidade do psicoterapeuta compreender a relação estabelecida com o paciente, assim como os elementos metapsicológicos depositados no campo, a partir de seu quadro de referência teórico-metodológico. A Configuração de Queixa Psicológica refere-se à aproximação do sofrimento psíquico e dos conflitos que subjazem à queixa orgânica ou manifesta. O Manejo dos Conflitos representa o modo como são interpretados e devolvidos a um paciente os conteúdos trazidos para a sessão. Ressalta-se, no manejo dos conflitos, a eleição de um foco de trabalho em que se privilegia a situação atual da vida do paciente relacionada especificamente à sua queixa. O Manejo da Transferência refere-se à forma como os aspectos transferenciais são compreendidos e devolvidos ao paciente. A neurose e psicose de transferência são evitadas e o trabalho é preferencialmente desenvolvido a partir da interpretação de situações extra-transferenciais. Por fim, o Enquadre engloba todos os aspectos formais e dinâmicos que constituem o campo emocional sobre o qual se trabalha. Este tipo de atendimento pode ser situado entre a entrevista psicológica e o atendimento em psicoterapia breve com objetivos e tempo limitados, variando de acordo com a qualidade adaptativa do paciente e sua motivação para o atendimento psicológico. Concluímos que este modelo de atendimento ambulatorial engloba aspectos tanto diagnósticos quanto de intervenção e que o papel do psicólogo neste contexto é auxiliar o paciente atendido a compreender sua queixa em seus aspectos latentes e manifestos, além de propiciar um espaço de escuta em que os conteúdos trazidos podem ser pensados e compreendidos

Effect of β-adrenoceptor antagonists on autonomic control of ciliary smooth muscle

Purpose: Pharmacological intervention with peripheral sympathetic transmission at ciliary smooth muscle neuro-receptor junctions has been used against a background of controlled parasympathetic activity to investigate the characteristics of autonomic control of ocular accommodation. Methods: A continuously recording infrared optometer was used to measure accommodation on a group of five visually normal emmetropic subjects under open- and closed-loop conditions. A double-blind protocol between saline, timolol and betaxolol was used to differentiate between the localised action on ciliary smooth muscle and effects induced by changes in stimulus conditions. Data were collected before and 45 min following the instillation of saline, timolol or betaxolol. Open-loop post-task decay was investigated following 3 min sustained near fixation of a stimulus placed 3 D above the subject's pre-task tonic accommodation level. Closed-loop dynamic responses were recorded for each treatment condition while subjects viewed sinusoidally (0.05-0.6 Hz) or stepwise vergence-modulated targets over a 2 D range (2-4 D). Results: Open-loop data demonstrate a rapid post-task regression to pre-task tonic accommodation levels for saline and betaxolol control conditions. A slow positive post-task shift was induced by timolol indicating that sympathetic inhibition contributes to accommodative adaptation during sustained near vision. Closed-loop accommodation responses to temporally modulated sinusoidal stimuli showed characteristic features for both saline and betaxolol control conditions. Timolol induced a reduced gain for low- and mid-temporal frequencies (< 0.3 Hz) but did not affect the response at higher temporal frequencies. Response times to stepwise stimuli increased following the instillation of timolol for the near-to-far fixation condition compared with the controls and was related to the period of sustained prior fixation. Conclusions: Modulation of accommodation under open- and closed-loop conditions by a non-selective β-blocker is consistent with the temporal and inhibitory features of sympathetic innervation to ciliary smooth muscle. Although parasympathetic innervation predominates there is evidence to support a role for sympathetic innervation in the control of ocular accommodation. © 2002 The College of Optometrists.

Auto plant closures, policy responses and labour market outcomes:a comparison of MG Rover in the UK and Mitsubishi in Australia

This paper provides a preliminary comparative longitudinal analysis of the impact on workers made redundant due to the closure of the Mitsubishi plant in Adelaide and the MG Rover plant in Birmingham. Longitudinal surveys of ex-workers from both firms were undertaken over a 12-month period in order to assess the process of labour market adjustment. In the Mitsubishi case, given the skills shortage the state of Adelaide was facing, together with the considerable growth in mining and defence industries, it would have been more appropriate if policy intervention had been redirected to further training or re-skilling opportunities for redundant workers. This opportunity was effectively missed and as a result more workers left the workforce, most notably for retirement, than could have otherwise been the case. The MG Rover case was seen as a more successful example of policy intervention, with greater funding assistance available and targeted support available, and with more emphasis on re-training needs to assist adjustment. However, despite the assistance offered and the rhetoric of successful adjustment in both cases, the majority of workers have nevertheless experienced deterioration in their circumstances particularly in the Australian case where casual and part-time work were often the only work that could be obtained. Even in the UK case, where more funding assistance was offered, a majority of workers reported a decline in earnings and a rise in job insecurity. This suggests that a reliance on the flexible labour market is insufficient to promote adjustment, and that more active policy intervention is needed especially in regard to further up-skilling.

Plasma vascular endothelial growth factor, angiopoietin-2, and soluble angiopoietin receptor tie-2 in diabetic retinopathy:effects of laser photocoagulation and angiotensin receptor blockade

Background: Proliferative diabetic retinopathy (PDR) may be a response to abnormal angiogenic growth factors such as vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2), and the soluble angiopoietin receptor tie-2. The authors hypothesised the following: (a) there are differences in plasma levels of these growth factors in different grades of diabetic retinopathy; and (b) that the effects of intervention with panretinal laser photocoagulation (PRP) for PDR, and angiotensin receptor blockade (using eprosartan) for patients with other grades of diabetic retinopathy will be to reduce levels of the growth factors. Methods: Cross sectional and interventional study (using PRP and eprosartan) in diabetic patients. VEGF, Ang-2, and tie-2 were measured by ELISA. Results: VEGF (p<0.001) and Ang-2 levels (p<0.001) were significantly higher in 93 diabetic patients compared to 20 healthy controls, with the highest levels in grade 2 and grade 3 diabetic retinopathy (p<0.05). Tie-2 was lower in diabetics compared to controls (p = 0.008), with no significant differences between the diabetic subgroups. Overall, VEGF significantly correlated with Ang-2 (p<0.001) and tie-2 (p = 0.004) but the correlation between Ang-2 and tie-2 levels was not significant (p = 0.065). Among diabetic patients only, VEGF levels were significantly correlated with Ang-2 (p<0.001) and tie-2 (p<0.001); the correlation between Ang-2 and tie-2 levels was also significant (p<0.001). There were no statistically significant effects of laser photocoagulation on plasma VEGF, Ang-2, and tie-2 in the 19 patients with PDR, or any effects of eprosartan in the 28 patients with non-proliferative diabetic retinopathy. Conclusion: Increased plasma levels of VEGF and Ang-2, as well as lower soluble tie-2, were found in diabetic patients. The highest VEGF and Ang-2 levels were seen among patients with pre-proliferative and proliferative retinopathy, but there was no relation of tie-2 to the severity of retinopathy. As the majority of previous research into Ang-2 and tie-2 has been in relation to angiogenesis and malignancy, the present study would suggest that Ang-2 and tie-2 may be used as potential indices of angiogenesis in diabetes mellitus (in addition to VEGF) and may help elucidate the role of the angiopoietin/tie-2 system in this condition.

An almond-enriched diet increases plasma α-tocopherol and improves vascular function but does not affect oxidative stress markers or lipid levels

Vascular dysfunction is one of the major causes of cardiovascular (CV) mortality and increases with age. Epidemiological studies suggest that Mediterranean diets and high nut consumption reduce CV disease risk and mortality while increasing plasma α-tocopherol. Therefore, we have investigated whether almond supplementation can improve oxidative stress markers and CV risk factors over 4 weeks in young and middle-aged men. Healthy middle-aged men (56 ± 5.8 years), healthy young men (22.1 ± 2.9 years) and young men with two or more CV risk factors (27.3 ± 5 years) consumed 50 g almond/day for 4 weeks. A control group maintained habitual diets over the same period. Plasma α-tocopherol/cholesterol ratios were not different between groups at baseline and were significantly elevated by almond intervention with 50 g almond/day for 4 weeks (p < 0.05). Plasma protein oxidation and nitrite levels were not different between groups whereas, total-, HDL- and LDL-cholesterols and triglycerides were significantly higher in healthy middle-aged and young men with CV risk factors but were not affected by intake. In the almond-consuming groups, flow-mediated dilatation (FMD) improved and systolic blood pressure reduced significantly after 50 g almonds/day for 4 weeks, but diastolic blood pressure reduced only in healthy men. In conclusion, a short-term almond-enriched diet can increase plasma α-tocopherol and improve vascular function in asymptomatic healthy men aged between 20 and 70 years without any effect on plasma lipids or markers of oxidative stress. © 2014 Informa UK, Ltd.

Avandamet:Combined metformin-rosiglitazone treatment for insulin resistance in type 2 diabetes

Insulin resistance is a major endocrinopathy underlying the development of hyperglycaemia and cardiovascular disease in type 2 diabetes. Metformin (a biguanide) and rosiglitazone (a thiazolidinedione) counter insulin resistance, acting by different cellular mechanisms. The two agents can be used in combination to achieve additive glucose-lowering efficacy in the treatment of type 2 diabetes, without stimulating insulin secretion and without causing hypoglycaemia. Both agents also reduce a range of atherothrombotic factors and markers, indicating a lower cardiovascular risk. Early intervention with metformin is already known to reduce myocardial infarction and increase survival in overweight type 2 patients. Recently, a single-tablet combination of metformin and rosiglitazone, Avandamet, has become available. Avandamet is suitable for type 2-diabetic patients who are inadequately controlled by monotherapy with metformin or rosiglitazone. Patients already receiving separate tablets of metformin and rosiglitazone may switch to the single-tablet combination for convenience. Also, early introduction of the combination before maximal titration of one agent can reduce side effects. Use of Avandamet requires attention to the precautions for both metformin and rosiglitazone, especially renal, cardiac and hepatic competence. In summary, Avandamet is a single-tablet metformin-rosiglitazone combination that doubly targets insulin resistance as therapy for hyperglycaemia and vascular risk in type 2 diabetes. © 2004 Blackwell Publishing Ltd.

Medical students' personal experience of high-stakes failure:case studies using interpretative phenomenological analysis

Abstract (provisional): Background Failing a high-stakes assessment at medical school is a major event for those who go through the experience. Students who fail at medical school may be more likely to struggle in professional practice, therefore helping individuals overcome problems and respond appropriately is important. There is little understanding about what factors influence how individuals experience failure or make sense of the failing experience in remediation. The aim of this study was to investigate the complexity surrounding the failure experience from the student’s perspective using interpretative phenomenological analysis (IPA). Methods The accounts of 3 medical students who had failed final re-sit exams, were subjected to in-depth analysis using IPA methodology. IPA was used to analyse each transcript case-by-case allowing the researcher to make sense of the participant’s subjective world. The analysis process allowed the complexity surrounding the failure to be highlighted, alongside a narrative describing how students made sense of the experience. Results The circumstances surrounding students as they approached assessment and experienced failure at finals were a complex interaction between academic problems, personal problems (specifically finance and relationships), strained relationships with friends, family or faculty, and various mental health problems. Each student experienced multi-dimensional issues, each with their own individual combination of problems, but experienced remediation as a one-dimensional intervention with focus only on improving performance in written exams. What these students needed to be included was help with clinical skills, plus social and emotional support. Fear of termination of the their course was a barrier to open communication with staff. Conclusions These students’ experience of failure was complex. The experience of remediation is influenced by the way in which students make sense of failing. Generic remediation programmes may fail to meet the needs of students for whom personal, social and mental health issues are a part of the picture.

Comparing direct and imagined intergroup contact among children:effects on outgroup stereotypes and helping intentions

We conducted an experimental intervention aimed at comparing the effectiveness of direct and imagined intergroup contact. Italian elementary school children took part in a three-week intervention with dependent variables assessed one week after the last intervention session. Results revealed that direct and imagined intergroup contact, compared to control conditions of direct and imagined intragroup contact, had an additive impact when it came to reducing negative stereotypes of immigrants and fostering future helping intentions toward this group. The theoretical and practical implications of the findings are discussed.

Oxidised LDL lipids, statins and a blood-brain barrier

Elevated cholesterol in mid-life has been associated with increased risk of dementia in later life. We have previously shown that low density lipoprotein (LDL) is more oxidised in the plasma of dementia patients although total cholesterol levels remained unchanged. Increased systemic oxidative modification (oxLDL) and nitration is also observed during hypercholesterolemia. We have investigated the hypothesis that disruption of blood brain barrier (BBB) function by oxLDL and their lipids may increase risk of neurodegeneration in later life and that statin intervention can mitigate the effects of hyperlipidaemia in mid-life. LDL isolated from statin-naïve hypercholesterolaemic subjects had higher mobility by agarose gel electrophoresis (Rf;0.53±0.06) and 8-isoprostane F2α concentration (43.5±8.42pg/ml) compared to control subjects (Rf; 0.46±0.05 and 24.2±5.37pg/ml respectively; p<0.05). Compared to HMVEC treatment with the LDL-lipids (5μM) from normolipidaemic subjects, LDL-lipids from hypercholesterolaemic subjects increased barrier permeability (103.4±12.5 Ωcm2 v 66.7±7.3 Ωcm2,P<0.01) and decreased cellular glutathione levels (18.5nmol/mg v 12.3nmol/mg) compared to untreated cells (26.2±3.6nmol/mg). LDL-lipids isolated from normolipidaemic subjects shows reduced risk to damage a BBB model compared with LDL-lipids from hypercholesterolaemic subjects. Moreover, a three month statin-intervention reduced the propensity for LDL-lipids from subjects with hyperlipidaemia to damage HMVEC. Post-statin treatment the cytotoxic and pro-inflammatory effects of LDL lipids disappeared. These data support the hypothesis that in vivo intervention with statins modifies LDL lipid oxidation, exerting a protective effect against in microvascular damage independent of cholesterol concentration.

Understanding the relationship between the Talented Twenty program and college aspirations for high ranking students at a high priority school

Percentage plans such as the Talented Twenty program purport to assist and motivate high ranking students to attend college and grant access to higher education. This type of plan is particularly important to students enrolled in high priority schools who might not view themselves as potential college students. This study examined the relationship between Florida’s Talented Twenty program that begins intervention with juniors and the college aspirations for high ranking students at a high priority school. Numerous studies have established that increased levels of education lead to higher salaries, career mobility, and an increased quality of life (e.g., Bowen, 1997; Leslie & Brinkman 1988; Pascarella & Terenzini, 1991, Swail, 2000). Given the importance of students’ decisions regarding whether or not they will attend college, understanding how and when they make decisions about attending college is important for them, their parents, advisors, and educational administrators. This research examined students’ perceptions and insights via interviews. The overarching research question was: How do high ranking high school students attending a high priority school in a south Florida district perceive their college opportunities? Sixteen high ranking students, grades nine – 12 from a high priority school in Miami-Dade County participated in the study. Participants were identified by a school counselor and individual semi structured interviews were conducted at the school. Utilizing a student development theoretical framework developed by Hossler and Gallagher (1987) that centered on students’ predisposition, search strategies and choices, data were organized and emergent themes analyzed. The analysis of the data revealed that in alignment with the framework (a) parents were the strongest influence in the development of these students’ college aspirations, (b) these students formalized their higher education plans between eighth and 10th grade, (c) these students actively engaged in academic searches and learning opportunities that increased their chances to be admitted into college, and (d) there was no relationship between knowledge regarding the Talented Twenty program and their educational decisions. This study’s findings suggest that interventions and programs intended to influence the educational aspirations of students are more likely to succeed if they take place by the eighth or ninth grade.

Singing About Expected Behaviors for Group Instruction

The proposed study will be displayed on a poster board that contains the research methods and results due to the use of music intervention with students with ASD.

Avaliação da genotoxicidade em mulheres com síndrome dos ovários policísticos: impacto da dieta

Introduction: Polycystic Ovary Syndrome (PCOS), present in 6-12% of women of reproductive age, the criterion of Rotterdam, is characterized by hyperandrogenism, insulin resistance (IR) and its inflammatory state, exacerbated by obesity and factors associated with the increase in damage DNA. Weight loss, combined with healthy eating, acts restoring the reproductive and metabolic functions in the SOP, though its influence in reducing DNA damage in PCOS are unknown. Aim: To investigate whether there are differences between DNA damage markers and factors of cardiometabolic risk in women with PCOS and control, and evaluate the effectiveness of nutritional intervention in DNA damage markers and cardiometabolic risk markers in overweight and obese women with PCOS. Methods: the study was conducted in two studies and the participants were aged between 18 and 35 years. In the first study, a prospective case-control, were included 27 women diagnosed with PCOS and 20 controls. In the second study, clinical trial of nutritional intervention with 12-week calorie-restricted diet 500Kcal / day. The genotoxicity, DNA damage (intensity tail, tail moment and tail length) was evaluated by the comet assay. Anthropometric data, dietary intake, hormonal, biochemical and inflammatory were evaluated in different studies. Results: there was no significant difference between the DNA damage marker tail intensity (p = 0.18), tail moment (p = 0.76) and tail length (p = 0.109) in PCOS when compared to the control group. Data after nutritional intervention in PCOS women with overweight and obesity showed a decrease in DNA damage markers: tail intensity (24.35 ± 5.86 - pre-diet vs. 17.15 ± 5.04 -Post-diet) and tail moment (20.47 ± 7.85 - pre-diet vs. 14.13 ± 6.29 -post-diet) (p <0.001). Reduction of weight (3.5%) and decreased cardiometabolic markers IR and hyperandrogenism. Conclusion: women with PCOS have a worse cardiometabolic risk profile compared to control however similar genotoxicity identified by DNA damage. Nutritional intervention reduced the genotoxicity of overweight and obese women with PCOS, and reduce the factors of cardiometabolic risk.

A produção oral de inglês como LE em uma escola pública de Natal: uma experiência com a abordagem baseada em tarefas

The aim of this action research of mixed-methods was investigating the role of the tasks proposed by the Task-Based Learning, TBL (WILLIS, 1996) in the process of development of speech production in English as a foreign language (EFL) at the public school. Twenty-three students from a grade of secondary school from a state school in Rio Grande do Norte were exposed systematically to the implementation of the learning tasks focused in the speech production in EFL during two months. The instruments used at the data collection – pre and post-questionnaire; field notes; focal group; and pre and post-tests - generated two kinds of data: a) qualitative (the perception of the students about their speech production and the teaching of this ability at the public school; and, the usage of strategies of communication for these learners facing TBL); and, b) quantitative (the development of pronunciation; of accuracy in the proficiency tests (test KET – Cambridge, adapted); and, of Global Oral Proficiency (POG) of these learners after the accomplishment of the learning tasks). The quantitative results of the study indicate that there was a statistically significant development of pronunciation and accuracy at the proficiency tests, after the tasks experience. The qualitative findings, in turn, represented by the learners‟ reports and from the research teacher, show that there has been greater focus on the use of communicative strategies during the learners‟ oral production throughout the intervention with the tasks.

O ensino por investigação: construindo possibilidades na formação continuada do professor de ciências a partir da ação-reflexão

Studies and reflections about the current trends on teaching Science show us the importance of include in the teaching practice, activities with a investigative and problematic approach, that allow to the learners to understand and to apply concepts and phenomena scientifics. On this perspective, the teacher continuing education is essential to effect the practice of this approach in the classroom. Therefore, this research has as an objective to contribute with Science teacher continuing formation in the basic education, in the use of the investigative approach, with a view to overcoming obstacles and making change in pedagogical practice using this research elements. For this, a qualitative research with science teachers of basic schools in the city of Natal/ RN/ Brazil was held, who attended the training course on teaching by investigation in 2012, through the project entitled "Em Busca de Novos Talentos para a Ciência: uma intervenção no ensino público" (Searching New Talents for Science: an intervention in public education).The research was conducted in four stages: Diagnosis of the conceptions of education for research and incorporation into practice after the New Talents course; projection of the intervention, intervention and evaluation. To obtain the data it was made a questionnaire, semi-structured interviews, group studies, written records and participant observation. It was analyzed that the course had significant contributions to the participating teachers to promote the approach and the motivation for incorporation of the investigative approach in practice. The permanence of weaknesses related to the theoretical basis was found, the wear resistance, difficulty in planning activities and the change in practice, diagnosed the previous course of this research. It was also noticed certain lack of domain of teaching principles of investigation by the teachers, who despite being well understood in theory, reveal gaps in practice. Despite not having been exploited the full potential of investigative activity is apparent that the inclusion of activities with an investigative approach to science and biology classes is essential for an active, critical and reflective posture of the students as well as the interest in learning about science. It was demonstrated that intervention with moments of reflection, engagement, knowledge exchange, it was effective in overcoming difficulties identified at baseline as well as providing greater motivation to face the innovations and changes in education, suggesting an important format to considered in the course of continuing education. This is because the planning and replanning allow teachers to reflect and evaluate their practice, contributing to overcoming difficulties of teachers on a daily basis.

O ensino por investigação: construindo possibilidades na formação continuada do professor de ciências a partir da ação-reflexão

Studies and reflections about the current trends on teaching Science show us the importance of include in the teaching practice, activities with a investigative and problematic approach, that allow to the learners to understand and to apply concepts and phenomena scientifics. On this perspective, the teacher continuing education is essential to effect the practice of this approach in the classroom. Therefore, this research has as an objective to contribute with Science teacher continuing formation in the basic education, in the use of the investigative approach, with a view to overcoming obstacles and making change in pedagogical practice using this research elements. For this, a qualitative research with science teachers of basic schools in the city of Natal/ RN/ Brazil was held, who attended the training course on teaching by investigation in 2012, through the project entitled "Em Busca de Novos Talentos para a Ciência: uma intervenção no ensino público" (Searching New Talents for Science: an intervention in public education).The research was conducted in four stages: Diagnosis of the conceptions of education for research and incorporation into practice after the New Talents course; projection of the intervention, intervention and evaluation. To obtain the data it was made a questionnaire, semi-structured interviews, group studies, written records and participant observation. It was analyzed that the course had significant contributions to the participating teachers to promote the approach and the motivation for incorporation of the investigative approach in practice. The permanence of weaknesses related to the theoretical basis was found, the wear resistance, difficulty in planning activities and the change in practice, diagnosed the previous course of this research. It was also noticed certain lack of domain of teaching principles of investigation by the teachers, who despite being well understood in theory, reveal gaps in practice. Despite not having been exploited the full potential of investigative activity is apparent that the inclusion of activities with an investigative approach to science and biology classes is essential for an active, critical and reflective posture of the students as well as the interest in learning about science. It was demonstrated that intervention with moments of reflection, engagement, knowledge exchange, it was effective in overcoming difficulties identified at baseline as well as providing greater motivation to face the innovations and changes in education, suggesting an important format to considered in the course of continuing education. This is because the planning and replanning allow teachers to reflect and evaluate their practice, contributing to overcoming difficulties of teachers on a daily basis.