Promoção da Adesão à Terapêutica e da Qualidade de Vida na Epilepsia

Tese apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Doutor em Ciências Sociais, especialidade em Psicologia

Antropologia e psicoterapia

Tese apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Doutor em Ciências Sociais, especialidade em Antropologia

The role of metabolism in the pathogenesis of adherent invasive Escherichia coli (AIEC)

Crohn’s disease (CD) is a chronic, relapsing inflammatory condition affecting the gastrointestinal tract of humans, of which there is currently no cure. The precise etiology of CD is unknown, although it has become widely accepted that it is a multifactorial disease which occurs as a result of an abnormal immune response to commensal enteric bacteria in a genetically susceptible host. Recent studies have shown that a new group of Escherichia coli, called Adherent Invasive Escherichia coli (AIEC) are present in the guts of CD patients at a higher frequency than in healthy subjects, suggesting that they may play a role in the initiation and/or maintenance of the inflammation associated with CD. Two phenotypes define an AIEC and differentiate them from other groups of E. coli. Firstly, AIEC can adhere to and invade epithelial cells; and secondly, they can replicate in macrophages. In this study, we use a strain of AIEC which has been isolated from the colonic mucosa of a CD patient, called HM605, to examine the relationship between AIEC and the macrophage. We show, using a systematic mutational approach, that while the Tricarboxylic acid (TCA) cycle, the glyoxylate pathway, the Entner-Doudoroff (ED) pathway, the Pentose Phosphate (PP) pathway and gluconeogenesis are dispensable for the intramacrophagic growth of HM605, glycolysis is an absolute requirement for the ability of this organism to replicate intracellularly. We also show that HM605 activates the inflammasome, a major driver of inflammation in mammals. Specifically, we show that macrophages infected with HM605 produce significantly higher levels of the pro-inflammatory cytokine IL-1β than macrophages infected with a non-AIEC strain, and we show by immunoblotting that this is due to cleavage of caspase-1. We also show that macrophages infected with HM605 exhibit significantly higher levels of pyroptosis, a form of inflammatory cell death, than macrophages infected with a non-AIEC strain. Therefore, AIEC strains are more pro-inflammatory than non-AIEC strains and this may have important consequences in terms of CD pathology. Moreover, we show that while inflammasome activation by HM605 is independent of intracellular bacterial replication, it is dependent on an active bacterial metabolism. Through the establishment of a genetic screen aimed at identifying mutants which activate the inflammasome to lower levels than the wild-type, we confirm our observation that bacterial metabolism is essential for successful inflammasome activation by HM605 and we also uncover new systems/structures that may be important for inflammasome activation, such as the BasS/BasR two-component system, a type VI secretion system and a K1 capsule. Finally, in this study, we also identify a putative small RNA in AIEC strain LF82, which may be involved in modulating the motility of this strain. Overall this works shows that, in the absence of specialised virulence factors, the ability of AIEC to metabolise within the host cell may be a key determinant of its pathogenesis.

Trophic role of small cetaceans and seals in Irish waters

Understanding the role of marine mammals in specific ecosystems and their interactions with fisheries involves, inter alia, an understanding of their diet and dietary requirements. In this thesis, the foraging ecology of seven marine mammal species that regularly occur in Irish waters was investigated by reconstructing diet using hard parts from digestive tracts and scats. Of the species examined, two (striped and Atlantic white-sided dolphin) can be considered offshore species or species inhabiting neritic waters, while five others usually inhabit more coastal areas (white-beaked dolphin, harbour porpoise, harbour seal and grey seal); the last species studied was the bottlenose dolphin whose population structure is more complex, with coastal and offshore populations. A total of 13,028 prey items from at least 81 different species (62 fish species, 14 cephalopods, four crustaceans, and a tunicate) were identified. 28% of the fish species were identified using bones other than otoliths, highlighting the importance of using all identifiable structures to reconstruct diet. Individually, each species of marine mammal presented a high diversity of prey taxa, but the locally abundant Trisopterus spp. were found to be the most important prey item for all species, indicating that Trisopterus spp. is probably a key species in understanding the role of these predators in Irish waters. In the coastal marine mammals, other Gadiformes species (haddock, pollack, saithe, whiting) also contributed substantially to the diet; in contrast, in pelagic or less coastal marine mammals, prey was largely comprised of planktivorous fish, such as Atlantic mackerel, horse mackerel, blue whiting, and mesopelagic prey. Striped dolphins and Atlantic white-sided dolphins are offshore small cetaceans foraging in neritic waters. Differences between the diet of striped dolphins collected in drift nets targeting tuna and stranded on Irish coasts showed a complex foraging behaviour; the diet information shows that although this dolphin forages mainly in oceanic waters it may occasionally forage on the continental shelf, feeding on available prey. The Atlantic white-sided dolphin diet showed that this species prefers to feed over the continental edge, where planktivorous fish are abundant. Some resource partitioning was found in bottlenose dolphins in Irish waters consistent with previous genetic and stable isotope analysis studies. Bottlenose dolphins in Irish waters appears to be generalist feeders consuming more than 30 prey species, however most of the diet comprised a few locally abundant species, especially gadoid fish including haddock/pollack/saithe group and Trisopterus spp., but the contribution of Atlantic hake, conger eels and the pelagic planktivorous horse mackerel were also important. Stomach content information suggests that three different feeding behaviours might occur in bottlenose dolphin populations in Irish waters; firstly a coastal behaviour, with animals feeding on prey that mainly inhabit areas close to the coast; secondly an offshore behaviour where dolphins feed on offshore species such as squid or mesopelagic fish; and a third more complex behaviour that involves movements over the continental shelf and close to the shelf edge. The other three coastal marine mammal species (harbour porpoise, harbour seal and grey seal) were found to be feeding on similar prey and competition for food resources among these sympatric species might occur. Both species of seals were found to have a high overlap (more than 80%) in their diet composition, but while grey seals feed on large fish (>110mm), harbour seals feed mostly on smaller fish (<110mm), suggesting some spatial segregation in foraging. Harbour porpoises and grey seals are potentially competing for the same food resource but some differences in prey species were found and some habitat partitioning might occur. Direct interaction (by catch) between dolphins and fisheries was detected in all species. Most of the prey found in the stomach contents from both stranded and by catch dolphins were smaller sizes than those targeted by commercial fisheries. In fact, the total annual food consumption of the species studied was found to be very small (225,160 tonnes) in comparison to fishery landings for the same area (~2 million tonnes). However, marine mammal species might be indirectly interacting with fisheries, removing forage fish. Incorporating the dietary information obtained from the four coastal species, an ECOPATH food web model was established for the Irish Sea, based on data from 2004. Five trophic levels were found, with bottlenose dolphins and grey and harbour seals occurring at the highest trophic level. A comparison with a previous model based on 1973 data suggests that while the overall Irish Sea ecosystem appears to be “maturing”, some indices indicate that the 2004 fishery was less efficient and was targeting fish at higher trophic levels than in 1973, which is reflected in the mean trophic level of the catch. Depletion or substantial decrease of some of the Irish Sea fish stocks has resulted in a significant decline in landings in this area. The integration of diet information in mass-balance models to construct ecosystem food-webs will help to understand the trophic role of these apex predators within the ecosystem.

Summer Sprite for Orchestra

Summer Sprite for Orchestra was completed in December, 2004. The piece originated from a singular encounter with little angels at Chang-Kyung Palace, which is the oldest and the most beautiful palace in Korea, and where the kings of the Chosun Dynasty (1393-1897) lived. This encounter was in the summer of 2002. I certainly could not prove that those angels I met were real. Possibly they were the reflection of drops of water after a sudden shower on that summer day. However, I definitely remember that short, unforgettable, and mysterious moment and the angels' beautiful dance-like celebration. Summer Sprite is based on these special memories and the encounter with the little angels that summer. Summer Sprite consists of 3 movements: "Greeting," "Encounter," and "Celebration." These follow the course of my encounter with the little angels. In Summer Sprite, I wished to describe the image of the angels as well as the progression of greeting, encounter, and celebration with them. The moods that follow in Summer Sprite are by turns lyrical, poetic, fantastic, mysterious, and dream-like. In each movement, I describe the meeting of angels and composer through the use of the soloists -- violin (sometimes viola) and cello. As suggested by the subtitle of the first movement, "Greeting" portrays the moment when a surprised I met the angels. It begins with tam-tam, marimba, harp, and piano and sets a mysterious and dark mood. The second movement, "Encounter," is shorter than the first movement. This movement provides a more tranquil mood as well as more unique timbres resulting from the use of mutes and special instruments (English horn, harp, crotales, suspended cymbal, and celesta). The delicate expression of the percussion is particularly important in establishing the static mood of this movement . The last movement, °?Celebration,°± is bright and energetic. It is also the longest. Here, I require the most delicate changes of dynamics and tempo, the most vigorous harmonies, and the fastest rhythmic figures, as well as the most independent, lyrical, and poetic melodies. For bright orchestral tone color, I used various kinds of percussion such as timpani, xylophone, marimba, vibraphone, cymbals, side drum, tambourine, triangle, and bass drum. This last movement is divided rondo-like into five sections: The first (mm.1-3), second (mm.4 - rehearsal number 1), third (rehearsal numbers 2-4), fourth (rehearsal numbers 5-7), and fifth, (rehearsal numbers 8 -18). To sum up, Summer Sprite describes an unforgettable and mysterious moment in a my life. My intention was to portray this through a concerto-like framework. A model for this would be Brahms°Ø °?Double Concerto°± in A minor, op.102, in which the solo cello stands for my angel and the solo violin (sometimes solo viola) for me.

Triangular flow in event-by-event ideal hydrodynamics in Au+Au collisions at √SNN = 200A GeV

The first calculation of triangular flow ν3 in Au+Au collisions at √sNN = 200A GeV from an event-by-event (3 + 1) d transport+hydrodynamics hybrid approach is presented. As a response to the initial triangularity Ie{cyrillic, ukrainian}3 of the collision zone, ν3 is computed in a similar way to the standard event-plane analysis for elliptic flow ν2. It is found that the triangular flow exhibits weak centrality dependence and is roughly equal to elliptic flow in most central collisions. We also explore the transverse momentum and rapidity dependence of ν2 and ν3 for charged particles as well as identified particles. We conclude that an event-by-event treatment of the ideal hydrodynamic evolution startingwith realistic initial conditions generates the main features expected for triangular flow. © 2010 The American Physical Society.

Indication of electron neutrino appearance from an accelerator-produced off-axis muon neutrino beam.

The T2K experiment observes indications of ν(μ) → ν(e) appearance in data accumulated with 1.43×10(20) protons on target. Six events pass all selection criteria at the far detector. In a three-flavor neutrino oscillation scenario with |Δm(23)(2)| = 2.4×10(-3)  eV(2), sin(2)2θ(23) = 1 and sin(2)2θ(13) = 0, the expected number of such events is 1.5±0.3(syst). Under this hypothesis, the probability to observe six or more candidate events is 7×10(-3), equivalent to 2.5σ significance. At 90% C.L., the data are consistent with 0.03(0.04) < sin(2)2θ(13) < 0.28(0.34) for δ(CP) = 0 and a normal (inverted) hierarchy.

SELECTED VARIATIONS BY COMPOSERS IN GERMANY AND FRANCE

The Haward of Dictionary of Music (1983), defines variation as "a technique modifying a given musical idea." From the Baroque period on, the form and the techniques of variation were developed and enriched in Germany and France. Therefore, I presented the works of composers from these two nations. Even though there was a vast number of possibilities, I wanted to be scholastically fair and interesting in making my selections by choosing well-known pieces along with lesser-known ones. Haydn's well-known Variations in F minor consist of two sets of double variations which break into an improvisation fantasy. The first movement of Beethoven Sonata in A flat major, Op. 26, is a set of five variations on the composer's original theme. The variations are positioned in the first movement instead of Sonata-Allegro form. In 1861 Brahrns composed the Variations and Fugue, Op. 24, on the theme of Handel. Brahms displays a wealth of rhythmic, harmonic and textural contrasts in the variations. Chopin's E Major Variations without opus number are written on a Swiss influenced German folksong. Faure's Theme and Variations in C sharp minor, Op. 73, includes eleven variations. The work displays the composer's subtlety, grace and reticence. 12 Variationen iiber ein eigenes Thema were written by Alban Berg as a composition study with Schonberg. The Finale of Dutilleux's Piano Sonata, titled "Chorale with Variations", is written in an impressionistic style. A rich expressiveness is well blended in a classical form. In 1742, the remarkable Aria and thirty variations known as the Goldberg Variations were composed by J. S. Bach. The thirty Variations are unified by the bass line, which forms the foundation of the Aria. The pieces discussed above were presented in three recitals. Compact disc recordings of these recitals are available in the Michelle Smith Performing Arts Library of the Clarice Smith Performing Arts Center at the University of Maryland.

The Development of Piano Variations in the Romantic Era

The purpose of this study is to illustrate the development of piano variations as a genre during the Romantic era. In order to facilitate this examination of piano variations techniques, a brief look at the types of variation procedures used by composers of previous eras will assist in understanding developments that later occurred in the Romantic period. Throughout the Baroque era, composers preferred the fured-bass, fixed-melody, and harmonic forms of variation. The crowning achievement of Baroque keyboard music, Bach's Goldberg Variations (1725), contains examples of the "constantharmonic" method in its collection of 30 variations, each of which maintains both the bass and harmonic structure of the themes. While most composers of the classical period favored the "melodic-outline" form of variation, Haydn developed hybrid variation procedure that exhibits recurrence of material rather than repetition, alternating variation (ABABA), rondo variation (ABACA), and ternary variation (ABA). Haydn, Mozart and early Beethoven variations also exhibit simpler textures than do their Baroque predecessors. The nineteenth century produced numerous compositions that display variation techniques, some based on such older, classical models as melodic-outline variation and hybrid variation, others in the style of the character variation or fiee variation. At the beginning of the nineteenth century, Beethoven and Schubert used such classical variation techmques as melodic-outline variations and hybrid variations. Beethoven's late sonatas displayed such new means of expression as variation, fugue, and dramatic recitatives. The third movement of the Sonata in E major, Op. 109 (1820) has a theme and six variations of the melodic-outline type. Johannes Brahms was particularly fond of composing variations for piano. Among the best known examples of formal-outline variations are those found in the Variations and Fugue on a Theme of Handel, Op. 24 (1861). Character variations, in which styles are characterized by the retention and variability of particular elements, also flourished during the Romantic period. Cesar Franck's Variations Symphoniques (1885) are, perhaps, among the most important examples of free variations. This composition is a one-movement work consisting of three sections, Introduction, Variations, and Finale (all movements played "attaca"). This work combines two independent classical formal structures, the concerto and the variation.

THE ART OF TRANSCRIBING FOR HARPSICHORD

A relatively unexplored area of the harpsichord repertoire is the group of transcriptions made by J.S. Bach (1685-1750), Jean Henry d'Anglebert (1629-1691), and Jean-Baptiste Forqueray (1699-1782). These transcriptions are valuable and worth exploring and performing. Studying them provides unique insights into their composer‘s musical thinking. By comparing transcriptions with their original sources, the transcriber's decisions and priorities can be observed. The performance component of this dissertation comprises three recitals. The first features works of Johann Sebastian Bach: two transcriptions of violin concerti by Antonio Vivaldi (1678-1741), and two transcriptions of trio sonatas by Johann Adam Reinken (1643-1722). The most salient feature of Bach‘s transcriptions is his addition of musical material: ornamenting slow movements, adding diminutions and idiomatic keyboard figurations throughout, and recomposing and expanding fugal movements. The second recital features works of Jean Henry d'Anglebert and Jean-Baptiste Forqueray, two French composer/performers. From d'Anglebert‘s many transcriptions, I assembled two key-related suites: the first comprised of lute pieces by Ennemond Gaultier (c. 1575-1651), and the second comprised of movements from operas by Jean-Baptiste Lully (1632-1687). Forqueray's transcriptions are of suites for viola da gamba and continuo, composed by his father, Antoine Forqueray (1671-1745). Creative and varied ornamentation, along with the style brisé of arpeggiated chords, are the most important features of d‘Anglebert‘s transcriptions. Forqueray‘s transcriptions are highly virtuosic and often feature the tenor and bass range of the harpsichord. The third recital features my own transcriptions: the first suite for solo cello by J.S. Bach, excerpts from the opera La Descente d’Orphée aux Enfers by Marc-Antoine Charpentier (1643-1704), and two violin pieces by Nicola Matteis (fl. c. 1670-c. 1698). In these transcriptions, I demonstrate what I have learned from studying and performing the works in the first two recitals. These recitals were performed in the Leah Smith Hall at the University of Maryland on May 4, 2010; May 11, 2010; and October 7, 2010. They were recorded on compact discs and are archived within the Digital Repository at the University of Maryland (DRUM).

EFFECT OF MUSIC ON THE SOUL: INTENT OR INDIFFERENCE IN THE COMPOSITION OF EWAZEN, FETTER, HIDAS, HOVHANESS, PEDERSON AND WILDER

This performance dissertation completed in 2009 by bass trombonist and Doctor of Musical Arts candidate Karl Wiederwohl consists of three live recitals and a written document which serves as a complement to the performances. The document discusses the six composers whose music is performed on the recitals. The document's six chapters respectively discuss each composer's disposition with regard to their purpose in composing music. As a complement to the performances the document gives special attention to each composer's thoughts on affecting listeners through their music. Wiederwohl creates a window into the mentality behind the artistry of Eric Ewazen, David Fetter, Frigyes Hidas, Alan Hovhaness, Tommy Pederson and Alec Wilder. The document serves to inform and enrich the experience of both performers and listeners of these six composers. This is achieved through the document's treatment of the following four questions for each composer: How did each come to be a composer? How did each come to compose in his particular style? Does the composer intend his music to serve a purpose? Does the composer intend his music to serve a purpose, and, if so, does this purpose involve reaching and/or affecting the listener at the deepest level?

PIANIST-COMPOSERS WHOSE WORKS INCLUDE PIANISTIC INNOVATIONS

Throughout the piano’s history, certain composers have created innovations in the areas of virtuosity and sonority. These innovations came not only from the composers’ imagination, but also from the development of instruments and changes in musical style from one period to another. To investigate what kinds of innovations these pianist composers made, I divided them into technique and sound from Mozart to Cowell. I chose two-piano music (Sonata in D major, K.448 by Mozart and Rachmaninoff’s Second Suite) to demonstrate their experiments with varieties of textures and sonorities, using different registers of the two pianos orchestrally. En Blanc et noir by Debussy shows this composer’s deep interest and originality in piano sonorities. For solo piano music, Beethoven’s Piano Sonata Op.53 shows extensive technical invention. His use of long pedal effects shows a pianistic possibility not explored by Mozart. Hummel’s Piano Sonata in D major represents orchestral devices as well as pianistic techniques showing recent developments in the instrument. Chopin’s Ballade No.3 and Scherzo No.3 show virtuosic moments and also the expanded range of the keyboard. His Nocturne Op.27, no.2, with its sonorities resulting from the combination of pedal, and widespread accompaniments derived from Alberti bass figures, is a perfect example of Chopin’s characteristic sound-world. “Vallée d’Obermann” by Liszt uses many virtuosic techniques as well as the extreme wide ranges of keyboard in both hands to create dramatic contrasts of texture. Debussy’s etude, “Pour les Sonorités opposés” is probably the first etude designed for sonority rather than for keyboard virtuosity. Albeniz’s “Evocación” and “Triana” show Spanish atmosphere. Prokofiev’s Sonata no.3 shows frequent motoric driving elements that demand percussive virtuosity. Cowell’s piano music is some of the earliest to explore the sonorities of tone clusters and playing on the strings. This performance dissertation consists of three recitals performed in the Orchestra Room, Leah Smith Hall, and Gildenhorn Recital Hall at the University of Maryland, College Park. These recitals are documented on compact disc recordings that are housed within the University of Maryland Library System.

VARIATION FORMS: A SURVEY THROUGH FOUR CENTURIES OF VIOLIN REPERTOIRE

Variation, or the re-working of existing musical material, has consistently attracted the attention of composers and performers throughout the history of Western music. In three recorded recitals at the University of Maryland School of Music, this dissertation project explores a diverse range of expressive possibilities for violin in seven types of variation form in Austro-German works for violin from the 17th through the 20th centuries. The first program, consisting of Baroque Period works, performed on period instrument, includes the divisions on “John come kiss me now” from The Division Violin by Thomas Baltzar (1631 – 1663), constant bass variations in Sonate Unarum Fidium by Johann Heinrich von Schmelzer (1623 – 1680), arbitrary variation in Sonata for Violin and Continuo in E Major, Op. 1, No. 12 “Roger” by George Friedrich Händel (1685 – 1759), and French Double style, melodic-outline variation in Partita for Unaccompanied Violin in B Minor by Johan Sebastian Bach (1685 – 1750). Theme and Variations, a popular Classical Period format, is represented by the Sonata for Piano and Violin in G Major K. 379 by Wolfgang Amadeus Mozart (1756 – 1791) and Sonata for Violin and Piano in A Major, Op. 47 No. 9 the “Kreutzer” by Ludwig van Beethoven (1770 – 1827). Fantasy for Piano and Violin in C Major D. 934 by Franz Schubert (1797 – 1828) represents the 19th century fantasia variation. In these pieces, the piano and violin parts are densely interwoven, having equal importance. Many 20th century composers incorporated diverse types of variations in their works and are represented in the third recital program comprising: serial variation in the Phantasy for Violin and Piano Op.47 of Arnold Schoenberg (1874 – 1951); a strict form of melodic-outline variation in Sonate für Violine allein, Op. 31, No. 2 of Paul Hindemith (1895 – 1963); ostinato variation in Johan Halvorsen’s (1864 – 1935) Passacaglia for Violin and Viola, after G. F. Handel’s Passacaglia from the Harpsichord Suite No. 7 in G Minor. Pianist Audrey Andrist, harpsichordist Sooyoung Jung, and violist Dong-Wook Kim assisted in these performances.

"Thinking too much": A systematic review of a common idiom of distress.

Idioms of distress communicate suffering via reference to shared ethnopsychologies, and better understanding of idioms of distress can contribute to effective clinical and public health communication. This systematic review is a qualitative synthesis of "thinking too much" idioms globally, to determine their applicability and variability across cultures. We searched eight databases and retained publications if they included empirical quantitative, qualitative, or mixed-methods research regarding a "thinking too much" idiom and were in English. In total, 138 publications from 1979 to 2014 met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology, and course of "thinking too much" idioms and compared them to psychiatric constructs. "Thinking too much" idioms typically reference ruminative, intrusive, and anxious thoughts and result in a range of perceived complications, physical and mental illnesses, or even death. These idioms appear to have variable overlap with common psychiatric constructs, including depression, anxiety, and PTSD. However, "thinking too much" idioms reflect aspects of experience, distress, and social positioning not captured by psychiatric diagnoses and often show wide within-cultural variation, in addition to between-cultural differences. Taken together, these findings suggest that "thinking too much" should not be interpreted as a gloss for psychiatric disorder nor assumed to be a unitary symptom or syndrome within a culture. We suggest five key ways in which engagement with "thinking too much" idioms can improve global mental health research and interventions: it (1) incorporates a key idiom of distress into measurement and screening to improve validity of efforts at identifying those in need of services and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in order to bolster cultural appropriateness of interventions; (3) strengthens public health communication to encourage engagement in treatment; (4) reduces stigma by enhancing understanding, promoting treatment-seeking, and avoiding unintentionally contributing to stigmatization; and (5) identifies a key locally salient treatment target.

K1 of Chevalley groups are nilpotent

Abstract Let F be a reduced irreducible root system and R be a commutative ring. Further, let G(F,R) be a Chevalley group of type F over R and E(F,R) be its elementary subgroup. We prove that if the rank of F is at least 2 and the Bass-Serre dimension of R is finite, then the quotient G(F,R)/E(F,R) is nilpotent by abelian. In particular, when G(F,R) is simply connected the quotient K1(F,R)=G(F,R)/E(F,R) is nilpotent. This result was previously established by Bak for the series A1 and by Hazrat for C1 and D1. As in the above papers we use the localisation-completion method of Bak, with some technical simplifications.