Processo de cuidar de um centro de tratamento oncológico

The objective was to understand the process of caring for a center for cancer treatment from the perspective of nurses and patients. This is a qualitative research, xploratory and descriptive, performed in a cancer treatment center in Natal / RN / Brazil. Data collection occurred between August 2013 and February 2014, being effected by means of two techniques: photographic record and projective interviews with nurses and patients. Social actors included in the study were ten professional nursing and ten patients admitted to the surgical department of the institution. The criteria used for inclusion of professionals were: be professional in the field of nursing, being an employee of the hospital, to be inserted in the scale of nurses of the institution at the time of data collection. For the patients were included who had preserved their cognitive abilities and who were hospitalized and at any stage of treatment. We used content analysis proposed by Bardin, for the analysis of material collected during projective interview. The research followed the ethical and legal principles that govern scientific research on human beings, being conducted by the project approval by the Research Ethics Committee of the Northern League Against Cancer Riograndense with 295 673 and look CAAE 16104313.0.0000.5293. Referring to nurses, they demonstrated different views about care, which sprouted from a holistic, multidisciplinary approach and welcoming, as well as linked to the performance of procedures and compliance with the requirements technicality. Furthermore, these subjects also showed that care unfolds through the actions of management in carrying out the records in the humanization of care by meeting the needs of the patient and ambience. Front of patients, it is noteworthy that, for them, care happens through attitudes of caring and professional approach, and by performing procedures, being mentioned as a careless lack of structure of the institution and the discomfort caused by this condition factors. It was evident also that the actors involved in the care, the perception of professionals and patients, are represented by nurses, doctors, psychologists, nutritionists, as well as kitchen assistants and cleaners; beyond family companion, the individual himself as responsible for their care and volunteer caregiver. In this opportunity, it is concluded 9 that an understanding of care from the perspective of nurses and patients involves broad issues ranging from perceptions of care that embraces a dynamic complex elements and attitudes imbued with meanings, in which those involved can assume both the role of carers as care beings, even a carefully tied to prescribed routines and performing procedures. Thus, the findings described refer to reflections on the care provided to cancer patients and whether this, in fact, translates principles of a humane practice

Sediment and pore water data of five cores from the continental slope off Uruguay

Assessing frequency and extent of mass movement at continental margins is crucial to evaluate risks for offshore constructions and coastal areas. A multidisciplinary approach including geophysical, sedimentological, geotechnical, and geochemical methods was applied to investigate multistage mass transport deposits (MTDs) off Uruguay, on top of which no surficial hemipelagic drape was detected based on echosounder data. Nonsteady state pore water conditions are evidenced by a distinct gradient change in the sulfate (SO4**2-) profile at 2.8 m depth. A sharp sedimentological contact at 2.43 m coincides with an abrupt downward increase in shear strength from approx. 10 to >20 kPa. This boundary is interpreted as a paleosurface (and top of an older MTD) that has recently been covered by a sediment package during a younger landslide event. This youngest MTD supposedly originated from an upslope position and carried its initial pore water signature downward. The kink in the SO4**2- profile approx. 35 cm below the sedimentological and geotechnical contact indicates that bioirrigation affected the paleosurface before deposition of the youngest MTD. Based on modeling of the diffusive re-equilibration of SO4**2- the age of the most recent MTD is estimated to be <30 years. The mass movement was possibly related to an earthquake in 1988 (approx. 70 km southwest of the core location). Probabilistic slope stability back analysis of general landslide structures in the study area reveals that slope failure initiation requires additional ground accelerations. Therefore, we consider the earthquake as a reasonable trigger if additional weakening processes (e.g., erosion by previous retrogressive failure events or excess pore pressures) preconditioned the slope for failure. Our study reveals the necessity of multidisciplinary approaches to accurately recognize and date recent slope failures in complex settings such as the investigated area.

What Does Board Capital Really Bring to the Table? Exploring the Effect of Directors’ Human and Social Capital on Effective Governance During International Expansion

What constitutes effective corporate governance? Which director characteristics render boards effective at positively influencing firm-level performance outcomes? This dissertation examines these questions by taking a multilevel, multidisciplinary approach to corporate governance. I explore the individual-, team-, and firm- level factors that enable directors to serve effectively as strategic resources during international expansion. I argue that directors’ international experience improves their ability to serve as effective strategic consultants and resource providers to firms during the complex internationalization process. However, unlike prior research, which tends to assume that directors with the potential to provide important resources uniformly do so, I acknowledge contextual factors (i.e. board cohesiveness, strategic relevance of directors’ experience) that affect their propensity to actually influence outcomes. I explore these issues in three essays: one review essay and two empirical essays. In the first empirical essay, I integrate resource dependence theory with insights from social-psychological research to explore the influence of board capital on firms’ cross-border M&A performance. Using a sample of cross-border M&As completed by S&P 500 firms from 2004-2009, I find evidence that directors’ depth of international experience is associated with superior pre-deal outcomes. This suggests that boards’ deep, market-specific knowledge is valuable during the target selection phase. I further find that directors’ breadth of international experience is associated with superior post-deal performance, suggesting that these directors’ global mindset helps firms in the post-M&A integration phase. I also find that these relationships are positively moderated by board cohesiveness, measured by boards’ internal social ties. In the second empirical essay, I explore the boundary conditions of international board capital by examining how the characteristics of firms’ internationalization strategy moderate the relationship between board capital and firm performance. Using a panel of 377 S&P 500 firms observed from 2004-2011, I find that boards’ depth of international experience and social capital are more important during early stages of internationalization, when firms tend to lack market knowledge and legitimacy in the host markets. On the other hand, I find that breadth of international experience has a stronger relationship with performance when firms’ have higher scope of internationalization, when information-processing demands are higher.

Characteristics of samples obtained during Pokhodsk 2012-2013 campaigns in the joint Russian-German POLYGON Project

Polygonal tundra, thermokarst basins and pingos are common and characteristic periglacial features of arctic lowlands underlain by permafrost in Northeast Siberia. Modern polygonal mires are in the focus of biogeochemical, biological, pedological, and cryolithological research with special attention to their carbon stocks and greenhouse-gas fluxes, their biodiversity and their dynamics and functioning under past, present and future climate scenarios. Within the frame of the joint German-Russian DFG-RFBR project Polygons in tundra wetlands: state and dynamics under climate variability in Polar Regions (POLYGON) field studies of recent and of late Quaternary environmental dynamics were carried out in the Indigirka lowland and in the Kolyma River Delta in summer 2012 and summer 2013. Using a multidisciplinary approach, several types of polygons and thermokarst lakes were studied in different landscapes units in the Kolyma Delta in 2012 around the small fishing settlement Pokhodsk. The floral and faunal associations of polygonal tundra were described during the fieldwork. Ecological, hydrological, meteorological, limnological, pedological and cryological features were studied in order to evaluate modern and past environmental conditions and their essential controlling parameters. The ecological monitoring and collection program of polygonal ponds were undertaken as in 2011 in the Indigirka lowland by a former POLYGON expedition (Schirrmeister et al. [eds.] 2012). Exposures, pits and drill cores in the Kolyma Delta were studied to understand the cryolithological structures of frozen ground and to collect samples for detailed paleoenvironmental research of the late Quaternary past. Dendrochronological and ecological studies were carried out in the tree line zone south of the Kolyma Delta. Based on previous work in the Indigirka lowland in 2011 (Schirrmeister et al. [eds.] 2012), the environmental monitoring around the Kytalyk research station was continued until the end of August 2012. In addition, a classical exposure of the late Pleistocene permafrost at the Achchaygy Allaikha River near Chokurdakh was studied. The ecological studies near Pokhodsk were continued in 2013 (chapter 13). Other fieldwork took place at the Pokhodsk-Yedoma-Island in the northwestern part of the Kolyma Delta.

Climate-Driven Range Shifts Within Benthic Habitats Across a Marine Biogeographic Transition Zone.

Anthropogenic climate change is causing unprecedented rapid responses in marine communities, with species across many different taxonomic groups showing faster shifts in biogeographic ranges than in any other ecosystem. Spatial and temporal trends for many marine species are difficult to quantify, however, due to the lack of long-term datasets across complete geographical distributions and the occurrence of small-scale variability from both natural and anthropogenic drivers. Understanding these changes requires a multidisciplinary approach to bring together patterns identified within long-term datasets and the processes driving those patterns using biologically relevant mechanistic information to accurately attribute cause and effect. This must include likely future biological responses, and detection of the underlying mechanisms in order to scale up from the organismal level to determine how communities and ecosystems are likely to respond across a range of future climate change scenarios. Using this multidisciplinary approach will improve the use of robust science to inform the development of fit-for-purpose policy to effectively manage marine environments in this rapidly changing world.

Climate-Driven Range Shifts Within Benthic Habitats Across a Marine Biogeographic Transition Zone.

Anthropogenic climate change is causing unprecedented rapid responses in marine communities, with species across many different taxonomic groups showing faster shifts in biogeographic ranges than in any other ecosystem. Spatial and temporal trends for many marine species are difficult to quantify, however, due to the lack of long-term datasets across complete geographical distributions and the occurrence of small-scale variability from both natural and anthropogenic drivers. Understanding these changes requires a multidisciplinary approach to bring together patterns identified within long-term datasets and the processes driving those patterns using biologically relevant mechanistic information to accurately attribute cause and effect. This must include likely future biological responses, and detection of the underlying mechanisms in order to scale up from the organismal level to determine how communities and ecosystems are likely to respond across a range of future climate change scenarios. Using this multidisciplinary approach will improve the use of robust science to inform the development of fit-for-purpose policy to effectively manage marine environments in this rapidly changing world.

Exploring the safety of chemotherapy for treating breast cancer during pregnancy

Introduction: The diagnosis of breast cancer during pregnancy (BCP) represents a unique challenge to the patient, her family and the treating physician. The proper management of this critical clinical situation is crucial, and requires a multidisciplinary approach. A proper understanding of the safety of chemotherapy during pregnancy is a vital step to avoid detrimental consequences on the mother and the fetus.Areas covered: The aim of this article is to review the available evidence on the safety of chemotherapy administration in managing BCP.Expert opinion: The rule of thumb of chemotherapy - avoiding first trimester exposure and starting therapy in the second trimester - can be considered applicable for classic agents that are used in managing pregnant breast cancer patients. Anthracycline-based regimens are considered the standard of care in managing BCP. Recently, a growing amount of data suggests the safety of taxanes during pregnancy. Pregnancy in cancer patients should be considered as "high risk": once the systemic treatment is initiated, regular fetal monitoring is highly recommended. Emerging data are available on the relative long-term safety secondary to anthracycline exposure during pregnancy. A continued monitoring of the health of individuals with prenatal exposure to chemotherapy into adulthood is recommended for the possible occurrence of long-term side effects.

Pneumothorax in the Emergency Room: personal caseload

The aim of this study was to collect information on the incidence, pathophysiology, treatment and mortality of pneumothorax in the Emergency Room. Pneumothorax is classified as spontaneous (primary, secondary or catamenial) or traumatic (iatrogenic or secondary to a blunt or penetrating chest injury). Between January 2007 and December 2009, 102 patients with pneumothorax were seen in our Emergency Room. Their records were examined and their data collected retrospectively. The type and side of the pneumothorax and age, sex, incidence and mortality were analyzed. The cases, involving 93 males and 9 females, broke down as follows: 68 spontaneous (66.7%), 33 traumatic (32.3%) and one iatrogenic (0.98%). The mean age was 47.3 (range 12-99); the incidence was 0.10%. There were no deaths due to pneumothorax in the Emergency Room. Traumatic pneumothorax was associated with blunt chest trauma, pleural effusion, hemothorax, cranial trauma, fractured collarbone, upper and lower limb fracture, pelvic fracture, vertebral and spinal trauma, sternum fracture and abdominal trauma. Pneumothorax is a common clinical problem. A multidisciplinary approach is essential to reduce the risk of morbidity and mortality. The incidence of pneumothorax in the Emergency Room was similar to that reported in the literature, while mortality data cannot be compared due to the lack of published studies.

Indications for and limits of conservative surgery in breast cancer

Improvements in diagnostic techniques and, above all, breast cancer screening campaigns - essential for early diagnosis - have enabled the objectives of conservative surgery to be pursued: disease control, no or low incidence of recurrences and an excellent esthetic result. However, to reach these objectives, it is essential to ensure a careful evaluation of the medical history of every patient, a detailed clinical examination and the correct interpretation of imaging. Particular attention should be paid to all factors influencing the choice of treatment and/or possible local recurrence: age, site, tumor volume, genetic predisposition, pregnancy, previous radiotherapy, pathological features, and surgical margins. The decision to undertake conservative treatment thus requires a multidisciplinary approach involving pathologists, surgeons and oncological radiologists, as well, of course, as the patient herself.

Desvios de erupção dos caninos superiores permanentes

Os caninos superiores permanentes possuem um longo e difícil trajeto de erupção, desde a sua formação até à sua posição final de erupção. Deste modo, estão susceptíveis a desvios de erupção por fatores etiológicos genéticos, ambientais ou locais. Quando se fala em desvios de erupção, a literatura remete-nos para casos de inclusão do canino permanente. Estes problemas clínicos são muito frequentes, sendo que o diagnóstico e tratamento desses problemas necessitam de uma abordagem multidisciplinar. Sendo de enorme importância o conhecimento dos padrões de normalidade que se estabelecem nos diferentes estágios de crescimento e desenvolvimento da dentição decídua, mista e permanente para um diagnóstico adequado e, posteriormente, para o sucesso do tratamento clínico. Quando não diagnosticado ou tratado inadequadamente, podem resultar no desenvolvimento de problemas, como: más oclusões, reabsorções dos dentes adjacentes, formação cística, infecções e problemas estéticos.

Pathological validation and significance of micrometastasis in sentinel nodes in primary breast cancer

In embracing a multidisciplinary approach to the management of patients with sentinel node biopsy in breast cancer, the pathologist task is to screen sentinel nodes for possible metastasis. The consequences of missing sentinel node micrometastasis can directly influence treatment strategies, and this screening therefore has to be performed with more attention than usual. There is presently great diversity in the histopathological work-up of sentinel nodes, with many centres employing additional techniques such as immunohistochemistry, reverse transcription polymerase chain reaction or flow cytometry in addition to routine haematoxylin and eosin staining. In this review, we address the pathological validation and significance of micrometastasis in sentinel node biopsy in primary breast cancer

A importância do DNA na Medicina Dentária Forense

Com o presente trabalho pretende-se discutir a importância do DNA na resolução de casos de investigação forense. O Homem, desde os tempos mais remotos tem revelado interesse na confirmação da identidade dos seus semelhantes, pelo desenvolvimento e prática de diversas técnicas de identificação. A partir de uma revisão da literatura, fez-se o estudo dos métodos de identificação humana, sendo este mais aprofundado no que diz respeito ao DNA. Frequentemente são encontrados corpos em que a única peça disponível para o processo de identificação é o dente. As peças dentárias são as estruturas mais resistentes e estáveis do corpo humano, mantendo as suas características e propriedades por longos períodos de tempo pós-morte. A análise do DNA contribui de forma muito importante para os processos de reconhecimento humano, principalmente em casos em que outros métodos de identificação falham devido a decomposição, fragmentação, incineração ou inexistência de dados comparativos ante-morte. Para a obtenção de um perfil genético é necessário executar as seguintes etapas: extração do DNA, sua quantificação e amplificação seguida de análise de determinadas regiões do genoma. Nos dias de hoje, muitos casos de identificação necessitam de uma abordagem multidisciplinar, isto porque em algumas situações existe falta de material padrão ou, por outro lado, pode haver mais do que uma evidência a ser examinada.

Just Another Pelvic Mass?

Objectives: To describe the case of a patient presenting with weight loss and a pelvic mass. Materials and methods: We performed an advanced search in MEDLINE using the key words "wasting syndrome", "actinomycosis" and "pelvic mass". Results: A 63-year-old woman had a well-delimited and tender pelvic mass and was found to be anaemic. Before scans were performed, clinicians considered malignancy and other diagnoses. Conclusion: Actinomycosis is a chronic infection that usually affects the abdomen. Because of the lack of specificity of clinical and radiological findings, a multidisciplinary approach is the keypoint for making an accurate diagnosis.

Competências do psicólogo em cuidados paliativos

Relatório de Estágio apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos, realizada sob a orientação científica do Professor Doutor Manuel Luís Capelas e Mestre Eduardo Manuel Neves Oliveira Carqueja, Professores Convidados pela Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco.

APP RERMS enriched matrix as an adhesion substrate for neuritic outgrowth

Specific domains can determine protein structural functional relationships. For the Alzheimer’s Amyloid Precursor Protein (APP) several domains have been described, both in its intracellular and extracellular fragments. Many functions have been attributed to APP including an important role in cell adhesion and cell to cell recognition. This places APP at key biological responses, including synaptic transmission. To fulfil these functions, extracellular domains take on added significance. The APP extracellular domain RERMS is in fact a likely candidate to be involved in the aforementioned physiological processes. A multidisciplinary approach was employed to address the role of RERMS. The peptide RERMS was crosslinked to PEG (Polyethylene glycol) and the reaction validated by FTIR (Fourier transform infrared spectrometry). FTIR proved to be the most efficient at validating this reaction because it requires only a drop of sample, and it gives information about the reactions occurred in a mixture. The data obtained consist in an infrared spectra of the sample, where peaks positions give information about the structure of the molecules, and the intensity of peaks is related to the concentration of the molecules. Subsequently substrates of PEG impregnated with RERMS were prepared and SH-SY5Y (human neuroblastoma cell line) cells were plated and differentiated on the latter. Several morphological alterations were clearly evident. The RERMS peptide provoked cells to take on a flatter appearance and the cytoskeletal architecture changed, with the appearance of stress fibres, a clear indicator of actin reorganization. Given that focal adhesions play a key role in determining cellular structure the latter were directly investigated. Focal adhesion kinase (FAK) is one of the most highly expressed proteins in the CNS (central nervous system) during development. It has been described to be crucial for radial migration of neurons. FAK can be localized in growth cones and mediated the response to attractive and repulsive cues during migration. One of the mechanisms by which FAK becomes active is by auto phosphorylation at tyrosine 397. It became clearly evident that in the presence of the RERMS peptide pFAK staining at focal adhesions intensified and more focal adhesions became apparent. Furthermore speckled structures in the nucleus, putatively corresponding to increased expression activity, also increased with RERMS. Taken together these results indicate that the RERMS domain in APP plays a critical role in determining cellular physiological responses. Here is suggested a model by which RERMS domain is recognized by integrins and mediate intracellular responses involving FAK, talin, actin filaments and vinculin. This mechanism probably is responsible for mediating cell adhesion and neurite outgrowth on neurons.