Quantitative analysis of chromosomal CGH in human breast tumors associates copy number abnormalities with p53 status and patient survival

We present a general method for rigorously identifying correlations between variations in large-scale molecular profiles and outcomes and apply it to chromosomal comparative genomic hybridization data from a set of 52 breast tumors. We identify two loci where copy number abnormalities are correlated with poor survival outcome (gain at 8q24 and loss at 9q13). We also identify a relationship between abnormalities at two loci and the mutational status of p53. Gain at 8q24 and loss at 5q15-5q21 are linked with mutant p53. The 9q and 5q losses suggest the possibility of gene products involved in breast cancer progression. The analytical techniques are general and also are applicable to the analysis of array-based expression data.

Avaliação de boas práticas em saúde mental na atenção psicossocial

A partir do redirecionamento do modelo assistencial no Brasil emerge a necessidade de discussão da reinvenção de práticas alinhadas com o cenário de transformações. As práticas agora devem se desenvolver no sentido de superar o isolamento das grades, dos muros e das chaves, do apagamento do sujeito, da supressão de sintomas e das personalidades dos sujeitos em sofrimento psíquico. Diante disso, é que este estudo tem como objetivos avaliar boas práticas em saúde mental na atenção psicossocial no contexto de um município da região Sul do Brasil. Para tanto, organizou-se como uma pesquisa avaliativa construtivista, com enfoque responsivo, a medida que desenvolve um consenso critico entre os grupos de interesse. Está baseada na Avaliação de Quarta Geração, proposta por Guba e Lincoln (2011), que emerge como opção metodológica e se articula com o referencial teórico das \"Boas Práticas em Saúde Mental Comunitária\", proposto por Thornicroft e Tansella (2010). Este é apresentado de modo a identificar boas práticas na saúde mental, com base na articulação de 3 eixos indispensáveis e indissociáveis: a ética, como princípio fundamental que deverá orientar o planejamento, a assistência e a avaliação dos serviços. A evidência deve embasar as intervenções e serviços. E a experiência como uma evidência do que vem sendo produzido nas experiências locais e regionais de organização da rede de serviços. Como resultado do processo as práticas de Acolhimento, Projeto Terapêutico Singular e Transferência de Cuidados emergiram para discussão. O Acolhimento torna-se concreto nas ações da Porta Aberta, e significa escuta qualificada no momento em que a necessidade emerge, além de representar a oferta de atenção de qualidade baseada no processo relacional que fortalece o estabelecimento de vínculos e a construção de projetos de vida. O Projeto Terapêutico Singular apresenta-se como uma boa prática, a medida que é capaz de dar resposta singularizada e individualizada às necessidades do sujeito, de modo a oportunizar como resultado uma pessoa capaz de andar na vida. É definido de forma compartilhada entre equipe, usuário e família, segundo os objetivos terapêuticos para cada sujeito, e utiliza o técnico de referência, as mini equipes, as oficinas terapêuticas, os grupos terapêuticos, as assembleias, enfim, ofertas e propostas que permitem ao sujeito retomar o envolvimento com os espaços da cidade, no caminho da produção de vida. Com relação à Transferência de Cuidados, esta possibilita ao sujeito que vive o processo não só circular em uma rede de serviços, mas, acima de tudo, buscar, com suporte dela, sua emancipação. Para tanto, investe em práticas que estimulem a autonomia dos sujeitos, por meio de instrumentos como o Acompanhamento Terapêutico, Grupo de Apoio à Alta, espaços de decisões e discussões, estímulo à busca e resolução de problemas, atividades de reconhecimento dos espaços da cidade, transporte, cultura e lazer. Além disso, investe nas ações com a Atenção Básica, a partir do Apoio Matricial com processos de formação continuada com as equipes, e mapeamento da situação da saúde mental nos territórios. Ao final deste estudo, é possível concluir que o modelo de atenção psicossocial demonstrou potencialidade de produzir boas práticas na atenção à saúde mental, e que estas tem transformado a vida dos sujeitos em sofrimento psíquico, bem como tem auxiliado no processo de reconquista de espaços sociais

The Importance of the First Psychotherapy Case in the Development of the Therapist's Professional Self as Viewed Through the Lens of Self Psychology

This paper explores the gap in the literature between what is herein referred to as the "first psychotherapy case" and its impact on the development of the trainee psychotherapist's professional self. The self psychology concepts of identity development, selfobject needs and fulfillment, narcissism, shame, countertransference, and structuralization are incorporated into the theoretical framework from which this developmental milestone is viewed. The theory's emphasis on early experiences and the development of self highlight the distinctiveness of the first case for the therapist. The beginning psychotherapy case poses a unique context for selfobject experiences and the developing self, involving both the therapist's presumably mature needs (assuming an existing cohesive nuclear self) and more infantile needs as the professional, peripheral self develops. As a result, the potential and important implications for the psychotherapist, the patient, training implications for the supervisor, and the ensuing treatment through termination are identified. The intent is to shed light on an area that is understudied thus far, and to begin a conversation as to why and how the impact of the first case on the psychotherapist should be examined. Implications, limitations, and ideas for future exploratory and qualitative research are also discussed.

Blurring the lines : how Japanese American internment camps re-defined art and religion's relationship

After the Japanese bombed Pearl Harbor during WWII, anyone of Japanese descent living on the West Coast was placed in internment camps scattered throughout the country. Life inside the camps included many different activities to make life as normal as possible. This study will focus on two intersecting day-to-day activities in particular, the practice of religion within the camps, as well as the creation of art. Art created in the camps was influenced by multiple religious traditions. An analysis of artworks created by professional and amateur artists, interviews and an examination of existing scholarship demonstrates that internment camps created a unique environment for the creation of art. The values of internees reflected the seamless coexistence of Christianity, Buddhism and Shinto in internment camp art.

Perceived emotional intelligence, general intelligence and early professional success: predictive and incremental validity

Although the study of factors affecting career success has shown connections between biographical and other aspects related to ability, knowledge and personality, few studies have examined the relationship be-tween emotional intelligence and professional success at the initial career stage. When these studies were carried out, the results showed significant relationships between the dimensions of emotional intelligence (emotional self-awareness, self-regulation, social awareness or social skills) and the level of professional competence. In this paper, we analyze the relationship between perceived emotional intelligence, measured by the Trait Meta-Mood Scale (TMMS-24) questionnaire, general intelligence assessed by the Cattell factor "g" test, scale 3, and extrinsic indicators of career success, in a sample of 130 graduates at the beginning of their careers. Results from hierarchical regression analysis indicate that emotional intelligence makes a specific contribution to the prediction of salary, after controlling the general intelligence effect. The perceived emotional intelligence dimensions of TMMS repair, TMMS attention and sex show a higher correlation and make a greater contribution to professional success than general intelligence. The implications of these results for the development of socio-emotional skills among University graduates are discussed.

Teachers’ beliefs about diversity: an analysis from a personal and professional perspective

The purpose of this study was to examine the beliefs that teachers have about diversity and their level of sensitivity towards some topics related to it. Moreover, beliefs were compared according to teachers’ personal and professional views and teaching experience. The Personal and Professional Beliefs about Diversity Scales (Pohan and Aguilar, 1999) were administered to a sample of 233 teachers. Results showed highly positive beliefs towards diversity in all its dimensions (cultural, linguistic and social diversity, ability, gender, sexual orientation and religion), especially regarding its personal implications compared to the professional ones. Likewise, it was observed a significant relationship between years of teaching experience and professional beliefs about diversity, so teachers with no school experience showed a higher tolerance than those with teaching experience, mainly in aspects related to cultural, linguistic and social differences, ability and gender. The implications that these results have for educational practice and the need for the development of multicultural education courses that favour an effective teaching are discussed.

The Virtual Interactive Relationship Between BIM Project Teams: Effective Communication to aid Collaboration in the Design Process

Building Information Modelling (BIM) provides a shared source of information about a built asset, which creates a collaborative virtual environment for project teams. Literature suggests that to collaborate efficiently, the relationship between the project team is based on sympathy, obligation, trust and rapport. Communication increases in importance when working collaboratively but effective communication can only be achieved when the stakeholders are willing to act, react, listen and share information. Case study research and interviews with Architecture, Engineering and Construction (AEC) industry experts suggest that synchronous face-to-face communication is project teams’ preferred method, allowing teams to socialise and build rapport, accelerating the creation of trust between the stakeholders. However, virtual unified communication platforms are a close second-preferred option for communication between the teams. Effective methods for virtual communication in professional practice, such as virtual collaboration environments (CVE), that build trust and achieve similar spontaneous responses as face-to-face communication, are necessary to face the global challenges and can be achieved with the right people, processes and technology. This research paper investigates current industry methods for virtual communication within BIM projects and explores the suitability of avatar interaction in a collaborative virtual environment as an alternative to face-to-face communication to enhance collaboration between design teams’ professional practice on a project. Hence, this paper presents comparisons between the effectiveness of these communication methods within construction design teams with results of further experiments conducted to test recommendations for more efficient methods for virtual communication to add value in the workplace between design teams.

Notificação de incidentes e segurança do doente : perceção dos enfermeiros

Enquadramento: A segurança do doente é um problema internacional e uma prioridade das políticas de saúde de múltiplos organismos/instituições nacionais de saúde. Neste âmbito, surgem os sistemas de notificação de incidentes. Objetivo: Conhecer a perceção dos enfermeiros sobre a notificação de incidentes e sobre a segurança do doente. Métodos: Recorremos a uma triangulação metodológica constituída por um estudo quantitativo (estudo A) e outro qualitativo (estudo B). O estudo A é analítico, transversal, realizado com 182 enfermeiros. Os dados foram recolhidos por questionário, constituído por variáveis sociodemográficas e profissionais e escalas para avaliar doze dimensões da notificação e segurança do doente. O estudo B é exploratório, realizado com 18 enfermeiros, através de entrevista semiestruturada. Resultados: Para os enfermeiros todos os incidentes devem ser notificados, mas a frequência de notificação é baixa e diminui com a gravidade do dano, 65,0% não registou qualquer ocorrência no último ano e 82,3% desconhece o sistema de notificação. Os principais obstáculos à notificação são o receio de punição e os principais fatores facilitadores são os benefícios que advêm da notificação para o doente, a ausência de retaliações no trabalho, uma relação positiva com os superiores hierárquicos, o anonimato e a perceção de resultados da notificação. Aproximadamente 60,0% dos enfermeiros tem uma perceção geral da segurança do doente positiva. Conclusão: A perceção dos enfermeiros sobre a notificação de incidentes reflete desconhecimento da temática, elevado receio de punição, originando baixa frequência de notificação. A perceção sobre a segurança do doente é positiva. É necessário melhorar a cultura de segurança da organização e o conhecimento dos enfermeiros sobre o papel da notificação. Palavras-Chave: segurança do doente, notificação de incidentes, enfermeiros.

The impact of depression on patient outcomes among older adults with lung cancer

Thesis (Ph.D.)--University of Washington, 2016-06

The relationship between acute alcohol consumption and consequent injury type

Aims: The aim of this study was to quantify the relationship between acute alcohol consumption and injury type (nature of injury, body region injured), while adjusting for the effect of known confounders (i.e. demographic and situational variables, usual drinking patterns, substance use and risk-taking behaviour). Methods: A cross-sectional study was conducted between October, 2000 and October, 2001 of patients aged >= 15 years presenting to a Queensland Emergency Department for treatment of an injury sustained in the preceding 24 h. There were three measures of acute alcohol consumption: drinking setting, quantity, and beverage type consumed in the 6 h prior to injury. Two variables were used to quantify injury type: nature of injury (fracture/dislocation, superficial, internal, and CNS injury) and body part injured (head/neck, facial, chest, abdominal, external, and extremities). Both were derived from patient medical records. Results: Five hundred and ninety three patients were interviewed. Logistic regression analyses indicated that, after controlling for relevant confounding variables, there was no significant association between any of the three measures of acute alcohol consumption and injury type. Conclusions: The effects of acute alcohol consumption are not specific to injury type. Interventions aimed at reducing the incidence of alcohol-related injury should not be targeted at specific injury types.

Remembrance of things past: Amnesic syndrome with partial preservation of professional skills

J.L., then a 25-year-old physiotherapist, became densely amnesic following herpes simplex encephalitis. She displayed severe retrograde amnesia, category-specific semantic memory loss, and a profound anterograde amnesia affecting both verbal and visual memory. Her working memory systems were relatively spared as were most of her cognitive problem-solving abilities, but her social functioning was grossly impaired. She was able to demonstrate several previously learned physiotherapy skills, but was unable to modify her application of these procedures in accordance with patient response. She showed no memory of theoretical or propositional knowledge, and could neither plan treatment or reason clinically. Three years later, J.L. had profound impairment of anterograde and retrograde declarative memory, with relative sparing of working memory for problem solving and long-term memory of procedural skills. The theoretical and practical implications of her amnesic syndrome are discussed.

Patient self-efficacy and health locus of control: relationships with health status and arthritis-related expenditure

Objective. To explore the relationship between measures of self-efficacy, health locus of control, health status and direct medical expenditure among community-dwelling subjects with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods. This analysis is part of a larger ongoing study of the costs and outcomes of arthritis and its treatments. Community-dwelling RA and OA respondents completed questionnaires concerning arthritis-related expenditure, health status, arthritis related self-efficacy and health locus of control. Results. Data were obtained from 70 RA respondents and 223 OA respondents. The majority of respondents were female with a mean age of 63 yr for RA respondents and 68 yr for OA respondents. Among the RA respondents, those with higher self-efficacy reported better health status and lower overall costs. Health locus of control was not consistently correlated with health status. OA respondents with higher self-efficacy reported better health status and lower costs. Health locus of control had more influence. OA respondents with higher external locus of control reported worse pain and function. A higher belief in chance as a determinant of health was correlated with more visits to general practitioners and a higher cost to both the respondent and the health system. Conclusion. Higher self-efficacy, which is amenable to change through education programmes, was associated with better health status and lower costs to the respondent and the health system in this cross-sectional study. Locus of control had less of an influence; however, the tendency was for those with higher external locus of control to have higher costs and worse health status. As the measurement of these constructs is simple and the outcome potentially affects health status, these results have implications for future intervention studies to improve quality of life and reduce the financial impact of arthritis on both the health-care system and patients.

Protein contamination of the laryngeal mask airway and its relationship to re-use

The Laryngeal Mask Airway is a reusable device for maintaining the patency of a patient's airway during general anaesthesia. The device can be reused after it has been cleaned and sterilized. Protein contamination of medical instruments is a concern and has been found to occur despite standard sterilization techniques. The reason for the concern relates to the possibility of the transmission of prions and the risk of developing a neurodegenerative disorder such as Creutzveldt-Jacob disease. The purpose of this study was to quantify the amount of protein contamination that occurs, and to relate this to the number of times the Laryngeal Mask Airway has been used. Fifty previously used Classic Laryngeal Masks were collected after routine sterilization and packaging. The devices were immersed in protein detecting stain and then visual inspection performed to assess the degree and distribution of the staining. The researcher was blinded to the number of times the Laryngeal Mask Airway had been used. Linear regression analysis of the degrees of staining of the airway revealed that protein contamination occurs after the first use of the device and this increases with each subsequent use. This finding highlights the concern that the currently used cleaning and sterilization methods do not prevent the accumulation of proteinaceous material on Laryngeal Mask Airways. Consideration should be given to the search for more efficient cleaning and sterilization techniques or the use of disposable devices.

A pilot study of email in an e-mentoring relationship

E-mentoring is an alternative to conventional face-to-face mentoring, incorporating the use of email, bulletin boards, discussion groups, instant messaging and videoconferencing. In a pilot trial, a New Zealand midwife mentored two new graduate midwives using a secure email system. The main themes of the email messages exchanged were debriefing and reflection, clinical queries, provision of information and discussion of professional issues. The pilot study showed that e-mentoring is a feasible option for midwives and warrants further investigation. Both mentor and mentees found the experience to be a helpful one. One of the advantages for both mentor and mentees was the flexibility of communication, since responses to email messages could be made at times that suited the authors. Nevertheless, issues of Internet access and the technical expertise of midwives will need to be considered in order for large scale e-mentoring to be implemented.

Reflections on the centrality of power in medical sociology: an empirical test and theoretical elaboration

This paper explores the contemporary relevance of sociological theorisations centred on medical power, including the medical dominance and deprofessionalisation theses. To achieve this it examines two issues that have been tentatively linked to the relative decline of the power and autonomy of biomedicine - complementary and alternative medicine (CAM) and the Internet-informed patient. Drawing on these two different but interconnected social phenomena, this paper reflects on the potential limitations of power-based theorisations of the medical profession and its relationship to patients and other non-biomedically situated professional groups. It is argued that power-based conceptual schemas may not adequately reflect the non-linear and complex strategic adaptations that are occurring among professional groups.