Evaluation of quality of life in a palliative care context: an integrative literature review

The use of scales that have been validated and standardized for different cultures is very useful for identifying demands in the field of Palliative Care and implementing the most appropriate care. This integrative literature review focuses on instruments assessing the Quality of Life of patients under Palliative Care through a journal search in electronic databases. The study consisted of 49 papers identified in Medline/PubMed, of which 18 met the inclusion criteria previously defined. Information concerning the selected studies is presented and later categorized, with a greater emphasis on the analysis of the psychometric properties of validations of the Palliative Outcome Scale, conducted in three countries. This review enabled the identification of instruments already developed and validated for different cultures, increasing the possibility of knowledge in the field.

Perioperative latex hypersensitivity reactions: an integrative literature review

This article characterizes hypersensitivity reactions during anesthetic-surgical procedures. This integrative literature review was conducted in the LILACS, CINAHL, COCHRANE and MEDLINE databases including papers published from 1966 to September 2011. A total of 17 case reports, two prevalence studies and one cohort study were identified. Latex reactions were mainly type III and the primary source of intraoperative reaction was latex gloves. The average time for clinical manifestation was 59.8 minutes after anesthetic induction; 44.4% of patients reported a reaction to latex at the pre-anesthetic evaluation. It was determined that the history of allergic reactions to latex obtained in the pre-anesthetic evaluation does not ensure the safety of patients if the staff is inattentive to the severity of the issue. There is also a tendency to initially attribute the anaphylactic event to the anesthetic drugs.

Neuroimaging in specific phobia disorder: a systematic review of the literature

OBJECTIVE: Specific phobia (SP) is characterized by irrational fear associated with avoidance of specific stimuli. In recent years, neuroimaging techniques have been used in an attempt to better understand the neurobiology of anxiety disorders. The objective of this study was to perform a systematic review of articles that used neuroimaging techniques to study SP. METHOD:A literature search was conducted through electronic databases, using the keywords: imaging, neuroimaging, PET, spectroscopy, functional magnetic resonance, structural magnetic resonance, SPECT, MRI, DTI, and tractography, combined with simple phobia and specific phobia. One-hundred fifteen articles were found, of which 38 were selected for the present review. From these, 24 used fMRI, 11 used PET, 1 used SPECT, 2 used structural MRI, and none used spectroscopy. RESULT: The search showed that studies in this area were published recently and that the neuroanatomic substrate of SP has not yet been consolidated. CONCLUSION: In spite of methodological differences among studies, results converge to a greater activation in the insula, anterior cingulate cortex, amygdala, and prefrontal and orbitofrontal cortex of patients exposed to phobia-related situations compared to controls. These findings support the hypotheses of the hyperactivation of a neuroanatomic structural network involved in SP.

Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL) ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT) ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with its minimally invasive counterparts.

Systematic studies of protein immobilization by surface plasmon field-enhanced fluorescence spectroscopy

The research interest of this study is to investigate surface immobilization strategies for proteins and other biomolecules by the surface plasmon field-enhanced fluorescence spectroscopy (SPFS) technique. The recrystallization features of the S-layer proteins and the possibility of combining the S-layer lattice arrays with other functional molecules make this protein a prime candidate for supramolecular architectures. The recrystallization behavior on gold or on the secondary cell wall polymer (SCWP) was recorded by SPR. The optical thicknesses and surface densities for different protein layers were calculated. In DNA hybridization tests performed in order to discriminate different mismatches, recombinant S-layer-streptavidin fusion protein matrices showed their potential for new microarrays. Moreover, SCWPs coated gold chips, covered with a controlled and oriented assembly of S-layer fusion proteins, represent an even more sensitive fluorescence testing platform. Additionally, S-layer fusion proteins as the matrix for LHCII immobilization strongly demonstrate superiority over routine approaches, proving the possibility of utilizing them as a new strategy for biomolecular coupling. In the study of the SPFS hCG immunoassay, the biophysical and immunological characteristics of this glycoprotein hormone were presented first. After the investigation of the effect of the biotin thiol dilution on the coupling efficiently, the interfacial binding model including the appropriate binary SAM structure and the versatile streptavidin-biotin interaction was chosen as the basic supramolecular architecture for the fabrication of a SPFS-based immunoassay. Next, the affinity characteristics between different antibodies and hCG were measured via an equilibrium binding analysis, which is the first example for the titration of such a high affinity interaction by SPFS. The results agree very well with the constants derived from the literature. Finally, a sandwich assay and a competitive assay were selected as templates for SPFS-based hCG detection, and an excellent LOD of 0.15 mIU/ml was attained via the “one step” sandwich method. Such high sensitivity not only fulfills clinical requirements, but is also better than most other biosensors. Fully understanding how LHCII complexes transfer the sunlight energy directionally and efficiently to the reaction center is potentially useful for constructing biomimetic devices as solar cells. After the introduction of the structural and the spectroscopic features of LHCII, different surface immobilization strategies of LHCII were summarized next. Among them the strategy based on the His-tag and the immobilized metal (ion) affinity chromatography (IMAC) technique were of great interest and resulted in different kinds of home-fabricated His-tag chelating chips. Their substantial protein coupling capacity, maintenance of high biological activity and a remarkably repeatable binding ability on the same chip after regeneration was demonstrated. Moreover, different parameters related to the stability of surface coupled reconstituted complexes, including sucrose, detergent, lipid, oligomerization, temperature and circulation rate, were evaluated in order to standardize the most effective immobilization conditions. In addition, partial lipid bilayers obtained from LHCII contained proteo-liposomes fusion on the surface were observed by the QCM technique. Finally, the inter-complex energy transfer between neighboring LHCIIs on a gold protected silver surface by excitation with a blue laser (λ = 473nm) was recorded for the first time, and the factors influencing the energy transfer efficiency were evaluated.

Oxidation and pyrolysis of methane and methyl formate in a plug flow reactor: computational and experimenal studies

Biodiesel represents a possible substitute to the fossil fuels; for this reason a good comprehension of the kinetics involved is important. Due to the complexity of the biodiesel mixture a common practice is the use of surrogate molecules to study its reactivity. In this work are presented the experimental and computational results obtained for the oxidation and pyrolysis of methane and methyl formate conducted in a plug flow reactor. The work was divided into two parts: the first one was the setup assembly whilst, in the second one, was realized a comparison between the experimental and model results; these last was obtained using models available in literature. It was started studying the methane since, a validate model was available, in this way was possible to verify the reliability of the experimental results. After this first study the attention was focused on the methyl formate investigation. All the analysis were conducted at different temperatures, pressures and, for the oxidation, at different equivalence ratios. The results shown that, a good comprehension of the kinetics is reach but efforts are necessary to better evaluate kinetics parameters such as activation energy. The results even point out that the realized setup is adapt to study the oxidation and pyrolysis and, for this reason, it will be employed to study a longer chain esters with the aim to better understand the kinetic of the molecules that are part of the biodiesel mixture.

Studies on the dual in Mycenaean, in the Homeric poetry and in the Attic Theatre of the 5th century — morphological, dialectal and stylistical variations

The present dissertation focuses on the dual number in Ancient Greek in a diachronical lapse stretching from the Mycenaean age to the Attic Drama and Comedy of the 5th century BC. In the first chapter morphological issues are addressed, chiefly in a comparative perspective. The Indo European evidence on the dual is hence gathered in order to sketch patterns of grammaticalisation and paradigmatisation of specific grams, growing increasingly functional within the Greek domain. In the second chapter syntactical problems are tackled. After a survey of scholarly literature on the Greek dual, we engage in a functional and typological approach, in order to disentangle some biased assessments on the dual, namely its alleged lack of regularity and intermittent agreement. Some recent frameworks in General Linguistics provide useful grounds for casting new light on the subject. Internal Reconstruction, for instance, supports the facultativity of the dual in each and every stage of its development; Typology and the Animacy Hierarcy add precious cross linguistical insight on the behaviour of the dual toward agreement. Glaring differences also arise as to the adoption — or avoidance — of the dual by different authors. Idiolectal varieties prove in fact conditioned by stylistical and register necessity. By means of a comparison among Epics, Tragedy and Comedy it is possible to enhance differences in the evaluation of the dual, which led sometimes to forms of ‘censure’ — thus triggering the onset of competing strategies to express duality. The last two chapters delve into the tantalising variety of the Homeric evidence, first of all in an account of the notorious issue of the Embassy of Iliad IX, and last in a commentary of all significant Homeric duals — mostly represented by archaisms, formulae, and ad hoc coinages.

Ontogenetic studies on the determination of the apical meristem in racemose inflorescences

This thesis presents a comparative developmental study of inflorescences and focuses on the production of the terminal flower (TF). Morphometric attributes of inflorescence meristems (IM) were obtained throughout the ontogeny of inflorescence buds with the aim of describing possible spatial constraints that could explain the failure in developing the TF. The study exposes the inflorescence ontogeny of 20 species from five families of the Eudicots (Berberidaceae, Papaveraceae-Fumarioideae, Rosaceae, Campanulaceae and Apiaceae) in which 745 buds of open (i.e. without TF) and closed (i.e. with TF) inflorescences were observed under the scanning electron microscope.rnThe study shows that TFs appear on IMs which are 2,75 (se = 0,38) times larger than the youngest lateral reproductive primordium. The shape of these IMs is characterized by a leaf arc (phyllotactic attribute) of 91,84° (se = 7,32) and a meristematic elevation of 27,93° (se = 5,42). IMs of open inflorescences show a significant lower relative surface, averaging 1,09 (se=0,26) times the youngest primordium size, which suggests their incapacity for producing TFs. The relative lower size of open IMs is either a condition throughout the complete ontogeny (‘open I’) or a result from the drastic reduction of the meristematic surface after flower segregation (‘open II’). rnIt is concluded that a suitable bulge configuration of the IM is a prerequisite for TF formation. Observations in the TF-facultative species Daucus carota support this view, as the absence of the TF in certain umbellets is correlated with a reduction of their IM dimensions. A review of literature regarding histological development of IMs and genetic regulation of inflorescences suggests that in ‘open I’ inflorescences, the histological composition and molecular activity at the tip of the IM could impede the TF differentiation. On the other side, in ‘open II’ inflorescences, the small final IM bulge could represent a spatial constraint that hinders the differentiation of the TF. The existence of two distinct kinds of ontogenies of open inflorescences suggests two ways in which the loss of the TF could have occurred in the course of evolution.rn

Validation of a new method to assess the long-term Hypothalamic-Pituitary-Adrenal Activity using hair glucocorticoids as biomarkers. - Studies on pigs and laboratory Sprague-Dawley Rats

The evaluation of chronic activity of the hypothalamic-pituitary-adrenal (HPA) axis is critical for determining the impact of chronic stressful situations. The potential use of hair glucocorticoids as a non-invasive, retrospective, biomarker of long term HPA activity is of great interest, and it is gaining acceptance in humans and animals. However, there are still no studies in literature examining hair cortisol concentration in pigs and corticosterone concentration in laboratory rodents. Therefore, we developed and validated, for the first time, a method for measuring hair glucocorticoids concentration in commercial sows and in Sprague-Dawley rats. Our preliminary data demonstrated: 1) a validated and specific washing protocol and extraction assay method with a good sensitivity in both species; 2) the effect of the reproductive phase, housing conditions and seasonality on hair cortisol concentration in sows; 3) similar hair corticosterone concentration in male and female rats; 4) elevated hair corticosterone concentration in response to chronic stress manipulations and chronic ACTH administration, demonstrating that hair provides a good direct index of HPA activity over long periods than other indirect parameters, such adrenal or thymus weight. From these results we believe that this new non-invasive tool needs to be applied to better characterize the overall impact in livestock animals and in laboratory rodents of chronic stressful situations that negatively affect animals welfare. Nevertheless, further studies are needed to improve this methodology and maybe to develop animal models for chronic stress of high interest and translational value in human medicine.

Nucleation studies on graphics processing units

Ein System in einem metastabilen Zustand muss eine bestimmte Barriere in derrnfreien Energie überwinden um einen Tropfen der stabilen Phase zu formen.rnHerkömmliche Untersuchungen nehmen hierbei kugelförmige Tropfen an. Inrnanisotropen Systemen (wie z.B. Kristallen) ist diese Annahme aber nicht ange-rnbracht. Bei tiefen Temperaturen wirkt sich die Anisotropie des Systems starkrnauf die freie Energie ihrer Oberfläche aus. Diese Wirkung wird oberhalb derrnAufrauungstemperatur T R schwächer. Das Ising-Modell ist ein einfaches Mo-rndell, welches eine solche Anisotropie aufweist. Wir führen großangelegte Sim-rnulationen durch, um die Effekte, die mit einer endlichen Simulationsbox ein-rnhergehen, sowie statistische Ungenauigkeiten möglichst klein zu halten. DasrnAusmaß der Simulationen die benötigt werden um sinnvolle Ergebnisse zu pro-rnduzieren, erfordert die Entwicklung eines skalierbaren Simulationsprogrammsrnfür das Ising-Modell, welcher auf verschiedenen parallelen Architekturen (z.B.rnGrafikkarten) verwendet werden kann. Plattformunabhängigkeit wird durch ab-rnstrakte Schnittstellen erreicht, welche plattformspezifische Implementierungs-rndetails verstecken. Wir benutzen eine Systemgeometrie die es erlaubt eine Ober-rnfläche mit einem variablen Winkel zur Kristallebene zu untersuchen. Die Ober-rnfläche ist in Kontakt mit einer harten Wand, wobei der Kontaktwinkel Θ durchrnein Oberflächenfeld eingestellt werden kann. Wir leiten eine Differenzialglei-rnchung ab, welche das Verhalten der freien Energie der Oberfläche in einemrnanisotropen System beschreibt. Kombiniert mit thermodynamischer Integrationrnkann die Gleichung benutzt werden, um die anisotrope Oberflächenspannungrnüber einen großen Winkelbereich zu integrieren. Vergleiche mit früheren Mes-rnsungen in anderen Geometrien und anderen Methoden zeigen hohe Überein-rnstimung und Genauigkeit, welche vor allem durch die im Vergleich zu früherenrnMessungen wesentlich größeren Simulationsdomänen erreicht wird. Die Temper-rnaturabhängigkeit der Oberflächensteifheit κ wird oberhalb von T R durch diernKrümmung der freien Energie der Oberfläche für kleine Winkel gemessen. DiesernMessung lässt sich mit Simulationsergebnissen in der Literatur vergleichen undrnhat bessere Übereinstimmung mit theoretischen Voraussagen über das Skalen-rnverhalten von κ. Darüber hinaus entwickeln wir ein Tieftemperatur-Modell fürrndas Verhalten um Θ = 90 Grad weit unterhalb von T R. Der Winkel bleibt bis zu einemrnkritischen Feld H C quasi null; oberhalb des kritischen Feldes steigt der Winkelrnrapide an. H C wird mit der freien Energie einer Stufe in Verbindung gebracht,rnwas es ermöglicht, das kritische Verhalten dieser Größe zu analysieren. Die harternWand muss in die Analyse einbezogen werden. Durch den Vergleich freier En-rnergien bei geschickt gewählten Systemgrößen ist es möglich, den Beitrag derrnKontaktlinie zur freien Energie in Abhängigkeit von Θ zu messen. Diese Anal-rnyse wird bei verschiedenen Temperaturen durchgeführt. Im letzten Kapitel wirdrneine 2D Fluiddynamik Simulation für Grafikkarten parallelisiert, welche u. a.rnbenutzt werden kann um die Dynamik der Atmosphäre zu simulieren. Wir im-rnplementieren einen parallelen Evolution Galerkin Operator und erreichen

The Trauma Towers: Dimensions of Trauma in 9/11 Literature

The topic of this dissertation is the aspects of trauma and reaction to the traumatic experience that can be found in 9/11 literature. The research engages in a comparative analysis of five books that can be categorised as 9/11 literature, which means that the events of 9/11 are central in the novels and are a recurrent theme. The books have been written by authors of different nationalities: "Extremely Loud & Incredibily Close" by J. S. Foer, "Falling Man" by D. DeLillo, "Windows on the World" by F. Beigbeder, "Saturday" by I. McEwan and "The Reluctant Fundamentalist" by M. Hamid. The characters have either experienced the attacks personally or their lives have been largely influenced by the event. In either case, the protagonist has been traumatised by the tragedy. Therefore, in this study two different fields are fused together – the field of comparative literature and that of trauma studies.

Studies towards the total synthesis of penicillipyrone b via a biomimetic approach

Pennicillipyrone A and B are two novel meroterpenoids isolated from the marine-derived fungus Penicilliump sp. Although a preliminary toxicity studies demonstrated the bioactivity of penicillipyrone A to be far superior to that of its congener penicillipyrone B, we were intrigued by its structure. Moreover, it appeared as though one could design an efficient total synthesis based on chemistry that was familiar to our laboratory. The purpose of this project was the study of a new synthesis of Pennicillipyrone B by way of a doubley-biomimetic approach. The intended approach proceeds through a polyene cascade reaction terminated by a nucleophilic pyrone - a reaction not yet known in the literature for the construction of this type of scaffold. During the course of this study we have learned about the unanticipated reactivity of C2 substituted keto-dioxinones with regard to self-condensation. In addition, four new compounds were synthesized and two synthetic routes to the target molecule are presented.

Borrelia in granuloma annulare, morphea and lichen sclerosus: a PCR-based study and review of the literature

Morphea, granuloma annulare (GA) and lichen sclerosus et atrophicans (LSA) have also been suggested to be linked to Borrelia infection. Previous studies based on serologic data or detection of Borrelia by immunohistochemistry and polymerase chain reaction (PCR) reported contradictory results. Thus, we examined skin biopsies of morphea, GA and LSA by PCR to assess the prevalence of Borrelia DNA in an endemic area and to compare our results with data in the literature.

Source of funding in experimental studies of mobile phone use on health: Update of systematic review

A previous review showed that among 59 studies published in 1995–2005, industry-funded studies were least likely to report effects of controlled exposure to mobile phone radiation on health-related outcomes. We updated literature searches in 2005–2009 and extracted data on funding, conflicts of interest and results. Of 75 additional studies 12% were industry-funded, 44% had public and 19% mixed funding; funding was unclear in 25%. Previous findings were confirmed: industry-sponsored studies were least likely to report results suggesting effects. Interestingly, the proportion of studies indicating effects declined in 1995–2009, regardless of funding source. Source of funding and conflicts of interest are important in this field of research.