Laços e nós: A comunicação na relação médico- paciente com câncer e dor crônica

É alta a prevalência de dor crônica em pacientes com câncer, que é comprovadamente associada ao sofrimento psicológico acentuado e muitas vezes não é adequadamente diagnosticada e tratada. Estudo que realizamos com 120 pacientes adultos em atendimento ambulatorial na Clínica de Dor do Instituto Nacional de Câncer, no Rio de Janeiro que demonstrou que os pacientes mesmo conhecendo o seu diagnóstico de câncer, não se sentiam informados sobre a doença e a dor oncológica a contento, o que trazia insatisfação com o tratamento recebido e maior exigência com os resultados do mesmo. Nosso estudo revelou, ainda, que o comportamento do profissional durante o atendimento pode ser percebido pelos pacientes como fator tanto de melhora como de piora da dor, sendo o comportamento atencioso do profissional muitas vezes mais valorizado pelos pacientes que a supressão da dor. Estes resultados suscitaram questões relativas à qualidade da interação entre médicos e pacientes, desenvolvidas nesta dissertação. Embora não sejam suficientemente investidas nem na relação médico-paciente, nem na educação e no treinamento profissional, as habilidades de comunicação do médico afetam diretamente o nível de informação e de satisfação do paciente, suas crenças e os resultados do tratamento. Ao longo do tempo a relação médico paciente vem mudando, deixando de ser tão centrada na doença e no médico, para centrar-se mais no doente como um ser integral, o que implica no reconhecimento, pelo médico, de saberes diferentes dos seus e de que o seu saber não constitui uma verdade absoluta a ser acatada pelos demais. Apesar de bem-vindas, estas mudanças trazem uma certa confusão nos papéis a serem desempenhados por médicos e pacientes e dificuldades aos médicos de lidarem com as diferenças, com as queixas subjetivas dos pacientes, com as emoções destes e as suas próprias. Se hoje é esperado que os pacientes sejam participativos, corresponsáveis por seus tratamentos e recuperação e que se deem conta do poder que eles têm, individual e coletivamente, espera-se que os médicos sejam estudiosos, bem informados, experientes, sinceros, empáticos, sensíveis, atenciosos, compassivos, perspicazes, bem treinados, hábeis em compartilhar informações e decisões com os pacientes, compreendendo o que estes querem e o que não querem e ajudando-os a expressar suas crenças, preferências e receios, disponibilizando tempo suficiente para isso. Tantas expectativas terminam por trazer conflitos que só poderão ser resolvidos com a melhoria da comunicação entre médicos e pacientes, num esforço de ambas as partes.

Luminescence behavior of Yb(3+)heavy-doped yttrium lanthanum oxide transparent ceramics

Yb3+ heavy-doped yttrium lanthanum oxide transparent ceramics were fabricated and their spectroscopic properties were investigated. The absorption bands of (YbxY0.9-xLa0.1)(2)O-3 (x = 0.05-0.15) ceramics are broad at wavelength of 900-1000 nm. The absorption cross-sections centered at 974 nm and the emission cross-sections at 1031 nm of Yb3+ ion are 0.89-1.12 x 10(-20) cm(2) and 1.05 x 10(-20) cm(2) respectively. The up-conversion luminescence intensity of Yb3+-doped yttrium lanthanum oxide ceramics increased firstly, then decreased with the increase of Yb3+ ion content. (C) 2008 Elsevier B.V. All rights reserved.

Studying the influence of substitutional elements on mechanical behavior of Alloy 718

In nickel-based superalloys, substitutional solute species have a strong impact on in service mechanical properties as well as on oxidation and corrosion resistances. In alloy 718, recent studies carried out by tensile tests highlighted the fact that refractory solute species are able to interact strongly with mobile dislocations during plastic deformation, generating dynamic strain ageing, and, in wide ranges of tests temperatures and strain rates, Portevin-Le Chatelier effect. The precise nature of the substitutional element responsible for such a dynamic interaction is still subject to debate. We addressed this question by means of mechanical spectroscopy studies of alloy 718 and various related alloys corresponding to monitored changes in the chemical composition. Only a single internal friction relaxation peak has been observed for all the studied alloys. By analyzing the damping behavior of these alloys at different imposed solicitation frequencies by sweeping a large temperatures range, the activation energies of the relaxation process and the type of mechanism involved have been determined. The process is a "Zener relaxation" in the alloys, i.e. a substitutional atoms dipole reorientation under applied stress. The results tend to prove that Niobium is not involved in the relaxation process whereas Molybdenum content seems to play an important role in the relaxation intensity.

The effect of organotin and copper sulfate on the late development and presettlement behavior of the hard clam Mercenaria mercenaria

The effect of organotin compounds and copper, commonly used as antifouling agent, were studied on Mercenaria mercernaria larvae. They were reared under usual hatchery conditions until they reached 190 um in diameter. The larvae were subjected to four compounds, tributylin chloride (TBT), monobutyltin chloride (MBT), trimethyltin chloride (TMT), cupric sulfate (CuSo4) plus control. Mortality was measured at 24, 48 h, and 96h. Behavioral and/or metamorphic changes were recorded in triplicate at 24-48 and 96 h. The appearance in swimming larvae of a functional foot was considered a sign of competence to set and was recorded as a "pediveliger". Swimming larvae were considered as larvae that have not yet reached their total development and they were recorded as "swimming". Larvae that did not show foot or swimming activity and were static but alive on the bottom were recorded as "bottom". TBT was found to completely inhibit swimming activity at sublethal concentrations throughout the period of observation. Copper and MBT inhibited swimming from 48 h, TMT did not inhibit swimming activity at any of the times recorded. The four compounds ranked in order of decreasing toxicity were TBT>TMT>CU>MBT.

An evaluation of the effects of blue crab (Callinectes sapidus) behavior on the efficacy of crab pots as a tool for estimating population abundance

Crab traps have been used extensively in studies on the population dynamics of blue crabs to provide estimates of catch per unit of effort; however, these estimates have been determined without adequate consideration of escape rates. We examined the ability of the blue crab (Callinectes sapidus) to escape crab pots and the possibility that intraspecific crab interactions have an effect on catch rates. Approximately 85% of crabs that entered a pot escaped, and 83% of crabs escaped from the bait chamber (kitchen). Blue crabs exhibited few aggressive behavioral interactions in and around the crab pot and were documented to move freely in and out of the pot. Both the mean number and size of crabs caught were significantly smaller at deeper depths. Results from this study show that current estimates of catch per unit of effort may be biased given the high escape rate of blue crabs documented in this study. The results of this paper provide a mechanistic view of trap efficacy, and reveal crab behavior in and around commercial crab pots.

Use of stereo camera systems for assessment of rockfish abundance in untrawlable areas and for recording pollock behavior during midwater trawls

We describe the application of two types of stereo camera systems in fisheries research, including the design, calibration, analysis techniques, and precision of the data obtained with these systems. The first is a stereo video system deployed by using a quick-responding winch with a live feed to provide species- and size- composition data adequate to produce acoustically based biomass estimates of rockfish. This system was tested on the eastern Bering Sea slope where rockfish were measured. Rockfish sizes were similar to those sampled with a bottom trawl and the relative error in multiple measurements of the same rockfish in multiple still-frame images was small. Measurement errors of up to 5.5% were found on a calibration target of known size. The second system consisted of a pair of still-image digital cameras mounted inside a midwater trawl. Processing of the stereo images allowed fish length, fish orientation in relation to the camera platform, and relative distance of the fish to the trawl netting to be determined. The video system was useful for surveying fish in Alaska, but it could also be used broadly in other situations where it is difficult to obtain species-composition or size-composition information. Likewise, the still-image system could be used for fisheries research to obtain data on size, position, and orientation of fish.

Flatfish herding behavior in response to trawl sweeps: a comparison of diel responses to conventional sweeps and elevated sweeps

Commercial bottom trawls often have sweeps to herd fish into the net. Elevation of the sweeps off the seaf loor may reduce seafloor disturbance, but also reduce herding effectiveness. In both field and laboratory experiments, we examined the behavior of flatfish in response to sweeps. We tested the hypotheses that 1) sweeps are more effective at herding flatfish during the day than at night, when fish are unable to see approaching gear, and that 2) elevation of sweeps off the seafloor reduces herding during the day, but not at night. In sea trials, day catches were greater than night catches for four out of six flatfish species examined. The elevation of sweeps 10 cm significantly decreased catches during the day, but not at night. Laboratory experiments revealed northern rock sole (Lepidopsetta polyxystra) and Pacific halibut (Hippoglossus stenolepis) were more likely to be herded by the sweep in the light, whereas in the dark they tended to pass under or over the sweep. In the light, elevation of the sweep reduced herding, and more fish passed under the sweep. In contrast, in the dark, sweep elevation had little effect upon the number of fish that exhibited herding behavior. The results of both field and laboratory experiments were consistent with the premise that vision is the principle sensory input that controls fish behavior and orientation to trawl gear, and gear performance will differ between conditions where flatfish can see, in contrast to where they cannot see, the approaching gear.