Apoiador matricial: uma possibilidade de promover a interdisciplinaridade entre profissionais da saúde

This study aims to reflect the organization of the mental health services in primary care from a new organizational arrangement to health work, defined as Matrix Support (Campos, 1999), which aims to build technical and educational support in the relationship between health professionals from mental health professionals in the Family Health Strategy. The methodology used in the Matrix Support the “Wheel” method, which is mediated by a supporter who, through questions and reflections, points out possibilities for case discussions, promotes links between the health teams, discusses the concept of link between professionals and users, strengthens the co-responsability for the actions of health and tries to break the logic related with the services organized by referrals. So the wheels when they occur in health services enables the interdisciplinary, and through it, it is expected to talk about the complexity of the phenomena that surround each subject, so that they overcome the dichotomy between individual and collective, social and biological revealing new values to be incorporated into health practices. In front of this analysis that is theoric and conceptual, allied with the experience from a nursisn area professional that worked in this work method, can be concluded that this experience related here, eas strategic for the health care actions for strengthen based on the Unique Health system and Psych Rebuild principles.

Avessos do excesso: a assexualidade

Pós-graduação em Psicologia - FCLAS

Deficiência auditiva: estudos clínicos sobre o narcisismo materno

The diagnosis of hearing loss (HL) in a child constitutes a crisis, includinga possible crash in parental narcissism, requiring an individual, matrimonial andfamiliar reorganization process. The mother is the main figure to devote herselfattending the baby and generally takes the most responsibilities in the processof habilitation or rehabilitation of the child, while still having to deal with her frustratedexpectations and narcissism. This study aims to investigate the effects of a deaf child’s birth on the mother’s narcissism. Here understood as a normal stage of psychosexual development of the human being, needed for life preservation, nota pathology. Five different clinical pratical studies were developed with mothers of deaf children that were diagnosed less than one year ago. The data were collected using individual semi-structured interviews and Thematic Apperception Test (TAT). Based on these studies it was found that the birth of a deaf child makes it difficult to obtain the expected narcissist satisfaction. The mother, investing all her affection and longing almost only on her child, hopes to rebuild her dream obtaining the "cure" and "normality" of her baby by submitting him/her to a cochlear implant.

O engenheiro como construtor e reconstrutor no mundo

The formation of an engineer in each one of the several categories of this field must initially be related with their holistic training. If it they are working with teaching, this relation becomes even greater, because the professors need to teach and educate their students making them use these teachings in order to improve the society and the environment as a whole. The engineer must be engaged with the social problems in a context composed by human being and society, especially the contributions given to the mentioned society. According to Ferraz (198 MN3), "the engineering function is to design social institutions, rebuild them and ensure that the existing ones are operating". According to the same author, this action is gradual and must go step by step, always being concerned with social values, by comparing the achieved results and the ones that were expected.

The use of remote sensing imagery for monitoring recovery in the aftermath of a natural disaster: the Hurricane Katrina Case

Although Recovery is often defined as the less studied and documented phase of the Emergency Management Cycle, a wide literature is available for describing characteristics and sub-phases of this process. Previous works do not allow to gain an overall perspective because of a lack of systematic consistent monitoring of recovery utilizing advanced technologies such as remote sensing and GIS technologies. Taking into consideration the key role of Remote Sensing in Response and Damage Assessment, this thesis is aimed to verify the appropriateness of such advanced monitoring techniques to detect recovery advancements over time, with close attention to the main characteristics of the study event: Hurricane Katrina storm surge. Based on multi-source, multi-sensor and multi-temporal data, the post-Katrina recovery was analysed using both a qualitative and a quantitative approach. The first phase was dedicated to the investigation of the relation between urban types, damage and recovery state, referring to geographical and technological parameters. Damage and recovery scales were proposed to review critical observations on remarkable surge- induced effects on various typologies of structures, analyzed at a per-building level. This wide-ranging investigation allowed a new understanding of the distinctive features of the recovery process. A quantitative analysis was employed to develop methodological procedures suited to recognize and monitor distribution, timing and characteristics of recovery activities in the study area. Promising results, gained by applying supervised classification algorithms to detect localization and distribution of blue tarp, have proved that this methodology may help the analyst in the detection and monitoring of recovery activities in areas that have been affected by medium damage. The study found that Mahalanobis Distance was the classifier which provided the most accurate results, in localising blue roofs with 93.7% of blue roof classified correctly and a producer accuracy of 70%. It was seen to be the classifier least sensitive to spectral signature alteration. The application of the dissimilarity textural classification to satellite imagery has demonstrated the suitability of this technique for the detection of debris distribution and for the monitoring of demolition and reconstruction activities in the study area. Linking these geographically extensive techniques with expert per-building interpretation of advanced-technology ground surveys provides a multi-faceted view of the physical recovery process. Remote sensing and GIS technologies combined to advanced ground survey approach provides extremely valuable capability in Recovery activities monitoring and may constitute a technical basis to lead aid organization and local government in the Recovery management.

Architettura delle centrali idroelettriche italiane 1910-1940. L'esperienza di Giovanni Muzio e Piero Portaluppi

Oggetto della ricerca è il tema dello spazio delle centrali idroelettriche costruite nella prima metà del Novecento dagli architetti Giovanni Muzio e Piero Portaluppi. L’individuazione del tema sorge dalla volontà di indagare quali siano stati gli sviluppi dal punto di vista architettonico all’interno di un genere così specifico durante un periodo di tempo in cui gli stili architettonici e le tendenze hanno subito stravolgimenti ed evoluzioni che ancora oggi trovano una difficile connotazione e definizione precisa. L’analisi dell’architettura delle centrali idroelettriche, effettuata ripercorrendo le principali vicende del settore idroelettrico dalla fine del secolo scorso al secondo dopoguerra, oltre a considerare il rapporto con il contesto territoriale e culturale del nostro Paese vuole prendere in considerazione anche il particolare rapporto che in più casi si è venuto a creare tra committenti e progettisti. Compito della tesi è rileggere un settore poco indagato finora e capire se vi sia stata effettivamente una evoluzione architettonica dal punto di vista tipologico o se la centrale sia stata sempre affrontata come semplice esercizio di “vestizione” di un involucro precostituito da precise esigenze tecniche. La ricerca infatti si pone come obiettivo lo studio delle centrali non solo dal punto di vista tipologico e spaziale dei suoi principali elementi, ma si pone come obiettivo anche lo studio della loro distribuzione nel sito in cui sono sorte, distribuzione che spesso ha portato alla formazione di una sorta di vera e propria “città elettrica”, in cui la composizione dei vari elementi segue una logica compositiva ben precisa. Dal punto di vista del contributo originale la ricerca vuole proporre una serie di riflessioni ed elaborati inerenti alcune centrali non ancora indagate. Nel caso specifico di Portaluppi l’apporto originale consiste nell’aver portato alla luce notizie inerenti centrali che sono sempre state poste in secondo piano rispetto le ben più note e studiate centrali della Val d’Ossola. Nel caso invece di Muzio il contributo consiste in una analisi approfondita e in una comparazione di documenti che di solito sono sempre stati pubblicati come semplice apparato iconografico, ma che messi a confronto danno una lettura di quelle che sono state le fasi e le elaborazioni progettuali apportate dall’autore. Il tema della ricerca è stato affrontato poi attraverso una lettura delle fonti dirette relative agli scritti degli autori, con una contemporanea lettura di testi, articoli e interventi tratti dalle riviste appartenenti al periodo in esame per comprendere al meglio il panorama culturale e architettonico che hanno fatto da scenario alle esperienze di entrambe le figure oggetto di studio. Infine la ricerca si è concentrata sull’analisi di alcune opere in particolare - due centrali idroelettriche per ciascun autore oggetto della tesi - scelte perché considerate rappresentative sia per impianto spaziale e tipologico, sia per le scelte compositive e stilistiche adottate. La lettura dei manufatti architettonici scelti è stata condotta con l’analisi di copie di elaborati grafici originali, foto d’epoca e altri documenti reperiti grazie ad una ricerca condotta in vari archivi. Le centrali scelte nell’ambito delle esperienze maturate da Muzio e Portaluppi sono state individuate per rappresentare il quadro relativo allo sviluppo e alla ricerca di un nuovo linguaggio formale da adottare nell’ambito dell’architettura di questi manufatti. Per entrambi i protagonisti oggetto della ricerca sono state individuate due centrali in grado di dare una visione il più possibile completa dell’evoluzione della tematica delle centrali idroelettriche all’interno della loro esperienza, prendendo in considerazione soprattutto gli aspetti legati all’evoluzione del loro linguaggio compositivo e stilistico. L’individuazione delle centrali da analizzare è stata dettata prendendo in considerazione alcuni fattori come il tipo di impianto, le relazioni e confronto con il contesto geografico e naturale e le soluzioni adottate.

Transport infrastructure and economic development in least developed countries: the case of Afghanistan

This PhD thesis tries to show the impact of transport infrastructure in economic development in least developed countries and in particular in the case of Afghanistan. Some least developed countries during 1990 to 1999 experienced lack of investment in transportation. Lack of investment further increased the economic development gap between developed and least developed countries. Moreover, lack of literature and research in poor countries such as Afghanistan encouraged me to do my research in this country in order to unveil the problems, facing poor people who are living in inaccessible places and suffer from lack of economic opportunities and long term unemployment. This thesis shows the effect of inaccessibility and immobility in economic opportunities and basic social services in Afghanistan. This thesis is important because it covers the role of transport infrastructures at the moment that international community promised to rebuild the infrastructures of post conflict Afghanistan.

Utilizzo di dispositivi magnetici nel trattamento della patologia artrosica del ginocchio

The use of scaffolds for Tissue Engineering (TE) is increasing due to their efficacy in helping the body rebuild damaged or diseased tissue. Hydroxyapatite (HA) is the most suitable bioactive ceramic to be used in orthopaedic reconstruction since it replicates the mineral component of the hard tissues, and it has therefore excellent biocompatibility properties. The temporal and spatial control of the tissue regeneration process is the limit to be overcome in order to treat large bone and osteochondral defects. In this thesis we describe the realization of a magnetic scaffolds able to attract and take up growth factors or other bio-agents in vivo via a driving magnetic force. This concept involves the use of magnetic nanoparticles (MNP) functionalized with selected growth factors or stem cells. These functionalized MNP act as shuttles transporting the bio-agents towards and inside the scaffold under the effect of the magnetic field, enhancing the control of tissue regeneration processes. This scaffold can be imagined as a fixed “station” that provides a unique possibility to adjust the scaffold activity to the specific needs of the healing tissue. Synthetic bone graft substitutes, made of collagen or biomineralized collagen (i.e. biomimetic Hydroxyapatite/collagen composites) were used as starting materials for the fabrication of magnetic scaffolds. These materials are routinely used clinically to replace damaged or diseased cartilaginous or bone tissue. Our magnetization technique is based on a dip-coating process consisting in the infilling of biologically inspired porous scaffolds with aqueous biocompatible ferrofluids’ suspensions. In this technique, the specific interconnected porosity of the scaffolds allows the ferrofluids to be drawn inside the structure by capillarity. A subsequent freeze-drying process allows the solvent elimination while keeping very nearly the original shape and porosity of the scaffolds. The remaining magnetic nanoparticles, which are trapped in the structure, lead to the magnetization of the HA/Collagen scaffold. We demonstrate here the possibility to magnetize commercially available scaffolds up to magnetization values that are used in drug delivery processes. The preliminary biocompatibility test showed that the investigated scaffolds provide a suitable micro-environment for cells. The biocompatibility of scaffold facilitates the growth and proliferation of osteogenic cells.

Rupture du silence. L'écriture engagée de Gisèle Pineau

A writer by passion and a psychiatric nurse by profession, Gisèle Pineau is described as the new feminine voice of the literature from the French Antilles (Martinique and Guadeloupe). In all her novels, she explores the human condition and more specifically that of women. Breaking the silence that oppresses Antillean women, Gisèle Pineau delves into the destinies of women from Guadeloupe, scrutinizing the environment of her island and elsewhere, reinventing the French language, and giving voice and identity to all those women who have never had the possibility to express themselves. After having introduced the author in a postcolonial context linked with the theory of the feminine writing and its expressions in Caribbean literature, the plight of women is described through the experience of their bodies in Antillean society and elsewhere. The author focuses on physical and psychological violence denouncing the treatment of women. Escaping from oppression, women look for the space to rebuild a new life and a new identity.

Processi e impatti della migrazione. L'esperienza di chi resta in tre famiglie peruviane

Questo studio propone un’esplorazione dei nessi tra fenomeno migratorio, dinamiche transnazionali e quadri familiari, in un contesto specificato che è quello peruviano. Dal confronto critico con i paradigmi disciplinari in uso negli ambiti dell’antropologia delle migrazioni, degli studi sul transnazionalismo e sulle famiglie transnazionali, e dell’etnografia multi-situata, si è tentata una lettura teorica e metodologica che renda conto del contesto socio-familiare di partenza non come parte periferica di una completa visione del migrante, ma quale oggetto specifico della ricerca. L’obbiettivo è verificare, a livello locale, quale siano gli impatti della migrazione esterna di uno o più membri sulle strutture e sulle dinamiche, sui codici e sui ruoli del nucleo parentale originario. E individuare, sul piano transnazionale, quali reti, quali rituali o pratiche di connessione funzionino tra coloro che vanno e coloro che restano, quali discorsi e quali culture migratorie si sviluppino e si condividano. La ricerca si è svolta in Perù tra il 2009 ed il 2011. Il campo dell’indagine si è diviso tra due località nell’area della Costa del Perù. Lima, la capitale, e Chiclín, un villaggio rurale nella regione settentrionale de La Libertad. Attraverso le tecniche d’inchiesta della pratica etnografica, una permanenza prolungata sul terreno e l’osservazione partecipante, si è lavorato con i membri adulti di ambo i sessi di tre gruppi parentali distribuiti tra i due luoghi menzionati, selezionati in partenza sulla base dei contatti forniti da alcuni dei loro familiari emigrati in Italia tra il 1990 ed il 2000. Centrare l’analisi sulle figure per certi aspetti marginali dell’esperienza della migrazione normalmente considerata, è servito da un lato a rovesciare parzialmente la prospettiva transnazionale aggiustandola proprio rispetto a quegli attori sociali; dall’altro e ad un tempo, ha permesso di fare luce su dinamiche migratorie più generali, di ricostruirle e di ri-teorizzarle.

Stability of Contour Augmentation and Esthetic Outcomes of Implant Supported Single Crowns in the Esthetic Zone. 3-Year Results of a Prospective Study With Early Implant Placement Post Extraction

Early implant placement is one of the treatment options after tooth extraction. Implant surgery is performed after a healing period of 4 to 8 weeks and combined with a simultaneous contour augmentation using the guided bone regeneration technique to rebuild stable esthetic facial hard- and soft-tissue contours.

Early implant placement with simultaneous guided bone regeneration following single-tooth extraction in the esthetic zone: a cross-sectional, retrospective study in 45 subjects with a 2- to 4-year follow-up

BACKGROUND: The concept of early implant placement is a treatment option in postextraction sites of single teeth in the anterior maxilla. Implant placement is performed after a soft tissue healing period of 4 to 8 weeks. Implant placement in a correct three-dimensional position is combined with a simultaneous guided bone regeneration procedure to rebuild esthetic facial hard and soft tissue contours. METHODS: In this retrospective, cross-sectional study, 45 patients with an implant-borne single crown in function for 2 to 4 years were recalled for examination. Clinical and radiologic parameters, routinely used in implant studies, were assessed. RESULTS: All 45 implants were clinically successful according to strict success criteria. The implants demonstrated ankylotic stability without signs of a peri-implant infection. The peri-implant soft tissues were clinically healthy as indicated by low mean plaque (0.42) and sulcus bleeding index (0.51) values. None of the implants revealed a mucosal recession on the facial aspect as confirmed by a clearly submucosal position of all implant shoulders. The mean distance from the mucosal margin to the implant shoulder was -1.93 mm on the facial aspect. The periapical radiographs showed stable peri-implant bone levels, with a mean distance between the implant shoulder and the first bone-implant contact of 2.18 mm. CONCLUSIONS: This retrospective study demonstrated successful treatment outcomes for all 45 implants examined. The mid-term follow-up of 2 to 4 years also showed that the risk for mucosal recession was low with this treatment concept. Prospective clinical studies are required to confirm these encouraging results.

Early implant placement with simultaneous guided bone regeneration following single-tooth extraction in the esthetic zone: 12-month results of a prospective study with 20 consecutive patients

BACKGROUND: Early implant placement is one of the treatment options in postextraction sites in the anterior maxilla. Implant placement is performed after a soft tissue healing period of 4 to 8 weeks. Implant placement is combined with a simultaneous guided bone regeneration (GBR) procedure to rebuild esthetic facial hard and soft tissue contours. METHODS: In this prospective case-series study, 20 consecutive patients treated with an implant-borne single crown were prospectively followed for 12 months. Clinical, radiologic, and esthetic parameters were recorded to assess treatment outcomes. RESULTS: At the 12-month examination, all 20 implants were successfully integrated, demonstrating ankylotic stability and healthy peri-implant soft tissues as documented by standard parameters. The esthetic outcomes assessed by a pink esthetic score (PES) and a white esthetic score (WES) demonstrated pleasing results overall. The WES values were slightly superior to the PES values. The periapical radiographs showed minimal crestal bone loss around the used bone level implants, with mean bone loss of 0.18 mm at 12 months. Only one implant showed >0.5 mm bone loss, combined with minor mucosal recession of 0.5 to 1.0 mm. CONCLUSIONS: This prospective case series study evaluating the concept of early implant placement demonstrated successful tissue integration for all 20 implants. The short-term follow-up of 12 months revealed pleasing esthetic outcomes overall, as assessed by objective parameters. The risk for mucosal recession was low; only one patient showed minor recession of the facial mucosa. These encouraging results need to be confirmed with 3- and 5-year follow-up examinations.

Transient dominance in a central African rain forest

The large-crowned emergent tree Microberlinia bisulcata dominates rain forest groves at Korup National Park, Cameroon, along with two codominants, Tetraberlinia bifoliolata and T. korupensis. M. bisulcata has a pronounced modal size frequency distribution around 110 cm stem diameter: its recruitment potential is very poor. It is a long-lived light-demanding species, one of many found in African forests. Tetraberlinia species lack modality, are more shade tolerant, and recruit better. All three species are ectomycorrhizal. M. bisulcata dominates grove basal area, even though it has similar numbers of trees (≥50 cm stem diameter) as each of the other two species. This situation presented a conundrum that prompted a long-term study of grove dynamics. Enumerations of two plots (82.5 and 56.25 ha) between 1990 and 2010 showed mortality and recruitment of M. bisulcata to be very low (both rates 0.2% per year) compared with Tetraberlinia (2.4% and 0.8% per year), and M. bisulcata grows twice as fast as the Tetraberlinia. Ordinations indicated that these three species determined community structure by their strong negative associations while other species showed almost none. Ranked species abundance curves fitted the Zipf-Mandelbrot model well and allowed “overdominance” of M. bisulcata to be estimated. Spatial analysis indicated strong repulsion by clusters of large (50 to <100 cm) and very large (≥100 cm) M. bisulcata of their own medium-sized (10 to <50 cm) trees and all sizes of Tetraberlinia. This was interpreted as competition by M. bisulcata increasing its dominance, but also inhibition of its own replacement potential. Stem coring showed a modal age of 200 years for M. bisulcata, but with large size variation (50–150 cm). Fifty-year model projections suggested little change in medium, decreases in large, and increases in very large trees of M. bisulcata, accompanied by overall decreases in medium and large trees of Tetraberlinia species. Realistically increasing very-large-tree mortality led to grove collapse without short-term replacement. M. bisulcata most likely depends on climatic events to rebuild its stands: the ratio of disturbance interval to median species' longevity is important. A new theory of transient dominance explains how M. bisulcata may be cycling in abundance over time and displaying nonequilibrium dynamics.

Dynamic Remodeling of the Stressed Heart: Role of Protein Degradation Pathways

The heart is a remarkable organ. In order to maintain its function, it remodels in response to a variety of environmental stresses, including pressure overload, volume overload, mechanical or pharmacological unloading and hormonal or metabolic disturbances. All these responses are linked to the inherent capacity of the heart to rebuild itself. Particularly, cardiac pressure overload activates signaling pathways of both protein synthesis and degradation. While much is known about regulators of protein synthesis, little is known about regulators of protein degradation in hypertrophy. The ubiquitin-proteasome system (UPS) selectively degrades unused and abnormal intracellular proteins. I speculated that the UPS may play an important role in both qualitative and quantitative changes in the composition of heart muscle during hypertrophic remodeling. My study hypothesized that cardiac remodeling in response to hypertrophic stimuli is a dynamic process that requires activation of highly regulated mechanisms of protein degradation as much as it requires protein synthesis. My first aim was to adopt a model of left ventricular hypertrophy and determine its gene expression and structural changes. Male Sprague-Dawley rats were submitted to ascending aortic banding and sacrificed at 7 and 14 days after surgery. Sham operated animals served as controls. Effective aortic banding was confirmed by hemodynamic assessment by Doppler flow measurements in vivo. Banded rats showed a four-fold increase in peak stenotic jet velocities. Histomorphometric analysis revealed a significant increase in myocyte size as well as fibrosis in the banded animals. Transcript analysis showed that banded animals had reverted to the fetal gene program. My second aim was to assess if the UPS is increased and transcriptionally regulated in hypertrophic left ventricular remodeling. Protein extracts from the left ventricles of the banded and control animals were used to perform an in vitro peptidase assay to assess the overall catalytic activity of the UPS. The results showed no difference between hypertrophied and control animals. Transcript analysis revealed decreases in transcript levels of candidate UPS genes in the hypertrophied hearts at 7 days post-banding but not at 14 days. However, protein expression analysis showed no difference at either time point compared to controls. These findings indicate that elements of the UPS are downregulated in the early phase of hypertrophic remodeling and normalizes in a later phase. The results provide evidence in support of a dynamic transcriptional regulation of a major pathway of intracellular protein degradation in the heart. The discrepancy between transcript levels on the one hand and protein levels on the other hand supports post-transcriptional regulation of the UPS pathway in the hypertrophied heart. The exact mechanisms and the functional consequences remain to be elucidated.