Development of the palliative care needs assessment tool (PC-NAT) for use by multi-disciplinary health professionals

Needs assessment strategies can facilitate prioritisation of resources. To develop a needs assessment tool for use with advanced cancer patients and caregivers, to prompt early intervation. A convenience sample of 103 health professionals viewed three videotaped consultations involving a simulated patient, his/her caregiver and a health professional, completed the Palliative Care Needs Assessment Tool (PC-NAT) and provided feedback on clarity, content and acceptability of the PC-NAT. Face and content validity, acceptability and feasibility of the PC-NAT were confirmed. Kappa scores indicated adequate inter-rater reliability for the majority of domains; the patient spirituality domain and the caregiver physical and family and relationship domains had low reliability. The PC-NAT can be used by health professionals with a range of clinical expertise to identify individuals' needs, thereby enabling early intervention. Further psychometric testing and an evaluation to assess the impact of the systematic use of the PC-NAT on quality of life, unmet needs and service utilisation of patients and caregivers are underway.

Markers of genetic susceptibility in human environmental hygiene and toxicology : the role of selected CYP, NAT and GST genes

Inherited genetic traits co-determine the susceptibility of an individual to a toxic chemical. Special emphasis has been put on individual responses to environmental and industrial carcinogens, but other chronic diseases are of increasing interest. Polymorphisms of relevant xenobiotic metabolising enzymes may be used as toxicological susceptibility markers. A growing number of genes encoding enzymes involved in biotransformation of toxicants and in cellular defence against toxicant-induced damage to the cells has been identified and cloned, leading to increased knowledge of allelic variants of genes and genetic defects that may result in a differential susceptibility toward environmental toxicants. "Low penetrating" polymorphisms in metabolism genes tend to be much more common in the population than allelic variants of "high penetrating" cancer genes, and are therefore of considerable importance from a public health point of view. Positive associations between cancer and CYP1A1 alleles, in particular the *2C I462V allele, were found for tissues following the aerodigestive tract. Again, in most cases, the effect of the variant CYP1A1 allele becomes apparent or clearer in connection with the GSTM1 null allele. The CYP1B1 codon 432 polymorphism (CYP1B1*3) has been identified as a susceptibility factor in smoking-related head-and-neck squameous cell cancer. The impact of this polymorphic variant of CYP1B1 on cancer risk was also reflected by an association with the frequency of somatic mutations of the p53 gene. Combined genotype analysis of CYP1B1 and the glutathione transferases GSTM1 or GSTT1 has also pointed to interactive effects. Of particular interest for the industrial and environmental field is the isozyme CYP2E1. Several genotypes of this isozyme have been characterised which seem to be associated with different levels of expression of enzyme activity. The acetylator status for NAT2 can be determined by genotyping or by phenotyping. In the pathogenesis of human bladder cancer due to occupational exposure to "classical" aromatic amines (benzidine, 4-aminodiphenyl, 1-naphthylamine) acetylation by NAT2 is regarded as a detoxication step. Interestingly, the underlying European findings of a higher susceptibility of slow acetylators towards aromatic amines are in contrast to findings in Chinese workers occupationally exposed to aromatic amines which points to different mechanisms of susceptibility between European and Chinese populations. Regarding human bladder cancer, the hypothesis has been put forward that genetic polymorphism of GSTM1 might be linked with the occurrence of this tumour type. This supports the hypothesis that exposure to PAH might causally be involved in urothelial cancers. The human polymorphic GST catalysing conjugation of halomethanes, dihalomethanes, ethylene oxide and a number of other industrial compounds could be characterised as a class theta enzyme (GSTT1) by means of molecular biology. "Conjugator" and "non-conjugator" phenotypes are coincident with the presence and absence of the GSTT1 gene. There are wide variations in the frequencies of GSTT1 deletion (GSTT1 *0/0) among different ethnicities. Human phenotyping is facilitated by the GST activity towards methyl bromide or ethylene oxide in erythrocytes which is representative of the metabolic GSTT1 competence of the entire organism. Inter-individual variations in xenobiotic metabolism capacities may be due to polymorphisms of the genes coding for the enzymes themselves or of the genes coding for the receptors or transcription factors which regulate the expression of the enzymes. Also, polymorphisms in several regions of genes may cause altered ligand affinity, transactivation activity or expression levels of the receptor subsequently influencing the expression of the downstream target genes. Studies of individual susceptibility to toxicants and gene-environment interaction are now emerging as an important component of molecular epidemiology.

30 MeV/u~(40)Ar+~(nat)Ag反应中类弹碎片发射的时-空演化

报道了 ３０ＭｅＶ／ ｕ(４０)Ａｒ＋(ｎａｔ)Ａｇ反应中中等质量碎片（ＩＭＦ）发射时间（τ）随发射源空间大小的演化规律，并对类弹碎片的发射时空进行了讨论．结果表明，ＩＭＦ的发射时标与中等质量碎片关联函数以及发射源的核物质密度（ρ）有关，而与发射源的质量数的关系不大．对于能量较高的类弹碎片来说，在较小的核物质密度下提取的发射时间也较小，因此，在正常核物质密度参数下提取出的发射时间值可作为碎片实际发射时间的上限值．中速碎片的发射时间随密度大小的变化非常缓慢，提取出的发射时间值即可作为实际的发射时间。

重离子与~(nat)W相互作用中Hf的生成研究

用放射化学方法研究了6.3、8.5、11.8、14.7、18.4、24.6、40 MeV/nucleon ~(40)Ar + ~(nat)W、10.5 MeV/nucleon ~(84)Kr + ~(nat)W、80 MeV/nucleon ~(16)O + ~(nat)W、135 MeV/nucleon ~(12)C + ~(nat)W反应中的Hf的生成，得到了Hf同位素的激发函数、反冲性质和同位素分布。研究结果指出利用HIRFL能量的重离子和丰中子靶核作用，能以一定的截面生成A > 170区丰中子新核素。重炮弹更有利于丰中子新核素的生成。使用厚靶，可以明显地提高丰中子新核素的产额。过高的入射能量对丰中子新核素的生成无明显贡献，相反却极大地增加了缺中子同位素产额，这对丰中子新核素的分离和鉴别是非常不利的

30MeV/u~(40)Ar+~(nat)Ag反应中中等质量碎片的发射机制及其发射时间测量

中等质量碎片（IMF）的发射是中能重离子碰撞的一大特点，且随着轰击能量的升高其产额迅速增加。通过测量30MeV/u 40Ar+natAg反应中出射的中等质量碎片，研究了高激发热核的发射机制、发射时标和时空演化规律。 对反应中发射碎片能谱的运动源拟合表明，前角区（11°—22°）中等质量碎片（IMF）来自于三种成分：类靶源、类弹源和中速源成分，其中类弹和中速成分占主导，关联测量的IMF能谱拟合得到，一个来自于类弹源而另一个来自于中速源成分的事件占有相当大的比例。 利用小相对角度内的两碎片关联测量，研究高激发核衰变中中等质量碎片的发射时标和寿命。IMF发射时间随能量的变化很大，从低能碎片的250 fm/c到高能粒子的100 fm/c，表明在此能量下，反应中出射的IMF主要来自于相继两体衰变。通过与其它实验的比较可知，随着束流能量的升高，IMF发射时间由相继两体衰变向多重碎裂过渡。 IMF时空演化研究表明，发射空间的大小对IMF关联函数的影响主要来自于发射源的核物质密度而几乎不依赖于发射源的质量数。

中能区~(40)Ar + ~(197)Au/~(159)Tb/~(nat)Ag反应中高激发热核性质研究

通过对中能区Ar+Au/Tb/Ag反应中高激发核的发射时标、发射次序、发射机制、核温度、集体运动等衰变特性的研究，提取了轻粒子和中等质量碎片（IMF）的发射时间，IMF发射时间随束流能的升高而变短，发射机制逐渐由相继衰变过渡至多重碎裂。研究了轻粒子和碎片间的发射次序，对高能粒子和碎片，轻粒子先于碎片发射，而低能时，则为碎片先于轻粒子发射。IMF发射成分与角度和碰撞参数有关，前角区来自于弹核碎裂，后角区来自于类靶热核的蒸发。在平面和出平面研究表明，中速粒子和碎片为在平面发射占主导，即存在类转动效应；对轻粒子，转动效应随粒子质量增加而增加；对中速产物均观测到该效应随碰撞参数饿增大而增大。采用几种不同的方法提取了热核的核温度，研究了不同方法之间的区别。

Regulacja karboksylazy/oksygenazy rybulozo-1,5-bisfosforanu (Rubisco) u Arabidopsis thaliana w odpowiedzi na zmianę natężenia światła z umiarkowanego na niskie

Wydział Biologii

Nat Gold, Sheet Metal Graduate from the New York Trade School

Nat Gold graduated from the Sheet Metal program at the New York Trade School in 1942. He is represented here in the sheet metal shop he owns. Notice the blueprints for the White Plains Senior High School hanging on the wall behind him. Original caption reads, "Shop Owner, Brook Sheet Metal Inc. Nat Gold - Sheet Metal 1942, represents one of many Sheet Metal graduates who became owners of their own business." Black and white photograph.

Mémoire de licence Quand un paysage naît, un autre meurt : – Une analyse écocritique du roman Naissance d'un pont

Ce mémoire est constitué par une analyse écocritique du roman Naissance d'un pont, écrit par Maylis de Kerangal. Le but général du mémoire est d'examiner comment ce roman décrit la relation entre l'homme et la nature. Nous examinons surtout les stratégies narratives employées par l'auteure pour transmettre l'image de cette relation et en plus, nous discutons le rôle joué par les différents paysages se retrouvant dans le récit. Finalement, l'analyse comprend aussi une brève réflexion sur la capacité éventuelle du roman d'influencer l'attitude du lecteur envers l'écologie. L'analyse des stratégies narratives se concentre sur le rôle du narrateur, ainsi que sur la présence et la fonction des perspectives éthiques, des noms symboliques et des figures de style. Ces stratégies contribuent à dépeindre une variété d'idées par rapport aux modes de vie de la société humaine, alors que les descriptions des paysages démontrent la relation complexe entre cette société et les paysages naturels et construits respectivement. Naissance d'un pont semble promouvoir une attitude à l'égard de la nature qui est plus humble que celle dominant dans la société moderne. Afin de pouvoir juger la capacité du roman de transmettre ces valeurs au lecteur, il serait pourtant raisonnable de tenir compte de plusieurs facteurs, tels que la complexité du langage et le niveau de crédibilité de l'histoire.

Os juízes diante da judicializção da saúde: o NAT como instrumento de aperfeiçoamento das decisões judiciais na área da saúde

Com o crescente número de pedidos de medicamentos por meio de ações judiciais, o Poder Judiciário se viu na difícil função de decidir questões tão relevantes e urgentes para as quais não possuía, necessariamente, conhecimento técnico. O fenômeno intitulado “judicialização da saúde” tem sido causa de preocupação, pois o alto gasto com a compra de medicamentos solicitados como resultado dessas ações podem interferir, diretamente, em verbas destinadas a outras políticas públicas e provoca uma discussão sobre o direito constitucional a saúde; que nesse aspecto é garantido a quem teve acesso a justiça. Na busca de dar auxilio aos magistrados na hora de decidirem sobre essas ações o Tribunal de Justiça do Estado do Rio de Janeiro em cooperação com a Secretaria de Justiça do Estado do Rio de Janeiro implementaram o Núcleo de Assessoria Técnica (NAT) em ações judiciais da saúde. Núcleo esse formado por profissionais ligados a saúde, que analisam detalhadamente os pedidos, confeccionam um parecer. Esse trabalho visa explanar sobre o funcionamento desse Núcleo e demonstrar se o auxilio técnico serve como instrumento de aperfeiçoamento das decisões judiciais na área da saúde. A abordagem para alcançar o nosso objetivo que é passa pelo conceito, doutrinas e características da Judicialização da saúde. Num segundo momento trabalharemos informações sobre o NAT, tratando da criação, objetivo, atribuição, dinâmica, com enfoque maior na atuação e expansão do Núcleo. Por fim, nosso objetivo é descrever, de forma mais detalhada, a ação do NAT com relação a quantos medicamentos são pedidos por via judicial, que tipo de medicamentos, os gastos com os mesmos e na opinião dos operadores de direito envolvidos nessa seara, como juízes e defensores, sobre o funcionamento do NAT.

A insurreição contestada: William Styron e As confissões de Nat Turner

This work presents intricacies of "truth" in the historical novel Confessions of Nat Turner, by William Styron, considering the point-of-view of the novel's narrator. When speaking about the black, Styron somehow keeps the white's perspective, and also perpetuates the distance created by the slavery and segregationist system of the United States of America.

NF-κB Drives the Synthesis of Melatonin in RAW 264.7 Macrophages by Inducing the Transcription of the Arylalkylamine-N-Acetyltransferase (AA-NAT) Gene

We demonstrate that during inflammatory responses the nuclear factor kappa B (NF-kappa B) induces the synthesis of melatonin by macrophages and that macrophage-synthesized melatonin modulates the function of these professional phagocytes in an autocrine manner. Expression of a DsRed2 fluorescent reporter driven by regions of the aa-nat promoter, that encodes the key enzyme involved in melatonin synthesis (arylalkylamine-N-acetyltransferase), containing one or two upstream kappa B binding sites in RAW 264.7 macrophage cell lines was repressed when NF-kappa B activity was inhibited by blocking its nuclear translocation or its DNA binding activity or by silencing the transcription of the RelA or c-Rel NF-kappa B subunits. Therefore, transcription of aa-nat driven by NF-kappa B dimers containing RelA or c-Rel subunits mediates pathogen-associated molecular patterns (PAMPs) or pro-inflammatory cytokine-induced melatonin synthesis in macrophages. Furthermore, melatonin acts in an autocrine manner to potentiate macrophage phagocytic activity, whereas luzindole, a competitive antagonist of melatonin receptors, decreases macrophage phagocytic activity. The opposing functions of NF-kappa B in the modulation of AA-NAT expression in pinealocytes and macrophages may represent the key mechanism for the switch in the source of melatonin from the pineal gland to immune-competent cells during the development of an inflammatory response.