Thesis (M.S.)--Naval Postgraduate School, 2002. / Title from title screen (viewed June 18, 2003). Includes bibliographical references.

As pesquisas envolvendo seres humanos geram preocupações éticas, pois os voluntários aceitam riscos e inconveniências com o objetivo de contribuir para o avanço do conhecimento científico e beneficiar outrem. A disposição para participar de pesquisas clínicas se mostra quando o paciente adere ao Termo de Consentimento Livre e Esclarecido (TCLE), compreendendo-o, assinando-o e comprometendo-se a cumprir todas as normas estabelecidas nesse documento, embora consciente de que, a qualquer momento, poderá suspender sua adesão. O TCLE aborda informações que precisam estar descritas de forma clara e de fácil compreensão, destacando riscos, possíveis benefícios e procedimentos. Além disso, garantir a participação voluntária e sua desistência em qualquer momento da pesquisa. Atualmente discute-se a possibilidade de sujeitos de pesquisa não entenderem totalmente o texto do TCLE nem seus direitos como participantes, mesmo tendo assinado o TCLE e aderido à pesquisa. A presente casuística analisa os dados de 793 pacientes, que foram convidados a participar de diferentes protocolos de pesquisa clínica, como especifica a seguir: 380 pacientes, que foram convidados a participar do grupo controle do projeto Genoma Clínico do Câncer; 365 pacientes, que foram convidados a participar do projeto Genoma Clínico do Câncer do Aparelho do Digestivo por apresentarem tumor em uma das seguintes localizações: câncer colorretal, câncer esofágico, câncer de cárdia ou câncer gástrico.; 48 pacientes que foram convidados a participar do Estudo Multicêntrico, Internacional, Randomizado, de Grupos Paralelos, Controlado por Placebo, Duplo-Cego, com subsidiária cega, para determinar o efeito de 156 semanas de tratamento com MK-966(antiinflamatório Anti-COX 2) na recorrência de pólipo adenomatoso de intestino grosso, em pacientes com histórico de adenoma colorretal ressecado por colonoscopia. Coletaram-se dados dos fichários de pesquisa científica para avaliar a aderência do sujeito de pesquisa ao protocolo, correlacionando-a com fatores demográficos (raça, sexo e idade), sociais (local de nascimento, morada atual e instituição de tratamento), relação risco/beneficio envolvida e nível de escolaridade. O grau de dificuldade dos textos que compõem os TCLE foi avaliado, aplicando-se os Índices de Legibilidade Flesch Reading Ease e Flesch- Kincaid. Aplicou-se questionário aos entrevistadores para avaliar, a posteriori, a postura do sujeito de pesquisa à adesão ao TCLE no momento de sua assinatura ou discordância. A adesão dos sujeitos de pesquisa aos protocolos propostos não teve influência dos fatores demográficos e sociais, no entanto, verificou-se maior adesão entre os pacientes de instituição de tratamento público (99,7%) em comparação com instituição de tratamento privada (93,7%). A adesão foi maior entre os pacientes que participaram de protocolos com menor risco (99,73%) em comparação com os pacientes que participaram de protocolos com maior risco (81,3%). Apesar de a adesão não ter tido influência do nível de escolaridade, este foi menor ou igual a 8 anos de estudo para 462 pacientes (58,26%), entre os quais 444 (96,1%) pacientes eram de instituição de tratamento público. Os índices de legibilidade obtidos variaram de 9.9 12 para o teste de Flesch-Kincaid e 33,1 51,3 para o teste de Flesch Reading Ease. Os resultados encontrados na aplicação dos testes de legibilidade classificaram todos os textos avaliados em nível de difícil compreensão, exigindo maior nível de escolaridade para o seu entendimento Os entrevistadores estimaram, através do questionário aplicado a eles, que 90% dos pacientes do hospital público preferem ouvir a explicação do TCLE a ler o texto. Na instituição privada esta estimativa foi de 40%. Apenas onze sujeitos de pesquisa não aderiram ao TCLE. A adesão não recebeu influência de fatores demográficos e sociais. O risco inerente aos protocolos apresentados influenciou a adesão dos sujeitos de pesquisa. Os textos avaliados não se constituíram em linguagem escrita de fácil entendimento, necessitando mais de 9 anos de estudo para sua compreensão. Esta pesquisa sugere que, apesar da alta incidência de adesão, a avaliação de novos métodos de aplicação do TCLE é necessária para que o sujeito de pesquisa menos instruído tenha condições de compreender adequadamente todo o conteúdo do texto proposto no TCLE. / Researches engaging human beings pose ethical concerns since volunteers take on risks and inconveniences aiming to contribute to advanced scientific knowledge and to benefit others. The moment patients sign the term of voluntary and informed consent TCLE (Termo de Consentimento Livre e Esclarecido) they show they are willing to participate in clinical trials and that they understand the term and commit to complying with all rules in the document, aware that they can, at any moment, withdraw acceptance. The TCLE addresses all issues in the research process and are therefore important to the study participants. The information given at the TCLE must be clearly stated and easily understood, highlighting risks, possible benefits and procedures in addition to guaranteeing volunteer participation and consent withdrawal at any time during the trial. Lately, it has been speculated that the study participants do not totally understand the TCLEs text content and their participants rights before accepting the TCLE and joining the trial. This study analyzes the data from 793 patients, invited to take part in different protocols of clinical trials, as follows: 380 patients, invited to join the Clinic Cancer Genome Project Control Group; 365 patients, invited to join the Genome Clinic Cancer Genome of the Digestive System since they had one of the four tumors: colorectal cancer, cancer of the esophagus, cardia adenocarcinoma and gastric cancer; 48 patients were invited to join the International Multicenter double-blind, randomized, parallel-group, placebocontrolled study, with undisclosed sponsor, to determine the outcome of a 156-week treatment with MK-966(anti-inflammatory Anti-COX 2) in recurrent adenomatous polyp of the large bowel, in patients with a history of colorectal resection for adenoma at colonoscopy. Data were collected from previous scientific studies to assess study participants acceptance, correlating it to demographic factors (ethnic group, gender and age), social (birthplace, home place, health institution), cost/benefit and schooling. The level of difficulty in the TCLE texts was assessed with Flesch Reading Ease and Flesch-Kincaid readability measures. Interviewers answered a questionnaire a posteriori, to evaluate the study participants attitude toward the TCLE acceptance at the moment they signed it or did not accept it. The study participants acceptance of the suggested protocols was not influenced by demographic and social factors. However, patients from public health institutions (99,7%) outnumbered those from private health institutions (93,7%). Acceptance was higher among patients taking part in low-risk protocols (99,73%) than in high-risk protocols (81,3%). Although schooling did not influence acceptance, it was 8 years or less in 462 patients (58,26%), among who 444 (96,1%) were patients from public health institutions. The indices of legibility had varied of 9.9 - 12 for the test of Flesch-Kincaid and 33.1 - 51,3 for the test of Flesch Reading Ease. The results found in the application of the legibility tests had classified all the texts evaluated in level of difficult understanding, demanding higher school level for its agreement. Interviewers reported in questionnaires that 90% of the patients from public hospitals would rather listen to an explanation of the TCLE than read the text whereas in patients from private institution the percentage dropped to 40%. Only eleven study participants did not join the TCLE. Acceptance was not influenced by social and demographic factors, but the protocols risk levels influenced the study participants decisions. The evaluated texts proved to be difficult to understand, demanding over 9 years of schooling to be understood. This study suggests that, in spite of being highly accepted, the TCLE requires new application methods so that less educated people can properly understand its text contents.

M.Comm. / A revolution in genetic research, known as the Human Genome Project (HGP), is taking place. This project, initiated in 1984, is a twenty-year, six billion-dollar science project designed to map the entire genetic structure (Genome) of the human species (Brockett and Tankersley, 1995). In 1998, the HGP leaders expected to complete the project by 2003 (Lowden, J. A., 1999:33). The Human Genome Project is designed to sequence the human genome (the blue print of genetic information) and to identify the estimated 100000 genesherein. This has added a new dimension to the technology available to underwriters in the life and health insurance industry for the selection of medical risks. Genetic testing can identify inherited diseases and predict illnesses that might not manifest for decades (Brackenridge & Elder, 1998:89). Genome research has opened up new opportunities for diagnosis and in some cases, early treatment of medical conditions. This new basis of knowledge is referred to as the advent of the molecular age in medicine. Medical journals, the mass media and genetic interest groups are treating human genetics and the opportunities it presents as a high-profile issue, with great attention being paid to the complex and emotive topics of life insurance and genetic testing (Regenauer & Schmidtke, 1998:5). The Insurance Industry can use genetic testing to identify high-risk applicants more accurately and price products accordingly, thereby improving risk assessment and profitability. These potential advantages, however, are counter-balanced by ethical considerations that are much more difficult to address (Lowden, J. A., 1999:33). Many consumers, ethicists and geneticists fear that insurers will use this data for unfair discriminatory purposes, identifying a genetic underclass of people who, although clinically well, will be uninsurable. Genetic testing could invade the privacy of applicants and their families. There are concerns about the confidential handling of genetic information as well as the accurate interpretation of genetic tests. The uncertainty about the predictive value of genetic tests, the shortage of trained geneticists and counsellors and the psychological impact of that knowledge of a predictable serious disease might have, have lead to much opposition to the use of genetic information by third parties. In the United States most Americans receive health insurance through their place of employment. There are fears that genetic testing will be used to discriminate against prospective employees and render many people unemployable and uninsurable (Council for responsible Genetics, 1997: http://www.gene-watch.org/genclisc htuil Consumer groups have lobbied effectively for the prohibition of testing or the use of testing by insurers in the United States and Europe and legislators aim to ban the use of genetic information on a broad basis. Insurers, on the other hand, are assuming that the new laws will cause untold damage to the fiscal stability of their companies (Lowden, J. A., 1999:33). However, it seems inevitable that genetic testing will affect risk classification sooner rather than later and to a greater extent than most believe (Chambers, 1997: http://www.Inrc.com/epirr/issues/143/143-4.htm).

The Human Genome Project (HGP), the name given to the scientific program to map and decode all of human genetic material, has been projected to revolutionize the conduct of biological science in the twenty-first century. For several years before its formation in 1990, a federally-funded, systematic study of the human genome was discussed first in the scientific arena and then in the public arena. The central thesis of this dissertation is that the arguments supporting or rejecting creation of the HGP and the rhetorical devices used to further those arguments had a major influence on the shape the HGP took in 1991. The argumentation used both for and against the creation of the HGP before the public as well as on the border between the public and scientific arenas is studied. The rhetorical devices such as metaphor, narrative, and selective word choices used to further these arguments are also examined. In particular, a rhetorical content analysis was performed on the 1986-1991 argumentation available to the most crucial audience for such persuasion: the members of Congress who ultimately voted for or against the program's funding and its establishment as a part of U.S. science policy. The proponents of the HGP, especially after the first year of public debate, presented their arguments in a wider arena of discussion and presented more and more varied arguments to advocate the project. The opposition raised questions that had for the most part been answered earlier in the debate. Often anti-HGP arguments focused on less effective audiences (scientists instead of members of Congress). Opposition to the project didn't become organized until near the end of the time frame studied, too late to have much of an impact on the outcome of the debate. The rhetorical devices studied served to magnify the impact of arguments used: in particular, the metaphor served as a boundary object to bridge discussions between the scientific and the public arenas. Ultimately the victory in the debate over the establishment of the HGP was awarded to the promulgators of the strongest underlying metaphor--the idealized excitement and profit of exploration of unknown territory--and the benefits to come from filling in and conquering the unknown areas of the human genetic map, territory the U.S. was eager to claim for its own. / Ph. D.

Etiquetas de sequências expressas (ESTs) são fundamentais para a identificação de genes no genoma humano e para definir características de expressão gênica. Neste trabalho, descrevemos uma nova abordagem para a geração de bibliotecas de cDNA, utilizando iniciadores arbitrários para a produção, por PCR, de mini-bibliotecas a partir de mRNA derivado de câncer de mama. Clones destas bibliotecas foram sequenciadas para gerar 6029 ESTs. Utilizando esta abordagem, foi possível observar uma significante normalização das diferentes sub-populações de mRNA e amplificação preferencial de porções centrais dos genes. Análise bioinformática destas sequências mostra que 3.350 ESTs (56%) tem similaridade significante a sequências de DNA e/ou cDNA já conhecidas (sequências anotadas) descritas em diferentes organismos, e 1509 ESTs (25%) não possuem qualquer similaridade a diferentes bancos de dados. Dentre as sequências anotadas, identificamos algumas sequências com alta similaridade a genes conhecidos em diferentes organismos, indicando a descoberta de alguns genes homólogos possivelmente envolvidos com processos carcinogênicos. Como exemplo, isolamos e caracterizamos parcialmente (i) uma nova isoforma do gene NABC1 (novel amplified sequence in breast carcinoma 1), o qual é pouco expresso em tumores coloretais, (ii) um novo gene da família de semaforinas (moléculas de motilidade axonal) que apresenta uma baixa expressão em linhagens celulares de glioblastoma tratadas com ácido retinóico, um agente antitumoral e (iii) o gene ortólogo humano Notch 2, aparentemente superexpresso em tumores mamários com maior malignidade. / Expressed sequence tags (ESTs) are of fundamental importance for the identification of genes within the human genome and defining gene expression characteristics. In this work, we describe a new approach for generating cDNA libraries using essentially arbitrary primers to construct PCR-based minilibraries from breast tumor mRNA. Clones from these libraries were sequenced to generate 6,029 ESTs. Using this approach, we were able to observe a significant normalization of the different mRNA subpopulations and a preferential amplification of the central portions of the genes. Bioinformatic analysis of these sequences shows that 3,350 ESTs (56%) have significant similarity to known DNA and/or cDNA sequences (annotated sequences) from different organisms and 1,509 ESTs (25%) show no similarity to any sequences on different databases. From the annotated sequences, we have identified some sequences with high similarity to known genes from different organisms, indicating the discovery of some homologous genes possibly correlated with carcinogenic processes. For instance, we have isolated and partially characterized (i) a new NABC1 (novel amplified sequence in breast carcinoma 1) isoform which is downregulated in colorectal tumors, (ii) a novel semaphorin member of axon guidance molecules that is down-regulated in glioblastoma cell lines treated with all-trans-retinoic acid, an anti-tumor agent and (iii) the ortolog Notch 2 human gene, apparenty overexpressed in breast tumors with higher malignancy.

This thesis examines one of the premier "big science" projects of the contemporary era - the globalised genetic mapping and sequencing initiative known as the Human Genome Project (HGP), and how Australia has responded to it. The study focuses on the relationship between the HGP, the biomedical model of health, and globalisation. It seeks to examine the ways in which the HGP shapes ways of thinking about health; the influence globalisation has on this process; and the implications of this for smaller nations such as Australia. Adopting a critical perspective grounded in political economy, the study provides a largely structuralist analysis of the emergent health context of the HGP. This perspective, which embraces an insightful nexus drawn from the literature on biomedicine, globalisation and the HGP, offers much utility by which to explore the basis of biomedical dominance, in particular, whether it is biomedicine's links to the capitalist infrastructure, or its inherent efficacy and efficiency, that sustains the biomedical paradigm over "other" or non-biomedical health approaches. Additionally, the perspective allows for an assessment of whether there should be some broadening of the way health is conceptualised and delivered to better account for social, economic, and environmental factors that affect living standards and health outcomes, and also the capacity of globalisation to promote such change. These issues are at the core of the study and provide the theoretical frame to examine the processes by which Australian policy makers have given an increasing level of support to human genomic research over the past decade and also the implications of those discrete policy choices. Overall, the study found that globalisation is renewing and extending the dominance of the biomedical model, which will further marginalise other models of health while potentially consuming greater resources for fewer real health outcomes. While the emerging genomic revolution in health care may lead to some wondrous innovations in the coming decades, it is also highly likely to exacerbate the problems of escalating costs and diminishing returns that characterise health care systems in industrialised countries, and to lead to greater health inequities both within and between societies. The Australian Government has chosen to underwrite human genomic research and development. However, Australia's response to the HGP has involved both convergences and variations from the experiences of more powerful industrial nations. The most significant divergence has been in industry and science policy, where until the mid-1990s, the Australian Government displayed no significant interest in providing dedicated research funding, facilities, or enabling agencies to the emerging field. Driven by the threat of economic marginalisation and cultural irrelevance, however, a transformation occurred. Beginning with the Major National Research Facilities Program of the Department of Industry, Science and Technology, and then the landmark Health and Medical Research Strategic Review, support for human genomic research grew strongly. Comprehensive policy settings have recently been established to promote the innovation, commercialisation, promotion and uptake of the products of medical biotechnology and genomics. As such, local advocates of a broader model of health will be forced to compete on the political and economic stage with yet another powerful new area of biomedicine, and thus struggle to secure resources for perhaps more viable and sustainable approaches to health care in the 21st century.

Etiquetas de sequências expressas (ESTs) são fundamentais para a identificação de genes no genoma humano e para definir características de expressão gênica. Neste trabalho, descrevemos uma nova abordagem para a geração de bibliotecas de cDNA, utilizando iniciadores arbitrários para a produção, por PCR, de mini-bibliotecas a partir de mRNA derivado de câncer de mama. Clones destas bibliotecas foram sequenciadas para gerar 6029 ESTs. Utilizando esta abordagem, foi possível observar uma significante normalização das diferentes sub-populações de mRNA e amplificação preferencial de porções centrais dos genes. Análise bioinformática destas sequências mostra que 3.350 ESTs (56%) tem similaridade significante a sequências de DNA e/ou cDNA já conhecidas (sequências anotadas) descritas em diferentes organismos, e 1509 ESTs (25%) não possuem qualquer similaridade a diferentes bancos de dados. Dentre as sequências anotadas, identificamos algumas sequências com alta similaridade a genes conhecidos em diferentes organismos, indicando a descoberta de alguns genes homólogos possivelmente envolvidos com processos carcinogênicos. Como exemplo, isolamos e caracterizamos parcialmente (i) uma nova isoforma do gene NABC1 (novel amplified sequence in breast carcinoma 1), o qual é pouco expresso em tumores coloretais, (ii) um novo gene da família de semaforinas (moléculas de motilidade axonal) que apresenta uma baixa expressão em linhagens celulares de glioblastoma tratadas com ácido retinóico, um agente antitumoral e (iii) o gene ortólogo humano Notch 2, aparentemente superexpresso em tumores mamários com maior malignidade. / Expressed sequence tags (ESTs) are of fundamental importance for the identification of genes within the human genome and defining gene expression characteristics. In this work, we describe a new approach for generating cDNA libraries using essentially arbitrary primers to construct PCR-based minilibraries from breast tumor mRNA. Clones from these libraries were sequenced to generate 6,029 ESTs. Using this approach, we were able to observe a significant normalization of the different mRNA subpopulations and a preferential amplification of the central portions of the genes. Bioinformatic analysis of these sequences shows that 3,350 ESTs (56%) have significant similarity to known DNA and/or cDNA sequences (annotated sequences) from different organisms and 1,509 ESTs (25%) show no similarity to any sequences on different databases. From the annotated sequences, we have identified some sequences with high similarity to known genes from different organisms, indicating the discovery of some homologous genes possibly correlated with carcinogenic processes. For instance, we have isolated and partially characterized (i) a new NABC1 (novel amplified sequence in breast carcinoma 1) isoform which is downregulated in colorectal tumors, (ii) a novel semaphorin member of axon guidance molecules that is down-regulated in glioblastoma cell lines treated with all-trans-retinoic acid, an anti-tumor agent and (iii) the ortolog Notch 2 human gene, apparenty overexpressed in breast tumors with higher malignancy.

No description available.

Orientador: Laymert Garcia dos Santos / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-05T01:28:26Z (GMT). No. of bitstreams: 1 Leite_Marcelo_D.pdf: 18137235 bytes, checksum: d2ccf296709649c706ae95e568a4a4e8 (MD5) Previous issue date: 2005 / Resumo: A tese central deste trabalho é que a aceitação pública despertada pelo Projeto Genoma Humano só se explica pelo uso político e retórico de um determinismo genético crescentemente irreconciliável com os resultados empíricos da pesquisa genômica atual. A complexidade verificada no genoma humano e em suas interações com o meio desautoriza a manutenção de uma noção simples e unidirecional de causalidade, contrariamente ao pressuposto na idéia de gene como único portador de informação, esteio da doutrina do determinismo genético. Um complexo de metáforas informacionais e/ou lingüísticas continuo vivo nos textos publicados por biólogos moleculares na literatura científica, notadamente nos artigos veiculados nos periódicos de alto impacto Nature e Science de 15 e 16 fevereiro de 2001, respectivamente. Tais metáforas inspiram um tipo de discurso ambíguo que modula nuances variadas de retórica determinista, conforme se dirija aos próprios pares ou ao público leigo" O campo da genômica ainda está longe de rejeitar a conjunção problemática das noções de gene pré-formacionista e de gene como recurso desenvo/vimenta/ na base da metáfora do gene como informação. Essa fusão inspirada pela terminologia cibernética propicia uma versão asséptica de gene, distanciada da natureza, puramente sintática, móvel e virtual o bastante para circular desimpedida nos circuitos de produção de valor como recurso genético passível de garimpagem e de patenteamento. Críticos dã tecnociência devem desafiar o campo da genômica a reformular drasticamente as metáforas que dão suporte a seu programa hegemônico de pesquisa / Abstract: The central thesis of this work is that the public support generated for the Human Genome Project and the hype surrounding it can be explained only by the political and rhetorical uses of genetic determinism, a notion which increasingly cannot be reconciled with the empirical results of on-going genomic research. The complexity that has been uncovered in the human genome and in its interactions with the environment implies that a simple and unidirectional notion of causality cannot be maintained, contrary to a presupposition of the idea of the gene as the sole carrier of iliformation, an idea that contributes to sustain the doctrine of genetic determinism. A complex of informational and/or linguistic metaphors lives on in the texts published by molecular biologists in the scientific press, most notably in the issues published February 15thand 16thof 2001 ofthe high impact journals Nature and Science, respectively. These metaphors generate an ambiguous type of discourse that modulates various nuances of deterministic rhetoric, depending on whether it addresses peers or the lay publico The field of genomics is still a long way ITom rejecting the questionable conflation of the notions of gene as preformation and gene as developmental resource which underpins the metaphor of gene as information. This conflation inspired by cybernetics terminology enables an aseptic version of the gene, separated ITom nature, portable and virtual enough to flow unimpeded through the channels ofvalue production as genetic resource suitable for mining and patenting. Critics of technoscience should challenge the field of genomics to drastically reshape the metaphors which have supported its hegemonic research agenda / Doutorado / Doutor em Ciências Sociais