Este estudo teve como objetivo avaliar os efeitos da morbidade materna grave na saúde sexual e reprodutiva de mulheres seis meses após o evento. Estudo observacional, transversal, realizado em dois hospitais na cidade de Ribeirão Preto, São Paulo Brasil: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto onde ficam internadas as puéperas que tiveram algum tipo de complicação na gestação (Grupo 1) e Centro de Referência em Saúde da Mulher, onde ficam internadas as puérperas de baixo risco gestacional (Grupo 2), totalizando 110 participantes, no período de maio de 2015 a agosto de 2016. A coleta de dados, a qual aconteceu da mesma forma nos dois hospitais, foi realizada em duas fases: a primeira correspondeu ao recrutamento das participantes enquanto ainda estavam internadas após o parto, onde foram obtidos os dados obstétricos, neonatais, sociodemográficos e reprodutivos diretamente do prontuário médico; a segunda ocorreu seis meses após a alta hospitalar das participantes, as quais foram contatadas via telefone para agendamento das visitas domiciliares, onde foram colhidos os dados sociodemográficos, econômicos, ginecológicos, obstétrico e os relacionados à saúde sexual, através do instrumento Female Sexual Function Index. Os dados foram analisados através do software Statistical Package for the Social Sciences e R versão 3.1.2. Foram utilizadas análises univariada e bivariada com distribuição de frequências absolutas e relativas, medidas de tendência central, variabilidade dos dados, testes Mann-Whitney, Qui-quadrado e Exato de Fisher, regressão beta inflacionada. No Grupo 1, a média de idade das mulheres foi de 30 anos, com prevalência da cor branca e a maioria solteira com relação ao estado civil, mas vivia junto com o companheiro há mais de 10 anos, enquanto no Grupo 2, a idade média foi de 27,1 anos com prevalência de cor parda, casada e com tempo de relacionamento entre dois e cinco anos. A escolaridade foi praticamente a mesma nos dois grupos, com uma média de 9,5 anos de estudo. Tanto no Grupo 1 quanto no Grupo 2, a maioria não fumava, nem fazia uso de drogas ilícitas ou bebidas alcoólicas. Enquanto no Grupo 1 a maioria havia feito cesárea, sendo 36,6% dos bebês nascidos prematuros, no Grupo 2, a maioria teve parto vaginal com apenas 7,2% dos bebês nascidos antes de 37 semanas. Das mulheres do Grupo 1, as morbidades materna grave mais frequentes foram as relacionadas aos distúrbios hipertensivos. Não houveram associações entre a ocorrência de morbidade materna grave e a predisposição à disfunção sexual, no entanto, em todos os domínios relacionados à função sexual (desejo, excitação, lubrificação, orgasmo, satisfação e dor), as mulheres do Grupo 2 tiveram melhores pontuações, no entanto com a regressão Beta inflacionada, foram encontradas associações entre os domínos orgasmo e a variável cor, domínio satisfação e a variável tempo de relacionamento e entre o domínio dor e a morbidade materna grave, demonstrando que esse grupo de mulheres sofre com dispareunia quando comparadas com as mulheres que não tiveram complicações na gestação / The objective of this study was to to evaluate the effects of severe maternal morbidity on sexual and reproductive health of women six months after the event. Cross-sectional observational study carried out in two hospitals in the city of Ribeirão Preto, São Paulo Brazil: Hospital of the Clinics of the Medical School of Ribeirão Preto, where the patients who had some kind of complication during pregnancy (Group 1) and Reference Center for Women\'s Health, where low-risk pregnancies (Group 2) are hospitalized, totaling 110 participants, from May 2015 to August 2016. Data collection, which occurred in the same way in both hospitals, was performed in two phases: the first corresponded to the recruitment of the participants while they were still hospitalized after delivery, where the obstetric, neonatal, sociodemographic and reproductive data were obtained directly from the medical record; the second occurred six months after the patients were discharged from the hospital, who were contacted by telephone to schedule home visits, where socio-demographic, economic, gynecological, obstetrical and sexual health data were collected through the Female Sexual Function Index . The data were analyzed through the software Statistical Package for the Social Sciences and R version 3.1.2. Univariate and bivariate analyzes were used with absolute and relative frequency distributions, central tendency measures, data variability, Mann-Whitney, Chi-square and Fisher Exact tests, inflated beta regression. In Group 1, the average age of the women was 30 years, with white prevalence and the majority single in relation to the marital status, but lived with the partner for more than 10 years, while in Group 2, the average age was 27.1 years old, with a prevalence of brown, married and with a relationship between two and five years. Schooling was practically the same in both groups, with an average of 9.5 years of study. In both Group 1 and Group 2, most did not smoke, nor did they use illicit drugs or alcoholic beverages. While in Group 1 the majority had delivered cesarean, with 36.6% of babies born preterm in Group 2, the majority had vaginal delivery with only 7.2% of babies born before 37 weeks. Of the women in Group 1, the most frequent severe maternal morbidities were those related to hypertensive disorders. However, in all domains related to sexual function (desire, arousal, lubrication, orgasm, satisfaction and pain), there were no associations between the occurrence of severe maternal morbidity and the predisposition to sexual dysfunction, the women in Group 2 had better scores However, with inflated beta regression, associations were found between domains orgasm and color variable, satisfaction domain and time relationship variable, and between pain domain and severe maternal morbidity, demonstrating that this group of women suffers from dyspareunia when compared with women who had no complications during pregnancy

As experiências de tratamento no campo da saúde mental infantil com crianças com distúrbios graves, atualmente existentes no país, carecem de avaliações mais precisas de seus modelos clínicos e institucionais para examinar sua efetividade e propiciar a indicação de parâmetros mais detalhados para as exigências desse campo. Esta pesquisa se desenvolveu a partir do trabalho de supervisão dos atendimentos de crianças com distúrbios graves, orientados pela psicanálise Freud-lacaniana, desenvolvido em uma clínica-escola de uma Universidade particular de Psicologia da Bahia. Adotou-se como estratégia clínica a inclusão da escuta a pais e crianças, em sessões separadas, pelo mesmo estagiário de psicologia. A questão central desta pesquisa é apontar que esse dispositivo pode ser implementado e desenvolvido na clínica-escola com esses estagiários. Foram apresentados e discutidos fragmentos de um atendimento clínico, selecionados em função de terem sido os desencadeadores das principais observações e questões clínico-teóricas abordadas. Analisa-se que uma intervenção na loucura a dois que se instala na relação mãe e criança deve ser feita e tem a eficácia de permitir que o traço nomeador da criança se escreva ou acabe de ser escrito. Dessa forma, a separação é o processo visado nessa proposição de trabalho que busca desalojar a criança do lugar de objeto incluído no Outro, e do qual ela condensa o gozo, fazendo surgir um sujeito. Acentua-se que é o trabalho com o significante que permite a quebra da repetição, possibilitando ao sujeito, em uma nova temporalidade, se posicionar ante os significantes que o marcaram. A pesquisa revela sua relevância científica e social, na medida em que indica ser possível a implementação do dispositivo psicanalítico proposto numa clínica-escola de Psicologia, o que aumenta os espaços de atendimento de crianças com distúrbios graves no campo da saúde mental / Current treatment experiences in the field of children\'s mental health for children with severe disorders, in our country, lack of more accurate evaluations of clinical and institutional models to be able to examine their effectiveness and to provide an indication for more detailed parameters for the requirements in this field. This research was developed from clinical supervision of the work with children with severe disorders based on Freud-lacanians psychoanalyses implemented in a psychology school-clinic of a private university at Bahia. We adopted as a clinical strategy the inclusion of psychoanalytic listening to parents and their children, in separate sessions by the same psychology intern. The central contention of this research is that this therapeutic device can be implemented and developed in school-clinic with this interns. Fragments of sessions from a clinic consultation were presented and discussed. These fragments were selected because they trigged the main observations of the clinical and theoretical issues addressed. Our analysis found that an intervention in the shared psychotic disorder in the relationship of mother and child should be made and this is effective in allowing the nominator trace of the child to be written or the writing to be finished. These separation is the main objective of this proposed process, that seeks to change the child from being an object included in another person, in whom she condenses all her jouissance, to a subject in and of itself. We stress that working with the signifier allows them to break the repetition circle, enabling the subjects, in a new temporality, to position themselves before the signifier who has marked them. This research reveals its scientific and social relevance as it indicates that is possible to implement psychoanalytic treatment device in a psychology clinical-school which increases the attendance spaces for children with severe disorders

O choque séptico é a complicação mais comum da sepse e responsável por um grande número de casos de morte em unidades de terapia intensiva. Em pacientes com diagnóstico de sepse, a febre é um dos sinais mais comuns, entretanto a hipotermia pode ocorrer e geralmente está associada a infecções severas, prognóstico pior e alta mortalidade. A confluência de vários fatores contribui para a deterioração da condição clínica do paciente que evolui para choque séptico. Um dos principais fatores é a aumentada síntese de óxido nítrico, que pode mediar alterações na função cardiovascular e termorregulatória. O enfermeiro é capaz de detectar o início dos sinais clínicos desses quadros, que incluem: complicação do quadro pulmonar (com presença de taquipnéia), sudorese fria, confusão mental, oligúria, taquicardia, hipotensão arterial e alteração da temperatura corporal. A detecção desses sinais pode ser facilmente realizada com instrumentos apropriados e exame físico. Neste estudo, o objetivo foi correlacionar os valores de temperatura e as concentrações plasmáticas de óxido nítrico em pacientes com diagnóstico de sepse, sepse grave e choque séptico. Nossos dados mostram que existe uma correlação negativa (p<0.0037; r2=0,1593; Coeficiente de Pearson -0,3991) entre os valores de temperatura corporal e os valores de concentração plasmática de nitrato em pacientes com diagnóstico de choque séptico. Estes dados mostram que quanto mais baixa a temperatura corporal, mais altas são as concentrações plasmáticas de nitrato. / Septic shock is the most common complication of sepsis and responsible for a large number of cases of death in intensive care units. In patients with sepsis, fever is one of the most common signs, but hypothermia can occur and is usually associated with severe infections, worse prognosis and high mortality. The confluence of several factors contributing to the deterioration of the clinical condition of patients who progress to septic shock. A key factor is the increased synthesis of nitric oxide may mediate changes in cardiovascular and thermoregulatory function. The nurse is able to detect the onset of clinical signs in these tables, which include: a complication of pulmonary symptoms (presence of tachypnea), cold sweating, mental confusion, oliguria, tachycardia, hypotension, and changes in body temperature. The detection of these signals can be easily accomplished with appropriate instruments and physical examination. In this study, we aimed to correlate the temperature and plasma concentrations of nitric oxide in patients with sepsis, severe sepsis and septic shock. Our data show that there is a negative correlation (p <0.0037, r2 = 0.1593, Pearson´s coefficient of -0.3991) between the values of body temperature and the values of plasma nitrate in patients with septic shock. These data show that the lower body temperature, the higher plasma concentrations of nitrate.

Made available in DSpace on 2017-07-21T20:42:32Z (GMT). No. of bitstreams: 1 Fernanda Aparecida Farias.pdf: 6839448 bytes, checksum: d86819dd1de8464678930b61469c884f (MD5) Previous issue date: 2009-12-11 / A duplex stainless steel with austenitic–ferritic structure, type S32205/S31803 was submitted to equal channel angular pressing, whose is based on very severe plastic deformation, at relatively low temperature, with no change in the dimensions along transversal section of the material. The processed material was heat treated at 1000° and 1200°C during 7.5, 15, 30 and 60 minutes, in order to evaluate the recovery aspects and recrystallization steps of the severely deformed duplex steel. The die was manufacturing from SAE 1045 steel (cemented, quenched and annealed) and heat treated and the plungers from tool steel. The extrusions were conducted at room temperature, using a universal type mechanical test machine, according three different pressing speeds: 1.5, 6.0 and 12.0 mm/min. The processing stress increase continuously during extrusion by friction forces between sample and die walls and very high pressing stress level was reached. The results show the increase of stress according to increase of speed processing. For 1,5 mm/min processing speed, the second pass could be done with maximum reached stress close to 3GPa. The friction forces promoted a very heterogeneous deformations process along the samples sections with increase of hardness from 257HV (start material) to 575HV (highest deformed point). This effect was observed by grains morphology and orientations changes after processing and along the sample dimensions. In the as heat treated samples surfaces two distinct structures type formation was verified with small surfaces positioned with well defined angles near of 90° and 109° between itself. The region with 90° between surfaces show a lot of cubic form structure probably as a consequence of dislocation pile up annihilation on the surface of body-centered-cubic phase (ferrite). In this crystalline structure, the slip system occurs mainly in the {110} planes which have 90º between then. In another side, the slip planes of face-centered-cubic structure slip systems (planes {111}) make 109º angles between then and consequently, dislocation annihilation on the surface may result in structures with this angles on the austenite regions. Sample surface observations detected “roof like” morphology with a well defined near 109º structures which suggest the dislocation annihilation on austenite. Another structure detected on the sample surface was the cold induced martensite. The preliminary evaluation of recrystallization of some processed and treated samples, at 1000°C for 7,5, 15 and 30 minutes identified located points of recrystallization in the grain contours. With increase of the time of heat treatment from 7,5 to 15 minutes, increase of recrystallization nuclei was detected, whereas after treatment of 30 minutes verifies increase of the size of crystals formed without expressive increase of the number of nucleis. / Este trabalho tem por objetivo processar um aço inoxidável dúplex de estrutura austenítica-ferrítica, tipo UNS S32205/S31803, através da extrusão em canal angular (ECA) e caracterizar o aço processado. O princípio da ECA está baseado na aplicação de uma deformação plástica severa, a uma temperatura relativamente baixa, sem nenhuma mudança nas dimensões da seção transversal do material. A matriz utilizada na extrusão foi construída a partir de um aço 1045, cementado e temperado, e os punções de aço ferramenta. A extrusão foi realizada a temperatura ambiente usando uma máquina de ensaios mecânicos, em três velocidades diferentes de aplicação da pressão de extrusão: 1,5, 6,0 e 12 mm/min. A tensão necessária para realizar a extrusão aumentou continuamente ao longo do processamento, atingindo valores próximos 3GPa. Isto é devido, principalmente, à força de atrito entre o corpo de prova e as paredes o canal da matriz. Os resultados também mostram que o aumento da tensão atingida durante o processamento está relacionado à velocidade de processamento e número de passes. A força de atrito promoveu grande heterogeneidade de deformação ao longo das seções das amostras com aumento de dureza de 257HV (material recebido) para 575HV(ponto que sofreu maior deformação). Este efeito foi observado pela morfologia e mudança de orientação dos grãos ao longo das dimensões da amostra processadas. Após o processamento, algumas amostras do material foram termicamente tratadas a 1000° e 1200°C por períodos 7,5, 15, 30 e 60 minutos. Na superfície das amostras processadas por 2 passes de ECA, a temperatura ambiente, com velocidade de 1,5 mm/min. e posterior tratamento térmico a 1200°C por 60 min, foi verificado formação de dois tipos de estruturas distintas com pequenas superfícies posicionadas com ângulos de 90° e ângulos próximos a 109° bem definidos entre si. A região de 90° entre as superfícies mostra uma estrutura predominante de formas cúbicas, provavelmente em conseqüências da aniquilação de empilhamento de discordância na superfície cúbica de corpo centrado da fase ferrita. Na estrutura cristalina, o sistema de deslizamento ocorre principalmente nos planos {110}, os quais têm ângulos de 90° entre si. Por outro lado, os planos de deslizamento da estrutura cúbica de face centrada, {111}, formam ângulos próximos a 109° entre eles e consequentemente, a aniquilação de discordância na superfície resulta em estruturas na região da austenita. A observação da superfície das amostras detectou uma morfologia semelhante a um telhado (“roof like”) com estruturas com ângulos próximos a 109°, os quais sugerem a aniquilação de discordância na austenita. Outra estrutura detectada nas superfícies das amostras processado por ECA com 1 passe a velocidade de 1,5mm/min. e posterior tratamento térmico a 1200°C durante 60 minutos, foi a martensita induzida por deformação a frio. A avaliação preliminar da recristalização de algumas amostras processadas por ECA com 1 passe a velocidade de 1,5mm/min., e posterior tratamento térmico a 1000°C por 7,5, 15 e 30 minutos identificou pontos localizados de recristalização nos contornos de grão. Com o aumento do tempo de tratamento térmico de 7,5 para 15 minutos, aumentou o número de núcleos de recristalização, ao passo que após tratamento por 30 minutos foi verificado aumento no tamanho dos cristais formados sem expressivo aumento o número de núcleos

Made available in DSpace on 2016-04-27T16:32:38Z (GMT). No. of bitstreams: 1 Luciane Staudt.pdf: 1153660 bytes, checksum: 0f28b6e7e6c58d75b23f0e3651bab8f9 (MD5) Previous issue date: 2012-05-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The objective of this study is the identification and the curriculum analysis of the pedagogical work in a special school for students with intellectual disabilities from higher social strata, and it has the intention of verify what is the education work developed in this school and if this school presents any different kind of teaching. This investigation is based in a triple theoretical perspective, discussed in the first chapter, with the contributions of Apple (1989), Sacristán (1998) and Perrenoud (1993) about curriculum, scholar education and pedagogical activities. In the sequence the issues about the intellectual disability definitions and their relation with schooling process, which one of most contributors was Vigotski (1989). In the end we looking for to take the ownership of Bourdieu (2009) contributions in the field of high society schooling to analyze the relationship between schooling and intellectual disability. The hypothesis of this investigation, that the curriculum of a special school for high society students with intellectual disability differs from the others schools that doesn t have this focus, and its main function is the child development by an better appropriation of scholar contents, can not be proven because the scholar organization and the pedagogical practices, mainly based in routinization of activities and not by the exploration of the manifestation of the students, seem to express a fixed and unchanging perspective of cognitive impairments presented by students / Este estudo teve como objetivo geral a identificação e a análise do currículo e do trabalho pedagógico realizado em uma escola especial destinada a alunos com deficiência intelectual proveniente de camadas sociais superiores, com a intenção de verificar qual é o trabalho educativo realizado e se tal escola apresenta de alguma forma um ensino diferenciado. Para tanto, esta investigação apresenta uma tríplice perspectiva teórica, discutida no primeiro capítulo, inicialmente com as contribuições de Apple (1989), Sacristán (1998) e Perrenoud (1993) sobre currículo, organização escolar, práticas e atividades pedagógicas e posteriormente abordamos questões referentes à definição de deficiência intelectual e sua relação com os processos de escolarização, onde destacamos as contribuições de Vigotski (1989). Por fim, procuramos nos apropriar das contribuições de Bourdieu (2009) no que se refere à escolarização das elites, para a análise da relação entre escolarização e deficiência intelectual. A hipótese inicial desta investigação, de que o currículo de uma escola especial voltada para o atendimento de alunos com deficiência intelectual provenientes das camadas sociais elevadas se diferencia dos voltados à maioria da população e tem por finalidade o desenvolvimento da criança para favorecer uma melhor apropriação do conteúdo escolar, não pode ser comprovada, uma vez que organização escolar e curricular e as práticas pedagógicas, marcadas fundamentalmente pela rotinização das atividades e pela não exploração da manifestação dos alunos, parecem expressar uma perspectiva fixa e imutável dos prejuízos cognitivos apresentados por seu alunado

A prevalência de Doença Mental Grave (do inglês Severe Mental Illness, SMI) atinge 5,4% em um ano segundo os estudos Baltimore Epidemiologic Catchment Area e National Comorbidity Survey. O conceito de SMI surgiu na década de 1970 para o planejamento dos serviços de saúde e apresentou importância crescente a partir do movimento de desinstitucionalização psiquiátrica. Uma das definições para SMI deriva do NIMH (National Institute of Mental Health) em 1987, e utiliza como critérios a presença de prejuízo funcional, decorrente de déficits em aspectos básicos do dia-a-dia, bem como a duração da doença. Casos agudos de SMI podem necessitar tratamento em Unidade de Internação Psiquiátrica em Hospital Geral (UIPHG). No entanto, há poucos estudos disponíveis no Brasil avaliando esta modalidade de tratamento e os desfechos destes pacientes. Evidências também apontam que os pacientes com transtornos psiquiátricos apresentam níveis reduzidos de Fator Neurotrófico Derivado do Cérebro (Brain-Derived Neurotrophic Factor, BDNF). O BDNF age no sistema nervoso central (SNC) promovendo crescimento e diferenciação de neurônios. Dentro deste contexto, a presente tese apresenta como objetivo principal a avaliação naturalística de desfechos clínicos e funcionais, associados à avaliação dos níveis séricos de BDNF, em pacientes com SMI. Os pacientes que foram encaminhados para tratamento na Unidade de Internação Psiquiátrica do Hospital de Clínicas de Porto Alegre foram incluídos se apresentassem os critérios de SMI: Avaliação Global de Funcionamento (Global Assessment of Functioning, GAF) menor ou igual a 50 e tempo de tratamento maior ou igual a dois anos. As avaliações ocorreram em dois momentos (admissão e alta). Compreenderam avaliação sociodemográfica, clínica e coleta de sangue (com dosagem de BDNF sérico). Foram realizadas avaliação diagnóstica pelo Mini-International Neuropsychiatric Interview (MINI) e aplicação das escalas Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression scale (CGI-S), GAF e World Health Organization Quality of Life Instrument—Short Version (WHOQOL-Bref). Ainda, foram aplicadas escalas específicas nos diagnósticos principais (i.e., depressão maior, depressão bipolar, episódio maníaco, esquizofrenia): Hamilton Depression Rating Scale (HAM-D); Young Mania Rating Scale (YMRS). O primeiro artigo desta tese descreve os desfechos clínicos, funcionais e também de qualidade de vida durante a internação psiquiátrica. Observou-se melhora significativa nos parâmetros avaliados nos pacientes com SMI como um todo. Os pacientes com episódio maníaco apresentaram maior chance (em relação aos com episódio depressivo) de atingir remissão pela CGI (OR: 4.03; 95% CI: 1.14-14.30; p=0.03). A duração média da hospitalização (LOS) foi 28,95 (± 19,86) dias. No segundo artigo, observou-se redução dos níveis séricos de BDNF nos pacientes com SMI em relação aos controles saudáveis, independentemente do diagnóstico. Houve aumento significativo no BDNF entre a admissão e a alta. Os resultados apresentados replicam dados previamente publicados a partir de amostra única de pacientes com SMI, sua característica diferencial. Estes resultados reforçam que a internação em UIPHG, uma intervenção relativamente breve, demonstra desfechos positivos e é alternativa bem estabelecida no tratamento da SMI. Além disso, a redução inespecífica do BDNF sérico seguida de um pequeno aumento associado ao tratamento reforçam a possibilidade do BDNF como marcador transdiagnóstico de transtorno mental. / The estimated prevalence of Severe Mental Illness (SMI) according to Baltimore Epidemiologic Catchment Area and National Comorbidity Survey studies is 5.4% in one year. One suggested definition of Severe Mental Illness (SMI) derives from the 1987 National Institute of Mental Health (NIMH) definition and is based on two criteria: 1. duration, characterized as involving “prolonged illness”, and 2. disability, which includes dangerous or disturbing social behavior, and mild impairment in achieving basic needs. These acute psychiatric conditions may require psychiatric inpatient treatment located in acute wards in General Hospitals. However, little data is currently available evaluating the characteristics and the outcomes during an acute inpatient stay in Brazil. Evidence also suggests that Brain-derived neurotrophic factor (BDNF) levels are significantly decreased in neuropsychiatric disorders. BDNF is found throughout the brain and is involved in neurogenesis and neuroplasticity. So, the main objectives of this work are to evaluate SMI patients’ outcomes during treatment in a psychiatric unit in a general hospital by symptomatology, functionality, quality of life and by the evaluation of BDNF serum levels. After the admission to a psychiatric unit in a general hospital in Brazil, patients were included and if they had two of the SMI criteria: Global Assessment of Functioning (GAF) ≤ 50 and duration of services contact ≥ 2 years. Patients were assessed in admission and upon discharge with Mini-International Neuropsychiatric Interview (MINI), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale (CGI), GAF, World Health Organization’s QOL Instrument—Short Version (WHOQOL-Bref) and diagnostic specific scales (Hamilton Depression Rating Scale, HAM-D; Young Mania Rating Scale, YMRS; and Hamilton Anxiety Rating Scale, HAM-A). Blood samples were also obtained. The first manuscript showed that SMI patients had marked and significant improvements in symptomatic and functional measures during psychiatric hospitalization. Patients with manic episode had higher chance of CGI remission (OR: 4.03; 95% CI: 1.14-14.30; p=0.03) when compared with patients with depressive episode. Mean LOS was 28.95 (± 19.86) days. The second manuscript showed that BDNF serum levels were equally reduced among different SMI diagnoses. Also, the observed improvements in SMI patients were associated with a significant, but small increase in mean serum BDNF levels. Therefore, the results replicate evidence from previous findings in single samples, suggesting that SMI patients can have marked acute improvements during a a relatively short intervention (approximately 1 month) represented by the psychiatric hospitalization in a general tertiary hospital. Also, the similar reduction observed in BDNF levels among SMI patients with different diagnoses and the significant increase but non-restoration indicate that BDNF serum levels could be considered a marker for the presence of an unspecific psychiatric disorder and possibly a transdiagnostic and unspecific marker of disease activity.

Homelessness and rough sleeping has dramatically increased in the UK over the past six years. Links between welfare changes, inequality and social exclusion are pronounced. This study looked into the experiences of a particular group of people experiencing homelessness; those with complex needs who had had multiple moves round homeless projects. Qualitative research of the lived experiences of those experiencing homelessness is limited, particularly for this group of individuals in the UK. An Interpretative Phenomenological Analysis was applied to interviews undertaken with six men with these experiences. The four main themes from this analysis were Moving forward vs no way forward, Being here has really helped but it's only temporary, Being treated as different and Desperately longing for yet deeply fearing relationships. These themes were supported with extensive participant quotes and were contextualised in the current literature. The themes reflect and demonstrate: Challenges with hope and future plans and the role of substance use; Relationships to help in the context of conditionality and the temporary nature of projects; Issues regarding coherent identity development and stigmatisation; and Complexity around forming relationships. These findings develop our understanding of this population and support improvements in practice. A clear role for Clinical Psychologists in this area was identified and recommendations across domains of individual, service level and community practice were presented.

Os genes var de Plasmodium falciparum codificam a proteína PfEMP1 expressa na superfície de eritrócitos infectados e que medeia os fenômenos de citoaderência e \"rosetting\". Ambos os fenômenos estão diretamente associados à malária grave, e seu domínio mais N-terminal, DBL1alfa, media especificamente \"rosetting\". Análise de seqüências DBL1alfa de isolados brasileiros e de outros países revelou que a similaridade entre elas não pode predizer origem geográfica. Com o objetivo de determinar se existem seqüências DBL1alfa associadas à malária grave, analisamos as seqüências DBL1alfa expressas em parasitas obtidos de pacientes brasileiros com esta manifestação clínica e encontramos que as seqüências predominantemente expressas apresentavam uma ou duas deleções de cisteínas. Significativamente, apesar de freqüentes no genoma de parasitas de pacientes com malária não grave, essas seqüências foram raramente expressas. Esses dados demonstram a primeira associação de seqüências PfEMP1 expressas e malária grave em pacientes da Amazônia Brasileira. / Plasmodium falciparum var genes code for PfEMP1, a protein expressed on the surface of infected erythrocytes, and which mediates cytoadherence and rosetting. Both phenomena are directly associated with severe malaria and the most N-terminal domain, DBL1alfa, specifically mediates rosetting. DBL1alfa sequence analysis from Brazilian and worldwide isolates revealed that sequence similarities cannot predict geographical origin. To determine whether there are DBL1alfa sequences associated with severe malaria, we examined expressed var DBL1alfa sequences in patients with severe malaria from the Brazilian Amazon and found that the predominantly expressed DBL1alfa sequences from these parasites lacked 1-2 cysteine residues. Significantly, these sequences were amply found on the genomic repertoire of parasites from patients with mild malaria and yet they were rarely expressed. These data demonstrate the first association of particular PfEMP1 expressed sequences and severe malaria in patients from the Brazilian Amazon.

Choy Wai Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 98-122). / Abstracts in English and Chinese. / Thesis committee --- p.i / Statement --- p.ii / Abstract --- p.iii / Acknowledgements --- p.vi / General abbreviations --- p.viii / Abbreviations of chemicals --- p.x / Table of contents --- p.xi / List of figures --- p.xv / List of tables --- p.xviii / Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Severe acute respiratory syndrome (SARS) - An overview --- p.1 / Chapter 1.1.1 --- Epidemiology of SARS --- p.1 / Chapter 1.1.2 --- Clinical presentation of SARS --- p.2 / Chapter 1.1.3 --- Diagnostic tests of SARS --- p.5 / Chapter 1.1.4 --- Treatment of SARS --- p.7 / Chapter 1.2 --- Severe acute respiratory syndrome coronavirus (SARS- CoV) --- p.8 / Chapter 1.2.1 --- The etiological agent of SARS --- p.8 / Chapter 1.2.2 --- The coronaviruses --- p.9 / Chapter 1.2.3 --- Genome of SARS-CoV --- p.11 / Chapter 1.3 --- Spike (S) glycoprotein of SARS-CoV --- p.14 / Chapter 1.3.1 --- Functions of SARS-CoV S glycoprotein --- p.15 / Chapter 1.3.2 --- Receptors for S glycoprotein of SARS-CoV --- p.17 / Chapter 1.4 --- 3C-like protease (3CLPro) of SARS-CoV --- p.20 / Chapter 1.4.1 --- Extensive proteolytic processing of SARS-CoV replicase polyproteins --- p.20 / Chapter 1.4.2 --- SARS-CoV 3CLPro --- p.21 / Chapter 1.4.3 --- Substrate specificity of SARS-CoV 3CLPro --- p.22 / Chapter 1.5 --- Combating SARS - Vaccine and drug development --- p.24 / Chapter 1.5.1 --- Vaccine development against SARS --- p.24 / Chapter 1.5.2 --- Drug development against SARS --- p.25 / Chapter 1.6 --- Project objectives of this thesis --- p.27 / Chapter 1.6.1 --- Synthetic Peptide Studies on SARS-CoV S glycoprotein --- p.27 / Chapter 1.6.2 --- Synthetic Peptide Studies on SARS-CoV 3CLPro --- p.28 / Chapter 2 --- Materials and Methods --- p.30 / Chapter 2.1 --- Synthetic peptide studies on SARS-CoV S glycoprotein --- p.30 / Chapter 2.1.1 --- Bioinformatics analyses of SARS-CoV S gly- coprotein --- p.30 / Chapter 2.1.2 --- Peptide design and molecular modeling --- p.32 / Chapter 2.1.3 --- Solid phase peptide synthesis (SPPS) --- p.33 / Chapter 2.1.4 --- Peptide conjugation --- p.35 / Chapter 2.1.5 --- Immunization in rabbits and monkeys --- p.36 / Chapter 2.1.6 --- ELISA analysis --- p.37 / Chapter 2.1.7 --- Immunofluorescent confocal microscopy --- p.39 / Chapter 2.2 --- Synthetic peptide studies on SARS-CoV 3CLpro --- p.40 / Chapter 2.2.1 --- Protein expression and purification --- p.40 / Chapter 2.2.2 --- Solid phase peptide synthesis (SPPS) --- p.41 / Chapter 2.2.3 --- Peptide cleavage assay --- p.44 / Chapter 2.2.4 --- Molecular docking --- p.46 / Chapter 3 --- Results --- p.48 / Chapter 3.1 --- Synthetic peptide studies on SARS-CoV S glycoprotein --- p.48 / Chapter 3.1.1 --- General features and structural analyses of the S glycoprotein --- p.48 / Chapter 3.1.2 --- Peptides design and synthesis --- p.53 / Chapter 3.1.3 --- ELISA analysis and immunofluorescent con- focal microscopy --- p.55 / Chapter 3.2 --- Synthetic peptide studies on SARS-CoV 3CLpro --- p.62 / Chapter 3.2.1 --- Substrate specificity of SARS-CoV 3CLPro . . --- p.62 / Chapter 3.2.2 --- Molecular docking of SARS-CoV 3CLPro and peptide substrates --- p.74 / Chapter 4 --- Discussion --- p.78 / Chapter 4.1 --- Synthetic peptide studies on SARS-CoV S glycoprotein --- p.78 / Chapter 4.1.1 --- Synthetic peptides elicited SARS-CoV specific antibodies --- p.78 / Chapter 4.1.2 --- Factors affecting the specificity and antigenic- ity of synthetic peptides --- p.80 / Chapter 4.1.3 --- Next step towards vaccine development --- p.83 / Chapter 4.1.4 --- A synthetic peptide-based approach --- p.84 / Chapter 4.2 --- Synthetic peptide studies on SARS-CoV 3CLpro --- p.86 / Chapter 4.2.1 --- A comprehensive overview of the substrate specificity of SARS-CoV 3CLpro --- p.87 / Chapter 4.2.2 --- Sequence comparison between SARS-CoV 3CLpro cleavage sites --- p.90 / Chapter 4.2.3 --- A rapid and high throughput approach to screen protease substrate specificity --- p.94 / Bibliography --- p.98

Coronaviruses are a diverse group of large, single-stranded RNA virus that cause respiratory and enteric diseases in mammalian and avian species. Phylogenetic analysis shows that SARS-CoV is an unique branch of coronavirus showing no close relationship to other groups of coronaviruses. The genome size of SARS-CoV is about 30 kilobase and the genome, like other coronaviruses, is composed of replicase (rep), spike (S), envelope (E), membrane (M) and nucleocapsid (N) and 8 additional unknown open reading frames (ORFs) (ORF 3a, ORF 3b, ORF 6, ORF 7a, ORF 7b, ORF8a, ORF 8b and ORF 9b). The 3a gene, the largest unknown ORF, encodes a viral protein which is predicted to be a transmembrane protein. In this study, we showed that the 3a protein was expressed in SARS patients' lung and intestinal tissues, and it is localized to the endoplasmic reticulum (ER) in 3a-transfected monkey kidney Vero E6 cells. Results from experiments including chromatin condensation, DNA fragmentation and antibody microarray suggest that the 3a protein may trigger apoptosis through a caspase-8-dependent pathway and possibly a PKR-mediated FADD-caspase-8 pathway. Our data show that over-expression of the SARS-CoV protein can induce apoptosis in vitro. / Severe acute respiratory syndrome (SARS), an atypical form of pneumonia, is first recognized in Guangdong Province, China in November 2002 and later spread to Hong Kong in mid February 2003. It is believed that the etiological agent of SARS is a previously unknown coronavirus - SARS-CoV. Over 8,400 cases and 789 deaths were reported to World Health Organization (WHO) from over 28 countries around the world including Hong Kong. Up to now, there are still no efficient antiviral drugs to treat the disease, and the detailed pathology of SARS-CoV infection and the host response to the viral infection are still unknown. During the epidemic, we have done complete genome sequencing for five SARS-CoV isolates and we postulate that at least two SARS-CoV strains with distinct etiological origins exist in the environment during the epidemic. / Law Tit-wan Patrick. / "Aug 2005." / Adviser: Stephen K. W. Tsui. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3594. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 156-172). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.