O primeiro passo para entender as funções da microbiota do trato digestivo na biologia dos insetos consiste na identificação dos membros destas comunidades. Neste trabalho, as bactérias presentes no mesêntero de lagartas da broca da cana-de-açúcar, Diatraea saccharalis e da lagarta-do-cartucho-do-milho, Spodoptera frugiperda, provenientes de diferentes localidades, espécies ou variedades de plantas hospedeiras, foram identificadas por isolamentos em meio de cultura TSA (Triptona de Soja Agar) e por técnicas moleculares que independem do cultivo dos microrganismos. As lagartas de D. saccharalis foram coletadas em nove variedades de cana-deaçúcar nos municípios paulistas de Bocaina, Tanabi e Luís Antônio. S. frugiperda foram coletadas diretamente no campo em milho em Piracicaba-SP e populações de campo e de laboratório foram também alimentadas com dieta artificial, milho, algodão, sorgo e arroz. Foram utilizadas 90 lagartas de D. saccharalis e 40 de S. frugiperda sendo a microbiota de cada lagarta avaliada individualmente. As bactérias isoladas foram testadas quanto à capacidade de degradação de celulose, hemicelulose, lignina e bagaço de cana. A caracterização molecular foi realizada por DGGE (Gel de eletroforese em gradiente desnaturante) usando-se a região 16S do RNA ribossômico amplificado de DNA metagenômico extraído do mesêntero de 57 lagartas de D. saccharalis e 26 de S. frugiperda. Posteriormente, 6 destas amostras de DNA metagenômico de cada uma das espécies de insetos foram clonadas e as 12 bibliotecas de clones foram sequenciadas. A comunidade de bactérias cultiváveis das duas espécies de insetos é composta por representantes dos filos Firmicutes, Proteobacteria e Actinobacteria. A afiliação filogenética das seqüências das bibliotecas de clones de rRNA 16S revelou a ocorrência, além destes filos, de Bacteroidetes em D. saccharalis e Bacteroidetes e Acidobacteria em S. frugiperda. Somente bactérias isoladas de D. saccharalis apresentaram resposta positiva nos testes de degradação in vitro para celulose, hemicelulose, lignina e bagaço de cana. A capacidade destes microrganismos de degradar celulose foi maior do que hemicelulose e poucos produziram enzimas para degradar lignina. Somente duas bactérias apresentaram resposta positiva aos testes de degradação para todas estas fontes de carbono. As seqüências de rRNA 16S destas se agrupam com representantes de Phyllobacterium trifolii e Bacillus subtilis. O maior número de sequências de bactérias cultiváveis pertence aos gêneros Bacillus (26,4 e 32.4% em D. saccharalis e S. frugiperda, respectivamente), Enterococcus (12,1 e 13%) e Microbacterium (18 e 12%). As análises das seqüências obtidas do DNA metagenômico revelaram que Klebsiella esteve presente em todas as amostras analisadas de D. saccharalis. As comunidades de bactérias em S. frugiperda apresentaram maior variação em função do alimento. Entretanto, Ralstonia e Hydrogenophilus estiveram presentes na maioria das lagartas. As variações das estruturas das comunidades bacterianas de S. frugiperda e de D. saccharalis estão diretamente relacionadas com a origem das populações e o tipo de alimentação dos insetos. A presença constante de algumas bactérias na maioria dos insetos indica que estas possam ser indispensáveis, exercendo alguma função vital para o inseto ou que apresentam alguma relação vantajosa para o hospedeiro. / The identification of members of the microbe communities is the first step to understand their roles on insect biology. We have characterized the midgut bacterial community of fifth ínstar caterpillars of sugarcane borer, Diatraea saccharalis, and of fall armyworm, Spodoptera frugiperda, through isolation on tryptic soy agar medium and through culture-independent molecular techniques. D. saccharalis caterpillars were collected on nine sugarcane varieties in Bocaina, Tanabi and Luís Antônio cities in São Paulo State. S. frugiperda were collected directly from corn fields in Piracicaba-SP and field and laboratory populations were reared on artificial diet, corn, cotton, sorghum and rice. Ninety D. saccharalis caterpillars and 40 S. frugiperda caterpillars were used. The microbiota community of each caterpillar was evaluated individually. The ability of bacterial isolates to degrade cellulose, hemicellulose, lignin and sugarcane bagasse was assessed. The molecular analyses were based on Denaturing Gradient Gel Electrophoresis (DGGE) of 16S ribosomal RNA sequences amplified from metagenomic DNA extracted from 57 individual midgut of D. saccharalis and 26 from S. frugiperda. Latter, 6 of these metagenomic DNA of each insect species were cloned and the 12 clone libraries were sequenced. The cultivable bacterial community of these two insect species is composed by representatives of the phyla Firmicutes, Proteobacteria and Actinobacteria. The phylotypes from the clone libraries of 16S rRNA were comprised by Bacteroidetes in D. saccharalis and Bacteroidetes and Acidobacteria in S. frugiperda, besides the three phyla found by culturing. Only bacteria isolated from D. saccharalis had ability to degrade cellulose, hemicelluloses, lignin and sugarcane bagasse in the in vitro tests. The ability to degrade cellulose was more common than the ability to degrade hemicelullose and just a few isolates had the ability to degrade lignin. The only two bacteria presenting a positive response to degradation of all carbon sources were clustered with Phyllobacterium trifolii and Bacillus subtilis. The greatest number of cultivable bacteria sequences belongs to genera Bacillus (26.4 and 32.4%, in D. saccharalis and S. frugiperda, respectively), Enterococcus (12.1 and 13%) and Microbacterium (18 and 12%). Sequence analysis from metagenomic DNA revealed the genera Klebsiella in all samples from D. saccharalis. Bacterial community varied according to S. frugiperda host plant; however, both Ralstonia and Hydrogenophilus genera were present in the digestive tracts of insects from most host plants. Community structure variation of S. frugiperda and D. saccharalis is related directly to insect population origin and type of insect food source. The constant presence of some bacteria in the majority of insects indicates that those microorganisms might either be indispensable, playing a vital role to the insect, or have some symbiotic or commensal relation with the insect.

Syftet med studien var att undersöka hur sjuksköterskor skildrar och kommunicerar med psykospatienter och vilket lärande de upplever i dessa möten inom slutenvården. Metoden var halvstrukturerade intervjuer som transkriberats och sedan analyserats med hjälp av van Manens fenomenologiska och hermeneutiska metod och hans livsvärldsexistentialer; relationen, rummet, tiden och kroppen. Sjuksköterskorna beskrev patienter med skilda egenskaper som från att vara starkt fysiskt påverkade och ha kramper till att vara vältränade och se bra ut men också från att vara skrämmande till att vara trevliga. Patienter kunde ha press från anhöriga, ha mycket resurser och de kunde förbättras snabbt men också snart återkomma för inläggning. Strategier vid kommunikation beskrevs som: Ett fokus på här, nu och framåt; ett balanserat, känsligt och kärleksfullt bemötande som förmedlar ett budskap av hopp, delaktighet och realistisk framtidstro. Fysisk omvårdnad kan motverka känslor av rädsla, misstänksamhet och skygghet. Sjuksköterskan kan behöva både sätta egna känslor åt sidan och tänka sig in i patientens situation. För en lyckad kommunikation krävs: Intresse, tålamod, lust och förmåga att se problem som en utmaning vilket skapar möjligheter till lärande för både vårdtagare och personal; utrymme för reflektion som kan förbättra arbetssätt; tid och tillgänglighet för ömsesidigt lärande mellan patient, anhöriga och sjuksköterskor. Humor kan förmedla hopp och avdramatisera kitsliga stämningar. Attityder till patienter som ”jobbig, tråkig eller obegriplig” skadar möjligheten för patienten att känna hoppfullhet. Tvångslagens utformning kan påverka attityder. Jag har funnit att sjuksköterskan bör ställa krav på sig att försöka förstå; inte ge upp; ha tålamod; känsligt möta patientens uppfattning; ingjuta hopp och inspirera till uthållighet; vara uppmärksam på patientens fysiska välbefinnande. Kärlek sågs som vägledande för ett etiskt lärande möte och erfarenheter från dessa användes i framtida möten med patienter. Kommunikationen måste anpassas till olika patienters behov och förutsättningar. / The aim of this study was to investigate how nurses depict meetings with psychosis patients, how they communicate with psychosis in-patients and what kind of learning they experience in these meetings. Semi structure interviews were transcripted and then analyzed with the phenomenological and hermeneutic perspective from van Manen and his life-world existentials; lived relation, lived space, lived time and lived body. The nurses described patients with varied characteristics, ranging from strong physical influence with spasms, to fit and good-looking but also as frightening or being pleasant. Patients could be exposed to pressure from relatives, have a lot of resources and quickly improve and despite these circumstances fall back into needing treatment. Strategies among the nurses when communicating with patients were described as: To focus on here, now and onwards; to give a balanced, sensitive and loving treatment that leaves an actual message of hope, participation and a realistic faith in the future. Physical care could work against feelings of fear, suspicion and shyness. Nurses need to both put their own feelings aside and to imagine themselves in the situation of the patient. To succeed in communicating the nurses need to have: Interest, patience, a will to help and the ability to see a problem as a challenge. These factors create possibilities for learning for both the patients and the staff, and also create time for reflection that can improve working methods, and give time and accessibility for mutual learning between patients, relatives and nurses. Humor could support the patient´s hope and calm an irritable atmosphere. Attitudes to patients as “trying, boring or incomprehensible” indicate a lack of competence and damage the possibility for a patient to perceive hope. The compulsory law design can have an influence on attitudes.  I have found that nurses should demand of themselves to try to understand; not give up; have patience; sensitively meet the patient’s concept; encourage hope and inspire to hold on and be aware of patient’s physical well-being. Love was seen as guide for an ethical learning in meetings with patients and the experiences from these meetings were used when meeting patients later on. Communication has to be adjusted to the patient´s individual needs and conditions.

La rectocolite hémorragique (RCH) est une maladie inflammatoire chronique de l'intestin responsable d'un handicap et d'une altération de la qualité de vie pouvant exposer les patients à des complications sévères en dépit des thérapeutiques actuelles. L'objectif de cette thèse était d'analyser les voies possibles d'amélioration de la prise en charge thérapeutique des patients à partir de données expérimentales et cliniques. Au niveau expérimentale nous nous sommes intéressés au mécanisme impliqué dans la régulation de l'expression de PPARγ, récepteur nucléaires aux propriétés anti-inflammatoires, primitivement diminuée au cours de la RCH et cible des 5-aminosalicylés. Il a été montré que son expression était d'une part sous le contrôle de la stéroidogenèse intraépithéliale, elle-même sous contrôlée par LRH-1 et d'autre part que l'hypoxie épithéliale diminuait son expression via une sur-expression de miR-27a. Par ailleurs, les effets de l'hypoxie sur l'expression de PPARγ étaient inversés en présence de sildénafil. Sur le versant clinique, l'analyse d'une nouvelle stratégie thérapeutique ciblant la cicatrisation muqueuse, c'est à dire l'abrogation de l'inflammation colique macroscopique était efficace et possible dans la pratique clinique. Cet objectif semble aujourd'hui fondamental pour diminué la morbi-mortalité induite par cette maladie. Enfin nous avons observé l'efficacité des anti-TNF dans le cas spécifique de la rectite réfractaire et l'importance de son utilisation prolongée pour éviter les rechutes de la maladie et l'obtention d'une rémission prolongée.

Dissertation (Ph.D.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 239 pages. Includes vita. Includes bibliographical references.

O primeiro passo para entender as funções da microbiota do trato digestivo na biologia dos insetos consiste na identificação dos membros destas comunidades. Neste trabalho, as bactérias presentes no mesêntero de lagartas da broca da cana-de-açúcar, Diatraea saccharalis e da lagarta-do-cartucho-do-milho, Spodoptera frugiperda, provenientes de diferentes localidades, espécies ou variedades de plantas hospedeiras, foram identificadas por isolamentos em meio de cultura TSA (Triptona de Soja Agar) e por técnicas moleculares que independem do cultivo dos microrganismos. As lagartas de D. saccharalis foram coletadas em nove variedades de cana-deaçúcar nos municípios paulistas de Bocaina, Tanabi e Luís Antônio. S. frugiperda foram coletadas diretamente no campo em milho em Piracicaba-SP e populações de campo e de laboratório foram também alimentadas com dieta artificial, milho, algodão, sorgo e arroz. Foram utilizadas 90 lagartas de D. saccharalis e 40 de S. frugiperda sendo a microbiota de cada lagarta avaliada individualmente. As bactérias isoladas foram testadas quanto à capacidade de degradação de celulose, hemicelulose, lignina e bagaço de cana. A caracterização molecular foi realizada por DGGE (Gel de eletroforese em gradiente desnaturante) usando-se a região 16S do RNA ribossômico amplificado de DNA metagenômico extraído do mesêntero de 57 lagartas de D. saccharalis e 26 de S. frugiperda. Posteriormente, 6 destas amostras de DNA metagenômico de cada uma das espécies de insetos foram clonadas e as 12 bibliotecas de clones foram sequenciadas. A comunidade de bactérias cultiváveis das duas espécies de insetos é composta por representantes dos filos Firmicutes, Proteobacteria e Actinobacteria. A afiliação filogenética das seqüências das bibliotecas de clones de rRNA 16S revelou a ocorrência, além destes filos, de Bacteroidetes em D. saccharalis e Bacteroidetes e Acidobacteria em S. frugiperda. Somente bactérias isoladas de D. saccharalis apresentaram resposta positiva nos testes de degradação in vitro para celulose, hemicelulose, lignina e bagaço de cana. A capacidade destes microrganismos de degradar celulose foi maior do que hemicelulose e poucos produziram enzimas para degradar lignina. Somente duas bactérias apresentaram resposta positiva aos testes de degradação para todas estas fontes de carbono. As seqüências de rRNA 16S destas se agrupam com representantes de Phyllobacterium trifolii e Bacillus subtilis. O maior número de sequências de bactérias cultiváveis pertence aos gêneros Bacillus (26,4 e 32.4% em D. saccharalis e S. frugiperda, respectivamente), Enterococcus (12,1 e 13%) e Microbacterium (18 e 12%). As análises das seqüências obtidas do DNA metagenômico revelaram que Klebsiella esteve presente em todas as amostras analisadas de D. saccharalis. As comunidades de bactérias em S. frugiperda apresentaram maior variação em função do alimento. Entretanto, Ralstonia e Hydrogenophilus estiveram presentes na maioria das lagartas. As variações das estruturas das comunidades bacterianas de S. frugiperda e de D. saccharalis estão diretamente relacionadas com a origem das populações e o tipo de alimentação dos insetos. A presença constante de algumas bactérias na maioria dos insetos indica que estas possam ser indispensáveis, exercendo alguma função vital para o inseto ou que apresentam alguma relação vantajosa para o hospedeiro. / The identification of members of the microbe communities is the first step to understand their roles on insect biology. We have characterized the midgut bacterial community of fifth ínstar caterpillars of sugarcane borer, Diatraea saccharalis, and of fall armyworm, Spodoptera frugiperda, through isolation on tryptic soy agar medium and through culture-independent molecular techniques. D. saccharalis caterpillars were collected on nine sugarcane varieties in Bocaina, Tanabi and Luís Antônio cities in São Paulo State. S. frugiperda were collected directly from corn fields in Piracicaba-SP and field and laboratory populations were reared on artificial diet, corn, cotton, sorghum and rice. Ninety D. saccharalis caterpillars and 40 S. frugiperda caterpillars were used. The microbiota community of each caterpillar was evaluated individually. The ability of bacterial isolates to degrade cellulose, hemicellulose, lignin and sugarcane bagasse was assessed. The molecular analyses were based on Denaturing Gradient Gel Electrophoresis (DGGE) of 16S ribosomal RNA sequences amplified from metagenomic DNA extracted from 57 individual midgut of D. saccharalis and 26 from S. frugiperda. Latter, 6 of these metagenomic DNA of each insect species were cloned and the 12 clone libraries were sequenced. The cultivable bacterial community of these two insect species is composed by representatives of the phyla Firmicutes, Proteobacteria and Actinobacteria. The phylotypes from the clone libraries of 16S rRNA were comprised by Bacteroidetes in D. saccharalis and Bacteroidetes and Acidobacteria in S. frugiperda, besides the three phyla found by culturing. Only bacteria isolated from D. saccharalis had ability to degrade cellulose, hemicelluloses, lignin and sugarcane bagasse in the in vitro tests. The ability to degrade cellulose was more common than the ability to degrade hemicelullose and just a few isolates had the ability to degrade lignin. The only two bacteria presenting a positive response to degradation of all carbon sources were clustered with Phyllobacterium trifolii and Bacillus subtilis. The greatest number of cultivable bacteria sequences belongs to genera Bacillus (26.4 and 32.4%, in D. saccharalis and S. frugiperda, respectively), Enterococcus (12.1 and 13%) and Microbacterium (18 and 12%). Sequence analysis from metagenomic DNA revealed the genera Klebsiella in all samples from D. saccharalis. Bacterial community varied according to S. frugiperda host plant; however, both Ralstonia and Hydrogenophilus genera were present in the digestive tracts of insects from most host plants. Community structure variation of S. frugiperda and D. saccharalis is related directly to insect population origin and type of insect food source. The constant presence of some bacteria in the majority of insects indicates that those microorganisms might either be indispensable, playing a vital role to the insect, or have some symbiotic or commensal relation with the insect.

Hauntology Man, a 48-minute documentary, follows former UNT Professor, Dr. Shaun Treat, as he leads a walking ghost tour of downtown Denton, Texas. As the expedition moves from storefront to storefront, each stop elicits a new tale. But, as Dr. Treat points out, the uncertainties of history are the real ghosts. That is, rather than simply presenting a "haunted history" of Denton, it's more accurate to say this movie's center resides at the precipice of a "haunting history." Not all ghost stories need spectres. Sometimes not knowing is ghost enough.

Background and Aims: Morphometric features such as the Milan criteria serve as standard criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Since it has been recognized that these criteria are too restrictive and do not adequately display the tumor biology, additional selection parameters are emerging. Methods: Concise review of the current literature on patient selection for downstaging and LT for HCC outside the Milan criteria. Results: The major task in patients outside the Milan criteria is the need for higher granularity with patient selection, since the benefit through LT is not uniform. The recent literature clearly shows that beneath tumor size and number, additional selection parameters are useful in the process of patient selection for and during downstaging. For initial patient selection, the alpha fetoprotein (AFP) level adds additional information to the size and number of HCC nodules concerning the chance of successful downstaging and LT. This effect is quantifiable using newer selection tools like the WE (West-Eastern) downstaging criteria or the Metroticket 2.0 criteria. Also an initial PET-scan and/or tumor biopsy can be helpful, especially in the high risk group of patients outside the University of California San Francisco (UCSF) criteria. After this entry selection, the clinical course during downstaging procedures concerning the tumor and the AFP response is of paramount importance and serves as an additional final selection tool Conclusion: Selection criteria for liver transplantation in HCC patients are becoming more and more sophisticated, but are still imperfect. The implementation of molecular knowledge will hopefully support a more specific risk prediction for HCC patients in the future, but do not provide a profound basis for clinical decision-making at present.

Detection systems are widely used in industry. Designers, operators and users of these systems need to choose an appropriate design, based on the intended usage and the operating environment. The purpose of this research is to analyze the effect of various system design variables (controllable) and system parameters (uncontrollable) on the performance of detection systems. To optimize system performance one must manage the tradeoff between two errors that can occur. A False Alarm occurs if the detection system falsely indicates a target is present and a False Clear occurs if the detection system falsely fails to indicate a target is present. Given a particular detection system and a pre-specified false clear (or false alarm) rate, there is a minimal false alarm (or false clear) rate that can be achieved. Earlier research has developed methods that address this false alarm, false clear tradeoff problem (FAFCT) by formulating a Neyman-Pearson hypothesis problem, which can be solved as a Knapsack problem. The objective of this research is to develop guidelines that can be of help in designing detection systems. For example, what system design variables must be implemented to achieve a certain false clear standard for a parallel 2-sensor detection system for Salmonella detection? To meet this objective, an experimental design is constructed and an analysis of variance is performed. Computational results are obtained using the FAFCT-methodology and the results are presented and analyzed using ROC (Receiver Operating Characteristic) curves and an analysis of variance. The research shows that sample size (i.e., size of test data set used to estimate the distribution of sensor responses) has very little effect on the FAFCT compared to other factors. The analysis clearly shows that correlation has the most influence on the FAFCT. Negatively correlated sensor responses outperform uncorrelated and positively correlated sensor responses with large margins, especially for strict FC-standards (FC-standard is defined as the maximum allowed False Clear rate). Suggestions for future research are also included. FC-standard is the second most influential design variable followed by grid size. / Master of Science

Hintergrund: Der Einfluss von rheumatoider Arthritis auf Psyche, Lebensqualität und Alltag der Patienten ist groß. Für eine positive Langzeitprognose sind frühzeitige Diagnosestellung und Therapieeinleitung entscheidend. Diese werden maßgeblich von den strukturellen Gegebenheiten der ambulanten rheumatologischen Versorgung beeinflusst. Hier zeigen sich trotz großer Fortschritte in den letzten Jahren weiterhin Defizite. Anhand einer Patientenbefragung in Leipzig sowie ländlichen Gebieten Sachsens sollen regionale Unterschiede und eventuelle Mängel in der ambulanten Versorgung sowie deren Einfluss auf die Lebensqualität, psychische Gesundheit und Entscheidungsfindungsprozesse untersucht werden. Methoden: Aus sechs Praxen in der Stadt Leipzig und drei Praxen in Kleinstädten (Naunhof, Plauen und Hoyerswerda) wurden Patienten mit der Erstdiagnose rheumatoide Arthritis im ersten Quartal 2011 mittels Fragebögen zu psychischer Gesundheit (Hospital Anxiety and Depression Scale und Short-Form-36-Health-Survey) sowie Entscheidungsfindungsprozessen (Decision Making Preference Scale) befragt. Ein eigens entwickelter Fragebogen erhob Beschwerde- und Behandlungsdauer sowie allgemeine medizinische Daten und Medikation. Ergebnisse: 19 Land- und 38 Stadtpatienten wurden eingeschlossen. Landpatienten suchten signifikant später den Hausarzt auf (Land 15, Stadt 12 Monate, p= .023). Die hausärztliche Behandlungsdauer bis zur Überweisung zum Rheumatologen betrug auf dem Land 5,4 und in der Stadt 2,4 Monate. Bei 70% der Stadt- und 40% der Landpatienten erfolgte die Überweisung innerhalb der ersten sechs Wochen. Die Gesamtdauer von Beschwerdebeginn bis zur Überweisung zum Rheumatologen war mit 20 Monaten auf dem Land signifikant länger als in der Stadt (15 Monate, p= .043). Die Wahl der Medikation durch den Rheumatologen hing signifikant mit der Herkunft der Patienten zusammen (p= .006). Nach Erstkontakt erhielten 65% der Land- und 55% der Stadtpatienten ein DMARD. In beiden Regionen wurde überwiegend mit Glukokortikoiden behandelt (Stadt 82%, Land 71%). Auf dem Land zeigten die Patienten weniger Interesse an Mitwirkung im partizipativen Entscheidungsfindungsprozess und waren mehrheitlich bereit, sich der Meinung des Arztes auch gegen den eigenen Willen anzuschließen. In der Stadt war der Wunsch nach aktiver Teilhabe an medizinischen Entscheidungen bei jüngeren und höher gebildeten Patienten signifikant größer als bei älteren oder bildungsfernen Erkrankten. Mit 21% wiesen tendenziell mehr Landpatienten depressive Symptome auf als in der Stadt (14%). Auf dem Land bestand häufiger der Verdacht auf krankheitsassoziierte Angststörungen. Zusätzlich litten die Patienten hier signifikant stärker unter ihren Schmerzen als in der Stadt (p= .026), wobei sich kein grundsätzlicher Unterschied in der gesundheitsbezogenen Lebensqualität ergab. Schlussfolgerung: In Stadt und Land zeigen sich Defizite in der ambulanten rheumatologischen Versorgung, wobei der Grad der Unterversorgung mit der Herkunft assoziiert ist und Landpatienten signifikant länger bis zum ersten Rheumatologenkontakt brauchen. Maßgeblich verantwortlich hierfür ist die verspätete Vorstellung der Patienten beim Hausarzt ebenso wie die ungleiche Facharztverteilung in Stadt und Land. Patienten auf dem Land sind tendenziell depressiver, passiver und schmerzgeplagter, wobei sich keine grundsätzlichen Unterschiede in der gesundheitsbezogenen Lebensqualität ergeben. Die Ergebnisse spiegeln Ärztemangel und infrastrukturelle Probleme wider. Weiterer Schulungs- und Aufklärungsbedarf zur verstärkten Bildung eines öffentlichen Bewusstseins für die Erkrankung rheumatoide Arthritis wird ebenso deutlich wie die Notwendigkeit für die Bahnung schnellerer Zugangswege zu rheumatologischer Behandlung.

Introdução: O sofrimento psíquico infanto-juvenil foi historicamente atrelado às limitações cognitivas (idiotia infantil) e à necessidade de ação sobre o abandono e delinquência juvenil e traz em seu bojo práticas de cuidado historicamente segregadoras e médico-científicas moralizantes. A assunção do Estado às práticas de cuidado à infância e adolescência principalmente nos movimentos reformadores da década de 80 no Brasil construção do Sistema Único de Saúde e Reforma Psiquiátrica reivindicou um novo olhar em torno desse cuidado, o que foi concretizado na construção de uma política de cuidado infantojuvenil enredada estrategicamente nos CAPS infantojuvenis, bem como na necessidade dos processos de trabalho que apoiassem práticas interseçoras e relacionais produtoras de usuários sujeitos de direitos nesses estabelecimentos. Objetivo: Evidenciar a relação entre as modalidades de produção de cuidado em saúde mental e os processos de trabalho desenvolvidos em um CAPS ADi. Método: cartografia dos processos de trabalho com profissionais de um CAPS ADi de São Bernardo do Campo - São Paulo e dois usuários do estabelecimento. Utilizou-se a metodologia do caso-traçador na congregação de quatro focos de análise sobre dois casos emblemáticos atendidos no CAPS: observação do cotidiano de trabalho, caracterização, grupos focais com profissionais e entrevistas com dois usuários. Resultados: Os resultados apontaram para uma dinâmica de trabalho bastante complexa e atravessada por questões cotidianas do serviço, bem como por diferentes concepções acerca do cuidado, do que é projeto terapêutico e de como cuidar de adolescentes que trazem histórias sociais tão diversas quanto às suas famílias e situações de vulnerabilidade nas quais o uso abusivo de drogas se faz, por vezes, secundário em relação à demanda vivenciada dia-a-dia. Conclusão: É de suma importância construir espaços de reflexão e autoanálise para que os profissionais possam partilhar e rediscutir os processos de subjetivação gerados a partir de suas ações nos usuários e em si próprios, bem como, resignificar o sentido do cuidado e da existência de um Centro de Atenção Psicossocial voltado para crianças e adolescentes que fazem uso abusivo de álcool e drogas / Introduction: The child and youth psychological suffering was historically tied to cognitive deficits and the need for action on child abandonment and juvenile delinquency. They will be cared for the practices historically segregated and medical-scientific moralizing. Nevertheless, the State care practices for childhood and adolescence, the emergence of specific knowledge about child and youth development, and especially the reform movements of the 80s in Brazil the construction of integrated and universal health system, and psychiatric reform - demanded a new point of view around that care, what was achieved later in the construction of a policy of child and youth careful established in Child and Youth Psychosocial Care Centers CAPSi and in need of work processes that supported relational practices intercessors and producing users having rights in these establishments. Objective: It aims to show the relationship between modes of production of mental health care and work processes developed in Child and Youth Psychosocial Care Center to treat drug abuse CAPS ADi. Methods: The work process mapping with professionals and two users of Chlid and Youth CAPS to treat drug abuse at São Bernardo do Campo - São Paulo. We used the methodology of \"case-tracer\" in the congregation of four foci analysis on two emblematic cases seen at CAPS: observation of daily work, characterization and focus groups with professionals and interviews with two users. Results: The results showed a dynamic work quite complex crossed by the everyday issues of service, as well as different conceptions of care, which is the therapeutic project and how to care for adolescents who bring social stories as diverse as their families and vulnerability situations in which drug abuse is done sometimes secondary demand experienced dayto-day. Conclusion: It is extremely important to ensure spaces for reflection so that professionals can share and revisit the processes of subjectivity generated from their actions on users and themselves as well, reframe the meaning of care and the existence of a Psychosocial Center facing children and adolescents who abuse alcohol and drugs