6,549 research outputs found

    Anuário científico da Escola Superior de Tecnologia da Saúde de Lisboa - 2021

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    É com grande prazer que apresentamos a mais recente edição (a 11.ª) do Anuário Científico da Escola Superior de Tecnologia da Saúde de Lisboa. Como instituição de ensino superior, temos o compromisso de promover e incentivar a pesquisa científica em todas as áreas do conhecimento que contemplam a nossa missão. Esta publicação tem como objetivo divulgar toda a produção científica desenvolvida pelos Professores, Investigadores, Estudantes e Pessoal não Docente da ESTeSL durante 2021. Este Anuário é, assim, o reflexo do trabalho árduo e dedicado da nossa comunidade, que se empenhou na produção de conteúdo científico de elevada qualidade e partilhada com a Sociedade na forma de livros, capítulos de livros, artigos publicados em revistas nacionais e internacionais, resumos de comunicações orais e pósteres, bem como resultado dos trabalhos de 1º e 2º ciclo. Com isto, o conteúdo desta publicação abrange uma ampla variedade de tópicos, desde temas mais fundamentais até estudos de aplicação prática em contextos específicos de Saúde, refletindo desta forma a pluralidade e diversidade de áreas que definem, e tornam única, a ESTeSL. Acreditamos que a investigação e pesquisa científica é um eixo fundamental para o desenvolvimento da sociedade e é por isso que incentivamos os nossos estudantes a envolverem-se em atividades de pesquisa e prática baseada na evidência desde o início dos seus estudos na ESTeSL. Esta publicação é um exemplo do sucesso desses esforços, sendo a maior de sempre, o que faz com que estejamos muito orgulhosos em partilhar os resultados e descobertas dos nossos investigadores com a comunidade científica e o público em geral. Esperamos que este Anuário inspire e motive outros estudantes, profissionais de saúde, professores e outros colaboradores a continuarem a explorar novas ideias e contribuir para o avanço da ciência e da tecnologia no corpo de conhecimento próprio das áreas que compõe a ESTeSL. Agradecemos a todos os envolvidos na produção deste anuário e desejamos uma leitura inspiradora e agradável.info:eu-repo/semantics/publishedVersio

    Estudo da remodelagem reversa miocárdica através da análise proteómica do miocárdio e do líquido pericárdico

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    Valve replacement remains as the standard therapeutic option for aortic stenosis patients, aiming at abolishing pressure overload and triggering myocardial reverse remodeling. However, despite the instant hemodynamic benefit, not all patients show complete regression of myocardial hypertrophy, being at higher risk for adverse outcomes, such as heart failure. The current comprehension of the biological mechanisms underlying an incomplete reverse remodeling is far from complete. Furthermore, definitive prognostic tools and ancillary therapies to improve the outcome of the patients undergoing valve replacement are missing. To help abridge these gaps, a combined myocardial (phospho)proteomics and pericardial fluid proteomics approach was followed, taking advantage of human biopsies and pericardial fluid collected during surgery and whose origin anticipated a wealth of molecular information contained therein. From over 1800 and 750 proteins identified, respectively, in the myocardium and in the pericardial fluid of aortic stenosis patients, a total of 90 dysregulated proteins were detected. Gene annotation and pathway enrichment analyses, together with discriminant analysis, are compatible with a scenario of increased pro-hypertrophic gene expression and protein synthesis, defective ubiquitinproteasome system activity, proclivity to cell death (potentially fed by complement activity and other extrinsic factors, such as death receptor activators), acute-phase response, immune system activation and fibrosis. Specific validation of some targets through immunoblot techniques and correlation with clinical data pointed to complement C3 β chain, Muscle Ring Finger protein 1 (MuRF1) and the dual-specificity Tyr-phosphorylation regulated kinase 1A (DYRK1A) as potential markers of an incomplete response. In addition, kinase prediction from phosphoproteome data suggests that the modulation of casein kinase 2, the family of IκB kinases, glycogen synthase kinase 3 and DYRK1A may help improve the outcome of patients undergoing valve replacement. Particularly, functional studies with DYRK1A+/- cardiomyocytes show that this kinase may be an important target to treat cardiac dysfunction, provided that mutant cells presented a different response to stretch and reduced ability to develop force (active tension). This study opens many avenues in post-aortic valve replacement reverse remodeling research. In the future, gain-of-function and/or loss-of-function studies with isolated cardiomyocytes or with animal models of aortic bandingdebanding will help disclose the efficacy of targeting the surrogate therapeutic targets. Besides, clinical studies in larger cohorts will bring definitive proof of complement C3, MuRF1 and DYRK1A prognostic value.A substituição da válvula aórtica continua a ser a opção terapêutica de referência para doentes com estenose aórtica e visa a eliminação da sobrecarga de pressão, desencadeando a remodelagem reversa miocárdica. Contudo, apesar do benefício hemodinâmico imediato, nem todos os pacientes apresentam regressão completa da hipertrofia do miocárdio, ficando com maior risco de eventos adversos, como a insuficiência cardíaca. Atualmente, os mecanismos biológicos subjacentes a uma remodelagem reversa incompleta ainda não são claros. Além disso, não dispomos de ferramentas de prognóstico definitivos nem de terapias auxiliares para melhorar a condição dos pacientes indicados para substituição da válvula. Para ajudar a resolver estas lacunas, uma abordagem combinada de (fosfo)proteómica e proteómica para a caracterização, respetivamente, do miocárdio e do líquido pericárdico foi seguida, tomando partido de biópsias e líquidos pericárdicos recolhidos em ambiente cirúrgico. Das mais de 1800 e 750 proteínas identificadas, respetivamente, no miocárdio e no líquido pericárdico dos pacientes com estenose aórtica, um total de 90 proteínas desreguladas foram detetadas. As análises de anotação de genes, de enriquecimento de vias celulares e discriminativa corroboram um cenário de aumento da expressão de genes pro-hipertróficos e de síntese proteica, um sistema ubiquitina-proteassoma ineficiente, uma tendência para morte celular (potencialmente acelerada pela atividade do complemento e por outros fatores extrínsecos que ativam death receptors), com ativação da resposta de fase aguda e do sistema imune, assim como da fibrose. A validação de alguns alvos específicos através de immunoblot e correlação com dados clínicos apontou para a cadeia β do complemento C3, a Muscle Ring Finger protein 1 (MuRF1) e a dual-specificity Tyr-phosphoylation regulated kinase 1A (DYRK1A) como potenciais marcadores de uma resposta incompleta. Por outro lado, a predição de cinases a partir do fosfoproteoma, sugere que a modulação da caseína cinase 2, a família de cinases do IκB, a glicogénio sintase cinase 3 e da DYRK1A pode ajudar a melhorar a condição dos pacientes indicados para intervenção. Em particular, a avaliação funcional de cardiomiócitos DYRK1A+/- mostraram que esta cinase pode ser um alvo importante para tratar a disfunção cardíaca, uma vez que os miócitos mutantes responderam de forma diferente ao estiramento e mostraram uma menor capacidade para desenvolver força (tensão ativa). Este estudo levanta várias hipóteses na investigação da remodelagem reversa. No futuro, estudos de ganho e/ou perda de função realizados em cardiomiócitos isolados ou em modelos animais de banding-debanding da aorta ajudarão a testar a eficácia de modular os potenciais alvos terapêuticos encontrados. Além disso, estudos clínicos em coortes de maior dimensão trarão conclusões definitivas quanto ao valor de prognóstico do complemento C3, MuRF1 e DYRK1A.Programa Doutoral em Biomedicin

    The Professional Identity of Doctors who Provide Abortions: A Sociological Investigation

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    Abortion is a medicalised problem in England and Wales, where the law places doctors at the centre of legal provision and puts doctors in control of who has an abortion. However, the sex-selection abortion scandal of 2012 presented a very real threat to 'abortion doctors', when the medical profession's values and practices were questioned in the media, society and by Members of Parliament. Doctors found themselves at the centre of a series of claims that stated doctors were acting both illegally and unethically, driven by profit rather than patient needs. Yet, the perspectives of those doctors who provide abortions has been under-researched; this thesis aims to fill that gap by examining the beliefs and values of this group of doctors. Early chapters highlight the ambiguous position of the abortion provider in Britain, where doctors are seen as a collective group of professionals motivated by medical dominance and medical autonomy. They outline how this position is then questioned and contested, with doctors being presented as unethical. By studying abortion at the macro-, meso- and micro-levels, this thesis seeks to better understand the values of the 'abortion doctor', and how these levels shape the work and experiences of abortion providers in England and Wales. This thesis thus addresses the question: 'What do abortion doctors' accounts of their professional work suggest about the contemporary dynamics of the medicalisation of abortion in Britain?'. It investigates the research question using a qualitative methodological approach: face-to-face and telephone interviews were conducted with 47 doctors who provide abortions in England and Wales. The findings from this empirical study show how doctors' values are linked to how they view the 'normalisation of abortion'. At the macro-level doctors, openly resisted the medicalisation of abortion through the position ascribed to them by the legal framework, yet at the meso-level doctors construct an identity where normalising abortion is based on further medicalising services. Finally, at the micro-level, the ambiguous position of the abortion provider is further identified in terms of being both a proud provider and a stigmatised individual. This thesis shows that while the existing medicalisation literature has some utility, it has limited explanatory power when investigating the problem of abortion. The thesis thus provides some innovative insights into the relevance and value of medicalisation through a comprehensive study on doctors' values, beliefs and practices

    The Adirondack Chronology

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    The Adirondack Chronology is intended to be a useful resource for researchers and others interested in the Adirondacks and Adirondack history.https://digitalworks.union.edu/arlpublications/1000/thumbnail.jp

    Investigating and mitigating the role of neutralisation techniques on information security policies violation in healthcare organisations

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    Healthcare organisations today rely heavily on Electronic Medical Records systems (EMRs), which have become highly crucial IT assets that require significant security efforts to safeguard patients’ information. Individuals who have legitimate access to an organisation’s assets to perform their day-to-day duties but intentionally or unintentionally violate information security policies can jeopardise their organisation’s information security efforts and cause significant legal and financial losses. In the information security (InfoSec) literature, several studies emphasised the necessity to understand why employees behave in ways that contradict information security requirements but have offered widely different solutions. In an effort to respond to this situation, this thesis addressed the gap in the information security academic research by providing a deep understanding of the problem of medical practitioners’ behavioural justifications to violate information security policies and then determining proper solutions to reduce this undesirable behaviour. Neutralisation theory was used as the theoretical basis for the research. This thesis adopted a mixed-method research approach that comprises four consecutive phases, and each phase represents a research study that was conducted in light of the results from the preceding phase. The first phase of the thesis started by investigating the relationship between medical practitioners’ neutralisation techniques and their intention to violate information security policies that protect a patient’s privacy. A quantitative study was conducted to extend the work of Siponen and Vance [1] through a study of the Saudi Arabia healthcare industry. The data was collected via an online questionnaire from 66 Medical Interns (MIs) working in four academic hospitals. The study found that six neutralisation techniques—(1) appeal to higher loyalties, (2) defence of necessity, (3) the metaphor of ledger, (4) denial of responsibility, (5) denial of injury, and (6) condemnation of condemners—significantly contribute to the justifications of the MIs in hypothetically violating information security policies. The second phase of this research used a series of semi-structured interviews with IT security professionals in one of the largest academic hospitals in Saudi Arabia to explore the environmental factors that motivated the medical practitioners to evoke various neutralisation techniques. The results revealed that social, organisational, and emotional factors all stimulated the behavioural justifications to breach information security policies. During these interviews, it became clear that the IT department needed to ensure that security policies fit the daily tasks of the medical practitioners by providing alternative solutions to ensure the effectiveness of those policies. Based on these interviews, the objective of the following two phases was to improve the effectiveness of InfoSec policies against the use of behavioural justification by engaging the end users in the modification of existing policies via a collaborative writing process. Those two phases were conducted in the UK and Saudi Arabia to determine whether the collaborative writing process could produce a more effective security policy that balanced the security requirements with daily business needs, thus leading to a reduction in the use of neutralisation techniques to violate security policies. The overall result confirmed that the involvement of the end users via a collaborative writing process positively improved the effectiveness of the security policy to mitigate the individual behavioural justifications, showing that the process is a promising one to enhance security compliance

    In her own words: exploring the subjectivity of Freud’s ‘teacher’ Anna von Lieben

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    This project is inspired by Roy Porter (1985), who draws attention to the patient-shaped gap in medical history, and Rita Charon (2006), who emphasises the need to bring the patient’s narrative to the fore in the practice of medicine. The principal aim was to devise a means of accessing the lived experience of a patient who is no longer alive in order to gain an understanding of her narrative. Anna von Lieben was identified as a suitable subject as she wrote a substantial quantity of autopathographical poetry suitable for analysis and her status as Freud’s patient makes her a person of significant interest to the history of medicine. The poems were analysed using Interpretative Phenomenological Analysis (IPA), an idiographic and inductive method of qualitative research, based on Heideggerian hermeneutic phenomenology, which explores the lived experience of individuals and is committed to understanding the first-person perspective from the third-person position. The main findings from the IPA study reveal that Anna experienced a prolonged period of malaise, starting in late adolescence which she believed to result, at least partly, from a traumatic experience which occurred at that time. The analysis also indicates that Anna suffered from deep and lasting feelings of guilt and shame. The discovery of additional family documentation enabled me to contextualise and add substance to the findings of the IPA study. Anna’s husband’s diaries in particular reveal that Anna: • had a severe and longstanding gynaecological disorder • suffered from severe morphinism • did not benefit from Freud’s treatment which seemed neither to ease her symptoms nor identify any cause • was treated in Paris, not by Jean-Martin Charcot as previously supposed, but by a French hydrotherapist, Theodore Keller, who appears to have become a person of considerable significance in her life. The above findings led me to investigate Anna’s comorbidities (gynaecological disease and morphinism) and to show how those could be responsible for much of the symptomatology identified by Freud as ‘hysteria’. I then explore the possibility that her psychotic-like experiences could have been iatrogenically induced by her treatment first by Keller and then by Freud. Finally, I propose a fourfold set of hypotheses as an alternative to Freud’s diagnosis of hysteria

    Developing end-of-life care at a Portuguese nursing home through participatory action research

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    Background: Nursing homes are places where older people live and often die but little is known about the needs of those who care for them, in Portugal. Aim: to identify the needs of nursing home staff when caring for older people at the end of life; to understand the cultural nuances of providing care at the end-of-life in nursing homes; to develop, with nursing home staff, a culturally appropriate programme that meets their needs; and to plan for future development. Methods: Participatory Action Research was used to identify needs and to develop interventions, designed by the staff themselves, aimed at improving care. Up to ten nursing home staff participated in a six-cycle research process, with data collected, analysed, and used in sequential plan-act-reflect steps. Findings: The silence that surrounds a resident’s death has a severe impact on the lives of those who survive him/her. Lacking competencies in grief management, and with no emotional and relational space to express grief emotions, staff strive to manage their loss, while trying to support other residents. Acknowledging the existence of death and its impact on nursing home life made the invisibility of death and mourning visible, and interventions possible, providing closure to all. Conclusion: The impact of death and dying on nursing home life needs to be recognised. If adequately supported, nursing home staff can develop strategies to manage grief and mourning, to improve their knowledge of the residents’ needs and wishes, improve communication among staff, and ultimately improve care

    "Disconnecting Something From Anything": Fetishized Objects, Alienated Subjects, and Literary Modernism

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    This dissertation explores modernist attitudes toward the commodity and the process of commodification under late capitalism. Some modernists, notably those commonly referred to as the "men of 1914," lament a reversal of the presumed proper relationship between subject and object, in which people become passive as a result of the mechanical routines of the workplace, and objects gain perverse independence from their human creators. My dissertation suggests that there is a feminist alternative to this familiar, hegemonic modernist critique in the work of Gertrude Stein, Djuna Barnes, and Virginia Woolf. For Stein, Barnes, and Woolf, the problem with commodification is not passive subjects and animated objects, but, to the contrary, domineering subjects and a fungible object world. Stein, Barnes, and Woolf seek not to reclaim humanitys world-creating powers, but to re-enchant the world of things and discover modes of ethical passivity that enable a more receptive, hospitable relationship to alterity. In articulating this alternative critique, I distinguish my position from two strains of modernist scholarship, one that acknowledges only one critique of commodification—that of the "men of 1914"—and a wave of scholarship that considers itself as, in the words of Kathryn Simpson, "exploding the myth [...] of modernist writers' and artists' absolute disinterest, detachment and contempt for popular and consumer culture" (1). While I align myself with the latter contingent, I differentiate my position through a consideration of the ways in which certain modernists reformulate a critique of the commodity in less absolutist and naïve terms. I argue that Stein, Barnes, and Woolf advance immanent critiques that do not presume to stand outside the commodity industry but draw power from certain tensions within commodification. Specifically, their critique is animated by a paradox: by exaggerating the alienation and fetishism characteristic of commodification, they hope to combat the commodity's reifying logic

    Human Rights practitioners’ approach to refugees and migrants. A therapeutic psychosocial perspective.

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    This thesis advances the argument that the best way to address the needs of involuntarily dislocated populations is to develop a combined framework that includes both psychosocial and therapeutic perspectives as well as human rights principles. Based on my professional experience as a refugee lawyer, I argue that only such a combined framework can adequately respond to the complexity of the refugee realities. Moreover, I demonstrate that, in some circumstances, the application only of human right rules can violate the same rights that they are meant to protect. I suggest that human rights practitioners are more likely to become aware of the real needs of those we help and, thus, provide them with targeted interventions, once we add a psychosocial perspective to our work. It is in this sense that our endeavours become therapeutic, which should be distinguished from offering them psychotherapy. The added therapeutic dimension also benefits refugees by rescuing them from developing victim identities. This empowering and participatory model of interaction also assists them with an awareness of their existing resources as well as of those new strengths they acquire from their exposure to adversity. Finally, they benefit from an improved level of self reflexivity and a deeper consideration of the socio-political and cultural contexts that act as background to the migratory experience. This study examines various possible applications of this proposed combined framework, ranging from the enrichment of the refugee lawyers curricula with tenets of psychosocial perspectives to the addition of a therapeutic dimension to the hearings of migration/asylum courts
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