CONSULTA DE ENFERMAGEM NO AMBULATÓRIO DE HIV/AIDS: A PERCEPÇÃO DOS USUÁRIOS

O estudo busca analisar como a consulta de enfermagem é percebida pelos usuários de um ambulatório especializado em Vírus da Imunodeficiência Humana/Síndrome da Imunodeficiência Adquirida (HIV/AIDS) no município de Fortaleza-CE. Trata-se de um estudo exploratório e descritivo, com abordagem qualitativa. Os dados foram coletados através de entrevista semiestruturada com quinze usuários da referida instituição e analisados com o suporte da análise de conteúdo. A consulta de enfermagem foi relatada pelos usuários como um momento de aprendizado, centrado no fornecimento de informações. A confiança e o apoio emocional estabelecido pelo profissional atuam como um suporte frente aos conflitos vivenciados pelo paciente, possibilitando a construção de um novo olhar frente à doença. Acreditamos que a realização da consulta de enfermagem em uma perspectiva dialogal poderá proporcionar aos sujeitos a ressignificação dos conflitos que permeiam o seu adoecimento

Ch. 6. Critical Systems Heuristics: The Idea and Practice of Boundary Critique

Critical systems heuristics (CSH) is a framework for reflective professional practice organised around the central tool of boundary critique. This chapter, written jointly by the original developer, Werner Ulrich, and Martin Reynolds, an experienced practitioner of CSH, offers a systematic introduction to the idea and use of boundary critique. Its core concepts are explained in detail and their use is illustrated by means of two case studies from the domain of environmental planning and management. A particular focus is on working constructively with tensions between opposing perspectives as they arise in many situations of professional intervention. These include tensions such as ‘situation’ versus ‘system’, ‘is’ versus ‘ought’ judgements, concerns of ‘those involved’ versus ‘those affected but not involved’, stakeholders’ ‘stakes’ versus ‘stakeholding issues’, and others. Accordingly, boundary critique is presented as a participatory process of unfolding and questioning boundary judgements rather than as an expert-driven process of boundary setting. The paper concludes with a discussion of some essential skills and considerations regarding the practice of boundary critique

Exploiting protein flexibility to predict the location of allosteric sites

Background: Allostery is one of the most powerful and common ways of regulation of protein activity. However, for most allosteric proteins identified to date the mechanistic details of allosteric modulation are not yet well understood. Uncovering common mechanistic patterns underlying allostery would allow not only a better academic understanding of the phenomena, but it would also streamline the design of novel therapeutic solutions. This relatively unexplored therapeutic potential and the putative advantages of allosteric drugs over classical active-site inhibitors fuel the attention allosteric-drug research is receiving at present. A first step to harness the regulatory potential and versatility of allosteric sites, in the context of drug-discovery and design, would be to detect or predict their presence and location. In this article, we describe a simple computational approach, based on the effect allosteric ligands exert on protein flexibility upon binding, to predict the existence and position of allosteric sites on a given protein structure. Results: By querying the literature and a recently available database of allosteric sites, we gathered 213 allosteric proteins with structural information that we further filtered into a non-redundant set of 91 proteins. We performed normal-mode analysis and observed significant changes in protein flexibility upon allosteric-ligand binding in 70% of the cases. These results agree with the current view that allosteric mechanisms are in many cases governed by changes in protein dynamics caused by ligand binding. Furthermore, we implemented an approach that achieves 65% positive predictive value in identifying allosteric sites within the set of predicted cavities of a protein (stricter parameters set, 0.22 sensitivity), by combining the current analysis on dynamics with previous results on structural conservation of allosteric sites. We also analyzed four biological examples in detail, revealing that this simple coarse-grained methodology is able to capture the effects triggered by allosteric ligands already described in the literature. Conclusions: We introduce a simple computational approach to predict the presence and position of allosteric sites in a protein based on the analysis of changes in protein normal modes upon the binding of a coarse-grained ligand at predicted cavities. Its performance has been demonstrated using a newly curated non-redundant set of 91 proteins with reported allosteric properties. The software developed in this work is available upon request from the authors