As funções terapêuticas da atividade: um estudo comparativo em terapia ocupacional

O propósito deste estudo foi verificar as alterações ocorridas em relação a assistência em terapia ocupacional na Unidade Psiquiátrica do Hospital São Paulo, vinculada ao Departamento de Psiquiatria e Psicologia Médica da Universidade Federal de São Paulo, através da análise da aplicação de um instrumento terapêutico da terapia ocupacional, a atividade. Este estudo baseou-se em pesquisa retrospectiva nos prontuários de pacientes internadas na Unidade Psiquiátrica. A pesquisa se propôs sistematizar o registro de procedimentos de terapeutas ocupacionais e de outros profissionais em relação a atividade, no sentido de dar uma contribuição universalização de alguns aspectos do discurso da Terapia Ocupacional, sistematizando-os em categorias. Pretendeu-se verificar a aplicabilidade do instrumento terapêutico pesquisado, através da comparação dos procedimentos encontrados em dois períodos. Os procedimentos metodológicos constaram de: a.- definição dos períodos a serem pesquisados: de 1/1/1988 a 31/12/1988 e de 1/1/1994 a 31/12/1994; b- coleta de dados: foram levantados em 257 prontuários de pacientes internadas na Unidade Psiquiátrica nos períodos acima definidos, os dados sócio demográficos e todos os registros encontrados nos prontuários, sobre uso de atividade e sobre terapia Ocupacional: c- categorização dos dados sobre atividade e terapia ocupacional segundo referências empíricas e funções da atividade e posteriormente em categorias empíricas em terapia ocupacional; d- análise dos dados: através do cotejamento do material encontrados nos dois períodos em relação As categorias criadas e A literatura. A análise dos dados demonstrou que não houve alterações no perfil sócio demográfico da clientela, não se alterando também a pouca atenção da equipe frente a dados relativos a origem, ocupação e perfil econômico. Em relação a idade média das pacientes e tempo de internação a distribuição dos mesmos difere, os indices mais altos encontrados relacionam-se ao segundo período. Quanto ao instrumento terapêutico, a atividade, o estudo comparativo, permitiu identificar modificações em relação a compreensão e uso do mesmo. No primeiro período, o recurso terapêutico, atividade, relaciona-se com a proposta de ambientoterapia, isto 6, toda a utilização da atividade insere-se num movimento mais amplo, grupal, com a participação efetiva de toda a equipe, voltado à experiências sociabilizantes, com raras abordagens especificas de terapeutas ocupacionais. No segundo período a utilização da atividade enquanto instrumento terapêutico, aproxima-se dos recursos teóricos e práticos da terapia ocupacional psicodinâmica, o que permitiu enfoques mais individualizados, introduziu a questão do processo terapêutico, a utilização deste recurso como uma aborgagem eletiva, ampliou o contato das terapeutas ocupacionais com a clientela em grupos específicos de terapia ocupacional e no ambulatório de egressos. Perdeu-se neste segundo período alguns procedimentos relativos a proposta da ambientoterapia e a uniformidade da equipe frente a esta questão. Percebeu-se que, a aplicabilidade deste recurso terapêutico, nos dois períodos, baseia-se nas possíveis funções da atividade, tomadas sempre como recursos estratégicos. Nos dois períodos foi possível verificar que a aplicabilidade deste instrumento terapêutico não se relacionou a categorias diagnósticas, podendo num sentido mais amplo, ter indicação a todos as pacientes.The purpose of this study was to verify the changes occurred within the Occupational Therapy assistance in the Psychiatric Unit of Hospital São Paulo, linked to the Psychiatry and Medical Psychology Department of Universidade Federal de Sao Paulo through the analysis of the use a therapeutic means of Occupational Therapy named the activity. The study was based on retrospective research of inpatients'clinical charts. The research purpose was to sistematyze the procedures of occupational therapists and of other professionals concerning the activity in order to contribute to the generalization of certains aspects of occupational therapy practices by arranging them into categories.Our intention was to verify the applicability of the therapeutic means under analysis through the comparison of procedures found in two distinct periods. The experimental methods consisted of: a. Definition of periods to be researched: from 01/01/1988 to 31/12/1988 and from 01/01/1994 to 31/12/1994. b.Data collection: Data were collected from 257 inpatineclinical charts during the above defined periods, specifically social demographics data and all the information found in charts concerning use of the activity and occupational therapy. c. data categorization about the activity and occupational therapy according to empirical references and functions of the activity and subsequently to empirical categories in occupational therapy d.data analyses: through comparison of the material found in both periods, through created categories and in reference to the existing literature. Data analyses showed that were no changes in patients social demographics profile, as well as in team members'poor charting of data relative to the source, occupation and economical profile of impatient. Concerning the age of the patients and hospitalization period, their distribution differed with higher levels found in the second period. As for the use of the therapeutic instrument, the activity, the comparison allowed the identification of due to its application.changes. In the first period, the activity relates to the millieu therapy proposal, that is, all the activity application inserts itself in a broader movement, with the effective participation of all the members focused on socialization with rare specif interventions of occupational therapists. In the secon period, the use of the activity as a therapeutic instrument follows the theoretical and practical resource of the psychodinamic occupational therapy; that allowed more specific approaches and introduced the subject of the therapeutic process in occupational therapy. The use of this resource as a choice approach enlarged the contact of occupational therapists with patients in Occupational Therapy groups and in the out patient follow-up treatment. During this second period some procedures relating to the millieu therapy project and the unity of the team concerning this subject were lost. We have noticed that the applicability of this therapeutic resource, the activity, during both periods is based on the possible functions of the activity, always taken as strategis resources. It was possible to verify, in both periods, that the applicability of this therapeutic instrument is not related to diagnostic categories, and it that can be beneficial to all the patients.BV UNIFESP: Teses e dissertaçõe

Enhanced selectivity for acidic contaminants in drinking water: From suspect screening to toxicity prediction

A novel analytical workflow for suspect screening of organic acidic contaminants in drinking water is presented, featuring selective extraction by silica-based strong anion-exchange solid-phase extraction, mixed-mode liquid chromatography-high resolution accurate mass spectrometry (LC-HRMS), peak detection, feature reduction and compound identification. The novel use of an ammonium bicarbonate-based elution solvent extended strong anion-exchange solid-phase extraction applicability to LC-HRMS of strong acids. This approach performed with consistently higher recovery and repeatability (88 ± 7 % at 500 ng L-1), improved selectivity and lower matrix interference (mean = 12 %) over a generic mixed-mode weak anion exchange SPE method. In addition, a novel filter for reducing full-scan features from fulvic and humic acids was successfully introduced, reducing workload and potential for false positives. The workflow was then applied to 10 London municipal drinking water samples, revealing the presence of 22 confirmed and 37 tentatively identified substances. Several poorly investigated and potentially harmful compounds were found which included halogenated hydroxy-cyclopentene-diones and dibromomethanesulfonic acid. Some of these compounds have been reported as mutagenic in test systems and thus their presence here requires further investigation. Overall, this approach demonstrated that employing selective extraction improved detection and helped shortlist suspects and potentially toxic chemical contaminants with higher confidence

SCA8 CAG/CTG Expansions, a Tale of Two TOXICities: A Unique or Common Case?

International audienc

Emergence of fractal geometries in the evolution of a metabolic enzyme

Fractals are patterns that are self-similar across multiple length-scales. Macroscopic fractals are common in nature; however, so far, molecular assembly into fractals is restricted to synthetic systems. Here we report the discovery of a natural protein, citrate synthase from the cyanobacterium Synechococcus elongatus, which self-assembles into Sierpiński triangles. Using cryo-electron microscopy, we reveal how the fractal assembles from a hexameric building block. Although different stimuli modulate the formation of fractal complexes and these complexes can regulate the enzymatic activity of citrate synthase in vitro, the fractal may not serve a physiological function in vivo. We use ancestral sequence reconstruction to retrace how the citrate synthase fractal evolved from non-fractal precursors, and the results suggest it may have emerged as a harmless evolutionary accident. Our findings expand the space of possible protein complexes and demonstrate that intricate and regulatable assemblies can evolve in a single substitution

Environmental Temperature Affects Prevalence of Blood Parasites of Birds on an Elevation Gradient: Implications for Disease in a Warming Climate

Background: The rising global temperature is predicted to expand the distribution of vector-borne diseases both in latitude and altitude. Many host communities could be affected by increased prevalence of disease, heightening the risk of extinction for many already threatened species. To understand how host communities could be affected by changing parasite distributions, we need information on the distribution of parasites in relation to variables like temperature and rainfall that are predicted to be affected by climate change.\ud \ud Methodology/Principal Findings: We determined relations between prevalence of blood parasites, temperature, and seasonal rainfall in a bird community of the Australian Wet Tropics along an elevation gradient. We used PCR screening to investigate the prevalence and lineage diversity of four genera of blood parasites (Plasmodium, Haemoproteus, Leucocytozoon and Trypanosoma) in 403 birds. The overall prevalence of the four genera of blood parasites was 32.3%, with Haemoproteus the predominant genus. A total of 48 unique lineages were detected. Independent of elevation, parasite prevalence was positively and strongly associated with annual temperature. Parasite prevalence was elevated during the dry season.\ud \ud Conclusions/Significance: Low temperatures of the higher elevations can help to reduce both the development of avian haematozoa and the abundance of parasite vectors, and hence parasite prevalence. In contrast, high temperatures of the lowland areas provide an excellent environment for the development and transmission of haematozoa. We showed that rising temperatures are likely to lead to increased prevalence of parasites in birds, and may force shifts of bird distribution to higher elevations. We found that upland tropical areas are currently a low-disease habitat and their conservation should be given high priority in management plans under climate change

Horizontal DNA transfer mechanisms of bacteria as weapons of intragenomic conflict

Horizontal DNA transfer (HDT) is a pervasive mechanism of diversification in many microbial species, but its primary evolutionary role remains controversial. Much recent research has emphasised the adaptive benefit of acquiring novel DNA, but here we argue instead that intragenomic conflict provides a coherent framework for understanding the evolutionary origins of HDT. To test this hypothesis, we developed a mathematical model of a clonally descended bacterial population undergoing HDT through transmission of mobile genetic elements (MGEs) and genetic transformation. Including the known bias of transformation toward the acquisition of shorter alleles into the model suggested it could be an effective means of counteracting the spread of MGEs. Both constitutive and transient competence for transformation were found to provide an effective defence against parasitic MGEs; transient competence could also be effective at permitting the selective spread of MGEs conferring a benefit on their host bacterium. The coordination of transient competence with cell-cell killing, observed in multiple species, was found to result in synergistic blocking of MGE transmission through releasing genomic DNA for homologous recombination while simultaneously reducing horizontal MGE spread by lowering the local cell density. To evaluate the feasibility of the functions suggested by the modelling analysis, we analysed genomic data from longitudinal sampling of individuals carrying Streptococcus pneumoniae. This revealed the frequent within-host coexistence of clonally descended cells that differed in their MGE infection status, a necessary condition for the proposed mechanism to operate. Additionally, we found multiple examples of MGEs inhibiting transformation through integrative disruption of genes encoding the competence machinery across many species, providing evidence of an ongoing "arms race." Reduced rates of transformation have also been observed in cells infected by MGEs that reduce the concentration of extracellular DNA through secretion of DNases. Simulations predicted that either mechanism of limiting transformation would benefit individual MGEs, but also that this tactic's effectiveness was limited by competition with other MGEs coinfecting the same cell. A further observed behaviour we hypothesised to reduce elimination by transformation was MGE activation when cells become competent. Our model predicted that this response was effective at counteracting transformation independently of competing MGEs. Therefore, this framework is able to explain both common properties of MGEs, and the seemingly paradoxical bacterial behaviours of transformation and cell-cell killing within clonally related populations, as the consequences of intragenomic conflict between self-replicating chromosomes and parasitic MGEs. The antagonistic nature of the different mechanisms of HDT over short timescales means their contribution to bacterial evolution is likely to be substantially greater than previously appreciated

Protocol for a pilot randomised controlled clinical trial to compare the effectiveness of a graduated three layer straight tubular bandaging system when compared to a standard short stretch compression bandaging system in the management of people with venous ulceration: 3VSS2008

<p>Abstract</p> <p>Background</p> <p>The incidence of venous ulceration is rising with the increasing age of the general population. Venous ulceration represents the most prevalent form of difficult to heal wounds and these problematic wounds require a significant amount of health care resources for treatment. Based on current knowledge multi-layer high compression system is described as the gold standard for treating venous ulcers. However, to date, despite our advances in venous ulcer therapy, no convincing low cost compression therapy studies have been conducted and there are no clear differences in the effectiveness of different types of high compression.</p> <p>Methods/Design</p> <p>The trial is designed as a pilot multicentre open label parallel group randomised trial. Male and female participants aged greater than 18 years with a venous ulcer confirmed by clinical assessment will be randomised to either the intervention compression bandage which consists of graduated lengths of 3 layers of elastic tubular compression bandage or to the short stretch inelastic compression bandage (control). The primary objective is to assess the percentage wound reduction from baseline compared to week 12 following randomisation. Randomisation will be allocated via a web based central independent randomisation service (nQuery v7) and stratified by study centre and wound size ≤ 10 cm²or >10 cm². Neither participants nor study staff will be blinded to treatment. Outcome assessments will be undertaken by an assessor who is blinded to the randomisation process.</p> <p>Discussion</p> <p>The aim of this study is to evaluate the efficacy and safety of two compression bandages; graduated three layer straight tubular bandaging (3L) when compared to standard short stretch (SS) compression bandaging in healing venous ulcers in patients with chronic venous ulceration. The trial investigates the differences in clinical outcomes of two currently accepted ways of treating people with venous ulcers. This study will help answer the question whether the 3L compression system or the SS compression system is associated with better outcomes.</p> <p>Trial Registration</p> <p>ACTRN12608000599370</p