Diversidades (inter)culturais na prática clínica : estudo comparativo da relação médico paciente em Portugal e França na consulta privada de medicina dentária

Tal como muitos outros profissionais, os médicos dentistas têm demonstrado uma vontade crescente de procurar novas oportunidades, exercendo a sua profissão fora do país de origem. Esta mobilidade progressiva torna necessário o conhecimento por parte dos médicos dentistas das diferenças (inter)-culturais na relação médico-paciente. A problemática subjacente ao tema de tese proposto leva-nos a reflectir sobre a existência de uma unidade cultural europeia na prática clinica, que ultrapassa as diversidades nacionais. Portugal e França poderão, pois, constituir exemplos possíveis dentro desta unidade. Através da observação de 40 consultas (amostra de 4 médicos dentistas – 2 franceses e 2 portugueses – e 10 consultas para cada médico), pretendemos verificar se as diversidades culturais próprias a cada país permanecem visíveis ao longo da consulta e se influenciam os aspectos socio-comunicacionais da prática clínica. Através da observação da abordagem linguística e comportamentalista do médico dentista e do paciente, determinamos as diferenças e semelhanças culturais na relação médico paciente em Portugal e em França. Da análise dos resultados, verificou-se a existência de semelhança linguística no discurso estabelecido entre médico e paciente, as diferenças culturais sendo mais visíveis na componente não verbal. Numa visão global, comprovou-se que os quatro médicos dentistas – independentemente da sua nacionalidade, género ou idade – demostraram-se competentes em estabelecer uma relação médico paciente eficiente. Nesta perspectiva, ultrapassam-se as culturas nacionais alcançando uma cultura profissional - a dos médicos dentistas. Conseguindo um consenso sobre a existência de uma unidade cultural europeia na prática clínica de Medicina Dentária para além de diversidades locais ou nacionais, pretendemos com este trabalho melhorar o conhecimento dos médicos dentistas e estudantes da área sobre a relevância da comunicação (inter)-cultural em saúdeLike many other professionals, dentists have shown an increasing willingness to seek new opportunities, exercising their profession outside their country of origin. This gradual mobility should compel them to be aware of (inter)-cultural differences in the doctor-patient relationship. The problem underlying the main topic of our work leads us to reflect on the existence of a European cultural unity in clinical practice, which goes beyond national diversities. Therefore, Portugal and France may be possible examples within this unity. By the observation of 40 consultations (sample of 4 dentists - 2 French and 2 Portuguese - 10 consultations for each doctor), our goal is to verify if the cultural features of each country remain visible throughout the consultation and influence the socio-communicational aspects of clinical practice. In this investigation, we will examine the cultural influence in health communication by observing the dentist’s and the patient´s linguistic and behavioural attitudes, and we will determine the cultural differences and similarities in the doctor-patient relationship between Portugal and France. Analysing the results, it was found that linguistic similarity in speech established between doctor and patient exists while the cultural differences are more visible in the non-verbal component. In an overall view, it was shown that the four dentists - regardless of nationality, gender or age - seemed competent to establish an efficient doctor-patient relationship. In this perspective, we overpass national cultures and reach a professional culture – the one of dentists. Having achieved a consensus on the existence of a European cultural unity in clinical practice of dentistry which goes beyond local and national diversities, we aim at improving the dentists’ and students’ knowledge about the relevance of (inter)-culture in health communication

Optimized Spectral Energy Distribution for Seyfert Galaxies

The temperature predicted by photoionization models for the Narrow Line Region of Seyfert 2 galaxies is lower than the value inferred from the observed [O III] {\lambda}4363A/{\lambda}5007A line ratio. We explore the possibility of considering a harder ionizing continuum than typically assumed. The spectral ionizing energy distribution, which can generate the observed {\lambda}4363A/{\lambda}5007A ratio, is characterized by a secondary continuum peak at 200 eV.Comment: 17 pages, 4 figures, accepted for publication in Revista Mexicana de Astronom\'ia y Astrof\'isic

Salt stress and K/Ca ratios of the nutrient solution in the production and quality of the melon

ABSTRACT Melon cultivation under saline conditions is a challenge, as the plants can suffer a reduction in fruit production and quality. The aim of this study was to evaluate the production and quality of noble melon fruit fertigated with different saline solutions and K/Ca ratios. The experimental design was of randomised blocks, with treatments arranged in a 3 x 6 factorial scheme, using three melon cultivars (Bazuca, McLaren, County) fertigated with six nutrient solutions [S1 - standard nutrient solution (SNS); S2 - SNS + NaCl (5.0 dS m-1); S3 - S2 enriched with K (50%); S4 - S2 enriched with K (100%); S5 - S2 enriched with Ca (50%); S6 - S2 enriched with Ca (100%)]. At the end of each cultivar cycle, the fruit was harvested and assessed for the following parameters: fresh fruit weight, fruit diameter, internal cavity, pulp thickness, pulp firmness, soluble solids content, titratable acidity, soluble solids/titratable acidity ratio, and vitamin C. Salt stress impaired the physical characteristics of the fruit of the three noble melon cultivars. The nutrient solution enriched with 50% K (S3) did not reduce the effect of salt stress on fresh weight or fruit size in the melon, but afforded an increase in fruit quality

Perfil Epidemiológico e Aspectos Clinicopatológicos dos Pacientes com Câncer de Cabeça e Pescoço em um Centro de Radioterapia do Agreste Pernambucano

Introdução: O câncer de cabeça e pescoço é uma neoplasia maligna com alta prevalência no Brasil e o sexto tipo mais comum no mundo. Objetivo: Evidenciar a prevalência, características sociodemográficas e clinicopatológicas de pacientes com câncer de cabeça e pescoço em um serviço de radioterapia. Método: Estudo transversal retrospectivo dos prontuários de pacientes com câncer de cabeça e pescoço tratados entre janeiro de 2010 e dezembro de 2020 em um centro de radioterapia localizado no Agreste de Pernambuco. Foram coletados os dados clínicos, sociodemográficos e os desfechos clínicos. A análise estatística foi elaborada a partir dos testes qui-quadrado de Pearson, razão de verossimilhança e exato de Fisher, além de ser adotado o nível de significância de 5%. Resultados: Foram obtidos dados de 908 pacientes. O sexo masculino foi o mais prevalente (71,5%), 48,5% dos pacientes tinham entre 50 e 69 de idade, 45,2% não concluíram o 1° grau, 29,3% eram analfabetos e 91% foram atendidos pelo Sistema Único de Saúde (SUS). O diagnóstico de câncer de boca foi o mais frequente (36,5%), sendo a língua o sítio mais acometido (21,1%), e o tipo histológico mais comum foi o carcinoma escamocelular (82%). Houve comprometimento vocal em 14% dos casos, uma pequena parcela realizou traqueostomia (6,6%) e 158 pacientes (17,4%) realizaram tratamento odontológico prévio. Conclusão: Evidenciar o perfil dos pacientes portadores de câncer de cabeça e pescoço possibilita o conhecimento dos grupos vulneráveis para promoção de políticas públicas e ações para melhorar a condição de vida desses indivíduos

Post-acute COVID-19 outcomes including participant-reported long COVID: amubarvimab/romlusevimab versus placebo in the ACTIV-2 trial

BackgroundIt is unknown if early COVID-19 monoclonal antibody (mAb) therapy can reduce risk of Long COVID. The mAbs amubarvimab/romlusevimab were previously demonstrated to reduce risk of hospitalization/death by 79%. This study assessed the impact of amubarvimab/romlusevimab on late outcomes, including Long COVID.MethodsNon-hospitalized high-risk adults within 10 days of COVID-19 symptom onset enrolled in a randomized, double-blind, placebo-controlled phase 2/3 trial of amubarvimab/romlusevimab for COVID-19 treatment. Late symptoms, assessed using a participant-completed symptom diary, were a pre-specified exploratory endpoint. The primary outcome for this analysis was the composite of Long COVID by participant self-report (presence of COVID-19 symptoms as recorded in the diary at week 36) or hospitalization or death by week 36. Inverse probability weighting (IPW) was used to address incomplete outcome ascertainment, giving weighted risk ratios (wRR) comparing amubarvimab/romlusevimab to placebo.FindingsParticipants received amubarvimab/romlusevimab (n = 390) or placebo (n = 390) between January and July 2021. Median age was 49 years, 52% were female, 18% Black/African American, 49% Hispanic/Latino, and 9% COVID-19-vaccinated at entry. At week 36, 103 (13%) had incomplete outcome ascertainment, and 66 (17%) on amubarvimab/romlusevimab and 92 (24%) on placebo met the primary outcome (wRR = 0.70, 95% confidence interval (CI) 0.53-0.93). The difference was driven by fewer hospitalizations/deaths with amubarvimab/romlusevimab (4%) than placebo (13%). Among 652 participants with available diary responses, 53 (16%) on amubarvimab/romlusevimab and 44 (14%) on placebo reported presence of Long COVID.InterpretationAmubarvimab/romlusevimab treatment, while highly effective in preventing hospitalizations/deaths, did not reduce risk of Long COVID. Additional interventions are needed to prevent Long COVID.FundingNational Institute of Allergy and Infectious Diseases of the National Institutes of Health. Amubarvimab and romlusevimab supplied by Brii Biosciences

Applications des laboratoires géologiques sur puce pour les problématiques du stockage du CO2

CO2 geological storage in deep saline aquifers represents a mediation solution for reducing the anthropogenic CO2 emissions. Consequently, this kind of storage requires adequate scientific knowledge to evaluate injection scenarios, estimate reservoir capacity and assess leakage risks. In this context, we have developed and used high pressure/high temperature microfluidic tools to investigate the different mechanisms associated with CO2 geological storage in deep saline aquifers. The silicon-Pyrex 2D porous networks (Geological Labs On Chips) can replicate the reservoir p,T conditions (25 < T < 50°C, 50 < p < 10 MPa), geological and topological properties. This thesis manuscript first highlights the strategies developed during this work to fabricate the GLoCs and to access to global characteristics of our porous media such as porosity and permeability, which are later compared to numerical modelling results. The carbon dioxide detection in GLoCs mimicking p,T conditions of geological reservoirs by using the direct integration of optical fiber for IR spectroscopy is presented. I then detail the strategies for following the dissolution of carbonates in GLoCs with X-rays laminography experiments.Then, the manuscript focuses on the use of GLoCs to investigate each CO2 trapping mechanism at the pore scale. The direct optical visualization and image processing allow us to follow the evolution of the injected CO2/aqueous phase within the reservoir, including displacement mechanisms and pore saturation levels.Eventually, I present the ongoing works such as experiments with reactive brines and hydrates formations in porous media.Le stockage géologique du CO2 dans les aquifères salins représente une stratégie prometteuse pour la réduction des émissions de CO2 anthropiques. Ce type de stockage requiert des connaissances fondamentales afin d'évaluer les scénarios d'injection, d'estimer la capacité des réservoirs et les risques de fuite. C'est dans ce contexte que des outils microfluidiques haute pression/haute température ont été développés afin d'étudier différents mécanismes liés aux technologies de stockage de CO2. Les laboratoires géologiques sur puce (GLoCs) permettent de mener des expériences à des conditions de pression et de température typiques des réservoirs (25 < T < 50°C, 50 < p < 10 MPa) et d'en mimer des propriétés géologiques.Ce manuscrit présente dans un premier temps les stratégies de fabrication des GLoCs et l'accès à leurs caractéristiques (porosité et perméabilité). La détection du CO2 directement au sein de GLoCs grâce à l'implémentation de fibres optiques par spectroscopie infrarouge est ensuite présentée, ainsi que la mise en œuvre de la technique de laminographie X menées à l'ESRF pour le suivi de dissolution de carbonates dans des microcanaux. Le manuscrit explicite ensuite les investigations, menées avec des GLoCs concernant les différents mécanismes de piégeage du CO2 à l'échelle du pore. La visualisation directe et le traitement d'image ont permis de suivre l'évolution des phases de CO2 et des phases aqueuses au sein du GLoC et les mécanismes de déplacement et de saturation. Enfin, les travaux en cours sont exposés, comme les expériences de drainage avec des saumures réactives ou la formation d'hydrates au sein de milieux poreux

Applications of geological labs onf chip for CO2 storage issues

Le stockage géologique du CO2 dans les aquifères salins représente une stratégie prometteuse pour la réduction des émissions de CO2 anthropiques. Ce type de stockage requiert des connaissances fondamentales afin d'évaluer les scénarios d'injection, d'estimer la capacité des réservoirs et les risques de fuite. C'est dans ce contexte que des outils microfluidiques haute pression/haute température ont été développés afin d'étudier différents mécanismes liés aux technologies de stockage de CO2. Les laboratoires géologiques sur puce (GLoCs) permettent de mener des expériences à des conditions de pression et de température typiques des réservoirs (25 < T < 50°C, 50 < p < 10 MPa) et d'en mimer des propriétés géologiques.Ce manuscrit présente dans un premier temps les stratégies de fabrication des GLoCs et l'accès à leurs caractéristiques (porosité et perméabilité). La détection du CO2 directement au sein de GLoCs grâce à l'implémentation de fibres optiques par spectroscopie infrarouge est ensuite présentée, ainsi que la mise en œuvre de la technique de laminographie X menées à l'ESRF pour le suivi de dissolution de carbonates dans des microcanaux. Le manuscrit explicite ensuite les investigations, menées avec des GLoCs concernant les différents mécanismes de piégeage du CO2 à l'échelle du pore. La visualisation directe et le traitement d'image ont permis de suivre l'évolution des phases de CO2 et des phases aqueuses au sein du GLoC et les mécanismes de déplacement et de saturation. Enfin, les travaux en cours sont exposés, comme les expériences de drainage avec des saumures réactives ou la formation d'hydrates au sein de milieux poreux.CO2 geological storage in deep saline aquifers represents a mediation solution for reducing the anthropogenic CO2 emissions. Consequently, this kind of storage requires adequate scientific knowledge to evaluate injection scenarios, estimate reservoir capacity and assess leakage risks. In this context, we have developed and used high pressure/high temperature microfluidic tools to investigate the different mechanisms associated with CO2 geological storage in deep saline aquifers. The silicon-Pyrex 2D porous networks (Geological Labs On Chips) can replicate the reservoir p,T conditions (25 < T < 50°C, 50 < p < 10 MPa), geological and topological properties. This thesis manuscript first highlights the strategies developed during this work to fabricate the GLoCs and to access to global characteristics of our porous media such as porosity and permeability, which are later compared to numerical modelling results. The carbon dioxide detection in GLoCs mimicking p,T conditions of geological reservoirs by using the direct integration of optical fiber for IR spectroscopy is presented. I then detail the strategies for following the dissolution of carbonates in GLoCs with X-rays laminography experiments.Then, the manuscript focuses on the use of GLoCs to investigate each CO2 trapping mechanism at the pore scale. The direct optical visualization and image processing allow us to follow the evolution of the injected CO2/aqueous phase within the reservoir, including displacement mechanisms and pore saturation levels.Eventually, I present the ongoing works such as experiments with reactive brines and hydrates formations in porous media

Applications of geological labs onf chip for CO2 storage issues

Le stockage géologique du CO2 dans les aquifères salins représente une stratégie prometteuse pour la réduction des émissions de CO2 anthropiques. Ce type de stockage requiert des connaissances fondamentales afin d'évaluer les scénarios d'injection, d'estimer la capacité des réservoirs et les risques de fuite. C'est dans ce contexte que des outils microfluidiques haute pression/haute température ont été développés afin d'étudier différents mécanismes liés aux technologies de stockage de CO2. Les laboratoires géologiques sur puce (GLoCs) permettent de mener des expériences à des conditions de pression et de température typiques des réservoirs (25 < T < 50°C, 50 < p < 10 MPa) et d'en mimer des propriétés géologiques.Ce manuscrit présente dans un premier temps les stratégies de fabrication des GLoCs et l'accès à leurs caractéristiques (porosité et perméabilité). La détection du CO2 directement au sein de GLoCs grâce à l'implémentation de fibres optiques par spectroscopie infrarouge est ensuite présentée, ainsi que la mise en œuvre de la technique de laminographie X menées à l'ESRF pour le suivi de dissolution de carbonates dans des microcanaux. Le manuscrit explicite ensuite les investigations, menées avec des GLoCs concernant les différents mécanismes de piégeage du CO2 à l'échelle du pore. La visualisation directe et le traitement d'image ont permis de suivre l'évolution des phases de CO2 et des phases aqueuses au sein du GLoC et les mécanismes de déplacement et de saturation. Enfin, les travaux en cours sont exposés, comme les expériences de drainage avec des saumures réactives ou la formation d'hydrates au sein de milieux poreux.CO2 geological storage in deep saline aquifers represents a mediation solution for reducing the anthropogenic CO2 emissions. Consequently, this kind of storage requires adequate scientific knowledge to evaluate injection scenarios, estimate reservoir capacity and assess leakage risks. In this context, we have developed and used high pressure/high temperature microfluidic tools to investigate the different mechanisms associated with CO2 geological storage in deep saline aquifers. The silicon-Pyrex 2D porous networks (Geological Labs On Chips) can replicate the reservoir p,T conditions (25 < T < 50°C, 50 < p < 10 MPa), geological and topological properties. This thesis manuscript first highlights the strategies developed during this work to fabricate the GLoCs and to access to global characteristics of our porous media such as porosity and permeability, which are later compared to numerical modelling results. The carbon dioxide detection in GLoCs mimicking p,T conditions of geological reservoirs by using the direct integration of optical fiber for IR spectroscopy is presented. I then detail the strategies for following the dissolution of carbonates in GLoCs with X-rays laminography experiments.Then, the manuscript focuses on the use of GLoCs to investigate each CO2 trapping mechanism at the pore scale. The direct optical visualization and image processing allow us to follow the evolution of the injected CO2/aqueous phase within the reservoir, including displacement mechanisms and pore saturation levels.Eventually, I present the ongoing works such as experiments with reactive brines and hydrates formations in porous media