Parent-child interaction in the etiology of dependent and self-critical depression

The role of caring parent-child relationships in the development of depression has been investigated in three types of research strategies: (a) the study of secure and insecure attachment patterns in infants and young children; (b) the study of depressed mother-child interactions based on the assumption that the caring patterns in these families of children at risk for depression could contribute to the understanding of the etiology of depression; and (c) the study of normal and depressed adults' retrospective accounts of early caring experiences with their parents. A major conclusion from all three research methodologies is that mental representations or internal working models of attachment of care-giving relationships are central constructs in understanding the development of a vulnerability to depression. Secure and disturbed patterns of caring relationships are internalized by the child as mental representations; impaired mental representations based on disturbed relationships can create a vulnerability to later depression. There are suggestions that an anxious or ambivalent insecure attachment may lead to a depression focused on issues of dependency, loss, and abandonment, whereas an avoidant insecure attachment may result in a depression focused on issues of self-worth and self-criticism, with angry feelings directed toward both the caregiver and toward the self. Indications of possible critical periods in the development of vulnerability to depression are also considered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30271/1/0000672.pd

Beta protein 1 homeoprotein induces cell growth and estrogen-independent tumorigenesis by binding to the estrogen receptor in breast cancer.

Expression of Beta Protein 1 (BP1), a homeotic transcription factor, increases during breast cancer progression and may be associated with tumor aggressiveness. In our present work, we investigate the influence of BP1 on breast tumor formation and size in vitro and in vivo. Cells overexpressing BP1 showed higher viability when grown in the absence of serum (p \u3c 0.05), greater invasive potential (p \u3c 0.05) and formed larger colonies (p \u3c 0.004) compared with the controls. To determine the influence of BP1 overexpression on tumor characteristics, MCF-7 cells transfected with either empty vector (V1) or overexpressor plasmids (O2 and O4) were injected into the fat pads of athymic nude mice. Tumors grew larger in mice receiving O2 or O4 cells than in mice receiving V1 cells. Moreover, BP1 mRNA expression levels were positively correlated with tumor size in patients (p = 0.01). Interestingly, 20% of mice injected with O2 or O4 cells developed tumors in the absence of estrogen, while no mice receiving V1 cells developed tumors. Several mechanisms of estrogen independent tumor formation related to BP1 were established. These data are consistent with the fact that expression of breast cancer anti-estrogen resistance 1 (BCAR1) was increased in O2 compared to V1 cells (p \u3c 0.01). Importantly, O2 cells exhibited increased proliferation when treated with tamoxifen, while V1 cells showed growth inhibition. Overall, BP1 overexpresssion in MCF-7 breast cancer cells leads to increased cell growth, estrogen-independent tumor formation, and increased proliferation. These findings suggest that BP1 may be an important biomarker and therapeutic target in ER positive breast cancer

Stress distribution on dentin-cement-post interface varying root canal and glass fiber post diameters. A three-dimensional finite element analysis based on micro-CT data

Objective: The aim of the present study was to analyze the influence of root canal and glass fiber post diameters on the biomechanical behavior of the dentin/cement/post interface of a root-filled tooth using 3D finite element analysis. Material and Methods: Six models were built using micro-CT imaging data and SolidWorks 2007 software, varying the root canal (C) and the glass fiber post (P) diameters: C1P1-C=1 mm and P=1 mm; C2P1-C=2 mm and P=1 mm; C2P2-C=2 mm and P=2 mm; C3P1-C=3 mm and P=1 mm; C3P2-C=3 mm and P=2 mm; and C3P3-C=3 mm and P=3 mm. The numerical analysis was conducted with ANSYS Workbench 10.0. An oblique force (180 N at 45º) was applied to the palatal surface of the central incisor. The periodontal ligament surface was constrained on the three axes (x=y=z=0). Maximum principal stress (σmax) values were evaluated for the root dentin, cement layer, and glass fiber post. Results: The most evident stress was observed in the glass fiber post at C3P1 (323 MPa), and the maximum stress in the cement layer occurred at C1P1 (43.2 MPa). The stress on the root dentin was almost constant in all models with a peak in tension at C2P1 (64.5 MPa). CONCLUSION: The greatest discrepancy between root canal and post diameters is favorable for stress concentration at the post surface. The dentin remaining after the various root canal preparations did not increase the stress levels on the root

CONSTRUÇÃO DE UM INSTRUMENTO PARA AVALIAÇÃO E CLASSIFICAÇÃO DE RISCO PARA ACOMPANHAMENTO FARMACOTERAPÊUTICO DE PACIENTES

Devido à necessária racionalização dos recursos clínicos em centros de saúde, a seleção de pacientes é necessária a fim de priorizar o seguimento farmacoterapêutico para aqueles com maior risco de desenvolver problemas relacionados a medicamentos. Dessa forma, a avaliação dos fatores de risco engloba não apenas a farmacoterapia prescrita, mas também a situação clínica do paciente hospitalizado gerando uma classificação clínica para o acompanhamento farmacoterapêutico. O trabalho tem por objetivo descrever a construção de um instrumento para classificação clínica dos pacientes hospitalizados para acompanhamento farmacoterapêutico. Trata-se de um estudo descritivo, realizado em um hospital filantrópico de fortaleza com perfil de atendimento para pacientes obstétricos, de clínica médica, cirúrgica e pediátrica, além de diversas especialidades. Possui cerca de 215 leitos, desses tem-se 2 unidades de terapia intensiva (UTI) adulto, 1 UTI neonatal e 1 UTI pediátrica. Devido ao crescimento do hospital, em 2016 viu-se a necessidade da construção desse instrumento devido ao número de leitos frente ao número de farmacêuticos clínicos. Para a construção desse instrumento considerou-se o perfil dos pacientes hospitalizados, número de farmacêuticos clínicos e relatos na literatura dos principais fatores associados à ocorrência de eventos adversos além de experiências semelhantes. Desse modo, foi construído um instrumento que contempla os seguintes fatores de risco: número de medicamentos utilizados na internação; número de medicamentos endovenosos prescritos; quantidade de medicamentos de alta vigilância; avaliação do suporte nutricional (uso de sonda e nutrição parenteral); idade do paciente; risco para tromboembolismo venoso; uso de antibiótico profilático, terapêutico ou restrito e presença de imunossupressão e/ou imunocomprometimento. Esse instrumento é aplicado em todos os pacientes admitidos no hospital fazendo parte da rotina do serviço de farmácia clínica. Para aqueles pacientes que obtenham pontuação maior ou igual a 9, obrigatoriamente, deveriam ter o acompanhamento farmacoterapêutico diário e são classificados como alto risco; para aqueles com pontuação entre 4 e 8 deveriam ser avaliados duas vezes por semana, sendo classificados como risco moderado e para aqueles com pontuação menor que 4 deveriam ser avaliados semanalmente, tendo classificação de baixo risco. Após aplicação do instrumento, os pacientes internados eram classificados clinicamente em alto, moderado ou baixo risco. Os pacientes são reavaliados quanto a classificação de risco a cada 10 dias. Através da classificação clínica dos pacientes internados por meio desse instrumento verificou-se uma racionalização do exercício do farmacêutico clínico, otimização do cuidado centrado naqueles pacientes com escore de risco alto e possibilidade de estratificação de risco das unidades assistenciais do hospital. Foi possível, também, tornar-se mais presente nas enfermarias em que há maiores problemas relacionado a medicamentos. A construção de um instrumento para classificação clínica dos pacientes de um hospital ampliou o olhar farmacêutico, para além da terapia medicamentosa prescrita, e tornou possível um acompanhamento farmacoterapêutico com ênfase nos pacientes de alto risco

Implicit Review Instrument to Evaluate Quality of Care Delivered by Physicians to Children in Emergency Departments

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144238/1/hesr12800_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144238/2/hesr12800.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144238/3/hesr12800-sup-0001-AppendixSA1.pd

Patientâ level Factors and the Quality of Care Delivered in Pediatric Emergency Departments

ObjectiveQuality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient’s race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patientâ level factors.MethodsThis was a retrospective, observational cohort study. Pediatric patients (<18 years) who received care between January 2011 and December 2011 at one of 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) were included. We analyzed demographic factors (including age, sex, and payment source) and clinical factors (including triage, chief complaint, and severity of illness). We measured quality of care using a previously validated implicit review instrument using chart review with a summary score that ranged from 5 to 35. We examined associations between demographic and clinical factors and quality of care using a hierarchical multivariable linear regression model with hospital site as a random effect.ResultsIn the multivariable model, among the 620 ED encounters reviewed, we did not find any association between patient age, sex, race/ethnicity, and payment source and the quality of care delivered. However, we did find that some chief complaint categories were significantly associated with lower than average quality of care, including fever (â 0.65 points in quality, 95% confidence interval [CI] = â 1.24 to â 0.06) and upper respiratory symptoms (â 0.68 points in quality, 95% CI = â 1.30 to â 0.07).ConclusionWe found that quality of ED care delivered to children among a cohort of 12 EDs participating in the PECARN was high and did not differ by patient age, sex, race/ethnicity, and payment source, but did vary by the presenting chief complaint.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142981/1/acem13347_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142981/2/acem13347-sup-0001-DataSupplementS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142981/3/acem13347.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142981/4/acem13347-sup-0002-DataSupplementS2.pd

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio