Conviver com o vírus da imunodeficiência humana - os desafios do diagnóstico / Living with the human immunodeficiency virus - the challenges of the diagnosis

Objetivo: descrever os sentimentos e enfrentamentos do antes e depois da descoberta do diagnóstico positivo para o vírus da imunodeficiência humana. Metodologia: estudo qualitativo, descritivo. Realizado em um ambulatório especializado em pessoas que vivem com HIV, localizado na cidade do Rio de Janeiro. Os participantes do estudo foram os usuários deste ambulatório, com idade superior a 18 anos. A coleta de dados foi realizada a partir de entrevistas semiestruturadas. Técnica de análise de conteúdo lexical, com auxílio do software Iramuteq 0.7 alpha 2. Resultados: a felicidade e o prazer em viver a vida são relatados com frequência como uma situação que ficou para trás, no passado, antes do diagnóstico, e que agora a morte se apresenta de uma forma mais concreta, uma ameaça sempre à espreita. Conclusões: para alguns participantes, a vida no passado era mais feliz, o presente é depressivo e o futuro, incerto; a morte é uma preocupação presente, posteriormente a aceitação vai acontecendo, a motivação para viver reaparece principalmente quando as pessoas vivendo com o vírus da imunodeficiência humana se sentem apoiadas e acolhidas.

Objective: to describe the feelings and confrontations of the before and after of the discovery of positive diagnosis of human immunodeficiency virus. Methodology: qualitative descriptive study. Held at an outpatient clinic specialized in people living with HIV, located in the city of Rio de Janeiro. Study participants were users of this clinic aged over 18 years. Data collection was performed using semi-structured interviews. Data collection was performed through semi-structured interviews. Lexical content analysis technique, with the aid of the Iramuteq 0.7 alpha 2 software. Results: happiness and pleasure in living life are often reported as a situation that was left behind in the past, before the diagnosis, and that now death presents itself in a more concrete way, a threat always lurking. Conclusions: for some participants, life in the past was happier and the present is depressing and the future, uncertain; death is a present concern, as time passes acceptance comes about; the motivation to live reappears mainly when people living with the human immunodeficiency virus feel supported and welcomed.

Mudanças no cotidiano de mulheres vivendo com HIV: análise ambulatorial, Rj, Brasil / Changes in the quotidian of women living with HIV: ambulatorial analysis, Rio de Janeiro state, Brazil / Cambios en el cotidiano de mujeres que viven con el VIH: análisis ambulatorio, Rj, Brasil

Objective: The study's purpose has been to scrutinize the changes in women's daily life, as well as to investigate how they stand after the diagnosis of HIV/AIDS and the introduction of Antiretroviral Therapy (ART). Methods: It is a descriptive and prospective study with a qualitative approach. Semi-structured interviews were performed with twenty-two HIV positive women, who were enrolled in the immunology ambulatory of a university hospital located in the Rio de Janeiro city. This research was approved by the Research Ethics Committee (CAAE: 45955315.0.0000.5285). Results: Most women dealt positively with the changes in their daily lives after discovering the disease, looking for a way of life with quality, although they still show some difficulties in that regard. Concerning the ART, there was struggle in its beginning; however, as the time went by the adaptations occurred mainly with the family support. Conclusion: It is essential to provide better support towards women during both HIV diagnosis and treatment, so that they can improve their coping strategies

Objetivo: Investigar as mudanças no cotidiano e analisar o enfrentamento de mulheres após o diagnóstico do HIV/AIDS e a introdução da Terapia Antirretroviral (TARV). Método: Estudo descritivo e prospectivo de natureza qualitativa. Realizadas entrevistas semiestruturadas com vinte e duas mulheres HIV positivas, matriculadas no ambulatório de imunologia de um hospital universitário do Rio de Janeiro. Aprovado pelo Comitê de Ética CAAE: 45955315.0.0000.5285. Resultados: A maioria das mulheres enfrentou positivamente as mudanças no seu cotidiano após a descoberta da doença, buscando viver com qualidade, embora ainda apresentem dificuldades na retomada de suas vidas. Com relação à TARV houve dificuldade em seu início, no entanto com o passar do tempo ocorreram adaptações principalmente com o apoio da família. Conclusão: É fundamental que haja um maior apoio as mulheres durante o diagnóstico e tratamento do HIV, para que possam elaborar melhor suas estratégias de enfrentamento

Objetivo: Investigar los cambios en la rutina y hacer un análisis del enfrentamiento de mujeres tras el diagnóstico del VIH/sida y la introducción de la Terapia Antirretroviral (TARV). Método: Estudio descriptivo y prospectivo de naturaleza cualitativa. Se realizaron entrevistas semiestructuradas con veintidós mujeres VIH positivas, matriculadas en el ambulatorio inmunológico de un hospital universitario de Río de Janeiro. Aprobado por el Comité de Ética CAAE: 45955315.0.0000.5285. Resultados: La mayoría de las mujeres enfrentó positivamente los cambios en su cotidiano después del descubrimiento de la enfermedad, buscando vivir con calidad, aunque todavía presentan dificultades en la reanudación de sus vidas. En cuanto a la TARV hubo dificultad en su inicio, sin embargo con el paso del tiempo ocurrieron adaptaciones principalmente con el apoyo de la familia. Conclusión: El apoyo a las mujeres durante el diagnóstico y tratamiento del VIH es fundamental, para que puedan elaborar sus estrategias de enfrentamiento

Vestígios da historiografia da loucura em Barbacena no conto “Sorôco, sua mãe, sua filha” sob a ótica da Nova História Cultural / Vestiges of the historiography of madness in Barbacena in the story “Sorôco, his mother, his daughter” from the perspective of the New Cultural History

Analisar sob a ótica da Nova História Cultural os vestígios da loucura em Barbacena no conto de João Guimarães Rosa “Sorôco, sua mãe, sua fi lha”. Metodologia: O percurso metodológico contempla o universo da Nova História Cultural, pautado nas representações e apropriações apresentadas neste campo, pelo historiador Roger Chartier. Destacaram-se três categorias temáticas: As representações da loucura no “trem de doido”; Os vestígios da loucura presentes nos atos da mãe e filha de Sorôco; Convivendo com a loucura sob o olhar de Sorôco. Resultado/Discussão: O trem é descrito por Guimarães Rosa como um local inóspito, repleto de marcas da tristeza dos familiares que a cada viagem do trem embarcam seus parentes que não voltarão mais. Ele compara os vagões repletos de grades a uma prisão. O autor se propõem a caracterizar a loucura nos trejeitos, modo de vestir e atos das duas personagens, que como coadjuvantes, compuseram a representação da loucura da época. Considerações Finais: Os sentimentos apresentados pelo autor no conto estão presentes na atualidade, a sociedade ainda se indigna com tamanha cantoria e expressão dos ditos “malucos”, “loucos”, “alienados”. Os trens não tem mais celas, mas suas representações, as imagens formadas no imaginário sobre o fato histórico não podem se apagar.

Contribuições do Estágio Supervisionado para a Formação da Identidade Profissional do Enfermeiro / Contribuciones de la Etapa Supervisada para la Formación de la Identidad Profesional de las enfermeiras / Contributions of Supervised Stage to Development Identity of Training Professional Nurses

Estudo qualitativo, descritivo e exploratório. Foram entrevistados onze estagiários de enfermagem do oitavo e nono períodos e dez preceptores de estágio de duas instituições de ensino superior, utilizando como cenário da pesquisa seus respectivos hospitais de ensino. As entrevistas foram consolidadas à luz da análise dos seus conteúdos. Descreve e analisa as contribuições do Estágio Supervisionado para a formação da identidade profissional do enfermeiro. Por que somos e como nos constituímos enfermeiros foram questões que emergiram ao longo da pesquisa direcionando- -nos ao estudo do processo de construção da identidade pelo estagiário de enfermagem. As associações entre o ser enfermeiro idealizadas e a realidade vivida no ambiente de trabalho apontam e ajudam a compreender a construção da identidade do profissional. Na enfermagem a identidade profissional se forma dentro de um ambiente de trabalho coletivo, de relações com parceiros (equipe interdisciplinar, paciente e família) inseridas em situações de trabalho, marcadas por uma divisão hierárquica do trabalho e de percursos de vida, marcados por imprevistos, continuidades e rupturas, êxitos e fracassos. Defronte ao estagiário, o enfermeiro preceptor abre as cortinas do saber e da profissão, mostrando-lhe o cotidiano do ser enfermeiro. Este espaço de trabalho ajuda os estagiários na definição de si mesmo, como pessoa e como profissional, contribuindo para a construção da identidade profissional (AU)

Objetivo: Describir y analizar las contribuciones de la Práctica Profesional Supervisada para la formación de la identidad profesional del enfermero. Metodología: se trata de un estudio de investigación cualitativa, descriptiva y exploratoria. Se ha entrevistado a once practicantes de enfermería del octavo y noveno semestres y diez instructores de práctica profesional de dos instituciones de la enseñanza superior, utilizando como escenario de la investigación sus respectivos hospitales universitarios. Las entrevistas fueron tratadas a la luz del análisis de sus contenidos. Resultados: El ¿por qué somos? y ¿cómo nos hicimos enfermeros?, fueron cuestiones que emergieron a lo largo de la investigación haciendo que volviéramos nuestra mirada hacia el proceso de construcción de la identidad por el practicante de enfermería. Las relaciones entre el ser enfermero, lo que generalmente es idealizado, y la realidad vivida en el ambiente de trabajo apuntan y ayudan a comprender la construcción de la identidad del profesional. Conclusiones: En la enfermería la identidad profesional se construye dentro de un ambiente de trabajo colectivo, de relaciones entre compañeros (equipo interdisciplinario, paciente y familia) insertadas en situaciones de trabajo, señalados por contratiempos, continuidades y rupturas, éxitos y fracasos. Frente al practicante, el instructor abre las puertas del saber mostrándole el cotidiano del ser enfermero. Este espacio de trabajo ayuda a los practicantes en la definición de uno mismo, como persona y como profesional, contribuyendo, por lo tanto, para la construcción de la identidad profesional (AU)

Objectives: To describe and analyze the contributions of Supervised Training for the training of professional nursing identity. Methodology: Qualitative, descriptive study. Were interviewed eleven nursing trainees from the eighth and ninth periods and ten stage tutors of two institutions of higher education, using as research scenario their respective teaching hospitals. Interviews were consolidated in the light of the analysis of its contents. Results: Why we are and how we are constituted nurses were issues that emerged during the research directing us to study the process of identity construction by nursing intern. Associations between being an idealized nurse and the reality experienced in the workplace point and help to understand the construction of the identity of the professional. Conclusions: In nursing professional identity is formed within a collective work environment, relationships with partners (interdisciplinary team, patient and family) inserted in work situations, marked by a hierarchical division of labor and life paths, marked by unforeseen, continuities and ruptures, successes and failures. In front of the trainee, the preceptor nurse opens the curtains of knowledge and profession, showing the daily life of nurses. This workspace helps the trainees to define yourself as a person and as a professional, contributing to the construction of professional identity (AU)

Are Brain Dead Individuals Dead? Grounds for Reasonable Doubt.

According to the biological definition of death, a human body that has not lost the capacity to holistically organize itself is the body of a living human individual. Reasonable doubt against the conclusion that it has lost the capacity exists when the body appears to express it and no evidence to the contrary is sufficient to rule out reasonable doubt against the conclusion that the apparent expression is a true expression (i.e., when the conclusion that what appears to be holistic organization is in fact holistic organization remains a reasonable explanatory hypothesis in light of the best evidence to the contrary). This essay argues that the evidence and arguments against the conclusion that the signs of complex bodily integration exhibited in ventilated brain dead bodies are true expressions of somatic integration are unpersuasive; that is, they are not adequate to exclude reasonable doubt against the conclusion that BD bodies are dead. Since we should not treat as corpses what for all we know might be living human beings, it follows that we have an obligation to treat BD individuals as if they were living human beings.

D. Alan Shewmon and the PCBE's White Paper on Brain Death: are brain-dead patients dead?

The December 2008 White Paper (WP) on "Brain Death" published by the President's Council on Bioethics (PCBE) reaffirmed its support for the traditional neurological criteria for human death. It spends considerable time explaining and critiquing what it takes to be the most challenging recent argument opposing the neurological criteria formulated by D. Alan Shewmon, a leading critic of the "whole brain death" standard. The purpose of this essay is to evaluate and critique the PCBE's argument. The essay begins with a brief background on the history of the neurological criteria in the United States and on the preparation of the 2008 WP. After introducing the WP's contents, the essay sets forth Shewmon's challenge to the traditional neurological criteria and the PCBE's reply to Shewmon. The essay concludes by critiquing the WP's novel justification for reaffirming the traditional conclusion, a justification the essay finds wanting.

The problem of fetal pain and abortion: toward an ethical consensus for appropriate behavior.

Debate exists over whether fetuses feel pain, and if so what to do about it. Because they cannot provide self-report, certitude on the question cannot be reached. The essay argues that a presumption of reasonable doubt is adequate to inform moral behavior. It looks at the most recent evidence from fetal anatomical, neurochemical, physiological and behavioral research and concludes that a reasonable doubt exists that fetuses from 20 to 23 weeks do not feel pain. It proposes that where abortion is legal, providers should be legally required both to provide full disclosure of the possibility of fetal pain starting at 20 weeks and to offer pain-relief measures to suppress fetal pain to all women seeking an abortion.

A Critique of the National POLST Paradigm through an Analysis of Colorado's New MOST Legislation.

Colorado recently legalized a new document for use in end-of-life care called a Medical Orders for Scope of Treatment (MOST) form. The legislation exempts from liability to homicide laws caregivers who execute MOST orders for the withdrawing or withholding of life-sustaining procedures. But it drops the requirement that patients be terminally ill before they are free to refuse those procedures. It permits anyone to refuse any medical treatment for any reason; and holds health-care institutions, practitioners, and surrogate decision makers free from liability when they carry out the orders. This essay criticizes the new law together with the view of autonomy implicit within it. The essay proposes six reasons grounded in the requisites of justice and the common good why the new law should be opposed. It recommends that Catholic hospitals refuse to accept MOST-type documents.

Visualization at supercomputing centers: the tale of little big iron and the three skinny guys.

Supercomputing centers are unique resources that aim to enable scientific knowledge discovery by employing large computational resources-the "Big Iron." Design, acquisition, installation, and management of the Big Iron are carefully planned and monitored. Because these Big Iron systems produce a tsunami of data, it's natural to colocate the visualization and analysis infrastructure. This infrastructure consists of hardware (Little Iron) and staff (Skinny Guys). Our collective experience suggests that design, acquisition, installation, and management of the Little Iron and Skinny Guys doesn't receive the same level of treatment as that of the Big Iron. This article explores the following questions about the Little Iron: How should we size the Little Iron to adequately support visualization and analysis of data coming off the Big Iron? What sort of capabilities must it have? Related questions concern the size of visualization support staff: How big should a visualization program be-that is, how many Skinny Guys should it have? What should the staff do? How much of the visualization should be provided as a support service, and how much should applications scientists be expected to do on their own?

"Other selves": moral and legal proposals regarding the personhood of cryopreserved human embryos.

This essay has two purposes. The first is to argue that our moral duties towards human embryos should be assessed in light of the Golden Rule by asking the normative question, "how would I want to be treated if I were an embryo?" Some reject the proposition "I was an embryo" on the basis that embryos should not be recognized as persons. This essay replies to five common arguments denying the personhood of human embryos: (1) that early human embryos lack ontological individuation; (2) that they are members of the species Homo sapiens but not yet human persons; (3) that the argument for personhood commits the "heap argument" fallacy; (4) that since human procreation in nature is inefficient, human embryos cannot be persons; and (5) the "burning building" scenario proves that all arguments for personhood are irrational or inconsistent. The second purpose is to set forth and criticize in light of the normative judgement defended in part one the present legal situation of cryo-preserved embryos in the U.S. The essay ends by proposing legislative reforms to protect ex utero human embryos.

[Registration of activities performed by general practitioners]. / Registrering av aktivitet under legevakt.

BACKGROUND: We studied what kind of action general practitioners in a Norwegian rural community choose to take in order to solve problems raised by patients who contact the primary health service off-hours. Problems are solved either on the phone or by allowing the patient to consult the doctor in the surgery, by a home call, or by an emergency call with ambulance. MATERIAL AND METHODS: The community has a population of 4,556. All five GPs in the community registered all off-hour patient contacts over a period of six weeks (off-hours defined as the period from 3.30 PM to 8.00 AM on week-days, plus the weekend). RESULTS: 450 patients contacts were registered. 33% were solved on the phone, 48% through consultations in the surgery, 18% by home calls. Only two out of 450 contacts were emergencies. DISCUSSION: GPs performing off-hour services serve their patients with ordinary consultations. Less than 1% of patient contacts were actual emergencies.

[Platelet satellitosis]. / Dostickový satelitizmus.

Platelet satellitism (PS) is a rare phenomenon described sporadically in the literature. It involves adhesion of thrombocytes sensitized by antibodies to leucocytes and is observed in vitro in EDTA anticoagulated blood. The authors' contribution to the problem is the observation of special thrombocyte aggregates surrounding neutrophils resembling comet tails, as well as the fact that the authors observed the formation of aggregates surrounding also lymphocytes and eosinophil cells.

Proteolytic activities in bronchoalveolar lavage fluid of interstitial lung diseases: correlation to stage and prognosis.

In 18 patients with sarcoidosis, 10 patients with idiopathic pulmonary fibrosis (IPF), 6 patients with exogen allergic alveolitis (EAA), and 9 control persons we investigated proteolytic activities in bronchoalveolar lavage fluid (BALF). In lymphocyte-macrophage alveolitis (i.e. sarcoidosis and EAA) proteolytic activities in BALF were low, but the activities correlated with lung function deterioration within 1 year. In IPF (i.e. in neutrophil alveolitis) we found a striking correlation between proteolytic activities and stage of disease: high activities correlated with early stages, lower values with late stages of IPF. Measurement of proteolytic activity in BALF seems to be of interest to differential diagnosis and to prognosis of interstitial lung disease.