Sintomas Obsessivo-Compulsivos na Esquizofrenia Resistente: a Propósito de um Caso Clínico

Introdução: Poyurovsky propôs a existência de um subtipo esquizo-obsessivo da esquizofrenia para delinear um subgrupo relativamente homogéneo de doentes com sintomas do espetro obsessivo-compulsivo persistentes e com impacto incremental àquele provocado pela esquizofrenia, associando-se a pior prognóstico. Neste trabalho, pretendemos exemplificar os desafios diagnósticos e terapêuticos da abordagem dos sintomas obsessivo-compulsivos na esquizofrenia resistente ao tratamento. Métodos: Reporte de um caso clínico, avaliação psicométrica e revisão não sistemática da literatura. Resultados: É apresentado um caso clínico de um indivíduo de 43 anos, com diagnóstico de esquizofrenia resistente ao tratamento, internado na Unidade de Cuidados Avançados de Esquizofrenia Resistente ao Tratamento do Centro Hospitalar e Universitário de Coimbra. Identificam-se sintomas positivos, negativos e cognitivos da esquizofrenia, que coexistem com sintomas do espetro obsessivo-compulsivo, de naturezas distintas: primários, presentes desde a fase prodrómica do processo esquizofrénico; secundários aos sintomas psicóticos; e secundários à introdução e aumento da clozapina. Conclusões: O correto enquadramento dos sintomas do espetro obsessivo-compulsivo na esquizofrenia permite o seu tratamento eficaz

Sistemas mecânicos, hidráulicos e motor

A filosofia Lean é considerada uma das metodologias mais eficazes na gestão e organização empresarial da actualidade, permitindo aumentar a produtividade de uma forma equilibrada e sustentável, eliminando os desperdícios associados, baseando-se na constante procura da excelência, aprendizagem e melhoria contínua dos processos. Este trabalho consiste na averiguação dos resultados obtidos através da implementação da metodologia Lean Management, nomeadamente a utilização do sistema Kanban, nas várias Secções que efectuam a manutenção da aeronave F-16 da Força Aérea Portuguesa, na Base Aérea nº 5, e comprovar a sua eficácia na melhoria e consolidação de todo o circuito de manutenção, obtendo assim a redução dos vários desperdícios de tempo e excesso de material, identificados nos processos de reparação. O estudo para esta Dissertação foi realizado na Base Aérea nº5 da Força Aérea Portuguesa, na Esquadra de Manutenção e na Esquadra de Abastecimento, entidades responsáveis pela reparação da aeronave F-16 e fornecimento de material aos hangares de manutenção da BA5. As três áreas objecto deste estudo são: Esquadrilha de Manutenção de Combustível/Hidrazina, Esquadrilha de Manutenção de Pneudráulicos e Esquadrilha de Manutenção de Motores, que efectuam manutenção dos respectivos sistemas. A análise foi efectuada através da consulta de registos produzidos pelas Esquadras e pelo Centro de Gestão de Manutenção (CGM), bem como assistindo no local às intervenções feitas, tendo como objectivo verificar se as alterações efectuadas surtiam efeitos positivos e quais os pontos onde se deveria melhorar, com especial destaque para a análise e verificação da adequação das alterações efectuadas nas várias áreas de manutenção através do sistema kanban, e ainda uma contabilização do material em excesso tendo no final uma perspectiva dos valores poupados e da melhoria dos processos.The Lean philosophy is considered one of the most effective methodologies in management and business organization nowadays. It allows for an increase of productivity, in a balanced and sustainable way, eliminating the associated wastage and is founded in the constant search for excellent, knowledge and continuous improvement of the processes. This work analyses the results obtained from the implementation of the Lean Management methodology, specifically in the utilization of the Kanban system in the various sections that perform maintenance to the Portuguese Air Force F-16 aircraft, in the Air Base number 5. It intends to confirm the methodology's efficacy in improving and consolidating the maintenance network to allow the reduction of the time and material wastage identified in the reparation process. The study for this thesis was accomplished in the Maintenance Squadron and the Supply Squadron of the Portuguese Air Force Air Base number 5, which are responsible for the F-16 aircraft reparation and for providing material for the maintenance hangars of the BA5. The three areas of focus for this study are: Fuel/Hydrazine Maintenance Squadron, Pneudraulics Squadron and Motor Maintenance Squadron, which perform the maintenance of their corresponding systems. The analysis was performed by examining the records produced by the Squadrons and by the CGM (Centro de Gestão de Manutenção - Maintenance Management Center), as well as attending local interventions. The main goal was to verify if the changes performed produced positive results and identify which areas could be improved. Special attention was given to the analysis and verification of the customization of the alterations performed in all maintenance areas through the kanban system. Furthermore, the excess material was calculated, determining the saved assets and the processes improvement

Social Cognition, Negative Symptoms and Psychosocial Functioning in Schizophrenia

Although functional recovery could be advocated as an achievable treatment goal, many e ective interventions for the treatment of psychotic symptoms, such as antipsychotic drugs, may not improve functioning. The last two decades of cognitive and clinical research on schizophrenia were a turning point for the rm acknowledgment of how relevant social cognitive de cits and negative symptoms could be in predicting psychosocial functioning. The relevance of so- cial cognition dysfunction in schizophrenia patients’ daily living is now unabated. In fact, social cognition de cits could be the most signi cant predictor of functionality in patients with schizophrenia, non-redundantly with neurocogni- tion. Emerging evidence suggests that negative symptoms appear to play an indirect role, mediating the relationship between neurocognition and social cognition with functional outcomes. Further explorations of this mediating role of negative symptoms have revealed that motivational de cits appear to be particularly important in explaining the relationship between both neurocognitive and social cognitive dysfunction and functional outcomes in schizophrenia. In this paper we will address the relative contribution of two key constructs—social cognitive de cits and negative symptoms, namely how intertwined they could be in daily life functioning of patients with schizophrenia

Negative symptoms mediate the relationship between social cognition and functioning in schizophrenia: a pilot study

In spite of significant advances in pharmacological and psychological treatments, schizophrenia still ranks among the leading causes of disability worldwide. People suffering from schizophrenia have significant impairment in major areas of everyday life, such as interpersonal relationships, work or school and even self-care. Enhancing the understanding of factors that hinder real-life functioning is therefore crucial for translating delivered care into more positive outcomes. Social cognition, defined as the mental operations that underlie social interactions, including perceiving, interpreting, and generating responses to the intentions, dispositions, and behaviors of others, has been implicated in impaired functioning. It is typically broken down into four domains: emotion processing, social perception, attributional bias and theory of mind. Negative symptoms have also been associated with patients' functional outcome; although generally conceptualized as a unitary construct, the most recent literature suggests that these symptoms are heterogeneous and include at least two factors: amotivation and diminished emotional expression. The aim of this study was to analyze the relationships between negative symptoms, social cognition and real-life functioning in people with schizophrenia. Methods: 12 patients with diagnosis of schizophrenia according to ICD-10 criteria were assessed cross-sectionally regarding relevant dimensions to our study: general psychopathology (Positive and Negative Syndrome Scale), social cognition (Face and Emotion Identification Test, Schema Component Sequencing Test - Revised, Social Perception Scale, Ambiguous Intentions and Hostility Questionnaire, Reading the Mind in The Eyes Test), negative symptoms (Clinical Assessment Interview for Negative Symptoms – CAINS) and general functioning (Personal and Social Performance scale – PSP). Spearman correlations were examined and regression and mediation models (Preacher and Hayes bootstrapping methodology) were performed. Results: In our preliminary results, emotion processing was the only social cognition dimension significantly correlated with functioning (rS = .87) and negative symptoms measured by the CAINS: rS = -.78 with amotivation; -.70 with diminished emotional expression and -.78 with total CAINS score (all Po.01). Both amotivation and diminished emotional expression, as well as negative symptoms as a whole, correlated with functioning (rS4.80, Po.01). Emotion processing was a significant predictor of amotivation, diminished emotional expression and total CAINS score (all Beta4-.65, p o.05). Both emotion processing (Beta = .71, P = 0.3) and amotivation (Beta = -.84, P = 0.001) were significant predictors of functioning. Finally, amotivation was found to be a partial mediator of the relationship between emotion processing and functioning (BCA 95% CI = .196 - 7.559). Discussion: Our results are in partial agreement with previous studies suggesting that emotional processing is the most relevant dimension of social cognition to everyday functioning, despite a possible contribution of theory of mind for such impairment in patients with schizophrenia. Regarding negative symptoms, amotivation seems to be the dimension of most relevance to functioning. Altogether, negative symptoms seem to be driven by social cognition deficits and, at least partially, negative symptoms may play a role in the deleterious impact of impaired social cognition on functional outcome. The complexity of the crosstalk between negative symptoms, social cognition and functioning will be better addressed in ongoing studies, as a greater understanding of underlying mechanisms is critical to development of effective treatments

Sensitivity Analysis of the Constitutive law Parameters on the Numerical Simulation of TAFSW Process

Dissertação de Mestrado em Engenharia Mecânica apresentada à Faculdade de Ciências e TecnologiaO objetivo da presente dissertação consistiu em realizar uma análise de sensibilidade dos parâmetros da lei constitutiva de Norton-Hoff na simulação numérica do processo Tool Assisted Friction Spot Welding (TAFSW), com recurso ao software COMET. Para tal foram traçadas curvas tensão-deformação em tração, numa gama variada de temperaturas e velocidades de deformação, para vários aços (DC01, DC05, DX200, HC420 e DP600), recorrendo ao software de modelação termo-mecânica JMATPro. As curvas obtidas para condições de solicitação quase-estáticas, à temperatura ambiente, foram validadas através da comparação das mesmas com dados experimentais, procedendo-se posteriormente à determinação dos coeficientes da equação de Norton-Hoff com base nas curvas correspondentes a diferentes temperaturas e velocidades de deformação. Para a determinação da sensibilidade à velocidade de deformação foi considerada uma gama variada de valores de deformação. Após terem sido determinados os coeficientes da equação de Norton-Hoff, e analisada a sua evolução com a temperatura e a velocidade de deformação, para os diferentes aços, procedeu-se à simulação numérica do processo TAFSW, assumindo duas condições de contacto, nomeadamente, Full-Sticking (FS) e Mixed Contact Conditions (MCC). As simulações foram efetuadas para os aços DC01 e DP600, utilizando os coeficientes de Norton-Hoff correspondentes aos diversos valores de deformação assumidos na análise da sensibilidade à velocidade de deformação, e ainda, uma condição hipotética representativa da ocorrência de sensibilidade à velocidade de deformação nula a temperaturas elevadas, para ambos os materiais. Nos estudos de simulação numérica foram testadas ainda duas velocidades de rotação da ferramenta (870 e 1500 rpm). As temperaturas máximas obtidas foram comparadas com resultados experimentais.A análise de resultados permitiu concluir que a sensibilidade à velocidade de deformação é um parâmetro que tem uma forte influência na previsão da temperatura máxima para todos os modelos de atrito e velocidades de deformação testados. Foi também registada uma forte influência das características do modelo de atrito na previsão da distribuição do calor na ferramenta e no metal base. Estes resultados foram registados para todos os modelos constitutivos ensaiados. Finalmente, registou-se também que, apesar de a velocidade de rotação ser um fator fortemente determinante na geração de calor, as temperaturas máximas registadas são fortemente determinadas pelo modelo adotado para descrever o comportamento mecânico do metal base.The goal of this dissertation was to make a sensitivity analysis of the parameters of the constitution law of Norton-Hoff in the numerical simulation of the Tool Assisted Friction Spot Welding (TAFSW) process, using the COMET software. For this, tensile stress-strain curves were drawn, in a varied range of temperatures and strain rates, for various steels (DC01, DC01, DX200, HC420 and DP600), using the JMATPro thermomechanical modeling software. The curves obtained for near-static request conditions at room temperature were validated by comparing them with experimental data, and then the coefficients of the Norton-Hoff equation were determined based on the curves corresponding to different temperatures and strain-rate values. For the determination of strain rate sensitivity, a varied range of deformation values was considered. After the coefficients of the Norton-Hoff equation were determined, and the evolution with the temperature and strain-rate was analyzed for the different steels, the numerical simulation of the TAFSW process was carried out, assuming two contact conditions, namely Full-Sticking (FS) and Mixed Contact Conditions (MCC). The simulations were performed for the DC01 and DP600 steels, using the Norton-Hoff coefficients corresponding to the various deformation values assumed in the analysis of the strain-rate sensitivity, and a hypothetical condition representative of the occurrence of strain-rate sensitivity equal to zero at high temperatures, for both materials. In the numerical simulation studies, two tool rotation velocities (870 and 1500 rpm) were also tested. The maximum temperatures obtained were compared with experimental results. The analysis of the results allowed us to conclude that the strain-rate sensitivity is a parameter that has a strong influence on the prediction of the maximum temperature for all models of friction and strain-rate tested. A strong influence of the characteristics of the friction model was also recorded in predicting the distribution of heat in the tool and base metal. These results were recorded for all the constituent models tested. Finally, it was also observed that, although the rotation speed is a strongly determining factor in heat generation, the maximum temperatures recorded are strongly determined by the model adopted to describe the mechanical behaviour of the base metal

Folkets försvinnande : Konstruktioner av det förflutna i svensk folkminnesforskning under 1920-talet

In Sweden, during the 1920s, the past played a definite part in the folklore research. The folklore scholars argued for collecting the cultural memories (folkminnen) of “the people”, as they were understood to disappear due to a threat from the modern civilization, which was thought to spread across the countryside at an ever-accelerating pace. This study shows that the past is constructed through discourse – not as a predefined object but rather as a dynamic process of temporal constructions. This study analyses the construction of the past in folklore research in Sweden during the 1920s. Two methodological tools have been primarily used to help unfold the process in which the past is constructed. First, by discourses of the past (förflutenhetsdiskurser) which is how, in my case the scholars, relate to the past by various verbal practices. Secondly, by identifying binary characterizations. In this study, the construction of the past, in folklore research, has been shown through three main themes. First, by understanding the importance of collecting the cultural memories of “the people” as an urgent project – due to their inevitable disappearing – but also as a duty towards the people of the past and as a duty towards future generations. Secondly, by identifying three different dichotomies which all functioned as part of the process of the construction of the past. Thirdly, by analyzing “the people” as a category that best is described as a compound of both culture and human

Neural connectivity in youth at-risk for bipolar disorder: a review of functional magnetic resonance imaging studies

Background: Delayed diagnosis of bipolar disorder (BD) is common in adolescents and young adults and the search for biomarkers to help in early diagnosis in BD at-risk populations is an important goal of neuroimaging research. Functional connectivity studies in BD patients suggests that anomalous connectivity between prefrontal and limbic regions could be risk biomarkers for BD. The aim of this review is to provide an overview of the neuroimaging literature that employed functional connectivity techniques in adolescents and young adults at-risk for BD. Methods: A literature search was conducted using PubMed and EMBASE databases, to identify fMRI studies that em- ployed a measure of functional or e ective connectivity or network based statistics and included individuals at-risk for BD who were in the age range of early-mid adolescence (13–18 years old) and/or young adulthood (19–25 years old). Results: Ten studies focusing on 4 functional imaging domains were identi ed, namely emotion processing, a ective cognition, reward processing and resting-state. Altered functional connectivity between amygdala and ventrolateral prefrontal cortex (PFC); amygdala and anterior cingulate cortex and between anterior cingulate cortex, ventrolateral PFC and dorsolateral PFC emerged as putative risk biomarkers. Heterogeneity in BD at-risk samples, tasks and connectivity analysis methods has been identi ed. Conclusions: Youth at-risk for BD have altered functional connectivity in prefrontal-limbic networks supporting emo- tion regulation that might underlie emotion lability and mood dysregulation predisposing to BD. Future longitudinal studies in adolescents and young adults with Bipolar At-Risk criteria are important to establish functional connectivity measures as risk biomarkers