Inter-professional collaboration reduces the burden of caring for patients with mental illnesses in primary healthcare. A realist evaluation study

Background:The implementation of primary care for mental health is often insufficient, whichleaves its mark on staff. A team-based approach of mental healthcare prevents poor staff mor-ale. A community health centre (CHC), therefore, set up a project promoting interprofessionalcollaboration with a mental health team (MHT).Objectives:This study aimed to understand how an MHT would influence staff morale in a pri-mary care setting, aiming to formulate some recommendations for future projects.Methods:In 2017, interviews and a focus group discussion were conducted among the staff ofa CHC. Using a qualitative approach, we aimed to unravel contextual factors and mechanismsthat determine the effect of an MHT on staff morale.Results:The project relieved the burden of the patient encounters and staff members felt morevaluable to patients. Underlying mechanisms were recognition, altered attitudes towards patientsand role clarity. Facilitating factors were intercultural care mediators and a positive team atmos-phere, whereas inhibiting factors were inefficient time management and communicative issues.Conclusion:Our study elucidated mechanisms and the contextual factors by which an MHT ingeneral practice improves staff morale

Loss of the arabidopsis protein kinases ANPs affects root cell wall composition, and triggers the cell wall damage syndrome

The Arabidopsis NPK1-related Protein kinases ANP1, ANP2 and ANP3 belong to the MAP kinase kinase kinase (MAPKKK) superfamily and were previously described to be crucial for cytokinesis, elicitor-induced immunity and development. Here we investigate the basis of their role in development by using conditional β-estradiol-inducible triple mutants to overcome lethality. In seedlings, lack of ANPs causes root cell bulging, with the transition zone being the most sensitive region. We uncover a role of ANPs in the regulation of cell wall composition and suggest that developmental defects of the triple mutants, observed at the cellular level, might be a consequence of the alterations of the pectic and cellulosic cell wall components. Lack of ANPs also induced a typical cell wall damage syndrome (CWDS) similar to that observed in plants treated with the cellulose biosynthesis inhibitor isoxaben (ISX). Moreover, anp double mutants and plants overexpressing single ANPs (ANP1 or ANP3) respectively showed increased and reduced accumulation of jasmonic acid and PDF1.2 transcripts upon ISX treatment, suggesting that ANPs are part of the pathway targeted by this inhibitor and play a role in cell wall integrity surveillance

Behavioural loyalty towards store brands.

This paper applies a consumer brand choice model to measure store brand (SB) loyalty. The aim of this paper is to examine whether SB loyalty is different across categories, and we focus on risk perception as an explanatory variable. The model is estimated using ACNielsen Spanish household scanner panel data on two laundry detergent categories over a 2 year period for more than 1107 households. Loyalty, price, socio demographics and shopping behaviour variables are included. The discrete choice model formulation is the logit modelStore brands; National brands; Brand loyalty; Logit model; Household scanner panel;

Multilateral development banks: comparisons between the European Investment Bank and the New Development Bank

No contexto atual, os bancos de desenvolvimento multilaterais (BDM) estão entre os principais contribuintes globais para o desenvolvimento, por utilizarem mecanismos multilaterais com vista à prevenção de crises globais e para a reconstrução de infraestruturas mais sustentáveis. Devido a alterações no poder geopolítico e às próprias alterações dos seus mandatos, os BDM podem encontrar-se numa posição sensível, em relação à implementação dos seus próprios projetos. Esta dissertação de mestrado propõe-se então analisar a situação atual dos BDM, ao comparar o Banco Europeu de Investimento (BEI) e o Novo Banco de Desenvolvimento (NBD), e esclarecer se as atividades e responsabilidades das duas instituições alcançam soluções semelhantes.In today's world, multilateral development banks (MDBs) are among the largest global contributors for development, by using multilateral mechanisms to prevent global crises or rebuild more sustainable infrastructures. Due to geopolitical power shifts and stretching mandates, the MDBs can be found challenged by their own mechanisms going forward. This master dissertation aims to analyse the current stance of the MDBs by comparing the European Investment Bank (EIB) and the New Development Bank (NDB), thus trying to establish whether or not their functions achieve similar results

Caracterização de carcinomas gástricos associados ao EBV

A nível mundial, o cancro gástrico (CG) é o sexto mais comum com cerca de 1 milhão de novos casos estimados em 2012. Em Portugal, os dados revelam que o CG é o quinto cancro mais frequente com cerca de 3000 novos casos por ano. Para além disso, o CG tem uma elevada taxa de mortalidade sendo responsável por 1387 mortes nos homens e 898 nas mulheres. Dados recentes têm mostrado que o vírus Epstein-Barr (EBV) é detectado em diferentes subtipos histopatológicos de carcinoma gástrico sendo estes tumores responsáveis por aproximadamente 10% de todos os casos. O presente estudo pretende caracterizar os carcinomas gástricos associados ao EBV (EBVaGC) através da sua detecção em tecidos tumorais gástricos de 136 pacientes atendidos no Instituto Português de Oncologia do Porto (IPO Porto FG EPE) no ano de 2011. A detecção de EBV foi realizada por hibridização in situ (ISH) utilizando uma sonda de ADN complementar para ARNs codificados pelo EBV (EBERs). Os resultados demonstraram que os carcinomas associados ao EBV representam 6,6% de todos os casos de CG. Analisando a distribuição de EBV entre os diferentes tipos histológicos, observou-se que o EBV estava presente em 6,6% dos tipos intestinais, em 11,1% dos tipos indeterminados e em 100% dos linfoepiteliomas, contudo nenhum caso foi detectado nos carcinomas difusos (p<0,001). A análise de risco, apesar de não ter sido estatisticamente significativa, sugeriu que os pacientes com carcinomas do tipo intestinal (p=0,350; OR=1,98; 95% IC=0,37-10,5) ou indeterminado (p=0,238; OR=2,78; 95% IC=0,55-15,5) apresentam um risco aumentado de ter EBVaGC; enquanto os pacientes com carcinomas difusos (p=0,078; OR=0,14; 95% CI=0,01-2,58) apresentam um risco diminuído de ter EBVaGC. Quanto à localização do tumor, verificou-se que os carcinomas das regiões superiores do estômago apresentam um risco aumentado de ter um EBVaGC (p=0,032; OR=4,68; 95% IC=1,11-19,7). Em conclusão, a infecção por EBV nos carcinomas gástricos em Portugal é semelhante à de outros países. Por outro lado, as características clínico-patológicas apresentaram diferenças quando comparadas com estudos anteriores, principalmente a ausência de EBV nos carcinomas difusos. Este é o primeiro estudo de caracterização dos EBVaGC em Portugal que reforça a necessidade de mais estudos para esclarecer o papel do EBV como biomarcador preditivo/prognóstico no desenvolvimento do cancro gástrico.Worldwide, Gastric Cancer (GC) is the sixth most common malignancy with nearly 1 million new cases estimated in 2012. In Portugal, data reveal that GC is the fifth most frequent cancer with about 3000 new cases per year. Moreover GC has still a higher mortality rates being responsible for 1387 deaths in men and 898 in women. Recent data showed that Epstein-Barr virus (EBV) has been detected in different histopathological subtypes of gastric carcinoma and EBV-associated gastric carcinoma (EBVaGC) accounts about 10% of all cases. This study pretends to characterize EBVaGC in our population through detection of EBV in gastric carcinoma tissues from 136 consecutive patients attended at Portuguese Institute of Oncology of Porto (IPO Porto FG EPE) in the year of 2011. EBV detection was performed by in situ hybridization (ISH) targeting EBV-encoded small RNA (EBER-ISH) with an EBER-DNA probe. The results showed that in our population EBVaGC represent 6.6% of all GC cases. Analyzing the distribution of EBV among the different histological types, we observed that EBV was present in 6.6% of intestinal-types, 11.1% of indeterminate types, 100% of lymphoepithelioma-like carcinomas and there were no positive cases among diffuse types (p<0.001). The risk analysis revealed that, despite there are not statistically significant differences, patients with intestinal (p=0.350; OR= 1.98, 95% CI=0.37-10.5) and indeterminate (p=0.238; OR=2.78, 95% CI=0.55-15.5) GC have an increased risk of having an EBVaGC; while diffuse GC (p=0.078; OR=0.14, 95% CI=0.01-2.58) have a decreased risk of having an EBVaGC. Regarding tumor location, the results demonstrated that patients with tumors in upper regions of stomach have an increased risk to have an EBVaGC (p=0.032; OR=4.68, 95% CI=1.11-19.7). In conclusion, the EBV infection rate among gastric carcinomas in Portugal is similar to that ascertained in other countries. Conversely, the clinicopathological features showed differences when compared with previous studies, mainly the absence of EBV in diffuse-type gastric carcinomas. This is the first study to characterize EBVaGC in Portugal which reinforce the need of further studies to clarify the role of EBV and to explore its potential value as predictive/prognostic biomarker in gastric cancer development

A re-evaluation of the central velocity-dispersion profile in NGC 6388

Recently, two independent groups found very different results when measuring the central velocity dispersion of the galactic globular cluster NGC 6388 with different methods. While L\"utzgendorf et al. (2011) found a rising profile and a high central velocity dispersion (23.3 km/s), measurements obtained by Lanzoni et al. (2013) showed a value 40% lower. The value of the central velocity dispersion has a serious impact on the mass and possible presence of an intermediate-mass black hole at the center of NGC 6388. We use a photometric catalog of NGC 6388 to create a simulated SINFONI and ARGUS dataset. The construction of the IFU data cube is done with different observing conditions reproducing the conditions reported for the original observations as closely as possible. In addition, we produce an N-body realization of a 10^6 M_SUN stellar cluster with the same photometric properties as NGC 6388 to account for unresolved stars. We find that the individual radial velocities, i.e. the measurements from the simulated SINFONI data, are systematically biased towards lower velocity dispersions. The reason is that due to the wings in the point spread function the velocities get biased towards the mean cluster velocity. This study shows that even with AO supported observations, individual radial velocities in crowded fields are likely to be biased. The ARGUS observations do not show this kind of bias but were found to have larger uncertainties than previously obtained. We find a bias towards higher velocity dispersions in the ARGUS pointing when fixing the extreme velocities of the three brightest stars but find those variations are within the determined uncertainties. We rerun Jeans models and fit the kinematic profile with the new uncertainties. This yields a BH mass of M_BH = (2.8 +- 0.4) x 10^4 M_SUN and M/L ratio M/L = (1.6 +- 0.1) M_SUN/L_SUN, consistent with our previous results.Comment: 8 pages, 8 figure, accepted for publication in A&

The Guatemala Community Day Care Program: an example of effective urban programming

Urban programming, Child care, Community Daycare Centers Program, Childcare and work, Gender,

A kinetic model of water adsorption, clustering and dissociation on the Fe3S4{001} surface

The interaction of water with catalyst surfaces is a common process which requires investigation. Here, we have employed density functional theory calculations to investigate the adsorption of up to ten water molecules on the {001} surface of greigite (Fe3S4), which owing to its redox properties, is of increasing interest as a catalyst, e.g. in electro-catalysis. We have systematically analyzed and characterized the modes of water adsorption on the surface, where we have considered both molecular and dissociative adsorption processes. The calculations show that molecular adsorption is the predominant state on these surfaces, from both a thermodynamic and kinetic point of view. We have explored the molecular dispersion on the surface under different coverages and found that the orientation of the molecule, and therefore the surface dipole, depends on the number of adsorbed molecules. The interactions between the water molecules become stronger with an increasing number of water molecules, following an exponential decay which tends to the interaction energy found in bulk water. We have also shown the evolution of the infra-red signals as a function of water coverage relating to the H-bond networks formed on the surface. Next we have included these results in a classical micro-kinetic model, which introduced the effects of temperature in the simulations, thus helping us to derive the water cluster size on the greigite surface as a function of the initial conditions of pressure, temperature and external potential. The kinetic model concluded that water molecules agglomerate in clusters instead of wetting the surface, which agrees with the low hydrophilicity of Fe3S4. Clusters consisting of four water molecules was shown to be the most stable cluster under a wide range of temperatures and external potential

Catalytic water dissociation by greigite Fe3S4surfaces: density functional theory study

The iron sulfide mineral greigite, Fe3S4, has shown promising capability as a hydrogenating catalyst, in particular in the reduction of carbon dioxide to produce small organic molecules under mild conditions. We employed density functional theory calculations to investigate the {001},{011} and {111} surfaces of this iron thiospinel material, as well as the production of hydrogen ad-atoms from the dissociation of water molecules on the surfaces. We systematically analysed the adsorption geometries and the electronic structure of both bare and hydroxylated surfaces. The sulfide surfaces presented a higher flexibility than the isomorphic oxide magnetite, Fe3O4, allowing perpendicular movement of the cations above or below the top atomic sulfur layer. We considered both molecular and dissociative water adsorption processes, and have shown that molecular adsorption is the predominant state on these surfaces from both a thermodynamic and kinetic point of view. We considered a second molecule of water which stabilizes the system mainly by H-bonds, although the dissociation process remains thermodynamically unfavourable. We noted, however, synergistic adsorption effects on the Fe3S4{001} owing to the presence of hydroxyl groups. We concluded that, in contrast to Fe3O4, molecular adsorption of water is clearly preferred on greigite surfaces

Does subsidized childcare help poor working women in urban areas?

High urbanization rates in Latin America are accompanied by an increase in women's participation in the labor force and the number of households headed by single mothers. Reliable and affordable childcare alternatives are thus becoming increasingly important in urban areas. The Hogares Comunitarios Program (HCP), established in Guatemala City in 1991, was a direct response to the increasing need of poor urban dwellers for substitute childcare. This government-sponsored pilot program was designed as a strategy to alleviate poverty by providing working parents with low-cost, quality childcare within their community. This paper presents preliminary findings from an evaluation of the HCP carried out in 1998 in urban slums of Guatemala City. The evaluation included both an operations (or process) evaluation and an impact evaluation. Key findings of the operations evaluation are summarized, and preliminary findings of the impact evaluation on children's dietary intakes are presented. Aspects related to the targeting, coverage, and cost of the program are also discussed, and the patterns of childcare use by nonbeneficiary households and their costs are described.Urbanization Latin America. ,Women Employment Guatemala. ,Child care Developing countries Evaluation. ,Urban poor Services for. ,Evaluation. ,Children Nutrition. ,Poverty alleviation. ,