Intervenção psicossocial na doença mental grave: revisão da evidência.

Introdução: Existe uma extensa quantidade de investigação empírica relativa a efectividade de várias intervenções psicossociais em pacientes com doenca mental grave (DMG). No entanto, estes resultados mostram-se, por vezes, contraditórios, fruto de trabalhos com sérias limitações metodológicas, sendo difícil a sua integração e aplicação na prática clínica. Objetivo: Revisão da literatura atual relativa à efetividade das várias intervenções psicossociais no doente mental grave, no âmbito da Psiquiatria Comunitária. Foram utilizadas bases de dados online – Medline, Cochrane Library, Embase e PsycINFO. Resultados: Os programas de treino de atividades diárias não evidenciam diferenças clinicamente significativas face a intervenções usuais. Os programas residenciais na comunidade parecem melhorar o funcionamento social, a integração no meio e a satisfação dos utentes com doença mental grave, além de promover a adesão à terapia farmacológica. Os programas dirigidos ao lazer e ao tempo livre parecem melhorar o funcionamento social dos indivíduos com DMG, bem como a satisfação geral. Em termos de programas orientados para o emprego, existe boa evidência quanto a programas com tipologias de emprego protegido ou apoio no emprego - colocação rápida, com treino prévio curto, e apoio individual frequente. Relativamente às intervenções ao nível dos serviços, o tratamento assertivo na comunidade está associado a uma maior probabilidade de manter o doente em contacto com os serviços, com efetiva redução dos internamentos hospitalares. O doente com DMG integrado em programa de terapeuta de referência – ‘Case Management’ (CM) – tem maior possibilidade de se manter em contacto com os serviços e maior adesão à medicação psicotrópica. O Case Management de aplicação intensiva poderá ter um desempenho mais eficiente face ao CM convencional, prevendo-se um melhor desempenho no paciente com DMG que tende a utilizar frequentemente os cuidados hospitalares. Os Hospitais de Dia (não-agudos) não evidenciam eficácia superior às intervenções regulares em termos de taxas de internamento, psicopatologia ou funcionamento social

A robust design methodology suitable for application to one-off products

Robust design is an activity of fundamental importance when designing large, complex, one-off engineering products. Work is described which is concerned with the application of the theory of design of experiments and stochastic optimization methods to explore and optimize at the concept design stage. The discussion begins with a description of state-of-the-art stochastic techniques and their application to robust design. The content then focuses on a generic methodology which is capable of manipulating design algorithms that can be used to describe a design concept. An example is presented, demonstrating the use of the system for the robust design of a catamaran with respect to seakeeping

Cosmology on a Three-Brane

In this paper a general solution is found for a five dimensional orbifold spacetime that induces a $k=0$ cosmology on a three-brane. Expressions for the energy density and pressure on the brane in terms of the brane metric are derived. Given a metric on the brane it is possible to find five dimensional spacetimes that contain the brane. This calculation is carried out for an inflationary universe and for a metric that corresponds to a radiation dominated universe in standard cosmology. It is also shown that any $k=0$ cosmology can be embedded in a flat five dimensional orbifold spacetime and the equation of the three-brane surface is derived. For an inflationary universe it is shown that the surface is the usual hyperboloid representation of de Sitter space, although it is embedded in an orbifold spacetime.Comment: 11 pages, LaTex. New solutions with a cosmological constant have been adde

Competitive market for multiple firms and economic crisis

The origin of economic crises is a key problem for economics. We present a model of long-run competitive markets to show that the multiplicity of behaviors in an economic system, over a long time scale, emerge as statistical regularities (perfectly competitive markets obey Bose-Einstein statistics and purely monopolistic-competitive markets obey Boltzmann statistics) and that how interaction among firms influences the evolutionary of competitive markets. It has been widely accepted that perfect competition is most efficient. Our study shows that the perfectly competitive system, as an extreme case of competitive markets, is most efficient but not stable, and gives rise to economic crises as society reaches full employment. In the economic crisis revealed by our model, many firms condense (collapse) into the lowest supply level (zero supply, namely bankruptcy status), in analogy to Bose-Einstein condensation. This curious phenomenon arises because perfect competition (homogeneous competitions) equals symmetric (indistinguishable) investment direction, a fact abhorred by nature. Therefore, we urge the promotion of monopolistic competition (heterogeneous competitions) rather than perfect competition. To provide early warning of economic crises, we introduce a resolving index of investment, which approaches zero in the run-up to an economic crisis. On the other hand, our model discloses, as a profound conclusion, that the technological level for a long-run social or economic system is proportional to the freedom (disorder) of this system; in other words, technology equals the entropy of system. As an application of this new concept, we give a possible answer to the Needham question: "Why was it that despite the immense achievements of traditional China it had been in Europe and not in China that the scientific and industrial revolutions occurred?"Comment: 17 pages; 3 figure

Long-term Stellar Variability in the Galactic Centre Region

© 2019 The Author(s) Published by Oxford University Press on behalf of the Royal Astronomical Society.We report the detection of variable stars within a 11.5' x 11.5' region near the Galactic centre (GC) that includes the Arches and Quintuplet clusters, as revealed by the VISTA Variables in the Via Lactea (VVV) survey. There are 353 sources that show Ks-band variability, of which the large majority (81%) correspond to red giant stars, mostly in the asymptotic giant branch (AGB) phase. We analyze a population of 52 red giants with long-term trends that cannot be classified into the typical pulsating star categories. Distances and extinctions are calculated for 9 Mira variables, and we discuss the impact of the chosen extinction law on the derived distances. We also report the presence of 48 new identified young stellar object (YSO) candidates in the region.Peer reviewe

Basement-cover relations and internal structure of the Cape Smith klippe: A 1.9 Ga greenstone belt in northern Quebec, Canada

The Cape Smith Belt is a 380x60 km tectonic klippe composed of greenschistto amphibolite-grade mafic and komatiitic lava flows and fine-grained quartzose sediment, intruded by minor syn- to post-tectonic granitoids. Previously studied transects in areas of relatively high structural level show that the belt is constructed of seven or more north-dipping thrust sheets which verge toward the Superior Province (Archean) foreland in the south and away from an Archean basement massif (Kovik Antiform) external to the Trans-Hudson Orogen (Early Proterozoic) in the north. A field project (mapping and structural-stratigraphic-metamorphic studies) directed by MRS was begun in 1985 aimed at the structurally deeper levels of the belt and underlying basement, which are superby exposed in oblique cross-section (12 km minimum structural relief) at the west-plunging eastern end of the belt. Mapping now complete of the eastern end of the belt confirms that all of the metavolcanic and most of the metasedimentary rocks are allochthonous with respect to the Archean basement, and that the thrusts must have been rooted north of Kovik Antiform. The main findings follow

Lactating Ewes Were Strongly Attracted to Salt When Spread on Sodium-Deficient Undergrazed Hill Pastures

New Zealand hill and high country pastures for sheep and cattle cover very variable topography. Shady south face hill country pastures on steeper slopes are grazed inefficiently because of their mature state and low nutritive value. Flatter more fertile areas reflect more frequent defoliation and stock camping behaviour. These inland pastures are deficient in sodium (Na) (Aspinall et al., 2004) because they are distant from coastal sea spray. Management alternatives are sought to improve pasture quality on steep, shady aspects. The provision of different nutrients such as Na or nitrogen (N), which are deficient in these under-grazed areas of pasture, is expected to improve herbage nutritive value and its attractiveness to animals. Consequentially this could be expected to improve pasture utilization