Avaliação do programa assistencial de um serviço de interconsulta psiquiátrica e psicológica

OBJECTIVE: To investigate the relevance of subjective criteria adopted by a psychiatry and psychology consultation-liaison service, and their suitability in the evaluation of case registries and objective results. METHODS: Semi-structured interviews were conducted and all supervisors of the university hospital service were interviewed. Routinely collected case registries were also reviewed. Standardized assessment with content analysis for each category was carried out. RESULTS: The results showed distortions in the adopted service focus (doctor-patient relationship) and consultant requests. This focus is more on consulting physician-oriented interventions than on patients. DISCUSSION: Evaluation of the relevance of service criteria could help promoting quality assessment of the services provided, mainly when objective criteria have not yet been established to assure their suitability.OBJETIVO: Investigar a pertinência dos critérios subjetivos adotados por um serviço de interconsulta psiquiátrica e psicológica e sua adequação na avaliação dos registros e resultados objetivos obtidos. MÉTODOS: Foram realizadas entrevistas semi-estruturadas com todos os supervisores do serviço estudado de um hospital universitário, e revisados os registros de caso coletados rotineiramente no serviço. Foi realizada avaliação formal por meio de análise de conteúdo para cada categoria. RESULTADOS: Os resultados mostram distorção entre o foco adotado pelo serviço (relação médico-paciente) e a demanda dos consultantes. Esse foco direciona para maior predomínio de intervenções direcionadas aos médicos consultantes do que aos pacientes. CONCLUSÃO: A avaliação da pertinência dos critérios adotados pelo serviço pode servir ao propósito de promover análise da qualidade do serviço prestado, principalmente em casos em que não se possuem ainda critérios objetivos que possam atestar sua adequação.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Mass Spectrum of Strings in Anti de Sitter Spacetime

We perform string quantization in anti de Sitter (AdS) spacetime. The string motion is stable, oscillatory in time with real frequencies $\omega_n= \sqrt{n^2+m^2\alpha'^2H^2}$ and the string size and energy are bounded. The string fluctuations around the center of mass are well behaved. We find the mass formula which is also well behaved in all regimes. There is an {\it infinite} number of states with arbitrarily high mass in AdS (in de Sitter (dS) there is a {\it finite} number of states only). The critical dimension at which the graviton appears is $D=25,$ as in de Sitter space. A cosmological constant $\Lambda\neq 0$ (whatever its sign) introduces a {\it fine structure} effect (splitting of levels) in the mass spectrum at all states beyond the graviton. The high mass spectrum changes drastically with respect to flat Minkowski spacetime. For $\Lambda\sim \mid\Lambda\mid N^2,$ {\it independent} of $\alpha',$ and the level spacing {\it grows} with the eigenvalue of the number operator, $N.$ The density of states $\rho(m)$ grows like \mbox{Exp}[(m/\sqrt{\mid\Lambda\mid}\;)^{1/2}] (instead of \rho(m)\sim\mbox{Exp}[m\sqrt{\alpha'}] as in Minkowski space), thus {\it discarding} the existence of a critical string temperature. For the sake of completeness, we also study the quantum strings in the black string background, where strings behave, in many respects, as in the ordinary black hole backgrounds. The mass spectrum is equal to the mass spectrum in flat Minkowski space.Comment: 31 pages, Latex, DEMIRM-Paris-9404

On Nonlinear Bosonic Coherent States

Nonlinear coherent states are an interesting resource for quantum technologies. Here we investigate some critical features of the single-boson nonlinear coherent states, which are theoretically constructed as eigenstates of the annihilation operator and experimentally realized as stationary states of a trapped laser-driven ion. We show that the coherence and the minimum-uncertainty properties of such states are broken for values of the Lamb-Dicke parameter corresponding to the roots of the Laguerre polynomials, which enter their explicit expression. The case of the multiboson nonlinear coherent states is also discussed.Comment: published versio

SO(3) versus SU(2) lattice gauge theory

We consider the SO(3) lattice gauge theory at weak coupling, in the Villain action. We exhibit an analytic path in coupling space showing the equivalence of the SO(3) theory with SU(2) summed over all twist sectors. This clarifies the ``mysterious phase'' of SO(3). As order parameter, we consider the dual string tension or center vortex free energy, which we measure in SO(3) using multicanonical Monte Carlo. This allows us to set the scale, indicating that ${\cal O}(700)^4$ lattices are necessary to probe the confined phase. We consider the relevance of our findings for confinement in other gauge groups with trivial center.Comment: 12 pages, 6 figures, to appear in the Proceedings of the NATO workshop on "Confinement, Topology, and other Non-Perturbative Aspects of QCD", Stara Lesna, Feb. 200

Developing an Action Learning Community Advocacy/Leadership Training Program for Community Health Workers and Their Agencies to Reduce Health Disparities in Arizona Border Communities

Community health workers (CHWs) make unique and important contributions to society. They serve as patient advocates, educators, and navigators in our health care system and a growing body of research indicates that they play an important role in the effective delivery of prevention and treatment services in underserved communities. CHWs also serve as informal community leaders and advocates for organizational and community change, providing valuable insiders\u27 insights about health promotion and the interrelatedness of individuals, their community, its institutions, and the surrounding environment. Accion Para La Salud or Action for Health (Accion) is a CDC-funded community based participatory research (CBPR) project addressing the social determinants of health affecting health-related behaviors with the ultimate goal of creating a mode in which community advocacy to address the systems and environmental factors influencing health is integrated into the role of CHWs working in chronic disease prevention. Kingdon\u27s three streams theory and the social ecological model provide an overarching conceptual framework for Accion. The curriculum and training are also grounded in the theory and principles of action learning, which emphasizes learning by doing, teamwork, real-world projects, and reflection. The curriculum was delivered in four workshops over thirteen months and included longitudinal team projects, peer support conference calls, and technical assistance visits. It is now being delivered to new groups of CHWs in Arizona using a condensed two-day workshop format

Pass By Reference Substitution During Code Migration

This disclosure describes code conversion techniques for replacement of function calls that utilize pass by reference in program code in a source language with equivalent constructs in a target language that does not support pass by reference. When a pass by reference is encountered in the source program code, a wrapper object is created by wrapping a native object with a pre-defined key. In the translated code, the value of the object for the specified key is updated instead of being accessed as a normal variable. Upon return of program control from the called function, the value assigned to the object for the key is assigned back to the original variable. The variable now stores an updated value, just as it would in a pass by reference scenario

Nuclear Matter and Nuclear Dynamics

Highlights on the recent research activity, carried out by the Italian Community involved in the "Nuclear Matter and Nuclear Dynamics" field, will be presented.Comment: Proceedings of the 12th Conference on Problems in Theoretical Nuclear Physics, to appear in Journal of Physics, Conference Serie

Multiple sclerosis susceptibility alleles in African Americans.

Multiple sclerosis (MS) is an autoimmune demyelinating disease characterized by complex genetics and multifaceted gene-environment interactions. Compared to whites, African Americans have a lower risk for developing MS, but African Americans with MS have a greater risk of disability. These differences between African Americans and whites may represent differences in genetic susceptibility and/or environmental factors. SNPs from 12 candidate genes have recently been identified and validated with MS risk in white populations. We performed a replication study using 918 cases and 656 unrelated controls to test whether these candidate genes are also associated with MS risk in African Americans. CD6, CLEC16a, EVI5, GPC5, and TYK2 contained SNPs that are associated with MS risk in the African American data set. EVI5 showed the strongest association outside the major histocompatibility complex (rs10735781, OR=1.233, 95% CI=1.06-1.43, P-value=0.006). In addition, RGS1 seems to affect age of onset whereas TNFRSF1A seems to be associated with disease progression. None of the tested variants showed results that were statistically inconsistent with the effects established in whites. The results are consistent with shared disease genetic mechanisms among individuals of European and African ancestry

Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis

BACKGROUND: Treatment with glucocorticoids is associated with bone loss starting soon after therapy is initiated and an increased risk of fracture. METHODS: We performed a randomized, double-placebo, double-blind clinical trial of 18 months' duration among patients with a rheumatic disease who were starting glucocorticoids at a daily dose that was equivalent to at least 7.5 mg of prednisone. A total of 201 patients were assigned to receive either alendronate (10 mg) and a placebo capsule of alfacalcidol daily or alfacalcidol (1 mu g) and a placebo tablet of alendronate daily. The primary outcome was the change in bone mineral density of the lumbar spine in 18 months; the secondary outcome was the incidence of morphometric vertebral deformities. RESULTS: A total of 100 patients received alendronate, and 101 received alfacalcidol; 163 patients completed the study. The bone mineral density of the lumbar spine increased by 2.1 percent in the alendronate group (95 percent confidence interval, 1.1 to 3.1 percent) and decreased by 1.9 percent in the alfacalcidol group (95 percent confidence interval, -3.1 to -0.7 percent). At 18 months, the mean difference of change in bone mineral density between the two groups was 4.0 percent (95 percent confidence interval, 2.4 to 5.5 percent). Three patients in the alendronate group had a new vertebral deformity, as compared with eight patients in the alfacalcidol group (of whom three had symptomatic vertebral fractures) (hazard ratio, 0.4; 95 percent confidence interval, 0.1 to 1.4). CONCLUSIONS: During this 18-month trial in patients with rheumatic diseases, alendronate was more effective in the prevention of glucocorticoid-induced bone loss than was alfacalcidol