Outpatient cognitive behavioural therapy programme for alcohol dependence impact of naltrexone use on outcome

Objective: Cognitive-behavioural therapy (CBT) has been effectively used in the treatment of alcohol dependence. Clinical studies report that the anticraving drug naltrexone, is a useful adjunct to treatment. Currently, few data are available on the impact of adding this medication to programmes in more typical, outpatient, and rehabilitation settings. The objective of this study was to examine the impact on outcome of adding naltrexone to an established outpatient alcohol rehabilitation program which employed CBT. Method: Fifty patients participated in an established 12-week, outpatient, 'contract'-based alcohol abstinence programme which employed CBT. They also received naltrexone 50 mg orally daily (CBT + naltrexone). Outcomes were compared with 50 historical, matched controls, all of whom participated in the same programme without an anticraving medication (CBT alone). All patients met DSM-IV criteria for alcohol dependence. Results: Programme attendance across the eight treatment sessions was lower in the CBT alone group (p < 0.001). Relapse to alcohol use occurred sooner and more frequently in the CBT alone group (p < 0.001). Rehabilitation programme completion at 12 weeks was 88% (CBT + naltrexone) compared with 36% for (CBT alone) (p < 0.001). Alcohol abstinence at 12 weeks was 76% (CBT + naltrexone) compared with 18% (CBT alone) (p < 0.001). Conclusion: When employing the same outpatient rehabilitation programme and comparing outcomes using matched historical controls, the addition of naltrexone substantially improves programme attendance, programme completion and reported alcohol abstinence. In a typical outpatient programme, naltrexone addition was associated with significantly improved programme participation, better outcomes and was well tolerated.

Feedback-stabilization of an arbitrary pure state of a two-level atom

Unit-efficiency homodyne detection of the resonance fluorescence of a two-level atom collapses the quantum state of the atom to a stochastically moving point on the Bloch sphere. Recently, Hofmann, Mahler, and Hess [Phys. Rev. A 57, 4877 (1998)] showed that by making part of the coherent driving proportional to the homodyne photocurrent one can stabilize the state to any point on the bottom-half of the sphere. Here we reanalyze their proposal using the technique of stochastic master equations, allowing their results to be generalized in two ways. First, we show that any point on the upper- or lower-half, but not the equator, of the sphere may be stabilized. Second, we consider nonunit-efficiency detection, and quantify the effectiveness of the feedback by calculating the maximal purity obtainable in any particular direction in Bloch space.

Pro re nata medication for psychoses: the knowledge and beliefs of doctors and nurses

Objective: To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders. Methods: Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March-June 1999. Results: Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94% ,and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of non-pharmacological alternatives to PRN medication than senior staff. Conclusions: Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.

Pro re nata medication for psychoses: an audit of practice in two metropolitan hospitals

Objective: To examine the use of pro re nata (PRN) (as needed) medication in hospitalized patients with psychotic disorders. Methods: Retrospective chart reviews were conducted at two large public psychiatry units situated in inner city general hospitals. Pro re nata medication prescription, administration and outcomes were examined during inpatient episodes of care for 184 consecutive admissions of patients diagnosed with a psychotic disorder. Patient demographics, diagnoses, and regularly prescribed medication were also recorded. All admissions were drawn from a three-month period from December 1998-February 1999. Results: The most prevalent diagnoses were schizophrenia related disorders (n = 111) and mania (n = 34). Substance use disorders (n = 49) were the most common comorbid dis-orders. Pro re nata medication was administered during the acute phase of 82% of admissions. Drugs prescribed Pro re nata were mostly typical antipsychotics, benzodiazepines and/or anti-cholinergics. Coprescription of typical antipsychotics PRN with regularly scheduled atypical antipsychotics was common (64%). Pro re nata medications accounted for 31% of the total antipsychotic dose and 28% of the total anxiolytic dose administered during acute treatment. Higher daily doses of PRN medication were given to manic patients, males, younger patients and those with substance use disorders. Pro re nata prescriptions usually specified a maximum daily dose (87%) but rarely gave indications for use (6%). Adminis-tration records frequently lacked a specified reason for use (48%) or a notation of outcome (64%). Unit staff noted medication-related morbidity in 37% of patients receiving PRN medication, compared to 3% of patients receiving only regularly scheduled medication. Extrapyramidal symptoms (EPS) were most frequently associated with administration of PRN haloperidol (Relative Risk vs other PRN medications = 5.61, 95% CI = 2.36-13.73). Conclusions: Pro re nata medications comprised a significant part of the treatment which psychotic patients received. The common practice of coprescribing PRN typical antipsychotics with scheduled atypical antipsychotics is potentially problematical since administration of PRN medication is associated with significant medication related morbidity. Preferential use of benzodiazepines as PRN agents may minimize this morbidity and foster subsequent compliance with regularly prescribed antipsychotics.

Are tryptophan and 5-hydroxytryptophan effective treatments for depression? A meta-analysis

Objective: To review the literature regarding the effectiveness of 5-hydroxytryptophan (5-HT) and L-tryptophan in the treatment of unipolar depression. Methods: A systematic review of the literature from 1966 to 2000 using the search terms 'tryptophan', 5-hydroxytryptophan', '5-HTP', '5-HT' and 'depression'. We extracted and grouped data for meta-analysis by pooling odds ratios (OR) and relative risks where possible. Results: One hundred and eight studies were located of which only two studies, one of 5-HT and one of L-tryptophan, with a total of 64 patients met sufficient quality criteria to be included. These studies suggest 5-HT and L-tryptophan are better than placebo at alleviating depression (Peto OR = 4.1, 95% CI = 1.3-13.2). However, the small size of the studies, and the large number of inadmissible, poorly executed studies, casts doubt on the result from potential publication bias, and suggests that they are insufficiently evaluated to assess their effectiveness. Conclusions: A large body of evidence was subjected to very basic criteria for assessing reliability and validity, and was found to largely be of insufficient quality to inform clinical practice. More well-designed studies are urgently required to enable an assessment of what may be an effective class of agents.

Young women in conflict: Filipinas growing up in Australia

This paper discusses the tensions of adaptation as experienced by 72 young women, born in the Philippines or to immigrant mothers and resident in southeast, far west and far north Queensland, Australia. As illustrated, these women, aged 14-25 years, often have difficulty balancing their expectations with those of their families and of the society in which they live. Like most young Australians they experience some conflicts with parents, but the intersections of race, gender and culture may make it particularly difficult for young Filipinas to develop a sense of their own identity and place in society. The retention of Filipino values often isolates young women from their peers and excludes them from participating in activities considered an important part of growing up Australian, but the adoption of 'Australian' behaviors such as drinking and smoking is not necessarily accompanied by an enhanced sense of belonging.

Electron exchange coupling for single-donor solid-state spin qubits

Intervalley interference between degenerate conduction band minima has been shown to lead to oscillations in the exchange energy between neighboring phosphorus donor electron states in silicon [B. Koiller, X. Hu, and S. Das Sarma, Phys. Rev. Lett. 88, 027903 (2002); Phys. Rev. B 66, 115201 (2002)]. These same effects lead to an extreme sensitivity of the exchange energy on the relative orientation of the donor atoms, an issue of crucial importance in the construction of silicon-based spin quantum computers. In this article we calculate the donor electron exchange coupling as a function of donor position incorporating the full Bloch structure of the Kohn-Luttinger electron wave functions. It is found that due to the rapidly oscillating nature of the terms they produce, the periodic part of the Bloch functions can be safely ignored in the Heitler-London integrals as was done by Koiller, Hu, and Das Sarma, significantly reducing the complexity of calculations. We address issues of fabrication and calculate the expected exchange coupling between neighboring donors that have been implanted into the silicon substrate using an 15 keV ion beam in the so-called top down fabrication scheme for a Kane solid-state quantum computer. In addition, we calculate the exchange coupling as a function of the voltage bias on control gates used to manipulate the electron wave functions and implement quantum logic operations in the Kane proposal, and find that these gate biases can be used to both increase and decrease the magnitude of the exchange coupling between neighboring donor electrons. The zero-bias results reconfirm those previously obtained by Koiller, Hu, and Das Sarma.

Ensino primário e matemática dos imigrantes e descendentes germânicos em Santa Leopoldina (1857-1907)

O objetivo da pesquisa é descrever o cenário da imigração germânica no século XIX, tratando também, de trilhar o caminho da educação por meio de educadores e das comunidades na Colônia de Santa Leopoldina, criada em 1857, na Província do Espírito Santo, considerando 50 anos a partir do início da imigração (1857-1907). A pesquisa histórica ancorou-se em consultas a documentos oficiais do Império, documentos e relatórios oficiais dos Presidentes da Província do Espírito Santo, jornais de circulação da época, fotografias, mapas geográficos, mapas estatísticos, livros didáticos antigos e livros de autores que abordaram o processo imigratório do Espírito Santo. O diálogo com Marc Bloch ajudou a entender essa multiplicidade de documentos, na complexa relação entre o passado e o presente da educação do Espírito Santo. O trabalho apresenta uma trajetória do imigrante germânico vindo da Europa até a ex-colônia e como a administração da província tratou a imigração e a educação. O ensino primário iniciou-se a partir de iniciativas públicas e particulares. Foram identificados as primeiras escolas e os nomes de muitos professores que atuaram no período estudado. Os livros utilizados nas escolas das comunidades teuto-brasileiras eram oriundos da Alemanha e posteriormente foram produzidos no sul do Brasil. Entre os livros escritos em alemão encontrados destacam-se o livro texto de alfabetização „Lese – Schule I für Deutsche Kinder in Brasilien‟, editado na Alemanha no final do século XIX, de autoria do diretor de uma escola particular em Santa Leopoldina, Albert Richard Dietze, e o primeiro volume do livro de matemática „Rechenbuch für Deutsch-Brasilianische Volksschulen‟, de Ferdinand Hackbart, Konrad Glaus e Hermann Lange. Foi feita uma análise sob os aspectos físicos e formais, o processo de ensino e os conteúdos do livro de matemática. A análise evidenciou que a proposta de ensino apoia-se no “cálculo mental” e o escrito, com a repetição dos conteúdos, envolvendo o treino intensivo. Os conceitos de matemática são apresentados partindo de problemas com situações concretas do aluno para a aquisição de competências necessárias para inserir o aluno em sua comunidade. Levando-se em conta que o livro foi editado em 1906, conclui-se que se trata de uma obra relevante com uma proposta de ensino que se manteve presente nos livros didáticos de matemática até os dias atuais.

A poesia nos livros didáticos : contribuição para um projeto educativo emancipatório

Este estudo tem por objetivo analisar poemas transcritos em livros didáticos do Ensino Médio adotados por escolas públicas, a partir do ano 2012, o estudo que as obras fazem dos poemas, o conteúdo das obras relacionado à poesia e à literatura e o trabalho que os professores fazem com os poemas em suas aulas, para verificar o possível potencial desestabilizador desses textos, relacionado à orientação dos discentes quanto à desigualdade e à exclusão social, em consonância com a ideologia de um Projeto Educativo Emancipatório sugerido por Boaventura de Sousa Santos. A pesquisa fundamenta-se nos pressupostos do “método crítico” de Bloch e as análises efetivadas possuem aspecto quantitativo e qualitativo. As informações dos docentes foram colhidas por meio de uma entrevista semiestruturada. Foi possível identificar que os poemas, em geral, nas duas obras, ocorrem em grande quantidade, contudo, em um número reduzido, se considerados aqueles que abordam situações de desigualdade e exclusão social; que há fragilidades importantes no estudo que as obras fazem deles, como uma pobre ou inexistente exploração do sentido textual, que dificulta um trabalho educativo crítico com os alunos; que os conteúdos relacionados à poesia e à literatura estão dispostos de forma fragmentada e desarticulada nas obras, comprometendo a aquisição de um conhecimento global pelos alunos; e que há, por parte dos docentes, um significativo trabalho com poemas, em geral, e um considerável trabalho com poemas do livro didático no sentido de orientar os alunos quanto à realidade social. Concluímos, então, que, apesar das inconsistências indicadas, nos poemas e nas obras, se os professores, conforme nos orienta Dalvi, encararem o livro didático como espaço de rasura e construírem novas visões sobre os seus conteúdos, de maneira a “trapacear” a “trapaça” que ele faz, podem torná-lo mais acessível e educativo para os alunos. Afinal, temos a potência da poesia do livro didático e a possibilidade dos docentes, que sinalizam para a possível tarefa de mostrar aos discentes situações de desigualdade e exclusão do passado, com o intuito de desestabilizá-los, no presente, em consonância com a ideia do supracitado Projeto.