Incidência e fatores associados à contenção física em pacientes agitados e/ou agressivos em emergências psiquiátricas

Os pacientes agressivos e/ou agitados correspondem a 10% de todas as internações em emergências psiquiátricas. Dependendo do grau de agitação, esses pacientes representam um risco para a integridade física, tanto para os profissionais que ali estão como para si mesmos. Dentre as alternativas para lidar com esses casos está a contenção física. Ainda que amplamente utilizada, seu uso é controverso e proibido em alguns países. No Brasil inexistem protocolos orientando o seu uso. O objetivo deste estudo foi conhecer a freqüência e os fatores associados a esta prática através de uma revisão sistemática e de um estudo em emergências psiquiátricas do município do Rio de Janeiro. A revisão identificou apenas quatro estudos, sendo três nos EUA e um na Índia. A freqüência de contenção em pacientes agitados e/ou agressivos nos serviços de emergência psiquiátrica variou de 14% até 59%. Os desenhos adotados, assim como as análises estatísticas, mostraram fragilidades para a investigação dos fatores explicativos para o uso de contenção física. O estudo nas emergências psiquiátricas do Rio de Janeiro lançou mão de informações sobre o uso de contenção física entre 298 pacientes participantes de um ensaio clínico comparando dois medicamentos para lidar com quadros de agitação psicomotora e comportamento agressivo nesses serviços. As variáveis investigadas foram aquelas coletadas antes da entrada do paciente no ensaio clínico. Portanto, variáveis que antecederam a decisão do médico conter o paciente. A análise dos dados fez uso do método Bayesiano. As prioris dos parâmetros utilizadas no modelo de regressão binária foram obtidas de um outro ensaio clínico, conduzido em uma das três emergências envolvidas no presente estudo. A freqüência no emprego da contenção física foi 24,5%, sem diferença entre os três hospitais. O estudo mostrou ainda que pacientes mais jovens, com quadros mais intensos, com suspeita diagnóstica de entrada de abuso de substâncias e que foram atendidos na parte da manhã apresentaram maior chance de serem fisicamente contidos. O presente trabalho aponta para a necessidade de conduzir estudos especificamente desenhados para avaliar a freqüência e os fatores associados com o uso de contenção física, os quais deverão subsidiar o desenvolvimento de protocolos sobre o uso desta prática em nosso meio.

O campo na luta por seus direitos: uma análise sobre a relação entre os trabalhadores rurais campistas e os direitos trabalhistas no Rio de Janeiro durante o período democrático(1945-1964)

A presente dissertação propõe um diálogo entre a história social dos movimentos rurais e a história social do Direito e para tanto investigamos a trajetória dos trabalhadores rurais da lavoura canavieira de Campos dos Goytacazes e as lutas empreendidas por estes, em meios institucionais ou não, pelos seus direitos trabalhistas entre os anos de 1945 à 1964. A trajetória da organização sindical dos trabalhadores rurais de Campos dos Goytacazes, o processo de proletarização vivenciado pelos canavieiros campistas a partir dos anos 1940 e a mobilização destes em greves e paralisações foram analisados no sentindo de resgatar a formação de uma identidade política entre a classe trabalhadora rural campista no decorrer do período democrático. Paralelamente, a análise dos dissídios individuais e coletivos promovidos pelo proletariado rural de Campos dos Goytacazes nos acórdãos julgados pelo Tribunal Regional do Trabalho da 1Região teve como objetivo evidenciar a existência de uma cultura jurídica entre os canavieiros campistas e seus representantes legais que permitia a estes elaborarem apropriações da legislação trabalhista tornando legítimos direitos sociais que aparentemente eram lhe negados, bem como observar os limites de demandas como justiça e igualdade numa sociedade classista.

A new Lagrangian-Eulerian shell-fluid coupling algorithm based on level sets

We propose a computational method for the coupled simulation of a compressible flow interacting with a thin-shell structure undergoing large deformations. An Eulerian finite volume formulation is adopted for the fluid and a Lagrangian formulation based on subdivision finite elements is adopted for the shell response. The coupling between the fluid and the solid response is achieved via a novel approach based on level sets. The basic approach furnishes a general algorithm for coupling Lagrangian shell solvers with Cartesian grid based Eulerian fluid solvers. The efficiency and robustness of the proposed approach is demonstrated with a airbag deployment simulation. It bears emphasis that in the proposed approach the solid and the fluid components as well as their coupled interaction are considered in full detail and modeled with an equivalent level of fidelity without any oversimplifying assumptions or bias towards a particular physical aspect of the problem.

Status of the shrimp sector in Bangladesh in the context of HACCP and trade issues: a review

Shrimp culture in Bangladesh has emerged as an important aquaculture industry over the last three decades although its culture in greater parts of the farming area is done in traditional ways. In the meantime, the government of Bangladesh has taken necessary measures along with the private sectors to increase production, upgrade processing industries and to promote export performance. Long supply chain in raw material collection, inadequate infrastructure facilities, poor level of cool chain and lack of adequate HACCP-based training on hygiene and sanitation of different groups of people involved in the field level are the main problems of quality loss of raw materials. Shortage of raw materials results in poor capacity utilization of the processing plants. The growth of bagda (P. monodon) hatchery has expanded rapidly over the last few years, remaining mostly concentrated in Cox's Bazar region is enough to meet the target production. However, there is a shortage of pelleted shrimp feed in Bangladesh. A large number of export processors are now producing increasing amounts of value-added products such as individually quick-frozen, peeled and divined, butterfly cut shrimp, as well as cooked products. The export earnings from value added products is about half of the total export value. About 95% of total fish products are exported to European countries, USA and Japan and the remaining to the Southeast Asia and the Middle East. Most of the EU approved shrimp processing industries have been upgraded with laboratory facilities and provided HACCP training to their workers. As of now, HACCP is applied on the processing plants, but to ensure the quality of raw materials and to reduce risks, shrimp farms are also required to adopt HACCP plan. There is increased pressure time to time from importing countries for fish processors to establish effective quality assurance system in processing plants. Fish Inspection and Quality Control (FIQC) of the Department of Fisheries while having moderately equipped laboratories with chemical, bio-chemical and microbiological testing facilities and qualified technical personnel, the creation of facilities for testing of antibiotics is underway. FIQC mainly supervises quality aspects of the processing plants and has little or no control over raw material supply chains from farm to processing plants. Bangladesh export consignments sometimes face rejection due to reported poor quality of the products. Three types of barriers are reported for export of shrimp to EU countries. These are:(1) government participation in trade and restrictive practices (state aid, countervailing duties, state trading enterprises, government monopoly practices), customs and administrative entry procedures (anti-dumping duties, customs valuation, classification, formalities, rules of origin); (2) technical barriers to trade or TBT (technical regulations, standards, testing, certification arrangement); (3) specific limitations (quantitative restrictions, import licensing, embargoes, exchange control, discriminatory sourcing, export restraints, measures to regulate domestic prices, requirements concerning marking, labeling and packaging).

Glass reinforced glass

Laminated glass units are traditionally used to provide a degree of post-fracture strength, but the residual strength is often limited to relatively low levels suffi cient for holding the glass fragments together for a predetermined amount of time. It is possible to achieve a higher level of residual strength, but this requires specific boundary conditions and/or opaque reinforcing materials. This paper describes the experimental investigations on laminated glass units that can provide a signifi cant degree of post-fracture resistance, without the need of boundary restraints or opaque reinforcing materials. The glass units are composed entirely of combinations of conventional transparent interlayers and commercially available glass (annealed, heat treated and chemically strengthened). The paper also describes an empirical energy based interpretation of the mechanical response of the laminated units.

成批生产计划调度的集成建模与优化

针对多品种批量生产类型,建立了调度约束的生产计划与调度集成优化模型。模型的目标函数是使总调整费用、库存费用及生产费用之和最小,约束函数包括库存平衡约束和生产能力约束,同时考虑了调度约束,即工序顺序约束和工件在单机上的加工能力约束,保证了计划可行性。该模型为两层混合整数规划模型,对其求解综合运用了遗传算法和启发式规则,提出了混合启发式求解算法。最后,针对某机床厂多品种批量生产类型车间进行了实例应用,对车间零件月份作业计划进行分解,得到各工段单元零件周作业计划,确定了零件各周生产批量与投产顺序。

记忆年老化与焦虑

It is well established that memory functioning deteriorates with advancing age. However, research indicates that the magnitude of age-related memory deficits varies across different types of memory, and broad individual differences can be observed in the rate and timing of memory aging. The general aim of this study was to investigate the selectivity and variability of memory functioning in relation to anxiety. Firstly, memory effectiveness was assessed in episodic memory tasks with reality monitoring and external source monitoring paradigms, semantic memory tasks referred to general knowledge and word fluency, and perceptual priming task reflected in word completion. According to the scores on trait version of STAI, the high-trait and low-trait anxious subjects were screened respectively from young and old participants matched for educational level. Secondly, based on the results of the first part, concurrent primary and secondary tasks with probe technique assessing spare processing capacity were used to explore the relation between memory efficiency and anxiety. The first main findings were that: (a) there were no age-related differences in semantic memory assessed by general knowledge and PRS, whereas age effects were observed in episodic memory and semantic memory assessed by word fluency with stringent time restraints. (b) Furthermore, comparison of age-related deficits in source and item was not related to the presentation ways and encoding effort for source, but was affected by types of source. Specifically, memory was more sensitive to aging than item memory in external source monitoring processes involved in discriminating two external sources (i.e., female vs. male voices), but not in reality monitoring processes in discriminating between internal and external sources (i.e., acting vs. listening). The second main findings were that: (a) Anxiety had no effects on the effectiveness and efficiency of semantic memory in recall of general knowledge and PRS, but impaired those of semantic memory in word fluency. (b) The effects of anxiety on episodic memory were different between the old and the young. Both the effectiveness and the efficiency of episodic memory of the old were affected adversely by anxiety. More importantly, source recall in external source monitoring processes was observed to be more vulnerable to anxiety than item memory. The effectiveness of episodic memory of the young was relatively unrelated to anxiety, while anxiety might have adverse effect on their memory efficiency. These results indicated that: First, the selectivity of age-related memory deficits existed not only between memory systems, but also within episodic memory system. The tendency to forget the source even when the fact was retained in external source monitoring was suggested to be a specific feature of cognitive aging. Second, anxiety had adverse impact on the individual differences in memory aging, and mediated partial age-related differences in episodic memory performance.

Research and design of high-speed advanced analogue front-ends for fibre-optic transmission systems

In the last decade, we have witnessed the emergence of large, warehouse-scale data centres which have enabled new internet-based software applications such as cloud computing, search engines, social media, e-government etc. Such data centres consist of large collections of servers interconnected using short-reach (reach up to a few hundred meters) optical interconnect. Today, transceivers for these applications achieve up to 100Gb/s by multiplexing 10x 10Gb/s or 4x 25Gb/s channels. In the near future however, data centre operators have expressed a need for optical links which can support 400Gb/s up to 1Tb/s. The crucial challenge is to achieve this in the same footprint (same transceiver module) and with similar power consumption as today’s technology. Straightforward scaling of the currently used space or wavelength division multiplexing may be difficult to achieve: indeed a 1Tb/s transceiver would require integration of 40 VCSELs (vertical cavity surface emitting laser diode, widely used for short‐reach optical interconnect), 40 photodiodes and the electronics operating at 25Gb/s in the same module as today’s 100Gb/s transceiver. Pushing the bit rate on such links beyond today’s commercially available 100Gb/s/fibre will require new generations of VCSELs and their driver and receiver electronics. This work looks into a number of state‐of-the-art technologies and investigates their performance restraints and recommends different set of designs, specifically targeting multilevel modulation formats. Several methods to extend the bandwidth using deep submicron (65nm and 28nm) CMOS technology are explored in this work, while also maintaining a focus upon reducing power consumption and chip area. The techniques used were pre-emphasis in rising and falling edges of the signal and bandwidth extensions by inductive peaking and different local feedback techniques. These techniques have been applied to a transmitter and receiver developed for advanced modulation formats such as PAM-4 (4 level pulse amplitude modulation). Such modulation format can increase the throughput per individual channel, which helps to overcome the challenges mentioned above to realize 400Gb/s to 1Tb/s transceivers.

Autophagy enhances NFκB activity in specific tissue macrophages by sequestering A20 to boost antifungal immunity.

Immune responses must be well restrained in a steady state to avoid excessive inflammation. However, such restraints are quickly removed to exert antimicrobial responses. Here we report a role of autophagy in an early host antifungal response by enhancing NFκB activity through A20 sequestration. Enhancement of NFκB activation is achieved by autophagic depletion of A20, an NFκB inhibitor, in F4/80(hi) macrophages in the spleen, peritoneum and kidney. We show that p62, an autophagic adaptor protein, captures A20 to sequester it in the autophagosome. This allows the macrophages to release chemokines to recruit neutrophils. Indeed, mice lacking autophagy in myeloid cells show higher susceptibility to Candida albicans infection due to impairment in neutrophil recruitment. Thus, at least in the specific aforementioned tissues, autophagy appears to break A20-dependent suppression in F4/80(hi) macrophages, which express abundant A20 and contribute to the initiation of efficient innate immune responses.

Low temperature crystal structures of two rhodanine derivatives, 3-amino rhodanine and 3-methyl rhodanine: geometry of the rhodanine ring

Rhodanines (2-thio-4-oxothiazolidines) are synthetic small molecular weight organic molecules with diverse applications in biochemistry, medicinal chemistry, photochemistry, coordination chemistry and industry. The X-ray crystal structure determination of two rhodanine derivatives, namely (I), 3-aminorhodanine [3-amino-2-thio-4-oxothiazolidine], C3H4N2OS2, and (II) 3-methylrhodanine [3-methyl-2-thio-4-oxothiazolidine], C4H5NOS2, have been conducted at 100 K. I crystallizes in the monoclinic space group P2(1)/n with unit cell parameters a = 9.662(2), b = 9.234(2), c = 13.384(2) angstrom, beta = 105.425(3)degrees, V = 1151.1(3) angstrom(3), Z = 8 (2 independent molecules per asymmetric unit), density (calculated) = 1.710 mg/m(3), absorption coefficient = 0.815 mm(-1). II crystallizes in the orthorhombic space group Iba2 with unit cell a = 20.117(4), b = 23.449(5), c = 7.852(2) angstrom, V = 3703.9(12) angstrom(3), Z = 24 (three independent molecules per asymmetric unit), density (calculated) = 1.584 mg/m(3), absorption coefficient 0.755 mm(-1). For I in the final refinement cycle the data/restraints/parameter ratios were 2639/0/161, goodness-of-fit on F-2 = 0.934, final R indices [I > 2sigma(I)] were R1 = 0.0299, wR2 = 0.0545 and R indices (all data) R1 = 0.0399, wR2 = 0.0568. The largest difference peak and hole were 0.402 and -0.259 e angstrom(-3). For II in the final refinement cycle the data/restraints/parameter ratios were 3372/1/221, goodness-of-fit on F(2) = 0.950, final R indices [I > 2sigma(I)] were R1 = 0.0407, wR2 = 0.1048 and R indices (all data) R1 = 0.0450, wR2 = 0.1088. The absolute structure parameter = 0.19(9) and largest difference peak and hole 0.934 and -0.301 e angstrom(-3). Details of the geometry of the five molecules (two for I and three for II) and the crystal structures are fully discussed. Corresponding features of the molecular geometry are highly consistent and firmly establish the geometry of the rhodanine

Low temperature crystal structure of N-Acetyl-L-Glutamic acid: comparison with the DFT calculated structure

N-acetyl-L-glutamic acid, crystallizes in the orthorhombic space group P2(1)2(1)2(1) with unit cell parameters a = 4.747(3), b = 12.852(7), c = 13.906(7) Å, V = 848.5(8) Å3, Z = 4, density (calculated) = 1.481 mg/m3, linear absorption coefficient 0.127 mm−1. The crystal structure determination was carried out with MoKalpha X-ray data measured with liquid nitrogen cooling at 100(2) K temperature. In the final refinement cycle the data/restraints/parameter ratios were 1,691/0/131; goodness-of-fit on F(2) = 1.122. Final R indices for [I > 2sigma(I)] were R1 = 0.0430, wR2 = 0.0878 and R indices (all data) R1 = 0.0473, wR2 = 0.0894. The largest electron density difference peak and hole were 0.207 and −0.154 eÅ(−3). Details of the molecular geometry are discussed and compared with a model DFT structure calculated using Gaussian 98.

Visions for the North Sea: The Societal Dilemma Behind Specifying Good Environmental Status.

We augment discussions about the Good Environmental Status of the North Sea by developing two extreme visions and assessing their societal benefits. One vision (‘Then’) assumes restoration of benthic functioning; we contend that trawling had already degraded the southern North Sea a century ago. Available information is used to speculate about benthic functioning in a relatively undisturbed southern North Sea. The second vision (‘Now’) draws on recent benthic functioning. The supply of five ecosystem services, supported by benthic functioning, is discussed. ‘Then’ offers confidence in the sustainable supply of diverse services but restoration of past function is uncertain and likely to be paired with costs, notably trawling restraints. ‘Now’ delivers known and valued services but sustained delivery is threatened by, for example, climate change. We do not advocate either vision. Our purpose is to stimulate debate about what society wants, and might receive, from the future southern North Sea.

Atomistic Insights into Rhodopsin Activation from a Dynamic Model

Rhodopsin, the light sensitive receptor responsible for blue-green vision, serves as a prototypical G protein-coupled receptor (GPCR). Upon light absorption, it undergoes a series of conformational changes that lead to the active form, metarhodopsin II (META II), initiating a signaling cascade through binding to the G protein transducin (G(t)). Here, we first develop a structural model of META II by applying experimental distance restraints to the structure of lumi-rhodopsin (LUMI), an earlier intermediate. The restraints are imposed by using a combination of biased molecular dynamics simulations and perturbations to an elastic network model. We characterize the motions of the transmembrane helices in the LUMI-to-META II transition and the rearrangement of interhelical hydrogen bonds. We then simulate rhodopsin activation in a dynamic model to study the path leading from LUMI to our META II model for wild-type rhodopsin and a series of mutants. The simulations show a strong correlation between the transition dynamics and the pharmacological phenotypes of the mutants. These results help identify the molecular mechanisms of activation in both wild type and mutant rhodopsin. While static models can provide insights into the mechanisms of ligand recognition and predict ligand affinity, a dynamic model of activation could be applicable to study the pharmacology of other GPCRs and their ligands, offering a key to predictions of basal activity and ligand efficacy.

Leadership for inclusion: Conceptualising and enacting inclusion in integrated schools in a troubled society

Inclusion is increasingly understood as an educational reform that responds to the diversity of all learners, challenging the marginalization, exclusion and underachievement which may result from all forms of ‘difference’. Leadership for inclusion is conceptualized here as driving a constant struggle to create shared meanings of inclusion and to build collaborative practice, an effort that needs to be rooted in critical practice lest it risk replicating existing patterns of disadvantage. In response to calls for further research that challenge how school leaders conceptualize inclusion and for research that investigates how leaders enact their understandings of inclusion, this paper aims to increase our understanding of the extent to which leadership vision can map onto a school’s culture and of the organizational conditions in schools that drive responses to diversity. We investigate the enactment of leadership for inclusion in the troubled context of Northern Ireland by looking at two schools that primarily aim to integrate Catholic and Protestant children but which are also sites for a range of other dimensions of student ‘difference’ to come together. Whilst the two schools express differing visions of the integration of Catholics and Protestants, leadership vision of inclusion is enacted by members of the school community with a consensus around this vision brought about by formal and informal aspects of school culture. Multiple and intersecting spheres of difference stimulate a concerted educational response in both schools but integration remains the primary focus. In this divided society, religious diversity poses a significant challenge to inclusion and further support is required from leaders to enable teachers to break through cultural restraints.

How Formal and Informal Institutions of Middle Eastern Countries Influence Managerial Discretion: An Empirical Investigation

Managerial discretion is the focal theme bridging the clash between two schools of thoughts; whether executives have greater influence on their firms’ outcomes or other factors restrain their actions (Hambrick & Finkelstein, 1987). It is argued that constraints come from inertial, normative and environmental forces (e.g. DiMaggio & Powell, 1983). Of these restraints is the institutional environment in which a firm is headquartered. Our paper falls within this research stream and provides an extension for Crossland and Hambrick (2007, 2011) work. We investigate the national level of discretion in new cross-cultural contexts, provide deeper understanding of its concept, and shed the light on undiscovered discretion’s antecedents and consequences. We adopt a quantitative approach in which questionnaires represent our data collection instrument. We anticipate that in high discretion countries firms tend to follow what Miles & Snow (1978) labeled ‘Prospector’ strategy as opposed to low discretion countries in which firms incline to implement a ‘Defender’ strategy.