Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders

Background: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge. Method: A comprehensive literature review (1990-2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process. Treatment recommendations: This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3-5 years following diagnosis since course of illness is strongly influenced by what occurs in this 'critical period'. Patients should not have to 'prove chronicity' before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at least two antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no special Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved.

Single line for assembly just-in-sequence multiple models

Programa Doutoral em Líderes para as Indústrias Tecnológicas

Política de la competència de la Unió Europea en el sector audiovisual. El cas dels operadors públics estatals de televisió a Espanya i el Regne Unit: RTVE i BBC

Estudi elaborat a partir d’una estada al Center for Socio-Legal Studies de la Universitat d’Oxford, Gran Bretanya, entre setembre del 2006 i gener del 2007. L'objectiu d'aquesta recerca ha estat determinar i avaluar com la política de la competència de la Unió Europea ha contribuït a la configuració del sector públic televisiu espanyol i britànic. El marc teòric està basat en el concepte d’ “europeització”, desenvolupat per Harcourt (2002) en el sector de mitjans, i que implica una progressiva referencialitat de les polítiques estatals amb les europees mitjançant dos mecanismes: la redistribució de recursos i els efectes en la socialització de la política europea. Per tal de verificar aquest impacte en el sector televisiu, la recerca ha desenvolupat una aproximació en dues etapes. En primer lloc, a banda de fer un inicial repàs bibliogràfic s'han estudiat les accions de la Comissió Europea en aquest terreny, sobre tot la Comunicació sobre aplicació de la reglamentació d'ajudes públiques al sector de la radiodifusió de 2001. En una segona etapa, s'han desenvolupat un seguit d'entrevistes personals a directius i polítics del sector a Brussel•les, Londres i Madrid. Els resultats de la recerca mostren que el procés d’Europeïtzació es un fenomen creixent en el sector audiovisual públic a Espanya i el Regne Unit, però que encara les peculiaritats estatals juguen un factor preponderant en regular aquesta influència de la UE. L'anàlisi de les entrevistes qualitatives mostren també que hi ha una relació inversament proporcional entre la tradició democràtica i el grau d’influència i de referència que suposa la UE en el sector audiovisual. Mentre que el Regne Unit, l'acció de la política de la competència de la UE es percep com a element suplementari, a Espanya la seva referencialitat ha estat clau, tot i que no decisiva, per la reforma dels mitjans públics estatals.  

On the artificial creation of the EL2 center by means of boron implantation in gallium arsenide

In the present work, an analysis of the dark and optical capacitance transients obtained from Schottky Au:GaAs barriers implanted with boron has been carried out by means of the isothermal transient spectroscopy (ITS) and differential and optical ITS techniques. Unlike deep level transient spectroscopy, the use of these techniques allows one to easily distinguish contributions to the transients different from those of the usual deep trap emission kinetics. The results obtained show the artificial creation of the EL2, EL6, and EL5 defects by the boron implantation process. Moreover, the interaction mechanism between the EL2 and other defects, which gives rise to the U band, has been analyzed. The existence of a reorganization process of the defects involved has been observed, which prevents the interaction as the temperature increases. The activation energy of this process has been found to be dependent on the temperature of the annealing treatment after implantation, with values of 0.51 and 0.26 eV for the as‐implanted and 400 °C annealed samples, respectively. The analysis of the optical data has corroborated the existence of such interactions involving all the observed defects that affect their optical parameters

Liiketoiminnan jakautumisen verotus

Tutkimuksen päätavoite on ollut selvittää, saavutetaanko liiketoiminnan jakautumisella verotuksessa hyötyä ja missä tilanteissa. Tutkimus on toteutettu toimintoanalyyttisellä tutkimusotteella. Tarkoituksena on ollut analysoida kirjallisuuden ja oikeustapausten avulla liiketoiminnan täydelliseen jakautumiseen liittyviä verotuksellisia kysymyksiä. Empiiristä tietoa on tutkimuksessa mukana puolistrukturoitujen asiantuntijahaastattelujen kautta. Tutkimuksessa havaittiin, että välitöntä verohyötyä jakautuvalle ja vastaanottaville yhtiöille sekä niiden osakkeenomistajille ei jakautumisella voida saavuttaa. Tarkasteltaessa verovaikutuksia pitemmällä ajanjaksolla, jakautumisella osana sarjatoimea voi olla mahdollista saavuttaa verohyötyä. Tapauskohtaisesti on selvitettävä onko kyseessä verosuunnittelu- vai veronkiertotilanne. Esimerkiksi jakautumisessa toteutetulla varallisuuden ja yritystoiminnan erottamisella voidaan saavuttaa verohyötyä osakkeenomistajille. Verohyöty voi toteutua, kun varallisuutta sisältävän yhtiön osakkeista luovutaan. Myöhemmällä osakkeiden myynnillä ei saa olla välitöntä yhteyttä jakautumiseen.

Réorganiser les services de réadaptation destinés aux enfants : utilisation d'une recherche-action participative pour documenter un nouveau modèle de services

Cette thèse a pour but de documenter la réorganisation des services effectuée au programme Enfants et adolescents (PEA) du Centre de réadaptation Estrie, Sherbrooke. Une démarche de recherche-action participative (RAP) est utilisée afin de collaborer au développement, à l’implantation et à l’évaluation d’un nouveau modèle de services visant à accroître l’accessibilité et la qualité des services de réadaptation offerts aux enfants ayant une déficience physique. Spécifiquement, les objectifs sont : 1) de documenter les retombées de la réorganisation des services; 2) de réaliser une analyse critique du processus de changement. Des méthodes quantitatives et qualitatives sont utilisées afin d’atteindre ces objectifs. Tout d’abord, la Mesure des processus de soins (MPOC) documente la perception de la qualité avant (2007), pendant (2008) et après (2009) l’implantation du nouveau modèle de services. Au total, cet outil est employé auprès de 222 familles et 129 intervenants. À quatre reprises, les intervenants et les gestionnaires répondent également à un questionnaire sur leurs perceptions des forces, des faiblesses, des opportunités et des menaces au PEA. En 2008 et en 2009, des focus groups et des entrevues téléphoniques sont réalisées auprès des familles (n=5), des intervenants (n=19) et des gestionnaires (n=13) afin de documenter leurs perceptions sur le processus de changement et sur les retombées de la réorganisation des services. Quant à l’observation participante, elle permet de recueillir de l’information sur le processus de réorganisation des services tout au long de ces trois années. Enfin, les informations recueillies sont analysées à l’aide de différentes approches, dont des tests statistiques et des analyses de contenu utilisant une grille de codification inspirée de la théorie des systèmes d’actions organisées. Les résultats indiquent que davantage d’enfants reçoivent des services en 2009 en comparaison à 2007. De plus, la qualité des services s’est maintenue selon les perceptions évaluées par la MPOC (article 1). L’utilisation d’interventions de groupe contribue fort probablement à augmenter le nombre d’enfants qui reçoivent des services, mais plusieurs défis doivent être adressés afin que cette modalité d’intervention soit réellement efficiente (article 2). Les résultats font ressortir que le processus de réorganisation des services est complexe. L’évaluation des forces, des faiblesses, des opportunités et des menaces d’un programme, de même que l’implication des acteurs dans le processus de développement d’un nouveau modèle de services, favorisent l’amélioration continue de la qualité (article 3). Or, les facilitateurs et les obstacles à l’implantation du nouveau modèle de services évoluent durant la réorganisation des services. Considérant cela, il est important de poser les actions nécessaires afin de soutenir le changement tout au long du processus (article 4). En résumé, cette thèse contribue à l’avancement des connaissances en réadaptation en comblant une lacune dans les écrits scientifiques. En effet, peu de projets visant le développement et l’implantation de nouveaux modèles de services sont évalués et documentés. Pourtant, des modèles tels que celui développé par le PEA semblent prometteurs afin d’améliorer l’accessibilité, et éventuellement, la qualité des services de réadaptation chez l’enfant.

El crecimiento económico de corea del sur y sus posibilidades de alterar el equilibrio en Asia-Pacífico

El interés de esta monografía es analizar el crecimiento económico de Corea del Sur y sus posibilidades de alterar el equilibrio en la región de Asia-Pacífico. A partir de los conceptos de poder duro y equilibrio de poder propuestos por Joseph Nye y Ernst Haas, se examinan los principales hitos del proceso de desarrollo nacional y se determina en qué sentido el incremento del poder duro nacional le permite a este país posicionarse como una potencia regional en ascenso. Así mismo, se evalúan los procesos de liderazgo regional de China y Japón que impiden a Corea del Sur alterar sustancialmente el equilibrio de poder en esta región del mundo.

Dip financing of financially distressed companies in Brazil – the conditions provided by the brazilian bankruptcy law act as real incentives for dip lenders as in chapter 11 of the American bankruptcy code?

O objeto deste trabalho é a compreensão do financiamento de empresas em crise, mais especificamente, o financiamento concedido após o pedido de recuperação judicial, como forma de permitir que a empresa saia da situação de crise e retorne à condição de normalidade. Para tanto, nos apropriando do termo cunhado pela doutrina norte-americana, para fazer referência ao aporte de recursos em empresas em dificuldade, utilizaremos o termo DIP financing ou financiamento DIP. Para uma compreensão adequada do objeto, é necessário que entendamos a origem do DIP financing nos Estados Unidos e como é a regulação norte-americana sobre a matéria atualmente. O segundo passo será avaliar a possibilidade de aplicação da mesma estrutura de aporte de recursos no Brasil. Ao estudarmos a origem desse mecanismo nos Estados Unidos, veremos os problemas que surgiram ao longo dos anos e como foram superados jurisprudencialmente e doutrinariamente para que o financiamento DIP se consolidasse como uma das formas de aporte de capital em empresas em crise, culminando no desenvolvimento de uma verdadeira indústria de crédito às empresas em dificuldade. Uma análise dos problemas enfrentados pelo sistema falimentar americano nos levará a hipótese de que, a menos que sejam afirmados mecanismos que assegurem a quem concede o financiamento após o pedido de recuperação judicial, uma super prioridade no recebimento após a recuperação judicial, será possível o desenvolvimento de um mercado de DIP financing no Brasil.

Gestao tecnologia: um estudo de caso no setor sucroalcooleiro

PEDRO, Edilson da Silva Pedro. Gestão tecnológica: um estudo de caso no setor sucroalcooleiro. 2004. 145f. Dissertaçao (Mestrado em Engenharia de Producao) - Universidade Federal de Sao Carlos, Sao Carlos, 2004.

Acute and subchronic exposure of diplopods to substrate containing sewage mud: Tissular responses of the midgut

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A expressão do pesar nas atividades ocupacionais quando alguém querido morre

O luto pela morte de um ente querido compreende um processo de reorganização pessoal frente à perda e que por isso tende a desdobramento singulares, conforme a natureza e intensidade do vínculo. A pessoa então pode experimentar uma variedade de reações que , conforme a ocorrência e a severidade das manifestações , irão repercutir na qualidade de viver. Esta pesquisa teve o objetivo de compreender a expressão do pesar nas atividades ocupacionais quando da morte de uma pessoa significativa. A estratégia metodológica fundamentou-se na abordagem qualitativa do tipo "estudo de caso", de duas pessoas (colaboradores) que chegaram em Serviço de Pronto Atendimento a Pessoas que Sofreram Perdas. Para a coleta dos dados foram definidos três encontros, sendo que nos dois primeiros foram realizadas às entrevistas abordando aspectos da vida pessoal e ocupacional e no terceiro uma oficina de atividades, sendo disponibilizados materiais plásticos; como papel , lápis de cor, canetas esferográficas, tesoura, revistas, cola branca, cola colorida, purpurina, entre outros, com o objetivo de favorecer a livre expressão nas atividades ocupacionais, estando de acordo com a hipótese de que, em situações de perdas e luto, as pessoas experiência um período de retraimento e afastamento das relações sociais e das atividades habituais, indicando que a perda interfere significativamente no cotidiano das suas ocupações, incluindo falta de prazer em desempenhar o trabalho, em ter cuidados pessoais e nas atividades da vida diária (AVD' S), sugerindo a ocorrência do luto ocupacional pela perda das atividade desempenhadas com e para o ente querido falecido. Neste sentido, pode ser observada alteração nas funções ocupacionais em que padrões habituais de atividades são rompidos, remetendo a difícil tarefa de renunciar, excluir e incluir novos papéis. Por outro lado, a estratégia proposta a coleta dos dados revelou-se como um recurso favorável à compreensão e expressão do enlutado, estimulando a aceitação da perda, a avaliação do vinculo co falecido (a) e a elaboração do luto. O uso do recurso material foi favorável a expressão dos pensamentos, sentimentos e necessidades, bem como de competência, habilidades, funções ocupacionais e outros aspectos da existência, ressaltando a importância da compreensão biopsicossocial e ocupacional da pessoa em situação de luto, em que se destaca a assistência Terapêutica Ocupacional agregando esforços na prevenção e promoção a saúde.

Deficiência auditiva: estudos clínicos sobre o narcisismo materno

The diagnosis of hearing loss (HL) in a child constitutes a crisis, includinga possible crash in parental narcissism, requiring an individual, matrimonial andfamiliar reorganization process. The mother is the main figure to devote herselfattending the baby and generally takes the most responsibilities in the processof habilitation or rehabilitation of the child, while still having to deal with her frustratedexpectations and narcissism. This study aims to investigate the effects of a deaf child’s birth on the mother’s narcissism. Here understood as a normal stage of psychosexual development of the human being, needed for life preservation, nota pathology. Five different clinical pratical studies were developed with mothers of deaf children that were diagnosed less than one year ago. The data were collected using individual semi-structured interviews and Thematic Apperception Test (TAT). Based on these studies it was found that the birth of a deaf child makes it difficult to obtain the expected narcissist satisfaction. The mother, investing all her affection and longing almost only on her child, hopes to rebuild her dream obtaining the "cure" and "normality" of her baby by submitting him/her to a cochlear implant.

Entre a literatura e a política: cultura e poder na representação do índio em José de Alencar

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Untersuchung des Reorientierungsverhaltens und Strukturierung dünner amphiphiler Blockcopolymerfilme zum Aufbau von Kompositen

Grundlage für die hier gezeigte Arbeit stellt die Eigenschaft von amphiphilen Blockcopolymeren dar immer den Block mit der niedrigsten Grenzflächenenergie zum angrenzenden Medium an die Oberfläche zu bringen. Durch einen Austausch des Mediums an der Grenzfläche zum Blockcopolymer kann eine Reorientierung erzwungen werden, wenn die Grenzflächenenergie des anderen Blocks nun die niedrigere Grenzflächenenergie besitzt. Dieses Verhalten von dünnen amphiphilen Blockcopolymerfilmen wurde zur Strukturierung von Oberflächen ausgenutzt und in nachfolgenden Synthesen weiter verstärkt. Um dies zu erreichen wurde das zur Strukturierung erforderliche Poly(4-Octylstyrol)block(4-hydroxystyrol) durch kontrollierte radikalische Polymerisationsmethode mit dem Tempo Unimer (2,2,6,6-Tetramethyl-1-1(1-phenyl-ethoxy)-piperidin) synthetisiert. Für die geplanten Reorientierungen und Modifizierungen von Oberflächen wurden dünne Filme durch Schleuderbeschichtung auf verschiedenen Substraten (Siliziumwafern, Glassubstraten und Goldoberflächen) hergestellt. Das Verhalten der Oberflächen von diesen Filmen wurde durch Kontaktwinkelmessungen untersucht. Auf diese Weise konnte gezeigt werden, dass die Oberfläche von Polymerfilmen nach der Präparation aus dem hydrophoben Block des Polymers gebildet wird. Durch Kontakt des Polymerfilms mit Wasser kann dieser zur Reorientierung gebracht werden, so dass der hydrophile Block des Polymers an der Oberfläche erscheint. Dieses Verhalten wurde zur Strukturierung mit softlithographischen Techniken genutzt. Dazu wurden hydrophil/hydrophob strukturierte Oberflächen durch Aufsetzen von hydrophoben PDMS-Stempeln, die Teile der Oberfläche selektiv abdeckten, und Einbringen von Wasser in die dabei entstehenden Kapillaren hergestellt. Dies ermöglichte es die Oberfläche selektiv im Größenbereich von 500nm bis zu 50µm zu strukturieren und an den reaktiven Bereichen Materialien, wie z.B. Kupfer, Titandioxid, Polyelektrolyte, photonische Kristalle und angegraftete Polymere, mit verschiedenen Methoden selektiv auf die Oberfläche aufzubringen. Um den Reorganisationsprozess der Oberfläche genauer zu studieren, wurde ein für diese Aufgabe besser geeignetes Polymer (Poly(Styrol)-block-poly(essigsäure-2-(2-(4-vinyl-phenoxy)-ethoxy)ethylester)) synthetisiert. Aus diesem Blockcopolymer wurden wieder dünne Filme durch Spincoaten hergestellt. Die Reorientierung dieses Polymers in 70°C warmen Wasser konnte durch Kontaktwinkelmessungen und NEXAFS Spektroskopie nachgewiesen werden. Mit Hilfe der NEXAFS Spektroskopie konnte festgestellt werden, dass die Geschwindigkeit der Reorientierung durch eine exponentielle Funktion beschrieben werden kann. Eine Auswertung der Geschwindigkeitskonstante für die Reorientierung einer hydrophilen zu einer hydrophoben Oberfläche des Polymers bei 60°C führt zu =75min. Aufgrund des exponentiellen Charakters der Reorientierung macht es den Anschein, dass die Reorientierung bei verschiedenen Reorientierungstemperaturen bis zu einem gewissen Grad erfolgt und dann stoppt. Eine weitere Reorientierung scheint erst wieder bei einer Temperaturerhöhung zu beginnen. Aus AFM Messungen ist ein Beginnen der Reorientierung durch Bildung kleiner Löcher in der Polymeroberfläche zu erkennen, die sich zu runden Erhöhungen und Vertiefungen vergrößern, um letztendlich in ein spinodales Entmischungsmuster über zu gehen. Dieses heilt dann im Laufe der Zeit langsam durch Verschwinden der hydrophilen Bereiche langsam aus. Der Beginn des zuvor beschriebenen Reorientierungsprozesses einer hydrophilen Oberfläche in eine hydrophobe konnte sowohl in den AFM, als auch in den NEXAFS-Messungen zu ca. 50°C bestimmt werden.

Comparability of Outcome Frameworks in Medical Education: Implications for framework development

Background: The demand for international harmonization in medical education increases with the growing mobility of students and health professionals. Many medical societies and governmental offices have issued outcome frameworks (OF), which describe aims and contents of medical education based on competencies. These national standards affect the development of curricula as well as assessment and licensing procedures. Comparing OF and identifying factors that limit their comparability may thus foster international harmonization of medical education. Summary of Work: We conducted a systematic search for national OF in MedLine, EmBase and the internet. We included all OF in German or English that resulted from a national consensus process and were published or endorsed by a national society or governmental body. We extracted information in five predetermined categories: history of origin, audience, formal structure, medical schooling system and key terms. Summary of Results: Out of 1816 results, 13 OF were included into further analyses. OF reference each other, often without addressing existing differences (e.g. in target audiences). The two most cited OF are “CanMEDs” and “Scottish Doctor”. OF differ especially in their level of detail as well as in the underlying educational system. Discussion and Conclusions: Based on our results we propose a two-step blueprint for OF, that may help to establish comparability for internationally aligned key features – so-called “core competencies” – while at the same time allowing for necessary regional adaptations in terms of “secondary competencies”. Take-home messages: Considerable differences in at least five categories of OF currently hinder the comparability of outcome frameworks.