Cognitive behaviour therapy (CBT) for depression by computer vs. therapist: patient experiences and therapeutic processes

This case series compares patient experiences and therapeutic processes between two modalities of cognitive behaviour therapy (CBT) for depression: computerized CBT (cCBT) and therapist-delivered CBT (tCBT). In a mixed-methods repeated-measures case series, six participants were offered cCBT and tCBT in sequence, with the order of delivery randomized across participants. Questionnaires about patient experiences were administered after each session and a semi-structured interview was completed with each participant at the end of each therapy modality. Therapy expectations, patient experiences and session impact ratings in this study generally favoured tCBT. Participants typically experienced cCBT sessions as less meaningful, less positive and less helpful compared to tCBT sessions in terms of developing understanding, facilitating problem-solving and building a therapeutic relationship.

Evaluation of Low Intensity Laser Therapy In Myofascial Pain Syndrome

Limited studies have demonstrated that low intensity laser therapy (LILT) may have a therapeutic effect on the treatment of myofascial pain syndrome (MPS). Sixty (60) patients with MPS and having one active trigger point in the anterior masseter and anterior temporal muscles were selected and assigned randomly to six groups (n=10): Groups I to III were treated with GaAIAS (780 nm) laser, applied in continuous mode and in a meticulous way, twice a week, for four weeks. Energy was set to 25 J/cm(2), 60 J/cm2 and 105 J/cm2, respectively. Groups IV to VI were treated with placebo applications, simulating the same parameters as the treated groups. Pain scores were assessed just before, then immediately after the fourth application, immediately after the eighth application, at 15 days and one month following treatment. A significant pain reduction was observed over time (p<0.001). The analgesic effect of the LILT was similar to the placebo groups. Using the parameters described in this experiment, LILT was effective in reducing pain experienced by patients with myofascial pain syndrome. Thus, it was not possible to establish a treatment protocol. Analyzing the analgesic effect of LILT suggests it as a possible treatment of MPS and may help to establish a clinical protocol for this therapeutic modality.

Nutritional information of meals supplied by companies, participating in the workers` meal program in Sao Paulo, Brazil

Objective. To compare the nutritional value of meals provided by companies participating in the Workers` Meal Program in the city of Sao Paulo, Brazil, to the nutritional recommendations and guidelines established by the Ministry of Health for the Brazilian population. Methods. The 72 companies studied were grouped according to economic sector (industrial, services, or commerce), size (micro, small, medium, or large), meal preparation modality (prepared on-site by the company itself, on-site by a hired caterer, or off-site by a hired caterer), and supervision by a dietitian (yes or no). The per capita amount of food was determined based on the lunch, dinner, and supper menus for three days. The nutritional value of the meals was defined by the amount of calories, carbohydrates, protein, total fat, polyunsaturated fat, saturated fat, trans fat, sugars, cholesterol, and fruits and vegetables. Results. Most of the menus were deficient in the number of fruits and vegetables (63.9%) and amount of polyunsaturated fat (83.3%), but high in total fat (47.2%) and cholesterol (62.5%). Group 2, composed of mostly medium and large companies, supervised by a dietician, belonging to the industrial and/or service sectors, and using a hired caterer, on averaged served meals with higher calorie content (P < 0.001), higher percentage of polyunsaturated fat (P < 0.001), more cholesterol (P = 0.015), and more fruits and vegetables (P < 0.001) than Group 1, which was composed of micro and small companies from the commercial sector, that prepare the meals themselves on-site, and are not supervised by a dietitian. Regarding the nutrition guidelines set for the Brazilian population, Group 2 meals were better in terms of fruit and vegetable servings (P < 0.001). Group I meals were better in terms of cholesterol content (P = 0.05). Conclusions. More specific action is required targeting company officers and managers in charge of food and nutrition services, especially in companies without dietitian supervision.

Susceptibility of Staphylococcus aureus to porphyrin-mediated photodynamic antimicrobial chemotherapy: an in vitro study

The ability of Staphylococcus aureus to develop multidrug resistance is well documented, and the antibiotic resistance showed by an increasing number of bacteria has shown the need for alternative therapies to treat infections, photodynamic therapy (PDT) being a potential candidate. The aim of this study was to determine the effect of photodynamic therapy as a light-based bactericidal modality to eliminate Staphylococcus aureus. The study investigated a technique based on a combination of light and a photosensitizer that is capable of producing oxidative species to induce a cytotoxic effect. A Staphylococcus aureus suspension was exposed to a light emitting diode (LED) emitting at 628 nm, 14.6 mW/cm(2), and energy density of 20J/cm(2), 40J/cm(2), or 60 J/cm(2) in the presence of different porphyrin concentrations (PhotogemA (R)). Three drug concentrations were employed: 12 mu l/ml, 25 mu l/ml, and 50 mu l/ml. The treatment response was evaluated by the number of bacterial colony forming units (CFU) after light exposure. The results indicated that exposure to 60 J/cm(2) eliminated 100% (10 log(10) scales) of bacteria, on average. The best PDT response rate to eliminate Staphylococcus aureus was achieved with exposure to LED light in combination with the photosensitizer at concentrations ranging from 25 mu l/ml to 50 mu l/ml. These data suggest that PDT has the potential to eliminate Staphylococcus aureus in suspension and indicates the necessary drug concentration and light fluency.

Visuellt & Auditivt korttidsminne

The aim of the present study was to investigate the effect of sensory modality on short-term memory recall. An exploratory, cross-sectional study was performed. A total of 119 individuals participated. There were 70 female and 49 male subjects, aged 4 to 80 years (M=34,3). The participants were presented with 12 different objects in auditory, visual or auditory/visual mode over a period of 24 seconds. The participants were then asked to recall as many of the 12 objects as possible in any order. The study took place at a day nursery, junior high schools, meetings with elderly and adults with house calls. Non-probability samples were used. The conclusion was that visual short-term memory generated the highest recollection and that adults had the highest mean on the different stimuli. A visual element is recommended at recollection.

A Diagnostic Assessment Of Evolutionary Multiobjective Optimization For Water Resources Systems

This study contributes a rigorous diagnostic assessment of state-of-the-art multiobjective evolutionary algorithms (MOEAs) and highlights key advances that the water resources field can exploit to better discover the critical tradeoffs constraining our systems. This study provides the most comprehensive diagnostic assessment of MOEAs for water resources to date, exploiting more than 100,000 MOEA runs and trillions of design evaluations. The diagnostic assessment measures the effectiveness, efficiency, reliability, and controllability of ten benchmark MOEAs for a representative suite of water resources applications addressing rainfall-runoff calibration, long-term groundwater monitoring (LTM), and risk-based water supply portfolio planning. The suite of problems encompasses a range of challenging problem properties including (1) many-objective formulations with 4 or more objectives, (2) multi-modality (or false optima), (3) nonlinearity, (4) discreteness, (5) severe constraints, (6) stochastic objectives, and (7) non-separability (also called epistasis). The applications are representative of the dominant problem classes that have shaped the history of MOEAs in water resources and that will be dominant foci in the future. Recommendations are provided for which modern MOEAs should serve as tools and benchmarks in the future water resources literature.

Estudo comparativo da viabilidade miocárdica em áreas dissinérgicas ao ecocardiograma basal : cintilografia tomográfica com Tecnécio 99m-mibi sob baixa dose de Dobutamina versus Tálio em repouso-redistribuição

A cintilografia com radioisótopos em repouso tem despertado muito interesse nos últimos anos para pesquisa da viabilidade miocárdica na disfunção isquêmica avançada do VE, porque esta pode ser reversível e porque há melhora prognóstica neste contexto. O objetivo desse trabalho é buscar identificar a acurácia da cintilografia tomográfica Tc-99m-Sestamibi, sob a infusão de dobutamina em baixa dose. Foram protocolados trinta pacientes que sofreram um infarto do miocárdio com padrão “Q”, com dissinergia ao ecocardiograma, e submetidos a estudos perfusionais em dias diferentes, com Tc-99m-Sestamibi − dobutamina e Tl-201 em repouso-redistribuição 4 horas, usado como padrão ouro. Não ocorreram complicações com nenhum paciente submetido ao protocolo do estudo. Os resultados revelaram: sensibilidade = 85%, especificidade = 87%, valor preditivo positivo = 96%, valor preditivo negativo = 65 % e acurácia de = 85,2%. A razão de probabilidade positiva foi de 6,68 e a razão de probabilidade negativa de 0,17. Confrontando-se nossos dados com uma metanálise de resultados para o Tc-99m-Sestamibi em repouso, a sensibilidade no presente estudo foi 85% vs. 81% e a especificidade de 87% vs. 60%. Em relação aos dados da literatura para Tl-201: 85% vs. 90% e 87% vs. 54%, sensibilidade e especificidade, respectivamente. Em conclusão, o Tc-99m-Sestamibi sob a infusão de dobutamina parece ser um método promissor para detectar viabilidade superior a esta modalidade de cintilografia em repouso, com valores preditivos comparáveis à literatura disponível para esse mesmo método: 85,2% vs. 87%, 96% vs. 90% e 65% vs. 83%, para acurácia, valor preditivo positivo e valor preditivo negativo, respectivamente.

Desenvolvimento de metodologia de rating baseada no modelo ordered probit

Nos últimos anos o mercado de crédito brasileiro apresentou grande crescimento em termos de volume e modalidade de operações de crédito. Além disso, observou-se também o aumento da participação dos bancos nesse setor, principais intermediários financeiros da economia. Com isso, em um mercado em desenvolvimento, torna-se cada vez mais importante a correta avaliação e administração do risco financeiro envolvido nas operações: o risco de crédito. Nesse contexto, a classificação de rating surge como referência para investidores. No entanto, como o mercado bancário brasileiro ainda é pouco desenvolvido, apenas instituições de grande porte são classificados pelas agências de rating em funcionamento no país. Este trabalho tem como objetivo o desenvolvimento de uma metodologia de rating baseada no modelo ordered probit, que seja capaz de replicar o nível de rating de uma determinada agência, e assim conseguir estimar o nível de rating para aqueles bancos que não têm a referida classificação de rating

Participação privada no financiamento e gestão de bens e serviços urbanos

O trabalho procurou analisar as demandas que a nova ordem internacional coloca sobre as grandes metrópoles que se pretendem cidades mundiais e as formas como podem se dar seu financiamento. Assim, é discutido o impacto da globalização sobre as metrópoles e os investimentos feitos por algumas cidades que se internacionalizaram. Com respeito aos financiamentos desses investimentos, foi dada ênfase à análise que privilegia a cooperação público-privada, principalmente project finance.

A educação à distância e suas implicações no ensino superior

This research was as principal interest to verify the motives the prominence of crescent outstanding of distance education in brazilian higher education. To make real the study were used the bibliographical and field researches. The bibliographical informations permitted to conclude that the total success of distance education in Brazil strikes against two obstacles: the digital exclusion and illiteracy. These, in turn, have created another problem called today digital illiteracy. Although there are those limitations, by the data about distance education in the country, it is patent that this modality of education is gaining more and more space in brazilian educational process. It has to detach that the greatest concentration of distance courses accredited in Brazil occurs in higher education. Today, distance courses at this level in the country are authorized in sequential, graduation, specialization, master and doctorate areas. The field research led to confirm practically all suppositions about the increase of distance education in higher education, proposed in anticipation. The flexibility that makes possible the transmission of knowledge at any place and time and the new technologies, chiefly the Internet, were the factors that more impelled the increase of distance education in brazilian higher teaching. Meanwhile, the quality improving of the courses was the less significative in respect to the growth of distance education it the higher level in Brazil. But, this fact does not signify that the distance higher courses have not quality. On the contrary, the courses are ministered by professionals of confirmed competence. What can still legitimize the presence of quality in distance higher teaching is its exponential growth in the country. Moreover, the importance attributed to the pedagogical project well planned in distance higher courses demonstrates the interest by excellence in the distance learning. Certainly, when a pedagogical project is well delineated, at any level of distance teaching, the trend of quality is perfect itself.

Comissão nacional de residência médica: caminhos e descaminhos na gestão desta modalidade de especialização médica no Brasil

Este trabalho procura analisar o papel da Comissão Nacional de Residência Médica (CNRM) como órgão responsável pela principal modalidade de especialização médica no Brasil. Para tanto faz-se uma revisão analítica da Residência Médica (RM) como política pública, seu traçado histórico e evolutivo, bem como da própria CNRM, desde a sua criação em 1977 até o ano de 1995, levando em consideração, tanto aspectos político-administrativos, quanto técnico-educacionais, considerados de importância relativos ao tema. Quanto à utilização de material adequado para a realização desta pesquisa buscou-se aproveitar dados de natureza bibliográfica e documental como base para uma abordagem mais ampla da questão, sendo, entretanto, dado ênfase à análise dos dados através do método de pesquisa qualitativa, pôr intermédio de entrevistas semi-estruturadas pessoais. Ao final promove-se algumas considerações, procurando vislumbrar alguns pontos que possam servir de consideração para uma melhor reflexão sobre a gestão da RM no Brasil.

Alternativas ao Crédito Rural Tradicional

The subject of the current work was to analyze the subject of the adequacy of Brazilian's agricultural activity financing model, as an alternative for the traditional agriculture credit. The main basis for this research is the evidence that the official resources for new loans, wherein it is analyzed a period within 30 years, had their highest peak in the final 70's decade and beginning of the80¿s had experimented a consistent trajectory of decline, returning to the initial levels of the final decades of the 60¿s. In parallel with the situation above, it is evidenced the increase of the Brazilian agriculture production by the official data, mainly grain plowing, followed by diverse problems like high levels of default in and continuously debt roll over, indicating depauperation from the traditional model which was institutionalized in 1965, under the Law n. 4829. A survey of official data regarding those loans, their default and field research with banks that deal with agriculture loans, from a broad Bibliographical research, ,was made in order to verify their managing strategy and willingness to use new financing mechanisms. The main proposed alternatives were: a) Cédula de Produto Rural (Rural Product Bill) b) Cédula de Produto Rural, financial modality c) Bolsa de Mercadorias e de Futuro¿s proposal d) Agricultural Receivable on Security e) Model based on Local Credit Agencies The best instrument for leveling resources were the first four alternatives, analyzing the advantages and disadvantages of each proposal. The creation of a system based on local branches for credit had not shown to be viable as for the difficulties for implementation and functioning. The work also points out a need to review the segmentation concerning rural clients. The traditional format for segmentation distinguishes 2 groups of producers: commercial agriculture and familiar agriculture. A third group is in eminence, which is the survival agriculture, with needs and distinct characteristics, indicating that the requirements for their needs must not have to be made by credit forms, but as aid programs, education and social welfare.