Factors that determine the level of care children and adolescents experiencing mental disorders receive

RESUMO: Resumo Uma prestação de serviços de saúde mental para crianças e adolescentes (CAMHS) oportuna, eficaz e baseada na evidência pode evitar incapacidade a longo prazo. No entanto, estes serviços são criticamente sub-financiados em todo o mundo. É um imperativo garantir que este precioso recurso não seja desperdiçado. Os governos e outras partes interessadas relevantes na área da saúde mental precisam de conhecer o estado de saúde mental da população, quais os recursos disponíveis e como melhor utilizar os recursos disponíveis para orientar uma política e decisões efectivas sobre os níveis de serviços. Objetivo: O objetivo deste artigo é explorar o papel da acuidade, gravidade e complexidade na determinação dos cuidados em saúde mental especializados recebidos por crianças e adolescentes que sofrem perturbações mentais. Métodos: Este estudo é exploratório envolvendo uma revisão sistemática da literatura. Foi realizada uma pesquisa com palavras-chave utilizando bases de dados PsychINFO, EMBASE, PubMed e MEDLINE. A literatura cinzenta também foi investigada com um enfoque nas abordagens sistémicas, organizacionais e políticas para a organização e comissionamento de CAMHS. Foram selecionados apenas documentos escritos em Inglês. Três países, Bélgica, Reino Unido e Estados Unidos, todos eles com modelos muito diferentes de organização de CAMHS, foram revistos para investigar de que forma os conceitos de acuidade, gravidade e complexidade foram utilizados na sua concepção de serviços para determinar o nível da assistência prestada. Resultados: Nem a Bélgica, nem o modelo norte-americano de CAMHS organização de serviço parecem estar alinhados com os principais conceitos na determinação do nível de prestação de serviços. O sistema de serviços do Reino Unido de CAMHS está mais estreitamente alinhado com esses conceitos e tem uma alocação de recursos mais equilibrada entre o hospital e a comunidade. O seu ponto fraco está na falta de flexibilidade entre os níveis de serviço e na falta de apoio para com o sector dos cuidados de saúde primários. Conclusões: A variabilidade na alocação de recursos a diferentes níveis especializados de CAMHS (em regime de internamento, ambulatório, e na comunidade) e o modelo diferente de estrutura de serviços entre os países estudados indica uma inconsistência na forma como as crianças e adolescentes que apresentam aos CAMHS são referenciados para os cuidados que recebem. Isto põe em questão se as crianças e adolescentes com perturbações mentais estão a receber o nível e tipo de cuidados concordantes com as suas necessidades. A concepção e o comissionamento de sistemas de CAMHS levam-nos à discussão de uma série de princípios fundamentais que devem ser considerados. O sistema perfeito no entanto, ainda está para ser encontrado. -------------------------------- ABSTRACT: Provision of timely, effective, evidence based mental health services to children and adolescents can prevent long term impairment, but they are critically underfunded across the globe. There is an imperative to ensure this precious resource is not wasted. Governments and other relevant mental health stakeholders need to know the mental health status of the population, what resources are available and how best to use the resources available to guide effective policy and decisions about service levels. Aim: The aim of this paper is to explore the role of acuity, severity and complexity in determining the specialist mental health care that children and adolescents experiencing mental disorders receive. Methods: This study is exploratory involving a systematic scan of the literature. A key word search was conducted using databases PSYCHINFO, EMBASE, PUBMED and MEDLINE. Grey literature was also searched to focus on systemic, organisational and policy approaches to the organisation and commissioning of CAMHS. Only documents written in English were selected. Three countries Belgium, UK and the US all with very different models of service organisation for CAMHS were reviewed to investigate how well the concepts of acuity, severity and complexity were used to determine the level of care delivered in their service design. Findings: Neither the Belgium nor the US model of CAMHS service organisation appear to align with the key concepts driving intensity of level of service provision. The UK CAMHS service system most closely aligns with the concepts. It has a more balanced resource allocation between hospital and community. Its downfall is in its lack of flexibility between service levels and its lack of support for the primary care sector. Conclusions: The variability in resource allocation to different service levels (inpatient, outpatient, community) within specialist CAMHS and the differing model of service structure across countries indicates an inconsistency in how children and adolescents presenting to CAMHS are allocated to the care they receive. This puts into question whether children and adolescent with mental disorders are receiving a level and type of care commensurate with their needs. In commissioning and designing CAMHS systems a number of key principles that should be considered are discussed. The perfect system however, is yet to be found.

Visual politics of the estado novo realized on the Alameda Dom Afonso Henriques in Lisbon – the construction of ideal citizenship?

The stylistic categorization of the Estado Novo has been intensely discussed by Portuguese art historians. The square Alameda Dom Afonso Henriques in Lisbon (Alameda) can be seen as paradigmatic for the architecture of power of the Estado Novo. The Alameda forms a gardened valley between two hills. There you find two prominent and highly propagandist buildings: The Instituto Superior Técnico (IST) and the Fonte Luminosa are dedicated to modern sciences and respectively to the harmonious contribution of nature to the city. The iconography of the Alameda as well as its incorporation into the propagandist use of urban planning in the 1930s and 1940s exemplify the visual politics during Salazarism. Urban planning programs intended to create cities that would preserve the character of a traditional catholic society and at the same time answer to the need to modernize the country and evoke the image of a progressive state. Thus, public buildings and urban squares such as the Alameda contributed to design a corporate image and to the ‘spirit’ of the regime.

Versão portuguesa do CANE (Camberwell Assessment of Need for the Elderly) : desenvolvimento e dados preliminares

RESUMO - A avaliação de necessidades de cuidados é crucial no planeamento, monitorização e avaliação de serviços de psiquiatria e saúde mental, bem como na investigação e na clínica. Este princípio é obviamente aplicável aos serviços responsáveis por populações de pessoas mais velhas. O instrumento CANE — Camberwell Assessment of Need for the Elderly possibilita uma avaliação consistente das necessidades de utentes idosos, nomeadamente em situações de patologia neuropsiquiátrica. Procede-se a uma avaliação cruzada, entrevistando a pessoa em questão, o seu cuidador informal e o técnico responsável. Esta avaliação multidimensional abrange domínios da esfera biológica, psicológica e social, sendo aplicável na comunidade ou em internamento (regime parcial ou completo). A utilidade do CANE tem sido evidenciada em contextos clínicos, de investigação e de avaliação de serviços. Existem múltiplas traduções a nível internacional, a maioria das quais validada. Na área da epidemiologia psiquiátrica nem sempre estão disponíveis os dados relativos à qualidade das adaptações de instrumentos, pelo que se apresenta o processo de desenvolvimento da versão portuguesa (de acordo com as regras para validação transcultural, no processo de tradução-retroversão). A aplicabilidade da versão portuguesa foi satisfatória neste estudo-piloto, representando a primeira fase de um trabalho multicêntrico nacional. Nesta fase inicial, foram considerados casos de idosos com patologia neuropsiquiátrica (maioritariamente demência — 71,4%), em dois centros (Lisboa e Porto) (n = 21). A média de idades foi 73,9 (± 6,3) anos, sendo 76,2% do sexo feminino. A maioria vivia em casa, apresentava co-morbilidade somática e estava em contacto com um cuidador informal (em geral, familiares do sexo feminino). Os avaliadores identificaram necessidades, nem sempre cobertas, nas seguintes dimensões: cuidados com a casa, alimentação, actividades diárias, memória, saúde física, sofrimento psicológico, companhia e dinheiro/economias. Nem sempre a perspectiva de doentes, cuidadores, técnicos e avaliadores foi inteiramente coincidente. Estes resultados preliminares da aplicação da versão portuguesa do CANE são consistentes quanto à sua validade ecológica, facial e de conteúdo, estando em curso contributos adicionais para a validação efectiva numa amostra de maior dimensão.

A prestação de contas e o regime especial da invalidade das deliberações

The obligation of accountability, or the need to make known the economic and financial state of the companies, ceased to be a purely internal activity, becoming a necessity of a general nature. The knowledge of the financial state of the companies, wich is provided by accountability documents, reveals more and more elementary for all interested in the results obtained, whether in terms of profitability, either with a view to assessing the economic and financial health of the companies. This essay aims to a deeper analysis to matters of accountability, in particular, to the special invalidity scheme of corporate resolutions, wich is enshrined in art. 69º of Portuguese Companies Code. We chose to reference the accrual basis accounts approval, through the analysis of financial statements, laying down a set of principles and criteria applicable to different entities. After consideration of the special scheme versed in art. 69º, we conclude there is a certain ambiguity in the adoption of the criteria do delimit each of the hypotheses of the precept, since the legislator uses indeterminate concepts. Nevertheless, if there is a rule, this will be the annulment, and only exceptionally will apply the nullity scheme, where there is injury to the public interest and the interests of the creditors.

Observations on dynamics of foraging hole construction of two leaf-feeding, soil-inhabiting Syntermes species (insecta: Isoptera) in an Amazonian Rainforest, Brazil

The intensity of construction of foraging access holes by two leaf-litter feeding, soil- inhabiting termite species, Syntermes molestus and Syntermes spinosus, in a Central Amazonian rain forest, was observed on consecutive nights for two weeks. Between 11 and 48 nest entrances per m2 were counted. Interaction between the two species was intense; some entrance holes were overtaken by the larger species during the observations; however, both species coexist in the area. A calculated minimum of 35 entrances/m2 is built every year by both species, emphasizing the importance of soil-burrowing termites for soil structure, aeration and water regime.

Analysis of output properties of the Peroxiredoxin/Thioredoxin/Thioredoxin reductase system

Dissertação de mestrado em Bioinformática

Diurnal variability of rainfall in southwest Amazonia during the LBA-TRMM field campaign of the austral summer of 1999

The TRMM-LBA field campaign was held during the austral summer of 1999 in southwestern Amazonia. Among the major objectives, was the identification and description of the diurnal variability of rainfall in the region, associated with the different rain producing weather systems that occurred during the January-February season. By using a network of 40 digital rain gauges implemented in the state of Rondônia, and together with observations and analyses of circulation and convection, it was possible to identify details of the diurnal cycle of rainfall and the associated rainfall mechanisms. Rainfall episodes were characterized by regimes of "low-level easterly" and "westerly" winds in the context of the large-scale circulation. The westerly regime is related to an enhanced South Atlantic Convergence Zone (SACZ) and an intense and/or wide Low Level Jet (LLJ) east of the Andes, which can extend eastward towards Rondônia, even though some westerly regime episodes also show a LLJ that remains close to the foothill of the Andes. The easterly regime is related to easterly propagating systems (e.g. squall-lines) with possible weakened or less frequent LLJs and a suppressed SACZ. Diurnal variability of rainfall during westerly surface wind regime shows a characteristic maximum at late afternoon followed by a relatively weaker second maximum at early evening (2100 Local Standard Time LST). The easterly regime composite shows an early morning maximum followed by an even stronger maximum in the afternoon.

Microphysical evidence of the transition between predominant convective/stratiform rainfall associated with the intraseasonal oscillation in the Southwest Amazon

The distinction between convective and stratiform precipitation profiles around various precipitating systems existent in tropical regions is very important to the global atmospheric circulation, which is extremely sensitive to vertical latent heat distribution. In South America, the convective activity responds to the Intraseasonal Oscillation (IOS). This paper analyzes a disdrometer and a radar profiler data, installed in the Ji-Paraná airport, RO, Brazil, for the field experiment WETAMC/LBA & TRMM/LBA, during January and February of 1999. The microphysical analysis of wind regimes associated with IOS showed a large difference in type, size and microphysical processes of hydrometeor growth in each wind regime: easterly regimes had more turbulence and consequently convective precipitation formation, and westerly regimes had a more stratiform precipitation formation.

Creep behaviour of cracked steel fibre reinforced self-compacting concrete laminar structures

Tese de Doutoramento - Civil Engineering

Social wasps of two wetland ecosystems in brazilian Amazonia (Hymenoptera, Vespidae, Polistinae)

In Brazilian Amazonia, 20 genera and more than 200 species of polistine wasps are recorded. Local faunas with 70 to 80 species are usually found in non floodable forest environments. However, a variety of wetlands exist in the region, the most expressive in surface area being varzea systems. In this paper, information is presented on polistines from two areas of wetlands in the Brazilian states of Amazonas and Amapá. These are reciprocally compared and also with nearby terra firme locations. Collecting methods consisted of active search for nests, handnetting and automatic trapping of individuals. Forty-six species of 15 genera were collected in Mamirauá, AM, most being widespread common wasps. However, five species deserve special mention in virtue of rarity and/or restricted distribution: Metapolybia rufata, Chartergellus nigerrimus, Chartergellus punctatior, Clypearia duckei, and Clypearia weyrauchi. In Região dos Lagos, AP, 31 species of 9 genera were collected, nearly all being common species with the exception of some Polistes, like P. goeldi and P. occipitalis. Even though less rich than vespid faunas from terra firme habitats, the Mamirauá fauna proved to be quite expressive considering limitations imposed by the hydrological regime. In Região dos Lagos, however, the very low diversity found was below the worst expectations. The virtual absence of otherwise common species in environments like tidal varzea forests along Araguari River is truly remarkable. The causes of low diversity are probably related to isolation and relative immaturity of the region, allied to strong degradation of forested habitats.

Active magneto-optical control of spontaneous emission in graphene

We investigate the spontaneous emission rate of a two-level quantum emitter near a graphene-coated substrate under the influence of an external magnetic field or strain induced pseudo-magnetic field. We demonstrate that the application of the magnetic field can substantially increase or decrease the decay rate. We show that a suppression as large as 99$\%$ in the Purcell factor is achieved even for moderate magnetic fields. The emitter's lifetime is a discontinuous function of $|{\bf B}|$, which is a direct consequence of the occurrence of discrete Landau levels in graphene. We demonstrate that, in the near-field regime, the magnetic field enables an unprecedented control of the decay pathways into which the photon/polariton can be emitted. Our findings strongly suggest that a magnetic field could act as an efficient agent for on-demand, active control of light-matter interactions in graphene at the quantum level.

Seasonal and spatial variations in limnological conditions of a floodplain lake (lake Catalão) connected to both the Solimões and Negro Rivers, Central Amazonia

Lakes play an important role in biogeochemical, ecological and hydrological processes in the river-floodplain system. The aim of this study was to evaluate the dynamics of the limnological conditions of Catalão Lake, an Amazon floodplain lake. Thus, some of the main limnological environment variables (O2, temperature, pH, nutrient, electrical conductivity) of the Catalão Lake were analyzed under temporal and spacial scales. The study was conducted between November/2004 and August/2005. Sampling excursion were carried out every three months; one excursion for each of the four different hydrological periods (low water, rising water, high water and falling water). Sampling points were chosen so that it could be obtained a gradient of the distance from Negro River. Limnological profiles in Catalão Lake showed generally acidic to slightly alcaline water, with low levels of dissolved oxygen and low concentrations of soluble reactive phosphorous. The Negro River seems to exert the main influence during the rising water period, while the Solimões River is the principal controlling river during peak water. The Principal Component Analysis (PCA) grouped the seasonal collections by hydrological period, showing the formation of a north-south spatial gradient within the lake in relation to the limnological variables. Multivariate dispersion analysis based on distance-to-centroid method demonstrated an increase in similarity over the course of the hydrological cycle, as the lake was inundated in response to the flood pulse of the main river channels. However, the largest spatial homogeneity in the lake was observed in the epilimnion layer, during the falling water period. The daily analysis of variation indicated an oligomitic pattern during the years in which the lake was permanently connected to the Negro River. Although Catalão Lake receives large quantities of both black water from the Negro River and sediment-filled water from the Solimões River, the physical and chemical characteristics of the lake are more similar to those of the Solimões (várzea lake) than the Negro (blackwater lake).

Electronic structure and optical signatures of semiconducting transition metal dichalcogenide nanosheets

CONSPECTUS: Two-dimensional (2D) crystals derived from transition metal dichalcogenides (TMDs) are intriguing materials that offer a unique platform to study fundamental physical phenomena as well as to explore development of novel devices. Semiconducting group 6 TMDs such as MoS2 and WSe2 are known for their large optical absorption coefficient and their potential for high efficiency photovoltaics and photodetectors. Monolayer sheets of these compounds are flexible, stretchable, and soft semiconductors with a direct band gap in contrast to their well-known bulk crystals that are rigid and hard indirect gap semiconductors. Recent intense research has been motivated by the distinct electrical, optical, and mechanical properties of these TMD crystals in the ultimate thickness regime. As a semiconductor with a band gap in the visible to near-IR frequencies, these 2D MX2 materials (M = Mo, W; X = S, Se) exhibit distinct excitonic absorption and emission features. In this Account, we discuss how optical spectroscopy of these materials allows investigation of their electronic properties and the relaxation dynamics of excitons. We first discuss the basic electronic structure of 2D TMDs highlighting the key features of the dispersion relation. With the help of theoretical calculations, we further discuss how photoluminescence energy of direct and indirect excitons provide a guide to understanding the evolution of the electronic structure as a function of the number of layers. We also highlight the behavior of the two competing conduction valleys and their role in the optical processes. Intercalation of group 6 TMDs by alkali metals results in the structural phase transformation with corresponding semiconductor-to-metal transition. Monolayer TMDs obtained by intercalation-assisted exfoliation retains the metastable metallic phase. Mild annealing, however, destabilizes the metastable phase and gradually restores the original semiconducting phase. Interestingly, the semiconducting 2H phase, metallic 1T phase, and a charge-density-wave-like 1T' phase can coexist within a single crystalline monolayer sheet. We further discuss the electronic properties of the restacked films of chemically exfoliated MoS2. Finally, we focus on the strong optical absorption and related exciton relaxation in monolayer and bilayer MX2. Monolayer MX2 absorbs as much as 30% of incident photons in the blue region of the visible light despite being atomically thin. This giant absorption is attributed to nesting of the conduction and valence bands, which leads to diversion of optical conductivity. We describe how the relaxation pathway of excitons depends strongly on the excitation energy. Excitation at the band nesting region is of unique significance because it leads to relaxation of electrons and holes with opposite momentum and spontaneous formation of indirect excitons.

Regulation of human mesenchymal stem cell osteogenesis by specific surface density of fibronectin: a gradient study

 The success of synthetic bone implants requires good interface between the material and the host tissue. To study the biological relevance of fi bronectin (FN) density on the osteogenic commitment of human bone marrow mesenchymal stem cells (hBMMSCs), human FN was adsorbed in a linear density gradient on the surface of PCL. The evolution of the osteogenic markers alkaline phosphatase and collagen 1 alpha 1 was monitored by immunohistochemistry, and the cytoskeletal organization and the cell-derived FN were assessed. The functional analysis of the gradient revealed that the lower FN-density elicited stronger osteogenic expression and higher cytoskeleton spreading, hallmarks of the stem cell commitment to the osteoblastic lineage. The identifi cation of the optimal FN density regime for the osteogenic commitment of hBM-MSCs presents a simple and versatile strategy to signifi cantly enhance the surface properties of polycaprolactone as a paradigm for other synthetic polymers intended for bone-related applications.

Desenvolvimento de modelos numéricos e análise experimental de subestruturas soldadas de transformadores de potência, sujeitas a forças de curto-circuito em regime transitório

Dissertação de mestrado integrado em Engenharia Mecânica