Guideline-based programs in the treatment of complex PTSD

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

Simple characterizations of the Nash and Kalai/Smorodinsky solutions

In this study we introduce two new properties, the Midpoint Outcome on a Linear Frontier (MOLF) and Balanced Focal Point (BFP) properties, to replace the Weak Pareto Optimality (WPO), Symmetry (SYM) and Independence of Equivalent Utility Representations (IEUR) properties in the axiomatic characterizations of the two most prominent solution concepts, namely the Nash and Kalai/Smorodinsky solutions, respectively.

Conserving the heritage spaces of Kuala Lumpur : a case study of the old Market Square (Medan Pasar)

Being one of the new Asian mega-cities today, the origins of Kuala Lumpur started as early as 1850s at the confluence between two rivers; Gombak and Klang. The history of Kuala Lumpur changed when tin was discovered in Ampang in I 857. To cater for the need of residents and miners, a small trading post was constructed at the confluence between these two rivers. This business activity expanded eastwards to the Klang River resulting in one of the busiest business centres in Kuala Lumpur. Shophouses were erected and streets formed. These rows of shophouses and streets, with the river located to the west, created a rectangular space, known as the Old Market Square (Medan Pasar) which later became the main focal point of Kuala Lumpur. Today, even though the native senlements, chaotic sheds and huts have totally disappeared, some of the original shophouses, streets and even spaces still exist. However, they are struggling to survive and to maintain their authenticity due to pressures of nearby developments. This article considers the status of the Old Market Square in regard to its historical evolution and its position in contemporary heritage legislation and policy.

Life during wartime : sexuality, recruitment and reality television

In 2010, Defence Force Recruiting (DFR) Navy Marketing entered into a media sponsorship package with the Australian version of the reality TV show So You Think You Can Dance (SYTYCD): Footage of the day aired on national television on SYTYCD and weekly ‘dancer bootcamp’ sessions training the dancers in Navy values featured on a dedicated and branded Navy section of the official SYTYCD website. This article analyses the Navy’s SYTYCD ‘integration opportunities’ to consider the role of reality television in the redefinition of the defence forces as a training and vocational pathway for young people. Underpinning such considerations is the conceptualization of the work of reality television through the prism of public and popular pedagogies. Taking sexuality as a focal point, the article will reflect on efforts to lift recruitment through an emphasis on the incorporation of diversity. Reading the work of Jasbir Puar against the Australian ‘archive’ of integration opportunities, this article contributes to queer critiques of homonormative and homonationalist tendencies in contemporary politics.

Single-subject research designs and data analyses for assessing elite athletes’ conditioning

Research in conditioning (all the processes of preparation for competition) has used group research designs, where multiple athletes are observed at one or more points in time. However, empirical reports of large inter-individual differences in response to conditioning regimens suggest that applied conditioning research would greatly benefit from single-subject research designs. Single-subject research designs allow us to find out the extent to which a specific conditioning regimen works for a specific athlete, as opposed to the average athlete, who is the focal point of group research designs. The aim of the following review is to outline the strategies and procedures of single-subject research as they pertain to the assessment of conditioning for individual athletes. The four main experimental designs in single-subject research are: the AB design, reversal (withdrawal) designs and their extensions, multiple baseline designs and alternating treatment designs. Visual and statistical analyses commonly used to analyse single-subject data, and advantages and limitations are discussed. Modelling of multivariate single-subject data using techniques such as dynamic factor analysis and structural equation modelling may identify individualised models of conditioning leading to better prediction of performance. Despite problems associated with data analyses in single-subject research (e.g. serial dependency), sports scientists should use single-subject research designs in applied conditioning research to understand how well an intervention (e.g. a training method) works and to predict performance for a particular athlete.

Desafios na economia do conhecimento - o caso do BNDES

Land, capital and work dictated the organizations¿ success in the industrial era. Added to these factors, the intangible assets are considered the key complement to determine business¿ sustainability in the knowledge era. The globalization creates a new dynamic in the markets and the knowledge management becomes focal point to the organizations. It becomes more common the incorporation of inter-organizational nets to improve business, in a strategy win-win where the tacit knowledge, noncodified, which is shared. More specifically, the innovation management, one of the intangible assets aspects, plays an important role in the Federal Government agenda, through the PDP and other market players. BNDES made significant progress to assist companies¿ demands in the knowledge era, among them: the adoption of the Intangible Assets BSC methodology to evaluate companies¿ credit risk and the partnership with Brightom University (UK) to train innovation management to companies¿ managers. Besides the initial steps, what are the challenges that BNDES will face from now on? In the bibliographic review, it is analyzed the competitive factors in the knowledge era, the evolution of the intangible assets concept, the consolidation of the networking as business strategy, evaluation its advantages and disadvantages, some innovation definitions and its management through the identification of the development level of the Brazilian companies¿ in this aspect. After that, it is analyzed the management tool so-called Balanced Scorecard, which is fundamental to the Intangible Assets BSC. The actions already implemented by BNDES, Sebrae and FINEP focused on the subject are identified in order to evaluate the integration level among those actions. Then, it is demonstrated the relevancy of the subject not only to BNDES, but also to society. This study faces the subject by the preparation of a diagnostic from 30 actives SMEs investments from BNDESPAR portfolio, a BNDES subsidiary, adopting the BSC methodology through questionnaire. The objective is to certify if there is enough space to elaborate an action plan focused on creating value to companies considering them intangible assets and, if it is viable, how this toll can be useful and adequate to achieve such objective. The questionnaire content, answered by the training participants in the innovation management program, is also evaluated to check the suggestions of actions to maximize the expected feedback. In the conclusion, it is verified that the tool so-called Intangible Assets BSC is adequate to the management activity of the investments in PMEs from BNDESPAR portfolio and there is enough space to adopt measures focused on creation of companies¿ value, mentioning some examples and highlighting some preliminary academicals contributions to improve the tool and also suggests other steps that BNDES can adopt to optimize the actions already implemented.

A situation awareness interface for a bi-wheeled industrial hovercraft: design, development and evaluation

The intention of this thesis is to develop a prototype interface that enables an operator to control a bi-wheeled industrial hovercraft that will work within a fusion power plant if the automation system fails. This fusion power plant is part of the ITER project a conjoint effort of various industrialized countries to develop cleaner sources of energy. The development of the interface prototype will be based on situation awareness concepts, which provide a means to understand how human operators perceive the world around, then process that information and make decisions based on the knowledge that they already have and the projected knowledge of the reactions that will occur in the world in response to the actions the operator makes. Two major situation awareness methods will be used, GDTA as a means to discover the requirements the interface needs to solve, and SAGAT to conduct the evaluation on the three interfaces. This technique can isolate the differences an operator has in situation awareness when presented with relevant information given by each of the three interfaces that were built for this thesis. Where the first interface presents the information within the operator’s focal point of view in a pictorial style, the second interface shows the same information within the same point of view has the first interface but only shows it in a textual manner. While the third interface shows the relevant information in the operator’s peripheral field of view. Also SAGAT can provide insight on the question to know if providing the operator with feed-forward information about the stoppage distances of the bi-wheeled industrial hovercraft has any effect on the operator’s decision making.

Integrating eye tracking in virtual reality for stroke rehabilitation

This thesis reports on research done for the integration of eye tracking technology into virtual reality environments, with the goal of using it in rehabilitation of patients who suffered from stroke. For the last few years, eye tracking has been a focus on medical research, used as an assistive tool  to help people with disabilities interact with new technologies  and as an assessment tool  to track the eye gaze during computer interactions. However, tracking more complex gaze behaviors and relating them to motor deficits in people with disabilities is an area that has not been fully explored, therefore it became the focal point of this research. During the research, two exploratory studies were performed in which eye tracking technology was integrated in the context of a newly created virtual reality task to assess the impact of stroke. Using an eye tracking device and a custom virtual task, the system developed is able to monitor the eye gaze pattern changes over time in patients with stroke, as well as allowing their eye gaze to function as an input for the task. Based on neuroscientific hypotheses of upper limb motor control, the studies aimed at verifying the differences in gaze patterns during the observation and execution of the virtual goal-oriented task in stroke patients (N=10), and also to assess normal gaze behavior in healthy participants (N=20). Results were found consistent and supported the hypotheses formulated, showing that eye gaze could be used as a valid assessment tool on these patients. However, the findings of this first exploratory approach are limited in order to fully understand the effect of stroke on eye gaze behavior. Therefore, a novel model-driven paradigm is proposed to further understand the relation between the neuronal mechanisms underlying goal-oriented actions and eye gaze behavior.

Análise de desempenho de um fogão solar construído a partir de sucatas de antena de tv

Given the growing environmental crisis caused by degradation, mainly due to the use of polluting energy sources, increasing the growing use of renewable energies worldwide, with emphasis on solar energy, an abundant supply and available to everyone, which can be harnessed in several ways: electricity generation; dehydration of food; heating, disinfection and distillation and cooking. The latter has as its primary feature the viability of clean, renewable energy for society, combating ecological damage caused by large-scale use of firewood for cooking foods, use in tropical countries with high solar radiation, and has funding NGOs throughout the world with the goal of achieving low-income population. The proposed project consists of a solar cooker for concentration, working from the reflection of sunlight by a hub that they converge to a focal point at the bottom of the pot, getting lots of heat. The solar cooker under study consists of two elliptical reflecting parabolas made from the recycling of scrap TV antenna, having 0.29 m² of surface area for each antenna, which were covered by multiple mirrors of 2 mm thick and mounted on a metal structure, with correction for the mobility of the apparent movement of the sun. This structure was built with the recycling of scrap metal, possessing a relatively low cost compared with other solar cookers, around US$ 50.00. This cost becomes negligible, since that will involve a great benefit to not have fuel costs for each meal, unlike the use of gas or firewood for cooking food. The tests show that the cooker has reached the maximum temperature of 740 ° C, for boiling water in an average time of 28 minutes, cooking various types of foods such as potatoes, rice and pasta in an average time of 45 minutes and still going as a solar oven, making pizza baking and meat. These cooking times do not differ much from the cooking times on a gas stove, it becomes the solar cooker as a good consumer acceptance, and furthermore not to deliver the same gases that can poison the food as with the wood stove. Proves the viability of using the stove to cook or bake in two daily meals for a family, still presenting a position to improve his performance with the addition of new materials, equipment and techniques

Resistência e performance na arte de João Cota

Researching about the art of tell and the tales told by João Cota is somehow revisiting the oral tradition and social practice in the story-telling art. It takes into consideration the resistance this art still exerts, mainly by using the performance of oral transmission and receptiveness to tales. The study of this practice contributes to the vivacious and dynamcis permanence of this authentic and traditional storyteller of his repertory and of his form to tellin our culture. Story-telling is part of the humankind living heritage communicated by means of popular wisdom. Despite the risk of vanishing into thin air, along with their narrators, the tales still manage to resist the contemporary mass culture model. How long further will stories like the ones narrated by João Cota be able to resist to strong and stronger structures dictated by writing and other communication means? João Cota s practice in story-telling will be studied not only as a proposal to identify the presence of this practice and the oral cultural resistance but also, through the performance prospective, to identify the oral transmission and receptiveness to the tales that are part of this storyteller s repertoire. In other words: what he tells, how he tells it, and why he tells it. The advent of new technologies such as internet, through which people can easily communicate with others in different parts of the world, and the greater and greater expansion in the writing skill concept interfere the maintenance of the oral tradition elements present in João Cota s narratives and inserted in the Brazilian culture. This has become more visible in the latest decades although we still notice the living tradition and permanence of the story-telling practice in several parts of the country through their wise storytellers. Our research target will require - in each of its study stages reference to works by several theoreticians namely Paul Zumthor, Mikhail Bakhtin, Câmara Cascudo, theoreticians from the receptiveness aesthetic, from the written culture history, from oral cultures and reading practices, from tradition and the Brazilian Culture of oral story-telling. In order to get to know and draw a profile of this storyteller, we ve chosen to use the comprehensive interview method by French Sociologist Jean Claude Kaufmann. The originality in the method consists of the qualitative data put together in situ , concentrated on the storyteller s narratives/speeches recorded on tape, which will be the focal point of this study. Our analysis method is based on tireless sessions of listening to interviews out of which we gathered information related to the storyteller, his practice in telling the tales, and his repertoire

Modelagem matemática para o aproveitamento da biomassa residual de colheita da cana-de-açúcar com menor custo

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

Strengthening biregional cooperation between Latin America and Asia-Pacific: the role of FEALAC

Includes bibliography

Fortalecimiento de la cooperación birregional entre América Latina y Asia y el Pacífico El papel del FOCALAE

Incluye bibliografía

From industrial economics to digital economics: an introduction to the transition

Includes bibliography

Gender-based violence: a human rights issue

Includes bibliography