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The Department of Defense (DoD) and veterans affairs (VA) built the practice-based implementation (PBI) Network in 2013 to facilitate more rapid translation of psychological health (PH) res...

Much research has highlighted the salience of acculturation to the experiences of international students, yet very little research has examined whether and how acculturation factors influence inter...

Although writing about the real relationship has existed from the beginnings of the "talking cure," it is only in recent years that empirical research has focused on this phenomenon. The real relationship is the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic. The strength of the real relationship is determined by both the extent to which it exists and the degree to which it is positive or favorable. In this article, a meta-analysis is presented on the association between the strength of the real relationship and the outcome of psychotherapy. Summed across 16 studies, this meta-analysis revealed a moderate association with outcome (r = .38, 95% confidence interval [.30, .44], p < .001, d = 0.80, N = 1.502). This real relationship-outcome association was independent of the type of outcome studied (treatment outcome, treatment progress, and session outcome) and of the source of the measure (whether the client or the therapist rated the real relationship and/or treatment outcome). We also present commonly used measures of the real relationship, limitations of the research, and patient contributions. The article concludes with diversity considerations and practice recommendations for developing and strengthening the real relationship. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

O conhecimento gerado pelas universidades é fator determinante para a inovação e competitividade das empresas. A literatura técnica, no entanto, aborda as limitações deste relacionamento. Este estudo foca na deficiente interação academia-empresa e propõe a criação de uma vitrine tecnológica como ferramenta para a aproximação dessa relação. Os dados foram coletados por meio de entrevista semiestruturada com 21 líderes de grupos de pesquisas da UFRR cadastrados no Diretório de Grupos de Pesquisa do CNPq. Os resultados evidenciam a necessidade de uma efetiva implementação de ações pelo NIT e fornecem as bases para a construção da vitrine tecnológica com a exposição de tecnologias protegidas e das competências tecnológicas dos pesquisadores, do lado da oferta, e com demandas das empresas para suas soluções tecnológicas, do lado da demanda.

This study aims to assess the perception of the actors of the Local Innovation System (SLI) about the innovation environment for small businesses in Boa Vista, to analyze the existing conditions and barriers for the local environment and to propose strategies for its strengthening, based on the model Triple Helix. This research is characterized as exploratory, qualitative, and cross-sectional. Data collection was carried out through semi-structured interviews with representatives of selected SLI entities. The results showed, except for Serviço Brasileiro de Apoio às Micros e Pequenas Empresas (SEBRAE), a perception of weak performance by the actors, affecting the credibility of the entire SLI. It was also found a satisfactory institutional articulation for structuring work, indicating that the actors are aware of the need for cumulative and interactive performance. Este estudo tem como objetivo avaliar a percepção dos atores do Sistema Local de Inovação (SLI) sobre a ambiência de inovação para pequenos negócios em Boa Vista, analisar as condições e barreiras existentes para a ambiência local e propor estratégias para o seu fortalecimento, baseadas no modelo Hélice Tríplice. Esta pesquisa é caracterizada como exploratória, qualitativa e de corte transversal. A coleta de dados foi realizada por meio de entrevista semiestruturada de representantes de entidades selecionadas do SLI. Os resultados apontaram, com exceção do Serviço Brasileiro de Apoio às Micros e Pequenas Empresas (SEBRAE), uma percepção de fraca atuação dos atores, afetando a credibilidade de todo o SLI. Constatou-se ainda uma articulação institucional satisfatória para trabalho estruturante, indicando que os atores estão conscientes da necessidade de atuação cumulativa e interativas.

Purpose: To compare the anatomic and functional outcome of two variants of the inverted internal limiting membrane (I-ILM) flap technique for idiopathic macular holes (IMH) larger than 400 µm. Methods: Twenty-seven consecutive patients undergoing PPV for IMH were randomly assigned to different variants of I-ILM technique: the Cover group included 14 patients in which the I-ILM was folded upside-down over the MH as a single layer while the Fill group enrolled 13 patients in which the I-ILM was folded within the MH in multiple layers. Results: MH closed in 12/14 Cover and in 13/13 Fill eyes (84.6 vs. 100%, p = 0.14; n.s.). Vision at 1 month was Snellen 0.44 ± 0.17 vs. 0.28 ± 0.21 (p = 0.05) and 0.48 ± 0.20 vs. 0.37 ± 0.25 (n.s.) at 3 months. IS/OS line interruption width was 463 ± 385 vs. 602 ± 210 µm, respectively, at 1 month (n.s.) and 602 ± 210 vs. 563 ± 209 µm at 3 months (n.s.). The Cover group showed outer retina cystic changes more often (p < 0.01). MH over 700 µm closed in 0/2 and in 2/2 cases, respectively, in the Cover and Fill groups (0.045). Conclusions: Cover and Fill I-ILM techniques allowed similar closure rates and post-operative vision at 3 months. The Cover group showed better anatomical restoration and vision at 1 month while the Fill technique might be more efficient in closing larger MHs.

Aims: Diabetic retinopathy (DR) represents the main cause of blindness among adults in the industrialized Countries. Use of telemedicine could offer an easy, smart specialist fundus oculi examination, as well as putting in a screening programme many patients who otherwise would be excluded. Materials and methods: The NO BLIND is a transversal, multicentre, observational study. Its pilot phase involved nine public outpatient clinics for 6 months. As endpoint of the study, we assessed the prevalence of DR by retinography in a subset of the Italian population. Patients' fundus oculi photos were performed by trained diabetologists through a digital smart ophthalmoscope. Results: According to our endpoint, in the final study population (n = 1461), obtained excluding patients for whom retinography was not able to provide any diagnosis, DR prevalence was equal to 15.5%. According to the receiver operating characteristic (ROC) curve performed, we can observe how retinography appears a highly accurate method to detect DR (AUROC 0.971, 95% confidence interval, 0.954-0.989), with a specificity of the 100% and a sensitivity of the 94.3%. Conclusions: Our findings, in an Italian setting, confirm main data in the literature about DR prevalence. Hence, telemedicine could represent an accurate, fast, and cheap method for screening of DR. © 2018 John Wiley & Sons, Ltd. Aims. Diabetic retinopathy (DR) represents the main cause of blindness among adults in the industrialized Countries. Use of telemedicine could offer an easy, smart specialist fundus oculi examination, as well as putting in a screening program many patients who otherwise would be excluded. Materials and Methods. The NO Blind is a transversal, multicentre, observational study. Its pilot phase involved nine public outpatient clinics for six months. As endpoint of the study, we assessed the prevalence of DR by retinography in a subset of the Italian population. Patients’ fundus oculi photos were performed by trained diabetologists through a digital smart ophthalmoscope. Results. According to our endpoint, in the final study population (n=1461), obtained excluding patients for whom retinography was not able to provide any diagnosis, DR This article is protected by copyright. All rights reserved. prevalence was equal to 15.5%. According to the ROC Curve performed, we can observe how retinography appears a highly accurate method to detect DR (AUROC 0.971 95% C.I. 0.954-0.989), with a specificity of the 100% and a sensitivity of the 94.3%. Conclusions. Our findings, in an Italian setting, confirm main data in the literature about DR prevalence. Hence, telemedicine could represent an accurate, fast and cheap method for screening of DR.

Aims: To assess the correlation between diabetic retinopathy (DR) and potential risk factors, as well as the relationship between DR and the other complications of diabetes, in a real-life population of type 2 diabetes patients recruited in several centres in Italy. Methods: The NO BLIND is a cross-sectional, multicentre, observational study, which involved nine public outpatient clinics in Italy. The patients were assessed for eligibility from November 2016 till November 2017. Those enrolled underwent standard fundus oculi exam. Clinical and laboratory data were also collected. Results: 2068 T2DM underwent fundus oculi exam. 435 received diagnosis of diabetic retinopathy (21%). Diabetic retinopathy was independently associated with HDL cholesterol (O.R.: 1.042; 95% C.I.: 1.012–1.109; p = 0.004), Albumin Excretion Rate (AER) (O.R.: 1.001; 95% C.I.: 1.000–1.002; p = 0.034) and GFR (O.R.: 1.159; 95% C.I.: 1.039–1.294; p = 0.008). HDL cholesterol values were hence split in two classes according to a potential cut-off (40 mg/dL), as defined by the ROC curve. Following analysis confirmed the association between DR and high HDL values (p = 0.032). Somatic neuropathy and diabetic ulcer were independently related with DR (p < 0.001 and p = 0.012, respectively). Conclusions: A novel relationship between high HDL cholesterol and DR was observed. © 2019 Elsevier B.V. Aims: To assess the correlation between diabetic retinopathy (DR) and potential risk factors, as well as the relationship between DR and the other complications of diabetes, in a real-life population of type 2 diabetes patients recruited in several centres in Italy. Methods: The NO BLIND is a cross-sectional, multicentre, observational study, which involved nine public outpatient clinics in Italy. The patients were assessed for eligibility from November 2016 till November 2017. Those enrolled underwent standard fundus oculi exam. Clinical and laboratory data were also collected. Results: 2068 T2DM underwent fundus oculi exam. 435 received diagnosis of diabetic retinopathy (21%). Diabetic retinopathy was independently associated with HDL cholesterol (O.R.: 1.042; 95% C.I.: 1.012–1.109; p = 0.004), Albumin Excretion Rate (AER) (O.R.: 1.001; 95% C.I.: 1.000–1.002; p = 0.034) and GFR (O.R.: 1.159; 95% C.I.: 1.039–1.294; p = 0.008). HDL cholesterol values were hence split in two classes according to a potential cut-off (40 mg/dL), as defined by the ROC curve. Following analysis confirmed the association between DR and high HDL values (p = 0.032). Somatic neuropathy and diabetic ulcer were independently related with DR (p < 0.001 and p = 0.012, respectively). Conclusions: A novel relationship between high HDL cholesterol and DR was observed.

Background and aims: Recently, the albuminocentric view of diabetic kidney disease (DKD) in type 2 diabetes (T2DM) has been changing. Therefore, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) has to be addressed according to this new clinical presentation of DKD. The aim of this study was to evaluate, in a real-world setting, the correlation DR–DKD in T2DM. Methods and results: A total of 2068 type 2 diabetic patients enrolled in a multicenter cross-sectional study were investigated. Albuminuric subjects were largely prevalent among subjects with DR (p = 0.019). In the whole study population, no difference in albumin excretion rate (AER) was observed between presence/absence of DR; instead, AER was significantly higher among patients with glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 (CKD) (p = 0.009), above all in those with CKD and AER ≥0.03 g/24 h (p = 0.005). Multivariate analysis confirmed that eGFR (O.R. 0.976; 95% C.I.: 0.960–1.028; p < 0.001) and AER (O.R. 1.249; 95% C.I. 1.001–1.619; p = 0.004) were independently associated with DR and HDL–cholesterol (O.R.: 1.042; 95% C.I.: 1.011–1.120; p = 0.014). Additionally, among patients with eGFR

This paper presents an economic nonlinear MPC based strategy for integrated control of the engine and the exhaust aftertreatment system (EATS) of a heavy-duty powertrain. The objectives of this control strategy are to improve the fuel economy while fulfilling real-driving emission legislation based on work-based-window, as stipulated in the Euro VI emission legislation for heavy-duty vehicles. The strategy is evaluated using a high-fidelity simulation platform including a validated GT-POWER model of a 13 L turbo compound diesel engine and a first principles model of an EATS. Simulation results show that the strategy always fulfills the real-driving emission legislation.

Os impactos ambientais de atividades agropecuárias podem prejudicar a qualidade de vida populacional e do ambiente. Com o objetivo de avaliar os impactos ambientais causados pela atividade de avicultura, foi realizado um levantamento na etapa de produção dessa atividade. Tais impactos, sua importância e os aspectos relacionados com a produção avícola foram avaliados pela matriz de ponderação de atributos. As ações impactantes identificadas foram avaliadas quanto aos aspectos magnitude, frequência e importância. Para os impactos identificados, foram propostas medidas mitigadoras para a redução destes. Os resultados obtidos demonstraram que dentre os impactos ambientais gerados, o consumo de água gera a redução do recurso natural de forma significativa, apresentando grande importância ambiental. Além disso, o consumo de energia apresentou grande importância no que se refere as diferentes operações de produção. Como impactos positivos têm-se a oportunidade de emprego e movimentação da economia local. As medidas mitigadoras propostas referem-se à diminuição do consumo de água e energia, a fim de diminuir a pressão sobre o recurso natural. Pode-se inferir que os resultados indicam que as atividades de produção avicultora contribuem para ocasionar problemas ativos ao meio ambiente, principalmente na redução dos recursos naturais e poluição do ar.