The present work shows some preliminary results of a longitudinal study aimed at validating a psychometric instrument - the Subjective Distance Scale (SDS) - developed to assess the patient's affective nearness/remoteness towards/from the psychiatric treatment in a Day Hospital program. 55 day hospital patients were assessed at different moments of the treatment: At admission they were evaluated by means of the SDS, the SCL-90-R (patient's psychiatric symptoms) and the GAS (patient's mental health level). Institutional therapeutic alliance was assessed one week from admission (IWAI-p) and finally, patient's psychiatric symptoms were retested (SCL-90-R) at the end of the treatment and 3 months from discharge. The main results reveal good psychometric properties of the SDS: its factorial structure partially confirms the dimensions theoretically hypothesised; its internal consistency - total and most of its subscales - reach adequate reliability levels; and related to its predicted validity, the scale correlates with some important aspects of the treatment, like the quality of the early institutional alliance, the symptomatic improvement and the stability of the improvements in time. New studies with larger samples and conducted in additional psychiatric settings are necessary to guarantee the validity and reliability of the scale before it could be used as a clinical screening instrument.
The relevance of a good therapeutic alliance development between patient and therapists in the treatment success has been documented in more than 3 decades of empirical research. In the case of the treatment of severely disturbed patients, the alliance construction process involves particular characteristics determined, in part, by the patients inability to form safety bonds with others and because of, usually, various therapeutic figures are engaged in their treatments. The present work offers a general review of the most important empirical evidence about the therapeutic alliance process in institutional context treatments (i.e., hospitalization, therapeutic community), introduces the concept of Institutional Therapeutic Alliance (ITA) - clinical and empirical phenomenon that accounts for the working bond between the patient and the therapeutic staff perceived as a whole - and reports the major results of a longitudinal study conducted to assess the ITA and explores the relationship with treatment outcomes.55 day-hospital patients take part in the research and were evaluated at admission, before one week, at discharge and after 3 months. The assessment battery included: Symptom Check List (SCL-90), Global Assessment Scale (GAS), Multidimensional Social Perceived Support Scale (MSPSS), Institutional Working Alliance Inventory (IWAI) and Subjective Distance Scale (SDS). The results show that ITA is positively correlated with symptomatic reduction at discharge and negatively associated with patient's re-hospitalization after 3 months.The work concludes by discussing, from a clinical point of view, the promoting and obstructing alliance factors linked with the patient, the staff and their relationships.
A critical component of an advanced gas-cooled reactor station is the graphite core. As a station ages, the graphite bricks that comprise the core can distort and may eventually crack. Since the core cannot be replaced, the core integrity ultimately determines the station life. Monitoring these distortions is usually restricted to the routine outages, which occur every few years, as this is the only time that the reactor core can be accessed by external sensing equipment. This paper presents a monitoring module based on model-based techniques using measurements obtained during the refuelling process. A fault detection and isolation filter based on unknown input observer techniques is developed. The role of this filter is to estimate the friction force produced by the interaction between the wall of the fuel channel and the fuel assembly supporting brushes. This allows an estimate to be made of the shape of the graphite bricks that comprise the core and, therefore, to monitor any distortion on them.