241 resultados para Tomlin, Lily
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Background: There have been no published studies observing what happens to children post hospital discharge and if medication discrepancies occurred between the hospital and General Practitioner (GP) interface.1 Objectives: To identify the type of discrepancies between hospital discharge prescription and the patient's medicines after their first GP prescription. Method: Over a 3 month period (March–June 2012) across two London NHS hospital sites, parents of children on long term medications aged 18 years and under, were approached and consented prior to discharge from the ward. The patients were followed up 21 days after discharge by telephone call or home visit depending on their preference. The parent was asked if they had contacted their GP for further medications during the follow up, and if not the follow up was rescheduled. The parents were interviewed to find out if there were any discrepancies that occurred post discharge by comparing the patient's hospital discharge letter and medication at follow up. All this information was captured on a data collection form. Results: Eighty-eight patients were consented and 60 patients (68%; 60/88) were followed up by telephone call 21 days post discharge. A total of 317 medications were ordered at discharge among the 60 patients. Of the 60 that were followed up, nine were lost to follow up, one died post discharge, one was excluded from the study, and 11 had not contacted the GP and were to be followed up at a later date. Of the 38 patients who were followed up, 254 medications were ordered. Of the 38 patients there were 12 (32%) patients who had discrepancies that occurred between the discharge letter and GP, 19 (50%) had no issues, and seven (18%) mentioned issues to do with post discharge that were not discrepancies. Of the 12 patients who had at least one medication discrepancy (total 34 medications, range 1–7 discrepancies per patient), six patients had GP discrepancies, four had discrepancies resulting from a hospital outpatient appointment, one related to the discharge letter order and one was a complex discrepancy. An example: a patient was discharged on amiodarone liquid 16.5 mg daily as opposed to 65 mg daily of amiodarone from the GP. Upon interview the parent used volume units to communicate dose as opposed to the actual dose itself and the strengths of liquid had changed. Conclusions: The preliminary results from the study have shown that discrepancies due to several causes occur when paediatric patients leave hospital.
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Objectives: NICE/NPSA excluded children under 16 from their guidance concerning medicines reconciliation (MR) upon admission.1 Our aims and objectives of conducting the literature review was to identify the epidemiology of medication discrepancies upon admission, transfer and discharge in children, and if they require MR. Method: Six bibliographical databases (Medline, Embase, CINAHL, International Pharmaceutical Abstracts, Web of Science and Biosis Previews) and selected key words were used to find epidemiological studies on medication discrepancies in children upon hospital admission, transfer and discharge (key words included ‘medication discrepancy’; ‘medication reconciliation’; ‘hospital admission’; ‘hospital discharge’; ‘hospital transfer’); studies where the data for children could be extracted were included. Results: From the 1239 articles found (in May 2011), eight of the articles had extractable paediatric information, (five from Canada, two from USA, one from UK). Five of the studies involved discrepancies on admission, one involved discrepancies on admission and transfer, one involved discrepancies at transfer and one considered discharge. The reference point used to compare against the admission, transfer and the discharge order differed in each of the studies. Four studies used a rating scale to assess the clinical significance of the discrepancies to demonstrate the potential adverse clinical outcome of patients in the absence of clinical intervention. Two studies2 3 used a rating scale that was used in adults.4 A study of paediatric neurosurgical patients found that initial hospital prescriptions for children differed from the preadmission prescriptions in 39% of occasions and 50% of all prescribing variations had the potential to cause moderate or severe discomfort or clinical deterioration.2 A study by Coffey et al in general paediatric admissions in Canada showed 22% of patients experienced at least one discrepancy and 29% of the discrepancies had the potential to cause moderate or severe discomfort or clinical deterioration.3 By comparison an epidemiological study in discrepancies in adults on admission had 38.6% of the discrepancies identified with a potential to cause moderate or severe discomfort or clinical deterioration.4 All the studies involved small samples or specific patient groups such as medically complex patients. However all of the studies demonstrated that discrepancies occurred among paediatric populations during transitions in care settings and mentioned MR as an intervention. Conclusion: The results have shown that discrepancies of medication upon hospital admission, transfer and discharge occur regularly in children. With only one published study in the UK looking at hospital admission in children, and no published articles on the incidence and epidemiology of medication discrepancies upon hospital transfer or discharge further research is required in a wider paediatric population. Further work is also required to define the required interventions to improve practice.
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Objectives: Hospital discharge is a transition of care, where medication discrepancies are likely to occur and potentially cause patient harm. The purpose of our study was to assess the prescribing accuracy of hospital discharge medication orders at a London, UK teaching hospital. The timeliness of the discharge summary reaching the general practitioner (GP, family physician) was also assessed based on the 72 h target referenced in the Care Quality Commission report.1 Method: 501 consecutive discharge medication orders from 142 patients were examined and the following records were compared (1) the final inpatient drug chart at the point of discharge, (2) printed signed copy of the initial to take away (TTA) discharge summary produced electronically by the physician, (3) the pharmacist's amendments on the initial TTA that were hand written, (4) the final electronic patient discharge summary record, (5) the patients final take home medication from the hospital. Discrepancies between the physician's order (6) and pharmacist's change(s) (7) were compared with two types of failures – ‘failure to make a required change’ and ‘change where none was required’. Once the patient was discharged, the patient's GP, was contacted 72 h after discharge to see if the patient discharge summary, sent by post or via email, was received. Results: Over half the patients seen (73 out of 142) patients had at least one discrepancy that was made on the initial TTA by the doctor and amended by the pharmacist. Out of the 501 drugs, there were 140 discrepancies, 108 were ‘failures to make a required change’ (77%) and 32 were ‘changes where none were required’ (23%). The types of ‘failures to make required changes’ discrepancies that were found between the initial TTA and pharmacist's amendments were paracetamol and ibuprofen changes (dose banding) 38 (27%), directions of use 34 (24%), incorrect formulation of medication 28 (20%) and incorrect strength 8 (6%). The types of ‘changes where none were required discrepancies’ were omitted medication 15 (11%), unnecessary drug 14 (10%) and incorrect medicine including spelling mistakes 3 (2%). After contacting the GPs of the discharged patients 72 h postdischarge; 49% had received the discharge summary and 45% had not, the remaining 6% were patients who were discharged without a GP. Conclusion: This study shows that doctor prescribing at discharge is often not accurate, and interventions made by pharmacist to reconcile are important at this point of care. It was also found that half the discharge summaries had not reached the patient's family physician (according to the GP) within 72 h.
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Aims and Objectives: The NICE/NPSA guidance on Medicines Reconciliation in adults upon hospital admission excludes children under the age of 16.1 Hence the primary aim and objective of this study was to use medicines reconciliation to primarily identify if discrepancies occur upon hospital admission. Secondary objectives were to clinically assess for harm discrepancies that were identified in paediatric patients on long term medications at four hospitals across the UK. Method: Medicines reconciliation is a procedure where the current medication history of a patient prior to hospital admission would be taken and verifying the medication orders made at hospital admission against this history, addressing any discrepancies identified. Medicines reconciliation was carried out prospectively for 244 paediatric patients on chronic medication across four UK hospitals (Birmingham, London, Leeds and North Staffordshire) between January – May 2011. Medicines reconciliation was conducted by a clinical pharmacist using the following sources of information: 1) the patient's Pre-Admission Medication (PAM) from the patient's general practitioner 2) examination of the Patient's Own Medications brought into hospital, 3) a semi-structured interview with the parent-carers and 4) identification of admission medication orders written on the drug chart prior to clinical pharmacy input (Drug Chart). Discrepancies between the PAM and Drug Chart were documented and classified as intentional or unintentional. Intentional discrepancies were defined as changes that were made knowingly by the prescriber and confirmed. Unintentional discrepancies were assessed for clinical significance by an expert panel and assigned a significance score based on the likelihood of causing potential discomfort or clinical deterioration: class 1 unlikely, class 2 moderate and class 3 severe.2 Results: 1004 medication regimens were included from the 244 patients across the four sites. 588 of the 1004 (59%) medicines, had discrepancies between the PAM and Drug Chart; of these 36% (n = 209) were unintentional and included for clinically assessment. 189 drug discrepancies 30% were classified as class 1, 47% were class 2 and 23% were class 3 discrepancies. The remaining 20 discrepancies were cases where deviating from the PAM would have been the right thing to do, which might suggest that an intentional but undocumented discrepancy by the prescriber writing up the admission order may have occurred. Conclusion: The results suggest that medication discrepancies in paediatric patients do occur upon hospital admission, which do have a potential to cause harm and that medicines reconciliation is a potential solution to preventing such discrepancies. References: 1. National Institute for Health and Clinical Excellence. National Patient Safety Agency. PSG001. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. London: NICE; 2007. 2. Cornish, P. L., Knowles, S. R., Marchesano, et al. Unintended Medication Discrepancies at the Time of Hospital Admission. Archives of Internal Medicine 2005; 165:424–429
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Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.
Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.
In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.
Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.
The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.
Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.
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Fossil associations from the middle and upper Eocene (Bartonian and Priabonian) sedimentary succession of the Pamplona Basin are described. This succession was accumulated in the western part of the South Pyrenean peripheral foreland basin and extends from deep-marine turbiditic (Ezkaba Sandstone Formation) to deltaic (Pamplona Marl, Ardanatz Sandstone and Ilundain Marl formations) and marginal marine deposits (Gendulain Formation). The micropalaeontological content is high. It is dominated by foraminifera, and common ostracods and other microfossils are also present. The fossil ichnoasssemblages include at least 23 ichnogenera and 28 ichnospecies indicative of Nereites, Cruziana, Glossifungites and ?Scoyenia-Mermia ichnofacies. Body macrofossils of 78 taxa corresponding to macroforaminifera, sponges, corals, bryozoans, brachiopods, annelids, molluscs, arthropods, echinoderms and vertebrates have been identified. Both the number of ichnotaxa and of species (e. g. bryozoans, molluscs and condrichthyans) may be considerably higher. Body fossil assemblages are comparable to those from the Eocene of the Nord Pyrenean area (Basque Coast), and also to those from the Eocene of the west-central and eastern part of South Pyrenean area (Aragon and Catalonia). At the European scale, the molluscs assemblages seem endemic from the Pyrenean area, although several Tethyan (Italy and Alps) and Northern elements (Paris basin and Normandy) have been recorded. Palaeontological data of studied sedimentary units fit well with the shallowing process that throughout the middle and late Eocene occurs in the area, according to the sedimentological and stratigraphical data.
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It is located in eastern Uganda, the wetland system is characterized by open water that is clear with some emergent vegetation mainly of sedges and floating vegetation dominated by the day water lily Nymphaea sp and submerged water weeds. Some patches of Cyperus papyrus exist in areas with minimal agricultural encroachment. The main inflow into the Opeta system is through River Sironko.
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This paper aims at studying UFRN Parafolclórico Group, whose aesthetic formation is subjected to our analysis, specially at its two last performances, that is, Flor do Lírio (Lily Flower), 2004, and Debaixo do Barro do Chão (Under the Mud of the Ground), 2008. Three targets are envisaged here: to analyze the aesthetic ideas backing Parafolclórico Group exhibitions; to evaluate how their many folk elements interact with different artist languages in order to compose a certain choreography; and finally, to identify the aesthetic conformation placed behind the two different choreographs of the last performances, their trends and innermost features that differentiate them. In accordance with the Analysis of Contents (BARDIN, 2006), interviews have been made with the choreographers and the staff of the spectacles, resulting in elucidating answers to the understanding of their thematic axis. On the first chapter we called attention to motivating subjects as recollection, personal experiences, bibliography research, research in loco regarded as propelling forces of the creative works. Herein, folk culture is depicted as a dynamic process opening a frank dialogue with contemporary events and reinforcing their continuity. On the second chapter, we approached the aesthetic conformation and the scenic elements (costumes, light, scenario, make-up), integrating the studied spectacles and disseminating folk songs in various ways. As what concerns the subjects discourse, we have obtained support in authors like Robatto (1994); Lobo; Navas (2008); Burke (1989); Canclini (2006); Dufrenne (2005); Medeiros (2005); Pavis (2005); Silva (2005), among others. Those authors have provided us with an indispensable theoretic support which, added to the interviews, convinced us that the Parafolclórico Group s aesthetic conception tends to identify itself with the artist languages and other techniques of that Group. It also made sure that the Group s course aims at an aesthetic conception which is not limited to popular culture manifestations, like dance, but admits to play with other media in order to communicate its art. In view of this situation, we arrived to two conclusions: first: the group s interchanges emphasize the dynamic character of popular culture which, by establishing contacts with different realities, receives influences capable of extending its own continuity; second: the contemporary state of arts also improves multiple interchanges opening way, so, for many accomplishments in their field. Therefore, UFRN Parafolclórico Group inserts itself in the contemporary scenery by performing new evaluations of the popular dances as long as it puts them in contact with different technical, aesthetic, artist and culture combinations
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Social anhedonia is a deficiency in the capacity to experience pleasure from social interactions. This study examined the implications of social anhedonia for romantic relationship functioning, including the association of social anhedonia with sentiments towards romantic partners that are central to relationship functioning (satisfaction, commitment, regard, and care), analogous perceptions of the partner’s sentiments, hostile behavior during relationship conflict, and perception of the partner’s hostile behavior. Data were collected from 281 participants who were involved in romantic relationships. Support was found for social anhedonia’s hypothesized negative association with satisfaction, regard, and care, as well as all four perceived partner sentiments. These associations were independent of attachment anxiety and avoidance. Additionally, attachment avoidance mediated social anhedonia’s relationship with commitment. However, no support was found for social anhedonia’s hypothesized positive association with actual and perceived partner hostile behavior. Results suggest that social anhedonia may undermine the functioning of interpersonal relationships.
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Critical thinking in learners is a goal of educators and professional organizations in nursing as well as other professions. However, few studies in nursing have examined the role of the important individual difference factors topic knowledge, individual interest, and general relational reasoning strategies in predicting critical thinking. In addition, most previous studies have used domain-general, standardized measures, with inconsistent results. Moreover, few studies have investigated critical thinking across multiple levels of experience. The major purpose of this study was to examine the degree to which topic knowledge, individual interest, and relational reasoning predict critical thinking in maternity nurses. For this study, 182 maternity nurses were recruited from national nursing listservs explicitly chosen to capture multiple levels of experience from prelicensure to very experienced nurses. The three independent measures included a domain-specific Topic Knowledge Assessment (TKA), consisting of 24 short-answer questions, a Professed and Engaged Interest Measure (PEIM), with 20 questions indicating level of interest and engagement in maternity nursing topics and activities, and the Test of Relational Reasoning (TORR), a graphical selected response measure with 32 items organized in scales corresponding to four forms of relational reasoning: analogy, anomaly, antithesis, and antinomy. The dependent measure was the Critical Thinking Task in Maternity Nursing (CT2MN), composed of a clinical case study providing cues with follow-up questions relating to nursing care. These questions align with the cognitive processes identified in a commonly-used definition of critical thinking in nursing. Reliable coding schemes for the measures were developed for this study. Key findings included a significant correlation between topic knowledge and individual interest. Further, the three individual difference factors explained a significant proportion of the variance in critical thinking with a large effect size. While topic knowledge was the strongest predictor of critical thinking performance, individual interest had a moderate significant effect, and relational reasoning had a small but significant effect. The findings suggest that these individual difference factors should be included in future studies of critical thinking in nursing. Implications for nursing education, research, and practice are discussed.
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Debido a los constantes cambios económicos y avances tecnológicos, la aplicación de nuevos enfoques y aumento en la competencia, obliga a las empresas a asumir nuevos retos, como mejorar sus procesos de costeo; utilizando métodos que permitan determinar de mejor manera como asignar los costos y así obtener cifras confiables para una acertada toma de decisiones.Para la realización de la investigación, se tomaron como unidades de análisis los restaurantes dedicados a la elaboración de pollo rostizado del municipio de san salvador, haciendo uso de herramientas de recolección de datos como el cuestionario, desarrollándose posteriormente el procesamiento de datos, dando como resultado un diagnóstico que muestra la situación actual de las entidades, de esta manera se constató que dichas empresas carecen de un método de costeo que muestre adecuadamente el costo invertido en la producción; es por ello que se propone en el presente trabajo la aplicación del sistema de costos basados en actividades como una respuesta a la problemática, permitiéndoles obtener de manera adecuada una distribución razonable de los desembolsos que no están directamente relacionados con la producción pero son indispensables para ella; ya que estos son distribuidos a las labores que son necesarias para la elaboración del producto. Hoy en día ABC ofrece la forma más rápida y eficaz de reducir los costos, porque se adquiere suficiente información para comprender cuáles son los verdaderos inductores de recurso y actuar sobre éstos para obtener un proceso racional, por lo tanto al distribuir los costes indirectos mediante la metodología de dicho sistema, se reconoce la relación causa efecto entre los generadores del costo con las actividades, brindando el conocimiento necesario para el mejoramiento, la optimización y la complejidad de los procesos que generará mayores coste. Se tomó como ejemplo un restaurante el cual proporciono la información necesaria, para describir las generalidades del proceso productivo; esto permitió determinar los costos a través del método (ABC), por consiguiente se realizó un análisis de los resultados obtenidos de modo que se determinó que la aplicación de este sistema, es conveniente para todo tipo de empresas, sean estas de servicios, industriales, comerciales; pues esta técnica innovadora identifica las actividades que generan valor a los productos logrando mayor precisión en la determinación de importe invertido en la producción. Por tanto, se concluye que es necesaria la implementación de una herramienta que les permita enfocar y asignar los costos a cada actividad y que le proporcione información oportuna para la toma de decisiones, mejorando los diferentes procesos productivos y su competitividad.
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Dissertação (mestrado)—Universidade de Brasília, Faculdade de Agronomia e Medicina Veterinária, Programa de Pós-Graduação em Agronomia, 2016.
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La presente investigación contiene un Estudio de Factibilidad realizado a las microempresas panificadoras del municipio de Pasaquina, sobre el incremento de su producción y venta. desarrollado mediante tres capítulos, donde se expresan las generalidades de las microempresas, sus características y clasificación, así como también el significado del Estudio de Factibilidad y la importancia de su aplicación, considerando el proceso productivo que poseen, la tecnología aplicada y la mano de obra calificada, como capítulo I. En dicha investigación, posee una metodología científica en la que se plantea el problema, se formulan los objetivos, así como también las hipótesis y se finaliza con el análisis e interpretación de los resultados que han sido determinados mediante una encuesta realizada a los consumidores y varias entrevistas a los productos, con base al cuestionario elaborado para ambos sectores involucrados. Lo anterior es lo que permite expresas el diagnóstico sobre la situación de estas microempresas panificadoras, que se resumen en las conclusiones presentadas, como es el caso de que estas microempresas, no incentivan el consumo de pan a clientes actuales ni potenciales, no poseen maquinaria moderna, no realiza planeación de ingresos ni egresos, no están constituidos legalmente, no capacitan a su personal, etc. En este mismo diagnostico se plantean las recomendaciones que mejoran la condición de estas como es: incentivar el consumo de pan mediante promoción y publicidad, adquirir maquinaria moderna, aumentar la variedad de pan, elaborar presupuesto de materia prima e insumos, constituirse legalmente, llevar registros contables, etc. Es lo que se logra en el capítulo II. mejorar las condiciones de dichas microempresas, es el objetivo que se pretende lograr con la implementación del Estudio de Factibilidad técnico y económico desarrollado. En el que plantea como se debe organizar panadería “LILY”, la misión que debe poseer, su visión, así como también sus objetivos y políticas. Además se analiza el producto actual y su proceso de producción como también sus productos propuestos y su nuevo proceso de producción adoptando nueva tecnología y capacitando la mano de obra. En este mismo Estudio de Factibilidad, se analiza la viabilidad técnica, legal, el incremento de la oferta de productos, la promoción y publicidad de los mismos y sobre todo la adquisición de maquinaria y equipo, lo que permite considerar si las mejoras propuestas son factibles para estas microempresas. Panadería “Lily”, realiza una inversión en la que su financiamiento y sus fuentes están propuestos, al igual que la implementación del estudio mediante el desarrollo del periodo de recuperación de la inversión, su tasa interna de retorno y su valor actual neto. Se demuestra también la rentabilidad que obtendría panadería “Lily” por cada dólar invertido y la amortización de la deuda adquirida en concepto de dichos presupuestos realizados para el monto de la inversión. Es necesario mencionar que la implementación de éste estudio, facilita el camino a seguir para alcanzar como empresa otra clasificación económica, genera una mayor rentabilidad a sus propietarios y al país mayor empleo a la población
Resumo:
This paper aims at studying UFRN Parafolclórico Group, whose aesthetic formation is subjected to our analysis, specially at its two last performances, that is, Flor do Lírio (Lily Flower), 2004, and Debaixo do Barro do Chão (Under the Mud of the Ground), 2008. Three targets are envisaged here: to analyze the aesthetic ideas backing Parafolclórico Group exhibitions; to evaluate how their many folk elements interact with different artist languages in order to compose a certain choreography; and finally, to identify the aesthetic conformation placed behind the two different choreographs of the last performances, their trends and innermost features that differentiate them. In accordance with the Analysis of Contents (BARDIN, 2006), interviews have been made with the choreographers and the staff of the spectacles, resulting in elucidating answers to the understanding of their thematic axis. On the first chapter we called attention to motivating subjects as recollection, personal experiences, bibliography research, research in loco regarded as propelling forces of the creative works. Herein, folk culture is depicted as a dynamic process opening a frank dialogue with contemporary events and reinforcing their continuity. On the second chapter, we approached the aesthetic conformation and the scenic elements (costumes, light, scenario, make-up), integrating the studied spectacles and disseminating folk songs in various ways. As what concerns the subjects discourse, we have obtained support in authors like Robatto (1994); Lobo; Navas (2008); Burke (1989); Canclini (2006); Dufrenne (2005); Medeiros (2005); Pavis (2005); Silva (2005), among others. Those authors have provided us with an indispensable theoretic support which, added to the interviews, convinced us that the Parafolclórico Group s aesthetic conception tends to identify itself with the artist languages and other techniques of that Group. It also made sure that the Group s course aims at an aesthetic conception which is not limited to popular culture manifestations, like dance, but admits to play with other media in order to communicate its art. In view of this situation, we arrived to two conclusions: first: the group s interchanges emphasize the dynamic character of popular culture which, by establishing contacts with different realities, receives influences capable of extending its own continuity; second: the contemporary state of arts also improves multiple interchanges opening way, so, for many accomplishments in their field. Therefore, UFRN Parafolclórico Group inserts itself in the contemporary scenery by performing new evaluations of the popular dances as long as it puts them in contact with different technical, aesthetic, artist and culture combinations