Resolução da ambivalência em terapia narrativa

Dissertação de mestrado integrado em Psicologia

Momentos de inovação e mudança na terapia cognitivo comportamental para a bulimia nervosa

Dissertação de mestrado em Psicologia Aplicada

Self-narrative reconstruction after dilemma-focused therapy for depression: a comparison of good and poor outcome cases

Objective: The aim of this study is to improve the understanding of self-changes after an intervention for depression focused on implicative dilemmas, a type of cognitive conflict related to identity. As recent research has highlighted the relevance of identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients’ self-narratives. Method: We used three instruments to observe differences between good (n = 5) and poor (n = 5) outcome cases: (i) the Repertory Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients’ accounts of changes at posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients’ novelties at the Change Interview. Results: Groups did not differ in terms of the number and relevance of client-identified significantly helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher levels of symptom improvement. Conclusions: Good outcome cases seem to be associated with the resolution of conflicts and high-level IMs.

Narrative change in Gloria Films: Comparing various processes of therapeutic innovation

Aims: The present study focuses on the analysis of novelty emergence in classic Gloria Films with Rogers, Perls, and Ellis to understand how the same client formulated her own problem and if and how change occurred in those three sessions. Method: The Innovative Moments Coding System was applied to track innovative moments (IMs) and their themes. Results: The session with Rogers showed more diversity in disclosed problems and themes of IMs, as well as a higher proportion of reflection IMs. The session with Perls demonstrated a high proportion of protest IMs. The session with Ellis showed less innovation than other sessions. The changes found were based mostly on reflection and protest IMs in three sessions. Conclusion: Narrative innovations occurred in the three single sessions. The type of dominant innovation is consistent with the therapeutic model and the IMs model. The exploration of the IMs’ themes allowed a more precise identification of Gloria's new narrative positions and their development throughout those sessions.

The GYRO System: a Recommended Approach to More Transparent Documentation

The GYRO documentation system offers a simple and efficient method for a friction ridge examiner to document the analysis and comparison stages of the ACE-V process. GYRO uses a color-coding system to convey the analyst's degree of confidence in the existence of a feature and the degree of variation to which that feature max appear in a corresponding exemplar print. We also explore the benefits and utility of the PiAnoS software, which bears some similarity to GYRO, but with added tools.

Innovation Process Management and System Modelling

Työn tavoitteena oli perehtyä innovaatiojohtamisen ja järjestelmän soveltamiseen prosessiteollisuuden toimintaympäristöön. Kirjallisuuslähteitä apuna käyttäen perehdyttiin liiketoimintaympäristön innovaatiojohtamiselle asettamiin vaatimuksiin ja erilaisiin innovaatiojärjestelmiin. Olennaisena osana innovaatiojohtamiseen liittyy sidosryhmien tarpeiden ja niiden tarjoamien resurssien huomioiminen toiminnassa. Myöskin tuotekehityksen menetelmät ja työkalut ovat omalta osaltaan merkittävässä asemassa toiminnan tehokkuutta arvioitaessa. Innovaatiojärjestelmä tulee sopeuttaa yrityksen toimintoihin ja sen erityispiirteet huomioonottaen siten, että toiminnan johtaminen prosessina tuo yritykselle ja sen sidosryhmille lisäarvoa. Innovaatiojärjestelmän luominen yritykselle on ainayksilöllinen prosessi ja siihen ei ole olemassa yleispätevää menetelmää, joka voitaisiin ottaa käyttöön sellaisenaan. Yritys, jonka liiketoiminta keskittyy kuitupohjaisten pakkausmateriaalien valmistamiseen, joutuu täyttämään toiminnassaan materiaalintoimittajien, omien tuotantoprosessiensa ja asiakkaiden sekä jopa loppukäyttäjien uusille tuotteille luomat odotukset. Innovaatiojohtamista sävyttää toiminnan tulosten suuri epävarmuus ja sen vaativien aineellisten ja henkisten resurssien mittavuus. Innovaatiotoiminnan johtaminen prosessina, käyttäen hyväksi järjestelmämallia, tavoittelee systemaattista ja asetettujen kriteerien täyttämää lähestymistapaa tuotekehityksen ja uusien liiketoimintainnovaatioiden alueella. Kehitetyn mallin tulee palvella monimutkaista liiketoimintaympäristöä, jokatoisaalta perustuu tehokkaaseen massatuotantoon ja toisaalta pyrkii erilaistumaan palvelemalla sekä huomioimalla asiakkaidensa tuotteille asettamat vaatimukset.

The Clinical Utility of the Adult Attachment Projective Picture System: A Clinician's Perspective

The Adult Attachment Projective Picture System (AAP) is the first performance- based measure of adult attachment to be developed. The purpose of the measure is to provide a clinical understanding of an adult client's attachment status and associated coping mechanisms. The AAP is a relatively new measure that has yet to be examined from a utility perspective. In the current study, seven psychologists completed a structured survey in order to identify their perspectives of the AAP and its utility as a clinical instrument. A phenomenological qualitative analysis of the data was conducted to derive themes about the AAP and its clinical utility. Analyses aimed to answer the following: What clinical considerations do clinician's focus on when deciding to use this measure? What are common factors among clinician's who do use the measure as well as those who do not? What aspects of the measure are user-friendly and what aspects are difficult? General themes that emerged include (a) the clinical information provided by the AAP is viewed by those who use it as unique and beneficial; (b) time commitment and cost for the clinician are common considerations when clinician's are deciding whether or not to use the AAP or when pursuing training; (c) the AAP provides an increased understanding of one's relational capacities and defenses; and (d) the coding system and transcription process are difficult aspects of the AAP and influence how and/or when it is used. In addition to these themes, multiple respondents discussed potential changes for the AAP that would increase their future use of the instrument. Finally, the implications of these results are discussed.

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

Background: The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods: The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

Retrieving designs from a sketch using an automated GT coding and classification system

While the retrieval of existing designs to prevent unnecessary duplication of parts is a recognised strategy in the control of design costs the available techniques to achieve this, even in product data management systems, are limited in performance or require large resources. A novel system has been developed based on a new version of an existing coding system (CAMAC) that allows automatic coding of engineering drawings and their subsequent retrieval using a drawing of the desired component as the input. The ability to find designs using a detail drawing rather than textual descriptions is a significant achievement in itself. Previous testing of the system has demonstrated this capability but if a means could be found to find parts from a simple sketch then its practical application would be much more effective. This paper describes the development and testing of such a search capability using a database of over 3000 engineering components.

Stimulating design reuse through automated coding

In designing new product the ability to retrieve drawings of existing components is important if costs are to be controlled by preventing unnecessary duplication if parts. Component coding and classification systems have been used successfully for these purposes but suffer from high operational costs and poor usability arising directly from the manual nature of the coding process itself. A new version of an existing coding system (CAMAC) has been developed to reduce costs by automatically coding engineering drawings. Usability is improved be supporting searches based on a drawing or sketch of the desired component. Test results from a database of several thousand drawings are presented.

Engineering design of an integrated sustainable process system for cassava biobased materials

Cassava contributes significantly to biobased material development. Conventional approaches for its bio-derivative-production and application cause significant wastes, tailored material development challenges, with negative environmental impact and application limitations. Transforming cassava into sustainable value-added resources requires redesigning new approaches. Harnessing unexplored material source, and downstream process innovations can mitigate challenges. The ultimate goal proposed an integrated sustainable process system for cassava biomaterial development and potential application. An improved simultaneous release recovery cyanogenesis (SRRC) methodology, incorporating intact bitter cassava, was developed and standardized. Films were formulated, characterised, their mass transport behaviour, simulating real-distribution-chain conditions quantified, and optimised for desirable properties. Integrated process design system, for sustainable waste-elimination and biomaterial development, was developed. Films and bioderivatives for desired MAP, fast-delivery nutraceutical excipients and antifungal active coating applications were demonstrated. SRRC-processed intact bitter cassava produced significantly higher yield safe bio-derivatives than peeled, guaranteeing 16% waste-elimination. Process standardization transformed entire root into higher yield and clarified colour bio-derivatives and efficient material balance at optimal global desirability. Solvent mass through temperature-humidity-stressed films induced structural changes, and influenced water vapour and oxygen permeability. Sevenunit integrated-process design led to cost-effectiveness, energy-efficient and green cassava processing and biomaterials with zero-environment footprints. Desirable optimised bio-derivatives and films demonstrated application in desirable in-package O2/CO2, mouldgrowth inhibition, faster tablet excipient nutraceutical dissolutions and releases, and thymolencapsulated smooth antifungal coatings. Novel material resources, non-root peeling, zero-waste-elimination, and desirable standardised methodology present promising process integration tools for sustainable cassava biobased system development. Emerging design outcomes have potential applications to mitigate cyanide challenges and provide bio-derivative development pathways. Process system leads to zero-waste, with potential to reshape current style one-way processes into circular designs modelled on nature's effective approaches. Indigenous cassava components as natural material reinforcements, and SRRC processing approach has initiated a process with potential wider deployment in broad product research development. This research contributes to scientific knowledge in material science and engineering process design.

Avaliação de um processo de aconselhamento na construção de carreira: estudo de caso

Dissertação de mestrado integrado em Psicologia

Restabelecimento da colaboração terapêutica num caso de sucesso seguido em Terapia Narrativa

Dissertação de mestrado integrado em Psicologia

Improved accuracy of co-morbidity coding over time after the introduction of ICD-10 administrative data.

BACKGROUND: Co-morbidity information derived from administrative data needs to be validated to allow its regular use. We assessed evolution in the accuracy of coding for Charlson and Elixhauser co-morbidities at three time points over a 5-year period, following the introduction of the International Classification of Diseases, 10th Revision (ICD-10), coding of hospital discharges.METHODS: Cross-sectional time trend evaluation study of coding accuracy using hospital chart data of 3'499 randomly selected patients who were discharged in 1999, 2001 and 2003, from two teaching and one non-teaching hospital in Switzerland. We measured sensitivity, positive predictive and Kappa values for agreement between administrative data coded with ICD-10 and chart data as the 'reference standard' for recording 36 co-morbidities.RESULTS: For the 17 the Charlson co-morbidities, the sensitivity - median (min-max) - was 36.5% (17.4-64.1) in 1999, 42.5% (22.2-64.6) in 2001 and 42.8% (8.4-75.6) in 2003. For the 29 Elixhauser co-morbidities, the sensitivity was 34.2% (1.9-64.1) in 1999, 38.6% (10.5-66.5) in 2001 and 41.6% (5.1-76.5) in 2003. Between 1999 and 2003, sensitivity estimates increased for 30 co-morbidities and decreased for 6 co-morbidities. The increase in sensitivities was statistically significant for six conditions and the decrease significant for one. Kappa values were increased for 29 co-morbidities and decreased for seven.CONCLUSIONS: Accuracy of administrative data in recording clinical conditions improved slightly between 1999 and 2003. These findings are of relevance to all jurisdictions introducing new coding systems, because they demonstrate a phenomenon of improved administrative data accuracy that may relate to a coding 'learning curve' with the new coding system.

Integration of teacher education into the Swiss higher education system

The integration of specific institutions for teacher education into the higher education system represents a milestone in the Swiss educational policy and has broad implications. This thesis explores organizational and institutional change resulting from this policy reform, and attempts to assess structural change in terms of differentiation and convergence within the system of higher education. Key issues that are dealt with are, on the one hand, the adoption of a research function by the newly conceptualized institutions of teacher education, and on the other, the positioning of the new institutions within the higher education system. Drawing on actor-centred approaches to differentiation, this dissertation discusses system-level specificities of tertiarized teacher education and asks how this affects institutional configurations and actor constellations. On the basis of qualitative and quantitative empirical data, a comparative analysis has been carried out including case studies of four universities of teacher education as well as multivariate regression analysis of micro-level data on students' educational choices. The study finds that the process of system integration and adaption to the research function by the various institutions have unfolded differently depending on the institutional setting and the specific actor constellations. The new institutions have clearly made a strong push to position themselves as a new institutional type and to find their identity beyond the traditional binary divide which assigns the universities of teacher education to the college sector. Potential conflicts have been identified in divergent cognitive normative orientations and perceptions of researchers, teacher educators, policy-makers, teachers, and students as to the mission and role of the new type of higher education institution. - L'intégration dans le système d'enseignement supérieur d'institutions qui ont pour tâche spécifique de former des enseignants peut être considérée comme un événement majeur dans la politique éducative suisse, qui se trouve avoir des conséquences importantes à plusieurs niveaux. Cette thèse explore les changements organisationnels et institutionnels résultant de cette réforme politique, et elle se propose d'évaluer en termes de différentiation et de convergence les changements structurels intervenus dans le système d'éducation tertiaire. Les principaux aspects traités sont d'une part la nouvelle mission de recherche attribuée à ces institutions de formation pédagogique, et de l'autre la place par rapport aux autres institutions du système d'éducation tertiaire. Recourant à une approche centrée sur les acteurs pour étudier les processus de différen-tiation, la thèse met en lumière et en discussion les spécificités inhérentes au système tertiaire au sein duquel se joue la formation des enseignants nouvellement conçue et soulève la question des effets de cette nouvelle façon de former les enseignants sur les configurations institutionnelles et les constellations d'acteurs. Une analyse comparative a été réalisée sur la base de données qualitatives et quantitatives issues de quatre études de cas de hautes écoles pédagogiques et d'analyses de régression multiple de données de niveau micro concernant les choix de carrière des étudiants. Les résultats montrent à quel point le processus d'intégration dans le système et la nouvelle mission de recherche peuvent apparaître de manière différente selon le cadre institutionnel d'une école et la constellation spécifique des acteurs influents. A pu clairement être observée une forte aspiration des hautes écoles pédagogiques à se créer une identité au-delà de la structure binaire du système qui assigne la formation des enseignants au secteur des hautes écoles spéciali-sées. Des divergences apparaissent dans les conceptions et perceptions cognitives et normatives des cher-cheurs, formateurs, politiciens, enseignants et étudiants quant à la mission et au rôle de ce nouveau type de haute école. - Die Integration spezieller Institutionen für die Lehrerbildung ins Hochschulsystem stellt einen bedeutsamen Schritt mit weitreichenden Folgen in der Entwicklung des schweizerischen Bildungswesens dar. Diese Dissertation untersucht die mit der Neuerung verbundenen Veränderungen auf organisatorischer und institutioneller Ebene und versucht, die strukturelle Entwicklung unter den Gesichtspunkten von Differenzierung und Konvergenz innerhalb des tertiären Bildungssystems einzuordnen. Zentrale Themen sind dabei zum einen die Einführung von Forschung und Entwicklung als zusätzlichem Leistungsauftrag in der Lehrerbildung und zum andern die Positionierung der pädagogischen Hochschulen innerhalb des Hochschulsystems. Anhand akteurzentrierter Ansätze zur Differenzierung werden die Besonderheiten einer tertiarisierten Lehrerbildung hinsichtlich der Systemebenen diskutiert und Antworten auf die Frage gesucht, wie die Reform die institutionellen Konfigurationen und die Akteurkonstellationen beeinflusst. Auf der Grundlage qualitativer und quantitativer Daten wurde eine vergleichende Analyse durchgeführt, welche Fallstudien zu vier pädagogischen Hochschulen umfasst sowie Regressionsanalysen von Mikrodaten zur Studienwahl von Maturanden. Die Ergebnisse machen deutlich, dass sich der Prozess der Systemintegration und die Einführung von Forschung in die Lehrerbildung in Abhängigkeit von institutionellen Ordnungen und der jeweiligen Akteurkonstellation unterschiedlich gestalten. Es lässt sich bei den neu gegründeten pädagogischen Hochschulen ein starkes Bestreben feststellen, sich als neuen Hochschultypus zu positionieren und sich eine Identität zu schaffen jenseits der herkömmlichen binären Struktur, welche die pädagogischen Hochschulen dem Fachhochschul-Sektor zuordnet. Potentielle Konflikte zeichnen sich ab in den divergierenden kognitiven und normativen Orientierungen und Wahrnehmungen von Forschern, Ausbildern, Bildungspolitikern, Lehrern und Studierenden hinsichtlich des Auftrags und der Rolle dieses neuen Typs Hochschule.