Introduction to the practice of telemedicine

Telemedicine is the delivery of health care and the exchange of health-care information across distances. It is not a technology or a separate or new branch of medicine. Telemedicine episodes may be classified on the basis of: (I) the interaction between the client and the expert (i.e. realtime or prerecorded), and (2) the type of information being transmitted (e.g. text, audio, video). Much of the telemedicine which is now practised is performed in industrialized countries, such as the USA, but there is increasing interest in the use of telemedicine in developing countries. There are basically two conditions under which telemedicine should be considered: (I) when there is no alternative (e.g. in emergencies in remote environments), and (2) when it is better than existing conventional services (e.g. teleradiology for rural hospitals). For example, telemedicine can be expected to improve equity of access to health care, the quality of that care, and the efficiency by which it is delivered. Research in telemedicine increased steadily in the late 1990s, although the quality of the research could be improved - there have been few randomized controlled trials to date.

The UN Security Council and the question of humanitarian intervention in Darfur

This article explores the different moral and legal arguments used by protagonists in the debate about whether or not to conduct a humanitarian intervention in Darfur. The first section briefly outlines four moral and legal positions on whether there is (and should be) a right and/or duty of humanitarian intervention: communitarianism, restrictionist and counter-restrictionist legal positivism and liberal cosmopolitanism. The second section then provides an overview of the Security Council's debate about responding to Darfur's crisis, showing how its policy was influenced by both normative concerns and hard-nosed political calculations. The article concludes by asking what Darfur's case reveals about the legitimacy and likelihood of humanitarian intervention in such catastrophes and the role of the UN Security Council as the primary authorising body for the use of international force. The authors argue that this case demonstrates that for the cosmopolitan/counter-restrictionist case to prevail pivotal states need to put humanitarian emergencies on the global agenda and express a willingness to act without Council authorisation, though the question of how to proceed in cases where the Council is deadlocked remains vexed.

OS DESAFIOS DO PROFESSOR COORDENADOR PEDAGÓGICO NA FORMAÇÃO CONTINUADA DOS DOCENTES DO ENSINO FUNDAMENTAL: O CASO DA REGIÃO DO VALE DO RIBEIRA/SP

O presente estudo realiza uma análise sobre as funções de trabalho do Professor Coordenador Pedagógico da Rede Pública Estadual de Ensino, considerando os desafios e as contribuições da ação coordenadora e, principalmente, como esse profissional do ensino articula a formação continuada dos docentes e a sua própria formação como educador. As questões norteadoras da pesquisa são: 1. De que forma o Professor Coordenador Pedagógico consegue dar conta da formação dos docentes, durante as reuniões de HTPC Horário de Trabalho Pedagógico e Coletivo? 2.Como consegue cuidar de sua própria formação continuada, diante dos inúmeros entraves e obstáculos, das múltiplas resistências, dos conflitos, das emergências, dos imediatismos e da sobrecarga de trabalho, tendo em vista as relações interpessoais no seio da Escola? O trabalho analisa os pontos comuns e os diferenciais da ação coordenadora e a forma como ela interfere na construção de um ensino de melhor qualidade, bem como o papel do Professor Coordenador Pedagógico como mediador e articulador desse processo. Os referenciais teóricos que fundamentam esta pesquisa encontram-se no legado de Paulo Freire (1982a/1982b/1983/1991/1997/2000), com a reintegração das dimensões do homem que o fazem humano, pessoal e social, o compromisso do profissional com a Sociedade, a formação continuada; a conscientização e a mudança necessária em Educação; e de outros autores que tratam das temáticas que envolvem a Coordenação Pedagógica, formação de docentes, HTPC e relações interpessoais, como: Placco (2008), Vasconcellos (2010ª/2010b/2010c), Bruno (2008), Libâneo (1993), Rios (2001), Thurler (2002), Sergiovanni (1976), Teixeira (1977), Perrenoud (1999)/ Perrenoud et al. (2002), Nidelcoff (1983), Araújo(2002), entre outros. A pesquisa de campo, de cunho qualitativo e que pretende contribuir para o debate das questões da Educação Pública, foi realizada com Professores Coordenadores Pedagógicos de escolas estaduais da Diretoria de Ensino de Miracatu, região do Vale do Ribeira/SP, especificamente no município de Itariri, com a aplicação de questionário e realização de entrevistas de aprofundamento e os resultados apontam para o fato de que o Professor Coordenador Pedagógico consegue (ou não) exercer as atribuições que lhe são conferidas conforme forem as relações interpessoais estabelecidas no cotidiano escolar.

Extreme events, organizations and the politics of decision making

Purpose – Threats of extreme events, such as terrorist attacks or infrastructure breakdown, are potentially highly disruptive events for all types of organizations. This paper seeks to take a political perspective to power in strategic decision making and how this influences planning for extreme events. Design/methodology/approach – A sample of 160 informants drawn from 135 organizations, which are part of the critical national infrastructure in the UK, forms the empirical basis of the paper. Most of these organizations had publicly placed business continuity and preparedness as a strategic priority. The paper adopts a qualitative approach, coding data from focus groups. Findings – In nearly all cases there is a pre-existing dominant coalition which keeps business continuity decisions off the strategic agenda. The only exceptions to this are a handful of organizations which provide continuous production, such as some utilities, where disruption to business as usual can be readily quantified. The data reveal structural and decisional elements of the exercise of power. Structurally, the dominant coalition centralizes control by ensuring that only a few functional interests participate in decision making. Research limitations/implications – Decisional elements of power emphasize the dominance of calculative rationality where decisions are primarily made on information and arguments which can be quantified. Finally, the paper notes the recursive aspect of power relations whereby agency and structure are mutually constitutive over time. Organizational structures of control are maintained, despite the involvement of managers charged with organizational preparedness and resilience, who remain outside the dominant coalition. Originality/value – The paper constitutes a first attempt to show how planning for emergencies fits within the strategy-making process and how politically controlled this process is.

Informal dissemination scenarios and the effectiveness of evacuation warning dissemination of households:a simulation study

Timely warning of the public during large scale emergencies is essential to ensure safety and save lives. This ongoing study proposes an agent-based simulation model to simulate the warning message dissemination among the public considering both official channels and unofficial channels The proposed model was developed in NetLogo software for a hypothetical area, and requires input parameters such as effectiveness of each official source (%), estimated time to begin informing others, estimated time to inform others and estimated percentage of people (who do not relay the message). This paper demonstrates a means of factoring the behaviour of the public as informants into estimating the effectiveness of warningdissemination during large scale emergencies. The model provides a tool for the practitioner to test the potential impact of the informal channels on the overall warning time and sensitivity of the modelling parameters. The tool would help the practitioners to persuade evacuees to disseminate the warning message informing others similar to the ’Run to thy neighbour campaign conducted by the Red cross.

Telehealth Approach for Glaucoma Progression Monitoring

This paper presents a Web-Centric [3] extension to a previously developed glaucoma expert system that will provide access for doctors and patients from any part of the world. Once implemented, this telehealth solution will publish the services of the Glaucoma Expert System on the World Wide Web, allowing patients and doctors to interact with it from their own homes. This web-extension will also allow the expert system itself to be proactive and to send diagnosis alerts to the registered user or doctor and the patient, informing each one of any emergencies, therefore allowing them to take immediate actions. The existing Glaucoma Expert System uses fuzzy logic learning algorithms applied on historical patient data to update and improve its diagnosis rules set. This process, collectively called the learning process, would benefit greatly from a web-based framework that could provide services like patient data transfer and web- based distribution of updated rules [1].

Algorithm of Decision Support in Emergency

Constant increase of human population result in more and more people living in emergency dangerous regions. In order to protect them from possible emergencies we need effective solution for decision taking in case of emergencies, because lack of time for taking decision and possible lack of data. One among possible methods of taking such decisions is shown in this article.

Medical emergency alarm dissemination in urban environments

During medical emergencies, the ability to communicate the state and position of injured individuals is essential. In critical situations or crowd aggregations, this may result difficult or even impossible due to the inaccuracy of verbal communication, the lack of precise localization for the medical events, and/or the failure/congestion of infrastructure-based communication networks. In such a scenario, a temporary (ad hoc) wireless network for disseminating medical alarms to the closest hospital, or medical field personnel, can be usefully employed to overcome the mentioned limitations. This is particularly true if the ad hoc network relies on the mobile phones that people normally carry, since they are automatically distributed where the communication needs are. Nevertheless, the feasibility and possible implications of such a network for medical alarm dissemination need to be analysed. To this aim, this paper presents a study on the feasibility of medical alarm dissemination through mobile phones in an urban environment, based on realistic people mobility. The results showed the dependence between the medical alarm delivery rates and both people and hospitals density. With reference to the considered urban scenario, the time needed to delivery medical alarms to the neighbour hospital with high reliability is in the order of minutes, thus revealing the practicability of the reported network for medical alarm dissemination. © 2013 Elsevier Ltd. All rights reserved.

Understanding knowledge coordination dynamics in traditional and fast-response IT organizations

This research takes a dynamic view on the knowledge coordination process, aiming to explain how the process is affected by changes in the operating environment, from normal situations to emergencies in traditional and fast-response organizations, and why these changes occur. We first conceptualize the knowledge coordination process by distinguishing between four dimensions - what, when, how and who - that together capture the full scope of the knowledge coordination process. We use these dimensions to analyze knowledge coordination practices and the activities constituting these practices, in the IT functions of traditional and fast-response (military) organizations where we distinguish between "normal" and "emergency" operating conditions. Our findings indicate that (i) inter-relationships between knowledge coordination practices change under different operating conditions, and (ii) the patterns of change are different in traditional and fast-response organizations.

Governmental social media use for emergency communication

The possibility of crowdsourced information, multi-geographical and multi-organisational information flows during emergencies and crises provided by web 2.0 tools are providing emergency management centres with new communication challenges and opportunities. Building on the existing emergency management and social media literature, this article explores how institutions are using and adopting social media for emergency communication. By examining the drivers and barriers of social media adoption in two European governmental agencies dealing with emergencies, the paper aims to establish a framework to examine whether and how institutional resilience could be improved.

Social media in emergency management:Twitter as a tool for communicating risks to the public

One of the main challenges of emergency management lies in communicating risks to the public. On some occasions, risk communicators might seek to increase awareness over emerging risks, while on others the aim might be to avoid escalation of public reactions. Social media accounts offer an opportunity to rapidly distribute critical information and in doing so to mitigate the impact of emergencies by influencing public reactions. This article draws on theories of risk and emergency communication in order to consider the impact of Twitter as a tool for communicating risks to the public. We analyse 10,020 Twitter messages posted by the official accounts of UK local government authorities (councils) in the context of two major emergencies: the heavy snow of December 2010 and the riots of August 2011. Twitter was used in a variety of ways to communicate and manage associated risks including messages to provide official updates, encourage protective behaviour, increase awareness and guide public attention to mitigating actions. We discuss the importance of social media as means of increasing confidence in emergency management institutions.

Um sistema inteligente de teleoftalmologia para o auxílio no diagnóstico de catarata

The increasing in world population, with higher proportion of elderly, leads to an increase in the number of individuals with vision loss and cataracts are one of the leading causes of blindness worldwide. Cataract is an eye disease that is the partial or total opacity of the crystalline lens (natural lens of the eye) or its capsule. It can be triggered by several factors such as trauma, age, diabetes mellitus, and medications, among others. It is known that the attendance by ophthalmologists in rural and poor areas in Brazil is less than needed and many patients with treatable diseases such as cataracts are undiagnosed and therefore untreated. In this context, this project presents the development of OPTICA, a system of teleophthalmology using smartphones for ophthalmic emergencies detection, providing a diagnostic aid for cataract using specialists systems and image processing techniques. The images are captured by a cellphone camera and along with a questionnaire filled with patient information are transmitted securely via the platform Mobile SANA to a online server that has an intelligent system available to assist in the diagnosis of cataract and provides ophthalmologists who analyze the information and write back the patient’s report. Thus, the OPTICA provides eye care to the poorest and least favored population, improving the screening of critically ill patients and increasing access to diagnosis and treatment.

A utilização da pesquisa operacional para o gerenciamento dos leitos em um hospital particular: estudo de caso baseado em simulação computacional

The hospital is a place of complex actions, where several activities for serving the population are performed such as: medical appointments, exams, surgeries, emergency care, admission in wards and ICUs. These activities are mixed with anxiety, impatience, despair and distress of patients and their families, issues involving emotional balance both for professionals who provide services for them as for people cared by them. The healthcare crisis in Brazil is getting worse every year and today, constitutes a major problem for private hospitals. The patient that comes to emergencies progressively increase, and in contrast, there is no supply of hospital beds in the same proportion, causing overcrowding, declines in the quality of care delivered to patients, drain of professionals of the health area and difficulty in management the beds. This work presents a study that seeks to create an alternative tool that can contribute to the management of a private hospital beds. It also seeks to identify potential issues or deficiencies and therefore make changes in flow for an increase in service capacity, thus reducing costs without compromising the quality of services provided. The tool used was the Computational Simulation –based in discrete event, which aims to identify the main parameters to be considered for a proper modeling of this system. This study took as reference the admission of a private hospital, based on the current scenario, where your apartments are in saturation level as its occupancy rate. The relocation of project beds aims to meet the growing demand for surgeries and hospital admissions observed by the current administration.

Representações sociais de familiares sobre o atendimento das emergências psiquiátricas

The reformist movements in the field of mental health have pointed battle flags, among which the prioritization of production of mental health care out of the asylum environment should be highlighted, aiming the reduction of psychiatric beds, greater control over the hospitalization, family co-participation and the rescue of the citizenship of the social players involved. With the progressive reduction of asylum beds, associated with a lot of structural problems in the health services, the occurrence of crises outside the hospital environment has been increasingly frequent, thus giving the family an important therapeutic role. In face of this scenario, there is an urgent need to understand the social construction of the care for psychiatric emergencies, identifying the meanings assigned by family members to their constituent aspects. This study seeks to answer the following research question: what are the social representations of family members about the care of psychiatric emergencies in the city of Mossoró, Rio Grande do Norte? Therefore, the aim is to analyze the social representations of family members about the care of psychiatric emergencies in the city of Mossoró, Rio Grande do Norte. This is an exploratory and descriptive study, with a mixed approach, making use of multimethods: for collection, the semi-structured interview and the Technique of Free Association of Words; for data analysis, the Thematic Analysis of Bardin and its steps was used, with the informational support of the softwares ALCESTE (Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte) and Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires); and the theoretical support of social representations. The study participants totaled 72, and they were selected from the following criteria: older than18 years, with degree of kinship with users suffering from some mental and behavioral disorder, and who have already witnessed a situation of crisis, rescued by the SAMU or other means and taken to the psychiatric hospital or general emergency room. Preliminary results point out: 1.Previous note of the research project with the aim to disseminate it in the scientific community and ensure the intellectual property of the work; 2.The contextual analysis of the care for emergencies in the study place. Reflection about the phenomenon provide a name to the care for the psychiatric emergencies, which is called immediate context; the technical and operational aspects that influence the care, as a specific/ general context; and mental health policies in Brazil are identified as metacontext; 3. The systematic review from randomized clinical trials in the databases PubMed, COCHRANE, LILACS, SciELO and SCIRUS, with the use of the descriptors: ‘Physical restraint’, ‘Psychiatric emergency services’, ‘Restraint’, ‘Physical and Emergency Services’, ‘Psychiatric’. Only one work met the search protocol criteria: a short-term essay that records limited results about the proportion of people who are in restraint and seclusion. It does not show statistically significant results in relation to indications, contraindications and risks of the use of physical restraint; 4. The social representations of the care for psychiatric emergencies. The study results point to the presence of five thematic categories: 1. feeling in the face of the crisis/care; 2. thoughts and perspectives about the crisis/care; 3. centrality of care in the medical- medication-hospitalization triad; 4. the thinking/acting in the face of the use of physical restraint and police force; 5. periodicity of crises. The central core of the representation is in the first category, whilst the peripheral elements are in the third and fifth categories. The contrast zone is in the second and fourth categories. The sadness is the most prominent element of the structure. The social representations about the care for psychiatric crises are at a time of transition between the hegemonic and reformist models, with the traditional aspects being predominant, but already showing peripheral and contrast elements that point to a possible change in the representational field.

Atividade de formação interprofissional em urgência pré-hospitalar

To acting in emergencies it is important that health professionals develop specific and differentiated skills, which shows us the importance of training in emergency planning. So undergraduate courses in medicine and nursing should encourage the development of these skills and evaluate them through various instruments targeted to the different fields. The aim of this study was to implement an optional and interprofessional curricular component, focusing on interprofessional education in pre-hospital emergency for medical and nursing courses Federal University of Rio Grande do Norte (UFRN). This is an exploratory descriptive study, with 24 medical and nursing graduates of last year undergraduate of supervised training, who underwent theoretical and practical training in the care of pre-hospital emergency services. There were theoretical and practical lessons per week for one school semester, taught by doctors and nurses of the Emergency Medical Service (EMS), where the topics discussed were: basic and advanced life support, safe transport in clinical emergencies, trauma, gynecological, obstetric, pediatric and psychiatric diseases, and have been carried out practical activities in ambulances. The students were evaluated by pre-test, post-test and practical stations made through the Objective Structured Clinical Evaluation (OSCE), in the skills laboratory of the Health Sciences Center. During the activities the students were encouraged to critical and reflective thinking, highlighting the importance of integration between the various health care professionals. It was observed that 88% of the students had a score increase over the pre-test. In the evaluation process carried out by medical students and nursing UFRN have similar expectations regarding the essential skills acquired during the training activity. The results of this study will form the basis for the organization of interprofessional education activity in pre-hospital emergency medical students and nursing, as well as helped to organize practices stations, identifying basic clinical skills, and implementing student assessment tools UFRN.