Talassoterapia para pacientes com fibromialgia: ensaio clínico radômico

Fibromyalgia (FM) is a chronic rheumatic syndrome characterized by diffuse muscle-skeletal pain, and aerobic exercises represent a fundamental portion in therapeutic approach. Objective of this study was to evaluate the effectiveness of aerobic exercises accomplished in the water of the sea (thalassotherapy) for women with FM and to compare with exercises accomplished in the swimming pool, involving a multidisciplinary team, composed by rheumatologists, physical therapists, students of physical therapy and students of physical education. Forty six (46) women with age between 18 and 60 years with FM were randomized in 2 groups: a swimming pool group (23 patients) and a sea group (23 patients). 80th groups trained a week with the same program of aerobic conditioning 3 times (60 minutes each) for 12 weeks. Ali the patients were evaluated, before and immediately after treatment, with Visual Analogical Scale (VAS) for pain and fatigue, number of tending points, Fibromyalgia Impact Ouestionnaire (FIO), Short Form 36 Health Survey (SF-36), Pittsburgh Sleep Ouality Index (PSOI) and Beck Oepression Inventory (BOI). For statistical analysis, it was used paired-t test for analysis intra-group and non-paired test for inter-groups analysis, significance levei of p <0,05. Four patients, of each group, didn't complete the training programo Groups were homogeneous and they were compared in initial evaluation, except for BOI (p <0,05). Both groups presented statistically significant improvement for ali appraised parameters in the post-treatment compared with initial evaluation, there were reduction of intensity of pain and fatigue, number of tending points, better functional capacity (FIO), life quality (SF-36), quality of sleep (PSQI) and depression indexes (BOI). However, in comparison among the groups, group of sea (thalassotherapy) presented better results for ali parameters, however with statistically significant difference just only for depression indexes (BOI). At the end, it was observed that accomplishment of aerobic exercises in sea water or swimming pool was effective as part of treatment for patients with FM. However, exercise programs with thalassotherapy seems to bring more benefits, mainly related to emotional aspects, could be a therapeutic option of low cost for patients with FM in our area

Estudo do perfil térmico de fornos do tipo "caipira" utilizados pelo setor de cerâmica vermelha em parelhas na região Seridó-RN

The present study aimed to characterize the thermal profile of wood fired oven used by the red ceramic industry in Parelhas, in the Seridó region/RN, aiming to propose structural interventions that can contribute to increasing productivity and product quality, optimize wood consumption and mitigate existing losses during the burning process. The study was conducted at Cerâmica Esperança in the city of Parelhas -RN, Brazil, during the period from August 2012 to September 2013. Four treatments were performed with three replicates, ie, with, a total of 12 experimental units (burnings). In the first stage 4 treatments were performed with three replicates, totaling 12 experimental units (firings). In the second stage 2 treatments were performed with three replications, totaling 6 experimental units (firings). The physical characteristics of the wood were analyzed using standard NBR 11941 and NBR 7190 for basic density and moisture, respectively. The clay was used as a reference parameter for distinguishing treatments. For both the analysis and characterization was carried out using techniques of fluorescence X (XRF) rays, X-ray diffraction (XRD) analysis, particle size analysis (FA). In the first and second stages were monitored: the time during the firing process, the amount of wood used at each firing, the number of parts enfornadas for subsequent determination of the percentages of losses, but also product quality. To characterize the thermal profile of the oven, we measured the temperature at 15 points scored in the surface charge put into the oven. Measurements were taken every 30 minutes from preheat until the end of burning, using a pyrometer laser sight sighting from preheating until the end of burning. In the second step 12 metal cylinders distributed on the oven walls, and the cylinder end walls 8 of the furnace 2 and rollers on each side walls are installed equidistant to 17 cm from the soil and the surface 30 of the wall are installed. The cylinders distributed on the front were placed 50 cm above the furnace, and the base of the oven 20 cm distant from the ground. 10 also thermocouples were installed, and five thermocouples distributed 1.77 cm above the combustion chambers, and one thermocouple on each side, and three thermocouples in front of the oven. We carried out the measurements of the temperatures every 1 hour during the burning two hours in cooling the cylinders with a pyrometer and thermocouples for dattaloger. These were fixed with depth of 30 cm from the wall. After statistical analysis it was found that: the thermal profile of the furnace surface and at different heights was heterogeneous; and the ranges of density and moisture content of wood are within recommended for use as an energy source standards. We conclude that even at low temperatures reached during firing there was a significant production of good quality products, this is due to high concentrations of iron oxide and potassium oxide found in clay, which lowers the melting point of the piece. The average burn time for each step varied 650-2100 minutes wood consumption was on average 20 m3, product quality was on average 16% of first quality, 70% second, third and 5% to 10% loss . The distance between the wire and the surface of the oven was a significant parameter for all treatments, but with different variations, meaning that the wire should not be so generic and unique form, used as a criterion for completion of the burn process. The central part of the furnace was the area that reached higher temperature, and in a unified manner, with the highest concentration of top quality products. The ideal temperature curve, which provided the highest quality of ceramic products was achieved in the central part of the furnace

Wittgenstein e Bourdieu: diálogos para uma sociologia prática

The dialogue between philosopher Ludwig Wittgenstein s notions and Pierre Bourdieu s sociological concepts related to social practice of language shows that the philosophy of language has an important influence on contemporary social theory. When we compare the ideas of these authors we discover that beyond the direct influences from the philosopher that the sociologist recognizes there are great parallelisms of thought. That is, Wittgenstein s pragmatic thought of the use of language does not concern only language, but also every socially built behavior. When we notice that the social and linguistic behavior are borne by the individual in a tacit way, that leads us to theorize about the prereflective dimension that builds human actions and even the habits of thought. The same processes allow the uses of language to build wider social practices. Besides, John Austin, one of Wittgenstein s disciples, and his speech acts theory, contribute with a way to reflecting on how language ressembles a concrete action. Finally, the linguistc therapy that Wittgenstein means to be his philosophical proposal is assimilated by Bourdieu, who takes it as one of the necessary topics of the sociological work

A festa do bom Jesus dos navegantes em propriá-se: história de fé, espaço das relações sociais e laços culturais

The study is a survey conducted for the Master of Social Sciences carried out in partnership between the Universidade Tiradentes-UNIT/SE and the Universidade Federal do Rio Grande do Norte (UFRN). Being a religious event, we seek to show that the religious parties generally have particular meanings for each nation or region. Amaral (1998) informs that the Brazilian parties regardless of where they occur are popular demonstrations that, as the context in which they present themselves, can dilute to crystallize, to celebrate, to ritualize or sacralize the particular social experience of the groups that do. They happen as a way to thank victories or important religious passages as Christmas, the June saints celebration, patron saints and patron saints considered. Thus, The Bom Jesus dos Navegantes party in Propriá-SE: story of faith, a space of social relations and cultural ties, is presented as our field of study because it is one of those celebrations that while celebrated in Sergipe, always on Sundays in January, by some municipalities situated along the river San Francisco, has the characteristic of overlap any others placed in town, including the one of the city's patron saint, Saint Anthony, held on June 13. Concerning the materials and methods, we opted for qualitative research and participant direct observation, using the techniques of personal notes, interviews, newspapers, websites, photos, videos and testimonials from participants and organizers, as well as references offered by experts of the area. With this research answers were sought to questions about what could keep alive the celebration of Bom Jesus dos Navegantes each year in order that this is a patron saint, not saint; the way as the investment of local government with more resources in this period, during the organization of arts festivals, has created a thread of tension with the Catholic Church promoting the religious rituals was reviewed. It was also analyzed how the sacred and profane spaces present themselves inseparable from the celebration and, finally, it was revealed that the party retains its value by preserving its tradition and making room for modernity, not weakening but suffering metamorphoses of time and space and can be seen in the social and cultural bonds wrapped by the time of religious faith

As cidades medias no desenvolvimento regional: um estudo sobre Pau dos Ferros (RN)

Esta tese versa sobre as cidades médias no atual contexto do desenvolvimento urbano brasileiro e nordestino. Na região Nordeste, o processo de urbanização foi lento, atomizado, geográfico e economicamente disperso, o que resultou numa rede urbana truncada, constituída principalmente por suas nove capitais regionais e cerca de duas dezenas de cidades de porte médio, em sua maioria, interiorizadas. Foi a partir dessa rede urbana nordestina interiorizada que nos propomos a estudar Pau dos Ferros, no Rio Grande do Norte e o papel que ela desempenha na rede urbana nordestina e potiguar. Compreender os determinantes da produção do espaço urbano-regional de Pau dos Ferros que o caracterizam como cidade média, com fins a refletir sobre o seu papel no desenvolvimento regional foi o objetivo geral desta pesquisa. Nossa hipótese é que, a despeito de um contingente populacional pequeno, Pau dos Ferros vem desempenhando na rede urbana do Nordeste e do Rio Grande do Norte as funções de cidade média, particularmente, na oferta dos serviços de educação superior e saúde, além da oferta de empregos, notadamente no comércio e nos serviços públicos, o que nos permitiu tratá-la à priori, a partir do conceito de cidade (inter) média. Para esta investigação, partimos da proposta de estudo e do pensamento de autores como Faria (1978), Benko (1999) e Brandão (2007), os quais propõem o estudo do urbano a partir de situações concretas que permitam compreender os fenomenos em sua múltiplas causalidades. Dessa forma, o fio condutor desta análise foi o modo como vem se reconfigurando as cidades médias e como essa reconfiguração tem afetado de diferentes formas as relações entre as cidades e entre as cidades e as regiões. Os resultados das análises apontaram que os investimentos públicos em saúde e educação têm contribuído para a atração de investimentos privados em suas respectivas áreas, e também em outras, o que tem ajudado a dinamizar a economia da cidade, inclusive modificado parcialmente sua estrutura ocupacional. Pau dos Ferros se destacou como um polo comercial e de serviços na rede urbana potiguar, formando um outlier no Alto Oeste, organizando uma bacia de empregos na sua área de influência que constatamos ser composta por 55 municípios do RN, CE e PB. Ao se consolidar como polo regional na oferta dos serviços de saúde e de educação superior, ampliou-se o fluxo de pessoas que realizam movimento pendular para trabalho e estudo. Em síntese, constatou-se que, a despeito do pequeno contingente populacional, a configuração urbano-regional de Pau dos Ferros, tanto em termos de sua dinâmica urbana, como de sua abrangência regional, fazem dela uma cidade média na rede urbana nordestina interiorizada

Diferentes frações inspiradas de oxigênio em coelhos hipovolêmicos anestesiados com propofol e submetidos à ventilação mecânica

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Morfometria da cicatrização do cólon descendente de eqüinos submetidos a enterorrafias aposicional e invaginante

A pesquisa foi conduzida com o objetivo de comparar duas técnicas de enterorrafias no cólon descendente de eqüinos, uma aposicional e outra invaginante, utilizando-se de avaliações morfométricas. As intervenções cirúrgicas foram executadas em 15 eqüinos adultos sadios, pelo flanco esquerdo, sob anestesia geral inalatória. As enterotomias foram realizadas na tênia antimesentérica do cólon descendente e as enterorrafias foram feitas com fio de poliglactina 910 n° 0. Os eqüinos foram distribuídos aleatoriamente em cinco grupos de três animais cada e submetidos à eutanásia aos três, sete, 14, 21 e 35 dias de pós-operatório para colheita de segmentos intestinais dos locais das enterorrafias para análise morfométrica. Com o auxílio de analisador de imagens, foram contados os números de neutrófilos, células mononucleares e eosinófilos ao redor do fio de sutura. Na contagem de neutrófilos, houve diferença (P = 0,05) entre as enterorrafias, com maior número na aposicional. Quanto aos mononucleares, observou-se diferença (P = 0,01) na interação entre os dias de pós-operatório e as enterorrafias. Não foram observadas diferenças (P > 0,05) na contagem de eosinófilos. Concluiu-se que a enterorrafia invaginante causou reação inflamatória de menor intensidade que a aposicional, sendo a opção preferencial para uso neste órgão.

Enterorrafias em plano aposicional convencionale com adesivo à base de cianoacrilato no cólon descendente de eqüinos

Em eqüinos, as enterotomias no cólon descendente são necessárias para remover enterólitos, corpos estranhos e material alimentar compactado que não podem ser removidos por técnicas conservativas. Este segmento intestinal possui um suprimento sangüíneo pobre, além de predisposição a complicações pós-operatórias relacionadas à contaminação bacteriana. Assim, este estudo foi conduzido com o objetivo de efetuar avaliações clínicas e anatomopatológicas do emprego de adesivo tecidual à base de cianoacrilato no cólon descendente de eqüinos, comparando-o a uma técnica de sutura aposicional convencional. A intervenção cirúrgica foi realizada em 15 animais posicionados em decúbito lateral direito, através de laparotomia pelo flanco esquerdo, sob anestesia geral inalatória. Após a exteriorização do cólon descendente, foram realizadas duas enterotomias de cinco centímetros de extensão cada, distanciadas 20cm uma da outra. Os animais foram aleatoriamente distribuídos em cinco tempos de observação de três animais cada e sacrificados aos três, sete, 14, 35 e 70 dias de pós-operatório. O adesivo butil-2-cianoacrilato e o fio de poliglactina 910 mostraram-se igualmente apropriados para uso em enterorrafias desse órgão, sendo que o fio de poliglactina 910 provocou inflamação inicial mais intensa que o cianoacrilato e, mais tardiamente, ambos causaram inflamação granulomatosa do tipo corpo estranho observada, primeiramente, junto ao fio de poliglactina 910 (7º dia) e, a partir do 35º dia, ao redor do cianoacrilato.

The effects of 2 levels of the inspired oxygen fraction on blood gas variables in propofol-anesthetized dogs with high intracranial pressure

The influence of 2 different levels of the inspired oxygen fraction (FiO(2)) on blood gas variables was evaluated in dogs with high intracranial pressure (ICP) during propofol anesthesia (induction followed by a continuous rate infusion [CRI] of 0.6 mg/kg/min) and intermittent positive pressure ventilation (IPPV). Eight adult mongrel dogs were anesthetized on 2 occasions, 21 d apart, and received oxygen at an FiO(2) of 1.0 (G100) or 0.6 (G60) in a randomized crossover fashion. A fiberoptic catheter was implanted on the surface of the right cerebral cortex for assessment of the ICP. An increase in the ICP was induced by temporary ligation of the jugular vein 50 min after induction of anesthesia and immediately after baseline measurement of the ICP. Blood gas measurements were taken 20 min later and then at 15-min intervals for 1 h. Numerical data were submitted to Morrison's multivariate statistical methods. The ICP, the cerebral perfusion pressure and the mean arterial pressure did not differ significantly between FiO(2) levels or measurement times after jugular ligation. The only blood gas values that differed significantly (P < 0.05) were the arterial oxygen partial pressure, which was greater with G100 than with G60 throughout the procedure, and the venous haemoglobin saturation, that was greater with G100 than with G60 at M0. There were no significant differences between FiO(2) levels or measurement times in the following blood gas variables: arterial carbon dioxide partial pressure, arterial hemoglobin saturation, base deficit, bicarbonate concentration, pH, venous oxygen partial pressure, venous carbon dioxide partial pressure and the arterial-to-end-tidal carbon dioxide difference.

Tramas da (ir)racionalidade contemporânea para a composição do mito-tecno-lógico

The plot myth-techno-logic, contemporary, was developed starting from the dualism myth-reason. In this study, we deepened the alluded dualism taking as reference the historical contexts of the Renaissance and of the Enlightenment, emphasizing the discussion of the economical rationalization as conductive thread of the western development, in which we identified the game of the rational and of the irrational, for assure the superiority of the reason. In the context of that game, we analyzed the implications of the modernization, for the education, in function of the instrumental rationality, responsible for the environment of adaptation of the technological instruments to the scenery of the contemporary modernization. The new context is constituted by points of union and of ruptures among the technique, the science and the myth. Through our analysis, we noticed that the basic needs for the contemporary society were linked to the changes in the production means, for which the machine determine the rhythm of the work and the quality of the product. However, the changes in the productive processes promoted the appearance of the commercial marks that, as we see it, they represented the synthesis of the perfect harmony of the myth, of the technique, of the science and of the technology, in the conduction of the economical rationalization to the contemporary modernization. Thus, the contemporary modernization it arrives us for the economical rationalization, developed with the support of the technician-scientific knowledge and communicated by the articulations of the myth-techno-logical

Autoconhecimento e práticas corporais: para uma educação transpessoal integradora do saber ao ser no processo de formação inicial dos alunos de educação física

This thesis deals with the self-knowledge importance and corporal practices and the contribution of the Transpersonal Education for the initial formation process of students of Physical Education. In this context, students are stimulated to come in contact with the bases of learning to know, to make, to live together and to be for the promotion of integral education. We give priority to holistic conception of educating based in Emergent Paradigm. In this conception, student in initial formation is led to get back the view of integral being, life and love as education basis. We had as starting point, the essential dimensions to the learning geared toward the embodiment integration, autopoiesis and trans-disciplinarity. This work presents tracks for the teacher formation of Physical Education. It deals with the unfolding of teaching experiences in 2006, in Graduation Course in Physical Education of Universidade Federal do Rio Grande do Norte, in subject of Corporal Conscience, offered to undergraduate students which can be characterized as an action-research. This process was chosen as knowledge and intervention method because it allowed knowing and acting at the same time, studying the conditions and results of accomplished experience. In shared meetings with reflected experiences, we appeal to the experiences of situations that had mobilized the corporal, emotional, mental and spiritual dimensions of participants. The data collected through observations, accounts, questionnaires and interviews of learning processes had been starting points for the beginning of dialogue along with students of Graduation Course in Physical Education. The findings had been interpreted through of hermeneutics and discourse analysis. In this research, participants are considered as protagonist and boosters of educative process. The theoretical basis was supported by Transpersonal Education which contributed for a peace culture and respectful relationship. In its initial formation process, this research protagonists had evidenced of the importance of transpersonal education, geared toward action and changing, new ways of being and living together, facing the daily conflicts from a human and rational perspective. The research emphasized the importance of a new look on the teacher formation of Physical Education to face the limits of fragmented formation. Thus, we recognize that through the teacher education process, the transpersonal education provided wide significant changes reported during research, extending and re-meaning different learning levels such as: cognitive, emotional, attitudinal, and behavioral geared toward the personal and transpersonal development, reiterating the relevance of self-knowledge for development and establishment of pedagogical practice which prioritizes the life direction. The necessity of integrating knowledge to being in the initial process of teaching formation was emphasized in all the transpersonal meetings

Protagonismo silencioso: a presença da OPAS na formação de recursos humanos em saúde no Brasil

The aim of this study is to assess the contribution of the Pan American Health Organization (PAHO) to the field of human resources for health in Brazil. The assumption is that this organization not only influenced the development of this field, but but that it was also influenced by Brazilian institutions and by national political movements, through the interaction of its consultants with these movements. Four projects were selected, through which the contribution of PAHO was evaluated: the Program for the Strategic Preparation of Health Personnel (PPREPS), the Project for the Large Scale Formation of Middle and Low Level Personnel (Large Scale Project), the Project for Qualification in the Development of Human Resources in Health (CADRHU) and the Project for the Managerial Development of Basic Units of the National Health System (GERUS). To operacionalize the study, we used three basic complementary procedures: a bibliographic research, documental research and an interview. The time frame considered was from 1975, the year an agreement was signed between PAHO, the Ministry of Health and the Ministry of Education and Culture, establishing PPREPS. It was through this program that the first PAHO team of national human resource consultants was contracted. The period between 1975 and 1999 was marked by political and social movements that changed the course of health in the country; among these was the Movement of Sanitary Reform in Brazil, which culminated in the implementation of the National Health System (SUS). This paper shows the connections of the PAHO consultants with this movement and the implications that this had for the Program of Cooperation in the Development of Human Resources of PAHO/Brazil. It also demonstrates that as the program became contaminated by national movements of health system reorganization and of democratization of Brazilian society, it proposed, in cooperation with national institutions, an organization of determinate areas of operation of these same institutions. The manuscript further reveals that, with the Large Scale Project, the human resources program determined the pedagogical and methodological option that would be the model for various other educational projects undertaken by a number of Brazilian institutions with the technical cooperation of PAHO. And finally, the repercussions and contributions of these projects, which strengthened the the field of human resources in the public health services of the country, are identified. Data analysis was based mainly on the theories of Bourdieu, Gramsci and Freire

Aspectos morfométricos da cicatrização do cólon descendente de eqüinos submetidos a enterorrafias aposicionais com poliglactina 910 e com cianoacrilato

Foi realizado estudo morfométrico do cólon descendente de 15 eqüinos hígidos, nove fêmeas e seis machos, submetidos a enterorrafias aposicionais com fio de poliglactina 910 ou com cianoacrilato. Os animais foram distribuídos aleatoriamente em cinco grupos de três animais cada e sacrificados aos três, sete, 14, 35 e 70 dias de pós-operatório para colheita dos segmentos intestinais operados e posterior processamento histológico de rotina. A análise morfométrica foi feita em microscópio óptico adaptado a um sistema de análise de imagens, onde se quantificou o infiltrado inflamatório, mediante contagens de neutrófilos, eosinófilos, macrófagos, linfócitos e plasmócitos, não sendo observadas diferenças (P>0,05) entre as enterorrafias. Houve diferenças significativas entre os dias de pós-operatório para as contagens de neutrófilos, eosinófilos, macrófagos e linfócitos. Também se mensuraram as espessuras das regiões operadas (cicatriz) e das áreas contíguas não operadas (controle), registrando-se diferenças entre os dias de pós-operatório e as regiões (P<0,05), mas não entre as enterorrafias. O fio de poliglactina 910 e o cianoacrilato apresentam a mesma eficácia para serem usados em enterorrafias aposicionais do cólon descendente de eqüinos.

Acesso e permanência na universidade federal do rio grande do Norte sob o ponto de vista do docente e do estudante com deficiência Natal-RN

Inclusion of students with disabilities is a recent case that has been discussed in school contexts, but the current policy of inclusion for access and retention of students in higher education is still a problem face there is much to do, therefore, are incipient studies in which this student body is involved. Accordingly, what is happening is that the most studies deal with on these students and little is said about them. For inclusive education thus the institution should prepare to receive students, having as one of its premises their point of views about what actually experience aiming at promoting education for all. Therefore, this study deals with the process of inclusion of students with disabilities regularly enrolled in undergraduate courses at the Universidade Federal do Rio Grande do Norte - UFRN.They were used the assumptions of qualitative research enabled by the case study method and semi-structured interviews. It has been analyzed by guiding actions and teaching practices, under the views of disabled students and teachers, the conditions of access and permanence offered by UFRN. Twelve students with physical, visual, hearing disabilities participated and five teachers from the acedemic centers that in academic year 2008 taught to these students. For data analysis it was used the technique of content analysis. It was extracted two themes: access and retention of students with disabilities in UFRN, in which emerged the categories described and analyzed in the course of this work. The results show the difficulties of access and retention of students with disabilities within the UFRN, such as attitudinal, pedagogical and architectural barriers. However, as it has also turned out, initial advances in the quest for achieving more effective actions to guarantee access and permanence of these students in UFRN. It has concluded that the scope for the exercise of citizenship in the pupils with disabilities who need this Higher Education Institution has an inclusive education Project, wide and consolidated, for the actions undertaken by the Ministry of Education - MEC, by itself, are not guaranteed to all students due to mobility, autonomy and security. It has hoped this work will bring benefits for new studies to develop features that were located, but were not our focus, because then the UFRN may advance the inclusive process of disabled students

O acolhimento no ambulatório de um hospital universitário na visão de usuários

This present study of quantitative/qualitative approach, aims to analyze the outpatient care at the Hospital Universitário Onofre Lopes (HUOL), and, having as guide, the reception of the user. In this regard were invited and interviewed 20 users. Besides the interviews, conducted in a period of 45 days, in this same period of time was used a field diary for more significant notes of observations more significant. In the analysis, we drafted the socio-demographic profile of the group and identified their main complaints, problems and suggestions. For this, we have built graphics, tables and pictures, in addition to standing out their testimony, as a resource for better understanding of the subjective aspects. The theoretical reference consisted of documents from the Ministry of Health about the reception and humanization, and the studies of Merhy, Franco, Pinheiro, Matumoto, Mariotti, Teixeira, among others. The results show the ambulatory of HUOL as a privileged space and of credibility, where users commonly, find answers to their problems. However, these same users were unanimous in saying the difficulties they face in obtaining consultations, from the basic unit, until the hospital. Regarding the service, although they feel satisfied as for the assistance received, they list a series of problems, of structural relationship order: lack of visual signalling, information, wheelchairs, hygiene, in the waiting rooms that offer some comfort, besides the inattention of some professionals. In summary, in the study, undertaken now, we cannot say that there is in the reality studied, the reception, in its full meaning, but the HUOL as hospital-school, has all the potential to accomplish it