Public reporting of hospital outcomes based on administrative data: risks and opportunities

In the wake of findings from the Bundaberg Hospital and Forster inquiries in Queensland, periodic public release of hospital performance reports has been recommended. A process for developing and releasing such reports is being established by Queensland Health, overseen by an independent expert panel. This recommendation presupposes that public reports based on routinely collected administrative data are accurate; that the public can access, correctly interpret and act upon report contents; that reports motivate hospital clinicians and managers to improve quality of care; and that there are no unintended adverse effects of public reporting. Available research suggests that primary data sources are often inaccurate and incomplete, that reports have low predictive value in detecting outlier hospitals, and that users experience difficulty in accessing and interpreting reports and tend to distrust their findings.

Is modern medicine at risk of losing the plot?

Contemporary medicine has much to its credit, but has created an insatiable demand for new technologies and more health services, fed by commercial promotion, professional advocacy and sociopolitical pressure. Total health expenditure at the national level is now almost 10% of gross domestic product and is expected to top 16% by 2020. After recent inquiries into the failings of its public health system, the Queensland Government has committed itself to a 25% increase in expenditure on health over the next 5 years. But will it lead to better population health, and is it sustainable? The return-on-investment curve for modern health care may be flattening out, in an environment of growing numbers of older patients with chronic illnesses, maldistribution of services and hospital overcrowding. A change in thinking is required if current medical practice is to avoid imploding when confronted with the next major economic downturn. Health policy, service funding and clinical training must focus on critical appraisal of the effectiveness of health care technologies and the structure and financing of health care systems. Practising clinicians will be obliged to provide leadership in determining value for money in the choice of health care for specific patient populations and how that care is delivered.

MIDIA IMPRESSA NA TRÍPLICE FRONTEIRA : estudo do jornal local A Gazeta do Iguaçu

Este estudo analisa a mídia impressa local produzida no lado brasileiro da Tríplice Fronteira, região limítrofe entre Brasil, Paraguai e Argentina e toma como exemplar o jornal brasileiro A Gazeta do Iguaçu, editado na cidade de Foz do Iguaçu, PR, que compõe a área trinacional. Os principais objetivos são analisar as características desta mídia local, a incidência de notícias sobre a fronteira, o relacionamento daquele veículo com as comunidades e com os grupos humanos que vivem na região, bem como o grau de influência e o nível de comprometimento do jornal com a política de Foz do Iguaçu. A base teóricometodológica constituiu-se de bibliografia sobre a questão global- local, dos estudos sobre multiculturalismo e diversidade cultural (estudos culturais), e dos questionamentos acerca de comunicação local e regional. As técnicas utilizadas foram, além da revisão bibliográfica, a análise de conteúdo do jornal A Gazeta do Iguaçu e entrevistas semi-estruturadas. Dentre as conclusões encontradas, verificou-se que a cobertura da fronteira é uma pauta prioritária, mas que ao mesmo tempo, perde espaço para o jornalismo de opinião, através das diversas colunas de opinião e sociais, que ocupam a maior parte do noticiário cotidiano local.(AU)

EFICÁCIA ADAPTATIVA E SITUAÇÕES DE CRISE EM PORTADORES DO VÍRUS HIV IMUNODEFICIÊNCIA HUMANA / AIDS.

O objetivo desta pesquisa foi investigar a eficácia adaptativa e situações de crise de indivíduos portadores do vírus HIV do Programa Municipal DST/AIDS de Aparecida SP. O instrumento utilizado foi a Entrevista Clínica Preventiva - EDAO (Escala Diagnóstica Adaptativa Operacionalizada). Participaram do estudo 5 homens e 5 mulheres que freqüentavam o serviço de saúde. Os resultados do trabalho revelaram que ser portador de uma doença crônica carregada de estigmas como a AIDS é um fator desestruturante para o diagnóstico. Foi percebida na população estudada o comprometimento dos setores afetivo-relacional e produtividade, seguido do sóciocultural. Foram observados alguns aspectos importantes como: a crise do impacto diagnóstico como sendo algo marcante em todos os participantes, bem como o uso de drogas, comportamentos vulneráveis que possivelmente levaram à infecção pelo vírus HIV, dificuldades de resolução de conflitos e nas relações interpessoais, perdas vivenciadas durante toda a vida e também no decorrer da infecção e o fenômeno da feminização do vírus HIV através das mulheres entrevistadas, que foram infectadas por seus parceiros sexuais estáveis. No setor orgânico de funcionamento, a população estudada mostrou adesão ao tratamento A maioria da população estudada foi diagnosticada com adaptação ineficaz severa. Este estudo trouxe questionamentos importantes sobre a maneira com a qual o indivíduo portador do vírus HIV mantém seu equilíbrio psíquico e suas relações com o trabalho que executa, chamando atenção para a necessidade de outros estudos que contemplem diferentes instrumentos para a compreensão do tema.

Before and after modelling:risk knowledge management is required

Risk and knowledge are two concepts and components of business management which have so far been studied almost independently. This is especially true where risk management is conceived mainly in financial terms, as, for example, in the banking sector. The banking sector has sophisticated methodologies for managing risk, such as mathematical risk modeling. However. the methodologies for analyzing risk do not explicitly include knowledge management for risk knowledge creation and risk knowledge transfer. Banks are affected by internal and external changes with the consequent accommodation to new business models new regulations and the competition of big players around the world. Thus, banks have different levels of risk appetite and policies in risk management. This paper takes into consideration that business models are changing and that management is looking across the organization to identify the influence of strategic planning, information systems theory, risk management and knowledge management. These disciplines can handle the risks affecting banking that arise from different areas, but only if they work together. This creates a need to view them in an integrated way. This article sees enterprise risk management as a specific application of knowledge in order to control deviation from strategic objectives, shareholders' values and stakeholders' relationships. Before and after a modeling process it necessary to find insights into how the application of knowledge management processes can improve the understanding of risk and the implementation of enterprise risk management. The article presents a propose methodology to contribute to providing a guide for developing risk modeling knowledge and a reduction of knowledge silos, in order to improve the quality and quantity of solutions related to risk inquiries across the organization.

Historical analysis of two contemporary issues at the International Community School of Abidjan, Cote d'Ivoire: Local -hired and overseas -hired teacher relationships. Community perceptions of the U.S. Embassy at ICSA

This study was a qualitative investigation to ascertain and describe two of the current issues at the International Community School of Abidjan, examine their historical bases, and analyze their impact on the school environment.^ Two issues emerged during the inquiry phase of this study: (1) the relationship between local-hired and overseas-hired teachers in light of the January 1994 devaluation which polarized the staff by negating a four-year salary scale that established equity, (2) the school community's wide variance in the perceived power that the U.S. Embassy has on school operations based on its role as ICSA's founding sponsor.^ A multiple studies approach was used in gathering data. An extensive examination of the school's archives was used to reconstruct an historical overview of ICSA. An initial questionnaire was distributed to teachers and administrators at an educational conference to determine the scope of the 1994 devaluation of the West and Central African CFA and its impact on school personnel in West African American-sponsored overseas schools (ASOS). Personal interviews were conducted with the school staff, administration, school board members, and relevant historical participants to determine the principal issues at ICSA at that time. The researcher, an overseas-hired teacher, also used participant observations to collect data. Findings based on these sources were used to analyze the two issues from an historical perspective and to form conclusions.^ Findings in this study pertaining to the events induced by the French and African governments' decision to implement a currency devaluation in January 1994 were presented in ex post-facto chronological narrative form to describe the events which transpired, describe the perception of school personnel involved in these events, examine the final resolution and interpret these events within a historical framework for analysis.^ The topic of the U.S. Embassy and its role at ICSA emerged inductively from open-ended personal interviews conducted over the course of a year. Contradictory perspectives were examined and researched for accuracy and cause. The results of this inquiry presented the U.S. Embassy role at ICSA from a two-sided perspective, examined the historical role of the Embassy, and presented means by which the role and responsibility of the U.S. Embassy could best be communicated to the school community.^ The final chapter provides specific actions for mediation of problems stemming from these issues, implications for administrators and teachers currently involved in overseas schools or considering the possibility, and suggestions for future inquiries.^ Examination of a two-tier salary scale for local-hired and overseas-hired teachers generated the following recommendations: movement towards a single salary scale when feasible, clearly stated personnel policies and full disclosure of benefits, a uniform certification standard, professional development programs and awareness of the impact of this issue on staff morale.^ Divergent perceptions and attitudes toward the role of the U.S. Embassy produced these recommendations: a view towards limiting the number of Americans on ASOS school boards, open school board meetings, selection of Embassy Administrative Officers who can educate school communities on the exact role of the Embassy, educating parents through the outreach activities that communicate American educational philosophy and involve all segments of the international community, and a firm effort on the part of the ASOS to establish the school's autonomy from special interests. ^

Da educação infantil ao ensino fundamental: o que contam as crianças sobre essa travessia na cultura de escola

From inquiries concerning the child as an individual with rights, this work takes as its object of study the perception of 5-7 years old children on their journey from kindergarten to elementary school, in a school culture. The objective of the research is, therefore, to investigate what the children tell in narratives drawn into a conversation circle about their experiences of school life in kindergarten and the first grade of elementary school. The participants were 18 children from a public school in the city of Natal (RN). Five rounds of conversation were held in which the children told a little alien, who was unaware of the school culture, what they knew about school and what they did at it. The research is linked to the project "Children's Narratives. What the children tell about childhood schools?"(Passeggi et all, 2011) and adopts epistemological principles and research methods of (auto)biographical education, taking as a working hypothesis the child's ability to reflect on their experiences and understand from their point of view, what happens to them. Analyses were organized based on the concept of school culture (Barroso, 2012). In the narratives of children, the three dimensions of school culture: the functionalist (purpose and rules), structural (structure and pedagogical organization) and the interactional (relations with others, with the spaces and with knowledge) are considered intertwined in their school perceptions and signal experienced tensions in a process of "conversion" from child to student. Children seem to realize the uniqueness of each level of education. They recognize as a characteristic of early childhood education the recreational activities, and as injunctions of the first year of elementary school the "study", "learning to read and write" to "be smart" to "change." The schooling will thus, constitute, in their eyes, as a time and a place where the children's culture gives way to school culture, and in this journey they experience that the desire to play and the duty/want to study cross the three dimensions of school. At the end of the journey, the status of children as cultural beings with rights is confirmed, whose narratives about school and about their experiences of "conversion" in a student, reveal much about the power of reflection on themselves, the school and the society in which they live, legitimizing their place in educational research and in child care policies.

La Corona y el control del reconocimiento nobiliario: la actividad del fiscal de la Real Chancillería de Granada a examen. Análisis y documentos

Se analizan y estudian aquí las averiguaciones hechas en 1590 sobre las actuaciones en pleitos de hidalguía de los fiscales de Granada desde 1579 a 1590, así como se edita una colección documental que viene a resumir la misma. Averiguaciones efectuadas por el oidor Benavente de Benavides, estuvieron centradas en el fiscal Diego de Amézaga y están insertas en la Visita de don Juan de Acuña a la Chancillería de Granada. La minuciosidad de esta actuación, su naturaleza netamente jurídica y las consecuencias que tuvo, aportan una nueva visión sobre estos contenciosos que en determinados casos han sido definidos por la historiografía como meros trámites y que sin embargo poseyeron una complejidad y una dureza, en cierto modo, hasta ahora inadvertida.

El papel de los museos en la sociedad actual: discurso institucional o museo participativo

Desde hace ya varias décadas se ha extendido un lema convertido en habitual año tras año: que los museos necesitan cambios y que, éstos, deben seguir produciéndose en el futuro para que estas instituciones sigan siendo significativas en la sociedad, es decir, para los ciudadanos a quienes representan y sirven. La cuestión de cómo afrontan los cambios es lo que verdaderamente ha dado lugar a reflexiones interesantes en el campo de la museología. No existe un enfoque único para una cuestión tan compleja, ya que está compuesta de múltiples capas que, en muchas ocasiones, son difícilmente acoplables. Sin embargo, en términos generales, podemos apuntar que va a ser en la exposición donde los nuevos planteamientos tendrán su desarrollo.

The Internet as opportunity and challenge in contemporary social movements

This paper explores the relationship between the rise of “new” social movements (15-M and Occupy) and the Internet. The new social media gives rise to new kinds of social movements  which embed this technology from the moment of conception. The future of social movements will be characterised by movinets, which will have the effect of developing new efficient ways of activism. The movinets, with their embedded technology and capacity to circulate ideas among different spheres of reality, have a potential to alter the dynamics of social mobilisation.

Imagerie Musicale Involontaire : caractéristiques phénoménologiques et mnésiques

L’imagerie musicale involontaire (IMIN) est un phénomène mental extrêmement commun. Il peut être défini en tant que type d’imagerie mentale musicale qui devient consciente sans effort ou intentionnalité et qui n’est pas pathologique. La forme la plus connue d’IMIN est le « ver d’oreille », qui se présente généralement comme un court extrait musical tournant en boucle en tête et dont on se débarrasse difficilement. L’objectif principal de la présente thèse est d’investiguer les mécanismes cognitifs sous-tendant le phénomène puisque, malgré l’intérêt répandu dans les médias populaires, son étude expérimentale est récente et un modèle intégré n’a pas encore été proposé. Dans la première étude, l’induction expérimentale a été tentée et les caractéristiques des images mentales d’épisodes d’IMIN ont été investiguées. Dans le laboratoire, des chansons accrocheuses (versus des proverbes) ont été présentées répétitivement aux participants qui devaient ensuite les chanter le plus fidèlement possible. Ils ont par après quitté le laboratoire, une enregistreuse numérique en mains, avec la consigne d’enregistrer une reproduction vocale la plus fidèle possible de ce qu’ils avaient en tête lors de tous leurs épisodes d’IMIN sur une période de quatre jours, ainsi que de décrire leur timbre. L’expérience a été répétée deux semaines plus tard. Douze des dix-huit participants du groupe expérimental ont rapporté des pièces induites comme épisodes d’IMIN, ce qui confirme l’efficacité de la procédure d’induction. La tonalité et le tempo des productions ont ensuite été analysés et comparés à ceux des pièces originales. Similairement pour les épisodes d’IMIN induits et les autres, les tempi produits et, dans une moindre mesure pour les non-musiciens, les tonalités étaient proches des originaux. Le timbre décrit était généralement une version simplifiée de l’original (un instrument et/ou une voix). Trois études se sont ensuite intéressées au lien entre le potentiel d’IMIN et la mémorabilité. Dans une étude préliminaire, 150 chansons du palmarès francophone radiophonique ont été évaluées en ligne par 164 participants, sur leur niveau de familiarité, d’appréciation et de potentiel d’IMIN. Les pièces ont ensuite été divisées en groupes de stimuli à faible et à fort potentiel d’IMIN, qui ont été utilisés dans une tâche typique de rappel libre/reconnaissance, premièrement avec des francophones (pour qui les pièces étaient familières) et ensuite avec des non-francophones (pour qui les pièces étaient non-familières). Globalement, les pièces à fort potentiel d’IMIN étaient mieux rappelées et reconnues que les pièces à faible potentiel. Une dernière étude a investigué l’impact de la variabilité inter-stimulus du timbre sur les résultats précédents, en demandant à une chanteuse d’enregistrer les lignes vocales des pièces et en répétant l’expérience avec ces nouveaux stimuli. La différence précédemment observée entre les stimuli à fort et à faible potentiel d’IMIN dans la tâche de reconnaissance a ainsi disparu, ce qui suggère que le timbre est une caractéristique importante pour le potentiel d’IMIN. En guise de conclusion, nous suggérons que les phénomènes mentaux et les mécanismes cognitifs jouant un rôle dans les autres types de souvenirs involontaires peuvent aussi s’appliquer à l’IMIN. Dépendamment du contexte, la récupération mnésique des pièces peut résulter de la répétition en mémoire à court terme, de l’amorçage à court et long terme ou de l’indiçage provenant de stimuli dans l’environnement ou les pensées. Une des plus importantes différences observables entre l’IMIN et les autres souvenirs involontaires est la répétition. Nous proposons que la nature même de la musique, qui est définie par la répétition à un niveau micro- et macro-structurel en est responsable.

Relações de Vinculação dos Jovens Institucionalizados com os Cuidadores Formais

No quadro da teoria da vinculação, é possível estabelecer relações de vinculação ao longo de toda a vida, sendo que, apesar dos jovens institucionalizados rejeitarem estabelecer novas relações de vinculação numa fase inicial, acabam por procurá-las, desde que essa figura desempenhe funções de cuidador responsivo, de modo estável e apoiante. Este estudo tem como objetivo principal perceber se as crianças e jovens acolhidos em Lares de Infância e Juventude (LIJ) estabelecem relações de vinculação com os cuidadores formais e compreender como essa relação foi construída. Foram utilizados os questionários Important People Interview (IPI; Kobak e Rosenthal, 2010) e Hierarquização das Figuras Significativas por Campos de Vida (HFSCV), criado para incluir os jovens que consideram não terem desenvolvido relações de vinculação com os cuidadores formais do LIJ. Foi, ainda, realizada uma entrevista semiestruturada. Apesar de usarmos uma metodologia quantitativa para análise dos resultados dos dois primeiros questionários, esta investigação prima sobretudo pela abordagem qualitativa, através do recurso à técnica de análise conteúdo das entrevistas. O estudo foi realizado no LIJ “Comunidade Juvenil de São Francisco de Assis”, localizado em Coimbra, contando com a participação de 16 jovens de ambos os géneros, com idades entre os 13 e os 19 anos (M=16; DP=1,8), com tempo de permanência no LIJ igual ou superior a 2 anos contínuos. Estes 16 jovens constituem a amostra total da investigação, sobre a qual incidiu a primeira parte do estudo (abordagem quantitativa), ao que se seguiu a segunda parte do estudo (abordagem qualitativa), que contou com a participação de uma subamostra de 11 jovens, pertencentes à amostra total. Os resultados sugerem que a maioria dos jovens estabeleceu relações de vinculação com os cuidadores formais do LIJ, sendo que a maioria das hierarquias das figuras de vinculação foram constituídas com base nos laços de familiaridade e na ligação afetiva com os seus cuidadores formais. Os jovens destacaram a compreensibilidade, confiabilidade e disponibilidade para o auxílio como sendo as características que determinaram a sua preferência em relação aos cuidadores formais do LIJ. Refira-se, ainda, que as situações que ativam a procura destas figuras estão relacionadas com a necessidade de apoio e proteção. O presente estudo sugere que é possível um LIJ promover relações semelhantes às desenvolvidas em meio familiar e atuar de forma reparadora ao nível das relações de vinculação. / In the attachment theory framework, one can establish attachment relationships throughout one's life. In the case of institutionalized youngsters, even though at first they seem to refuse new attachment relationships, these adolescents end up looking for them, if the person is perceived as a responsive, stable and supportive caregiver. The main goal of this study is to understand whether children and young people taken into Child and Youth Residential Care establish attachment relationships with formal caregivers and, if so, understand how that relationship is built. We have used the questionnaires Important People Interview (IPI; Kobak & Rosenthal, 2010) and Hierarquização das Figuras Significativas por Campos de Vida (HFSCV) (Hierarchization of Significant Figures by Life Fields), created to include the youngsters who consider not have developed attachment relations with Residential Care's formal caregivers. We have also conducted a semi-structured interview. Even though we used a quantitative methodology to process the results of the two inquiries, this research nevertheless privileges a qualitative approach, thorough the technique of analysis of interview content. The study was conducted at the “Comunidade Juvenil de São Francisco de Assis” residential care institution, in Coimbra, Portugal. It had the participation of 16 youngsters of both genders, with ages between 13 and 19 (M=16; DP=1,8), who had been staying at the home for two or more years, non-interrupted. These 16 adolescents are therefore the total sample for this study, and all of them were submitted to the first part (the quantitative approach) of the research. For the second part (the qualitative approach) we worked with a subsample of 11 youngsters, chosen from the initial sample of 16. Results suggest that most young people have indeed developed attachment relationships with residential care's formal caregivers, and most hierarchies of attachment figures were built based on familiarity and affection bonds with their formal caregivers. The subjects have highlighted understanding, trustworthiness and helpfulness as the features that best determine their preference regarding formal caregivers. We must note that the need for protection and support is what enables young people to look out for attachment figures the most. The current study suggests that it is possible for Child and Youth Residential Care to promote relationships similar to those developed in family environment and acts as repairing in what concerns attachment relationships.

Situating preparedness education within public pedagogy

Both ‘disaster preparedness’ and ‘public pedagogy’ have been broadly defined and diversely utilised. Preparedness has been dealt within the disciplines such as civil engineering, sociology of disasters, public health and psychology, rather than education. Recently, inquiries into the learning and teaching of preparedness is increasing in the field of education, and some of them position preparedness education within the field of public pedagogy. However, conceptual discussion as to how and why the two fields are associated has been limited. The primary aim of this paper is to fill this gap by drawing on public pedagogy literature that conceptualises ‘publics’ and ‘pedagogies’. By doing so, the paper attempts to respond to Burdick et al’s call for Problematizing Public Pedagogy.