Family Health Strategy Professionals Facing Medical Social Needs: difficulties and coping strategies

Professionals of Family Health Strategy (FHS) work in communities where there are complex medical social problems. These contexts may lead them to psychological suffering, jeopardizing their care for the users, and creating yet another obstacle to the consolidation of FHS as the primary health care model in Brazil. The study investigated the difficulties and coping strategies reported by health professionals of the FHS teams when they face medical social needs of the communities where they work. Focus groups and semi-structured interviews were carried out with 68 professionals of three primary care units in the city of Sao Paulo (Southeastern Brazil). Drug dealing and abuse, alcoholism, depression and domestic violence are the most relevant problems mentioned by the study group. Professionals reported lack of adequate training, work overload, poor working conditions with feelings of professional impotence and frustration. To overcome these difficulties, professionals reported collective strategies, particularly experience sharing during team meetings and matrix support groups. The results indicate that the difficulties may put the professionals in a vulnerable state, similar to the patients they care for. The promotion of specialized and long term support should be reinforced, as well as the interaction with the local network of services and communities leaders. That may help professionals to deal with occupational stress related to medical and social needs present in their routine work; in the end, it may as well contribute to the strengthening of FHS.

Collective Organization of Complex Networks: Emergent Scales, Vulnerability, and Targeting of Desired Dynamics

Cuando una colectividad de sistemas dinámicos acoplados mediante una estructura irregular de interacciones evoluciona, se observan dinámicas de gran complejidad y fenómenos emergentes imposibles de predecir a partir de las propiedades de los sistemas individuales. El objetivo principal de esta tesis es precisamente avanzar en nuestra comprensión de la relación existente entre la topología de interacciones y las dinámicas colectivas que una red compleja es capaz de mantener. Siendo este un tema amplio que se puede abordar desde distintos puntos de vista, en esta tesis se han estudiado tres problemas importantes dentro del mismo que están relacionados entre sí. Por un lado, en numerosos sistemas naturales y artificiales que se pueden describir mediante una red compleja la topología no es estática, sino que depende de la dinámica que se desarrolla en la red: un ejemplo son las redes de neuronas del cerebro. En estas redes adaptativas la propia topología emerge como consecuencia de una autoorganización del sistema. Para conocer mejor cómo pueden emerger espontáneamente las propiedades comúnmente observadas en redes reales, hemos estudiado el comportamiento de sistemas que evolucionan según reglas adaptativas locales con base empírica. Nuestros resultados numéricos y analíticos muestran que la autoorganización del sistema da lugar a dos de las propiedades más universales de las redes complejas: a escala mesoscópica, la aparición de una estructura de comunidades, y, a escala macroscópica, la existencia de una ley de potencias en la distribución de las interacciones en la red. El hecho de que estas propiedades aparecen en dos modelos con leyes de evolución cuantitativamente distintas que siguen unos mismos principios adaptativos sugiere que estamos ante un fenómeno que puede ser muy general, y estar en el origen de estas propiedades en sistemas reales. En segundo lugar, proponemos una medida que permite clasificar los elementos de una red compleja en función de su relevancia para el mantenimiento de dinámicas colectivas. En concreto, estudiamos la vulnerabilidad de los distintos elementos de una red frente a perturbaciones o grandes fluctuaciones, entendida como una medida del impacto que estos acontecimientos externos tienen en la interrupción de una dinámica colectiva. Los resultados que se obtienen indican que la vulnerabilidad dinámica es sobre todo dependiente de propiedades locales, por tanto nuestras conclusiones abarcan diferentes topologías, y muestran la existencia de una dependencia no trivial entre la vulnerabilidad y la conectividad de los elementos de una red. Finalmente, proponemos una estrategia de imposición de una dinámica objetivo genérica en una red dada e investigamos su validez en redes con diversas topologías que mantienen regímenes dinámicos turbulentos. Se obtiene como resultado que las redes heterogéneas (y la amplia mayora de las redes reales estudiadas lo son) son las más adecuadas para nuestra estrategia de targeting de dinámicas deseadas, siendo la estrategia muy efectiva incluso en caso de disponer de un conocimiento muy imperfecto de la topología de la red. Aparte de la relevancia teórica para la comprensión de fenómenos colectivos en sistemas complejos, los métodos y resultados propuestos podrán dar lugar a aplicaciones en sistemas experimentales y tecnológicos, como por ejemplo los sistemas neuronales in vitro, el sistema nervioso central (en el estudio de actividades síncronas de carácter patológico), las redes eléctricas o los sistemas de comunicaciones. ABSTRACT The time evolution of an ensemble of dynamical systems coupled through an irregular interaction scheme gives rise to dynamics of great of complexity and emergent phenomena that cannot be predicted from the properties of the individual systems. The main objective of this thesis is precisely to increase our understanding of the interplay between the interaction topology and the collective dynamics that a complex network can support. This is a very broad subject, so in this thesis we will limit ourselves to the study of three relevant problems that have strong connections among them. First, it is a well-known fact that in many natural and manmade systems that can be represented as complex networks the topology is not static; rather, it depends on the dynamics taking place on the network (as it happens, for instance, in the neuronal networks in the brain). In these adaptive networks the topology itself emerges from the self-organization in the system. To better understand how the properties that are commonly observed in real networks spontaneously emerge, we have studied the behavior of systems that evolve according to local adaptive rules that are empirically motivated. Our numerical and analytical results show that self-organization brings about two of the most universally found properties in complex networks: at the mesoscopic scale, the appearance of a community structure, and, at the macroscopic scale, the existence of a power law in the weight distribution of the network interactions. The fact that these properties show up in two models with quantitatively different mechanisms that follow the same general adaptive principles suggests that our results may be generalized to other systems as well, and they may be behind the origin of these properties in some real systems. We also propose a new measure that provides a ranking of the elements in a network in terms of their relevance for the maintenance of collective dynamics. Specifically, we study the vulnerability of the elements under perturbations or large fluctuations, interpreted as a measure of the impact these external events have on the disruption of collective motion. Our results suggest that the dynamic vulnerability measure depends largely on local properties (our conclusions thus being valid for different topologies) and they show a non-trivial dependence of the vulnerability on the connectivity of the network elements. Finally, we propose a strategy for the imposition of generic goal dynamics on a given network, and we explore its performance in networks with different topologies that support turbulent dynamical regimes. It turns out that heterogeneous networks (and most real networks that have been studied belong in this category) are the most suitable for our strategy for the targeting of desired dynamics, the strategy being very effective even when the knowledge on the network topology is far from accurate. Aside from their theoretical relevance for the understanding of collective phenomena in complex systems, the methods and results here discussed might lead to applications in experimental and technological systems, such as in vitro neuronal systems, the central nervous system (where pathological synchronous activity sometimes occurs), communication systems or power grids.

Raiders of the Lost Art: Strategy-Making in Europe. Security Policy Brief No. 40, November 2012

Have Europeans lost the art of making grand strategy? In a reflection process initiated by Sweden, Poland, Italy and Spain, they are invited to rediscover it and draft a “European Global Strategy”. This policy brief argues that what the EU needs most is a short set of priorities for collective action, to be reassessed for each term of the High Representative.

Pharmacy and public health: examining the link between strategy and practice

Despite having been described by the then (2003) Chief Pharmaceutical Officer for England as ·probably the biggest untapped resource for health improvement", the development of the public health function of community pharmacists has been limited. However, devolution of healthcare budgets has led 10 differential rates of development of the public health function in each administration of the UK (England, Scotland, Wales and Northern Ireland). This is measured and reflected upon in this thesis. Two large-scale surveys were conducted, one of key strategic personnel (Directors of Public Health and Chief Pharmacists) in Primary Care Organisations (PCOs) and one of practicing community pharmacists. This research highlights the fact that community pharmacists have developed an individualistic, service-based approach to their engagement with public health that is contrary to the more collective approach adopted by the wider public health movement. The study measures the scope and level of health-improving services through community pharmacy across the UK and shows that the nature of the pharmacy contractor (independent, multiple etc.) may impact on the range and nature of services provided. Survey data also suggest that attitudes towards pharmacy involvement in the public health agenda vary markedly between Directors of Public Health, PCO Chief Pharmacists, and community pharmacists. Furthermore, within the community pharmacist population, attitudes are affected by a wide range of factors including the nature of employment (owner, employee, self-employed) and the type of employing pharmacy (independent, multiple etc.). Implications for policy and areas for further research aimed at maximising the public health function of community pharmacists are suggested.

Seminars and examinations:students' perceptions of the seminar in their examination revision strategy

Students’ performance in examinations is often weaker than in other forms of assessment. Yet it should not be assumed that examination technique is innate or skill based. Successful examination performance calls on students to synthesize information and to demonstrate academic competence. Successful academic performance is primarily concerned with articulatory principles of subject formation and appropriation. However, research into seminars, lectures and examination performances mostly seek to establish a relationship between ‘performance’ and ‘potential’, with much attention focused discretely upon either organizational considerations or the reluctant learner. By emphasizing the social construction of learning situations, this project locates the learning process within a notion of collective social experiences and mutual cooperation. In the broader sense it is interested in questions of meaning and understanding and the process by which concepts are constructed and understood. This process depends on ‘ritualization’, ‘participation frameworks’ and ‘embedding’ (Goffman, 1981). Some students experience difficulties in participating in the ritualized behaviour, which may affect their academic development. By seeking to investigate students’ perception of how they use seminars to develop their academic expertise, this project seeks to contribute to our understanding of the learning process, in particular, the relationship between students’ participation in the examination process and assessment strategies.

Tribes under threat : the collective behavior of firms during the stock market crisis

Due to their unpredictable behavior, stock markets are examples of complex systems. Yet, the dominant analysis of these markets as- sumes simple stochastic variations, eventually tainted by short-lived memory. This paper proposes an alternative strategy, based on a stochastic geometry defining a robust index of the structural dynamics of the markets and based on notions of topology defining a new coef- ficient that identifies the structural changes occurring on the S&P500 set of stocks. The results demonstrate the consistency of the random hypothesis as applied to normal periods but they also show its in- adequacy as to the analysis of periods of turbulence, for which the emergence of collective behavior of sectoral clusters of firms is mea- sured. This behavior is identified as a meta-routine.

A second order control-volume finite-element least-squares strategy for simulating diffusion in strongly anisotropic media

An unstructured mesh �nite volume discretisation method for simulating di�usion in anisotropic media in two-dimensional space is discussed. This technique is considered as an extension of the fully implicit hybrid control-volume �nite-element method and it retains the local continuity of the ux at the control volume faces. A least squares function recon- struction technique together with a new ux decomposition strategy is used to obtain an accurate ux approximation at the control volume face, ensuring that the overall accuracy of the spatial discretisation maintains second order. This paper highlights that the new technique coincides with the traditional shape function technique when the correction term is neglected and that it signi�cantly increases the accuracy of the previous linear scheme on coarse meshes when applied to media that exhibit very strong to extreme anisotropy ratios. It is concluded that the method can be used on both regular and irregular meshes, and appears independent of the mesh quality.