A comunicação com o utente no aconselhamento farmacêutico

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

A dor no período pós-cirúrgico abdominal em doentes geriátricos

A dor é uma das principais causas do sofrimento humano, comprometendo a qualidade de vida dos indivíduos, em especial o idoso que, devido aos problemas cognitivos e à elevada medicação os torna mais suscetíveis aos efeitos adversos dos medicamentos utilizados para o alívio da dor. Neste contexto, o objetivo deste estudo é avaliar a dor na pós-cirurgia abdominal em doentes geriátricos; identificar a localização e a intensidade dolorosa utilizando a Escala Numérica; analisar a dor nas dimensões sensorial, afetiva e cognitiva, utilizando o Questionário para Dor de McGill; relacionar o processo álgico com a idade, sexo, religião e tipo de abordagem cirúrgica; saber se as intervenções autónomas de enfermagem contribuem para o alívio da dor pós-operatória. Trata-se de um estudo descritivo correlacional longitudinal, com abordagem quantitativa, desenvolvido entre 14 de fevereiro e 30 de março de 2012 num Hospital no Serviço de Cirurgia Geral. A amostra constou de 30 pacientes submetidos a cirurgias abdominais. Os dados que serviram de base a este estudo foram recolhidos através da aplicação da Escala Numérica e do Questionário de Dor de McGill. Os resultados mostraram que 60% eram homens, 50% dos doentes tinham 65 e 69 anos e todos (100%), eram católicos romanos. Na primeira avaliação, 60% apresentaram dor pós-operatória moderada, 30% severa e 10% leve. Os descritores escolhidos com maior frequência foram: fisgada (90%); fina, agulhada e pontada (70%); beliscão (60%); sensível (50%); cansativa (60%) e que incomoda (50%). Nas três avaliações seguintes houve diminuição da dor severa e moderada que, aos 180 minutos era de 0% e 3% respetivamente, aumentando a percentagem de pacientes com dor leve (7%). Não encontramos relação significativa entre a variável dor pós-operatória e o sexo mas, pelo contrário, a intensidade da dor pós-operatória e a idade. O índice de dor total e sensitiva é influenciado pelo sexo. A localização da dor é influenciada pelo tipo de cirurgia, pela idade e pelo sexo. A dor pós-operatória era, principalmente, de intensidade moderada. Mesmo nos doentes a quem não foi administrado fármaco (50%), a dor foi aliviada ao longo das quatro avaliações. Desta forma, podemos inferir que as que as intervenções autónomas de enfermagem contribuem para o alívio da dor. A informação/atualização permanente dos profissionais de saúde é indispensável para que seja possível evitar ou minimizar a ocorrência de dor.

Computer-Mediated Communication and Ecclesiological Challenges To and From the Reformed Tradition

Communities of faith have appeared online since the inception of computer -­ mediated communication (CMC)and are now ubiquitous. Yet the character and legitimacy of Internet communities as ecclesial bodies is often disputed by traditional churches; and the Internet's ability to host the church as church for online Christians remains a question. This dissertation carries out a practical theological conversation between three main sources: the phenomenon of the church online; ecclesiology (especially that characteristic of Reformed communities); and communication theory. After establishing the need for this study in Chapter 1, Chapter 2 investigates the online presence of Christians and trends in their Internet use, including its history and current expressions. Chapter 3 sets out an historical overview of the Reformed Tradition, focusing on the work of John Calvin and Karl Barth, as well as more contemporary theologians. With a theological context in which to consider online churches in place, Chapter 4 introduces four theological themes prominent in both ecclesiology and CMC studies: authority; community; mediation; and embodiment. These themes constitute the primary lens through which the dissertation conducts a critical-­confessional interface between communication theory and ecclesiology in the examination of CMC. Chapter 5 continues the contextualization of online churches with consideration of communication theories that impact CMC, focusing on three major communication theories: Narrative Theory; Interpretive Theory; and Speech Act Theory. Chapter 6 contains the critical conversation between ecclesiology and communication theory by correlating the aforementioned communication theories with Narrative Theology, Communities of Practice, and Theo-­Drama, and applying these to the four theological themes noted above. In addition, new or anticipated developments in CMC investigated in relationship to traditional ecclesiologies and the prospect of cyber-­ecclesiology. Chapter 7 offers an evaluative tool consisting of a three-­step hermeneutical process that examines: 1) the history, tradition, and ecclesiology of the particular community being evaluated; 2) communication theories and the process of religious-­social shaping of technology; and 3) CMC criteria for establishing the presence of a stable, interactive, and relational community. As this hermeneutical process unfolds, it holds the church at the center of the process, seeking a contextual yet faithful understanding of the church.

Large-Scale Neural Systems for Vision and Cognition

— Consideration of how people respond to the question What is this? has suggested new problem frontiers for pattern recognition and information fusion, as well as neural systems that embody the cognitive transformation of declarative information into relational knowledge. In contrast to traditional classification methods, which aim to find the single correct label for each exemplar (This is a car), the new approach discovers rules that embody coherent relationships among labels which would otherwise appear contradictory to a learning system (This is a car, that is a vehicle, over there is a sedan). This talk will describe how an individual who experiences exemplars in real time, with each exemplar trained on at most one category label, can autonomously discover a hierarchy of cognitive rules, thereby converting local information into global knowledge. Computational examples are based on the observation that sensors working at different times, locations, and spatial scales, and experts with different goals, languages, and situations, may produce apparently inconsistent image labels, which are reconciled by implicit underlying relationships that the network’s learning process discovers. The ARTMAP information fusion system can, moreover, integrate multiple separate knowledge hierarchies, by fusing independent domains into a unified structure. In the process, the system discovers cross-domain rules, inferring multilevel relationships among groups of output classes, without any supervised labeling of these relationships. In order to self-organize its expert system, the ARTMAP information fusion network features distributed code representations which exploit the model’s intrinsic capacity for one-to-many learning (This is a car and a vehicle and a sedan) as well as many-to-one learning (Each of those vehicles is a car). Fusion system software, testbed datasets, and articles are available from http://cns.bu.edu/techlab.

Living long-term with acquired brain injury in Ireland: towards a counter discourse

Irish literature on Acquired Brain Injury (ABI) is very scant and is mainly deficits and/or needs based. The focus is generally on how to manage the short term needs of the younger population with ABI. The starting position of my thesis is that people living long-term with ABI are important participants in developing knowledge about this social phenomenon, living with ABI while accepting that their brain injury does not determine them. Six mature adults with ABI and their six significant others participated in this longitudinal study. Using a narrative approach in interviews, over twenty months, five repeat individual interviews with each of the twelve participants was held. From this I gained an understanding of their lived experiences, their life-world and their experiences of our local public ABI/disability services, systems and discourse. Along with this new empirical data, theoretical developments from occupational therapy, occupational science, sociology, and disability studies were also used within a meta-narrative informed by critical theory and critical realism to develop a synthesis of this study. Social analysis of their narratives co-constructed with me, allowed me generate nuanced insights into tendencies and social processes that impacted and continues to impact on their everyday-everynight living. I discuss in some depth here, the relational attitudinal, structural, occupational and environmental supports, barriers or discrimination that they face(d) in their search for social participation and community inclusion. Personal recognition of the disabled participants by their family, friends and/or local community, was generally enhanced after much suffering, social supports, slow recovery, and with some form of meaningful occupational engagement. This engagement was generally linked with pre-injury interests or habits, while Time itself became both a major aid and a need. The present local ABI discourse seldom includes advocacy and inclusion in everyday/every night local events, yet most participants sought both peer-support or collective recognition, and social/community inclusion to help develop their own counter-discourse to the dominant ABI discourse. This thesis aims to give a broad social explanation on aspects of their social becoming, 'self-sameness' and social participation, and the status of the disabled participants wanting to live 'the slow life'. Tensions and dialectical issues involved in moving from the category of a person in coma, to person with a disability, to being a citizen should not demote the need for special services. While individualized short-term neuro-rehabilitation is necessary, it is not sufficient. Along with the participants, this researcher asks that community health and/or social care planners and service-providers rethink how ABI is understood and represented, and how people with ABI are included in their local communities

Team-teaching for inclusive learning: Purposes, practices and perceptions of a team-teaching initiative in Irish post-primary schools

Background. Schools unequivocally privilege solo-teaching. This research seeks to enhance our understanding of team-teaching by examining how two teachers, working in the same classroom at the same time, might or might not contribute to the promotion of inclusive learning. There are well-established policy statements that encourage change and moves towards the use of team-teaching to promote greater inclusion of students with special educational needs in mainstream schools and mainstream classrooms. What is not so well established is the practice of team-teaching in post-primary settings, with little research conducted to date on how it can be initiated and sustained, and a dearth of knowledge on how it impacts upon the students and teachers involved. Research questions and aims. In light of the paucity and inconclusive nature of the research on team-teaching to date (Hattie, 2009), the orientating question in this study asks ‘To what extent, can the introduction of a formal team-teaching initiative enhance the quality of inclusive student learning and teachers’ learning at post-primary level?’ The framing of this question emerges from ongoing political, legal and educational efforts to promote inclusive education. The study has three main aims. The first aim of this study is to gather and represent the voices and experiences of those most closely involved in the introduction of team-teaching; students, teachers, principals and administrators. The second aim is to generate a theory-informed understanding of such collaborative practices and how they may best be implemented in the future. The third aim is to advance our understandings regarding the day-to-day, and moment-to-moment interactions, between teachers and students which enable or inhibit inclusive learning. Sample. In total, 20 team-teaching dyads were formed across seven project schools. The study participants were from two of the seven project schools, Ash and Oak. It involved eight teachers and 53 students, whose age ranged from 12-16 years old, with 4 teachers forming two dyads per school. In Oak there was a class of first years (n=11) with one dyad and a class of transition year students (n=24) with the other dyad. In Ash one class group (n=18) had two dyads. The subjects in which the dyads engaged were English and Mathematics. Method. This research adopted an interpretive paradigm. The duration of the fieldwork was from April 2007 to June 2008. Research methodologies included semi-structured interviews (n=44), classroom observation (n=20), attendance at monthly teacher meetings (n=6), questionnaires and other data gathering practices which included school documentation, assessment findings and joint examination of student work samples (n=4). Results. Team-teaching involves changing normative practices, and involves placing both demands and opportunities before those who occupy classrooms (teachers and students) and before those who determine who should occupy these classrooms (principals and district administrators). This research shows how team-teaching has the potential to promote inclusive learning, and when implemented appropriately, can impact positively upon the learning experiences of both teachers and students. The results are outlined in two chapters. In chapter four, Social Capital Theory is used in framing the data, the change process of bonding, bridging and linking, and in capturing what the collaborative action of team-teaching means, asks and offers teachers; within classes, between classes, between schools and within the wider educational community. In chapter five, Positioning Theory deductively assists in revealing the moment-to-moment, dynamic and inclusive learning opportunities, that are made available to students through team-teaching. In this chapter a number of vignettes are chosen to illustrate such learning opportunities. These two theories help to reveal the counter-narrative that team-teaching offers, regarding how both teachers and students teach and learn. This counter-narrative can extend beyond the field of special education and include alternatives to the manner in which professional development is understood, implemented, and sustained in schools and classrooms. Team-teaching repositions teachers and students to engage with one another in an atmosphere that capitalises upon and builds relational trust and shared cognition. However, as this research study has found, it is wise that the purposes, processes and perceptions of team-teaching are clear to all so that team-teaching can be undertaken by those who are increasingly consciously competent and not merely accidentally adequate. Conclusions. The findings are discussed in the context of the promotion of effective inclusive practices in mainstream settings. I believe that such promotion requires more nuanced understandings of what is being asked of, and offered to, teachers and students. Team-teaching has, and I argue will increasingly have, its place in the repertoire of responses that support effective inclusive learning. To capture and extend such practice requires theoretical frameworks that facilitate iterative journeys between research, policy and practice. Research to date on team-teaching has been too focused on outcomes over short timeframes and not focused enough on the process that is team-teaching. As a consequence team-teaching has been under-used, under-valued, under-theorised and generally not very well understood. Moving from classroom to staff room and district board room, theoretical frameworks used in this research help to travel with, and understand, the initiation, engagement and early consequences of team-teaching within and across the educational landscape. Therefore, conclusions from this study have implications for the triad of research, practice and policy development where efforts to change normative practices can be matched by understandings associated with what it means to try something new/anew, and what it means to say it made a positive difference.

Covert conversations: disciplined improvisation and meaning-making in the masters (MA) supervisory relationship

This research asks the question: “What are the relational dynamics in Masters (MA) supervision?” It does so by focusing upon the supervisory relationship itself. It does this through dialoguing with the voices of both MA supervisors and supervisees in the Humanities using a Cultural Historical Activity Theory (CHAT) framework. In so doing, this research argues for a re-evaluation of how MA supervision is conceptualised and proposes a new theoretical framework for conceptualising MA supervision as a relational phenomenon. The research design was derived from an Activity Theory-influenced methodology. Data collection procedures included the administration of Activity Theory Logs, individual semi-structured interviews with both supervisors and supervisees and the completion of reflective journals. Grounded Theory was used to analyse the data. The sample for the study consists of three supervisor-supervisee dyads from three disciplines in the Humanities. Data was collected over the course of one academic year, 2010-2011. This research found that both individual and shared relational dynamics play an important role in MA supervision. Individual dynamics, such as supervisors’ iterative negotiation of ambiguity/clarity and supervisees’ boundary work, revealed that both parties attempt to negotiate a separation between their professional-academic identities and personal identities. However, an inherent paradox emerged when the shared relational dynamics of MA supervision were investigated. It was found that the shared space created by the supervisory relationship did not only exist in a physical setting, but was also psychoactive in nature and held strong emotional resonances for both parties involved. This served to undermine the separation between professional-academic and personal identities. As a result, this research argues that the interaction between the individual and shared relational dynamics in MA supervision enables, for both supervisors and supervisees, a disciplined improvisation of academic identity.

Supporting therapist engagement in evidence based practice: Developing a continuing education programme through participatory action research

Therapists find it challenging to integrate research evidence into their clinical decision-making because it may involve modifying their existing practices. Although continuing education (CE) programmes for evidence-based practice (EBP) have employed various approaches to increase individual practitioner’s knowledge and skills, these have been shown to have little impact in changing customary behaviours. To date, there has been little attempt to actively engage therapists as collaborators in developing educational processes concerning EBP. The researcher collaborated with seven clinical therapists (one occupational therapist, four physiotherapists and two speech and language therapists) enrolled in a new post-qualification Implementing Evidence in Therapy Practice (IETP) MSc module to monitor and adapt the learning programme over ten weeks. The participating therapists actively engaged in participatory action research (PAR) iterative cycles of reflecting→ planning→ acting→ observing→ reflecting with the researcher. Mixed methods were used to evaluate the IETP module and its influence on therapists’ subsequent engagement in EBP activities. Data were gathered immediately on completion of the module and five months later. Immediate post-module findings revealed four components as being important to the therapists: 1) characteristics of the learning environment; 2) acquisition of relevant EBP skills; 3) nature of the learning process; and 4) acquiring confidence. The two themes and sub-themes which emerged from individual interviews conducted five months post-module expanded on the four components already identified. Theme 1: Experiencing the learning (sub-themes: module organisation; learning is relational; improving the module); and theme 2: Enacting the learning through a new way of being (sub-themes: criticality and reflection; self agency; modelling EBP behaviours; positioning self in an EB work culture). The therapists’ perspectives had by then shifted from that of a learner to that of a clinician constructing a new sense of self as an evidence-based practitioner. Findings from this study underline the importance of the process of socially constructed knowledge and of empowering learners through collaboratively designed continuing education programmes. In the student-driven learning environment, therapists chose repetitive skill-building and authentic problem-solving activities which reflected the complexity of the environments to which they were expected to transfer their learning. These findings have implications for educators designing EBP continuing education programmes, during which students develop professional ways of being.

States of play: Irish childhoods, race and belonging

This thesis explores the meaning-making practices of migrant and non-migrant children in relation to identities, race, belonging and childhood itself in their everyday lives and in the context of ‘normalizing’ discourses and spaces in Ireland. The relational, spatial and institutional contexts of children’s worlds are examined in the arenas of school, home, family, peer groups and consumer culture. The research develops a situated account of children’s complex subject positions, belongings and exclusions, as negotiated within discursive constructs, emerging in the ‘in-between’ spaces explored with other children and with adults. As a peripheral EU area both geographically and economically, Ireland has traditionally been a country of net emigration. This situation changed briefly in the late 1990s to early 2000s, sparking broad debate on Ireland’s perceived ‘new’ ethnic, cultural and linguistic diversity arising from the arrival of migrant people both from within and beyond the EU as workers and as asylum seekers, and drawing attention to issues of race, identity, equality and integration in Irish society. Based in a West of Ireland town where migrant children and children of migrants comprise very small minorities in classroom settings, this research engages with a particular demographic of children who have started primary school since these changes have occurred. It seeks to represent the complexities of the processes which constitute children’s subjectivities, and which also produce and reproduce race and childhood itself in this context. The role of local, national and global spaces, relational networks and discursive currents as they are experienced and negotiated by children are explored, and the significance of embodied, sensory and affective processes are integrated into the analysis. Notions of the functions and rhetorics of play and playfulness (Sutton-Smith 1997) form a central thread that runs throughout the thesis, where play is both a feature of children’s cultural worlds and a site of resistance or ‘thinking otherwise’. The study seeks to examine how children actively participate in (re)producing definitions of both childhood and race arising in local, national and global spaces, demonstrating that while contestations of the boundaries of childhood discourses are contingently successful, race tends to be strongly reiterated, clinging to bodies and places and compromising belonging. In addition, it explores how children access belongings through agentic and imaginative practices with regard to peer and family relationships, particularly highlighting constructions of home, while also illustrating practices of excluding children positioned as unintelligible, including the role of silences in such situations. Finally, drawing on teachers’ understandings and on children’s playful micro-level negotiations of race, the study argues that assumptions of childhood innocence contribute to justifying depoliticised discourses of race in the early primary school years, and also tend to silence children’s own dialogues with this issue. Central throughout the thesis is an emphasis on the productive potentials of children’s marginal positioning in processes of transgressing definitional boundaries, including the generation of post-race conceptualisations that revealed the borders of race as performative and fluid. It suggests that interrupting exclusionary raced identities in Irish primary schools requires engagement with children’s world-making practices and the multiple resources that inform their lives.

Contemporary pilgrimage in Ireland: a cultural geographic perspective

Using the lenses of contemporary cultural geography, this research develops an understanding of pilgrimage as a relational and reciprocal process that co-produces self and world. Drawing on the phenomenology of Merleau-Ponty, I argue that through the performances and experiences of contemporary pilgrimage in Ireland, participants and locations emerge as pilgrims and pilgrimage places. This approach unites different strands of cultural geography, including the mobilities field, more-than representational concerns, discussions of embodiment and practice, emotional and affective geographies, and religious and spiritual geographies. I explore how pilgrimage is an active process in which self and world, belief and practice, and the numinous and material entwine and merge. An autoethnographic methodology is enacted as an embodied, intersubjective, and reflexive research approach that incorporates the motivations, experiences, and beliefs of research participants, alongside my own descriptions and reflections. The methodology is focused on encountering and documenting pilgrimage practices as they occur in place and relating these embodied spatial practices to the accounts of pilgrims. The insights generated by engagements with research participants and through my own pilgrimages, offer new appreciations of the enduring appeal of pilgrimage in Ireland as a religious-spiritual and cultural activity that allows people to express personal intentions, to develop their faith, and to seek numinous encounters. Through the pilgrimages at Lough Derg, Croagh Patrick, and three holy wells, I produce a layered account of the empirical circumstances of the practices. The presentation of these places and events is enhanced by the use of evocative images and audiovisual recordings. By centring my study on the practices and experiences of different pilgrimages in present-day Ireland, and critically deploying strands of cultural geography and pilgrimage studies, this research produces new qualitative understandings of pilgrimage and contributes to discussions concerned with the relationships between self and world.

An intelligent assistant for design and material engineers in the submarine cable industry

This paper describes an industrial application of case-based reasoning in engineering. The application involves an integration of case-based reasoning (CBR) retrieval techniques with a relational database. The database is specially designed as a repository of experiential knowledge and with the CBR application in mind such as to include qualitative search indices. The application is for an intelligent assistant for design and material engineers in the submarine cable industry. The system consists of three components; a material classifier and a database of experiential knowledge and a CBR system is used to retrieve similar past cases based on component descriptions. Work has shown that an uncommon retrieval technique, hierarchical searching, well represents several search indices and that this techniques aids the implementation of advanced techniques such as context sensitive weights. The system is currently undergoing user testing at the Alcatel Submarine Cables site in Greenwich. Plans are for wider testing and deployment over several sites internationally.

Intelligent design assistant (IDA): a case base reasoning system for material and design

This paper describes the approach to the modelling of experiential knowledge in an industrial application of Case-Based Reasoning (CBR). The CBR involves retrieval techniques in conjunction with a relational database. The database is especially designed as a repository of experiential knowledge, and includes qualitative search indices. The system is intended to help design engineers and material engineers in the submarine cable industry. It consists of three parts: a materials database; a database of experiential knowledge; and a CBR system used to retrieve similar past designs based upon component and material qualitative descriptions. The system is currently undergoing user testing at the Alcatel Submarine Networks site in Greenwich.

A case based model to assist in the design process in the manufacture of furniture products

This paper describes progress on a project to utilise case based reasoning methods in the design and manufacture of furniture products. The novel feature of this research is that cases are represented as structures in a relational database of products, components and materials. The paper proposes a method for extending the usual "weighted sum" over attribute similarities for a ·single table to encompass relational structures over several tables. The capabilities of the system are discussed, particularly with respect to differing user objectives, such as cost estimation, CAD, cutting scheme re-use, and initial design. It is shown that specification of a target case as a relational structure combined with suitable weights can fulfil several user functions. However, it is also shown that some user functions cannot satisfactorily be specified via a single target case. For these functions it is proposed to allow the specification of a set of target cases. A derived similarity measure between individuals and sets of cases is proposed.

SOFT – generating highly flexible object code from XML specifications

Many code generation tools exist to aid developers in carrying out common mappings, such as from Object to XML or from Object to relational database. Such generated code tends to possess a high binding between the Object code and the target mapping, making integration into a broader application tedious or even impossible. In this paper we suggest XML technologies and the multiple inheritance capabilities of interface based languages such as Java, offer a means to unify such executable specifications, thus building complete, consistent and useful object models declaratively, without sacrificing component flexibility.

An analysis of human behaviour during the WTC disaster of 9/11 based on published survivor accounts

This paper presents an analysis of survivor experiences from the World Trade Centre (WTC) evacuation of 11 September 2001. The experiences were collected from published accounts appearing in the print and electronic mass media and are stored in a relational database specifically developed for this purpose.