IMPLEMENTING BACK PAIN TREATMENT PATHWAYS IN CLINICAL PRACTICE: QUALITATATIVE ANALYSIS OF STAKEHOLDER PERCEPTIONS

Background
Evidence-based practice advocates utilising best current research evidence, while reflecting patient preference and clinical expertise in decision making. Successfully incorporating this evidence into practice is a complex process. Based on recommendations of existing guidelines and systematic evidence reviews conducted using the GRADE approach, treatment pathways for common spinal pain disorders were developed.

Aims
The aim of this study was to identify important potential facilitators to the integration of these pathways into routine clinical practice.

Methods
A 22 person stakeholder group consisting of patient representatives, clinicians, researchers and members of relevant clinical interest groups took part in a series of moderated focus groups, followed up with individual, semi-structured interviews. Data were analysed using content analysis.

Results
Participants identified a number of issues which were categorized into broad themes. Common facilitators to implementation included continual education and synthesis of research evidence which is reflective of everyday practice; as well as the use of clear, unambiguous messages in recommendations. Meeting additional training needs in new or extended areas of practice was also recognized as an important factor. Different stakeholders identified specific areas which could be associated with successful uptake. Patients frequently defined early involvement in a shared decision making process as important. Clinicians identified case based examples and information on important prognostic indicators as useful tools to aiding decisions.

Conclusion
A number of potential implementation strategies were identified. Further work will examine the impact of these and other important factors on the integration of evidence-based treatment recommendations into clinical practice.

Shared Photography: (Photo)journalism and political mobilisation in Rio de Janeiro's favelas

One of the most important civic phenomena emerging from favelas in Rio de Janeiro today is “community (photo)journalism”, which is practised by favela residents who are trained in journalistic and artistic techniques to raise critical awareness and promote political mobilisation in- and outside favelas. This paper looks at some of the work produced at one training place for community photographers, the agency-school Imagens do Povo (“Images of the People”) in Nova Holanda, a favela located in Rio’s North Zone. Using an ethnographic approach, this article first provides an account of the working practices of the School and its photographers. This is followed by a discussion of a small sample of their photographic work, for which we employ a social semiotic paradigm of image analysis. This methodological synergy provides insights into how these journalists document long-term structural as well as “spectacular” violence in favelas, while at the same time striving to capture some of the “beauty” of these communities. The paper concludes that this form of photographic work constitutes an important step towards a more analytical brand of journalism with different news values that encourage a more context-sensitive approach to covering urban violence and favela life.

KEYWORDS: alternative media, Imagens do Povo, multimodality, news values, photojournalism.

COLLABORATIVE TESTING ACROSS SHARED SOFTWARE COMPONENTS

Large component-based systems are often built from many of the same components. As individual component-based software systems are developed, tested and maintained, these shared components are repeatedly manipulated. As a result there are often significant overlaps and synergies across and among the different test efforts of different component-based systems. However, in practice, testers of different systems rarely collaborate, taking a test-all-by-yourself approach. As a result, redundant effort is spent testing common components, and important information that could be used to improve testing quality is lost. The goal of this research is to demonstrate that, if done properly, testers of shared software components can save effort by avoiding redundant work, and can improve the test effectiveness for each component as well as for each component-based software system by using information obtained when testing across multiple components. To achieve this goal I have developed collaborative testing techniques and tools for developers and testers of component-based systems with shared components, applied the techniques to subject systems, and evaluated the cost and effectiveness of applying the techniques. The dissertation research is organized in three parts. First, I investigated current testing practices for component-based software systems to find the testing overlap and synergy we conjectured exists. Second, I designed and implemented infrastructure and related tools to facilitate communication and data sharing between testers. Third, I designed two testing processes to implement different collaborative testing algorithms and applied them to large actively developed software systems. This dissertation has shown the benefits of collaborative testing across component developers who share their components. With collaborative testing, researchers can design algorithms and tools to support collaboration processes, achieve better efficiency in testing configurations, and discover inter-component compatibility faults within a minimal time window after they are introduced.

New developments in daily licencing practice workshop

New developments in higher education and research are having their repercussions in dailylicencing practice. Examples are; demands for perpetual access usage of licensed content incourse packs or virtual research environments text mining open access to publications. Atthe Knowledge Exchange workshop on LicencingPractice, twenty Experts discussed how these newdevelopments could be incorporated in licencing. The workshop consisted of four presentations oncurrent developments in licencing followed by threeparallel breakout sessions on the topics open access,new developments and data and text mining. This led toa lively exchange of ideas. Especially the aspect of dataand text mining provided valuable insights in how thiscould be incorporated in licencing. The Knowledge Exchange Licensing expert group willwork on how to implement the model provisions discussed. Input from the workshop was collected for a workshop with publishers to take place in March 2012 and will include these provisions in their licences. The various suggestions will be also shared with other international organisations working inthis field.

The Idiosyncratic Body: Contemporary Clown Theory and Practice

Drawing on historical research, personal interviews, performance analysis, and my own embodied experience as a participant-observer in several clown workshops, I explore the diverse historical influences on clown theatre as it is conceived today. I then investigate how the concept of embodied knowledge is reflected in red-nose clown pedagogy. Finally, I argue that through shared embodied knowledge spectators are able to perceive and appreciate the humor of clown theatre in performance. I propose that clown theatre represents a reaction to the eroding personal connections prompted by the so-called information age, and that humor in clown theatre is a revealing index of socio-cultural values, attitudes, dispositions, and concerns.

Every nation under heaven: the importance of the biblical concept of nations for contemporary mission practice

Is there a concept of nationhood in the Bible that can provide us with a framework for cross-cultural Christian mission? This thesis argues that current evangelical missiology has accepted too willingly the categories of the secular Enlightenment understanding of ethnicity and nationhood, and that it needs to rethink its understanding of nations from a biblical standpoint. While the pressures of globalisation are seen by some as rapidly eclipsing the nation-state, this thesis will argue that we need to move beyond the narrower secular categories of citizenship, political power and the boundaries of the state to recover a more biblical understanding of nationhood. By reference to Genesis 10-11, Acts 2:1-11 and those passages in the Book of Revelation that discuss the destiny of the nations, it will show that the biblical understanding of nations includes deeper ideas of shared history, culture and language as the essential components of nationhood. It will explain how nations are part of the created order, and explore the impact of the Babel narrative on our understanding of nations in relation to God. It will demonstrate that Pentecost did not reverse the curse of Babel, but served rather to honour the dignity and value of nations and their languages. It will also argue that nations have a destiny in the New Creation according to the Book of Revelation. This biblical concept of nationhood has significant implications in several areas: the development of a public theology; a Christian response to nationalism; the question of how urban mission fits within mission to the nations; and the importance of indigenous languages in cross-cultural mission, especially in the multicultural cities of Europe.

[the Teaching Of Social Sciences In Health: Between Practice And Theory].

The models of teaching social sciences and clinical practice are insufficient for the needs of practical-reflective teaching of social sciences applied to health. The scope of this article is to reflect on the challenges and perspectives of social science education for health professionals. In the 1950s the important movement bringing together social sciences and the field of health began, however weak credentials still prevail. This is due to the low professional status of social scientists in health and the ill-defined position of the social sciences professionals in the health field. It is also due to the scant importance attributed by students to the social sciences, the small number of professionals and the colonization of the social sciences by the biomedical culture in the health field. Thus, the professionals of social sciences applied to health are also faced with the need to build an identity, even after six decades of their presence in the field of health. This is because their ambivalent status has established them as a partial, incomplete and virtual presence, requiring a complex survival strategy in the nebulous area between social sciences and health.

Otoneurological Evaluation: Current Good Practice.

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[recommendations For Physical Exercise Practice During Pregnancy: A Critical Review].

Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child.

The Environment Of Professional Practice And Burnout In Nurses In Primary Healthcare.

to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare. cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used. the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job. the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas.

Is Sport Practice A Risk Factor For Shoulder Injuries In Tetraplegic Individuals?

A retrospective cohort. To report the incidence rates of shoulder injuries diagnosed with magnetic resonance imaging (MRI) in tetraplegic athletes and sedentary tetraplegic individuals. To evaluate whether sport practice increases the risk of shoulder injuries in tetraplegic individuals. Campinas, Sao Paulo, Brazil. Ten tetraplegic athletes with traumatic spinal cord injury were selected among quad rugby athletes and had both the shoulders evaluated by MRI. They were compared with 10 sedentary tetraplegic individuals who were submitted to the same radiological protocol. All athletes were male with a mean age of 32.1 years (range 25-44 years, s.d.=6.44). Time since injury ranged from 6 to 17 years, with a mean value of 9.7 years and s.d. of 3.1 years. All sedentary individuals were male with a mean age of 35.9 years (range 22-47 years, s.d.=8.36). Statistical analysis showed a protective effect of sport in the development of shoulder injuries, with a weak correlation for infraspinatus and subscapularis tendinopathy (P=0.09 and P=0.08, respectively) and muscle atrophy (P=0.08). There was a strong correlation for acromioclavicular joint (ACJ) and labrum injuries (P=0.04), with sedentary individuals at a higher risk for these injuries. Tetraplegic athletes and sedentary individuals have a high incidence of supraspinatus tendinosis, bursitis and ACJ degeneration. Statistical analysis showed that there is a possible protective effect of sport in the development of shoulder injuries. Weak evidence was encountered for infraspinatus and subscapularis tendinopathy and muscle atrophy (P=0.09, P=0.08 and P=0.08, respectively). Strong evidence with P=0.04 suggests that sedentary tetraplegic individuals are at a greater risk for ACJ and labrum injuries.Spinal Cord advance online publication, 17 March 2015; doi:10.1038/sc.2014.248.

Educação física escolar e relações de gênero : risco, confiança, organização e sociabilidades em diferentes conteúdos

Universidade Estadual de Campinas. Faculdade de Educação Física

O lazer e a residência secundária em Angra dos Reis-RJ = : The leisure and the second homes in Angra dos Reis, RJ

Universidade Estadual de Campinas . Faculdade de Educação Física

A formação continuada do professor de educação fisica : possibilitando praticas reflexivas

Universidade Estadual de Campinas . Faculdade de Educação Física

Contribution Of Antepartum And Intrapartum Hemorrhage To The Burden Of Maternal Near Miss And Death In A National Surveillance Study

Objective To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.Design Multicenter cross-sectional study.Setting Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010.Population A total of 9555 women categorized as having obstetric complications.Methods The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.Main outcome measures The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.Results Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).Conclusion Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.