Testamentary capacity and aphasia: A descriptive case report with implications for clinical practice

Background: Testamentary capacity (the capacity to make a will) is recognised in the literature as an important issue for speech-language pathologists' assessment of people with aphasia, but current guidelines for clinical practice lack an empirical base. Aims: The research aimed to suggest some guidelines for clinical practice based on information considered relevant for the court in determining testamentary capacity. Methods & Procedures: A recent legal case involving a challenge to the will of a woman with severe aphasia was critically examined with reference to current guidelines in the literature regarding assessment of testamentary capacity. Outcomes & Results: Examination of the information available on the case indicated that the judge gave priority to accounts of the everyday communication of the person with aphasia (including reported discourse samples) over the information provided by expert medical witnesses. The extent to which communication effectiveness could be maximised was found to be a matter of key significance to the determination of capacity. Conclusions: This study has implications for speech-language pathologists' assessment practices and reports, as well as for scope of practice with regard to legal decision making of people with aphasia. These issues are discussed in relation to the World Health Organisation's ICF framework of functioning for social participation.

Clinical aspects of gestational trophoblastic disease: A review based partly on 25-year experience of a statewide registry

Background: Gestational trophoblastic disease is a fascinating group of pregnancy disorders characterised by abnormal proliferation of trophoblast, ranging from benign to malignant. Because the disease is uncommon, there is a need to formulate management with the assistance of collective information. Methodology: A review of available information from English written literature was undertaken especially data reported by registries around the world (Charing Cross Hospital in England, the North-western University and the New England area in the USA as well as our own experience in Queensland, Australia). Where possible, collated data from relevant studies were analysed to answer some of the questions posed in clinical practice, with reference to metastatic disease to liver and brain, twinning of molar gestation and coexisting fetus, and placental-site tumour. Results: We found that molar gestation can be classified according to its clinical presentation which influences the time taken to reach human chorionic gonadotropin (HCG) 'negativity' and the risk of persisting disease. Categorisation of risk is the basis for choice of chemotherapy to achieve good outcomes. Metastases to liver and brain remain problems in management; the development of 'new' metastases during chemotherapy is a very poor prognostic factor. In the variant of twinning with molar gestation and coexisting fetus, it is important to elucidate the fetal karyotype in planning management: a 69XXX fetus is not salvageable but a normal 46XX or 46XY fetus faces the prospect of early preterm delivery. The placental-site tumour is very rare; localised disease is curable by surgery; chemotherapy is less effective in disseminated disease. From collated worldwide data, the recurrence rate after one mole is 1.3% and after two or more is 20%. Reproductive outcome in subsequent pregnancies, even after multidrug chemotherapy, is not different from the general population. Because of the increased risk long-term of second tumours after multidrug chemotherapy a closer surveillance of these patients is necessary Conclusion: In general, the disease in its persisting or malignant form is 'a cancer model par excellence' because of an identifiable precursor condition, a reliable HCG marker, and sensitivity of the disease to cytotoxic drugs. With current management, retention of fertility is possible and normal reproductive outcome assured.

Conselhos municipais de pol??ticas p??blicas: uma an??lise explorat??ria

Os Conselhos Gestores s??o f??runs h??bridos onde se viabiliza a participa????o popular no desenho das pol??ticas p??blicas, nas negocia????es de interesses da coletividade, na elabora????o de programas e projetos sociais e na fiscaliza????o das a????es governamentais. O significado e a dimens??o dos Conselhos para a democracia participativa s??o enormes, justificando a import??ncia da realiza????o deste estudo, que se baseou na an??lise explorat??ria de 12 Conselhos locais do munic??pio mineiro de Vi??osa, com o objetivo de avaliar o desempenho dos mesmos. A avalia????o do desempenho levou em considera????o os mesmos par??metros dimensionais, tanto para a coleta de dados prim??rios quanto para a coleta secund??ria. A coleta de dados prim??rios foi realizada a partir da aplica????o de question??rios semi-estruturados aos presidentes dos Conselhos em an??lise. Utilizou-se o programa SPSS, vers??o 15.0, para an??lise estat??stica das quest??es objetivas dos question??rios e a t??cnica de an??lise de conte??do para exame das quest??es abertas. Ap??s essa etapa, realizou-se um workshop com os presidentes dos Conselhos, visando ?? obten????o de novos dados e informa????es. Os Conselhos municipais analisados apresentaram resultados pouco discrepantes entre a teoria aplicada ao tema e a sua efetiva pr??tica no campo p??blico. Contudo, a pesquisa revelou que o grau de desenvolvimento institucional dos Conselhos n??o ?? homog??neo, ou seja, h?? alguns melhores gestores que outros. A escolha independente e democr??tica dos membros n??o-governamentais dos Conselhos em Vi??osa revelou o seu grau de independ??ncia do Poder Executivo. Por??m, a capacita????o de conselheiros precisa ser implementada para evitar uma desfigura????o dos Conselhos. No que tange ?? governan??a, destacouse em Vi??osa o seu grau e formas de aplicabilidade observadas na gest??o de v??rias pol??ticas. Da mesma forma, foi observado um n??vel de governabilidade que confere legitimidade ??s pol??ticas implementadas. Por fim, verificou-se que a efetividade da accountability societal tem sido instrumentalizada pelos Conselhos no ??mbito das diversas pol??ticas setoriais. J?? os dados secund??rios da an??lise foram obtidos por meio das s??nteses dos relat??rios de fiscaliza????o de munic??pios do Estado de Minas Gerais, realizadas pela Controladoria Geral da Uni??o. Foram identificados todos os registros pertinentes aos Conselhos Gestores Municipais do Estado de Minas Gerais, no per??odo de 2003 a 2006. Verificou-se que os maiores problemas se referem aos Conselhos Municipais de Sa??de e Assist??ncia Social. Entre as in??meras falhas apontadas, destacam-se problemas graves na constitui????o e operacionaliza????o dos Conselhos, resultando na inoper??ncia desses mecanismos nos munic??pios fiscalizados. A avalia????o do desempenho dos Conselhos locais de Vi??osa possibilitou concluir que esses mecanismos apresentaram um desempenho bem satisfat??rio na gest??o e controle das pol??ticas p??blicas no munic??pio.

Aprender a governar: a aprendizagem de funcion??rios p??blicos para as carreiras de estado

Esta tese investiga como dois grupos de funcion??rios p??blicos seleciona dos para as carreiras de Estado no Brasil aprendem a desempenhar as suas fun????es. Deste m odo, busca compreender os processos de aprendizagem, formais e informais, da e ntrada desses servidores p??blicos como alunos nos espa??os destinados ?? sua forma????o, at?? sua inser ????o nos espa??os de trabalho, como aprendizes. A pesquisa justifica-se porque, sendo as am ostras estudadas consideradas boas refer??ncias no servi??o p??blico, faz-se necess??ri o compreender como se d?? a aprendizagem para o exerc??cio dessas carreiras de Estado. Quatro dimens??es s??o consideradas para investigar a aprendizagem dos funcion??rios p??blicos: primeira, o surgimento e evolu????o da forma????o em administra????o p??bli ca no Pa??s. Segunda, as escolas de governo, lugares prop??cios ?? aprendizagem, influente s para a administra????o p??blica do Pa??s, inclinados ?? discuss??o de novas solu????es e cr??ticos na identifica????o, an??lise e apropria????o das experi??ncias verificadas em outras realidades. Te rceira, os cursos de forma????o inicial, espa??os para o primeiro contato com a fun????o escol hida e os seus desafios, saberes necess??rios e ferramentas dispon??veis. Quarta, a inse r????o no ambiente de trabalho, decisiva para o processo de aprendizagem social dos funcion??rios novatos por interm??dio das comunidades de pr??tica.

Formação, educação física e inclusão : compreendendo os processos inclusivos

No intuito de contribuir para a problematização da Educação, numa perspectiva inclusiva, esta dissertação procura conhecer e analisar a prática pedagógica inclusiva experimentada pelos professores de Educação Física na escola, por meio de suas narrativas, em uma ação de formação continuada. O projeto de extensão intitulado Formação Continuada de Professores de Educação Física para a Educação Inclusiva foi a estratégia utilizada para a criação de um grupo de estudos, denominado Grupo Operativo de Formação (GOF). A ação de formação continuada foi realizada durante o período de julho a dezembro de 2011, em um encontro presencial semanal, totalizando dezesseis encontros, com uma carga horária final de 90h. Participaram da ação de formação quatro professores da Secretaria Municipal de Educação de Vitória-ES. A pesquisa baseia-se em elementos da pesquisa-ação, utilizando como instrumentos e procedimentos para a produção dos dados a narrativa, o diário de campo, o memorial e a entrevista. Da análise dos dados produzidos identifica três categorias norteadoras das discussões: a) o trabalho coletivo como possibilidade para inclusão; b) trilhando caminhos para o desenvolvimento de práticas inclusivas: o autismo como foco do percurso; c) o olhar dos professores sobre a ação de formação experimentada no GOF. As análises realizadas revelam que essa ação de formação traz resultados que sinalizam positivamente para sua efetivação como instrumento ativo no processo de formação de professores para a educação básica, na perspectiva da inclusão. Portanto, essa é uma interessante ferramenta a ser utilizada pelas redes de ensino como alternativa metodológica em programas de formação continuada. Além disso, a proposta promove momentos para a prática reflexiva dos professores, representando uma rica oportunidade, capaz de fazer com que eles se apropriem de teorias educacionais que poderão contribuir na elaboração de suas aulas.

Dashboard services for pragmatics-based interoperability in cloud and ubiquitous manufacturing

The real Cloud and Ubiquitous Manufacturing systems require effectiveness and permanent availability of resources, their capacity and scalability. One of the most important problems for applications management over cloud based platforms, which are expected to support efficient scalability and resources coordination following SaaS implementation model, is their interoperability. Even application dashboards need to easily incorporate those new applications, their interoperability still remains a big problem to override. So, the possibility to expand these dashboards with efficiently integrated communicational cloud based services (cloudlets) represents a relevant added value as well as contributes to solving the interoperability problem. Following the architecture for integration of enriched existing cloud services, as instances of manufacturing resources, this paper: a) proposes a cloud based web platform to support dashboard integrating communicational services, and b) describe an experimentation to sustain the theory that the effective and efficient interoperability, especially in dynamic environments, could be achieved only with human intervention.

Performance management framework: the fit between PM framework adopted in Portuguese local government and the Otley’s framework

Purpose/objectives: This paper seeks to investigate whether performance management (PM) framework adopted in Portuguese local government (PLG) fit the Otley’s PM framework (1999). In particularly, the research questions are (1) whether PM framework adopted in PLG (SIADAP) fit the Otley´s framework, and (2) how local politicians (aldermen) see the operation of performance management systems (PMS) in PLG (focusing on the goal-setting process and incentive and reward structures). Theoretical positioning/contributions: With this paper we intend to contribute to literature on how the Otley’s PM framework can guide empirical research about the operation of PMS. In particular, the paper contributes to understand the fit between PMS implemented in PLG and the Otley´s PM framework. The analysis of this fit can be a good contribution to understand if PMS are used in PLG as a management tool or as a strategic response to external pressures (based on interviews conducted to aldermen). We believe that the Otley’s PM framework, as well as the extended PM framework presented by Ferreira and Otley (2009), can provide a useful research tool to understand the operation of PMS in PLG. Research method: The first research question is the central issue in this paper and is analyzed based on the main reforms introduced by Portuguese government on PM of public organizations (like municipalities). On the other hand, interviews conducted on three larger Portuguese municipalities (Oporto, Braga, and Matosinhos) show how aldermen see the operation of PMS in PLG, highlighting the goals setting process with targets associated and the existing of incentive and reward structures linked with performance. Findings: Generally we find that formal and regulated PM frameworks in PLG fit the main issues of the Otley’s PM framework. However, regarding the aldermen perceptions about PMS in practice we find a gap between theory and practice, especially regarding difficulties associated with the lack of a culture of goals and targets setting and the lack of incentive and reward structures linked with performance.

Semi-automatic 3D Segmentation Of Costal Cartilage In CT Data From Pectus Excavatum Patients

One of the current frontiers in the clinical management of Pectus Excavatum (PE) patients is the prediction of the surgical outcome prior to the intervention. This can be done through computerized simulation of the Nuss procedure, which requires an anatomically correct representation of the costal cartilage. To this end, we take advantage of the costal cartilage tubular structure to detect it through multi-scale vesselness filtering. This information is then used in an interactive 2D initialization procedure which uses anatomical maximum intensity projections of 3D vesselness feature images to efficiently initialize the 3D segmentation process. We identify the cartilage tissue centerlines in these projected 2D images using a livewire approach. We finally refine the 3D cartilage surface through region-based sparse field level-sets. We have tested the proposed algorithm in 6 noncontrast CT datasets from PE patients. A good segmentation performance was found against reference manual contouring, with an average Dice coefficient of 0.75±0.04 and an average mean surface distance of 1.69±0.30mm. The proposed method requires roughly 1 minute for the interactive initialization step, which can positively contribute to an extended use of this tool in clinical practice, since current manual delineation of the costal cartilage can take up to an hour.