Managerialism at the bottom of the pyramid: a case study in Brazil

Nas últimas décadas, a Base da Pirâmide tem sido cada vez mais debatida entre líderes ocidentais como a nova terra das oportunidades. Com o advento do neoliberalismo no campo do desenvolvimento na década de 1990, o papel da sociedade civil e, em particular, o de Organizações Não-Governamentais, passou a ser enfatizado como sendo central nas estratégias ocidentais no "Sul" do mundo. Os atores do desenvolvimento, no entanto, muitas vezes abordaram essas questões utilizando perspectivas tradicionais, que estavam geralmente fora de contexto. A tese foca na controvérsia em torno do uso de técnicas de gestão em cenários que diferem daqueles nos quais estas ferramentas têm sido desenvolvidas. Em particular, ela procura compreender em que medida o gerencialismo - a ideologia da gestão - está a influenciando as atividades de uma Organização Não-Governamental brasileira, a Galpão Aplauso. O estudo, usando uma estrutura teórica, analisa o relacionamento entre a ONG e seus parceiros, sublinhando os resultados de conflitos ideológicos. No geral, descobriu-se como o encontro das perspectivas do Norte e do Sul originou alguns debates que levaram, em parte, à aceitação de ideias gerencialistas, tais como a replicabilidade e sistematização de processos, enquanto que em alguns casos, eles intensificaram a resistência da ONG sobre conceitos como sustentabilidade financeira e transformação em um negócio social.

Carbon credit trading in Brazil: an overview of a new business sector

This article discusses the Carbon Credit Trading Market in Brazil and opportunities for technological development and innovation related. The international trade in carbon credits becomes a source of opportunities for developing countries because of the Clean Development Mechanism. Committed to reduce polluting levels from 2008 to 2012, and ahead, industrialized countries started to seek ecological solutions internally or compensatory actions such as buying carbon credits from low-emission countries. This strategy brought up a brand-new industrial sector that still requires productive structures and a solid international commercialization system. This is a qualitative study, based on documentary research, referring to the Brazilian territory. The data obtained point out a set of efforts such as researching and developing products and processes environment friendly. Other findings indicate opportunities to expand Green Economy Sector through supporting a set of newborn firms such as waste management and recycling, in addition to other actions that reinforce sustainable development opportunities to the country and, at the end, to the world.

How Do Tourist Guides Add Value to An Ecotour? Interpreting Interpretation in the State of Amazonas, Brazil

In Ecotourism, interpretation by a guide creates or shapes the experience for the tourist, differentiating one episode from another. As such, the guide S interpretation adds value to the tourism product and contributes to the visitor S experience. This paper discussed the role of interpretation by guides in the State of Amazonas, Brazil, finding in them patterns from which lessons may be drawn. Given the intangibility of the Ecotourism product, this paper argues that it is the guide who defines the quality of the product. The guide may draw the tourist toward or away from sustainable practices, and significantly contributes to the success or failure of the escotouristic venture. The State of Amazonas in Brazil already has guides, but this study questions their education and training in interpretive skills as well as their professional organization and working conditions

Influence of habitat on the reproductive ecology of the Amazonian palm, Mauritia flexuosa, in Roraima, Brazil

Although Mauritia flexuosa (Arecaceae) plays a pivotal role in the ecology and economy of the Amazon, and occurs in a variety of habitats, little is known about the influence of habitat on the reproductive biology of this palm. My dissertation focuses on the reproductive biology of M. flexuosa in three habitats in Roraima, Brazil: undisturbed forest, undisturbed forest-savanna ecotone, and savanna disturbed by plantations of the exotic tree, Acacia mangium. First, I calculated sex ratios and linked precipitation patterns with phenology. Sex ratios were female-biased. Precipitation was negatively associated with flowering, and positively associated with fruiting. Habitat appears to have no significant influence on phenology of M. flexuosa, although short-term climate variation may affect phenology of this species. Second, I examined floral biology, observed floral visitors, and performed exclusion experiments to determine the pollination system of M. flexuosa. Fruit set did not differ significantly between the visitor exclusion treatment and the control, but was significantly lowest in the wind + visitor exclusion treatment, suggesting that this dioecious palm is anemophilous, independent of habitat. Third, I identified the abiotic and biotic factors explaining variation in fruit mass, seed mass, seed number per fruit, and total fruit yield among habitats. Soil moisture and flooding during the wet season were the best predictors of fruit and seed output. The number of leaves, diameter at breast height, and height were all accurate predictors of reproductive output, but crown volume did not accurately predict fruit yields. Results re-evaluate traditional assumptions about wind-pollination in the tropics, and highlight abiotic and biotic factors responsible for variation in reproductive output of M. flexuosa, with implications for effective management of this palm. Finally, I interviewed harvesters and vendors to document the traditional knowledge and market dynamics of the fruit of M. flexuosa, buriti. Traditional knowledge corroborated results from scientific studies. Vendors argued that the price of buriti must increase, and must fluctuate with varying supply. With appropriate economic incentives to vendors/harvesters, Roraima may expand its market infrastructure for buriti, effectively stimulating the regional economy and practicing sustainable harvesting.

The main criteria of biomass selection for energy generation in Brazil

The principal aim of this paper is to examine the criteria assisting in the selection of biomass for energy generation in Brazil. To reach the aim, this paper adopts case study and survey research methods to collect information from four biomass energy case companies and solicits opinions from experts. The data gathered are analysed in line with a wide range of related data, including selection criteria for biomass and its importance, energy policies in Brazil, availability of biomass feedstock in Brazil and its characteristics, as well as status quo of biomass-based energy in Brazil. The findings of the paper demonstrate that there are ten main criteria in biomass selection for energy generation in Brazil. They comprise geographical conditions, availability of biomass feedstock, demand satisfaction, feedstock costs and oil prices, energy content of biomass feedstock, business and economic growth, CO2 emissions of biomass end-products, effects on soil, water and biodiversity, job creation and local community support, as well as conversion technologies. Furthermore, the research also found that these main criteria cannot be grouped on the basis of sustainability criteria, nor ranked by their importance as there is correlation between each criterion such as a cause and effect relationship, as well as some overlapping areas. Consequently, this means that when selecting biomass more comprehensive consideration is advisable.

Examples of “land stewarship” in Brazil. The “Projecto Sempre Viva” (Mucugê-Bahia)

In recent years the concept of "Land Stewardship" has gained a great importance. In short, it means that local entities and individuals can protect enclave of high ecological and cultural value. This vision has been effective in some places in the world with success. For example, the “Projeto Sempre Viva”, created in the town of Mucugê, a place located in one of Brazil´s most renowned Natural Protected Areas: the Chapada Diamantina (State of Bahia). We had looked over the available information about this project on the Internet, as well as a personal visit that was made to the site to know it and to have the possibility to talk to their managers. On this basis, it has been reached to the conclusion that this project, born to protect a Sempre Viva´s endemic species in danger of extinction, has turned into an important site for tourism and environmental education, completed with the preservation of the cultural identity of this region which is linked to diamond mining.

Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study

AIMS AND OBJECTIVES: To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

BACKGROUND: Pain management in end-stage dementia is a fundamental aspect of end of life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.

DESIGN: A qualitative study using semi-structured interviews and thematic analysis to examine data.

METHODS: 24 registered nurses caring for people dying with advanced dementia were recruited from ten nursing homes, three hospices, and two acute hospitals across a region of the United Kingdom. Interviews were conducted between June 2014 and September 2015.

RESULTS: Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.

CONCLUSIONS: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

RELEVANCE TO CLINICAL PRACTICE: Nurses considered pain management fundamental to end of life care provision; however, nurses working in acute care and nursing home settings may be under-supported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology. This article is protected by copyright. All rights reserved.

The effectiveness of a nurse practitioner-led pain management team in long-term care: A mixed methods study

BACKGROUND: Considering the high rates of pain as well as its under-management in long-term care (LTC) settings, research is needed to explore innovations in pain management that take into account limited resource realities. It has been suggested that nurse practitioners, working within an inter-professional model, could potentially address the under-management of pain in LTC.

OBJECTIVES: This study evaluated the effectiveness of implementing a nurse practitioner-led, inter-professional pain management team in LTC in improving (a) pain-related resident outcomes; (b) clinical practice behaviours (e.g., documentation of pain assessments, use of non-pharmacological and pharmacological interventions); and, (c) quality of pain medication prescribing practices.

METHODS: A mixed method design was used to evaluate a nurse practitioner-led pain management team, including both a quantitative and qualitative component. Using a controlled before-after study, six LTC homes were allocated to one of three groups: 1) a nurse practitioner-led pain team (full intervention); 2) nurse practitioner but no pain management team (partial intervention); or, 3) no nurse practitioner, no pain management team (control group). In total, 345 LTC residents were recruited to participate in the study; 139 residents for the full intervention group, 108 for the partial intervention group, and 98 residents for the control group. Data was collected in Canada from 2010 to 2012.

RESULTS: Implementing a nurse practitioner-led pain team in LTC significantly reduced residents' pain and improved functional status compared to usual care without access to a nurse practitioner. Positive changes in clinical practice behaviours (e.g., assessing pain, developing care plans related to pain management, documenting effectiveness of pain interventions) occurred over the intervention period for both the nurse practitioner-led pain team and nurse practitioner-only groups; these changes did not occur to the same extent, if at all, in the control group. Qualitative analysis highlighted the perceived benefits of LTC staff about having access to a nurse practitioner and benefits of the pain team, along with barriers to managing pain in LTC.

CONCLUSIONS: The findings from this study showed that implementing a nurse practitioner-led pain team can significantly improve resident pain and functional status as well as clinical practice behaviours of LTC staff. LTC homes should employ a nurse practitioner, ideally located onsite as opposed to an offsite consultative role, to enhance inter-professional collaboration and facilitate more consistent and timely access to pain management.

“There’s a Catch-22”. The complexities of pain management for people with advanced dementia nearing the end of life: a qualitative exploration of physicians’ perspectives

Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring: barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Settings/Participants: Twenty-three physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care (n=9), psychiatry (n=7) and hospice care (n=7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side-effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialties. Cross-specialty mentoring, and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusions: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002

Project Pró-Natal: population-based study of perinatal and infant mortality in Natal, Northeast Brazil

RAMOS, Ana Maria de Oliveira et al. Project Pró-Natal: population-based study of perinatal and infant mortality in Natal, Northeast Brazil. Pediatric and Developmental Pathology, v.3, n.1, p.29-35, 2000

Surgical Site Infection in a University Hospital in Northeast Brazil

We examined prevention of surgical site infection (SSI) in a tertiary teaching hospital in northeast Brazil, from January 1994 to December 2003. The survey included 5,742 patients subjected to thoracic, urologic, vascular and general surgery. The criteria for diagnosing SSI were those of the Centers for Disease Control, USA, and the variables of the National Nosocomial Infection Surveillance risk index were used. Data analysis revealed that anesthetic risk scores, wound class and duration of surgery were significantly associated with SSI. A total of 296 SSIs were detected among the 5,742 patients (5.1%). The overall incidence of SSI was 8.8% in 1994; it decreased to 3.3% in 2003. In conclusion, the use of educational strategies, based on guidelines for SSI prevention reduced SSI incidence. Appropriate management of preoperative, intraoperative, and postoperative incision care, and a surveillance system based on international criteria, were useful in reducing SSI rates in our hospital

Learning from one another: evaluating the impact of horizontal knowledge exchange for environmental management and governance

There is increasing advocacy for inclusive community-based approaches to environmental management, and growing evidence that involving communities improves the sustainability of social-ecological systems. Most community-based approaches rely on partnerships and knowledge exchange between communities, civil society organizations, and professionals such as practitioners and/or scientists. However, few models have actively integrated more horizontal knowledge exchange from community to community. We reflect on the transferability of community owned solutions between indigenous communities by exploring challenges and achievements of community peer-to-peer knowledge exchange as a way of empowering communities to face up to local environmental and social challenges. Using participatory visual methods, indigenous communities of the North Rupununi (Guyana) identified and documented their community owned solutions through films and photostories. Indigenous researchers from this community then shared their solutions with six other communities that faced similar challenges within Guyana, Suriname, Venezuela, Colombia, French Guiana, and Brazil. They were supported by in-country civil society organizations and academics. We analyzed the impact of the knowledge exchange through interviews, field reports, and observations. Our results show that indigenous community members were significantly more receptive to solutions emerging from, and communicated by, other indigenous peoples, and that this approach was a significant motivating force for galvanizing communities to make changes in their community. We identified a range of enabling factors, such as building capacity for a shared conceptual and technical understanding, that strengthens the exchange between communities and contributes to a lasting impact. With national and international policy-makers mobilizing significant financial resources for biodiversity conservation and climate change mitigation, we argue that the promotion of community owned solutions through community peer-to-peer exchange may deliver more long-lasting, socially and ecologically integrated, and investment-effective strategies compared to top-down, expert led, and/or foreign-led initiatives.