846 resultados para Clinical reasoning process
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Formal specification is vital to the development of distributed real-time systems as these systems are inherently complex and safety-critical. It is widely acknowledged that formal specification and automatic analysis of specifications can significantly increase system reliability. Although a number of specification techniques for real-time systems have been reported in the literature, most of these formalisms do not adequately address to the constraints that the aspects of 'distribution' and 'real-time' impose on specifications. Further, an automatic verification tool is necessary to reduce human errors in the reasoning process. In this regard, this paper is an attempt towards the development of a novel executable specification language for distributed real-time systems. First, we give a precise characterization of the syntax and semantics of DL. Subsequently, we discuss the problems of model checking, automatic verification of satisfiability of DL specifications, and testing conformance of event traces with DL specifications. Effective solutions to these problems are presented as extensions to the classical first-order tableau algorithm. The use of the proposed framework is illustrated by specifying a sample problem.
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A fuzzy logic intelligent system is developed for gas-turbine fault isolation. The gas path measurements used for fault isolation are exhaust gas temperature, low and high rotor speed, and fuel flow. These four measurements are also called the cockpit parameters and are typically found in almost all older and newer jet engines. The fuzzy logic system uses rules developed from a model of performance influence coefficients to isolate engine faults while accounting for uncertainty in gas path measurements. It automates the reasoning process of an experienced powerplant engineer. Tests with simulated data show that the fuzzy system isolates faults with an accuracy of 89% with only the four cockpit measurements. However, if additional pressure and temperature probes between the compressors and before the burner, which are often found in newer jet engines, are considered, the fault isolation accuracy rises to as high as 98%. In addition, the additional sensors are useful in keeping the fault isolation system robust as quality of the measured data deteriorates.
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Estudo de natureza qualitativa, descritiva e exploratória, que teve como objeto o raciocínio clínico elaborado pelos enfermeiros ao cuidarem de feridas em clientes com afecções oncológicas. Os objetivos traçados para o estudo foram: identificar as estratégias cognitivas que os enfermeiros com especialização em área oncológica consideram adotar para o estabelecimento de um julgamento clínico na avaliação de feridas em clientes com afecções oncológicas e caracterizar as etapas de elaboração mental para construção do raciocínio clínico que os enfermeiros consideram percorrer quando da avaliação de feridas em cliente acometido por afecções oncológicas. O campo de pesquisa foi o Instituto Nacional do Câncer, no qual os cenários de coleta foi a unidade HC-I nas Seções de Oncologia Clínica, Neurocirurgia, Abdominopélvica, Centro de Tratamento Intensivo e Cirurgia de Cabeça e Pescoço. Os sujeitos do estudo foram treze enfermeiros com especialização em oncologia, que assistiam clientes com afecções oncológicas, há pelo menos cinco anos. A coleta dos dados aconteceu nos meses de junho e julho de 2009, sendo utilizado um roteiro de entrevista semi-estruturada para captar as informações. A análise dos dados foi realizada com base no método de análise de conteúdo, que ao ser aplicado possibilitou a apreensão de quatro categorias: (1) a afecção oncológica como fator expressivo na elaboração mental diagnóstica do enfermeiro; (2) a relevância do conhecimento teórico-prático avançado para a elaboração mental avaliativa do enfermeiro; (3) a construção da elaboração mental para o raciocínio clínico diagnóstico do enfermeiro; (4) a importância da interação humana no contexto avaliativo. Concluiu-se que, este estudo identificou, na discussão das categorias, as quatro principais estratégias cognitivas que os enfermeiros com especialização em área oncológica consideram adotar para o estabelecimento de um julgamento clínico na avaliação de feridas em clientes com afecções oncológicas e caracterizou as etapas de elaboração mental para construção do raciocínio clínico diagnóstico do tipo hipotético-dedutivo e intuitivo. Compreendeu-se que os sujeitos da pesquisa detêm qualidades intelectuais específicas e avançadas, quando elaboram diagnósticos e intervenções baseadas nas respostas humanas em situação de avaliação de feridas nos clientes com doença oncológica, e foi considerado que o ensino pode impulsionar o desenvolvimento das competências cognitivas no sentido de formar profissionais capazes de avaliar o próprio conhecimento, bem como a fomentação de novas pesquisas relativas a essa temática imprescindível para uma assistência de enfermagem qualificada.
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Pressupõe-se que o cotidiano do cuidar da integralidade do cliente com câncer de cavidade bucal (CCB) reveste-se de significado especial devido à sensibilidade e responsabilidade dos profissionais de enfermagem; e, do mesmo modo, exige destas pessoas competência e habilidades técnicas e sociais para atuar constantemente com o sofrimento. Portanto, foram elaboradas as questões de pesquisa: quais são os limites e possibilidades da aplicação do processo clínico de cuidar em enfermagem ao cliente com câncer na cavidade bucal? Os objetivos foram: descrever os limites e possibilidades de aplicação do Process Clinical Caritas, formulado por Jean Watson, aos clientes com câncer na cavidade bucal; identificar as características individuais e profissionais dos membros da equipe de enfermagem atuantes na área de oncologia; identificar os aspectos do cuidar componentes do Process Clinical Caritas (PCC) aplicados pela equipe de enfermagem junto aos clientes com CCB, analisando a autopercepção da equipe de enfermagem sobre o seu desenvolvimento de tecnologias de cuidados, comparando-o à aplicação do PCC proposto por Jean Watson. O estudo centra-se na teorização do cuidado transpessoal, visando à compreensão dos aspectos do bem-estar propiciado, inclusive pela autêntica relação interpessoal entre profissional de enfermagem e cliente. Escolheu-se a abordagem de pesquisa quantitativa, aplicando-se o método descritivo e a técnica de autorrelato. A investigação ocorreu no período de agosto a setembro de 2012 em uma Instituição de Saúde Federal do Rio de Janeiro, Brasil, especializada em oncologia. Foram sujeitos do estudo 33 membros da equipe de enfermagem, atuantes em serviço de tratamento de CCB. Para implementar a técnica de autorrelato, utilizou-se um formulário, contendo, na primeira parte, as variáveis sociodemográficas e profissionais, e na segunda, uma adaptação dos 10 aspectos do PCC. Os dados quantitativos foram tratados mediante estatística descritiva simples, e as respostas sobre a aplicação do PCC foram submetidas à análise de conteúdo. Constatou-se que, do total de 33 sujeitos, 88% eram do sexo feminino, 37% na faixa etária de 30 a 39 anos. Predominou a renda individual de 4 a 8 salários mínimos. A maioria da equipe era composta por técnicos de enfermagem. Havia 26 especialistas em oncologia; 78% eram estatutários com carga horária de 40 horas semanais, com exercício predominante de 11 a 15 anos. Referente à aplicação dos 10 aspectos do PCC, foram delimitadas quatro categorias: respeitando as praticas espirituais e a religiosidade; proporcionando ao cliente uma relação de cuidado e conforto; ser presente e tratar o cliente com empatia e respeito; competência e orientação ao autocuidado para o cuidado integral ao cliente. Aplicando o critério de avaliação à prática dos aspectos do PCC, verificou-se que somente três: práticas de amor e gentileza; desenvolvendo relação de ajuda; e ajudar nas necessidades básicas atenderam ao PCC. Conclui-se, que além da realização dos cuidados técnicos ao cliente com CCB, é necessário que a equipe de enfermagem se conscientize da importância do cuidado transpessoal para a reconstituição do equilíbrio corporal físico, mental e espiritual do cliente, visando seu bem-estar, apesar das dificuldades do adoecimento.
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Design knowledge can be acquired from various sources and generally requires an integrated representation for its effective and efficient re-use. Though knowledge about products and processes can illustrate the solutions created (know-what) and the courses of actions (know-how) involved in their creation, the reasoning process (know-why) underlying the solutions and actions is still needed for an integrated representation of design knowledge. Design rationale is an effective way of capturing that missing part, since it records the issues addressed, the options considered, and the arguments used when specific design solutions are created and evaluated. Apart from the need for an integrated representation, effective retrieval methods are also of great importance for the re-use of design knowledge, as the knowledge involved in designing complex products can be huge. Developing methods for the retrieval of design rationale is very useful as part of the effective management of design knowledge, for the following reasons. Firstly, design engineers tend to want to consider issues and solutions before looking at solid models or process specifications in detail. Secondly, design rationale is mainly described using text, which often embodies much relevant design knowledge. Last but not least, design rationale is generally captured by identifying elements and their dependencies, i.e. in a structured way which opens the opportunity for going beyond simple keyword-based searching. In this paper, the management of design rationale for the re-use of design knowledge is presented. The retrieval of design rationale records in particular is discussed in detail. As evidenced in the development and evaluation, the methods proposed are useful for the re-use of design knowledge and can be generalised to be used for the retrieval of other kinds of structured design knowledge. © 2012 Elsevier Ltd. All rights reserved.
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It has reported that individuals with nonverbal learning disabilities (NLD) have deficits in visual-spatial organization and strengths in rote language abilities. At present, there are few studies on higher order cognitive abilities of adolescents with NLD, such as the reasoning about spatial relations. The study sampled three groups: a normal group (a control group, C), a nonverbal learning disabilities group (NLD), and a verbal learning disabilities group (VLD). The aim of this study was to examine spatial and nonspatial relation reasoning abilities in adolescents with NLD under figure and word conditions, and assessed the relative involvement of different working memory components in four types of reasoning tasks: reasoning about figure-spatial, figure-nonspatial, verbal-spatial, and verbal-nonspatial relations. Using the double-tasks methodology, visual, spatial, central-executive, and phonological loads were realized. We tried to find how working memory components impact on adolescents with NLD spatial and nonspatial reasoning. The main results of present research are as follows. (1) The NLD group didn’t differ from normal group on reasoning about figure-nonspatial relations. The NLD group scored lower than the C group in spatial problems. So, adolescents with NLD showed a dissociation between spatial and non-spatial relation reasoning. They scored higher in non-spatial problems than in spatial ones. Adolescents with VLD developed well in reasoning about figure-nonspatial relations, but showed deficits in other three tasks. (2) For each reasoning task, the difficult of four types of reasoning problem had different changing trend. For figure and verbal spatial problems, mental model approach can interpret performance of the four problems well. For verbal nonspatial problems, a logical rule approach can interpret performance of the four problems well. (3) Adolescents with NLD did not differ from adolescents with VLD and normal adolescents in phonological, central-executive, and visual dual tasks. But the NLD group had lower performance than the other two groups in spatial dual task. The results showed a dissociation between visual and spatial working memory in NLD group. The VLD group only experienced deficits in central-executive subsystem. (4) The studies found that spatial reasoning mainly loaded spatial working memory, whist the involvement of spatial resources in nonspatial reasoning was little. Visual working memory mainly involved in reasoning about spatial and figure-nonspatial relations, especially in figure-nonspatial problems, and had few impacts on verbal-nonspatial reasoning. Central executive system was involved in all reasoning tasks. The role of phonological loop in the reasoning tasks required further explored. (5) According to the findings, we concluded that the deficits in spatial working memory resulted in poor spatial reasoning abilities for teenagers with NLD, whist because of the limited central executive capability, teenagers with VLD showed poor reasoning abilities. (6) The three groups can used multiple strategies during the reasoning process. They didn’t differ from each other in reasoning strategies. They all used mental model strategy to solve figure and verbal spatial problems, and used logic rule strategy to solve verbal nonspatial problems.
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There has been much interest in the area of model-based reasoning within the Artificial Intelligence community, particularly in its application to diagnosis and troubleshooting. The core issue in this thesis, simply put, is, model-based reasoning is fine, but whence the model? Where do the models come from? How do we know we have the right models? What does the right model mean anyway? Our work has three major components. The first component deals with how we determine whether a piece of information is relevant to solving a problem. We have three ways of determining relevance: derivational, situational and an order-of-magnitude reasoning process. The second component deals with the defining and building of models for solving problems. We identify these models, determine what we need to know about them, and importantly, determine when they are appropriate. Currently, the system has a collection of four basic models and two hybrid models. This collection of models has been successfully tested on a set of fifteen simple kinematics problems. The third major component of our work deals with how the models are selected.
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Aim and objectives To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Background Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. Design A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Methods Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Results Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Conclusions Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Relevance to clinical practice Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation
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Spotting patterns of interest in an input signal is a very useful task in many different fields including medicine, bioinformatics, economics, speech recognition and computer vision. Example instances of this problem include spotting an object of interest in an image (e.g., a tumor), a pattern of interest in a time-varying signal (e.g., audio analysis), or an object of interest moving in a specific way (e.g., a human's body gesture). Traditional spotting methods, which are based on Dynamic Time Warping or hidden Markov models, use some variant of dynamic programming to register the pattern and the input while accounting for temporal variation between them. At the same time, those methods often suffer from several shortcomings: they may give meaningless solutions when input observations are unreliable or ambiguous, they require a high complexity search across the whole input signal, and they may give incorrect solutions if some patterns appear as smaller parts within other patterns. In this thesis, we develop a framework that addresses these three problems, and evaluate the framework's performance in spotting and recognizing hand gestures in video. The first contribution is a spatiotemporal matching algorithm that extends the dynamic programming formulation to accommodate multiple candidate hand detections in every video frame. The algorithm finds the best alignment between the gesture model and the input, and simultaneously locates the best candidate hand detection in every frame. This allows for a gesture to be recognized even when the hand location is highly ambiguous. The second contribution is a pruning method that uses model-specific classifiers to reject dynamic programming hypotheses with a poor match between the input and model. Pruning improves the efficiency of the spatiotemporal matching algorithm, and in some cases may improve the recognition accuracy. The pruning classifiers are learned from training data, and cross-validation is used to reduce the chance of overpruning. The third contribution is a subgesture reasoning process that models the fact that some gesture models can falsely match parts of other, longer gestures. By integrating subgesture reasoning the spotting algorithm can avoid the premature detection of a subgesture when the longer gesture is actually being performed. Subgesture relations between pairs of gestures are automatically learned from training data. The performance of the approach is evaluated on two challenging video datasets: hand-signed digits gestured by users wearing short sleeved shirts, in front of a cluttered background, and American Sign Language (ASL) utterances gestured by ASL native signers. The experiments demonstrate that the proposed method is more accurate and efficient than competing approaches. The proposed approach can be generally applied to alignment or search problems with multiple input observations, that use dynamic programming to find a solution.
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The objective of my Portfolio is to explore the working hypothesis that the organic growth of a firm is governed by the perspectives of individuals and such perspectives are governed by their meaning-making. The Portfolio presents explorations of the transformation of my meaning making and in adopting new practices to support the organic growth of a firm. I use the work of other theorists to transition my understanding of how the world works. This transition process is an essential tool to engage with and understand the perspectives of others and develop a mental capacity to “train one’s imagination to go visiting” (Arendt, 1982; p.43). The Portfolio, therefore, is primarily located in reflective research. Using Kegan’s (1994) approach to Adult Mental Development, and Sowell’s (2007) understanding of the visions which silently shape our thoughts I organise the developments of my meaning making around three transformation pillars of change. In pillar one I seek to transform an unthinking respect for authority and break down a blind pervasiveness of thought within my reasoning process arising from an instinct for attachment and support from others whom I trust. In pillar two I seek to discontinue using autocratic leadership and learn to use the thoughts and contributions of a wider team to make improved choices about uncertain future events. In pillar three I explore the use of a more reflective thinking framework to test the accuracy of my perceptions and apply a high level of integrity in my reasoning process. The transformation of my meaning making has changed my perspectives and in turn my preferred practices to support the organic growth of a firm. I identify from practice that a transformative form of leadership is far more effective that a transactional form of leadership to stimulate the trust and teamwork required to sustain the growth a firm. Creating an environment where one feels free to share thoughts and feelings with others is an essential tool to build a team to critique the thoughts of one other. Furthermore, the entrepreneurial wisdom to grow a firm must come from a wider team, located both inside and outside the boundaries of a firm. No individual or small team has the mental capacity to provide the entrepreneurship required to drive the organic growth of a firm. I address my Portfolio to leaders in organisations who have no considered framework on the best practices required to lead a social organisation. These individuals may have no sense of what they implicitly believe drives social causation and they may have no understanding if their meaning making supports or curtails the practices required to grow a firm. They may have a very limited capacity to think in a logical manner, with the result they are using guesses from their ‘gut’ to make poor judgements in the management of a firm.
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In this paper we describe how an evidential-reasoner can be used as a component of risk assessment of engineering projects using a direct way of reasoning. Guan & Bell (1991) introduced this method by using the mass functions to express rule strengths. Mass functions are also used to express data strengths. The data and rule strengths are combined to get a mass distribution for each rule; i.e., the first half of our reasoning process. Then we combine the prior mass and the evidence from the different rules; i.e., the second half of the reasoning process. Finally, belief intervals are calculated to help in identifying the risks. We apply our evidential-reasoner on an engineering project and the results demonstrate the feasibility and applicability of this system in this environment.
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In two experiments we tested the prediction derived from Tversky and Kahneman's (1983) work on the causal conjunction fallacy that the strength of the causal connection between constituent events directly affects the magnitude of the causal conjunction fallacy. We also explored whether any effects of perceived causal strength were due to graded output from heuristic Type 1 reasoning processes or the result of analytic Type 2 reasoning processes. As predicted, Experiment 1 demonstrated that fallacy rates were higher for strongly than for weakly related conjunctions. Weakly related conjunctions in turn attracted higher rates of fallacious responding than did unrelated conjunctions. Experiment 2 showed that a concurrent memory load increased rates of fallacious responding for strongly related but not for weakly related conjunctions. We interpret these results as showing that manipulations of the strength of the perceived causal relationship between the conjuncts result in graded output from heuristic reasoning process and that additional mental resources are required to suppress strong heuristic output.
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Background: A suite of 10 online virtual patients developed using the IVIMEDS ‘Riverside’ authoring tool has been introduced into our undergraduate general practice clerkship. These cases provide a multimedia-rich experience to students. Their interactive nature promotes the development of clinical reasoning skills such as discriminating key clinical features, integrating information from a variety of sources and forming diagnoses and management plans.
Aims: To evaluate the usefulness and usability of a set of online virtual patients in an undergraduate general practice clerkship.
Method: Online questionnaire completed by students after their general practice placement incorporating the System Usability Scale questionnaire.
Results: There was a 57% response rate. Ninety-five per cent of students agreed that the online package was a useful learning tool and ranked virtual patients third out of six learning modalities. Questions and answers and the use of images and videos were all rated highly by students as useful learning methods. The package was perceived to have a high level of usability among respondents.
Conclusion: Feedback from students suggest that this implementation of virtual patients, set in primary care, is user friendly and rated as a valuable adjunct to their learning. The cost of production of such learning resources demands close attention to design.
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ENQUADRAMENTO: A prestação de cuidados de saúde coloca osenfermeiros face a situações complexas, exigindo a mobilização de umconjunto de saberes própriosque lhes permita responder de modo criativo e adequado à diversidade e singularidade dos problemas com que se deparam.Com o ensino clínico pretende-se assegurar a aquisição/construção de conhecimentos, aptidões e atitudes necessárias às intervenções autónomas e interdependentes do exercício profissional de enfermagem. Para isso o valor da reflexão na e sobre a acçãocomo elemento facilitador da aprendizagem do estudante em contextos clínicos tem sido demonstrado sabendo-se quequando a reflexão é intencionalmente realizada conduz à construção do saber e sendo teórica e metodologicamente enquadrada permite a emancipaçãoprofissional, o aprender a aprender e a consciência da tomada de decisão. Desconhecem-se, contudo, as potencialidades da reflexão sistemática e continuada em ensino clínico na aprendizagem e desenvolvimento dosestudantes de enfermagem OBJECTIVO: Analisar criticamente as potencialidades da construção denarrativas reflexivas e metareflexões no processo de aprendizagem edesenvolvimento do estudante de enfermagem, em contexto de ensino clínicode enfermagem, potencialidades encaradas enquanto força catalisadora epromotora de construção de saberes experienciais e de aquisição edesenvolvimento de competências pessoais e profissionais por partedos estudantes de enfermagem em ensino clínico METODO: Realizámos um estudo de caso com abordagem qualitativa com recurso à investigação narrativa e fenomenográfica. Ao longo de um anolectivo foi implementado um programa educacional em ensino clínico promotor de processos reflexivos. 189 Estudantes realizaram narrativas reflexivas sobreas suas práticas de cuidados de modo sistemático e continuado, dos quaisrecolhemos 50 narrativas reflexivas e 10 metareflexões de dez estudantesseleccionados aleatoriamente. Aquela informação foi submetida a análisequalitativa, com critérios dehermenêutica interpretativa, com recurso ao programa NUD*IST QSR N6. Os resultadosdas narrativas foram submetidos a matrizes de intersecção no sentido de identificar elementos devariabilidade entre estudantes, contexto e continuidade na construção narrativa. RESULTADOSe DISCUSSÃO: Seis temas emergiram da análise dasnarrativas: i) Situações significativas de cuidados; ii) Modos de Interacçãoafectiva, cognitiva e comportamental com as situações significativas; iii) Modos de resposta activados; iv) Aquisição e construção de conhecimento; v)Aquisição e desenvolvimento de competências; e vi) Concepções acerca doprocesso reflexivo. Nas metareflexões foram identificadas as percepções dos estudantes sobre os processos reflexivos realizados que convergem com osresultados emergentes da análise das narrativas. O cruzamento dos resultadoscom referenciais teóricos permite afirmar que a aprendizagem edesenvolvimento dos estudantes se expressana confluência da aprendizagem significativa, potenciada por factores de mediação e construída na transição ecológica pela reflexividade. RELEVÂNCIA PARA A DIDÁCTICA DA ENFERMAGEM: A utilização deenquadramentos para a reflexão usados de modo sistemático e continuado nos ensinos clínicos acompanhados de metareflexões finais têm expressãopositiva no processo de aprendizagem e desenvolvimento pessoal eprofissional do estudante de enfermagem, pelo que se recomenda a suaimplementação no processo na aprendizagem clínica dos estudantes.
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Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção do grau de Mestre em Educação - Especialização em Supervisão em Educação