Professional Master's degree in Nursing: knowledge production and challenges

OBJETIVO:analisar a produção do conhecimento gerada pelos programas de mestrado profissional em enfermagem e refletir sobre suas perspectivas para a área.MÉTODO:estudo descritivo e analítico. Foram incluídos dados das dissertações de três instituições de ensino que titularam alunos em programas de mestrado profissional em enfermagem entre 2006 e 2012.RESULTADOS:a maioria dos 127 trabalhos de conclusão analisados se desenvolveu no contexto hospitalar; houve tendência de concentração nas áreas organizacional e assistencial, nas linhas de pesquisa processo de cuidar e gerenciamento e predomínio de estudos qualitativos. Há diversidade de produtos resultantes dos trabalhos de conclusão: avaliação de serviços/programas de saúde e geração de processos, protocolos assistenciais ou de ensino.CONCLUSÃO:os programas de mestrado profissional em enfermagem, em fase de consolidação, têm produção recente, em desenvolvimento, havendo lacuna na geração de tecnologias duras e inovação. São fundamentais para o desenvolvimento das práticas profissionais inovadoras que articulem o setor saúde e a educação.

O professor da Educação Especial e o processo de ensino-aprendizagem de alunos com autismo

This paper has as subject autism, and sought to verify how the process of teaching and learning of students with autism occurs in a special education school. The Infantile Autism is today sorted as one of the “Global Developmental Disorders (PDD)” and is characterized by a severe and global impairment in several areas of development, such as reciprocal social interaction skills, communication skills and presence of stereotypic behavior, interests and activities. This study aimed to identify the teaching methodology used with adolescents with autism in special education and see in what ways this methodology assists in the teaching and learning of these students. To this end, participated in this study a teacher, expert in this issue, and three students with autism in a Special Education School located within the State of São Paulo. For data collection, 19 observations of activities performed by students with autism in the classroom were conducted and a semi-structured interview with the specialized teacher was applied. The results revealed that the teacher mentioned above does not use any specific teaching methodology to assist in the teaching and learning of these students, although there are some specific methodologies for individuals with autism, which are used in special education schools. Thus, there is a gap in the teaching process on the part of the teacher and an uncertainty about the learning process of these students with autism in this institution.

A análise de assunto no processo de indexação: um percurso entre teoria e norma

Considered the step that constitutes the intellectual work of the indexer, the approach runs the focus of the initial phase of the indexing process - the subject analysis. Among the various denominations that can be achieved, the subject analysis reaches its dimension applied when observed the rules that underlie the indexing process. The release of the documentary information requires the development of contributions to aid in the procedures of analysis, synthesis and representation of the contents documentary, seeking contributions to both the theoretical sedimentation, and for fostering the professional practice of the librarian. Through bibliographic exploratory research, this article aims to contribute to the relevance of subject analysis, concluding that there is a gap in the use of NBR 12676/1992, as well as the need for its updating.

A autonomia no contexto Teletandem institucinal integrado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Do fracasso à reforma das operações de paz das Nações Unidas (2000-2010)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Notes on competencies in engineering education

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A sífilis na gestação e sua influência na morbimortalidade materno-infantil

Syphilis in pregnancy is a public health problem, responsible for the high intrauterine mortality rates. This article aims to present a review of historical and epidemiological aspects, clinical manifestations, diagnosis, the treatment of maternal and congenital syphilis, and its perinatal repercussions. The manuscript also describes the Brazilian main policies in public health care for pregnant women with syphilis and for congenital syphilis eradication. The set of words used were “congenital syphilis”, “syphilis in pregnancy” and “syphilis prenatal care”. The databases searched were PubMed (National Library of Medicine - USA), SciELO (Scientific Electronic Library Online), LILACS (Latin American and Caribbean Health Sciences), PAHO (Pan American Health Organization), IBECS, and WHOLIS Cochrane Library, from 1980 to 2011. Fifty-six articles were included in this review, 18 institutional technical manuals, two textbooks and 36 articles relating to maternal and congenital syphilis. The present review showed that there is a gap between intention and action needed to control and eradicate the disease especially with regard to the expansion of access, not only in relation to the number of visits recommended male gender, it is important to assess the quality of their content as well as the actions to be carried out between appointments.

Die Identifizierung und Charakterisierung von HLA-Klasse-I-restringierten Minorhistokompatibilitätsantigenen und Leukämie-assoziierten Antigenen mittels cDNA-Expressionsklonierung

Die allogene hämatopoetische Stammzelltransplantation (allo-HSCT) bietet bei einem hohen Anteil akuter Leukämien die einzige kurative Behandlungsmöglichkeit. Um die mit ihr assoziierte Morbidität und Mortalität zu senken und ihre Effektivität zu steigern, soll die GvL (graft-versus-leukemia)-Reaktion als eigentliches Therapieziel gegenüber der unerwünschten GvHD (graft-versus-host disease) möglichst selektiv verstärkt werden. Wesentliche Mediatoren beider Effekte sind alloreaktive T-Zellen. Bei HLA-Übereinstimmung zwischen Spender und Empfänger sind so genannte Minorhistokompatibilitätsantigene (mHAgs) und Leukämie-assoziierte Antigene (LAA) die mutmaßlichen Zielstrukturen beider Reaktionen. Im Rahmen der vorliegenden Arbeit wurden in dem Leukämie-Modell der Patientin MZ201 [akute myeloische Leukämie (AML) vom Subtyp FAB M5] mittels T-Zell-basierter cDNA-Expressionsklonierung zwei neue Antigene identifiziert, die von allogenen, AML-reaktiven CD8+ T-Lymphozyten aus Blut eines HLA-passenden gesunden Spenders erkannt wurden. Es handelt sich zum einen um das HLA-B*5601-restringierte mHAg PLAUR-317P, das aus einem Polymorphismus des Gens PLAUR (plasminogen activator, urokinase receptor) resultiert. Das von den T-Zellen am Besten erkannte Peptid enthält die Aminosäuren 316 - 327. PLAUR wird in lymphohämatopoetischen Zellen und in verschiedenen Malignomen überexprimiert und ist dabei mit schlechterer Prognose und vermehrter Gewebeinvasivität assoziiert. Etwa 30% getesteter Individuen tragen das Allel PLAUR-317P. Zum anderen handelt es sich um ein Epitop aus der Signalregion des Chemokins CXCL3 [chemokine (C-X-C motif) ligand 3], das von CD8+ T-Zellen des gleichen Spenders auf Leukämiezellen der Patientin MZ201 in Assoziation mit HLA-A*0201 erkannt wurde. Auch CXCL3 wird vorwiegend in Zellen der Myelopoese exprimiert. Aufgrund ihres Expressionsmusters sind beide Antigene potentielle Zielstrukturen für die Elimination der Empfänger-Hämatopoese unter Einschluss der Leukämieblasten im Rahmen der allo-HSCT. Weiterführende Untersuchungen müssen zeigen, ob diese Antigene tatsächlich in vivo GvL-Reaktionen hervorrufen. Die Kenntnis eines repräsentativen Spektrums solcher Antigene würde verbesserte Spenderselektionen erlauben und neue Wege des adoptiven T-Zelltransfers erschließen helfen.

Do domestic interests matter? – Der Einfluss nationaler Interessengruppen auf die Position von Staaten zur Umweltpolitik auf EU-Ebene

Wie kann man Ergebnisse internationaler Umweltpolitik erklären? Wie hilfreich ist dabei die liberale Theorie der Internationalen Beziehungen (IB) von Andrew Moravcsik? Die vorliegende Arbeit versucht diese Fragen anhand eines Fallbeispiels internationaler Umweltpolitik – der Position der Bundesrepublik Deutschland bezüglich der einzelnen Streitfragen der EU-Verordnung 443/2009 über den CO2-Ausstoß von Automobilen – zu beantworten. Es wird eine theoriegeleitete Außenpolitikanalyse durchgeführt, deren Hauptaugenmerk auf der spezifischen nationalen Präferenzbildung in einem bestimmten Fall liegt. Hier weist Moravcsiks Theorie eine „Lücke“ auf. Wessen Interessen sich aus welchen Gründen in einer bestimmten Situation wie durchsetzen und damit Politik beeinflussen bleibt unklar. Deshalb erweitert die Arbeit Moravcsiks liberale Theorie der IB mithilfe von Annahmen und Erkenntnissen aus der Verbändeforschung nach innen. Auf diese Weise werden die situationsspezifischen Interessen und die situationsspezifische Durchsetzungsfähigkeit der betroffenen Akteure – nationale Interessengruppen – erhoben und untersucht, inwiefern man mit ihrer Hilfe die deutsche Position zur EU-Verordnung 443/2009 erklären kann. Empirisch erweist sich dabei, dass die Position der BRD zu acht von neun Streitfragen der EU-Verordnung 443/2009 den Interessen einer Koalition aus Industriegewerkschaft (IG) Metall und Verband der Automobilindustrie (VDA) entsprach, weil diese im vorliegenden Fall mit Abstand die größte Durchsetzungsfähigkeit aufwiesen. Lediglich bezüglich einer Streitfrage wich die Position der BRD von den Interessen von IG Metall und VDA ab. Damit lässt sich festhalten: Die Position der BRD zur EU-Verordnung 443/2009 kann weitgehend mithilfe der nach innen erweiterten liberalen Theorie nach Andrew Moravcsik erklärt werden. Trotz möglicher Schwierigkeiten bei der Übertragung erscheint daher eine Anwendung des nach innen erweiterten Liberalismus auf weitere erklärungsbedürftige Phänomene der internationalen Umweltpolitik und damit eine Überprüfung der Theorie insgesamt eine interessante und sinnvolle Aufgabe zu sein.

A nation-wide initiative against venous thromboembolism

There is a gap between knowledge and recommendations regarding venous thromboembolism (VTE) on the one hand and daily practice on the other. This fact has prompted a Swiss multidisciplinary group consisting of angiologists, haematologists, internists, and emergency medicine and pharmaceutical medicine specialists interested in VTE, the SAMEX group, to set up a series of surveys and studies that give useful insight into the situation in our country. Their projects encompassed prophylactic and therapeutic aspects of VTE, and enrolled over 7000 patients from five academic and 45 non-academic acute care hospitals and fifty-three private practices in Switzerland. This comprehensive Swiss Clinical Study Programme forms the largest database surveying current clinical patterns of VTE management in a representative sample of the Swiss patient population. Overall the programme shows a lack of thromboprophylaxis use in hospitalised at-risk medical patients, particularly in those with cancer, acute heart or respiratory failure and the elderly, as well as under-prescription of extended prophylaxis beyond hospital discharge in patients undergoing major cancer surgery. In regard to VTE treatment, planning of anticoagulation duration, administration of LMWH for cancer-associated thrombosis, and the use of compression therapy for prevention of post-thrombotic syndrome in patients with symptomatic proximal DVT require improvement. In conclusion, this programme highlights insufficient awareness of venous thromboembolic disease in Switzerland, underestimation of its burden and inconsistent application of international consensus statement guidelines regarding prophylaxis and treatment adopted by the Swiss Expert Group.

Time-domain modeling of high-frequency electromagnetic wave propagation, overhead wires, and earth

Prediction of radiated fields from transmission lines has not previously been studied from a panoptical power system perspective. The application of BPL technologies to overhead transmission lines would benefit greatly from an ability to simulate real power system environments, not limited to the transmission lines themselves. Presently circuitbased transmission line models used by EMTP-type programs utilize Carson’s formula for a waveguide parallel to an interface. This formula is not valid for calculations at high frequencies, considering effects of earth return currents. This thesis explains the challenges of developing such improved models, explores an approach to combining circuit-based and electromagnetics modeling to predict radiated fields from transmission lines, exposes inadequacies of simulation tools, and suggests methods of extending the validity of transmission line models into very high frequency ranges. Electromagnetics programs are commonly used to study radiated fields from transmission lines. However, an approach is proposed here which is also able to incorporate the components of a power system through the combined use of EMTP-type models. Carson’s formulas address the series impedance of electrical conductors above and parallel to the earth. These equations have been analyzed to show their inherent assumptions and what the implications are. Additionally, the lack of validity into higher frequencies has been demonstrated, showing the need to replace Carson’s formulas for these types of studies. This body of work leads to several conclusions about the relatively new study of BPL. Foremost, there is a gap in modeling capabilities which has been bridged through integration of circuit-based and electromagnetics modeling, allowing more realistic prediction of BPL performance and radiated fields. The proposed approach is limited in its scope of validity due to the formulas used by EMTP-type software. To extend the range of validity, a new set of equations must be identified and implemented in the approach. Several potential methods of implementation have been explored. Though an appropriate set of equations has not yet been identified, further research in this area will benefit from a clear depiction of the next important steps and how they can be accomplished. Prediction of radiated fields from transmission lines has not previously been studied from a panoptical power system perspective. The application of BPL technologies to overhead transmission lines would benefit greatly from an ability to simulate real power system environments, not limited to the transmission lines themselves. Presently circuitbased transmission line models used by EMTP-type programs utilize Carson’s formula for a waveguide parallel to an interface. This formula is not valid for calculations at high frequencies, considering effects of earth return currents. This thesis explains the challenges of developing such improved models, explores an approach to combining circuit-based and electromagnetics modeling to predict radiated fields from transmission lines, exposes inadequacies of simulation tools, and suggests methods of extending the validity of transmission line models into very high frequency ranges. Electromagnetics programs are commonly used to study radiated fields from transmission lines. However, an approach is proposed here which is also able to incorporate the components of a power system through the combined use of EMTP-type models. Carson’s formulas address the series impedance of electrical conductors above and parallel to the earth. These equations have been analyzed to show their inherent assumptions and what the implications are. Additionally, the lack of validity into higher frequencies has been demonstrated, showing the need to replace Carson’s formulas for these types of studies. This body of work leads to several conclusions about the relatively new study of BPL. Foremost, there is a gap in modeling capabilities which has been bridged through integration of circuit-based and electromagnetics modeling, allowing more realistic prediction of BPL performance and radiated fields. The proposed approach is limited in its scope of validity due to the formulas used by EMTP-type software. To extend the range of validity, a new set of equations must be identified and implemented in the approach. Several potential methods of implementation have been explored. Though an appropriate set of equations has not yet been identified, further research in this area will benefit from a clear depiction of the next important steps and how they can be accomplished.

Der allergische Notfall: Adrenalin das Mittel der Wahl bei der Anaphylaxie

Although allergic emergencies do not occur every day, they are as unpredictable as the course of the reaction, and require rapid treatment. Anaphylaxis is a life-threatening general reaction that usually manifests within a few minutes after a known or potential antigen contact. While sole cutaneous symptoms are not sufficient to diagnose anaphylaxis, an episode of acute bronchospasm or hypotension in rare cases may be the only symptom. Almost always two or more organ systems are affected and usually the skin and/or mucous membranes are involved. Epinephrine (adrenaline) is the most important and effective drug in the treatment of anaphylaxis. Since there is no absolute contraindication, epinephrine should be administered intramuscularly at the first signs of anaphylaxis. However, there is a gap between the international treatment guidelines and the daily practice in the treatment of acute allergic, particularly anaphylactic, reactions. This is due not least to the fact that anaphylaxis, the most severe form of allergy, is not sufficiently clear or uniformly defined. After a systemic allergic reaction, all patients should be equipped with emergency medications, appropriately instructed obtain a complete allergy work-up.

A systematic review of community-based colorectal cancer screening randomized controlled trials with multi-ethnic groups

Background. The CDC estimates that 40% of adults 50 years of age or older do not receive time-appropriate colorectal cancer screening. Sixty percent of colorectal cancer deaths could be prevented by regular screening of adults 50 years of age and older. Yet, in 2000 only 42.5% of adults age 50 or older in the U.S. had received recommended screening. Disparities by health care, nativity status, socioeconomic status, and race/ethnicity are evident. Disparities in minority, underserved populations prevent us from attaining Goal 2 of Healthy People 2010 to “eliminate health disparities.” This review focuses on community-based screening research among underserved populations that includes multiple ethnic groups for appropriate disparities analysis. There is a gap in the colorectal cancer screening literature describing the effectiveness of community-based randomized controlled trials. ^ Objective. To critically review the literature describing community-based colorectal cancer screening strategies that are randomized controlled trials, and that include multiple racial/ethnic groups. ^ Methods. The review includes a preliminary disparities analysis to assess whether interventions were appropriately targeted in communities to those groups experiencing the greatest health disparities. Review articles are from an original search using Ovid Medline and a cross-matching search in Pubmed, both from January 2001 to June 2009. The Ovid Medline literature review is divided into eight exclusionary stages, seven electronic, and the last stage consisting of final manual review. ^ Results. The final studies (n=15) are categorized into four categories: Patient mailings (n=3), Telephone outreach (n=3), Electronic/multimedia (n=4), and Counseling/community education (n=5). Of 15 studies, 11 (73%) demonstrated that screening rates increased for the intervention group compared to controls, including all studies (100%) from the Patient mailings and Telephone outreach groups, 4 of 5 (80%) Counseling/community education studies, and 1 of 4 (25%) Electronic/multimedia interventions. ^ Conclusions. Patient choice and tailoring education and/or messages to individuals have proven to be two important factors in improving colorectal cancer screening adherence rates. Technological strategies have not been overly successful with underserved populations in community-based trials. Based on limited findings to date, future community-based colorectal cancer screening trials should include diverse populations who are experiencing incidence, survival, mortality and screening disparities. ^

Environmental policy and knowledge. Copying with complexity through inclusive management

Scholars agree that governance of the public environment entails cooperation between science, policy and society. This requires the active role of public managers as catalysts of knowledge co-production, addressing participatory arenas in relation to knowledge integration and social learning. This paper deals with the question of whether public managers acknowledge and take on this task. A survey accessing Directors of Environmental Offices (EOs) of 64 municipalities was carried out in parallel for two regions - Tuscany (Italy) and Porto Alegre Metropolitan Region (Brazil). The survey data were analysed using the multiple correspondence method. Results showed that, regarding policy practices, EOs do not play the role of knowledge co-production catalysts, since when making environmental decisions they only use technical knowledge. We conclude that there is a gap between theory and practice, and identify some factors that may hinder local environmental managers in acting as catalyst of knowledge co-production, raising a further question for future research.

Optimización del peaje en autopistas interurbanas que compiten con carreteras convencionales libres de pago : una perspectiva de eficiencia y equidad

En algunos países, como por ejemplo España, es común que entre un origen y un destino existan dos carreteras paralelas en las que existen ciertas diferencias. La más importante es que una de las vías es una autopista que ofrece a los usuarios una mayor comodidad y un menor tiempo de viaje a cambio del pago de un peaje, el cual no es necesario abonar en la carretera convencional paralela. Así, el problema de la tarificación vial ha sido estudiado en diversas ocasiones. Existe un amplio consenso en que para lograr el máximo bienestar social, los usuarios deben internalizar las externalidades que producen y no perciben a través de un peaje. Sin embargo, dicho peaje puede perjudicar a los usuarios con bajos ingresos. Dependiendo del objetivo (por ejemplo, maximizar el bienestar, maximizar la equidad social, la amortización de la construcción de la carretera, etc) el peaje óptimo podría variar sustancialmente. La literatura académica acerca de los peajes, la eficiencia y la equidad es vasta y diversa. Sin embargo, hemos encontrado una deficiencia en dicha literatura sobre el peaje óptimo, en corredores donde una carretera y una autopista con diferentes características de calidad compiten para capturar el tráfico. Particularmente no se ha encontrado ninguna investigación acerca del establecimiento del peaje que maximice el bienestar social o la equidad para distintas distribuciones del valor del tiempo de viaje (VTT), caracterizadas por su media y varianza. Por ello, el principal objetivo de la investigación es estimar la influencia que tiene la distribución de la renta de una sociedad sobre el peaje óptimo. La presente tesis doctoral trata de obtener, por medio de una metodología robusta, las diferentes políticas de peajes que los planificadores de transporte deberían llevar a cabo según la riqueza y cohesión social de los potenciales usuarios del corredor, la demanda y el objetivo que se busque con dicha tarificación, esto es, maximizar el bienestar social o la equidad. Adicionalmente también se obtienen los peajes óptimos dependiendo de si el corredor se encuentra totalmente tarificado o únicamente se debe pagar un peaje por circular en la autopista. In some countries, such as Spain, it is very common that in the same corridor there are two roads with the same origin and destination but with some differences. The most important contrast is that one is a toll highway which offers a better quality than the parallel road in exchange of a price. The users decide if the price of the toll worth to pay for the advantages offered. The problem of road pricing has been largely studied. It is well acknowledged that in order to achieve the maximum social welfare, users must internalize the externalities they produce and do not perceive through a toll. However, that toll can harm users with low income. Depending on the objective (e.g. maximize welfare, maximize social equity, amortize the construction of the road, etc) the optimal toll might vary substantially. The academic literature about pricing, efficiency and equity is vast and diverse. However, as far as we have found, there is a gap in the literature regarding the optimal price where a road and a highway with different quality characteristics compete for capturing the traffic in a corridor. Particularly we did not find any research estimating the optimal welfare price or the optimal equity price for different Value of Travel Time (VTT) distributions characterized by different VTT average and variance. The objective of the research is to fill this gap. In this research a theoretical model in order to obtain the optimal price in a toll highway that competes for capturing the traffic with a conventional road is developed. This model is done from the welfare and equity perspective and for non‐usual users who decide over the expectation of free flow conditions. The model is finally applied to the variables we want to focus on: average value of travel time (VTT) which is strongly related with income, dispersion of this VTT, different kind of distributions of VTT and traffic levels, from free flow to congestion. Furthermore, we also obtain the optimal tolls with the corridor completely charged or with untolled alternative.