Investigação da eficácia da teleconsulta na programação do implante coclear

A demanda crescente de usuários de implante coclear (IC) e a distribuição irregular de profissionais especializados no país, tornam necessário o deslocamento de pacientes por longas distâncias para os atendimentos, com consequente aumento dos custos diretos e indiretos do tratamento. A teleconsulta pode ser vista como uma alternativa em potencial para o acesso desta população a estes serviços. O presente ensaio clínico, randomizado, controlado, avaliou a eficácia da teleconsulta síncrona na programação dos sistemas de IC em usuários acompanhados em um Programa de Implante Coclear credenciado pelo Sistema Único de Saúde. Participaram do estudo 79 indivíduos com idades entre nove e 68 anos (média de 21,6), 41 do sexo masculino e 38 do sexo feminino, usuários de IC por um período de 0,58 a 24,75 anos. Estes indivíduos foram divididos em dois grupos, de acordo com o modo de programação do IC: controle (n=40), que realizou o procedimento face a face e experimental (n=39) que realizou a teleconsulta síncrona. Treze fonoaudiólogos sem experiência na programação do dispositivo atuaram como facilitadores das teleconsultas. Os procedimentos de programação do IC englobaram a telemetria de impedância, definição dos níveis de estimulação elétrica, varredura e balanceamento dos eletrodos e ajuste fino da programação. Como medidas de avaliação de resultados foram utilizados o tempo dispendido na consulta, a audiometria em campo livre, o percentual de reconhecimento de sentenças no silêncio e no ruído, o limiar de reconhecimento de sentenças no silêncio e ruído (HINT-Brasil), a avaliação da satisfação com a consulta (escala MISS-21) e de aspectos pertinentes à teleconsulta. Os facilitadores responderam as questões abertas referentes à suas impressões dos atendimentos. Os dados foram analisados por meio de estatística inferencial (testes t de Student, Wilcoxon, Mann-Whitney e correlação de Spearman). Os resultados mostraram que após a programação do IC, em média, os participantes apresentaram limiares audiométricos abaixo de 30 dB NA. O reconhecimento da fala pós atendimento, respectivamente para os grupos experimental e controle, foram de 81,3% e 83,8% (silêncio) e 57,9% e 58,1% (ruído). No HINT-Brasil os resultados foram, respectivamente, para os grupos experimental e controle 61,4 dB NA e 61,8 dB NA (silêncio) e relação S/R de 9,5 dB NA e 10,4 dB NA (ruído). Os participantes estiveram satisfeitos com a consulta. Não houve diferença estatisticamente significativa entre os grupos em nenhuma das medidas de resultado. Todos os participantes relataram que teleconsulta pode ser vista como uma alternativa viável ao atendimento face a face e sua aplicação clínica facilitaria a rotina de pacientes usuários de IC. Os facilitadores destacaram a sua importância para o aprendizado e como ferramenta de formação continuada. A teleconsulta síncrona foi eficaz na programação dos sistemas de IC e amplamente aceita pelos usuários e profissionais.

Modified Dialectical Behavior Therapy Program Applied Within a Time-Limited Corrections Setting

Dialectical Behavioral Therapy (DBT) is an empirically supported therapy developed to treat individuals with Borderline Personality Disorder that has sustained efficacy following completion of the treatment (Linehan, 1993; Van Den Bosch et al., 2005). The core concepts of DBT include mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance, which seek to foster more functional ways of interacting with others, coping with distress, and managing difficult emotions. Using a standard DBT format in a corrections setting can be difficult due to the population's multifaceted composition. The Denver County Jail is a unique corrections setting because it contains a unit specifically developed for male inmates with mental health issues. A corrections modified, time-limited DBT curriculum was developed to fit the needs of this unique population. During the course of the group, staff appeared to be accepting of the group material and initial feedback from inmates and officers was positive.

From The Holding Cell to the Holding Environment: Applying an Intersubjective Approach into Trauma Treatment with Women in the Correctional Setting

Abstract This paper investigates themes and parallels related to the traumatic experiences women face within the correctional setting and how these experiences influence women's behavior choices that increase their risk of recidivism. Intersubjective Systems Theory is used to conceptualize the distinct dynamics and impact of trauma with this particular population. Intersubjectivity also informs the changes needed to create an environment that would help women in correctional settings to heal, avoid recidivism, and foster successful community reintegration. Principles from Intersubjective Systems Theory are reviewed in this paper to demonstrate: (a) how developmental trauma impacts the lives of incarcerated women, (b) how these women's attempts at self-healing are often maladaptive and lead to arrests, (c) how the current climate in corrections leads to retraumatization and promotes later recidivism, and (d) what changes in the corrections system would promote optimal healing and better outcomes for incarcerated women. Improved outcomes are defined as healthy boundaries, empowerment in choice of relationships, improvement of social support and occupational skills, and reduction of relapse and recidivism.

Psychological Perspectives on the Civil Liberties of Transgendered Inmates in a Prison Setting

As society becomes increasingly less binary, and moves towards a more spectrum based approach to mental illness, medical illness, and personality, it becomes necessary to address this shift within formerly rigid institutions. This paper explores this shift as it is occurring within correctional settings around the United States concerning the medical care, housing, and safety of transgendered inmates. As there is no legal standard for the housing or access to gender-affirming medical care (i.e., hormone therapy, sexual reassignment surgery), these issues are addressed on an institutional level, with very little consistency throughout the country. Currently, most institutions follow a genitalia-based system of classification. Within the system, core beliefs are held, some adaptive and some no longer adaptive, that drive the system's behavior and outcomes. With regard to transgendered inmates, several underlying beliefs within the system serve to maintain the status quo; however, the most basic underpinning is the system's reliance on a binary gender system. As views of humane treatment of the incarcerated expand and modernize, the role of mental health within corrections has also expanded. Psychologists, social workers, counselors, and psychiatrists are found in almost all correctional facilities, and have become a voice of advocacy for an often underserved population.

Setting Congress Up to Fail

In Shelby County v. Holder the Supreme Court invalidated key provisions of the Voting Rights Act of 1965 based on Congress’s failure to justify the formula used to determine which jurisdictions would be subject to the Act’s pre-clearance requirement of submitting all changes to voting procedures to the Justice Department for prior approval. This short essay explores one problematic feature of the Court’s analysis: its refusal to consider the legislative record as adequate because it was created to justify the coverage formula after the fact, rather than to facilitate deliberation on the coverage formula before a decision had been made. This reasoning essentially imports from administrative law a rule called the Chenery principle, and as this essay explains, it does so without justification. The differences between administrative and legislative decision making processes compel different treatment by the courts, and treating legislative records like administrative ones, in essence, asks of Congress something it is institutionally ill-equipped to perform. It sets Congress up to fail.

Green education using open educational resources (OER): setting up a green OER repository

A wealth of open educational resources (OER) focused on green topics is currently available through a variety of sources, including learning portals, digital repositories and web sites. However, in most cases these resources are not easily accessible and retrievable, while additional issues further complicate this issue. This paper presents an overview of a number of portals hosting OER, as well as a number of “green” thematic portals that provide access to green OER. It also discusses the case of a new collection that aims to support and populate existing green collections and learning portals respectively, providing information on aspects such as quality assurance/collection and curation policies, workflow and tools for both the content and metadata records that apply to the collection. Two case studies of the integration of this new collection to existing learning portals are also presented.

Co-design: setting relational domains for deep sustainability

This paper draws mainly on the work of Elizabeth Sanders who has being practising, thinking and mapping participatory design research for over 25 years, connecting it to insights from Maturana (1984), Capra (2002), Jovchelovitch (1995, 2000, 2007) and Preece (2011), to propose that the process of design per se is a relational domain of cocreativity that is essential to construct a way toward deeper sustainability.

The Mammalian faunas of the Washakie Formation, Eocene Age, of Southern Wyoming. Introduction: The geology, history, and setting / William D. Turnbull --.

v.33:no.30(1978)

Changing Attitudes And Expectations In A University Setting: A Case Study

First and second year students enrolled in a four-year movement education based university Physical Education program completed a questionnaire regarding their expectations on entering university. In addition, graduates of the program were interviewed, one year after graduation, with regard to their understanding of and attitude towards movement education and how these had developed relative to their overall degree program. Most students had no knowledge of movement education prior to entering the program and the selection of this particular program was simply coincidental with their desire to pursue physical education. Whereas the students did participate in an activity course and a theory course in Year 1, it was only when participating in a Year 2 movement course which combined theory and practice within the same course that students recognized the movement base of the content. The progress of the students through the program reflects distinct declarative and procedural stages in knowledge development followed by an ability to generalize that knowledge a conceptual stage. The real understanding of movement education came as the students were required to teach movement education to students, children, and other groups.

European antitrust control and standard setting. Bruegel Working Paper 2013/01, February 2012

Standards reduce production costs and increase products’ value to consumers. Standards however entail risks of anti-competitive abuse. After the adoption of a standard, the chosen technology normally lacks credible substitutes. The owner of the patented technology might thus have additional market power relative to locked-in licensees, and might exploit this power to charge higher access rates. In the economic literature this phenomenon is referred to as ‘hold-up’. To reduce the risk of hold-up, standard-setting organisations often require patent holders to disclose their standard-essential patents before the adoption of the standard and to commit to license on fair, reasonable and non-discriminatory (FRAND) terms. The European Commission normally investigates unfair pricing abuse in a standard-setting context if a patent holder who committed to FRAND ex-ante is suspected not to abide to it ex-post. However, this approach risks ignoring a number of potential abuses which are likely harmful for welfare. That can happen if, for example, ex-post a licensee is able to impose excessively low access rates (‘reverse hold-up’) or if a patent holder acquires additional market power thanks to the standard but its essential patents are not encumbered by FRAND commitments, for instance because the patent holder did not directly participate to the standard setting process and was therefore not required by the standard-setting organisations to commit to FRAND ex-ante. A consistent policy by the Commission capable of tackling all sources of harm should be enforced regardless of whether FRAND commitments are given. Antitrust enforcement should hinge on the identification of a distortion in the bargaining process around technology access prices, which is determined by the adoption of the standard and is not attributable to pro-competitive merits of any of the involved players.

Standard-setting abuse: the case for antitrust control. Bruegel Policy Brief 2013/01, February 2013

Standards reduce production costs and increase the value of products to consumers; ultimately they significantly contribute to economic development. Standards however entail risks of anti-competitive abuse. After the adoption of a standard, the elimination of competition between technologies can lead to consumer harm. Fair, reasonable, nondiscriminatory (FRAND) commitments made by patent holders have been used to mitigate that risk. The European Commission recognises the importance of standards, but European Union competition policy is still seeking to identify well-targeted and efficient enforcement rules.