Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

Purpose: Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to five tasks included in SINERGIA laparoscopic virtual reality simulator. Methods: Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1–R8) of the five mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of R1, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005. Results: In total, 84.38% of the metrics provided by SINERGIA and included in this study show significant differences when comparing R1 and R8. Metrics are mostly improved in the first session of training (75.00% when R1 and R4 are compared vs. 37.50% when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics are improved. On the other hand, Navigation just improves 60% of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks. Conclusions: Learning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the first part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.

Effects of dietary restriction combined with different exercise programs or physical activity recommendations on blood lipids in overweight adults

Background and aim: Many exercise studies, although generally showing the beneficial effects of supervised aerobic, resistance or combined exercise on blood lipids, have sometimes reached equivocal conclusions. The aim of this study is to evaluate the impact of different programs that combined exercise and dietary restriction on blood lipids versus a clinical practice intervention for weight loss, in overweight adults. Methods: For this study 66 subjects participated in a supervised 22 weeks training program, composed of three sessions per week and they were randomized in three groups: strength training (S; n = 19), endurance training (E; n = 25), a combination of E and S (SE; n = 22). Eighteen subjects served as physical activity group (PA) that followed a clinical intervention consisted of physical activity recommendations. All groups followed the same dietary treatment, and blood samples were obtained for lipids measurements, at the beginning and end of the study. Results: Lipid profile improved in all groups. No significant differences for baseline and post-training values were observed between groups. In general, SE and PA decreased low-density lipoprotein cholesterol (LDL-C) values (p menor que 0.01). S decreased triglyceride levels (p menor que 0.01) and E, SE, and PA decreased total cholesterol levels (p menor que 0.05, p menor que 0.01 and p menor que 0.01, respectively). Conclusions: These results suggest that an intervention program of supervised exercise combined with diet restriction did not achieved further improvements in blood lipid profile than diet restriction and physical activity recommendations, in overweight adults. (Clinical Trials gov number: NCT01116856).

The Learning of the Mathematical Models to Aid Decision Making in the High Level Engineering Schools?

At present, in the University curricula in most countries, the decision theory and the mathematical models to aid decision making is not included, as in the graduate program like in Doctored and Master´s programs. In the Technical School of High Level Agronomic Engineers of the Technical University of Madrid (ETSIA-UPM), the need to offer to the future engineers training in a subject that could help them to take decisions in their profession was felt. Along the life, they will have to take a lot of decisions. Ones, will be important and others no. In the personal level, they will have to take several very important decisions, like the election of a career, professional work, or a couple, but in the professional field, the decision making is the main role of the Managers, Politicians and Leaders. They should be decision makers and will be paid for it. Therefore, nobody can understand that such a professional that is called to practice management responsibilities in the companies, does not take training in such an important matter. For it, in the year 2000, it was requested to the University Board to introduce in the curricula an optional qualified subject of the second cycle with 4,5 credits titled " Mathematical Methods for Making Decisions ". A program was elaborated, the didactic material prepared and programs as Maple, Lingo, Math Cad, etc. installed in several IT classrooms, where the course will be taught. In the course 2000-2001 this subject was offered with a great acceptance that exceeded the forecasts of capacity and had to be prepared more classrooms. This course in graduate program took place in the Department of Applied Mathematics to the Agronomic Engineering, as an extension of the credits dedicated to Mathematics in the career of Engineering.

Resources to introduce Inquire Based Scientic Education in Secondary and High School

The global Hands-on Universe association is producing and distributing free resources world- wide to implement Inquire Based Scienti?c Education (IBSE) at secondary and high school levels. The materials are inspired in astronomical research and space exploration. The association is implementing the Galileo Teacher Training Program world-wide. In this contribution, a summary on the most recent resources being implemented by HOU-Espa~na and developed with Spanish participation is presented.

Building the qualification and a skill development program within the ENEN-III European Project

The ENEN III project covers the structuring, organization, coordination and implementation of training schemes in cooperation with local, national and international training organizations, to provide training to professionals active in nuclear organizations or their contractors and sub-contractors. The training schemes provide a portfolio of courses, training sessions, seminars, and workshops for continuous learning for upgrading knowledge and developing skills. The training schemes allow individuals to acquire qualifications and skills, as required by the specific positions in the nuclear sector which will be documented in a training passport. The essence of such passport is to be recognized within the EU by the whole nuclear sector which provides mobility to the individual looking for employment and an EU wide recruitment field for the nuclear employers.

Contribution to flexible service coordination in mobile prosumer environments

Este trabajo de Tesis se desarrolla en el marco de los escenarios de ejecución distribuida de servicios móviles y contribuye a la definición y desarrollo del concepto de usuario prosumer. El usuario prosumer se caracteriza por utilizar su teléfono móvil para crear, proveer y ejecutar servicios. Este nuevo modelo de usuario contribuye al avance de la sociedad de la información, ya que el usuario prosumer se transforma de creador de contenidos a creador de servicios (estos últimos formados por contenidos y la lógica para acceder a ellos, procesarlos y representarlos). El objetivo general de este trabajo de Tesis es la provisión de un modelo de creación, distribución y ejecución de servicios para entorno móvil que permita a los usuarios no programadores (usuarios prosumer), pero expertos en un determinado dominio, crear y ejecutar sus propias aplicaciones y servicios. Para ello se definen, desarrollan e implementan metodologías, procesos, algoritmos y mecanismos adaptables a dominios específicos, para construir entornos de ejecución distribuida de servicios móviles para usuarios prosumer. La provisión de herramientas de creación adaptadas a usuarios no expertos es una tendencia actual que está siendo desarrollada en distintos trabajos de investigación. Sin embargo, no se ha propuesto una metodología de desarrollo de servicios que involucre al usuario prosumer en el proceso de diseño, desarrollo, implementación y validación de servicios. Este trabajo de Tesis realiza un estudio de las metodologías y tecnologías más innovadoras relacionadas con la co‐creación y utiliza este análisis para definir y validar una metodología que habilita al usuario para ser el responsable de la creación de servicios finales. Siendo los entornos móviles prosumer (mobile prosumer environments) una particularización de los entornos de ejecución distribuida de servicios móviles, en este trabajo se tesis se investiga en técnicas de adaptación, distribución, coordinación de servicios y acceso a recursos identificando como requisitos las problemáticas de este tipo de entornos y las características de los usuarios que participan en los mismos. Se contribuye a la adaptación de servicios definiendo un modelo de variabilidad que soporte la interdependencia entre las decisiones de personalización de los usuarios, incorporando mecanismos de guiado y detección de errores. La distribución de servicios se implementa utilizando técnicas de descomposición en árbol SPQR, cuantificando el impacto de separar cualquier servicio en distintos dominios. Considerando el plano de comunicaciones para la coordinación en la ejecución de servicios distribuidos hemos identificado varias problemáticas, como las pérdidas de enlace, conexiones, desconexiones y descubrimiento de participantes, que resolvemos utilizando técnicas de diseminación basadas en publicación subscripción y algoritmos Gossip. Para lograr una ejecución flexible de servicios distribuidos en entorno móvil, soportamos la adaptación a cambios en la disponibilidad de los recursos, proporcionando una infraestructura de comunicaciones para el acceso uniforme y eficiente a recursos. Se han realizado validaciones experimentales para evaluar la viabilidad de las soluciones propuestas, definiendo escenarios de aplicación relevantes (el nuevo universo inteligente, prosumerización de servicios en entornos hospitalarios y emergencias en la web de la cosas). Abstract This Thesis work is developed in the framework of distributed execution of mobile services and contributes to the definition and development of the concept of prosumer user. The prosumer user is characterized by using his mobile phone to create, provide and execute services. This new user model contributes to the advancement of the information society, as the prosumer is transformed from producer of content, to producer of services (consisting of content and logic to access them, process them and represent them). The overall goal of this Thesis work is to provide a model for creation, distribution and execution of services for the mobile environment that enables non‐programmers (prosumer users), but experts in a given domain, to create and execute their own applications and services. For this purpose I define, develop and implement methodologies, processes, algorithms and mechanisms, adapted to specific domains, to build distributed environments for the execution of mobile services for prosumer users. The provision of creation tools adapted to non‐expert users is a current trend that is being developed in different research works. However, it has not been proposed a service development methodology involving the prosumer user in the process of design, development, implementation and validation of services. This thesis work studies innovative methodologies and technologies related to the co‐creation and relies on this analysis to define and validate a methodological approach that enables the user to be responsible for creating final services. Being mobile prosumer environments a specific case of environments for distributed execution of mobile services, this Thesis work researches in service adaptation, distribution, coordination and resource access techniques, and identifies as requirements the challenges of such environments and characteristics of the participating users. I contribute to service adaptation by defining a variability model that supports the dependency of user personalization decisions, incorporating guiding and error detection mechanisms. Service distribution is implemented by using decomposition techniques based on SPQR trees, quantifying the impact of separating any service in different domains. Considering the communication level for the coordination of distributed service executions I have identified several problems, such as link losses, connections, disconnections and discovery of participants, which I solve using dissemination techniques based on publish‐subscribe communication models and Gossip algorithms. To achieve a flexible distributed service execution in mobile environments, I support adaptation to changes in the availability of resources, while providing a communication infrastructure for the uniform and efficient access to resources. Experimental validations have been conducted to assess the feasibility of the proposed solutions, defining relevant application scenarios (the new intelligent universe, service prosumerization in hospitals and emergency situations in the web of things).

Uncertainties in the modal estimation from output-only data in civil structures

Cualquier estructura vibra según unas frecuencias propias definidas por sus parámetros modales (frecuencias naturales, amortiguamientos y formas modales). A través de las mediciones de la vibración en puntos clave de la estructura, los parámetros modales pueden ser estimados. En estructuras civiles, es difícil excitar una estructura de manera controlada, por lo tanto, las técnicas que implican la estimación de los parámetros modales sólo registrando su respuesta son de vital importancia para este tipo de estructuras. Esta técnica se conoce como Análisis Modal Operacional (OMA). La técnica del OMA no necesita excitar artificialmente la estructura, atendiendo únicamente a su comportamiento en servicio. La motivación para llevar a cabo pruebas de OMA surge en el campo de la Ingeniería Civil, debido a que excitar artificialmente con éxito grandes estructuras no sólo resulta difícil y costoso, sino que puede incluso dañarse la estructura. Su importancia reside en que el comportamiento global de una estructura está directamente relacionado con sus parámetros modales, y cualquier variación de rigidez, masa o condiciones de apoyo, aunque sean locales, quedan reflejadas en los parámetros modales. Por lo tanto, esta identificación puede integrarse en un sistema de vigilancia de la integridad estructural. La principal dificultad para el uso de los parámetros modales estimados mediante OMA son las incertidumbres asociadas a este proceso de estimación. Existen incertidumbres en el valor de los parámetros modales asociadas al proceso de cálculo (internos) y también asociadas a la influencia de los factores ambientales (externas), como es la temperatura. Este Trabajo Fin de Máster analiza estas dos fuentes de incertidumbre. Es decir, en primer lugar, para una estructura de laboratorio, se estudian y cuantifican las incertidumbres asociadas al programa de OMA utilizado. En segundo lugar, para una estructura en servicio (una pasarela de banda tesa), se estudian tanto el efecto del programa OMA como la influencia del factor ambiental en la estimación de los parámetros modales. Más concretamente, se ha propuesto un método para hacer un seguimiento de las frecuencias naturales de un mismo modo. Este método incluye un modelo de regresión lineal múltiple que permite eliminar la influencia de estos agentes externos. A structure vibrates according to some of its vibration modes, defined by their modal parameters (natural frequencies, damping ratios and modal shapes). Through the measurements of the vibration at key points of the structure, the modal parameters can be estimated. In civil engineering structures, it is difficult to excite structures in a controlled manner, thus, techniques involving output-only modal estimation are of vital importance for these structure. This techniques are known as Operational Modal Analysis (OMA). The OMA technique does not need to excite artificially the structure, this considers its behavior in service only. The motivation for carrying out OMA tests arises in the area of Civil Engineering, because successfully artificially excite large structures is difficult and expensive. It also may even damage the structure. The main goal is that the global behavior of a structure is directly related to their modal parameters, and any variation of stiffness, mass or support conditions, although it is local, is also reflected in the modal parameters. Therefore, this identification may be within a Structural Health Monitoring system. The main difficulty for using the modal parameters estimated by an OMA is the uncertainties associated to this estimation process. Thus, there are uncertainties in the value of the modal parameters associated to the computing process (internal) and the influence of environmental factors (external), such as the temperature. This Master’s Thesis analyzes these two sources of uncertainties. That is, firstly, for a lab structure, the uncertainties associated to the OMA program used are studied and quantified. Secondly, for an in-service structure (a stress-ribbon footbridge), both the effect of the OMA program and the influence of environmental factor on the modal parameters estimation are studied. More concretely, a method to track natural frequencies of the same mode has been proposed. This method includes a multiple linear regression model that allows to remove the influence of these external agents.

The relationship between young people's transit use and their perceptions of equity concepts in transit service provision

This study investigates the effect of price and travel mode fairness and spatial equity in transit provision on the perceived transit service quality, willingness to pay, and habitual frequency of use. Based on the theory of planned behavior, we developed a web-based questionnaire for revealed preferences data collection. The survey was administered among young people in Copenhagen and Lisbon to explore the transit perceptions and use under different economic and transit provision conditions. The survey yielded 499 questionnaires, analyzed by means of structural equation models. Results show that higher perceived fairness relates positively to higher perceived quality of transit service and higher perceived ease of paying for transit use. Higher perceived spatial equity in service provision is associated with higher perceived service quality. Higher perceived service quality relates to higher perceived ease of payment, which links to higher frequency of transit use.

Relevance of Higher Education. How to measure it? The case of masters of engineering in Peru

Existing evaluation models for higher education have, mainly, accreditation purposes, and evaluate the efficiency of training programs, that is to say, the degree of suitability between the educational results and the objectives of the program. However, it is not guaranteed that those objectives adequate to the needs and real interests of students and stakeholders, that is to say, they do not assess the relevance of the programs, a very important aspect in developing countries. From the review of experiences, this paper proposes a model for evaluating the relevance of engineering masters program, and applies it to the case of a master?s degree at the University of Piura, Peru. We conclude that the proposed model is applicable to other masters program, offers an objective way for determining is a training program keep being relevant, and identifies improvement opportunities

Do psicólogo no programa de residência multiprofissional em saúde: posição-sujeito, análise de discurso e psicanálise lacaniana

A residência multiprofissional em saúde é uma modalidade de ensino de pós graduação lato sensu, voltada para a educação em serviço. Emerge no contexto brasileiro como uma proposta complementar a fim de se atingir as metas e os princípios preconizados pelo sistema único de saúde (SUS), principalmente quanto à integralidade. Além de trazer implicações e lançar desafios ao exercício profissional do psicólogo, inserindo-o no entrelaçamento de campos densos e complexos (saúde, educação e políticas públicas), a modalidade propõe que profissionais com formações diferentes atuem num mesmo campo, com discussões e intervenções conjuntas. A questão que move a pesquisa é a posição-sujeito no programa de residência multiprofissional face ao modelo de educação-saúde vinculado. Assevera-se que a posição-sujeito é objeto discursivo deslizante (de tessitura simbólica) que toma em consideração o sujeito constituído no claudicar da linguagem e interpelado pelo inconsciente e que se manifesta como efeito de significantes em direção ao grande Outro. Para tal, vale-se da interface dos aportes teóricos da análise de discurso pêchetiana e da psicanálise lacaniana. A análise de discurso sustenta o discurso como efeito de sentidos mediados pela ideologia e ocupa-se, especialmente, da incursão da alteridade do discurso-outro sobre o mesmo. A psicanálise lacaniana, por sua vez, reitera a primazia do inconsciente estruturado como linguagem diante de um eu imaginário e versa para o sujeito marcado como falta que, dividido, faz do discurso o estatuto do significado. Assim, é proeminente na análise do objeto a metodologia indiciária dada ao caráter simbólico e cambiante da posição-sujeito no discurso. A análise se realizou mediante o dispositivo da interpretação como gesto analítico, que acompanha as elações próprias do objeto. O corpora é constituído por uma materialidade escrita e por uma oral. A escrita compõe-se de recortes de leis, portarias e resoluções que fundam a modalidade de residência multiprofissional e reforçam os ideias do sistema único de saúde; a materialidade oral compõe-se de recortes e fragmentos discursivos advindos da transcrição de supervisões realizadas mediante a prática clínica do psicólogo-residente na cena hospitalar. Da análise, conclui-se que a materialidade escrita se posta como campo-Outro que ordena a estrutura política da residência multiprofissional e direciona a manutenção da ordem e reprodução das relações hierárquicas mediante ideologia assujeitante. Essa materialidade, por sua vez, age como intradiscurso e reverbera-se na memória discursiva e na prática clínica. A posição-sujeito, no plano da articulação significante, faz deslizar e produzir sentidos que denotam ora a manutenção e reprodução de uma posição fusionada ao discurso médico, científico-positivista; ora a posição-sujeito é marcada pelo saber condicionado ao fetiche da mercadoria, deflagrando a ordem do capital nas insígnias da multiprofissionalidade e da educação permanente. O trabalho propiciou, enfim, acompanhar as transmutações da posição-sujeito, independentemente do indivíduo ou da naturalização de sentidos provenientes da função que exerce. O objeto posição-sujeito reiterou a construção da realidade a partir da condição faltante. É essa condição faltante e incompleta que outorga ao desejo o modo de o sujeito se posicionar desta e outra maneira - na formação, no trabalho, na vida.

A educação interprofissional e o Pró PET-Saúde USP-Capital 2012/2014: a percepção de tutores, preceptores e estudantes

Nos últimos trinta anos, pesquisadores da área da saúde tem dado especial atenção ao tema da educação interprofissional (EIP), por esta estar relacionada com uma maior satisfação dos usuários e a oferta de uma assistência em saúde mais resolutiva e satisfatória. A necessidade de adotarmos a EIP como uma ferramenta para a formação de profissionais da saúde surge a partir do momento que percebemos que nosso sistema de saúde presta cuidados fragmentados e pouco resolutivos. Atualmente, estudos científicos comprovam que a prática colaborativa e um cuidado ofertado com qualidade é facilmente alcançável se os profissionais trabalharem em equipe com objetivos comuns, sendo imprenscindível o desenvolvimento de habilidades de comunicação interprofissional e prática colaborativa desde o início da graduação. Desta forma, este estudo tomou como objeto de investigação a educação interprofissional, no contexto da atenção primária a saúde e na perspectiva da integração do ensino com os serviços públicos de saúde, por meio do programa Pró PET-Saúde USP-Capital 2012/2014. A escolha do programa para o presente estudo foi devido a natureza interprofissional do projeto, visto que engloba estudantes, preceptores e tutores de diversos cursos da área da saúde e por este ter constituído um espaço privilegiado de aprendizado e aperfeiçoamento na formação em saúde, dando origem a outras iniciativas interprofissionais na Universidade de São Paulo (USP). A coleta de dados ocorreu de duas formas, sendo a primeira por meio de questionários individuais destinado aos profissionais de saúde (preceptores) e estudantes, com trechos da obra de Lewis Carroll \"As Aventuras de Alice no País das Maravilhas\", e por meio de um roteiro de entrevista destinado aos docentes (tutores) participantes do programa. Os dados obtidos foram analisados através da análise temática proposta por Minayo. Os resultados mostram que assim como a personagem Alice do livro de Carroll, muitas vezes ficamos confusos sobre quais opções escolher para aperfeiçoar a nossa formação em saúde. Se não soubermos onde queremos chegar, qualquer caminho se torna o certo, porém as evidências comprovam que a escolha por oportunidades de educação interprofissional na graduação e na pós graduação em saúde podem minimizar estereótipos e preconceitos formados pelos estudantes em relação as outras categorias profissionais e desenvolver habilidades de comunicação interprofissional e resolução de conflitos que contribuirá para uma prática colaborativa e a melhor assistência em saúde. Como produto do mestrado profissional foi elaborado um plano de aula destinado aos estudantes da USP com a finalidade de problematizar e permitir uma breve experiência da educação interprofissional.

Multiple Perspectives on Academic Service-Learning Partnerships at the American University in Cairo: A Mixed Method Study

This mixed method study aimed to redress the gap in the literature on academic service-learning partnerships, especially in Eastern settings. It utilized Enos and Morton's (2003) theoretical framework to explore these partnerships at the American University in Cairo (AUC). Seventy-nine community partners, administrators, faculty members, and students from a diverse range of age, citizenship, racial, educational, and professional backgrounds participated in the study. Qualitative interviews were conducted with members of these four groups, and a survey with both close-ended and open-ended questions administered to students yielded 61 responses. Qualitative analyses revealed that the primary motivators for partners' engagement in service-learning partnerships included contributing to the community, enhancing students' learning and growth, and achieving the civic mission of the University. These partnerships were characterized by short-term relationships with partners' aspiring to progress toward long-term commitments. The challenges to these partnerships included issues pertaining to the institution, partnering organizations, culture, politics, pedagogy, students, and faculty members. Key strategies for improving these partnerships included institutionalizing service-learning in the University and cultivating an institutional culture supportive of community engagement. Quantitative analyses showed statistically significant relationships between students' scores on the Community Awareness and Interpersonal Effectiveness scales and their overall participation in community service activities inside and outside the classroom, as well as a statistically significant difference between their scores on the Community Awareness scale and department offering service-learning courses. The study's outcomes underscore the role of the local culture in shaping service-learning partnerships, as well as the role of both curricular and extracurricular activities in boosting students' awareness of their community and interpersonal effectiveness. Cultivating a culture of community engagement and building support mechanisms for engaged scholarship are among the critical steps required by public policy-makers in Egypt to promote service-learning in Egyptian higher education. Institutionalizing service-learning partnerships at AUC and enhancing the visibility of these partnerships on campus and in the community are essential to the future growth of these collaborations. Future studies should explore factors affecting community partners' satisfaction with these partnerships, top-down and bottom-up support to service-learning, the value of reflection to faculty members, and the influence of students' economic backgrounds on their involvement in service-learning partnerships.

A integralidade no cuidado das pessoas vivendo com HIV e AIDS: a experiência do Centro de Referência e Treinamento em DST/AIDS da SES-SP

Ao assumir o compromisso com a prevenção e tratamento, baseada no princípio da integralidade, a estratégia brasileira, fez a diferença na resposta nacional à aids nas décadas de 1980/90 e criou um novo paradigma que mostrou-se avançado do ponto de vista técnico, ético e político, contribuindo para a mudança nas recomendações das agências internacionais (OMS\\Banco Mundial) - do \"não tratar e só prevenir\" do início dos anos 1990, para o \"Tratamento como Prevenção\", base da atual proposta dos 90/90/90. Essa estratégia de controle da epidemia concentra responsabilidade na Rede de Serviços, em um período de discussão sobre mudanças no modelo de atenção a ser priorizado no país. Características relevantes dos contextos político e programáticos permitiram uma maior efetivação do cuidado às PVHA no Estado de São Paulo. O objetivo do presente estudo é recuperar a história do Centro de Referência e Treinamento em DST/Aids (CRT) na gestão e organização programática do cuidado em HIV/Aids no Estado de São Paulo, no período de 1988 a 2015, interpretando-a sob a perspectiva dos aspectos facilitadores e limitadores da incorporação prática do princípio da integralidade às ações de saúde. Realizou-se, nesse sentido, uma revisão narrativa da literatura sobre o tema da integralidade no campo da Saúde Coletiva Brasileira nas últimas cinco décadas. Tomando por base o cotejamento com esse desenvolvimento conceitual, a trajetória do CRT foi analisada por meio de entrevistas com atores-chaves no processo da gestão e organização programática do cuidado das PVHA no Estado de São Paulo, e análise dos documentos produzidos no processo. Esta análise foi organizada em torno de dois grandes eixos temáticos: (1) a criação e estruturação do CRT, e (2) as relações entre o CRT, os Programas Municipais de DST/aids e a rede de serviços assistenciais no Estado de São Paulo. Entre os resultados do estudo, destacam-se o resgate e reflexão crítica sobre o desenvolvimento dos discursos tecnocientíficos sobre integralidade no contexto das propostas de reforma da saúde no Brasil; a incorporação desses construtos às propostas desenvolvidas pelo CRT, especialmente em torno aos conceitos de vulnerabilidade, cuidado, clínica ampliada e direitos humanos em saúde; e a identificação de arranjos institucionais, estratégias técnicas e configurações políticas que permitiram ao CRT o exercício articulado de três níveis de gestão do cuidado (das PVHA, dos serviços e da Rede) numa mesma plataforma. Conclui-se apontando alcances e limites na efetivação da integralidade, que se mostraram desiguais nos três níveis de gestão do cuidado. Aponta-se maiores avanços na dimensão gerencial da rede e as maiores dificuldades na efetivação da integralidade no cuidado das PVHA e na gestão dos serviços de saúde

Capacity-building through English language training to improve long-term resettlement success: A case study of the refugees along the Thailand-Burma border

Achieving long-term resettlement success is a challenge for many refugees seeking to restart their lives after displacement and being uprooted from their lives. Refugees must deal with finding employment, integrating into a society immensely different from what they have known their whole lives, and starting over from scratch. Learning a new language enables refugees to progress towards integration and long-term resettlement success, however, resettled refugees face a multitude of barriers in the U.S. to accessing language classes and attaining English proficiency. This study seeks to bridge this problem by exploring the possibilities of implementing a standardized language training program in the refugee camps to better prepare refugees for resettlement. A case study of the refugees along the Thai-Burma border demonstrated the significance of learning English in the camps on eventual English proficiency as well as the need for increased partnerships to overcome the barriers of lack of motivation and lack of funding. The author explores the possibilities of implementing a language training program in the camps by determining need, interest, barriers, and perceptions through the use of interviews, surveys, and focus groups of camp refugees, resettled refugees, and key organizational representatives. The significance of these results offers the possibility of leveraging and unlocking resettlement as a durable solution for more of the world's refugees in protracted situations.

DUI program as OEF/OIF Veterans Outreach: Descriptive Data from Two Community-Based Outpatient Clinics

Although initially conceived as providing simply the preventive portion of an extended continuum of care for veterans, the Driving Under the Influence (DUI) program has turned out to be an important outreach service for active duty or recently discharged OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. Veterans receive empirically-based, state-mandated education and therapy under the only Department of Veterans Affairs (VA) - sponsored DUI program in the State of Colorado, with the advantage of having providers who are sensitive to symptoms of Post-Traumatic Stress Disorder (PTSD) and other relevant diagnoses specific to this population, including Traumatic Brain Injury (TBI). In this paper, the rapid growth of this program is described, as well as summary data regarding the completion, discontinuation, and augmentation of services from the original referral concern. Key results indicated that for nearly one third (31.9%) of the OEF/OIF veterans who were enrolled in the DUI program, this was their initial contact with the VA health care system. Furthermore, following their enrollment in the DUI program, more than one fourth (27.6%) were later referred to and attended other VA programs including PTSD rehabilitation and group therapy, anger management, and intensive inpatient or outpatient dual diagnosis programs. These and other findings from this study suggest that the DUI program may be an effective additional pathway for providing treatment that is particularly salient to the distinctive OEF/OIF population; one that may also result in earlier intervention for problem drinking and other problems related to combat. Relevant conclusions discussed herein primarily aim to improve providers' understanding of effective outreach, and to enhance the appropriate linkages between OEF/OIF veterans and existing VA services.