841 resultados para Bioethics and Medical Ethics
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Since 2008, the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences has contributed to ensuring the substitution of sharp curettage by manual vacuum aspiration (MVA) and medical abortion in selected hospitals in participating countries of South-Southeast Asia. This initiative facilitated the registration of misoprostol in Pakistan and Bangladesh, and the approval of mifepristone for "menstrual regulation" in Bangladesh. The Pakistan Nursing Council agreed to include MVA and medical abortion in the midwifery curriculum. The Bangladesh Government has approved the training of nurses and paramedics in the use of MVA to treat incomplete abortion in selected cases. The Sri Lanka College of Obstetricians and Gynaecologists, in collaboration with partners, has presented a draft petition to the relevant authorities appealing for them to liberalize the abortion law in cases of rape and incest or when lethal congenital abnormalities are present. Significantly, the initiative has introduced or strengthened the provision of postabortion contraception.
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Gamma detectors based on monolithic scintillator blocks coupled to APDs matrices have proved to be a good alternative to pixelated ones for PET scanners. They provide comparable spatial resolution, improve the sensitivity and make easier the mechanical design of the system. In this study we evaluate by means of Geant4-based simulations the possibility of replacing the APDs by SiPMs. Several commercial matrices of light sensors coupled to LYSO:Ce monolithic blocks have been simulated and compared. Regarding the spatial resolution and linearity of the detector, SiPMs with high photo detection efficiency could become an advantageous replacement for the APDs
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A small Positron Emission Tomography demonstrator based on LYSO slabs and Silicon Photomultiplier matrices is under construction at the University and INFN of Pisa. In this paper we present the characterization results of the read-out electronics and of the detection system. Two SiPM matrices, composed by 8 × 8 SiPM pixels, 1.5 mm pitch, have been coupled one to one to a LYSO crystals array. Custom Front-End ASICs were used to read the 64 channels of each matrix. Data from each Front-End were multiplexed and sent to a DAQ board for the digital conversion; a motherboard collects the data and communicates with a host computer through a USB port. Specific tests were carried out on the system in order to assess its performance. Futhermore we have measured some of the most important parameters of the system for PET application.
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Background Most aerial plant parts are covered with a hydrophobic lipid-rich cuticle, which is the interface between the plant organs and the surrounding environment. Plant surfaces may have a high degree of hydrophobicity because of the combined effects of surface chemistry and roughness. The physical and chemical complexity of the plant cuticle limits the development of models that explain its internal structure and interactions with surface-applied agrochemicals. In this article we introduce a thermodynamic method for estimating the solubilities of model plant surface constituents and relating them to the effects of agrochemicals. Results Following the van Krevelen and Hoftyzer method, we calculated the solubility parameters of three model plant species and eight compounds that differ in hydrophobicity and polarity. In addition, intact tissues were examined by scanning electron microscopy and the surface free energy, polarity, solubility parameter and work of adhesion of each were calculated from contact angle measurements of three liquids with different polarities. By comparing the affinities between plant surface constituents and agrochemicals derived from (a) theoretical calculations and (b) contact angle measurements we were able to distinguish the physical effect of surface roughness from the effect of the chemical nature of the epicuticular waxes. A solubility parameter model for plant surfaces is proposed on the basis of an increasing gradient from the cuticular surface towards the underlying cell wall. Conclusions The procedure enabled us to predict the interactions among agrochemicals, plant surfaces, and cuticular and cell wall components, and promises to be a useful tool for improving our understanding of biological surface interactions.
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Background Most aerial plant parts are covered with a hydrophobic lipid-rich cuticle, which is the interface between the plant organs and the surrounding environment. Plant surfaces may have a high degree of hydrophobicity because of the combined effects of surface chemistry and roughness. The physical and chemical complexity of the plant cuticle limits the development of models that explain its internal structure and interactions with surface-applied agrochemicals. In this article we introduce a thermodynamic method for estimating the solubilities of model plant surface constituents and relating them to the effects of agrochemicals. Results Following the van Krevelen and Hoftyzer method, we calculated the solubility parameters of three model plant species and eight compounds that differ in hydrophobicity and polarity. In addition, intact tissues were examined by scanning electron microscopy and the surface free energy, polarity, solubility parameter and work of adhesion of each were calculated from contact angle measurements of three liquids with different polarities. By comparing the affinities between plant surface constituents and agrochemicals derived from (a) theoretical calculations and (b) contact angle measurements we were able to distinguish the physical effect of surface roughness from the effect of the chemical nature of the epicuticular waxes. A solubility parameter model for plant surfaces is proposed on the basis of an increasing gradient from the cuticular surface towards the underlying cell wall. Conclusions The procedure enabled us to predict the interactions among agrochemicals, plant surfaces, and cuticular and cell wall components, and promises to be a useful tool for improving our understanding of biological surface interactions.
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Analysis of the "European Charter on General Principles for Protection of the Environment and Sustainable Development" The Council of Europe Document CO-DBP (2003) 2
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En la interacción con el entorno que nos rodea durante nuestra vida diaria (utilizar un cepillo de dientes, abrir puertas, utilizar el teléfono móvil, etc.) y en situaciones profesionales (intervenciones médicas, procesos de producción, etc.), típicamente realizamos manipulaciones avanzadas que incluyen la utilización de los dedos de ambas manos. De esta forma el desarrollo de métodos de interacción háptica multi-dedo dan lugar a interfaces hombre-máquina más naturales y realistas. No obstante, la mayoría de interfaces hápticas disponibles en el mercado están basadas en interacciones con un solo punto de contacto; esto puede ser suficiente para la exploración o palpación del entorno pero no permite la realización de tareas más avanzadas como agarres. En esta tesis, se investiga el diseño mecánico, control y aplicaciones de dispositivos hápticos modulares con capacidad de reflexión de fuerzas en los dedos índice, corazón y pulgar del usuario. El diseño mecánico de la interfaz diseñada, ha sido optimizado con funciones multi-objetivo para conseguir una baja inercia, un amplio espacio de trabajo, alta manipulabilidad y reflexión de fuerzas superiores a 3 N en el espacio de trabajo. El ancho de banda y la rigidez del dispositivo se han evaluado mediante simulación y experimentación real. Una de las áreas más importantes en el diseño de estos dispositivos es el efector final, ya que es la parte que está en contacto con el usuario. Durante este trabajo se ha diseñado un dedal de bajo peso, adaptable a diferentes usuarios que, mediante la incorporación de sensores de contacto, permite estimar fuerzas normales y tangenciales durante la interacción con entornos reales y virtuales. Para el diseño de la arquitectura de control, se estudiaron los principales requisitos para estos dispositivos. Entre estos, cabe destacar la adquisición, procesado e intercambio a través de internet de numerosas señales de control e instrumentación; la computación de equaciones matemáticas incluyendo la cinemática directa e inversa, jacobiana, algoritmos de detección de agarres, etc. Todos estos componentes deben calcularse en tiempo real garantizando una frecuencia mínima de 1 KHz. Además, se describen sistemas para manipulación de precisión virtual y remota; así como el diseño de un método denominado "desacoplo cinemático iterativo" para computar la cinemática inversa de robots y la comparación con otros métodos actuales. Para entender la importancia de la interacción multimodal, se ha llevado a cabo un estudio para comprobar qué estímulos sensoriales se correlacionan con tiempos de respuesta más rápidos y de mayor precisión. Estos experimentos se desarrollaron en colaboración con neurocientíficos del instituto Technion Israel Institute of Technology. Comparando los tiempos de respuesta en la interacción unimodal (auditiva, visual y háptica) con combinaciones bimodales y trimodales de los mismos, se demuestra que el movimiento sincronizado de los dedos para generar respuestas de agarre se basa principalmente en la percepción háptica. La ventaja en el tiempo de procesamiento de los estímulos hápticos, sugiere que los entornos virtuales que incluyen esta componente sensorial generan mejores contingencias motoras y mejoran la credibilidad de los eventos. Se concluye que, los sistemas que incluyen percepción háptica dotan a los usuarios de más tiempo en las etapas cognitivas para rellenar información de forma creativa y formar una experiencia más rica. Una aplicación interesante de los dispositivos hápticos es el diseño de nuevos simuladores que permitan entrenar habilidades manuales en el sector médico. En colaboración con fisioterapeutas de Griffith University en Australia, se desarrolló un simulador que permite realizar ejercicios de rehabilitación de la mano. Las propiedades de rigidez no lineales de la articulación metacarpofalange del dedo índice se estimaron mediante la utilización del efector final diseñado. Estos parámetros, se han implementado en un escenario que simula el comportamiento de la mano humana y que permite la interacción háptica a través de esta interfaz. Las aplicaciones potenciales de este simulador están relacionadas con entrenamiento y educación de estudiantes de fisioterapia. En esta tesis, se han desarrollado nuevos métodos que permiten el control simultáneo de robots y manos robóticas en la interacción con entornos reales. El espacio de trabajo alcanzable por el dispositivo háptico, se extiende mediante el cambio de modo de control automático entre posición y velocidad. Además, estos métodos permiten reconocer el gesto del usuario durante las primeras etapas de aproximación al objeto para su agarre. Mediante experimentos de manipulación avanzada de objetos con un manipulador y diferentes manos robóticas, se muestra que el tiempo en realizar una tarea se reduce y que el sistema permite la realización de la tarea con precisión. Este trabajo, es el resultado de una colaboración con investigadores de Harvard BioRobotics Laboratory. ABSTRACT When we interact with the environment in our daily life (using a toothbrush, opening doors, using cell-phones, etc.), or in professional situations (medical interventions, manufacturing processes, etc.) we typically perform dexterous manipulations that involve multiple fingers and palm for both hands. Therefore, multi-Finger haptic methods can provide a realistic and natural human-machine interface to enhance immersion when interacting with simulated or remote environments. Most commercial devices allow haptic interaction with only one contact point, which may be sufficient for some exploration or palpation tasks but are not enough to perform advanced object manipulations such as grasping. In this thesis, I investigate the mechanical design, control and applications of a modular haptic device that can provide force feedback to the index, thumb and middle fingers of the user. The designed mechanical device is optimized with a multi-objective design function to achieve a low inertia, a large workspace, manipulability, and force-feedback of up to 3 N within the workspace; the bandwidth and rigidity for the device is assessed through simulation and real experimentation. One of the most important areas when designing haptic devices is the end-effector, since it is in contact with the user. In this thesis the design and evaluation of a thimble-like, lightweight, user-adaptable, and cost-effective device that incorporates four contact force sensors is described. This design allows estimation of the forces applied by a user during manipulation of virtual and real objects. The design of a real-time, modular control architecture for multi-finger haptic interaction is described. Requirements for control of multi-finger haptic devices are explored. Moreover, a large number of signals have to be acquired, processed, sent over the network and mathematical computations such as device direct and inverse kinematics, jacobian, grasp detection algorithms, etc. have to be calculated in Real Time to assure the required high fidelity for the haptic interaction. The Hardware control architecture has different modules and consists of an FPGA for the low-level controller and a RT controller for managing all the complex calculations (jacobian, kinematics, etc.); this provides a compact and scalable solution for the required high computation capabilities assuring a correct frequency rate for the control loop of 1 kHz. A set-up for dexterous virtual and real manipulation is described. Moreover, a new algorithm named the iterative kinematic decoupling method was implemented to solve the inverse kinematics of a robotic manipulator. In order to understand the importance of multi-modal interaction including haptics, a subject study was carried out to look for sensory stimuli that correlate with fast response time and enhanced accuracy. This experiment was carried out in collaboration with neuro-scientists from Technion Israel Institute of Technology. By comparing the grasping response times in unimodal (auditory, visual, and haptic) events with the response times in events with bimodal and trimodal combinations. It is concluded that in grasping tasks the synchronized motion of the fingers to generate the grasping response relies on haptic cues. This processing-speed advantage of haptic cues suggests that multimodalhaptic virtual environments are superior in generating motor contingencies, enhancing the plausibility of events. Applications that include haptics provide users with more time at the cognitive stages to fill in missing information creatively and form a richer experience. A major application of haptic devices is the design of new simulators to train manual skills for the medical sector. In collaboration with physical therapists from Griffith University in Australia, we developed a simulator to allow hand rehabilitation manipulations. First, the non-linear stiffness properties of the metacarpophalangeal joint of the index finger were estimated by using the designed end-effector; these parameters are implemented in a scenario that simulates the behavior of the human hand and that allows haptic interaction through the designed haptic device. The potential application of this work is related to educational and medical training purposes. In this thesis, new methods to simultaneously control the position and orientation of a robotic manipulator and the grasp of a robotic hand when interacting with large real environments are studied. The reachable workspace is extended by automatically switching between rate and position control modes. Moreover, the human hand gesture is recognized by reading the relative movements of the index, thumb and middle fingers of the user during the early stages of the approximation-to-the-object phase and then mapped to the robotic hand actuators. These methods are validated to perform dexterous manipulation of objects with a robotic manipulator, and different robotic hands. This work is the result of a research collaboration with researchers from the Harvard BioRobotics Laboratory. The developed experiments show that the overall task time is reduced and that the developed methods allow for full dexterity and correct completion of dexterous manipulations.
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La segmentación de imágenes es un campo importante de la visión computacional y una de las áreas de investigación más activas, con aplicaciones en comprensión de imágenes, detección de objetos, reconocimiento facial, vigilancia de vídeo o procesamiento de imagen médica. La segmentación de imágenes es un problema difícil en general, pero especialmente en entornos científicos y biomédicos, donde las técnicas de adquisición imagen proporcionan imágenes ruidosas. Además, en muchos de estos casos se necesita una precisión casi perfecta. En esta tesis, revisamos y comparamos primero algunas de las técnicas ampliamente usadas para la segmentación de imágenes médicas. Estas técnicas usan clasificadores a nivel de pixel e introducen regularización sobre pares de píxeles que es normalmente insuficiente. Estudiamos las dificultades que presentan para capturar la información de alto nivel sobre los objetos a segmentar. Esta deficiencia da lugar a detecciones erróneas, bordes irregulares, configuraciones con topología errónea y formas inválidas. Para solucionar estos problemas, proponemos un nuevo método de regularización de alto nivel que aprende información topológica y de forma a partir de los datos de entrenamiento de una forma no paramétrica usando potenciales de orden superior. Los potenciales de orden superior se están popularizando en visión por computador, pero la representación exacta de un potencial de orden superior definido sobre muchas variables es computacionalmente inviable. Usamos una representación compacta de los potenciales basada en un conjunto finito de patrones aprendidos de los datos de entrenamiento que, a su vez, depende de las observaciones. Gracias a esta representación, los potenciales de orden superior pueden ser convertidos a potenciales de orden 2 con algunas variables auxiliares añadidas. Experimentos con imágenes reales y sintéticas confirman que nuestro modelo soluciona los errores de aproximaciones más débiles. Incluso con una regularización de alto nivel, una precisión exacta es inalcanzable, y se requeire de edición manual de los resultados de la segmentación automática. La edición manual es tediosa y pesada, y cualquier herramienta de ayuda es muy apreciada. Estas herramientas necesitan ser precisas, pero también lo suficientemente rápidas para ser usadas de forma interactiva. Los contornos activos son una buena solución: son buenos para detecciones precisas de fronteras y, en lugar de buscar una solución global, proporcionan un ajuste fino a resultados que ya existían previamente. Sin embargo, requieren una representación implícita que les permita trabajar con cambios topológicos del contorno, y esto da lugar a ecuaciones en derivadas parciales (EDP) que son costosas de resolver computacionalmente y pueden presentar problemas de estabilidad numérica. Presentamos una aproximación morfológica a la evolución de contornos basada en un nuevo operador morfológico de curvatura que es válido para superficies de cualquier dimensión. Aproximamos la solución numérica de la EDP de la evolución de contorno mediante la aplicación sucesiva de un conjunto de operadores morfológicos aplicados sobre una función de conjuntos de nivel. Estos operadores son muy rápidos, no sufren de problemas de estabilidad numérica y no degradan la función de los conjuntos de nivel, de modo que no hay necesidad de reinicializarlo. Además, su implementación es mucho más sencilla que la de las EDP, ya que no requieren usar sofisticados algoritmos numéricos. Desde un punto de vista teórico, profundizamos en las conexiones entre operadores morfológicos y diferenciales, e introducimos nuevos resultados en este área. Validamos nuestra aproximación proporcionando una implementación morfológica de los contornos geodésicos activos, los contornos activos sin bordes, y los turbopíxeles. En los experimentos realizados, las implementaciones morfológicas convergen a soluciones equivalentes a aquéllas logradas mediante soluciones numéricas tradicionales, pero con ganancias significativas en simplicidad, velocidad y estabilidad. ABSTRACT Image segmentation is an important field in computer vision and one of its most active research areas, with applications in image understanding, object detection, face recognition, video surveillance or medical image processing. Image segmentation is a challenging problem in general, but especially in the biological and medical image fields, where the imaging techniques usually produce cluttered and noisy images and near-perfect accuracy is required in many cases. In this thesis we first review and compare some standard techniques widely used for medical image segmentation. These techniques use pixel-wise classifiers and introduce weak pairwise regularization which is insufficient in many cases. We study their difficulties to capture high-level structural information about the objects to segment. This deficiency leads to many erroneous detections, ragged boundaries, incorrect topological configurations and wrong shapes. To deal with these problems, we propose a new regularization method that learns shape and topological information from training data in a nonparametric way using high-order potentials. High-order potentials are becoming increasingly popular in computer vision. However, the exact representation of a general higher order potential defined over many variables is computationally infeasible. We use a compact representation of the potentials based on a finite set of patterns learned fromtraining data that, in turn, depends on the observations. Thanks to this representation, high-order potentials can be converted into pairwise potentials with some added auxiliary variables and minimized with tree-reweighted message passing (TRW) and belief propagation (BP) techniques. Both synthetic and real experiments confirm that our model fixes the errors of weaker approaches. Even with high-level regularization, perfect accuracy is still unattainable, and human editing of the segmentation results is necessary. The manual edition is tedious and cumbersome, and tools that assist the user are greatly appreciated. These tools need to be precise, but also fast enough to be used in real-time. Active contours are a good solution: they are good for precise boundary detection and, instead of finding a global solution, they provide a fine tuning to previously existing results. However, they require an implicit representation to deal with topological changes of the contour, and this leads to PDEs that are computationally costly to solve and may present numerical stability issues. We present a morphological approach to contour evolution based on a new curvature morphological operator valid for surfaces of any dimension. We approximate the numerical solution of the contour evolution PDE by the successive application of a set of morphological operators defined on a binary level-set. These operators are very fast, do not suffer numerical stability issues, and do not degrade the level set function, so there is no need to reinitialize it. Moreover, their implementation is much easier than their PDE counterpart, since they do not require the use of sophisticated numerical algorithms. From a theoretical point of view, we delve into the connections between differential andmorphological operators, and introduce novel results in this area. We validate the approach providing amorphological implementation of the geodesic active contours, the active contours without borders, and turbopixels. In the experiments conducted, the morphological implementations converge to solutions equivalent to those achieved by traditional numerical solutions, but with significant gains in simplicity, speed, and stability.
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The use of tungsten disulphide inorganic nanotubes (INT-WS2) offers the opportunity to produce novel and advanced biopolymer-based nanocomposite materials with excellent nanoparticle dispersion without the need for modifiers or surfactants via conventional melt blending. The study of the non-isothermal melt-crystallization kinetics provides a clear picture of the transformation of poly(L-lactic acid) (PLLA) molecules from the non-ordered to the ordered state. The overall crystallization rate, final crystallinity and subsequent melting behaviour of PLLA were controlled by both the incorporation of INT-WS2 and the variation of the cooling rate. In particular, it was shown that INT-WS2 exhibits much more prominent nucleation activity on the crystallization of PLLA than other specific nucleating agents or nano-sized fillers. These features may be advantageous for the enhancement of mechanical properties and process-ability of PLLA-based materials. PLLA/INT-WS2 nanocomposites can be employed as low cost biodegradable materials for many eco-friendly and medical applications, and the exceptional crystallization behaviour observed opens new perspectives for scale-up and broader applications.
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Poly(3-hydroxybutyrate) (PHB) nanocomposites containing environmentally-friendly tungsten disulphide inorganic nanotubes (INTeWS2) have been successfully prepared by a simple solution blending method. The dynamic and isothermal crystallization studies by differential scanning calorimetry (DSC) demonstrated that the INTeWS2 exhibits much more prominent nucleation activity on the crystallization of PHB than specific nucleating agents or other nanoscale fillers. Both crystallization rate and crystallinity significantly increase in the nanocomposites compared to neat PHB. These changes occur without modifying the crystalline structure of PHB in the nanocomposites, as shown by wide-angle X-ray diffraction (WAXS) and infrared/Raman spectroscopy. Other parameters such as the Avrami exponent, the equilibrium melting temperature, global rate constant and the fold surface free energy of PHB chains in the nanocomposites were obtained from the calorimetric data in order to determine the influence of the INTeWS2 filler. The addition of INTeWS2 remarkably influences the energetics and kinetics of nucleation and growth of PHB, reducing the fold surface free energy by up to 20%. Furthermore, these nanocomposites also show an improvement in both tribological and mechanical (hardness and modulus) properties with respect to pure PHB evidenced by friction and nanoindentation tests, which is of important potential interest for industrial and medical applications.
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Background The aim of this study is to present face, content, and constructs validity of the endoscopic orthogonal video system (EndoViS) training system and determines its efficiency as a training and objective assessment tool of the surgeons’ psychomotor skills. Methods Thirty-five surgeons and medical students participated in this study: 11 medical students, 19 residents, and 5 experts. All participants performed four basic skill tasks using conventional laparoscopic instruments and EndoViS training system. Subsequently, participants filled out a questionnaire regarding the design, realism, overall functionality, and its capabilities to train hand–eye coordination and depth perception, rated on a 5-point Likert scale. Motion data of the instruments were obtained by means of two webcams built into a laparoscopic physical trainer. To identify the surgical instruments in the images, colored markers were placed in each instrument. Thirteen motion-related metrics were used to assess laparoscopic performance of the participants. Statistical analysis of performance was made between novice, intermediate, and expert groups. Internal consistency of all metrics was analyzed with Cronbach’s α test. Results Overall scores about features of the EndoViS system were positives. Participants agreed with the usefulness of tasks and the training capacities of EndoViS system (score >4). Results presented significant differences in the execution of three skill tasks performed by participants. Seven metrics showed construct validity for assessment of performance with high consistency levels. Conclusions EndoViS training system has been successfully validated. Results showed that EndoViS was able to differentiate between participants of varying laparoscopic experience. This simulator is a useful and effective tool to objectively assess laparoscopic psychomotor skills of the surgeons.
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Tungsten disulphide nanotubes (INT-WS2) have been successfully dispersed in a bio-based polyamide matrix (nylon 11) by conventional melt processing. The effect of INT-WS2 content on the morphology, thermal stability, crystallization behaviour and dynamic mechanical properties is investigated. The results indicate that these inorganic nanotubes can be efficiently incorporated into the bio-based polymer matrix without the need for modifiers or surfactants. Additionally, it is found that the non-isothermal crystallization behaviour of nylon 11/INT-WS2 depends on both the cooling rate and INT-WS2 concentration. In particular, crystallization kinetics results demonstrate that the nucleating activity of INTs plays a dominant role in accelerating the crystallization of nylon 11. This fact leads to the appearance of the more-disordered phase at higher temperature. More significantly, it was shown that these INT-WS2 nanocomposites can facilitate a good processability and cost efficiency, and will be of interest for many eco-friendly and medical applications.
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As condições inadequadas vivenciadas nas organizações afligem não só os trabalhadores da iniciativa privada, pois são igualmente encontradas no segmento estatal, contrariando a expectativa de que o aparato governamental eliminaria as condições insalubres e criaria outras melhores nas quais prevalecesse à promoção de saúde. Diante desse panorama questionou-se porque, uma vez que, pelo menos do ponto de vista da sociedade leiga, esses servidores estão submetidos a condições privilegiadas de trabalho. O presente estudo objetivou identificar e descrever possíveis relações entre o clima organizacional e o burnout em servidores públicos de uma instituição federal de ensino. Objetivou-se ainda descrever o clima organizacional predominante. A pesquisa realizada teve cunho quantitativo, tipo estudo de caso e exploratória. A coleta de dados deu-se por meio das escalas ECO (escala de clima organizacional), ECB (escala de caracterização do burnout) e um questionário sociodemográfico, todos os instrumentos autoaplicáveis eletronicamente disponíveis à instituição. Participaram do estudo 201 servidores públicos federais, com idade média de 37 anos, majoritariamente de nível superior e casados. Os resultados revelaram que cerca de um quarto dos participantes raramente experimentaram burnout, no entanto outra quarta parte deles frequentemente experimentaram altos níveis de burnout, resultado bastante expressivo. Os servidores perceberam clima organizacional mediano, destacando-se a boa coesão entre os colegas de trabalho e a percepção de baixa recompensa. Merece destaque a grande dispersão entre as percepções de clima, o que permite inferir haver subclimas não identificados nesta investigação, possivelmente ocasionados por uma força de clima fraca e pela participação dos servidores de unidades de ensino geograficamente distintas, geridas por gestores locais com relativa autonomia. Os resultados dos cálculos de correlação revelaram que, quanto menos os participantes percebem apoio da chefia e da organização, coesão entre colegas, e mais controle/pressão, mais exaustos se sentem, mais desumanizam as pessoas com quem tratam e mais se decepcionam no trabalho e vice-versa. Conforto físico menor está associado a maior desumanização e a mais decepção no trabalho e vice-versa; e que controle/pressão, relaciona-se positiva e fracamente com desumanização e vice-versa. Desta forma, a hipótese de que existe associação entre burnout e clima organizacional foi confirmada. Os resultados também revelaram que os servidores com burnout, perceberam pior clima organizacional que os seus pares sem burnout, confirmando a segunda hipótese. Esses servidores também se mostraram neutros quanto à percepção de apoio da chefia e conforto físico; não percebem controle pressão, nem recompensa; todavia percebem coesão entre os colegas. Esses resultados sugerem que os participantes têm se apoiado nessas relações para suportar a indiferença e ausência de estímulos experimentados no trabalho. Os resultados obtidos nesse estudo permitiram concluir que o clima organizacional é fraco, provavelmente influenciado por uma cultura organizacional fraca, explicando a heterogeneidade da percepção do clima organizacional pelos servidores. Além disso, embora haja burnout entre poucos participantes, há que se atentar que cerca de um quarto deles, encontra-se acometido desta síndrome e isto poderá contagiar os demais.
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Funding A Health Systems Research Initiative Development Grant from the UK Department for International Development (DFID), Economic and Social Research Council (ESRC), Medical Research Council (MRC (and the Wellcome Trust (MR/N005597/1) funds the research presented in this paper. Support for the Agincourt HDSS including verbal autopsies was provided by The Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z), and the University of the Witwatersrand and Medical Research Council, South Africa.
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Acknowledgements We would like to thank the staff of the animal facility for their support and care for our animals. Funding was provided by the Wellcome Trust (102705) and Medical Research Council (UK) (MR/J004820/1) and a University of Aberdeen Studentship to BK.