Sedação consciente em Odontopediatria

O medo e a ansiedade estão estreitamente relacionados com o tratamento dentário e, infelizmente, na população infantil este facto assume uma magnitude aumentada traduzindo-se muitas vezes de forma negativa no comportamento da criança comprometendo ou mesmo inviabilizando a execução do mesmo. O tratamento dentário de pacientes pediátricos com problemas comportamentais pode ser um verdadeiro desafio para o médico dentista e as tradicionais técnicas de controlo comportamental não farmacológicas nem sempre são suficientes para conseguir a cooperação da criança pelo que, em muitos casos, é necessária a associação dos mesmos a técnicas farmacológicas. A sedação consciente é utilizada em odontopediatria como uma técnica de controlo comportamental farmacológica, que visa induzir na criança, um estado mínimo de depressão da consciência, tornando-a passível de cooperar e viabilizando que os tratamentos necessários sejam efectuados com segurança. Existem inúmeros fármacos, técnicas e associações das mesmas que podem ser utilizadas para o efeito sendo que actualmente, em odontopediatria, predomina a prática da sedação consciente inalatória com protóxido de azoto e a utilização de benzodiazepinas como o midazolam. Apesar das muitas técnicas descritas, nenhuma delas é passível de ser administrada a todos os pacientes, pelo para cada caso, tendo em conta todas as particularidades, haverá uma técnica mais adequada. Apesar prática da sedação consciente ser uma mais-valia em odontopediatria, não é isenta de riscos e o médico dentista deve ter formação adequada para a providenciar de forma segura. Diferentes entidades publicaram guidelines que visam orientar a prática segura da sedação e minimizar o risco de incidentes.

Pico Cell Integration to Operator’s Incident Management Process

Mobile network coverage is traditionally provided by outdoor macro base stations, which have a long range and serve several of customers. Due to modern passive houses and tightening construction legislation, mobile network service is deteriorated in many indoor locations. Typically, solutions for indoor coverage problem are expensive and demand actions from the mobile operator. Due to these, superior solutions are constantly researched. The solution presented in this thesis is based on Small Cell technology. Small Cells are low power access nodes designed to provide voice and data services.. This thesis concentrates on a specific Small Cell solution, which is called a Pico Cell. The problem regarding Pico Cells and Small Cells in general is that they are a new technological solution for the mobile operator, and the possible problem sources and incidents are not properly mapped. The purpose of this thesis is to figure out the possible problems in the Pico Cell deployment and how they could be solved within the operator’s incident management process. The research in the thesis is carried out with a literature research and a case study. The possible problems are investigated through lab testing. Pico Cell automated deployment process was tested in the lab environment and its proper functionality is confirmed. The related network elements were also tested and examined, and the emerged problems are resolvable. Operators existing incident management process can be used for Pico Cell troubleshooting with minor updates. Certain pre-requirements have to be met before Pico Cell deployment can be considered. The main contribution of this thesis is the Pico Cell integrated incident management process. The presented solution works in theory and solves the problems found during the lab testing. The limitations in the customer service level were solved by adding the necessary tools and by designing a working question pattern. Process structures for automated network discovery and pico specific radio parameter planning were also added for the mobile network management layer..

La pratique de l'orientation dans les organisations: un champ d'intervention à développer pour les conseillères et les conseillers d'orientation

Nous voilà rendus à l'aube du troisième millénaire. Que de changements se sont produits depuis la révolution industrielle. Selon plusieurs auteurs cités par Defrenne et Delvaux (1990), nous sommes maintenant arrivés à la société postindustrielle que certains appellent la société super-industrielle, la post-civilisation, la société technétronique, la société technicisée et, pour Defrenne et Delvaux (1990), il s'agit de la société de l'incertitude. Pour eux, elle est une réplique du chaos planétaire où l'organisation se fait, se défait et se refait, jamais tout à fait semblable. Il nous apparaît important de définir ce que nous entendons par "organisation". Il s'agit d'un «groupement, association en général d'une certaine ampleur, qui se propose des buts déterminés» (Dictionnaire Petit Larousse, 1993) comme les organisations privées, publiques et para-publiques. Dans les organisations, ce véritable chaos se traduit par des processus de restructuration où l'on accorde souvent davantage d'importance à l'organisation et ses structures, et ce au détriment des individus qui y travaillent. Il en résulte une perte du potentiel des travailleurs, ce qui occasionne un déficit au plan des ressources humaines dont on ne soupçonne pas les conséquences pour l'organisation et les individus. Les propos qu'entretiennent les deux auteurs sont assez éloquents à ce sujet: «Les points de repères disparaissent sans être remplacés par d'autres, imprévus et imprévisibles, ils s'avèrent impuissants à faire face au changement, dont les composantes non gérées deviennent synonymes de facteurs de désordre. C'est pourquoi l'univers professionnel et la vulnérabilité des travailleurs reproduisent la fragilité de l'organisation. Ce désordre se traduit à l'intérieur des entreprises par des vécus désadaptatifs et des conduites dysfonctionnelles, de tous genres au travail. Ils entraînent des coûts psychologiques, sociaux, financiers et économiques importants. Ils peuvent aller jusqu'à ruiner les politiques, les stratégies et détruire l'image de l'organisation. À l'extérieur, les faits divers rapportent des incidents qui témoignent de fautes de gestion ou de spéculations douteuses, dévoilent les carences en matière d'intervention efficace, placent l'ensemble des entreprises dans un environnement mouvant et mutant par rapport auquel elles sont sommées de se réajuster perpétuellement.» (Defrenne et Delvaux 1990, p. 23) Cette société de l'incertitude, que nous décrivent ces deux auteurs, n'est pas sans conséquences pour les différents acteurs des organisations face à de futurs scénarios multiples, irréversibles et imprévisibles, engendrant des coûts dont on ne peut soupçonner l'ampleur. Devant de tels changements, la plupart des travailleurs vivront des transitions au cours de leur vie personnelle et professionnelle. Le conseiller d'orientation, un travailleur faisant partie de ce monde en mutation, est lui aussi touché. Il voit sa pratique se modifier, ses champs d'intervention traditionnelle se transforment peu à peu et d'autres commencent à s'ouvrir. À la différence de bien des travailleurs, le conseiller d'orientation possède des compétences et des connaissances qui lui seront très utiles dans un tel contexte de changement. En outre, il pourra les mettre au service des organisations aux prises avec de nouveaux besoins organisationnels engendrés par la société postindustrielle. Comme il devient impératif de tenir compte de plus en plus des besoins de l'individu dans une nouvelle gestion des ressources humaines, on ne doit pas seulement gérer les effectifs mais l'on doit également les développer et les mobiliser autour d'objectifs communs que sont ceux de l'organisation et des individus. Pour en arriver à mobiliser les travailleurs et les gestionnaires autour d'une même vision de l'organisation, certaines pratiques dans la gestion des ressources humaines doivent être renouvelées et appuyées par des programmes de développement de carrière, de formation de la main-d'oeuvre, d'aide aux transitions personnelles et professionnelles et par le développement des politiques de gestion des ressources humaines. Un grand défi demeure pour les organisations: comment faire face à de tels changements qui affectent à la fois la culture de l'organisation, les politiques, les méthodes de travail, les relations entre les travailleurs et le personnel cadre. Tout se bouscule pour eux à une vitesse qui est hors de contrôle, d'où l'importance pour les dirigeants de s'ouvrir à de nouvelles formes de gestion et de s'entourer de professionnels spécialisés dans les problématiques de l'individu au travail. La présente étude vise à tracer le portrait de la situation actuelle au Québec concernant la pratique des conseillers d'orientation dans les organisations. Ce document se divise en trois parties. Dans un premier temps, vous prendrez connaissance au chapitre 1 de la problématique dans laquelle vous retrouverez des informations concernant l'historique et l'évolution de la profession de conseiller d'orientation au coeur des transformations du marché du travail. Au chapitre 2, nous abordons la méthodologie utilisée pour la réalisation de cette enquête. Au chapitre 3, nous terminons enfin par l'analyse des résultats et l'interprétation. Cette consultation menée auprès des conseillers pratiquant dans les organisations, à titre soit d'employé, soit de consultant, nous a permis de recueillir plusieurs données concernant leurs caractéristiques, leurs pratiques et leurs besoins. Pour terminer, nous vous faisons part de nos conclusions.

Care planning for aggression management in a specialist secure mental health service: user involvement

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation.

Postoperative Bowel Function and Related Factors in Enhanced Recovery Protocol with Patients Undergoing Hepatectomy

Patients’ bowel dysfunction is a major factor that weakens the results of surgical care as it can cause pain and weaken patients’ rehabilitation. Bowel dysfunction is a common postoperative problem, yet most incidents remain undocumented. The nursing profession has a significant role in enhancing the bowel function postoperatively. However, studies of postoperative bowel function after hepatectomy are scarce and somewhat incongruous. Enhanced recovery protocols are innovative models of care aiming for better outcomes of surgical care. Enhanced recovery protocols can improve gastrointestinal function after surgery, yet patients are also known to be satisfied with their care. The aim was to investigate if postoperative bowel function day varies between patients in terms of age, gender, ASA score, type of surgery, histology, patients’ experienced pain and experienced satisfaction three days after discharge and three months after operation in patients undergoing hepatectomy. The goal was to produce information for basis of scientific research, to give nurses in clinical setting more tools to work with hepatectomy patients undergoing enhanced recovery protocol and to produce information to nurse managers to use in process management of patients undergoing enhanced recovery protocol. The design of this study is descriptive. Data was collected retrospectively from hepatectomy patients (n = 134) undergoing enhanced recovery protocol within the first year of enhanced recovery protocol implementation. The data was based on registers and analyzed statistically. Mean age of patients was 62 years and mean day of discharge was 4. Main (n = 72) histology of the patients was colorectal liver metastases. Mean bowel function day was 3. Most of the patients were very satisfied or satisfied with the care three days after discharge (99%) and three months (90%) after operation. Most of the patients (72%) experienced moderate pain three days after discharge, but three months after operation 47% of the patients did not experience pain and 48% experienced moderate pain. There were no statistically significant differences in bowel function between different age groups, genders, ASA score groups or histologies. Neither were there statistically significant differences in postoperative bowel function in terms of experienced satisfaction or pain. There were statistically significant differences in postoperative bowel function between different types of surgery (p < 0.01). Nurses should take into consideration hepatectomy patients’ type of surgery and pay special attention in supporting major open hepatectomy patients’ postoperative bowel function. Nurses should educate patients undergoing major open hepatectomy about prolonged postoperative bowel function.

Medicinal Water? The occurrence and fate of pharmaceuticals in aquatic environments A short communication

Although very little is known about the transport, fate and toxic effects of medical compounds in aquatic environments, the presence of these compounds in potable water sources can no longer be overlooked. We can argue that trace concentrations of drugs in the water is relatively a minor problem, however, the current and future demands on global potable freshwater supplies will probably lead to greater incidents of indirect and direct water-reuse situations at the local, regional, and cross-border levels. It is important to remark that the solution of this emerging ecological issue does not rely on new and better wastewater treatment technologies, but a new paradigm of responsibility and the understanding of the relations between anthropogenic actions and their ecological effects as well. The objective of this brief communication is to present the state of the art of research conducted in the last decade in Europe and United States concerning the presence of pharmaceuticals products in aquatic environments.

DISPATCHING AND RELOCATION OF EMERGENCY VEHICLES ON FREEWAYS: THEORIES AND APPLICATIONS

Resource allocation decisions are made to serve the current emergency without knowing which future emergency will be occurring. Different ordered combinations of emergencies result in different performance outcomes. Even though future decisions can be anticipated with scenarios, previous models follow an assumption that events over a time interval are independent. This dissertation follows an assumption that events are interdependent, because speed reduction and rubbernecking due to an initial incident provoke secondary incidents. The misconception that secondary incidents are not common has resulted in overlooking a look-ahead concept. This dissertation is a pioneer in relaxing the structural assumptions of independency during the assignment of emergency vehicles. When an emergency is detected and a request arrives, an appropriate emergency vehicle is immediately dispatched. We provide tools for quantifying impacts based on fundamentals of incident occurrences through identification, prediction, and interpretation of secondary incidents. A proposed online dispatching model minimizes the cost of moving the next emergency unit, while making the response as close to optimal as possible. Using the look-ahead concept, the online model flexibly re-computes the solution, basing future decisions on present requests. We introduce various online dispatching strategies with visualization of the algorithms, and provide insights on their differences in behavior and solution quality. The experimental evidence indicates that the algorithm works well in practice. After having served a designated request, the available and/or remaining vehicles are relocated to a new base for the next emergency. System costs will be excessive if delay regarding dispatching decisions is ignored when relocating response units. This dissertation presents an integrated method with a principle of beginning with a location phase to manage initial incidents and progressing through a dispatching phase to manage the stochastic occurrence of next incidents. Previous studies used the frequency of independent incidents and ignored scenarios in which two incidents occurred within proximal regions and intervals. The proposed analytical model relaxes the structural assumptions of Poisson process (independent increments) and incorporates evolution of primary and secondary incident probabilities over time. The mathematical model overcomes several limiting assumptions of the previous models, such as no waiting-time, returning rule to original depot, and fixed depot. The temporal locations flexible with look-ahead are compared with current practice that locates units in depots based on Poisson theory. A linearization of the formulation is presented and an efficient heuristic algorithm is implemented to deal with a large-scale problem in real-time.

Twenty years of Hendra virus: laboratory submission trends and risk factors for infection in horses

Hendra virus (HeV) was first described in 1994 in an outbreak of acute and highly lethal disease in horses and humans in Australia. Equine cases continue to be diagnosed periodically, yet the predisposing factors for infection remain unclear. We undertook an analysis of equine submissions tested for HeV by the Queensland government veterinary reference laboratory over a 20-year period to identify and investigate any patterns. We found a marked increase in testing from July 2008, primarily reflecting a broadening of the HeV clinical case definition. Peaks in submissions for testing, and visitations to the Government HeV website, were associated with reported equine incidents. Significantly differing between-year HeV detection rates in north and south Queensland suggest a fundamental difference in risk exposure between the two regions. The statistical association between HeV detection and stockhorse type may suggest that husbandry is a more important risk determinant than breed per se. The detection of HeV in horses with neither neurological nor respiratory signs poses a risk management challenge for attending veterinarians and laboratory staff, reinforcing animal health authority recommendations that appropriate risk management strategies be employed for all sick horses, and by anyone handling sick horses or associated biological samples.

O docente generalista: a importância da continuidade pedagógica para o sucesso na aprendizagem

Relatório de Estágio apresentado à Escola Superior de Educação de Paula Frassinetti para obtenção do grau de Mestre em Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico

Clouds of Suspicion: Airspace Arrangements, Escalation, and Discord in U.S./NATO-Russian Relations

How have cooperative airspace arrangements contributed to cooperation and discord in the Euro-Atlantic region? This study analyzes the role of three sets of airspace arrangements developed by Euro-Atlantic states since the end of the Cold War—(1) cooperative aerial surveillance of military activity, (2) exchange of air situational data, and (3) joint engagement of theater air and missile threats—in political-military relations among neighbors and within the region. These arrangements provide insights into the integration of Central and Eastern European states into Western security institutions, and the current discord that centers on the conflict in Ukraine and Russia’s place in regional security. The study highlights the role of airspace incidents as contributors to conflict escalation and identifies opportunities for transparency- and confidence-building measures to improve U.S./NATO-Russian relations. The study recommends strengthening the Open Skies Treaty in order to facilitate the resolution of conflicts and improve region-wide military transparency. It notes that political-military arrangements for engaging theater air and missile threats created by NATO and Russia over the last twenty years are currently postured in a way that divides the region and inhibits mutual security. In turn, the U.S.-led Regional Airspace Initiatives that facilitated the exchange of air situational data between NATO and then-NATO-aspirants such as Poland and the Baltic states, offer a useful precedent for improving air sovereignty and promoting information sharing to reduce the fear of war among participating states. Thus, projects like NATO’s Air Situational Data Exchange and the NATO-Russia Council Cooperative Airspace Initiative—if extended to the exchange of data about military aircraft—have the potential to buttress deterrence and contribute to conflict prevention. The study concludes that documenting the evolution of airspace arrangements since the end of the Cold War contributes to understanding of the conflicting narratives put forward by Russia, the West, and the states “in-between” with respect to reasons for the current state of regional security. The long-term project of developing a zone of stable peace in the Euro-Atlantic must begin with the difficult task of building inclusive security institutions to accommodate the concerns of all regional actors.

Twenty years of Hendra virus: laboratory submission trends and risk factors for infection in horses

SUMMARY Hendra virus (HeV) was first described in 1994 in an outbreak of acute and highly lethal disease in horses and humans in Australia. Equine cases continue to be diagnosed periodically, yet the predisposing factors for infection remain unclear. We undertook an analysis of equine submissions tested for HeV by the Queensland government veterinary reference laboratory over a 20-year period to identify and investigate any patterns. We found a marked increase in testing from July 2008, primarily reflecting a broadening of the HeV clinical case definition. Peaks in submissions for testing, and visitations to the Government HeV website, were associated with reported equine incidents. Significantly differing between-year HeV detection rates in north and south Queensland suggest a fundamental difference in risk exposure between the two regions. The statistical association between HeV detection and stockhorse type may suggest that husbandry is a more important risk determinant than breed per se. The detection of HeV in horses with neither neurological nor respiratory signs poses a risk management challenge for attending veterinarians and laboratory staff, reinforcing animal health authority recommendations that appropriate risk management strategies be employed for all sick horses, and by anyone handling sick horses or associated biological samples.

Práticas de ensino e investigativas em educação pré-escolar e 1º CEB : estilos do adulto e direitos das crianças no recreio / Francisca Raquel Moita Santos

O relatório final de estágio inclui uma apreciação das aprendizagens realizadas nas práticas de ensino supervisionadas do mestrado em Educação Pré-Escolar e Ensino do 1.º CEB e o estudo desenvolvido no contexto de estágio que procurou fazer face a dois objetivos centrais: caraterizar o estilo do adulto e as interações que são estabelecidas com as crianças, no período do recreio, e analisá-las em termos de adequação aos Direitos das Crianças. Para dar resposta a estes objetivos aliámo-nos aos autores de referência, à legislação em vigor e a uma investigação realizada em contexto escolar. Em termos empíricos, o estudo teve um caráter qualitativo, com recurso à observação durante o recreio utilizando a Escala de Empenhamento do Adulto. Recorreu-se, também, a uma observação com registo de incidentes críticos. Os resultados obtidos através da Escala de Empenhamento do Adulto encontram-se abaixo do que seria adequado, ou seja, não se atinge o valor mínimo de qualidade (3,5). Os direitos mais vezes postos em causa foram: “A criança tem o direito de exprimir livremente a sua opinião sobre questões que lhe digam respeito e de ver essa opinião tomada em consideração” (Artigo 12.º) e “A criança tem direito ao repouso, a tempos livres e a participar em atividades culturais e artísticas” (Artigo 31.º). Com base nos baixos níveis nas dimensões sensibilidade, estimulação e autonomia e na análise de situações registadas que representam violações dos Direitos das Crianças, concluiu-se existir urgência na formação das equipas educativas no âmbito dos Direitos das Crianças e da importância do recreio para as crianças. A própria organização do espaço e dos materiais, assim como da dinâmica do recreio, são discutidos em termos de promoção de aprendizagens e de concretização dos direitos.

Désensibilisation morale et légitimation de l'intimidation entre pairs au secondaire

Cette thèse doctorale, qui prend la forme de quatre articles, est une étude corrélationnelle mettant en relation le raisonnement moral et la légitimation des dynamiques d’intimidation par les pairs chez des adolescents de 3ème secondaire. L’objectif principal poursuivi était d’examiner la contribution de la désensibilisation morale aux conduites adoptées par les adolescents lors d’incidents d’intimidation à l’école. L’objectif secondaire était d’examiner l’importance accordée respectivement à des standards de conduite issus des domaines moral, conventionnel et personnel chez les adolescents impliqués dans des incidents d’intimidation. Le premier article expose la problématique de la légitimation des dynamiques d’intimidation par les jeunes en faisant état des croyances normatives et des caractéristiques des environnements scolaires qui y sont associées. L’article discute de l’écart qui s’observe entre l’opposition affirmée de la majorité des adolescents face aux conduites d’intimidation et leur récurrence dans les milieux scolaires et vient compléter une première section décrivant les conséquences de l’intimidation pour les communautés scolaires. Le deuxième article s’inscrit dans le cadre théorique de cette thèse et fait état des connaissances sur le raisonnement moral des élèves impliqués dans des dynamiques d’intimidation. Il présente une explication des conduites d’intimidation dans la perspective de la théorie des domaines de la connaissance sociale et dans celle de la théorie de l’agentivité morale. Ces approches ont été retenues pour opérationnaliser le concept de désensibilisation morale afin de rencontrer les objectifs de recherche poursuivis. Le troisième article rapporte la démarche utilisée pour vérifier l’hypothèse d’une relation positive entre les conduites d’intimidation et l’acceptabilité d’incidents d’intimidation hypothétiques, de même que l’hypothèse d’une relation positive entre les conduites d’intimidation et le désengagement moral chez les adolescents impliqués. Le quatrième article rapporte la démarche utilisée pour examiner les justifications sociomorales émises par différents profils d’adolescents impliqués dans des incidents d’intimidation de façon à associer leur conduite avec les domaines de connaissances normatives auxquels se rattachent leurs justifications. Les résultats obtenus sont ensuite discutés au chapitre suivant afin de mettre en évidence la contribution de chacune des approches morales retenues à l’explication des conduites en contexte d’intimidation et les caractéristiques du raisonnement moral associées aux rôles adoptés et des pistes d’intervention sont offertes. Finalement, cette thèse doctorale conclue que seul le niveau moyen de désengagement moral, un indice global de l’adhésion à des croyances normatives antisociales, contribue statistiquement à l’explication des conduites adoptées lors d’incident d’intimidation au-delà du sexe des participants. Quant au raisonnement sociomoral, il informe davantage sur la façon dont les circonstances d’incidents d’intimidation sont reliées à la désensibilisation morale des jeunes impliqués. Les adolescents qui prennent activement la défense de pairs intimidés étaient caractérisés par un raisonnement moral plus uniforme, tandis que le raisonnement des élèves qui intimident et de ceux qui demeurent passifs était caractérisé par la subordination de principes moraux, respectivement en faveur d’impératifs à caractère conventionnel et d’impératifs à caractère personnel.

Assessment of change in psychoanalysis : Another way of using the change after psychotherapy scales

A systematic method is presented whereby material from a full course of psychoanalytic treatment is analyzed to assess changes and identify patterns of change. Through an analysis of session notes, changes were assessed using the CHange After Psychotherapy scales (CHAP; Sandell 1987a), which evaluate changes in five rating variables (symptoms, adaptive capacity, insight, basic conflicts, and extratherapeutic factors). Change incidents were identified in nearly every session. Early in the analysis, relatively more change incidents related to insight were found than were found for the other types of change. By contrast, in the third year and part of the fourth year, relatively more change incidents related to basic conflicts and adaptive capacity were found. While changes related to symptoms occurred throughout the course of treatment, such changes were never more frequent than other types of change. A content analysis of the change incidents allowed a determination of when in the treatment the patient's main conflicts (identified clinically) were overcome. A crossing of quantitative data with clinical and qualitative data allowed a better understanding of the patterns of change.

Maneiras de fazer pedagogia: a transmissão e a participação em dois contextos de estágio

Relatório de Estágio apresentado à Escola Superior de Educação de Paula Frassinetti para obtenção de grau de Mestre em Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico