“I used to think that they were all abnormal. And I was the normal one”: conceptualizing mental health and mental health treatment under Improving Access to Psychological Therapies (IAPT)

Background: Improving Access to Psychological Therapies (IAPT) was introduced in the United Kingdom in 2006 to provide more effective and efficient services to people experiencing mild to moderate mental ill health. The model represents a paradigm shift in how we provide psychological care to large populations. Aims: We wanted to document how the IAPT programme impacted on patients’ understanding of their mental health, and mental health treatment. Methods: We used Foucauldian Discourse Analysis to analyse six semi-structured research interviews with patients from one IAPT service in a major UK city. Results: Participants constructed their mental health problems as individual pathologies. Constructions of mental health and of treatment evidenced the privileging of personal responsibility and social productivity over dependency on others and the state. Conclusions: Services are functioning well for some. The role of IAPT in pathologising those who are dependent on people and services requires further commentary and action. Declaration of interest: The first author was employed by the same organisation that delivered the IAPT service, although through a separate staffing and management line.

The metamorphosis of authority: a case study of the Aga Khan Development Network and the Ismaili Imamate

This research is a study of modern developments of the institutions of the Nizārī Ismaili imamate during the time of the present Ismaili Imam, Shāh Karīm al-Ḥusaynī, Aga Khan IV, as the 49th hereditary living Imam of Shiʿi Nizārī Ismaili Muslims, particularly addressing the formation of the Aga Khan Development Network (AKDN) and the functions of the Community institutions. Using the case study of the Aga Khan Development Network and the Nizārī Ismaili imamate, this research demonstrates that the three ideal types of authority as proposed by Weber, namely the traditional, charismatic and legal-bureaucratic types, are not sufficient to explain the dynamics of authority among Muslims. This is partly due to Weber’s belief in the uniqueness of Western civilisation, which is a product of his thesis on Protestant Ethics and partly because his ideal typical system does not work in the case of the Muslim societies. The Ismaili imamate with its multifarious institutions in contemporary times is the most suitable counter-example by which to powerfully demonstrate that Weberian models of authority fail to explain this phenomenon and it would indeed appear as a paradoxical institution if viewed with Weberian theses. The Ismaili imamate in contemporary times represents a paradigm shift and a transmutation not only as regards the Weberian models but also when viewed from inside the tradition of Shiʿi Muslim history. This evolutionary leap forward, which has been crystallised over the course of the past half a century, in the Ismaili imamate suggests the development of a new form of authority which is unprecedented. There are clearly various elements in this form of authority which could be discerned as rooted in tradition and history; however the distinctive elements of this new form of authority give it a defining and exciting dimension. There are several qualities which are peculiar to the contemporary condition of the Ismaili imamate and its style of leadership which are distinctive. Most importantly, while some central features, like succession by way of designation (naṣṣ) has not changed, there is one overarching quality which can best capture all these elements and that is the transmutation of the Ismaili imamate from the person of the Imam into the office of imamate and thus we are now facing the institutionalisation of the imamate and the office being the embodiment of the authority of the Imam. I have described this new development as a metamorphosis of the authority because it gives an entirely new form and content to the previously familiar concept of authority in the Shiʿi Ismaili Muslim tradition.

Introduction: The ‘material turn’ in migration studies

This introduction firstly discusses the ongoing paradigm shift in the study of transnational migration, in particular the emergent interest in the convergence of migration and material culture as the starting point of our investigation. Then it highlights three aspects that this Special Issue could further in the current study of migration and materialities: namely, historical consciousness in materialising migration experiences and the notion of generational transmission; the everyday experience of body as the site for mutual constitution between subject and object; and the unique value of a language-based, interdisciplinary-oriented approach for migration studies. In the final part, it summarizes the four articles that follow, highlighting the contribution that each makes to our overall objective of making a ‘material turn’ in migration studies, and discusses some ways it could be further developed.

Interoperability on e-learning 2.0: the PEACE case study

The confluence of education with the evolution of technology boosted the paradigm shift of the face-to-face learning to distance learning. In this scenario e-Learning plays an essential role as a facilitator of the teaching/learning process. However new demands associated with the new Web paradigm require that existent e-Learning environments characterized mostly by monolithic systems begin interacting with new specialized services. In this decentralized scenario the definition of a strategy of interoperability is the cornerstone to ensure the standardization communication among systems. This paper presents a definition of an interoperability strategy for an e-Learning environment at our School (ESEIG) called PEACE – Project for ESEIG Academic Content Environment. This new interoperability model relies on the application of several coordination and integration standards on several services, controlled by teachers and students, and included in the PEACE environment such as social networks, repositories, libraries, e-portfolios, intelligent tutors, recommendation systems and virtual classrooms.

Percepção do estado de saúde de doentes com anticoagulação oral

RESUMO - O aumento da incidência das doenças crónicas representa um desafio enorme para todos os Sistemas de Saúde, pelo que a assistência de Saúde a doentes crónicos se tornou num problema das sociedades ocidentais. Os países mais pobres são os que mais sofrem, embora nos países desenvolvidos também se verifique um aumento notável das doenças crónicas. Estima-se que estas representem mais de 60% do total das doenças mundiais no ano 2020 (WHO, 2001). A adaptação dos actuais modelos de saúde aos doentes crónicos não atingiu os objectivos, o que conduziu a que, de há alguns anos a esta parte, se procure alternativas mais eficazes e eficientes. Uma das pressões do mercado que se fazem sentir será caracterizada por uma maior aposta na Promoção da Saúde e Prevenção da doença. O conceito de “Saúde” migrou de “não existência de doença” para “Bem-estar Físico e Psicológico”. Desta forma, o foco dos cuidados de saúde teve que ser adaptado, o que conduziu a uma situação em que o âmbito da prestação de cuidados de saúde é um contínuo de serviços que vai desde a promoção da saúde, medicina preventiva e medicina curativa aos cuidados continuados e cuidados paliativos. As tecnologias de informação e comunicação desempenharão um importante papel nesta tendência, permitindo estabelecer ligações contínuas entre os consumidores e prestadores de cuidados de saúde. Por outro lado, as potencialidades da Internet, das comunicações móveis, dispositivos portáteis e do instrumental electrónico, tornam-se evidentes no desenvolvimento de serviços de e-Saúde: para monitorização, seguimento e controlo dos doentes extra hospitalar - serviços estes centrados no doente. O objectivo geral do presente estudo consiste no desenho de um projecto de investigação para posterior avaliação da percepção do estado de saúde dos doentes seguidos na consulta de hipocoagulação do Hospital de Santa Marta. Devido à escassez de investigação na temática deste trabalho em Portugal, procedeu-se a um trabalho exploratório, descritivo, de carácter comparativo e enquadrado na abordagem quantitativa. O campo de análise consiste em comparar doentes que fazem anticoagulação oral, seguidos na consulta de cardiologia (consulta convencional), com os doentes seguidos no programa Airmed (através das comunicações móveis). 4 Para avaliação da percepção do estado de saúde foi utilizado o questionário SF-36.----ABSTRACT - The increasing incidence of chronic diseases represents an enormous challenge to the Health Systems and on cause of that, the Health Assistance to chronic patients became a concern of the Occidental society. The Countries with lower economical resources are the ones that suffers the most, but also the Developed countries have a noticeable increase of chronic diseases. It is estimated these will represent over 60% of total diseases world wide in 2020 (WHO,2001). The adaptation of the actual Health Models to chronic patients did not achieved it’s goals, what leaded to look for more effective and efficient alternatives. One of the more sensitive market pressure factor is to look for a better Health Promotion and Disease Prevention. The concept of “Health” merged from “Disease absence” to “Physic and Psychic Wellness”. In this way the Health Care focus had to be adapted, what drove to a status where the scope of the Health care is a continuum of services that goes from the Health Promotion, Preventive and Curative to Continued and Palliative Medical Care. The Information and Communication Technologies will play a crucial role in this trend, allowing to establish continued connections between patients and Health Care providers. In parallel the potential of the Internet, mobile communications, portable devices and electronic instruments became evident to deploy e-Health services: to monitor, follow-up and control of patients outside the Hospital. The overall objective of the present study is an Investigation Project Design to further evaluate the health status perception of the patients followed in the consultation for Hypocoagulation in the “Hospital de Santa Marta”. Due to lack of investigation in this thematic, in Portugal, this study is developed in an exploratory way, descriptive, comparative, within a scope of a quantified approach. The analysis field consists on comparing patients prescribed with oral anticoagulants and followed-up at the

Qualidade de vida familiar e sua relação com o suporte social: perceções dos cuidadores de crianças com incapacidade

A criança com incapacidade é parte integrante da sua família, devendo as suas necessidades ser contempladas conjuntamente com as dos restantes elementos familiares (Dunst, Trivette & Deal, 1994). A abordagem da Qualidade de Vida Familiar (QVF) é a expressão da mudança de paradigma na prestação de serviços a pessoas com incapacidade, de um foco de suporte na criança para um foco familiar (Turnbull et al. 2007 citados por Samuel, Rillotta & Brown, 2012), tendo como objetivo assegurar suportes adequados às necessidades das famílias, permitindo-lhes tomar decisões ajustadas a si e às suas crianças com incapacidade e garantindo o empowerment familiar (Brown & Brown, 2004a). O presente estudo teve como objetivo avaliar a satisfação dos cuidadores de crianças com incapacidade intelectual com a QVF e determinar a adequabilidade dos recursos à disposição das famílias, de modo a analisar a associação entre estas variáveis. As famílias reportaram níveis de satisfação elevados com a QVF e boa adequação dos recursos, existindo relação entre os mesmos e a QVF. Verificaram-se correlações significativas entre as habilitações académicas e zona de residência e a QVF, com cuidadores com habilitações académicas superiores e a residirem em zonas rurais a percecionarem maior satisfação a esse nível. Os cuidadores com rendimentos superiores identificaram maior adequação dos recursos, existindo correlação positiva entre o rendimento e os recursos da família. Dadas as escassas investigações nacionais relacionadas com a QVF de famílias de crianças com incapacidade, serão necessários estudos futuros que incidam sobre a temática, com amostras de maior dimensão e diversidade.

Proposta de implementação da responsabilidade social numa empresa de engenharia e construção

Este estudo tem como finalidade analisar a possibilidade de implementação e integração do sistema de gestão da responsabilidade social numa empresa de engenharia e construção, de acordo com a norma NP 4469-1 (2008). Um dos objetivos deste trabalho é explorar uma das atividades fundamentais para o crescimento da economia: a construção. Esta funciona como barómetro da economia nacional, ou seja, movimenta vários setores importantes na sua cadeia de produção, contribuindo na criação de riqueza como também de emprego. Como consequência das mudanças na economia nos últimos anos, o comércio nacional transformou-se em comércio globalizado, tendo como mercado não só um país mas o mundo inteiro. As empresas veem isso como um desafio, independentemente da sua dimensão. A redução de custos e a diferenciação não podem ser a única fonte de competitividade. A recente situação de instabilidade económica mundial impulsiona as empresas a inovarem na sua imagem para com os stakeholders e, assim, garantir o seu desenvolvimento e sustentabilidade financeira. A temática da Responsabilidade Social Empresarial (RSE) surgiu da necessidade de existir um espírito empresarial responsável, ao encontro do conceito de desenvolvimento sustentável (Baylis e Smith, 2005). Apesar da ampla divulgação da noção de responsabilidade social das empresas, não se verifica, no entanto, uma definição exata da mesma, pois o tema tem sido abordado de diversas formas e tem dividido opiniões ao longo dos anos. A responsabilidade social é, assim, um fruto da gestão das organizações e das profundas críticas sociais, legais, éticas e económicas, inspiradas nos parâmetros da obtenção de valor social (Parra, 2003). A sustentabilidade revela uma mudança de paradigma do mundo empresarial, na medida em que as empresas devem adotar práticas socialmente responsáveis, que integrem de forma voluntária as preocupações ambientais, sociais e económicas no desenvolvimento das suas atividades operacionais e das suas interações com as partes interessadas.

The optimization of the complaints management system

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Breaking the Pattern and Creating New Paths – Feminist Mizrahi Women Artists in Israel

This article addresses the work of Mizrahi women artists, i.e., Israeli-Jewish women of Asian or African ethnic origin, using the artist Vered Nissim as a case study. Nissim seeks to affirm the politics of identity and recognition, as well as feminism in order to create a paradigm shift with regards to the local regime of cultural representations in the Israeli art scene. Endeavouring to find ways of undermining the rigid imbalances between different social groups, she calls for a comprehensive reform of the status quo through artistic activism. Nissim employs a style, content, and medium that disrupts the accepted social order, using humour and irony as unique weapons with which she takes liberties with conventional moral, social, and economic values. Placing issues of race, class and gender at the centre of her work, she seeks to undermine and problematize essentialist attitudes, highlighting the political intersections of different identity categories as the critical analysis of intersectionality unfolds.

Cultural journalism in a digital environment : new models, practices and possibilities

Both culture coverage and digital journalism are contemporary phenomena that have undergone several transformations within a short period of time. Whenever the media enters a period of uncertainty such as the present one, there is an attempt to innovate in order to seek sustainability, skip the crisis or find a new public. This indicates that there are new trends to be understood and explored, i.e., how are media innovating in a digital environment? Not only does the professional debate about the future of journalism justify the need to explore the issue, but so do the academic approaches to cultural journalism. However, none of the studies so far have considered innovation as a motto or driver and tried to explain how the media are covering culture, achieving sustainability and engaging with the readers in a digital environment. This research examines how European media which specialize in culture or have an important cultural section are innovating in a digital environment. Specifically, we see how these innovation strategies are being taken in relation to the approach to culture and dominant cultural areas, editorial models, the use of digital tools for telling stories, overall brand positioning and extensions, engagement with the public and business models. We conducted a mixed methods study combining case studies of four media projects, which integrates qualitative web features and content analysis, with quantitative web content analysis. Two major general-interest journalistic brands which started as physical newspapers – The Guardian (London, UK) and Público (Lisbon, Portugal) – a magazine specialized in international affairs, culture and design – Monocle (London, UK) – and a native digital media project that was launched by a cultural organization – Notodo, by La Fábrica – were the four case studies chosen. Findings suggest, on one hand, that we are witnessing a paradigm shift in culture coverage in a digital environment, challenging traditional boundaries related to cultural themes and scope, angles, genres, content format and delivery, engagement and business models. Innovation in the four case studies lies especially along the product dimensions (format and content), brand positioning and process (business model and ways to engage with users). On the other hand, there are still perennial values that are crucial to innovation and sustainability, such as commitment to journalism, consistency (to the reader, to brand extensions and to the advertiser), intelligent differentiation and the capability of knowing what innovation means and how it can be applied, since this thesis also confirms that one formula doesn´t suit all. Changing minds, exceeding cultural inertia and optimizing the memory of the websites, looking at them as living, organic bodies, which continuously interact with the readers in many different ways, and not as a closed collection of articles, are still the main challenges for some media.

Portugal (1928-1968) : Um Filme de J. Leitão de Barros

Apoio financeiro da FCT e do FSE no âmbito do III Quadro Comunitário de Apoio

A study of self-directed learning at an Ontario college of applied arts and technology

Ontario Colleges of Applied Arts and Technology (CAATs) are currently in the process of restructuring to ensure quality, accountability, and accessibility of college education. References to learner involvement and self-directed learning are prevalent. "Alternative delivery" and "paradigm shift" are current buzzwords within the Ontario CAAT system as an environment is created supportive of change. Instability of funding has also dictated a need for change. Therefore, a focus has become quality of learning with less demand on public resources. This qualitative case study was conducted at an Ontario CAAT to gather descriptive, perceptual data from post-secondary community college educators who were identified as supportive of self-directed learning and from post-secondary, traditional-aged college students who were perceived by their educators to be selfdirected learners. This college was selected because of initiatives to modify its academic paradigm to encourage what was reputed in the Ontario CAAT system to be self-directed learning. The purpose of this study was to investigate how postsecondary, traditional-aged college students and their educators perceive self-directed learning as part of the teaching-learning experience within a community college setting. Educator participants of the study were selected based on the results of a teaching and learning survey intended to identify educators supportive of self-directed learning. A total of 317 surveys were distributed to every full-time educator at the sample college; 192 completed surveys were returned for a return rate of 61 %. Of these, 8% indicated instructional beliefs and values supportive of self-directed learning. A purposive sample of six educators was selected using a maximulp variation sampling strategy. A network selection sampling strategy was used to select a purposive sample of seven post-secondary students who were identified by the sample educators as selfdirected learners. The results of the study show that students and educators have similar perspectives and operating definitions of self-directed learning and all participants believe they either practice or facilitate self-directed learning. However, their perspectives and practices are not consistent with the literature which emphasizes learner autonomy or control in course structure and content. A central characteristic of the participants represented in this study is the service-oriented professions with which each is associated. Experientiallearning opportunities were highly valued for the options provided in increasing learner independence and competencies in reflective practice. Although there were discrepancies between espoused theory and theory in practice in terms of course structure, the process of self-directed learning was being practiced and supported outside the classroom structure in clinical settings, labs and related experiences.

Exploring the experience of the pioneers of change

The world of work with Western society appears to be undergoing a major change. The literature has described this phenomenon as a change from an industrialbased economy to a knowledge-based economy. This change will represent a complete transformation of the world of work; some suggest that everything we have come to accept and know as normal will change. Our present society seems to be in a period of transition. It is a time with many challenges and problems, many of which cannot be solved with thinking patterns from an old industrial-based economy. A fundamental shift in thinking patterns consistent with a new emerging world of work must take place. This change in thinking represents a fundmental shift from traditional and linear ways of seeing the world (worldview), to more holistic ways of seeing the world. In this investigation the word paradigm was used to define how people see their world. A paradigm shift is defined as a change in how a person sees their world: a change from an old to new or different way of viewing the world. Those individuals who are the first to shift their paradigm are called paradigm pioneers. These individuals do not only shift their ways of seeing the world, but they also begin to act and behave in ways consistent with the new paradigm. Thus far the research literature has adequately described the concepts of paradigms and paradigm shifts. However, little is known regarding how people actually and eventually make a shift. As it will be important for each individual to make a personal paradigm shift, then it will be extremely valuable to learn more about the process itself. The purpose of this investigation was to explore these issues in more detail and specifically, describe the experience of paradigm shifts and explore the experience of paradigm pioneers. A qualitative research methodology involving in-depth interviews was used to investigate the experiences of four participants identified as paradigm pioneers. It is interesting to note that the participants in this study did not describe an allencompassing paradigm shift. In fact, each participant, defined a paradigm shift in several different ways. They did relate several examples of paradigm shifts. However, even among these examples, there was a high degree of variability. The findings of this investigation centered upon the participants' experience as pioneers. Each pioneer shared many of the same qualities, the first quality of which described how these pioneers dealt with change. I called this a change-sense quality. The pioneers viewed change in an open and positive manner, and were also aware of change taking place in their world. Finally, they displayed an understanding of change, and a bias to take positive action in the face it. The participants also shared an inner quality. The four pioneers demonstrated a personal purpose and vision, and were selfdirected individuals. They also had an innate curiosity which translated into a love of learning. They also displayed a quality where relationships with others were highly valued. Relationships were important to the pioneers because they played a support role to help them deal with the challenges of being a pioneer. Pioneers also valued relationships because, they relied on others to make change happen. The above mentioned qualities enabled pioneers to be effective in a changing world of work. The findings from this investigation have many implications for research and practice. First, the concept of paradigms and paradigm shifts must be further researched. A great deal more must be learned in order to better understand the kind of shift individuals must make to be effective in the new world of work. Second, the qualities displayed by pioneers are important for all members of the world of work to develop. The qualities shared by pioneers appeared to represent an enduring set of traits that can possibly help individuals deal more positively with uncertainty and rapid change taking place in today's North American world of work.

Miss-understand-ing: design education in Ontario secondary schools : an exploration of the issues with stakeholders and recommendations for change /

For most people design is a mystery. The products of design are integrated into our daily lives to the point that design has become invisible to us. However. what is subsumed in design practice is a creative problem-solving process that is applicable as a teaching strategy as well as a method for teaching the subject of design. The purpose of this study was to inquire into the current classroom practice of Ontario Visual Arts and Technological Education teachers, understand the goals of Ontario government curriculum developers, and explore the position held by the professional design community on secondary school design education. Data for this study were collected from: (a) a textual analysis of 4 Ministry curriculum documents; (b) interviews with JO stakeholders; (c) unobtrusive observations and informal conversations conducted at 7 secondary school open house events; and (d) observation of 2 sessions of an AQ course for Design and Technology. The research design modeled the design process and was divided into 2 parts: a discovery or problem-finding phase and a discussion or problem-solving phase. The results showed that design is misunderstood and misused; it has become lost between visual arts and technology where neither program holds responsibility for its delivery; students mistake working on computers for design practice; and while there is a desire within the professional community to have a voice in secondary school design education. there is no forum for participation. The technology-driven paradigm shift taking place in society today calls for a new framework for tellching and practicing dcsign. Further research is required; howcvcr. in the meantime. secondary school educators might benefit from professional development and classroom support from the professional dcsign community.