O trabalho político do profissional de saúde mental em um processo de desinstitucionalização: um estudo sobre integralidade e reforma psiquiátrica

O trabalho pretende apresentar uma cartografia das atividades desenvolvidas pelos profissionais de saúde mental que prestam assistência aos moradores dos serviços residenciais terapêuticos do município de Carmo, no Estado do Rio de Janeiro. Estas moradias constituem uma etapa do processo de desinstitucionalização de um hospital psiquiátrico estadual do tipo colônia agrícola, fundado na década de 40 do século passado, onde estavam internados cerca de 280 pacientes. A partir de 2003, com a extinção do hospital coordenada pelo gestor estadual e a municipalização dos recursos, uma pequena parcela dos internos retornou ao seio familiar, mas a maioria (cerca de 160) foi alocada em moradias assistidas, espalhadas pelas áreas urbana e rural do município. Tomando a tarefa de reinserção social como o viés político da Reforma Psiquiátrica Brasileira, o trabalho cotidiano da equipe multiprofissional é focalizado. Neste plano relacional o texto busca a conceitualização de Política e de um trabalho político, através das idéias de Arendt, Gramsci, Deleuze e Guattari, entre outros; já a ergologia possibilita uma metodologia para a abordagem do trabalho humano. Com base na pesquisa de campo, a cartografia revela como a tarefa política é realizada, nas atividades dos técnicos, quer dizer, na micropolítica dos encontros dos profissionais uns com os outros, com a sociedade civil e com os moradores, onde os valores da Reforma Psiquiátrica são negociados. No fim, trata-se de uma etapa em um processo, ainda a meio caminho entre a gestão estadual e a gestão municipal, onde a proposta mantém-se sustentada pela vontade política do gestor e, na via da hegemonia, deve ser trabalhada entre os profissionais e na sociedade civil. O panorama é heterogêneo, e a dinâmica revela a diversidade de entendimentos e interesses. No cenário do trabalho cotidiano, conceitos como autonomia e cidadania se atualizam em atividades que caracterizam a vida nas cidades e se desdobram em torno de certos temas, como o uso do dinheiro, ou a apropriação do espaço. A experiência dos técnicos envolvidos mais diretamente com os moradores, como os cuidadores, produz uma técnica de escuta e mobilização, que não admite cartilhas nem regras pré-estabelecidas ou imutáveis. Este trabalho conjunto, formador de redes e sustentado na interação, é indicador de integralidade na execução da proposta da Reforma Psiquiátrica.

Testemunhas do esquecimento: uma análise do auto de resistência a partir do estado de exceção e da vida nua

O Auto de Resistência, uma figura atípica no Direito Penal, é utilizado comumente pelas forças de Segurança Pública do Estado, e vêm sendo legitimado pelo discurso punitivo, presente não apenas no judiciário, mas na sociedade brasileira de forma geral. Este dispositivo é analisado neste trabalho como um sintoma de uma questão muito mais profunda, arraigada dentro da própria origem do direito. Na grande maioria dos casos, o Auto de Resistência são, na realidade, execuções sumárias realizadas pelas forças de Segurança Pública estatais, mas que tornam-se legitimadas pela alegação de legítima defesa policial. No entanto, a incidência desta violação em áreas pobres e sobre indivíduos negros, aponta que este é apenas um dos dispositivos que permitem a seletividade de um sistema penal e de segurança pública fundamentalmente racista e elitista. As categorias presentes na teoria de Giorgio Agamben e Walter Benjamin parecem lançar nova luz sobre a realidade política brasileira, principalmente, ao se analisar o aparato biopolítico da segurança pública. Este sistema, desde sua origem excludente, confirma que os oprimidos, ou homo sacer, se manifestam em nossa sociedade no pobre e negro. Estes sujeitos singulares encontram-se no estado de exceção permanente, não havendo sob a perspectiva brasileira nenhuma experiência de ruptura emancipatória, mas sim, alternações de ciclos de violência que põe o direito (como a transição do sistema oligárquico para a República, ou da ditadura para a democracia) e que mantém o direito (como a presente no atual suposto Estado de Direito). Mantiveram-se as estruturas e reforçaram-se os estereótipos penais e discriminatórios. Questiona-se então a importância de se pensar uma justiça anamnética, uma potência testemunhal do oprimido como força messiânica que faz com que o passado e o presente se unam em um só tempo na busca de reparação.

Energy level analyses of even-parity J=1 and 2 Rydberg states of Sn I by multichannel quantum defect theory

This paper analyzes the energy levels along the even-parity J=1 and 2 Rydberg series of Sn I by multichannel quantum defect theory. A good agreement between theoretical and experimental energy levels was achieved. Below 59198 cm~(-1), a total of 85 and 23 new energy levels, respectively, in the J=1 and J=2 series, which cannot be measured previously by experiments, are predicted in this work. Based on the calculated admixture coefficients of each channel, interchannel interactions were discussed in detail. The results are helpful to understand the characteristics of configuration interaction among even-parity levels in Sn I.

基于GIS的高速公路养护管理信息系统的设计与开发

China is experiencing a rapid development of highway ever since 1990s. By the end of 2004, the total length of the highway summed up to 33 thousand kilometers, ranking 2n in the world. After the open of highway, the accumulation of time and traffic causes the decrease of its capability. To ensure its good quality, security and operation functions, we should take some reasonable measures to maintain it periodically. At present, a big problem is that the traditional maintain measures can no longer meet the increasing requirements. Due to the characters of highway, the relationship of various maintenance data and geographic positions is even closer than any others. If we wan to improve the quality and efficiency of the maintenance work, particularly when there is need for decision-making, a great number of data that is related to geographic positions are absolutely necessary. Evidently, Geographical Information System (GIS) has incomparably advantages in dealing with these spatial information. As a result, a management system for highway maintenance work based on GIS became inevitable for the development of the maintenance of highway. The purpose of this paper is to establish a management system for highway maintenance work base on Geographical Information System (GIS), Global Positioning System (GPS) and spatial database, to manage all kinds of problems encountered in the work, and to provide support on information and methods. My study mainly includes: (1) Analysis on the current status of the maintenance and management work; overview on the history of domestic and international highway maintenance management systems; identifying the necessity and importance for establishing a management system for highway maintenance work based on GIS. (2) Based on the requirement analysis, I proposed a general design for this management system, and discussed the objective, design principles, framework, systematical structure and function design. (3) Outdoor data collection is not only a prime way to understand the current situation of the road, but also an important method for data update after the system is put into use. This paper also intends to establish a set of plan to collect data efficiently and precisely which is based on GIS and GPS technologies. (4) The maintenance management database is a supporting platform for various maintenance decision-makings. Such decisions need the support of a great amount of data, which would cause other problems, such as the diversity of the data source, difference of data formats. This paper also discussed how to deal with these problems and establish such a database. (5) To propose an approach to assess the condition of pavement, based on GIS and related maintenance models. Among all the maintenance models, the two for assessing and forecasting pavement condition are the most important and mature. This paper also analyzed these two models and introduced them in terms of the integration of models. (6) This paper took the Guangshen Highway for example, explaining how to realize a GIS for management of highway maintenance work.

Reabilitação e Sustentabilidade

Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Arquitetura e Urbanismo

Conservative Interventions for mobile Pes Planus in Adults: a systematic review

Antecedentes. Pes Adulto planus (pie plano) es un problema común encontrado por muchos profesionales de la salud. A pesar de la percepción de que el pie plano puede causar dolor y deteriorar su función, la disponibilidad y el uso generalizado de diversos tratamientos, no hay consenso sobre la estrategia óptima de tratamiento. Objetivo. Evaluar la efectividad de las intervenciones conservadoras (no quirúrgicos) para pie plano en los adultos. Método. Se realizó una búsqueda sistemática de la literatura. Esto incluye: el Registro Cochrane Central de Ensayos Controlados; los Juicios CMSG Especializados Registro; una búsqueda electrónica se realizó utilizando MEDLINE (1960 a junio de 2012), EMBASE (1980 a junio de 2012), y CINAHL (1982 - junio de 2012). Revistas especializadas, listas de referencias de ensayos y artículos de revisión se realizaron búsquedas manuales. Criterios de selección: Ensayos aleatorios o cuasialeatorios de intervenciones de tratamiento para el pie plano en los adultos. Se excluyeron los ensayos que incluyeron patologías específicas como el dolor plantar del talón, las fracturas por sobrecarga de los metatarsianos, disfunción del tendón tibial posterior-, fracturas de tobillo, patologías del pie reumatoide, enfermedades neuromusculares y las complicaciones del pie diabético. Recopilación y análisis de datos: Dos autores seleccionaron de forma independiente los resultados de la búsqueda para identificar a aquellos que satisfacen los criterios de inclusión y evaluaron la calidad de los incluidos mediante una lista de control basado en la Evaluación de la Colaboración Cochrane de Riesgo. Esta herramienta se centró en el riesgo de la selección, el rendimiento, la detección, la heterogeneidad y el sesgo de notificación. Resultados. Cuatro ensayos, con 140 sujetos, cumplieron los criterios de inclusión para la revisión. Los cuatro fueron juzgados como de alto riesgo de sesgo en al menos un área, y también estaban en riesgo de sesgo incierto en al menos otra zona. Todos anotaron altamente en relación al sesgo de deserción, debido al corto seguimiento tiempos y diseños experimentales utilizados. Los datos no se agruparon debido al alto nivel de heterogeneidad identificada en las intervenciones evaluadas, los participantes seleccionados y medir los resultados. Los resultados de un estudio sugieren que después de cuatro semanas de uso ortesis puede resultar en una mejora significativa en vaivén lateral medio, y pueden resultar en una mejor, aunque no significativa, en general relacionados con la calidad de vida de los pies (Roma 2004). Un estudio (Redmond 2009) sugiere que su efecto sobre la distribución de la presión plantar en el pie puede no depender de si son personalizados o dispositivos prefabricados. Aunque este estudio se identificaron cambios significativos en algunas variables de presión plantar tanto con la costumbre y dispositivos prefabricados, otro (Esterman 2005) no encontró ningún efecto significativo de longitud ¾ ortesis prefabricadas sobre el dolor, la incidencia de lesiones, salud pie o de calidad de vida en un grupo de reclutas de la fuerza aérea. El cuarto estudio (Jung 2009) sugiere que el ejercicio de los músculos intrínsecos del pie puede mejorar el efecto de las ortesis. A pesar de estos resultados, ya que cada estudio incurrió riesgo de sesgo en al menos un área no se pueden sacar conclusiones

Data mining approach identifies research priorities and data requirements for resolving the red algal tree of life

Background. The assembly of the tree of life has seen significant progress in recent years but algae and protists have been largely overlooked in this effort. Many groups of algae and protists have ancient roots and it is unclear how much data will be required to resolve their phylogenetic relationships for incorporation in the tree of life. The red algae, a group of primary photosynthetic eukaryotes of more than a billion years old, provide the earliest fossil evidence for eukaryotic multicellularity and sexual reproduction. Despite this evolutionary significance, their phylogenetic relationships are understudied. This study aims to infer a comprehensive red algal tree of life at the family level from a supermatrix containing data mined from GenBank. We aim to locate remaining regions of low support in the topology, evaluate their causes and estimate the amount of data required to resolve them. Results. Phylogenetic analysis of a supermatrix of 14 loci and 98 red algal families yielded the most complete red algal tree of life to date. Visualization of statistical support showed the presence of five poorly supported regions. Causes for low support were identified with statistics about the age of the region, data availability and node density, showing that poor support has different origins in different parts of the tree. Parametric simulation experiments yielded optimistic estimates of how much data will be needed to resolve the poorly supported regions (ca. 103 to ca. 104 nucleotides for the different regions). Nonparametric simulations gave a markedly more pessimistic image, some regions requiring more than 2.8 105 nucleotides or not achieving the desired level of support at all. The discrepancies between parametric and nonparametric simulations are discussed in light of our dataset and known attributes of both approaches. Conclusions. Our study takes the red algae one step closer to meaningful inclusion in the tree of life. In addition to the recovery of stable relationships, the recognition of five regions in need of further study is a significant outcome of this work. Based on our analyses of current availability and future requirements of data, we make clear recommendations for forthcoming research.

Interpretation of electrochemical measurements made during micro-scale abrasion-corrosion

This paper brings together and analyzes recent work based on the interpretation of the electrochemical measurements made on a modified micro-abrasion-corrosion tester used in several research programmes. These programmes investigated the role of abradant size, test solution pH in abrasion-corrosion of biomaterials, the abrasion-corrosion performance of sintered and thermally sprayed tungsten carbide surfaces under downhole drilling environments and the abrasion-corrosion of UNS S32205 duplex stainless steel. Various abrasion tests were conducted under two-body grooving, three-body rolling and mixed grooving-rolling abrasion conditions, with and without abrasives, on cast F75 cobalt-chromium-molybdenum (CoCrMo) alloy in simulated body fluids, 2205 in chloride containing solutions as well as sprayed and sintered tungsten carbide surfaces in simulated downhole fluids. Pre- and post-test inspections based on optical and scanning electron microscopy analysis are used to help interpret the electrochemical response and current noise measurements made in situ during micro-abrasion-corrosion tests. The complex wear and corrosion mechanisms and their dependence on the microstructure and surface composition as a function of the pH, abrasive concentration, size and type are detailed and linked to the electrochemical signals. The electrochemical versus mechanical processes are plotted for different test parameters and this new approach is used to interpret tribo-corrosion test data to give greater insights into different tribo-corrosion systems. Thus new approaches to interpreting in-situ electrochemical responses to surfaces under different abrasive wear rates, different abrasives and liquid environments (pH and NaCl levels) are made. This representation is directly related to the mechano-electrochemical processes on the surface and avoids quantification of numerous synergistic, antagonistic and additive terms associated with repeat experiments. (C) 2010 Elsevier Ltd. All rights reserved.

Supervisor Continuity or Co-Location: Which Matters in Residency Education? Findings From a Qualitative Study of Remote Supervisor Family Physicians in Australia and Canada

Purpose: Changes to health care systems andworking hours have fragmentedresidents’ clinical experiences withpotentially negative effects ontheir development as professionals.Investigation of off-site supervision,which has been implemented in isolatedrural practice, could reveal importantbut less overt components of residencyeducation. 

Method: Insights from sociocultural learningtheory and work-based learning provideda theoretical framework. In 2011–2012,16 family physicians in Australia andCanada were asked in-depth how theyremotely supervised residents’ workand learning, and for their reflectionson this experience. The verbatiminterview transcripts and researchers’memos formed the data set. Templateanalysis produced a description andinterpretation of remote supervision. 

Results: Thirteen Australian family physiciansfrom five states and one territory, andthree Canadians from one province,participated. The main themes werehow remoteness changed the dynamicsof care and supervision; the importanceof ongoing, holistic, nonhierarchical,supportive supervisory relationships; andthat residents learned “clinical courage”through responsibility for patients’ careover time. Distance required supervisorsto articulate and pass on their expertiseto residents but made monitoringdifficult. Supervisory continuityencouraged residents to build on pastexperiences and confront deficiencies. 

Conclusions: Remote supervision enabled residents todevelop as clinicians and professionals.This questions the supremacy of co-locationas an organizing principle forresidency education. Future specialists maybenefit from programs that give themongoing and increasing responsibilityfor a group of patients and supportive.

Undergraduate interprofessional education using high-fidelity paediatric simulation

BACKGROUND: High-fidelity simulation is becoming increasingly important in the delivery of teaching and learning to health care professionals within a safe environment. Its use in an interprofessional context and at undergraduate level has the potential to facilitate the learning of good communication and teamworking, in addition to clinical knowledge and skills.

METHODS: Interprofessional teaching and learning workshops using high-fidelity paediatric simulation were developed and delivered to undergraduate medical and nursing students at Queen's University Belfast. Learning outcomes common to both professions, and essential in the clinical management of sick children, included basic competencies, communication and teamworking skills. Quantitative and qualitative evaluation was undertaken using published questionnaires.

RESULTS: Quantitative results - the 32-item questionnaire was analysed for reliability using spss. Responses were positive for both groups of students across four domains - acquisition of knowledge and skills, communication and teamworking, professional identity and role awareness, and attitudes to shared learning. Qualitative results - thematic content analysis was used to analyse open-ended responses. Students from both groups commented that an interprofessional education (IPE) approach to paediatric simulation improved clinical and practice-based skills, and provided a safe learning environment. Students commented that there should be more interprofessional and simulation learning opportunities.

DISCUSSION: High-fidelity paediatric simulation, used in an interprofessional context, has the potential to meet the requirements of undergraduate medical and nursing curricula. Further research is needed into the long-term benefits for patient care, and its generalisability to other areas within health care teaching and learning.

Expressividade e performance pianística

Esta tese consiste em uma pesquisa empírica sobre a expressividade musical. Os principais objetivos foram: identificar padrões e estratégias para o aprimoramento expressivo aplicados por profissionais de excelência; identificar como os performers conceitualizam a expressividade; identificar os principais componentes da expressividade; verificar relações entre a expressividade e o momento da performance; elaborar estratégias de estudo a partir das informações obtidas e aplicar estas estratégias na prática; verificar a sua pertinência e realizar uma avaliação qualitativa; e elaborar um modelo prático de estudo para a expressividade. Foram realizadas entrevistas com pianistas profissionais a fim de obter dados consistentes acerca da expressividade, e posteriormente foi conduzido um estudo de caso no qual estratégias de estudo sistematizadas a partir do relato dos pianistas foram aplicadas em um trabalho apoiado na autoetnografia, a fim de verificar a pertinência e realizar uma avaliação qualitativa sobre tais estratégias. Em termos gerais, os resultados indicaram que a expressividade consiste em um fenômeno de comunicação influenciado pela capacidade do intérprete em transmitir a mensagem e estrutura musical, cujos principais componentes compreendem elementos como o caráter, articulação e o fraseado. Além disso, os performers geralmente relacionam a expressividade a "modas" e tendências estético-interpretativas específicas e a elementos extramusicais. As principais estratégias pertinentes ao aprimoramento expressivo relacionam-se ao fraseado, realização de contrastes e sonoridade. A priorizar estes elementos, foi construído um modelo de estudo.

Sound Seam

A moving image work based on research with neurologists and audiologists, collectors and archivists. The film gives voice to the idea that every surface, in particular parts of our anatomy, is potentially inscribed with an unheard sound or echoes of voices from the past. The soundtrack’s musical composition is interlaced with a voice-over which draws on Rainer Maria Rilke’s text 'Primal Sound', where he reflects on the possibility of playing the coronal suture of a skull with a phonograph needle. The film uses microscopic photography, scanning electron microscopy, and sounds of otoacoustic emissions to uncover haunting aural bonescapes. The voiceovers too are recorded using old sound technology as a filter - writing and over-writing of wax cylinder to create unexpected scratches, glitches, loops and echoes. Exhibitions: shown as multi-channel sound/film installation AV festival (Newcastle 2010); solo exhibition at Wellcome Collection (London 2010-11); group exhibition ‘Samsung Art+ Prize’ BFI Southbank (London 2012); group exhibition ‘Transcendence’, Gertrude Contemporary, Melbourne (2014); solo exhibition as part of the International Rotterdam Film Festival (2013); group exhibition ‘The Sight of Sound’, Deutsche Bank VIP Lounge, Frieze Art Fair, NY (2012). Screenings: mini-retrospective at the Lincoln Centre, NY, as part of the New York Film Festival (2013); Jarman Award Tour screenings (2012, venues included Whitechapel Gallery, London; FACT, Liverpool; CCA, Glasgow; The Northern Charter in partnership with CIRCA projects; Nottingham Contemporary, Nottingham; Watershed, Bristol; Duke of York Cinema, Brighton), Whitechapel Gallery, London; FACT, Liverpool; CCA, Glasgow; The Northern Charter in partnership with CIRCA projects, Newcastle (special Q&A Aura Satz with Rebecca Shatwell, director of AV festival); Nottingham Contemporary, Nottingham; Watershed, Bristol; Duke of York Cinema, Brighton; Mini-retrospective at Tate Britain (London 2014); Mini-retrospective screening, DIM Cinema, The Cinematheque (Vancouver 2015); Mini-retrospective at Whitechapel Gallery (London 2016). Publications: ‘Sound Seam’ booklet with contributions by Steven Connor and Tom McCarthy (2010).

Supporting Completion of an Online Continuing Professional Development Programme For Newly Qualified Practitioners: a Qualitative Evaluation

Background: Development programmes to support newly qualified practitioners gain confidence in their first professional role often show varied levels of engagement, due to competing priorities and demands. In Scotland, the Flying Start NHS® programme uses a structured programme of online and work-based learning with associated mentoring, to support individuals through an often difficult transition to become capable, confident practitioners. . Whilst the programme was generally well received, the factors leading to widely varying completion rates between professions and organisations were not well understood. Aim: to identify the factors leading to successful completion of Flying Start, a transition programme for newly qualified practitioners. Method: A qualitative approach was adopted to gather data from two groups of participants. Semi-structured telephone interviews were conducted with strategic and management level participants (n=23), from five health boards in Scotland. Semi-structured interviews (n=22) and focus groups (n=11) were conducted with practitioners within 6 months either side of completing the programme. The interviews were transcribed and analysed using framework analysis. Results: Four key themes related to successful completion emerged from the analysis: organisational support; the format of the programme; understanding completion; motivation and incentives to complete. Factors leading to successful completion were identified at programme, organisational and individual level. These included clear communication and signposting, up-to-date and relevant content, links with continuing professional development frameworks, effective leadership, mentor and peer support, setting clear standards for assessment, and facilitating appropriate IT access. Conclusions: A strong strategic commitment to embedding a development programme for newly qualified practitioners can ensure the necessary support is available to encourage timely completion. The mentor’s role - to provide face-to-face support - is identified as a key factor in completion and is achieved through setting attainable targets, monitoring progress, and providing motivation. However organisational structures that facilitate the mentoring relationship are also necessary.

Leading as designing: how educational developers in leadership and management studies can use architectural design to facilitate student learning about delivering innovation

This paper describes a qualitative observational study of how a work based learning masters leadership development programme for middle managers in health and social care in the UK introduced students to key aspects of delivering innovation, through a formative assignment on contemporary architectural design. Action learning and activity theoretical approaches were used to enable students to explore common principles of leading the delivery of innovation. Between 2001 and 2013 a total of 89 students in 7 cohorts completed the assignment. Evaluation lent support for the view that the assignment provided a powerful learning experience for many. Several students found the creativity, determination and dedication of architects, designers and structural engineers inspirational in their ability to translate a creative idea into a completed artefact, deploy resources and negotiate complex demands of stakeholders. Others expressed varying levels of self-empowerment as regards their capacity for fostering an equivalent creativity in self and others. Theoretical approaches in addition to activity theory, including Engeström’s concepts of stabilisation knowledge and possibility knowledge, are discussed to explain these differing outcomes and to clarify the challenges and opportunities for educational developers seeking to utilise cross-disciplinary, creative approaches in curriculum design.