A VIVÊNCIA DO ONCOLOGISTA NA INFORMAÇÃO DO DIAGNÓSTICO DE CÂNCER À PACIENTE

O presente estudo teve como objetivo, por meio de uma pesquisa qualitativa segundo a abordagem fenomenológica existencial, investigar os pensamentos, sentimentos e atitudes do oncologista na informação do diagnóstico de câncer à paciente. Foram realizadas 5 entrevistas semi-dirigidas com oncologistas que atendem em consultório particular, e foi delimitada a análise compreensiva fenomenológica do conteúdo. Os resultados obtidos mostraram que: A informação do diagnóstico de câncer de mama para pacientes jovens em idade reprodutiva foi considerada a mais marcante para os médicos, lhes causando maior preocupação, medo e tristeza, devido às limitações impostas pela doença aos planos de vida da paciente e às questões da maternidade. Os entrevistados referiram que em qualquer caso, o momento da notícia lhes repercute emocionalmente, pela vivência do sentimento de tristeza, ou por fantasias relacionadas à responsabilidade pela doença. Eles apontaram como mais difícil nesse processo, o confronto com as reações emocionais da paciente e falar sobre o câncer utilizando palavras para amenizar o impacto dessa informação. Diante dessas dificuldades, a evolução da medicina, a possibilidade de cirurgia conservadora e a reconstrução mamária foram consideradas atenuantes. Os médicos afirmaram que informam a paciente de maneira clara, objetiva e gradativa, mas nem todos eles utilizam sempre a palavra câncer . Procuram encorajar a paciente com otimismo e solidariedade, engajando-a no tratamento como participante ativa. Além disso, sentem-se responsáveis por motivar aquela que demonstra desânimo ou que reluta em seguir o tratamento. Eles percebem que a partir da informação do diagnóstico a paciente estabelece um vínculo de confiança e dependência, e identificam que em alguns casos eles também se vinculam à paciente. Entretanto, reconhecem que desse vínculo deriva um desgaste emocional que os leva ao questionamento sobre a escolha de sua especialidade. Constatou-se que alguns oncologistas podem emitir sua opinião sobre determinado diagnóstico, às vezes, a pedido da paciente, mas que ao errarem nesse pré-julgamento, evidenciam sentimentos de impotência, ou fracasso, ou culpa, por não se prepararem, nem à paciente, para o momento da informação. Os casos em que a família interfere com questionamentos ou com o pedido de ocultação da informação não foram vistos por eles de modo negativo, contudo, o pedido de ocultação nem sempre é acatado. Os entrevistados referiram algum tipo de aprendizado através do contato com a paciente oncológica, ou por meio da reavaliação de seus valores morais, ou da reflexão sobre sua própria finitude. Particularmente nos casos de câncer avançado ou terminal, esse aprendizado abrangeu o apoio nos momentos que precedem a morte, ou o reconhecimento da própria impotência. Conclusão: A análise dos resultados revelou os conflitos e as dúvidas do médico como ser ético , que assume os riscos ao escolher quanto, quando e como informar o diagnóstico à paciente, sua consciência de culpabilidade, a ansiedade existencial desencadeada pelas reações emocionais da paciente, a manifestação de sua maneira preocupada de existir no mundo, a busca pelo encontro autêntico e criativo, a subjetividade utilizada como caminho para a compreensão do ser doente e a possibilidade do fracasso de um projeto resultar em frustração e num rebaixamento temporário da confiança em sua própria capacidade. Desse modo, esse trabalho demonstra a inevitável influência dos fatores subjetivos na atitude do médico que informa o diagnóstico de câncer para sua paciente e que esse processo está muito além de qualquer pretensa objetividade.

Beyond all reason:spaces of hope in the struggle for England’s universities

This essay examines how academics and students in England have been primed to comply with a political agenda of “deep” neoliberalization through cumulative processes of institutional and subjective undermining and considers what might be an appropriate logic of critical response. It first describes how the embedding of principles and mechanisms of market governance within academic life has depoliticized methods for critically theorizing and collectively resisting these processes and then explores the work of recent student-led opposition to the British government’s new policies, teasing out some theoretical implications of the logic of occupation being cultivated there. It suggests that by fusing a determination for autonomy with a transgressive cultivation of new forms of thinking and social practice, the occupations illustrate new critical-experimental work in the politics of possibility. The underlying logic thus offers some resources for reimagining modalities of resistance to processes of deep neoliberalization; however, becoming receptive to them may also require a critique of professional academic subjectivities and reevaluation of attachments to existing forms of the university itself.

State-of-the-art of ‘Lean’ in the aviation maintenance, repair, and overhaul industry

The increasing need for maintenance, repair, and overhaul (MRO) organizations to meet customers' demands in quality and reduced lead times is key to its survival within the aviation industry. Furthermore, with the unpredictability in the global market and difficulties with forecasting characteristic of the MRO industry there is an increased need for the reevaluation of the operation models of organizations within this sector. However, severe economic turmoil and ever-increasing global competition introduce the opportunity for the adoption of a resilient, tried, and tested business operation model such as 'Lean'. In order to understand this concept, its long-term viability, and its application within the aerospace MRO sector fully, this paper presents the state-of-the-art in terms of the adoption of Lean within the MRO industry by carrying out a systematic review of the literature. This paper establishes the common perception of Lean by the MRO industry and the measurable progress that has been made on the subject. Some issues and challenges are also highlighted including the misconceptions that arise from the direct transference of the perception of Lean from other industrial sectors into the aerospace MRO industry. The 'enablers and inhibitors' of Lean within the aviation industry are also discussed. This paper exposes the scarcity of the literature and the general lagging behind of the industry to the adoption of the Lean paradigm and thus highlights areas where further research is required. © 2011 Authors.

On the Threshold of Paradise and Present: Memory in Contemporary Cuban – American Literature

The exile leaving his or her homeland for new and unknown territory travels with much more than just luggage and the clothes on his or her back. He or she carries a weighty collection of memories. Available for the exile in times when the harmony of the past is far removed from the difficult circumstances present during the process of cultural assimilation, these memories present an opportunity for the exile to fashion for him or herself an identity that mimics the realities of life in the home left behind. In this creative endeavor, I seek to examine the powerful potential of memory as it is exercised by a collection of Cubans and Cuban-Americans in different corners of the United States. Analyzing Achy Obejas’ Memory Mambo, Cristina García’s Dreaming in Cuban, Ana Menéndez’s In Cuba I Was a German Shepherd, and Elías Miguel Muñoz’s Brand New Memory, I aim to trace the suggestive potential of memory as it is used by each of the characters in these works in an effort to reconcile their Cuban identities with the ones that are in the process of creation in the U.S. I will borrow from a collection of literature dealing with identity and exile, relevant graduate-level theses on Cuban-American literature, as well as theoretical perspectives on memory formation and nostalgia in order to trace the various ways in which memory is relied on in the process of cultural assimilation and emotional coping. Being presented in Miami, which hosts the largest concentration of Cuban immigrants, this thesis aims to present itself as a reflective tool for Cubans and Cuban-Americans who may find value in seeing their personal sentiments portrayed in literature, thus allowing for a potential reevaluation of identity. If the existing literature on my topic of analysis reveals anything, it is that the scope of my project is one that has not been inspected previously, thus making my analytical contribution a new one that will add a new interpretive set of lens through which readers of contemporary Cuban-American literature can examine the works.

On the Threshold of Paradise and Present: Memory in Contemporary Cuban‐American Literature

The exile leaving his or her homeland for new and unknown territory travels with much more than just luggage and the clothes on his or her back. He or she carries a weighty collection of memories. Available for the exile in times when the harmony of the past is far removed from the difficult circumstances present during the process of cultural assimilation, these memories present an opportunity for the exile to fashion for him or herself an identity that mimics the realities of life in the home left behind. In this creative endeavor, I seek to examine the powerful potential of memory as it is exercised by a collection of Cubans and Cuban-Americans in different corners of the United States. Analyzing Achy Obejas’ Memory Mambo, Cristina García’s Dreaming in Cuban, Ana Menéndez’s In Cuba I Was a German Shepherd, and Elías Miguel Muñoz’s Brand New Memory, I aim to trace the suggestive potential of memory as it is used by each of the characters in these works in an effort to reconcile their Cuban identities with the ones that are in the process of creation in the U.S. I will borrow from a collection of literature dealing with identity and exile, relevant graduate-level theses on Cuban-American literature, as well as theoretical perspectives on memory formation and nostalgia in order to trace the various ways in which memory is relied on in the process of cultural assimilation and emotional coping. Being presented in Miami, which hosts the largest concentration of Cuban immigrants, this thesis aims to present itself as a reflective tool for Cubans and Cuban-Americans who may find value in seeing their personal sentiments portrayed in literature, thus allowing for a potential reevaluation of identity. If the existing literature on my topic of analysis reveals anything, it is that the scope of my project is one that has not been inspected previously, thus making my analytical contribution a new one that will add a new interpretive set of lens through which readers of contemporary Cuban-American literature can examine the works.

The Drama of History: Representation and Revolutionaries in Haitian Theater, 1818-1907

Since the beginning of the Haitian theatrical tradition there has been an ineluctable dedication to the representation of Haitian history on stage. Given the rich theatrical archive about Haiti throughout the world, this study considers operas and plays written solely by Haitian playwrights. By delving into the works of Juste Chanlatte, Massillon Coicou, and Vendenesse Ducasse this study proposes a re-reading of Haitian theater that considers the stage as an innovative site for contesting negative and clichéd representations of the Haitian Revolution and its revolutionary leadership. A genre long mired in accusations of mimicking European literary forms, this study proposes a reevaluation of Haitian theater and its literary origins.

O Lean Management e os desafios da gestão de recursos humanos na FAP

O estudo que se apresenta teve como objetivo analisar a implementação do modelo de Serviços Partilhados, com recurso à metodologia lean, nos serviços de apoio de pessoal do Complexo de Alfragide que decorreu no contexto da sua implementação na Força Aérea Portuguesa, determinada pelo Despacho do CEMFA n.º 59/2015, de 31 de julho. Para desenvolver este trabalho foi utilizada uma estratégia de investigação mista (quantitativa e qualitativa), seguindo o raciocínio hipotético-dedutivo. O desenho de pesquisa utilizado foi o estudo de caso, recorrendo a entrevistas, à análise documental e a um questionário para recolha de dados. Os resultados apurados através das entrevistas e do inquérito permitem concluir que a implementação do novo modelo alcançou alguns dos objetivos a que se propunha, nomeadamente, a melhoria dos serviços de apoio de pessoal prestados aos militares e civis. Apesar de se antever um elevado potencial ao nível da racionalização de Recursos Humanos, de momento, esse objetivo ainda não foi inteiramente alcançado. Conclui-se a presente investigação sugerindo a reavaliação numa fase mais adiantada da implementação do modelo de Serviços Partilhados no Complexo de Alfragide e o alargamento a outras Unidades de modo a obter uma visão mais abrangente da realidade na Força Aérea. Abstract: The study aimed to analyze the implementation of the Shared Services model, using the lean methodology, in the personnel support services in Complexo de Alfragide. This process took place in the context of implementation of this model in the Portuguese Air Force, determined by CEMFA Order No. 59/2015 of 31 July. To develop this work was used a mixed research strategy (quantitative and qualitative), following the hypothetical-deductive reasoning. The research design used was the case study, interviews, document analysis and a questionnaire. By the results obtained through the views expressed in the interviews and in the investigation, it can be concluded that the implementation of the Shared Services model has achieved some of the goals that it proposed like the improvement in personnel support services. Although foreseen great potential in terms of gains of Human Resources rationalization and due to several factors, has not yet been possible to achieve this goal. This research is concluded suggesting a reevaluation at a later stage of the implementation of the Shared Services model in the Complexo de Alfragide and extension to other Units for a more comprehensive view of reality in the Air Force.