Objetivo: Este artigo tem como objetivo avaliar o impacto da implantação da estratégia de triagem com classificação de risco e da unidade vascular no processo assistencial dos pacientes atendidos no serviço de emergência do Hospital de Clínicas de Porto Alegre, HCPA. Método:Trata-se de um quasi-experimento em que 3.700 pacientes atendidos na emergência nos meses de março a maio de 2005 e 4.954 pacientes atendidos no mesmo período de 2007, após a implantação das novas tecnologias, tiveram seu processo de atendimento medidos e comparados.O impacto da reorganização do serviço com a implantação destas tecnologias foi avaliado através da comparação dos indicadores de “Tempo de Permanência”, “Tempo de espera para realização de Exames” e “Tempo de espera para realização Cirurgias e Procedimentos” de todos os pacientes atendidos e especificamente dos pacientes com doenças cardiovasculares. Resultados: O tempo mediano de triagem de todos os pacientes foi de 11,8 minutos (0-92,5) e de 6,3 minutos (0-53) dos pacientes com doenças cardiovasculares. Foi evidenciado aumento significativo da mediana de tempo de permanência: 2005: 12,3h (0-510,8) e 2007:15,5h.(0-388,9), P<0,001. O mesmo ocorreu com os pacientes cardiovasculares que passaram de uma mediana de tempo de permanência de 24,5h (0,5- 341) em 2005 para 74h (0,6 -287,h), P <0,001.O exame de tomografia de crânio apresentou redução significativa no tempo mediano de espera para todos os pacientes 2005: 4h (0,08-76,4), 2007: 3h (0,2-62,7), P =0,006,e para os pacientes com doenças cardiovasculares, 2005: 4,2h (0,5-15,9), 2007: 0,9h (0,5-7,9), P =0,001.O cateterismo cardíaco realizado pelos doentes cardiovasculares agudos apresentou uma redução significativa no tempo mediano de espera, 2005: 55,6h (31,2-90,4) e 2007 13,6h (0,6-97,6), P =0,025. Conclusão: Embora tenha havido aumento de 25,3% nos casos atendidos entre 2005 e 2007, acompanhado do aumento da mediana de idade, do escore de gravidade e de casos demandando procedimentos cirúrgicos, a implantação de estratégia de triagem com estratificação de risco e da unidade vascular em serviço de emergência de hospital universitário esteve associada à redução dos tempos de espera para procedimentos diagnósticos e terapêuticos considerados como essenciais em pacientes com síndrome vascular aguda. / Objective: This study assesses the impact of implementing a strategy of screening using risk rating and creating a vascular unit for patients admitted to the emergency department of Hospital de Clinicas de Porto Alegre. Method: This study describes a quasi-experiment in which 3700 patients treated at the emergency department from March to May 2005 (P1) and 4954 patients treated during the same months of 2007 (P2), after the introduction of new care technologies. The process of care was measured and compared. The impact of department reorganization with these technologies was evaluated comparing length of stay, length of stay to perform tests and length of stay to perform surgery or procedure, measured for all patients and specifically for cardiovascular disease patients. Results: Screening median time was 11.8 min (0-92.5) for all patients and 6.3 min (0- 53) for cardiovascular disease patients. Our results showed a significant increase in median length of stay from P1 to P2 for all patients, 12.3 min (0-510.8) and 15.5 hr (0-388.9) respectively, P < 0.001. Cardiovascular disease patients had a median length of stay of 24.5 min (0.5-341) and 74 hr (0.6-287) in 2005 and 2007 respectively. Cranial tomography scan had a significant time reduction for all patients from P1 to P2, 4 hr (0.08-76.4) and 3 hr (0.2-62.7) respectively, P = 0.006, and for cardiovascular disease patients 4.2 hr (0.5-15.9) and 0.9 hr (0.5-7.9) respectively, P = 0.001. Cardiac catheterization for acute cardiovascular disease patients showed a significant decrease in median waiting time, from 55.6 min (31.2- 90.4) in P1 to 13.6 min (0.6-97.6) in P2, P = 0.025. Conclusion: Although there was a 25.3 percent increase in admitted patients from 2005 to 2007 and an increase in age, severity score and surgical patients, the implementation of a screening strategy with risk stratification and creation of a vascular unit in the emergency department was associated with reduction of waiting times of diagnostic and therapeutic procedures for acute cardiovascular disease patients.

Recent theoretical approaches, such the Psychology of Working perspective (Blustein, 2006; Duffy, Blustein, Diemer, & Autin, 2016), have emphasized social stratification and social justice, and quantitative assessments of these constructs are needed. The current study examines the development and initial validation of the Work and Human Needs Inventory (WAHNI), which assesses the extent to which individuals’ work meets several human needs: survival, power, autonomy, social connection, and purpose. Items were constructed and refined using content analysis of relevant constructs, expert analysis, and a pilot study. Exploratory factor analysis on a sample of 338 working adults revealed five factors: Provision, Purpose, Power, Autonomy, and Connection. Confirmatory factor analyses on a separate sample of 203 working adults supported this factor structure. Scale intercorrelations with the Differential Status Identity Scale (Brown et al., 2002), the MacArthur Scale of Subjective Social Status (Adler, Epel, Castellazzo, & Ickovicks, 2000), and the Meaning in Life Questionnaire (Steger, Frazier, Oishi, & Kaler, 2006) provided validity evidence. Research and practical implications for the WAHNI are discussed.

Ce travail de recherche propose d’étudier les inégalités de santé et de recours aux soins entre la population native et la population immigrée. Une attention particulière est portée au rôle du capital social, qui suppose une influence des réseaux sociaux ou des interactions sociales sur l'état de santé et le recours aux soins. Nous adoptons une approche micro-économétrique et construisons notre réflexion autour de trois thèmes : (i) la mise en évidence des inégalités de santé et de recours aux soins liées à l’immigration, (ii) la compréhension des mécanismes qui génèrent ces inégalités, et enfin (iii) l’évaluation de l’impact causal du capital social sur l’état de santé et le recours aux soins des immigrés. En termes de politiques publiques, l’analyse des mécanismes générant les inégalités incite à penser que plusieurs leviers d’action sont envisageables. Compte tenu du rôle protecteur du capital social sur la santé, le développement d’actions de proximité spécifiques apparaît nécessaire pour accroître l’insertion sociale et le soutien social des personnes immigrées. L’importance de la couverture complémentaire santé dans la détermination des inégalités témoigne ensuite, de la nécessité de simplifier l’accès aux droits à l’Aide Médicale d’État et à la Couverture Maladie Universelle afin de favoriser la prévention et l’accès aux soins des personnes immigrées / The objective of this research is the study of health and health care use inequalities between immigrant and native populations. A special attention is focused on the role played by social capital, which supposes an influence of social networks or social interactions on health and health care utilisation. In using a micro-econometric framework, our analysis is based on three topics: (i) the emphasis of health or health care use inequalities related to immigration, (ii) the understanding of the contributory factors that generate inequalities, and (iii) the evaluation of the causal impact of social capital on immigrant health and health care use. From a public policy perspective, the analysis of the determinants of health inequalities shows that several types of action could be envisaged. Given the protective role played by social capital on health status, the development of specific neighbourhood actions would seem relevant in improving immigrants’ social inclusion and social support. The prominent role of complementary health care coverage also gives evidence of the need to simplify access to Sate Medical Assistance and mean-tested health insurance so as to favour health prevention and access to health care for immigrants

This study describes my experience 111 the research 1 conducted in two Harare secondary schools in which the interpretive ethnographic qualitative research methodology was used. The objective of the research was to assess the infuence of ability grouping on learners, given that ability grouping is a common practice in Zimbabwean schools. In particular, this study sought to find out how this practice affected classroom instruction, learner performance and the social relationship among learners. This study was conducted over three months at each of the schools, during which time formal interviews with teachers, administrators and learners, were conducted. These were complemented with informal conversations, where relevant comments were noted. Observation and limited participation in the two schools were also employed as means of collecting data. Analysis of documents was also done to supply more data about the practice and how it was implemented. As customary with qualitative research, I, as the researcher, was the instrument for data collection. Data were analysed by identifying themes which emerged from the statements of the respondents, and interpretation was done using the mechanism of thick description of what the respondents said and did during the interviews and observation, and what the documents had to say about this practice. I, as researcher, concluded from this study that ability grouping had a negative effect on classroom instruction for the low ability groups, since teachers tended not to prepare thoroughly for them. There was also a tendency among high ability groups to look down upon the low ability groups and to stigmatise them as "those who do not want to learn." Naturally this created a counter reaction from the low ability groups, making social relationships between members of the groups sour. l, as researcher, recommend a re-examination of this practice by the schools, with a view to either discontinue it or to work out mechanisms to remove the negative factors. / Educational Studies / D. Ed. (Didactics)

No description available.

A presente dissertação de mestrado busca contribuir para o debate em desenvolvimento sobre a emergência de países do Sul Global, a partir do estudo das relações de poder hierarquizadas em que estes esses países estão inseridos. Nesse sentido, questiona-se como estruturas de assimetria material atuam sobre o comportamento de distintos atores do sistema internacional. As oportunidades e constrangimentos de tais estruturas materiais se manifestam especificamente para distintos atores? Como essa variação se articula com as possibilidades de emergência de países do Sul Global? A partir da resposta a essas perguntas, busca-se propor um caminho para identificar episódios históricos de constituição, por parte de países do Sul Global, de capacidade transformativa de sua posição nas relações internacionais em que se inserem. Para tanto, mobiliza-se um diálogo entre a literatura sobre diferenciação estrutural e sobre a hierarquia nas relações internacionais, como modo de articular analiticamente o processo de socialização entre estruturas políticas e econômicas. Desse diálogo estrutural, pretende-se compreender os mecanismos de exclusão que perpetuam assimetrias materiais no sistema internacional e os meios instrumentalizáveis para sua ruptura. / This master's thesis aims to contribute to the debate on the rise of countries from the Global South, proposing the study of hierarchical power relations that they entail. In this sense, it questions how structures of material asymmetries act conditioning the behavior of actors throughout the international system. Are the opportunities and constraints deriving such structures specifically varying for different actors? How is this variation related to the possibilities of rise in the Global South? From the answers to these questions, it is hoped to propose an alternative to identify historical episodes of constitution, by countries the Global South, of transformative capacity of their position in the international relations that they operate. Therefore, the work mobilizes a dialogue between the literature on structural differentiation and hierarchy in international relations, as a way of analytically articulate the process of socialization of political and economic structures. This structural dialogue focuses on identifying mechanisms of exclusion that perpetuate materials asymmetries in the international system and the means to their rupture.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Com a presente tese, buscou-se investigar as desigualdades educacionais que permeiam o ensino médio, principal gargalo do sistema educacional brasileiro. Inicialmente, questionou-se o papel central da educação como legitimadora das desigualdades sociais nas sociedades democráticas. Apresentaram-se os estudos pioneiros da Sociologia da Educação que procuraram explicar as desigualdades educacionais para, então, abordar as hipóteses teóricas elaboradas sobre as tendências da desigualdade de oportunidades educacionais (DOE) ao longo do tempo. Em seguida, testaram-se empiricamente essas hipóteses a partir de modelos de regressão logística sequenciais que permitiram estimar a evolução do efeito das características da família de origem nas chances condicionais de entrada e conclusão do ensino médio durante um período de mais de vinte anos. Observou-se de forma inédita, de 1986 a 2009, que a DOE relativa ao ingresso e à conclusão desse nível de ensino se manteve significativa e relativamente constante, mesmo no período mais recente no qual as taxas de transição no ensino médio vivenciaram seu maior crescimento. Esses resultados corroboram aqueles previstos pela hipótese da Desigualdade Maximamente Mantida (MMI) e aqueles encontrados por estudos anteriores. Incluiu-se também uma análise das mudanças qualitativas da DOE, evidenciando-se um significativo crescimento, entre o ano de 1982 e a década de 2000, no impacto das variáveis que medem o capital cultural e econômico dos estudantes nas chances destes frequentarem a rede de ensino médio particular. Logo, a estratificação entre a rede pública e particular no ensino médio está cada vez mais marcada pela desigualdade na seleção dos seus respectivos alunos, reforçando a dualidade de desempenho que caracteriza essas duas redes de ensino, conforme previsto pela hipótese da Desigualdade Efetivamente Mantida (EMI). Além dessas análises da evolução quantitativa e qualitativa da DOE no ensino médio, investigou-se o quadro geral de desigualdades que incidem sobre o ensino médio técnico à luz das experiências internacionais, tendo em vista que essa é uma modalidade ainda incipiente no Brasil, mas cuja rede está em rápida expansão. Diferentemente do que ocorre na maioria dos países, os jovens de origem menos privilegiada não são os maiores beneficiários dessa modalidade. Apesar de a mesma ser propagada como principal solução para a falta de qualificação juvenil, a ampliação desse tipo de ensino deve ser avaliada com cautela, tendo em vista o público que está sendo efetivamente atingido e o potencial impacto negativo em termos de estratificação educacional observado nos países que seguiram esse caminho. / With this thesis, we sought to investigate the educational inequalities in the upper secondary education, the main bottleneck of the Brazilian educational system. Initially, the central role of education as a way of legitimating social inequalities in democratic societies was discussed. Classic studies of Sociology of Education that tried to explain those educational inequalities were presented, and the theoretical assumptions about trends in inequality of educational opportunities (IEO) over time were addressed. Subsequently, those hypotheses were empirically tested using sequential logit regression models, which allowed the estimation of the evolution of the social background effects on educational transition related to high school during a period of more than twenty years. It was observed, in an unprecedented way, from 1986 thru 2009, that the IEO related to entrance and completion of this educational level remained significant and relatively constant, even in the most recent period, when the transition rates to high school experienced its greatest growth. Those results corroborate the ones predicted by the hypothesis of Maximally Maintained Inequality (MMI) and those found by previous studies. An analysis of the qualitative changes of the IEO was also included, demonstrating significant increase, between 1982 and the 2000s, of the effect of variables that measure the economic and cultural capital of high school students on their chances of enrollment in private high schools (vs. public ones). Hence, the stratification between the public and private high schools is increasingly marked by the inequality in the selection of their respective students, reinforcing the performance duality that characterizes those two school systems, as predicted by the hypothesis of Effectively Maintained Inequality (EMI). In addition to those quantitative and qualitative IEO analyses, the general framework of inequalities concerning the vocational high school was investigated in light of international experiences, taking into account that such type of education is still incipient in Brazil, but expanding rapidly. Unlike what happens in most countries, young people from less privileged background are not the greatest beneficiaries of that educational scheme. Despite being propagated as the main solution to the lack of youth qualification, the expansion of that sort of education should be evaluated with caution, considering the public effectively reached and the potential negative impact in terms of educational stratification observed in countries that followed that path.

Made available in DSpace on 2014-06-11T19:26:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-22Bitstream added on 2014-06-13T18:54:23Z : No. of bitstreams: 1 pedrazzi_fjm_me_rcla.pdf: 6663596 bytes, checksum: 0e9d03b7b531f91d8f6add54957a1a89 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Considerando a grande importância da bacia do Alto do Rio Sorocaba para a região de Sorocaba, seja para o abastecimento da população, geração de energia elétrica, irrigação e usos industriais, este trabalho teve como objetivo principal avaliar a qualidade da água do reservatório de Itupararanga. O estudo foi desenvolvido pela da geração de um banco de dados georreferenciado, avaliação da qualidade de água no seu gradiente espacial (horizontal e vertical) e temporal (épocas de seca e chuvosa), visando conhecer o comportamento de alguns elementos e compostos na coluna d´água e sua distribuição neste reservatório, correlacionando-os ao uso e ocupação do solo adjacente. Assim, de acordo com os resultados obtidos no gradiente horizontal (montante-jusante) na época de seca 90% dos pontos estavam eutrofizados (IET > 54) e na época de chuva 60%. No gradiente vertical (lâmina d’águafundo) observou-se que a distribuição de elementos metálicos e nutrientes variaram de acordo com o pH e presença de clorofila-a, indicando que a eutrofização do reservatório altera as condições de crescimento de algas que por sua vez afeta a estratificação de elementos na coluna d’agua. Portanto, entende-se que são necessárias ações voltadas ao planejamento do uso e ocupação do solo e gerenciamento integrado desta importante bacia hidrográfica localizada no interior paulista. / Considering the great importance of upper Sorocaba basin to the Sorocaba region to water supply, electric generation, irrigation and industrial uses, this work has the main objective to evaluate the water quality of Itupararanga reservoir. The study was conducted with the generation of a georreferenced data base, the water quality evaluation in the spacial gradient (horizontal and vertical distribuition) and temporal (dry and wet climate), trying to know the comportament of some elements and solutions in water column in the reservoir, trying to make the correlation between the data and land use. The results show that in horizontal gradient (upstream – downstream) in the dry period, 90% of collecting points are eutrophic (IET > 54), in the wet period, 60%. In vertical gradient (up – bottom) was observed that the distribuition of some metallic elements and some compounds varied in accordance with pH and chlorophyll-a, indicating that the reservoir eutrophization shifts the algal growing, that causes, with the temperature, stratifies elements in water column. Actions to plan the land use in this watershed are needed to reduce the environment and water quality degradation, making a integrated managing of this important watershed in countryside of São Paulo State.

Objetivo: Este artigo tem como objetivo avaliar o impacto da implantação da estratégia de triagem com classificação de risco e da unidade vascular no processo assistencial dos pacientes atendidos no serviço de emergência do Hospital de Clínicas de Porto Alegre, HCPA. Método:Trata-se de um quasi-experimento em que 3.700 pacientes atendidos na emergência nos meses de março a maio de 2005 e 4.954 pacientes atendidos no mesmo período de 2007, após a implantação das novas tecnologias, tiveram seu processo de atendimento medidos e comparados.O impacto da reorganização do serviço com a implantação destas tecnologias foi avaliado através da comparação dos indicadores de “Tempo de Permanência”, “Tempo de espera para realização de Exames” e “Tempo de espera para realização Cirurgias e Procedimentos” de todos os pacientes atendidos e especificamente dos pacientes com doenças cardiovasculares. Resultados: O tempo mediano de triagem de todos os pacientes foi de 11,8 minutos (0-92,5) e de 6,3 minutos (0-53) dos pacientes com doenças cardiovasculares. Foi evidenciado aumento significativo da mediana de tempo de permanência: 2005: 12,3h (0-510,8) e 2007:15,5h.(0-388,9), P<0,001. O mesmo ocorreu com os pacientes cardiovasculares que passaram de uma mediana de tempo de permanência de 24,5h (0,5- 341) em 2005 para 74h (0,6 -287,h), P <0,001.O exame de tomografia de crânio apresentou redução significativa no tempo mediano de espera para todos os pacientes 2005: 4h (0,08-76,4), 2007: 3h (0,2-62,7), P =0,006,e para os pacientes com doenças cardiovasculares, 2005: 4,2h (0,5-15,9), 2007: 0,9h (0,5-7,9), P =0,001.O cateterismo cardíaco realizado pelos doentes cardiovasculares agudos apresentou uma redução significativa no tempo mediano de espera, 2005: 55,6h (31,2-90,4) e 2007 13,6h (0,6-97,6), P =0,025. Conclusão: Embora tenha havido aumento de 25,3% nos casos atendidos entre 2005 e 2007, acompanhado do aumento da mediana de idade, do escore de gravidade e de casos demandando procedimentos cirúrgicos, a implantação de estratégia de triagem com estratificação de risco e da unidade vascular em serviço de emergência de hospital universitário esteve associada à redução dos tempos de espera para procedimentos diagnósticos e terapêuticos considerados como essenciais em pacientes com síndrome vascular aguda. / Objective: This study assesses the impact of implementing a strategy of screening using risk rating and creating a vascular unit for patients admitted to the emergency department of Hospital de Clinicas de Porto Alegre. Method: This study describes a quasi-experiment in which 3700 patients treated at the emergency department from March to May 2005 (P1) and 4954 patients treated during the same months of 2007 (P2), after the introduction of new care technologies. The process of care was measured and compared. The impact of department reorganization with these technologies was evaluated comparing length of stay, length of stay to perform tests and length of stay to perform surgery or procedure, measured for all patients and specifically for cardiovascular disease patients. Results: Screening median time was 11.8 min (0-92.5) for all patients and 6.3 min (0- 53) for cardiovascular disease patients. Our results showed a significant increase in median length of stay from P1 to P2 for all patients, 12.3 min (0-510.8) and 15.5 hr (0-388.9) respectively, P < 0.001. Cardiovascular disease patients had a median length of stay of 24.5 min (0.5-341) and 74 hr (0.6-287) in 2005 and 2007 respectively. Cranial tomography scan had a significant time reduction for all patients from P1 to P2, 4 hr (0.08-76.4) and 3 hr (0.2-62.7) respectively, P = 0.006, and for cardiovascular disease patients 4.2 hr (0.5-15.9) and 0.9 hr (0.5-7.9) respectively, P = 0.001. Cardiac catheterization for acute cardiovascular disease patients showed a significant decrease in median waiting time, from 55.6 min (31.2- 90.4) in P1 to 13.6 min (0.6-97.6) in P2, P = 0.025. Conclusion: Although there was a 25.3 percent increase in admitted patients from 2005 to 2007 and an increase in age, severity score and surgical patients, the implementation of a screening strategy with risk stratification and creation of a vascular unit in the emergency department was associated with reduction of waiting times of diagnostic and therapeutic procedures for acute cardiovascular disease patients.

Made available in DSpace on 2014-06-11T19:24:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2004Bitstream added on 2014-06-13T20:47:18Z : No. of bitstreams: 1 oliveira_sr_me_bauru.pdf: 4056726 bytes, checksum: da2b55b91a9531fddc60a2ca6a750172 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / É desenvolvido um modelo matemático para estudar o comportamento da estratificação térmica de líquido em um tanque armazenador com meio poroso. O tanque considerado é de geometria retangular com relação comprimento-altura igual a 1. O modelo utiliza a formulação transiente de vorticidade e função corrente para predizer o desenvolvimento dos campos de função corrente e temperaturas durante um processo de carregamento. Foi fixado um número de Reynolds igual a 200 para o escoamento de entrada e uma faixa do número de Richardson de 0,001 a 10. Outros parâmetros considerados incluem o número de Biot (perda de calor pelas paredes do tanque), o número de Darcy (permeabilidade do meio poroso), a posição e a espessura do meio poroso. Os resultados mostram a influência desses parâmetros físicos que devem ser considerados para um bom projeto de tanques armazenadores com estratificação térmica. / A mathematical model is developed to study the behaviour of thermal stratification of liquid in a typical storage tank with porous medium. The tank considered has rectangular geometry with lenght-to-height ratio equal of 1. The model employs a transient stream function-vorticity formulation to predict the development of stream function and temperature fields in a charging process. The Reynolds number of the inlet flow is fixed at 200 and a range of the Richardson number from 0,001 to 10. Other parameters considered include the Biot number (heat loss from tank walls), the Darcy number (permeability of the porous medium), the position and the thickness of the porous medium. The results show the influence of these physic parameters that should be considered for a good design of storage tanks with thermal stratification.