Intra-operative imaging is sometimes available to assist in needle biopsy, but typical open- loop insertion does not account for unmodeled needle deflection or target shift. Robotic closed-loop compensation for deviation from an initial straight-line trajectory can reduce the targeting error, using image-guidance for rotational control of an asymmetric bevel tip. By pairing closed-loop trajectory compensation with a hands-on cooperatively controlled needle insertion, a physician's control of the procedure can be maintained while incorporating benefits of robotic accuracy. Additionally, if puncture of a membrane can be detected, an enhanced haptic response can assist the physician in perceived anatomical localization of the needle tip. Functionality was implemented on a needle placement robot suitable for use in the MR environment and capable of holding a typical clinically used biopsy gun. The robot is configured for cooperatively controlled needle insertion with continuous closed-loop image- guided needle rotation. The robot and custom controller were tested for their effect on the Signal-to-Noise ratio (SNR) of MR images, and the results showed an approximate drop of only 12% in signal when the robot was present, and no additional signal drop when the robot was powered on or moving. The hardware and software subsystems were developed for clinical translation, and after each was validated in the lab they were integrated into the clinical environment to mimic the workflow of MRI-guided targeted biopsy. The full system was evaluated in-bore at Brigham and Women’s Hospital in Boston, MA where experiments for real-time puncture detection and MR image-guided targeted needle insertions under cooperative control were performed. Results showed overall targeting accuracy was 3.42mm RMS, improving accuracy by approximately 50% as compared to clinical trials of prostate biopsy using manual needle insertion. A cooperatively controlled robotic biopsy is more likely to gain acceptance by physicians over teleoperation due to maintaining proximity to the surgical site, but regulatory hurdles regarding robotic needle insertion still exist. The current robotic system framework is suitable for clinical use as it was fully validated in-bore, but some modifications could be made to increase the likelihood of regulatory approval. With these modifications the system could be ready for cadaver and pre- clinical animal trials within one year, and ready for in-human clinical trials in the next two to three years.

Made available in DSpace on 2016-04-26T18:13:14Z (GMT). No. of bitstreams: 1 Gabrielly Ferreira.pdf: 1007990 bytes, checksum: a1a44cda9c27e772743dbdc0f849062a (MD5) Previous issue date: 2013-07-04 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The body is the beginning and the end of every kind of communication. Through it we can take part in sociocultural environments and create bounds. Using the senses and contact, we change the environment we live in and change the body in order to adapt it to this environment. With the evolution we notice that the body is highly flexible to changings and may be given another meaning, molded and transformed in order to adapt itself. Today we can say that estetic surgeries are tools to change the body that is the body´s media copy. There is an exagerate number of estetic surgeries happening day after day due to the body to dream about being another body. Then we wonder in what measure the creation of mediatic bodies executed by the action of estetic surgery make use of the molds of image edition softwares and the image of media such as mimetic samples. It is possible to see this need throughthe images, previous and after images, from people who have gone under those surgeries to become or to look like the mediatic body. These images are taken from articles from the web, especially from G1 site on bizzar planet. These images are object of this survey about previous and after estetic surgeries. To understand this phenomenon I use the concepts of Ivan Bystrina, Czech, who wrote about semiotic culture to explain the matter of the imaginary and how the second reality acts contamining the first one. Harry Pross, who talks about primary, secondary and thrid media, on a line where communication begins and ends at the body. Noval Baitello Jr., that works on the image matter, on iconofagia and incommunication, elements that are essential to corroborate with the proposed hypothesis. Dietmar Kamper, German, writer of media, philosopher and sociologist about the body. We cannot talk about the body without at least consulting Kamper, for his are the most updated ideas and concepts in the field of communication. Gunter Gebauer and Christof Wulf, that plot a wonderful panorama of which are the consequences of mimese in social relationships. These theories are related in order to spot the object and let us get to know and realize that we live in a society of images that rules by itself using us as a stand / O corpo é o início e o final de toda comunicação. Através dele, participamos dos ambientes socioculturais e criamos vínculos. Com o uso dos sentidos e do contato, modificamos o meio em que vivemos e modificamos o corpo, para se adaptar á este meio. Percebemos com a evolução que o corpo é altamente flexível á modificações e pode ser resignificado, moldado e transformado para se adaptar. Hoje, pode-se dizer que as cirurgias estéticas são ferramentas para a mudança deste corpo, que é cópia, do corpo da mídia. Existe uma exacerbação de cirurgias estéticas sendo feitas, dia após dia, devido ao corpo sonhar ser um outro corpo. Então nos perguntamos: Em que medida a criação de corpos midiáticos, executada pela ação das intervenções estéticas, utiliza os moldes dos softwares de edição de imagem e as imagens dos media como modelos miméticos? É possível verificar esta necessidade, através de imagens, imagens de antes e depois, de pessoas que passam por estas intervenções, para ser ou pare(ser) com o corpo midiático. Estas imagens são retiradas de reportagens em sites da internet, principalmente do portal G1 em planeta bizarro. Esta pesquisa tem como objeto estas imagens, de antes e depois de cirurgias estéticas. Para compreender este fenômeno, utilizo os conceitos de Ivan Bystrina, Tcheco, teórico de semiótica da cultura para explicar a questão do imaginário e de como a segunda realidade atua contaminando a primeira. Harry Pross, que discursa sobre mídia primária, secundária e terciária, em um trajeto onde a comunicação se inicia e termina no corpo. Norval Baitello Jr., que trabalha com a questão da imagem, de iconofagia e incomunicação, elementos que se fazem essenciais para corroborar com a hipótese proposta. Dietmar Kamper, Alemão, teórico da mídia, filósofo e sociólogo do corpo. Não se pode falar de corpo sem ao menos consultar Kamper, pois suas ideias e concepções são as mais atuais no campo da comunicação. Gunter Gebauer e Christoph Wulf, que traçam um maravilhoso panorama de quais são as consequências da mimese no convívio social. Estas teorias são entrelaçadas para iluminar o objeto e nos fazer conhecer e reconhecer que estamos em uma sociedade de imagens que imperam sozinhas, nos usando apenas como suportes

INTRODUÇÃO: Os suportes vasculares bioabsorvíveis (SVB) surgiram com a finalidade de aumentar a segurança tardia das intervenções coronárias percutâneas (ICP). Estes dispositivos liberam o fármaco antiproliferativo no local da obstrução e são absorvidos com o passar do tempo. A utilização do ultrassom intracoronário (USIC) pode ajudar na avaliação do processo de absorção deste dispositivo. OBJETIVOS: Primário: avaliar e comparar, pelo USIC, o volume e a área da luz, do vaso e do SVB imediatamente após o implante da prótese, e, tardiamente, aos 6 e 18 meses. Objetivos secundários: avaliar e comparar, pelo USIC, o volume e área da placa imediatamente após o implante da prótese, e, tardiamente, aos 6 e 18 meses e os diâmetros do vaso, lúmen e SVB após ICP e no seguimento. Percentual de estenose e perda tardia do lúmen pela angiografia no seguimento e incidência de eventos cardíacos adversos maiores (ECAM) até os 18 meses. MÉTODO: Trata-se de um estudo prospectivo, não randomizado com a inclusão de 20 pacientes que foram submetidos ao implante do SVB DESolve®. Foi realizado o USIC após o procedimento e aos 6 e 18 meses de seguimento. RESULTADOS: Dos 20 pacientes selecionados, um paciente recusou realizar o USCI aos 6 meses e dois não realizaram o exame aos 18 meses, sendo excluídos do estudo. Totalizando 17 pacientes analisados. A idade média foi de 58,59 ± 8,73 anos e 70,6% eram do sexo masculino. O quadro clínico predominante era de angina estável. A via de acesso preferencial foi a radial, todos os pacientes foram submetidos à pré e pós-dilatação e o sucesso angiográfico ocorreu em todos os casos. No seguimento, houve aumento significativo na área (6,41 ± 1,35 mm2 vs. 7,35 ± 1,53 mm2, p < 0,002), volume (101,19 ± 20,9 mm3 vs. 118,51 ± 26,6 mm3, p = 0,001) e diâmetros do dispositivo, pelo USIC, aos 6 meses quando comparado ao procedimento índice. Não houve alteração significativa nas áreas, nos volumes e nos diâmetros do vaso e lúmen, em qualquer comparação no seguimento. A perda tardia foi de 0,22 ± 0,30 mm aos 6 e de 0,33 ± 0,44 mm aos 18 meses. Não houve nenhum caso de reestenose angiográfica e trombose do dispositivo. No seguimento, não houve casos de ECAM. CONCLUSÕES: A ICP com a utilização do SVB DESolve® para o tratamento da doença arterial coronária não complexa demonstrou resultados promissores. Houve aumento do volume e área do dispositivo aos 6 meses e uma supressão eficaz da hiperplasia intimal sem ECAM no seguimento. / INTRODUCTION: The bioresorbable vascular scaffolds (BVS) emerged in order to increase late safety of percutaneous coronary interventions (PCI). These devices release the antiproliferative drug to the site of obstruction and are absorbed over time. The use of intravascular ultrasound (IVUS) can help in the evaluation of this device absorption process. OBJECTIVES: The primary endpoint was to evaluate and compare, through IVUS, the volume and the area of the lúmen, the vessel and the device immediately after its implantation, and later at 6 and 18 months. The secondary endpoints were to evaluate and compare, through IVUS, the volume and the area of the plaque immediately after its implantation, and later at 6 and 18 months and diameters of the vessel, lúmen and BVS after PCI and at follow-up. Percentage of stenosis and late lúmen loss by angiography and incidence of major adverse cardiac events (MACE) up to 18 months. METHOD: This is a prospective, non-randomized study, with the inclusion of 20 patients who underwent implantation of DESolveTM. IVUS was performed after the procedure and at 6 and 18 months of follow-up. RESULTS: Of the 20 patients selected, one patient refused to perform the USCI at 6 months and two did not undergo the exam at 18 months and were excluded from the study. In total, 17 patients were analyzed. The average age was 58.59 ± 8.73 years and 70,6% were male. The most common clinical presentation was stable angina. The preferred vascular acess was to radial, all patients underwent pre- and post-dilation and angiographic success occurred in all cases. At follow-up there was a significant increase in area (6,41 ± 1,35 mm2 vs. 7,35 ± 1,53 mm2, p < 0,002), volume (101,19 ± 20,9 mm3 vs. 118,51 ± 26,6 mm3, p = 0,001) and diameters of the device, by IVUS, at 6 months when compared to the index procedure. There was no significant change in the areas, volumes and diameters of the vessel and lúmen, in any comparison at follow-up. The late loss was 0,22 ± 0,30 mm at 6 and 0,33 ± 0,44 mm at 18 months. There were no cases of restenosis and scaffold thrombosis. During follow-up there was no case of MACE. CONCLUSIONS: PCI with the use of DESolve scaffold for the treatment of non-complex coronary artery disease has shown promising results. There was an increase in the volume and area of the device at 6 months and an effective suppression of intimal hyperplasia without MACE at follow-up.

We asked whether the design of a Science Data Repository (SDR) can influence data sharing behaviour in small scientific collaborations. We hypothesised that an SDR can influence data-sharing behaviour when its design considers the context of data-sharing. We proposed an alternative approach to those documented in the literature, employing a combination of socio-technical empirical and analytical methods for context capturing, and choice architecture for context incorporation. To evaluate the approach we applied it to design features in a Scientific Data Repository for a population of small scientific collaborations within the Life Sciences. The application of this thesis' approach consisted of an exploratory case study, a review of factors associated with data sharing, the definition of design claims, and implementation of a set of design features. We collected data using interviews with members of the collaborations and designers of the SDR; as well as obtaining the data-logs from the collaborations' SDR. We evaluated the resulting design features using an asynchronous web experiment. We found that using the empirical approach to context capturing we are able to effectively identify factors associated with data sharing in the small scientific collaborations. Moreover, we identified a number of limitations on the application of the analytical approach to context capturing. Furthermore, we found that the Choice Architecture based procedure for context incorporation can define effective design features in Science Data Repositories. In this work, we show that we can facilitate data-sharing by incorporating context into the design of a Science Data Repository, and identified a set of restrictions to use our approach. The approach proposed in this thesis can be used by practitioners wishing to improve data sharing in an SDR. Contributions, such as the survey of factors associated with data sharing behaviour, can be used by researchers to understand the problems associated with data sharing in small scientific collaborations.

There is increasing interest in the role of peers in facilitating the social interaction of pupils with ASD through Peer-mediated Interventions (PMI). A systematic literature review was conducted to provide an overview of methods used to evaluate the impact of PMI and provide examples of innovative practice. Four databases were searched. Following application of inclusion and exclusion criteria and coding of studies, 10 were included in the final review. The review found that measuring the outcome of PMI at the level of target pupils has been a focus, with less attention given to exploring experiences of participants; impact on peers and implementation of PMI within an educational context. An innovative PMI was implemented within a mainstream primary school to promote the social inclusion of a Year 3 male pupil with ASD, with his class and five peers. Key elements of the PMI included development of the programme with school staff, whole class awareness raising and a small group peer network. The intervention was evaluated through structured playground observations of pupil-peer interaction, interviews with the target pupil and school staff and a peer focus group. Findings indicated that this small-scale PMI had a positive impact at the level of the target pupil and peers. Key factors facilitating the implementation of this intervention within a school context were also identified. A structured dissemination strategy that involved consultation activities with key stakeholders explored the refinement of an ecologically valid and feasible model for delivery in mainstream schools. Future considerations in developing the intervention framework include; refining elements of the programme based on feedback from key stakeholders and trialling the delivery of the intervention by school staff trained in the programme. Implications for Educational Psychologists (EPs) in the development and delivery of the intervention are discussed.

Suicide is a complex phenomenon that occurs on a continuum with thoughts of suicide, plans and attempts that can eventually result in death. Suicide is one of the top ten reasons for death in most countries. Governments are challenging healthcare systems to reduce suicide through preventative healthcare. The first paper explores psychological interventions for people with suicidal thoughts and behaviours delivered through technology. It explores the evidence-base for internet-based Cognitive Behavioural Therapy, telephone based interventions, CD-ROMs and other Internet-based therapies. Nineteen papers were identified with four papers of good quality evidence supporting Internet-based cognitive behavioural interventions. The second paper is a feasibility and acceptability study which explores a diary and intervention delivered through a mobile phone. Twenty participants were recruited through adult secondary care community mental health teams in the North West of England. High completion rates and low dropout rates were found. Participants rated the technology and interventions high in terms of practicality, ease of use and overall satisfaction with the programme and reported that it was moderately helpful. Preliminary data on effectiveness suggests reactivity to the method in the short term but a reduction in symptoms overall. These results and ESM methodology must be treated with caution for people with suicidal thoughts due to the increase in symptoms found following the intervention. The third paper offers a critical reflection on the first and second papers.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / As normas ortogrÃficas sÃo convenÃÃes sociais criadas para facilitar a comunicaÃÃo escrita. A escola tem o papel de desenvolver atividades que promovam a apropriaÃÃo das regras pelos alunos, e ao professor de lÃngua portuguesa cabe a tarefa de incluir em suas prÃticas de ensino o estudo da correta notaÃÃo da lÃngua escrita, visto que os conhecimentos ortogrÃficos tÃm relevÃncia social e sÃo necessÃrios para o competente uso da lÃngua. No entanto, os aprendizes demonstram dificuldades na ortografia, mesmo nas sÃries finais do ensino fundamental. Muitas dessas dificuldades estÃo relacionadas à oralidade, nÃo raro, seus textos apresentam diversas palavras grafadas conforme sÃo produzidas na oralidade. Observa-se que os alunos nÃo tÃm o domÃnio do sistema ortogrÃfico e desconhecem as diferenÃas entre lÃngua escrita e lÃngua oral. à necessÃrio, portanto, que um trabalho pedagÃgico seja desenvolvido pelo professor para que os estudantes superem tais dificuldades. Assim, este trabalho tem como objetivo o tratamento de dois problemas ortogrÃficos especÃficos e inter-relacionados: o apagamento do -r em coda final de verbos no infinitivo, erro ortogrÃfico de fonte fonolÃgica e a inserÃÃo desse rÃtico ao final de palavras formando, indevidamente, o infinitivo verbal, o que configura uma hipercorreÃÃo. Tais problemas ortogrÃficos foram os mais frequentes â nos textos de alunos de duas turmas do 8 ano do ensino fundamental II â analisados neste estudo, daà a necessidade de uma intervenÃÃo. Para a fundamentaÃÃo teÃrica deste estudo, foram considerados, principalmente, alguns processos fonolÃgicos apresentados por Seara, Nunes e Lazzarotto-VolcÃo (2015), as reflexÃes e pesquisas de Cagliari (2001, 2002b), bem como, os estudos de Morais (2007a, 2007b, 2007c, 2008), Bortoni-Ricardo (2004a, 2004b), Bortoni-Ricardo e Oliveira (2013), Callou, Serra e Cunha (2015). Trata-se de uma pesquisa-aÃÃo de carÃter quanti-qualitativo. Primeiramente, foi realizado um diagnÃstico com aplicaÃÃo de redaÃÃes para a identificaÃÃo dos erros mais recorrentes nos textos dos alunos da primeira turma; e um ditado de frases para verificaÃÃo, apenas, dos erros em foco, na segunda turma, visto que tais problemas jà haviam sido selecionados a partir do diagnÃstico inicial na turma 1. Para o tratamento, foram realizadas intervenÃÃes pedagÃgicas periÃdicas, dentro do tempo pedagÃgico destinado Ãs aulas de lÃngua portuguesa. As atividades aplicadas foram baseadas na reflexÃo da escrita com o apoio de textos nos diversos gÃneros. Os resultados apontaram melhoria considerÃvel na escrita correta dos verbos no infinito. Chegou-se à conclusÃo de que atividades ortogrÃficas planejadas e aplicadas com regularidade geram resultados positivos. / Orthographic norms are social conventions designed to facilitate written communication. The school has the role of developing activities that promote the appropriation of the rules by the students, and the Portuguese teacher is responsible for including in their teaching practices the study of the correct notation the written language, since knowledge of spelling has social relevance and are necessary for the competent use of the language. However, learners show difficulties in spelling, even in the final grades of middle school. Many of these difficulties are related to oral language, often their texts present several words written as they are pronounded. It is clear that the students do not have the mastery of the orthographic system and they do not know the differences between written language and oral language. It is necessary, therefore, that a pedagogical work be developed by the teacher so that the students overcome these difficulties. Thus, this work has as objective the treatment of two specific and interrelated orthographic problems: deletion of -r in the final codas of verbs in the infinitive, orthographic error of phonological source and the insertion of this rhotic at the end of words forming, unduly, the verbal infinitive, which constitutes an overgeneralization of the rule. Such spelling problems were the most frequent - in the texts of students from two classes of the 8th grade of middle school - analyzed in this study, hence the need for an intervention. For the theoretical basis of this study, some phonological processes presented by Seara, Nunes and Lazzarotto-VolcÃo (2015), the reflections and researches of Cagliari (2001, 2002b), as well as the studies of Morais (2007a, 2007b, 2007c, 2008), Bortoni-Ricardo (2004a, 2004b), Bortoni-Ricardo and Oliveira (2013), Callou, Serra and Cunha (2015) were considered. This study is a quantitative-qualitative action research. Firstly, a diagnosis was conducted with the use of essays to identify the most recurrent errors in the texts of the students in the first class; and a dictation of sentences to verify only the errors in focus in the second group, since such problems had already been selected from the initial diagnosis in class 1. For the treatment, periodic pedagogical interventions were carried out within the pedagogical time allotted to the Portuguese lessons. The activities were based on the reflection of writing with the support of texts in the different genres. The results pointed out considerable improvement in the correct writing of verbs in the infinitive. It was concluded that regularly scheduled orthographic activities generate positive results.

INTRODUÇÃO: As Estratégias de Diagnóstico e Intervenções Breves (EDIB) propostas pela Organização Mundial de Saúde são consideradas efetivas para o diagnóstico e prevenção dos agravos decorrentes do uso do álcool. Atitudes, crenças e expectativas dos profissionais de saúde em relação ao uso de álcool influenciam o efeito destas novas propostas. OBJETIVO: Este trabalho propõe a avaliação do efeito do treinamento em EDIB sobre as crenças e expectativas a respeito do uso de álcool. MÉTODOS: O estudo é do tipo observacional, transversal, comparativo, sobre uma amostra de 88 profissionais da atenção primária à saúde, provenientes de Ribeirão Preto e região, que concordaram em participar da pesquisa conforme os procedimentos éticos recomendados, treinados pelo Programa de Ações Integradas para Prevenção e Atenção ao Uso de Álcool e Drogas na Comunidade (PAIPAD) no período de 2003 a 2006. Os dados foram coletados através de questionários individuais aplicados antes do treinamento e no período de 4 a 6 meses depois. Os questionários incluíram um formulário sócio-demográfico, o Teste de Conhecimento sobre álcool e Intervenções Breves (IB), o Inventário de Expectativas e Crenças Pessoais acerca do Álcool (IECPA) e um formulário de estimativas sobre o uso do AUDIT (Alcohol Use Disorder Identification Test) e das IB. A amostra foi caracterizada quanto à prática e preparação profissional na atenção primária, papel, atitudes e crenças dos profissionais em relação aos problemas relacionados ao uso de álcool ou outras drogas pelos seus pacientes. RESULTADOS: No Teste de Conhecimento sobre álcool e Intervenções Breves, a pontuação média foi maior após o treinamento, passando de 4,1 para 5,57(Wilcoxon Test: z= -4,936; p 0,001). Os resultados médios do IECPA passaram de 93,45 pontos na fase pré para 78,74 pontos na fase pós-treinamento (Wilcoxon, z=-4,138; p 0,001). Através do teste de Spearman observou-se tendência à correlação positiva entre a aquisição de conhecimento e as variações no IECPA (p=0,095); o nível de conhecimento pré-treinamento e as estimativas de realização de EDIB(p=0,082); as estimativas de aplicação de AUDITS e o intervalo de tempo(p=0,009). As variações do IECPA se correlacionaram positivamente com as expectativas de aplicação de EDIB (Nonparametric Chi-Square: p=0,053). No Teste de Conhecimento, o nível médio (incompleto e completo) apresentou menor nível de aproveitamento que os outros níveis de escolaridade. As maiores variações no IECPA foram observadas entre os profissionais de nível de escolaridade superior (incompleto e completo). Os profissionais com ocupações de nível superior apresentaram maiores variações positivas quanto ao conhecimento que os de nível técnico, e maior redução na pontuação do IECPA. CONCLUSÕES: A estratégia de formação oferecida pelo PAIPAD foi efetiva, promovendo mudanças nas crenças e expectativas da equipe sobre uso de álcool, interferindo positivamente na conduta preventiva dos profissionais treinados junto aos pacientes. / BACKGROUND: The Strategies of Screening, Brief Intervention and Referral to Treatment (SBIRT) proposed by World Health Organization (WHO) are considered effective to perform the diagnosis and the prevention of damage caused by alcohol. Attitudes, beliefs and expectations of health professionals in relation to alcohol use have influence over the effect of these new proposals. OBJECTIVE: This study aimed at evaluating the effect of training in SBIRTs on the beliefs and expectations of professionals about the alcohol use. METHODS: The study is observational, cross-sectional and comparative, with a sample of 88 professionals of primary care, from Ribeirão Preto and region, who agreed to participate following ethical procedures, trained by Program of Integrated Action for Prevention and Attention to Alcohol and Drug Use in the Community (PAIPAD), in period from 2003 to 2006. Data were collected through individual questionnaires applied before the training and in the period from 4 to 6 months later. The questionnaires included a socio-demographic inventory, the Test of Knowledge about alcohol and brief interventions (IB), the Inventory of Positive Expectations and Beliefs about Alcohol (IECPA) and an inventory of estimates on the use of the AUDIT (Alcohol Use Disorder Identification Test) and brief interventions. The sample was characterized in relation to the practice and professional preparation in primary care, the professional role in primary care and attitudes and beliefs of professionals about problems related to alcohol or other drugs for their patients. RESULTS: In the Test of Knowledge about alcohol and brief interventions, the average score was higher after the training, increasing from 4.1 to 5.57 (Wilcoxon test: z =- 4.936, p0001). The IECPA average changed from 93.45 points to 78.74 points after intervention, in the post-training (Wilcoxon, z =- 4.138, p0001). A trend toward positive correlation between the acquisition of knowledge and changes in IECPA (p = 0,095) was found (Spearman test), as well the level of pre-training knowledge and estimates of conducting SBIRTs (p = 0,082), estimates of implementing AUDIT and the time (p = 0,009). In the Test of Knowledge, the intermediate level of schooling (complete and incomplete) showed lower score than the others. Variations of IECPA correlated positively with the expectations of applying SBIRTs (Nonparametric Chi-Square: p = 0,053). The highest changes in IECPA were seen among higher level professionals (complete and incomplete). The professionals of higher-level occupations showed bigger positive changes in knowledge than workers of technical level and higher reduction in scores of IECPA. CONCLUSIONS: The strategy of training offered by PAIPAD was effective, promoting changes in beliefs and expectations of the team about alcohol use, interfering positively in the preventive attitudes of trained professionals with the patients.

Purpose: The systematic review explored whether self-management interventions improve patient activation in long-term conditions, and if any improvements are greater than the amount of change experienced by patients in usual care or active control conditions. It also aimed to determine if positive effects on activation are maintained at follow-up. The empirical study sought to explore relationships between patient activation, psychological factors (depression and valued living), perceived clinician empathy, perceived symptom severity, self-management and demographic variables. It also examined whether depression, valued living and perceived clinician empathy are unique predictors of activation, and if activation is a unique predictor of self-management for MS, when relevant confounding variables are controlled for. Methods: For the systematic review, a comprehensive search of multiple electronic databases was conducted to identify intervention research reporting on patient activation outcomes, as measured by the short-form Patient Activation Measure (PAM-13), in people with long-term conditions. For the empirical study, a cross-sectional survey of 118 people with MS explored patient activation, MS symptom severity, valued living, depression, perceived clinician empathy, self-management for MS and demographic factors. Correlation and hierarchical regression analyses were employed to explore relationships between variables. Results: Twenty-five studies were eligible for inclusion in the systematic review, reporting a wide range of long-term conditions. Twenty-one studies (10 RCTs; 1 non-randomised study; and 10 uncontrolled studies) found an improvement in patient activation at post-intervention. Nine studies reported a significantly greater improvement in activation in self-management conditions compared with usual care or an active control at post-intervention. In six out of eight studies, gains in patient activation were maintained in the intervention group at follow-up. However, in four of these six studies, patient activation in the control group also improved over time. Findings from the empirical study suggested that only valued living was a significant predictor of patient activation after controlling for demographic variables and MS symptom severity. Neither depression nor perceived clinician empathy significantly predicted activation. After controlling for valued living, depression and perceived clinician empathy, patient activation independently predicted 5.5% of variance in self-management for MS. Both activation and perceived clinician empathy were significant predictors of self-management for MS. Conclusions: Self-management interventions improve patient activation in long-term conditions compared with usual care or active control. Patient activation gains appear to be maintained longer-term; however, the impact of self-management interventions on activation is unclear due to increases in activation in control groups over time. Valued living is associated with patient activation in MS, while patient activation and perceived clinician empathy are associated with MS self-management. Self-management interventions targeting valued living and the patient-clinician relationship may be effective for addressing low levels of activation in some patients with MS.

The current study evaluated the implementation of evidence-based reading interventions using a multifaceted implementation measurement approach. Multilevel modeling was used to examine how three direct measures of implementation related to each other and to student academic outcomes and to examine patterns of implementation across time. Eight instructional groups were video taped weekly for nine weeks, and pre- and post-test assessments were given to 31 at-risk kindergartners from two schools using established evidence-based practices. Each implementation measure represented a different measurement approach (i.e., discrete behavioral measurement, global ratings) and focused on different aspects of implementation (e.g., structural, process, or multicomponent elements). Overall, results of this analysis indicated that (a) the implementation tools were highly correlated with each other, (b) only the multicomponent tool independently accounted for group differences, (c) together the multicomponent and process-oriented measures appear to account for additional variance in group differences, and (d) there were no significant trends in implementation across time as measured by any of the tools, however there were significant differences in trends over time between groups when using the structural measure. Implications for research and practice are discussed, including the importance of taking a multifaceted approach to measuring implementation and aligning implementation measures with program theory.