A residência multiprofissional em saúde é uma modalidade de ensino de pós graduação lato sensu, voltada para a educação em serviço. Emerge no contexto brasileiro como uma proposta complementar a fim de se atingir as metas e os princípios preconizados pelo sistema único de saúde (SUS), principalmente quanto à integralidade. Além de trazer implicações e lançar desafios ao exercício profissional do psicólogo, inserindo-o no entrelaçamento de campos densos e complexos (saúde, educação e políticas públicas), a modalidade propõe que profissionais com formações diferentes atuem num mesmo campo, com discussões e intervenções conjuntas. A questão que move a pesquisa é a posição-sujeito no programa de residência multiprofissional face ao modelo de educação-saúde vinculado. Assevera-se que a posição-sujeito é objeto discursivo deslizante (de tessitura simbólica) que toma em consideração o sujeito constituído no claudicar da linguagem e interpelado pelo inconsciente e que se manifesta como efeito de significantes em direção ao grande Outro. Para tal, vale-se da interface dos aportes teóricos da análise de discurso pêchetiana e da psicanálise lacaniana. A análise de discurso sustenta o discurso como efeito de sentidos mediados pela ideologia e ocupa-se, especialmente, da incursão da alteridade do discurso-outro sobre o mesmo. A psicanálise lacaniana, por sua vez, reitera a primazia do inconsciente estruturado como linguagem diante de um eu imaginário e versa para o sujeito marcado como falta que, dividido, faz do discurso o estatuto do significado. Assim, é proeminente na análise do objeto a metodologia indiciária dada ao caráter simbólico e cambiante da posição-sujeito no discurso. A análise se realizou mediante o dispositivo da interpretação como gesto analítico, que acompanha as elações próprias do objeto. O corpora é constituído por uma materialidade escrita e por uma oral. A escrita compõe-se de recortes de leis, portarias e resoluções que fundam a modalidade de residência multiprofissional e reforçam os ideias do sistema único de saúde; a materialidade oral compõe-se de recortes e fragmentos discursivos advindos da transcrição de supervisões realizadas mediante a prática clínica do psicólogo-residente na cena hospitalar. Da análise, conclui-se que a materialidade escrita se posta como campo-Outro que ordena a estrutura política da residência multiprofissional e direciona a manutenção da ordem e reprodução das relações hierárquicas mediante ideologia assujeitante. Essa materialidade, por sua vez, age como intradiscurso e reverbera-se na memória discursiva e na prática clínica. A posição-sujeito, no plano da articulação significante, faz deslizar e produzir sentidos que denotam ora a manutenção e reprodução de uma posição fusionada ao discurso médico, científico-positivista; ora a posição-sujeito é marcada pelo saber condicionado ao fetiche da mercadoria, deflagrando a ordem do capital nas insígnias da multiprofissionalidade e da educação permanente. O trabalho propiciou, enfim, acompanhar as transmutações da posição-sujeito, independentemente do indivíduo ou da naturalização de sentidos provenientes da função que exerce. O objeto posição-sujeito reiterou a construção da realidade a partir da condição faltante. É essa condição faltante e incompleta que outorga ao desejo o modo de o sujeito se posicionar desta e outra maneira - na formação, no trabalho, na vida. / The multidisciplinary residency in health is a postgraduate modality of education, focused on the education service. It emerges in the Brazilian context as a complementary proposal in order to achieve the goals and the principles recommended by the Unified Health System (SUS), particularly as to the integrality. In addition to bringing implications and challenges for the psychology in professional practice, inserting it into the entanglement of dense and complex fields (health, education and public policy), the modality proposes that professionals with different backgrounds act in the same field, with joint discussions and interventions. The question that drives the research is the subject-position in multidisciplinary residency program in terms of the combined health-education model. It asserts that the subject-position is the sliding discursive object (symbolic texture) that takes into account the subject constituted in hobble of the language and questioned by the unconscious, and that manifests as significant effect towards of the great Other. For this, appraise the interface of the theoretical contributions of the Pecheutian discourse analysis and Lacanian psychoanalysis. The discourse analysis sustain the discourse as effect of senses mediated by ideology, and occupies, especially, of the incursion of otherness of the discourse-other about the same. The Lacanian psychoanalysis, in turn, confirms the primacy of the unconscious structured as a language face an imaginary self and seek for the subject marked as missing, that divided, makes of the discourse the statute of the meaning. Thus, it is prominent in the analysis of the object the circumstantial methodology given the symbolic and hobbling character of the position-subject in the discourse. The analysis was performed by the interpretation as an analytical gesture, accompanying the proper elations of the object. The corpora consists of a both written and oral materiality. The written consists of clippings of laws, ordinances and resolutions that found a modality of multiprofessional residency and reinforce the ideals of the unified health system; the oral materiality comprise of clippings and discursive fragments coming from the transcription of the supervision performed by the clinical practice of psychologist resident in the hospital scene. From the analysis, it is concluded that the written materiality stands as field-Other that ordains the political structure of multiprofessional residency and directs the maintenance of the order and reproduction of the hierarchical relations by the ideology. This materiality, in turn, acts as intradiscourse and reverberates in the discursive memory and in the clinical practice. The position-subject, in the plan of the significant articulation, slides and produce meanings that denote either the maintenance and reproduction of a position merged to the medical discourse, scientific-positivist; nevertheless the subject-position is marked by knowledge conditioned to the commodity fetish, triggering the order of the capital in the insignia of multiprofessionality and continuing education. The work led, finally, follow the transmutations of the position-subject, regardless of the individual or the naturalization of the senses from the function it holds. The object position-subject reiterated the construction of reality from the missing condition. It\'s that missing and incomplete condition that grants to desire the way that the subject will position in this and other way - in training, at work, in life.

INTRODUCTION: Mortality associated with hepatitis C virus (HCV) infection is increasing, yet only a small percentage of HCV-infected individuals are aware of their infections, complete treatment, and achieve a cure, defined as a sustained virologic response. In March 2015, the Section of General Internal Medicine at Boston Medical Center (BMC), New England’s largest safety-net hospital, implemented the Adult Primary Care HCV Treatment and Triage Program to increase access to treatment. We are unaware of prior studies that have explored a pharmacist-centered primary care-based HCV treatment model in the era of newer direct-acting antiviral (DAA) medications. OBJECTIVES: To gain a deeper understanding of the roles of each program staff member, as well as an understanding of how primary care providers (PCPs) who refer patients to the program perceive and interact with the program. Such an understanding will help promote implementation and dissemination of the program. METHODS: We conducted in-depth semi-structured interviews with six staff members and with five PCPs in the Section of General Internal Medicine at BMC who refer patients to the program. We asked staff members about their roles and their perception of the program’s impact on patient linkage to HCV treatment. We probed PCPs about their experiences with HCV screening, referral, and follow-up processes, and differences in accessing HCV treatment for their patients prior to and following the implementation of the program. We audiotaped and transcribed interviews, and identified major themes through qualitative analysis. RESULTS: We identified five major themes that characterize how the HCV treatment program delivers care: 1) efficiency (“So here I feel like…they get evaluated…they get treated. Boom, it’s done”); 2) clear and open communication (“…one of the strengths of our program is that we have…a lot of direct contact with patients…”); 3) personalized medicine (“…I've set up the pill box for them [patients]…we tailor it to whatever they need”); 4) high patient engagement (“So if I get a referral for a patient…I call the patient three times. If I haven’t heard from the patient…I send them a letter and I tell the PCP”); 5) patient empowerment through education (“I think patient education is the best thing…if the patient is involved then… they’ll do what they need to do”). Additionally, the public health social worker and the pharmacist play key roles in the program. The social worker supports patients throughout treatment and addresses psychosocial barriers to treatment engagement (“I had a patient…who stopped taking his medication because his apartment was infested with bed bugs…[Social worker] got the patient furniture for free and got an exterminator…”). The pharmacist provides medication management during face-to-face patient visits (“…I go over everything imaginable...proper adherence…adverse effects, interactions…”). CONCLUSIONS: The HCV treatment program at BMC is a promising model to deliver HCV treatment to urban, underserved patient populations. Our findings suggest that public health social workers and pharmacists may be one approach to increasing access to HCV treatment in primary care settings in the era of DAA medications. Further study of the program’s efficacy in improving HCV outcomes is warranted.

As exigências do cenário mercadológico requerem adaptações nos modelos de trabalho das empresas que visam sobrevivência no longo prazo por meio da satisfação das necessidades de clientes. Nesse contexto, o processo de desenvolvimento de produtos (PDP) é um processo crítico e de crescente importância. Sua alta relevância estratégica para as organizações, devido especialmente às rápidas mudanças nos ambientes de negócios, tem conduzido à necessidade da utilização de equipes multidisciplinares no processo, objetivando maximizar o valor agregado por meio dos conhecimentos específicos dos profissionais envolvidos. Nesse sentido, o conhecimento de mercado, preponderantemente possuído pelas equipes de vendas, é subsídio essencial para o desenvolvimento de novos produtos aderentes ao potencial de mercado. Portanto, a transferência de conhecimento entre os times de maneira colaborativa é fator crítico de sucesso. Assim, o presente trabalho propõe um método que auxilia a diagnosticar a efetividade de transferência de conhecimentos para o trabalho colaborativo entre os setores de desenvolvimento de produto e vendas. O método proposto apoia a identificação dos fluxos de conhecimento entre estas áreas, os tipos de conhecimento compartilhados e ferramentas utilizadas. O trabalho é desenvolvido por meio de uma pesquisa-ação realizada em uma organização do setor de comunicação e mídia. / Current market demands require adaptations in companies’ work models aiming for long-term survival through customer needs satisfaction. In this context, new product development (NPD) is a critical process with increasing importance. The high strategic relevance of the NPD process in organizations, mainly due to the rapid changing environments, led to the need of adopting multidisciplinary teams to maximize the added value through the specific knowledge of the professionals involved. In this sense, market knowledge, which is mostly possessed by sales teams, is an essential subsidy for the development of new products that are adherent to the market potential. Therefore, knowledge transfer between teams working in a collaborative approach is a critical factor of success. Thus, this work proposes a method that assists to diagnose the effectiveness of knowledge transfer for the collaborative work between NPD and sales departments. The proposed method helps to identify knowledge flows between these areas, the types of knowledge to be shared and tools used. This is developed by means of an action research in an organization of the communication and media sector.

O tratamento antineoplásico está associado a efeitos adversos sendo inúmeros na cavidade bucal que podem aumentar a morbidade e mortalidade nos pacientes. O suporte odontológico ao paciente com câncer se faz necessário, porém ainda não é uma realidade em vários centros de tratamento oncológicos. O objetivo do presente estudo foi capacitar as equipes de odontologia e equipe multidisciplinar dos centros oncológicos pediátricos da capital e interior do RS, a fim de gerar conhecimento técnico-científico sobre as complicações bucais do tratamento oncológico para melhorias no manejo do paciente infanto-juvenil com câncer. Foi realizado um curso de capacitação de profissionais da área de saúde no manejo de pacientes em tratamento oncológico com carga horária de 3 horas/aula. Os participantes responderam um questionário pré e pós-aula (19 questões). Foi realizada análise descritiva, teste não paramétrico de Wilcoxon para a avaliação do resultado geral préteste/ pós-teste e o teste não paramétrico de McNemar para avaliação das questões de forma individualizada O nível de significância de 5% de probabilidade ou o p-valor correspondente foi considerado. Foram realizadas 11 capacitações contabilizando na amostra final 270 participantes. Os participantes foram 215 (92,3%) do gênero feminino, principalmente dentistas/estudantes de odontologia (24,5%) e técnicos de enfermagem (23,6%) com experiência de até 5 anos (50,7%). A média de acertos no préteste foi de 9,85 (51,89%) e no pós-teste 14,35 (75,57%) sendo esta diferença estatisticamente significante (p>0.001). O aumento médio de acertos após a realização da intervenção foi de 68,66%. Conclui-se que a capacitação foi eficiente para disseminar e aprofundar os conhecimentos sobre o manejo odontológico do paciente em tratamento oncológico e atingiu os principais centros de referência de tratamento do câncer infanto-juvenil do estado. / The antineoplastic treatment is associated with side effects being several of them observed in the oral cavity contributing for patient’s morbidity and mortality. Oral care in cancer patients is necessary, but it is not yet a reality in several cancer treatment centers. The aim of the present study was to perform a training course to dental and multidisciplinary teams in the pediatric cancer centers in southern Brazil, in order to improve knowledge about oral complications in pediatric and juvenile cancer treatment. The training course for health professionals involved the management of patients undergoing oncological treatment with a 3 hours class. Participants answered a pre and post-test (19 questions). Descriptive analysis, non-parametric Wilcoxon test (for overall pre-test / post-test) and McNemar's non-parametric test (questions individually) were performed. The significance level of 5% probability or the corresponding p-value was considered. Eleven trainings were carried out and involved 270 participants. The sample was composed by 215 (92.3%) female, mainly dentists / dental students (24.5%) and nursing technicians (23.6%) with experience of up to 5 years (50.7%). The mean accuracy in the pre-test was 9.85 (51.89%) and in the post-test was 14.35 (75.57%), and this difference was statistically significant (p> 0.001). The average of correct answers after the intervention was 68.66%. It is concluded that the training was efficient to disseminate and improve the knowledge about the oral care of the patients submitted to cancer treatment. Also, we can reached the main centers of reference for pediatric and juvenile cancer in southern Brazil state.

Previous studies have suggested that Davis tube (DT) experiment can used to study wet low intensitymagnetic separation (WLIMS) for magnetic iron ores. But DT process has never been used to mapWLIMS process, specifically in a geometallurgical framework. This thesis work is a step towardsfulfilling this gap by studying the Davis tube experiment performed on 13 different samples fromLeveäniemi iron ore deposit. The methodology adapted to map WLIMS concentrate quality includesstudy and analysis of feed, DT and WLIMS. Analyses were made using experimental data, processingdata using some analytical tools, some data-processing tools and post processing tools. For coveringthe geometallurgical aspect the analysis was done for both elements and minerals. The results fromthis study has reviled that DT can be used to predict WLIMS concentrate quality to an acceptablelevel of confidence. Furthermore, results show that a combination of DT and WLIMS informationproduce very accurate and highly reliable models for predicting and mapping WLIMS concentratequality. This work serves as the first step towards studying an unexplored field pertaining to magneticiron ore concentrate and has opened door to possible future work that could take this work a stepfurther. Supplementing this study with more data from different sample is required not only tovalidate the model but also to make it better. A better modal mineralogy of the samples is needed tounlock the full potentials of mineralogical modelling approach used in this work. / <p>I am a graduate from the of Erasmus Mundus masters in Georesource Engineering, 2017.</p> / Primary Resource Efficiency by Enhanced Prediction (PREP)

A presente pesquisa foi desenvolvida com o objetivo de descrever a ocorrência de moléstia degenerativa osteoarticular (MDO) em pacientes atendidos em clínica especializada de fisioterapia, caracterizando a população de estudo segundo variáveis demográficas, socioeconômicas, prática de atividades físicas, índice de massa corporal e uso anterior de fisioterapia, verificando possíveis associações com a atividade profissional, afastamento do trabalho, antecedentes familiares e freqüência de orientação médica. Foram estudados 108 pacientes encaminhados para um serviço público de fisioterapia localizado em Sertãozinho, São Paulo, com diagnóstico clínico e radiológico comprovado de MDO. O estudo identificou que a doença predomina no sexo feminino (69,4%) e na faixa etária acima de 60 anos para ambos os sexos. A obesidade é preponderante entre as mulheres (40% contra 24,3%, respectivamente). Sessenta e dois por cento dos participantes já haviam feito fisioterapia, com índices progressivamente crescentes de indivíduos das faixas etárias mais avançadas. O estudo permite ainda identificar que as áreas da coluna foram as mais comumente atingidas (64,9%), com predomínio da atividade braçal (94,5%). A maioria dos participantes referiram postura durante a atividade laborativa que favorecia o desenvolvimento da MDO, porém somente 25,9% referiram afastamento anterior do trabalho. A dor foi o principal sintoma, acometendo mais intensamente a coluna e o quadril, e os antiinflamatórios corresponderam ao medicamento mais comumente utilizado. Quarenta dos 108 participantes referiram antecedentes familiares de MDO. Tratamento cirúrgico foi indicado em 10,2% dos participantes, predominando entre os indivíduos com acometimento de joelho e naqueles com dor leve e moderada. Ocorreu predomínio dos estratos econômicos C e D, sendo que o entendimento da evolução da doença pelos participantes, independentemente do estrato econômico, foi referido por apenas 25,9% deles. As atividades laborais, embora não responsáveis pelo desenvolvimento da doença, interferiram no agravamento dos sintomas, principalmente na dor articular, sendo esta o principal fator limitante do exercício profissional. Enfatiza-se a necessidade de implantação de programas de saúde pública voltados à prevenção de MDO e atendimento multidisciplinar, integrando a fisioterapia aos serviços de atenção primária à saúde, além de priorizar o aprimoramento da relação do profissional com o paciente, de modo a fazê-lo entender sua doença e participar ativamente do processo terapêutico. / This research was carried out with the objective of describing the occurrence of osteoarthritis in patients that attended a specialized clinic of physical therapy, characterizing the studied population according to demographic and social-economics variables, practice of physical activities, Body Mass Index (BMI) variables and the prior use of physical therapy, verifying possible associations with professional activity, labor withdraw, family background and frequency of medical orientation. A hundred eight patients were studied and sent to a public clinic of physical therapy in Sertãozinho (State of São Paulo), with clinical and radiological diagnose of osteoarthritis. The study identified that the disease prevails in the female (69,4%) and at the age above 60, for both sex. Obesity is preponderant among women, (40% and 24,3%, respectively). Sixty and two percent of all the patients had been submitted to physical therapy, with progressively increasing index of elderly patients. This study also allows to identify that most commonly affected articulation was the column (64,9%), prevailing manual activity (94,5%). Most of the patients referred position during labor activity that favored the development of osteoarthritis, but only 25.9% referred previous labor withdraw. Pain was the main symptom, affecting more intensively column and hip. Antiinflammatory drugs were the most frequent medication taken by these patients. Forty out of the 108 participants referred family history of osteoarthritis. Surgical treatment was indicated in 10,2% of the participants, mostly in patients with knee involvement and those with mild to moderate pain. Predominance of economic stratus C and D was observed, and understanding the development of the disease by these patients was referred by only 25.9% of them. Labor activities, although not responsible for the development of the disease, caused worsening of symptoms, mainly in articular pain, being this one the main limitant factor in professional activity. There is a need to improve public health care programs that look forward preventing osteoarthritis, and also a multidisciplinary care for these patients, integrating physical therapy to primary public health care services, besides prioritizing the improvement of doctor/patient relationship in a way of making patients to understand their disease and to participate in the therapeutic process.

INTRODUÇÃO: Observado inicialmente em países desenvolvidos, o envelhecimento populacional atualmente é uma realidade presente também em países em desenvolvimento. O diabetes mellitus consiste em uma doença de caráter crônico, envolve acompanhamento e tratamento por toda a vida, e apresenta dificuldades no monitoramento e na garantia de uma boa adesão dos pacientes às orientações das equipes de saúde. OBJETIVO: Estudar as características dos idosos com diagnóstico de diabetes mellitus tipo 2, cadastrados em uma unidade de saúde da família, em relação à assistência à saúde, parâmetros clínicos de monitoramento e estado nutricional, a partir da avaliação dos prontuários clínicos destes pacientes. MÉTODO: O estudo é descritivo, com abordagem quantitativa, com fonte de dados secundários. O grupo de estudo é composto por usuários atendidos em uma unidade de saúde da família de Ribeirão Preto-SP, com diagnóstico confirmado de diabetes mellitus tipo 2, cadastrados no Sistema de Informação da Atenção Básica (SIAB), com idade igual ou superior a 60 anos, apresentando ao menos uma consulta de acompanhamento no último ano. Foram compilados dados referentes aos hábitos de vida, assistência à saúde e estado nutricional no primeiro ano de acompanhamento na unidade e no ano da coleta da dados. As informações referentes aos dois períodos estudados foram comparadas por meio de estatística descritiva. Para a comparação de médias das variáveis foi usado o teste t de Student para dados pareados. RESULTADOS: Foram analisados os prontuários de 60 idosos, com média de 9 anos de acompanhamento no serviço. Os diagnósticos das comorbidades mais frequentes foram hipertensão arterial sistêmica, dislipidemias e obesidade. Entre os parâmetros bioquímicos, houve redução de hemoglobina glicada (HbA1C), glicemia de jejum e lipídios para homens e redução de colesterol total, HDL colesterol e LDL colesterol entre as mulheres. Ocorreu redução na frequência dos registros de orientação alimentar no segundo período, com orientação específica de nutricionista em apenas 15% dos prontuários. A orientação mais frequente relatada referiu-se ao fracionamento das refeições. Além do nutricionista, o farmacêutico e fisioterapeuta foram os profissionais com maior frequência de visitas domiciliares. Os registros de participação em grupos de educação em saúde representaram apenas 5% da amostra. CONCLUSÃO: Os resultados encontrados evidenciam atendimento clínico eficiente no monitoramento e controle do diabetes mellitus, porém reforçam a necessidade de estímulo às práticas de promoção e prevenção da saúde no âmbito da atenção básica, com o objetivo de prevenção de complicações relacionadas ao envelhecimento e ao diabetes mellitus, contribuindo para melhora da qualidade de vida dos usuários do serviço, aumento da resolutividade da atenção básica e redução dos custos para o Sistema Único de Saúde. / INTRODUCTION: Initially observed in developed countries, the aging population is now present in developing countries. The diabetes mellitus consists in a chronic disease that involves monitoring and treatment for a lifetime, with difficulties to monitoring and to assurance a patient compliance to health team recommendations. OBJECTIVE: To study type 2 diabetes mellitus aged characters, registered in a family health unit, in relation to de health care, medical parameter and nutritional assessment, from medical records of them. METHODS: It\'s a descriptive study, with quantitative approach and secondary data source. The study group is compose of patients treated in a family health unit in Ribeirão Preto - SP, with confirmed type 2 diabetes mellitus diagnosis, register in the Primary Care Information System, aged over 60 years, presenting at least one follow-up visit last year. Data were compiled relating to lifestyle, health care and nutritional status in the first and last year of the monitoring unit. Two periods information were compared using descriptive statistics. To compare the means of the variables we used the Student t test for paired data. RESULTS: The elderly medical records were analyzed with average of nine years in follow-up service. The most common comorbidities diagnosis were hypertension, dyslipidemia and obesity. Among the biochemical parameters, glycated hemoglobin (HbA1c), fasting plasma glucose and blood lipids decreased among men and total cholesterol, HDL cholesterol and LDL cholesterol decreased among women. The frequency of dietary guidance recording decreased in the second period, with specific nutritionist guidance in only 15% of the records.! Fractionation meal is the most frequent orientation reported. In addition to the nutritionist, pharmacist and physiotherapist were professionals with higher frequency of home visits. Records of participation in health education groups accounted for only 5% of the sample. CONCLUSION: The results show efficient medical care in monitoring and control of diabetes mellitus, but reinforce the need for stimulus to promotion and prevention health practices in the scope of primary care, in order to prevent complications related to aging and diabetes mellitus, contributing to improved quality of life for service users, increasing resoluteness of primary care and reducing costs for the Unified Health System.

Submitted by Daniella Santos (daniella.santos@ufma.br) on 2017-08-08T16:12:41Z No. of bitstreams: 1 ANTONIO JOSÉ ARAÚJO LIMA.pdf: 2092877 bytes, checksum: 8c1569f24bbbed888a7219971047055e (MD5) / Made available in DSpace on 2017-08-08T16:12:41Z (GMT). No. of bitstreams: 1 ANTONIO JOSÉ ARAÚJO LIMA.pdf: 2092877 bytes, checksum: 8c1569f24bbbed888a7219971047055e (MD5) Previous issue date: 2017-05-31 / Child hospitalization is a difficult process for the child's development in a hostile and indifferent environment with resistance to adapt to the new reality. The playful care helps to make the stay in the hospital easier, favors the child's development and healing. The feeling of finitude of life afflicts the child, the family those who accompany him in the hospital, during hospitalization. The imminent fear of death, the homesickness of the home makes difficult the relationship with: nurses, doctors, psychologists, physiotherapists, among others. In the context, we investigated the perceptions of professionals of the multidisciplinary health team in relation to the development of play activities in 2 pediatric public hospitals of São Luís/MA. An exploratory, descriptive research was developed. The participants were 8 professionals belonging to the health area, among them, 2 are doctors, 2 nurses, 2 psychologists and 2 occupational therapists, 6 of which are female and 2 are male, with an average of 6 years of professional experience in hospitals. The data were collected through semi-structured interviews. The results indicate that play activities developed with children are relevant in the processes of socialization and integration of the child to the reality of hospitalization. The professionals of the multidisciplinary health team emphasize that the play activities developed in pediatric hospitals contribute to the recovery process of the child's health, adding to the treatment of the pathology. / O atendimento lúdico contribui para tornar a permanência no hospital, mais fácil, favorece o desenvolvimento da criança e cura. O sentimento de finitude da vida aflige a criança, a família os que a acompanham no hospital, durante a internação. O medo iminente de morte, a saudade do lar dificulta o relacionamento com: enfermeiros, médicos, psicólogos, fisioterapeutas, entre outros. No contexto, investigaram-se as percepções de profissionais da equipe multidisciplinar de saúde em relação ao desenvolvimento de atividades lúdicas em 2 hospitais públicos pediátricos de São Luís/MA. Desenvolveu-se uma pesquisa exploratória, descritiva. Os participantes foram 8 profissionais pertencentes à área da saúde, dentre esses, 2 são médicos, 2 enfermeiros, 2 psicólogos e 2 terapeutas ocupacionais, sendo 6 pertencentes ao sexo feminino e 2 ao sexo masculino, possuindo em média 6 anos de experiências profissionais em hospitais pediátricos. Os dados foram coletados por meio de entrevistas semiestruturadas. Os resultados sinalizam que as atividades lúdicas desenvolvidas com crianças são relevantes nos processos de socialização e integração da criança à realidade da internação. Os profissionais da equipe muldisciplinar de saúde, enfatizam que as atividades lúdicas desenvolvidas nos hospitais pediátricos contribuem no processo de recuperação da saúde da criança, somando no tratamento da patologia.

Effective team working across disciplines is essential to solve the technological and managerial problems associated with construction projects. However, while it is widely accepted that this method of working is critical to the achievement organisational goals, it is a poorly understood process. Generic best practice recipes on how to improve team work in collaborative projects appears to have had limited impact on performance. Unless the realities of implementing and managing such joint endeavours are conceptualised and articulated in a manner that reflects the actual processes and patterns of behaviour, multi-disciplinary team working will remain a poorly understood working model. The goal of this work was to develop a conceptual framework that visualises the real success factors of multi-disciplinary working so that practitioners can apply a new understanding of predictable processes and patterns of behaviours to improve collaborative project outcomes. To achieve this, the project started with an exploration of critical success factors in multi-disciplinary design projects, encompassing extensive interviewing, workshops and a survey followed by a grounded theory (GT) study of collaborative working in six multi-disciplinary design projects. The switch to GT methodology offered possibilities to further probe into the dynamics of multi-disciplinary team working from the perspective of the team members. The findings show that team working in multi-disciplinary design projects can be explained through the social process of informalising. Informalising refers to the strategies practitioners use to cope with the multiple pressures and unforeseen demands that pervade the collaborative design environments. It portrays the relevance of managing of expectations and value-judging to remain effective and efficient in the face of change and uncertainty. These are critical factors that influence the project trajectory and experience of those involved. Alongside these results the work also demonstrates the importance of so called super soft factors such as shared values, creativity and innovation and passion and enthusiasm to achieve positive project outcomes. Overall, recognising that the process of informalising forms an essential part of cultivating collaboration, and hence getting the work done, more attention should be given to understand such activity in today s turbulent and transient project organisations. Knowledge and understanding of this form of emergent and improvisational strategy may enable managers to predict and control patterns of behaviour inherent in the management of collaborative design projects, and positively influence project outcomes in terms of perceived value and profit.

The rights and obligations of States concerning their shared transboundary groundwates are not fully understood. The primary reasons for this are the complex characteristics and behaviours of groundwater, and the lack of full understanding of its interconnection with the surrounding environment. Consequently, States appear to be reluctant in concluding legally binding arrangements that specifically address this topic. This complexity is further intensified under difficult political situations, whereby the Parties sharing groundwater are unable to foresee the benefits of cooperation concerning this resource. This thesis represents an inquiry into the rules and principles governing the utilization of shared transboundary groundwater, and how cooperative frameworks can be initiated implemented, in the complex political context of the Mountain Aquifer shared between Israel and Palestine. The main objective of this thesis is to achieve an integrative mutually beneficial arrangement in the case of the Mountain Aquifer, based on lessons learnt from international law. The proposal for approaching the problem within the Palestinian-Israeli context is to progressively establish a solid basis for long-term sustainable arrangements. The progressive approach starts with a non-binding flexible arrangement that can serve the short-term need, which gradually builds up into a final legally binding arrangement based on international law.