A pesquisa tem como objeto a atuação das associações transnacionais de defensorias públicas e de defensores públicos, especialmente a Associação Interamericana de Defensorias Públicas (AIDEF) e o Bloco de Defensores Públicos Oficiais do MERCOSUL (BLODEPM), e a sua mobilização em prol da difusão da defensoria como modelo nas Américas, e de seu fortalecimento institucional. A análise realizada neste trabalho foi exploratória, na medida em que buscou reconstituir a atuação das instituições regionais de representação defensorias nas Américas. Como metodologia, o estudo utilizou análise de conteúdo para examinar as atas das associações, buscando mapear a rede de atores com os quais estas instituições interagiram. O referencial teórico desta pesquisa são os estudos sobre acesso à justiça e reforma judicial, associados ao debate sobre difusão de ideias, constituição de redes e processos de mobilização. Os achados deste trabalho complementam a literatura sobre políticas de acesso à justiça (BERNEY; PIERCE, 1975; SMITH, 2011) e a sua explicação para o desenvolvimento das instituições que prestam o serviço de assistência judiciária gratuita baseada quase exclusivamente em condicionantes internas dos países, de modo a apresentar que prováveis fatores externos podem influenciar o desenho desse tipo de política. Consideramos que a criação das instituições transnacionais como a AIDEF e o BLODEPM e a adoção de normativas regionais que recomendam aos países a adoção do modelo de defensorias públicas independente e autônoma na região é algo excepcional que permite olhar para os processos de estruturação e reformas destes serviços nos países latino-americanos sob o viés da mobilização de defensores públicos e da difusão de ideias. / The research has as its object the work of the transnational associations of public defenders and public defenders, especially Inter-American Association of Public Defender´s Office (AIDEF) and the MERCOSUR Official Public Defender Block (BLODEPM), and its mobilization for the dissemination of de Defender’s Office as a model in the Americas, and its institutional strengthening. The analysis carried out in this study was exploratory, because it sought to reconstitute the performance of regional representative representation institutions in the Americas. As a methodology, the study used content analysis to examine the minutes of the associations, seeking to map the network of actors with whom these institutions interacted. The theoretical framework of this research is the studies on access to justice and judicial reform, associated with the debate about the diffusion of ideas, the constitution of networks and processes of mobilization. The findings of this study complement the literature on access to justice policies (BERNEY; PIERCE, 1975; SMITH, 2011) and its explanation for the development of institutions providing free legal aid services based almost exclusively on internal conditions of countries, in order to show that probable external factors can influence the design of this type of policy. We believe that the creation of transnational institutions such as AIDEF and BLODEPM and the adoption of regional norms recommending countries to adopt the model of independent and autonomous Public Defender’s Offices in the region is an exceptional opportunity to look at the processes of structuring and reforming these services in the Latin American countries under the bias of the mobilization of public defenders and the diffusion of ideas.

Neste trabalho avaliou-se a influência da forma da seção transversal e da excentricidade do carregamento sobre o efeito de confinamento em pilares de concreto encamisados com polímeros reforçados com fibras (PRF). Para estas avaliações foi utilizada a análise experimental, por meio de ensaios de pilares sob flexo-compressão, e a análise numérica com o método dos elementos finitos. Observou-se que ocorreram reduções significativas dos efeitos de confinamento em pilares de seção quadrada e retangular quando a relação entre o raio de arredondamento dos cantos e o maior lado da seção transversal diminuiu. A influência da relação entre o lado maior e menor, no caso de pilares de seção retangular, não foi tão significativa se comparada ao efeito redutor do raio de arredondamento mencionado anteriormente. Ocorreram ganhos de resistência em todos os pilares ensaiados, indicando que o encamisamento com PRF pode ser utilizado mesmo em situações em que a força de compressão seja aplicada com pequenas excentricidades. O efeito da excentricidade sobre o confinamento dependeu da forma da seção transversal considerada. Em pilares de seção circular a excentricidade reduziu levemente os efeitos de confinamento. Nos pilares de seção quadrada a excentricidade não reduziu significativamente os efeitos de confinamento, sendo que para os menores raios de arredondamento o efeito de confinamento foi até maior na presença da excentricidade. Nos pilares de seção retangular observou-se que aplicando a excentricidade na direção da menor inércia o comportamento foi semelhante ao dos pilares de seção quadrada. Porém, aplicando a excentricidade na direção da maior inércia observou-se um grande efeito de confinamento, maior inclusive que no pilar centrado. / In this work the influence of the cross section shape and eccentricity of the compressive load on the confinement of concrete columns wrapped by fiber reinforced polymer (FRP) was evaluated. Experimental analysis, through flexural compression tests of columns, and numerical analysis developed through the finite element method were used to study these effects. Significant reductions of confinement effects were noticed in square and rectangular cross sections when the ratio of the round off radius to the major side of the column was reduced.The ratio between the major and minor side in rectangular columns was not so important to define the effectiveness of confinement as was the fore mentioned factor. Increases of strength were noticed in all columns tested, showing that FRP wrapping can be successfully used even with small eccentricities of loading. The effect of the eccentricity on the confinement showed to be dependent on the cross section shape. In circular columns the eccentricity of loading reduced the confinement effects. For the square cross section columns tested the confinement was not significantly affected by the eccentricity. In fact, for square columns with low round off radius, the eccentricity increased the confinement effects. Rectangular columns subjected to eccentric loading in the direction of the minor inertia showed a behavior similar to square columns. On the other hand, with the eccentricity applied in the direction of the major inertia, an important confinement effect was observed, more important than in the case of concentric loading.

<b>Background:</b> External Quality Assessment assesses the quality of the structures, processes and outcomes of health facilities using pre-determined standards. South Africa is introducing a national policy on External Quality Assessment, operationalised by a newly established External Quality Assessment agency: the Office of Health Standards Compliance. This thesis seeks to answer three research questions: What is the relationship between External Quality Assessment and patient outcomes (specifically Healthcare Associated Infections) at the specialist-care facility level in South Africa? What are the facilitators of and barriers to health facility performance (i.e. attainment of compliance with standards) in External Quality Assessment at the district hospital level in South Africa? What has been the experience of External Quality Assessment by frontline healthcare workers at the district hospital level in South Africa? <b>Methods:</b> Three systematic literature reviews are conducted that attempt to identify the existing evidence base for the above-mentioned research questions in the international literature. A convergent parallel mixed methods design is used to answer the research questions, comprising an Interrupted Time Series Analysis and a multiple embedded case study of two pairs of health facilities that had undergone External Quality Assessment by the Office of Health Standards Compliance. The Interrupted Time Series Analysis assesses whether an effectiveness relationship can be demonstrated between External Quality Assessment and the Healthcare Associated Infection Methicillin-resistant Staphylococcus Aureus (MRSA) in eight South African specialist-care hospitals using monthly MRSA data from 2004 to 2014. MRSA is used in this thesis as the proxy patient outcome indicator. In order to answer research questions two and three, I participated in a district hospital External Quality Assessment as a participant observer as well as conducted fifteen in-depth interviews with healthcare workers from two pairs of district hospitals and thirteen in-depth interviews with Office of Health Standards Compliance inspectors. These findings are triangulated with health facility External Quality Assessment reports. <b>Results:</b> No conclusive evidence is found of a relationship between implementation of External Quality Assessment and changes in MRSA. The major theoretical lenses drawn from in the analysis of the qualitative findings are systems thinking theory and regulatory theory. The qualitative research suggests that facilitators of performance in External Quality Assessment in South Africa include strong directional leadership within health facilities, a collaborative organisational culture, a whole systems approach, staff development, incentives, a robust information system and a supportive External Quality Assessment agency. The research also identifies poor alignment of External Quality Assessment standards, under-developed and limited human resources, inadequate decision-making space afforded to district hospital leadership, limited financial resources, the use of penalties and negative staff perceptions of External Quality Assessment as barriers to health facility performance in External Quality Assessment. In unpacking the experiences of South African healthcare workers of External Quality Assessment, this research finds that the work of the Office of Health Standards Compliance is valued by healthcare workers as a potential educational opportunity and is useful in providing the health system with a means to compare health facilities using a standardised tool. The implementation of the Office of Health Standards Compliance's External Quality Assessments requires significant improvement and, in their current form, they have potential unintended negative consequences on healthcare worker motivation as well as potentially, inadvertently encouraging the gaming of External Quality Assessment. <b>Conclusion:</b> The Office of Health Standards Compliance is being set up in such a way that once fully established it will be the primary regulator of quality of care in the South African health system. This thesis attempts to identify some of the strengths and weaknesses of this largely under-researched health system intervention and to contribute to strengthening its implementation.

Most reinforced concrete (RC) structures are continuous in some way, and many of these structures are strengthened using fibre-reinforced polymer (FRP) materials as a routine basis. The problem of how to exploit moment redistribution in FRP-strengthened continuous RC structures is still unresolved. Reduction in ductility has been recognised in such structures. However, FRP-strengthening is introduced as an effective method to enhance the strength and load bearing capacity of RC structures. As a result, design guidelines worldwide employ conservative guidance for design, such that they limit the potential exploitation of moment redistribution in FRP-strengthened members. To date, limited research has been conducted into the redistribution of bending moment in such structures. Previous theoretical studies have not yet led to a reliable and rigorous solution for quantifying moment redistribution throughout the loading cycle. In addition, a wide scatter of moment redistribution percentage findings, from zero to 56%, has been reported in previous experimental studies. This demonstrates the need for further research to effectively characterise the circumstances under which moment redistribution can be relied on, both into and out of FRP-strengthened zones in continuous RC flexural members. This research aims to encourage the use of FRP for strengthening existing RC structures in a more efficient manner. The findings help to better understand restrictions on moment redistribution into and out of FRP-strengthened zones, effect of mechanical anchorage of the FRP on the degree of moment redistribution, and the extent to which moment redistribution can be relied on. A new analytical model, only based on structural mechanics, is developed in this research. A comprehensive set of large-scale structural testing is undertaken to validate the analytical model under various strengthening circumstances. The analytical and experimental results show that moment redistribution can occur into FRP-strengthened zones to full capacity without any limitation, even if the FRP is unanchored. Further, bending moment can also be redistributed out of strengthened zones to a considerable extent (up to 20%), depending on the quantity and stiffness of the FRP, and provided that the FRP is fully anchored. A set of parametric studies is conducted to investigate the effectiveness of different parameters on the level of moment redistribution. The major parameters include compressive strength of concrete, steel reinforcement proportion, steel yield strength, FRP quantity and stiffness, ultimate strain of the FRP, strengthening configuration, load position, beam shape, and curvature ductility. The outcomes demonstrate that it is not only the curvature ductility of FRP-strengthened sections that is important to the capacity for moment redistribution (out of such zones), but also the mode of failure, strength of the other critical zones, the ratio of stiffness between the critical zones, and the loading arrangement. It is concluded that moment redistribution in continuous FRP-strengthened concrete structures should be permitted both into and out of strengthened zones, provided that the criteria for such redistribution are met.

O presente trabalho avaliou a influência dos concretos de ultra-alto desempenho com fibras (UHPFRC) e sem fibras (UHPC) no reforço de pilares curtos de concreto armado de seção transversal circular e quadrada. Avaliou-se também a adição de armaduras adicionais de reforço e de polímeros reforçados com fibras de carbono (PRFC) em alguns pilares reforçados. Para a avaliação deste novo sistema de reforço optou-se pela realização de um programa experimental e simulações numéricas. É importante ressaltar que no programa experimental, nenhum pilar reforçado possuía seção transversal maior que a seção do pilar de referência. Foi verificado por meio do programa experimental, que as camisas de UHPC apresentaram ruína de natureza frágil e não se recomenda a sua utilização a menos que acompanhada de mecanismos que garantam adequado confinamento do pilar reforçado. Nos pilares circulares e quadrados reforçados com UHPFRC foram verificados, respectivamente, incrementos de resistência de 106,4% e 83,6% onde o concreto do cobrimento foi substituído por UHPFRC, 154,3% e 111,7% onde além da substituição do cobrimento foram inseridas armaduras adicionais e 160% e 85,6% onde houve a colocação de PRFC após a substituição do cobrimento. Todos os pilares reforçados com UHPFRC não apresentaram destacamento da camisa de reforço. Foram realizadas simulações numéricas variando a espessura da camisa de UHPFRC e do número de camadas de PRFC tanto nos pilares de seção circular como nos pilares de seção quadrada. Por meio destas simulações, notou-se que a adição de pequenos incrementos de espessura da camisa de UHPFRC, proporciona elevados incrementos de resistência ao pilar reforçado, ao passo que o aumento do número de camadas de PRFC não influenciaria significantemente no incremento de resistência e sim na ductilidade do conjunto. / The present work evaluated the influence of ultra-high performance concrete with fibers (UHPFRC) and without fibers (UHPC) on the strengthening of short columns of reinforced concrete of circular and square cross section. It was also evaluated the addition of additional reinforcement and carbon fiber reinforced polymers (PRFC) on some strengthened columns. For the evaluation of this new system of strengthening we opted for the realization of an experimental program and numerical simulations. It is important to note that in the experimental program, no strengthened columns had a larger cross section than the reference column section. It was verified through the experimental program that the UHPC shirts presented ruin of a fragile nature and their use is not recommended unless accompanied by mechanisms that guarantee adequate confinement to the strengthened columns. In the circular and square columns strengthened with UHPFRC, respectively, resistance increments of 106.4% and 83.6% were verified, where the cover concrete was replaced by UHPFRC, 154.3% and 111.7%, in addition to the substitution of additional reinforcement were inserted and 160% and 85.6% where PRFC placement was performed after the replacement of the cover. All strengthened columns with UHPFRC did not present detachment of the strengthening jacket. Numerical simulations were performed by varying the thickness of the UHPFRC jacket and the number of PRFC layers on both the circular section columns and the square section columns. Through these simulations, it was noted that the addition of small thickness increments of the UHPFRC jacket would provide high increments of strength to the strengthened columns, while increasing the number of PRFC layers would not significantly influence the increase in strength but rather ductility of the assembly.

O programa federal de transferência de renda Bolsa-Família foi estudado nesta pesquisa com o objetivo de analisar a identidade local no processo de fortalecimento comunitário dos sujeitos que residem na periferia do município de São Paulo, utilizando como referência o bairro de São Miguel Paulista. Observou-se que na busca pelos direitos sociais básicos, esses sujeitos reagem a outras ações do Estado, as quais lhes negam e até mesmo silenciam a plenitude de experiências sociais e políticas no território. Neste viés, em um processo de gestão social, a renda confere condições básicas para a sobrevivência das famílias ao passo que pode sofisticar a tentativa de tutela e controle sobre as mesmas, levando-as ao silenciamento político e/ou a compactuar com a luta política dentro de limites institucionais nos quais as relações de poder encontram-se consolidadas. Para escutarmos a produção de sentidos a partir das interfaces entre o Bolsa Família e a identidade periférica em uma realidade dialética realizamos entrevistas com bolsistas. Por meio de seus discursos identificamos dispositivos cotidianos de resistência e de sociabilidade. No limite, a transferência de renda associada ao processo de pertencimento ao cotidiano da vizinhança podem impulsionar sentidos relacionados à emancipação individual e coletiva, favorecendo a construção de pontes à participação política / The federal program Bolsa Familia cash transfer was studied in this research in order to analyze the local identity in the community strengthening process of the individuals residing in the outskirts of São Paulo, using as reference the São Miguel Paulista neighborhood. It was observed that in the search for basic social rights, these guys react to other state actions, which they deny and even silence the fullness of social and political experiences in the territory. In this bias, in a social management process, income gives basic conditions for the survival of families while can sophisticate attempting to protection and control over them, leading them to the political silencing and / or condoning the political struggle within institutional boundaries in which power relations are consolidated. To listen to the production of meaning from the interfaces between the Bolsa Família and peripheral identity in a dialectic reality we conducted interviews with bolsistas. Through his speeches we identify everyday devices resistance and sociability. Ultimately, the transfer of income associated with the process of belonging to the neighborhood daily can boost meanings related to individual and collective emancipation, favoring the construction of bridges to political participation

Background: Although immunisation services are provided free at all public health facilities in South Africa, immunisation coverage remains variable and disease outbreaks still occur. The coverage rate in the Overberg district is recorded as 75.8%, below the national target of 90% (Western Cape Government Provincial Treasury 2013:2). The researcher wanted to understand what the barriers to accessing immunisation services were and how this might relate to other primary health care services. Methods: The researcher visited 22 households and interviewed nine mothers who had brought their children to Zwelihle Clinic to be immunised and nine community health workers servicing the Zwelihle community in the Overberg district, Western Cape Province. Findings: A key finding is that the data does not reflect the actual situation – children in the community either are immunised at other facilities or have left the catchment area, hence strong relationships between the facility and the community and an electronic patient tracking system become important. Findings impacting access to services include the attitude of administrative staff, waiting times and the impact of migratory communities. Recommendations are made to improve the quality of data, provide training to administrative staff, improve patient education, reduce waiting times and improve the relationship between the clinic and the community in order to better track patient migration / Health Studies / M.A. (Public Health)

Most of the blood transfusion facilities had adequate space, but lacked some of the basic equipment. Blood collected in these facilities was not adequate to meet the blood needs of the regions. These facilities lacked specialised personnel and some of those practicing blood transfusion were not conversant with blood groups, transfusion reactions and the measures to be taken if a reaction occurs. The findings of this study will be used to strengthen blood transfusion services in these hard to reach regions.

Mitigation of the blast risk associated with terrorist attacks and accidental explosions threatening critical infrastructure has become a topic of great interest in the civil engineering community, both in Canada and abroad. One method of mitigating blast risk is to retrofit vulnerable structures to resist the impulsive effects of blast loading. A comprehensive re-search program has been undertaken to develop fibre reinforced polymer (FRP) retrofit methodologies for structural and non-structural elements, specifically reinforced concrete slabs and walls, subjected to blast loading. The results of this investigation are equally valid for flexure dominant reinforced concrete beams subject to blast effects. The objective of the research program was to generate a large volume of research data for the development of blast-resistant design guidelines for externally bonded FRP retrofit systems. A combined experimental and analytical investigation was performed to achieve the objectives of the program. The experimental program involved the construction and simulated blast testing of a total of thirteen reinforced concrete wall and slab specimens divided into five companion sets. These specimens were subjected to a total of sixty simulated explosions generated at the University of Ottawa Shock Tube Testing Facility. Companion sets were designed to study one- and two-way bending, as well as the performance of specimens with simply-supported and fully-fixed boundary conditions. The majority of the specimens were retrofitted with externally bonded carbon fibre reinforced polymer (CFRP) sheets to improve overall load-deformation characteristics. Specimens within each companion set were subjected to progressively increasing pressure-impulse combinations to study component behaviour from elastic response up to inelastic component failure. The blast performance of companion as-built and retrofitted specimens was quantified in terms of measured load-deformation characteristics, and observed member behaviour throughout all stages of response. The results show that externally bonded FRP retrofits are an effective retrofit technique to improve the blast resistance of reinforced concrete structures, provided that debonding of the composite from the concrete substrate is prevented. The test results also indicate that FRP retrofitted reinforced concrete structures may survive initial inbound displacements, only to failure by moment reversals during the negative displacement phase. The experimental test data was used to verify analytical techniques to model the behaviour of reinforced concrete walls and slabs subjected to blast loading. The force-deformation characteristics of one-way wall strips were established using inelastic sectional and member analyses. The force-deformation characteristics of two-way slab plates were established using commonly accepted design approximations. The response of all specimens was computed by explicit solution of the single degree of freedom dynamic equation of motion. An equivalent static force procedure was used to analyze the response of CFRP retrofitted specimens which remained elastic after testing. The predicted maximum displacements and time-to-maximum displacements were compared against experimental results. The analysis indicates that the modelling procedures accurately describe the response characteristics of both retrofitted and unretrofitted specimens observed during the experiment.

Mitigation of the blast risk associated with terrorist attacks and accidental explosions threatening critical infrastructure has become a topic of great interest in the civil engineering community, both in Canada and abroad. One method of mitigating blast risk is to retrofit vulnerable structures to resist the impulsive effects of blast loading. A comprehensive re-search program has been undertaken to develop fibre reinforced polymer (FRP) retrofit methodologies for structural and non-structural elements, specifically reinforced concrete slabs and walls, subjected to blast loading. The results of this investigation are equally valid for flexure dominant reinforced concrete beams subject to blast effects. The objective of the research program was to generate a large volume of research data for the development of blast-resistant design guidelines for externally bonded FRP retrofit systems. A combined experimental and analytical investigation was performed to achieve the objectives of the program. The experimental program involved the construction and simulated blast testing of a total of thirteen reinforced concrete wall and slab specimens divided into five companion sets. These specimens were subjected to a total of sixty simulated explosions generated at the University of Ottawa Shock Tube Testing Facility. Companion sets were designed to study one- and two-way bending, as well as the performance of specimens with simply-supported and fully-fixed boundary conditions. The majority of the specimens were retrofitted with externally bonded carbon fibre reinforced polymer (CFRP) sheets to improve overall load-deformation characteristics. Specimens within each companion set were subjected to progressively increasing pressure-impulse combinations to study component behaviour from elastic response up to inelastic component failure. The blast performance of companion as-built and retrofitted specimens was quantified in terms of measured load-deformation characteristics, and observed member behaviour throughout all stages of response. The results show that externally bonded FRP retrofits are an effective retrofit technique to improve the blast resistance of reinforced concrete structures, provided that debonding of the composite from the concrete substrate is prevented. The test results also indicate that FRP retrofitted reinforced concrete structures may survive initial inbound displacements, only to failure by moment reversals during the negative displacement phase. The experimental test data was used to verify analytical techniques to model the behaviour of reinforced concrete walls and slabs subjected to blast loading. The force-deformation characteristics of one-way wall strips were established using inelastic sectional and member analyses. The force-deformation characteristics of two-way slab plates were established using commonly accepted design approximations. The response of all specimens was computed by explicit solution of the single degree of freedom dynamic equation of motion. An equivalent static force procedure was used to analyze the response of CFRP retrofitted specimens which remained elastic after testing. The predicted maximum displacements and time-to-maximum displacements were compared against experimental results. The analysis indicates that the modelling procedures accurately describe the response characteristics of both retrofitted and unretrofitted specimens observed during the experiment.