Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-15T11:18:21Z No. of bitstreams: 2 Dissertação - Gilma Moreira de Sousa - 2015.pdf: 7674658 bytes, checksum: f3ccb13ec9b9825208853c50c6774598 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-15T11:28:37Z (GMT) No. of bitstreams: 2 Dissertação - Gilma Moreira de Sousa - 2015.pdf: 7674658 bytes, checksum: f3ccb13ec9b9825208853c50c6774598 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-15T11:28:37Z (GMT). No. of bitstreams: 2 Dissertação - Gilma Moreira de Sousa - 2015.pdf: 7674658 bytes, checksum: f3ccb13ec9b9825208853c50c6774598 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-03-13 / To analyze the practices and knowledge in administration medication intramuscularly between nurses and nursing auxiliaries/ technicians in fixed pre-hospital emergency units of Goiânia -Go Methodology: descriptive, exploratory cross-sectional study, the research was conducted in the period February to May 2014. the study population consisted of nurses, technicians and nursing auxiliaries of fixed pre- hospital units and pediatric clinical urgency of Goiânia -Go , was investigated demographic data partners, knowledge acquired in vocational training and clinical practice in the conduct of drug delivery techniques intramuscularly ( IM ). Results: the study 176 nursing professional, 58 nurses and 111 nursing technicians and seven nursing auxiliaries. And 91.5% were female with an average age between 31 and 40 years and 60.3% had up to 10 years of experience in nursing. 99.0% of nursing auxiliaries / technicians mentioned that perform the IM for drug delivery regularly, while nurses, 32.7% and 5.2% rarely ever do. The deltoid muscle (100% and 95.6%) and dorsal gluteal (96.6% and 98.1%) were the regions that nurses and nursing auxiliaries / technicians, respectively said it had more information and practice during the course formation. 29.4 % of nurses and 32.3 % of nursing auxiliaries / technicians cited who did not know the technical ventral gluteal while students. The criteria cited for choosing the drug administration site were: the volume of the drug, size of muscles, needle size, thickness of fat tissue, user preference, and the service daily practice. Since the daily practice was mention ed more often by auxiliaries / technicians nursing (27.1%) already by nurses was 8.6%, this difference was statistically significant (p=0.005). The dorsal gluteal region back is the most used IM to drug use in adults, both by nurses (56.6%) and by auxiliarie / technicians nursing (69.8%). The experience of nurses in drug delivery in all regions was 64.9% while the auxiliaries / technicians nursing was 41.0% which is statistically significant difference between the categories (p=0.003). Conclusion It was found that the IM medication administration are not implemented in accordance with the recommendations in the literature, for much of the nurses and nursing auxiliaries / technicians claiming that the knowledge acquired during the training were insufficient to act in professional practice. The regions most commonly used drug for IM administration were dorsal gluteal in children and adults and the vastus lateralis thigh in neonates and infants. Poor adherence of nursing professionals, medication administration in the ventral gluteal region was justified by the insecurity in the technical implementation and the lack of knowledge in the correct identification of the place. Therefore the result of this study highlights the need to invest in continuing education , making nursing professionals to act safely and ethically in daily activities the role of nursing requires reflective practices based on scientific evidence , to ensure the safety of the professional and the patient. / Analisar as práticas e conhecimentos em administração de medicamentos por via intramuscular entre enfermeiros e auxiliares/técnicos de enfermagem em unidades préhospitalares fixas de urgência de Goiânia-Go Metodologia: estudo descritivo, exploratório de corte transversal, a pesquisa foi realizada no período de fevereiro a maio de 2014. A população do estudo constituiu-se de enfermeiros, técnicos e auxiliares de enfermagem das unidades préhospitalares fixas de urgência clínica e pediátrica de Goiânia-Go, foi investigado os dados sócios demográficos, conhecimentos adquiridos na formação profissional e a prática clínica na execução das técnicas de administração de medicamento por via intramuscular (IM). Resultados: participaram do estudo 176 profissionais de enfermagem, sendo 58 enfermeiros e 111 técnicos de enfermagem e sete auxiliares de enfermagem. Sendo 91,5% do sexo feminino com idade média entre 31 e 40 anos e 60,3% possuíam até 10 anos de atuação na enfermagem. 99,0% dos auxiliares/técnicos de enfermagem citaram que realizavam a administração de medicamento por via IM regularmente, enquanto que os enfermeiros, 32,7% raramente e 5,2% nunca o faziam. O músculo deltoide (100% e 95,6%) e dorso glúteo (96,6% e 98,1%) foram as regiões mais citadas pelos enfermeiros e auxiliares/técnicos de enfermagem como conhecimento adquirido durante o curso de formação profissional, 29,4% dos enfermeiros e 32,3% dos auxiliares/técnicos de enfermagem citaram que não conheceram a técnica ventro glútea enquanto estudantes. Os critérios citados para a escolha do local da administração do medicamento foram: o volume da droga, tamanho da musculatura, tamanho da agulha, espessura do tecido adiposo, preferência do usuário, e prática cotidiana do serviço. Sendo que a prática cotidiana foi mais citada pelos auxiliares/técnicos de enfermagem (27,1%) já pelos enfermeiros foi de 8,6%, esta diferença foi estatisticamente significante (p=0,005). A região dorso glútea apresentou como a mais utilizada para administração de medicamento IM em adultos, tanto pelos enfermeiros (56,6%) quanto pelos auxiliares/técnicos de enfermagem (69,8%). A experiência dos enfermeiros na administração de medicamento em todas as regiões foi de 64,9% enquanto dos auxiliares/técnicos foi de 41,0% sendo esta uma diferença entre as categorias estatisticamente significante (p=0,003). Conclusão: Verificou-se que a administração do medicamento IM não são executadas de acordo com o preconizado na literatura, grande parte dos enfermeiros e auxiliares/técnicos de enfermagem alegaram que os conhecimentos adquiridos durante a formação profissional em relação à administração de medicamento injetáveis por via IM foram insuficientes para a atuação na prática profissional. As regiões mais utilizadas para a administração de medicamento IM foram a dorso glútea em crianças e adultos e a vasto lateral da coxa em recém-nascidos e lactentes. A pouca adesão dos profissionais de enfermagem, na administração de medicamentos na região ventro glútea foi justificada pela insegurança na execução da técnica e pela falta de conhecimentos na identificação correta do local. Portanto o resultado desse estudo evidencia a necessidade de investimentos em educação permanente, fazendo com que os profissionais de enfermagem atuem de forma segura e ética nas atividades do cotidiano. A atuação da enfermagem exige práticas reflexivas, baseadas em evidências cientificas, que garanta a segurança do profissional e do paciente.

O SAMU brasileiro utiliza o modelo francês e opera com uma Central Única de Regulação Médica regionalizada, hierarquizada e descentralizada na composição das equipes de socorro e unidades móveis como USBs (Unidade de Suporte Básico) e USAs (Unidade de Suporte Avançado) que variam de acordo com o tipo de gravidade do caso. Na cidade de Ribeirão Preto, o serviço do SAMU, implantado em 1996, era municipal até 2012, porém seguindo as resoluções e portarias do Ministério da Saúde houve a necessidade da transição do SAMU Municipal para o SAMU Regional, com um único número (192) para os 26 municípios do Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) sendo composto/constituído por 38 (trinta e oito) USBs sendo 01 USB para cada base descentralizada, 13 USB para Ribeirão Preto, 01 (uma) equipe de motolância e mais 03 (três) USAs (unidades de suporte avançado de vida) para cada base nos municípios polos microrregionais (Ribeirão Preto, Sertãozinho e Batatais). Com base nessas informações, este estudo visou caracterizar a estrutura e funcionamento do SAMU Municipal e sua Central de Regulação de Urgência e a transição para a regionalização nos seus aspectos estruturais, recursos humanos, tecnológicos e principalmente a viabilidade financeira, considerando o repasse tripartite (estado - união e município) insuficientes. Para a viabilidade financeira foi instituído o Consórcio CIS-AVH (consórcio intermunicipal de saúde - Aquífero guarani, Vale das cachoeiras e Horizonte verde). Os Consórcios Intermunicipais de Saúde (CISs) são importantíssimos instrumentos de cooperação e gestão entre municípios integrados, com 9interesses comuns definidos através do Plano Anual de Trabalho descritos pelos gestores municipais, conselhos e entidades públicas que estabelecem as prioridades e necessidades de determinado local e região. O objetivo foi criar soluções para problemas comuns, racionalizando a ação governamental a partir da realização conjunta de atividades de promoção, proteção e recuperação da saúde. Observa-se o fortalecimento da co-gestão compartilhada em saúde, em especial para os municípios de menor porte, cujas capacidades de investimento no setor são reduzidas em razão do limitado orçamentos disponível, as crescentes necessidades dos cidadãos, o avanço do aparato tecnológico e seus custos e principalmente o ganho por meio de editais de aquisição, compras ou contratação em escala seja de serviços, exames ou insumos. / The Brazilian SAMU uses the French model and operates with a regionalized, hierarchical and decentralized Single Regulated Medical Regulation Center in the composition of rescue teams and mobile units such as USBs (Basic Support Unit) and USAs (Advanced Support Unit) that vary according to with the type of severity of the event. In the city of Ribeirão Preto, the SAMU service, implemented in 1996, was municipal until 2012, but following the resolutions and ordinances of the Ministry of Health, there was a need to transition from SAMU Municipal to SAMU Regional, with a single number (192) for the 26 municipalities of the Regional Health Department of Ribeirão Preto (DRS XIII) consisting of 38 (thirty-eight) USBs, with 1 USB for each decentralized base, 13 USB for Ribeirão Preto, 01 (one) motolance team and more 03 (three) USAs (advanced life support units) for each base in the microregional poles municipalities (Ribeirão Preto, Sertãozinho and Batatais). Based on this information, this study aimed to characterize the structure and functioning of the Municipal SAMU and its Central Emergency Regulation and the transition to regionalization in its structural aspects, human resources, technological and mainly financial viability, considering the tripartite pass-through insufficient. (2013 to 2016). For the financial viability, the CIS-AVH Consortium (inter-municipal health consortium - Aquifer, Guaraní, Vale das cachoeiras and Horizonte verde) was instituted. The Intermunicipal Health Consortiums (CISs) are very important instruments of cooperation and 11management among integrated municipalities, with common interests defined through the Annual Work Plan described by municipal managers, councils and public entities that establish the priorities and needs of a given place and region. With the objective of creating a solution to common problems, rationalizing government action through joint activities to promote, protect and recover health. The strengthening of shared co-management in health is observed, especially for smaller municipalities, whose investment capacities in the sector are reduced due to the limited budgets available, the growing needs of the citizens, the advancement of the technological apparatus and its costs, and especially the gain through purchase, purchase or scale calls for services, examinations or inputs.

This dissertation investigates discourses of anti-violence strategies in the context of international development. While violence against women is, of course, an urgent problem, this dissertation explores how the urgency to end violence against women is socially, culturally, economically, and politically constructed. I consider the manufacturing of urgency in three case studies of contemporary anti-violence initiatives: i) American foreign policy including what has been branded as “The Hillary Doctrine” and proposed International Violence Against Women Act; ii) the World Bank’s report entitled The Cost of Violence; and iii) the United Nation’s UNiTE To End Violence Against Women and Say NO campaigns. In doing so, I argue that World Bank, the United Nations, and American foreign policies are too often technocratic, narrow, depoliticized, and are executed in an urgent manner in the interest of neoliberal economic growth, security concerns, and “feel good” aid at the expense of more holistic, effective and accountable responses to global violence against women.

Detta projekt ska resultera i direktiv för framtida utveckling av ljudsignaler och varningsljud i bil. Signalerskarakteristiska drag undersöks för en djupare förståelse för de parametrar som ger upphov till specifika känslor ochbeteenden. Signaler från Saab 9-5 modifieras för att passa befintliga teorier om design av ljudsignaler. Dessajämförs med originalsignaler samt signaler från Saab 9-3, BMW 3-serie och Audi A6 i en användarstudie.Resultaten visar på möjligheten att utveckla mindre irriterande signaler vid lägre ljudnivåer med bibehållenallvarsnivå. Resultaten pekar även på att ökad allvarsnivå kan fås med kortare periodtid och signallängd, ökat antalrepetitioner och frekvenser samt ökad upplevd tonstyrka (på sonskalan). Resultat från SAM-skalan visar att bådeoriginal- samt modifierade signaler tenderar att placera sig enligt teorin (högre aktivering och negativitet för signalerpå höga allvarsnivåer och vice versa). Studien visade även att utförligare arbete krävs för att stärka Saabs identitetnär det gäller ljudsignaler och att detaljerade studier om perception och förarbeteende krävs vid framtagning av nyasignaler. / This project aims to result in guidelines for future development of auditory signals in cars. The characteristics ofdifferent types of signals are investigated for a greater understanding of what parameters in auditory signals thatgive rise to certain feelings or behaviour. Auditory signals from Saab 9-5 are modified to fit existing theories aboutauditory alerts. These are then compared to their original signals and signals from Saab 9-3, BMW 3-series and AudiA6 in a user study. The results show that there is a possibility to design signals with no significant difference inurgency that are seen as less annoying at lower sound levels. Urgency seems to depend negatively on sound cadenceand signal length and positively on number of repetitions and frequencies and also loudness. SAM scale resultsshowed that both original and modified signals tend to move according to desired theories (higher activation andlower valence for high urgency signals and vice versa). The study also showed that further work needs to be put onstrengthening Saabs brand identity concerning auditory signals and that detailed studies on driver perception andbehaviour is needed when developing new signals.

This study recognizes the need to identify and prioritize critical issues facing families. The literature review identifies and documents a number of critical issues facing families in American society. Survey questionnaires, which contained an abstract version of 33 previously identified issues, were sent to a sample of 2,000 people in Utah. The sample was randomly selected from resident listings in Utah telephone books. The survey asked respondents to rate each of 33 issues on a scale of 1 to 10, 1 being the least urgent and 10 being the most urgent. These issues include childhood, economic, health, and elderly concerns. Mean scores and variances of individual issues and factor-analyzed issue categories were utilized in this study. It was hypothesized that there would be no significant difference with regard to urgency between categories of six demographic variables for each issue. Hypotheses were tested on each issue and eight major issue categories identified by a factor analysis. The six demographic variables utilized in the analyses of variance were: rural/urban status, gender, family income, marital status, age, and education level. When viewing results from the issues, results show that the hypothesis of no difference between gender, income, and education categories was rejected. Testing this same hypothesis of issue categories resulted in rejection for gender and education. In looking at the variance of all 33 issues combined, results show that individuals in Utah most likely to view issues with a higher sense of urgency were: female, low income, and residents with a lower level of educational attainment. A ranking of the 33 issues, as provided, could assist policy makers and professionals in knowing what issues Utah residents perceive as being the most pressing. Information gained from this study may assist policy makers in the allocation of funding for the variety of family related difficulties that Utah faces. The results from the analyses of variance may help explain public concern and interest relative to specific counties or communities. The study also identifies a method of identifying and prioritizing family-related issues. This method may be beneficial to other states in the nation.

It is well documented that adolescent substance use is associated with deficits in brain function and behavior. However, possible deficits that predate substance use initiation remain poorly characterized in preadolescents at-risk for developing substance use disorder (SUD). To characterize potential brain and behavioral differences that predate substance use, substance naïve preadolescents, ages 11–12, were recruited into three groups to complete functional magnetic resonance imaging delay discounting: (1) High-risk youth (n=35) with a family history of SUD and externalizing psychiatric disorders, (2) psychiatric controls (n=35) with no family history of SUD, but equivalent externalizing psychiatric disorders as high-risk youth, and (3) healthy controls (n=29) with no family history of SUD and minimal psychopathology. While no behavioral differences between groups were identified, there were group differences in posterior cingulate cortex (PCC) function during decision making. Specifically, the high-risk group showed stronger deactivation of the PCC than healthy controls. These results suggest that high-risk preadolescents may need to suppress activity of key nodes of the default mode network (a task negative network) to a greater extent to properly allocate attention to the task.

Background: Individuals with binge eating disorder (BED) experience a loss of control (i.e., poor inhibitory control) during binge eating, where stress is a common antecedent for binge episodes. However, few studies examine acute stress in BED and, to date, psychosocial stress relationships with inhibitory control are unexamined. Purpose: The current study investigated acute psychosocial stress effects on inhibitory control in BED. Additionally, inhibitory control relationships with BED treatment outcome were explored. Methods: Thirty-three individuals with BED were randomized to a stress (n = 17) or no stress condition (n = 16). All completed self-report measures including the Profile of Mood States and the Binge Urge Scale. Following the stressor, individuals completed the Stop-Signal Task (SST), a well-validated measure of inhibitory control. Relationships between post-stress anxiety with inhibitory control and eating pathology were explored. Furthermore, treatment outcome relationships with levels of inhibitory control, and negative urgency (an impulsive personality trait) were explored. Results: In the stress condition, individuals reported increased state anxiety immediately following stress, but experienced a decrease back to baseline levels of anxiety by the end of the SST. Stress resulted in impaired inhibitory control performance on the SST. Binge urges increased across both conditions over time. Measures of inhibitory control and negative urgency did not relate to treatment outcome. Conclusion: This study is novel in directly examining psychosocial stress effects on inhibitory control, which has not been studied in BED. These results show subjective stress effects in BED are short-lived; however, behaviourally, stress has a lingering effect on inhibitory control. Increasing binge urges across the experimental session in the no stress condition suggests a role for generalized anxiety on this impulse. These findings have clinical implications for binge urges as a therapeutic target, and for informing individuals with BED about the implications of stress on their binge eating. / Thesis / Master of Science (MSc)

The only way to simplify and promote the effective use of an alerting system that must be comprehensive in its coverage of hazardous or non-normal conditions is to convey top level information that provides an indication of criticality and identity. In order to prevent the continued proliferation of aural alerting signals presented in the flight deck, a simple aural alert categorization scheme that provides flight deck function and urgency level information was proposed and evaluated in this study. Specifically, the present investigation examined the ability of a population having "normal" hearing to: 1) distinguish among four sets of aural alerting signals having distinctive rhythmic patterns and pitch contours, 2) perceive three urgency levels having distinctive tempos within each alerting set, and 3) associate each alerting set and its related urgency levels with one of the four major flight deck functions. Magnitude estimation ratings revealed that subjects perceived differences between low urgency level alerts and moderate urgency level alerts and between low urgency level alerts and high urgency level alerts. Pair comparison ratings of similarity revealed that subjects differentiated among the four within of the alerting sets relatively well after participating in a brief training session. alerting sets. A sound identification task revealed that subjects were able to associate functional categories with four aural alerting sets and were also able to simultaneously distinguish among and perceive three urgency levels within each of the alerting sets relatively well after participating in a brief training session. / Master of Science

Cette étude consiste à démontrer que les procédures administratives d’urgence ont entraîné une modification de la conception du rôle du juge administratif : d’une part, par rapport aux libertés fondamentales dont le juge administratif a dû déterminer et encadrer la notion ; d’autre part, par rapport à l’autorité administrative vis-à-vis de laquelle le juge administratif a retiré un pouvoir accru qui lui donne la vigueur d’un juge administrateur. Cette étude est présenté en deux parties on s’attacher, dans une première partie, à montrer comment les procédures d’urgence, mises à sa disposition par la loi du 30 juin 2000, permettent au juge administratif de faire cesser les atteintes aux libertés fondamentales. Dans une deuxième partie, on tentera de mettre en lumière l’évolution du rôle du juge administratif dans ses relations avec l’administration. Les procédures d’urgence ont conduit à l’élargissement de ses pouvoirs, ce qui a entraîné un renforcement de l’autorité du juge administratif par rapport l’administration. / This study is aims to demonstrate that the administrative procedures of urgency has led to a redefinition of the role of administrative judge: first, in relation to the fundamental libertie whose the administrative judge had a duty to determine this concept. Secondly, in relation to administrative authority vis-à-vis which the administrative judge withdrew an increased power that gives it the force of a administration judge. This study is presented in two parts: in the first part, we show how the urgency procedures provided by the law N° 2000-597 of 30 June 2000, allows the administrative judge to stop violations of fundamental liberties. In The second part we attempt to highlight the changing role of the administrative judge in its relations with the administration. The urgency procedures have led to the expansion of its powers, which led to a strengthening of the authority of the administrative judge against the administration

The proposed study examined whether negative urgency and positive urgency are dynamic traits that hold bi-directional relationships with binge and prolonged alcohol use across time. Individuals between the ages of 18-30 were recruited from Amazon Mechanical Turk (MTurk; n = 179) and university student (n = 66) pools. Participants completed three batteries of self-report assessments approximately 30 days apart, each containing measures assessing negative and positive urgency, as well as drinking frequency and binge behavior during the prior month. Latent variable cross-lagged panel models examined the effects of alcohol use from the previous month on negative and positive urgency while controlling for concurrent and autoregressive effects. Results of the current study indicated that for the full sample, there was not an effect for the influence of binge/prolonged drinking on either negative or positive urgency during the subsequent month. However, when examined separately by sample (Turkers vs. university) and gender (male vs. female), significant effects were found more for individuals who were Turkers, male, and/or heavy drinkers, suggesting that increases in positive and negative urgency at Time 2 could be partially explained by variance in drinking patterns at Time 1 for these individuals. However, these relationships were not replicated again between Time 2 and Time 3 due to a decrease in all drinking behaviors during these times. Lastly, the study found that while urgency scores were related to psychosocial problems and dependence symptoms associated with drinking, there was no evidence to support that urgency scores had substantial relationships to specific frequency and/or bingeing behavior across the overall sample, although positive urgency had support for a relationship with bingeing, particularly among heavily drinking men. Thus, while the primary findings did not indicate any effects for a general sample of young adults, the effects observed among heavy male drinkers in the present study add to a growing body of literature indicating potential for interactive effects among personality, environmental, and sociobiological factors across the trajectory of the human lifespan. Future research that continues to examine urgency and how it relates to alcohol use in longitudinal contexts, utilizing diverse samples, is warranted.