A interconsulta cardiológica corresponde a uma parcela considerável das atividades assistenciais e de ensino do cardiologista, refletindo gasto extra de tempo e recursos. Apesar disso, essa atividade não tem recebido a devida atenção da literatura, com poucos estudos sobre o tema. O objetivo do presente estudo foi, primariamente, comparar a evolução clínica dos pacientes envolvidos na interconsulta cardiológica que tiveram as recomendações seguidas pela equipe médica solicitante (grupo ACEITADOR) com aqueles em que as recomendações não foram seguidas (grupo NÃO ACEITADOR). De forma secundária, procuramos identificar as variáveis determinantes da aceitação das sugestões da equipe cardiológica. Para isso, foi realizado um estudo observacional envolvendo pacientes internados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, para os quais foram solicitadas interconsultas cardiológicas, no período de março a setembro de 2008. Os dados referentes às interconsultas foram coletados pelo investigador de maneira prospectiva a partir do prontuário dos pacientes. Dentre as 589 interconsultas selecionadas para o estudo, 271 consistiam em avaliações clínicas e 318 avaliações pré-operatórias. Em relação à taxa de aceitação das recomendações cardiológicas, 77% dos pacientes foram classificados no grupo ACEITADOR e 23% classificados no grupo NÃO ACEITADOR. A análise da evolução clínica demonstrou que, dentre os pacientes do grupo NÃO ACEITADOR, 38,8% evoluíram de forma desfavorável (piora clínica ou óbito) contra 5,4% dos pacientes do grupo ACEITADOR (P<0,0001). Após análise de regressão logística, pertencer ao grupo NÃO ACEITADOR (P<0,001; OR 10,25; IC 95% 4,45 - 23,62) e a idade dos pacientes (P=0,017; OR 1,04; IC 95% 1,01 1,07) estiveram associados de forma independente a uma evolução clínica desfavorável. Foram identificados quatro preditores independentes de aceitação das recomendações: a realização de visitas de seguimento (P<0,001; OR 2,43; IC 95% 1,48 4,01), reforço verbal das recomendações (P=0,001; OR 1,86; IC 95% 1,23 2,81), número de recomendações sugeridas (P=0,001; OR 0,87; IC 95% 0,80 0,94) e idade dos pacientes (P=0,002; OR 0,98; IC 95% 0,96 0,99). Portanto, na presente análise, a não aceitação das recomendações da equipe cardiológica por parte da equipe médica solicitante esteve associada a uma evolução clínica desfavorável dos pacientes envolvidos. A realização de visitas de seguimento, reforço verbal, número limitado de recomendações e a menor idade dos pacientes estiveram associados a uma maior aceitação das recomendações da equipe cardiológica / Cardiology referral represents an important part of cardiologist activities, accounting for substantial workload and demanding extra time and resources. Despite the importance of these facts, it has received little attention in the medical literature in the last years. The purpose of this study was to compare the clinical outcome of patients involved in cardiology referral who had the cardiologic recommendations followed by the requesting service (ACCEPTING group) with those whose recommendations were not followed (NON-ACCEPTING group). Secondly, we aimed to determine which of the variables involved in cardiology referral were related to acceptance to consultants recommendations. An observational study was performed at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, involving cardiology consultations during the months of March 2008 through September 2008. Data regarding consultations were prospectively extracted from the medical records by a physician-researcher. Among the 589 cardiology consultations selected for the study, 271 were clinical evaluations and 318 were preoperative evaluations. Regarding compliance of the referring service in following the recommendations offered by cardiology team, 77% of patients were classified in the ACCEPTING group and 23% in the NON-ACCEPTING group. A clinical outcome analysis was performed and showed that 38,8% of patients allocated to NON-ACCEPTING group had evolved unfavorably (clinical deterioration or death) against 5,4% of patients allocated to accepting group (P<0.0001). After logistic regression analysis, belong to NON-ACCEPTING group (P<0.001; OR 10.25; CI 95% 4.45 23.62) and patients age (P=0.017; OR 1.04; CI 95% 1.01 1.07) were variables independently associated to an unfavorable clinical outcome. The multivariate analysis indentified 4 independent predictors of acceptance to consultants recommendations: follow-up notes in the chart (P<0.001; OR 2.43; CI 95% 1.48 4.01), personal communication (P=0.001; OR 1.86; CI 95% 1.23 2.81), number of recommendations (P=0.001; OR 0.87; CI 95% 0.80 0.94) and patients age (P=0.002; OR 0.98; CI 95% 0.96 0.99). Therefore, in this analysis of cardiology referral, a poorer acceptance of cardiologic recommendations was associated to an unfavorable clinical outcome. Follow-up notes in the chart, personal communication, limited number of recommendations and lower patients age were associated to greater acceptance of cardiologic recommendations

Arbetet handlar om specialpedagogers syn på handledning och på rollen som handledare. Syftet med studien är att undersöka specialpedagogers syn på handledning för det kollegiala lärandet samt de möjligheter och utmaningar specialpedagoger möter när de handleder. Begreppen handledning och kollegialt lärande diskuteras och en forskningsöversikt inom området redovisas. Det empiriska materialet består av inspelningar från intervjuer med fyra yrkesverksamma specialpedagoger från grundskolan. En tematisk analys har genomförts och jag har utgått från ett socialkonstruktivistiskt perspektiv. Resultatet av studien redovisar tre teman; utveckling genom samtal och reflektion, kollegialt lärande genom grupphandledning och förutsättningar för handledning. Specialpedagogerna upplever att begreppet handledning är svårdefinierbart, de ägnar en stor del av sin arbetstid åt handledning och strävar efter att ställa reflekterande frågor och vara ett bollplank åt lärarna. De har goda erfarenheter av kollegialt lärande men gruppsammansättning och tid ses som de största utmaningarna för en lyckad handledning. Rollen som handledare beskrivs som givande men också utmanande. Handledningen syftar till att främja utveckling på individ-, grupp- och organisationsnivå och utgår från ett socialkonstruktivistiskt perspektiv då det är i mötet med andra som utveckling sker. Specialpedagogers handledning som verkar för att främja det kollegiala lärandet kan resultera i förbättrade lärmiljöer och resultat för eleverna. / This undergraduate thesis is about SENCOs’ view of consultation and the role as consultants, the purpose is to examine SENCOs’ view of consulting for PLC, Professional Learning Communities, and the possibilities and challenges they meet when consulting. The concepts of consulting and PLC are discussed and a research overview is included. The empirical material consists of recorded interviews with four active SENCOs. A thematic analysis is implemented and social contructivism is the theoretical perspective. The result of the study shows three different themes; development through conversation and reflection, consulting for PLC and the basis of consultation. The SENCOs´ experience the concept of consulting hard to define, they spend a great deal of their working hours consulting and they strive to ask reflective questions instead of giving the answers. They have positive experiences of PLC but time and group constellations are challenging. Consulting is rewarding but also challenging. Consulting aim to facilitate development on induvidual, group and organisation level and originate from social constructivism. SENCOs are proficent consultants aiming for PLC to result in better learning environment and better results for students.

The present study examined the relationship between the occurrence of reported supervision and the professional practices of school psychologists. Information provided by more than 1,700 school psychologists in response to the National Association of School Psychologists: Demographic and Professional Practices Survey 1999-2000 School Year - NASP-DPPS 2000 survey were used to create the 1999-2000 national database (Curtis, et al., 2000) and served as the basis for secondary analyses in the current study. The NASPDPPS 2000 collected information regarding the demographic characteristics, employment conditions and professional practices of school psychologists the United States. Correlational and multiple regression analyses were completed to examine the relationship between professional practices and the reported receipt of supervision, background of the supervisor, and ratio of school psychologists to supervisor. Professional practices did not appear to be significantly related to vary as a function of the occurrence of reported supervision. School psychologists reporting receiving supervision completed significantly more initial psychoeducational assessment and reevaluations than school psychologists who reported not receiving supervision. Initial pyshcoeducational assessment and reevaluations are professional practices that can be categorized as special education and direct service delivery model. The subsample of school psychologists who reported the occurrence of supervision was examined for the remaining analyses. In addition, supervised school psychologists' professional practices did not vary as a function the supervisor's type of educational background (i.e., school psychology or non-school psychology), and level of educational preparation (i.e., doctoral or nondoctoral). Finally, the school psychologists-to-supervisor ratio and nature of the school psychologists' professional practices was examined. The remaining correlations were considered non-significant. It was noted that the questions included in the NASP-DPPS 2000 survey did not allow for specific information about the type, topography, or quality of supervision. This limitation precluded drawing specific conclusions regarding the research questions addressed.

Les projets d’aménagement urbain provoquent de plus en plus d’inquiétudes et de mobilisations spontanées, qui créent des tensions sur les conditions de prise de décision. L’action publique se heurte à des résistances tant dans sa conception que sa réalisation. Et dans un contexte où la participation citoyenne à l’élaboration des projets tend à devenir un nouveau mode de gouvernance, les riverains ne veulent plus que leurs rôles se limitent aux simples « pourvoyeurs » des avis. S’appropriant l’espace public et les dispositifs participatifs, ils aspirent non seulement à l’expression de leurs opinions, mais aussi à une confrontation des expertises. C’est dans ce cadre-là que s’inscrit le projet de la ligne B du métro dans la métropole rennaise. Ayant appris l’hypothèse d’une insertion aérienne du métro entre les deux étangs dans leur quartier – les Longs Champs -, les riverains se sont mobilisés pour exprimer leur désaccord. Compte tenu de l’ampleur de cette mobilisation, le maître d’ouvrage décida d’organiser une « concertation spécifique » à l’issue de laquelle le projet métropolitain a été retenu aux dépens des projets « habitants » et « urbaniste ». Notre thèse a pour objectifs d’examiner les collectifs d’ habitants des Longs Champs pour essayer d’appréhender la rationalisation organisationnelle dans une action collective orientée vers un objectif commun; explorer les enjeux sociopolitiques et infocommunicationnels des dispositifs participatifs ; interroger les modes de production des savoirs profanes dans une perspective de confrontation des légitimités concernant l’élaboration et la mise en oeuvre d’un projet d’intérêt général. / Urban planning projects lead to more and more waves of public concern and spontaneous mobilization, which lead to tensions surrounding the way decisions are made. Public action sees its conception and implementation be faced with obstacles. And in a context where citizens’ participation in the development of projects seems to be new mode of governance, residents no longer want their role to be limited to that of a simple “opinions provider”. Using the public space and participatory tools, they expect to be able to express their opinion, and also for different surveys to be confronted. It is whiting this framework that Rennes’s B line is being examined. Having learnt of the possibility of there being an overground portion of the line between two ponds in the Longs Champs district, the residents gathered to voice their disagreement.Because of the scale of the mobilization, the project owner decided to organize a “specific consultation” after which the metropolitan project was adopted at the expense of “residential” and “urbanist” projects. The objectives of our thesis are to examine the residents’ groups, to try and grasp the organizational rationalization of collective action aiming towards a common goal; to explore the sociopolitical and communicational issues of participatory tools; to question the production methods of knowledges in the perspective of confroncting legitimate opinions regarding the elaboration and implementation of a project of general interest.

The growing number of school-aged children displaying challenging behavior has increased the need for effective interventions. School-based consultants (SBC) report using behavioral consultation to assist teachers in designing behavior intervention plans (BIP) that help students engage in appropriate behavior in the classroom. Research indicates that direct training methods increase teacher's implementation of the BIP. One commonly used direct training method, performance feedback (PF), is used to assess teachers' treatment integrity. Research also indicates that checklists (non-direct measures) are more cost efficient methods. The purpose of this paper was to evaluate a direct training method used to train teachers to self-monitor their own implementation of their student's BIP in an effort to increase accuracy of self-report and sustainable treatment integrity outcomes. Two educators who worked with children with challenging behavior participated in this study. The effect of using self-monitoring on both educators' implementation of BIPs was evaluated. Results indicated that both educators' implementation increased and maintained into the maintenance phase. Also, results indicated that educator's accuracy of reporting was similar to independent observers.

This study intends to analyze the importance of institutional trust in the process of democratization. In this particular case, the period from 494 to 88 BC in the Roman republic is examined. The theories of Charles Tilly and Robert Putnam are utilized to more deeply examine the concepts and manifestations of trust and democratization. Using the ideas and theories of these authors together provides a unique insight into the means by which a population comes to trust that government is responsive, and further comes to expect increased responsiveness in the future. Institutional trust as an element of mutually binding consultation will be explored via proposed and successful plebeian legislation in the Roman republic. This study examines legislative actions, defined as proposed legislation (rogationes) alongside successful legislation (plebiscita and leges), which originated in the plebeian assembly, the concilium plebis, under the guidance of the tribunes of the plebs, the elected officials of the plebeian population at Rome. In all, 236 legislative actions between 494 and 88 BC are divided into four themes of democratizing action, termed equality, broadening of participation, protection and mutually binding consultation, and then further organized into one of nine sub-categories for each theme. Findings suggest that the final period of 192 to 88 BC, which is period of frenzied plebeian political activity through the concilium plebis and the tribunes of the plebs, is made possible by a marked increase in legislative actions related to mutually binding consultation in the pervious period (292 to 193 BC). These findings support the claim by Tilly and Putnam that democratization can occur only with increases in institutional trust.

The field of school psychology has grown tremendously within the past 100 years, and legislation has played a major role in many changes related to the field. A review of the literature revealed that many studies have been conducted that explored demographic information, professional practices, and employment conditions. The studies tend to be somewhat narrow in focus (e.g., one study may look at demographic characteristics, while another considers only professional practices) and consider state differences rather than regional differences. In accordance with a policy established by the National Association of School Psychologists (NASP) that a study be conducted every five years, Graden and Curtis (1991) surveyed school psychologists who were members of the NASP for the purpose of developing a national database that reflected the demographic characteristics, employment conditions, and professional practices for the field during the 1989-1990 school year. Members of the NASP have been surveyed relative to the same information every five years since that initial study. The fourth national NASP study was initiated in June of 2005 using data based on the 2004-2005 school year. The database was created using survey data. The present study represented a secondary analysis of the database for the purpose of examining regional differences across the nine U.S. census regions. Regional differences in demographic characteristics, professional practices related to special education, direct and indirect services to students, and employment conditions were analyzed utilizing chi-square analyses and analyses of variance. When significant relationships were found, follow up t-tests were conducted to identify regions between which differences existed. Results indicated statistically significant regional differences for highest degree earned, licensure that allowed for independent practice in non-school settings, the number of re-evaluations conducted, the percentage of ethnic minority students in the district and served, the ratio of students to school psychologists for the district and based on caseloads, the number of days in respondents' contracts, salaries, and percentage of respondents who received clinical supervision.

To develop a sustainable future for the rangelands, partnerships are needed — partnerships between scientists, policy makers, visitors, and most significantly, the various communities of people who live and work in the rangelands. The views of these people are as variable as the country about which they care; rangeland communities are not homogeneous. The power relations between these people are at the base of many conflicts. How we handle the relationships between these groups, and manage these conflicts, are crucial for success in land management. ¶ The first part of this thesis reviews the history of both community participation and power theory. While participatory approaches are part of the rhetoric in Australian land management, proponents are generally naïve about the complexities of power and power relations. The philosophical literature highlights that power is a contested concept; and these divisions are epitomised by the works of Habermas and Foucault. Their writings are compared and contrasted to provide a rich understanding of power relations in community participation. ¶ Power relations influence whose voices are heard: those who exercise power, and the sets of rules that define what is seen as true or false at any given time in history. Power relations also determine whose knowledge is incorporated in land management policy and practice. The model proposed in this thesis demonstrates that power relations interact with every dimension of community participation: context, goals, scale, stage, who is involved, the capacity of those involved, and the methods used. ¶ Research was undertaken within agricultural and natural resource management programs and projects in south-west Queensland. A variety of participatory approaches are used by government agencies to encourage grazier participation and the adoption of more sustainable practices, such as Landcare, Bestprac and the regional groups, such as the South West Strategy. While government staff in south-west Queensland purport to share decision-making power with landholders, landholders tend to have different perspectives about the level of power that is being shared. ¶ One of the key findings of this research is that power is not static within any project. Rather, power is ultradynamic, fluid, and highly dependent on context. In terms of land management programs, the levels of power sharing fluctuate over time and between actors. The micro-physics of power, or the power relations among individuals, are often invisible to, or neglected by, the facilitators of land management programs. ¶ Government agencies tend to focus on the processes used, and on finding the best participatory methods, rather than on the individuals who implement the process or the individuals who participate. Greater flexibility is needed in approaches to land management; correspondingly, greater responsibility is needed from all individuals who have a stake in it. To find sustainable solutions for the rangelands and its people, all involved in participatory land management projects need to better understand the dynamics of power, so as to manage any negative effects.

Abstract Older adults with complex memory problems benefit when they have the opportunity to consult with a specialist for a comprehensive cognitive assessment. Specialists such as geriatricians, psychogeriatricians or neurologists often work in major cities or large metropolitan towns. Travelling to see a specialist either alone or with a carer is complicated for an older person because of medical issues or disability. The use of videoconferencing may provide a way to link a specialist with a patient without the need for the patient, or the specialist, to travel long distances. Two literature reviews were carried out. The initial review identified studies of the diagnosis of cognition via telemedicine. Thirty-two studies were identified which assessed cognition via telephone or video conference. The focus of the study was either the administration of a standardised cognitive assessment tool (n=30) or an unstructured comprehensive cognitive assessment interview (all via video conference) (n=2). The sample sizes were small but the levels of agreement were high, suggesting that further work in this area may identify that diagnosis of dementia via video conference is reliable. There has been limited work in the area of diagnostic agreement when a specialist is assessing a patient for the first time via video conference, even less work in the area of mental health assessment of older people. The second literature review identified 19 studies of diagnostic agreement using video conference with a sample size of 20 or more. The fields of research were: Dermatology (n=10); Mental Health (n=4); Minor Injuries (n=2); Neurology (n=2); and Rheumatology (n=1). Of the four studies in the area of mental health, one focused on the diagnosis of dementia with the publication of a protocol for assessing Alzheimer’s disease (AD) via video conference. The review highlighted that diagnosis via video conference in other medical fields had been shown to be reliable but that limited work was evident regarding the reliability of diagnosing dementia via video conference. A range of statistical analyses have been used to measure agreement in studies of diagnosis via VC. Overall Proportional Agreement (Po) and Cohen’s kappa (K) are the two most common calculations. There was little uniformity of reporting in the studies identified in the literature review. The variation in reporting made it difficult to compare results or provide data for a meta-analysis of similar studies. Consideration of the methods for analysing diagnostic agreement was undertaken using the approaches identified in the literature review as a starting point. The aim of this research was to identify if a diagnosis of the presence of dementia in an older adult by a specialist is reliable when the assessment interview occurs via video conference. A pilot study was carried out prior to the implementation of a National Health and Medical Research Council (NHMRC) funded multi-site project to test inter-rater agreement for the diagnosis of dementia and subsidiary questions. The candidate is a Chief Investigator (CI) on the NHMRC project grant and participated in writing the grant submission. A pilot study was completed for the purpose of refining the research protocol and establishing preliminary data for the calculation of sample size. A geriatrician carried out a cognitive assessment via video conference with the patient and the carer. The doctor had access to the patient’s chart and the results of a battery of standardised cognitive assessments administered face-to-face (FTF) by the clinic nurse earlier in the day. A second interview was carried out, face-to-face, by a second doctor on the same day. Inter-rater reliability was assessed between doctors. To place the level of agreement in context, inter-rater reliability between paired face-to-face assessments was also measured. Forty-two participants were divided into two groups: paired face-to-face assessments (FF, n=22) or paired video conference and face-to-face assessments (FV/VF, n=20). Twenty-two participants were male. Their average age was 70 years (SD=11.1, Range 50-90). The mean Standardised Mini-Mental State Examination (SMMSE) score was 23.93 (SD=5.42, Range 8-30)[1]. The outcome of agreement was measured using PO and Cohen’s K. FF group (PO=0.636; K=0.430, p=0.005) and the FV/VF group (PO=0.650; K=0.650, p=0.004) showed similar levels of agreement. The main study was a non-inferiority, prospective cohort study following a similar format as the pilot. Patients were randomised to two groups. The first group participated in two interviews; one via VC, the other was face-to-face (FV/VF). The second group was subjected to dual face-to-face assessments (FF). The video conference interview consisted of real-time video conference with the doctor interacting with both the carer and the patient. A battery of standardised assessments, a medical history, imaging and blood tests were prepared before hand and available to the doctor for use in the interview. One hundred and fifty-five participants were divided into two groups: paired face-to-face assessments (FF, n=73) or paired video conference and face-to-face assessments (FV or VF, n=82). Seventy-five of the participants were male. The average age was 76-years (SD=9, Range 54-95). The mean SMMSE was 23.8 (SD=4.4, Range 8-30). Overall proportional agreement (Po) and Weighted K were calculated as a measure of agreement for the presence of dementia. The FF group (Po=0.740; K=0.57, p<0.0001) and the FV/VF group (Po=0.780; K=0.64, p<0.0001) showed similar levels of agreement. Using the same study cohort, additional data were collected to identify the significance of the physical examination (PE) for diagnosing dementia. One of two doctors was allocated the task of completing a physical examination of the patient following initial assessment interview and after the diagnosis decisions had been recorded. Following the physical examination a second record of diagnosis decisions were recorded by the same doctor. The doctor was asked to identify if the diagnosis, formulation, treating options or additional investigations had altered as a result of the in-person physical examination. The physical examination supported clarity of the diagnosis particularly if a vascular element was involved. This dissertation provides evidence of the reliability of a diagnosis of dementia obtained via video conference. Furthermore, the work detailed in this dissertation represents the largest international study on assessing diagnostic accuracy of cognition and makes a significant contribution to the work in telemedicine in the area of mental health. This dissertation provides generalisations that can impact the use of video conference for diagnosis across a range of specialities, with the ultimate goal of improving access to specialist advice for people living in rural areas.

<p>The secessionist conflict in Transdniestrian region of the Republic of Moldova have led to more than a decade of political dialogueon finding a peaceful solution to conflict resolution, proving that the current format of negotiations is inefficient. The increased interest of the EU in the resolution of this conflict is caused by prospective inclusion of Romania in the EU, placing the Transdniestrian conflict at EU periphery, where confrontation is contrary to the all-European orientation at stability and integration. Presumably the involvement of the EU could lead to finding a political solution to the Transdniestrian conflict. Thus, the purpose of this research is to explore how EU involvement in the Transdniestrian conflict could lead to its prospective resolution. The results of this research, in form of conclusions and recommendations, depict that a more active involvement of the EU in Transdniestrian conflict resolution, as consulter and mediator, make it feasible to find a solution to the long-lasting disputes in the Republic of Moldova.</p>