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This qualitative study examined retrospective client accounts of hindering experiences that occurred during therapy. In order to explore in-depth and descriptive information about client experiences of hindering events, a structured thematic analysis methodology was used that resulted in conceptual ordering (Corbin & Strauss, 2008). Data collection was conducted through face-to-face semi-structured interviews of 9 participants who had previously experienced a hindering event. Structured thematic analysis (Braun & Clarke, 2006) was used to distill themes from the collected data, where four major themes emerged from the data that were relevant to the research questions of the present study: 1) Identified Hindering Events, 2) Subjective Experience of the Event, 3) Response to the Event, 4) Handling/ Addressing the Event. Results from this study contribute to further understanding of client experiences of hindering events that occur in therapy. Implications for therapeutic organizations, therapists/ counsellors, and educators are discussed.

Made available in DSpace on 2014-06-11T19:32:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2007Bitstream added on 2014-06-13T19:25:54Z : No. of bitstreams: 1 berezuck_ag_dr_prud.pdf: 3585867 bytes, checksum: 369d960412156cb7787dd35cbfac2fd4 (MD5) / A análise dos modos de atuação dos mecanismos atmosféricos é uma das bases da ciência climatológica, pois, através dessas, os pesquisadores estão aptos a fazer as diagnoses regionais, as prognoses climáticas, avaliar o possível impacto de variações climáticas e desenvolver projetos para mitigá-los. Seguindo essa lógica, foi elaborada a análise de adversidade climática do oeste paulista e do norte do Paraná. Para a efetuação dessa tarefa, foi utilizada a técnica de análise rítmica de Monteiro, sendo pesquisados os anos de 1997, 1998 e 2001 nas localidades de Presidente Prudente, Maringá e Londrina. Além da pesquisa dos dados diários desses três anos, em que foram criados 108 gráficos de análise rítmica e 108 gráficos de eventos climáticos, foram analisados 27 anos de dados mensais e anuais (1976- 2003) que possibilitaram a elaboração de 54 figuras, 67 tabelas, 102 gráficos e 9 organogramas, em que foram analisadas as características atmosféricas regionais, observando possíveis tendências de alterações climáticas futuras. Foram constatados, ao longo da análise, que a área de estudo está passando por um processo de aquecimento de até 1ºC, além de um processo de fortalecimento sazonal, com as estações mais secas e chuvosas tornando-se mais bem definidas, o que pode causar, futuramente, uma maior quantidade de eventos extremos e adversidades climáticas, que, por sua vez, podem afetar as cidades e a produção agrícola. / Analyzing how the atmospheric mechanisms act is a great base of the climate science because it allows the researches to know about the regional weather aspects, to discuss the possible impact of climatic variations and to develop projects in order to protect the region against these possible variations in the soon future. Following this idea, we elaborated an analysis about hazards in the Western Sao Paolo State and the North Parana State in Brazil. We based on the Monteiro rhythm analysis method to study the cities Presidente Prudente, Maringa and Londrina in the years 1997, 1998 and 2001. Through the search of diary weather statistics we created 108 rhythm analysis graphics and 108 climatic event graphics. Besides them, we studied 27 years of mensal and annual statistics (1976 - 2003) which allowed the creation of 54 figures, 67 tables, 102 graphics and 9 examples. Through these we analyzed regional climatic aspects, searching for future tendencies of climate variations. It was verified by the analysis a warming of one Celsius degree at the studied areas and also a process of sazonalization which showed more clearly the division of wet and dry seasons. We see that it could result in the future more cases of hazards that could affect the cities and the agricultural production. The thesis revels that the climatic rhythms study, the interpretation of regional climatic variation and the study of the necessary actions to protect the areas against hazards are complex questions which involve great series of variables that, sometimes, the statistical techniques are not able to solve, despite its powerful and recognition in science. Because of that, it is extremely important the careful interpretation of climatic aspects by rhythm paradigm, mainly linking it with statistical techniques as well.

Esta é uma dissertação de caráter teórico-empírico que apresenta como resultado uma proposta de método ou seqüência de etapas com conceitos, análises, \"ferramentas\" e atividades fundamentais para realização do planejamento estratégico de marketing nas empresas organizadoras de eventos vistas como empresas inseridas em redes de organizações que atendem a demanda do turismo de eventos. Para se chegar a proposta de método foi realizada a revisão teórica de quatro obras e seus métodos, encontradas na literatura em marketing, turismo e eventos. As etapas (com suas atividades e análises) propostas nos métodos estudados foram selecionadas, reunidas e \"enriquecidas\" com o enfoque de rede e análises adicionais. No campo empírico, antes de ser estruturada e apresentada definitivamente, a proposta de método foi apresentada a especialistas e gestores de empresas organizadoras de eventos em entrevistas, na busca de contribuições. Os conhecimentos tratados na revisão teórica em contato com a experiência prática levantada nas entrevistas permitiram estabelecer um diálogo entre a combinação das teorias que compuseram o método pré-estruturado a partir de outros métodos e a prática dos gestores e especialistas gerando como resultado um novo conhecimento para a gestão de marketing de eventos. / This is a theoretical and empirical dissertation which presents as result a proposal of method or sequence of steps with concepts, analysis, \"tools\" and fundamental activities to the strategic marketing planning process at the special events organizer companies, seen as companies inserted in networks of organizations that deal with tourism events demand. In order to reach the method\'s proposal it was made a review of four books and its methods, found in the marketing, tourism and special events literature. The steps (including its activities and analysis) proposed at the method were selected, grouped and improved with the network focus and additional analysis. At the empirical field, before have been structured and presented definitively, the method proposal was presented to specialists and managers of events organizer companies on interviews in search of contributions. The knowledge collected by the theoretical review in contact with the practical experience raised from the interviews allowed establishing a dialog between the combinations of theories that composed the prestructured method from the other methods and the practice of specialists and managers generating as result a new knowledge for the marketing management of events.

The present study is an interrogation of theories of culture and nation in the context of spectacular sports. It proposes a view of nationalism as discourses that articulate and produce nations through narrative acts. A wide array of concepts and tools are drawn from the work of Pierre Bourdieu and contrasted with methods and notions from discursive and semiotic analysis to interrogate a national-sports nexus in which sports are vehicles to embody nations, their matrices of thought and perception, and their dominant order of masculinity and heteronormativity in the national subject, so that this order appears natural and commonsensical. Particular attention is given to the case of South Africa’s participation in the 1998 World Cup, and the way the epic genre was employed to frame the event and produce a particular kind of national body. Spectacular sports events provide nations with opportunities to disseminate narratives that regulate desire and conjure a particular kind of national fantasy – what Bourdieu referred to as illusio – in subjects. This work makes a distinction between an epic body of nationalism, a body enmeshed in "the natural and authentic," and an excessive body. However, mediations of sports are never merely reflections of social events but themselves participate in producing these events as meaningful and anchor them as national. Furthermore, an actively interpreting subject is required for the production of meaning, and in this regard the thesis offers a critique of Bourdieu’s limited view on what it entails for a recipient of nationalist discourse to be active. The questions addressed by this study is twofold: how and what kind of national order of the body and desire is manufactured through spectacular sports events, and how are mediations of such events made meaningful in subjects? The open-ended character of signification means that beneath the level of nationalist anchorage of spectacular sports events other articulations are possible. Drawing on Bourdieu’s view of sports as forms of silent dressage, the thesis suggests that there is a potential excess of meaning that enables such events to become potential sites of subjective truth: as viewers realise the fantasmatic character of such mediations they may come to question the notion that spectacular sports are something more than just a game.

[pt] Os desvanecimentos por multipercurso atmosférico são a principal causa de degradação do desempenho de enlaces rádio digitais de alta capacidade, acentuando os efeitos do ruído térmico e da interferência intersimbólica na taxa de bits errados. A previsão da distribuição cumulativa de probabilidades destes desvanecimentos em função de parâmetros do enlace e características rádio climáticas da região é de fundamental importância no projeto de sistemas rádio digitais terrestres. Existem na literatura técnica métodos para previsão do desvanecimento em enlaces individuais, mas não para um tronco de microondas formado por vários enlaces. Medidas realizadas no Brasil indicam que a usual suposição de decorrelação total entre desvanecimentos profundos em enlaces consecutivos em um mesmo tronco é pessimista, podendo levar a uma indisponibilidade combinada maior do que a real. Neste trabalho foram analisados dados experimentais de 15 enlaces na região centro-oeste do Brasil e 5 enlaces no Japão e desenvolvido um modelo empírico de previsão da distribuição conjunta do desvanecimento por multipercurso atmosférico conjunta em enlaces adjacentes. O modelo apresenta boa concordância com os resultados experimentais e fornece uma nova expressão para o cálculo da indisponibilidade em troncos de microondas formados por vários enlaces. Os dados experimentais foram utilizados ainda para modelar a duração de eventos de atenuação por multipercurso em enlaces em visibilidade. Mostrou-se que a distribuição de duração de eventos é bem caracterizada por distribuições de Weibull. Esta caracterização permite a distinção entre eventos de perda de qualidade (duração inferior a 10 segundos) e de indisponibilidade (duração superior a 10 segundos). / [en] Multipath fading is the main cause of performance degradation in high capacity line-of-sight microwave links, increasing enhancing the effects of the thermal noise and intersymbol interference in the bit error rate. Tested methods are available in the literature for the prediction of cumulative probability distribution multipath fading in individual link but not in a microwave network formed by several tandem links. Measurements carried out in Brazil indicate that the usual assumption that deep fade events in consecutive links are totally uncorrelated may be pessimistic for tropical regions and may lead to the prediction excessive multihop links unavailability. Experimental data obtained in measurements of multipath fading in 15 pairs of tandem links located in the center- western region of Brazil were analyzed to provide cumulative distributions of attenuation in each pair. Similar results are available in the literature for 5 pairs of links in Japan. Based on these results, an empirical model was developed for the prediction of the joint probability distribution the multipath fading in adjacent links was developed. The attenuation simultaneously exceeded in both links for given percentage of time can be predicted as a function of the equiprobable values of attenuation exceeded in the individual links, path lengths and operation frequency. The predicted distributions show good agreement with the experimental results and provide an expression for the calculation of unavailability of line-of- sight tandem links. The experimental data had been used still to model the duration of events of attenuation for multipath of links in visibility. One revealed that the distribution of duration of events well is characterized by distributions of Weibull. This characterization allows the distinction between events of loss of quality (lowest duration at 10 seconds) and of non-availability (higher duration the 10 seconds).

Class of 2005 Abstract / Objectives: The purpose of this retrospective investigation is to compare the quantity, importance, and associated cost implications of drug-related problems identified (and ultimately resolved) through order entry/verification versus other clinical activities of a decentralized critical care pharmacist. Methods: The data from this study was collected by one decentralized pharmacist assigned to a surgical intensive care unit. A standard form was used to document all interventions during the period of this observation. For the purposes of this retrospective evaluation the following data will be extracted from the existing database: amount of time spent performing various clinical activities, how drug-related problems were identified (e.g., order entry verification versus chart reviews), the time it took to identify and resolve drug-related problems, a general description of interventions, the importance of the intervention, and the estimated economic impact associated with interventions. Results: In only a 41⁄2 month period, 111 patients would have likely experienced an adverse drug event had the ICU pharmacist not intervened. This equals a cost avoidance to the institution of anywhere from $200,000 to $280,000 for as little on average of 15-30 minutes of the pharmacist time. Implications: As previous studies have shown, the presence of a pharmacist in an ICU is crucial to lowering the incidence of adverse drug events. Our results have proven the interventions pharmacist make during team rounding and chart review are not only cost effective, but substantially improve patient care.

Background: Adverse events are poor health outcomes caused by medical care rather than the underlying disease process. Voluntary reporting is a key component to adverse event reduction; however, incident reporting systems contain many limitations. The Patient Safety Learning System (PSLS) is an electronic incident reporting system with several unique features that were designed to address the weaknesses of previous systems, including a process for physician assessment of reported events to determine their significance. The primary objectives for this study were to determine the positive predictive value of the PSLS for identifying adverse events. Secondary objectives were to identify event, patient, and system-level factors associated with true events, and to assess event rates over time. Methods: I performed a retrospective cohort study using electronic health care data collected data from the Ottawa Hospital, between April 1 2010 and September 30, 2011. We Included all reported patient safety events if they occurred in adults aged 18 and older, admitted to an inpatient ward at the Civic, General, or Heart Institute campus. Events that occurred on Psychiatry, Rehabilitation services, were excluded due to data restrictions. A Clinical Reviewer manually reviewed each event to distinguish true events from non-events. For each hospital program, we used a generalized linear mixed model (GLIMMIX) to predict true events, using the role of the reporter as a random effect. Results: Over the study period, there were 2,569 events reported by hospital staff and physicians. Of these, 660 were rated as adverse events and 1,909 were rated as near misses. This yielded an overall positive predictive value of the PSLS system of 63% (95% CI 62-65%). The variance between reporters was not significant for Critical Care, Heart Institute, Nephrology, Obstetrics and Gynecology, Surgery and Periops, therefore I used a traditional logistic regression model with a common intercept. Number of months the PSLS was available was the only significant covariate found in all programs; the direction of the relationship was the same across all programs, and showed a decrease in true events reported over time. Other common covariates included: time from admission to event, severity of illness, and admission type. All models achieved a good calibration, yet discrimination was poor (c <0.70) in all models except Heart Institute. Discrimination ranged from 65% in Critical Care to 77% in the Heart Institute. Overall, the rate of patient safety events reported for inpatients was 6.39 per 1000 patient days. After an initial learning period, from April 2010-January 2011, in which rates were low, reporting rates increased and stabilized; remaining constant from month to month. The rate of true patient safety event reporting fluctuated greatly from April 2010-January 2011, after which they began to steadily decline. Trends in reporting were similar across hospital campus, reporter, and program. The majority of patient safety events were reported by nurses (44%), and laboratory staff (42%). The remaining 14% of events were reported by the classification ‘Other,’ which included all other hospital staff, such as technicians, physicians, and administrative staff. Only 7 physicians reported events to the PSLS during my study period, therefore, they were categorized under ‘Other’. Conclusions: Despite the many unique advantages of the PSLS, the proportion of true events reported has remained low. The overall utility of statistical models to predict patient safety events is limited. The traditional patient and system-level covariates, which are used to predict risk of adverse outcomes with high accuracy, did not help us discriminate between true patient safety events from non events. It is possible that many different individual and institutional barriers are influencing reporting and perhaps reviewing behavior, which in turn leads to non-clinical variability in what gets reported and classified as a patient safety event.

Background Previous measurements of preventable death in hospital do not account for the uncertainty of preventability ratings. Objective To determine the proportion of deaths in hospital that a have high probability of being prevented with high quality care. Methods We created summaries for every death at a tertiary care hospital over 4-months. Four reviewers assigned preventability ratings to each death and latent class analysis was used to classify deaths into high and low preventability categories. Results There were 480 decedents with mean age of 73.9. Inter-rater reliability was poor with an intra-class correlation of 0.14. The best latent class model found that 6.2% (95% CI 0.00 – 15.2%) of deaths had a 31.0% probability of being rated more likely preventable than not by each reviewer. In contrast, 93.8% (95% CI 84.8 - 100.0%) of deaths had a 0.8% probability of being rated more likely preventable than not by each reviewer. The incidence of truly preventable deaths is less than the 6.2% that are deemed possibly preventable. xi Conclusion Very few deaths in hospital are preventable. The low incidence of preventable deaths and low inter-rater reliability means that peer review methodology is only sensitive to large differences in preventable death rate.

In recent time Hemnet has faced an intensified criticism because of the latest introduction of ad-fees, and not least because of the take-over regarding Swedbank Fastighetsbyrån and Svensk Fastighetsförmedling. There is a growing concern amongst real estate agents about the development for which the Swedish real estate advertising market is taking. Many of the competitors on the market that have previously experienced difficulties in establishing on the market now see their opportunity to make use of the situation that has emerged regarding Hemnet. By offering better and more lucrative terms they could potentially bring in enough real estate agencies to pose a real threat on the advertising market. Hemnet is part-owned by four organizations, Fastighetsbyrån, Svensk Fastighetsförmedling, Mäklarsamfundet and Fastighetsmäklarförbundet. All of which have a 25 percent share in Hemnet. With Fastighetsbyrån now possibly taking-over Svensk Fastighetsförmedling, their share would rise to 50 percent. Many are those who have expressed their worry and anger with the whole situation and within the real estate industry a sigh of disappointment is spreading given the way Hemnet is developing. The vision was never to become a profit-driven platform, but a fair and just platform owned by the real estate agents, to escape the dependency-state and growing ad-costs for which they otherwise would have to pay the newspapers. It proved important to use the internet in its early stages to build a good platform from where they could compete with the newspapers. It turned out to be a successful move and Hemnet soon became a leader on the market, by some regarded as nothing short of a monopoly. Hemnet is now being challenged perhaps for the first time from all sides in form of competitors, but even by its own organization. A tough period awaits Hemnet with their over a decade long market leading position at stake