L’optimisation du statut tissulaire en acides gras polyinsaturés à longues chaines n-3 (AGPILC n-3) fait partie des objectifs actuels en nutrition humaine. En effet, de nombreux effets bénéfiques sur la santé humaine ont été démontrés pour ces différents AGPILC n-3. Néanmoins, la bioconversion de ces dérivés à partir de leur précurseur alimentaire, l’acide α-linolénique, est limitée chez l’Homme et ne permet pas de subvenir aux besoins. Parmi cette famille d’acides, l’acide docosahexaénoïque (DHA) et de l’acide eicosapentaénoïque (EPA) ont été largement étudiés à l’inverse de ceux de l’acide docosapentaénoïque n-3 (DPA). Le premier objectif de ces travaux a été d’étudier l’impact d’une supplémentation nutritionnelle en DPA sur le métabolisme des acides gras et le métabolisme lipidique chez le rat sain. Pour cela, une méthode de purification du DPA à haute pureté et en grande quantité par chromatographie liquide a tout d’abord été mise en place. Ce résultat participe à faciliter la recherche future des effets in vivo du DPA dont la disponibilité commerciale est faible. Après sa supplémentation nutritionnelle, le DPA a été incorporé dans de multiples tissus et a impacté les compositions tissulaires en AGPILC n-3 de certains organes spécifiques comme le foie, le cœur, le poumon, la rate et le rein. Ainsi, la supplémentation en DPA pourrait être une source d’EPA, de DPA, et dans une moindre mesure de DHA. Enfin, comparé à une supplémentation en EPA ou en DHA, le DPA a été l’AGPILC n-3 le plus puissant pour améliorer la triglycéridémie et la cholestérolémie des animaux. Ces informations participeront certainement à une prise en compte plus importante du DPA tant dans les études nutritionnelles ainsi que dans l’installation des futures recommandations nutritionnelles. Le deuxième axe de recherche a porté sur la capacité d’une incorporation partielle de lipides laitiers dans le régime à augmenter le statut tissulaire en AGPI-LC n-3. L’incorporation de lipides laitiers a augmenté le statut en DHA cérébral et rétinien et le statut en DPA dans les autres tissus étudiés. De plus, l’induction de la conversion des AGPILC n-3 à partir de leur précurseur par les lipides laitiers a été complémentaire avec la supplémentation en DPA pour augmenter le statut tissulaire en AGPI-LC n-3. Ces résultats s’insèrent dans un contexte de nutrition infantile, période pendant laquelle l’incorporation des AGPI-LC n-3 est maximale dans les tissus nerveux. Ainsi, ces résultats apportent des données intéressantes tant pour les entreprises que pour les professionnels de santé pour recommander à la consommation des formules infantiles contenant des lipides laitiers. / The optimization of tissue status in n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) is one of the current goals in human nutrition. Indeed, many beneficial effects on human health have been demonstrated for these different n-3 LCPUFA. However, the bioconversion of these derivatives from their food precursor, α-linolenic acid, is limited in humans and it does not meet the needs of the organism. Among this family of fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been widely studied in contrast to those of n-3 docosapentaenoic acid (DPA). The first objective of this work was to study the impact of dietary supplementation with DPA on fatty acid metabolism and lipid metabolism in healthy rats. For this, a method for purifying DPA with high purity and in large quantities by liquid chromatography was first established. This result helps future research of the in vivo effects of DPA, poorly commercially available. After its nutritional supplementation, DPA was incorporated into multiple tissues and it has affected the n-3 LCPUFA tissue compositions of specific organs such as the liver, heart, lung, spleen and the kidney. Thus, supplementation with DPA could be a source of EPA, DPA, and to a lesser extent DHA. Finally, compared to supplementation with EPA or DHA, DPA was the most potent n-3 LCPUFA to improve triglyceridemia and cholesterolemia in animals. This information will certainly contribute to a greater consideration of DPA both in nutritional studies and in the direction of future nutritional recommendations. The second area of ​​research focused on the ability of a partial incorporation of dairy lipids in the diet to increase the tissue status in n-3 LCPUFA. Incorporation of dairy lipids in the diet increased DHA status in brain and retina and DPA status in the other studied tissues. In addition, the induction of conversion of n-3 LCPUFA from their precursor by dairy lipid was complementary with the DPA supplementation to increase n-3 LCPUFA status in tissues. These results fit into a context of infant nutrition, during which the incorporation of n-3 LCPUFA is maximal in nervous tissues. Thus, these results provide interesting data for both companies and health professionals to recommend infant formulas containing dairy lipids for consumption.

Mitochondrial dysfunction has been implicated for a wide range of human diseases. One of the major biosynthetic processes in human mitochondria is the biogenesis of Iron-Sulfur (Fe-S) clusters which primarily involves in electron transfer reactions during oxidative phosphorylation (OXPHOS). Defects in Fe-S cluster biogenesis process leads to mitochondrial dysfunction and that eventually results in various human mitochondrial disorders. One of the major mitochondrial disorders associated with Fe-S cluster biogenesis impairment is exercise intolerance disorder ISCU myopathy, which is a result of loss of function of Fe-S cluster scaffold protein ISCU. Our biochemical results using yeast model system and HeLa cells lines suggests that ISCU Myopathy results in defective Fe-S cluster biogenesis in mitochondrial compartment. As a result, electron transport chain (ETC) complexes demonstrate significant reduction in their redox properties, leading to loss of cellular respiration. Furthermore, in ISCU Myopathy, mitochondria display enhancement in iron levels and reactive oxygen species, thereby causing oxidative stress leading to impairment in the mitochondrial functions. On the other hand, in mammalian mitochondria, the initial step of Fe-S cluster assembly process is assisted by NFS1-ISD11 complex, which delivers sulfur to the scaffold protein ISCU during Fe-S cluster synthesis. In humans, loss of ISD11 function leads to development of respiratory distress disorder, Combined Oxidative Phosphorylation Deficiency 19 (COXPD19). Our study maps the important ISD11 amino acid residues critical for in vivo Fe-S cluster biogenesis. Importantly, mutation of these critical ISD11 residues to alanine leads to its compromised interaction with NFS1, which results in reduced stability and enhanced aggregation of NFS1 in the mitochondria. Moreover, our findings highlight that, COXPD19 associated R68L ISD11 mutant displays reduced affinity to form a stable sub-complex with NFS1, thereby fails to prevent NFS1 aggregation, resulting impairment of Fe-S cluster biogenesis. The prime affected machinery is the ETC complex which demonstrates compromised redox properties, causing diminished mitochondrial respiration in COXPD19 patients. In summary, our findings provide compelling evidence that respiration defect due to impaired biogenesis of Fe-S clusters in ISCU myopathy patients, leads to manifestation of complex clinical symptoms. Additionally, our study highlights the role of ISD11 protein in Fe-S cluster biogenesis and maps the surface residues of ISD11 protein that are involved in interaction with sulfur donor protein NFS1. Moreover, we have demonstrated the molecular basis of disease progression of COXPD19 as a result of R68L ISD11 mutation.

O presente estudo teve como objetivo analisar a constituição do atendimento educacional especializado em educação especial para crianças da Educação Infantil. Para tanto, procurei descrever como se configuram esses serviços na Rede Municipal de Ensino de Porto Alegre, especificamente o de Educação Precoce (EP) e Psicopedagogia Inicial (PI), assim como refletir sobre seus possíveis efeitos. As questões que orientaram o desenvolvimento da pesquisa foram às seguintes: como se organiza o atendimento às crianças com deficiência na perspectiva da educação inclusiva na educação infantil? Que singularidades constituem o atendimento na Rede Municipal de Ensino de Porto Alegre na proposição de serviços especializados de apoio às crianças de zero a cinco anos de idade? É possível considerar que estes serviços servem como um suporte para a permanência da criança na escola? Essas questões embasaram a análise do serviço de atendimento educacional especializado que integra a presente pesquisa. Busquei também a compreensão histórica de uma rede de ensino que tem dado prioridade às políticas de inclusão escolar, identificando aspectos que podem ser considerados cruciais, como os da transição entre os diferentes níveis de escolarização. Com base nas reflexões do pensamento sistêmico de Gregory Bateson e Humberto Maturana, foram priorizados os pressupostos da abordagem qualitativa, utilizando os seguintes instrumentos metodológicos: entrevista semiestruturada, observação participante e o diário de campo. As entrevistas foram realizadas com quatorze educadoras especiais e com a Coordenadora do serviço de EP e PI. Foram priorizadas as observações em espaços onde ocorre o serviço (atendimento e assessorias). Como possíveis resultados, destaco a importância da articulação entre os campos da educação especial e da educação infantil na construção de propostas pedagógicas que sirvam como suporte aos diferentes sujeitos envolvidos (professores, comunidade, família, criança) para a efetiva permanência do aluno com deficiência no ensino comum; a presença de uma variedade de modos de recepção e compreensão do movimento de inclusão escolar por parte dos educadores envolvidos e o reconhecimento de que o local de instituição de um serviço produz impacto para se pensar os processos de escolarização de seus alunos e a tomada de decisão relativa a esses processos. / The present study had as objective to analyze the constitution of the specialized educational attendance in special education to children of infantile education. For so, it was looked to describe how these services in the Municipal Teaching Network of Porto Alegre are configured, specifically the ones of Precocious Education (EP) and Initial Psycho pedagogy (PI), as well as to reflect about their possible effects. The questions that guided the development of this research were: How is the attendance to children with deficiency in the perspective of inclusive education in the infantile education constituted? Which singularities constitute the attendance in the Municipal Teaching Network of Porto Alegre in the proposition of specialized services of support to children between zero and five years old? Can we consider that these services are constituted as a brace to the permanence of the children in the school? These questions laid the foundation to the analysis of the service of the specialized educational attendance that takes part in this research. It was searched for the historical comprehension of a teaching network which has given priority to the policy of scholar inclusion; identifying aspects that can be considered crucial, as the transition between the different stages of education. Based on the reflections of the systemic thought of Gregory Bateson and Humberto Maturana, the presupposition of qualitative approach was prioritized, using the following methodological tools: semi-structured interview, the participant observation and the research diary. The interviews were done with fourteen special education teachers and the Coordinator of EP and PI services. The observations gave priority to the places where the services occur (attendance and assistance). As possible results, I highlight the importance of articulation between the fields of special education and infantile education in the construction of pedagogical proposals that are organized as a brace to the different people involved (teachers, community, family and children) to the effective permanence of a student with deficiency in the common education; the presence of a variety in the ways of reception and comprehension of the movement in the educational inclusion by the teachers involved, and the recognition that the place of institution of a service produces impact to think the processes of education and to make decisions related to these processes. / Este estudio tuvo como objeto la constitución del atendimiento educacional con especialidad en educación especial para niños de la educación infantil. Para lo cual, busqué describir como se configuran esos servicios en la Red Municipal de Enseñanza de Porto Alegre, específicamente el de Educación Temprana y Sicopedagogía Inicial, de igual manera reflexionar sobre sus posibles efectos. Las cuestiones que orientaron el desemvolvimiento de la pesquisa fueron las siguientes: ¿cómo se organiza el atendimiento a los niños con deficiencia en la perspectiva de la educación inclusiva en la educación infantil? ¿qué singularidades constituyen el atendimiento en la Red Municipal de Enseñanza de Porto Alegre en la propuesta de servicios con especialidad de apoyo a los niños de cero a cinco años de edad? ¿es posible considerar que estos servicios sirvan como un soporte a la permanencia del niño en la escuela? Esas cuestiones fundamentaron el análisis del servicio de atendimiento educacional con especialidad que integra esta investigación. Busqué también la comprensión histórica de una Red de Enseñanza que dio prioridad a las políticas de inclusión escolar, identificando aspectos que pueden ser considerados cruciales, como los de la transición entre los diferentes niveles de escolarización. Basado en la reflexiones del pensamiento sistémico de Gregory Bateson y Humberto Maturana, fueron privilegiados los presupuestos del abordaje cualitativo los siguientes instrumentos metodológicos: entrevista semiestructurada, observación participante y diario de pesquisa. Las entrevistas fueron realizadas con catorce docentes especialistas y con la Cordinadora del servicio de Educación Temprana y Sicopedagogía Inicial. Fueron privilegiadas las observaciones en espacios donde ocurre el servicio (atendimiento y asesoría). Como posibles resultados, destaco la importancia de la articulación entre los campos de la educación especial y de la educación infantil en la construcción de propuestas pedagógicas que sirvan como soporte a las diferentes personas envueltas (profesores, comunidad, familia, niños) para la efectiva permanencia del alumno con deficiencia en la enseñaza regular; la presencia de una gama de modos de recibimiento y comprensión del movimiento de inclusión escolar por los docentes envueltos y el reconocimiento de que el lugar en donde sucede el servicio produce un impacto, da lugar a reflexionar sobre los procesos de escolarización de los niños con deficiencia.

CABRAL, Marcelle Arruda. Identidade étnico-racial em contexto lúdico: um jogo de cartas marcadas? 2007. 118f. Dissertação (Mestrado em Educação) - Universidade Federal do Ceará, Faculdade de Educação, Programa de Pós-Graduação em Educação Brasileira, Fortaleza-CE, 2007. / Submitted by Maria Josineide Góis (josineide@ufc.br) on 2012-07-26T15:13:01Z No. of bitstreams: 1 2007_Dis_MACabral.pdf: 4344478 bytes, checksum: 596f4d50095eae3e3d8a2fd4ece75aac (MD5) / Approved for entry into archive by Maria Josineide Góis(josineide@ufc.br) on 2012-07-27T12:00:00Z (GMT) No. of bitstreams: 1 2007_Dis_MACabral.pdf: 4344478 bytes, checksum: 596f4d50095eae3e3d8a2fd4ece75aac (MD5) / Made available in DSpace on 2012-07-27T12:00:00Z (GMT). No. of bitstreams: 1 2007_Dis_MACabral.pdf: 4344478 bytes, checksum: 596f4d50095eae3e3d8a2fd4ece75aac (MD5) Previous issue date: 2007

DIEB, Messias Holanda. Móbeis, sentidos e saberes: o professor da educação infantil e sua relação com o saber. 2007. 316f. Tese (Doutorado em Educação) – Universidade Federal do Ceará, Faculdade de Educação, Programa de Pós-Graduação em Educação Brasileira, Fortaleza-CE, 2007. / Submitted by Raul Oliveira (raulcmo@hotmail.com) on 2012-08-08T13:36:30Z No. of bitstreams: 1 2007_TESE_MHDIEB.pdf: 1222047 bytes, checksum: c9ee2f47186106dcbc05cd9d0fb882b7 (MD5) / Approved for entry into archive by Maria Josineide Góis(josineide@ufc.br) on 2012-08-09T11:46:43Z (GMT) No. of bitstreams: 1 2007_TESE_MHDIEB.pdf: 1222047 bytes, checksum: c9ee2f47186106dcbc05cd9d0fb882b7 (MD5) / Made available in DSpace on 2012-08-09T11:46:43Z (GMT). No. of bitstreams: 1 2007_TESE_MHDIEB.pdf: 1222047 bytes, checksum: c9ee2f47186106dcbc05cd9d0fb882b7 (MD5) Previous issue date: 2007 / Esta pesquisa buscou compreender como se caracteriza a relação com o saber do professor da educação infantil (EI) na escola pública. Para isso, tomou por base as experiências profissionais e os processos que perpassam o desenvolvimento de sua função docente. Como fundamentação para o alcance de tal objetivo foi utilizado o conceito teórico de Bernard Charlot (2000) sobre a relação com o saber, formulado a partir de reflexões acerca dos processos de aprendizagem compreendidos como experiências cujo êxito ou fracasso está condicionado ao significado pessoal que os aprendizes lhes atribuem. Assim, as noções de atividade, mobilização, saber e sentido foram essenciais para pensar a construção do sujeito professor da EI e sua relação com o saber. O corpus analisado resulta de uma pesquisa qualitativa, de cunho etnográfico, constituído a partir de dois instrumentos metodológicos: balanço do saber e entrevistas semi-estruturadas, ambos trabalhados com nove professoras da EI, na rede pública da cidade de Assú - RN. A análise, realizada sob os auspícios de uma perspectiva sócio-histórica, centrou-se nas experiências significativas para o professor e nos processos que o mobilizam à aprendizagem de sua função, especialmente aqueles em que o professor faz uso de si para a construção dos saberes que são utilizados em sua prática pedagógica. Os dados revelaram que a relação com o saber do professor da EI tem sido fragilizada em duas dimensões: epistêmica e identitária. Não obstante isso, a dimensão social dessa relação e uma “leitura em positivo” da experiência profissional do professor na EI permite perceber que ele busca descobrir seus próprios caminhos para o saber e o prazer, contradizendo as forças sociais que o cercam. Assim sendo, o professor não vê na função que exerce apenas uma oportunidade de melhorar suas condições de vida, mas também de contribuir com a formação ético-moral e intelectual da criança. Para isso, é-lhe exigida a construção de saberes profissionais cuja aprendizagem se deve mais às exigências cotidianas da atividade prática e às relações nela construída do que aos momentos de formalização e sistematização dessa prática. Com base nessa construção, é possível ainda inferir quatro tendências dominantes na relação do professor com a específica atividade de cuidar e educar. A primeira dessas tendências sinaliza que a função de cuidar e educar é compreendida pela maioria dos professores como algo que depende fundamentalmente de sua aproximação com a criança, expressa pela afetividade entre ambos. Uma segunda tendência, por sua vez, mostra que o cuidar e educar implica um esforço e uma postura ativa do professor para a instrução escolar da criança. Além dessas, as outras duas tendências sinalizam para uma aprendizagem que promova a transformação tanto da vida das crianças como do professor e, sobretudo, para uma experimentação constante em sua prática na busca de amenizar as incertezas e dificuldades das situações difíceis e imprevistas da sala de aula. / Cette recherche a l’objectif de comprendre comme se caractérise le rapport au savoir de l’enseignant de l’éducation infantile (niveau maternnel) dans l'école publique à travers les expériences professionnelles e des processus qui traversent le développement de sa fonction enseignante. Elle utilise comme fondement théorique le concept du rapport au savoir , formulé par Bernard Charlot (2000), à partir des réflexions sur l'apprentissage comme une expérience dans laquelle le succès ou l’échec est conditionné par la signification personnelle attribuée par le sujet. Ainsi, les notions d'activité , de mobilisation , de savoir et de sens ont été essentielles pour penser la construction du sujet enseignant de l’éducation infantile et son rapport au savoir . Il s'agit d'une recherche qualitative, avec des caraterístics de l'ethnographie, dont le corpus analysé a résulté de deux instruments méthodologiques: le bilan du savoir et l'entretien semi-structuré , desquels ont participé neuf enseignantes de l'éducation infantile publique de la ville d'Assú, état de Rio Grande do Norte, Brésil. L'analyse est guidée par une perspective socio-historique et se centre dans les expériences qui mobilisent l'enseignant à apprendre son rôle, surtoutles processus significatifs pour la construction des savoirs exigés par la pratique pédagogique. Les données ont révélées que le rapport au savoir de l'enseignant de l'éducation infantile est fragilisé dans deux dimensions: epistémique et identitaire. Mais, la dimension sociale de ce rapport et une "lecture en positif" de l'expérience professionnelle de l'enseignant permet de percevoir qu'il cherche découvrir ses propres chemins au le savoir et au plaisir, malgré l’opposition des forces sociales. Ainsi, l'enseignant ne voit pas sa fonction seulement comme une occasion d'améliorer sa condition de vie, mais aussi comme une opportunité de contribuer à la formation éthique, morale et intellectuelle de l'enfant, d’où son besoin de construire des savoirs professionnelles. Cependant, l'apprentissage de ces savoirs se doit plus aux éxigences quotidiennes de la pratique et aux rapports construits qu’ aux moments de formalisation et de systématisation de cette pratique. Pendant la construction du savoir professionnel, il est encore possible d'inférer quatre tendances dominants de l'activité de "soigner et instruire". Ainsi, la première de ces tendances signale que "soigner et instruire" est comprise, par la majorité des enseignants, comme une action qui dépend fondamentalement de son approche à l'enfant, exprimée par un rapport d'affectivité . Une seconde tendance, à son tour, indique que cette activité implique un et une position active de l'enseignant pour l'instruction de l'enfant. Les autres deux tendances signalent pour un espace d’apprentissage nécessaire à la transformation de la vie des enfants et de la vie de l'enseignant et, surtout, pour une expérimentation constant dans leur pratique qui vise à égayer l'incertitude et la difficulté des situations difficiles et imprévisibles de la classe.

O presente estudo teve como objetivo analisar a constituição do atendimento educacional especializado em educação especial para crianças da Educação Infantil. Para tanto, procurei descrever como se configuram esses serviços na Rede Municipal de Ensino de Porto Alegre, especificamente o de Educação Precoce (EP) e Psicopedagogia Inicial (PI), assim como refletir sobre seus possíveis efeitos. As questões que orientaram o desenvolvimento da pesquisa foram às seguintes: como se organiza o atendimento às crianças com deficiência na perspectiva da educação inclusiva na educação infantil? Que singularidades constituem o atendimento na Rede Municipal de Ensino de Porto Alegre na proposição de serviços especializados de apoio às crianças de zero a cinco anos de idade? É possível considerar que estes serviços servem como um suporte para a permanência da criança na escola? Essas questões embasaram a análise do serviço de atendimento educacional especializado que integra a presente pesquisa. Busquei também a compreensão histórica de uma rede de ensino que tem dado prioridade às políticas de inclusão escolar, identificando aspectos que podem ser considerados cruciais, como os da transição entre os diferentes níveis de escolarização. Com base nas reflexões do pensamento sistêmico de Gregory Bateson e Humberto Maturana, foram priorizados os pressupostos da abordagem qualitativa, utilizando os seguintes instrumentos metodológicos: entrevista semiestruturada, observação participante e o diário de campo. As entrevistas foram realizadas com quatorze educadoras especiais e com a Coordenadora do serviço de EP e PI. Foram priorizadas as observações em espaços onde ocorre o serviço (atendimento e assessorias). Como possíveis resultados, destaco a importância da articulação entre os campos da educação especial e da educação infantil na construção de propostas pedagógicas que sirvam como suporte aos diferentes sujeitos envolvidos (professores, comunidade, família, criança) para a efetiva permanência do aluno com deficiência no ensino comum; a presença de uma variedade de modos de recepção e compreensão do movimento de inclusão escolar por parte dos educadores envolvidos e o reconhecimento de que o local de instituição de um serviço produz impacto para se pensar os processos de escolarização de seus alunos e a tomada de decisão relativa a esses processos. / The present study had as objective to analyze the constitution of the specialized educational attendance in special education to children of infantile education. For so, it was looked to describe how these services in the Municipal Teaching Network of Porto Alegre are configured, specifically the ones of Precocious Education (EP) and Initial Psycho pedagogy (PI), as well as to reflect about their possible effects. The questions that guided the development of this research were: How is the attendance to children with deficiency in the perspective of inclusive education in the infantile education constituted? Which singularities constitute the attendance in the Municipal Teaching Network of Porto Alegre in the proposition of specialized services of support to children between zero and five years old? Can we consider that these services are constituted as a brace to the permanence of the children in the school? These questions laid the foundation to the analysis of the service of the specialized educational attendance that takes part in this research. It was searched for the historical comprehension of a teaching network which has given priority to the policy of scholar inclusion; identifying aspects that can be considered crucial, as the transition between the different stages of education. Based on the reflections of the systemic thought of Gregory Bateson and Humberto Maturana, the presupposition of qualitative approach was prioritized, using the following methodological tools: semi-structured interview, the participant observation and the research diary. The interviews were done with fourteen special education teachers and the Coordinator of EP and PI services. The observations gave priority to the places where the services occur (attendance and assistance). As possible results, I highlight the importance of articulation between the fields of special education and infantile education in the construction of pedagogical proposals that are organized as a brace to the different people involved (teachers, community, family and children) to the effective permanence of a student with deficiency in the common education; the presence of a variety in the ways of reception and comprehension of the movement in the educational inclusion by the teachers involved, and the recognition that the place of institution of a service produces impact to think the processes of education and to make decisions related to these processes. / Este estudio tuvo como objeto la constitución del atendimiento educacional con especialidad en educación especial para niños de la educación infantil. Para lo cual, busqué describir como se configuran esos servicios en la Red Municipal de Enseñanza de Porto Alegre, específicamente el de Educación Temprana y Sicopedagogía Inicial, de igual manera reflexionar sobre sus posibles efectos. Las cuestiones que orientaron el desemvolvimiento de la pesquisa fueron las siguientes: ¿cómo se organiza el atendimiento a los niños con deficiencia en la perspectiva de la educación inclusiva en la educación infantil? ¿qué singularidades constituyen el atendimiento en la Red Municipal de Enseñanza de Porto Alegre en la propuesta de servicios con especialidad de apoyo a los niños de cero a cinco años de edad? ¿es posible considerar que estos servicios sirvan como un soporte a la permanencia del niño en la escuela? Esas cuestiones fundamentaron el análisis del servicio de atendimiento educacional con especialidad que integra esta investigación. Busqué también la comprensión histórica de una Red de Enseñanza que dio prioridad a las políticas de inclusión escolar, identificando aspectos que pueden ser considerados cruciales, como los de la transición entre los diferentes niveles de escolarización. Basado en la reflexiones del pensamiento sistémico de Gregory Bateson y Humberto Maturana, fueron privilegiados los presupuestos del abordaje cualitativo los siguientes instrumentos metodológicos: entrevista semiestructurada, observación participante y diario de pesquisa. Las entrevistas fueron realizadas con catorce docentes especialistas y con la Cordinadora del servicio de Educación Temprana y Sicopedagogía Inicial. Fueron privilegiadas las observaciones en espacios donde ocurre el servicio (atendimiento y asesoría). Como posibles resultados, destaco la importancia de la articulación entre los campos de la educación especial y de la educación infantil en la construcción de propuestas pedagógicas que sirvan como soporte a las diferentes personas envueltas (profesores, comunidad, familia, niños) para la efectiva permanencia del alumno con deficiencia en la enseñaza regular; la presencia de una gama de modos de recibimiento y comprensión del movimiento de inclusión escolar por los docentes envueltos y el reconocimiento de que el lugar en donde sucede el servicio produce un impacto, da lugar a reflexionar sobre los procesos de escolarización de los niños con deficiencia.

O presente estudo teve como objetivo analisar a constituição do atendimento educacional especializado em educação especial para crianças da Educação Infantil. Para tanto, procurei descrever como se configuram esses serviços na Rede Municipal de Ensino de Porto Alegre, especificamente o de Educação Precoce (EP) e Psicopedagogia Inicial (PI), assim como refletir sobre seus possíveis efeitos. As questões que orientaram o desenvolvimento da pesquisa foram às seguintes: como se organiza o atendimento às crianças com deficiência na perspectiva da educação inclusiva na educação infantil? Que singularidades constituem o atendimento na Rede Municipal de Ensino de Porto Alegre na proposição de serviços especializados de apoio às crianças de zero a cinco anos de idade? É possível considerar que estes serviços servem como um suporte para a permanência da criança na escola? Essas questões embasaram a análise do serviço de atendimento educacional especializado que integra a presente pesquisa. Busquei também a compreensão histórica de uma rede de ensino que tem dado prioridade às políticas de inclusão escolar, identificando aspectos que podem ser considerados cruciais, como os da transição entre os diferentes níveis de escolarização. Com base nas reflexões do pensamento sistêmico de Gregory Bateson e Humberto Maturana, foram priorizados os pressupostos da abordagem qualitativa, utilizando os seguintes instrumentos metodológicos: entrevista semiestruturada, observação participante e o diário de campo. As entrevistas foram realizadas com quatorze educadoras especiais e com a Coordenadora do serviço de EP e PI. Foram priorizadas as observações em espaços onde ocorre o serviço (atendimento e assessorias). Como possíveis resultados, destaco a importância da articulação entre os campos da educação especial e da educação infantil na construção de propostas pedagógicas que sirvam como suporte aos diferentes sujeitos envolvidos (professores, comunidade, família, criança) para a efetiva permanência do aluno com deficiência no ensino comum; a presença de uma variedade de modos de recepção e compreensão do movimento de inclusão escolar por parte dos educadores envolvidos e o reconhecimento de que o local de instituição de um serviço produz impacto para se pensar os processos de escolarização de seus alunos e a tomada de decisão relativa a esses processos. / The present study had as objective to analyze the constitution of the specialized educational attendance in special education to children of infantile education. For so, it was looked to describe how these services in the Municipal Teaching Network of Porto Alegre are configured, specifically the ones of Precocious Education (EP) and Initial Psycho pedagogy (PI), as well as to reflect about their possible effects. The questions that guided the development of this research were: How is the attendance to children with deficiency in the perspective of inclusive education in the infantile education constituted? Which singularities constitute the attendance in the Municipal Teaching Network of Porto Alegre in the proposition of specialized services of support to children between zero and five years old? Can we consider that these services are constituted as a brace to the permanence of the children in the school? These questions laid the foundation to the analysis of the service of the specialized educational attendance that takes part in this research. It was searched for the historical comprehension of a teaching network which has given priority to the policy of scholar inclusion; identifying aspects that can be considered crucial, as the transition between the different stages of education. Based on the reflections of the systemic thought of Gregory Bateson and Humberto Maturana, the presupposition of qualitative approach was prioritized, using the following methodological tools: semi-structured interview, the participant observation and the research diary. The interviews were done with fourteen special education teachers and the Coordinator of EP and PI services. The observations gave priority to the places where the services occur (attendance and assistance). As possible results, I highlight the importance of articulation between the fields of special education and infantile education in the construction of pedagogical proposals that are organized as a brace to the different people involved (teachers, community, family and children) to the effective permanence of a student with deficiency in the common education; the presence of a variety in the ways of reception and comprehension of the movement in the educational inclusion by the teachers involved, and the recognition that the place of institution of a service produces impact to think the processes of education and to make decisions related to these processes. / Este estudio tuvo como objeto la constitución del atendimiento educacional con especialidad en educación especial para niños de la educación infantil. Para lo cual, busqué describir como se configuran esos servicios en la Red Municipal de Enseñanza de Porto Alegre, específicamente el de Educación Temprana y Sicopedagogía Inicial, de igual manera reflexionar sobre sus posibles efectos. Las cuestiones que orientaron el desemvolvimiento de la pesquisa fueron las siguientes: ¿cómo se organiza el atendimiento a los niños con deficiencia en la perspectiva de la educación inclusiva en la educación infantil? ¿qué singularidades constituyen el atendimiento en la Red Municipal de Enseñanza de Porto Alegre en la propuesta de servicios con especialidad de apoyo a los niños de cero a cinco años de edad? ¿es posible considerar que estos servicios sirvan como un soporte a la permanencia del niño en la escuela? Esas cuestiones fundamentaron el análisis del servicio de atendimiento educacional con especialidad que integra esta investigación. Busqué también la comprensión histórica de una Red de Enseñanza que dio prioridad a las políticas de inclusión escolar, identificando aspectos que pueden ser considerados cruciales, como los de la transición entre los diferentes niveles de escolarización. Basado en la reflexiones del pensamiento sistémico de Gregory Bateson y Humberto Maturana, fueron privilegiados los presupuestos del abordaje cualitativo los siguientes instrumentos metodológicos: entrevista semiestructurada, observación participante y diario de pesquisa. Las entrevistas fueron realizadas con catorce docentes especialistas y con la Cordinadora del servicio de Educación Temprana y Sicopedagogía Inicial. Fueron privilegiadas las observaciones en espacios donde ocurre el servicio (atendimiento y asesoría). Como posibles resultados, destaco la importancia de la articulación entre los campos de la educación especial y de la educación infantil en la construcción de propuestas pedagógicas que sirvan como soporte a las diferentes personas envueltas (profesores, comunidad, familia, niños) para la efectiva permanencia del alumno con deficiencia en la enseñaza regular; la presencia de una gama de modos de recibimiento y comprensión del movimiento de inclusión escolar por los docentes envueltos y el reconocimiento de que el lugar en donde sucede el servicio produce un impacto, da lugar a reflexionar sobre los procesos de escolarización de los niños con deficiencia.

Du fait de son impact sur la morbidité et la mortalité infantile, ainsi que de ses implications sur la santé à l’âge adulte, le petit poids de naissance constitue un problème majeur de santé publique. Le Burkina Faso, pays sahélien enclavé au cœur de l’Afrique occidentale est classé dans le groupe des pays pauvres très endettés et présente une forte prévalence de petit poids de naissance, imputable dans la majorité des cas au retard de croissance intra-utérine. Le contexte de ce travail, réalisé en milieu rural, se caractérise par une situation socioéconomique précaire se traduisant par un faible niveau des indicateurs de l’état de santé et une faible accessibilité aux services sociaux de base.<p><p>Objectifs, hypothèses<p>Ce travail repose sur les hypothèses que les facteurs socioéconomiques influencent la survenue du petit poids de naissance et que le petit poids de naissance a un impact négatif sur la croissance et la survie au cours de la première année de vie. <p>Ce travail s’est fixé pour objectifs de :<p>•connaître l’importance du petit poids de naissance à terme ;<p>•analyser les déterminants du petit poids de naissance ;<p>•proposer un score pour l’identification des femmes enceintes à risque de mise au monde d’un enfant de petit poids ;<p>•identifier les facteurs influençant la croissance des enfants nés de petit poids ;<p>•étudier l'impact du déficit pondéral à la naissance sur la morbidité et la mortalité infantile ;<p>•formuler des recommandations pour la prévention et la prise en charge du petit poids de naissance en milieu défavorisé dans le but d’orienter les stratégies de réduction de la mortalité infantile.<p><p>Méthodologie<p>Trois types d’études ont été réalisés:<p>•une étude de cohorte rétrospective portant sur 435 enfants dans le but d’explorer les facteurs de risque, la croissance, le statut nutritionnel et la mortalité des enfants nés de petit poids de naissance à terme.<p>•Une étude transversale portant sur 1013 naissances vivantes à terme qui a permis de déterminer la fréquence du petit poids de naissance et d’analyser les facteurs associés qui lui étaient associés.<p>•Une étude de cohorte prospective au cours de laquelle les 1013 enfants enrôlés dans l’étude transversale ont été suivis afin d’analyser leur croissance et leur survie au cours des 12 premiers mois de vie.<p><p>Principaux résultats <p>•Le petit poids de naissance représente 15,8% des naissances à terme. <p>•Le sexe féminin est prédominant chez les enfants de petit poids.<p>•Les facteurs sociodémographiques associés au petit poids de naissance sont essentiellement des caractéristiques sociodémographiques maternelles :le jeune âge de la mère (moins de 20 ans), le faible niveau d’instruction, le mauvais état nutritionnel et la faible accessibilité géographique aux structures de santé.<p>•Les facteurs obstétricaux associés au petit poids sont :la primiparité, la survenue de vomissements gravidiques, l’exécution de travaux champêtres et une charge de travail plus importante en cours de grossesse.<p>•Le score proposé pour l’identification des femmes à risque a un pouvoir de discrimination acceptable et présente une bonne stabilité et une faible marge d’erreur de prédiction.<p>•Indépendamment de la catégorie de poids à la naissance, tous les enfants demeurent en dessous des médianes des courbes de référence internationales pour l’ensemble des indices nutritionnels entre 0 et 12 mois. <p>•Malgré des gains plus importants mais de façon non significative, les enfants de PPN montrent une incapacité à combler leur retard en taille et en poids.<p>•Le PPN est associé à un risque significativement plus élevé de retard de croissance et d’insuffisance pondérale au cours de la première année de vie.<p>•Le petit poids de naissance et la non-complétude de la consultation prénatale étaient associés à un risque deux fois plus important de décès. <p>•L’état nutritionnel à l’âge de 3 mois ainsi qu’à l’âge de 6 mois joue un rôle plus important dans la survie chez les enfants de PPN que chez les enfants nés de poids normal.<p><p> <p>Conclusions<p>Les solutions au problème du petit poids de naissance impliquent un paquet d’interventions intégrant des stratégies avant, pendant et après la grossesse et des programmes de prise en charge ciblant les enfants de petit poids après leur naissance. Il s’agit prioritairement de :<p>•l’information et de la sensibilisation des populations pour un meilleur suivi de la grossesse et une complétude de la consultation prénatale ;<p>•l’adoption de pratiques et d’habitudes en faveur d’une alimentation équilibrée des femmes enceintes ;<p>•un plaidoyer pour un allègement de la charge de travail des femmes enceintes ;<p>•l’utilisation de méthodes opérationnelles pour l’identification des femmes à risque ;<p>•l’amélioration de la qualité des prestations de surveillance de la grossesse ;<p>•la redéfinition du contenu et des protocoles des programmes de suivi et de promotion de la croissance des jeunes enfants avec une attention particulière pour les enfants nés de petit poids ;<p>•la lutte contre certaines pratiques sociales comme les mariages précoces et les grossesses chez les adolescentes et les femmes de moins de 20 ans ;<p>•la promotion de la scolarisation des jeunes filles et l’alphabétisation des mères ;<p>•l’amélioration de l’état nutritionnel de la population ;<p>•la réalisation d’études pour évaluer l’impact de certains déterminants et interventions sur l’incidence du petit poids et le devenir des enfants nés avec un handicap pondéral :rôle de l’infection palustre, interventions nutritionnelles ciblant les enfants de petit poids, apports nutritionnels pendant la grossesse.<p><p>Summary<p><p>Due to its impact on infant morbidity and mortality, and its effects on adult’s health, low birth weight (LBW) is a major issue in the public health sector. Burkina Faso, a Sahelian country land-locked in the heart of West Africa is listed among the heavily indebted poor countries, with a high prevalence of Low Birth Weight, caused in most cases by intra uterine growth retardation. The context of the current study, conducted in urban area, is characterised by a poor socio-economic situation resulting in weak health indicators and difficult access to the basic social services.<p><p>Objectives, assumptions<p><p>The study is based o the assumptions that socio-economic factors have an influence on the occurrence of Low Birth Weight and that Low Birth Weight has a negative impact on growth and survival during the first year of the infant.<p>The study has the following objectives:<p>•To assess the importance of low birth weight a term;<p>•To analyse the determinant factors of low birth weight;<p>•To suggest a classification for the identification of pregnant women at risk of giving birth to low birth weight infants ;<p>•To identify factors which have an impact on the growth of low birth weight children ;<p>•To look at the impact of body weight deficiency at birth on infant morbidity and mortality ;<p>•To give recommendations on the prevention and treatment of low birth weight children from underprivileged background with the aim to orientate strategies for infant mortality reduction.<p><p>Methodology<p>Three types of studies were conducted:<p>•A retrospective cohort study of 435 children aiming at exploring risk factors, growth, nutritional status, and mortality of low birth weight infants in the long run.<p>•A cross-sectional study of 1013 live full-term births, which led to determining the frequency of low birth weight and at analysing associated factors which are linked to low birth weight.<p>•A prospective cohort study during which the 1013 children taken into consideration for the cross-sectional study were followed up so as to analyse their growth and survival all along the first 12 months of their life.<p><p>Main results<p>•Low birth weight represents 15.8% of full-term births.<p>•Female babies are predominant among low birth weight babies.<p>•Socio-demographic factors linked to low birth weight are mainly maternal socio-demographic characteristics: young mother (below 20 years old), low educational level, poor nutritional status and limited geographical access to health infrastructures.<p>•Obstetrical factors linked to low birth weight are the following: primiparity, occurrence of vomiting during pregnancy, field work and a heavier workload during pregnancy.<p>•The suggested classification for the identification of women at risk proves to have an acceptable power of discrimination and shows good stability and limited margin of error for prediction.<p>•Regardless of weight categories at birth, all children remain below medians of international reference curves for all nutritional indicators between 0 and 12 months. <p>•In spite of more important but not significant weight gains, LBW children prove not to be able to catch up on height and weight.<p>•LBW is linked to a significantly higher risk in growth retardation and weight deficiency during the newborn’s first year of life.<p>•LBW and non-complete antenatal visits are linked to a death risk multiplied by two.<p>•The nutritional status at the age of 3 months and 6 months old plays a more important role in the survival in LBW children than in children born with normal weight.<p><p>Conclusions<p>Solutions to LBW imply a package of interventions which should integrate strategies before, during and after pregnancy, together with treatment programmes targeting LBW children after their birth. In priority, these are:<p>•Information and awareness given to population for a better follow-up of pregnancies and complete cycles antenatal visits ;<p>•New practices and habits to be taken on favouring a balanced diet of pregnant women ;<p>•Advocacy actions aiming at reducing the workload of pregnant women ;<p>•The use of operational methods to identify women at risk ;<p>•Improving the quality of monitoring of pregnancy; <p>•Redefined content and procedures of monitoring programs and promoting young children growth, with particular focus on LBW children ;<p>•The fight against some social practices such as early marriages and pregnancies of teenagers and women below 20 years;<p>•The promotion of school education for young girls and literacy for mothers ;<p>•Improving the nutritional status of the population;<p>•The realisation of studies to assess the impact of some determinant factors and interventions on the occurrence of low birth weight and on the future of children born with weight deficiency: role of malaria, nutritional interventions targeting LBW children, nutritional intakes during pregnancy<p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Dans cette thèse, nous décrivons les résultats d’un projet de recherche visant à mesurer et évaluer la qualité des soins obstétricaux des hôpitaux de référence au Mali et au Sénégal. Dans ces pays, la mortalité maternelle hospitalière est élevée et est liée en partie à la pratique médicale inadéquate. Cette recherche a été réalisée dans le cadre de l’étude QUARITE, un essai randomisé en grappe évaluant l’efficacité du programme GESTA International visant à réduire la mortalité maternelle hospitalière. GESTA a été mis en œuvre entre 2008 et 2010 et consistait en la formation des professionnels de santé et en la revue des cas de décès maternels. En parallèle de QUARITE, les programmes de prévention de la transmission du VIH de la mère à l’enfant (PTME) ont été mis à l’échelle à travers les pays. Ces derniers ayant également la capacité d’augmenter la qualité des soins obstétricaux, nous avons donc évalué les effets des deux programmes (GESTA et PTME) sur la qualité des soins. Dans un premier temps, à l’aide d’une recension des écrits nous avons évalué la capacité d’un audit clinique basé sur des critères à mesurer la qualité des soins obstétricaux. Cet audit vérifiait si l’offre des soins avait respecté les critères cliniques définissant la meilleure prise en charge selon l’évidence scientifique et l’avis des experts. Nous avons démontré que cet outil est largement utilisé dans les pays à faibles et moyens revenus, malgré le peu d’évidence sur sa validité (article 1). Dans un deuxième temps, nous avons développé un audit clinique basé sur des critères qui s’applique au contexte ouest-africain et qui a été approuvé par des experts-obstétriciens nationaux et internationaux. À partir des dossiers obstétricaux, les actes médicaux posés pendant le travail et l’accouchement ont été évalués à l‘aide de cet instrument. La qualité des soins a été estimée sous forme de pourcentage de critères atteints. Appliqué dans différents contextes et par différents auditeurs, nous avons démontré que notre instrument est fiable et valide (article 3). Néanmoins, l’expérience de l’audit nous a amenés à nous questionner sur le mauvais remplissage des dossiers médicaux et ses conséquences sur la qualité des soins (article 2). Dans un troisième temps, l’outil a été appliqué à large échelle pour évaluer les effets de l’intervention GESTA (article 4). Nous avons mené une révision de plus de 800 dossiers obstétricaux dans 32 hôpitaux de référence (16 bénéficiaires de l’intervention et 16 non-bénéficiaires). Grâce à cet audit clinique, nous avons démontré que le programme GESTA contribue à l’amélioration de la qualité des soins, spécifiquement l’examen clinique lors de l’admission et le suivi après l’accouchement. Dernièrement, nous avons utilisé cet instrument afin d’évaluer les effets des programmes de PTME sur la qualité des soins obstétricaux (article 5). Notre travail a documenté que seulement certaines composantes du programme de PTME améliorent la qualité des soins telles que la formation des professionnels et les services complémentaires en nutrition. En conclusion, cette recherche a identifié plusieurs pistes d’intervention pour améliorer la qualité des soins obstétricaux en Afrique de l’Ouest. / In this thesis, we describe the results of a research project that aimed to measure and evaluate quality of care in referral hospitals in Mali and Senegal. In these countries, hospital maternal mortality is high and linked, in part, to inadequate medical practice. This research was conducted as part of the QUARITE cluster randomized trial that assessed whether the program, ALARM International, could reduce facility maternal mortality. ALARM was implemented from 2008 to 2010 and consisted of the training of local health professionals and the use of maternal death reviews. At the same time as QUARITE was ongoing, programs for the prevention of maternal to child transmission of HIV (PMTCT) were scaled- up; these can also improve obstetrical quality of care. Thus, we evaluated the effects of both programs (ALARM and PMTCT) on quality of care. We began with a systematic review of the literature to evaluate the capacity of a criterion-based clinical audit to measure the quality of obstetrical care (article 1). This type of audit verifies if the care provided meets criteria indicative of best clinical practices, according to the literature and expert opinion. Our review demonstrates that this tool has been used in a variety of low- and middle-income settings, but the way it has previously been employed leaves doubts as to its validity (article 1). We thus developed a criterion based clinical audit specific to the West African context and approved by national and international expert obstetricians. Using patient medical records, with this instrument we evaluated obstetrical care provided during labour and delivery. Quality of care was calculated based on the percentage of care criteria met. Applied to different sites and by different auditors, our instrument demonstrated concordant results and provided a valid image of the quality of obstetrical care provided at hospitals in the region (article 3). Nonetheless, the audit experience raised concerns about the implications of poor medical recordkeeping and archiving on quality of care (article 2). We used the criterion-based clinical audit to review over 800 medical records at 32 QUARITE hospitals (16 intervention and 16 control hospitals) in order to evaluate the effects of the ALARM intervention. We demonstrated that the ALARM program contributes to better obstetrical quality of care, especially during the first clinical examination and postpartum monitoring of women treated at intervention hospitals (article 4). Finally, we used this instrument to evaluate the effects of PMTCT programs on obstetrical quality of care (article 5). Our work demonstrated that certain components of a PMTCT program, specifically training of healthcare professionals and supplementary nutritional services, are associated with better obstetrical care. In all, this research identified several mechanisms that can be targeted by quality improvement interventions in West Africa.

Mon poste de psychologue clinicienne au sein d’une maison de retraite m’a sensibilisée à la souffrance psychique des aides-soignantes. A partir de l’écoute des aides-soignantes dans le cadre de ma mission de support technique à l’équipe, émerge la plainte récurrente d’un déficit égotiste de désinvestissement émotionnel et affectif et la non reconnaissance de la pénibilité de leur tâche, qui me conduit à poser l’hypothèse d’un burn out. La recherche porte donc sur le Syndrome d’Épuisement Professionnel. Elle étudie les relations complexes entre le personnel médico-social aides-soignantes et la cadre de santé, et entre la personne âgée et sa fille. Un questionnaire clinique a fait ressortir l’ampleur du ressenti subjectif d’être épuisé. L’échelle standardisée MSP de Louise Lemyre, celle du ressenti subjectif d’être stressé. Le stress étant convoqué dans la position conceptuelle théorique retenue du Syndrome d’Épuisement Professionnel.L’analyse de ces deux ressentis a révélé les rapports complexes entre soignante–soignée et la cadre et entre fille–mère et grand-mère. C’est ainsi que l’enjeu narcissique du personnel fait ressurgir les origines archaïques de la sexualité infantile dans le lien intime au corps. En même temps, à cause d’une féminisation généralisée de la profession, la spécificité de la fonction du Féminin Psychique s’impose.Cette recherche souhaite apporter, grâce à ce Féminin Psychique, un éclairage autre sur la position intermédiaire de la Cadre. Le statut de bonne ou mauvaise mère que les aides-soignantes lui reconnaissent, aggrave ou diminue le Syndrome d’Épuisement Professionnel et le stress. Enfin, cette recherche insiste une nouvelle fois sur la nécessité impérieuse de la formation permanente institutionnelle et du travail d’élaboration psychique de ces personnels et ce, à périodicités constantes. / As a psychologist in an EHPAD (a regulated home for dependent seniors), I became very much aware of the auxiliary nurses’ psychological sufferings. Listening to them during my team-supporting mission, I heard a recurring complaint emerge, that of an egotistical deficit of emotional and affective disinvestment and of a lack of recognition of the painfulness of their task. This has led me to hypothesize professional exhaustion. The research in this thesis therefore focuses on the burn out syndrome. It studies the complex relations between the auxiliary nurses as medico-social staff and the health manager in charge as well as between the elderly person and his/her daughter.A clinical questionnaire highlighted the depth of the subjective feeling of exhaustion while Louise Lemyre’s standardized scale highlighted the depth of the subjective feeling of stress, an operational notion in the theoretical concept of burn out.The analysis of both feelings revealed the complex relations between patient-auxiliary nurse and manager as well as between daughter-mother and grandmother. The narcissism at stake with the staff reactivates the archaic origins if child sexuality in the nursing place. A t the same time, because of the general feminization of the profession, the specificity of the feminine psyche is of foremost importance.Thanks to this notion, the research paper aims to shed a different light on the intermediary position of the manager. The status of good or bad mother figure that auxiliary nurses grant her worsens or lessens the burn out and stress.Last, this research paper further insists on the absolute necessity of permanent institutional training and of psychic elaborative work for the staff at regular intervals.