O uso de medicamentos representa um dos recursos terapêuticos mais utilizados na resolução de grande parte dos problemas e situações em saúde. Nesse contexto, o interesse na forma como os pacientes gerem suas doenças e tratamentos farmacológicos tem crescido em importância. Esta tese objetivou compreender as dimensões da autogestão do uso de medicamentos e variáveis associadas na população brasileira. Para isso, foram analisados três comportamentos relacionados ao uso de medicamentos: a automedicação, a não-adesão intencional e as alterações das doses prescritas. Os dados analisados são provenientes da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), estudo transversal realizado entre os meses de setembro de 2013 e janeiro de 2014 em 245 municípios brasileiros distribuídos nas cinco regiões geográficas do país. A população do estudo foram os indivíduos residentes em domicílios permanentes na zona urbana do território brasileiro. Nesta tese, foram analisados os dados de 31.573 indivíduos com idade igual ou superior a 20 anos. Modelos de Regressão de Poisson com ajuste robusto da variância foram utilizados a fim de estimar o efeito independente de cada variável nos três comportamentos estudados. Entre os entrevistados, 73,6% declararam utilizar algum medicamento sem indicação médica quando já fizeram uso do mesmo produto anteriormente, 73,8% declararam utilizar medicamentos sem prescrição médica quando já tem o medicamento em casa e 35,5% declararam utilizar algum medicamento sem prescrição quando conhecem alguém que já tomou o mesmo medicamento. As variáveis que se mostraram associadas à maior probabilidade de uso de medicamentos por automedicação foram: região geográfica do Brasil, sexo, faixa etária, renda per capita, auto avaliação da saúde, declaração de que usa medicamento sem prescrição médica quando já usou o mesmo medicamento anteriormente e declaração de que usa medicamento sem prescrição médica quando já tem o medicamento em casa. Mais da metade dos entrevistados relataram alguma situação de automedicação, enquanto que 38% relataram deixar intencionalmente de tomar medicamentos prescritos em alguma situação. Com relação às alterações nas prescrições, 8,8% dos entrevistados relataram amentar a dose dos medicamentos em alguma situação e mais de 21% relataram diminuir a dose. Nos modelos de regressão ajustados, as variáveis sexo, idade e autoavaliação de saúde mostraram-se associadas à não-adesão intencional. As alterações de dose aparecem associadas à idade, renda e autoavaliação de saúde. Os resultados indicam, portanto, que um percentual significativo da população brasileira utiliza medicamentos não exclusivamente da forma como são prescritos pelo médico. Buscando contemplar esses diferentes comportamentos cotidianos dos indivíduos em relação aos medicamentos, a presente tese propôs o conceito de “autogestão do uso de medicamentos”. Esse conceito visa ampliar a compreensão do uso de medicamentos para além da adesão às prescrições médicas como já indicado no conceito de medication self-management e de compliance. A partir dessa perspectiva, destaca-se a necessidade de adoção de outros paradigmas nos cuidados em saúde, como o dos cuidados colaborativos e da corporalidade (lived body), onde o próprio indivíduo, com a colaboração dos profissionais da saúde, tome as decisões sobre as estratégias mais adequadas de tratamento e promoção da saúde. / The use of medications represents one of the most utilized therapeutic resources to the resolution of most health problems and situations. In this context, the interest in how patients manage their diseases and pharmacological treatment has increased. This thesis had as main objective to comprehend the self-management of medications use and related variables on the Brazilian population. Three behaviors related to the use of medications were analyzed: self-medication, intentional non-adherence and prescribed doses changes. Analyzed data are part of the “Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)”, a cross-sectional study performed between September 2013 and January 2014 in 245 Brazilian cities in the five geographic regions. Study population were individuals living permanently in the urban area of Brazil. In this thesis, data from 31.573 individuals aged 20 years or above were analyzed. Poisson Regression Models with robust variance adjustment were used to estimate independent effect of each variable on the three studied behaviors. Among the interviewed, 73.6% have declared the use of any medication without medical prescription when they have used the same product previously, 73.8% have declared the use of not prescribed drugs when the medication is available at home and, 35.5% have declared to use any drug without medical prescription when someone they know have used the same medication. Variables related to higher probability of drug use by self-medication were: geographic region, gender, age, per capita income, health self-evaluation, the use without medical prescription of the same drug used before and the use without medical prescription when the drug is available at home declarations. More than half of the interviewed reported any situation of self-medication while 38% reported to, intentionally, stop taking prescribed medications in any situation. Regarding prescription alterations, 8.8% of the interviewed reported to increase the medication dose in any situation and more than 21% reported to decrease medication dose. On the adjusted regression models variables as gender, age and health self-evaluation showed to be related to intentional nonadherence. Dose changes are related to age, income and health self-evaluation. Therefore, results show that a significant percentage of the Brazilian population uses medications not exclusively as they are prescribed by the physician. Seeking to address these different daily behaviors of individuals regarding medications, this thesis has proposed the concept of “self-management of medications use”. This concept aims to amplify the comprehension of medications use beyond medical prescriptions adherence as already indicated in the concept of medication self-management and compliance. From this perspective stands out the need of other paradigms introduction on health care, such as collaborative care and lived body, in which the individual himself, with health professionals’ collaboration, take the decisions about the most adequate treatment strategies and health promotion.

Pour répondre à un marché de plus en plus concurrentiel, les organisations tendent aujourd'hui à se regrouper sous la forme d'organisations virtuelles (OV). Concevoir le système d'information (SI) d'une OV sur la base des SI des organisations participantes pose des problèmes méthodologiques et techniques. En particulier, l'identification et l'expression des besoins, déjà difficile lors du développement d'un SI « classique », représente un enjeu important. Le SI de l'OV jouant un rôle prépondérant pour la collaboration et la coopération des organisations participantes et l'atteinte de l'objectif commun. Nous proposons des critères permettant d'identifier et de classifier précisément et à un niveau intentionnel, les différentes informations nécessaires à la conception du SI de l'OV ainsi que des modèles graphiques et textuels simples. Notre travail comprend une transformation partielle à partir des modèles intentionnels jusqu'aux modèles de processus métier de base au niveau organisationnel. / Nowadays, organizations which aim to be competitive in a more concurrent market, tend to group together into virtual organizations (VO). Designing the information system (IS) of such a VO on the basis of the IS of those participating arises methodological and technical problems. Particularly, the formal identification and representation of requirements which has been researched to a large extent for a single organization, is not adequate for a VO. Indeed, the IS of a VO plays an important role in the collaboration and the cooperation of the participants organizations to achieve a common goal. We propose at an intentional level, criteria allowing virtual organizations to be identified and classified, as well as simple graphical and textual models to design the virtual organization's IS. Our work includes a partial transformation proposal from the intentional models to basic business process models at the organizational level.

O crescente número de geradores distribuídos conectados em redes de distribuição de energia elétrica é uma realidade dos sistemas elétricos de todo o mundo. Embora a política atual seja desconectar os geradores distribuídos do sistema elétrico de potência (SEP) caso ocorra uma falha na rede da concessionária, conforme preconizam os principais guias técnicos nacionais e internacionais, o módulo 3 dos Procedimentos de Distribuição de Energia Elétrica no Sistema Elétrico Nacional (PRODIST) mostra-se favorável à operação ilhada, pois afirma que este tipo de operação pode ser realizado em comum acordo entre as centrais geradoras de energia e o Operador Nacional do Sistema Elétrico (ONS), permitindo alcançar uma maior disponibilidade no fornecimento de energia. No entanto, para que a operação ilhada seja possível e possa ser praticada de forma segura, o ilhamento intencional precisa superar alguns desafios, dentre os quais estão aqueles relacionados ao sistema de proteção da rede de distribuição, tais como: coordenação indevida de dispositivos de proteção, perda da sensibilidade da proteção, abertura inadequada de fusíveis e religamentos automáticos fora de sincronismo. Portanto, este trabalho avalia o impacto da geração distribuída (GD) sobre o sistema de proteção de sobrecorrente de uma rede de distribuição operando ilhada. A ideia principal é dividir a rede em regiões delimitadas pelos dispositivos de proteção existentes, para em seguida, adequá-los à nova situação operacional, certificando se os ajustes propostos atendem ao comportamento síncrono e estável do sistema de geração por meio de uma análise de estabilidade transitória. Propõe-se então um conjunto de procedimentos para tomada de ações que permitam readequar o sistema de proteção de sobrecorrente existente à operação ilhada. Os resultados obtidos demonstram que a inibição do religamento automático e da curva de atuação instantânea acrescida de reajustes nas curvas temporizadas dos relés e religadores, melhoraram a coordenação e seletividade da rede operando ilhada. / The growing number of distributed generators connected to electricity distribution networks is a reality of electrical systems throughout the world. Although the current policy is to disconnect the distributed generators from the electric power system (EPS) in the event of loss of mains, as required by main national and international technical guides, the module 3 of the Procedures for Electric Power Distribution in the Electric National System (PRODIST) shows itself in favor of islanded operation, it states that this type of operation can be carried out in agreement between power generation plants and the National Electric System Operator (ONS), allowing achieve larger availability in energy supply. However, to make the islanded operation possible and safe, the intentional islanding must overcome some challenges, among which are those related to the protection system of the distribution network, such as improper coordination of protective devices, loss of protection sensitivity, inadequate opening of fuses and automatic reclosing out of synchronism. Therefore, this work evaluates the impact of distributed generation (DG) on the overcurrent protection system of a distribution network operating islanded. The main idea is to divide the network into regions bounded by existing protection devices, to then adapt them to the new operational situation, making sure that the proposed adjustments meet the synchronous and stable behavior of the generation system by means of a transient stability analysis. Thus, a set of procedures is proposed to indicate actions that allow readjusting the existing overcurrent protection system to the islanded operation. The results demonstrate that the inhibition of automatic restart and of the instantaneous operating curve plus adjustments in time delay curves of relays and reclosers, improved the coordination and selectivity of the network operating islanded.

O crescente número de geradores distribuídos conectados em redes de distribuição de energia elétrica é uma realidade dos sistemas elétricos de todo o mundo. Embora a política atual seja desconectar os geradores distribuídos do sistema elétrico de potência (SEP) caso ocorra uma falha na rede da concessionária, conforme preconizam os principais guias técnicos nacionais e internacionais, o módulo 3 dos Procedimentos de Distribuição de Energia Elétrica no Sistema Elétrico Nacional (PRODIST) mostra-se favorável à operação ilhada, pois afirma que este tipo de operação pode ser realizado em comum acordo entre as centrais geradoras de energia e o Operador Nacional do Sistema Elétrico (ONS), permitindo alcançar uma maior disponibilidade no fornecimento de energia. No entanto, para que a operação ilhada seja possível e possa ser praticada de forma segura, o ilhamento intencional precisa superar alguns desafios, dentre os quais estão aqueles relacionados ao sistema de proteção da rede de distribuição, tais como: coordenação indevida de dispositivos de proteção, perda da sensibilidade da proteção, abertura inadequada de fusíveis e religamentos automáticos fora de sincronismo. Portanto, este trabalho avalia o impacto da geração distribuída (GD) sobre o sistema de proteção de sobrecorrente de uma rede de distribuição operando ilhada. A ideia principal é dividir a rede em regiões delimitadas pelos dispositivos de proteção existentes, para em seguida, adequá-los à nova situação operacional, certificando se os ajustes propostos atendem ao comportamento síncrono e estável do sistema de geração por meio de uma análise de estabilidade transitória. Propõe-se então um conjunto de procedimentos para tomada de ações que permitam readequar o sistema de proteção de sobrecorrente existente à operação ilhada. Os resultados obtidos demonstram que a inibição do religamento automático e da curva de atuação instantânea acrescida de reajustes nas curvas temporizadas dos relés e religadores, melhoraram a coordenação e seletividade da rede operando ilhada. / The growing number of distributed generators connected to electricity distribution networks is a reality of electrical systems throughout the world. Although the current policy is to disconnect the distributed generators from the electric power system (EPS) in the event of loss of mains, as required by main national and international technical guides, the module 3 of the Procedures for Electric Power Distribution in the Electric National System (PRODIST) shows itself in favor of islanded operation, it states that this type of operation can be carried out in agreement between power generation plants and the National Electric System Operator (ONS), allowing achieve larger availability in energy supply. However, to make the islanded operation possible and safe, the intentional islanding must overcome some challenges, among which are those related to the protection system of the distribution network, such as improper coordination of protective devices, loss of protection sensitivity, inadequate opening of fuses and automatic reclosing out of synchronism. Therefore, this work evaluates the impact of distributed generation (DG) on the overcurrent protection system of a distribution network operating islanded. The main idea is to divide the network into regions bounded by existing protection devices, to then adapt them to the new operational situation, making sure that the proposed adjustments meet the synchronous and stable behavior of the generation system by means of a transient stability analysis. Thus, a set of procedures is proposed to indicate actions that allow readjusting the existing overcurrent protection system to the islanded operation. The results demonstrate that the inhibition of automatic restart and of the instantaneous operating curve plus adjustments in time delay curves of relays and reclosers, improved the coordination and selectivity of the network operating islanded.

Researchers have tried to demonstrate the effectiveness of written teacher feedback over the course of the last sixty years, and the results are inconclusive. Many studies point to improvement on subsequent drafts as evidence of student improvement; however, this only indicates students' abilities to follow directions. It is not an indication of autonomous writing ability. This study demonstrates that with proper curriculum support high school students can develop intentional transferability (the autonomous, intentional transferring of writing skills to varied rhetorical situations) throughout the course of one academic year without receiving any teacher written feedback.

The retail food safety chain is vulnerable to deliberate contamination, yet food safety professionals and emergency managers typically respond to intentional contamination in different ways. Little is known about the practices of environmental health food safety professionals (EHFSP) as compared to emergency managers and whether those approaches can be combined to more successfully impede intentional food contamination. The purpose of this narrative policy analysis was to use routine activity theory to compare the narratives of EHFSPs and emergency managers to determine whether there are opportunities to better understand the relationship between vulnerability and resiliency of the retail food safety chain. Data were primarily collected through interviews with 5 EHFSPs and 5 emergency managers from various regions in the United States. Interview data were inductively coded and then subjected to Braun and Clarke's thematic analysis procedure. Key findings indicate that EHFSPs generally are ill-suited to meet resiliency goals, ambivalence voiced by EHFSPs results from a lack of continual preparedness training, and neither EHFSPs nor emergency management officials' familiarity with the social dimensions of resiliency is at a point where they can design adequate measures for a resilient retail food system. Therefore, recommendations to policy makers focus on a need for an enhanced training that is inspired by principles of emergency management so that they are better able to respond to acts of intentional contamination, thereby building a resilient retail food chain with economic and social benefits.

The chief aim of this dissertation was to establish the respective contributions of automatic and intentional memory processes to misinformation effects in 5-, 8-, and 9-year-old children. In the first two experiments children were presented with a picture story followed by misleading post-event details that were either read to participants, or were self-generated in response to semantic and perceptual hints. Children were then presented with original and suggested items and given a yes / no recognition test under inclusion or exclusion instructions. The application of Jacoby’s (1991) process dissociation procedure to children’s recognition performance revealed that the contribution of intentional processing to misinformation acceptance increased following the self-generation of suggestions. Automatic processing made a strong contribution to misinformation effects regardless of the way that misinformation was encoded. Experiment 3 extended this general pattern of results to a forced choice recognition paradigm. Experiment 4 examined the role of social demand factors in children’s suggestibility using Belli’s (1989) yes / no retrieval paradigm. Little evidence of an influence of social demand on children’s suggestible responses was found with automatic processes again the predominant factor determining suggestibility. In the final experiment, the temporal order of the original and post-event phases was reversed such that 5-year-olds were initially presented with a post-event summary containing misinformation, followed by a witnessed event. The results of this study confirmed that children’s suggestions were unlikely to be the result of trace alteration or social demand. The implications of the findings for theoretical accounts of the misinformation effect in children’s recognition and for children’s eyewitness testimony are discussed. / PhD Doctorate

This PhD thesis addresses the threat posed to society by sources that can produce high power electromagnetic pulses (HEPM) and be used maliciously to disturb or damage electronic equipment. The vulnerability from intentional electromagnetic interference (IEMI) has increased in the recent decades due to the widespread dependence of the civil society on sensitive electronic systems and proliferation of radiation sources. As the characteristics of the disturbances associated with IEMI often have very high frequency content, the existing mitigation measures and protection components may not be adequate. It was seen that for ultra wideband (UWB) transients low voltage protection components may not work as intended, due to parasitic components that arises from the packaging of the device. The large spatial distribution of many civilian facilities and critical infra-structures (e.g., power generation, communications, train system, etc.) presents many unexpected ports for an attacker as the majority of the parts of these systems are not protected or secure. As the new European Rail Traffic Management System (ERTMS) will utilize wireless communication for communication and control of the trains the vulnerability from different radiating HPEM sources was investigated. Angles of incidence and frequencies that are a threat in a given situation are identified. Due to the possibility of unexpected ports, the propagation of differential mode ultra wideband transients in low voltage power networks, when injected into a power socket of a facility, was studied. The effects on the transient propagation from cable bends, switches and junctions were studied, both in a laboratory setup and in the network of a facility. Also, as modern electronic equipment and systems may not be tested for waveforms and disturbances other than standardized EMC tests, experiments on some common commercial-off-the-shelf (COTS) equipment were performed with non-standard test situation. It was seen that these could easily be disturbed or even permanently damaged. In addition, due to the inherent difficulties with IEMI, a new method for classifying facilities from IEMI is suggested. It is based on available terminology of accessibility (A), susceptibility (S) and consequence (C), but expands these and forms the so called IEMI/ASC-cube.

Conceptual change is one of the most important influences in modern educational research and this theoretical framework can be used for empirical research aimed at improving our common knowledge about learning as well as developing new theories and practices within the education system. In its very basic meaning, conceptual change can be explained as a person who during the course of the learning experience changes their initial conception of a phenomenon (such as a object or a concept) from one specific point of view to another. The aim of this study is to map out the differences and similarities between two seemingly opposite movements within today’s pedagogical research community. Within phenomenography a constitutionalist approach to learning is used, which means that the conceptions formed by students are considered to be an internal representation of the individual’s interpretation of their own knowledge in relation to their surroundings. The intentional analytical approach suggests that contextualisation is necessary for conceptual change to take place, for the student to be able to interpret the assignment or task at hand and then incorporate that in meaningful activity that will lead to a successful learning process. Both the intentional and the phenomenographic approach agree that it is the meaning of a task that is important in the learning situation, but the differences lie in the ways of distinguishing what this meaning consists of as well as the means of finding out what the meaning is to an individual. / Begreppsutveckling är en av de viktigaste influenserna inom det pedagogiska forskningsområdet. Denna teoretiska inriktning innebär att man genom empirisk forskning studerar lärande och dess kontext. Detta kan sedan bidra till vår kunskap om vad som påverkar lärprocessen samt hur denna skulle kunna användas i utvecklingen av nya didaktiska metoder och verktyg. Begreppsutveckling kan förstås som teorier om hur en individ, genom övning och reflektion ändrar en grundläggande uppfattning om ett fenomen eller objekt från en specifik uppfattning till en annan. I den här litteraturstudien, kommer jag att försöka kartlägga två skilda sätt att anta utmaningen att undersöka hur lärande genom begreppsutveckling kan förstås och tolkas, nämligen fenomenografi och intentionell analys. Fenomenografi är utvecklat med en konstitutionell ansats till lärandet, där man menar att de koncept som individen använder formas genom interna representationer av den egna tolkningen av omgivningen samt hur det egna konceptet relaterar till omgivningen. Intentionell analys å andra sidan menar att begreppsutveckling uppstår när individen kontextualiserar uppgiften genom meningsskapande processer i relation till omgivningen och att detta beskriver lärprocessen. Den gemensamma nämnaren för båda dessa perspektiv är att det är meningsskapandet för individen som är nyckeln till lärandet. Skillnaden mellan dem märks i synen på lärandet i de meningsskapande processerna där man närmar sig betydelsen av denna process som den ter sig för den lärande individen.

Conscious Living is a series of visual solutions to a current and escalating problem in increasingly populated modern societies between its citizens and the environment they inhabit. Documented in the photographs are two dissimilar intentional communities that both strive to operate harmoniously with the surrounding ecology. Originally intending to address the misconception that low impact living is uncomfortable or unsatisfying, this research and my firsthand experience has led to conclusions that are more complex and less didactic. Although the images focus on these two communities, ultimately the intention is to provide the viewer with new perspectives on these niche groups, as well as options to implement low impact alternatives to their lifestyle.