La bifurcation coronaire est un site privilégié d’athérosclérose. Jusqu’alors aucune des techniques de stenting provisionnel percutanées avec juxtaposition de ballons n’a démontré de bénéfice clinique. Ces échecs peuvent être expliqués par le non-respect de la géométrie fractale des bifurcations qui pourtant doit toujours guider la revascularisation (correction de la malapposition et optimisation de l’ostium de la branche collatérale). Fort de ce constat, nous avons imaginé une nouvelle technique séquentielle et simple, en 3 temps, le rePOT, associant Proximal Optimizing Technique (POT) initial, ouverture de la branche collatérale et POT final. Son évaluations s’est voulue progressive en 4 étapes : 1) concept, 2) preuve expérimentale de concept, 3) confirmation des bénéfices mécaniques in vivo, et 4) validation clinique. Dans ce travail nous avons donc d’abord expérimentalement démontré la supériorité du résultat mécanique final du rePOT par rapport aux techniques non séquentielles de provisional stenting (manuscrit # 1). Ainsi, le rePOT effondre la malapposition globale du stent, conserve la circularité proximale physiologique et optimise l’obstruction ostiale résiduelle de la branche accessoire. Ces excellents résultats sont confirmés indépendamment du design ou de la composition des stents (manuscrits # 2, 4). Nous avons par ailleurs démontré l’importance de chacune des 3 étapes du rePOT: POT initial (manuscrit # 1), ouverture de SB et POT final (manuscrit # 3). Enfin, fort de ces démonstrations expérimentales, nous avons confirmé in vivo avec mesures OCT itératives à la fois les excellents résultats expérimentaux et la bonne évolution clinique à moyen terme (manuscrit # 5). Ce travail démontre donc étape par étape, de l’expérimentale à la clinique, l’ensemble des bénéfices de cette nouvelle technique séquentielle de stenting provisionnel "rePOT", devenue une référence en Europe dans la revascularisation percutanée des bifurcations coronaires / Coronary bifurcations are a preferential location for atherosclerosis development. Until now, no technic with balloons juxtaposition demonstrated a clinical benefit in percutaneous coronary bifurcation revascularization by provisional stenting (with 1 stent). Successive failures could be explained by the absence of respect of the bifurcations fractal geometry, which need to be systematically followed during all revascularization (correction of the malapposition and optimization of the side branch ostium). Thus, we imagined a new technique, simple and sequential, in 3 steps, named rePOT. It is combining initial Proximal Optimizing Technique (POT), side-branch opening and final POT. We proposed a demonstration in 4 steps : 1) concept, 2) experimental proofs of concept, 3) confirmation of the clinical benefits in vivo, and 4) clinical validation. In this work, we experimentally demonstrated the superiority of the final mechanical results of the rePOT compared to all non-sequential provisional stenting (manuscript # 1). Thus, rePOT decreased stent global malapposition, maintained the initial proximal circularity and optimized the final ostial side branch obstruction. These excellent results were confirmed independently of stent design or material (manuscripts # 2, 4). Moreover, we demonstrated the specific benefits of each steps of the rePOT : initial POT (manuscript # 1), SB opening, and final POT (manuscript # 3). Finally, we confirmed in vivo, with serial OCT analysis, these excellent mechanical results and the good clinical outcome at mid-term. (manuscript # 5). Thank to this step by step demonstration, from experimental to clinic, we confirmed all benefits of this new provisional stenting sequential technique "rePOT". Thereby, before the last step of the demonstration, rePOT became a reference in Europe for the percutaneous revascularization of coronary bifurcations

Contexte : Etant donné la forte progression de la prévalence du surpoids et de l'obésité à l'adolescence ces dernières décennies, la prévention est devenue une priorité de santé publique internationale. Objectif : L'essai PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) évalue l'impact de trois stratégies de prévention du surpoids et de l'obésité - « Education », « Environnement », « Dépistage » - chez les adolescents en milieu scolaire, sur la corpulence, les connaissances, attitudes et comportements des adolescents vis-à-vis de la nutrition (alimentation et activité physique). Méthode : Les trois stratégies ont été affectées à 24 lycées de la région Lorraine (Nord-est de la France) sur 2 années (en classe de seconde et de première) par randomisation en grappe (=lycée), selon un plan factoriel 2x2x2. La stratégie Éducation consistait en des cours et des travaux de groupe sur la nutrition et une fête nutritionnelle annuelle. La stratégie Environnement consistait à améliorer l'offre nutritionnelle des lycées et organiser une fête nutritionnelle annuelle. La stratégie Dépistage consistait en un repérage des adolescents en surpoids ou obèses suivi d'une prise en charge adaptée collective. Les données ont été recueillies à 3 reprises : à l'entrée en classe de seconde (T0), de première (T1) et de terminale (T2). L'indice de masse corporelle (IMC), son z-score et la proportion d'adolescents en surpoids ou obèses étaient les critères de jugement principaux. Les critères de jugement secondaires étaient les connaissances et comportements nutritionnels. Les différences d'évolution T0-T2 des critères de jugement entre les 12 lycées ayant bénéficié d'une stratégie et les 12 lycées témoins de cette stratégie a été analysée à l'aide de modèles mixtes. Une évaluation du processus a permis d'estimer la dose réelle d'intervention de chaque stratégie dans chacun des lycées. Résultats : La stratégie Dépistage a entrainé une amélioration de la corpulence : augmentation moins importante de l'IMC avec la stratégie Dépistage (+0,6 vs +0,7, p=0,0303), diminution plus importante du z-score de l'IMC (-0,9 vs -0,5, p=0,0173) et de la prévalence du surpoids et de l'obésité (-2,3% vs -0,6%, p=0,0386). La stratégie Education a entrainé une amélioration de certains comportements nutritionnels : augmentation plus importante de la proportion d'adolescent suivant la recommandation nutritionnelle sur les féculents (3,6% vs -0,7%, p=0,0357) et du nombre d'activités physiques pratiquées (+0,02 vs -0,10, p=0,0047). La stratégie Environnement a amélioré les comportements et les connaissances nutritionnels : diminution moins importante de la proportion d'adolescents suivant la recommandation nutritionnelle sur le nombre de repas hebdomadaire (-4,5% vs -8,5%, p=0,0101) et amélioration plus importante du score de connaissances nutritionnelles (+1,9 point vs +1,0 point, p=0,0094). Des différences dans la réalisation des activités et la participation ont été mises en évidence suite à l'estimation de la dose d'intervention et peuvent expliquer certains résultats observés. Conclusion : Une stratégie de dépistage structurée en milieu scolaire apparaît bénéfique sur la réduction du surpoids et de l'obésité. L'addition d'activités d'éducation nutritionnelles dans le cursus n'induit pas d'effets sur la corpulence à court terme. La modification de l'environnement nutritionnel scolaire semble avoir un effet sur les indicateurs intermédiaires de connaissances et comportements nutritionnels / Background: Given the increasing prevalence of youth overweight and obesity in the last decade, prevention as become an international public health priority.Objective: The aim of The PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) trial was to evaluate the 2-year effectiveness of three strategies - « Education », « Screening » et « Environment »- aimed at preventing overweight and obesity among adolescents in high school setting on body size and nutritional knowledge and behaviours. Method: PRALIMAP was a school-based randomized controlled trial beginning in 24 state-run high schools (clusters) in Lorraine (north-eastern France). Each study high school was assigned to receive or not, over a 2-year period (grades 10 and 11), each of the three prevention strategies according to a 2x2x2 factorial school randomization. The prevention strategies were: ?education? (development of nutritional knowledge and skills), "environment" (creation of favourable environment by improving availability of dietary items with a good nutritional quality and physical activity), and "screening" (detection of overweight and obesity and, if necessary, adapted care management). The follow-up consisted of three visits: at the entry of grade 10(T0), grade 11(T1) and grade 12(T2). Body mass index (BMI), BMI z-score and prevalence of overweight and obesity were the main outcomes measures. Secondary outcomes measures were nutritional knowledge and behaviours. Comparisons of changes (T2-T0) of outcomes measures between each strategy schools and their control were carried out using a three-level hierarchical mixed model. A process evaluation allowed estimating an intervention dose really received by adolescents. Results: The 2-year change of anthropometric outcomes was more favourable in the 12 screening high schools as compared with the no-screening ones: a lower increase in BMI (+0,6 vs +0,7, p=0,0303), a greater decrease in BMI z-score (-0,9 vs -0,5, p=0,0173) and a greater decrease in overweight / obesity prevalence (-2,3% vs -0,6%, p=0,0386). The education strategy resulted in improved nutritional behaviours: a greater increase in achievement of starchy food guidelines (3,6% vs -0.7%, p=0.0357) and physical activity practice (+0,02 vs -0,10, p=0,0047). The environment strategy resulted in improved nutritional attitudes: a lower decrease in achievement of number of weekly meals guidelines (-4.5% vs -8.5%, p=0.0101) and greater increase in nutritional knowledge (+1,9 point vs +1,0 point, p=0.0094). Some differences in activity implementation and participation were highlighted and can explain some of the results observed. Conclusions: The screening strategy is an effective way to prevent, at two years, overweight and obesity among adolescents in a high school setting. Nutritional education added to the curriculum is not effective in the short term on body size. The school nutritional environment modification is slightly associated with improved nutritional knowledge and behaviours

Li, Xiang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 161-184). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendix also in Chinese.

Esta tese foi inspirada no desejo de aprofundar modos de pesquisar e intervir através da fotografia e no reconhecimento das condições de possibilidade de construção de novas práticas no campo da saúde mental. Realizou-se no contexto do projeto de pesquisa e extensão Oficinando em Rede – parceria entre Universidade Federal do Rio Grande do Sul e o Centro Integrado de Atenção Psicossocial para crianças e adolescentes (CIAPS) do Hospital Psiquiátrico São Pedro, em Porto Alegre. Tal projeto realiza oficinas tecnológicas – internet, robótica, fotografia e vídeo – junto aos trabalhadores e usuários do local. Nas oficinas de fotografia, observamos que a entrega de câmeras aos jovens, para que fotografassem livremente, produzindo suas próprias inscrições, era algo estranho no contexto, pois as práticas discursivas em hospitais psiquiátricos geralmente colocam usuários em uma posição de objeto do olhar médico-especializado. Isto se deu em função da fotografia manter uma relação de similaridade perceptiva com a realidade, o que a diferencia de outras práticas artísticas em saúde mental, como pintura, escrita e desenho. Por outro lado, se a legitimidade da fotografia é garantida por uma crença na possibilidade de reprodução do real, os exercícios de autoria muitas vezes ficam invisíveis. Nosso objetivo foi problematizar as vias de exercícios de autoria no âmbito institucional, assim como estudar a experiência de si de trabalhadores e jovens em relação aos discursos e práticas em saúde mental. Neste âmbito, formulamos quatro proposições para esta tese. A primeira delas, teórica, é baseada nas noções de Michel Foucault e consiste em estabelecer relações entre experiência de si e exercícios de autoria. A segunda, também teórica, busca aprofundar a discussão sobre as peculiaridades da fotografia através da teoria de Gilbert Simondon e consiste em analisar os processos de individuação da fotografia. A terceira, designada como metodológica, é produzir conhecimento acerca da fotografia enquanto estratégia de pesquisa e intervenção. A quarta, empírica, consiste em construir vias de exercícios de autoria através de oficinas de fotografia no CIAPS. O trabalho de campo se deu a partir da realização de oficinas de fotografia dirigidas aos trabalhadores (equipe fixa e terceirizada) e jovens (ambulatório e internação) do CIAPS. Elas eram divididas em três etapas: 1) sensibilização para a condição simbólica da imagem e possibilidade de exercícios de autoria através da fotografia; 2) solicitação de que os sujeitos fotografassem a partir da questão “como você percebe o CIAPS?” e 3) expressão verbal sobre a experiência e as imagens. As análises incidiram sobre a forma como a proposta foi recebida, o processo de fotografar, as possibilidades de exercícios de autoria no regime no local e as diversas leituras dos sujeitos e pesquisadores acerca das imagens produzidas. As imagens e discussões abordaram o aprisionamento, as contradições nas políticas públicas em saúde mental e o questionamento à lógica manicomial. A fotografia se mostrou potente não apenas pela condição simbólica, que enfatizava exercícios de autoria, mas também pelas posições icônica e indiciária, que permitiram análises e discussões com o comitê de ética, trabalhadores e jovens. Em função disso, entende-se que a potencialidade de trabalhar com fotografia em pesquisa e intervenção reside na construção de estratégias que abarquem sua complexidade epistemológica. / This thesis was inspired by the desire to pursue ways to perform research and intervention through photography, and in the recognition of the possibilities of constructing new practices in the field of mental health. It took place in the context of the Oficinando em Rede research and extension project – a partnership between the Federal University of Rio Grande do Sul and the Integrated Center for Psychosocial Care of Children and Adolescents (CIAPS) of the São Pedro Psychiatric Hospital in Porto Alegre, Brazil. This project develops technological workshops – on internet, robotics, photography and video – with hospital workers and young patients. During the photography workshops, we observed that giving cameras to patients and allowing them to use the equipment freely and to produce their own inscriptions generated a feeling of unease in the hospital personnel, due to the torsion of legitimized positions in which patients were usually viewed as objects of specialized medical knowledge. This was due to the fact that photography maintains a similarity relationship with reality which differentiates it from other artistic practices in mental health (such as painting, writing and drawing). On the other hand, if the legitimacy of photography is warranted by the belief in its capability to reproduce reality, exercises of authorship through it are frequently invisible. Our aim was to discuss the ways in which authorship is exercised in the institutional context, and to study the self-experience of workers and patients with regard to the discourses and practices in mental health. In this context, we formulated four propositions for this thesis. The first, theoretical, is based on the concepts of Michel Foucault and consists of establishing relationships between self-experience and exercises of authorship. The second one, also theoretical, aims to discuss the peculiarities of photography through the theories of Gilbert Simondon and consists in analyzing individuation processes in photography. The third, designated as methodological, is to produce knowledge about photography as a research and intervention strategy. The fourth one, empirical, consists of building ways to exercise authorship through photography workshops in the CIAPS. Our field work consisted of organizing photography workshops directed to workers (permanent and third-party) and patients of the CIAPS (outpatients and inpatients). These workshops were divided into three stages: 1) sensitization to the symbolic condition of photography and to the possibility of exercising authorship through photography; 2) requiring subjects to photograph based on the question “What is the CIAPS?” and 3) verbal expression about the experience and photographed images. Our analysis was based on the way in which the proposal was received, on the process of photographing, on the possibilities of exercises of authorship within the institution and on the various readings of the subjects and researchers concerning the photographed images. The photographs and discussions revolved around themes such as imprisonment, contradictions in public policies on mental health and questioning on the role of the psychiatric hospital. Photography was shown to be powerful not only due to its symbolic condition, which emphasized exercises of authorship, but also to its iconic and index positions, which allowed analysis and discussions with workers, patients and the hospital’s ethics committee. Based on this, we believe that the potential of working with photography in research and intervention resides in the construction of strategies which can encompass its epistemiological complexity.

This study investigates the team aspects of a process improvement project situated in an Internet banking system maintenance and modification phase. To investigate how team processes could be improved in this context, four interventional change techniques were introduced and implemented during an action research study in which the researcher was included as one of the team members and participated during group meetings and discussions. Internet banking is an important Internet-delivered service which is expected to provide benefits for both commercial banks and bank customers. Internet banking allows bank customers to have the freedom to perform their financial activities at their convenience. Developing, maintaining, and improving Internet banking systems requires large amounts of investment to maintain high levels of Internet banking service quality, and the maintenance and modification phase of the overall lifecycle cost is a considerable part of this investment. Therefore, in order to ensure high levels of usability, reliability, and quality for these Internet banking services, commercial banks need to make significant investments in the maintenance and modification phases of their Internet banking systems' lifecycle. The four interventional change techniques used in this study were: departmental participation, equal participation, holistic scenario, and management support. The four techniques were found to be influential in developing process improvements in the maintenance and modification phase of Internet banking systems. These techniques generated several significant improvements which directly affected the way team members managed their work. The significant contributions of these interventional change techniques were: the creation of cross-functional multilevel teams, development of effective departmental participation and communication techniques, extended scope and knowledge by the team members of Internet banking systems, an increase in team learning and understanding, techniques to change problem structure, and an end to end problem-solving approach. ii These contributions also directly improved the performance of the Internet banking systems maintenance team, and there was a significant improvement in the outcomes of the Internet banking systems maintenance and modification phase.

Imaging guidance may allow minimally invasive alternatives to open surgical exposure and help reduce procedure risk and morbidity. The inherent vascular and soft-tissue contrast of MRI make it an appealing imaging modality to guide cardiovascular interventional procedures. Advances in real-time MRI have made MRI-guided procedures a realistic possibility. The MR environment, however, introduces additional challenges to the development of compatible, conspicuous and safe devices. The overall goal of this work was to enable selected MRI-guided cardiovascular interventional procedures with clearly visible MR devices. In the first part of this work, we developed actively visualized devices for three distinct MRI-guided interventional procedures and techniques to assess their signal performance. We then investigated factors influencing complex device safety in the MR environment and evaluated a technique to better determine and monitor potential device heating. This input contributed to the development of a system to further improve device safety with continual device monitoring and dynamic scanner feedback control. In the final part of this work, we demonstrated the utility of MRI guidance and actively visualized devices to enable traditional and complex cardiovascular access. Together these provide important elements to bring MRI-guided cardiovascular interventional procedures closer to clinical implementation.

L’imagerie hyperspectrale issue de la télédétection, va devenir une nouvelle modalité d’imagerie médicale pouvant assister le diagnostic de plusieurs pathologies via la détection des marges tumorales des cancers ou la mesure de l’oxygénation des tissus. L’originalité de ce travail de thèse est de fournir au chirurgien en cours d’intervention une vision améliorée du champ opératoire grâce à une image RGB affichée sur écran, résultat de traitements des cubes hyperspectraux dans le visible, le proche infrarouge et le moyen infrarouge (400-1700 nm). Notre application permet la détection des tissus difficilement détectables et vitaux comme l’uretère. Deux prototypes d’imagerie hyperspectrale utilisant les filtres programmables à cristaux liquides ont été développés, calibrés et mis en oeuvre dans de nombreuses campagnes d’expérimentations précliniques. Les résultats présentés dans cette thèse permettent de conclure que les méthodes de sélection de bandes sont les plus adaptées pour une application interventionnelle de l’imagerie hyperspectrale en salle d’opération puisqu’elles affichent une quantité maximale d’information, un meilleur rendu naturel de l’image RGB résultante et une amélioration maximale de la visualisation de la scène chirurgicale puisque le contraste dans l’image résultat entre le tissu d’intérêt et les tissus environnants a été triplé par rapport à l’image visualisée par l’oeil du chirurgien. Le principal inconvénient de ces méthodes réside dans le temps d’exécution qui a été nettement amélioré par les méthodes combinées proposées. De plus, la bande spectrale du moyen infrarouge est jugée plus discriminante pour explorer les données hyperspectrales associées à l’uretère puisque la séparabilité entre les tissus y est nettement supérieure par rapport à la gamme spectrale du visible. / Hyperspectral imagery initially applied for remote sensing will become a new medical imaging modality that may assist the diagnosis of several diseases through the detection of tumoral margins of cancers or the measure of the tissue oxygenation. The originality of this work is to provide, during surgery, an improved vision of the operative field with a RGB image displayed on screen, as the result of hyperspectral cubes processing in the visible, near infrared and mid-infrared (400-1700 nm). Our application allows the detection of hard noticeable and vital tissues as the ureter. Two hyperspectral imaging prototype using liquid crystal tunable filters have been developed, calibrated and implemented in many preclinical experiments campaigns. The results presented in this thesis allow to conclude that the methods of band selection are most suitable for interventional application of hyperspectral imaging in operating room since they show a maximal amount of information, a better natural rendering of the resulting RGB image and a maximal improvement of visualization of the surgical scene as the contrast in the resulting image between the tissue of interest and the surrounding tissues was tripled compared to the image viewed by the surgeon’s eye. The main drawback of these methods lies in the execution time which was significantly improved by the proposed combined methods. Furthermore, the mid-infrared spectral range is considered more discriminating to explore hyperspectral data associated with the ureter as the separability between tissues is significantly higher compared to the visible spectral range.

Esta tese foi inspirada no desejo de aprofundar modos de pesquisar e intervir através da fotografia e no reconhecimento das condições de possibilidade de construção de novas práticas no campo da saúde mental. Realizou-se no contexto do projeto de pesquisa e extensão Oficinando em Rede – parceria entre Universidade Federal do Rio Grande do Sul e o Centro Integrado de Atenção Psicossocial para crianças e adolescentes (CIAPS) do Hospital Psiquiátrico São Pedro, em Porto Alegre. Tal projeto realiza oficinas tecnológicas – internet, robótica, fotografia e vídeo – junto aos trabalhadores e usuários do local. Nas oficinas de fotografia, observamos que a entrega de câmeras aos jovens, para que fotografassem livremente, produzindo suas próprias inscrições, era algo estranho no contexto, pois as práticas discursivas em hospitais psiquiátricos geralmente colocam usuários em uma posição de objeto do olhar médico-especializado. Isto se deu em função da fotografia manter uma relação de similaridade perceptiva com a realidade, o que a diferencia de outras práticas artísticas em saúde mental, como pintura, escrita e desenho. Por outro lado, se a legitimidade da fotografia é garantida por uma crença na possibilidade de reprodução do real, os exercícios de autoria muitas vezes ficam invisíveis. Nosso objetivo foi problematizar as vias de exercícios de autoria no âmbito institucional, assim como estudar a experiência de si de trabalhadores e jovens em relação aos discursos e práticas em saúde mental. Neste âmbito, formulamos quatro proposições para esta tese. A primeira delas, teórica, é baseada nas noções de Michel Foucault e consiste em estabelecer relações entre experiência de si e exercícios de autoria. A segunda, também teórica, busca aprofundar a discussão sobre as peculiaridades da fotografia através da teoria de Gilbert Simondon e consiste em analisar os processos de individuação da fotografia. A terceira, designada como metodológica, é produzir conhecimento acerca da fotografia enquanto estratégia de pesquisa e intervenção. A quarta, empírica, consiste em construir vias de exercícios de autoria através de oficinas de fotografia no CIAPS. O trabalho de campo se deu a partir da realização de oficinas de fotografia dirigidas aos trabalhadores (equipe fixa e terceirizada) e jovens (ambulatório e internação) do CIAPS. Elas eram divididas em três etapas: 1) sensibilização para a condição simbólica da imagem e possibilidade de exercícios de autoria através da fotografia; 2) solicitação de que os sujeitos fotografassem a partir da questão “como você percebe o CIAPS?” e 3) expressão verbal sobre a experiência e as imagens. As análises incidiram sobre a forma como a proposta foi recebida, o processo de fotografar, as possibilidades de exercícios de autoria no regime no local e as diversas leituras dos sujeitos e pesquisadores acerca das imagens produzidas. As imagens e discussões abordaram o aprisionamento, as contradições nas políticas públicas em saúde mental e o questionamento à lógica manicomial. A fotografia se mostrou potente não apenas pela condição simbólica, que enfatizava exercícios de autoria, mas também pelas posições icônica e indiciária, que permitiram análises e discussões com o comitê de ética, trabalhadores e jovens. Em função disso, entende-se que a potencialidade de trabalhar com fotografia em pesquisa e intervenção reside na construção de estratégias que abarquem sua complexidade epistemológica. / This thesis was inspired by the desire to pursue ways to perform research and intervention through photography, and in the recognition of the possibilities of constructing new practices in the field of mental health. It took place in the context of the Oficinando em Rede research and extension project – a partnership between the Federal University of Rio Grande do Sul and the Integrated Center for Psychosocial Care of Children and Adolescents (CIAPS) of the São Pedro Psychiatric Hospital in Porto Alegre, Brazil. This project develops technological workshops – on internet, robotics, photography and video – with hospital workers and young patients. During the photography workshops, we observed that giving cameras to patients and allowing them to use the equipment freely and to produce their own inscriptions generated a feeling of unease in the hospital personnel, due to the torsion of legitimized positions in which patients were usually viewed as objects of specialized medical knowledge. This was due to the fact that photography maintains a similarity relationship with reality which differentiates it from other artistic practices in mental health (such as painting, writing and drawing). On the other hand, if the legitimacy of photography is warranted by the belief in its capability to reproduce reality, exercises of authorship through it are frequently invisible. Our aim was to discuss the ways in which authorship is exercised in the institutional context, and to study the self-experience of workers and patients with regard to the discourses and practices in mental health. In this context, we formulated four propositions for this thesis. The first, theoretical, is based on the concepts of Michel Foucault and consists of establishing relationships between self-experience and exercises of authorship. The second one, also theoretical, aims to discuss the peculiarities of photography through the theories of Gilbert Simondon and consists in analyzing individuation processes in photography. The third, designated as methodological, is to produce knowledge about photography as a research and intervention strategy. The fourth one, empirical, consists of building ways to exercise authorship through photography workshops in the CIAPS. Our field work consisted of organizing photography workshops directed to workers (permanent and third-party) and patients of the CIAPS (outpatients and inpatients). These workshops were divided into three stages: 1) sensitization to the symbolic condition of photography and to the possibility of exercising authorship through photography; 2) requiring subjects to photograph based on the question “What is the CIAPS?” and 3) verbal expression about the experience and photographed images. Our analysis was based on the way in which the proposal was received, on the process of photographing, on the possibilities of exercises of authorship within the institution and on the various readings of the subjects and researchers concerning the photographed images. The photographs and discussions revolved around themes such as imprisonment, contradictions in public policies on mental health and questioning on the role of the psychiatric hospital. Photography was shown to be powerful not only due to its symbolic condition, which emphasized exercises of authorship, but also to its iconic and index positions, which allowed analysis and discussions with workers, patients and the hospital’s ethics committee. Based on this, we believe that the potential of working with photography in research and intervention resides in the construction of strategies which can encompass its epistemiological complexity.

Esta tese foi inspirada no desejo de aprofundar modos de pesquisar e intervir através da fotografia e no reconhecimento das condições de possibilidade de construção de novas práticas no campo da saúde mental. Realizou-se no contexto do projeto de pesquisa e extensão Oficinando em Rede – parceria entre Universidade Federal do Rio Grande do Sul e o Centro Integrado de Atenção Psicossocial para crianças e adolescentes (CIAPS) do Hospital Psiquiátrico São Pedro, em Porto Alegre. Tal projeto realiza oficinas tecnológicas – internet, robótica, fotografia e vídeo – junto aos trabalhadores e usuários do local. Nas oficinas de fotografia, observamos que a entrega de câmeras aos jovens, para que fotografassem livremente, produzindo suas próprias inscrições, era algo estranho no contexto, pois as práticas discursivas em hospitais psiquiátricos geralmente colocam usuários em uma posição de objeto do olhar médico-especializado. Isto se deu em função da fotografia manter uma relação de similaridade perceptiva com a realidade, o que a diferencia de outras práticas artísticas em saúde mental, como pintura, escrita e desenho. Por outro lado, se a legitimidade da fotografia é garantida por uma crença na possibilidade de reprodução do real, os exercícios de autoria muitas vezes ficam invisíveis. Nosso objetivo foi problematizar as vias de exercícios de autoria no âmbito institucional, assim como estudar a experiência de si de trabalhadores e jovens em relação aos discursos e práticas em saúde mental. Neste âmbito, formulamos quatro proposições para esta tese. A primeira delas, teórica, é baseada nas noções de Michel Foucault e consiste em estabelecer relações entre experiência de si e exercícios de autoria. A segunda, também teórica, busca aprofundar a discussão sobre as peculiaridades da fotografia através da teoria de Gilbert Simondon e consiste em analisar os processos de individuação da fotografia. A terceira, designada como metodológica, é produzir conhecimento acerca da fotografia enquanto estratégia de pesquisa e intervenção. A quarta, empírica, consiste em construir vias de exercícios de autoria através de oficinas de fotografia no CIAPS. O trabalho de campo se deu a partir da realização de oficinas de fotografia dirigidas aos trabalhadores (equipe fixa e terceirizada) e jovens (ambulatório e internação) do CIAPS. Elas eram divididas em três etapas: 1) sensibilização para a condição simbólica da imagem e possibilidade de exercícios de autoria através da fotografia; 2) solicitação de que os sujeitos fotografassem a partir da questão “como você percebe o CIAPS?” e 3) expressão verbal sobre a experiência e as imagens. As análises incidiram sobre a forma como a proposta foi recebida, o processo de fotografar, as possibilidades de exercícios de autoria no regime no local e as diversas leituras dos sujeitos e pesquisadores acerca das imagens produzidas. As imagens e discussões abordaram o aprisionamento, as contradições nas políticas públicas em saúde mental e o questionamento à lógica manicomial. A fotografia se mostrou potente não apenas pela condição simbólica, que enfatizava exercícios de autoria, mas também pelas posições icônica e indiciária, que permitiram análises e discussões com o comitê de ética, trabalhadores e jovens. Em função disso, entende-se que a potencialidade de trabalhar com fotografia em pesquisa e intervenção reside na construção de estratégias que abarquem sua complexidade epistemológica. / This thesis was inspired by the desire to pursue ways to perform research and intervention through photography, and in the recognition of the possibilities of constructing new practices in the field of mental health. It took place in the context of the Oficinando em Rede research and extension project – a partnership between the Federal University of Rio Grande do Sul and the Integrated Center for Psychosocial Care of Children and Adolescents (CIAPS) of the São Pedro Psychiatric Hospital in Porto Alegre, Brazil. This project develops technological workshops – on internet, robotics, photography and video – with hospital workers and young patients. During the photography workshops, we observed that giving cameras to patients and allowing them to use the equipment freely and to produce their own inscriptions generated a feeling of unease in the hospital personnel, due to the torsion of legitimized positions in which patients were usually viewed as objects of specialized medical knowledge. This was due to the fact that photography maintains a similarity relationship with reality which differentiates it from other artistic practices in mental health (such as painting, writing and drawing). On the other hand, if the legitimacy of photography is warranted by the belief in its capability to reproduce reality, exercises of authorship through it are frequently invisible. Our aim was to discuss the ways in which authorship is exercised in the institutional context, and to study the self-experience of workers and patients with regard to the discourses and practices in mental health. In this context, we formulated four propositions for this thesis. The first, theoretical, is based on the concepts of Michel Foucault and consists of establishing relationships between self-experience and exercises of authorship. The second one, also theoretical, aims to discuss the peculiarities of photography through the theories of Gilbert Simondon and consists in analyzing individuation processes in photography. The third, designated as methodological, is to produce knowledge about photography as a research and intervention strategy. The fourth one, empirical, consists of building ways to exercise authorship through photography workshops in the CIAPS. Our field work consisted of organizing photography workshops directed to workers (permanent and third-party) and patients of the CIAPS (outpatients and inpatients). These workshops were divided into three stages: 1) sensitization to the symbolic condition of photography and to the possibility of exercising authorship through photography; 2) requiring subjects to photograph based on the question “What is the CIAPS?” and 3) verbal expression about the experience and photographed images. Our analysis was based on the way in which the proposal was received, on the process of photographing, on the possibilities of exercises of authorship within the institution and on the various readings of the subjects and researchers concerning the photographed images. The photographs and discussions revolved around themes such as imprisonment, contradictions in public policies on mental health and questioning on the role of the psychiatric hospital. Photography was shown to be powerful not only due to its symbolic condition, which emphasized exercises of authorship, but also to its iconic and index positions, which allowed analysis and discussions with workers, patients and the hospital’s ethics committee. Based on this, we believe that the potential of working with photography in research and intervention resides in the construction of strategies which can encompass its epistemiological complexity.

Submitted by Maike Costa (maiksebas@gmail.com) on 2017-03-24T12:18:25Z No. of bitstreams: 1 arquivototal.pdf: 4393557 bytes, checksum: 0a76f9aecca908cea2df415266f7e030 (MD5) / Made available in DSpace on 2017-03-24T12:18:25Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 4393557 bytes, checksum: 0a76f9aecca908cea2df415266f7e030 (MD5) Previous issue date: 2016-12-07 / We present the research on segmentations not conventional, hypo, hyper and hybrid segmentation, whose objective was to analyze these phenomena in texts written by 5th and 9th years of Basic Education. It was carrying through in a public school and in private school of the city of Joao Pessoa. Structures as “denovo” written for "de novo"; “so frendo” instead of "sofrendo; “derrepente”, written for “derre pente" exemplify, respectively, these phenomena. The date had been extracted from the 08 narrative texts, consisting of 05 texts from 5th years and 03 texts from the 9th year, coming from public school. Amongst theoretical discussions that had subsidized us, there are studies made for Bisol (1994, 1999, 2000 and 2004), Bortoni-Ricardo (2006), Cunha (2004), Cunha and Miranda (2008), Camara Jr (2004) Selkirk (1982, 1984), Silva (2014) e Tenani (2002). We consider that the number of findings was not significant quantitatively, but believe, from the reading of the data found on the subject in vast studied literature, to be a recurrent problem in other schools and, therefore, we decide to give mini workshops to provide to the participating teachers of this research information on the functioning of language, specifically concerning not conventional phonological processes of which we believe can elapse segmentations, and also a interventional exercise that could deal with these phenomena. The activities had the objective to take to the teachers the proposal of remedial intervention for the eight pupils who present problems of segmentation in the study, as well as for other pupils in other schools that present problem in the future concerning the same findings. / Apresentamos uma pesquisa sobre segmentacões nao convencionais – hipossegmentação, hipersegmentação e segmentação hibrida – cujo objetivo foi analisar esses fenômenos em textos escritos por alunos de 5o e 9o anos do Ensino Fundamental. Foi realizada em uma escola da rede pública e em uma da rede privada da cidade de Joao Pessoa. Estruturas como “denovo”, grafada para "de novo”; “so frendo” grafada para “sofrendo”; e “derre pente”, grafada para "de repente" exemplificam, respectivamente, esses fenômenos. Os dados foram extraídos de um corpus 08 textos narrativos, constituído por 05 dos 5os anos e 03 dos 9os anos do Ensino Fundamental I e II, respectivamente, de uma escola pública. Dentre as discussões teóricas que nos subsidiaram, temos estudos feitos por Bisol (1994, 1999, 2000, 2005), Bortoni-Ricardo (2006), Cunha (2004), Cunha e Miranda (2008), Camara Jr. (2004), Selkirk (1982, 1984), Silva (2014) e Tenani (2002). Consideramos que o número de achados nao foi significativo quantitativamente, mas acreditamos, a partir da leitura dos dados encontrados sobre o assunto na vasta literatura estudada, ser um problema recorrente em outras escolas e, por isso, decidimos ministrar minioficinas para disponibilizar aos professores participantes da pesquisa informacões sobre o funcionamento da língua, especificamente, acerca de processos fonológicos dos quais acreditamos podem decorrer as segmentacões nao convencionais, e também com exercícios de intervencao para os alunos que pudessem lidar com esses fenômenos. As atividades construídas tiveram como objetivo levar aos professores uma proposta de intervencao remediadora para os oito alunos que apresentam problemas de segmentacao no estudo, assim como para outros alunos em outras escolas que apresentarem o mesmo problema em constatacões futuras.