This thesis explored the ways in which people experiencing psychosis respond to their distressing experiences. Mixed methodology was used to address the research questions. Chapter two included a thorough systematic review and meta-analysis to investigate the relationship between safety seeking behaviours and psychosis. This review concluded that safety seeking behaviours, avoidance and resistance were associated with increased distress whereas engagement was associated with reduced distress. The review also highlighted some conceptual difficulties with differentiating between safety seeking and coping in this population. Study one, a qualitative exploration of how people respond to the experience of psychosis is presented in chapter four. This study found three key themes relating to perceived importance of responses, accuracy of threat appraisals and perceptions of ability to control experiences. An overarching theme of fighting a daily battle to maintain functioning was also identified. This analysis provided some support for the model of safety seeking responses but also demonstrated additional complexities in the way that people respond to their distressing experiences. Chapter five presents study two, the development and validation of a measure of responses to psychosis. Principal Components Analysis identified three subscales: threat monitoring and avoidance, social control and reassurance seeking and conscious self-regulation attempts. The subscales were found to have good internal consistency and convergent validity. To build on this work, study three used Structural Equation Modelling to test an integrative cognitive and metacognitive model of voice hearing (chapter six). In support of this model, it was found that voice hearing predicted beliefs and beliefs predicted responses and negative affect. Responses were not predicted either by voice hearing or negative affect. It was also found that both schematic beliefs and meta-worry mediated the relationship between avoidance and negative affect. Finally, in study four, presented in chapter seven, the response styles of attentional avoidance and attentional focusing were manipulated in response to an ambiguous auditory task in an experimental study. It was found that the attentional avoidance response resulted in a significantly greater increase in words heard during the task. However, the manipulation did not have an impact on distress levels. This thesis has demonstrated significant relationships between response styles, distress, appraisals and voice hearing. This, therefore, confirms the important role of responses to unusual experiences in models of psychosis. It appears that avoidance is likely to be unhelpful however, it should not be assumed that other responses are either helpful or unhelpful as this is likely to be person and context specific. The clinical and research implications of this are discussed.

This research has arisen from recent changes in attitudes to offshore safety. To help demonstrate structural safety to the Health and Safety Executive, operators are increasingly using structural system reliability assessments. While significant developments have been achieved in this area, there are still a number of uncertainties associated with such assessments. Unresolved technical issues also introduce significant variability in the results. The aim of this project is to develop a framework for system reliability, which will set a basis for moving towards more consistent reliability assessments. An extensive review study was undertaken first to establish the state of the art in the area of structure system reliability analysis of offshore structures. Based on the findings of this study, a generic system reliability framework was developed which was then developed further for specific application to fixed offshore platforms. These initial studies identified some of the key technical issues that required further investigation. The subsequent offshore application and sensitivity study, using a representative fixed platform model, concentrated on these issues and in particular on the effects of foundation parameters on ultimate strength and their interaction with other key parameters in determining the resistance function. The effect of foundation parameters and different modelling methods on system strength and reliability of fixed offshore platforms, which has largely been neglected in the past, was also investigated. The response surface methodology was developed for system reliability assessment of offshore structures incorporating the effect of foundation reliability. The findings were then used to revise the framework and provide more comprehensive account of key steps in the process of system reliability assessment. Some guidelines on the application of the response surface technique to fixed platform assessment were developed. In addition, an initial screening tool was also proposed for assessing the level of complexity required for the resistance model of the reliability assessment. The presentation of the reliability framework provides a comprehensive account of the various steps, methods and decisions associated with system reliability analysis. The framework, which can be used in both the design and reassessment of structures, can provide a basis for moving towards more consistent reliability assessments. Recommendations on areas that require further research are also presented.

O gerenciamento de riscos e a segurança são aspectos importantes a serem considerados na elaboração de projetos. No entanto, o primeiro é pouco utilizado pelas empresas em geral, apesar das ferramentas e técnicas existentes. No caso da segurança, existe uma lacuna referente ao modo que as empresas gerenciam a segurança de seus projetos. Assim, a presente dissertação teve como objetivo estudar a aplicabilidade e a importância do gerenciamento de riscos e da segurança para a condução de projetos bem-sucedidos. Foram utilizados como métodos de investigação entrevistas e questionários, os quais possibilitaram obter conhecimentos e opiniões, referentes ao assunto em estudo, de vinte e oito gestores de projetos de diferentes áreas. Os resultados obtidos evidenciaram que o gerenciamento de riscos nem sempre é aplicado nos projetos, apesar dos avanços ocorridos na área. Quanto à segurança, constatou-se que fatores como o tipo de projeto, porte e exigência do cliente determinam sua inserção no ambiente de gerenciamento de projetos. Além disso, observou-se que o gerenciamento de riscos associado à segurança são importantes para a realização de projetos bem-sucedidos, embora sua utilização não ocorra em todos os projetos. Ainda que os resultados tenham mostrado a necessidade de mais treinamentos e estudos adicionais para auxiliar no entendimento e aplicação do gerenciamento de riscos e da segurança, ficou constatado que os gestores possuem consciência da importância da aplicação destes durante o desenvolvimento de seus projetos. Isto representa um progresso na direção de uma mudança cultural nas organizações. / Risk management and safety are important aspects to be considered during projects development. However, the first is used too little by companies in general, despite of the tools and techniques already developed. In the case of safety, exists a gap about the way enterprises management it in their projects. Thus, the present essay had to objective study the applicability and importance of risk management and safety to projects success. Interviews and questionary were conducted, which allowed to obtain knowledge and opinions concerned to subject in study of twenty and eight project managers from different areas. The results evidenced that risk management is not always applied in the projects, although the advances occurred in the area. In relation to safety, it was verified that factors like project’s type, size and customer requirements determine the insertion of safety in the project management. In the same time, it was found out that risk management associated with safety are important to project success, even so it is not applied in all projects developed. Moreover, the results have indicated the need for more training and additional studies to help understanding the usage of risk management and safety tools and techniques, it was found out that managers are aware of importance to consider its use during the projects development. This denotes a progress in the direction of a cultural change in the organizations.

Made available in DSpace on 2014-06-11T19:32:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-31Bitstream added on 2014-06-13T20:47:23Z : No. of bitstreams: 1 carvalho_rj_dr_guara.pdf: 1285081 bytes, checksum: bddc8097d4880ae300a5a56557d83d3b (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo desta tese foi identificar e analisar fatores relacionados com o ambiente profissional e pessoal do funcionário que possam contribuir para a ocorrência de quase-acidentes. Para isso foi realizado um estudo de caso em uma equipe operacional de logística de uma indústria química do Vale do Paraíba. O grupo pesquisado era composto de quarenta funcionários que participaram de um programa preventivo para redução de quase-acidentes em 2003. Foram conduzidas entrevistas semi-estruturadas que permitiram obter informações sobre o ambiente profissional e pessoal dos funcionários. Ao analisar o histórico de quase-acidentes ocorridos entre 2002 e 2009 foi possível definir dois grupos distintos: um grupo que não se envolveu com quase-acidentes e outro grupo que se envolveu com pelo menos um quase-acidente. Verificando as informações obtidas nas entrevistas e levando-se em conta os distintos grupos, foi possível identificar fatores com grande potencial para causar quase-acidentes. Analisando ainda os relatórios de segurança do departamento de logística verificou-se um crescimento dos quase-acidentes desde 2003, o que permitiu reaplicar um questionário no grupo pesquisado para verificar quais foram os fatores relacionados com o ambiente organizacional da logística que mais contribuíram para esse crescimento. Os resultados dessa tese confirmam o conceito de que acidentes não são fatalidades, pois as causas podem ser identificáveis eliminando, assim, a idéia de que o risco é um componente intrínseco do trabalho / This thesis aims to identify and to analyze factors related with the employee's professional and personal environment that can contribute to the occurrence of near misses. For that a case study was done with an operational logistics team of a chemical industry of Vale do Paraíba. The researched group was composed of forty employees who participated of a preventive program for reduction of near misses in 2003. Semi-structured interviews were done, which allowed in obtaining information on the employees' professional and personal environment. After analyzing the history of near misses happened between 2002 and 2009 two different groups could be defined: a group that was not involved with near misses and other group that was involved with at least one near miss. Verifying the information obtained with interviews and considering the different groups, it was possible to identify factors with great potential to cause near misses. Analyzing the safety reports of the logistics department it was verified a growth of near misses since 2003, what allowed reapply a questionnaire with the group researched to verify which were the factors related with the logistics operational environment that have contributed more to that growth. The results of this thesis confirm the concept that accidents are not fatalities, as the causes can be identifiable, so eliminating the idea that the risk is an intrinsic component of the work

Air traffic congestion problems in many areas of the world are well known and have been highly publicised in recent years. This airspace dilemma, which results in delays and other undesirable knock-on effects, is escalating at a phenomenal rate and requires immediate attention. Correspondingly, there is concern about safety standards in some worldwide airspace regions. In addition, it is imperative that the significant projected growth in air transport movements over the next two decades is accommodated. Thus, there is an urgent need to solve the current airspace problems and plan in a responsible manner to meet forecast demand. Solutions to these predicaments have been developed and are encompassed under the auspices of the term 'future air navigation systems'. The systems include technologies and procedures that merge to optimise the potential of airport and airspace resources so that the capacity, flexibility and safety of these resources are maximised, while delays and their operating costs are minimised. Future air navigation systems use automated communications. navigation and surveillance technologies to provide enhanced air traffic management through continuous information on aircraft positions and intention, so that reductions in separation are possible without compromising safety. However, confusion exists regarding what technologies and procedures constitute these future air navigation systems. Additionally, their current worldwide integration status is not as advanced as it should be and, in fact, remains largely unknown. Indeed, their successful introduction is far from guaranteed at present. Therefore, this research addresses these requirements by evaluating and improving implementation of tile systems on a global basis. Ultimately, this thesis provides a comprehensive analysis that discovers what systems are pertinent and whether or where they have been applied to date, in addition to developing and validating a framework strategy for improved introduction of the future air navigation systems around the world.

Nickel is frequently reported as an agent causing allergic contact dermatitis in humans and was selected as an example for the investigation into the molecular mechanisms of the sensitivity. Nickel, as a hapten, may not constitute the complete antigen. The protein of cellular conjugates of nickel formed in the skin may represent the antigenic complexes, but the number and nature are unknown. In this submission, allergic contact dermatitis to nickel is reviewed; data on the immunological processes from various human and animal-model systems relevant to this problem are appraised and experimental investigations into the antigenic complexes of nickel are described. The albino guinea-pig was selected as a suitable animal model and a test system was developed to induce and elicit allergic contact dermatitis to nickel in this species. Under the exposure conditions of this system, an incidence of the sensitivity of 70-100% in a test population was experimentally induced. This consistently high incidence was not achieved by the use of standard published animal methods. Time-coursed In vivo exposure studies, employing 63NiCl2 as a radiotracer, were performed to qualitatively and quantatively examine the absorption and accumulation of nickel in the skin. The results indicated that soluble nickel salts are poorly absorbed across the skin. Maximum plasma levels were seen after 12 hours of exposure, although these represented only a very small percentage of the appled nickel salts (0.06%). Absorbed nickel was excreted in the urine. Microautoradiography of in vivo exposed skin indicated that transappendageal passage may be the main route of entry into the body. Accumulation of nickel was apparent in the highly keratinized areas of the skin, and labelling of basal and supra-basal epidermal cells was observed. Dermal accumulation was not seen. Fractionation of the in vivo exposed epidermis by zonal ultracentrification and gel filtration revealed four main areas of nickel localization. It was found associated with a microsomal fraction, with albumin, with an epidermal protein fraction (molecular weight 8,700) and with low molecular weight (< 5,000) residues. The antigenicity of each isolated nickel-containing fraction was assessed by in vitro lymphocyte transformation. The primary antigens in this system were the epidermal protein fraction (molecular weight 8,700) and the microsomal fraction. The low molecular weight residues possessed some very weak antigenic properties. Allergic contact dermatitis appears to be a complex sensitivity reaction to more than one antigen in the skin. The recognition of antigen by the immune system is protein-carrier dependant and the processing of haptenic or antigenic information by microsomal constituents may be an importanat function in the induction phase of the dematitis.

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Introdução: O aumento no consumo mundial de imunoglobulina humana tem desafiado os sistemas de saúde no estabelecimento de padrões de utilização adequados a esta terapia. O conhecimento das políticas públicas pelos profissionais de saúde, aderidos a uma conscientização ao uso racional e estudos baseados em evidências científicas é fundamental para assegurar o acesso adequado e uma maior segurança e efetividade de tratamento. Objetivo: Avaliar a utilização de imunoglobulina humana em hospital universitário de alta complexidade do sul do país e suas indicações relacionando as mesmas aos protocolos clínicos estabelecidos. Métodos: Trata-se de um estudo transversal, retrospectivo, baseado na busca de informações através do prontuário eletrônico dos pacientes do Hospital de Clínicas de Porto Alegre no período de janeiro à dezembro de 2015 Resultados: Foram identificadas 191 prescrições de imunoglobulina humana endovenosa, totalizando 116 pacientes. Desses pacientes, 23% apresentaram síndrome de Guillain Barré, púrpura trombocitopênica idiopática, miastenia gravis, transplante renal, imunodeficiência com aumento de IgM e outras anemias hemolíticas autoimunes. Todas essas situações clínicas tem indicação de uso de acordo com os protocolos estabelecidos pelo Ministério da Saúde. Os demais casos identificados (77%) não constam nas indicações previstas nos protocolos do Ministério da Saúde. Conclusão: Foi possível identificar a utilização de imunoglobulina humana endovenosa em hospital de alta complexidade e quantificar os casos clínicos que fazem uso desse medicamento e que apresentam protocolos nacionais orientando os profissionais de saúde quanto a correta administração desse medicamento. Observou-se que a maioria dos casos identificados no estudo não apresentam regulamentos oficiais que autorizem a sua administração. / Introduction: The increase in the world consumption of human immunoglobulin has challenged the health systems in establishing appropriate standards of use for this therapy. Knowledge of public policies by health professionals adhering to rational use awareness and evidence-based studies is critical to ensure adequate access and greater safety and effectiveness of treatment. Objective: To evaluate the use of human immunoglobulin in a university hospital of high complexity in the South of the country and its indications relating them to the established clinical protocols. Methods: This is a cross-sectional, retrospective study based on the search of information through the electronic medical records of patients from the Hospital de Clínicas of Porto Alegre from January to December 2015 Results: 191 prescriptions of intravenous human immunoglobulin were identified, totaling 116 patients. Of these patients, 23% had Guillain Barré syndrome, idiopathic thrombocytopenic purpura, myasthenia gravis, renal transplantation, immunodeficiency with increased IgM and other autoimmune hemolytic anemias. All of these clinical situations are indicated for use according to protocols established by the Ministry of Health. The other cases identified (77%) are not included in the indications provided for in the protocols of the Ministry of Health. Conclusion: It was possible to identify the use of intravenous human immunoglobulin in hospital of high complexity and to quantify the clinical cases that use this medicine and that present national protocols guiding healthcare professionals about the correct administration of this medicine. It was observed that the majority of the cases identified in the study do not present official regulations that authorize its administration.

No description available.