Introdução: o Programa ATLS foi desenvolvido nos EUA na década de 70, visando estabelecer um método padronizado para avaliação e tratamento iniciais dos pacientes vítimas de trauma pelos médicos que trabalham nas unidades de emergência. Hoje, apesar do sucesso e de sua ampla disseminação internacional, os benefícios do Programa em relação à modificação dos índices de mortalidade das vítimas de trauma ainda não foram largamente comprovados. Objetivos: o objetivo deste estudo é avaliar a efetividade do Programa ATLS no atendimento do traumatizado em cidade de pequeno porte do Brasil, analisando seu impacto sobre os índices de mortalidade, sobre o tempo de internação e sobre a realização de determinados procedimentos diagnósticos e terapêuticos. Métodos: no período compreendido entre 01 de Janeiro de 2003 e 31 de Dezembro de 2005, foram analisados 240 pacientes, vítimas de trauma, atendidos em hospital universitário de cidade de pequeno porte no Brasil, com RTS \"Revised Trauma Score\" - Escore Revisado de Trauma <6,62, subdivididos em duas amostras: grupo pré-ATLS (120 pacientes) - quando não havia protocolo específico para atendimento ao trauma, e grupo pós-ATLS (120 pacientes) - após a implantação do programa. Resultados: Houve diferença estatisticamente significativa na mortalidade, com redução média de 17% no grupo pós-ATLS. Também foi constatado, no grupo pós-ATLS, aumento estatisticamente significativo da mortalidade após 24 horas da chegada do paciente ao hospital. Quanto ao tempo de internação, não houve diferença estatisticamente significativa entre os grupos. Conclusão: a implantação do programa ATLS reduziu o índice de mortalidade global atestando efetividade no atendimento ao trauma. / Introduction: the ATLS Program was developed in U.S.A. in the decade of 70, aiming to provide a standardized method for initial evaluation and management of the trauma patient for the doctors that work at the emergency room. Today, despite the success and of its ample international dissemination, the impact of the benefits of the Program on trauma care has not been wide scientifically proven. Objectives: the objective of this study is to analyze the effectiveness of the ATLS Program in the management of trauma patients in a small size city of Brasil, studying the real impact on the mortality index, the time of hospital stay and the accomplishment of determined diagnostic and therapeutic procedures. Methods: starting on January 01, 2003 and ending on December 31, 2005, 240 trauma victims were studied at the university hospital of a small size city of Brasil, with RTS (Revised Trauma Score) < 6.62, subdivided in two samples: group pre-ATLS (120 patients) - when there was no specific protocol for trauma care, and group post-ATLS (120 patients) - after the implementation of the program. Results: It had statistical significant difference in mortality, with average reduction of 17% in the group post-ATLS. Also it was evidenced, in the group after-ATLS, statistical significant increase of mortality after 24 hours of the arrival of the patient to the hospital. Concerning the length of hospital stay, there was no statistical significant difference between the groups. Conclusion: the implementation of the ATLS program reduced the index of global mortality certifying effectiveness in the management of the trauma patient.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2017-04-19T13:31:55Z No. of bitstreams: 1 JULIANA FATIMA SERRAGLIO PASINI_.pdf: 2321629 bytes, checksum: 991ec935f9ab785e766e00af290db5aa (MD5) / Made available in DSpace on 2017-04-19T13:31:56Z (GMT). No. of bitstreams: 1 JULIANA FATIMA SERRAGLIO PASINI_.pdf: 2321629 bytes, checksum: 991ec935f9ab785e766e00af290db5aa (MD5) Previous issue date: 2016-12-19 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O foco dessa pesquisa é o modo como as avaliações em larga escala repercutem no contexto da prática, tomando como espaço empírico cinco municípios de pequeno porte (com até 10 mil habitantes) do estado do Paraná. A abordagem teórico-metodológica considera que as políticas se desenvolvem em contextos de disputas contemplando arenas, lugares e grupos de interesses. Nessa tese o contexto de influência caracteriza-se pelo histórico da implementação das políticas de avaliação em âmbito federal e estadual e o contexto da prática, pela pesquisa com foco em ações desenvolvidas em âmbito escolar. A investigação teve como objetivo geral analisar a relação entre as políticas de avaliação em larga escala e as desenvolvidas em municípios de pequeno porte, a fim de identificar como repercutem no contexto da prática escolar, e, como objetivos específicos: (a) levantar os indicadores sociais e educacionais de cada município da pesquisa, no período de 2005 a 2013; (b) descrever as estratégias da gestão escolar e as implicações para o contexto da prática; (c) identificar as políticas educacionais desenvolvidas em âmbito municipal, a fim de promover melhorias no IDEB no período de 2005 a 2013; e (d) compreender como as políticas em nível federal e estadual repercutem nas políticas municipais. A coleta de dados desenvolveu-se com foco em ações desenvolvidas em âmbito escolar, mediante entrevistas (25) com diretores, coordenadores pedagógicos e professores, de escolas que participaram de, pelo menos, um dos ciclos da Prova Brasil, no período de 2005 a 2013. Utilizou-se o NVivo 11 para análise e organização do material obtido nas entrevistas. Como resultados, a pesquisa aponta fragilidades nas estatísticas quando apresentadas como fotografia da realidade educacional, o que acontece quando as redes e a sociedade tratam o IDEB como único ou principal instrumento para indicar a qualidade da educação, desconsiderando as especificidades de cada local e homogeneizando as características socioeconômicas, culturais e educacionais. Também revela que, mesmo em municípios de pequeno porte, a performatividade e o gerencialismo permeiam o contexto da prática, envolvendo ações relacionadas ao atendimento das especificidades das avaliações em larga escala. Entretanto, há resistência dos profissionais para que esses princípios não sejam determinantes da prática pedagógica escolar. Verifica-se grande preocupação com a aprendizagem dos alunos, desenvolvimento de projetos e atividades de contra turno, embora os resultados das avaliações em larga escala não sejam ignorados. / This research focuses on the way large-scale evaluations reverberate in the context of practice, taking as empirical space five small cities (with up to 10 thousand inhabitants) of the state of Paraná. Its theoretical-methodological approach considers that policies develop in contexts of dispute, contemplating arenas, places and groups of interest. In this thesis, the context of influence is characterized by the history of implementation of evaluation policies in federal and state spheres and by the context of practice; it focuses on actions developed in school settings. The main goal of this thesis was to analyze the relation between large-scale evaluation policies and the policies developed in small cities, in order to verify how they reverberate in the context of school practice; the specific objectives were: (a) to verify the social and educational indicators of each city in which the research was carried, in the period between 2005 and 2013; (b) to describe the school management strategies and its implications for the context of practice; (c) to identify the educational policies developed in municipal level, in order to promote improvements in IDEB in the period between 2005 and 2013; and (d) to understand how policies in federal and state levels reverberate in municipal policies. The collection of data focused in actions developed in school environments, by means of 25 interviews with directors, pedagogical coordinators and teachers from schools that participated in, at least, one of the cycles of Prova Brasil, in the period between 2005 and 2013. NVivo 11 was used to analyze and organize the material obtained during these interviews. As results, the research points the fragilities of the statistics when they are presented as a reflection of educational reality, which happens when educational networks and society take IDEB as the only or main tool for indicating education quality, disregarding the specificities of each place and homogenizing social and educational characteristics. It also shows that, even in small cities, performativity and managerialism permeate the context of practice, involving actions related to the meeting of large-scale evaluations' specificities. However, there is opposition from professionals so that these principles are not decisive in school pedagogical practice. Great concern with the learning of students is verified, as well as the development of projects and after-school activities, although the large-scale evaluation results are not ignored.

O presente trabalho tem como objetivo compreender as transformações da área urbana do município de Monte Alegre de Minas, em razão da construção dos conjuntos habitacionais (Pedra Branca, J.Tolendal e Primavera) por intermédio do Programa Minha Casa, Minha Vida (PMCMV). Este estudo tem em relação à ciência geográfica uma significativa importância, pois, o mesmo poderá contribuir para a compreensão das transformações que o espaço das pequenas cidades sofre diante da implantação desse tipo de empreendimento. Para a realização do mesmo, optou-se metodologicamente pela pesquisa bibliográfica e pela documental referente às políticas de produção de moradia no Brasil e o papel do Estado, a importância das pequenas cidades na rede urbana, assim como a legislação brasileira com abordagem nos direitos dos indivíduos, ressaltando a moradia digna como um desses. Outro instrumento metodológico foram as análises empíricas nos três conjuntos habitacionais com intuito de conhecer a realidade observada por meio de fotografias e imagens satélites, pois os mesmos se localizam em áreas distintas da cidade. Além disso, utilizaram-se recursos tecnológicos para elaboração de mapas de localização do município e dos conjuntos. E por fim, foram coletadas informações por meio de depoimentos livres das famílias que foram beneficiadas pelo programa e também daquelas que residem em áreas próximas desses locais. Concluiu-se, então, que o PMCMV tem assumido relevante papel no que se refere à minimização de um dos problemas mais críticos da contemporaneidade brasileira, o déficit habitacional e a incorporação do mesmo em Monte Alegre de Minas, resultando na modificação do espaço (físico e funcional), pois algumas áreas inicialmente apresentavam apenas 40 (quarenta) residências, todavia com o interesse imobiliário e pelo fato de estarem localizadas em uma área mais próxima do centro da cidade, transformaram-se em conjuntos com mais de 200 (duzentas) residências, com a presença de um pequeno comércio e de serviços de atendimento básico (área de lazer e creche de educação infantil) que atendem até mesmo os outros bairros. / The objective this work is to analyze the changes in the urban area of the municipality of Monte Alegre de Minas due to the construction of the housing complexes (Pedra Branca, J Tolendal and Primavera) through the My House, My Life program. This study has a great relevance in relation to the geographical studies, since it can contribute significantly to the understanding of the transformations that the space of the small cities suffer before the implantation of this type of enterprise. In order to carry out this study, methodological choice was made for bibliographical and documentary research concerning housing production policies in Brazil and the role of the State, the importance of small cities in the urban network, as well as Brazilian legislation with an approach to the rights of individuals, emphasizing decent housing as one of these. Another methodological instrument was empirical analysis in the three housing complexes in order to know the reality observed through photographs and satellite images, since they are located in different areas of the city, in addition, technological resources were used for the elaboration of location maps Municipality and set. Finally, information was collected through free testimonials from the families that benefited from the program, as well as from those living in areas near those sites. It was concluded that the PMCMV has assumed a relevant role in minimizing one of the most critical problems of the Brazilian contemporaneity the housing deficit and its incorporation in Monte Alegre de Minas resulted in the modification of the physical and functional space, because some areas initially had only 40 (forty) residences, but with real estate interest and because they were located in an area closer to the central area of the city, they became groups with more than 200 (two hundred) residences, with the presence a small local commerce and basic care services (leisure area and kindergarten) that serves even the other neighborhoods. / Dissertação (Mestrado)

Introdução: o Programa ATLS foi desenvolvido nos EUA na década de 70, visando estabelecer um método padronizado para avaliação e tratamento iniciais dos pacientes vítimas de trauma pelos médicos que trabalham nas unidades de emergência. Hoje, apesar do sucesso e de sua ampla disseminação internacional, os benefícios do Programa em relação à modificação dos índices de mortalidade das vítimas de trauma ainda não foram largamente comprovados. Objetivos: o objetivo deste estudo é avaliar a efetividade do Programa ATLS no atendimento do traumatizado em cidade de pequeno porte do Brasil, analisando seu impacto sobre os índices de mortalidade, sobre o tempo de internação e sobre a realização de determinados procedimentos diagnósticos e terapêuticos. Métodos: no período compreendido entre 01 de Janeiro de 2003 e 31 de Dezembro de 2005, foram analisados 240 pacientes, vítimas de trauma, atendidos em hospital universitário de cidade de pequeno porte no Brasil, com RTS \"Revised Trauma Score\" - Escore Revisado de Trauma <6,62, subdivididos em duas amostras: grupo pré-ATLS (120 pacientes) - quando não havia protocolo específico para atendimento ao trauma, e grupo pós-ATLS (120 pacientes) - após a implantação do programa. Resultados: Houve diferença estatisticamente significativa na mortalidade, com redução média de 17% no grupo pós-ATLS. Também foi constatado, no grupo pós-ATLS, aumento estatisticamente significativo da mortalidade após 24 horas da chegada do paciente ao hospital. Quanto ao tempo de internação, não houve diferença estatisticamente significativa entre os grupos. Conclusão: a implantação do programa ATLS reduziu o índice de mortalidade global atestando efetividade no atendimento ao trauma. / Introduction: the ATLS Program was developed in U.S.A. in the decade of 70, aiming to provide a standardized method for initial evaluation and management of the trauma patient for the doctors that work at the emergency room. Today, despite the success and of its ample international dissemination, the impact of the benefits of the Program on trauma care has not been wide scientifically proven. Objectives: the objective of this study is to analyze the effectiveness of the ATLS Program in the management of trauma patients in a small size city of Brasil, studying the real impact on the mortality index, the time of hospital stay and the accomplishment of determined diagnostic and therapeutic procedures. Methods: starting on January 01, 2003 and ending on December 31, 2005, 240 trauma victims were studied at the university hospital of a small size city of Brasil, with RTS (Revised Trauma Score) < 6.62, subdivided in two samples: group pre-ATLS (120 patients) - when there was no specific protocol for trauma care, and group post-ATLS (120 patients) - after the implementation of the program. Results: It had statistical significant difference in mortality, with average reduction of 17% in the group post-ATLS. Also it was evidenced, in the group after-ATLS, statistical significant increase of mortality after 24 hours of the arrival of the patient to the hospital. Concerning the length of hospital stay, there was no statistical significant difference between the groups. Conclusion: the implementation of the ATLS program reduced the index of global mortality certifying effectiveness in the management of the trauma patient.

Small town economic decline has been experienced in many countries across the globe and can be explained through Geographical Economics, particularly the New Economic Geography, which suggests that agglomeration occurs as a natural outcome of high transportation and transactional costs. Yet despite the economic rationale behind their decline it is not an economic inevitability and there is evidence of towns in the United States, New Zealand and Canada that have reversed their economic fortunes. [n South Africa approximately 5 million people live in the 500 small towns and many more live in their rural hinterlands where povelty levels are extremely high within a national context. Within this context the thesis examines the current economic status and potential growth prospects of small towns in the Eastern Cape Midlands in South Africa in order to identify critical growth dri vers within small town economies. Five small towns were selected for the study via means of a purposive sample and were subjected to two regional modelling techniques, namely Shift-Share Analysis and Economic Base Theory to determine their current economic trends and past growth patterns, while a Social Accounting Matrix was utilised to identify important sectoral linkages, potential avenues for growth and evident leakages within small town economies. The sampled towns experienced negative economic growth trends between 1996 and 200 I, the primary loss in employment being accounted for by regional economic changes as opposed to national or industrial trends. The decline was more severely felt in primary/industrial sectors of the economy; evidence was found that manufacturing activities declined in all of the centres, despite the industry growing nationally. The Social Accounting Matrix highlighted strong links between the agricultural and services sectors within the national economy. Thus, considering that agriculture was identified as the primary economic driver within the region and the services sector the largest employer in all of the towns it is evident that the economic potential of the towns is to a certain extent linked to the success of agriculture in their hinterlands. Seven growth drivers, namely size, local economic development, existing markets, existing industries, infrastructure, municipal leadership and local entrepreneurs and were linked via means of a scoring framework to the sampled towns' economic potential. Whilst the results of actually determining a towns economic potential are not definitive the study does provide useful insights about the impact and potential role played by these drivers. Linked to this scoring framework and to Cook's (1971) hierarchy of places in the Eastern Cape Midlands four categories of towns were identified in the commercial falming areas and recommendations were made about appropriate developmental interventions at a municipal level, such as the need to retain local entrepreneurs and to invest in social amenities. Considering the evident need for development in rural areas the study provides critical insights into how to prioritise development strategies within small rural towns in commercial farming areas. In addition it would enable municipalities to critically reflect on their municipal Local Economic Development strategies and the relevance within the context of small towns. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

The most important resource is no longer the river, forest or mine - it is information, creativity and knowledge. Larger urban areas has transformed in to bigger cities with global perspectives, cities where we ́ve never before seen as much segregation and class differences. The smaller cities that once transformed Sweden from a poor peripheral nation to a country in the financial and social forefront, has been deprived of the possibility of being part of the knowledge economy. However, in this hierarchical transformation of the society the digitalization is forming a new type of center - an autonomous bomb goes off - and we all become our own center. This project explores the possibilities for a more decentralized society development, when the big cities is unable to deliver the perfect life setting for all. Smaller cities of the periphery is often beautifully situated and offers life qualities and spaces that many are longing for. Though, the last decades have been tough and left a lot of the smaller cities with a scattered and rough context – and a common lack of spaces to meet in. Therefore this project ended up becoming, what I imagine to be a new kind of symbolic building for meetings - that with its form, function and programme should express the new future of the periphery. The ambition is to introduce spaces which could act as a generator of a new time where the small towns get to be part of the knowledge economy, a time where people get to choose their own location of center through the tecnology of today. A future concept allowing the whole of Sweden to become more vibrant, connected to essential functions and filled with life - no matter the amount of people or the physical location of the place. / Den viktigaste råvaran är inte längre vår skog, gruva eller flod - utan dagens råvaror är information, kreativitet och kunskap. Större urbana platser har fått följa med sin tid och förvandlats till storstäder med globala perspektiv - städer där vi samtidigt aldrig skådat så stora skillnader i klasstillhörighet. Landets småstäder som i begynnelsen förvandlade Sverige från en fattig utkantsnation till ett land i framkant - har dock berövats möjligheten att vara en del av kunskapsekonomin. I detta hierarkiska samhällsbyggande kan vi dock genom digitaliseringen se ett nytt typ av centrum ta form - en autonomibomb smäller - och vi blir alla vårt eget centrum. Detta projekt utreder möjligheterna till en mer decentraliserande samhällsutveckling - när storstaden inte lyckas leverera den perfekta tillvaron till alla.

Text in English with summaries in English, isiXhosa and Sesotho / Includes bibliographical references (leaves 141-153) / Provision of municipal services to urban residents particularly those residing in small towns across developing countries, is facing challenges. A small town or rural district of Luwingu in Zambia, is no exception. This study provides an analysis of factors that influence provision of municipal services in developing countries with Luwingu town or rural district in Zambia as the case study. Through this study, it has been shown that urban residents in small towns and to some extent, those residing in urban peripheries such as informal settlements, low-income residential neighbourhoods in major cities continues to experience poor provision and access to basic services such as drinking water, sanitation, refuse removal and electricity supply. Influencing effective provision of municipal services in the developing countries including Luwingu district council in Zambia, is a number of factors. Amongst others, is inadequate service infrastructure; lack of human and financial resources in various local municipalities particularly small rural local municipalities including Luwingu district council in Zambia. / Phano ya ditshebeletso ya masepala ho baahi ba diteropo haholo ba dulang diteropong tse nyane ho pharalla le dinaha tse ntseng di tswelapele, e lebane le mathata. Torotswana e nyane kapa setereke sa mahaeng sa Luwingu ho la Zambia, le yona e ya tshwana. Phuputso ena e fana ka manollo ya dintlha tse amang phano ya ditshebeletso tsa masepala dinaheng tse ntseng di tswelapele e sebedisa teropo kapa setereke sa mahaeng sa Luwingu jwalo ka mohlala wa phuputso. Ka phuputso ena, ho bontshitswe hore baahi ba diteropong ba leng diteropong tse nyane le ka tsela e itseng, ba dulang mabopong a diteropo jwalo ka diahelo tse sa hlophiswang, metse ya batho ba kgolang tjhelete e nyane diteropokgolong tse kgolo, ba tswelapele ho fumana phano e fokolang le phihlello ho ditshebeletso tsa motheo tse jwalo ka metsi a nowang, tlheko ya dikgwerekgwere, tlhwekiso ya dithole le phepelo ya motlakase. Ke dintlha tse mmalwa tse amang phano e ntle ya ditshebeletso tsa masepala dinaheng tse ntseng di tswelapele ho kenyelletswa khansele ya setereke ya Luwingu e Zambia. Hara tse ding ke boteng bo fokolang ba disebediswa tsa ditshebeletso; tlhokeho ya ditjhelete le basebetsi dimasepaleng tse fapaneng tsa lehae tse kenyelletsang khansele ya setereke ya Luwingu e Zambia. / Ukunikezelwa kweenkonzo zikamasipala kujongene nemingeni kubahlali basezidolophini, ngakumbi abo bahlala kwiidolophu ezincinci kumazwe asaphuhlayo. Le nto iyenzeka nakwidolophana encinci okanye isithili sasemaphandleni aseLuwingu eZambia. Esi sifundo sihlalutya izinto ezinefuthe kunikezelo lweenkonzo zikamasipala kumazwe asaphuhlayo, kwaye sizekelisa ngedolophana okanye iphandle laseLuwingu eZambia. Ngokwenza esi sifundo, kubonakele ukuba abahlali beedolophana ezincinci kunye nabo bahlala kufuphi nazo, njengabo bahlala kwiindawo ezingekho sesikweni nabahlala kwiindawo zabantu abanemivuzo ephantsi kwizixeko ezikhulu, bafumana iinkonzo ezikumgangatho osezantsi. Ezo nkonzo zifana namanzi okusela, ukugcina ucoceko, ukuthuthwa kwenkunkuma nokunikezelwa kombane. Ziliqela iimeko ezinefuthe ekunikezelweni kweenkonzo zikamasipala ezisemgangathweni kumazwe asaphuhlayo njengeZambia, kwisithili saseLuwingu. Phakathi kwezo meko singabalula ukungafakwa ngokwaneleyo kwezilungiselelo nezibonelelo zeenkonzo, (infrastructure); ukunqongophala kwemali nabantu abaqeqeshelwe umsebenzi koomasipala bendawo abahlukeneyo, ngakumbi abeendawo ezincinci, kuquka nekhansile yesithili saseLuwingu eZambia. / Development Studies / M.A. (Development studies)