The present study documents a language educator's reflection on two transitions that mirror current curricular changes in undergraduate language programs in the United States. The first chronicles her personal pedagogical transformation from a general-purposes Spanish language professor and her adjustment to teaching as a visiting professor in a Spanish for Specific Purposes (SSP) language-learning environment at the United States Air Force Academy. The second reports the evolution over several decades of the Spanish language program at University of Alabama at Birmingham from a traditional general Spanish-language program to a multipurpose program. The study suggests that SSP and liberal arts values are not mutually exclusive, and it explores what Spanish for General Purposes (SGP) can learn from SSP. Spanish programs that find common ground and hybridize to respond to multiple demands of today's Spanish learners are likely to be the most successful in the future. ; To cite the digital version, add its Reference URL (found by following the link in the header above the digital file). ; A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 88 The Unexpected Spanish for Specific Purposes Professor: A Tale of Two Institutions Sheri Spaine Long United States Air Force Academy University of Alabama at Birmingham Abstract: The present study documents a language educator's reflection on two transitions that mirror current curricular changes in undergraduate language programs in the United States. The first chronicles her personal pedagogical transformation from a general-purposes Spanish language professor and her adjustment to teaching as a visiting professor in a Spanish for Specific Purposes (SSP) language-learning environment at the United States Air Force Academy. The second reports the evolution over several decades of the Spanish language program at University of Alabama at Birmingham from a traditional general Spanish-language program to a multipurpose program. The study suggests that SSP and liberal arts values are not mutually exclusive, and it explores what Spanish for General Purposes (SGP) can learn from SSP. Spanish programs that find common ground and hybridize to respond to multiple demands of today's Spanish learners are likely to be the most successful in the future. Keywords: language learning curriculum, liberal arts, medical Spanish, military language learning, Spanish for General Purposes (SGP), Spanish instruction, Spanish for Specific Purposes (SSP), United States Air Force Academy, University of Alabama at Birmingham (UAB) Introduction This academic year, I dubbed myself the unexpected Spanish for Specific Purposes (SSP) professor because specialized career-focused instruction became part of my pedagogical repertoire. Working in a SSP language-learning environment has made me take stock of what mainstream language educators can gain from exposure to the philosophy and instructional techniques of languages for specific purposes. I am serving currently as Distinguished Visiting Professor of Spanish at the United States Air Force Academy. I am a permanent Professor of Spanish at the University of Alabama at Birmingham (UAB). In this reflective paper, I chronicle two transitions. First, I share observations about my transition from general purposes language instruction to the more focused language-learning setting at the United States Air Force Academy. Language learning at the United States Air Force Academy exemplifies the definition of a Spanish for Specific Purposes (SSP) program because it is dedicated to the goal of educating future Air Force officer-leaders with a global perspective. Secondly, I narrate from an administrative/ administrator's point of view UAB's evolution from a traditional Spanish curriculum to a dual-purpose program that includes a SSP certificate. I conclude that both the United States Air Force Academy and UAB Spanish language programs provide unique insights into the curricular changes and challenges in language teaching that have emerged during the last several decades in higher education. My experiences in these respective undergraduate Spanish programs show that signature language curricula have been and can be developed to serve diverse missions of learners and institutions and that intellectual and practical needs simultaneously helped mold these A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 89 programs. The United States Air Force Academy and UAB Spanish language programs are traditional and nontraditional at the same time. I posit they will resemble our future hybridized Spanish language programs. For purposes of this paper, I understand hybridized to mean multipurpose programs that have SSP components and a liberal arts foundation. The subfield of SSP can be defined as a practice that gives language learners access to the Spanish that they need to accomplish their own academic or occupational goals (Sánchez-López, 2013). It is necessary to locate SSP within the domain of Second Language Acquisition (SLA) in order to recognize that SSP is not a departure from current theory or practices in foreign language education. The counterpoint to SSP is Spanish for General Purposes (SGP). SGP is a broad descriptor for the teaching and learning of Spanish in ways that can be exploratory in nature. It is language teaching and learning that is likely not to have a singular career focus. Along with the concept of language learning for cultural breadth, traditionally SGP has been ensconced within the notion of liberal arts education. After almost 20 years of teaching principally undergraduate SGP at UAB, I relocated to Colorado Springs to experience anew the teaching and learning of Spanish in a different context. The learning environment that I envisioned at the service academy would be focused on the specific Air Force mission within undergraduate higher education. By contrast, I am the product of a liberal arts education that was not singularly focused on a specific career. For the last several decades, I have taught students with a variety of goals, both professional and personal. The teaching and learning environment with which I am the most familiar is rooted in the model of a liberal education that has historically framed SGP programs across the United States over the last 75 years. Goals of the liberal arts education include such attributes as thinking critically, possessing broad analytical skills, learning how to learn, thinking independently, seeing all sides of an issue, communicating clearly (orally and in writing), exercising self-control for the sake of broader loyalties, showing self-assurance in leadership ability, and participating in and enjoying (cross-)cultural experience (Blaich, Bost, Chan, & Lynch, 2010). By reviewing some attributes commonly found in definitions of a liberal arts education, I highlight the cornerstone of numerous undergraduate programs in higher education. My goal is not to produce a comprehensive list of its characteristics. In fact, one finds variations in the definition of the liberal arts education tailored to suit institutional realities and needs. The elements that I emphasize in the present discussion are particular characteristics, such as analytical and critical thinking, leadership development, civic responsibility and cultural breadth, which are especially relevant to how these two Spanish language programs evolved at both the United States Air Force Academy and UAB. Although critical thinking may not be one of the characteristics that spring to mind within military education given the realities of obedience, discipline and hierarchy, critical thinking is an essential characteristic of military officers that must make decisions in complex situations. The teaching/learning of the ability to analyze critically is key in military service academies and in civilian institutions, such as UAB. UAB and arrived at the United States Air Force Academy in summer 2011. Because of the courses that I had been asked to design and teach, I knew that the United States Air Force Academy's curriculum was not about technical instruction as in Spanish for Military Purposes. In fact, my fall courses had mainstream course titles that one might find in any Spanish program: Literature and Film of Spain and Latin American Civilization and Culture. My military supervisors told me that I was invited here to bring a different perspective and pedagogy into the classroom. As my first semester unfolded, I set out to learn from diverse A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 90 pupils and faculty members and to absorb and adapt to the differences before me. The United States Air Force Academy's mission fits neatly on a sign that everyone reads upon entering the military installation: "Developing Leaders of Character." The United States Air Force Academy (2011) is an undergraduate institution, awarding the BS degree as part of its mission to inspire and develop officers with knowledge, character and discipline. Undergraduates are referred to as cadets, and this underscores both the military and academic focus of the learners. After a few weeks at the United States Air Force Academy, I realized that I had landed in a one-of-a-kind educational setting. The institution subscribes to and emphasizes many of the key core values that I associate with a liberal arts education while additionally providing technical training. As Pennington (2012) pointed out in her recent commentary in The Chronicle of Higher Education, we need to acknowledge that preparing for work and pursuing a liberal arts education are not mutually exclusive. Considering liberal arts principles and professional training as polar opposites is a deeply ingrained notion by many individuals in higher education and in society at large. This belief needs to change because of the type of complex preparation that today's students will need to flourish in the future. Below is the complete list of shared outcomes of the Unites States Air Force Academy. Even with a cursory examination, one finds intertwined traditional liberals arts concepts and elements associated with technical education for engineers, scientists and warriors: Shared United States Air Force Academy Outcomes (2011) Commission leaders of character who embody the Air Force core values. . . . . .committed to Societal, Professional, and Individual Responsibilities Ethical Reasoning and Action Respect for Human Dignity Service to the Nation Lifelong Development and Contributions Intercultural Competence and Involvement . . .empowered by integrated Intellectual and Warrior Skills Quantitative and Information Literacy Oral and Written Communication Critical Thinking Decision Making Stamina Courage Discipline Teamwork . . .grounded in essential Knowledge of the Profession of Arms and the Human & Physical Worlds Heritage and Application of Air, Space, and Cyberspace Power National Security and Full Spectrum of Joint and Coalition Warfare A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 91 Civic, Cultural and International Environments Ethics and the Foundations of Character Principles of Science and the Scientific Method Principles of Engineering and the Application of Technology Source: http://www.usafa.edu/df/usafaoutcomes.cfm?catname=Dean%20of%20Faculty Values such as critical thinking, ethics and ethical reasoning, respect for human dignity, lifelong development and contributions, intercultural competence, and oral and written communication are integral to a liberal arts education and are the foundation of cadet education. The first phrase that frames the entire list—"Commission leaders of character who embody the Air Force core values. . ."—is key to my contention that the United States Air Force Academy's type of SSP is the teaching and learning of languages in the broader context of leadership education. The direct relationship between what one associates with well-informed leaders and liberal arts values emphasizes the importance of nurturing future leaders (whether cadets or college students) that are civically and globally astute. Leadership development clearly underpins both liberal arts values and those of the United States Air Force Academy. Like many undergraduate institutions in the United States, Spanish is widely taught at the United States Air Force Academy. According to Diane K. Johnson, an institutional statistician, there are a total of more than 500 cadets (out of a total cadet enrollment of over 4,000) that are in Spanish classes (introductory through advanced) in spring semester 2012. There are also cadets enrolled in 7 other languages that are labeled strategic or enduring. Notably, there is no language major at the United States Air Force Academy. However, there is a Foreign Area Studies major. Also, cadets can declare a minor in a language. There were 327 cadets with minor in languages at the time of this spring semester 2012 snapshot. The specific mission statement of the United States Air Force Academy's Department of Foreign Languages is: "To develop leaders of character with a global perspective through world-class language and culture education." Language and culture are embedded in the concept of the kind of global perspective that a 21st-century leader must possess. From Washington DC to Wall Street, there is agreement that future leaders internationally—both military and civilian—need to be multilingual and culturally adept to be able to navigate and lead in the 21st century (Education for global leadership, 2006). According to Lt. Col. Western (2011), it is imperative that our military comprehend that maintaining world leadership and security requires a broad understanding of other languages, cultures and thought processes. Although the Department of Defense's report (2012) on "Sustaining United States Global Leadership: Priorities for 21st Century Defense" does not directly address language and cultural expertise, many of theses priorities rely on knowledge from military leaders with considerable language and cultural acumen. Historically, the language department has always had a dual purpose that has consisted of SSP focusing on developing future Air Force officers, while providing many elements of a liberal arts education. From the following list, you will see a sampling of the generic course titles. They are not a departure from what one might find at other institutions: Basic Spanish I & Basic Spanish II (Spanish 131–132), Intermediate Spanish A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 92 I & Intermediate Spanish II (Spanish 221–222), Advanced Spanish I & Advanced Spanish II (Spanish 321–322), Civilization and Culture (Spanish 365), Current Events in the Spanish-Speaking World (Spanish 371), Introduction to Peninsular Literature (Spanish 376), Introduction to Latin American Literature (Spanish 377), Advanced Spanish Readings (Spanish 491), and Special Topics (Spanish 495). The course titles do not offer clues as to how these classes might differ from the average civilian college or university classes with similar names. In my experience teaching and/or observing these classes, differences do stand out because language learners at the United States Air Force Academy focus on application of language as a skill combined with cultural and historical knowledge. The cadets also seek intellectual breadth through the analysis of multiple perspectives particularly found in intermediate- to upper-level Spanish language classes. In the first six months in residence at the United States Air Force Academy, I observed that cadets are more intellectually broad than I assumed at the outset. Cadets read about literature and culture, analyzed film, and even wrote poetry in Spanish with gusto. They do perform in the classroom with a defined career in mind. The focus on the military profession and leadership changes the daily routine in the language classroom. By emphasizing deliberate leadership and language teaching and/or learning opportunities, crosspollination enhances the classroom exper-ience and improves institutional learning outcomes. Form cannot be divorced from function in language learning, so the synthesis of leadership development and language/cultural learning occurs. Recent studies from interdisciplinary research with the neurosciences and education show that fusion between disciplines can provide effective pathways to learning (Coyle, Hood, & Marsh, 2010). Teaching Spanish at the United States Air Force Academy altered my preparations and delivery. Because of SSP, I adapted to differences that are administrative, operational, pedagogical, experiential and conceptual. First, I experienced the surface-level administrative transformations from SGP to the special brand of SSP at this institution. I learned about: Classroom rituals that include military protocols, such as calling the class to attention in Spanish, inspecting students' regulation dress and upholding other classroom standards in the target language; References to Air Force traditions and military rank in the target language; And, lock down, active shooter and natural disaster drills that might happen during class time in the target language. Additionally, there were different details in course design that reshaped my pedagogical filter. During an examination of all Spanish language course syllabi at the United States Air Force Academy, I noticed that the communities standard from the 5Cs in the Standards for Foreign Language Learning (1999) is often replaced with a different C that stands for Careers. The focus on the professional use of Spanish is starkly emphasized through this substitution. On an operational level in the classroom, staying abreast of current events in the Spanish-speaking world and being able to interpret them—such as changes in government officials, political and economic transitions in the target culture—take on greater importance while teaching at the United States Air Force Academy. For example, when A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 93 learners know that they might be assigned to carry out tasks in any Latin American country in the future, the learners understandably pay more attention to geographical details, how economic conditions impact political situations, how longstanding historical realities affect the current mood, and so on. The language-learning environment carries with it a cachet of practical information, and it also supplies complex situations and problem-solving scenarios on which future Air Force decision makers can cut their teeth. Language practice includes creating a number of hypothetical SSP situations in which cadets participate in order to foreshadow their leadership roles, such as role-play opportunities that are relevant to Air Force operations. For example, cadets might be asked what they would do and say as a United States Air Attaché or an intelligence officer stationed in Latin America. On the conceptual level, I am currently organizing and creating a seminar that is titled War in the Arts, Literature and Film in Spain and Latin America. It is a themed-humanities seminar that offers a rich lexical environment and an opportunity to focus on the profession of war, ethics, conflict and peacekeeping in the context of film, art and print texts of the Spanish-speaking world. Considering, for example, the representation of the warrior in a literary work provides an opportunity to discuss ethics and strategies and to analyze the representation of leaders across cultures. At the United States Air Force Academy, I have participated in preparing cadets to go on semester-long exchanges to foreign military academies. Some of this is done through wayside teaching at our Spanish conversation table, emphasizing the type of current and relevant social, linguistic, and cultural information that a cadet might need to function abroad in a variety of contexts and represent the United States. One way to prepare for going abroad has been to encourage and mentor cadets to volunteer for selection to host visiting military dignitaries, such as ranking delegations from the Colombian and Mexican Air Force. To prepare cadets, instructors share with them tips about how to interact appropriately and to display leadership through social intelligence and knowledge of protocol in the target language and culture. As a follow up, debriefing after these events is essential to discuss perceptions and observations and to develop cross-cultural competence. Much like teaching and interacting with SGP students, there are immediate needs, and then, there is the important long-range goal of encouraging life-long learning in Spanish. In the context of the United States Air Force, there are programs that make this objective more concrete than what is generally experienced by students in civilian colleges and universities. To take advantage of what the Air Force has to offer, I have also learned about LEAP (Language Enabled Airman Program), which provides for structured life-long language learning for specific purposes in the Air Force. According to the Air Force Culture and Language Center ("Air force culture," 2012), LEAP is designed to sustain, enhance and utilize the existing language skills and talents of Airmen in the program. The stated goal of LEAP is to develop a core group of Airmen across specialties and careers possessing the capability to communicate in one or more foreign languages. To become a participant in LEAP, Airmen must already possess moderate to high levels of proficiency in a foreign language. Individuals that apply and are accepted into the LEAP program receive regular training both face to face and online in the target language as well as have immersion opportunities at intervals during their careers. Working to encourage and help cadets apply for LEAP is another SSP goal at the United States Air Force. A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 94 These are an overview of my unexpected SSP experiences at the Air Force Academy. My transformation from SGP to SSP started with learning and applying new vocabulary that focuses on cadets' professional needs. Later, I began to think of my learners as future leaders that will need to perform and apply knowledge to make judgments about the Spanish-speaking individuals and groups. This motivated me to reorganize courses and reconceive of them with a keener eye toward performance and to explore ways to get cadets to think beyond their immediate milieu. With the overlay of leadership development and military culture, this teaching experience has driven me to operate in a more interdisciplinary fashion than before. I experienced first hand a teaching and learning climate that offers a unique hybrid of liberal arts and technical education in a military context. Perhaps the best lesson that SSP teaches is to constantly question the relevance of what you are doing in the classroom: to whom is it relevant and for what purpose? Within the Department of Foreign Languages at the United States Air Force Academy, the SSP focus on career preparation in language instruction and the liberal arts connection with leadership evolved simultaneously. This dual focus of the curriculum contrasts the reality in most civilian language departments where there was one general focus and departments are being (or have been retrofitted) to include new curricula and/or tracks. Many civilian language departments are currently transitioning from SGP programs and integrating more SSP language options. In the late 1980s and on into the 1990s, Spanish for Business and Medical Spanish courses appeared. The integration of professional courses happened in response to societal needs (Doyle, 2010). The Department of Foreign Languages at the United States Air Force Academy offers a rare, fully integrated model of the curricular common ground of career-focused language learning with an underpinning of liberal arts breadth. Conversely, civilian language programs have transitioned to dual-purpose or multipurpose programs for different reasons. In many cases, motives for transitioning programs have been to maintain relevance and enrollments. The latter was clearly the case with the Spanish language program at UAB in the 1990s. This two-fold reality raises the palpable issue of how best to organize these dual-purpose programs from both a curricular and an administrative point of view. Undergraduate language departments and programs have to meet the needs of both their general and specific constituencies. There is a general consensus in the language discipline that multiple paths to the language major, as advocated by the Modern Language Association in the report "Foreign Languages and Higher Education: New Structures for a Changed World" (2007), will be a necessity for the future survival of undergraduate language programs. With curricular reform underway, how do traditional language programs best transition from general purposes programs to hybridized programs that also house languages for specific purposes? Another obvious driver of dual-purpose Spanish language programs is the limited support for language teaching and learning. As programs transform, we need to be mindful of the realities that face most undergraduate language programs: 1) limited financial resources to support language programs, 2) staffing limitations because of faculty back-ground and adaptability, 3) reward systems that favor faculty members who work in the more established subdisciplines in the language field, and 4) multifoci and/or shifting interests of undergraduate students. Because of these conditions, exploring ways that resources can be shared intentionally and constructively will be essential to benefit general A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 95 and specific purposes language programs at the same time. The UAB Spanish language program learned to share resources and evolved into a multipurpose program. The UAB Spanish language program transitioned from SGP to include SSP gradually over several decades. This transformation aligns the department with the institution's vision and mission, which is outlined below: The UAB Vision UAB's vision is to be an internationally renowned research university—a first choice for education and health care. The UAB Mission UAB's mission is to be a research university and academic health center that dis- covers, teaches and applies knowledge for the intellectual, cultural, social and eco- nomic benefit of Birmingham, the state and beyond. Source: http://www.uab.edu/plan/ Reflecting the mission and vision at UAB, these statements clearly present the dual role of the institution: it is both medical and educational. When I joined the faculty 20 years ago, we spoke of the medical side and the academic side of campus in a way that implied a scant relationship between the two. Therefore, the undergraduate curriculum in the language department in the early years of my appointment had no relationship with the health sciences. This separation slowly eroded over the years. When I was hired in 1992, the curriculum for the UAB undergraduate language major would best be described as traditional: language and literature. UAB students studied languages for a variety of reasons, ranging from enrichment to the fulfillment of the compulsory language requirement. We had a multiquarter language requirement that was rescinded in the mid-1990s as a result of the politics between the state's community colleges and the universities. Currently, UAB has no foreign language requirement. Almost 650 students were enrolled in Spanish in spring 2012 out of an undergraduate population of close to 12,000 students ("UAB student profile," 2011). Ironically, the lack of a language requirement in the undergraduate curriculum set the department on a path toward popularizing SSP. At that time, the UAB Department of Foreign Languages and Literatures began to turn its attention to providing courses that the students demanded. As a result in the mid-1990s, UAB offered its first medical Spanish classes for undergraduate students. From that time on, I became interested increasingly in SSP for reasons that had to do with the institution's human capital both faculty and student. Also from 2002–2009, I served as chairperson of the UAB Department of Foreign Languages and Literatures. I took an administrator's interest in growing and integrating a SSP program into the existing general Spanish program. The medical Spanish courses were a good match for the interests of our student body. Approximately 40% of the freshmen that enroll at UAB declare that they are on the premedicine track. Many students are attracted to our campus because UAB houses an internationally known School of Medicine, although many freshmen abandon the premedicine track for other health-related fields. A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 96 Student interest grew in professionally focused language courses and key faculty members invested in SSP as well. In 2001, our first applied linguist in Spanish was hired in the language department. She shared her vision of starting a SSP program by offering a few courses to appeal to pre-professionals. She became the director of the nascent SSP program. Over the years, the SSP program became so popular that it evolved into a more defined and elaborate SSP certificate program ("UAB Spanish for specific purposes program," 2012) that had 62 students enrolled in the program in spring 2012. It was the first undergraduate certificate program on the UAB campus. As the program grew, the SSP Director was successful in convincing existing junior faculty to take professional development seminars in SSP and develop additional SSP courses, such as Intermediate Spanish for the Professions, Advanced Business Spanish and Advanced Spanish for Health Professionals. In 2007, we hired a Spanish instructor to develop and expand the medical Spanish courses in the undergraduate curriculum under the umbrella of SSP. She began to collaborate with the Schools of Nursing, Medicine, and Dentistry to provide short courses to their graduate students. Over time, signs of curricular integration increased between the medical and academic sides of campus. Also, there was a confluence of external events in the state of Alabama and internal events on the UAB campus that occurred in the late 1990s and the first decade of the 21st century that promoted the success of the SSP program. Prior to the 2007 recession, a rapidly growing Spanish-speaking population in Alabama had health professionals in a reactive mode because they were not prepared to handle patients that spoke limited English ("Demographic profile of Hispanics in Alabama," 2012). In 2005, UAB hosted campus-wide events around its first freshmen discussion book The Spirit Catches you and you Fall Down: A Hmong Child, her American Doctors and the Collision of two Cultures by Ann Fadiman (1997). The book was widely read across campus, especially in the School of Medicine. Fadiman's volume chronicled Hmong (not Spanish) speakers. Nevertheless, the book captured the timely problem of the critical need for communication with the foreign born in the health professions. From that year on, the importance of cross-cultural communication became part of the UAB campus dialogue. Also around this time, UAB's prominent, grant-funded Minority Health and Research Center unofficially broadened its definition of minority to include Latinos. Meanwhile, within the UAB Department of Foreign Languages and Literatures we were able to offer our first scholarship award for a Spanish major on the premedicine track in 2003. Beginning in 2003, I recall anecdotally receiving periodic inquiries from ranking individuals in the School of Medicine that wanted to collaborate. Typically, they requested the assistance of Spanish-speaking faculty with informed-consent forms. There were repeated requests for help with interpretation until the UAB clinics developed protocols to deal with Spanish-language only patients. In January 2010, we piloted a short course in Spanish (Davidson & Long, 2012) that was offered as part of the medical school elective curriculum. In 2002, the staff of the language department informally observed a trend in the increase of undergraduate students who declared a double major in Spanish and Biology/Chemistry. I procured a modest donation from a local physician for the aforementioned scholarship. All of these events fueled the popularity of the UAB SSP program and clearly defined the need for it. The current SSP program and certificate houses a number of preprofessional courses that are not limited exclusively to SSP students. The full program description can A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 97 be viewed at http://www.uab.edu/languages/languages-programs/ssp. The number of general versus pre-professional students varies from course to course, but courses such as Spanish Translation and Interpretation tend to enroll students from both cohorts, whereas Spanish for the Health Professionals enrolls few general-purposes students. Of course, the faculty members have noticed over time that our student clientele had slowly changed: two very different types of students were sitting in the same classroom. Professionally focused Spanish students and general Spanish students enrolled in the some of the same courses. This presented new pedagogical challenges for our faculty members and raised the issue: how does one meet the needs of both groups (SSP and SGP) in the context of our institution's student body? To date, this matter has not been systematically dealt with in the UAB Spanish Division. Individual professors have developed strategies, like individualizing projects, and yet, other faculty members teach to one group to the exclusion of the other. The curricular changes discussed by the Modern Language Association have come about in many language departments, and they have been welcomed by some faculty members but not by all. Embracing the notion that the traditional liberal arts language learner can cohabitate with the interdisciplinary and/or career-focused language learner (as demonstrated at the United States Air Force Academy) is key. Highlighting the philo-sophical common ground rooted in a liberal arts education is what may be perceived by some individuals as strictly technical training may help ease the transition. The next phase will be to articulate relevant practices for educators and administrators, as well as shared values and outcomes, and to provide models that show transitional programs how to achieve what I would like to call 'constructive hybridity.' I define constructive hybridity as a positive and collective effort to sort out and integrate the best of traditional Spanish language programs with different SSP practices evidencing more focused professional goals. The next task is to define the 'shared canon' between the various tracks in any given Spanish program. Obviously, this is not a one-size-fits-all charge due to different student, societal and institutional needs, but there is foundational work to be done in order to come up with more consensuses. Given my administrative experiences as a faculty member at UAB and my teaching experience at the United States Air Force Academy, I have come to realize that both general and specific missions in Spanish-language learning are not mutually exclusive. In June 2011, I marched off to Colorado to teach and to learn. I have learned that there is a place for time-tested liberal arts values within SSP programs and that hybridized programs (liberal arts and SSP) can be successful and beneficial to the learner. As suggested by the United States Air Force Academy and UAB programs, future programs in Spanish-language instruction will need to focus on our common ground to serve multiple purposes. Thus, I return to the concept that I mentioned at the outset: it is time to think hybrid. Our future undergraduate language programs will have multiple tracks/purposes. This hybridization can be as positive and enriching for both faculty members and language learners as it has been for me during this phase of my career as a language educator. Returning to my own narrative as a committed, career Spanish professor, I have no doubt that, in the future, my newfound SSP instructional acumen and orientation will inform my future general purposes classes and improve them. A TALE OF TWO INSTITUTIONS Scholarship and Teaching on Languages for Specific Purposes (2013) 98 Disclaimer The views expressed in this paper are those of the author and do not necessarily represent those of the United States Air Force Academy, the United States Air Force, The Depart-ment of Defense or the United States Government. References Air force culture and language center. (2012, May). Retrieved from http://www.culture.af.mil/leap/index.aspx Blaich, C., Bost, A., Chan, E., & Lynch, R. (2010). Defining liberal arts education. Retrieved from http://www.liberalarts.wabash.edu/storage Coyle, D., Hood, P., & Marsh, D. (2010). Content and language integrated learning (p. 25). Cambridge: Cambridge University Press. Davidson, L., & Long, S. S. (2012). Medical Spanish for US medical students: A pilot case study. Dimension, 1–13. Retrieved from http://scolt.webnode.com/ Demographic profile of Hispanics in Alabama. (2012). Retrieved from http://www.pewhispanic.org/states/state/al/ Doyle, M. S. (2010). A responsive, integrative Spanish curriculum at UNC Charlotte. Hispania, 93(1), 80–84. Education for global leadership: The importance of international studies and foreign language education for US economic and national security. (2006). Washington, DC: Committee for Economic Development. Fadiman, A. (1997). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. NY: Farrar, Straus and Giroux. Foreign languages and higher education: new structures for a changed world. (2007) MLA ad hoc committee on foreign languages. Profession published by the Modern Language Association, 2007 (May), 1–11. Pennington, H. (2012, April 13). For student success, stop debating and start improving. The Chronicle of Higher Education, pp. A33–A34. Sánchez-López, L. (2013). Spanish for specific purposes. In C. Chapelle (Ed.), The Encyclopedia of Applied Linguistics. Oxford, UK: Wiley-Blackwell. Standards for foreign language learning in the 21st century. (1999) Lawrence, KS: National Standards in Foreign Language Education Project, Allen Press. Sustaining US global leadership: Priorities for 21st century defense. (2012) Washington DC: Department of Defense. UAB Spanish for specific purposes program. (2012). Retrieved from http://www.uab.edu/languages/ssp UAB Student profile. (2011). Retrieved from http://www.uab.edu/home/about/student-profile-accomplishments United States Air Force Academy curriculum handbook 2011–2012. (2011). USAF Academy, CO: Academy Board. Western, D. J. (2011). How to say 'national security' in 1,100 languages. Air & Space Power Journal, 48–61. Retrieved from http://www.airpower.au.af.mil
Background. According to domestic scientists, 75% of combat veterans diagnosed with symptoms that can diagnose mental and behavioral disorders because of alcohol consumption. Almost 100 thousand patients with alcohol dependence registered at the narcological dispensaries annually in Ukraine. The aim of the study was to study the pharmaceutical provision of addiction syndrome because of alcohol use (F10.2) with the definition of the parameters of the control regime among participants in combat operations. Materials and methods. In order to achieve this goal, existing international and domestic legislative, normative and legal, methodological documents; scientific sources; instructions for medical use of medicines; Internet-resources that processed using normative legal, documentary, forensic, pharmaceutical, comparative and graphical methods of analysis were used. Results. The consistency of the pharmacotherapy principles of alcohol addiction syndrome (F10.2) at the international and national levels was clarified by comparative analysis of the clinical and pharmacological groups of medicines in the following regulatory documents: Drugs used in alcohol dependence EBM Guidelines 8.9.2017 (Latest changes 8.9. 2017 Kaarlo Simojoki); the Order of the Ministry of Healthcare of Ukraine No. 681 dated September 21, 2009 "On Approval of Clinical Protocols for the Provision of Medical Aid in the Specialty "Narcology"; the Order of the Ministry of Healthcare of Ukraine No. 868 dated May 10, 2018 "On approval of the tenth issue of the State Form of Medicines and ensuring their availability"; the Decree of the Cabinet of Ministers of Ukraine No. 333 dated September 25, 2009 "Some issues of state regulation of prices for medicines and medical products", which approved the National List of Basic Medicines. Conclusions. The pharmaceutical provision for addiction syndrome because of alcohol consumption (F10.2) studied with determination of the parameters of the control regime among the participants of the military operations. Analyzed the rubricification of code F10.2 "Addiction syndrome due to alcohol use" for ICD-10 numbering 11 items. Systematized the clinical and pharmacological groups of medicinal products used for the pharmaceutical provision of addiction syndrome due to the use of alcohol among participants of military operations. Based on the analysis of the regulatory framework, determined that in the clinical protocols of the provision of medical care in the specialty "Narcology" all studied clinical and pharmacological groups of medicines for the pharmacotherapy of addiction syndrome due to alcohol use were included; in the State Form of Medicine there are no sensitizing drugs; in the National List of Essential Medicines there are no 4 clinical and pharmacological groups: psychoanalyptics (antidepressants), sensitizing drugs, peripheral vasodilators, derivatives of g-aminobutyric acid (sodium oxybutyrate), parameters of the control regimen of drugs for pharmacotherapy of addiction syndrome due to alcohol use Participants in military operations. Noted that the special regime of control has according to the classification and legal group 3 psychotropic drugs (diazepam, sodium oxibiturate and phenobarbital), which should be located in healthcare institutions on the subject and quantitative accounting. Proved in the comparative aspect, the features of licensing of studied medicinal products in medical and pharmacy establishments of healthcare. Regarding the legal status of the investigational medicinal products, taking into account the parameters of their control regime, they will increase the level of their legal, informational and physical accessibility for doctors, pharmacists and patients, and also proper organization of circulation procedure of such drugs on the stages of the appointment, discharge, storage, accounting, quality control and delivery in accordance with the current legislation of Ukraine. ; Актуальность. По данным отечественных ученых, у 75% ветеранов боевых действий отмечаются симптомы, которые позволяют диагностировать психические и поведенческие расстройства вследствие употребления алкоголя. В Украине ежегодно почти 100 тысяч пациентов с алкогольной зависимостью становятся на учет в наркологические диспансеры. Цель исследования: Изучить фармацевтическое обеспечение синдрома зависимости вследствие употребления алкоголя (F 10.2) с определением параметров режима контроля среди участников боевых действий. Материалы и методы. Для достижения поставленной цели были использованы действующие международные и отечественные законодательные, нормативно-правовые и инструктивно-методические документы; научные источники; инструкции по применению лекарственных средств; Internet-ресурсы, которые были обработаны с применением нормативно-правового, документального, судебно-фармацевтического, сравнительного и графического методов анализа. Результаты. Согласованность принципов фармакотерапии синдрома зависимости от алкоголя (F 10.2) на международном и национальном уровнях определялась путем сравнительного анализа клинико-фармакологических групп лекарственных средств в таких нормативно-правовых документах: Drugs used in alcohol dependence EBM Guidelines 8.9.2017 (Latest change 8.9. 2017 Kaarlo Simojoki); приказ МЗ Украины № 681 от 21.09.2009 г. «Об утверждении клинических протоколов оказания медицинской помощи по специальности "Наркология"»; приказ МЗ Украины № 868 от 10.05.2018 г. «Об утверждении десятого выпуска Государственного формуляра лекарственных средств и обеспечения его доступности»; Постановление КМ Украины № 333 от 25.09.2009 г. «Некоторые вопросы государственного регулирования цен на лекарственные средства и изделия медицинского назначения», которым утвержден Национальный перечень основных лекарственных средств. Выводы. Изучено фармацевтическое обеспечение синдрома зависимости вследствие употребления алкоголя (F 10.2) с определением параметров режима контроля среди участников боевых действий. Проанализирована рубрификация кода F10.2 «Синдром зависимости вследствие употребления алкоголя» согласно МКБ-10, которая насчитывает 11 позиций. Систематизированы клинико-фармакологические группы лекарственных средств, которые используются для фармацевтического обеспечения синдрома зависимости вследствие употребления алкоголя среди участников боевых действий. На основании анализа нормативной базы определено, что в клиническом протоколе оказания медицинской помощи по специальности «Наркология» включены все исследуемые клинико-фармакологические группы лекарственных средств для фармакотерапии синдрома зависимости вследствие употребления алкоголя; в Государственном формуляре лекарственных средств отсутствуют сенсибилизирующие лекарственные средства; в Национальном перечне основных лекарственных средств отсутствуют 4 клинико-фармакологические группы: психоаналептики (антидепрессанты); сенсибилизирующие лекарственные средства; периферические вазодилататоры, производные g-аминомасляной кислоты (натрия оксибутират). Установлены параметры режима контроля лекарственных средств для фармакотерапии синдрома зависимости вследствие употребления алкоголя среди участников боевых действий. Указано, что специальный режим контроля имеют по классификационно-правовой группе 3 психотропные лекарственные средства (диазепам, натрия оксибутират и фенобарбитал), которые должны находиться в учреждениях здравоохранения на предметно-количественном учете. В сравнительном аспекте обоснованы особенности лицензирования оборота лекарственных средств в медицинских и аптечных учреждениях. Внедрение в деятельность учреждений здравоохранения данных относительно правового статуса лекарственных средств с учетом параметров их режима контроля обеспечит повышение уровня их правовой, информационной и физической доступности для врачей, провизоров и пациентов, а также надлежащую организацию порядка обращения таких лекарственных средств на этапах назначения, выписки, хранения, учета, контроля качества и отпуска в соответствии с требованиями действующего законодательства Украины. ; Актуальність. За даними вітчизняних вчених, у 75% ветеранів бойових дій відзначаються симптоми, які дозволяють діагностувати психічні і поведінкові розлади внаслідок вживання алкоголю. В Україні щороку майже 100 тисяч пацієнтів з алкогольною залежністю поступають на облік у наркологічні диспансери. Мета дослідження: вивчити фармацевтичне забезпечення синдрому залежності внаслідок вживання алкоголю (F 10.2) з визначенням параметрів режиму контролю серед учасників бойових дій. Матеріали та методи. Для досягнення поставленої мети було використано чинні міжнародні та вітчизняні законодавчі, нормативно-правові та інструктивно-методичні документи; наукові джерела; інструкції для медичного застосування лікарських засобів; Internet-ресурси, які було оброблено із застосуванням нормативно-правового, документального, судово-фармацевтичного, порівняльного та графічного методів аналізу. Результати. Узгодженість принципів фармакотерапії синдрому залежності від алкоголю (F 10.2) на міжнародному і національному рівнях з'ясовувалася шляхом порівняльного аналізу клініко-фармакологічних груп лікарських засобів у таких нормативно-правових документах: Drugs used in alcohol dependence EBM Guidelines 8.9.2017 (Latest change 8.9.2017 Kaarlo Simojoki); наказ МОЗ України № 681 від 21.09.2009 р. «Про затвердження клінічних протоколів надання медичної допомоги зі спеціальності "Наркологія"»; наказ МОЗ України № 868 від 10.05.2018 р. «Про затвердження десятого випуску Державного формуляра лікарських засобів та забезпечення його доступності»; Постанова КМ України № 333 від 25.09.2009 р. «Деякі питання державного регулювання цін на лікарські засоби і вироби медичного призначення», якою затверджено Національний перелік основних лікарських засобів. Висновки. Вивчено фармацевтичне забезпечення синдрому залежності внаслідок вживання алкоголю (F 10.2) з визначенням параметрів режиму контролю серед учасників бойових дій. Проаналізовано рубрифікацію коду F10.2 «Синдром залежності внаслідок вживання алкоголю» за МКХ-10, що налічує 11 позицій. Систематизовано клініко-фармакологічні групи лікарських засобів, що використовуються для фармацевтичного забезпечення синдрому залежності внаслідок вживання алкоголю серед учасників бойових дій. На підставі аналізу нормативної бази визначено, що в клінічному протоколі надання медичної допомоги зі спеціальності «Наркологія» включено всі досліджувані клініко-фармакологічні групи лікарських засобів для фармакотерапії синдрому залежності внаслідок вживання алкоголю; у Державному формулярі лікарських засобів відсутні сенсибілізуючі лікарські засоби; у Національному переліку основних лікарських засобів відсутні 4 клініко-фармакологічні групи: психоаналептики (антидепресанти); сенсибілізуючі лікарські засоби; периферичні вазоділататори; похідні g-аміномасляної кислоти (натрію оксибутирату). Встановлено параметри режиму контролю лікарських засобів для фармакотерапії синдрому залежності внаслідок вживання алкоголю серед учасників бойових дій. Зазначено, що спеціальний режим контролю мають за класифікаційно-правовою групою 3 психотропні лікарські засоби (діазепам, натрію оксибутират і фенобарбітал), які повинні бути в закладах охорони здоров'я на предметно-кількісному обліку. У порівняльному аспекті доведено особливості ліцензування обігу досліджуваних лікарських засобів у медичних та аптечних закладах охорони здоров'я. Висновки. Впровадження в діяльність закладів охорони здоров'я даних щодо правового статусу досліджуваних лікарських засобів з урахуванням параметрів їх режиму контролю забезпечить підвищення рівня їх правової, інформаційної та фізичної доступності для лікарів, провізорів і пацієнтів, а також належну організацію порядку обігу таких лікарських засобів на етапах призначення, виписування, зберігання, обліку, контролю якості та відпуску відповідно до вимог чинного законодавства України.
Esta tesis analiza la práctica del skate en Gran La Plata (Ensenada, Berisso y La Plata), Argentina, a la vez que indaga en sus relaciones con el campo de la Educación Física. La investigación ha profundizado en modos, características, sentidos y significados que tiene el skate para quienes lo practican, así como para una parte del resto de la sociedad. Estas prácticas son realizadas por sujetos en su mayoría jóvenes, aunque también por niños y adultos. Para ello hemos utilizado un abanico de conceptos y estrategias metodológicas que pusieron en diálogo a la antropología, la sociología, las ciencias de la educación y la Educación Física. De modo más específico, los postulados de la Praxiología Motriz fueron empleados para analizar la lógica interna y la lógica externa. La relación de los sujetos con los espacios (plazas, skateparks, y en particular con el espacio público) se destacó como un importante eje analítico en la tesis. Asimismo, fueron estudiadas las relaciones con los materiales, con el tiempo y con los otros participantes. La metodología utilizada fue cualitativa y de corte interpretativo. Los instrumentos de construcción de datos fueron entrevistas, observación participante y fuentes secundarias (tales como documentos, páginas de internet, redes sociales y videos). Desde el surgimiento del skate como práctica recreativa y de tiempo libre, han existido formatos de competición que lo vincularon con el mundo del deporte; actualmente se observa que la organización de torneos ha fortalecido el avance del skate como práctica deportiva (vertiente que se ve potenciada por su inclusión en los próximos Juegos Olímpicos de Tokyo 2020). En este contexto se han generado intensos debates que retomamos y analizamos en los capítulos de la tesis. Comprender al skate como deporte permitió además ampliar la discusión en torno al propio concepto deporte y a sus alcances. Otro de los ejes analíticos lo constituyó el relevamiento de cómo se lleva adelante la enseñanza en el skate. Desde esos resultados, se introducen algunas sugerencias pedagógicas intentando contribuir a la enseñanza de esta práctica, a la vez que podría colaborar a reflexionar sobre la enseñanza de otras prácticas corporales en el campo de la Educación Física. El trabajo de investigación llega a conclusiones que nos permiten también visibilizar que los practicantes de skate en la región se manifiestan a través de acciones políticas en virtud de reclamos que consideran justos, y que se expresan y potencian por la grupalidad. El estudio pone también en evidencia la coexistencia de diferentes modos de práctica del skate, diversidad que se construye tanto en relación a los espacios utilizados (calle o street, y pista), así como en relación a la forma en que lo practican y lo entienden los propios skaters (sea de una manera más "libre" o más reglada y deportiva). En definitiva, se trata de una práctica corporal que exhibe diferentes facetas, mostrando un dinamismo que impide encorsetarla en rígidas conceptualizaciones. Sin lugar a dudas, el skateboarding se ha consolidado como un objeto de estudio reconocido internacionalmente, revelándose como una práctica que, al analizarla, nos permite una mejor comprensión de las sociedades urbanas actuales. ; This thesis analyses the practice of skate in Gran La Plata (Ensenada, Berisso y La Plata), Argentina, while it investigates its connections with the physical education field. The research deepens in ways, characteristics, senses and meanings for the people who practice skate and for a part of the rest of the society. These practices are realized mostly by young people, but also by children and adults. For this we have used a range of concepts and methodological strategies that combine the anthropology, the sociology, the educational sciences and the physical education. In a more specific way, the postulates of Motor Praxiology were used to analyse the internal logic and the external logic. The relations the subjects with the spaces (squares, skate parks and in particular with the public space) stood out as an important analytical axis in the thesis. As well, the relations with the materials were studied with time and other participants. The used methodology was qualitative and interpretive. The data construction instruments were interviews, participant observation and secondary sources (such as documents, websites, social networks and videos). Since the emergence of skateboarding as a recreational and free time practice, there have been competition formats that linked it to the world of sports; it is currently observed that the tournament organization has strengthened the progress of skateboarding as a sports practice (aspect that is enhanced by its inclusion in the next Tokyo 2020 Olympic Games). In this context, intense debates have been generated that we resume and analyze in the thesis chapters. Understanding skateboarding as a sport also allowed us to broaden the discussion about the concept of sport itself and its scope. Another of the analytical axes was the survey of how skate teaching is carried out. From these results, some pedagogical suggestions are introduced trying to contribute to the teaching of this practice, and at the same time it could help to reflect on the teaching of other bodily practices in the field of Physical Education. The research paper reaches conclusions that also allow us to make visible that skateboarders in the region manifest themselves through political actions by virtue of claims that they consider fair, and that they express and strengthen by the group. The study also highlights the coexistence of different modes of skate practice, diversity that is built both in relation to the spaces used (street and park), as well as in relation to the way they practice and understand it the skaters themselves (either in a more "free" or more regulated and sporty way). In short, it is a bodily practice that exhibits different facets, showing a dynamism that prevents being limited to rigid conceptualizations. Without a doubt, skateboarding has established itself as an internationally recognized object of study, revealing itself as a practice that, when analyzed, allows us a better understanding of today's urban societies. ; La présente thèse analyse la pratique du skate à Gran La Plata (Ensenada, Berisso et La Plata), Argentine, et en même temps, étudie ses liens avec le domaine de l'éducation physique. La recherche a mis l'accent sur les façons de faire, les caractéristiques, les sens et les significations du skate pour ceux qui le pratiquent, ainsi que pour une partie du reste de la société. La plupart de ces pratiques sont réalisées par des jeunes, mais aussi par des enfants et des adultes. Dans la cadre de notre recherche, nous avons mis en place un éventail de concepts et d'stratégies méthodologiques permettant de combiner l'anthropologie, la sociologie, les sciences de l'éducation et l'éducation physique. De façon plus spécifique, les postulats de la praxéologie motrice ont été employés dans l'analyse de la logique interne et de la logique externe. Le lien entre les sujets et les espaces (parcs, skateparks et particulièrement les espaces publics) a été soulevé comme un axe important de la thèse. Les rapports entre les sujets et les matériaux, le temps et les autres participants ont aussi été étudiés. La méthodologie employée a été qualitative, permettant une démarche interprétative. Les méthodes de collecte de données ont été des entretiens, l'observation participante, et des sources secondaires (tels que des documents, des pages Web, des réseaux sociaux et des vidéos). Depuis la naissance du skate en tant que pratique récréative et du loisir, différents formats de compétition, qui l'on rattaché au monde du sport, ont vu le jour. Actuellement, l'organisation de tournois a contribué au progrès du skate en tant que pratique sportive (volet qui s'est vu fortifié par l'inclusion du skate aux prochains Jeux olympiques de Tokyo 2020). Plusieurs débats intenses -que nous reprenons et analysons à travers les chapitres de cette thèse-, ont apparu dans ce contexte. Reconnaître le skate en tant que sport a permis d'élargir la discussion par rapport au concept de sport en soi et à son étendue. L étude en ce qui concerne la nature de l'enseignement du skate, a engendré un autre axe analytique. Les résultats obtenus constituent la base pour l'introduction de suggestions pédagogiques, dans le but de contribuer à l'enseignement de la pratique et elles pourraient pousser la réflexion sur la façon d'enseigner d'autres pratiques corporelles de l'éducation physique. Le travail de recherche aboutit à des conclusions qui nous permettent de visualiser que les pratiquants de skate de la région s'expriment à travers des actions politiques potentialisées par le phénomène de groupe, menant de réclamations qu'ils considèrent justes. L'étude souligne aussi la coexistence de modes variés dans la pratique du skate. Cette diversité est attribuée à la relation développée avec l'espace utilisé (rue ou street, ou piste), et à la façon dont le skate et pratiqué et conçu par les pratiquants (soit une façon plus « libre » ou plus sportive et réglementée.) Finalement, il s'agit d'une pratique corporelle qui expose différentes facettes, présentant un dynamisme qui empêche de la limiter à des conceptualisations rigides. Sans aucun doute, le skateboarding s'est consolidé en tant qu'objet d'étude de reconnaissance internationale, s'affirmant comme une pratique dont l'analyse nous permet une meilleure compréhension des sociétés urbaines actuelles. ; Fil: Saraví, Jorge Ricardo. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.
Актуальность. По данным отечественных ученых, у 75% ветеранов боевых действий отмечаются симптомы, которые позволяют диагностировать психические и поведенческие расстройства вследствие употребления алкоголя. В Украине ежегодно почти 100 тысяч пациентов с алкогольной зависимостью становятся на учет в наркологические диспансеры. Цель исследования: Изучить фармацевтическое обеспечение синдрома зависимости вследствие употребления алкоголя (F 10.2) с определением параметров режима контроля среди участников боевых действий. Материалы и методы. Для достижения поставленной цели были использованы действующие международные и отечественные законодательные, нормативно-правовые и инструктивно-методические документы; научные источники; инструкции по применению лекарственных средств; Internet-ресурсы, которые были обработаны с применением нормативно-правового, документального, судебно-фармацевтического, сравнительного и графического методов анализа. Результаты. Согласованность принципов фармакотерапии синдрома зависимости от алкоголя (F 10.2) на международном и национальном уровнях определялась путем сравнительного анализа клинико-фармакологических групп лекарственных средств в таких нормативно-правовых документах: Drugs used in alcohol dependence EBM Guidelines 8.9.2017 (Latest change 8.9. 2017 Kaarlo Simojoki); приказ МЗ Украины № 681 от 21.09.2009 г. «Об утверждении клинических протоколов оказания медицинской помощи по специальности "Наркология"»; приказ МЗ Украины № 868 от 10.05.2018 г. «Об утверждении десятого выпуска Государственного формуляра лекарственных средств и обеспечения его доступности»; Постановление КМ Украины № 333 от 25.09.2009 г. «Некоторые вопросы государственного регулирования цен на лекарственные средства и изделия медицинского назначения», которым утвержден Национальный перечень основных лекарственных средств. Выводы. Изучено фармацевтическое обеспечение синдрома зависимости вследствие употребления алкоголя (F 10.2) с определением параметров режима контроля среди участников боевых действий. Проанализирована рубрификация кода F10.2 «Синдром зависимости вследствие употребления алкоголя» согласно МКБ-10, которая насчитывает 11 позиций. Систематизированы клинико-фармакологические группы лекарственных средств, которые используются для фармацевтического обеспечения синдрома зависимости вследствие употребления алкоголя среди участников боевых действий. На основании анализа нормативной базы определено, что в клиническом протоколе оказания медицинской помощи по специальности «Наркология» включены все исследуемые клинико-фармакологические группы лекарственных средств для фармакотерапии синдрома зависимости вследствие употребления алкоголя; в Государственном формуляре лекарственных средств отсутствуют сенсибилизирующие лекарственные средства; в Национальном перечне основных лекарственных средств отсутствуют 4 клинико-фармакологические группы: психоаналептики (антидепрессанты); сенсибилизирующие лекарственные средства; периферические вазодилататоры, производные g-аминомасляной кислоты (натрия оксибутират). Установлены параметры режима контроля лекарственных средств для фармакотерапии синдрома зависимости вследствие употребления алкоголя среди участников боевых действий. Указано, что специальный режим контроля имеют по классификационно-правовой группе 3 психотропные лекарственные средства (диазепам, натрия оксибутират и фенобарбитал), которые должны находиться в учреждениях здравоохранения на предметно-количественном учете. В сравнительном аспекте обоснованы особенности лицензирования оборота лекарственных средств в медицинских и аптечных учреждениях. Внедрение в деятельность учреждений здравоохранения данных относительно правового статуса лекарственных средств с учетом параметров их режима контроля обеспечит повышение уровня их правовой, информационной и физической доступности для врачей, провизоров и пациентов, а также надлежащую организацию порядка обращения таких лекарственных средств на этапах назначения, выписки, хранения, учета, контроля качества и отпуска в соответствии с требованиями действующего законодательства Украины. ; Актуальність. За даними вітчизняних вчених, у 75% ветеранів бойових дій відзначаються симптоми, які дозволяють діагностувати психічні і поведінкові розлади внаслідок вживання алкоголю. В Україні щороку майже 100 тисяч пацієнтів з алкогольною залежністю поступають на облік у наркологічні диспансери. Мета дослідження: вивчити фармацевтичне забезпечення синдрому залежності внаслідок вживання алкоголю (F 10.2) з визначенням параметрів режиму контролю серед учасників бойових дій. Матеріали та методи. Для досягнення поставленої мети було використано чинні міжнародні та вітчизняні законодавчі, нормативно-правові та інструктивно-методичні документи; наукові джерела; інструкції для медичного застосування лікарських засобів; Internet-ресурси, які було оброблено із застосуванням нормативно-правового, документального, судово-фармацевтичного, порівняльного та графічного методів аналізу. Результати. Узгодженість принципів фармакотерапії синдрому залежності від алкоголю (F 10.2) на міжнародному і національному рівнях з'ясовувалася шляхом порівняльного аналізу клініко-фармакологічних груп лікарських засобів у таких нормативно-правових документах: Drugs used in alcohol dependence EBM Guidelines 8.9.2017 (Latest change 8.9.2017 Kaarlo Simojoki); наказ МОЗ України № 681 від 21.09.2009 р. «Про затвердження клінічних протоколів надання медичної допомоги зі спеціальності "Наркологія"»; наказ МОЗ України № 868 від 10.05.2018 р. «Про затвердження десятого випуску Державного формуляра лікарських засобів та забезпечення його доступності»; Постанова КМ України № 333 від 25.09.2009 р. «Деякі питання державного регулювання цін на лікарські засоби і вироби медичного призначення», якою затверджено Національний перелік основних лікарських засобів. Висновки. Вивчено фармацевтичне забезпечення синдрому залежності внаслідок вживання алкоголю (F 10.2) з визначенням параметрів режиму контролю серед учасників бойових дій. Проаналізовано рубрифікацію коду F10.2 «Синдром залежності внаслідок вживання алкоголю» за МКХ-10, що налічує 11 позицій. Систематизовано клініко-фармакологічні групи лікарських засобів, що використовуються для фармацевтичного забезпечення синдрому залежності внаслідок вживання алкоголю серед учасників бойових дій. На підставі аналізу нормативної бази визначено, що в клінічному протоколі надання медичної допомоги зі спеціальності «Наркологія» включено всі досліджувані клініко-фармакологічні групи лікарських засобів для фармакотерапії синдрому залежності внаслідок вживання алкоголю; у Державному формулярі лікарських засобів відсутні сенсибілізуючі лікарські засоби; у Національному переліку основних лікарських засобів відсутні 4 клініко-фармакологічні групи: психоаналептики (антидепресанти); сенсибілізуючі лікарські засоби; периферичні вазоділататори; похідні g-аміномасляної кислоти (натрію оксибутирату). Встановлено параметри режиму контролю лікарських засобів для фармакотерапії синдрому залежності внаслідок вживання алкоголю серед учасників бойових дій. Зазначено, що спеціальний режим контролю мають за класифікаційно-правовою групою 3 психотропні лікарські засоби (діазепам, натрію оксибутират і фенобарбітал), які повинні бути в закладах охорони здоров'я на предметно-кількісному обліку. У порівняльному аспекті доведено особливості ліцензування обігу досліджуваних лікарських засобів у медичних та аптечних закладах охорони здоров'я. Висновки. Впровадження в діяльність закладів охорони здоров'я даних щодо правового статусу досліджуваних лікарських засобів з урахуванням параметрів їх режиму контролю забезпечить підвищення рівня їх правової, інформаційної та фізичної доступності для лікарів, провізорів і пацієнтів, а також належну організацію порядку обігу таких лікарських засобів на етапах призначення, виписування, зберігання, обліку, контролю якості та відпуску відповідно до вимог чинного законодавства України. ; Background. According to domestic scientists, 75% of combat veterans diagnosed with symptoms that can diagnose mental and behavioral disorders because of alcohol consumption. Almost 100 thousand patients with alcohol dependence registered at the narcological dispensaries annually in Ukraine. The aim of the study was to study the pharmaceutical provision of addiction syndrome because of alcohol use (F10.2) with the definition of the parameters of the control regime among participants in combat operations. Materials and methods. In order to achieve this goal, existing international and domestic legislative, normative and legal, methodological documents; scientific sources; instructions for medical use of medicines; Internet-resources that processed using normative legal, documentary, forensic, pharmaceutical, comparative and graphical methods of analysis were used. Results. The consistency of the pharmacotherapy principles of alcohol addiction syndrome (F10.2) at the international and national levels was clarified by comparative analysis of the clinical and pharmacological groups of medicines in the following regulatory documents: Drugs used in alcohol dependence EBM Guidelines 8.9.2017 (Latest changes 8.9. 2017 Kaarlo Simojoki); the Order of the Ministry of Healthcare of Ukraine No. 681 dated September 21, 2009 "On Approval of Clinical Protocols for the Provision of Medical Aid in the Specialty "Narcology"; the Order of the Ministry of Healthcare of Ukraine No. 868 dated May 10, 2018 "On approval of the tenth issue of the State Form of Medicines and ensuring their availability"; the Decree of the Cabinet of Ministers of Ukraine No. 333 dated September 25, 2009 "Some issues of state regulation of prices for medicines and medical products", which approved the National List of Basic Medicines. Conclusions. The pharmaceutical provision for addiction syndrome because of alcohol consumption (F10.2) studied with determination of the parameters of the control regime among the participants of the military operations. Analyzed the rubricification of code F10.2 "Addiction syndrome due to alcohol use" for ICD-10 numbering 11 items. Systematized the clinical and pharmacological groups of medicinal products used for the pharmaceutical provision of addiction syndrome due to the use of alcohol among participants of military operations. Based on the analysis of the regulatory framework, determined that in the clinical protocols of the provision of medical care in the specialty "Narcology" all studied clinical and pharmacological groups of medicines for the pharmacotherapy of addiction syndrome due to alcohol use were included; in the State Form of Medicine there are no sensitizing drugs; in the National List of Essential Medicines there are no 4 clinical and pharmacological groups: psychoanalyptics (antidepressants), sensitizing drugs, peripheral vasodilators, derivatives of g-aminobutyric acid (sodium oxybutyrate), parameters of the control regimen of drugs for pharmacotherapy of addiction syndrome due to alcohol use Participants in military operations. Noted that the special regime of control has according to the classification and legal group 3 psychotropic drugs (diazepam, sodium oxibiturate and phenobarbital), which should be located in healthcare institutions on the subject and quantitative accounting. Proved in the comparative aspect, the features of licensing of studied medicinal products in medical and pharmacy establishments of healthcare. Regarding the legal status of the investigational medicinal products, taking into account the parameters of their control regime, they will increase the level of their legal, informational and physical accessibility for doctors, pharmacists and patients, and also proper organization of circulation procedure of such drugs on the stages of the appointment, discharge, storage, accounting, quality control and delivery in accordance with the current legislation of Ukraine.
Background. Increasing the number of mass casualty incident such as traffic accidents or terrorist attacks which causes significant number of victim needs the medical assistance, so several chapters of health response plan to be revived. The term "event with mass casualty incident" (for healthcare institution) in the article presents the situation, because of which there is a mismatch between the simultaneous admission of a large number of victims and the possibility of providing medical assistance without introducing changes in everyday forms and methods of work. Unlike the "emergency situation", the need to involve external resources by the health care institution is absent or minimal. The purpose of the study was the improving management system of medical assistance for the victims after the mass casualty incident. Materials and methods. The work is based on the own experience of the authors on the organization and the direct provision of medical assistance to victims after mass casualty incident in Ukraine and outside, participation in international projects and exercises, in particular under the auspices of the European Civil Protection and Humanitarian Aid Operations. The research uses bibliographic and semantic methods of cognition. The organizational aspects of medical support in 46 cases of mass casualty incident that occurred in the world during 1979–2015 are summarized, of which 33 (71.7 %) — as a result of terrorist attacks using explosive devices, 6 (13 %) — using firearms against an unprotected civilian population, fires in recreation facilities — 3 (6.5 %), strong poisonous substances — 2 (4.3 %) and due to transport accidents — 2 (4.3 %). Results. The organization of medical care for those who suffered because of mass casualty incident should be based on the principles of 4C crisis management in accordance with the level of the introduced regime of functioning. In the health care system of Ukraine, it is advisable to introduce the modes of operation of the system that are used in the European Union countries: 1) readiness for the possible admission of a large number of victims ("Green Level"), 2) partial mobilization of available resources of the health care institution ("Yellow Level"), 3) complete mobilization ("Red Level"). The primary medical triage of victims at the prehospital stage provides for dividing into two groups: "urgent" and "non-urgent". "Non-urgents" to be sent to hospitals that are geographically located near the scene of the incident, but not to the nearest, which should be ready to provide emergency medical care to "urgent" patients and applied independently — "self-reported", the number of which significantly exceed those who are delivered by ambulance team. The management group of health facilities includes responsible on — duty surgeon and anesthesiologist. The forms of information support of health care management system at the prehospital stage include: 1) the forces and facilities at the scene, 2) the triage of the victims at the scene, and 3) the need to strengthen the prehospital stage. At the hospital stage, the possibilities of conducting surgeries and the number of free hospital beds are determined: 1) the operating unit, 2) hospital beds. Conclusions. In the health care system of Ukraine, it is advisable to introduce appropriate levels of functioning in mass casualty incident which applied in the European Union countries. Redistribution of available health care resources when providing medical care to the victims after mass casualty incident at prehospital and hospital stages is critically necessary to save the life and health of people. The medical response requires the adequate information support for the prehospital and hospital stages, and the introduction of sectoral and interagency cooperation. ; Актуальность. Увеличение количества чрезвычайных ситуациях с массовым поражением людей, в том числе вследствие аварий на транспорте или террористических актов, приводит к одновременному поступлению значительного количества пострадавших в учреждения здравоохранения и требует увеличения готовности системы здравоохранения к медицинскому реагированию через постоянный пересмотр и обновление Плана реагирования и взаимодействия при возникновении чрезвычайных ситуаций и ликвидации их последствий. Под понятием «события с массовым поражением людей» (для учреждения здравоохранения) в представленной статье понимают ситуацию, при которой возникает несоответствие между одновременным поступлением значительного количества пострадавших и возможностями оказания им медицинской помощи без внедрения изменений в повседневную форму и методы работы, в отличие от чрезвычайной ситуации, при которой потребность привлечения внешних ресурсов учреждением здравоохранения отсутствует или минимальна. Цель. Оптимизация информационного обеспечения системы управления медицинской помощью пострадавшим при событиях с массовым поражением людей. Материалы и методы. Работа основывается на собственном опыте авторов организации и непосредственного оказании медицинской помощи пострадавшим при событиях с массовым поражением людей и чрезвычайных ситуациях в Украине и за ее пределами, участия в международных проектах и учениях, в частности под эгидой Европейской комиссии гуманитарной помощи и защиты. При проведении исследования применены библиографический и семантический методы познания. Обобщены организационные аспекты медицинского обеспечения 46 случаев массового поражения людей, произошедших в мире на протяжении 1979–2015 гг., из них в результате террористических нападений с использованием взрывных устройств — 33 (71,7 %), огнестрельного оружия против незащищенного гражданского населения — 6 (13 %), пожаров в учреждениях отдыха — 3 (6,5 %), сильнодействующих ядовитых веществ — 2 (4,3 %) и в результате транспортных аварий — 2 (4,3 %). Результаты. Организация медицинской помощи пострадавшим в результате событий с массовым поражением должна основываться на принципах 4С кризисного менеджмента в соответствии с уровнем введенного режима функционирования. В системе здравоохранения Украины целесообразно внедрить режимы функционирования системы, которые используют в странах Европейского союза: 1) готовность к возможному поступлению значительного количества пострадавших («зеленый уровень»); 2) частичная мобилизация имеющихся ресурсов учреждения здравоохранения («желтый уровень»); 3) полная мобилизации («красный уровень»). Первичная медицинская сортировка пострадавших на догоспитальном этапе предусматривает деление на две группы: срочные и несрочные. Пострадавших, которые отнесены к группе несрочных, доставляют в больницы, которые географически расположены недалеко от места происшествия, но не в ближайшую, которая должна быть готова к оказанию экстренной медицинской помощи срочным больным и обратившимся самостоятельно (самообращение), количество которых может существенно превышать тех, кого доставляют бригады экстренной (скорой) медицинской помощи. В группу управления учреждения здравоохранения включают ответственных дежурных — врача-хирурга и врача-анестезиолога. К формам информационного обеспечения системы управления оказания медицинской помощи догоспитального этапа относятся: 1) силы и средства на месте происшествия; 2) распределение пострадавших соответственно на месте происшествия; 3) потребность усиления догоспитального этапа. На госпитальном этапе применяют: 1) операционный блок; 2) больничные койки. Выводы. В систему здравоохранения Украины целесообразно внедрить соответствующие уровни функционирования при событиях с массовым поражением людей, использующиеся в странах Европейского союза. Перераспределение имеющихся ресурсов здравоохранения при оказании медицинской помощи пострадавшим при событиях с массовым поражением людей на догоспитальном и госпитальном этапах критически необходимо для сохранения жизни и здоровья пострадавших. Управление оказанием медицинской помощи при массовом поражении людей требует соответствующего информационного обеспечения догоспитального и госпитального этапов, внедрения отраслевого и межведомственного взаимодействия. ; Актуальність. Збільшення кількості надзвичайних ситуацій із масовим ураженням людей, зокрема через аварії на транспорті або терористичні напади, призводить до одночасного надходження значної кількості постраждалих осіб до закладів охорони здоров'я та потребує збільшення готовності системи охорони здоров'я до медичного реагування через постійний перегляд і опрацювання Плану реагування та взаємодії під час виникнення надзвичайних ситуацій і ліквідації їх наслідків. Під поняттям «події з масовим ураженням людей» (для закладу охорони здоров'я) у поданій статті розуміють ситуацію, через яку виникає невідповідність між одночасним надходженням значної кількості постраждалих і можливостями надання їм медичної допомоги без впровадження змін у повсякденні форми та методи роботи, на відміну від надзвичайної ситуації потреба залучення зовнішніх ресурсів закладом охорони здоров'я відсутня або мінімальна. Мета. Оптимізація інформаційного забезпечення системи управління медичною допомогою постраждалим при подіях із масовим ураженням людей. Матеріали та методи. Робота ґрунтується на власному досвіді організації та безпосередньому наданні медичної допомоги постраждалим при подіях із масовим ураженням людей і надзвичайних ситуаціях в Україні та за її межами, участі у міжнародних проектах і навчаннях, зокрема під егідою Європейської комісії гуманітарної допомоги та цивільного захисту. Під час проведення дослідження застосовано бібліографічний і семантичний методи пізнання. Узагальнено організаційні аспекти медичного забезпечення 46 випадків масового ураження людей, які відбулись у світі впродовж 1979–2015 рр., із них унаслідок терористичних нападів з використанням вибухових пристроїв — 33 (71,7 %), вогнепальної зброї проти незахищеного цивільного населення — 6 (13 %), пожежі в закладах відпочинку — 3 (6,5 %), сильнодіючих отруйних речовин — 2 (4,3 %) і внаслідок транспортних аварій — 2 (4,3 %). Результати. Організація медичної допомоги постраждалим внаслідок подій із масовим ураженням має ґрунтуватись на принципах 4С кризового менеджменту відповідно до введеного режиму функціонування органів і закладів охорони здоров'я. В системі охорони здоров'я України доцільно впровадити режими, що існують в країнах Європейського Союзу: 1) готовність до можливого надходження значної кількості постраждалих («зелений рівень»); 2) часткова мобілізація («жовтий рівень»); 3) повна мобілізації («червоний рівень»). Первинне медичне сортування постраждалих на догоспітальному етапі передбачає розподіл на дві основні групи: термінові та нетермінові. Нетермінових постраждалих слід доставити до лікарень, які географічно розташовано недалеко від місця події, але не до найближчого закладу, який має бути готовим до надання екстреної медичної допомоги терміновим хворим і тим, хто звернувся самостійно (самозвернення), кількість яких може суттєво перевищувати тих, кого доставлено бригадами екстреної (швидкої) медичної допомоги. До групи управління закладу охорони здоров'я включають відповідальних чергових — лікаря-хірурга та лікаря-анестезіолога. До форм інформаційного забезпечення системи управління надання медичної допомоги на догоспітальному етапу належать: 1) сили та засоби на місці події; 2) розподіл постраждалих на місці події; 3) потреба підсилення догоспітального етапу. На госпітальному етапі визначають можливості проведення хірургічних операцій та кількість вільних лікарняних ліжок: 1) операційний блок; 2) лікарняні ліжка. Висновки. В систему охорони здоров'я України при подіях із масовим ураженням людей доцільно впровадити відповідні рівні функціонування, що використовують в країнах Європейського Союзу. Перерозподіл наявних ресурсів охорони здоров'я при наданні медичної допомоги постраждалим при подіях із масовим ураженням людей на догоспітальному та госпітальному етапах критично важливе для збереження життя та здоров'я постраждалих. Управління надання медичної допомоги при масовому ураженні людей потребує відповідного інформаційного забезпечення догоспітального та госпітального етапів, впровадження галузевої та міжвідомчої взаємодії.
El objetivo de esta investigación es fijar el campo semántico del concepto de representación en el momento de su origen (siglos XVII y XVIII). Pretendemos identificar las diversas esferas de la experiencia sobre las que se ha fundamentado esta construcción conceptual y, al mismo tiempo, describir las mutaciones que ha sufrido, hasta su crisis. Estas esferas son: artística, epistemológica y jurídico-política. Nuestra hipótesis supone que la nueva concepción del poder político contractualista depende de la metáfora de la representación teatral. Trataremos de mostrar cómo la vieja metáfora del Theatrum Mundi, liberada del sistema teológico, se va a transformar en el Barroco en una forma de sociedad espectacular. El ciudadano se convierte en espectador tanto en el teatro como en la sociedad y en la política. Nuevas relaciones de poder y nuevos sujetos (la burguesía y las masas urbanas), pero también nuevos espacios ciudadanos: reales y abiertos (plazas y jardines), y espacios virtuales y cerrados (teatros). Ese complejo estético-político tiene en la ópera cómica, desarrollada durante el clasicismo, el signo distintivo de la Ilustración y de la burguesía. Los textos han sido tratados por una metodología hermenéutica haciendo una nueva lectura de todos aquellos documentos originales que presentaban una perspectiva de esa metáfora escénica. La problemática actual de la representación política se ha tratado desde el método genealógico usando tres perspectivas que constituyen sendas figuras conceptuales. La primera es la que presenta las tres disciplinas por las que conocemos la representación en Occidente: la teoría política, la epistemología y la estética. La segunda hace referencia a los personajes representativos: el político, el científico y el artista. Finalmente, la representación cultivada por estos tres personajes constituye el espectáculo que se ofrece al público. El espectador "actúa" en la representación como el representado. El espectador (público-masa), constituye la tercera figura conceptual o perspectiva. El resultado de este tratamiento nos permite ver cómo, gracias a esa forma de diferenciación social basada en la distinción o gusto estético, frente a la ópera y otras manifestaciones artísticas, se configuraba un sistema espectacular absolutamente vertical. Las altas culturas se presentaban a aquellos individuos distinguidos, convertidos en personajes representativos (alta burguesía). La moderna sociedad de clases reinventa la desigualdad a través de la cultura. En las reflexiones sobre el arte dramático hemos descubierto las claves para la comprensión del moderno hombre público en tanto que personaje representativo. El espacio público se ha transformado en un escenario (El gran teatro del mundo) y se presenta bajo la forma de la representación. La sociedad y la ciudad se han convertido en una escenografía para el espectáculo; el ciudadano es el público y para él se procede a organizar la compleja representación. Se diseña la figura profesional del representante de los asuntos públicos: el político representativo, casi de la misma manera que hay un protagonista de la representación en el teatro: el actor. Dentro de las conclusiones constatamos que la representación no ha entrado en crisis, como viene anunciado en arte y política, más bien al contrario, se ha reforzado, y la moderna red global está organizada por los sistemas mediáticos que gestionan la opinión pública y estimulan el consumo espectacular de las masas. Hemos identificado, en diálogo con Foucault, que la crisis no ha afectado al sistema completo de la representación sino a uno de sus componentes, ese que caracterizó al racionalismo clásico: al modelo cartesiano del orden metódico. En consecuencia, podemos constatar la pervivencia del clasicismo actualmente. Las músicas populares, las dramaturgias cinematográficas, etc. van a promover un nuevo género que regresa a las fuentes populares, aunque se aleja de los patrones musicales del clasicismo ya convertido en música culta, música clásica. El mundo de la comedia clásica está en nuestra sensibilidad, las estructuras espectaculares creadas en aquella época siguen funcionando. Este mundo de la comedia ilustrada ha llegado a convertirse en la dramaturgia de la cultura de masas que la Dialéctica de la Ilustración llamó "industria cultural". Este trabajo ha pretendido realizar la genealogía de los contenidos de esa cultura que impregna todos los productos culturales que se producen en la segunda mitad del siglo XX, especialmente después de que la ilusión de la crisis de la representación haya acabado con la Vanguardia. Y a través de ese análisis hemos definido un modelo crítico de la actitud ciudadana. Respecto a esa construcción cultural se construyen dos figuras del espectador: la ofrecida por Rousseau y otra de Diderot. Nuestra perspectiva es más diderotiana que roussoniana: el espectador debe dejar de serlo, pero en el teatro mismo, no contra el teatro. Nuestras formas culturales y espectaculares forman parte de nuestra identidad y, por ello, debemos exigir no solo su mantenimiento sino la calidad de su custodia, su renovación y su desarrollo. The objective of this research is to set the semantic field of the concept of representation at the time of its origin (17th and 18th centuries). We aim to identify the various areas of the experience on which this conceptual structure is based upon and, at the same time, describe the mutations it has suffered up to its crisis, in its triple aspect: artistic, epistemological and juridical. We will try to show how the old metaphor of the Theatrum Mundi, freed from the theological system, became a form of spectacular society, during the Baroque period Our hypothesis is that the new concept of contractual political power, depends on the metaphor of the theatrical performance, which is the indisputable paradigm of this cultural model. The citizen becomes a spectator both at the theatre as in society and politics. New relations of power and new individuals (the bourgeoisie and the urban masses), but also new urban and civic spaces: real and open (squares and gardens), or virtual and closed (theatres). These aesthetic-political complex performances will reveal through the musical show invented in the 16th century: the opera. During the 18 th. century, the comic opera became a hallmark of the Enlightenment and the bourgeoisie. The texts have been submitted by a hermeneutics methodology by doing a transversal reading about all those original documents presenting a perspective of this scenic metaphor. The current issue of political representation has been treated since the genealogical method using three perspectives. The first one by presents the three disciplines which we know the representation in the West: political theory, epistemology and aesthetics. The second perspective, that illuminates a capital element within this system, makes reference to the representative characters: the politician, the scientist and the artist. Finally, the representation cultivated by these three characters is the performance that is offered to the public, which "acts" in the representation as the represented: the spectator (the crowd-audience), which is the third conceptual figure or perspective. The result of this process lets us see how, thanks to that form of social differentiation based on the distinction or aesthetic taste, opposite the opera and other artistic manifestations, a spectacular system absolutely vertical was configured. High cultures addressed those distinguished individuals converted into emblematic (representative) characters (gentry). We have discovered the keys to the understand the modern public man as a symbol, through our reflections about drama. The public space has been transformed into a stage (the great theatre of the world) and is presented in the form of representation. The society, the city, has become a stage for the show; the citizen is the public and for it proceeds to organize complex representation. The professional figure of the public affairs representative is designed: the political representative, almost in the same way that there is a protagonist of the representation in the Theatre: the actor. One of the most important conclusions is that performance has not entered into crisis, but strengthened enormously while the modern global network is organized by the media that manage public opinion and stimulate mass consumption. Therefore, the crisis has not affected the whole system of performance, but us one of its components, the one which characterized classical rationalism, the Cartesian model of the methodical order. As a result, we can recognize the survival of classicism: popular music, the cinema dramaturgy, etc. generate a new genre that returns to the popular sources, although it moves away from the musical patterns of classicism as converted into art music, classical music. The world of classical comedy is in our sensitivity, the spectacular structures created at that time are still operating. This world of the illustrated comedy has become the drama of mass culture that Dialectics of Enlightenment called cultural industry. This work has tried to carry out the genealogy of the contents of that culture that permeates all cultural products that are produced in the second half of the 20th century, especially since the illusion of the crisis of performance finished with the avant-garde. Through this analysis, we have defined a critical model of citizen attitude. Two figures of the viewer are built on that cultural construction: the one offered by Rousseau and another by Diderot. Our perspective is more Diderot-like than Roussonian: the spectator must cease to be, but within the theatre itself, not against the theatre. Our cultural and spectacular forms are part of our identity, thus we must demand not only its maintenance but also the quality of its custody, renewal and development.
228 p. Cd ; El referente teórico que soporte este proyecto de investigación es poder identificar el alcance de una evaluación de impacto determinando en que forma el proyecto, mejora las condiciones sociales de las comunidades beneficiadas, si responde a los objetivos propuestos en términos de eficacia, eficiencia y efectividad y poder tomar las decisiones de ajustarlo, mejorarlo o por el contrario terminarlo de acuerdo a los resultados que este genera. Es la academia un facilitador y articulador de procesos de análisis que da al Magister de Gestión Pública y Gobierno las Herramientas necesarias para poder hacer una análisis real del impacto de los programas asistencialista, como es el caso de Familias en Acción cuyo objeto es desde el año 2001, mejorar las condiciones de salud y educación de las familias vulnerables del estrato uno, siendo este programa, el objeto central del Proyecto de Invest igació n. Entre los referentes teóricos que sustenta el proyecto, se encuentra la escritora Irma Arriagada, asesora de la CEPAL y Blanca Esther Bonilla,las cuales en diversos artículos y libros abordan el tema de Familias, Políticas Públicas y Evaluaciones de Impacto, asimismo el Banco Mundial y Comité de Ayuda al Desarrollo (OCDE) define la evaluación de impacto como la medición de los cambios en el bienestar de los individuos que pueden ser atribuidos a un programa o a una política específica su realización y sus resultados; se consulto al Profesor Paulo Freire y Margaret Shuler que desde tiempos atrás plantearon los conceptos de empoderamiento, otro referente fue los estudios realizados por el DPN en los años 2006-2008, los cuales en resumen dan un aval positivo al programa familias en acción. Con la sustentación de una metodológica de una Investigación Cuantitativa tipo Descriptiva Transversal mediante la aplicación de instrumentos estructurados como la encuesta y lista de chequeo para la auditoria a Historias clínicas; se identifico y midió independientemente cada una de las variables, se logro determinar el nivel de empoderamiento que se da en forma natural frente al programa Familias en Acción, evidenciado entre otros aspectos, por el Estado Nutricional del niño beneficiario en comparación con niños no beneficiarios, analizando factores externos. Como alcance del proyecto se logra describir como las Políticas Públicas Sociales Asistencialista generan aspectos positivos o negativos en el pensamiento y comportamiento de las comunidades vulnerables a lo largo del tiempo, se dio cumplimiento a los objetivos porque se pudo medir y concluir que el nivel de empoderamiento de las mujeres referenciadas es un nivel bajo independiente si son o no beneficiarias asimismo se identifico que los niños no beneficiarios presentan una tendencia a tener un estado nutricional mejor frente a los niños beneficiarios, se encontró una relación directa entre el empoderamiento de la mujer frente al cuidado de su hijos más nos frente a los problemas de la comunidad o que el programa le haya generado tener pensamientos y deseos de superación y/o auto sostenibilidad. El aporte social de la Investigación se da en la medida en que las conclusiones y recomendaciones planteadas sean un sustento teórico para mejorar las estrategias de abordaje del problema de pobreza, se plantea, dando cumplimento al cuarto objetivo de la investigación, un Plan de Mejora, en la planeación del programa Familias en Acción desde las Fases de Estructura, Proceso y Resultados, que involucran una articulación y compromiso de las instituciones del Estado, partiendo de la base del logro de los objetivos de la investigación. ; The theoretical reference that supports this research project is to identify the extent of an impact assessment in determining how the project improves the social conditions of the communities served, if it meets the objectives in terms of effectiveness, efficiency and effectiveness and able to make decisions to adjust, improve or otherwise terminate according to the results it generates. Academy is a facilitator and coordinator of analysis processes giving the Master of Public Management and Government the tools needed to make an effective impact analysis of welfare programs , such as Families in Action which aims since 2001 , improving the health and education of vulnerable families in stratum one, being this program , the focus of the research project . Among the theoretical framework behind the project , is the writer Irma Arriagada, CEPAL adviser and Blanca Esther Bonilla , which in several articles and books address the issue of Families, and Public Policy Impact Assessments also the World Bank and Development Assistance Committee (OECD ) defines impact assessment as measuring changes in the welfare of individuals that can be attributed to a specific policy program or its implementation and results; were consulted Professor Paulo Freire and Margaret Shuler since time ago raised the concepts of empowerment , another reference was studies by the DPN in the years 2006-2008 , which in summary are given a positive endorsement families in Action program . With a methodological support a Descriptive Quantitative Research Transverse type by applying structured instruments such as the survey and checklist for audit of Medical Records , was identified and measured independently of each of the variables , is able to determine the level of empowerment that occurs naturally in front of the Families in Action program , as evidenced among other things, by the State child Nutrition beneficiary children compared to non-beneficiaries , analyzing external factors. As project scope is achieved described as Public Policy Social welfare generate positive or negative aspects of thought and behavior of vulnerable communities over time , he met the objectives that could be measured and concluded that the level of empowerment of women is a low level referenced independently whether or not they are also beneficiaries identify beneficiaries that children have a tendency to have a better nutritional status compared to children beneficiaries , we found a direct relationship between the empowerment of women against care of their children more we face the problems of the community or that the program has generated have thoughts and desires for improvement and / or self- sustainability . The social contribution of the research is given to the extent that the conclusions and recommendations made be a basis for improving strategies theoretical approach to the problem of poverty , arises , giving compliance to the fourth objective of the research, an Improvement Plan , in planning the Families in Action program from Phases Structure , Process and Outcomes , involving a joint and commitment of state institutions , on the basis of the achievement of the objectives of the research . ; INTRODUCCIÓN 21 1. PLANTEAMIENTO DEL PROBLEMA 23 1.1 TITULO DE LA PROPUESTA INVESTIGATIVA 23 1.1.1 Subtitulo 23 1.2 PROBLEMA DE INVESTIGACIÓN 23 1.2.1 Descripción del problema 23 1.3 HIPÓTESIS 34 1.4 JUSTIFICACIÓN 35 1.5 OBJETIVOS 38 1.5.1 Objetivo general 38 1.5.2 Objetivos específicos 38 2. MARCOS DE REFERENCIA 40 2.1 ANTECEDENTES 40 2.1.1 Antecedentes internacionales 40 2.1.2 Antecedentes departamentales 43 2.2 MARCO CONCEPTUAL 45 2.3 MARCO TEÓRICO 51 2.3.1 Conceptos teóricos sobre impacto 51 2.4 MARCO CONTEXTUAL 56 2.4.2 Contexto geográfico 60 2.5 MARCO LEGAL 61 2.5.1 Constitución política del 1991 61 2.5.2 Objetivos del milenio 2005 61 2.5.3 Decreto 1011 del 2006 62 2.5.4 Decreto 3039 del 2007 62 2.5.5 Ley 1283 del 2009 64 2.5.6 Decreto 2055 del 2009 64 2.5.7 Ley 1098 del 2010, de infancia y adolescencia 65 2.5.8 Ley 1438 del 2011 66 2.5.9. El plan Nacional de Salud pública 2011-2021 66 3. METODOLOGÍA Y PLAN DE TRABAJO 68 3.1 TIPO DE ESTUDIO 68 3.2 POBLACIÓN Y MUESTRA 69 3.2.1 Población 69 3.2.2 Muestra 69 3.3 ELABORACIÓN DE INSTRUMENTOS DE MEDICIÓN 70 3.3.1 Viabilidad del instrumento de medición 74 3.4 PLAN DE ANÁLISIS DE RESULTADOS 74 3.4.1 Variables 74 3.5 CRONOGRAMA DE ACTIVIDADES 75 3.6 ALCANCE 76 3.7 IMPACTO ESPERADO 76 3.8 RESULTADOS Y PRODUCTOS 77 3.8.1 A nivel formativo 77 3.8.2 A nivel de la sociedad 77 3.8.3 Indicadores de medición 78 3.9.1 Fuente de financiamiento 79 4. RESULTADOS DE LA INVESTIGACIÓN 80 4.1 INTRODUCCIÓN 80 4.2 OBJETIVOS 80 4.2.1 Objetivo general 80 4.2.1.1 Primer objetivo específicos 80 4.2.1.2 Segundo objetivo específico 84 4.2.1.3 Tercer objetivo específico 93 4.2.1.4 Cuarto objetivo específico 98 5. PRESENTACIÓN CUANTITATIVA DE RESULTADOS 121 5.1 Parte A. Preguntas de observación 121 5.1.1 Caracterización comparativa de las mujeres beneficiarias y no beneficiarias al programa familias en acción 121 5.2 PREGUNTAS DE SELECCIÓN 131 5.3 PARTE B. PREGUNTAS DE OPINIÓN 138 5.3.1 Comparativo del nivel de empoderamiento de las mujeres beneficiarias o no beneficiarias 138 5.4 Gráficos de tabulación de historias clínicas auditadas del crecimiento y desarrollo de los niños beneficiarios y no beneficiarios del programa familias en acción 149 5.4.1 Evaluación del estado de crecimiento y desarrollo de los niños menores de 7 años beneficiarios y no beneficiario. 150 5.4.2 Otros factores intervinientes en el crecimiento y desarrollo de los niños menores de 7 años beneficiarios y no beneficiarios 151 6. CONCLUSIONES 165 7. RECOMENDACIONES 171 BIBLIOGRAFÍA 173 ANEXOS 180 ; Ej. 1 ; Maestría ; Magister en Gestión en Servicios de Salud
Este artículo constituye uno de los núcleos teóricos y metodológicos de mi tesis doctoral Testigos de sí mismos: narrativas políticas de jóvenes bogotanos. En él se proporcionan los argumentos teóricos y epistemológicos para transitar de una escritura teórica a una escritura literaria como estrategia para acceder a los pliegues más ocultos de la subjetividad tanto del investigador como de los informantes y, sobre todo, para desvanecer las fronteras de dos tipos de escritura (o, si se quiere, de dos géneros discursivos): el científico y el literario. El texto está dividido en cinco partes. En la primera se discute la relación entre metáfora y concepto; en la segunda, el lugar que ocupan la autobiografía y el testimonio en esta discusión; en la tercera, se debate el agotamiento de las categorías sociales y el papel que eventualmente juega aquí la escritura literaria; en la cuarta se describen y establecen las limitaciones del papel de la antropología poética chilena como precursora de este planteamiento; y finalmente, se discuten las implicaciones metodológicas de la propuesta. Transferencia a la prácticaEste artículo propone la escritura literaria como herramienta y metodología de investigación social, esto es, justificar y argumentar el paso de una escritura teórica y académica a una escritura literaria en una investigación social de alta densidad epistemológica y etodológica. Para lograr este objetivo, se asume que la escritura literaria pone al investigador en el mismo plano de sus informantes al retomar sus propias narrativas –a horcajadas entre la teoría, la experiencia y la imaginación– como insumos para la construcción del relato, exactamente de la misma forma como lo hace con las narrativas de sus sujetos. Planteado de esta manera, no solo se justifica proponer las conclusiones de una investigación social (e incluso, todo el informe) en forma de un macrorrelato (BolívarBotía, Domingo-Segovia & Fernández-Cruz, 2001) construido a partir de las narrativas expresadas por los informantes y las propias narrativas del investigador, sino que se desvanecen las fronteras subjetivas y discursivas del autor, el investigador y el narrador en el texto y, por tanto, actuando y hablando como personajes, quedaremos en el mismo orden para la lectura del interpretante. De esta forma, la investigación social, transpuesta literariamente, queda presentada a partir de personajes en busca de lector, con posibilidad de múltiples interpretaciones y, sobre todo, de cuantos usos se le quieran hacer. ; This paper contains one of the theoretical and methodological cores of the author's dissertation: Witnesses of themselves: political narratives of young people in Bogotá, providing theoretical and epistemological arguments for the transition of theoretical writing to literary writing as a strategy to explore the hidden aspects of subjectivity of both scholars and informers, and to erase the borders between two types of writing (or discourse genres): scientific and literary. The text is organized in five parts. First, the relation between metaphor and concept is discussed; second, the place of the autobiography and the testimonial in this discussion; third, the exhaustion of social categories and the possible role of literary writing; fourth, the limitations of the Chilean Poetical Anthropology as a pioneer tendency; and finally, the methodological implications of the proposal.Transference to practiceAs for possible applications, the paper puts forward literary writing as a tool and method for social investigation, as it justifies and provides arguments for the transition of theoretical and scholarly writing to literary writing for social research with high epistemological and methodological densities. Literary writing is assumed to put researchers and their informers on the same level, as they explore their own narratives, galloping between theory, experience and imagination, as instruments for the construction of stories in exactly the same way their subjects construct their stories. This approach justifies the presentation of conclusions of social research –or even the whole report– as a macro-narration (Bolívar-Botía, Domingo-Segovia & FernándezCruz, 2001) built from stories provided by informers and researchers. The borders of subjectivity and discourse of authors, researchers and narrators disappear. Therefore, scholars will be at the same level for those who read and interpret. Social research written in a literary manner will be interpreted through a series of characters looking for a reader, opening the possibility for multiple interpretations and, above all, multiple uses. ; Cet article constitue un de focus théoriques et méthodologiques de la thèse doctorale de l'auteur: Témoins d'eux-mêmes: narratives politiques de jeunes de Bogota. L'article nous donne les arguments théoriques et épistémologiques pour transiter d'une écriture théorique à une écriture littéraire en tant qu'une stratégie pour accéder aux plis les plus cachés de la subjectivité tantôt du chercheur que de ses témoins et, surtout, pour effacer les frontières de deux types d'écriture (ou, si l'on veut, de deux genres discursives): le scientifique et le littéraire. Le texte a été divisé en cinq parties. Dans la première partie, on discute le rapport entre la métaphore et le concept; dans la deuxième le lieu qui occupent l'autobiographie et le témoignage dans ce débat; dans la troisième, on débat sur l'achèvement des catégories sociales et le rôle qui y joue l'écriture littéraire; dans la quatrième on décrit et on établit les limitations du rôle de l'Anthropologie Poétique au Chili en tant que pays précurseur de ce type de rapport; et finalement, on discute les implications méthodologiques du rapport.Transfert à la pratiqueDepuis le point de vue appliqué, cet article propose l'écriture littéraire en tant qu'outil et méthodologie de recherche sociale, ceci veut dire qu'il justifie et argument le passage de l'écriture théorique et académique à une écriture littéraire dans une recherche sociale de haut densité épistémologique et méthodologique. Pour parvenir à cet objectif, on assume que l'écriture littéraire situe au chercheur dans le même niveau que ses témoins lorsqu'il prend ses propres narratives –à califourchon entre la théorie, l'expérience et l'imagination– comme matières pour la construction du récit, exactement de la même manière, comment il le fait avec les narratives de ses sujets. Présentée de cette façon, non seulement on justifie proposer les conclusions d'une recherche sociale (et même, tout le rapport) à la manière d'un macro-récit (Bolívar-Botía, Domingo-Segovia & Fernández-Cruz, 2001) construit à partir de narratives exprimées par les témoins et les propres narratives du chercheur, ainsi les frontières subjectives et discursives de l'auteur s'effacent, le chercheur et le narrateur dans le texte; et, pout tant ils agissent et parlent en tant que personnages, on reste dans le même ordre en ce qui concerne la lecture de l'interprète. De cette façon, la recherche sociale, dans sa transposition littéraire se présente à partir de personnages en quête d'un lecteur, avec la possibilité de variées interprétations, et, surtout, de combiens d'usages voudrait-on le donner. ; Este artigo constitui um dos núcleos teóricos e metodológicos da tese doutoral do autor: Testemunhas de si mesmos: Narrativas políticas de jovens bogotanos. Nele são propostos os argumentos teóricos e epistemológicos para transitar de uma escrita teórica a uma escrita literária como estratégia para se chegar aos espaços mais ocultos da subjetividade tanto do pesquisador como dos informantes e, sobretudo, para dissipar as fronteiras de dois tipos de escrita (ou, se se quer, de dois gêneros discursivos): a científica e a literária. O texto está dividido em cinco partes. Na primeira se discute a relação entre metáfora e conceito; na segunda, o lugar que ocupam nesta discussão a autobiografia e o depoimento; na terceira, debate-se o esgotamento das categorias sociais e o papel que eventualmente tem aqui a escritura literária; na quarta se descrevem e se estabelecem as limitações do papel da Antropologia Poética Chilena como precursora desta proposta; e finalmente, discutem-se as implicações metodológicas da proposta.Transferência à práticaDo ponto de vista da aplicação, este artigo propõe a escrita literária como ferramenta e metodologia de pesquisa social, isto é, justifica e argumenta a passagem de uma escrita teórica e acadêmica a uma escrita literária numa pesquisa social de alta densidade epistemológica e metodológica. Para conseguir este objetivo, assume-se que a escrita literária coloca o(a) pesquisador(a) no mesmo plano de seus informantes ao retomar suas próprias narrativas –pressionadas entre a teoria, a experiência e a imaginação– como insumos para a construção do relato, exatamente da mesma forma como o faz com as narrativas de seus sujeitos. Colocado desta maneira, não só se justifica propor as conclusões de uma pesquisa social (e inclusive, todo o relatório) em forma de um macrorelato (Bolívar-Botía, Domingo-Segovia & Fernández-Cruz, 2001) construído a partir das narrativas expressas pelos informantes e das próprias narrativas do pesquisador(a), mas também se desvanecem as fronteiras subjetivas e discursivas do autor, do pesquisador e do narrador no texto e, portanto, atuando e falando como personagens, ficam dispostos da mesma maneira para a leitura do interpretante. Desta forma, a pesquisa social, transposta literariamente, se apresenta a partir de personagens que procuram leitor, com possibilidade de múltiplas interpretações e, sobretudo, de quantos usos lhe queiram fazer.
Con este trabajo se implementó las herramientas de Rondas de Seguridad y Sesiones breves de Seguridad en el Servicio de Medicina Interna del Hospital Universitario de Santander HUS para mejorar la cultura de seguridad del paciente. La metodología utilizada fue descriptiva de corte transversal donde se tomó como población, 23 profesionales y 23 pacientes que se encontraban en el momento de realizar la ronda de seguridad en el servicio. Dentro de los resultados se encontró que: El personal sanitario del servicio de medicina interna no sigue a cabalidad el protocolo establecido por la institución (HUS) sobre el manejo de medicamentos, en cuanto a su almacenamiento y rotulación; ya que se encontraron algunos sin rotulo y en lugares inadecuados. Cabe destacar que los medicamentos se encontraban clasificados según la identidad del paciente. Se identificó que el hospital universitario en donde se llevó a cabo la investigación le falta reforzar y consolidar una cultura de seguridad del paciente al interior del servicio de medicina interna, ya que el 61% de los encuestados dice no saber los eventos adversos que se han presentado ese año en el servicio. Existen varios aspectos por mejorar en el servicio que requieren ser trabajados por la institución en el corto tiempo para mejorar la seguridad del paciente; con un 39% se afirma que es necesario mejorar la seguridad en las habitaciones, y en menor proporción incrementar el personal sanitario de planta, mejorar la disponibilidad de insumos y contar con un stock permanente de medicamentos. 12 Es necesario reforzar el concepto, procedimiento y/o protocolo para el reporte de eventos adversos y la compresión de su obligatoriedad en el hospital, ya que solamente el 43% lo reporta en el formato institucional, los demás lo hacen de forma verbal y algunos no lo reportan y el 4% de los encuestados dice no saber que un evento adverso. Conclusiones: Se evidenció la necesidad de sensibilizar y capacitar al personal sobre los lineamientos institucionales de la política de seguridad del paciente implementada en el HUS y la importancia de la adherencia del servicio de medicina interna al mismo. El Hospital Universitario de Santander con la implementación de las dos herramientas de rondas de seguridad y sesiones breves de seguridad en el servicio de medicina interna, logrará promover la cultura justa, en donde se reconozca que los errores siempre van a existir porque hacen parte de los riesgos cuando se presta atención en salud y que el sistema de reporte de eventos adversos es un mecanismo que ayuda a los profesionales de la salud a minimizarlos. En el estudio realizado en el Servicio de Medicina Interna del Hospital Universitario de Santander se puede concluir que las situaciones inseguras que más implican riesgo para los pacientes son las infecciones nosocomiales, la atención no oportuna del paciente, demora en los trámites administrativos y en la autorización de procedimientos por parte de la EPS. En el Servicio de Medicina Interna del Hospital Universitario de Santander el compromiso sobre la seguridad de los pacientes deberá empezar desde la gerencia, que trazarán estrategias para sensibilizar a los trabajadores, que comprendan la importancia de medir y evaluar los procesos, porque esa cultura del reporte, medición y evaluación permitirá el mejoramiento continuo de las organizaciones y será el comienzo de un cambio en la cultura de las mismas. El estudio realizado fue una experiencia muy enriquecedora para nosotras a nivel profesional como personal porque en esta práctica pudimos vivenciar el papel del auditor en servicios de salud a través de la respuesta asertiva de los profesionales en todo el proceso de la implementación de la herramienta ; Centro de Estudios de la Salud (CES) ; RESUMEN 11 ABSTRACT 14 1 FORMULACIÓN DEL PROBLEMA 16 1.1 PLANTEAMIENTO DEL PROBLEMA 16 1.2 JUSTIFICACIÓN DE LA PROPUESTA 18 1.3 PREGUNTA(S) DE INVESTIGACIÓN 21 2 MARCO TEÓRICO 22 2.1 MARCO LEGAL 22 2.1.1 Ley 100 de 1993 22 2.1.2. Resolución 1474 de 2002 23 2.1.3 Decreto 2309 de 2002 23 2.1.4 Decreto 1011 de 2006 24 2.1.5 Resolución 1043 de 2006 25 2.1.6 Resolución 1445 de 2006 25 2.1.7 Resolución 1446 de 2006 26 2.2 ANTECEDENTES Y CONCEPTOS FUNDAMENTALES 27 2.3 SEGURIDAD DEL PACIENTE 31 2.3.1 Lineamientos para la implementación de la política de seguridad 32 2.3.1.1 Los Principios orientadores de la Política 33 2.3.1.2 Objetivos de la política de seguridad del paciente. 34 2.3.1.3 Modelo conceptual de la politica de seguridad del paciente 35 2.3.2 Los elementos conceptuales de la estrategia institucional de seguridad 35 2.4 CULTURA JUSTA 39 2.4.1 Rondas de Seguridad 42 2.4.1.1 Propósito 43 2.4.1.2 ¿Quién debe liderarlas? 43 2.4.1.5 Introducción 44 2.4.1.6 Preguntas 44 2.4.1.7 Cierre 45 2.5.2 Sesiones Breves de Seguridad 45 3 OBJETIVOS 47 3.1 OBJETIVO GENERAL 47 3.2 OBJETIVOS ESPECÍFICOS 47 4 METODOLOGÍA 48 4.1 ENFOQUE METODOLÓGICO DE LA INVESTIGACIÓN 48 4.2 TIPO DE ESTUDIO 48 4.3 POBLACIÓN 48 4.4 DISEÑO MUESTRAL 48 4.5 DESCRIPCIÓN DE LAS VARIABLES 49 4.5.1 Diagrama de variables 49 4.5.2 Tabla de variables 50 4.6 TÉCNICAS DE RECOLECCIÓN DE INFORMACIÓN 54 4.6.1 Fuentes de información 54 4.6.2 Instrumento de recolección de información 54 4.6.3 Proceso de obtención de la Información (qué, quién, cómo, cuándo) 55 4.6.3. Instructivo Rondas de Seguridad. 56 4.6.3.2 Sesiones breves de seguridad. 59 4.7 PRUEBA PILOTO 59 4.8 CONTROL DE ERRORES Y SESGOS 60 4.9 TÉCNICAS DE PROCESAMIENTO Y ANÁLISIS DE LOS DATOS 60 5 CONSIDERACIONES ÉTICAS 61 6 RESULTADOS 62 6.1 RESULTADOS DE LA LISTA DE CHEQUEO 62 6.2 RESULTADOS DE LA ENCUESTA AL PERSONAL SANITARIO 64 6.3 RESULTADOS DE LA ENCUESTA AL PACIENTE 86 6.4 RESULTADOS DE LAS SESIONES BREVES DE SEGURIDAD 88 6.5 FOTOGRAFÍAS 91 7 DISCUSIÓN 95 7.1 LISTA DE CHEQUEO 95 7.2 ENCUESTA DEL PACIENTE 96 7.3 ENCUESTA AL PERSONAL SANITARIO 96 7.4 SESIONES BREVES DE SEGURIDAD 97 8 CONCLUSIONES 99 REFERENCIAS BIBLIOGRÁFICAS 100 ANEXOS 103 ; Especialización ; With this work, the tools for Safety Rounds and Short Safety Sessions were implemented in the Internal Medicine Service of the Santander University Hospital HUS to improve the culture of patient safety. The methodology used was descriptive, cross-sectional, where 23 professionals and 23 patients who were at the time of the security round in the service were taken as the population. Among the results it was found that: The health personnel of the internal medicine service do not fully follow the protocol established by the institution (HUS) on the handling of medications, in terms of their storage and labeling; since some were found without a label and in inappropriate places. It should be noted that the drugs were classified according to the identity of the patient. It was identified that the university hospital where the research was carried out lacks reinforcing and consolidating a culture of patient safety within the internal medicine service, since 61% of those surveyed say they do not know the adverse events that have occurred. presented that year in service. There are several aspects to improve in the service that need to be worked on by the institution in a short time to improve patient safety; 39% affirm that it is necessary to improve room security, and to a lesser extent increase the plant health personnel, improve the availability of supplies and have a permanent stock of medicines. It is necessary to reinforce the concept, procedure and / or protocol for the reporting of adverse events and the understanding of its obligation in the hospital, since only 43% report it in the institutional format, the rest do it verbally and some do not. they report it and 4% of those surveyed say they do not know that an adverse event is. Conclusions: The need to sensitize and train staff on the institutional guidelines of the patient safety policy implemented in the HUS and the importance of adherence by the internal medicine service to it was evidenced. The Santander University Hospital with the implementation of the two tools of security rounds and brief security sessions in the internal medicine service, will be able to promote a fair culture, where it is recognized that errors will always exist because they are part of the risks when providing health care and that the adverse event reporting system is a mechanism that helps health professionals to minimize them. In the study carried out in the Internal Medicine Service of the University Hospital of Santander, it can be concluded that the unsafe situations that imply the most risk for patients are nosocomial infections, untimely care of the patient, delay in administrative procedures and authorization procedures by the EPS. In the Internal Medicine Service of the Santander University Hospital, the commitment to patient safety must start from the management, who will draw up strategies to sensitize workers, who understand the importance of measuring and evaluating processes, because that culture of reporting , measurement and evaluation will allow continuous improvement of organizations and will be the beginning of a change in their culture. The study carried out was a very enriching experience for us on a professional and personal level because in this practice we were able to experience the role of the auditor in health services through the assertive response of professionals throughout the process of implementing the tool
I sistemi bibliotecari delle università in Italia sono stati considerati a lungo inefficienti e dispersivi, con costi alti e risultati bassi. A partire dagli anni Settanta prima nel mondo professionale, poi sempre di più anche nelle autorità accademiche e negli studenti, è cresciuta l'insoddisfazione e quindi il tentativo di miglioramento e della razionalizzazione, anche in conseguenza della introduzione dei sistemi computerizzati nelle biblioteche.Il quadro dei servizi bibliotecari dell'Università di Pisa non si discosta molto dalla media italiana: il sistema delle biblioteche di ateneo si presenta con un grande patrimonio bibliografico, disperso su molte sedi e con servizi discontinui. Rispetto ad altri sistemi universitari le varianti più importanti riguardano la presenza, in pochi chilometri, di altre importanti biblioteche legate all'università e alla ricerca.Da alcuni anni sono state intraprese alcune trasformazioni dei servizi bibliotecari, dal punto di vista istituzionale, organizzativo, informatico. Nel 1987 fu attivata una Commissione di ateneo per le biblioteche, dai cui lavori uscirono alcune proposte di riorganizzazione, basate su un moderato accentramento e sull'introduzione di servizi di base più ampi e servizi innovativi, anche di tipo informatico, più qualificati. Con questa spinta fu varato un nuovo regolamento per le biblioteche e fu istituito un Servizio centrale per le biblioteche, assieme alla costituzione di otto biblioteche centri di servizi, finanziate anche dall'amministrazione centrale.All'inizio del 1999 l'Ateneo, rafforzando le linee di politica bibliotecaria seguite nel corso di dieci anni, ha deliberato un'ulteriore formalizzazione del sistema, basata su:a) modifica dello Statuto, che riconosce come parte del sistema bibliotecario solo le biblioteche organizzate come centri di servizi bibliotecari;b) delineazione delle aggregazioni per arrivare, entro il 1º settembre 2000, alla formazione di 15 biblioteche costituite come centri di servizi bibliotecari coordinate attraverso il Servizio per il sistema bibliotecario di ateneo;c) indicazione di linee guida con gli standard per i servizi bibliotecari e degli obiettivi di massima del sistema.L'indirizzo politico del sistema è dato dagli organi accademici, tramite la Commissione di ateneo per le biblioteche, formata da rappresentanti del Senato accademico e del Consiglio di amministrazione, e integrata da esperti.Il coordinamento tecnico è compito del Servizio per il sistema bibliotecario: il Servizio si occupa direttamente di cataloghi comuni, di proposte di formazione e seminari professionali, di standard, di statistiche e raccolta dati d'insieme, di informatizzazione e basi dati di ateneo, di progetti e obiettivi comuni al sistema, e fornisce il suo supporto alle biblioteche per tutti gli altri aspetti organizzativi e gestionali. Le singole biblioteche, che amministrativamente sono centri di spesa autonomi, hanno un consiglio direttivo, un presidente e un direttore operativo. Sul piano delle risorse umane è stata avviata una risistemazione della pianta organica delle biblioteche previste dal piano; alla base della pianta organica sono stati posti parametri indicativi del bacino di utenza e del carico di lavoro, cioè quattro dei sei utilizzati per l'assegnazione di fondi di ateneo.Sul piano delle risorse finanziarie alle biblioteche riconosciute come centri, oltre ai finanziamenti provenienti dalle facoltà e dai dipartimenti interessati, viene assegnata una quota stabilita sulla base di sei parametri indicativi del bacino di utenza (docenti, studenti), della spesa pro capite, cioè della spesa dei dipartimenti e facoltà in rapporto al loro bacino di utenza, del servizio erogato (ore settimanali di apertura), del carico di lavoro (abbonamenti in corso e nuove acquisizioni).L'ateneo ha stabilito una serie di obiettivi, privilegiando i servizi al pubblico; contestualmente sono state date le indicazioni di massima (linee guida per i servizi bibliotecari) sui compiti del sistema, sui criteri fondamentali, sugli standard dei servizi principali.Parallelamente è stata avviata una attività di formazione del personale, nel quadro della formazione di ateneo del personale tecnico-amministrativo. Nel 1998 si è svolta la prima serie di corsi finalizzati:a) al coinvolgimento di tutto il personale nella prospettiva "di sistema bibliotecario";b) all'orientamento del sistema verso i servizi e gli utenti, con l'obiettivo della qualità:c) al recupero di lacune da una parte e all'accrescimento di competenze professionali dall'altra.Tutti i corsi si sono conclusi con un test, che ha dato luogo a valutazione differenziata del risultato, e con la compilazione da parte dei formati di una scheda di valutazione sui contenuti e sulla qualità del corso seguitoSul versante informatico la situazione attuale è caratterizzata dalla compresenza di vari sistemi distribuiti su più data base, unificati come uscita Web in un metaopac con circa 300.000 registrazioni bibliografiche, che rappresentano il 25% del patrimonio bibliografico dell'ateneo, con punte dal 50% al 90% nelle biblioteche con informatizzazione più consolidata, nelle quali vengono utilizzate più ampiamente procedure informatiche diverse dalla catalogazione, come il prestito, la gestione dei periodici, la gestione degli ordini. A questa situazione si prevede di sostituire entro 12-18 mesi un sistema unico di ateneo, con architettura client/server, database relazionale e interfaccia grafica.Per quanto riguarda il database networking, è stato attivato un server ERL per alcune banche dati di carattere generale. In questo settore è stata attivata una interessante cooperazione con la Scuola normale superiore, la Scuola superiore S.Anna e l'area di ricerca del CNR. Con la Scuola normale e la Biblioteca universitaria è allo studio l'ipotesi di condividere banche dati gestite attraverso Ultranet. La crescita dei nuovi servizi di document delivery ha portato all'attivazione di Ariel nei centri di servizi bibliotecari.Il modello organizzativo che emerge è basato sull'accentramento di indirizzi, criteri, standard, valutazioni, statistiche, gestione informatica e gestione delle banche dati di ateneo, formazione, e sul decentramento nelle 15 biblioteche della gestione dei servizi e del personale.Il fulcro del sistema è rappresentato dalla misurazione dei risultati e dei servizi. È un modello non sacrifica astrattamente il funzionamento dei servizi e le specificità disciplinari, ma si radica nell'esperienza concreta e nella storia delle realtà bibliotecarie dell'ateneo, con l'obiettivo di riorganizzarle secondo la prospettiva del miglioramento della qualità e dell'orientamento all'utente-cliente. ; Italy's university library system has long been considered both inefficient and wasteful, with high costs and poor results. Since the 1970's there has been a growing dissatisfaction with the situation, firstly within the professional world and later increasingly within academic and student circles. As a result, many universities have attempted to both improve and rationalise library systems, thanks also in part to the introduction of computerised systems in libraries. The University of Pisa's library services differ little from those of the average Italian university. The university library system has considerable bibliographic resources, scattered among many centres, with uneven service levels. Compared with other university systems, the most important variable is the presence, within just a few kilometres, of other important libraries linked to the university and to research.The University of Pisa has modified the management and computerisation of its libraries to achieve a comprehensive network of services.Although the process of change, itself a result of a convergence of new policies and management, and professional culture, is still only in progress, it is, however, producing a promising series of results and prospects for the future.The university Committee for libraries, which was set up in 1987, has produced a number of proposals for reorganisation, based on a certain amount of centralisation and on the introduction of more widely based, and also more innovative and advanced computerised services. New rules for libraries, together with a centralised library service, were thus introduced.In early 1999, the university, building on the library policy which pursued in the preceding decade, considered a further development of the system based on:a) modification of the University Statute to recognise only those libraries organised in the central library service as part of the library system;b) a centralisation process to achieve, by September 2000, the establishment of 15 central library services for large subject areas, co-ordinated by the university's library system service;c) a set of guidelines with standards for the library services and the main objectives of the system.The system's policy direction is given by the academic bodies through the university Committee for libraries, which consists of representatives of the academic senate and of the administrative council, with additional input from specialists. Technical co-ordination is the task of the university library system service, which is directly responsible for shared cataloguing, proposals for professional training and seminars, standards and statistics and collection of data as a whole, and computerisation and university databases. It also assists the libraries on all other aspects of management and organisation. The individual libraries, which are financially independent, have a board, a president and a managing director. As regards human resources, a reorganisation of library staff has taken place following the planning of duties.As regards financial resources, all the libraries recognised as centres are financed by the interested faculty and departments, and receive additional University funding on the basis of 6 parameters: number of potential users (teaching staff; students); department/faculty funding per potential user; weekly opening hours; workload (current serials subscriptions; new acquisitions).The University has established a series of objectives considering firstly the public services, then the guidelines for library services, the system's tasks, the essential criteria and the standards for the principal services.Similarly, staff training has initiated courses that aim to involve all the staff in the library system's perspectives, to place the emphasis on services and users to attain the best quality, and to increase professional skills.As regards automation, there are at present various systems and many databases, merged in a Web metaOPAC of some 300.000 bibliographic records representing 25% of the University's collection. In the main libraries the coverage of online catalogues ranges from 50% to 90% and automated systems are in use also for loans, serials control and acquisitions. The University has planned a migration, within 12-18 months, to a single automated system, with client/server architecture and a graphic interface.As regards database networking, we have activated an ERL server with some general databases and also initiated an interesting co-operation programme with the Scuola Normale Superiore, the Scuola Superiore S. Anna and the National Research Council.As regards document delivery, the growth of demand led to the choice of the Ariel system for the central library services.The management model is based on:1) the centralisation of policies, standards, statistics and evaluation, system and database management and staff training;2) the devolution of the management of staff and services to the 15 libraries.Feedback comes from the evaluation of services and results. We can say that this model arises from the concrete experience and the past evolution of university libraries. The objective is to reorganise libraries, improving their quality and user orientation.
The concepts of freedom and time underlay all other philosophical and theological questions. This dissertation addresses the natures and relations of freedom and time and their impact upon theological reflection, primarily through the works of the philosopher of science, David Bohm and the philosopher of the humanities, Pauli Pylkkö. These two representatives come from the two competing cultures of the sciences and humanities, which illustrate the deep philosophical conflict that has emerged between these cultures concerning the natures of freedom and time. Specifically, the paradigmatic contributions of Albert Einstein's four-dimensional 'timeless space-time' (with timeless freedom) alongside Bohm, on the one hand, and Martin Heidegger's four-dimensional 'temporal time-space' (with temporal freedom) alongside Pylkkö, on the other hand, clearly illustrate the contrasting ideas which contemporary reflection has generated concerning the natures and relations of freedom and time, as well as their functions within theology. Within the study, chapter 1 introduces the background, problem, and methodology employed in the investigation, as well as describing the role that the most perplexing area of natural science, quantum physics, has played in recent reflection on the natures of freedom and time. Chapter 2 surveys the contemporary extent and context of the conflicting understandings of freedom and time, tracing both their interrelationship as well as influence upon broader discussions between science and religion, as well as various "third culture" disciplines, such as psychology and psychiatry, economics, and the socio-political sciences, and the role religion and theological reflection have within these third cultures. It was demonstrated that the basic philosophical impulses driving Einstein and Bohm, on the one hand, and Heidegger and Pylkkö, on the other hand, are in fact traceably related to many of the widespread polarizations occurring throughout the socio-political disciplines. Chapters 3 and 4, in turn, examine the concepts of freedom and time within the work of Bohm, who is building off of Einstein's theories, and Pylkkö, who is building off of Heidegger's ideas. Chapter 5 compares and evaluates Bohm and Pylkkö's concepts of freedom and time, both for the sciences and humanities, and demonstrates how their contributions fit within the contemporary dialogue concerning science and religion, as well as projects how they may contribute to future developments within the sciences, humanities, and a variety of issues within theology. This was done with specific regard to the differing and incompatible trajectories encouraged by the two cultures of the sciences and humanities. The findings of this study indicate that although the conflict over the concepts of freedom and time is now generally well recognized by close observers of the developments in philosophy and society, and its effects are virtually omnipresent, it is still widely neglected by many specialist practitioners within the two cultures, which, as 'cultures,' do indeed often operate within isolated 'bubbles.' This has only led philosophy and society unwittingly down a path into a widespread implicit contradiction, the consequences of which are just now beginning to reach an explicit or critical stage throughout societies at large. Thus, the need was discovered for a reconceptualization of the concepts of freedom and time to 'reconcile,' or redefine, the differing cultures and their conflict. One of the more promising avenues for finding conceptual replacements for freedom and time, and the reconceptualization of the two cultures themselves, is found in the perplexing and mysterious realm of quantum physics. Unfortunately, the quantum phenomena can be interpreted in at least four contradictory ways. First, as simply a continuation of the classical world, pending just a bit more information (that may or may not be forthcoming–in harmony with the early Bohm). Second, as providing a possible support for the traditional dualism concerning the mental and physical world (the standard Copenhagen view). Third, as opening up the possibility of a new way of seeing physical reality, one oriented towards an infinite depth of interwoven yet differentiated layers which retain, in many core respects, the classical image of science–David Bohm's later view, building off Einstein. And fourth, as indicative of the need to break down the reign of classical science altogether, not merely for the study of nature, but dissolving its very methodology as applied even in the social sciences–Pauli Pylkkö's view, building off Heidegger. For the purposes of true conceptual replacement, and through a review of the potential of the first two options to actually aid in resolving the conflict, it was determined that Bohm's and Pylkkö's proposals do offer the most potential for progress beyond the impasse between the two cultures. First, Bohm's views of freedom and time are indeed distinct from previous concepts that have dominated throughout history. He believes that there are many different layers with differing orders within reality that are all interconnected, in contrast to the atomistic view which dominates classical science. What distinguishes his view from others is that the different layers may necessarily involve the appearance of disorder from the perspective of a higher or lower order. Because of the infinite complexity of reality, it is impossible to actually perceive any absolute determinism in nature which grants one meaningful freedom. Correspondingly, the meaning of time is transformed into one of relative degrees of temporal and timeless vertical orders in various relationships to each other throughout an overall 'timeless' holomovement. Critically, the social spheres are also included within the various posited layers. Second, Pylkkö's views of freedom and time are also distinct from most concepts that have dominated history. Pylkkö also believes that all of reality is fundamentally interconnected. However, he also believes that the relationship between order and disorder is itself one of the key fundamental features exhibited in nature, and that randomness plays a critical role. He also dismisses the idea of any residual 'timeless' platonic realm. Freedom and time are fundamentally constituted by their relationship to the interconnected or nonlocal yet locally manifested random events of nature, creating an aconceptual experiential flow. Because this basic feature is common to all reality, including the social spheres, the concepts of freedom and time Pylkkö articulates are operative at every level, guiding the meaning of social and cultural movements, as well as those in physics. As such, rather than freedom being an exceptional case within a deterministic world, determinism is rather the 'illusion' within a more fundamentally free world, noting that freedom here is tied to random temporally and nonlocally extended events. Laws, including natural ones, can only exist within an underlying framework that possesses freedom of some sort–and this freedom should be considered foundational, rather than the laws, though this is not to dismiss the existence of laws nor their necessity, either in nature or at the social level. Bohm's and Pylkkö's theories, while in some ways similar and parallel efforts to resolve a common problem, are nevertheless very different and incompatible in other ways. The most important feature of their incompatibility is found in the opposite terminology they use, which in some ways perpetuates one of the most fundamental conflicts between the two cultures. Bohm retains and endorses the language of timelessness, whereas Pylkkö retains and endorses the language of temporality. As such, in some ways, while indeed moving beyond the precise characteristics of the broader conflict between the two cultures, they too perpetuate it. If nothing else, this illustrates clearly that, indeed, freedom and time are the fundamental concepts both creating and dividing the two cultures. Furthermore, because of the close relationship freedom and time have in relation to the idea of God, divergent theologies are inevitable so long as this crisis persists. Within the dialogue between science and religion and within the sphere of theology, Bohm's and Pylkkö's ideas contribute to problems created by the two cultures. Within the sciences, it appears unlikely that either the dogmatic classical view or the neoplatonic Copenhagen view will welcome the insights of Bohm and Pylkkö. In part, this is because of the powerful dominance of the scientific culture, which controls so many sectors of society and the academy. Bohm and Pylkkö will likely remain outsiders to this dominance for some time, if not permanently. Theologies that embrace the sciences 'as they are' will only be open to limited aspects of the work of Bohm, and less so, Pylkkö. Ironically, tenets of each of their ideas are also present in the most advanced interpretations of physics. Specifically, overall determinism within the realm of 'science,' which is in harmony with the earlier Bohm, and the acceptance of genuine randomness 'in some manner' within nature, which is in harmony with Pylkkö. Both of these are accepted by many mainstream theologians supportive of the scientific community. However, the synthetic work that Bohm and Pylkkö have each attempted challenges the status quo in ways which the scientific community overall, as a culture, will likely find unpalatable. The same would be true for the many theologians who show great deference to science today. Conversely, within the realm of the humanities, the work of both Bohm and Pylkkö is likely to find much greater resonance, or, at the same time, elicit even sharper disagreement. The concepts of freedom and time play a central role in several major issues intersecting the humanities with theology, including religious pluralism, politics and social justice, soteriology alongside the Sanctuary and atonement, the reality of biblical prophecy, the Sabbath and rest, and the biblical concept of the Remnant and the philosophical significance of a minority holding the truth. In all of these areas, Bohm's and Pylkkö's conceptions of freedom and time could profoundly transform these socio-religious, theological, and biblical issues by modifying our views of how freedom and time intersect with hermeneutics and thus theology itself. However, in most cases, the trajectories their ideas would encourage concerning these areas would be in opposite directions. Thus, the theoretical continuation of the two cultures' impasse may endure. Nevertheless, theologians are far more likely to find Bohm's and Pylkkö's ideas attractive, and the integration of their thinking, especially Bohm's, has already begun to take place. Overall, the study offers the following specific conclusions. First, the contrasting descriptions of freedom and time given by Einstein and Heidegger do fundamentally conflict, and their differences have had a profound impact on philosophy, science, and theological reflection. Second, essentially all further sub-disciplines, particularly the third culture disciplines that most directly impact human societies and the earth, are also profoundly affected by the contradictory tension. Third, the more classic 'science and religion' debate, as well as a host of other related issues, such as the nature of hermeneutics, are also profoundly affected by this conflict. Fourth, potential avenues toward ameliorating the conflict are present in the contributions of Bohm and Pylkkö. However, fifth, the conceptions of freedom and time presented in Bohm and Pylkkö also conflict, leaving philosophy and theology with a primordial choice between timeless time and determinism or, perhaps, its accompanying timeless freedom or temporal time and temporal nondeterminate freedom. It is not one that need be left merely theoretical, however, as the impact and consequences of their ideas can be traceably worked out in both a variety of disciplines as well as within theology. This allows one to a posteriori explore the issue, rather than leaving it merely an abstract hypothetical question. This does not mean a resolution is simple to achieve, but that there is more research that can be undertaken to obtain more knowledge about the concepts. Lastly, sixth, this study brings to clearer light several issues pertaining to freedom and time that some theologians and theistic scientists are simply unaware of or passively ignoring. Many do operate, consciously or unconsciously, within a 'bubble.' This state of things cannot continue, or their respective contributions will slide into irrelevancy on one side or contribute unknowingly or unnecessarily toward a deepening of the polarization. The reality is, many biblical interpreters simply ignore the debates between science and religion, but if the philosophical issues undergirding both disciplines and discussions are in fact rooted in common concepts, then greater interdisciplinary efforts should be pursued to fully appreciate and critique the impact philosophy has upon both theology and science. Biblical exegesis is directly impacted by the clash of the two philosophical cultures, yet many theologians remain unaware of the depth and significance of this reality. Our ability, as theologians, to navigate the issues and questions facing the 21st century requires we engage this conflict intelligently, and in this we can learn from both Bohm and Pylkkö. This may alter how we relate to many past paradigms, especially in science, the arena which Bohm and Pylkkö have exposed as far more vibrant and open for philosophical reflection than has generally been previously realized. Obviously, given the attention to the subject matter in the present study, it would seem that there is value to critically engaging the more dominant culture, particularly in the academy, which is that of the sciences. The dominance of 'science' as such must always be critically addressed, especially by those from within the discipline of theology. Yet, at the same time, the 'science' of today is immensely complex, and the work of physicists and philosophers like Bohm and Pylkkö make this abundantly clear.
Este artículo se propone analizar las estrategias de seguridad alimentaria y nutricional (SAN) desarrollada por los miembros de la Asociación de Orgánicos Productores de Ceará Mirim (APPOCM), ubicado en el estado de Rio Grande do Norte. La misma fue creada en el año 2010, con el desafío de producir alimentos de calidad en cantidad suficiente, sin perjudicar el medio ambiente y teniendo en cuenta las relaciones de equidad social. Es una de las escasas iniciativas de este tipo que tienen lugar en un territorio marcado por los peores indicadores sociales en Brasil (un Índice de Desarrollo Humano, IDH = 0,555). La investigación es del tipo cualitativo y los datos analizados se obtuvieron a través de entrevistas semiestructuradas, realizadas en los sitios de producción de cada agricultor. Tomando como referencia el concepto de SAN, la herramienta de investigación trató de identificar y caracterizar las estrategias de SAN a través de las siguientes variables: cómo acceder a los alimentos; las formas de adquisición de los alimentos; estrategias para el autoconsumo; políticas públicas accesibles y sus consecuencias, incluyendo la manera cómo se asocian con la cultura alimentaria local. Del estudio se concluyó que la mayoría de las estrategias de SAN identificadas han resultado del encadenamiento de diferentes políticas públicas. Estas estrategias han traído mejoras en la alimentación, provocando así mismo cambios en los hábitos alimentarios en el área objeto de estudio –en particular, en la diversificación de la producción destinada al autoconsumo–. Esto a su vez ha garantizado autonomía alimentaria, al tiempo que ha ampliado los canales de comercialización, ya sea a través de ferias o de los mercados institucionales. También se encontró que se ampliaron las relaciones de reciprocidad (i.e., los actos de dar, recibir e intercambiar). Tales relaciones son indispensables para alcanzar la seguridad alimentaria en tiempos de dificultades, además de contribuir a promover la producción orgánica, mediante los intercambios de insumos. ; This article analyzes the strategies of food and nutritional security (SAN) developed by the members of the Association of Organic producers of Ceara Mirim (APPOCM), located in the State of Rio Grande do Norte, created in the year of 2010, with the challenge of producing food quality in sufficient quantity, without harming the environment and considering the relations of social equity. One of the few initiatives of this kind in a territory marked by the worst social indicators in Brazil (HDI = 0.555). The data reviewed here were obtained from semi-structured interviews, carried out in the places of production of each farmer and departing from a qualitative approach. Taking as reference the concept of SAN, the instrument of research, sought to identify and characterize the strategies from the following variables: How does access to food; the form of purchasing food; strategies for consumption; public policies accessed that have strengthened those strategies and as it joins the local food culture. From the study, it was concluded that most SAN strategies identified resulted from the chaining of different public policies that strengthened existing and developed other strategies, as in the case of organic production that constitutes the primary motivation, including for the Organization of the Group researched. These strategies have brought improvements in feed, causing changes in your eating habits, in particular, on the diversification of production to consumption. This in turn, has secured greater autonomy power and expanded sales channels, either through fairs or institutional markets. It was found, also,that relations of reciprocity (acts of giving, exchange and receive) widened after the organic production and that these are indispensable in ensuring food in times of difficulties, in addition to contributing to promote organic production, through the exchanges of inputs. ; Cet article vise à analyser les stratégies de sécurité alimentaire et nutritionnelle (SAN) développées par les membres de l'Association de Producteurs Bio de Ceará Mirim (APPOCM), dans l'État de Rio Grande do Norte. Cette association a été créée en 2010, dans le but de produire des aliments de qualité, respectant l'environnement et en prenant en compte l'équité sociale. Cette initiative est l'une des rares qui a été mise en place au Brésil, dans un territoire qui connait les pires indicateurs sociaux (HDI = 0,555). Cette recherche est réalisée sous une approche qualitative et les données proviennent d'entrevues semi-structurées. En prenant comme référence le concept de SAN, on a cherché à identifier, caractériser et analyser les aspects suivants : Comment l'agriculteur accède-t-il à l'alimentation (achète-t-il ses aliments ou bien il les produit); quel est le formulaire d'achat d'aliments; quelles sont les stratégies pour la consommation; quelles sont les politiques publiques qui ont été utilisées pour renforcer ces stratégies et si elles sont reliées à la culture alimentaire locale. La recherche a conclu que la plupart des stratégies de SAN identifiées résultent des politiques publiques successives, ce qui a renforcé et développé d'autres stratégies. C'est le cas du mode de production biologique qui constitue la principale motivation de l'organisation du groupe étudié. Ces stratégies ont apporté des améliorations dans l'alimentation des agriculteurs provoquant des changements dans les habitudes alimentaires, en particulier, en ce qui concerne la diversification de la production et de la consommation. De même, les agriculteurs ont obtenu une plus grande autonomie et ont élargi leurs canaux de vente grâce aux marchés qui sont mis en place pour l État. On a constaté, aussi que les relations de réciprocité (donation et échange) se sont trouvées renforcées après la mise en place du mode de production biologique et que ces relations sont indispensables afin d'assurer l'approvisionnement en aliments pendant les périodes de difficulté et de contribuer à encourager la production biologique à travers les échanges de semences et d'autres formes de coopération. ; Este artigo se propõe a analisar as estratégias de Segurança Alimentar e Nutricional (SAN) desenvolvidas pelos membros da Associação de Produtores e Produtoras Orgânicos de Ceará Mirim (APPOCM), localizada no estado do Rio Grande do Norte. Essa instituição foi criada em 2010, com o desafio de produzir alimentos com qualidade e quantidade suficiente, respeitando o meio ambiente e o princípio de equidade social. Essa associação é uma das poucas iniciativas dessa natureza em um território que apresenta os mais baixos indicadores sociais do Brasil (IDH = 0,555). A pesquisa é de natureza qualitativa e os dados aqui analisados foram obtidos a partir de entrevistas semiestruturadas. O trabalho buscou identificar, caracterizar e analisar as estratégias de Segurança Alimentar e Nutricional partir das seguintes variáveis: como se dá o acesso ao alimento; as formas de aquisição de alimentos; estratégias para autoconsumo; políticas públicas acessadas e seus desdobramentos, incluindo como isso se associa à cultura alimentar local. A partir do estudo, concluiu-se que a maior parte das estratégias de SAN identificadas resulta do encadeamento com diferentes políticas públicas. Estas iniciativas acabaram por ativar outras medidas, como no caso da produção orgânica empreendida pelos agricultores da associação. Tais estratégias trouxeram melhorias na alimentação, trazendo mudanças positivas nos hábitos alimentares, em especial, na diversificação da produção de autoconsumo. Isto por sua vez, tem garantido maior autonomia alimentar e ampliado os canais de comercialização, seja por meio de feiras, seja através do acesso aos mercados institucionais. Verificou-se, também, que as relações de reciprocidade (atos de doar, trocar e receber) se ampliaram, as quais são imprescindíveis para a garantia de alimentos em momentos de dificuldades, além de contribuir para fomentar a produção orgânica, através das trocas de insumos. ; 151-164