Thesis (Ph. D.)--Kent State University, 2004. / Title from PDF title page (viewed on Apr. 27, 2006). Includes bibliographical references (p. 175-209).

Over the last few years, policies have been introduced in the UK which aim to improve organ transplantation rates by changing the way that potential organ donors are treated before death. Patients incapacitated due to catastrophic brain injury may now undergo ante-mortem donor optimisation procedures to facilitate deceased organ donation. As I identify in this thesis, the most significant ethical and legal problem with these policies is that they are not based on what the patient would have chosen for themselves in the specific circumstances. The policies identify and treat patients meeting certain clinical criteria as a group rather than the individuals, with their own viewpoints, that the law on best interests requires. They equate registration on the Organ Donation Register with ante-mortem donor optimisation procedures being in their best interests, despite registrants having neither been informed about nor given consent to ante-mortem interventions. The overarching claim I make in this thesis is that a system of specific advance consent is needed to provide a clear and unequivocal legal justification for ante-mortem donor optimisation procedures. The ethical foundation for this claim is autonomy, and this is the central theme running through all six chapters. I argue that autonomy should be incorporated into donor optimisation policy to promote the dignity and integrity of potential organ donors and to safeguard trust in the organ donation programme. I argue that a system of specific advance consent is needed as part of the duty of care owed to registrants on the Organ Donor Register and to facilitate the determination of the best interests of the potential organ donor. I argue that the state has not established the necessity of the current policy of non-consensual donor optimisation procedures and that they are under an ethical and legal obligation to introduce an autonomy-based framework for ante-mortem interventions to facilitate organ donation.

The course of endstage renal disease (ESRD) and receiving hemodialysis (HD) treatment is complex and filled with uncertainty. Part of this illness experience includes making end-of-life (EOL) care decisions. Many families are unprepared to make such decisions. Advance care planning (ACP) creates an excellent context for laying the groundwork for these emotionally charged conversations. Hemodialysis patients, their families and healthcare providers (HCPs) are in a unique position to begin the ACP process early in the illness trajectory, revisiting it when the patient’s health status, prognosis and treatment modality changes. To date, little research has focused directly on how families experience ACP conversations in the context of ESRD or HD. The purpose of this study was to explore family members’ experiences of participating in a facilitated ACP conversation with the HD patient. This approach recognizes and privileges the family’s role in the illness trajectory of ESRD and validates that they too are HCPs’ clients. Five families, consisting of the HD patient and one family member, who went through the ACP process were interviewed along with an ACP facilitator from the nephrology program. This focused ethnographic study applied the theoretical perspective of postmodernist critical theory to derive and analyze data from in-depth semi-structured interviews. Findings revealed a detailed description of the ACP process that included timing, readiness to acknowledge the potentiality of death, facing mortality, and finding meaning in the illness experience. As families started to deconstruct their experiences, they shared stories of communication breakdown, highlighting the complexities of their relationships with HCPs. Understanding the factors that potentially contribute to HD patients’, their families’ and the renal staff’s discomfort with death were analyzed. The study findings provide important direction for HCPs about how families make ACP decisions, how they perceive the ACP process, and what they identify as their EOL care needs and wishes. Failure to implement ACP as part of an EOL care program means that death will continue to be denied and clients’ EOL care needs will remain un-addressed. In order for ACP to be effective on HD units, sustainable resources are essential for patients, their families and HCPs. / Applied Science, Faculty of / Nursing, School of / Graduate

No description available.

The problem of this study is to analyze some of the effects of selected ESEA, Title III, PACE projects on the educational processes in Texas.

The problem of this study was to determine whether the advance organizer would affect students' perception of instructor communication competence. The study also sought to determine any effect the organizer would have on student achievement.

En la presente investigación tiene como propósito evaluar el impacto tributario que tiene los pagos adelantados por la venta de un bien inmueble. Para obtener dicha información se realizará una evaluación a las empresas inmobiliarias que tengan o hayan tenido proyectos inmobiliarios en el distrito de Jesús María. Esta investigación se basará en la aplicación de las normas tributarias tanto como la Ley del Impuesto General a las Ventas, Ley del Impuesto a la Renta, Reglamento de Comprobante de Pago y sanciones impuestas por SUNAT. Para el mismo, se utilizará una metodología de investigación mixta, es decir, cuantitativa y cualitativa. Para el desarrollo de esta investigación, se validará las hipótesis propuestas para ello se ha realizado trabajos de campo a las principales empresas inmobiliarias como encuestas, entrevistas, también apoyado en información documentaria y casos para así generar un análisis lo más completo posible. De los datos analizados se llegó a la conclusión que el efecto tributario que ocasiona los pagos adelantados en la venta de inmuebles, impacta en las empresas del sector inmobiliario en proyectos del distrito de Jesús María. / The purpose of this research is to evaluate the tax impact of advance payments for the sale of real estate. To obtain this information, an evaluation will be made to the real estate companies that have or have had real estate projects in the Jesus Maria district. This investigation will be based on the application of tax regulations as well as the General Sales Tax Law, the Income Tax Law, the payment voucher regulation and sanctions imposed by SUNAT. For the same, a methodology of mixed research will be used, that is, quantitative and qualitative. For the development of this research, the hypotheses proposed for this will be validated. Field work has been carried out to the main real estate companies such as surveys, interviews, and also supported by documentary information and cases in order to generate the most complete analysis possible. From the analyzed data, it was concluded that the tax effect caused by the advance payments in the purchase of real estate, impacts on companies in the real estate sector in projects of the Jesus Maria district. / Tesis

O presente trabalho tem por escopo o estudo do princípio do respeito à autonomia do paciente à luz das recentes alterações trazidas pelo novo CEM Resolução do Conselho Federal de Medicina nº 1.931, de 17 de setembro de 2009 , que prestigia a autonomia do paciente e propõe um novo formato para a relação médico-paciente, impondo novas posturas tanto ao médico como ao paciente, e privilegia sua autodeterminação, ao mesmo tempo em que o obriga à tomada de decisões e à assunção de responsabilidade compartilhada quanto ao processo terapêutico. O objeto do estudo é a nova relação médico-paciente sob o enfoque da autonomia do último, ressaltando-se a responsabilidade compartilhada com o médico em relação à tomada de decisões atinentes ao processo terapêutico, às escolhas terapêuticas, bem como os limites e o conteúdo do poder de decidir e sua autonomia diante da enfermidade e da terminalidade da vida. Nesta hipótese, a reflexão concentra-se nos cuidados paliativos e na adoção de diretivas prévias estatuídas pelo paciente a serem observadas pelo médico e por eventual terceiro responsável por aquele, caso ele não possa manifestar sua vontade durante cuidados paliativos ou situações que revelem iminente terminalidade. / This proposal aims to study the principle of respect for patient autonomy in light of recent changes introduced by the new CEM Resolution of the Federal Medical Council nº 1931 of September 17, 2009 which honors the patients autonomy and proposes a new format for the doctor-patient relationship, imposing new attitudes to both the patient and physician, emphasizes self-determination and, at the same time that forces decision making and the assumption of shared responsibility as to the therapeutic process. The object of the study is the new doctor-patient relationship from the perspective of this autonomy, emphasizing shared responsibility with the physician regarding decisions pertaining to the therapeutic process, the therapeutic choices, and the limits of power and content and their autonomy to decide on the terminally ill and life. In this case, reflection focuses on palliative care and the adoption of policies laid by the previous patient to be seen by the doctor and by any third party responsible for that, if he can not express his desire for palliative care or situations that reveal impending finality.

O proposito deste estudo foi avaliar as alteracoes esqueleticas, dentoalveolares e tegumentares decorrentes da utilizacao do aparelho fixo associado ao Jasper Jumper e aos elasticos intermaxilares de Classe II em fases distintas do tratamento da ma oclusao de Classe II por meio da analise cefalometrica de 96 telerradiografias, em norma lateral, de 24 pacientes de ambos os generos, com idade inicial media de 12,58 anos, tratados por um periodo medio de 2,14 anos. As telerradiografias, em norma lateral, foram avaliadas em cada fase do tratamento: T1 (inicial), T2 (final do nivelamento e alinhamento), T3 (apos o Jasper Jumper) e T4 (final). As variaveis cefalometricas foram comparadas por meio da analise de variancia (ANOVA) a um criterio e o teste de comparacoes multiplas de Tukey. Houve restricao do deslocamento da maxila para anterior, porem, sem diferença estatisticamente significantes entre as fases estudadas. Observou-se ausencia de alteracoes significantes no posicionamento mandibular, sendo que ocorreu um aumento significante no comprimento mandibular na fase do nivelamento. A relação maxilomandibular foi corrigida, ja a fase de utilizacao de elasticos nao teve influencia estatisticamente significante nessa relacao. O tratamento ocasionou a rotação horaria da mandibula, sendo significante apenas para a medida S-GO na fase de nivelamento, ocorrendo aumento significante da altura facial antero-inferior nas fases de nivelamento e Jasper Jumper. Os incisivos superiores apresentaram extrusão estatisticamente significante na fase do Jasper Jumper. Na fase de nivelamento e dos elasticos de Classe II, nao houve influencia estatistica significante nessa variavel. Houve inclinacao para lingual dos incisivos superiores em todas as fases. Foi observada retrusao significante dos incisivos superiores, exceto na fase dos elasticos; Nao houve alteracao significante para o posicionamento mesiodistal dos molares superiores. Os incisivos inferiores apresentaram uma tendencia de protrusao estatisticamente significante apos a fase de nivelamento e restrição estatisticamente significante do seu desenvolvimento vertical nas fases ortopedica e de elasticos. Os molares inferiores foram extruidos significantemente nas fases de nivelamento e ortopedica e mesializados (alteracao estatisticamente significante obtida na fase ortopedica e mantida nas outras fases). O trespasse vertical diminuiu (estatisticamente significante) em todas as fases. Ja o trespasse horizontal não apresentou significancia estatistica apenas na primeira fase estudada. Na relação molar, a maior alteracao (estatisticamente significante) foi observada na fase ortopedica. O perfil tegumentar (H.NB, H-Nariz, Ls-E) apresentou alterações estatisticamente significantes com a utilizacao do Jasper Jumper. Na fase do nivelamento e de utilizacao dos elasticos, a unica variavel tegumentar que apresentou significancia estatistica foi Li-E, tendo demonstrado retrusao do lábio inferior. / The aim of this study was acess the skeletal, dentoalveolar and soft tissue changes occured with fixed appliance associated to Jasper Jumper and Class II intermaxillary elastics in distinct phases of Class II malocclusion treatment by means of the cephalometric analysis of 96 lateral radiographs of 24 patients of both genders, with initial mean age of 12.58 years, treated for a mean period of 2.14 years. The lateral radiographs were evaluated in each phase of the treatment: T1 (initial), T2 (final of alignment and leveling), T3 (after the Jasper Jumper), T4 (final). The cephalometric variables were compared by means of the Variance Analysis (ANOVA) to a criterion and the Tukey multiple comparison test. There was a restriction of the anterior displacement of the maxilla, however, without statistical significant differences among the studied phases. It was observed absence of significant changes in the mandibular position occurring a significant increase in the mandibular length during the leveling phase. The maxillomandibular relationship was corrected without any statistically significant influence of the elastics in this relation. The treatment caused a clockwise mandibular rotation being significant only for S-GO measure during the leveling phase occurring significant increase of the lower anterior facial height during the leveling and Jasper Jumper phases. The upper incisors showed a statistically significant extrusion in the Jasper Jumper phase. During the leveling and Class II elastic phases there were no statistically significant influence of this variable. There was a palatal inclination of the upper incisors during all phases. It was observed a significant retrusion of the upper incisors, except in the elastic phase; there were not significant change for the mesiodistal position of the upper molars. The lower incisors showed a tendency of a significant protrusion after the leveling phase and a statistically significant restriction of their vertical development during the orthopedic and elastic phases. The lower molars extruded significantly during the leveling and orthopedic phases and they mesialized (statistically significant change obtained in the orthopedic phase and maintained during the other phases. The vertical trespass decreased (statistically significant) in all phases. On the other hand, the horizontal trespass do not showed any statistical significance only in the first studied phase. In the molar relationship, the great change (statistically significant) was observed in the orthopedic phase. The soft tissue profile (H.NB, Hnose, Ls-E) showed statistically significant changes with the wear of Jusper Jumper. In the leveling and elastic phases the only soft tissue variable that showed statistical significance was Li-E having demonstrated lower lip retrusion.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2019-03-15T12:25:43Z No. of bitstreams: 1 Heloísa Menegaz Loyola.pdf: 596996 bytes, checksum: 1430869299ab1f1a56c31b7ab740db79 (MD5) / Made available in DSpace on 2019-03-15T12:25:43Z (GMT). No. of bitstreams: 1 Heloísa Menegaz Loyola.pdf: 596996 bytes, checksum: 1430869299ab1f1a56c31b7ab740db79 (MD5) Previous issue date: 2019-02-20 / With the advent of the New Code of Civil Procedure, provisional protection proves to be one of the institutes with the greatest debate, in view of its new procedure and the introduction of a microsythematics at the disposal of legal operators. We present a study about the provisional protection and the possibility of stabilization in the Labor Procedural Law with its necessary adaptations in order to meet the scopes of the labor market / Com o advento do Novo Código de Processo Civil, a tutela provisória revela-se como um dos institutos de maior debate, tendo em vista seu novo procedimento e introdução de uma microssistemática à disposição dos operadores de direito. Apresentamos estudo acerca da tutela provisória e a possiblidade de estabilização no Direito Processual do Trabalho com suas necessárias adaptações, a fim de atender aos escopos da seara laboral