This study is designed to investigate the nature of pathologically significant placentas and their corresponding fetal and neonatal outcomes in term infants. We aim to examine the correlation between specific placental pathologies and neonatal clinical conditions, including brain injury, requiring admission to a neonatal care unit and subsequent follow-up in our High Risk Newborn Follow-up Program (HRFU). A retrospective cohort study was conducted through review of maternal and neonatal reports. Overall 48 neonates had placentas submitted for examination. Sixty-one percent of placentas in the HRFU group and 62% of placentas in the non-HRFU group had findings consistent with ischemic changes, meconium staining and calcifications. Three infants had hypoxic ischemic encephalopathy. This study found no difference in placental pathology between non-HRFU infants and infants enrolled in the HRFU Program. This raises questions and warrants further study on the efficacy for placental submission as a predictive measure for neonatal outcomes.

The thesis is concerned with the means by which labour is managed in the young, turbulent and high risk industry of North Sea oil extraction. To explain this, the study had to extend beyond the more usual focus of research attention, the inmediate relationship between employer and employee, to examine the wider commercial relationship between the major oil companies and their contractors from the perspective of both parties. The response of the trade unions is assessed in this broader context. In a relatively short period of time an industrial relations system of considerable complexity has developed. The spreading of financial risk by the operating companies (oil majors) is paralleled in industrial relations by the delegation of responsibility to contractors. As a result, a two tier workforce has developed. The study analyses the processes at work, drawing on a range of interview, observation and archival techniques. Collective bargaining has been widely used to cope with the labour problems posed by these extreme financial and environmental circumstances. It is demonstrated that this has sometimes been imposed upon the contractors and that it operates at both the mUlti-employer, industry level, and at that of the individual company. However, the thesis concludes that this collective bargaining rests more on loose, informal agreements, and trade union lobbying, rather than formal agreements and procedures.

Recent high-risk coronary artery disease (CAD), defined as Canadian Cardiovascular Society (CCS) class III or IV angina or acute coronary syndromes (ACS) unstable angina, is independently associated with increased mortality and morbidity following non-cardiac surgery. It remains unclear how the components of high-risk CAD, use of stents and timing of surgery after a high-risk CAD event is associated with risk. This project will address these issues and how they affect current perioperative medicine. / Thesis / Master of Science (MSc)

nÃo hà / O estudo objetivou buscar e avaliar evidÃncias disponÃveis na literatura sobre os DiagnÃsticos de Enfermagem em gestantes. Para tanto, desenvolveu-se revisÃo integrativa da literatura, seguindo as etapas preconizadas por Whittemore e Knafl (2005). A busca e seleÃÃo dos estudos foram realizadas nas bases de dados LILACS, CINAHL, MEDLINE e SCOPUS. A amostra foi de 14 estudos nÃo experimentais, com nÃvel de evidÃncia VI. Os estudos foram avaliados e distribuÃdos em trÃs categorias temÃticas: diagnÃsticos de enfermagem em gestantes saudÃveis; diagnÃsticos de enfermagem em gestantes enfermas; e diagnÃsticos de enfermagem especÃficos. Em relaÃÃo aos resultados, os estudos foram publicados entre 1999 e 2010, eram brasileiros, tinham como idioma o portuguÃs, com autores vinculados à enfermagem. A primeira categoria foi composta por cinco estudos, dos quais foram relacionados 15 diagnÃsticos mais frequentes, relacionados a alteraÃÃes fisiolÃgicas da gestaÃÃo. Destacaram-se os diagnÃsticos Conhecimento deficiente, PadrÃo de sono prejudicado, NÃusea e Risco de infecÃÃo. A segunda categoria foi composta por sete estudos que investigaram a presenÃa de diagnÃsticos de enfermagem em gestantes com patologias, como a SÃndrome Hipertensiva da GestaÃÃo, a Amniorrexe prematura, o Trabalho de Parto Prematuro, a SÃndrome da ImunodeficÃncia adquirida, a Anemia Ferropriva, ou seja, gestantes de alto risco. Nesta categoria, os diagnÃsticos tenderam aparecer isoladamente em cada estudo, correlacionados com a patologia que a cometia as gestantes que estavam sendo investigadas. Foram destacados 33 diagnÃsticos mais frequentes, com Ãnfase para os diagnÃsticos: Conhecimento deficiente, Risco de infecÃÃo, Dor aguda, ManutenÃÃo do lar prejudicada, Ansiedade, Medo e ManutenÃÃo ineficaz da saÃde. A terceira e Ãltima categoria foi composta por dois estudos que investigaram como os DE Fadiga, PrivaÃÃo de sono e PadrÃo de sono prejudicado aconteciam na gravidez. Os diagnÃsticos retratados na revisÃo se relacionaram a aspectos biolÃgicos, psicolÃgicos, sociais e familiares das gestantes, o que vai ao encontro da necessidade de se investigar a gestante de forma integral, bem como de se prestar cuidado holÃstico a esta populaÃÃo e famÃlia. A presente revisÃo integrativa seguiu o rigor metodolÃgico adequado e identificou e avaliou os DE em gestantes. Ademais, permitiu aprofundamento teÃrico sobre a prÃtica baseada em evidÃncias, os mÃtodos de revisÃo integrativa, os diagnÃsticos de enfermagem e o processo de enfermagem relacionado à gravidez. Identificou-se a necessidade de se desenvolverem estudos quase experimentais ou experimentais, envolvendo a temÃtica dos diagnÃsticos de enfermagem em gestantes, visto que os estudos desta revisÃo foram classificados com nÃvel de evidÃncia VI. Entendendo-se com isto que à necessÃrio empreender esforÃos para o desenvolvimento de pesquisas com delineamentos que produzam evidÃncias fortes relacionadas ao tema, elevando, assim, o poder de generalizaÃÃo dos achados. Pretende-se com esta revisÃo estimular enfermeiros a consumirem resultados de pesquisa, bem como a produzirem pesquisas que resultem em uma prÃtica clÃnica de qualidade, contribuindo para promoÃÃo da saÃde de gestantes, seus conceptos e familiares. E, sobretudo, para a Enfermagem Baseada em EvidÃncias. / This study aimed to search and assess the available evidences in the literature on the Nursing Diagnoses in pregnant women. For this purpose, we performed integrative literature review, following the steps proposed by Whittemore and Knafl (2005). The search and selection of studies were conducted in the LILACS, CINAHL, MEDLINE and SCOPUS databases. The sample consisted of 14 non-experimental studies with evidence level VI. The studies were assessed and divided into three thematic categories: nursing diagnoses in healthy pregnant women; nursing diagnoses in sick pregnant women; and specific nursing diagnoses. Regarding the results, the studies were published between 1999 and 2010, were Brazilians, in Portuguese language, with authors associated to nursing. The first category consisted of five studies, of which the 15 most frequent diagnoses were reported; related to physiological changes of pregnancy. With special reference to the diagnoses Knowledge, deficient; Sleep pattern disturbance; Nausea; and Risk for infection. The second category consisted of seven studies that investigated the presence of nursing diagnoses in patients with diseases such as Hypertension Syndrome of Pregnancy, Premature Rupture of Membranes, Preterm Labor, Acquired Immunodeficiency Syndrome, Iron-deficiency Anemia, i.e. high-risk pregnancies. In this category, diagnoses tended to appear separately in each study, correlated with the pathology that affected the pregnant women who were being investigated. The 33 most frequent diagnoses were highlighted, with emphasis on the diagnoses: Knowledge, deficient; Risk for infection; Acute pain; Impaired home maintenance; Anxiety; Fear; and Ineffective health maintenance. The third and final category consisted of two studies that investigated how the nursing diagnoses Fatigue; Sleep deprivation; and Sleep pattern disturbance occur in pregnancy. The diagnoses portrayed in the review were related to biological, psychological, social and family aspects of the pregnant women, which meets the need to investigate the pregnant woman integrally, as well as to provide holistic care to this population and family. This integrative review followed the appropriate methodological rigor and identified and assessed the nursing diagnoses in pregnant women. Moreover, it allowed the theoretical deepening on the evidence-based practice, the integrative review methods, the nursing diagnoses and the nursing process related to pregnancy. We identified the need to develop experimental or quasi-experimental studies involving the topics of nursing diagnoses in pregnant women, since studies in this review were classified as evidence level VI. Understanding that efforts are needed to develop researches with designs that produce strong evidence related to the issue, thus, raising the generalization of findings. With this review, we aimed to encourage nurses to consume search results, as well as to produce researches that result in a quality clinical practice, helping the health promotion of pregnant women, their fetuses and family. And, above all, for the Evidence-Based Nursing.

Adverse childhood experiences (ACEs) play a role in the development of chronic mental and physical diseases in adulthood. These experiences include adversities such as: emotional/verbal abuse, sexual abuse, physical abuse, and household dysfunction. In this study, we hypothesize that forensic mental health offenders will have higher ACE scores than community participants. Secondly, we hypothesize that these participants will show higher rates of and earlier incidences of offending, arrest, incarceration, and hospitalization as a result of their ACE scores. Further, we hypothesize that males and females will be affected by ACEs differently. Using archival data from a secure forensic psychiatric facility in the Midwestern US, data were collected from 211 participants, of which 80% were males and 18% females. The ages of the participants ranged from 23 to 72 with a median age of 43. Using SPSS software, we were able to determine frequency of the ten categories of abuse, maltreatment, and familial dysfunction as included in the original ACE research. Correlations were run to determine the relationship between ACEs and criminal behavior. Statistical comparisons were also run to examine the differences between males and females. ACE score significantly correlated with age at first psychiatric admission. Males and females were significantly different with regard to ACE score. However, other variables were not significant and suggest that future research need to more deeply examine these differences, and additional variables that may determine criminal outcomes in high-risk samples.

Previous research has shown a large genetic influence over personality traits, especially sensation seeking. One gene thought to influence this behavioural trait is the dopamine-4-receptor gene (DRD4), in which variants have been associated with sensation seeking and novelty seeking in some, but not all studies. The inconsistencies between studies may be due to heterogeneity in both the behaviours and the populations being assessed. Some studies included only males and few studies have a priori analyzed males and females separately. SS has been associated with high-risk sports, including skiing; however, this is the first study to address the possibility that genetics may play a role in individuals’ inclination towards SS in sport. Using the Contextual Sensation Seeking Questionnaire for Skiing (CSSQ-S), developed and validated for this study, and the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), levels of SS in males and females were analyzed in association with the alleles of a polymorphism in the dopamine-4-receptor, -521 C/T (a C or a T at position -521). Behavioural analysis of skiers (N = 200) revealed a significant correlation (r²= .506, p < .001) between skier behaviour (CSSQ-S) and skier personality score (ZKPQ) for sensation seeking. Genotype analysis (N = 74) revealed allele frequencies of .58 C and .42 T and an over-representation of the C allele was found in the population of skiers compared with a general Caucasian population (p < .01). In females, a significant association was found between the homozygous C/C genotype and high levels of contextual skiing SS behaviour (N = 36, p = .006, η² = .2), along with a non-significant trend between ZKPQ impulsive SS scores and the alleles of -521 C/T (p = .086). No association, however, was found in males (N=38, p ZKPQ = .473, p CSSQ-S = .345). This study supports the hypothesis that alleles of the DRD4 -521 C/T polymorphism are associated with context-specific SS behaviours, however only in females. Social pressures may differentially influence male and female sensation-seeking behaviour which may explain the lack of association in males, though this hypothesis requires further investigation.

There is minimal information available regarding test characteristics of the Rourke and the NDDS, two tools commonly used to screen for developmental delay. The objectives are to (a) generate preliminary descriptive data about the population and outcomes of interest, (b) determine test characteristics of the tools compared to the gold standard assessment, BSITD-III. Thirty-six month old children at high risk of developmental delay were recruited from the Perinatal Follow-up Program at the IWK Health Centre in Halifax, NS. The Rourke and NDDS results were obtained via parental report, the BSITD-III via clinical assessment. Results suggest that both tools may possess appropriate test characteristics to screen for developmental delay. Both perform more accurately when the criterion for delay is extended to two flagged areas of concern on the assessment tools. In conclusion, both tools appear to be sensitive to detecting developmental delay. Further investigation via a full scale study is warranted.

The feminist qualitative research undergirding this thesis focuses on the Nova Scotia high risk case coordination program, a protocol used to flag and coordinate woman abuse cases where there is a risk of serious injury or lethality. The research involved interviews with twenty-nine abused women in the high risk protocol, as well as focus groups with service providers implementing the protocol, including police, victim services, transition houses, men’s intervention programs, corrections and child welfare.The data collected through this research illuminated three broad themes regarding societal responses to woman abuse: the need to rethink the approach to the abuser, the need to rethink the approach to the victim, and the need to avoid one-size-fits-all solutions.The research also highlighted tensions and contradictions within the dominant domestic violence discourse. This thesis attempts to move beyond the dichotomous “either/or” thinking reflected in many of the current policies and programs relating to woman abuse.

The overall aim of the present study was to contribute to the argument put forward by Burt, Chmiel and Hayes (2009) that trust in the context of employee selection and training can be negative for safety. The present study builds on these authors argument that new employees pose a safety risk and any effort to build trust in the safety behaviours of new team members and/or to reduce perceptions of the safety risk of new employees (e.g. through selection and training) could likely have negative consequences. The research was conducted in eight organisations from the manufacturing, construction, engineering and rail industries which are characterised by high accident rates (Statistics New Zealand, 2008). There were 118 participants which completed an anonymous occupational safety questionnaire. The participants were employees who worked in teams in high risk industries characterised by a history of turnover. The results supported past findings in that trust in selection and training was positively correlated with immediate trust in new team members. There were mixed results regarding the hypothesis that trust in selection and training is negatively correlated with perceived risk from new team members. In particular there was some support for this hypothesis at the highest job risk level. The results supported the hypothesis that there is a positive correlation between the number of selection and training processes used by organisations and immediate trust in new team members. The results also indicated that the previous safety outcomes of new team members acts as a mediator between trust in selection and training, and immediate trust in new team members. Results are discussed in terms of the concerns and implications for organisations aiming to reduce accident rates.

Previous research has shown a large genetic influence over personality traits, especially sensation seeking. One gene thought to influence this behavioural trait is the dopamine-4-receptor gene (DRD4), in which variants have been associated with sensation seeking and novelty seeking in some, but not all studies. The inconsistencies between studies may be due to heterogeneity in both the behaviours and the populations being assessed. Some studies included only males and few studies have a priori analyzed males and females separately. SS has been associated with high-risk sports, including skiing; however, this is the first study to address the possibility that genetics may play a role in individuals’ inclination towards SS in sport. Using the Contextual Sensation Seeking Questionnaire for Skiing (CSSQ-S), developed and validated for this study, and the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), levels of SS in males and females were analyzed in association with the alleles of a polymorphism in the dopamine-4-receptor, -521 C/T (a C or a T at position -521). Behavioural analysis of skiers (N = 200) revealed a significant correlation (r²= .506, p < .001) between skier behaviour (CSSQ-S) and skier personality score (ZKPQ) for sensation seeking. Genotype analysis (N = 74) revealed allele frequencies of .58 C and .42 T and an over-representation of the C allele was found in the population of skiers compared with a general Caucasian population (p < .01). In females, a significant association was found between the homozygous C/C genotype and high levels of contextual skiing SS behaviour (N = 36, p = .006, η² = .2), along with a non-significant trend between ZKPQ impulsive SS scores and the alleles of -521 C/T (p = .086). No association, however, was found in males (N=38, p ZKPQ = .473, p CSSQ-S = .345). This study supports the hypothesis that alleles of the DRD4 -521 C/T polymorphism are associated with context-specific SS behaviours, however only in females. Social pressures may differentially influence male and female sensation-seeking behaviour which may explain the lack of association in males, though this hypothesis requires further investigation.