Introdução: A episiotomia é intervenção instituída rotineiramente no Brasil, a partir da hospitalização do parto, em meados do século XX. Tida como facilitadora do parto no período expulsivo, vem sendo questionada pelas evidências científicas. Comprovou-se que a intervenção não impede lacerações importantes, incontinência urinária, dispareunia ou disfunções sexuais, e é associada a mais dor pós-parto e a complicações da episiorrafia. No Brasil, há médicos que fazem o procedimento rotineiramente, enquanto outros a praticam de modo seletivo ou, mais raramente, nunca o fazem. Este estudo buscou compreender o processo por meio do qual tais profissionais aprenderam e iniciaram sua prática, se esta foi revista, e as razões do posicionamento técnico e ético quanto ao procedimento, na atualidade. Objetivos: descrever e analisar o processo vivenciado pelos médicos obstetras, e que os levou ao posicionamento com relação à prática da episiotomia, tendo em vista sua formação, sua prática, o posicionamento de seus pares e o ambiente institucional. Método: Trata-se de estudo qualitativo, com análise temática a partir do referencial de gênero. A população de estudo foi composta por 12 médicos(as) obstetras que atendiam partos pela via vaginal, obedecendo ao método snowball. Os dados foram obtidos por meio de entrevistas norteadas por questões semiestruturadas. Resultados: A educação médica, no recorte da episiotomia, dá-se em escalonamento hierárquico, sem que o aluno aprenda por meio de professor, mas entre alunos, do mais graduado para o menos graduado. Transmite-se a insegurança técnica e o impedimento de questionar as indicações, a segurança do procedimento ou lesões decorrentes. Não se discute a autonomia da paciente, os direitos reprodutivos, o direito à integridade corporal ou a real informação para o consentimento. Vários entrevistados relatam dificuldades para deixar de praticar a episiotomia, o que resulta de pressão exercida pelos pares, pela corporação e pela instituição em que atende. Conclusões: É imprescindível a reforma na educação médica, para que professores, atualizados com as evidências científicas, transmitam as técnicas de modo adequado às taxas preconizadas internacionalmente. Sugerese alterar a didática e conteúdo de disciplina que discuta bioética, tornando-a mais conectada com a prática e a ética médica, além de contextualizar a lei vigente. Conclui-se, enfim, pela necessidade de exigir a justificativa em prontuário para a intervenção, a anotação de toda episiotomia realizada e de toda lesão espontânea, além da aplicação de ferramentas de segurança da paciente, adotando uma assistência que promova a integridade genital no parto. / Introduction: Episiotomy is an intervention routinely established in Brazil, from birth hospitalization, in mid-twentieth. Considered as a facilitative intervention in the expulsive stage of birth, it has been questioned by scientific evidences. It was concluded that the intervention does not prevent main lacerations, urinary incontinence, either dyspareunia or sexual dysfunction, and is related to after-birth pain and complications developed from episiorrhaphy. In Brazil, there are physicians that perform it routinely, while some perform it selectively or never use it. This ressearch aimed to understand the way those professionals learned and started their practice, if it has been reviewed, and the reasons for their technical and ethic positioning about the intervention, nowadays. Objective: Describe and analyze the process experienced by obstetricians, and what took them to their positioning regarding to episiotomy practice, in terms of their professional education, their practice, their peers positioning and institutional environment. Method: This is a qualitative study, with thematic analysis, based on gender references. The study population was composed by 12 obstetricians, who attended vaginal births, following snowball method. Data were obtained by interviews guided by semi-structured questions. Results: The medical education, on episiotomy, occurs in a hierarchical scheduling, and the student doesnt learn through a teacher, but through a more graduate student, resulting on technical uncertainty and the impossibility to question indications, the procedure safety or resulting injuries. Patient autonomy, reproductive rights, body integrity or information to the consent are not questioned. Many physician finds it difficult to stop practicing episiotomy, because of intense pressure from peers, corporative and institution. Conclusions: Some changes are essential in medical education, so that teachers, updated on scientific evidences, transmit the techniques adequately to the internationally recommended rates. It is suggested to change teaching and disciplines that discuss bioethics, making it more connected with the practice and medical ethics, and contextualize it to the current law. It follows, finally, the need to require physicians to justify interventions in medical charts, the annotation of all performed episiotomy and all spontaneous lacerations, as well as applying patient safety tools, adopting an assistance that promotes genital integrity at birth.

This research is situated within the practice-led method, enabling me as a playwright to gain stimulus for creating trauma informed plays. The framework for creating such plays in this research is the centre-periphery concept (Ashcroft, Griffiths and Tiffin, 2013, 43) situated with the imagined nation as backdrops for understanding postcolonial trauma. In order to gain stimulus for playwriting in this research, I explored Chinua Achebe's Things Fall Apart and Wole Soyinka's Death and the King's Horseman to understanding postcolonial trauma in my part of Africa, being Nigeria. I also explored other sources for the purpose of gaining stimulus from embedded trauma motifs, useful for writing The Longest Snake, The Endless Walk and the Alternative plays. The Alternative plays draw meanings from the initial plays and are interventive and socio-dramatic; revealing how trauma may be understood from other perspectives. The originality of this research and contribution to knowledge may be perceived in the new plays which incorporate trauma notions; the role of the 'circle' in conceptualisation and the use of the 'centre-periphery' concepts as template for playwriting and analysis. The originality may also be inferred from the interventive relevance of the created plays, touching on how postcolonial trauma may be understood from the lens of the imagined nation, and events in the centre-periphery context. It is also important to mention how the collectives are traumatically affected by the negative effects of colonisation as mirrored in the textual sources explored. Equally relevant are my personal experiences and the African folklore and folktale milieu, which are relevant for understanding postcolonial trauma through praxis; reiterating Gray and Marlins' (2016: 2) thoughts that 'We learn most effectively by doing - by active experience, and reflection on that experience,' which may be seen in the context of the practice-led approach I adopted in this research.

Introdução O direito à escolha informada das mulheres sobre suas vivências na gravidez e no parto é fruto do percurso histórico dos direitos sexuais e reprodutivos, respaldados em bases éticas da autonomia, integridade corporal, igualdade e diversidade. No Brasil, sua história política e social vem sendo construída por meio da interlocução com o movimento de mulheres e os aparelhos governamentais, propulsionando políticas públicas que os garantam. Entretanto, as desigualdades de gênero no âmbito do conhecimento médico-científico levaram a uma leitura pessimista acerca do corpo feminino, que trata a experiência do parto como um evento patológico, dependente da tecnologia e de intervenções desnecessárias na assistência. Objetivo Descrever e analisar a perspectiva das mulheres sobre a dinâmica da disponibilização, acesso e qualidade das informações no pré-natal para as negociações do tipo de parto e os procedimentos da assistência focados na episiotomia, ocitocina e acompanhante, nas redes de saúde pública e suplementar. Metodologia Estudo qualitativo, alicerçado nas perspectivas teóricas de gênero e dos direitos reprodutivos, realizado por meio de entrevistas semiestruturadas de três tipos (por email, Skype e presencial), com 26 mulheres assistidas nos dois setores de saúde, em diversas regiões do país. Resultados Embora garantido pela política pública, ainda é difícil o acesso das mulheres às informações de qualidade que favoreçam suas escolhas e decisões de parto e intervenções na assistência. Essa dificuldade está imbricada em fatores sociais, econômicos, culturais e de gênero que transferem o poder de decisão sobre o tipo de parto e de intervenções no parto normal para os profissionais médicos e suas instituições. Conclusões Frequentemente, a disponibilização das informações no pré-natal foi insuficiente nos dois setores de saúde, revelando o silêncio em torno do parto. No pré-natal, as mulheres não são incentivadas à busca ativa por informações; e, quando elas existem, são imprecisas e desconsideram os seus direitos reprodutivos. Mesmo quando existe o acesso às informações da rota específica da humanização não há total garantia da possibilidade de negociação. Além disso, nem todas as mulheres conseguem acessá-la. De modo geral, a informação, isoladamente, não representou a possibilidade de êxito para as decisões no parto, dadas às diversas dificuldades que os mecanismos profissionais e institucionais impõem às mulheres / Introduction The right of women to informed choice about their experiences of pregnancy and childbirth is the result of the historical journey of sexual and reproductive rights, supported on ethical foundations of autonomy, bodily integrity, equality and diversity. In Brazil, its political and social history is being constructed through dialogue with the women\'s movement and the government apparatus, propelling public policies that guarantee these rights. However, gender inequalities within the medical and scientific knowledge led to a pessimistic approach to the female body, resulting in an a experience of childbirth as a pathological event, dependent on technology and unnecessary interventions in care. Objective To describe and analyze the women\'s perspective on the dynamics of availability, access and quality of information on prenatal care for the negotiations of the type of delivery and the procedures of care, focused on episiotomy, oxytocin and companion in public and insurance- managed health services. Methodology A qualitative study, based on the theoretical perspectives of gender and reproductive rights, conducted through semi-structured interviews of three types (email, Skype and face), with 26 women who attended the two health sectors in various regions of the country. Results Although guaranteed by public policy, it is still difficult for women to access quality information that support their choices and decisions about interventions in childbirth care. This difficulty is embedded in social, economic, cultural and gender aspects that transfer the power to decide on the type of delivery and interventions in childbirth to medical professionals and their institutions. Conclusions Often, the availability of information on prenatal care was insufficient in both health sectors, revealing the \"silence\" around childbirth. In prenatal care, women are not encouraged to actively search for information, and when information is available it is often inaccurate and ignoring of women`s reproductive rights. Even when there is access to information coming from specific route of humanizade care is no complete assurance about the possibility of negotiation. Also, not all women are able to access it. In general, information alone does not represent the possibility of success for decisions in labor, given the various difficulties that professional and institutional mechanisms impose on women

O objetivo deste trabalho é analisar a relação que a peça Musik für Renaissance-Instrumente (1966), de Mauricio Kagel (1931-2008), estabelece com o material musical da tradição e das vanguardas, na segunda metade do século 20. A partir da definição de material musical em Adorno investigaremos historicamente a crítica que se delineia em sua peça com relação às posturas estéticas em questão. Este trabalho pretende refletir criticamente sobre o sentido do movimento de interpretação historicamente informada e dos movimentos de vanguarda, identificando suas convergências e afinidades estéticas. Por fim, nosso objetivo é traçar o sentido estético e filosófico da obra de Kagel no contexto musical de sua emergência, buscando refletir sobre a importância de sua obra para o contexto atual de produção musical. / The aim of this research is to analyze the relation established by Mauricio Kagel\'s Musik für Renaissance-Instrumente with traditional musical material and also with material built by the musical avant-garde from the second half of the 20th century. Based on the definition of musical material in Theodor Adorno\'s philosophy we also intend to investigate through historical perspective how Kagel\'s criticism in composition applies to both of the aforementioned tendencies. Furthermore a critical assessment of the historical interpretation movement as well as of the avant-garde has been carried out, with the main purpose of establishing their mutual aesthetical affinities. Lastly, our foremost objective was to outline the meaning of Kagel\'s composition in the context of its appearance, in order to ponder about its importance for contemporary context of musical production.

Introdução: A episiotomia é intervenção instituída rotineiramente no Brasil, a partir da hospitalização do parto, em meados do século XX. Tida como facilitadora do parto no período expulsivo, vem sendo questionada pelas evidências científicas. Comprovou-se que a intervenção não impede lacerações importantes, incontinência urinária, dispareunia ou disfunções sexuais, e é associada a mais dor pós-parto e a complicações da episiorrafia. No Brasil, há médicos que fazem o procedimento rotineiramente, enquanto outros a praticam de modo seletivo ou, mais raramente, nunca o fazem. Este estudo buscou compreender o processo por meio do qual tais profissionais aprenderam e iniciaram sua prática, se esta foi revista, e as razões do posicionamento técnico e ético quanto ao procedimento, na atualidade. Objetivos: descrever e analisar o processo vivenciado pelos médicos obstetras, e que os levou ao posicionamento com relação à prática da episiotomia, tendo em vista sua formação, sua prática, o posicionamento de seus pares e o ambiente institucional. Método: Trata-se de estudo qualitativo, com análise temática a partir do referencial de gênero. A população de estudo foi composta por 12 médicos(as) obstetras que atendiam partos pela via vaginal, obedecendo ao método snowball. Os dados foram obtidos por meio de entrevistas norteadas por questões semiestruturadas. Resultados: A educação médica, no recorte da episiotomia, dá-se em escalonamento hierárquico, sem que o aluno aprenda por meio de professor, mas entre alunos, do mais graduado para o menos graduado. Transmite-se a insegurança técnica e o impedimento de questionar as indicações, a segurança do procedimento ou lesões decorrentes. Não se discute a autonomia da paciente, os direitos reprodutivos, o direito à integridade corporal ou a real informação para o consentimento. Vários entrevistados relatam dificuldades para deixar de praticar a episiotomia, o que resulta de pressão exercida pelos pares, pela corporação e pela instituição em que atende. Conclusões: É imprescindível a reforma na educação médica, para que professores, atualizados com as evidências científicas, transmitam as técnicas de modo adequado às taxas preconizadas internacionalmente. Sugerese alterar a didática e conteúdo de disciplina que discuta bioética, tornando-a mais conectada com a prática e a ética médica, além de contextualizar a lei vigente. Conclui-se, enfim, pela necessidade de exigir a justificativa em prontuário para a intervenção, a anotação de toda episiotomia realizada e de toda lesão espontânea, além da aplicação de ferramentas de segurança da paciente, adotando uma assistência que promova a integridade genital no parto. / Introduction: Episiotomy is an intervention routinely established in Brazil, from birth hospitalization, in mid-twentieth. Considered as a facilitative intervention in the expulsive stage of birth, it has been questioned by scientific evidences. It was concluded that the intervention does not prevent main lacerations, urinary incontinence, either dyspareunia or sexual dysfunction, and is related to after-birth pain and complications developed from episiorrhaphy. In Brazil, there are physicians that perform it routinely, while some perform it selectively or never use it. This ressearch aimed to understand the way those professionals learned and started their practice, if it has been reviewed, and the reasons for their technical and ethic positioning about the intervention, nowadays. Objective: Describe and analyze the process experienced by obstetricians, and what took them to their positioning regarding to episiotomy practice, in terms of their professional education, their practice, their peers positioning and institutional environment. Method: This is a qualitative study, with thematic analysis, based on gender references. The study population was composed by 12 obstetricians, who attended vaginal births, following snowball method. Data were obtained by interviews guided by semi-structured questions. Results: The medical education, on episiotomy, occurs in a hierarchical scheduling, and the student doesnt learn through a teacher, but through a more graduate student, resulting on technical uncertainty and the impossibility to question indications, the procedure safety or resulting injuries. Patient autonomy, reproductive rights, body integrity or information to the consent are not questioned. Many physician finds it difficult to stop practicing episiotomy, because of intense pressure from peers, corporative and institution. Conclusions: Some changes are essential in medical education, so that teachers, updated on scientific evidences, transmit the techniques adequately to the internationally recommended rates. It is suggested to change teaching and disciplines that discuss bioethics, making it more connected with the practice and medical ethics, and contextualize it to the current law. It follows, finally, the need to require physicians to justify interventions in medical charts, the annotation of all performed episiotomy and all spontaneous lacerations, as well as applying patient safety tools, adopting an assistance that promotes genital integrity at birth.

In this thesis, I argue that the interdependence between personal identity and practical concerns is overstated. In paradigmatic places where philosophers and common sense suggest that personal identity constrains how we should reason and care, or vice versa, the two spheres are in fact neutral to each other. I defend this claim by considering four specific cases. First, a rough characterization of the distinction between the complex and the simple view is that the former takes personal identity to consist in other relations, whereas the latter does not. I argue that the extreme claim according to which the complex view fails to give reasons for future-directed concern can be resisted. We maintain forward-looking attitudes and projects not because someone will be us, but because we relate to future selves in other, more important ways. Second, I argue that intuitions in a range of popular imaginary cases are contaminated by practical concerns whose relevance for personal identity is far from straightforward. Third, I argue that on a closer look, the complex versus simple distinction is confused. It thus cannot be what grounds differences in judgements on what matters. Debates about personal identity should be framed in terms of better understood notions. Finally, I argue that it is not a constraint on rational transformative choice that decision-maker and transforming individual are identical. Moreover, whether we are deciding for ourselves or for others - the importance of informed consent for transformative treatments is not diminished by the decision-maker's failure to projectively imagine the outcomes.

Made available in DSpace on 2016-04-27T13:10:23Z (GMT). No. of bitstreams: 1 Adilson Peron.pdf: 1186813 bytes, checksum: 5ebb7419e0360630b3d63cef39acfe9f (MD5) Previous issue date: 2014-02-12 / Introduction: Cholelithiasis is very prevalent surgical disease, with approximately 60,000 admissions per year in the Unified Health System in Brazil (Sistema Único de Saúde - SUS). Is often asymptomatic or oligosymptomatic and major complications arise from the migration of calculi to biliary low tract. Despite these complications are severe and life threatening, many patients refuse surgical treatment. Objectives: To understand the reasons why individuals with cholelithiasis refuse cholecystectomy before complications inherent to the presence of gallstones in the bile duct and pancreatitis occur. Methods: To investigate the justifications for refusing to submit to surgery we performed individual interviews according to a predetermined script. In these interviews, we evaluate the degree of knowledge of individuals about the disease and its complications and the reasons for the refusal of surgical treatment. We interviewed 20 individuals with cholelithiasis who refused or postponed surgical treatment without a plausible reason. In these interviews, we apply the thematic analysis (MINAYO, 2006). Results: The majority of participants has good knowledge of their disease and its possible complications, were well oriented and had the right surgical indications by their physicians. The refusal for surgery is based primarily on negative experiences of themselves or family members with surgery, including anesthesia; unexplained fears of surgery and, some, cannot specify the reason for the denial or prefer to get the risk and wait for complications to then have to solve them compulsorily. Conclusions: The reasons for the refusal to surgical resolution of cholelithiasis are diverse, but are closely related to personal negative surgical experiences or related persons or complex problems of psychological nature that must be adequately addressed by the surgeon and other qualified professionals. Our study has the proposal of an informed consent that brings all the information about the surgery, its preoperative and postoperative risks, as well as figures with friendly format intended to inform and to help the patients in their decisions / Introdução: A colelitíase é uma doença de resolução cirúrgica muito prevalente, com aproximadamente 60.000 internações por ano no SUS. Muitas vezes é assintomática ou oligossintomática e as principais complicações advêm da migração dos cálculos para as vias biliares baixas. Apesar das complicações serem graves e com risco de morte, muitos pacientes se recusam ao tratamento cirúrgico. Objetivos: Entender as razões pelas quais os indivíduos com colelitíase recusam a colecistectomia antes que ocorram complicações inerentes à presença de cálculos na vesícula, nas vias biliares e a possível pancreatite. Métodos: Para conhecer as justificativas da recusa à cirurgia realizamos entrevistas individuais segundo um roteiro de perguntas pré-determinadas. Nestas entrevistas procuramos avaliar o grau de conhecimento dos indivíduos sobre a doença e suas complicações e as razões para a recusa do tratamento cirúrgico. Entrevistamos 20 indivíduos portadores de colelitíase que se recusavam ou adiavam sem uma justificativa plausível o tratamento cirúrgico. A estas entrevistas aplicamos a análise temática (Minayo, 2006). Resultados: A grande maioria dos entrevistados tem bom conhecimento de sua doença, das possíveis complicações, foram bem orientados e tiveram a indicação cirúrgica pelos seus médicos assistentes. A recusa para a cirurgia foi baseada (principalmente) em experiências negativas próprias ou de familiares com o ato cirúrgico, incluindo aí a anestesia; medos inexplicáveis do ato cirúrgico e alguns não conseguiram especificar a razão para a recusa, preferiram correr o risco e esperar pelas complicações para então ter que resolvê-las. Conclusões: As razões para a recusa à resolução cirúrgica da colelitíase são diversas, mas estão intimamente ligadas às experiências cirúrgicas negativas pessoais ou de pessoas relacionadas ou a complexos problemas de natureza psicológicas que devem ser adequadamente abordados pelo cirurgião e por outros profissionais habilitados. Nosso estudo faz a proposta de um termo de consentimento livre e esclarecido que traz todas as informações sobre a cirurgia, seus riscos pré e pós-operatório assim como figuras com formato amigável que pretendem informar e ajudar o paciente na sua decisão.

Prevention, social work, and community awareness programs have not led to the successful reduction of opioid overdose deaths nationwide, and particularly in Ohio. This study explored social work perspectives about trauma-€informed care (TIC) for persons with opioid use disorder in Ohio. The research questions for this study examined how social workers in Ohio implemented TIC when providing outpatient treatment to opioid users and what challenges they faced when providing TIC. Using an action research methodology, data were collected through individual semistructured interviews with 5 social work professionals, selected through purposive sampling based on experience in the field of substance use in Ohio and the use of TIC. Contemporary trauma theory and TIC were chosen to frame the research project. Three themes emerged through thematic analysis of the data: appreciation for trauma-€informed opioid use disorder treatment, organizational and professional challenges to the use of trauma-€informed opioid use disorder treatment, and environmental barriers to successful trauma-€informed outpatient opioid use disorder programming. The study aligned with the social work core values of competence and principles of harm reduction. The findings from the study might bring about social change by igniting dialogue among treatment providers about how TIC interventions could support integrated treatment and holistic approaches to combatting opioid addiction in Ohio.

Doctor of Philosophy / This arts-informed inquiry is grounded in the lived experiences of five self-proclaimed artists including the researcher, who have turned to careers in teaching at varying stages of their lives. The stories of their transitions and evolving identities as both artists and teachers provide the investigative focus for this study. Although this research is relevant to teachers more generally, it specifically focuses on those who have chosen to teach Visual Arts. Particularly suited to a postmodern, arts-informed inquiry, the diverse forms of knowing that create our everyday experiences are acknowledged. The researcher became the bricoleur who collaged the individual stories of the first year artist-teachers into an integrated work of art. This constructivist approach included the use of visual imagery to transcend linguistic description. Through artworks, photographs, a self-narrative and novelette, the multiple ways these early career Visual Arts teachers came to understand themselves and their journeys are explored. This study has the potential to inform novice teachers of the transitions they may experience as they enter the teaching profession. Possible challenges, including the recognition that idealised beliefs might be traded in for more realistic representations, are discussed along with the notions of teaching as an art and the concept of resilience.

實務界多將監視制度之實施效果定義為防止操縱市場。的確，國內股市一向投機氣氛濃厚、短線交易盛行，惟異常交易未必全導因於投機炒作，事實上，股市交易者交易目的有四種：一是風險分攤(risk sharing)，二是變現性交易(liquidity tradings)，三是具有訊息基礎的交易(information-based tradings)，四是炒作(manipulation)。異常交易宣告訊息在實證上，可以同時作為最可能發生市場訊息不對稱的樣本組，異常交易之肇致，究竟是否純係炒作造成，抑或具有訊息基礎的交易亦佔若干比重，應是一有趣之研究課題。 　　以下研究主題為本研究之重心： 　　1.在公告警示股票的漲跌方向，分為合併與漲幅、跌幅三類宣告來計算其累積異常報酬。 　　2.檢視股價之超額報酬與警示之宣告有無干預之效果。 　　3.檢視警示股票在警示前後其對訊息之衝擊反應有無差異，並探討警示宣告對股票之價格資訊性之影響。 　　4.檢視警示股票與非警示股票在對訊息之衝擊有無反應上的差異。 　　5.檢視警示股票對不同的交易量造成股票買賣價差的衝擊。 　　6.檢視前後期價格變動與前後期交易量之因果關係。 　　本研究有以下結論： 　　結論1.畢竟警示門檻為公開資訊，一異常交易投在警示宣告前，市場應可預期，而不應在警示後存在任何方向之顯著異常報酬；國內股票市場仍不能稱具有半強式效率。 　　結論2.股票受警示後具負異常報酬，顯示警示制度對飆漲股票確有干預作用。 　　結論3.警示前後一張一千股買單，所呈現之訊息大小好壞沒有差異。 　　結論4.在警示股與非警示股間一張一千股買單，對警示般的衝擊較大，顯示警示股對訊息反應較敏感。 　　結論5.警示股的報價修正與價差之影響都和買單大小成正比，股票普遍存在當期價量有回饋關係，前一期是當期價量關係之前因。顯示Information-based確為肇致異常交易之主因。 　　結論6.警示宣告後，訊息不對稱仍然存在，且不見有效降低。 　　結論7.警示後交易者對股價認知變異增加，由投資者對價差之調整過程可看出警示後投資者之過度反應的行為。有此現象可能因為有投資者認為是明牌股而購買，也有投資者怕因高風險而導致損失，故及早出脫，因此對股價有兩極化的看法。 　　結論8.警示宣告後，買單追隨買單情形降低，可能是風險增加導致原追買追賣交易者轉趨保守。