<p>Ett av EU:s främsta syfte är att skapa fri rörelse av kapital. Genom att kontinuerligt reducera handelshinder strävar de efter att skapa lika förutsättningar mellan medlemsstaterna. I och med den globalisering som skett och fortfarande sker blir det allt mer vanligt förekommande att svenska bolag konkurrerar och samverkar med andra europeiska bolag.</p><p>Mycket har hänt på redovisnings- och revisionsområdet det senaste decenniet vilket har gjort att den svenska lagstiftningen delvis har skrivits om och anpassats efter EG:s direktiv. Internationella redovisningsstandarder har fått stort inflytande på framförallt de stora svenska bolagen. Dessa standarder var ursprungligen anpassade för börsnoterade bolag vilket har medfört att mindre svenska bolag under de senaste åren ålagts orimligt omfattande redovisningsskyldigheter. I november 2004 presenterade Justitiedepartementet en promemoria vilken bland annat avsåg förenklade redovisningsregler. Deras bedömning var att de två gränsvärdena som i dag benämns i ÅRL och BFN bör samordnas till ett gemensamt. Motiveringen till detta var att små och medelstora bolag i större utsträckning bör undantas från betungade regler gällande bokföring och bokslut. Under vintern 2005/2006 har en lag-rådsremiss och en proposition offentliggjorts där remissinstanserna BFN, FAR, SRS m.fl. givit uttryck för sina åsikter. Detta resulterade i att delvärdena i den samordnade gränsvärdet fastställdes till 50 anställda, 25 miljoner kronor i balansomslutning samt 50 miljoner kronor i totala intäkter.</p><p>Syftet med denna uppsats är att utreda vilka konsekvenser detta får för de små och medelstora bolagen i Sverige. Undersökningen har genomförts ur två perspektiv, dels för att återspegla de generella konsekvenserna med harmoniseringen och dels vilka konsekvenser det samordnade gränsvärdet blir redovisningsmässigt. För att uppnå syftet genomfördes fyra expertintervjuer. Resultatet av dessa var att redovisningsprinciperna blir något förenklade men eftersom förslaget ej trätt i laga kraft ännu är det svårt att peka på konkreta konsekvenser. Dock kan man förutse vissa skillnader avseende bland annat delårsrapportering, balansering av egenupparbetade immateriella anläggningstillgångar och restvärdesavskrivningar.</p><p>Efter att ha tagit del av respondenternas svar samt vad som sägs i lagrådsremissen kan vi konstatera att förändringarna på flera plan går mot att uppgifter ej är lagstadgade utan snarare styrs av intressenterna. Delårsrapporter är en sådan uppgift, då det ej åligger revisionsplikt på dem ser vi det som en naturlig utveckling att ta bort den lagstadgade uppgiftsskyldigheten för K3 – bolagen.</p><p>Vidare diskuteras huruvida K2 – blocket kommer innefatta bolag med allt för stora skillna-der i omfattning av verksamhet och hur detta skulle kunna undvikas. Vi föreslår en höjning av K1-blocket från tre till fem miljoner kronor i nettoomsättning där aktiebolag ej ska in-kluderas. Anledningen till detta är att få bort de minsta bolagen ur K2 – blocket genom att fler bolag bör överväga alternativa bolagsformer för att undvika allt för omfattande redovisningsmässiga skyldigheter.</p><p>Från och med den första januari 2007 träder ett nytt regelverk beträffande redovisningsprinciper i kraft i Sverige. Regelverket är delvis utformat efter EU:s redovisningsdirektiv och är ett steg i harmoniseringen. De bolag som vid årsskiftet skall till-lämpa det nya regelverket är de som ej överskrider det nya 50/25/50 - värdet, dvs. K1 och K2 - bolagen. För större bolag, K3 samt K4, kommer reglerna träda i kraft med det räkenskapsår som påbörjas första januari 2010.</p> / <p>One of EU:s primary purposes is to create freedom of movement for capital. Through continuous reducing of trade obstacles they strive to create equal conditions between the member nations. Through the globalization that has taken place and still is taking place it is increasingly common for Swedish companies to compete and cooperate with European companies.</p><p>A lot has happened in the accounting and auditor area during the last decade which has forced the Swedish legislation partly to be rewritten and adjusted to EG directives. International accounting standards has had a great deal of influence on the major Swedish companies. These standards are originally adapted for stock exchange introduced companies which in the last couple of years have resulted in unreasonable extensive accounting obligations for smaller Swedish companies. In November 2004 the ministry of Justice presented a memorandum which among other things intended to simplify accounting obligations. Their assessment was that the two threshold values that today are termed in ÅRL and BFN should be coordinated into one common threshold. The motivation for this was that small and medium companies in a greater extent should be able to make exceptions from onerous rules concerning bookkeeping and closure. During the winter 2005/2006 a referral and a government bill was made public where BFN, FAR and SRS gave expression of their opinions. This resulted in that the partial value in the coordinated threshold was established to 50 employees, 25 million in balanced turnover and 50 million in total reve-nue.</p><p>The purpose of this paper is to investigate which consequences this will have to the small and medium companies in Sweden. The investigation has been carried out through two perspectives, one to reflect the general consequences with the harmonious and also which consequences the coordinated threshold value will bring to the accounts. To reach the pur-pose four expert interviews were carried out. The conclusion of these interviews was that the accounting standards will be a bit more simplified but since the proposal has not yet become legally binding it is hard to point to concrete consequences. We can still predict to a certain extend with respect to among other things; quarterly reports, balancing of non-material internally acquired inventory and depreciation of residual values.</p><p>After studying the respondents’ answers and the referral we can establish that the changes on several levels will progress to the point of information not being statutory but rather controlled by interest organisations. Quarterly reports are that sort of task, when it is not mandatory audit on this sort of report we can not see any reason not to remove the statu-tory information obligation for the K – 3 companies.</p><p>The thesis further discusses whether the K2 – block will include companies with much too large differences in the extent of activity and how this should be avoided. We suggest a raise of the K-1 block from three too five million in net turnover, where joint-stock companies not will be included. The reason for this is to get rid of the smallest companies in the K-2 block; more companies should consider alternative company forms to avoid all too extensive accounting obligations.</p><p>Starting on the first of January 2007, the new regulation concerning accounting principles will take effect in Sweden. The regulations are partly designed according to the EU:s ac-counting directives and are a step in the harmonious direction. Those companies who will apply the new regulation at the turn of the year are those which do not exceed the new 50/25/50 value i.e. K-1 and K-2 companies. For the bigger companies, K-3 and K-4, the new regulation takes effect with the accounting year that starts on the first of January 2010.</p>

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Résumé : Contexte : La participation des patients et de leurs proches au processus de choix de soins ainsi que l’implication des différents professionnels de la santé dans ce processus sont des priorités pour améliorer la qualité des soins. Objectifs : L ’objectif de cette recherche était de décrire comment le processus de communication entourant le choix de soins entre les professionnels, le patient et ses proches pouvait être amélioré dans le contexte de maladies graves. Suivant une perspective de recherche-action, ce projet visait également à élaborer une intervention pour favoriser ce processus. M éthode : Deux séries de quatre entretiens avec des professionnels de la santé du Centre de santé et de services sociaux de Rouyn-Noranda (CSSSRN) ont été menées entre 2009 et 2010. Les groupes représentaient des équipes (a) des soins intensifs et de l’urgence, (b) des étages de médecine et de chirurgie, (c) des soins de longue durée et de la réadaptation, (d) des soins à domicile et de cliniques externes. La première série d’entretiens a fait l’objet d’une analyse thématique alors que la deuxième série a fait l’objet d ’un questionnement analytique. Résultats : Vingt-sept et 29 participants représentant 9 professions de la santé ont respectivement participé aux entretiens de la première et de la deuxième série. La première série d’entretiens a révélé que tous les professionnels de la santé jouent un rôle dans le processus de communication entourant le choix de soins. Des stratégies utilisées par les professionnels pour favoriser la participation du patient et de ses proches à ce processus sont aussi ressorties de même que des moyens de communication utilisés entre les professionnels. Un outil de communication multidisciplinaire a été conçu à la lumière des résultats et la feuille de Niveaux d ’intervention thérapeutique (NIT) du CSSSRN a été modifiée. La deuxième série d ’entretiens a mis en relief qu’un outil de communication multidisciplinaire permettrait une meilleure reconnaissance des rôles joués par les professionnels non médecins et qu’un outil avec des choix d’objectifs de soins plutôt que des niveaux d ’interventions favoriserait la participation des professionnels non médecins, du patient et de ses proches au processus de choix de soins. Enfin, la pertinence d’un outil de référence avec des stratégies de communication pour discuter des choix de soins a été soulignée. Conclusion : Ce projet de recherche-action a permis de mieux connaître les rôles que jouent les professionnels non médecins dans la communication entourant le choix de soins et de faire ressortir des pistes de solution pour améliorer l’impact de leur participation et en accroître la légitimité. Finalement, trois outils pour améliorer la communication entourant le choix de soins ont été élaborés dans le cadre de cette recherche-action. // Abstract : Background : The involvement of patients, patients' kin and health care professionals in the communication surrounding the medical decision making process must be improved to insure health care quality. Objectives : The objective of this research was to describe how the communication between a patient, his kin and his health professionals could be improved in regards to the medical decision making process for severe illnesses. Following an action research perspective, this project also aimed to develop an intervention to facilitate this process. Method : Two rounds of four group interviews were conducted with professionals from a regional health center in northern Quebec (Centre de sante et de services sociaux de Rouyn-Noranda: CSSSRN) between 2009 and 2010. The groups represented teams from (a) the intensive care unit and the emergency room, (b) medical and surgical wards, (c) long term care and rehabilitation, (d) home care and specialized outpatient clinics. The transcripts from the first round of interviews were submitted to a thematic analysis while the ones from the second round were submitted to an analytical questioning. Results : Twenty-seven and 29 participants representing 9 health care professions participated to the interviews of the first and second rounds respectively. The first round of interviews revealed that all the health care professionals are involved in the communication associated with the medical decision making process. Strategies used by professionals to improve the participation of patients and patients' kin in the process of choosing care were identified, as well as relevant means of communication used by the professionals amongst themselves. The results inspired the development of a multidisciplinary communication tool and the revision of the decision-making tool used in the health center where the research was conducted. The second round of interviews demonstrated that a multidisciplinary communication tool could allow a better acknowledgement of the roles played by non-doctor professionals, and that a decision-making tool with goals of care rather than levels of care could improve the participation of patients, patients' kin and health care professionals in the choice of care. Finally, a reference tool guiding the communication surrounding the medical decision making process was suggested. Conclusion : This action research project allowed a better understanding of the roles played by non-doctor professionals in the communication surrounding the medical decision making process, and suggested solutions to improve the impact and the legitimacy of their involvement. Finally, three tools to improve the communication around choices of care were developed.

本篇研究目的在於藉由分析句法直接性(syntactic directness)、語意修飾(semantic modification)以及內容 (content)來探討漢語母親規範語中的控制行為(control acts)，也就是指令(directives)和禁止(prohibitions)。語料來自一名以漢語為母語的母親與兒童之間的日常對話。研究結果顯示，指令隨著兒童年紀增長而遞減，而禁止卻隨著兒童年紀增長而遞增。句法直接性分析結果發現，不論指令或是禁止的情況下，漢語母親常使用祈使句(imperative)的句式。語意修飾方面結果發現，漢語母親主要是採用未修飾(bald)以及縮小(minimization)。內容方面顯示，指令常使用在從事能力活動(competent action)，而禁止常使用在得體行為(appropriate behavior)和自立(caretaking)。 / The purpose of this study is to investigate Mandarin maternal control acts including the directives and prohibitions in maternal regulatory language by analyzing syntactic directness, semantic modification, and content. The data collected were natural conversations of one Mandarin-speaking mother-child dyad. The data of maternal regulatory language was analyzed when the child’s ages were 2;1, 2;7, 3;1, and 3;7. The results show that the frequency of directives decreases with the child’s age, but the frequency of prohibitions increases. In addition, the preferred sentence type is imperative in both directives and prohibitions. The child’s cognitive development and the culture factors which would determine the style of regulatory language used by the Mandarin mother are discussed. Furthermore, the results of semantic modification reveal that bald and minimization are two dominant modifications. The mother’s adoption of bald and minimization may be influenced by her power status and politeness. Two major kinds of semantic combinations are also discovered in this study. Finally, the results of contents show that competent action often occurs in directives. As for prohibitions, appropriate behavior and caretaking are most related. Our finding would shed some light on the Mandarin maternal regulatory language.

Introdução: O avanço tecnológico da medicina, sem dúvida trouxe aspectos positivos ao homem como salvar vidas. Em contrapartida, tem contribuído de forma desmedida para o prolongamento dessas, o que tem gerado diversos questionamentos do ponto de vista bioético principalmente na área da Terapia Intensiva. Ambiente esse, que com frequência se depara com pacientes em fase de terminalidade da vida e com perda da capacidade de exercício da autonomia. Objetivos: Avaliar o posicionamento dos médicos que atuam em Unidades de Terapia Intensiva (UTIs) diante de diretivas antecipadas de vontade (DAV) de pacientes e como objetivos específicos, avaliar o conhecimento e valores associados às DAV; identificar possíveis fatores que possam interferir na tomada de decisão; avaliar o desenvolvimento psicológico-moral destes médicos como meio de verificar a capacidade de tomada de decisão e comparar estas características, entre os médicos que atuam em Belém do Pará e em Porto Alegre. Métodos: Estudo transversal de base populacional, envolvendo UTIs de seis hospitais públicos, cinco no Pará e um no Rio Grande do Sul. Dois instrumentos foram utilizados para a coleta dos dados, um questionário autopreenchido composto por dados sociodemográficos e características dos profissionais, questões relacionadas ao tema e quatro diferentes cenários clínicos apresentados para avaliar o posicionamento dos médicos. O segundo instrumento buscou avaliar o desenvolvimento psicológico-moral dos profissionais. Os dados foram avaliados de forma quantitativa e qualitativa. Resultados: Os 115 participantes da pesquisa apresentaram uma média de idade de 40,59±9,06 anos. A maioria relatou prática religiosa (54,8%) com associação estatisticamente significativa entre os grupos estudados (p<0,001), em Belém 76,4% dos médicos praticavam uma religião e em Porto Alegre 35%, predominando a religião católica. Dentre os participantes, a maioria tinha mais de 10 anos de formado (66,9%), o mesmo se observando com o tempo de atuação em UTI (50,4%). Dentre esses, a maioria era Intensivista (63,5%). Três associações significativas foram observadas em relação às especialidades: a titulação em Medicina Intensiva, se associou com Porto Alegre (P<0,001) e a Cirurgia Geral (P<0,001) e ausência de titulação especializada (P<0,005) com Belém. Quanto ao desenvolvimento psicológico-moral, observou-se quatro estágios: conformista (2,5%), consciencioso (44,1%), autônomo (44,1%) e integrado (6,8%). Quanto ao conhecimento sobre DAV, a maioria dos participantes (83,5%) afirmou conhecer. Com relação à utilização desse instrumento, (80,9%) foi favorável, seguido dos que talvez utilizasse (14,8%) e não utilizaria (4,3%), com associação significativa entre os grupos (P=0,013), evidenciando-se, resposta "sim" para Porto Alegre e "não" para Belém. A principal justificativa para a utilização das DAV foi a autonomia (67,7%). Entre os participantes que talvez utilizasse esse documento, a justificativa foi que, esse poderia limitar a decisão (29,3%). Na necessidade de uma legislação específica, a maioria dos médicos foi favorável (88,7%), havendo uma associação estatisticamente significativa (P=0,045), entre os grupos, com Belém, se associando a uma posição mais legalista. A justificativa mais utilizada para uma legislação foi o amparo legal (53,9%). Em caso de legislação específica a maioria dos médicos (81,7%) acataria a DAV. No primeiro cenário, a maioria dos médicos (94,0%) levaria em consideração a vontade do paciente em diferentes níveis, havendo uma associação significativa entre os grupos (P=0,004). No segundo cenário, 80,0% considerou a vontade do paciente determinante. No terceiro, (96,5%) levaria em consideração a vontade do paciente em diferentes graus, com destaque (71,3%) para a vontade do paciente ser determinante, com associação significativa entre os grupos (P=0,003). No quarto cenário, a maioria dos médicos (86,1%) também levaria em consideração a vontade do paciente em diferentes graus, com associação significativa (P=0,001) entre os grupos. Quanto à justificativa para implantar ou não implantar terapêutica fútil, (83,5%) consideraram ambas justificáveis, com significância estatística entre os grupos (P=0,001). Quanto aos fatores que influenciam a tomada de decisão, os mais frequentes foram, os aspectos éticos (94,8%), legais (88,7%), morais (73,9%), técnicos (67,0%) e aspectos religiosos do paciente (52,2%). Conclusão: É possível concluir que os médicos participantes deste estudo conhecem e utilizariam as diretivas antecipadas de vontade, mas reconhecem a necessidade de ter um amparo legal específico para esta questão. Os dados gerados neste estudo, evidenciam que os médicos valorizam a vontade dos pacientes e buscam realizar decisões compartilhadas. Além disto, fica evidente a influencia regional nos fatores associados ao processo de tomada de decisão. / Introduction: Technological advancements in the medical field have undoubtedly brought forth positive aspects to man such as saving lives. On the other hand, these advancements have contributed fearlessly to prolong these lives raising a great deal of questioning from a bioethical viewpoint mainly in the area of Intensive Therapy. Such area frequently deals with patients in the end of life and some who has lost the capacity to exercise autonomy. Objectives: to evaluate the opinion of physicians who work at Intensive Care Units (ICUs) regarding advance directives (AD) of patients and as specific objectives to evaluate the knowledge and values associated to AD; identify possible factors that can interfere with decision making process; evaluate the psychological-moral development of these physicians as a means to exam their capacity to make decision and compare these features between physicians who work in Belém do Pará and in Porto Alegre. Method: This is a transversal study based on population involving ICUs of six public hospitals five in Pará and one in Rio Grande do Sul. Two tools were used in data collection process, a self-completed questionnaire composed of social demographic data and features of the professional, questions related to the theme and four different settings were presented to evaluate the position of the physicians. The second tool sought to assess the psychological-moral development of the professionals. The data were assessed in terms of quantity and quality. Results: The 115 participants in the research were between de 26 a 63 years old, with mean age 40,59±9,06. Most of them reported some kind of religious practice (54,8%) showing significant statistic association between the groups evaluated (p<0,001), in Belém 76,4% of the physicians had some religious practice and in Porto Alegre 35%, Catholicism predominating. Amongst the participants most of them had been graduated for more than 10 years (66,9%), the same was seen regarding time of activity at ICU (50,4%). Most of these were Intensive Care Physicians (63,5%). Three significant associations were perceived in relations to the specialties: entitling in Intensive Medicine associated to Porto Alegre (P<0,001) and General Surgery (P<0,001) and the lack of specialized entitling (P<0,005) to Belém. Regarding to psychological-moral development, four stages were observed: conformist (2,5%), conscientious (44,1%), autonomous (44,1%) and integrated (6,8%). In regard to knowledge of AD, most of the participants (83,5%) claimed to know it. In relation to the use of this tool (80,9%) was favorable, followed by those who would maybe use it (14,8%) and those who would not use it (4,3%), showing significant association between the groups (P=0,013), evidencing the answer "yes" for Porto Alegre and "no" for Belém. The main justification for the use of AD was the autonomy (67,7%). Among the participants who would maybe use such document, the justification was that it could hinder the decision (29,3%). As for the necessity of specific legislation, most of the physicians were favorable (88,7%) revealing a significant statistic association (P=0,045) between the groups, where Belém associated to a more legalistic position. The most common justification for legislation was legal support (53,9%). In case of specific legislation most of the physicians (81,7%) would comply with the AD. In the first setting, most of the physicians (94,0%) would take into account the will of the patient in different levels revealing a significant association between the groups (P=0,004). In the second setting 80,0% considered the patient’s will as determinant. In the third (96,5%) would consider the patient’s will in different degrees highlighting (71,3%) the patient’s will as determinant, with significant association between the groups (P=0,003). In the fourth setting, most of the physicians (86,1%) would also consider the patient’s will in different degrees with significant association (P=0,001) between the groups. As regards the justification to introduce or not futile therapy (83,5%) considered both justifiable showing significant statistic between the groups (P=0,001). Related to the factors that influence decision making, the most frequent were ethical (94,8%), legal (88,7%), moral (73,9%), technical (67,0%) and the religious aspects of the patient (52,2%). Conclusion: It is possible to conclude that the physicians participating in this study know and would use advance directives, but they recognize the need of specific legal support in this matter. Data resulting from this study reveal that physicians value the will of the patient and seek to make shared decisions. Furthermore, the regional influence is evident in the factors related to decision making process.

The United Kingdom (UK)’s transposition of the European Directive on motor insurance (the Directive) is shot through with provisions that fall below the minimum standard of compensatory protection for accident victims prescribed under this superior law. These expose third party victims to the risk of being left undercompensated, or recovering nothing at all. The author’s research has demonstrated that the handful of cases that had previously been perceived as isolated anomalies in the UK’s transposition of this European law are in fact symptomatic of a more extensive and deep-rooted nonconformity. His published articles over the past five years were the first to reveal the prevalence of this problem and the resulting lack of legal certainty. He has been the first to offer detailed proposals for reform, as well as fresh insights into legal remedies potentially available to private citizens affected by these irregularities. Sections 2 and 3 of this paper are a summary of the author’s views covered in his various articles and research into the causes and effects of this disparity. They explain that whilst both the UK and European Union’s legislature share a policy objective the different approaches to achieving that end have resulted in different standards of compensatory protection. Section 4 recounts the author’s empirical approach that led him to undertake the first comprehensive comparative law analysis in this field. Section 5 explains the original, if sometimes controversial, nature of the author’s case commentaries, articles and official reports proposing reform. Section 6 sets out the author’s contribution to legal knowledge and practice in this area. This includes his opinion, contrary to long established precedent, that the Directive is capable of having direct effect against the Motor Insurers’ Bureau.

A dignidade da pessoa humana e a autonomia privada espraiam-se pela experiência da vida, alcançando a doença e a morte. As diretivas antecipadas, gênero dos quais são espécies o testamento vital e o mandato duradouro, constituem negócio jurídico de caráter existencial que têm por objetivo assegurar a realização da dignidade da pessoa e o cumprimento dos atos de autonomia nas situações em que a pessoa estiver incapacitada para manifestar sua vontade. As diretivas representam instrumento de autodeterminação através do qual a pessoa disciplina os tratamentos médicos que aceita ou não ser submetida, autoriza doação de órgão, estipula se tem interesse em conhecer seu estado clínico e/ou nomeia terceira pessoa para tomar estas decisões em seu lugar. As três primeiras hipóteses constituem o que usualmente se qualifica como testamento vital, enquanto a última situação descrita configura o mandato duradouro. O objeto de estudo abrange a evolução das diretivas antecipadas, a disciplina existente em países que já regulamentaram o tema, a legitimação no sistema jurídico brasileiro (o que autoriza a conclusão favorável a sua utilização independentemente de lei expressa) e a sistematização deste negócio jurídico perante o ordenamento jurídico. / Human dignity and autonomy get extended through life, reaching illness and death. The advanced directives, which species are the living will and durable power of attorney, represent an existential act aimed to fulfill human dignity and to preserve ones autonomy when lacking the ability of transmitting ones desire personally (disability). The advance directives are an instrument of self-determination that may contain clauses to withheld or withdraw medical treatment, authorize organ donation, discipline the right to know ones medical condition and to indicate an attorney for health care, to whom will be delegate those decisions. The object of study covers the evolution of the advance directives, their discipline in the countries that already legislate about it, the source of legitimation in brazilian Law system (what includes a positive understanding on its usage even though without a specific law) and the guide lines of the act, such as form and legitimacy.

Hereby submitted thesis {\clqq}EC law contravened by member state`` describes duties of member states regarding the harmonization of national rules of law to the communitary one. Thesis shows consequences of correct or incorrect conversion of superordinated communitary rules of law to national legal systems using concrete cases (examples) from Czech legal practice.

Introdução: O avanço tecnológico da medicina, sem dúvida trouxe aspectos positivos ao homem como salvar vidas. Em contrapartida, tem contribuído de forma desmedida para o prolongamento dessas, o que tem gerado diversos questionamentos do ponto de vista bioético principalmente na área da Terapia Intensiva. Ambiente esse, que com frequência se depara com pacientes em fase de terminalidade da vida e com perda da capacidade de exercício da autonomia. Objetivos: Avaliar o posicionamento dos médicos que atuam em Unidades de Terapia Intensiva (UTIs) diante de diretivas antecipadas de vontade (DAV) de pacientes e como objetivos específicos, avaliar o conhecimento e valores associados às DAV; identificar possíveis fatores que possam interferir na tomada de decisão; avaliar o desenvolvimento psicológico-moral destes médicos como meio de verificar a capacidade de tomada de decisão e comparar estas características, entre os médicos que atuam em Belém do Pará e em Porto Alegre. Métodos: Estudo transversal de base populacional, envolvendo UTIs de seis hospitais públicos, cinco no Pará e um no Rio Grande do Sul. Dois instrumentos foram utilizados para a coleta dos dados, um questionário autopreenchido composto por dados sociodemográficos e características dos profissionais, questões relacionadas ao tema e quatro diferentes cenários clínicos apresentados para avaliar o posicionamento dos médicos. O segundo instrumento buscou avaliar o desenvolvimento psicológico-moral dos profissionais. Os dados foram avaliados de forma quantitativa e qualitativa. Resultados: Os 115 participantes da pesquisa apresentaram uma média de idade de 40,59±9,06 anos. A maioria relatou prática religiosa (54,8%) com associação estatisticamente significativa entre os grupos estudados (p<0,001), em Belém 76,4% dos médicos praticavam uma religião e em Porto Alegre 35%, predominando a religião católica. Dentre os participantes, a maioria tinha mais de 10 anos de formado (66,9%), o mesmo se observando com o tempo de atuação em UTI (50,4%). Dentre esses, a maioria era Intensivista (63,5%). Três associações significativas foram observadas em relação às especialidades: a titulação em Medicina Intensiva, se associou com Porto Alegre (P<0,001) e a Cirurgia Geral (P<0,001) e ausência de titulação especializada (P<0,005) com Belém. Quanto ao desenvolvimento psicológico-moral, observou-se quatro estágios: conformista (2,5%), consciencioso (44,1%), autônomo (44,1%) e integrado (6,8%). Quanto ao conhecimento sobre DAV, a maioria dos participantes (83,5%) afirmou conhecer. Com relação à utilização desse instrumento, (80,9%) foi favorável, seguido dos que talvez utilizasse (14,8%) e não utilizaria (4,3%), com associação significativa entre os grupos (P=0,013), evidenciando-se, resposta "sim" para Porto Alegre e "não" para Belém. A principal justificativa para a utilização das DAV foi a autonomia (67,7%). Entre os participantes que talvez utilizasse esse documento, a justificativa foi que, esse poderia limitar a decisão (29,3%). Na necessidade de uma legislação específica, a maioria dos médicos foi favorável (88,7%), havendo uma associação estatisticamente significativa (P=0,045), entre os grupos, com Belém, se associando a uma posição mais legalista. A justificativa mais utilizada para uma legislação foi o amparo legal (53,9%). Em caso de legislação específica a maioria dos médicos (81,7%) acataria a DAV. No primeiro cenário, a maioria dos médicos (94,0%) levaria em consideração a vontade do paciente em diferentes níveis, havendo uma associação significativa entre os grupos (P=0,004). No segundo cenário, 80,0% considerou a vontade do paciente determinante. No terceiro, (96,5%) levaria em consideração a vontade do paciente em diferentes graus, com destaque (71,3%) para a vontade do paciente ser determinante, com associação significativa entre os grupos (P=0,003). No quarto cenário, a maioria dos médicos (86,1%) também levaria em consideração a vontade do paciente em diferentes graus, com associação significativa (P=0,001) entre os grupos. Quanto à justificativa para implantar ou não implantar terapêutica fútil, (83,5%) consideraram ambas justificáveis, com significância estatística entre os grupos (P=0,001). Quanto aos fatores que influenciam a tomada de decisão, os mais frequentes foram, os aspectos éticos (94,8%), legais (88,7%), morais (73,9%), técnicos (67,0%) e aspectos religiosos do paciente (52,2%). Conclusão: É possível concluir que os médicos participantes deste estudo conhecem e utilizariam as diretivas antecipadas de vontade, mas reconhecem a necessidade de ter um amparo legal específico para esta questão. Os dados gerados neste estudo, evidenciam que os médicos valorizam a vontade dos pacientes e buscam realizar decisões compartilhadas. Além disto, fica evidente a influencia regional nos fatores associados ao processo de tomada de decisão. / Introduction: Technological advancements in the medical field have undoubtedly brought forth positive aspects to man such as saving lives. On the other hand, these advancements have contributed fearlessly to prolong these lives raising a great deal of questioning from a bioethical viewpoint mainly in the area of Intensive Therapy. Such area frequently deals with patients in the end of life and some who has lost the capacity to exercise autonomy. Objectives: to evaluate the opinion of physicians who work at Intensive Care Units (ICUs) regarding advance directives (AD) of patients and as specific objectives to evaluate the knowledge and values associated to AD; identify possible factors that can interfere with decision making process; evaluate the psychological-moral development of these physicians as a means to exam their capacity to make decision and compare these features between physicians who work in Belém do Pará and in Porto Alegre. Method: This is a transversal study based on population involving ICUs of six public hospitals five in Pará and one in Rio Grande do Sul. Two tools were used in data collection process, a self-completed questionnaire composed of social demographic data and features of the professional, questions related to the theme and four different settings were presented to evaluate the position of the physicians. The second tool sought to assess the psychological-moral development of the professionals. The data were assessed in terms of quantity and quality. Results: The 115 participants in the research were between de 26 a 63 years old, with mean age 40,59±9,06. Most of them reported some kind of religious practice (54,8%) showing significant statistic association between the groups evaluated (p<0,001), in Belém 76,4% of the physicians had some religious practice and in Porto Alegre 35%, Catholicism predominating. Amongst the participants most of them had been graduated for more than 10 years (66,9%), the same was seen regarding time of activity at ICU (50,4%). Most of these were Intensive Care Physicians (63,5%). Three significant associations were perceived in relations to the specialties: entitling in Intensive Medicine associated to Porto Alegre (P<0,001) and General Surgery (P<0,001) and the lack of specialized entitling (P<0,005) to Belém. Regarding to psychological-moral development, four stages were observed: conformist (2,5%), conscientious (44,1%), autonomous (44,1%) and integrated (6,8%). In regard to knowledge of AD, most of the participants (83,5%) claimed to know it. In relation to the use of this tool (80,9%) was favorable, followed by those who would maybe use it (14,8%) and those who would not use it (4,3%), showing significant association between the groups (P=0,013), evidencing the answer "yes" for Porto Alegre and "no" for Belém. The main justification for the use of AD was the autonomy (67,7%). Among the participants who would maybe use such document, the justification was that it could hinder the decision (29,3%). As for the necessity of specific legislation, most of the physicians were favorable (88,7%) revealing a significant statistic association (P=0,045) between the groups, where Belém associated to a more legalistic position. The most common justification for legislation was legal support (53,9%). In case of specific legislation most of the physicians (81,7%) would comply with the AD. In the first setting, most of the physicians (94,0%) would take into account the will of the patient in different levels revealing a significant association between the groups (P=0,004). In the second setting 80,0% considered the patient’s will as determinant. In the third (96,5%) would consider the patient’s will in different degrees highlighting (71,3%) the patient’s will as determinant, with significant association between the groups (P=0,003). In the fourth setting, most of the physicians (86,1%) would also consider the patient’s will in different degrees with significant association (P=0,001) between the groups. As regards the justification to introduce or not futile therapy (83,5%) considered both justifiable showing significant statistic between the groups (P=0,001). Related to the factors that influence decision making, the most frequent were ethical (94,8%), legal (88,7%), moral (73,9%), technical (67,0%) and the religious aspects of the patient (52,2%). Conclusion: It is possible to conclude that the physicians participating in this study know and would use advance directives, but they recognize the need of specific legal support in this matter. Data resulting from this study reveal that physicians value the will of the patient and seek to make shared decisions. Furthermore, the regional influence is evident in the factors related to decision making process.

In this essay, I have investigated whether players of World of Warcraft change their language to suit the gender of the character they play. I have researched if there are gender differences that correspond to what is defined as male and female language in mixed-sex conversations. Chat-logs, collected during four participant observations, were used for making an analysis based primarily on research by Coates (1993) and Yale (2007). Seven features were selected for analysis: amount of participation, hedges, questions, directives and commands, taboo language, compliments and grammar. It was possible to discover gender differences, but these were not consistent in all areas of research. For example, female characters had a higher contribution than males, as well as a higher use of hedges and tag-questions among males, which contradicts previous research. The lack of consistency might be due to the fact that the participants do not specifically consider all areas as typically female or male, or their unawareness of these tendencies. We also need to consider disagreement in previous gender studies as well as folklinguistic belief. The explanation of the lack of consistent differences may be a more equal relationship between males and females in this context, or due to thepossibility that the participants, who are usually male, make use of their normal male language.