This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background.¿ The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites' choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology.¿ Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results.¿ This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions.¿ Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice.¿ This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.

The Birth Centre is a midwife-led, out-of-hospital facility for normal births in Winnipeg, Manitoba. Exploring women’s experiences of choosing the Birth Centre was the primary objective for this thesis. Through a feminist perspective and using interpretative phenomenological analysis (IPA), each participant’s idiographic description of the decision-making experience was analysed. A sample of seventeen women participated in in-depth interviews. Six themes emerged through the qualitative analysis: Exercising personal agency; Making the decision in the context of relationships; An expression of one’s ideology; Really thinking it through; Fitting into the eligibility criteria; and The psychology of the space. The findings suggest that a woman’s sense of safety is related to these themes. The women had a normal birth influence in their lives from personal relationships, past experiences, or personal values and beliefs. The study highlighted the importance of access to midwifery services in order to increase awareness and access to the Birth Centre.

Investigation of the historically informed performance movement with regard to its influence on violoncello playing since 1981 is approached in this critical commentary through the analysis of three different interpretations of Haydn’s Cello Concerto in C major. These interpretations are recordings by prominent cellists who have influenced or been influenced by the rise in popularity of the historically informed performance movement, namely Anner Bylsma, Pieter Wispelwey and Yo-Yo Ma. The critical commentary includes a brief summary of the musical careers of each individual and reports on the publicity surrounding them in an attempt to discover each performer’s views on the importance of historical performance practice and the extent to which these views are reflected in their performances. In order to establish what constitutes a historically informed interpretation of Haydn’s Cello Concerto, this document provides a brief background to the historical performance movement and also to the work itself. In the critical commentary, this work is analysed in relation to six specific aspects of historically informed interpretation: instrumentation, pitch, vibrato, tempo, ornamentation and cadential improvisation. By examining and comparing these aspects in the aforementioned twentieth-century recordings, this critical commentary concludes in support of Taruskin’s (1984) position on the now fashionable debate of historical performance practice. Namely, that the historical performance movement has been influenced as much by modern taste and aesthetics as by the attempt to create historically ‘accurate’ music.

Investigation of the historically informed performance movement with regard to its influence on violoncello playing since 1981 is approached in this critical commentary through the analysis of three different interpretations of Haydn’s Cello Concerto in C major. These interpretations are recordings by prominent cellists who have influenced or been influenced by the rise in popularity of the historically informed performance movement, namely Anner Bylsma, Pieter Wispelwey and Yo-Yo Ma. The critical commentary includes a brief summary of the musical careers of each individual and reports on the publicity surrounding them in an attempt to discover each performer’s views on the importance of historical performance practice and the extent to which these views are reflected in their performances. In order to establish what constitutes a historically informed interpretation of Haydn’s Cello Concerto, this document provides a brief background to the historical performance movement and also to the work itself. In the critical commentary, this work is analysed in relation to six specific aspects of historically informed interpretation: instrumentation, pitch, vibrato, tempo, ornamentation and cadential improvisation. By examining and comparing these aspects in the aforementioned twentieth-century recordings, this critical commentary concludes in support of Taruskin’s (1984) position on the now fashionable debate of historical performance practice. Namely, that the historical performance movement has been influenced as much by modern taste and aesthetics as by the attempt to create historically ‘accurate’ music.

Investigation of the historically informed performance movement with regard to its influence on violoncello playing since 1981 is approached in this critical commentary through the analysis of three different interpretations of Haydn’s Cello Concerto in C major. These interpretations are recordings by prominent cellists who have influenced or been influenced by the rise in popularity of the historically informed performance movement, namely Anner Bylsma, Pieter Wispelwey and Yo-Yo Ma. The critical commentary includes a brief summary of the musical careers of each individual and reports on the publicity surrounding them in an attempt to discover each performer’s views on the importance of historical performance practice and the extent to which these views are reflected in their performances. In order to establish what constitutes a historically informed interpretation of Haydn’s Cello Concerto, this document provides a brief background to the historical performance movement and also to the work itself. In the critical commentary, this work is analysed in relation to six specific aspects of historically informed interpretation: instrumentation, pitch, vibrato, tempo, ornamentation and cadential improvisation. By examining and comparing these aspects in the aforementioned twentieth-century recordings, this critical commentary concludes in support of Taruskin’s (1984) position on the now fashionable debate of historical performance practice. Namely, that the historical performance movement has been influenced as much by modern taste and aesthetics as by the attempt to create historically ‘accurate’ music.

Thesis (Ph. D.)--University of Toronto, 2004. / Adviser: Michele Peterson-Badali.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 1998. / Vita. Includes bibliographical references (leaves 152-164).

Thesis (DClinPsychol)-Salomons Centre. BLDSC no.DX220778.

Descreve e analisa a dinâmica psicossocial da identidade, considerando a participação do individuo em um grupo denominado amor e união, que faz parte do movimento de solidariedade no desemprego, organizado pela associação paulista de solidariedade no desemprego (apsd). Parte do pressuposto de que ha uma relação significativa entre a participação e as formas de sociabilidade que os indivíduos desenvolvem dentro do grupo e as mudanças que ocorrem em suas identidades. Os ss são 6 mulheres do grupo amor e união, sediado no jardim Elisa Maria-SP, com idade entre 27 e 41 anos. Efetua o trabalho de campo durante 3 anos (1984-87), através do método de pesquisa participante, realizando, no ultimo ano, as observações sistemáticas e entrevistas com os membros do grupo. Analisa os dados com base nas teorias de George Mead, Peter Berger, Thomas Luckman e Jurgen Habermas, confirmando o pressuposto apresentado e demonstrando que ocorrem mudanças em torno da participação dos membros; que o grupo se torna um outro generalizado para seus integrantes e que isto ocorre de forma diferenciada entre eles. Conclui que a afirmação da identidade do grupo esta, em grande medida, na negação parcial do agente socializador, que e a apsd. Desta forma, a identidade deve ser entendida não só como igualdade mas, principalmente, como alteridade e contradição / This essay aims to describe and analise the basic psycho-social dynamics of the identity of a Unemployment Solidarity group Amor e União, taking into consideration the participation of the individual in this group. The group is part of the Unemployment Solidarity Movement, coordinated by the Unemployment Solidarity I Association of São Paulo (APSD). The basic supposition of this study is that there is a significant relation between participation and the forms of sociability that are developed by the individuals within the group, and the changes that occur in their identities. The analysis demonstrates that changes did occur as a result of this participation and that the group acts as a generalized other\" for its participants in a distinct way for each of them. Another important conclusion is that the afirmation of the identity of the group lies to a great extent in the partial denial of the model of the socializing agent, wich is the APSD. This conclusion indicates an understing of identity not only as equality or equivalence but, above all, as otherness\" and contradiction. Four authors - George H. Mead, Peter Berger, Thomas Luckmann and Jurgen Habermas - have been linked in the theoretical back-up to the study and the field work carried out trough participative research

El consentimiento informado es una de las aportaciones más innovadoras e importantes de la ciencia jurídica a la medicina. Pues en el ámbito de la medicina, la concepción tradicional de la relación médico-paciente ha sido paternalista, es decir, una relación en la que el médico era considerado como un sabio, capaz de tomar las decisiones más adecuadas para el paciente respecto al tratamiento que éste debía seguir, sin tener en cuenta su voluntad; en cambio el paciente, era considerado un individuo carente de racionalidad e incapaz de saber lo que le conviene para mejorar su salud. Hoy en día, resulta indiscutible la función esencial que cumple la autonomía de la voluntad del paciente, por el cual se le atribuye un papel mucho más activo y participativo en la toma de decisiones frente al que tenía en generaciones pasadas. Ello implica, el reconocimiento del derecho que tiene el paciente a decidir lo que resulta mejor para sus intereses, esto es, la autonomía que tiene para consentir o rechazar un procedimiento, diagnóstico o terapia recomendado. Como consecuencia de este reconocimiento, es que surge en garantía de éste el derecho a la información, ello como una manifestación de protección a la salud. Y es que resulta indiscutible el carácter fundamental de este derecho en las relaciones médico-paciente, cuyos avances en investigación clínica y el rápido desarrollo de la tecnología médica han hecho que se planteen nuevas medidas y normativas con miras a proteger los derechos de los pacientes. 7 Por tanto, la presente investigación tiene por objeto el realizar un estudio jurídico sobre el consentimiento informado en las relaciones médico-paciente tanto en el ámbito nacional como en el internacional. Y es que el consentimiento informado como tal, no ha sido un tema frecuentemente desarrollado a profundidad por la doctrina e incluso por los tratados de biomedicina; ello quizás porque su aplicabilidad se ha visto reducido a la elaboración de un complejo protocolo del acto médico a realizar, lo que finaliza con la aceptación por parte del paciente. El asombro e indignación que este hecho causa, acompañado además de la insensibilidad del médico por explicar con claridad el proceso a seguir y de las posibles complicaciones que puede generar este procedimiento o tratamiento, así como la vulneración del derecho a la información que tiene todo paciente, nos ha conducido a desarrollar esta investigación por capítulos, en los cuales de manera clara y sencilla se explica la problemática, los objetivos de la investigación, su regulación y el planteamiento de posibles soluciones. Tal es el caso, que en el Capítulo I se describe de forma concreta la problemática de la presente investigación, estableciendo las hipótesis a responder, la importancia y los objetivos a obtener. Seguidamente, el Capítulo II desarrollamos el derecho a la salud como derecho fundamental de todo ser humano, derecho importante para definir posteriormente al consentimiento informado, toda vez que éste es una manifestación del mencionado derecho y que por ende merece ser tratado a profundidad a fin de determinar su importancia. 8 En el Capítulo III, hacemos un breve recuento de los antecedentes históricos del consentimiento informado, expresado en sus inicios a través de la jurisprudencia norteamericana en cuyos casos, se explica y se trata con detalle por primera vez el término consentimiento informado. El Capítulo IV, se darrolla el contenido, titular y momento del Consentimiento Informado. Asimismo, el Capítulo V se explica el tratamiento del consentimiento informado tanto en el ordenamiento jurídico como en la jurisprudencia nacional; así como en la normativa y jurisprudencia internacional, en específico de los países de Costa Rica y España. En el capítulo VI, se desarrolla la ausencia del consentimiento informado, punto relevante ya que ante la omisión de brindar la información al paciente, este hecho constituye una vulneración no sólo al derecho a la información del paciente sino que también, vulnera los derechos a la salud, a la determinación y a la dignidad que todo ser humano por su condición de tal posee. Finalmente, el Capítulo VII abarca la propuesta legislativa como posible solución ante el incorrecto uso de este derecho, toda vez que no se subsume a un simple protocolo o formulario escrito, sino que su principal objetivo es mantener informado de forma clara y comprensible al paciente, de manera que éste puede otorgar su consentimiento en un total plano de conciencia-juicio de valor sobre la situación dada.