Esse estudo teve como objetivos identificar os diagnósticos de enfermagem presentes em pacientes em pós-operatório imediato de colecistectomia, submetidos à anestesia geral com base na Taxonomia II da North American Nursing Diagnoses Association (NANDA) e no Modelo Conceitual de Horta; analisar os diagnósticos de enfermagem presentes nesses pacientes em relação aos fatores relacionados, características definidoras e fatores de risco e em relação ao seu estabelecimento e resolução no pós-operatório imediato; dentre os pacientes estudados que apresentaram o Diagnóstico de Enfermagem de Dor aguda, identificar as manifestações de dor apresentadas no pós-operatório imediato e compará-las com as características definidoras apresentadas pela NANDA e por outras literaturas. Para a etapa de coleta de dados, foi elaborado e validado um instrumento de coleta de dados com base no Modelo Conceitual de Wanda Horta. Foram avaliados 15 pacientes adultos no período pós-operatório imediato de colecistectomia laparoscópica, durante o período de setembro de 2004 a janeiro de 2005, no Centro de Recuperação Pós-anestésica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Para o estabelecimento dos diagnósticos de enfermagem, utilizou-se um modelo de processo raciocínio diagnóstico, sendo esses nomeados de acordo com a Taxonomia II da NANDA. Foram identificados nove diferentes diagnósticos de enfermagem: Integridade tissular prejudicada (100%), Risco para infecção (100%), Percepção sensorial perturbada (100%), Risco para aspiração (100%), Risco para função respiratória alterada (80%), Hipotermia (60%), Risco para temperatura corporal desequilibrada (40%), Nutrição desequilibrada: mais do que as necessidades corporais (33,3%) e Dor aguda (26,7%). Para cada diagnóstico foram identificados e discutidos os fatores relacionados e características definidoras. Os pacientes que manifestaram o diagnóstico de enfermagem de Dor aguda apresentaram as seguintes características definidoras: relato verbal, evidência observada, expressão facial e comportamento de defesa. Observamos que todas essas manifestações são características definidoras apresentadas pela NANDA (2002) para esse diagnóstico. Em relação ao seu estabelecimento e resolução no pós-operatório imediato, os diagnósticos de enfermagem Risco para aspiração, Percepção sensorial perturbada e Hipotermia foram resolvidos em 50 minutos após a sua identificação. Para os diagnósticos de Risco para função respiratória alterada, Risco para temperatura corporal desequilibrada e Dor aguda, o tempo médio de resolução foi de 63,7, 77,5 e 36 minutos, respectivamente. Destacamos que os diagnósticos de Integridade tissular prejudicada, Risco para infecção e Nutrição desequilibrada: mais do que as necessidades corporais estiveram presentes desde a admissão do paciente no Centro de recuperação pós-anestésica até o momento da alta do paciente. / This study aimed to identify what nursing diagnoses are present in patients who had been submitted to general anesthesia during the immediate post-operative period after cholecystectomy, based on North American Nursing Diagnoses Association (NANDA) Taxonomy II and on Horta?s Conceptual Model; to analyze the nursing diagnoses that were present in these patients in terms of related factors, defining characteristics and risk factors, as well as with respect to their development and solution in the immediate post-operative period; to identify, among those study participants who presented the Nursing Diagnosis of Acute pain, the pain manifestations they presented during the immediate post-operative period and to compare them with the defining characteristics presented by NANDA and other literature sources. With a view to data collection, we elaborated and validated a data collection instrument on the basis of Wanda Horta?s Conceptual Model. 15 adult patients were evaluated in the immediate post-operative period after laparoscopic cholecystectomy, between September 2004 and January 2005, at the Post-Anesthesia Recovery Center of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. The nursing diagnoses were established by means of a diagnostic reasoning process model, and were named in accordance with NANDA Taxonomy II. We identified nine different nursing diagnoses: Impaired tissue integrity (100%), Risk for infection (100%), Sensory perception alterations (100%), Risk for aspiration (100%), Risk for altered respiratory function (80%), Hypothermia (60%), Risk for imbalanced body temperature (40%), Altered nutrition: more than body needs (33,3%) and Acute pain (26,7%). For each diagnosis, we identified and discussed the related factors and defining characteristics. Patients with the nursing diagnosis of Acute pain presented the following defining characteristics: verbal report, observed evidence, facial expression and defense behavior. We observe that all of these manifestations are defining characteristics NANDA (2002) presented for this diagnosis. With respect to their development and solution during the immediate post-operative period, the nursing diagnoses Risk for aspiration, Sensorial perception alterations and Hypothermia were solved within 50 minutes after their identification. For the diagnoses Risk for altered respiratory function, Risk for imbalanced body temperature and Acute pain, average solution time was 63.7, 77.5 and 36 minutes, respectively. We highlight that diagnoses of Impaired skin integrity, Risk for infection and Unbalanced nutrition: more than body requirements were present from the patient admission on Post anesthesia Care Unit until the patient?s discharge.

Dados oficiais do censo escolar, produzidos e divulgados pelo Instituto de estudos e pesquisas educacionais Anísio Teixeira em 2009, confirmam a prevalência de 2/3 de meninos entre as matrículas da educação especial registradas no Brasil e no município de São Paulo, com uma ligeira predominância dos alunos brancos no Brasil e mais de 40% no município de São Paulo. No entanto, chama atenção o fato de mais de 38% dos alunos matriculados nessa modalidade não terem declarado sua cor/raça em nível nacional e pouco mais de 22% no município estudado. Estudos localizados sobre o tema diferenças de sexo, e de gênero e escolarização não são conclusivos e constatou-se número restrito de produções nacionais sobre esse assunto. A literatura estrangeira indica uma super-representação de meninos negros em serviços de educação especial encaminhados, principalmente, por questões culturais e socioeconômicas. Nesta pesquisa, de natureza qualitativa, pretendeu-se averiguar e analisar os motivos que embasam o encaminhamento dos alunos para Salas de recursos da rede municipal de São Paulo, com recorte de gênero e cor/raça, cotejando-os com orientações e/ou critérios oficiais para o seu encaminhamento. Para alcançar os objetivos desta tese, foi solicitado à Secretaria Municipal de Educação dados sobre a matrícula e o atendimento dos alunos atendidos nesse serviço. A análise das informações indicou-nos que a maioria dos alunos atendidos nas Salas de recursos em 2011 era composta por aqueles com deficiência intelectual sendo que havia mais estudantes do sexo masculino (60,52%) e que, em quase todos os tipos de deficiência e Transtorno global de desenvolvimento, registrou-se mais meninos atendidos do que meninas. A respeito da cor/raça dos alunos com deficiência intelectual, em 2011 a Rede municipal de ensino registrou supremacia no atendimento de alunos classificados como brancos, cerca de 84%, seguidos pelos pardos (57%), os não declarados (45%) e os pretos (11%). Para a segunda fase deste estudo, escolheu-se como delineamento de pesquisa o estudo de caso. A coleta de dados foi realizada em uma escola municipal paulistana de ensino fundamental, na qual foram entrevistadas a coordenadora pedagógica e a professora da sala de recursos, e também foram analisados os prontuários dos alunos que estavam em atendimento pela referida sala. Foram encaminhados questionários de caracterização socioeconômica para os alunos da Sala de recursos e para os seus colegas das classes comuns. A análise dos dados mostrou-nos que nessa escola a maioria dos alunos atendidos nessa sala possuía laudo clínico e não havia predominância de alunos negros, todavia, pode-se considerar, tal como em outros estudos brasileiros, que a professora tendeu a embranquecer alguns alunos. Em relação a situação socioeconômica, verificou-se que os alunos atendidos na Sala de recursos, tal como a amostra de estudantes das classes comuns da escola na qual realizamos a pesquisa, estavam inseridos na classe C. Desse modo, as condições de gestão e de trabalho pedagógico encontradas na escola pesquisada podem justificar os dados que não confirmam os estudos sobre gênero, cor/raça e educação especial. / Official data from the school census, produced and released by Instituto de estudos e pesquisas educacionais Anísio Teixeira in 2009, confirm the prevalence of 2/3 of boys between the enrollment of special education registered in Brazil and in São Paulo municipality, with a slight predominance of white students in Brazil and over 40% in São Paulo. However, it draw attention that more than 38% of the students enrolled in this modality have not declared their color/race nationally and just over 22% in the municipality. Studies located about gender differences and gender and schooling topic are not conclusive and it was found limited number of national productions on this subject. Foreign literature indicates an overrepresentation of black children in special education services directed mainly by socioeconomic and cultural issues. In this qualitative research, it was intended to assess and analyze the reasons for the referral of students to resource rooms in the municipality of São Paulo, looking at gender and race/color information, comparing them with guidelines and/or official criteria for their referral. To achieve the objectives of this thesis it was solicited to the Municipal Department of Education data about enrollment and attendance of students serve on this service. Analysis of the data indicated us that the majority of students served in resource rooms in 2011 was composed of those with intellectual disabilities and that there were more male students (60.52%) and that in almost all types of deficiency disorder and global development, there were more boys than girls attended. Regarding the color/race of students with intellectual disabilities, in 2011 the municipal school network recorded supremacy in serving students classified as white, about 84%, followed by brown (57%), the unreported (45%) and blacks (11%). For the second phase of this study, it was chosen as the research design case study. Data was collected in a municipal elementary school, where we interviewed the educational coordinator and the resource room teacher, and also analyzed the records of students who were in attendance by that room. Questionnaires were sent for the socioeconomic characterization of the students Resource room and their colleagues from common classes. Data analysis showed us that in this school most of the students served in the resource room had a clinical report and there was no predominance of black students, however, can be considered, as in other Brazilian studies, that the teacher tended to \"whiten\" some students. Regarding socioeconomic status, it was found that the students served in the resource room, such as the sample of students in regular classes in school which the survey was conducted, were classified in Class C. Thus, the conditions of management and pedagogical work found in the school where the study was carried on can justify the data that not confirm the studies on gender, color / race and special education.

Made available in DSpace on 2017-07-10T16:16:56Z (GMT). No. of bitstreams: 1 Eliane Pertile.pdf: 1300783 bytes, checksum: 5901f9178110708c11e0744e1fe1ff6b (MD5) Previous issue date: 2014-03-12 / The present study aimed to understand the proposal released by the Ministry of Education (MEC) for teaching work in Rooms Multifunction Resources (SRM), with students with intellectual disabilities. The survey was conducted through documentary and bibliographical study. On desk research, we selected regulations that establish special education in inclusive perspective and guiding materials for pedagogical issues, published by the MEC. The literature, in turn, made the analysis of these documents by understanding the social context that determines the depth and specificity on the development of people with intellectual disabilities, through the prism of Historical-Cultural Theory. We undertook an analysis of the underlying language meanings expressed in the documents as identification of intentionality that they serve. We understand that this approach is relevant considering that the SRM was disseminated nationally, gained prominence in referrals for special education in inclusive perspective and constituted as an official proposal to meet students, with priority space for the realization of Specialized Educational Services (ESA ). The study had developed the understanding that the argumentative framework expressed by advisors, published and disseminated by the MEC documents, is compatible with these principles in constructivist theory, presents a conception of human development spontaneist, sustained a biological understanding, the learner's own regulates their development and thus empties the mediations inherent in the process of schooling, since devalues school content and the act of teaching. Based on the research that we use, it was possible to understand that such guidelines are consistent with the formation of the right man for the composition of the workforce updated with the requirements of the contemporary production process. Thus, they predict a unilateral training with restricted and immediate acquisition of skills targeted at the work. We understand, therefore, that once they are in agreement with the demands of training expected to reproduction of existing conditions, the proposals for the teaching job does not converge to the humanization of individuals with intellectual disabilities / O estudo apresentado teve o objetivo de compreender a proposta divulgada pelo Ministério da Educação (MEC) para o trabalho docente nas Salas de Recursos Multifuncionais (SRM), junto a alunos com deficiência intelectual. A pesquisa foi realizada por meio de estudo documental e bibliográfico. Na investigação documental, selecionamos normativas que estabelecem a educação especial na perspectiva inclusiva e materiais orientadores para as questões pedagógicas, divulgados pelo MEC. A pesquisa bibliográfica, por sua vez, subsidiou a análise desses documentos por meio da compreensão do contexto social que os determina e do aprofundamento sobre a especificidade do desenvolvimento da pessoa com deficiência intelectual, sob o prisma da Teoria Histórico-Cultural. Empreendemos a análise dos sentidos subjacentes à linguagem expressa nos documentos como forma de identificação da intencionalidade a que estes atendem. Compreendemos que tal abordagem é relevante tendo em vista que a SRM foi disseminada nacionalmente, ganhou destaque nos encaminhamentos da educação especial na perspectiva inclusiva e se constituiu como proposta oficial para o atendimento aos alunos, sendo espaço prioritário para a realização do Atendimento Educacional Especializado (AEE). O estudo desenvolvido apresentou a compreensão de que o quadro argumentativo expresso pelos documentos orientadores, publicados e divulgados pelo MEC, é compatível com os princípios presentes na teoria Construtivista, apresenta uma concepção de desenvolvimento humano espontaneísta, sustentada num entendimento biológico, em que o próprio aluno regula seu desenvolvimento e, assim, esvazia as mediações inerentes ao processo de escolarização, uma vez que desvaloriza os conteúdos escolares e o ato de ensinar. Com base nos pesquisadores a que recorremos, foi possível entender que tais orientações são coerentes com a formação do homem adequado para a composição da mão de obra atualizada às exigências do processo produtivo contemporâneo. Assim, elas preveem uma formação unilateral, com aquisição de competências restritas e imediatas direcionadas para o trabalho. Compreendemos, portanto, que uma vez que estejam em concordância com as demandas da formação esperada para a reprodução das condições vigentes, as proposições para o trabalho docente não convergem para a humanização dos sujeitos com deficiência intelectual

Under 1950- och 1960-talet byggdes det många stadsdelstorg och centrum i Sverige tack vare den växande ekonomin som rådde i landet. Ett flertal av dessa platser är idag folktomma och ödsliga. Agö torg som ligger i Brynäs centrum är ett exempel på ett stadsdelstorg och centrum som byggdes under denna perioden och har sedan dess i stort sett förblivit oförändrat. Torget är ingen naturlig mötesplats i Gävle och det utnyttjas idag dåligt. Torget fungerar till största del som transportsträcka för de boende i stadsdelen för att komma till den service som finns i direkt anslutning till torget. Ett bra utformat torg är en plats där möjligheten för möten mellan människor är god och där det finns en attraktion och en funktion som inspirerar till att besöka och vistas på platsen. Torg är en del av det offentliga stadsrummet och är viktiga ingredienser i en stad för att öka livskvalitén. Syftet med denna studie är därför att ta reda på hur torget och centrumet kan utvecklas till en levande och användbar plats för de boende i stadsdelen och besökare. Två gestaltningsförslag har tagits fram. Ett gestaltningsförslag är baserat på mina egna kunskaper och ett gestaltningsförslag togs fram med hjälp av litteratur inom ämnet samt en inventering, enkät och observationer. Observationerna utfördes enligt Gehl och Svarres metoder. Förslagen jämfördes sedan mot nollalternativet, d.v.s. hur torget ser ut idag och hur det används idag. Detta gjordes med hjälp av multikriterieanalys (MKA) i form av analytisk hierarkisk process (AHP), observationer och en enkät som delades ut till besökare till torget. Resultatet efter AHP visar att både mitt förslag och förslaget som bygger på teori och metodik är en klar förbättring mot hur platsen är idag. Viktiga faktorer för att göra torget till en attraktiv mötesplats är tillgänglighet, trygghet, grönska, attraktioner samt kontemplation. Med den teoretiska bakgrunden och den insamlade empirin som underlag till ett gestalningsförslag som enligt den gällande landskapskonvetionen tar vara på natur och kulturvärden förefaller det finnas goda möjligheter att genomföra en förändring av Agö torg till en attraktiv mötesplats med gestaltningsförslagen som utgångspunkt. En förutsättning för att lyckas är att medborgarna fortsätter att engageras i utforming och framtida användning av Agö torg. / During the 1950s and 1960s, many urban squares and centers in Sweden were built thanks to the growing economy prevailing in the country. A number of these places are today desolate. Agö Square, located in Brynäs, is an example of a district square and center built during this period and has since then largely remained unchanged. The square is not a natural meeting place in Gävle and is currently being poorly used. The square works largely as the distance of transport for the residents of the district to get to the service that is directly adjacent to the square. A well-designed square is a place where the opportunity for meetings between people is good and where there is an attraction and a function that inspires to visit and stay on site. Squares are part of the public realm and are important ingredients in a city to enhance the quality of life. The purpose of this study is, therefore, to find out how the square and the center can be developed into a vivid and useful meeting place for residents of the district and visitors. Two proposals have been produced. The first proposal is based on my own knowledge and the second proposal were made using literature and an inventory, survey and observations. Observations were conducted according to Gehl and Svarre’s methods. The proposals were compared with the zero alternative, i.e. what the square looks like today and how it is used today. This was done using the multicriteria decision analysis (MCDA) through analytic hierarchy process (AHP), observations and a questionnaire that were distributed to visitors to the square. The result of the AHP shows that both my proposal and the proposal based on theory and methodology are a clear improvement in the way the site is today. Important factors for making the square an attractive meeting place are accessibility, security, greenery, attractions and contemplation. With the theoretical background and the collected empirics as the basis for a proposal which, according to the current landscape convention, takes on nature and cultural values, there seems to be good opportunities for implementing a change of Agö square into an attractive meeting place with the design proposals as a starting point. One prerequisite for success is that citizens continue to be engaged in the design and future use of Agö Square.

Na primeira parte do trabalho, foram investigados materiais ativos para eletro-oxidar etanol e acetaldeído seletivos para a rota C2 (Carbono 2) e, também, ativos para eletro-oxidar hidrogênio molecular, visando a aplicação em células a combustível de hidrogênio indireto. Neste tipo de célula, um processador de combustível externo desidrogena o etanol e os produtos desta reação, contendo H2, acetaldeído e, possivelmente, etanol residual, são direcionados para alimentar o ânodo. Neste sentido, o eletrocatalisador anódico pode ser ativo para a eletro-oxidação de etanol residual, bem como acetaldeído, mas este deve catalisar a reação via C2 com o objetivo de evitar a formação de espécies que envenenam a superfície catalítica (CO ou CHx), ou seja, a ligação C-C deve permanecer intacta. Os eletrocatalisadores bimetálicos foram formados por M/Pt/C (onde M = W, Ru ou Sn) e os produtos reacionais foram analisados por DEMS On-line. Os resultados mostraram que Ru/Pt/C e Sn/Pt/C apresentaram maiores taxas de reação global, no entanto, eles não foram seletivos. Por outro lado, W2/Pt3/C foi mais seletivo para a rota C2, dada a não formação de CH4 e CO2. Além disso, este material também foi ativo e estável para a eletro-oxidação de H2, mesmo na presença de acetaldeído, o que o torna um potencial catalisador para aplicação no ânodo de células a combustível de hidrogênio indireto. Na segunda parte do trabalho, o objetivo foi relacionado com o estudo de eletrocatalisadores seletivos para a rota C1 (Carbono 1). A oxidação eletroquímica do etanol e de seus produtos reacionais foram investigados por DEMS on-line em temperatura ambiente e intermediária (245oC). Para temperatura ambiente, utilizou-se solução aquosa de ácido sulfúrico (H2SO4) e, para temperatura intermediária, utilizou-se ácido sólido (CsH2PO4) como eletrólito. Os eletrocatalisadores investigados foram formados por SnOxRuOx-Pt/C e Pt/C. Em temperatura ambiente, os resultados de polarização potenciodinâmica mostraram uma maior atividade eletrocatalítica para o material SnOxRuOx-Pt/C, com eficiência de corrente para formação de CO2 de 15,6% contra 15,2% para Pt/C, sob condições estagnantes, sem controle por transporte de massa. O stripping de resíduos reacionais, após a eletro-oxidação de etanol bulk, sob condições de fluxo, mostraram o acúmulo de espécies com 1 átomo de carbono (CO e CHx) que causam o bloqueio dos sítios ativos e são oxidadas eletroquimicamente somente em mais altos potenciais (ca. 1,0 V). Por outro lado, as curvas de polarização a 245oC mostraram maiores valores de eficiências de correntes para formação de CO2 (45% para Pt/C em ambos potenciais 0,5 V e 0,8 V contra 36% e 50% para SnOxRuOx-Pt/C em 0,5 V e 0,8 V respectivamente) quando comparado com os valores obtidos em temperatura ambiente, mas com atividades similares para SnOxRuOx-Pt/C e Pt/C. Para ambos os eletrocatalisadores, os estudos de espectrometria de massas a 245oC evidenciaram que as rotas eletroquímicas ocorrem em paralelo com rotas puramente químicas, envolvendo catálise heterogênea, de decomposição do etanol, produzindo H2 e CO2 como produtos majoritários. / In the first part of this study were investigated active materials to electro-oxidize ethanol and acetaldehyde selective for the C2 route (Carbon 2), besides active to electro-oxidize molecular hydrogen, in order to apply into indirect hydrogen fuel cells. In this type of cell, ethanol can be dehydrogenated in the external fuel processor and the products generated in this reaction, containing H2, acetaldehyde and, possibly, unreacted ethanol are used to feed the fuel cell anode. Therefore, the anode electrocatalyst has to be active to electro-oxidize residual ethanol and acetaldehyde, however, it has to catalyze the reaction via C2 route aiming to avoid the species formation that poison the catalyst surface (CO and CHx), in the other words, the C-C bond should remain intact. The bimetallic electrocatalysts were formed by W, Ru and Sn-modified Pt nanoparticles. The reaction products were followed by on-line differential electrochemical mass spectrometry (DEMS) experiments. The results showed that Ru/Pt/C and Sn/Pt/C presented higher overall reaction rate when compared to the other studied materials, however, they were non-selective. On the other hand, W/Pt/C with high W content was more selective to the C2 route, evidenced by the absence of the DEMS signals for molecules with one carbon atom such as CH4 and CO2. Additionally, this material was active and stable for H2 electro-oxidation even in the acetaldehyde presence, what turns it into a potential electrocatalyst for application in the anode of indirect hydrogen fuel cells. In the second part of this work, we investigated conditions and electrocatalysts selective to the C1 route. The ethanol electro-oxidation and its reaction products were investigated by on-line DEMS at room and intermediate temperature. At room, and intermediate temperature (245oC), the electrolytes were aqueous sulfuric acid and solid-state acid (CsH2PO4), respectively. The catalysts investigated were SnOxRuOx-Pt/C and Pt/C. The results of potentiodynamic polarizations at room temperature showed much higher electrocatalytic activity for the SnOxRuOx-Pt/C material, with current efficiency for CO2 formation of 15.6% against 15.2% for Pt/C under stagnant conditions. The reaction residues stripping after the ethanol electro-oxidation, under continuous flow conditions, showed the accumulation of species containing 1 carbon atom (CO and CHx), which are oxidized just at high potentials (ca. 1.0 V) and they cause the obstruction of the active sites. On the other hand, the polarization curves at 245oC showed higher values of current efficiencies (45% for Pt/C for both potentials 0.5 V and 0.8 V against 36% and 50% to SnOxRuOx-Pt/C at 0.5 V and 0.8 V respectively) for the CO2 formation than at ambient condition, however, with similar activities for SnOxRuOx-Pt/C and Pt/C. For both electrocatalysts, in parallel with the electrochemical pathways, heterogeneous chemical catalysis of ethanol decomposition also takes place, producing H2 and CO2, as major products.

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among surgical options, a woman’s decision becomes one of personal preference. The decision-making process is complex and involves consideration of potential benefits and harms with each option. The purpose of this dissertation was to: 1) analyze the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale, 2) critically review Decisional Conflict Scales and 3) prospectively identify demographic, clinical, cognitive and affective factors influencing a woman’s decision to choose either breast conserving surgery or mastectomy with contralateral prophylactic mastectomy and to identify self-reported sources of information in the surgical decision-making process. Three manuscripts make up the dissertation. A secondary data analysis was conducted to test the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale (DASS). The results of this analysis supported the reliability and validity of the DASS anxiety subscale. A critical review of decisional conflict measures for use with early stage breast cancer patients making surgical treatment decisions was conducted. The results of this review supported the use of Decisional Conflict Scales from a clinical and research perspective. Existing Decisional Conflict Scales show moderate to acceptable reliability. The first two manuscripts provided background and support for the use of scales included in the research study described in the third manuscript. This study was a prospective, exploratory, cross-sectional, mixed-methods study describing factors influencing preference for surgical choice among women with early stage breast cancer. A sample of 78 participants enrolled in the study, 47 who chose breast conserving surgery and 31 who chose mastectomy with contralateral prophylactic mastectomy. Differences were tested between the groups. Women who chose mastectomy with contralateral prophylactic mastectomy were younger, more likely to work full or part-time, had larger tumors and participated in preoperative genetic counselling. Women who chose breast conserving surgery were more likely to have participated in preoperative breast magnetic resonance imaging. Overall, women choosing either surgery were not experiencing severe levels of distress, depression, anxiety or stress although there were individual variations. Women choosing mastectomy with contralateral prophylactic mastectomy were more anxious and had more frequent intrusive thoughts about the diagnosis. They also had less decisional conflict as compared to women choosing breast conserving surgery. Information sources were similar but the most influential information source differed among the two groups. In both groups, intention for surgical choice was matched by the final decision. There are many factors influencing surgical choice among women with early stage breast cancer. Previous work has focused on clinical, demographic and diagnostic processes influencing the decision. With this study, evidence regarding the influence of cognitive and affective factors is described.

The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications after cardiac surgery. Specific aim one was addressed through a secondary analysis of data collected during the Patient Response to Myocardial Infarction following a Teaching Intervention Offered by Nurses trial to determine whether hostility was a predictor of ACS recurrence and mortality. Hostility was common after ACS and predicted all-cause mortality. Hostility did not predict recurrent ACS. Specific aim 2 was addressed in a secondary analysis of baseline data from a randomized controlled trial in male prisoners. Participants completed the BSI at baseline prior to the intervention. Internal consistency reliability was good for both subscales (Cronbach’s alpha - hostility 0.83, anxiety 0.81). Items from the two dimensions were analyzed together using exploratory factor analysis with varimax rotation. Two dimensions, anxiety and hostility, were identified. Construct validity was supported; those with high anxiety and hostility reported a greater number of days where their self-reported health was rated as fair or poor. Those prisoners with less perceived control had higher levels of anxiety and hostility. Specific aim 3 was addressed through a prospective, descriptive correlational study that measured patient and caregiver anxiety, hostility and depressive symptoms, at baseline to determine whether these predicted quality of life using a multilevel dyadic analysis; and to evaluate the association of baseline anxiety, hostility and depressive symptoms and quality of life with postoperative complications and mortality. Anxiety, hostility, and depressive symptoms were common in both cardiac patients and their caregiver. Psychological state influenced quality of life in both dyad members, but was not associated with complications.

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical. Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity and mortality is on the horizon unless aggressive measures are taken at mitigating risk. Similarly, as the obesity epidemic expands, obesity-related comorbid conditions including obstructive sleep apnea (OSA) are likely to grow. The purpose of this research was to explore the relationship between ambulatory orthopedic patient-reported activities (quality of life metrics) and diagnostic factors (physical and perioperative care data) in the immediate postoperative period that are predictive of arterial oxygen desaturation. Data was obtained using a novel patient journal exploring sleep, pain, nausea, tobacco use, alcohol use, and appetite in conjunction with a valid and reliable portable, wrist-worn pulse oximeter. Additional assessment data was taken from the preanesthetic assessment. All participants were scored according to the STOP-Bang questionnaire, an accepted survey of OSA risk. Patients were recruited from a busy metropolitan ambulatory surgery center in Richmond, Virginia that sees approximately 500 cases monthly, and a 309-bed tertiary care hospital in West Burlington, Iowa. The target sample included 52 individual patients with data collected over the first two post-operative nights following discharge. Two patients were excluded. Negative binomial regression, log10 transformation, and least-squares regression examined the relationships the STOP-Bang questionnaire, quality of life data, and physical perioperative data had on postoperative desaturation events. Results suggested the STOP-Bang score predicted desaturation events and that age and BMI were significant individual predictors. Opiate pain medication treatment, a happy mood, and home CPAP use were associated with decreased events. This study provided a unique perspective in patient safety research, relating human behaviors and experiences with postoperative oxygen desaturation. Future research projects aligned with postoperative monitoring, pulse oximetry, patient safety, and obstructive sleep apnea are potential following the findings of this study.

Title: Requirements of Selected Czech Media for Media Relations of Sports Organisations Objectives: The objective of this thesis is to synthesize sports media's opinions on media relations of sports organizations in Czech republic. The aim is to create a document that will have the potential to improve communication between media and Czech sports organizations. Methods: The qualitative method of interviews was used for data collection, alongside with a guideline based on theoretical framework. Respondents were selected by targeted sampling employing criteria. Interviews were recorded and subsequently transcribed into written form. Obtained data were processed by the deductive method of thematic analysis. Results: The result of this thesis is a summary of requests from media representatives. The results reflect the theoretical framework with practical comments for the Czech sports environment. Overall, media representatives focus on trust from sports organizations and their representatives. They recall that a media output is also a part of a sports career of athletes. They wish to be seen as someone who is a partner in spreading information to the public and fans, not as an enemy. Keywords: public relations, communication, press release, press conference, sports media, media guide, media room,...

This study explores the experiences of relatives waiting. Often relatives wait for considerably long periods, especially in critical care areas, whilst their loved one, whose health status is unknown, receives care. To explore these experiences and to understand the symbolic meaning behind the participants’ stories, a grounded theory approach was utilised which is firmly rooted in the sociological theory of symbolic interactionism. A qualitative approach was employed in order to yield a rich description of the human experience often not found in quantitative studies (Jamerson, Scheibmeir, Bott, Crighton, Hinton and Kuckelman, 1996, p. 468). Similarly, the use of feminist principles to guide this study has facilitated a greater understanding of such issues as gender roles, language, power and hierarchy. Using grounded theory methodology, audio-taped interviews were conducted with six female relatives who were recruited using theoretical sampling. Simultaneous recruitment, data collection, analysis and literature review took place, as advocated and outlined by Barney Glaser and Anselm Strauss (1967). The overarching core category discovered using this approach which epitomises the waiting experience, is the balancing of both positive and negative aspects of the four codes identified. These four codes are -mothering, trust, flustered anxiety and institutional and medical power. Each code had negative aspects, such as being denied the felt need to mother the critically ill loved one, being asked to entrust the health of a loved one to people that relatives had never met, feelings of fluster and anxiety, and a perception that they would interfere with medial care if they were to be involved in their loved one’s care. Conversely, each code could potentially have a positive aspect, such as being involved in the care of the loved one, feelings of relief once the care of the loved one was entrusted to ‘professional’ health care providers, affiliating with other relatives who were waiting in similar circumstances, and receiving frequent information from staff. A final model was produced that illustrates the balance that many relatives aspire to when waiting in the Emergency Department waiting room. If the balance tips in favour of the negative aspects of the codes, a negative impact on the relative’s feelings of well being can result.