Die Kopf-Hals-Region ist eine der anatomisch kompliziertesten Regionen und enthält et- wa 300 Lymphknoten, die innerhalb eines komplexen Lymphgefäßsystems miteinander in Verbindung stehen. Die meisten Plattenepithelkarzinome der oberen Luft- und Speise- wege sind potentiell heilbar, aber sie metastasieren früh in die regionalen zervikalen Lymphknoten. Der Status dieser Lymphknoten ist der signifikanteste prognostische Faktor in der Therapie der Kopf-Hals-Tumoren. Die Neck Dissection, englisch für „Halsausräu- mung“, wird auch im deutschsprachigen Raum so genannt und ist der Standard der chir- urgischen Behandlung. Die vorliegende monozentrische Studie untersucht erstmals mittels Workflowanalyse ei- ne Serie von Neck dissections (ND) im Interoperateur-Vergleich und zielt auf die quali- tätsrelevante Erfassung der Operationssystematik ab. Von Januar bis Dezember 2011 wurden an einer onkologisch ausgerichteten HNO-Univer- sitätsklinik 42 selektive NDs (SND) und modifiziert radikale NDs (MRND) bei 5 unter- schiedlichen Operateuren mit der Workflowaufnahmesoftware s.w.an-Editor systemati- siert kodiert und vergleichend ausgewertet. Die Operateure variierten in ihrer Operationserfahrung mit Neck dissections zwischen 1- 17 Jahren und führten im Untersuchungszeitraum 19-76 NDs durch. Die Gesamtpräpara- tionszeit (15min. (2-48)) korrelierte negativ mit der Anzahl der jährlich durchgeführten NDs (p<.033). Bei der Dauer der Entfernung der einzelnen Lymphknotenpakete (33min. (10-81)) ergab sich eine negative Korrelation mit der jeweiligen Erfahrung des Opera- teurs (p<.001). 63 Als bevorzugte Reihenfolge der entfernten Level zeigte sich die Chronologie: 3-2A-(2B)- 5-4-(1). Diese variierte trotz „Schule des Hauses“ signifikant. Bei SNDs ergab sich eine Korrelation (p<.038) zwischen Erfahrung und Befolgung dieser Reihenfolge. Die Summe der entfernten Lymphknoten im histopathologischen Präparat gesamt (17 (0- 29)) sowie pro Level (3,8 (0-11)) zeigte keinen signifikanten Unterschied in Abhängigkeit von Erfahrung, Anzahl der 2011 durchgeführten NDs, befolgter Chronologie und Dauer der Operation. Trotz signifikanter Unterschiede bei den Operateuren im operativen Vorgehen fanden sich keine signifikanten Unterschiede in Gesamtsumme der entnommenen Lymphknoten- zahl. Die Workflowanalyse hilft, die Operationssystematik zu erfassen und damit bei wechselnden Operateuren einen Standard zu definieren.

O instituto jurídico da responsabilidade civil é um dos instrumentos previstos em lei, do qual qualquer paciente pode se valer para promover uma ação de reparação de danos contra o cirurgião-dentista, pelos prejuízos causados. Com o incremento do número de processos, aumenta proporcionalmente a importância do conhecimento das características dessas demandas, no intuito de estabelecer uma orientação fundamentada para que o profissional possa se resguardar e, na ocorrência de lides, encontrar-se municiado para produzir sua competente defesa. Ante tal fato, torna-se fundamental a verificação dos entendimentos dos Tribunais sobre a responsabilidade civil dos cirurgiões-dentistas, sendo que não existem pesquisas que se preocupam em analisar o tema em âmbito nacional. O objetivo deste trabalho foi realizar o levantamento das jurisprudências a respeito das ações de responsabilidade civil promovidas contra o cirurgião-dentista, utilizando a Internet, bem como apresentar o panorama e o entendimento dos principais temas perante os Tribunais do Brasil. Foram obtidos, quando possível, dados relativos à origem, à obrigação assumida, ao seu fundamento, ao agente, à inversão do ônus da prova e às especialidades mais demandadas. Para facilitar a comparação entre os vários entes da Federação, foi proposto um coeficiente de experiência processual que relaciona o número de processos e a quantidade de cirurgiões-dentistas. Foram levantadas 482 jurisprudências, sendo 1 no Supremo Tribunal Federal, 3 no Superior Tribunal de Justiça e 478 nos Tribunais Estaduais e Distrito Federal. Dessas 478, foi possível verificar uma tendência de aumento no número e na quantidade de Estados que tiveram experiências com processos judiciais. Em relação à origem, 18,6% foram consideradas como Contratual, enquanto 6% relacionavam-na como Extracontratual. Foram encontradas 10,6% como obrigação de resultado e, 4,1% como obrigação de meio. Como fundamento, 58,15% tiveram a Teoria Subjetiva, enquanto que 8,15% a Teoria Objetiva. A responsabilidade do agente foi observada como direta em 99,3% e, em 0,6%, como indireta. Houve o deferimento da inversão do ônus da prova em 2,7% dos casos. Em 48,3%, foi possível identificar as especialidades odontológicas, das quais as mais citadas foram: cirurgia (32,9%); prótese (26,4%); ortodontia (15,6%); implantodontia (13%); endodontia (6,5%), periodontia (2,6%); pediatria (1,7%); patologia (0,9%) e, por último, disfunção têmporo-mandibular e dor oro-facial (0,4%). Os Estados que apresentaram maior quantidade de processos foram: Rio de Janeiro, com 107; Minas Gerais, com 101; São Paulo, com 94; Rio Grande do Sul, com 75; o Distrito Federal, com 32. Quanto ao coeficiente de experiência processual, a cada 1.000 profissionais, no Brasil, 2,23 já tiveram experiência com processos. A Região mais exposta a processos foi a Região Sul, seguida das Regiões Centro-Oeste, Sudeste, Norte e Nordeste. Em relação aos Estados e Distrito Federal, verificou-se que o Distrito Federal apresenta 6,22 profissionais processados civilmente a cada 1.000. No Rio Grande do Sul são 5,95; no Rio de Janeiro, 4,22; Minas Gerais, 3,82; Rondônia, 2,15; Paraná, 1,91; Mato Grosso do Sul, 1,81; Espírito Santo, 1,75; Santa Catarina, 1,36; São Paulo, 1,31; Bahia, 1,13; Goiás, 1,06; Tocantins, 0,89; Alagoas, 0,54; Rio Grande do Norte, 0,43; e, por último, no Estado de Pernambuco, 0,18. / The civil liability act is one of the resources provided by law, which can be used by any patient in order to bring a legal action for damages against dentists. With the increase in the number of cases, the necessity of a sound knowledge on the features of these lawsuits has proportionally augmented, so that the professionals may have a solid orientation to protect themselves, and in case of a legal process, be able to produce their competent defense. In view of this fact, the checking of the jurisprudences concerning dentists\' civil liability becomes of paramount importance, since in Brazil there are no studies analyzing this matter. The objective of this study has been to survey the jurisprudences of civil liability lawsuits against dentists, by using the Internet, as well as to present an outlook on jurisprudences related to the main topics in Brazilian Courts. When possible, data have been obtained regarding the origin, professional obligation, legal basis, defendant, inversion of the burden of proof, and more demanded dental specialties. In order to facilitate the comparison between the Brazilian states, a coefficient of procedural experience has been proposed. This coefficient correlates the number of legal processes and the quantity of dentists. 482 jurisprudences have been studied: 01, in the Federal Supreme Court; 03, in the Supreme Court of Justice, and 478, in the State Courts and the Federal District. From these 478, it has been possible to verify an increasing trend in the number and quantity of the states which have experienced lawsuits. As to the origin, 18.6% have been considered contractual, while 6%, extracontractual. 10.6% have been regarded as obligation de résultat (obligation of result), and 4.1%, as obligation de moyens (obligation of means). 58.15% have been legally based on the Subjective Theory, whereas 8.15%, on the Objective Theory. The liability of the defendant has been evaluated as direct in 99.3%, and indirect in 0.6%. The granting of the inversion of the burden of proof has occurred in 2.7% of the cases. It has been possible to identify the dental specialties in 48.3%, from which the most cited ones have been: dental surgery (32.9%), prosthodontics (26.4%), orthodontics (15.6%), implantology (13%), endodontics (6.5%), periodontics (2.6%), pediatrics (1.7%), pathology (0.9%), and finally, temporomandibular joint dysfunction and orofacial pain (0.4%). The states presenting the largest quantity of legal processes have been: Rio de Janeiro, with 107, Minas Gerais with 101, São Paulo with 94, Rio Grande do Sul with 75, the Federal District with 32. Concerning the coefficient of procedural experience, in Brazil, 2.23 professionals have already experienced lawsuits out of 1,000. The Southern Region has had more lawsuits, followed by the Central-Western, Southeastern, Northern, and Northeastern ones. In relation to the states and the Federal District, it has been noted that the Federal District have presented 6.22 professionals who have faced civil lawsuit out of 1,000; Rio Grande do Sul, 5.95; Rio de Janeiro, 4.22; Minas Gerais, 3.82; Rondônia, 2.15; Paraná, 1.91; Mato Gosso do Sul, 1.81; Espírito Santo, 1.75; Santa Catarina, 1.36; São Paulo, 1.31; Bahia, 1.13; Goiás, 1.06; Tocantins, 0.89; Alagoas, 0.54; Rio Grande do Norte, 0.43; and Pernambuco, 0,18.

MFA Thesis for Shanell B. Papp on Loners, textiles, video/film, re-purposing and pattern breaking.<p> w/ work from Marcel Duchamp, Edward Keinholz, Rene Magritte, Joseph Beuys, Eugene Atget, Arthur Fellig (Weegee), David Hoffos, Sarah Lucas, Tracey Emin, Mike Kelly, Allyson Mitchell, Madonna, Weird Al.

MFA Thesis for Shanell B. Papp on Loners, textiles, video/film, re-purposing and pattern breaking.<p> w/ work from Marcel Duchamp, Edward Keinholz, Rene Magritte, Joseph Beuys, Eugene Atget, Arthur Fellig (Weegee), David Hoffos, Sarah Lucas, Tracey Emin, Mike Kelly, Allyson Mitchell, Madonna, Weird Al.

Die Kopf-Hals-Region ist eine der anatomisch kompliziertesten Regionen und enthält et- wa 300 Lymphknoten, die innerhalb eines komplexen Lymphgefäßsystems miteinander in Verbindung stehen. Die meisten Plattenepithelkarzinome der oberen Luft- und Speise- wege sind potentiell heilbar, aber sie metastasieren früh in die regionalen zervikalen Lymphknoten. Der Status dieser Lymphknoten ist der signifikanteste prognostische Faktor in der Therapie der Kopf-Hals-Tumoren. Die Neck Dissection, englisch für „Halsausräu- mung“, wird auch im deutschsprachigen Raum so genannt und ist der Standard der chir- urgischen Behandlung. Die vorliegende monozentrische Studie untersucht erstmals mittels Workflowanalyse ei- ne Serie von Neck dissections (ND) im Interoperateur-Vergleich und zielt auf die quali- tätsrelevante Erfassung der Operationssystematik ab. Von Januar bis Dezember 2011 wurden an einer onkologisch ausgerichteten HNO-Univer- sitätsklinik 42 selektive NDs (SND) und modifiziert radikale NDs (MRND) bei 5 unter- schiedlichen Operateuren mit der Workflowaufnahmesoftware s.w.an-Editor systemati- siert kodiert und vergleichend ausgewertet. Die Operateure variierten in ihrer Operationserfahrung mit Neck dissections zwischen 1- 17 Jahren und führten im Untersuchungszeitraum 19-76 NDs durch. Die Gesamtpräpara- tionszeit (15min. (2-48)) korrelierte negativ mit der Anzahl der jährlich durchgeführten NDs (p<.033). Bei der Dauer der Entfernung der einzelnen Lymphknotenpakete (33min. (10-81)) ergab sich eine negative Korrelation mit der jeweiligen Erfahrung des Opera- teurs (p<.001). 63 Als bevorzugte Reihenfolge der entfernten Level zeigte sich die Chronologie: 3-2A-(2B)- 5-4-(1). Diese variierte trotz „Schule des Hauses“ signifikant. Bei SNDs ergab sich eine Korrelation (p<.038) zwischen Erfahrung und Befolgung dieser Reihenfolge. Die Summe der entfernten Lymphknoten im histopathologischen Präparat gesamt (17 (0- 29)) sowie pro Level (3,8 (0-11)) zeigte keinen signifikanten Unterschied in Abhängigkeit von Erfahrung, Anzahl der 2011 durchgeführten NDs, befolgter Chronologie und Dauer der Operation. Trotz signifikanter Unterschiede bei den Operateuren im operativen Vorgehen fanden sich keine signifikanten Unterschiede in Gesamtsumme der entnommenen Lymphknoten- zahl. Die Workflowanalyse hilft, die Operationssystematik zu erfassen und damit bei wechselnden Operateuren einen Standard zu definieren.:1.1. KOPF-HALS-TUMOREN 1.2. ÄTIOLOGIE UND RISIKOFAKTOREN 1.3. EPIDEMIOLOGIE 1.4. KLINIK 1.5. DIAGNOSTIK 1.6. HISTORISCHER ÜBERBLICK 1.6.1. ANFÄNGE DER CHIRURGIE 1.6.2. ENTWICKLUNG DER STRAHLENTHERAPIE 1.6.3. RADIKALE NECK DISSECTION 1.6.4. FUNKTIONELLE ODER MODIFIZIERT RADIKALE NECK DISSECTION 1.6.5. SELEKTIVE NECK DISSECTION 1.6.6. NOMENKLATUR DER LYMPHKNOTEN-LEVEL 1.6.7. NOMENKLATUR DER NECK DISSECTION 1.7. THERAPIE 1.7.1. STRAHLENTHERAPIE 1.7.2. NECK DISSECTION 1.7.3. CHEMOTHERAPIE 1.8. AKTUELLEENTWICKLUNGEN 1.8.1. ENTWICKLUNGEN IN DER DIAGNOSTIK 1.8.2. ENTWICKLUNGEN DES CHIRURGISCHEN VORGEHENS 1.9. KOMPLIKATIONEN 1.10. PROGNOSE 2. AUFGABENSTELLUNG 3. MATERIAL UND METHODEN 3.1. PATIENTEN 3.2. DATENERHEBUNG 3.3. EIN- UND AUSSCHLUSSKRITERIEN DER ERHOBENEN DATEN 3.4. STATISTISCHE METHODEN II 4. ERGEBNISSE 4.1. GESAMTKOLLEKTIV 4.1.1. PATIENTENGUT 4.1.2. EINTEILUNG DER OPERATION IN PHASEN 4.1.3. EINTEILUNG DER DATEN NACH KOMPLEXITÄT DER OPERATION 4.2. OPERATEURE IM VERGLEICH 4.2.1. ERFAHRUNG UND ROUTINE DER OPERATEURE 4.2.2. GESAMTDAUER DER OPERATION 4.2.3. ANZAHL DER DURCHGEFÜHRTEN ARBEITSSCHRITTE 4.2.4. KORRELATION ZWISCHEN ERFAHRUNG SOWIE ROUTINE DER OPERATEURE UND DAUER DER OPERATION 4.3. LYMPHKNOTEN IM FOKUS 4.3.1. CHRONOLOGIE DER LYMPHKNOTENENTNAHME 4.3.2. HISTOPATHOLOGIE 5. DISKUSSION 5.1. GESAMTKOLLEKTIV 5.1.1. PATIENTENGUT 5.1.2. EINTEILUNG DER OPERATION IN PHASEN 5.1.3. EINTEILUNG DER DATEN NACH KOMPLEXITÄT DER OPERATION 5.2. OPERATEURE IM VERGLEICH 5.2.1. ERFAHRUNG UND ROUTINE DER OPERATEURE 5.2.2. GESAMTDAUER DER OPERATION 5.2.3. ANZAHL DER DURCHGEFÜHRTEN ARBEITSSCHRITTE 5.2.4. KORRELATION ZWISCHEN ERFAHRUNG SOWIE ROUTINE DER OPERATEURE UND DAUER DER OPERATION 5.3. LYMPHKNOTEN IM FOKUS 5.3.1. CHRONOLOGIE DER LYMPHKNOTENENTNAHME 5.3.2. HISTOPATHOLOGIE 5.4. SCHLUSSFOLGERUNG 6. BIBLIOGRAFIE

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The practise of male traditional circumcision is severely challenged with enormous problems ranging from hospitalisation of the initiates as well as deaths of the initiates. The background of the problem is focused in the Eastern Cape Province where the researcher has noted several initiates being treated in hospitals for physical and as well for psychological problems. The objective of this study was to explore and describe newly initiated Xhosa men's experiences of traditional circumcision rites at East London in the Eastern Cape Province and to describe the guidelines for support of these newly initiated Xhosa men by public health professionals. A qualitative explorative, descriptive contextual and phenomenological design was followed. Purposive sampling technique was used to select the participants. Fourteen participants volunteered to participate in the study after they met the eligible criteria. Focused group interviews were used as a method for data collection. Data analysis of the study showed that there are several factors affecting newly initiated men whilst undergoing circumcision rites. These factors can present at any of the three circumcision stages i.e. pre-circumcision, peri-circumcision and post-circumcision. The recommendations of the study strongly suggest a cultural competence in rendering effective health care services to culturally and ethnically diverse clients. All the five constructs of cultural competence are entailed in the support guidelines that have been developed by the researcher. They are cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire. Finally limitation of the study and the need for a further research has been clearly stated. / Health Studies / M.A.

The practise of male traditional circumcision is severely challenged with enormous problems ranging from hospitalisation of the initiates as well as deaths of the initiates. The background of the problem is focused in the Eastern Cape Province where the researcher has noted several initiates being treated in hospitals for physical and as well for psychological problems. The objective of this study was to explore and describe newly initiated Xhosa men's experiences of traditional circumcision rites at East London in the Eastern Cape Province and to describe the guidelines for support of these newly initiated Xhosa men by public health professionals. A qualitative explorative, descriptive contextual and phenomenological design was followed. Purposive sampling technique was used to select the participants. Fourteen participants volunteered to participate in the study after they met the eligible criteria. Focused group interviews were used as a method for data collection. Data analysis of the study showed that there are several factors affecting newly initiated men whilst undergoing circumcision rites. These factors can present at any of the three circumcision stages i.e. pre-circumcision, peri-circumcision and post-circumcision. The recommendations of the study strongly suggest a cultural competence in rendering effective health care services to culturally and ethnically diverse clients. All the five constructs of cultural competence are entailed in the support guidelines that have been developed by the researcher. They are cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire. Finally limitation of the study and the need for a further research has been clearly stated. / Health Studies / M.A.