Fatores associados à integridade perineal e à episiotomia no parto normal: estudo transversal

Introdução: Investigar os fatores associados à condição perineal no parto vaginal pode possibilitar modificações no cuidado com o períneo, de forma a contribuir para menores frequências de episiotomia e de lacerações perineais. Objetivos: Identificar os fatores associados à episiotomia; identificar os fatores associados à integridade perineal no parto vaginal; descrever os motivos apontados para a realização de episiotomia por enfermeiras obstétricas; e identificar as manobras de proteção perineal realizadas por enfermeiras obstétricas em um Centro de Parto Normal. Método: Estudo transversal com coleta de dados prospectiva por meio de formulário aplicado junto às enfermeiras obstétricas de um Centro de Parto Normal intra-hospitalar de São Paulo e que incluiu dados de todas as mulheres que deram à luz neste serviço no período de fevereiro de 2014 a janeiro de 2015. Na análise estatística, as associações entre as variáveis dependentes (episiotomia e integridade perineal) e as variáveis sociodemográficas, obstétricas e assistenciais foram estimadas por meio de Odds Ratios (OR), calculadas por meio de regressão logística binária univariada e múltipla com intervalos de confiança de 95 por cento (IC 95 por cento ), no programa estatístico SPSS versão 20. Foram realizadas análises separadas para cada variável dependente. Os motivos para a realização de episiotomia e o uso de manobras de proteção perineal foram descritos por meio de frequências e porcentagens. O estudo foi aprovado nos Comitês de Ética em Pesquisa das instituições proponente e coparticipante. Resultados: Foram analisados os dados de 802 mulheres (frequência de episiotomia de 23,8 por cento , 191 mulheres; integridade perineal de 25,9 por cento , 208 mulheres; laceração perineal de 50,3 por cento , 403 mulheres). Os fatores independentemente associados à episiotomia foram: não ter parto vaginal anterior (OR 26,72; IC 95 por cento 15,42-46,30), uso de ocitocina durante o trabalho de parto (OR 1,69; IC 95 por cento 1,12-2,57), puxos dirigidos (OR 2,05; IC 95 por cento 1,23-3,43), intercorrência no trabalho de parto (OR 2,61; IC 95 por cento 1,43-4,77) e posição semissentada no parto (5,45; IC 95 por cento 1,06-28,01). O uso de uma manobra de proteção perineal (OR 0,11; IC 95 por cento 0,04-0,26) ou de duas manobras ou mais (OR 0,09; IC 95 por cento 0,04-0,22) se apresentou como fator de proteção contra a episiotomia. Em relação à integridade perineal, os fatores independentemente associados foram: ter parto vaginal anterior (OR 3,88; IC 95 por cento 2,41-6,23) e cor da pele autorreferida não branca (OR 1,43; IC 95 por cento 1,01-2,04). As indicações para episiotomia incluíram, predominantemente, motivos relacionados às condições e dimensões do períneo. As manobras de proteção perineal foram utilizadas em aproximadamente 95 por cento dos partos vaginais, mas não impactaram as taxas de integridade perineal. Conclusões: As variáveis associadas à episiotomia incluíram, em sua maioria, fatores que podem ser controlados pelo profissional de saúde. Estas variáveis não impactaram as taxas de integridade perineal. Informar os profissionais que atuam na assistência ao parto e as mulheres que buscam esse atendimento sobre os fatores associados à condição perineal no parto vaginal pode contribuir para a redução da frequência de episiotomia e para preservar a integridade perineal no parto vaginal.

Análise das políticas nacional e estadual paulista de recursos hídricos

A realização deste estudo propiciou analisar a aplicação dos instrumentos previstos na legislação brasileira levantada para a gestão dos recursos hídricos, por meio dos Comitês de Bacias Hidrográficas e municípios. Foram eleitos a cidade de Araraquara e o Comitê de Bacia Hidrográfica Tietê-Jacaré, como forma de apurar a aplicação dos instrumentos de gestão existentes nas Políticas Federal e Estadual Paulista de Recursos Hídricos, consubstanciadas nas leis 9.433/97 e 7.663/91, respectivamente. Tal escolha se deu uma vez que o referido município encontra-se, aparentemente, organizado dentro dos ditames existentes no ordenamento ambiental legal brasileiro e faz parte da competência territorial daquele comitê. Constatou-se que o CBH-TJ não realiza suas atividades de forma adequada, pois, além de estar estruturado em desacordo com os ditames na lei federal de recursos hídricos, ainda carece de recursos financeiros, técnicos e de tomada de decisão (por ainda não possuir o Plano de Bacia e Agência de Água). O Poder Executivo do Município de Araraquara, mesmo tendo uma situação ambiental relativamente controlada, não utiliza o comitê da forma preconizada nas políticas de recursos hídricos, pois sua participação nele é pouco efetiva, o que acaba influenciando negativamente seu modo de gestão administrativa municipal, tornando-o apenas local, em alguns aspectos, deixando em segundo plano o restante da bacia hidrográfica.

Investigating the causes of the response of the thermohaline circulation to past and future climate changes

The Atlantic thermohaline circulation (THC) is an important part of the earth's climate system. Previous research has shown large uncertainties in simulating future changes in this critical system. The simulated THC response to idealized freshwater perturbations and the associated climate changes have been intercompared as an activity of World Climate Research Program (WCRP) Coupled Model Intercomparison Project/Paleo-Modeling Intercomparison Project (CMIP/PMIP) committees. This intercomparison among models ranging from the earth system models of intermediate complexity (EMICs) to the fully coupled atmosphere-ocean general circulation models (AOGCMs) seeks to document and improve understanding of the causes of the wide variations in the modeled THC response. The robustness of particular simulation features has been evaluated across the model results. In response to 0.1-Sv (1 Sv equivalent to 10^6 ms^3 s^-1) freshwater input in the northern North Atlantic, the multimodel ensemble mean THC weakens by 30% after 100 yr. All models simulate sonic weakening of the THC, but no model simulates a complete shutdown of the THC. The multimodel ensemble indicates that the surface air temperature could present a complex anomaly pattern with cooling south of Greenland and warming over the Barents and Nordic Seas. The Atlantic ITCZ tends to shift southward. In response to 1.0-Sv freshwater input, the THC switches off rapidly in all model simulations. A large cooling occurs over the North Atlantic. The annual mean Atlantic ITCZ moves into the Southern Hemisphere. Models disagree in terms of the reversibility of the THC after its shutdown. In general, the EMICs and AOGCMs obtain similar THC responses and climate changes with more pronounced and sharper patterns in the AOGCMs.

Ethnic Violence on Kenya's Periphery: Informal Institutions and Local Resilience in Conflict-Affected Communities

Deadly, inter-ethnic group conflict remains a threat to international security in a world where the majority of armed violence occurs not only within states but in the most ungoverned areas within states. Conflicts that occur between groups living in largely ungoverned areas often become deeply protracted and are difficult to resolve when the state is weak and harsh environmental conditions place human security increasingly under threat. However, even under these conditions, why do some local conflicts between ethnic groups escalate, whereas others do not? To analyze this puzzle, the dissertation employs comparative methods to investigate the conditions under which violence erupts or stops and armed actors choose to preserve peace. The project draws upon qualitative data derived from semi-structured interviews, focus group dialogues, and participant observation of local peace processes during field research conducted in six conflict-affected counties in Northern Kenya. Comparative analysis of fifteen conflict episodes with variable outcomes reveals the conditions under which coalitions of civic associations, including local peace committees, faith-based organizations, and councils of elders, inter alia, enhance informal institutional arrangements that contain escalation. Violence is less likely to escalate in communities where cohesive coalitions provide platforms for threat-monitoring, informal pact making, and enforcement of traditional codes of restitution. However, key scope conditions affect whether or not informal organizational structures are capable of containing escalation. In particular, symbolic acts of violence and the use of indiscriminant force by police and military actors commonly undermine local efforts to contain conflict. The dissertation contributes to the literatures on civil society and peacebuilding, demonstrating the importance of comparing processes of escalation and non-escalation and accounting for interactive effects between modes of state and non-state response to local, inter-ethnic group conflict.

Refugios antiaéreos de la Guerra Civil en Alicante: intervenciones arqueológicas en las plazas de Séneca y Dr. Balmis

El golpe militar de 1936 conducirá a una dura contienda civil. Durante la misma, la Aviación Legionaria Italiana y, en menor medida, la Legión Cóndor bombardeará duramente numerosas ciudades de la costa mediterránea. Para proteger a la población, las Juntas Locales de Defensa Pasiva llevarán a cabo un programa de construcción de refugios antiaéreos sin precedentes hasta entonces. En Alicante serán numerosos los refugios construidos, entre ellos los situados en las plazas de Séneca y del Dr. Balmis, ambas construcciones salen a la luz, tras años de olvido, a raíz de sendos proyectos de remodelación de las zonas en las que se encuentran enclavados.

Aproximación al estudio de la gestación de sustitución desde la perspectiva del bioderecho

Los avances científicos en el campo de la genética y de la biología han obligado al legislador a adoptar soluciones jurídicas concretas, generalmente partiendo de determinados criterios éticos que, en ocasiones, entran en conflicto con la ética individual o libertad de conciencia. Pues bien, una de estas cuestiones es la llamada «gestación de sustitución». La gestación de sustitución ha suscitado un intenso debate en el ámbito social, ético y jurídico, que continúa vigente porque en la práctica seguimos encontrando casos de gestación de sustitución que generan conflictos de difícil solución y que revelan, sin duda, la complejidad de este fenómeno.

[Notes from the minutes of the Board of Overseers, ca. 1799]

Small notebook containing handwritten entries of actions for the years 1718-1799 recorded in Volumes I-IV of the Harvard Board of Overseers formal meeting minutes. The entries note the appointment of Committees of inquiry and votes related to salary increases and allowances.

College Book 7, 1750-1778

This volume contains a fair copy of minutes from Corporation meetings held from Sept. 17, 1750 through April 23, 1778. It begins with an alphabetical index and contains entries related to a wide range of topics, including the challenges of operating the Charlestown ferry (due to the river freezing, fear of smallpox, and other issues); increases in "pecuniary mulcts" (fines) for breaches of specific College laws; the establishment of the Dudleian lecture; the selection and financial support of missionaries to various Indian tribes; honorary degrees awarded to Benjamin Franklin and George Washington; gifts to the library as it was rebuilt in the wake of the fire of 1764 (many entries provide the title and author of books donated); the management of land and property belonging to Harvard; Treasurers' reports and other financial accounts; changes in the College laws; gifts to the College, ranging from two Egyptian mummies to a solar microscope; the construction of the First Parish Meeting House in Cambridge and the use of adjacent College property by parishoners; rules of endowed professorships; salaries and appointments; closures due to the threat of smallpox; rules governing Commons and the College Library; reports of various Visiting Committees; class schedules, according to subject; student disorders; the establishment of a designated museum space to display "Curiosities"; the effects of the Revolutionary War on Harvard, including repeated requests to the General Court after the war for compensation for damage to College buildings; the cost of various foods and changes in what was served at Commons; and the danger of the chapel's roof, built of too-heavy slate, falling in. Also of interest are minutes from a May 5, 1761 meeting, which note that the General Court voted to pay for Hollis Professor John Winthrop to travel to Newfoundland to observe the transit of Venus "over the Suns disc."

Letter from John Avery to Cotton Tufts, 1790 April 9

A handwritten invitation from John Avery to Cotton Tufts for a meeting of the Harvard Board of Overseers' "Committee to enquire into the state of the College" on April 13, 1790.

The adoption of IPSASs in the Iberian Peninsula: the perspective of the standar-setters

The last decades have been fruitful in reforms in public sector accounting across the world, namely moving from cash-based into accrual-based regimes. In this process of bringing public sector accounting close to business accounting, International Public Sector Accounting Standards (IPSASs) have been developed and adopted in several countries. In the EU context, public sector harmonization among member-States is currently being considered, namely via the development of European Public Sector Accounting Standards (EPSASs). Both IPSASs and EPSASs are understood as, among other things, important to contribute for a more informative and transparent financial reporting of public sector entities and governments. Moreover they are expected to approximate public sector accounting and the National Accounts, hence allowing for more reliable information to monitor fiscal discipline among EU countries. The Iberian countries, after using accrual accounting in the public sector for more than twenty years (Spain from middle 1980s and Portugal from 1990s), have acknowledged the need to embark in an international harmonization process adopting IPSASs, particularly after the adoption of IFRSs in the business sector, which was creating some difficulties for consolidated accounts. Spain has passed the Chart of Accounts for the Public Sector through the Order EHA/1037/2010, which is adapted to IPSASs; Portugal has just passed Law-decree 192/2015, September 11, and is expecting to start implementation in 2017. In both countries a central role in this reform has been assumed by the national standard-setters for public sector accounting. Based on the “Actor Network Theory” to help understanding how and why organizations interact and how this interaction could have an impact on their choice of accounting policies, this paper aims to analyse, from the Iberian public sector accounting standard-setters perspective, how the adoption/adaptation of IPSASs has been considered and developed in these countries. Research questions to be considered are the following, which will be asked in interviews to the members of the standard-setting committees in both Portugal and Spain: • What were the driving forces leading to the decision to adopt and implement IPSASs? • Which other governmental bodies’ experiences, if any, were considered in the adoption of IPSASs? • What specific steps were/are being undertaken to prepare for the conversion from the existing system to IPSASs? • What were/are the institutional challenges faced/expected to face? • What assistance have been received from IFAC and/or IPSASB, or from other sources, if any, throughout the adoption/implementation? • How can the success of the adoption/implementation be characterised? • What benefits can/have the government derive/derived from the adoption and implementation of IPSASs? The paper is expected to contribute to the understanding of the issues underlying the process of embarking in public sector accounting reforms towards IPSASs.

Perspective maternelle de la consultation anténatale pour travail préterme : une approche relationnelle

Une femme à risque d’un accouchement prématuré vit un enjeu de santé très éprouvant et stressant ; elle sera souvent hospitalisée pour recevoir des traitements médicaux visant à prolonger la grossesse et améliorer le pronostic du bébé. Dans ce contexte, une consultation avec un néonatalogiste est demandée. Plusieurs associations professionnelles médicales ont émis des lignes directrices sur cette consultation, insistant sur le besoin d’informer les parents au sujet des complications potentielles de la prématurité pour leur enfant. Ces recommandations s’inspirent du point de vue médical, et très peu d’études ont examiné la perspective, les attentes et les besoins des parents à risque d’un accouchement prématuré. Ce projet de thèse a pour objectif de proposer un modèle de relation médecin-patient informé de la perspective maternelle de la consultation anténatale, pour développer une approche clinique répondant à leurs besoins. Afin d’examiner cette problématique de façon complète, un travail constant de va-et-vient a été effectué entre la recension de données empiriques et une réflexion normative bioéthique féministe. Un projet de recherche empirique a d’abord permis d’explorer les attentes et le vécu de ces femmes. Les participantes espéraient recevoir plus que de l’information sur les complications de la prématurité. Elles souhaitaient que le néonatologiste soit attentif à leur situation particulière et qu’il développe une relation de confiance avec elles, leur permettant d’explorer leurs futurs rôles de mères et les encourageant à formuler leurs propres questions. Le cadre théorique féministe d’autonomie relationnelle a ensuite permis de proposer une approche de soin qui sache répondre aux besoins identifiés par les patientes, tout en adressant des enjeux de pouvoir intrinsèques à la clinique, qui influencent la santé et l’autonomie de ces femmes. Cette approche insiste sur l’importance de la relation de soin en clinique, contrastant avec un modèle encourageant une vision réductrice de l’autonomie, dans laquelle un simple transfert de données scientifiques serait équivalent au respect de la norme médicolégale du consentement éclairé. Ce modèle relationnel propose des actions concrètes et pratiques, encourageant les cliniciens à entrer en relation avec chaque patiente et à considérer l’influence qu’ils exercent sur l’autonomie relationnelle de leurs patientes.

Agents et modèles de l'adaptation publicitaire en agence de communication marketing

L’industrie de la publicité doit se renouveler sans cesse pour suivre la réalité en constante évolution des entreprises et de leurs consommateurs, afin de produire des messages qui toucheront, séduiront, puis convaincront les publics visés. Différents facteurs socioéconomiques, politiques mais également technologiques incitent les annonceurs à orchestrer de vastes campagnes multilingues et multiculturelles, où est présentée une idée unique, conforme à l’identité de la marque, qui sera adaptée dans différents marchés. Il s’agit d’une stratégie très différente de celle de la création de campagnes propres à chaque culture, par des agences locales. Le choix de l’adaptation, motivé par des raisons économiques bien sûr, mais également stratégiques, entraîne une évolution de la perception de l’acte traduisant et de ses acteurs au sein du milieu du marketing et de la publicité. Alors que nous assistons à un rapprochement des industries du marketing et de la traduction, principalement dans les marchés secondaires comme le Québec, ce projet doctoral propose une réflexion traductologique sur la place que peut occuper l’adaptation dans une stratégie en publicité marketing, et sur les différentes fonctions que peut remplir un traducteur intégré à une équipe de spécialistes de la communication. Par ailleurs, de la réception du mandat d’adaptation à l’agence de marketing jusqu’à la diffusion du message dans la culture cible, nous explorons dans notre travail les différentes avenues que peut prendre le processus d’adaptation publicitaire. Cette thèse par articles comprend six publications en traductologie, publiées ou acceptées par des comités scientifiques, qui étudient la question de l’adaptation publicitaire sous un angle traductologique, mais ce travail multidisciplinaire s’inspire aussi des contributions des experts des études sur l’adaptation, la culture ainsi que la communication publicitaire. D’abord, le premier chapitre définit les notions de traduction, d’adaptation et d’appropriation auxquelles nous référerons tout au long de la thèse, et les situe dans le contexte de la communication promotionnelle internationale, notamment. Le deuxième chapitre dresse un portrait pratique et théorique de l’adaptation publicitaire, et porte sur les relations de travail entre le traducteur et les autres professionnels de l’agence. Nous y énumérons notamment les raisons de la progression du marché mondial de l’adaptation, comparativement à celui des multiples créations locales. Ensuite, le chapitre 3 définit les défis variés de l’adaptation publicitaire, et en présente une classification inspirée par la taxonomie de la théorie fonctionnaliste en traductologie, formée de quatre problèmes et deux difficultés traductionnels. Le chapitre 4 présente une réflexion sur les mécanismes intellectuels de l’adaptation publicitaire et sur les différentes lectures que le traducteur doit faire du texte source pour produire un message efficace, respectivement la lecture analytique (rationnelle et raisonnée), puis la lecture empathique, où il anticipe la réaction émotive des cibles. Le cinquième chapitre se concentre sur un aspect de la traduction audiovisuelle presque exclusive à l’industrie publicitaire : la double version, où le traducteur traduit non pas des dialogues apposés à l’image originale, mais plutôt le scénario dans son entièreté, afin de produire un nouveau message vidéo avec des acteurs appartenant à la culture cible. Enfin, notre sixième chapitre est une étude de cas menée en agence de publicité, qui analyse la pratique professionnelle de traducteurs dans leur environnement de travail, les mandats qui leur sont confiés ainsi que les ressources dont ils disposent. Ensemble, ces six chapitres visent à mieux faire connaître la démarche intellectuelle de l’adaptation publicitaire, à comprendre comment différents facteurs influencent le rôle du traducteur au sein d’une agence, à déterminer comment mieux préparer les professionnels de demain à exceller dans le marché très prometteur du marketing international, et à contribuer à l’avancement de la réflexion traductologique par l’étude d’un type de traduction spécialisée qui se démarque par ses pratiques et ses défis aussi intéressants qu’uniques.

The Judicial Dimension of the European Neighbourhood Policy. EU Diplomacy Paper 08/2013, November 2013

In this paper, the expression “neighbourhood policy” of the European Union (EU) is understood in a broad way which includes the members of the European Free Trade Association (EFTA) contracting parties to the European Economic Area (EEA), the EFTA State Switzerland, candidate states, the countries of the European Neighbour-hood Policy (ENP), and Russia. The European Court of Justice (ECJ) is the centre of gravity in the judicial dimension of this policy. The innermost circle of integration after the EU itself comprises the EFTA States who are party to the European Economic Area. With the EFTA Court, they have their own common court. The existence of two courts – the ECJ and the EFTA Court – raises the question of homogeneity of the case law. The EEA homogeneity rules resemble the ones of the Lugano Convention. The EFTA Court is basically obliged to follow or take into account relevant ECJ case law. But even if the ECJ has gone first, there may be constellations where the EFTA Court comes to the conclusion that it must go its own way. Such constellations may be given if there is new scientific evidence, if the ECJ has left certain questions open, where there is relevant case law of the European Court of Human Rights or where, in light of the specific circumstances of the case, there is room for “creative homogeneity”. However, in the majority of its cases the EFTA Court is faced with novel legal questions. In such cases, the ECJ, its Advocates General and the Court of First Instance make reference to the EFTA Court’s case law. The question may be posed whether the EEA could serve as a model for other regional associations. For the ENP states, candidate States and Russia this is hard to imagine. Their courts will to varying degrees look to the ECJ when giving interpretation to the relevant agreements. The Swiss Government is – at least for the time being – unwilling to make a second attempt to join the EEA. The European Commission has therefore proposed to the Swiss to dock their sectoral agreements with the EU to the institutions of the EFTA pillar, the EFTA Surveillance Authority (ESA) and the EFTA Court. Switzerland would then negotiate the right to nominate a member of the ESA College and of the EFTA Court. The Swiss Government has, however, opted for another model. Swiss courts would continue to look to the ECJ, as they did in the past, and conflicts should also in the future be resolved by diplomatic means. But the ECJ would play a decisive role in dispute settlement. It would, upon unilateral request of one side, give an “authoritative” interpretation of EU law as incorporated into the relevant bilateral agreement. In a “Non-Paper” which was drafted by the chief negotiators, the interpretations of the ECJ are even characterised as binding. The decision-making power would, however, remain with the Joint Committees where Switzerland could say no. The Swiss Government assumes that after a negative decision by the ECJ it would be able to negotiate a compromise solution with the Commission without the ECJ being able to express itself on the outcome. The Government has therefore not tried to emphasise that the ECJ would not be a foreign court. Whether the ECJ would accept its intended role, is an open question. And if it would, the Swiss Government would have to explain to its voters that Switzerland retains the freedom to disregard such a binding decision and that for this reason the ECJ is not only no foreign court, but no adjudicating court at all.

Advances in EU Gender Equality: Missing the mark? EPIN [Working] Paper No. 41/September 2014

Gender balance has been a particularly salient issue in the recent process of formulating the list of designated commissioners. Jean-Claude Juncker’s success, as President-elect of the European Commission, in securing the designation of nine women as commissioners should be seen in perspective. Female representation in top EU positions remains low. This paper analyses the EP committees, finding a clear divergence in legislative influence between committees chaired by men and women. Although female political representation has been increasing, this is happening at a very slow pace and the most influential leadership roles in the EP remain dominated by men. This raises questions of the possible need to resort to stronger measures to improve female representation in the EU institutions.

The Italian Parliament and the EU: a slow and gradual Europeanization. ACES Working Papers, August 2009

In this paper we discussed how the literature traces a growing involvement of the national parliaments in EU policy-making. Three phases can be distinguished: limited or no involvement was the trend until the 1980s; after the Single Act (SEA, 1987), national parliaments started to be interested in European affairs and to set up specialized committees; following the Maastricht Treaty (TUE, 1992), the involvement of national parliaments in EU affairs became a response to the question of "democratic deficit" in the EU (Norton, 1995). The growing number of policies dealt with at the EU level, the consequently increased influence of EU law in national legislations, the new powers of the Union: all of these worked together to push national legislators to seek a scrutiny role in the drafting of EU legislation. According to Laprat (1995: 1), once the TUE was formally approved, a more parliamentary climate prevailed. In more recent years, national parliaments have distinguished themselves for their increased role in the scrutiny of EU legislation (Raunio and Hix, 200I: !52); more specialized MPs sit in the committees on EU affairs; the amount of work for EU specialists has increased. Also, parliamentary scrutiny, initially only optional and ex post, is now increasingly ex ante and/or mandatory (Maurer and Wessels, 2001: 425-475).