Prevalência e fatores associados à morbidade materna: inquérito populacional em Natal/RN

INTRODUCTION: Severe maternal morbidity , also known as maternal near miss , has been used as an alternative to the study of maternal mortality , since being more frequent shares the same determinants and enables the implementati on of epidem iological surveillance of cases . Since then, hospital audits ha ve been carried out to determine the rates of maternal near miss, its mai n causes and associated factors . More recently, population surveys based on self - reported morbidity have als o been presented as vi able in identifying these cases . OBJECTIVE: The aim of this study was to determine the prevalence and associated factors of maternal near miss and complications during pregnancy and puerperal period in Natal/RN. METHODS: A cross - secti onal population - based study was conducted in Natal /RN , Brazil, which has as its target population women aged 15 to 49 years who were pregnant in the last five years. It was carried out a probabilistic sam pling design based on a multi - stage complex sample , in which 60 census tracts were selected from three strata (north , south - east and west). Afterwards, domiciles were visited in order to obtain a sample of the 908 eligible women in whom a questionnaire was applied. The descriptive analyzes and bivariate ass ociations were performed using the Chi - square test and the estimate of the prevalence ratio (PR ) with 95% confidence interval (CI) and considering the weights and design effects . The Poisson regression analysis , also with 5% significance and 95% CI, was us ed for analyzes of associated factors. RESULTS: 848 women were identified and interviewed after visits in 8.227 households corresponding to a response rate of 93 . 4 %. The prevalence of maternal near miss was 41 . 1 /1 000NV, being the Intensive Care Unity stay i ng (19 . 1 /1 000 LB ) and eclampsia (13 . 5/1000LB) the most important marker s . The prevalence of complications in the puerperal peri od was 21 . 2 %, and hemorrhage (10 . 7%) and urinary tract infection (10 . 7%) the most frequently reported clinical conditions and rema in ing in the hospital for over a week after delivery the mo st frequent intervention (5.4%) . Regarding associated factors , the bivariate analysis showed an association between the increased number of complications in women of black/brown race ( PR= 1 . 23; CI95 % : 1 . 04 - 1 . 46) and lower socioeconomic status ( PR= 1 . 33; CI95%: 1 . 12 - 1 . 58) in women who had pre natal care in public service ( PR= 1 . 42; CI95%: 1 . 16 to 1 . 72 ) and that were not advised during prenatal about where they should do the d elivery (PR= 1 . 24; CI95%: 1 . 05 - 1 . 46), made the del ivery in the public service (PR= 1 . 63; CI95%: 1 . 30 - 2 . 03), had to search for more than one hospital for delivery (PR=1 . 22; CI95%: 1 . 03 - 1 . 45) and had no companion during childbirth ( PR =1 . 19; CI95%: 1 . 01 - 1 . 41) or at all times of childbirth c are - before, during and after childbirth - ( PR= 1 . 25, CI95%: 1 . 05 - 1 . 48) . Moreover, the number of days postpartum hospitalization was higher in women who had more complications (P R= 1 . 59 ; CI95%: 1 . 36 - 1 . 86). In the final regression model for both birth place (P R= 1 . 21 ; CI 95% : 1 . 02 to 1 . 44 ) and socioeconomic status (PR = 1.54 ; CI95%: 1 . 25 - 1 . 90 ) the association remained. CONCLUSION : Conducting population surveys using the pragmatic definition of near miss is feasible and may add importa nt information about this ev ent . It was possible to find the expression of health inequalities related to maternal health in the analysis of both socioeconomic conditions and on the utilization of health services.

Padrão epidemiológico das oclusopatias muito graves em adolescentes brasileiros

OBJECTIVE: To describe the distribution of malocclusion and its associated factors in Brazilian adolescents. METHODS: Data from 7,328 subjects aged 12 years and 5,445 adolescents aged 15-19 years were analyzed. The adolescents took part in the Brazilian Oral Health Survey (SBBrasil 2010). The outcome was severe malocclusion according to the dental aesthetic index. The independent variables were sex, skin color, monthly household income, possessions, number of individuals in the household, untreated dental caries, missing teeth and dental appointments or lack thereof, frequency, and reason. Logistical regression analysis was carried out, considering the complex sampling cluster design, based on a hierarchical model. RESULTS: The prevalence of severe malocclusion was 6.5% and 9.1% in the 12-year-olds and the 15-19-year-olds, respectively. After adjustment, those with lighter- skinned black or black skin were 1.59 (95%CI 1.08;2.34) times more likely to present the outcome compared with those with white skin. The loss of one or more first molars increased 2.66 (95%CI 1.26;5.63) the chance to present severe malocclusion by the age of 12. Adolescents aged 15-19 whose household income was below R$ 1,500.00 (OR 2.69 [95%CI 1.62; 4.47]) and those who had seen a dentist for treatment (OR 2.59 [95%CI 2.55;4.34]) had the greatest chance of having severe malocclusion compared with those with higher incomes and those who visited the dentist for prevention.

Social media integration for the purpose of self-regulated learning

In this study, design based research in a teacher design team is performed. Teachers who intend to use social media to extend their school class teaching, are confronted with a lack of clear guidelines that inform them how to utilize them effectively. In this study, we aim at formulating such guidelines and testing their usefulness. First, opportunities to facilitate self-regulated learning (SRL) in higher education through the use of social media are elaborated in a literature study. Second, these opportunities are translated into teacher education to search for stimulating and limiting factors within the design, resulting in guidelines for effective social media integration.

The effect of multilingual facilitation on active participation in MOOCs Authors:

A new approach for overcoming the language and culture barriers to participation in MOOCs is reported. It is hypothesised that the juxtaposition of English as the language of instruction, used for interacting with course materials, and one’s preferred language as the language of participation, used for interaction with peers and facilitators, is preferable to ‘English only’ for participation in a MOOC. The HANDSON MOOC included seven teams of facilitators, each catering for a different language community. Facilitators were responsible for promoting active participation and peer tutoring. Comparing language groups revealed a series of predictors of intention to learn, some of which became apparent in the first days of the MOOC already. The comparison also uncovered four critical factors that influence participation: facilitation, language of participation, group size, and a pre-existing sense of community. Especially crucial was reaching a sufficient number of active participants during the first week. We conclude that multilingual facilitation activates participation in MOOCs in various ways; and that synergy between the four aforementioned factors is critical for the formation of the learning network that supports a social dynamics of active participation. Our approach suggests future targets for the development of the multilingual and community potential of MOOCs.

Naar verantwoorde zelfregulatie in opvoeding, onderwijs en diagnostiek.

De beoordeling van vorderingen en inzet van (extra) diagnostiek ('indicatiestelling') in het onderwijs kunnen de kans op het ontstaan van problemen bij een kind vergroten. Tijdige herkenning en preventieve ondervanging van de problemen vragen veranderingen in de inhoudelijke, evaluatieve, didactisch-organisatorische en diagnostische systematieken in en rond scholen. Daarom wordt gewerkt aan de opbouw van een inhoudelijk integrerende, pedagogisch-didactische kernstructuur (PDKS). Deze helpt de dialoog en samenwerking tussen opvoedeling(en) of leerling(en), opvoeder(s), leerkracht(en) en andere professionals eenduidig in te richten en te optimaliseren. Didactisch-organisatorische steun wordt verleend door passende software in de vorm van 'Diagnostische, Instructie en Management Systemen' (DIMS). De beoogde veranderingen worden samen met leerkrachten en schoolleidingen ontwikkeld en proefondervindelijk gerealiseerd in enkele scholen voor primair onderwijs. De schoolontwikkeling biedt de contextuele condities ter realisatie van 'verantwoorde zelfregulatie' van elk kind of elke leerling. Dit wordt toegelicht in verschillende praktijkvoorbeelden. Ook worden volgende ontwikkelingen geschetst.

‘Optimaliserend Onderwijs’ voor elke leerling. Multiniveau theoretisch ontwerp en praktijkontwikkeling

Een review van onderwijsanalyses en (beleids)onderzoeken verricht in de periode 1916-2015 wijst uit dat de reguliere jaarklassensystematiek in het Nederlandse primair en voortgezet onderwijs aanleiding geeft tot prestatie- en motivatieproblemen bij risico-leerlingen. Dit zijn met name de leerlingen die qua ontwikkelingspotenties of leervorderingen (aanvankelijk) duidelijk naar beneden of naar boven afwijken van leeftijdsgenoten in een groep of klas. Ondervanging van deze problemen lijkt mogelijk via een preventieve systematiek van ‘Optimaliserend Onderwijs’ voor elk kind in de vóór- of vroegschoolse educatie en elke leerling in het primair of voortgezet onderwijs. Een eerste vraag betreft de inhoudelijke en vormgevingskenmerken van dit onderwijsontwerp: welke richtlijnen en specificaties daarvan kunnen het onderwijs, spelen en leren voor elke leerling, zo optimaal mogelijk inhoud en vorm geven en hoe ziet een model van dit Optimaliserend Onderwijs eruit? Een tweede vraag is gericht op de realisatie van dit onderwijsontwerp: hoe is deze onderwijssystematiek te ontwikkelen in de Nederlandse schoolpraktijk? Gebruik van de sneeuwbalmethode in met name Nederlandse onderzoeks- en designliteratuur leidt tot beantwoording van de eerste vraag in de vorm van een multiniveau theoretisch ontwerp van ‘Optimaliserend Onderwijs’. Kernpunten hierin zijn: landelijke (deel)curricula gekenmerkt door instructievarianten; integratie van dubbele diagnostiek (individueel-longitudinaal en vergelijkend-genormeerd); flexibele certificerings- en diplomeringsstructuur; een ondersteunende schoolorganisatie; gecontroleerde opbrengst-optimalisering per kind of leerling en op instellings- en schoolniveau; per vóór- of vroegschoolse instelling of school(bestuur) kunnen ook vrije ofwel eigen onderwijsinvullingen worden ingericht. Beantwoording van de tweede vraag gebeurt met behulp van (onderzoeks)literatuur over multiniveau onderwijsinnovatie in de schoolpraktijk. Aanbevolen wordt om, op basis van een gezamenlijk besluit van het ministerie van Onderwijs, Cultuur en Wetenschap, de Tweede Kamer, relevante onderwijsinstanties, schoolbesturen en ouderorganisaties, te komen tot inrichting van samenhangende ontwikkelingsprojecten en -onderzoeken. Via een projectenserie in instellingen voor vóór- of vroegschoolse educatie en scholen voor primair en voortgezet onderwijs kan gecontroleerd worden samengewerkt tussen leid(st)ers, leerkrachten en docenten, scholen, ontwikkelings- en andere onderwijsinstellingen, instellingen voor onderzoek en informatietechnologie, en onderwijspolitiek. Tussenresultaten van Optimaliserend Onderwijs worden steeds in andere instellingen en scholen beproefd en verder verspreid.

Beginkenmerken en Pedagogisch-Didactische Kern Structuur®: Handleiding voor scholen en leerkrachten in het Primair Onderwijs

Kinderen worden in basisscholen veelal in leeftijdsgroepen ingedeeld. Er zijn dan steeds leerlingen die ten opzichte van leeftijdsgenoten heel goed of juist slecht presteren. Dit leidt bij deze 'relatief afwijkende leerlingen' tot demotivatie, gerichtheid op andere activiteiten, en 'onderpresteren'. In de hier voorgestane pedagogiek en didactiek wordt elk kind, per ontwikkelings- of competentiegebied, doorlopend en adequaat gesteund. Dit is ook conform de vigerende onderwijswetgeving. De praktische consequentie is dat het onderwijsaanbod in elke groep of klas steeds dient te zijn afgestemd op de werkelijke (begin)kenmerken van de aanwezige leerlingen. Vervolgens dient elk kind in school steeds iets boven het eigen niveau te kunnen spelen en leren, deels volgens eigen voorkeuren en eigen regulatie. Dit vereist voorbereide onderwijsleersituaties en een doorlopend helder inzicht in relevante diagnostische ontwikkelings- en leerniveaus alsmede in de individuele leerprocessen en -effecten. Praktische realisatie van deze eisen vraagt ten eerste om vaststelling van de beginkenmerken van leerlingen. Ten tweede dient het feitelijke speel- en leeraanbod te zijn georganiseerd in aansluiting op deze individuele beginkenmerken, in een meer flexibele vormgeving dan gebruikelijk. Deze twee onderwijsaspecten worden hier concreet uitgewerkt en ingevuld in het kader van een handleiding voor ontwikkelings- of design-based onderzoek dat samen met leerkrachten en management wordt uitgevoerd.

Optimaliseren van leren in en rond PO, VO en MBO.

In deze presentatie wordt ingegaan op mogelijkheden het onderwijs voor en het leren van jonge kinderen en leerlingen in het PO, VO en MBO te optimaliseren.

Learning for self-regulation: Improving instructional benefits for pupils, teachers, parents, schools, and society at large

Compulsory education laws oblige primary and secondary schools to give each pupil positive encouragement in, for example, social, emotional, cognitive, creative, and ethical respects. This is a fairly smooth process for most pupils, but it is not as easy to achieve with others. A pattern of pupil, home or family, and school variables turns out to be responsible for a long-term process that may lead to a pupil’s dropping out of education. A systemic approach will do much to introduce more clarity into the diagnosis, potential reduction and possible prevention of some persistent educational problems that express themselves in related phenomena, for example low school motivation and achievement; forced underachievement of high ability pupils; concentration of bullying and violent behaviour in and around some types of classes and schools; and drop-out percentages that are relatively constant across time. Such problems have a negative effect on pupils, teachers, parents, schools, and society alike. In this address, I would therefore like to clarify some of the systemic causes and processes that we have identified between specific educational and pupil characteristics. Both theory and practice can assist in developing, implementing, and checking better learning methods and coaching procedures, particularly for pupils at risk. This development approach will take time and require co-ordination, but it will result in much better processes and outcomes than we are used to. First, I will diagnose some systemic aspects of education that do not seem to optimise the learning processes and school careers of some types of pupils in particular. Second, I will specify cognitive, social, motivational, and self-regulative aspects of learning tasks and relate corresponding learning processes to relevant instructional and wider educational contexts. I will elaborate these theoretical notions into an educational design with systemic instructional guidelines and multilevel procedures that may improve learning processes for different types of pupils. Internet-based Information and Communication Technology, or ICT, also plays a major role here. Third, I will report on concrete developments made in prototype research and trials. The development process concerns ICT-based differentiation of learning materials and procedures, and ICT-based strategies to improve pupil development and learning. Fourth, I will focus on the experience gained in primary and secondary educational practice with respect to implementation. We can learn much from such practical experience, in particular about the conditions for developing and implementing the necessary changes in and around schools. Finally, I will propose future research. As I hope to make clear, theory-based development and implementation research can join forces with systemic innovation and differentiated assessment in educational practice, to pave the way for optimal “learning for self-regulation” for pupils, teachers, parents, schools, and society at large.

Investigation of the effects of flow conditions at rotor inlet on mixed flow turbine performance for automotive applications

Current trends in the automotive industry have placed increased importance on engine downsizing for passenger vehicles. Engine downsizing often results in reduced power output and turbochargers have been relied upon to restore the power output and maintain drivability. As improved power output is required across a wide range of engine operating conditions, it is necessary for the turbocharger to operate effectively at both design and off-design conditions. One off-design condition of considerable importance for turbocharger turbines is low velocity ratio operation, which refers to the combination of high exhaust gas velocity and low turbine rotational speed. Conventional radial flow turbines are constrained to achieve peak efficiency at the relatively high velocity ratio of 0.7, due the requirement to maintain a zero inlet blade angle for structural reasons. Several methods exist to potentially shift turbine peak efficiency to lower velocity ratios. One method is to utilize a mixed flow turbine as an alternative to a radial flow turbine. In addition to radial and circumferential components, the flow entering a mixed flow turbine also has an axial component. This allows the flow to experience a non-zero inlet blade angle, potentially shifting peak efficiency to a lower velocity ratio when compared to an equivalent radial flow turbine.
This study examined the effects of varying the flow conditions at the inlet to a mixed flow turbine and evaluated the subsequent impact on performance. The primary parameters examined were average inlet flow angle, the spanwise distribution of flow angle across the inlet and inlet flow cone angle. The results have indicated that the inlet flow angle significantly influenced the degree of reaction across the rotor and the turbine efficiency. The rotor studied was a custom in-house design based on a state-of-the-art radial flow turbine design. A numerical approach was used as the basis for this investigation and the numerical model has been validated against experimental data obtained from the cold flow turbine test rig at Queen’s University Belfast. The results of the study have provided a useful insight into how the flow conditions at rotor inlet influence the performance of a mixed flow turbine.

Rockalbumets grafik : Återkommande designelement och landstypiska utseenden – en visuell innehållsanalys

För att ge insikt hur design för ett nytt rockalbum ska ske och ge information kring vad som bör finnas med på ett nytt omslag har denna studie utförts. Studien framförde information om att albumsgrafik var relevant. Först sades det att en nedåtgående trend gick att anta, eftersom den digitala musikbranschen tog över från den fysiska. Men det visade sig därefter vara precis lika stor försäljning på de fysiska albumen som de digitala. För att besvara målen i studien utfördes en visuell innehållsanalys och informationssökning på internet. Studiens syfte var att visuellt granska rockalbum från tre olika ursprungsländer, som var Sverige, Storbritannien och USA. Genom analysen kategoriserades designelement, teman och framtogs landstypiska albumomslag. Studien berörde även vem som styr designen av ett omslag samt ifall det kunde ses någon tongivande designer bland de album som ingick i analysen. I slutsatsen framgick det att Storbritannien och USA hade mycket lika grafiskt manér och att omslag från Sverige såg annorlunda ut. Det framgick även att banden styr utseendet på omslaget mer än designern, och från analysen framgick inte någon tongivande designer.

Deconstruction-reconstruction of Computer Game and Immersive Environment Semiotics

Computer game technology produces compelling ‘immersive environments’ where our digitally-native youth play and explore. Players absorb visual, auditory and other signs and process these in real time, making rapid choices on how to move through the game-space to experience ‘meaningful play’. How can immersive environments be designed to elicit perception and understanding of signs? In this paper we explore game design and gameplay from a semiotic perspective, focusing on the creation of meaning for players as they play the game. We propose a theory of game design based on semiotics.

Conception, fabrication et caractérisation d'un biocapteur SPR à base de guides d'ondes photoniques sur substrat de verre

Résumé : Malgré le nombre croissant de capteurs dans les domaines de la chimie et la biologie, il reste encore à étudier en profondeur la complexité des interactions entre les différentes molécules présentes lors d’une détection à l’interface solide-liquide. Dans ce cadre, il est de tout intérêt de croiser différentes méthodes de détection afin d’obtenir des informations complémentaires. Le principal objectif de cette étude est de dimensionner, fabriquer et caractériser un détecteur optique intégré sur verre basé sur la résonance plasmonique de surface, destiné à terme à être combiné avec d’autres techniques de détection, dont un microcalorimètre. La résonance plasmonique de surface est une technique reconnue pour sa sensibilité adaptée à la détection de surface, qui a l’avantage d’être sans marquage et permet de fournir un suivi en temps réel de la cinétique d’une réaction. L’avantage principal de ce capteur est qu’il a été dimensionné pour une large gamme d’indice de réfraction de l’analyte, allant de 1,33 à 1,48. Ces valeurs correspondent à la plupart des entités biologiques associées à leurs couches d’accroche dont les matrices de polymères, présentés dans ce travail. Étant donné que beaucoup d’études biologiques nécessitent la comparaison de la mesure à une référence ou à une autre mesure, le second objectif du projet est d’étudier le potentiel du système SPR intégré sur verre pour la détection multi-analyte. Les trois premiers chapitres se concentrent sur l’objectif principal du projet. Le dimensionnement du dispositif est ainsi présenté, basé sur deux modélisations différentes, associées à plusieurs outils de calcul analytique et numérique. La première modélisation, basée sur l’approximation des interactions faibles, permet d’obtenir la plupart des informations nécessaires au dimensionnement du dispositif. La seconde modélisation, sans approximation, permet de valider le premier modèle approché et de compléter et affiner le dimensionnement. Le procédé de fabrication de la puce optique sur verre est ensuite décrit, ainsi que les instruments et protocoles de caractérisation. Un dispositif est obtenu présentant des sensibilités volumiques entre 1000 nm/RIU et 6000 nm/RIU suivant l’indice de réfraction de l’analyte. L’intégration 3D du guide grâce à son enterrage sélectif dans le verre confère au dispositif une grande compacité, le rendant adapté à la cointégration avec un microcalorimètre en particulier. Le dernier chapitre de la thèse présente l’étude de plusieurs techniques de multiplexage spectral adaptées à un système SPR intégré, exploitant en particulier la technologie sur verre. L’objectif est de fournir au moins deux détections simultanées. Dans ce cadre, plusieurs solutions sont proposées et les dispositifs associés sont dimensionnés, fabriqués et testés.

Conversor de energia das ondas em energia elétrica com dispositivo de coluna de água oscilante: simulação numérica e estudo geométrico

Os oceanos representam um dos maiores recursos naturais, possuindo expressivo potencial energético, podendo suprir parte da demanda energética mundial. Nas últimas décadas, alguns dispositivos destinados à conversão da energia das ondas dos oceanos em energia elétrica têm sido estudados. No presente trabalho, o princípio de funcionamento do conversor do tipo Coluna de Água Oscilante, do inglês Oscillating Water Colum, (OWC) foi analisado numericamente. As ondas incidentes na câmara hidro-pneumática da OWC, causam um movimento alternado da coluna de água no interior da câmara, o qual produz um fluxo alternado de ar que passa pela chaminé. O ar passa e aciona uma turbina a qual transmite energia para um gerador elétrico. O objetivo do presente estudo foi investigar a influência de diferentes formas geométricas da câmara sobre o fluxo resultante de ar que passa pela turbina, que influencia no desempenho do dispositivo. Para isso, geometrias diferentes para o conversor foram analisadas empregando modelos computacionais 2D e 3D. Um modelo computacional desenvolvido nos softwares GAMBIT e FLUENT foi utilizado, em que o conversor OWC foi acoplado a um tanque de ondas. O método Volume of Fluid (VOF) e a teoria de 2ª ordem Stokes foram utilizados para gerar ondas regulares, permitindo uma interação mais realista entre o conversor, água, ar e OWC. O Método dos Volumes Finitos (MVF) foi utilizado para a discretização das equações governantes. Neste trabalho o Contructal Design (baseado na Teoria Constructal) foi aplicado pela primeira vez em estudos numéricos tridimensionais de OWC para fim de encontrar uma geometria que mais favorece o desempenho do dispositivo. A função objetivo foi a maximização da vazão mássica de ar que passa através da chaminé do dispositivo OWC, analisado através do método mínimos quadrados, do inglês Root Mean Square (RMS). Os resultados indicaram que a forma geométrica da câmara influencia na transformação da energia das ondas em energia elétrica. As geometrias das câmaras analisadas que apresentaram maior área da face de incidência das ondas (sendo altura constante), apresentaram também maior desempenho do conversor OWC. A melhor geometria, entre os casos desse estudo, ofereceu um ganho no desempenho do dispositivo em torno de 30% maior.

Dimensionamento de um pavilhão metálico para armazenamento de paletes de madeira

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Estruturas