Increasing the percentage of vaginal birth in the private sector in Brazil through the redesign of care model

OBJETIVO: Implantar um novo modelo de cuidado ao parto e reduzir o percentual de cesarianas entre as gestantes da UNIMED Jaboticabal.MÉTODOS: Estudo descritivo desenvolvido em uma instituição do interior paulista, que teve início em 2012 e propôs o redesenho do modelo de cuidado ao parto com a revisão de todo o processo assistencial por meio da Ciência da Melhoria Contínua. Para medir os resultados das mudanças, foram selecionados nove indicadores e suas respectivas metas.RESULTADOS: O indicador de partos vaginais atingiu a meta de 40%, após sete meses do início da intervenção. Este indicador entre as gestantes do SUS atingiu 66%. A taxa de mortalidade perinatal decresceu 25% comparando-se 2012 a 2014 e a taxa de prematuridade foi de 3/100 nascidos vivos em 2014. O percentual de gestantes da UNIMED com 6 ou mais consultas de pré-natal atingiu 95%. Em relação aos custos hospitalares per capita referentes à assistência ao parto, notou-se um decréscimo de 27%, quando comparados os anos de 2012 e 2013. Tal queda não se sustentou e o custo hospitalar per capita, em 2014, retornou aos mesmos patamares de 2012. A remuneração dos obstetras registrou um acréscimo de 72%, se comparados os anos de 2012, 2013 e 2014. Houve queda de 61% dos custos com a unidade de terapia intensiva (UTI) neonatal, comparando os anos de 2012 e 2013. A taxa de admissão em UTI neonatal acompanhou a redução dos custos e foi de 55%, se comparados os anos de 2012 a 2014, entre as gestantes da UNIMED. Não houve o alcance da meta de 80% de participação das gestantes nos cursos de preparação para o nascimento. A porcentagem de gestantes satisfeitas e muito satisfeitas com a assistência ao parto atingiu 86%.CONCLUSÃO: Este projeto atingiu seus objetivos, reduzindo o percentual de cesarianas entre as gestantes da UNIMED Jaboticabal, e constituiu-se em um exemplo concreto da realização do triplo objetivo em saúde: melhorar a experiência dos envolvidos e os resultados de saúde de populações e indivíduos e realizar estas duas tarefas com menor custo, eliminando desperdícios assistenciais.

Partnerships in sustainable urban development : experiences from Sweden and Finland

This thesis examines partnerships in sustainable urban development projects. Achievement of urban development requires the involvement of several parties. The cooperation of the actors of sustainable urban development is achieved by forming partnerships. The purpose of this study is to find solutions and best practices for the management of partnerships in sustainable residential development projects by examining partnerships and their success factors in sustainable urban development. The impact of the roles, responsibilities and interactions of actors taking part in the processes of creating sustainable urban development in outcomes of these development projects and thus on the overall success of accomplishing sustainable development raises the question of how to manage these collaborations. In order to be able to find the best ways of organizing sustainable urban development projects, it is crucial to have the knowledge of how the interactions between all the parties involved in the development can be managed successfully to give the best outcomes. The main research question of this study is: What are the characteristics of successful partnerships in sustainable urban development projects? In order to answer this question, the success factors in partnerships between actors of sustainable urban development are analyzed. In addition, challenges related to these partnerships are examined to get a more comprehensive view of the features of these collaborative ventures and the obstacles that have to be overcome to ensure the successfulness of cooperation. The research approach is multiple case study comprising four cases. The empirical data has been gathered through theme interviews from four different sustainable residential district projects in Sweden and Finland. A comparative analysis of the cases is performed, based on which seven success factors of partnerships in sustainable urban development supported by the prevailing theories are formulated. In addition, challenges faced by projects regarding the partnerships are discussed.

Networks and partnerships in third party logistics service production

Third party logistics, and third party logistics providers and the services they offer have grown substantially in the last twenty years. Even though there has been extensive research on third party logistics providers, and regular industry reviews within the logistics industry, a closer research in the area of partner selection and network models in the third party logistics industry is missing. The perspective taken in this study was of expanding the network research into logistics service providers as the focal firm in the network. The purpose of the study is to analyze partnerships and networks in the third party logistics industry in order to define how networks are utilized in third party logistics markets, what have been the reasons for the partnerships, and whether there are benefits for the third party logistics provider that can be achieved through building networks and partnerships. The theoretical framework of this study was formed based on common theories in studying networks and partnerships in accordance with models of horizontal and vertical partnerships. The theories applied to the framework and context of this study included the strategic network view and the resource-based view. Applying these two network theories to the position and networks of third party logistics providers in an industrial supply chain, a theoretical model for analyzing the horizontal and vertical partnerships where the TPL provider is in focus was structured. The empirical analysis of TPL partnerships consisted of a qualitative document analysis of 33 partnership examples involving companies present in the Finnish TPL markets. For the research, existing documents providing secondary data on types of partnerships, reasons for the partnerships, and outcomes of the partnerships were searched from available online sources. Findings of the study revealed that third party logistics providers are evident in horizontal and vertical interactions varying in geographical coverage and the depth and nature of the relationship. Partnership decisions were found to be made on resource based reasons, as well as from strategic aspects. The discovered results of the partnerships in this study included cost reduction and effectiveness in the partnerships for improving existing services. In addition in partnerships created for innovative service extension, differentiation, and creation of additional value were discovered to have emerged as results of the cooperation. It can be concluded that benefits and competitive advantage can be created through building partnerships in order to expand service offering and seeking synergies.

The role of public export promotion in Finland Industry view of public export promotion in Southwest Finland

The role of the public export promotion in Finland needed more research. The part of the public sector export promotion in the overall export is significant. In an ever more global world not only the companies but also the counties compete against each other and the governments have an interest to boost their economy as much as they are able to. Every industrialized country has export promotion services in some form or another. In the 21st century the tendency has been the bundling of the services and this has also been done in Finland with Team Finland. The role and the efficiency of the services provided deserve more research. The research question of this study is: What is the role of the public export promotion services in Finland? The question is researched primary by expert interviews conducted for this study. The situation in Southwest Finland is studied from the viewpoint of the companies of the region by conducting a survey aimed to the successfully internationalized companies of the region and asking them on their views on the impact and role of public export services in their internationalization. The theory base is formed out of various export promotion studies, studies monitoring the effects of the promotion and theories of the internationalization process of companies. The primary material for the study are the three expert interviews conducted and the answers to the survey conducted. The research method in the first part is a constructive qualitative research. The research approach in the second part, where the views of the companies in Southwest Finland are studied, is quantitative. The study findings from the expert interviews: the aligning of the public export promotion done in Finland to the previous research and the addition of the role of the public sector in classical frameworks. The study findings from the survey: the utilizing of the public export promotion services is heavily delayed and the internationalizing companies start to utilize the services very late in their internationalization process, the average being 10,3 years from the beginning of the internationalization. Another central finding from the survey is that the successfully internationalized companies see the public export promotion services generally as highly beneficial but in the light of the answers the effect on their own company is not as significant. Concluding can be stated that the public export promotion is seen as beneficial, but the monitoring of the efficiency is complicated in the case of services. Getting the companies to start utilizing the services earlier in their internationalization needs attention from the service providers. By communicating the achieved results and benefits better to the potential users of the services the internationalization process of the companies could be accelerated

Home schooling in view of John Calvin : a study in education and communion of saints /

This study explores the tension that has emerged around the rise of home schooling in a faith-community strongly committed to establishing and maintaining day schools in the tradition of John Calvin. It aims to identify and understand factors that contributed to this tension and to find ways to bridge, diffuse, reduce, or eliminate it. In line with Calvin, personal convictions, and the nature of the community, the study takes a Christian epistemological and axiological stance. Its premise is that the integrity of the commvmity is more important than the manner in which its children are taught. The study reviews relevant literature and several interviews. It considers both secular and Christian literature to understand communities, community breakdown, and community restoration. It also examines literature about the significance of home, school, and community relationships; the attraction of Reformed day schools; and the appeal of home schooling. Interviews were conducted with 4 home schooling couples and 2 focus groups. One focus group included local school representatives, and the other home schoolers and school representatives from an area with reputedly less tension on the issue. Interviews were designed for participants to give their perspectives on reasons for home schooling, the existing tension, and ways to resolve the issues. The study identifies the rise of home schooling in this particular context as the initial issue and the community's deficiency to properly deal with it as the chief cause for the rising tensions. However, I argue that, within the norms the community firmly believes in, home schooling need not jeopardize its integrity. I call for personal, social, and spiritual renewal to restore the covenant community in gratitude to God.

The neo-liberal state and the crisis of public service broadcasting in the Anglo-American democracies /

The NeO'liberal State and the Crisis ofPublic Service Broadcasting in the Anglo-American Democracies The purpose ofthis analysis ofthe present condition ofpublic service broadcasting in the Anglo- American democracies was to investigate whether such media can still be regarded as the primarypublic spherefor a dialogue between each nation 's civil society and the State. The motivationfor this thesis was based on a presumption that such fora for public discussion on the central issues of each society have become viewed as less relevant bypoliticians andpolicy-makers and thepublics they were intended to serve in the Anglo-American democracies over thepast two decades. It is speculated that this is the case because ofa beliefthat the post-war consensus between the respective States andpublics that led to the construction of the Keynesian Welfare State and the notion ofpublic service broadcasting has been displaced by an individualistic, neo-liberal, laissez-faire ideology. In other words, broadcasting as a consumer-oriented, commercial commodity has superseded concerns pertaining to the importance ofthe public interest. The methodology employed in this thesis is a comparative analysisfrom a criticalpolitical economy perspective. It was considered appropriate to focus on the United Kingdom, Australia, Canada and the\ United States because they comprise the four largest Anglo-American nations with democratic political systems andprimarily market economies. Justificationfor this particular sample is reinforced by thefact that case study countries also share a common socio-political and economic tradition. The evidence assembledfor this thesis consisted almost exclusively ofexisting literature on the subjects ofpublic service broadcasting, global economic andpolitical integration, and the ascendance ofthe 'free-market ' ethos in Western democracies since the late mid- to late-1970s. In essence, this thesis could be considered as a reinterpretation ofthe existing literature relevant to these issues. Several important common features werefound among the political, economic and broadcasting systems of the four case study nations. It is proposed that the prevalence of the neo-liberal world view throughout the political and policy environments of the four countries has undermined the stability and credibility of each nation 's national public service broadcasting organization, although with varying intensity and effect,. Deregulation ofeach nation 's broadcasting system and the supremacy ofthe notion of 'consumer sovereignty' have marginalized the view of broadcasting on any basis other than strictly economic criteria in thefour case study countries. This thesis concludes that,for a reconstruction ofa trulyparticipatory anddemocraticpublicsphere to be realized in the present as well as thefuture, a reassessment ofthe conventional concept ofthe 'public sphere ' is necessary. Therefore, it is recommended that thefocus ofpolicy-makers in each Anglo-American democracy be redirectedfrom that which conceived ofan all-encompassing, large, state-ownedand operated public broadcasting service toward a view which considers alternativeforms ofpublic communication, such as local community and ethnic broadcasting operations, that are likely to be more responsive to the needs of the increasingly diverse and heterogeneous populations that comprise the modem Anglo-American democracies. The traditional conception of public broadcasters must change in accordance with its contemporary environment if the fundamental principles of the public sphere and public service broadcasting are to be realized.

"Where is the value in education for me?": experiences and perspectives of Ontario secondary students at risk of non-completion of their Ontario Secondary School Diploma /

This study examined students considered at risk of non-completion of their Ontario Secondary School Diploma and aimed to offer insight into the questions, "What factors currently lead to school disconnect" and "How can these factors be addressed?" Eight students currently enrolled in an alternative learning environment participated in the study. Each was asked to take part in two, digitally recorded interviews that were subsequently transcribed by the researcher. The data were then coded and analysed according to specific themes: obstacles, empowerment, goals, views about success, opinions of school, and power of the teacher. From these themes, three broad focus areas emerged that were used to keep the data analysis focused: worldview, school effects, and self-image. Variances between the data collected and ideas presented in the current literature were highlighted as a reminder that when dealing with a human population, we cannot rely on textbook definitions and theory alone.

Changes in education and student-centred learning as related to senior secondary school English

The main purpose of this thesis is to t r ace broadly the educational changes in the past two decades showing a shift of emphasis from a teacher-directed, content-centred philosophy of teaching to a self-directed, student-centred mode of learning. The major justification for an Independent or an Individualized Learning programme with emphasis on "the response to literature approach" is 2 to produce the independent learner. Comprehensive r eading and t he use of t he ERIC system reveal widespread educational thought and practice related t o Individualization and Independent Study as a really democratic way of learning with freedom, independence and responsibility.

The status of drama in education in an Ontario school board

Drama in education has been describea- as a valuable pedagogical medium and methodology, enriching child development in the cognitive, skill, affective, and aesthetic domains, and spanning all areas of curriculum ~ oontent. However, despite its considerable versatility and cost-effectiveness, drama appears to maintain low status within the education system of ontario. This thesis investigated teacher perceptions of both the value and status of drama in education in one ontario school board. Data were gathered in the form of an attitude questionnaire, which was devised for the purpose of this research and administered to a stratified cluster sample of 126 teachers employed in the board's elementary schools. These data were then used to examine teacher perceptions based on their knowledge, attitudes, and self-reported behaviour in the classroom. Teacher characteristics of gender, teaching assignment, years experience, and courses taken in drama were also analyzed as potential determinants of teacher attitudes towards drama in education. Results of the study confirmed apparent discrepancy between teacher perceptions of the value of drama and its current educational status. It was indicated that what teachers value most about drama is its capacity to enhance creativity, social skills, empathy, personal growth, and problem-solving ability among students. Teachers attribute its low status both to school and board priorities of time and resources, and to deficiencies in their knowledge and confidence in the planning, implementation, and evaluation of drama in the classroom. Teacher subgroup analysis revealed no significant differences in attitudes towards the status of drama in education; it did, however, suggest that both teachers who have studied drama and teachers with between ten and twenty years experience are most likely to value drama more highly than their colleagues. Recommendations proposed by the study include the provision of increased - time and resource allotment for drama within the elementary curriculum as well as increased teacher training at both faculty of education and board inservice levels.

Drama in education : deconstructing the role of movement in text

The purpose of this study was to conduct a comparative textual analysis on the role of movement in 3 texts in Drama in Education in Canada. As the subject is holistic and encourages creative, active participation, movement was expected to appear, even inadvertently, in both theory and practice. It was hoped that guidelines for the use of movement within Drama in Education would emerge from the texts and that these guidelines would serve as models for others to use. A total of 26 Drama in Education experts in Canada were each asked to list the 10 most important texts in the field. Those who answered were assigned numbers and charted according to age, gender, and geography. An objective colleague helped narrow the group to 16 participants. A frequency count was used, assigning 10 points to the first text on each list, and descending to 1 point for the tenth text listed. Based on the highest number of points calculated, the 5 most frequently used texts were identified. These were compared to ascertain the widest representation ofthe authors' geographic location and gender, as well as differences in theory and practice. The final selection included 3 texts that represented differing approaches in their presentation and discussion of Drama in Education theories and practices. Analysis involved applying 5 levels of commitment to determine if,how, why, when, and with what results movement was explicitly or implicitly addressed in the 3 texts. Analysis resulted in several unexpected surprises around each of the 3 texts. The study also provided suggestions for extending and clarifying the role of movement in teaching and learning in general, as well as for Drama in Education in particular.

An Act to authorise the stock held by private parties in the Welland Canal to be purchased on behalf of the Province [Welland Canal Stock Bill], 1841

The bill is a proposal by the government to purchase Welland Canal stock held in private hands. The bill was read for the first time on Wednesday 4 August, 1841, and received second reading on 10th August, 1841. One hundred and fifty copies were printed of the bill. This example was addressed to Samuel Street at the Falls of Niagara, by William Hamilton Merritt, September 1841.

Aboriginal women in education : Honouring our experiences a vision of access to and success within the university

This thesis explores Aboriginal women's access to and success within universities through an examination of Aboriginal women's educational narratives, along with input from key service providers from both the Aboriginal and non-Aboriginal community. Implemented through the Wildfire Research Method, participants engaged in a consensusbased vision of accessible education that honours the spiritual, emotional, intellectual, and physical elements necessary for the success of Aboriginal women in university. This study positions Aboriginal women as agents of social change by allowing them to define their own needs and offer viable solutions to those needs. Further, it connects service providers from the many disconnected sectors that implicate Aboriginal women's education access. The realities of Aboriginal women are contextualized through historical, sociocultural, and political analyses, revealing the need for a decolonizing educational approach. This fosters a shift away from a deficit model toward a cultural and linguistic assets based approach that emphasizes the need for strong cultural identity formation. Participants revealed academic, cultural, and linguistic barriers and offered clear educational specifications for responsive and culturally relevant programming that will assist Aboriginal women in developing and maintaining strong cultural identities. Findings reveal the need for curriculum that focuses on decolonizing and reclaiming Aboriginal women's identities, and program outcomes that encourage balance between two worldviews-traditional and academic-through the application of cultural traditions to modern contexts, along with programming that responds to the immediate needs of Aboriginal women such as childcare, housing, and funding, and provide an opportunity for universities and educators to engage in responsive and culturally grounded educational approaches.