Tesis por compendio / [EN] Currently, there is a trend towards sustainability, especially in developed countries, where the concerns of society about environmental degradation and social problems have increased. Following this trend, the construction sector is one of the most influential sectors due to its high economic, environmental, and social impacts. At the same time, there is an increase in the demand for transport, which drives a need to develop and maintain the necessary infrastructure for this purpose. Taking all these factors into account, bridges become a key structure and therefore assessment of sustainability throughout their whole life-cycle is essential. The main objective of this thesis is to propose a methodology that allows assessment of the sustainability of a bridge under uncertain initial conditions (subjectivity of the decision-maker or variability of initial parameters) and optimization of the design to obtain a robust optimal bridge. To this end, an extensive bibliographic review of all the works that perform assessments of the sustainability of bridges through the valuation of criteria related to their main pillars (economic, environmental, or social) has been carried out. In this review, it has been observed that the most comprehensive way to evaluate the environmental and social pillars is through the use of life-cycle impact assessment methods. These methods allow sustainability assessment to be performed for the whole life-cycle of the bridge. This process provides valuable information to decision-makers for the assessment and selection of the most sustainable bridge. However, the decision-makers' subjective assessments of the relative importance of the criteria influence the final assessment of sustainability. For this reason, it is necessary to create a methodology that reduces the associated uncertainty and seeks robust solutions according to the opinion of decision-makers. In addition, for bridges, the design and decision-making are conditioned by the initially defined parameters. This leads to solutions that may be sensitive to small changes in these initial conditions. A robust optimal design makes it possible to obtain optimal solutions and structurally stable designs under variations of the initial conditions as well as sustainable designs that are not influenced by the preferences of the stakeholders who are part of the decision-making process. Thus, obtaining a robust optimal design becomes a probabilistic optimization process that has a high computational cost. For this reason, the use of metamodels has been integrated into the proposed methodology. Specifically, Latin hypercube sampling is used for the definition of the initial sample and a kriging model is used for the definition of the mathematical approximation. In this way, kriging-based heuristic optimization reduces the computational cost by more than 90% with respect to conventional heuristic optimization while obtaining very similar results. This thesis provides, first of all, an extensive bibliographic review of both the criteria used for the assessment of sustainability of bridges and the different methods of life-cycle impact assessment to obtain a complete profile of the environmental and social pillars. Subsequently, a methodology is defined for the full assessment of sustainability, using life-cycle impact assessment methods. Likewise, an approach is proposed that makes it possible to obtain structures with little influence from the structural parameters, as well as from the preferences of the different decision-makers regarding the sustainability criteria. The methodology provided in this thesis is applicable to any other type of structure. / [ES] Actualmente existe una tendencia hacia la sostenibilidad, especialmente en los países desarrollados donde la preocupación de la sociedad por el deterioro ambiental y los problemas sociales ha aumentado. Siguiendo esta tendencia, el sector de la construcción es uno de los sectores que mayor influencia tiene debido a su alto impacto económico, ambiental y social. Al mismo tiempo, existe un incremento en la demanda de transporte que provoca la necesidad de desarrollo y mantenimiento de las infraestructuras necesarias para tal fin. Con todo esto, los puentes se convierten en una estructura clave, y por tanto, la valoración de la sostenibilidad a lo largo de toda su vida es esencial. El objetivo principal de esta tesis es proponer una metodología que permita valorar la sostenibilidad de un puente bajo condiciones iniciales inciertas (subjetividad del decisor o variabilidad de parámetros iniciales) y optimizar el diseño para obtener puentes óptimos robustos. Para ello, se ha realizado una extensa revisión bibliográfica de todos los trabajos en los que se realiza un análisis de la sostenibilidad mediante la valoración de criterios relacionados con sus pilares principales (económico, medio ambiental o social). En esta revisión, se ha observado que la forma más completa de valorar los pilares medioambientales y sociales es mediante el uso de métodos de análisis de ciclo de vida. Estos métodos permiten llevar a cabo la valoración de la sostenibilidad durante todas las etapas de la vida de los puentes. Todo este procedimiento proporciona información muy valiosa a los decisores para la valoración y selección del puente más sostenible. No obstante, las valoraciones subjetivas de los decisores sobre la importancia de los criterios influyen en la evaluación final de la sostenibilidad. Por esta razón, es necesario crear una metodología que reduzca la incertidumbre asociada y busque soluciones robustas frente a las opiniones de los agentes implicados en la toma de decisiones. Además, el diseño y toma de decisiones en puentes está condicionado por los parámetros inicialmente definidos. Esto conduce a soluciones que pueden ser sensibles frente a pequeños cambios en dichas condiciones iniciales. El diseño óptimo robusto permite obtener diseños óptimos y estructuralmente estables frente a variaciones de las condiciones iniciales, y también diseños sostenibles y poco influenciables por las preferencias de los decisores que forman parte del proceso de toma de decisión. Así pues, el diseño óptimo robusto se convierte en un proceso de optimización probabilística que requiere un gran coste computacional. Por este motivo, el uso de metamodelos se ha integrado en la metodología propuesta. En concreto, se ha utilizado hipercubo latino para la definición de la muestra inicial y los modelos kriging para la definción de la aproximación matemática. De esta forma, la optimización heurística basada en kriging ha permitido reducir más de un 90% el coste computacional respecto a la optimización heurística conveniconal obteniendo resultados muy similares. Esta tesis proporciona en primer lugar, una amplia revisión bibliográfica, tanto de los criterios utilizados para la valoración de la sostenibilidad en puentes como de los diferentes métodos de análisis de ciclo de vida para obtener un perfil completo de los pilares ambientales y sociales. Posteriormente, se define una metodología para la valoración completa de la sostenibilidad, usando métodos de análisis de ciclo de vida. Asimismo, se propone un enfoque que permite obtener estructuras poco influenciables por los parámetros estructurales, así como por las preferencias de los diferentes decisores frente a los criterios sostenibles. La metodología proporcionada en esta tesis es aplicable a cualquier otro tipo de estructura. / [CA] Actualment existeix una tendència cap a la sostenibilitat, especialment en els països desenrotllats on la preocupació de la societat pel deteriori ambiental i els problemes socials ha augmentat. Seguint aquesta tendència, el sector de la construcció és un dels sectors que major influència té a causa del seu alt impacte econòmic, ambiental i social. Al mateix temps, existeix un increment en la demanda de transport que provoca la necessitat de desenrotll i manteniment de les infraestructures necessàries per a tal fi. En tot açò, els ponts es converteixen en una estructura clau, i per tant, la valoració de la sostenibilitat al llarg de tota la seua vida és essencial. L'objectiu principal d'aquesta tesi doctoral és proposar una metodologia que permeta valorar la sostenibilitat d'un pont baix condicions inicials incertes (subjectivitat del decisor o variabilitat dels paràmetres inicials) i optimitzar el disseny per a obtenir ponts òptims robusts. Per a això, s'ha realitzat una extensa revisió bibliogràfica de tots els treballs en els quals es realitza un anàlisis de la sostenibilitat mitjançant la valoració de criteris relacionats amb els seus pilars principals (econòmic, ambiental o social). En aquesta revisió s'ha observat que la forma més completa de valorar els pilars ambientals i socials és mitjançant l'ús de mètodes d'anàlisis de cicle de vida. Aquests mètodes permeten realitzar la valoració de la sostenibilitat al llarg de totes les etapes de la vida dels ponts. Tot aquest procediment proporciona informació molt valuosa als decisors per a la valoració i selecció del pont més sostenible. No obstant això, les valoracions subjectives dels decisors sobre la importància dels criteris influeixen en l'avaluació final de la sostenibilitat. Per aquesta raó, és necessari crear una metodologia que reduïsca la incertesa associada i busque solucions robustes enfront de les opinions dels agents implicats en la presa de decisions. A més, el disseny i la presa de decisions en ponts està condicionat pels paràmetres inicialment definits. Açò condueix a solucions que poden ser sensibles front a menuts canvis en les dites condicions inicials. El disseny òptim robust permet obtenir dissenys òptims i estructuralment estables front a variacions de les condicions inicials, i també dissenys sostenibles i poc influenciables per les preferències dels decisors que formen part del procés de presa de decisió. D'aquesta manera, el disseny òptim robust es converteix en un procés d'optimització probabilística que requereix un gran cost computacional. Per aquest motiu, l'ús de metamodels s'ha integrat en la metodologia proposta. En concret, s'ha utilitzat l'hipercub llatí per a la definició de la mostra inicial i els models kriging per a la definició de l'aproximació matemàtica. D'aquesta forma, l'optimització heurística basada en kriging ha permés reduir més d'un 90% el cost computacional respecte a l'optimització heurística convencional obtenint resultats molt similars. Aquesta tesi doctoral proporciona en primer lloc, una ampla revisió bibliogràfica, tant dels criteris utilitzats per a la valoració de la sostenibilitat en ponts com dels diferents mètodes d'anàlisis de cicle de vida per a obtenir un perfil complet dels pilars ambientals i socials. Posteriorment, es defineix una metodologia per a la valoració completa de la sostenibilitat, utilitzant mètodes d'anàlisis de cicle de vida. Així mateix, es proposa un enfocament que permet obtenir estructures poc influenciables pels paràmetres estructurals, així com per les preferències dels diferents decisors enfront dels criteris sostenibles. La metodologia proporcionada en aquesta tesi doctoral és aplicable a qualsevol altre tipus d'estructura. Nº de páginas: / I would like to acknowledge the economic support of the Spanish Ministry of Economy and Competitiveness, formerly called Spanish Ministry of Science and Innovation. This thesis has been possible thanks to the FPI fellowship and the financially support of BRIDLIFE (Research Project BIA2014-56574-R) and DIMALIFE (Project BIA2017-85098-R). / Penadés Plà, V. (2020). Life-cycle sustainability design of post-tensioned box-girder bridge obtained by metamodel-assisted optimization and decision-making under uncertainty [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/147480 / Compendio

This study focused on learners’ assessment practices in overcrowded classes in Kamwenge District, Uganda. Apart from a literature review, an empirical investigation based on qualitative and quantitative methods were used to collect data by the researcher at 4 primary schools in Kamwenge district so as to find answers to the research questions. The empirical findings elicited that all teachers agreed that assessment was useful to them and had a clear idea of what classroom assessment was all about. An interpretive paradigm made it possible for the researcher to gain an in-depth understanding of learners’ assessment practices within their school contexts. There was a mismatch between what teachers said they do and what they practiced and this follows that the majority of teachers may have the theoretical knowledge of methods and tools used to assess learners but fail to translate it to classroom practice. / Educational Leadership and Management / M. Ed. (Educational Management)

Owing to past injustices, the South African higher education sector is characterised by inequalities of resource allocation and of learning opportunities. Through the National Qualification Framework (NQF), recognition of prior learning (RPL) was established to address the previous inequalities in higher education and training. RPL can be used as a mechanism to offer non-traditional learners such as workers, adult learners, and community workers access to learning programmes in Library and Information Science (LIS) schools. It can also be used for up-skilling within LIS sector, to enable staff to migrate from paraprofessional to professional roles. LIS schools could possibly use this approach to offer experienced but unqualified library workers opportunities for progressive professional development and career growth. Despite it being a national policy and its obvious benefits, very little is known about RPL implementation in LIS schools in South Africa. This study was conducted to investigate the nature of RPL implementation in LIS schools in South Africa and make recommendations for effective and efficient RPL practice in these schools. The study used the questionnaire as the main data collection tool. In addition, document analysis was used to validate the collected data. The results of the study indicated that there were islands of good RPL practice in LIS schools in South Africa specifically with regard to the aspect of RPL assessment process. However, certain weaknesses were identified in other aspects of RPL implementation in LIS schools including the policy environment, training of personnel conducting RPL assessment and the quality management systems. Among other things, the study recommends that RPL quality management system (QMS) should ideally be driven by the head/chair of the school/department. Furthermore, an integrated student management system should be used to monitor the progression of RPL candidates through the formal academic system post RPL. / Information Science / D. Litt et. Phil. (Information Science)

This study focused on learners’ assessment practices in overcrowded classes in Kamwenge District, Uganda. Apart from a literature review, an empirical investigation based on qualitative and quantitative methods were used to collect data by the researcher at 4 primary schools in Kamwenge district so as to find answers to the research questions. The empirical findings elicited that all teachers agreed that assessment was useful to them and had a clear idea of what classroom assessment was all about. An interpretive paradigm made it possible for the researcher to gain an in-depth understanding of learners’ assessment practices within their school contexts. There was a mismatch between what teachers said they do and what they practiced and this follows that the majority of teachers may have the theoretical knowledge of methods and tools used to assess learners but fail to translate it to classroom practice. / Educational Leadership and Management / M. Ed. (Educational Management)

Owing to past injustices, the South African higher education sector is characterised by inequalities of resource allocation and of learning opportunities. Through the National Qualification Framework (NQF), recognition of prior learning (RPL) was established to address the previous inequalities in higher education and training. RPL can be used as a mechanism to offer non-traditional learners such as workers, adult learners, and community workers access to learning programmes in Library and Information Science (LIS) schools. It can also be used for up-skilling within LIS sector, to enable staff to migrate from paraprofessional to professional roles. LIS schools could possibly use this approach to offer experienced but unqualified library workers opportunities for progressive professional development and career growth. Despite it being a national policy and its obvious benefits, very little is known about RPL implementation in LIS schools in South Africa. This study was conducted to investigate the nature of RPL implementation in LIS schools in South Africa and make recommendations for effective and efficient RPL practice in these schools. The study used the questionnaire as the main data collection tool. In addition, document analysis was used to validate the collected data. The results of the study indicated that there were islands of good RPL practice in LIS schools in South Africa specifically with regard to the aspect of RPL assessment process. However, certain weaknesses were identified in other aspects of RPL implementation in LIS schools including the policy environment, training of personnel conducting RPL assessment and the quality management systems. Among other things, the study recommends that RPL quality management system (QMS) should ideally be driven by the head/chair of the school/department. Furthermore, an integrated student management system should be used to monitor the progression of RPL candidates through the formal academic system post RPL. / Information Science / D. Litt. et Phil. (Information Science)

Online learning has grown exponentially within higher education in the past decade, especially at community colleges. As online course offerings expand community colleges need to assess student learning in order to ensure quality learning experiences for students and for accreditation purposes. The purpose of this study was to compare the assessment methods of community college faculty who teach the same course in both face-to-face and online formats, in order to determine the similarities and differences that exist in assessment practices. This study stemmed from the constructionist and pragmatic perspectives of the researcher. Additionally this study asked how community college faculty perceive the effectiveness of different assessment methods on student learning. The method for this research was a qualitative multiple case study in which community college accounting faculty were interviewed to explore how they assess student learning in both the online and face-to-face formats. Homework problems, exams, quizzes were the most commonly used methods of assessment of student learning in both formats by the study participants. Furthermore, exams and quizzes were believed to be most effective in assessing student learning, among the community college faculty members interviewed. Another discovery from this study included the prevalent use of publisher's software,called My Accounting Lab, among community college accounting faculty in administering assessments to students. Additional concerns around assessing online students effectively, managing online student group work, and mitigating online student cheating were also revealed during interviews with study participants. / Graduation date: 2013

The purpose of this diploma thesis is to understand financing of drug development from an enterprise risk management perspective as well as to critically assess the efficiency of the ISO framework and risk management techniques used for determining whether to fund drug development or not. The diploma thesis is divided into theoretical and practical part. The first part starts with perception and assessment of uncertainty and risk in the past. It describes how risk-averse individuals attempted to deal with uncertainty and different risk. This is followed by the evolution of traditional risk management into the fast developing enterprise risk management. The text further analyses commonly used risk management standards COSO ERM and ISO 31000:2009. However, the main focus is on the critical assessment of analytical tools which are frequently used for evaluating and assessing risks, especially financial ones, during drug development. The theoretical part is finished by a drug development process, whose phases are briefly described. The practical part was written in co-operation with AstraZeneca, a top-notch pharmaceutical company. The overview of its business is preceded by an explanation of current issues in the pharmaceutical industry. Furthermore, the risk analysis is conducted with respect to the ISO framework. Subsequently, selected risk assessment techniques are applied on the simplified financial model of two different drugs, which was created based on AstraZeneca's real data. These risk assessment tools are used in different phases of drug development so it could be seen clearly how the results are changing during a project. The outcomes of this risk analysis are compared with original plans used by AstraZeneca which were used for deciding whether to fund drug development or not.

INTRODUÇÃO: O antecedente de parto prematuro espontâneo em gestação anterior é considerado o principal e mais importante fator de risco clínico para prematuridade, principal causa de morbidade e mortalidade neonatal. Cerca de 25% das pacientes que tiveram parto prematuro apresentarão recorrência. A prevenção secundária consiste na pesquisa de marcadores de maior risco, com o intuito de instituir medidas terapêuticas apropriadas e de evitar tratamentos desnecessários. A hipótese do presente estudo é a de que existe correlação entre os resultados da avaliação do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1) e que a utilização de ambos em associação possa predizer a ocorrência de parto prematuro com maior sensibilidade. OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para phIGFBP-1 na predição do parto prematuro antes de 37 e de 34 semanas, a existência de relação dos testes entre si, o melhor valor de corte da medida do colo em diferentes idades gestacionais e a melhor época de realização de cada um dos exames. MÉTODO: Foram compilados e submetidos a análise secundária os dados de 101 gestantes com antecedente de parto prematuro atendidas no Setor de Baixo Peso Fetal da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 2003 e 2008. A medida do comprimento cervical e o teste para phIGFBP-1 foram realizados a cada três semanas, entre 24 e 34 semanas de gestação, e comparados com o desfecho de parto prematuro e nascimento com 34 semanas ou menos, e o melhor valor de corte do colo uterino foi estabelecido por meio de curva de características operacionais. RESULTADOS: Das 101 gestações estudadas, 25 (24,8%) terminaram em parto prematuro, das quais 12 (11,9%) ocorreram com 34 semanas ou menos. As idades gestacionais médias de avaliação foram de 24, 27, 30 e 33 semanas, e os valores de corte do colo uterino foram de 22, 21, 20 e 16 mm, respectivamente. A medida do comprimento do colo apresentou maior sensibilidade (cerca de 70%) e foi capaz de predizer o parto prematuro em todas as avaliações. O teste para phIGFBP-1 não foi útil com 24 semanas, porém foi capaz de detectar de forma independente o risco de prematuridade com 27, com 30 e com 33 semanas. Houve associação estatística dos exames entre si, de forma que o comprimento cervical médio foi menor em gestantes com teste positivo para phIGFBP-1. A associação dos exames elevou a sensibilidade e o valor preditivo negativo de forma significativa. CONCLUSÕES: A medida do comprimento do colo pela ultrassonografia transvaginal constitui bom marcador de risco para parto prematuro com 24 semanas, e o teste para phIGFBP-1 é útil após 27 semanas. A associação dos dois exames possui alta sensibilidade e alto valor preditivo negativo em gestantes de alto risco para prematuridade espontânea, e a realização do primeiro com 24 semanas e do segundo com 27 semanas constitui bom modelo preditivo para o parto prematuro / INTRODUCTION: The history of spontaneous preterm birth in a previous pregnancy is considered the main and most important clinical risk factor for preterm birth, the leading cause of neonatal morbidity and mortality. About 25% of these patients will deliver prematurely again. Secondary prevention consists in the search for markers of increased risk, in order to institute appropriate therapeutic actions and to avoid unnecessary treatments. The hypothesis of this study is that there is a correlation between the results of the evaluation of the cervix and the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and that the use of both in combination can predict the occurrence of preterm delivery with higher sensitivity. OBJECTIVES: To investigate the usefulness of the measurement of the cervical length and phIGFBP-1 rapid test in the prediction of preterm birth before 37 and 34 weeks, the existence of a relationship between the tests themselves, the best cutoff value of cervical length measurement at different gestational ages and the best time to carry out each of the exams. METHODS: Data of 101 women with previous preterm birth assisted at the Obstetrical Clinic of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo between 2003 and 2008 were collected and subjected to secondary analysis. The measurement of cervical length and the phIGFBP-1 test were performed every three weeks, between 24 and 34 weeks gestation, and compared with the outcome of premature birth before 37 and 34 weeks, and the best cutoff value of the cervix was determined by receiver operator characteristic curves. RESULTS: Of the 101 pregnancies studied, 25 (24.8%) ended in preterm birth, of which 12 (11.9%) occurred at 34 weeks or less. The mean gestational age in each evaluation was 24, 27, 30 and 33 weeks, and the cutoff of the cervix were 22, 21, 20 and 16 millimeters, respectively. The measurement of cervical length showed the highest sensitivity (approximately 70%) and was able to predict preterm birth in all evaluations. The phIGFBP-1 test was not useful at 24 weeks, but was able to independently detect the risk of prematurity at 27, 30 and 33 weeks. Statistical association between the exams was observed, so that the mean cervical length was lower in pregnant women testing positive for phIGFBP-1. The combination of both tests significantly increased the sensitivity and negative predictive value. CONCLUSIONS: The measurement of cervical length by transvaginal ultrasound is a good marker of risk for preterm delivery at 24 weeks, and the test for phIGFBP-1 is useful after 27 weeks. The association of the two tests is valuable and shows high sensitivity and high negative predictive value in women at high risk for spontaneous preterm birth, when the first is preformed with 24 weeks, and the second with 27 weeks

INTRODUÇÃO: O antecedente de parto prematuro espontâneo em gestação anterior é considerado o principal e mais importante fator de risco clínico para prematuridade, principal causa de morbidade e mortalidade neonatal. Cerca de 25% das pacientes que tiveram parto prematuro apresentarão recorrência. A prevenção secundária consiste na pesquisa de marcadores de maior risco, com o intuito de instituir medidas terapêuticas apropriadas e de evitar tratamentos desnecessários. A hipótese do presente estudo é a de que existe correlação entre os resultados da avaliação do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1) e que a utilização de ambos em associação possa predizer a ocorrência de parto prematuro com maior sensibilidade. OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para phIGFBP-1 na predição do parto prematuro antes de 37 e de 34 semanas, a existência de relação dos testes entre si, o melhor valor de corte da medida do colo em diferentes idades gestacionais e a melhor época de realização de cada um dos exames. MÉTODO: Foram compilados e submetidos a análise secundária os dados de 101 gestantes com antecedente de parto prematuro atendidas no Setor de Baixo Peso Fetal da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 2003 e 2008. A medida do comprimento cervical e o teste para phIGFBP-1 foram realizados a cada três semanas, entre 24 e 34 semanas de gestação, e comparados com o desfecho de parto prematuro e nascimento com 34 semanas ou menos, e o melhor valor de corte do colo uterino foi estabelecido por meio de curva de características operacionais. RESULTADOS: Das 101 gestações estudadas, 25 (24,8%) terminaram em parto prematuro, das quais 12 (11,9%) ocorreram com 34 semanas ou menos. As idades gestacionais médias de avaliação foram de 24, 27, 30 e 33 semanas, e os valores de corte do colo uterino foram de 22, 21, 20 e 16 mm, respectivamente. A medida do comprimento do colo apresentou maior sensibilidade (cerca de 70%) e foi capaz de predizer o parto prematuro em todas as avaliações. O teste para phIGFBP-1 não foi útil com 24 semanas, porém foi capaz de detectar de forma independente o risco de prematuridade com 27, com 30 e com 33 semanas. Houve associação estatística dos exames entre si, de forma que o comprimento cervical médio foi menor em gestantes com teste positivo para phIGFBP-1. A associação dos exames elevou a sensibilidade e o valor preditivo negativo de forma significativa. CONCLUSÕES: A medida do comprimento do colo pela ultrassonografia transvaginal constitui bom marcador de risco para parto prematuro com 24 semanas, e o teste para phIGFBP-1 é útil após 27 semanas. A associação dos dois exames possui alta sensibilidade e alto valor preditivo negativo em gestantes de alto risco para prematuridade espontânea, e a realização do primeiro com 24 semanas e do segundo com 27 semanas constitui bom modelo preditivo para o parto prematuro / INTRODUCTION: The history of spontaneous preterm birth in a previous pregnancy is considered the main and most important clinical risk factor for preterm birth, the leading cause of neonatal morbidity and mortality. About 25% of these patients will deliver prematurely again. Secondary prevention consists in the search for markers of increased risk, in order to institute appropriate therapeutic actions and to avoid unnecessary treatments. The hypothesis of this study is that there is a correlation between the results of the evaluation of the cervix and the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and that the use of both in combination can predict the occurrence of preterm delivery with higher sensitivity. OBJECTIVES: To investigate the usefulness of the measurement of the cervical length and phIGFBP-1 rapid test in the prediction of preterm birth before 37 and 34 weeks, the existence of a relationship between the tests themselves, the best cutoff value of cervical length measurement at different gestational ages and the best time to carry out each of the exams. METHODS: Data of 101 women with previous preterm birth assisted at the Obstetrical Clinic of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo between 2003 and 2008 were collected and subjected to secondary analysis. The measurement of cervical length and the phIGFBP-1 test were performed every three weeks, between 24 and 34 weeks gestation, and compared with the outcome of premature birth before 37 and 34 weeks, and the best cutoff value of the cervix was determined by receiver operator characteristic curves. RESULTS: Of the 101 pregnancies studied, 25 (24.8%) ended in preterm birth, of which 12 (11.9%) occurred at 34 weeks or less. The mean gestational age in each evaluation was 24, 27, 30 and 33 weeks, and the cutoff of the cervix were 22, 21, 20 and 16 millimeters, respectively. The measurement of cervical length showed the highest sensitivity (approximately 70%) and was able to predict preterm birth in all evaluations. The phIGFBP-1 test was not useful at 24 weeks, but was able to independently detect the risk of prematurity at 27, 30 and 33 weeks. Statistical association between the exams was observed, so that the mean cervical length was lower in pregnant women testing positive for phIGFBP-1. The combination of both tests significantly increased the sensitivity and negative predictive value. CONCLUSIONS: The measurement of cervical length by transvaginal ultrasound is a good marker of risk for preterm delivery at 24 weeks, and the test for phIGFBP-1 is useful after 27 weeks. The association of the two tests is valuable and shows high sensitivity and high negative predictive value in women at high risk for spontaneous preterm birth, when the first is preformed with 24 weeks, and the second with 27 weeks

Text in Afrikaans / Summaries in Afrikaans and English / This study aims to investigate and explain how the L2 -facilitator can effectively employ the various facilitation skills of language teaching in Afrikaans Second Language within the Outcomes Based Education framework in the learner-centred classroom. The facilitator is critical in providing an opportunity for multicultural learners to develop the necessary language learning skills to enjoy Afrikaans Second Language/Additional Language learning as an interesting learning experience within a positive learning milieu. In the learner-centred U -classroom, learners too must accept responsibility for their own and their peers' learning within the co-operative learning group. This study reveals how the L2 -facilitator can develop the necessary knowledge and skills concerning groupwork, such as the strategies enhancing L 2 -learning, effective group facilitation skills, learner attitudes towards the facilitator, problem-solving skills, co-operative learning as a control technique, communication, learners' behaviour and the advantages of groupwork. Furthermore, elements of classroom negotiation and the facilitator's methods of working in this negotiated partnership are also discussed. Since language learning is integral to lifelong learning, multicultural learners must be motivated to learn Afrikaans Second/ Additional language with greater enthusiasm. This necessitates the L2 -facilitator creating an interesting, challenging and authentic language learning environment where mutual respect and trust are emphasised. This study reveals how the L2 -facilitator could develop his/her knowledge of task-based L2 -teaching and use it with the effective techniques of facilitation and negotiation skills in the taskorientated second language classroom to lead learners to effective Afrikaans L2 -learning. The new National Language Standardisation Policy 200112002 necessitates the facilitator of Afrikaans L 2 -teaching/learning within the Outcomes Based Education framework and the revised Curriculum 2005 to be aufait with assessment and his/her role in assessment. Being knowledgeable on the various criteria and strategies regarding assessment is therefore imperative. Finally, chapter five illustrates practically how the facilitator could plan, organise, base, integrate and present authentic Afrikaans L 2 -lessons/work based on the theoretical knowledge and aspects of facilitation skills, group-work, task-based learning and assessment discussed in chapters two to four. / Daar word in die studie gepoog om te ondersoek en te verduidelik hoe die T2-fasiliteerder die verskillende fasiliteringsvaardighede ten opsigte van T2 -Afrikaansonderrig binne die UGO -raamwerk in die leerdergesentreerde T2-klaskamer effektief kan gebruik. Die fasiliteerder behoort sy multikulturele leerders die geleentheid te gun om die nodige taalleervaardighede te ontwikkel sodat hulle Afrikaans Tweedetaalleer/ Addisionele Taalleer as 'n interessante leerervaring binne 'n positiewe leerklimaat kan geniet. In die leerdergesentreerde T2 -klaskamer moet die leerders ook die verantwoordelikheid vir bulle eie leer, en vir die leer van ander leerders binne kooperatiewe leergroepe kan aanvaar. Die wyse waarop die fasiliteerder van T2-leer die nodige kennis en vaardighede ten opsigte van groepwerk kan ontwikkel, word deur die studie aan die lig gebring. Die verskillende strategiee wat die aanleer van die tweedetaal binne groepwerk bevorder, effektiewe groepsfasiliteringsvaardighede, leerders se gesindhede teenoor die fasiliteerder, die probleemoplossingsvaardighede, kooperatiewe leer as beheertegniek, kommunikasie, leerdergedragswyses en die voordele van groepwerk kom aan bod. Elemente van klaskameronderhandeling en die fasiliteerder se werkswyse in die onderhandelingsvennootskap word ook bespreek. Aangesien taalleer 'n integrale faset van lewenslange leer vorm, moet multikulturele leerders gemotiveer word om Afrikaans Tweedetaal/ Addisionele Taal op 'n meer entoesiastiese wyse te kan leer. Die T2 -fasiliteerder moet 'n interessante, uitdagende, outentieke taalleeromgewing skep waarin wedersydse respek en vertroue beklemtoon word. Die studie toon die wyse aan waarop die T2 -fasiliteerder sylhaar kennis in verband met taakgerigte T2 -onderrig kan ontwikkel en dit met die effektiewe fasiliteringstegnieke en onderhandelingsvaardighede in die taakgeorienteerde T2-klaskamer kan kombineer en gebruik om leerders tot effektiewe T2 -Afrikaansleer/ Addisionele Taalleer te kan lei. Die nuwe Nasionale Taalstandaardiseringsbeleid 2001/2002 vereis dat die fasiliteerder van T2-Afrikaansonderrig/-leer binne die UGO -raamwerk en die hersiene Kurrikulum 2005 deeglike kennis moet dra van assessering en sylhaar rol in assessering. Deeglike kennis ten opsigte van die verskillende assesseringskriteria en assesseringstegnieke is dus noodsaaklik. Daar word in hoofstuk vyf aangetoon op watter wyse die fasiliteerder outentieke praktiese T2-Afrikaanslesse/-werk, kan beplan, organiseer en dit op die teoretiese kennis en aspekte ten opsigte van fasiliteringsvaardighede, groepwerk, taakgerigte leer en assessering wat in hoofstukke twee tot vier bespreek word, kan toepas en geintegreerd kan aanbied. / Afrikaans and Theory of Literature / D.Litt. et Phil. (Afrikaans)