The current set of experiments sought to address a variable involved in slot machine gambling that has been termed the near-miss effect. In the present paper, the conceptual underpinnings of this `effect' were examined from a behavioral as well as a non-behavioral psychological perspective. The experiments and rationale for conducting them were prefaced with an in-depth analysis of problem gambling in general including prevalence, demographics, etiology, assessment, and treatment. A comprehensive review of behavioral analytic investigations on gambling in the areas of programmed contingencies, structural features, verbal behavior, the near miss effect, and treatment components was also presented. In terms of the empirical analyses, Experiments 1 and 2 examined the near miss effect as measured by response allocation to concurrently available simulated slot machines in non-pathological gamblers. The results of these studies indicated that verbal rule formation, only when it was presented through multiple exemplars, was significant enough to override programmed contingencies as well as near miss outcomes. Experiments 3 and 4 incorporated participants with a history of problem gambling and sought to reduce the verbal rule involved in the near miss effect through varying treatment strategies associated with Acceptance and Commitment Therapy. Experiment 3 demonstrated that one process of ACT was not sufficient in suppressing this behavior however, Experiment 4 showed that a brief ACT intervention incorporating all of its core processes was successful in treating the near miss effect. Implications of these findings are discussed in terms of a functional approach to the treatment of problem gambling and future extensions of this research are offered.

Severe maternal morbidity generally refers to the most severe complications of pregnancy and includes: hemorrhage, embolism, acute renal failure, stroke, acute myocardial infarction, and other complications. These complications affect more than 50,000 women in the United States every year, with rates significantly increasing from 1998 to 2011. In an effort to reduce these increasing complication rates, clinicians and researchers have emphasized the need to identify potential modifiable risk factors for severe maternal morbidity, and the need to study the relationships between these risk factors and severe maternal morbidity. The overall goal of this study is to improve the understanding of the increasing rates of severe maternal morbidity. The objective of the first study is to examine the association between prepregnancy BMI and severe maternal morbidity in women residing in Florida who had a live birth during 2007-2014. Additionally, the specific association between prepregnancy BMI and the most common individual conditions that comprise the composite measure of severe maternal morbidity will also be examined. We conducted a population-based retrospective cohort study using Florida’s linked birth certificate and maternal hospital discharge data for the years 2007-2014. The risk of severe maternal morbidity associated with BMI was then estimated by odds ratios (OR) and 95% confidence intervals (CI) derived using generalized estimating equations (GEE) for logistic regression. This final model was rerun separately for the most common conditions that comprise severe maternal morbidity as the outcome measure to assess differences by type of condition. Unadjusted rates of severe maternal morbidity increased with increasing BMI; however, after risk adjustment overweight and obese women had slightly protective odds of severe maternal morbidity when compared with normal weight women. The association between prepregnancy BMI and severe maternal morbidity differs by types of severe maternal morbidity. A protective dose-response relationship was seen for blood transfusion and disseminated intravascular coagulation, with the odds of morbidity decreasing with increasing BMI. The odds of heart failure, adult respiratory distress syndrome, and ventilation all increased with increasing BMI. This study shows that severe maternal morbidity is a complex measure and not just a single condition. In future studies, it will be imperative to analyze severe maternal morbidity as a composite measure and as individual conditions to identify modifiable risk factors to focus on for interventions. The objective of the second study is to identify potential determinants of the increase in the rate of severe maternal morbidity among women residing in Florida who had a live birth during 2005-2014. We examined severe maternal morbidity rates and related risk factors in live births to Florida women between 2005 and 2014, using Florida’s linked birth certificate and hospital discharge data. We initially conducted a Kitagawa analysis to evaluate the components of the increased rate of severe maternal morbidity between 2005 and 2014. Additionally, we performed a multivariable regression analysis to estimate the contribution of the multiple factors to differences in the rate of severe maternal morbidity in 2005 and 2014. The rate of severe maternal morbidity in 2014 was 19.3 per 1,000 live births, which was 1.65 times higher than the rate in 2005. Nearly all of the excess severe maternal morbidity and blood transfusions in 2014 can be explained by differences in the rate of severe maternal morbidity and blood transfusion between the two time periods. In total, sociodemographic factors, medical factors, and individual and hospital health service factors explained 9.1% of the overall severe maternal morbidity increase in 2014 compared with 2005, and only explained 2.5% of the increase in blood transfusions during this time period. Our study findings indicate that the increase in the rate of severe maternal morbidity is comprised almost entirely by an increase in the rate of blood transfusions. Further research will need to be conducted to explain the increase in the rate of severe maternal morbidity and blood transfusions. Consistent with national trends, the rates of severe maternal morbidity have been increasing in Florida. This increase is driven almost entirely by blood transfusions and cannot be explained by traditional factors that are readily available in current datasets. In addition to the differences between the trends of blood transfusions and the 20 severe maternal morbidity conditions, there are also differences in risk factors associated with these different conditions. Prepregnancy overweight and obesity is associated with a protective effect with blood transfusions and disseminated intravascular coagulation that is not seen in the other conditions. Therefore, initiatives to decrease the rates of severe maternal morbidity will need to take these differences into account.

During the last two decades, the performance of CPU has been developed much faster than that of memory. In order to reduce the performance gap between CPU and memory, cache memories should have been used between CPU and memory. In general, cache memory is a small and fast buffer to reduce memory access time by saving data in advance before CPU uses. There are two types of cache memory: instruction cache and data cache. In addition, there can be multi-levels (Level 1, 2, ?etc) in memory hierarchy (memory and cache memories) for system purpose: the level 1 (on-chip) cache is the closest one to CPU and it affects system performance directly. In this study, we evaluated two factors in designing an efficient Level 1 data cache. Those factors are: distance between two data in an array and multi xor mapping functions in a bank. We designed a data cache called SLDC (Store/Load Dependent Cache, Two-way) to implement the first factor. This cache uses the distance between two data addresses of data-transfer instructions (load and store). It groups close data into the same group and places into the same bank. The other cache we designed for the second factor is called Multi-XOR (MXOR). The MXOR splits the cache virtually into several zones (2 to 6 areas); a different xor mapping function per area is used to index data (for better cache utilization). In this study, we used the SimpleScalar simulation program to implement data cache with SPEC2000FP benchmark programs. Based on the experiment results, we recommended considering those factors in designing an efficient cache memory since SLDC and MXOR show some improvement (5-to-10%) compared to a conventional cache memory (two-way set-associative).

Introdução – A mortalidade materna apresenta grande diferença entre os países desenvolvidos e em desenvolvimento e espelha a qualidade da assistência prestada à saúde da mulher. Para evidenciar melhor essa assistência novos métodos de estudo vêm sendo utilizados, dentre eles a investigação das morbidades materna graves – near misses. Objetivo - Analisar se a cor é fator de risco determinante de casos de near miss, das mulheres residentes em três municípios da Região Metropolitana de Curitiba. Método - Estudo de caso-controle prospectivo de base populacional. Resultados - Foram identificados 68 casos de near miss, dentre eles um óbito materno direto, um indireto tardio e um direto tardio, sendo relação de 1 óbito para cada 23 casos de near miss ou 4,41%. A razão de mortalidade materna ficou em 36,05/100 mil nascidos vivos, atingindo 108,15/100 mil nascidos vivos considerando os dois óbitos tardios. Os casos representam taxa de 2,45% das gestantes ou 24,50/1000 partos. Tanto na análise univariada como na multivariada a cor não apresentou significância estatística sendo o p= 0,497 e 0,8964 respectivamente. Houve significância estatística na interação entre cor e paridade p= 0,0095, OR 3,67 (IC 95% 1,37 – 9,80). Conclusões – Dentre outros achados a relação de 1 óbito materno para 23 casos de near miss e o salto da razão de mortalidade materna de 36,05 para 108,15/100 mil nascidos vivos justificam o estudo da morbidade materna grave, possibilitando conhecer a real situação da assistência a saúde da mulher. A variável cor não foi identificada como sendo fator de risco para near miss. Evidenciou-se a necessidade de aprofundamento da análise das variáveis identificadas como fatores de risco para near miss: idade e outras causas de internação para mulheres brancas, número de gestações e doenças associadas para as mulheres negras, assim como a instituição de outros parâmetros de análise como as transferências e reinternações. / Introduction - Maternal mortality presents great difference between the developed and developing countries and reflects the quality of the woman health care delivered. To evidence this assistance better new study methods come being used, amongst them, the investigation of the severe maternal morbidity - near misses. Objective – Evaluate if the color is a determinative factor to cases of near miss to women who live in three cities of Metropolitan Region Curitiba. Method – Prospective case-control study of population-based. Results – 68 cases of near miss had been identified, amongst them one direct maternal death, one delayed indirect and one delayed direct, being relation of 1 death for each 23 cases of near miss or 4.41%. The maternal mortality ratio was in 36,05/100,000 live births, reaching 108,15/100,000 live births considering the two delayed deaths. The cases represent 2,45% of the pregnants or 24,50/1000 live births. As much in the univariate analysis as in multivariate the color did not present statistic significance, being p= 0,497 and 0,8964, respectively. There was statistic significance in the interaction between color and parity p= 0,0095, OR 3,67 (IC 95% 1,37 - 9,80). Conclusions – Amongst other findings, the relation of 1 maternal death for 23 cases of near miss and the jump of the maternal mortality ratio from 36,05 to 108,15/100,000 live births justify the maternal morbidity study making possible to know the real situation of the assistance the health of the woman. The variable color was not identified as being factor of risk to near miss. It was proven necessity of deepening of the analysis of the identified variable as factors of risk to near miss: age and other causes of internment for white women, number of gestations and diseases associates for the black women, as well as the institution of other parameters of analysis as the transferences and re-internment

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-04-17T17:46:45Z No. of bitstreams: 1 467349 - Texto Completo.pdf: 1380139 bytes, checksum: a0f35ff3198d62b3c575ffb10f483c76 (MD5) / Made available in DSpace on 2015-04-17T17:46:45Z (GMT). No. of bitstreams: 1 467349 - Texto Completo.pdf: 1380139 bytes, checksum: a0f35ff3198d62b3c575ffb10f483c76 (MD5) Previous issue date: 2015-03-20 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / The present investigation aims at analysing the alliance between the State and the Church according to the actions of Ordem de S?o Francisco and Companhia de Jesus, at Rio da Prata Colonial territory. The analysis will be carried out from the conflict involving the jesuits and the Franciscan Bernardino de C?denas, nominated Bishop of Assun??o in 1638 and Governor in 1649, thus gathering both the religious and the civil power of the Province in his hands. The time ranging between the two nominations corresponds to the period of the conflict which starts at the arrival of the new Bishop to Paraguay, in 1642 and will continue up to1660, when the courts of Rome and Spain will decide on the conflict. The feud breaks out due to the economic crisis in Paraguai, as the local settlers could not find satisfactory native labor to help them. Their difficulties continued increasing, mainly after the jesuits stablished the Jesuitic reductions according to which the reduced natives could not be incorporated to the encomienda system. This study will also indicate some differences and similarities in the reduction model proposed by the religious Orders, as well as their relations with the Royal Patronage, which will start to provide the jesuits with privileges, originating an overlap of powers which will generate the conflict. / O objetivo central desta investiga??o ? analisar a alian?a entre Estado e Igreja por meio da atua??o da Ordem de S?o Francisco e da Companhia de Jesus no territ?rio do Rio da Prata Colonial. A an?lise se desenvolver? a partir do conflito envolvendo os jesu?tas e o franciscano Bernardino de C?rdenas, nomeado bispo de Assun??o em 1638 e Governador em 1649, reunindo na sua pessoa, o poder civil e religioso da prov?ncia. A delimita??o temporal corresponde ao desenrolar do conflito, que se estabelece, sobretudo, a partir da chegada do novo Bispo ao Paraguai, em 1642, e se e estender? at? 1660 quando as cortes de Roma e Espanha deliberar?o acerca do conflito. A contenda eclode devido ? crise econ?mica que o Paraguai se encontrava, visto que os colonos locais n?o conseguiam de maneira satisfat?ria a m?o de obra ind?gena necess?ria para o trabalho. A dificuldade dos colonos somente aumentava, sobretudo ap?s o estabelecimento das redu??es Jesu?ticas que n?o permitiam que os ind?genas reduzidos se incorporassem ao sistema de encomienda. O estudo ainda acena nos indicar? algumas diferen?as e semelhan?as no modelo de redu??o proposto pelas Ordens religiosas, bem como suas rela??es com o real padroado, que passar? a deliberar privil?gios aos jesu?tas, ocasionando uma sobreposi??o de poderes que gerar? o conflito.

The work aimed to identify the needs that still permeated the tools of analysis and detect plagiarism for further development of a new tool, called Miss Marple, which met the requirements identified in the course of research, besides continuing the work called DIP - Evidence of Plagiarism Detector. The research conducted in this work allowed the survey of the characteristics of each tool enabling trace a comparative study between them and the development of the new tool. The validation of the developed tool was performed in two modes of travel, and distance, and by evaluating the usability of the tool. The results showed that Miss Marple tool, developed, presented good results in the analysis of percentage signs of plagiarism coming to an accuracy of approximately 100% and got the best processing time when compared with three of the tools that were studied (Sniffer plagiarism, Plagius detector and VIPER). In addition to the processing time and consistency analysis of evidence of plagiarism, another factor that deserves mention is the construction of the repository file submitted for analysis, which provides the user access to the texts with similar passages that are stored locally on your hardware. / O trabalho desenvolvido objetivou identificar as necessidades que ainda permeavam as ferramentas de análise e detecção de indícios de plágio para posterior desenvolvimento de uma nova ferramenta, denominada Miss Marple, a qual atendesse aos requisitos identificados no decorrer das pesquisas, além de dar continuidade ao trabalho desenvolvido denominado DIP - Detector de Indícios de Plágio. As pesquisas realizadas no decorrer deste estudo possibilitaram o levantamento das características de cada ferramenta estudada, possibilitando tracejar um comparativo entre as mesmas e o desenvolvimento da nova ferramenta. A validação da ferramenta desenvolvida foi realizada em duas modalidades de curso, presencial e a distância, além da avaliação de usabilidade da ferramenta. Os resultados alcançados evidenciaram que a ferramenta Miss Marple, desenvolvida, apresentou bons resultados nas análises de percentual de indícios de plágio chegando a uma precisão aproximada de 100% e obteve o melhor tempo de processamento quando comparada com três das ferramentas que foram estudadas (Farejador de Plágio, Plagius detector e VIPER). Além do tempo de processamento e consistência da análise de indícios de plágio, outro fator que merece destaque é a construção do repositório de análise por arquivo submetido, o qual proporciona ao usuário o acesso aos textos com trechos similares que ficam armazenados localmente em seu hardware.

Introdução – A mortalidade materna apresenta grande diferença entre os países desenvolvidos e em desenvolvimento e espelha a qualidade da assistência prestada à saúde da mulher. Para evidenciar melhor essa assistência novos métodos de estudo vêm sendo utilizados, dentre eles a investigação das morbidades materna graves – near misses. Objetivo - Analisar se a cor é fator de risco determinante de casos de near miss, das mulheres residentes em três municípios da Região Metropolitana de Curitiba. Método - Estudo de caso-controle prospectivo de base populacional. Resultados - Foram identificados 68 casos de near miss, dentre eles um óbito materno direto, um indireto tardio e um direto tardio, sendo relação de 1 óbito para cada 23 casos de near miss ou 4,41%. A razão de mortalidade materna ficou em 36,05/100 mil nascidos vivos, atingindo 108,15/100 mil nascidos vivos considerando os dois óbitos tardios. Os casos representam taxa de 2,45% das gestantes ou 24,50/1000 partos. Tanto na análise univariada como na multivariada a cor não apresentou significância estatística sendo o p= 0,497 e 0,8964 respectivamente. Houve significância estatística na interação entre cor e paridade p= 0,0095, OR 3,67 (IC 95% 1,37 – 9,80). Conclusões – Dentre outros achados a relação de 1 óbito materno para 23 casos de near miss e o salto da razão de mortalidade materna de 36,05 para 108,15/100 mil nascidos vivos justificam o estudo da morbidade materna grave, possibilitando conhecer a real situação da assistência a saúde da mulher. A variável cor não foi identificada como sendo fator de risco para near miss. Evidenciou-se a necessidade de aprofundamento da análise das variáveis identificadas como fatores de risco para near miss: idade e outras causas de internação para mulheres brancas, número de gestações e doenças associadas para as mulheres negras, assim como a instituição de outros parâmetros de análise como as transferências e reinternações. / Introduction - Maternal mortality presents great difference between the developed and developing countries and reflects the quality of the woman health care delivered. To evidence this assistance better new study methods come being used, amongst them, the investigation of the severe maternal morbidity - near misses. Objective – Evaluate if the color is a determinative factor to cases of near miss to women who live in three cities of Metropolitan Region Curitiba. Method – Prospective case-control study of population-based. Results – 68 cases of near miss had been identified, amongst them one direct maternal death, one delayed indirect and one delayed direct, being relation of 1 death for each 23 cases of near miss or 4.41%. The maternal mortality ratio was in 36,05/100,000 live births, reaching 108,15/100,000 live births considering the two delayed deaths. The cases represent 2,45% of the pregnants or 24,50/1000 live births. As much in the univariate analysis as in multivariate the color did not present statistic significance, being p= 0,497 and 0,8964, respectively. There was statistic significance in the interaction between color and parity p= 0,0095, OR 3,67 (IC 95% 1,37 - 9,80). Conclusions – Amongst other findings, the relation of 1 maternal death for 23 cases of near miss and the jump of the maternal mortality ratio from 36,05 to 108,15/100,000 live births justify the maternal morbidity study making possible to know the real situation of the assistance the health of the woman. The variable color was not identified as being factor of risk to near miss. It was proven necessity of deepening of the analysis of the identified variable as factors of risk to near miss: age and other causes of internment for white women, number of gestations and diseases associates for the black women, as well as the institution of other parameters of analysis as the transferences and re-internment

Orientadores: Eliana Martorano Amaral, Maria José Martins Duarte Osis / Texto em português e inglês / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T07:32:37Z (GMT). No. of bitstreams: 1 Luz_AdrianaGomes_D.pdf: 2135363 bytes, checksum: 77f86d7ebfa7deb2bd88661c7df7380d (MD5) Previous issue date: 2013 / Resumo: Introdução: A morte materna é a 5ª meta do Desenvolvimento do Milênio e persiste como um problema complexo de saúde. Para alcançar esta meta, é preciso conhecer exatamente quais as condições e processos de cuidado que levam as mulheres a situações clínicas críticas e morte durante o ciclo gravídico-puerperal. Neste cenário, um grupo de pesquisadores implantou um projeto com objetivo de criar a rede nacional de cooperação científica para realizar vigilância, estimar frequência dos casos de near-miss maternos, realizar uma investigação multicêntrica sobre a qualidade dos cuidados das mulheres com complicações severas na gestação e conduzir uma avaliação multidimensional de um grupo selecionado destas mulheres (Rede Nacional de Vigilância de Morbidade Materna Grave - RNVMMG), composta de 27 serviços de referência em diferentes regiões do Brasil. Objetivo: avaliar a perspectiva dos profissionais sobre o impacto na qualidade dos cuidados oferecidos às mulheres com a participação do serviço na Rede Nacional de Vigilância de Morbidade Materna Grave (RNVMMG). Sujeitos e Métodos: Estudo multicêntrico com todos os participantes da RNVMMG nas 27 unidades obstétricas das cinco diferentes regiões geográficas do Brasil. Para o estudo, realizaram-se entrevistas com os coordenadores, pesquisadores e gestores de cada instituição, 6 e 12 meses após o término da coleta de dados da Rede. Os dados foram coletados a partir das entrevistas telefônicas gravadas, utilizando sistema digital NVIVO 9.0 ®, após consentimento informado verbal. Foi realizada análise qualitativa de conteúdo das respostas abertas das entrevistas e análise descritiva dos dados quantitativos. O conteúdo das respostas abertas foi submetido à análise temática, definindo-se as categorias e subcategorias emergentes dos discursos dos profissionais, segundo sua inserção institucional e na Rede. Resultados: Foram realizadas 122 entrevistas nas duas fases, incluindo pesquisadores e gestores dos serviços participantes, abrangendo 75,3% das entrevistas previstas, com maior participação dos gestores na 2ª fase. A maioria dos entrevistados considerou que a participação na RNVMMG mudou sua percepção e atitude diante da identificação dos casos de risco à morbidade/ mortalidade materna, ajudou a difundir os conhecimentos adquiridos no próprio serviço e tomar a conduta médica mais eficiente na condução desses casos. A divulgação científica dos resultados finais foi um fator determinante, em muitos serviços, para a discussão de mudanças de protocolo. Porém, não ficou evidente um impacto institucional duradouro. A necessidade de manter uma rede de vigilância morbidade materna grave foi salientada. Conclusão: Houve uma mudança significativa na capacidade dos profissionais que participaram da RNVMMG para identificar os casos, que se aprimorou ao longo do tempo. Os serviços participantes em sua maioria tiveram melhoria na qualidade dos cuidados oferecidos / Abstract: Background: Maternal death remains as a complex health problem and its reduction is the 5th Millennium Development Goal. To achieve this goal, countries need to know exactly what conditions lead to the death of women during pregnancy and childbirth. In this scenario, a group of researchers implemented a project to create a national network of scientific cooperation to surveillance, in order to know the frequency of near miss, to conduct a multicenter investigation on quality care of women with severe complications in pregnancy and to conduct a multidimensional assessment of a select group of these women (Brazilian Network for Surveillance of Severe Maternal Morbidity - BNSMM), with the participation of 27 centers in different regions of the country, Objective: To evaluate the perspective of professionals about the impact of the surveillance during the network study on the quality of care .Subjects and Methods: A multicenter study with 27 obstetric referral facilities in 5 different geographic regions of Brazil. For the study, researchers conducted a telephone interview with research coordinator, principal investigator and manager from each institution, six and 12 months after the end of the data collection from the surveillance study. Data was collected through interviews recorded using a digital system NVIVO® 9.0, after verbally authorized informed consent. Data analysis was performed by qualitative content analysis of open answers from the interviews and descriptive data analysis. The contents of the open answers were subjected to thematic analysis, defining the categories and subcategories of emerging discourses of professionals according to their insertion and institutional network. Results: We performed a total of 122 interviews in two phases including researchers and managers of the participating hospitals, covering 75.3% of the sample, with greater involvement of managers in the 2nd phase. Most of researchers felt that participation in BNSMM changed their perception and attitude towards the identification of cases with risk of severe maternal morbidity / mortality and helped to disseminate the knowledge acquired in the service itself and they considered that the medical management was more efficient in conducting these cases. Participants believe that the scientific publication of the final results was a determining factor to change practice. However, there was no evidently a lasting institutional impact. Participants emphasized need to maintain a network of severe maternal morbidity surveillance. Conclusion: There was a significant change in the ability of the professionals who participated in the RNVMMG to identify cases, which improved over time. Services participants mostly had improvement in quality of care offered / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

Orientadores: João Paulo Dias de Souza, José Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T16:41:03Z (GMT). No. of bitstreams: 1 Chaves_SolangedaCruz_M.pdf: 1613021 bytes, checksum: 7d4197dbf48569d759c9b1315425c34b (MD5) Previous issue date: 2015 / Resumo: Objetivos: Avaliar se as características propostas da Transição Obstétrica ¿ um modelo conceitual criado para explicar as mudanças graduais que os países apresentam ao eliminar a mortalidade materna evitável ¿ são observadas em um grande banco de dados multipaíses sobre a saúde materna e perinatal.Métodos: Trata-se de análise secundária de um estudo transversal da OMS que coletou informações de todas as mulheres que deram à luz em 359 unidades de saúde de 29 países da África, Ásia, América Latina e Oriente Médio, durante um período de 2 a 4 meses entre 2010 e 2011. As razões de Condições Potencialmente Ameaçadoras da Vida (CPAV), Resultados Maternos Graves (RMG), Near Miss Materno (NMM), e Mortalidade Materna (MM) foram estimadas e estratificadas por estágio de transição obstétrica. Resultados: Dados de 314.623 mulheres incluídas neste estudo demonstram que a fecundidade das mulheres, indiretamente estimada pela paridade, foi maior nos países que estão em estágio menor da transição obstétrica, variando de uma média de 3,0 crianças por mulher no Estágio II para 1,8 crianças por mulher no Estágio IV. O nível de medicalização do nascimento nas instituições de saúde dos países participantes, avaliada pelas taxas de cesárea e de indução de trabalho de parto, tendeu a aumentar à medida que os estágios de transição obstétrica aumentam. No Estágio IV, as mulheres tiveram 2,4 vezes a taxa de cesáreas (15,3% no Estágio II e 36,7% no Estágio IV) e 2,6 vezes a taxa de indução de trabalho de parto (7,1% no Estágio II e 18,8% no Estágio IV) que as mulheres de países no Estágio II. À medida que os estágios da transição obstétrica aumentaram, a média de idade das primíparas também aumentou. A ocorrência de ruptura uterina apresentou uma tendência decrescente, caindo aproximadamente 5,2 vezes, de 178 para 34 casos para 100 000 nascidos vivos à medida que os países transicionaram do Estágio II para o Estágio IV. Conclusões: Esta análise corroborou o modelo da Transição Obstétrica utilizando um banco de dados de grande porte e multipaíses. O modelo da Transição Obstétrica pode justificar a individualização da estratégia de redução da mortalidade materna de acordo com os estágios da transição obstétrica de cada país / Abstract: Objectives: To test whether the proposed features of the Obstetric Transition Model¿a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality¿are observed in a large, multicountry, maternal and perinatal health database. Methods: This was a secondary analysis of a WHO cross-sectional study that collected information on all women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2¿4-month period in 2010 ¿ 2011. The ratios of Potentially Life-threatening Conditions (PLTC), Severe Maternal Outcomes (SMO), Maternal Near Miss (MNM) and Maternal Death (MD) were estimated and stratified by stages of obstetric transition. Results: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. The level of medicalization in health facilities in participating countries, defined by the number of caesarean deliveries and number of labor inductions, tended to increase as the stage of obstetric transition increased. In Stage IV, women had 2.4 times the caesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) than women in Stage II. As the stages of obstetric transition increased, the mean age of primiparous women also increased. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. Conclusions: This analysis supports the concept of obstetric transition using multicountry data. The obstetric transition model could provide justification for customizing strategies for reducing maternal mortality according to a country¿s stage in the obstetric transition / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

Dominick Argento's Miss Havisham's Wedding Night is the least explored of his artistic output. A monodrama in one act for soprano, Miss Havisham's Wedding Night contains some of Argento's most beautiful and challenging music of his compositional output. The purpose of a detailed analysis of the structure and content of Argento's Miss Havisham's Wedding Night is to facilitate the solo vocal performer's interpretation. Argento's setting of Miss Havisham's Wedding Night is unique in that he musically translates the manic psychological state of the literary character. Argento structured the one act opera in such a manner that the music would illuminate the text and the audience might connect with the unstable psychological episodes and outbursts demonstrated by Miss Havisham. To that end, each section and phrase has its own psychological motivation, which in turn demands a varied musical and dramatic interpretation. Utilizing selected scenes from Miss Havisham's Wedding Night, the researcher will analyze Argento's musical manifestation of Dickens's literary work. This research will include an investigation into the manner in which Argento uses the shape of melody and the musical phrase along with the harmonic materials to enhance the text and dramatic content. The author will explore the musical nuances Argento incorporates in an effort to develop and portray Miss Havisham's psychological state. Through an analysis of the orchestral writing the author will show how Argento's aesthetic balance between the music and text represents the emotional and psychological implications of the monodrama.