This thesis addresses the question of how a dialogue may be developed between the socio-political notion of pluralism and a pluralistic public sphere, and the design of public space and public architecture. More particularly, it considers how architecture may both accommodate multiple publics while simultaneously framing connection or association between them. Following an exploration of this question at an abstract, theoretical level, the thesis moves to a more specific architectural investigation. This investigation takes the form of a design project situated within the Robson Square complex in downtown Vancouver. The complex, constructed in the mid-1970's, was designed by Canada's pre-eminent architect Arthur Erickson and is the major civic space in the city. The thesis design project undertakes a theoretical re-evaluation and physical renovation of this Utopian mega-structure, with the intention of shifting the existing homogeneity and institutionality of the complex to align it with the thesis argument. Through the vehicle of a design project,, the abstract theoretical argument is translated and focused through the particularities of an architecture embedded in its site. This methodology requires the project to address issues connected to the existing masterwork, including: the question of how to conceptualize monumentally in a grid city; the relationship between the 'sacred' space of the civic circumstance and the 'profane' space of the street and commercial program; the form of the institution within the city; and the issue of working within, and manipulating, a pre-existing architectural language. Further, the scale of the site is reflected in the scope of the design project. The project moves from the development of urban design strategies to the detailed consideration of the material and construction of the different interventions. The architecture remains, however, conceptual and is a demonstration of how the developed strategies may generate form and guide program. The project does not attempt to fully develop a building in detail. The thesis concludes with an afterword on the success of the project as a demonstration of the thesis argument. At the same time, the limits of architecture to act as a socio-political device are acknowledged. Further, speculations are made as to the way in which the position and the strategies developed within the thesis might inform wider discussions on architecture and the urbanism of grid cities such as Vancouver. The key concept forming the basis of these speculations is the idea of a 'difficult' co-existence of parts and a whole, reflecting the pluralistic ideal of association within fragmentation. / Applied Science, Faculty of / Architecture and Landscape Architecture (SALA), School of / Graduate

A sharp increase in caesarean section (CS) rates at the Muhimbili National Referral Hospital (MNH) – a tertiary referral hospital in Tanzania – by 50% in 2000–2011, was associated with concomitant increase in maternal complications and deaths and inconsistent improvement in newborn outcomes. The aims of this thesis were to explore care providers’ in-depth perspective of the reasons for these high rates of CS, and to evaluate and improve standards of care for the most common indica-tions of CS, obstructed labour and fetal distress, which are also major causes of adverse maternal and neonatal outcomes. This thesis reports an investigation performed at MNH, Tanzania. For Paper I, qualitative methods were employed and demonstrated how care providers dismissed their responsibility for the rising CS rate; and, instead, projected the causes onto factors beyond their control. Additionally, dysfunctinal teamwork, transparency, and previous poorly conducted clinical audits led to fear of blame among care providers in cases of poor outcome that subsequently encougared defensive practise by assigning unnecessary CS. Papers II and III evaluated stand-ards of care using a criteria-based audit (CBA) of obstructed labour and fetal dis-tress. After implementing audit-feedback recommendations, the standards of diag-nosis of fetal distress improved by 16% and obstructed labour by 7%. Similarly, the standards of management preceding CS improved tenfold for fetal distress and doubled for obstructed labour. The impact of the CBA process was evaluated by comparing the maternal and perinatal outcomes categorized into Robson groups (Paper IV) of all deliveries occurring before and after the audit process (n=27,960). After the CBA process, there was a 50% risk reduction of severe perinatal morbidi-ty/mortality for patients with obstructed labour. The overall CS rates increased by 10%, and this was attributed to an increase in the CS rate among breech, term preg-nancies (Robson group 6), and preterm pregnancies (Robson group 10) that specifi-cally had reduced risk of poor perinatal outcome. The overall neonatal distress rates were also reduced by 20%, and this was attributed to a decrease in the neonatal distress rate among low-risk, term pregnancies (Robson group 3). Importantly, the increased rates of poor perinatal outcomes were associated with referred patients that had higher risk of neonatal distress and PMR than non–referred patients, after CBA process.  In conclusion, the studies managed to educate the care providers to take on their roles as decision-makers and medical experts to minimize unnecessary CS, using the available resources. Care providers’ commitment to achieve the best practice should be sustained and effort for stepwise upgrading quality of obstetric care should be supported by the hospital management from the primary to tertiary referral level.

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Submitted by Wagner Junior (wagner.junior@unioeste.br) on 2018-07-11T19:58:43Z No. of bitstreams: 2 Fabiana_Aparecida_Spohr_2018.pdf: 1390462 bytes, checksum: 12be128306b00d757f14e693ec862901 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-07-11T19:58:43Z (GMT). No. of bitstreams: 2 Fabiana_Aparecida_Spohr_2018.pdf: 1390462 bytes, checksum: 12be128306b00d757f14e693ec862901 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-02 / The incidence of cesarean sections has increased considerably in Brazil and in the world. This type of delivery refers to a safe surgical procedure that must be performed to resolve an obstetric emergency, based on specific recommendations to preserve mother and newborn life. Surgical delivery can trigger complications which involve injury to the woman and the newborn when applied in an untimely manner, without indication. For the fetus, the risks result in premature births and increase the incidence of hospitalization in a neonatal intensive care unit. The objective of this study was to identify the incidence of surgical deliveries and the indication according to the Robson Classification in border region. Data collection was performed in the first semester of 2017. The population was composed of all the women who went through the birthing process from 2012 to 2016, in a hospital institution of reference for gestation of high risk in Foz do Iguaçu, PR. Data analysis was performed through the Statistica 8.0 program, using the χ2 test with significance level of 5% and for the multivariate analysis the logistic regression model will be used. Gross Odds Ratios (OR) and their 95% confidence intervals will be estimated, with a p value of <0.05. The Robson Classification was used. A total of 21,159 records of women were analyzed in the period 2012-2016, in which 11,442 were vaginal deliveries and 9,717 surgical deliveries were classified according to Robson Classification. For nationality, 90.25% were Brazilian, 4.78% were Paraguayan, and 2.75% had this dual citizens, 0.75% were from Argentina and 1.39% were from another country. Robson group 3 was the most significant for births for 28% for Brazilians and 27.35% for foreigners. The Robson Groups with the highest incidence of surgical delivery were 1, 3 and 5, and groups 1, 2, 3 and 4 need more attention and evaluation to avoid unnecessary caesars in these particular groups.The Robson Classification was shown to be very important in order to analyze cesarean in an unnecessary way. The use of the 10 Robson’s groups points to a restructuring of the care directed to the woman in the period of pregnancy and puerperal and in this study they point to specific groups of Robson that deserve attention as groups 1 to 4, in which the major concern is to avoid cesarean. / A incidência de cesáreas vem aumentando consideravelmente no Brasil e no mundo. Esse tipo de parto refere-se a um procedimento cirúrgico seguro que deve ser realizado para resolver uma emergência obstétrica a partir de recomendações específicas para preservar a vida da mãe e do recém-nascido. O parto cirúrgico pode desencadear complicações que envolvem prejuízos à mulher e ao recém-nascido quando aplicado de forma inoportuna, sem a real indicação. Para o feto, os riscos resultam em nascimentos prematuros e aumentam a incidência de internação em unidade de terapia intensiva neonatal. O objetivo desta pesquisa é identificar a incidência de partos cirúrgicos e a indicação, segundo a Classificação de Robson, em região de fronteira. Trata-se de um estudo de corte transversal, cuja coleta de dados foi realizada no primeiro semestre de 2017. A população foi composta por todas as mulheres que passaram pelo processo de parto, no período de 2012 a 2016, em uma instituição hospitalar de referência para gestação de alto risco em Foz do Iguaçu, PR. A análise dos dados foi realizada por meio do programa Statistica 8.0, por intermédio do teste χ2, com nível de significância de 5%; e para a análise multivariada, utilizado o modelo de regressão logística. Foram estimadas as Odds Ratios (OR) brutas e os respectivos intervalos de confiança de 95%, com o valor de p de <0.05. Foram analisados 21.159 prontuários de mulheres no período de 2012 a 2016, das quais 19.097 (90,25%), são brasileiras 1.011 (4,78%) paraguaias, 582 (2,75%) apresentam dupla cidadania, mulheres brasileiras que residem no paraguai (chamadas brasiguaias), 159 (0,75%) argentinas e 295 (1,39%) de outra nacionalidade. Somente 15 parturientes (0,07%) não apresentaram dados ou exibiram categorias inexistentes. O grupo 3 de Robson com maior significância para nascimentos entre brasileiras foi 28% e 27,35% para estrangeiras. Os Grupos de Robson com maior incidência de parto cirúrgico foram 1, 3 e o 5. A classificação dos 10 grupos de Robson demostrou-se uma ferramenta importante para analisar cesárea desnecessária. A classificação dos 10 grupos de Robson aponta para uma reestruturação da assistência voltada à mulher no período gravídico e puerperal, assim como em outros estudos a classificação dos 10 grupos de Robson apontam para grupos específicos como os grupos 1, 2, 3 e 4, em que a maior preocupação está em evitar cesárea nesses grupos.

New Zealand-born architect Joseph Fearis Munnings (1879-1937) is largely forgotten in the country of his birth. Considering the importance of his public works in Bihar and Orissa, India (1912-1919) and his prominence as a school architect in New South Wales, Australia (1923-1937), recognition of his architectural achievements is long overdue. This thesis takes as its premise the notion that early twentieth century architecture in colonial New Zealand, India and Australia was British, the rationale expounded by G. A. Bremner in Imperial Gothic– Religious Architecture and High Anglican Culture in the British Empire (2013). My thesis argues that, considering Munnings’ colonial upbringing and English training, the styles he employed reflected his and his clients’ identity as British. It explores the extent to which Munnings adapted British styles, by incorporating features appropriate for colonial conditions. Drawing upon the work of Ian Lochhead on the achievements of Samuel Hurst Seager, my thesis considers the role played by Seager in mentoring Munnings and guiding his philosophy of architecture. Peter Scriver’s papers, ‘Edge of empire or edge of Asia’ (2009) and ‘Complicity and Contradiction in the Office of the Consulting Architect to the Government of India, 1903-1921’ (1996), also inform my analysis of Munnings’ work in India. To enable an analysis of Munnings’ work, this study divides his career into chronological stages: Early experiences and training, Christchurch, New Zealand, 1879-1903 Architectural training, London, England, 1903-1906 Partnership with Hurst Seager and Cecil Wood, Christchurch, 1906-1909 Work with Leonard Stokes, London, 1909 Responsibilities and achievements, India, 1910-1918 Contributions and achievements, New Zealand, 1919-1923 Partnership with Power and Adam, Sydney, Australia, 1923-1937. This thesis, the first comprehensive study of Munnings’ career, illuminates the extent of his architectural legacy in India, his significant contribution to school architecture in New South Wales, and asserts his place as an architect of the British Empire.

During the 1740’s, Hudson Bay went from an obscure backwater of the British Empire to a locus of colonial ambition. Arthur Dobbs revitalized Northwest Passage exploration, generating new information about the region’s environment and indigenous peoples. This study explores evolving English and British representations of Hudson Bay’s climate and landscape in travel and natural history writing, and probes British anxieties about foreign environments. I demonstrate how Dobbs’ ideology of improvement optimistically re-imagined the North, opening a new discursive space wherein the Subarctic could be favourably described and colonized. I examine how Hudson Bay explorers’ responses to difficulties in the Arctic and Subarctic were seen to embody, even amplify, central principles and features of eighteenth-century British culture and identity. Finally, I investigate how latitude served as a benchmark for civilization and savagery, subjugating the Lowland Cree and Inuit to British visions of settlement and improvement in their home territories.

La Communauté française décide en concertation avec la Région bruxelloise et la Région wallonne, de financer un Centre d’Epidémiologie Périnatale (CEpiP). Les Communautés et Régions chargent le CEpiP de les assister dans la vérification, le remplissage et la correction des certificats concernant les naissances à partir du 1er janvier 2008. Le CEpiP est également chargé d’encoder les certificats bruxellois, les certificats wallons étant toujours encodés par un sous-traitant.<p>Un problème souvent rencontré dans l’analyse des certificats de naissance est la présence de données manquantes. Des informations manquaient sur 64.0% des certificats bruxellois de janvier 2008 (situation de base). Le renforcement de l’enregistrement par le CEpiP durant l’année 2008 est lié à une diminution des informations manquantes sur les certificats initiaux (à la sortie des maternités et services d’état civil) après la première et la deuxième année d’enregistrement :20,8% et 19,5% des naissances en décembre 2008 et 2009 respectivement. Le taux résiduel de données manquantes après correction grâce aux listes envoyées aux maternités et services d’Etat civil est faible. En particulier, la nationalité d’origine des parents était souvent manquante, jusqu’à 35% à Bruxelles (données non publiées), et ce taux est passé à 2.6% en 2008 et 0.1% en 2009. Certaines données manquantes ne sont pas distribuées de façon équivalente selon la nationalité de la mère, même après correction. Les mères d’origine sub-saharienne ont les taux de remplissage les moins élevés. Enfin, le taux de mort-nés a augmenté par rapport aux données de 2007, au profit des mort-nés avant l’âge de 28 semaines, et suggère une amélioration de l’enregistrement suite au renforcement de l’information.<p>Les données concernant l’indice de masse corporelle des patientes sont donc relevées depuis 2009 pour l’ensemble des mères qui accouchent en Belgique. L’obésité maternelle et l’immigration sont en augmentation en Belgique, et ont été rarement étudiées au travers d’études de population sur les certificats de naissance. Des études ont pourtant montré que ces mères étaient à risque de complications périnatales, comme la césarienne ou la mortalité périnatale. L’obésité et l’immigration ont en commun le fait qu’elles recouvrent des réalités médicales, sociales et relationnelles face au personnel soignant, qui les mettent à risque de complications périnatales.<p>Des différences en termes de complications obstétricales et néonatales entre populations immigrantes et autochtones ont été observées en Belgique et dans d’autres pays, mais elles sont encore mal comprises. <p>Dans un premier travail d’analyse, nous avons évalué les taux de mortalité périnatale chez les mères immigrantes, en fonction du fait qu’elles étaient naturalisées ou non.<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères immigrantes (8.6‰) que non-immigrantes (6.4‰).<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères non naturalisées (10.3‰) que chez les mères naturalisées (6.1‰).<p>Le taux de mortalité périnatale varie selon l’origine des mères, mais dans chaque sous-groupe étudié, les mères non naturalisées ont un taux plus élevé de mortalité périnatale.<p><p>Des études ont successivement montré davantage, ou moins de césariennes chez les mères immigrantes. Peu de facteurs confondants étaient généralement pris en compte. Dans un second travail d’analyse, nous avons comparé les taux de césarienne dans plusieurs sous-groupes de nationalités.<p>Les taux de césarienne varient selon les sous-groupes de nationalités. Les mères originaires d’Afrique sub-saharienne ont un odds ratio ajusté pour la césarienne de 2.06 (1.62-2.63) en comparaison aux mères belges. L’odds ratio ajusté n’est plus statistiquement significatif après introduction des variables anthropométriques dans le modèle multivariable pour les mères d’Europe de l’Est, et après introduction des interventions médicales pour les mères du Maghreb.<p><p>Peu d’études ont analysé la relation entre l’obésité maternelle et les complications néonatales, et la plupart de ces études n’ont pas ajusté leurs résultats pour plusieurs variables confondantes. Nous avons eu pour but dans un troisième travail d’analyse d’étudier la relation entre l’obésité maternelle et les paramètres néonatals, en tenant compte du type de travail (induit ou spontané) et du type d’accouchement (césarienne ou voie basse). Les enfants de mères obèses ont un excès de 38% d’admission en centre néonatal après ajustement pour toutes les caractéristiques du modèle multivariable (intervalle de confiance à 95% :1.22-1.56) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 45% (1.21-1.73) et 34% (1.10-1.63) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 18% (0.86-1.63) et non statistiquement significatif.<p>Les enfants de mères obèses ont un excès de 31% de taux d’Apgar à 1 minute inférieur à 7, après ajustement pour toutes les caractéristiques du modèle mutivariable (1.15-1.49) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 26% (1.04-1.52) et 38% (1.12-1.69) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 50% (0.96-2.36) et non statistiquement significatif.<p><p>In 2008, a Centre for Perinatal Epidemiology was created inter alia to assist the Health Departments of Brussels-Capital City Region and the French Community to check birth certificates. A problem repeatedly reported in birth certificate data is the presence of missing data. The purpose of this study is to assess the changes brought by the Centre in terms of completeness of data registration for the entire population and according to immigration status. Reinforcement of data collection was associated with a decrease of missing information. The residual missing data rate was very low. Education level and employment status were missing more often in immigrant mothers compared to Belgian natives both in 2008 and 2009. Mothers from Sub-Saharan Africa had the highest missing rate of socio-economic data. The stillbirth rate increased from 4.6‰ in 2007 to 8.2‰ in 2009. All twin pairs were identified, but early loss of a co-twin before 22 weeks was rarely reported.<p>Differences in neonatal mortality among immigrants have been documented in Belgium and elsewhere, and these disparities are poorly understood. Our objective was to compare perinatal mortality rates in immigrant mothers according to citizenship status. Perinatal mortality rate varied according to the origin of the mother and her naturalization status: among immigrants, non-naturalized immigrants had a higher incidence of perinatal mortality (10.3‰) than their naturalized counterparts (6.1‰). In a country with a high frequency of naturalization, and universal access to health care, naturalized immigrant mothers experience less perinatal mortality than their not naturalized counterparts. <p>Our second objective was to provide insight into the differential effect of immigration on cesarean section rates, using Robson classification. Cesarean section rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from Sub-Saharan Africa with a term, singleton infant in cephalic position, without previous cesarean section, appear to carry the highest burden.<p>If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the last study, after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis. Neonatal admission to intensive care and low Apgar scores were more likely to occur in infants from obese mothers, both after spontaneous and <p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished