Introduction Increased use of caesarean section (CS) as a mode of delivery is of concern for maternal and child health in many countries. The World Health Organization (WHO) has set guideline of population caesarean section rate between 5% - 15% for CS deliveries. Accordingly the South African National Department of Health (NDOH) has set a national target for district hospitals, that no more than 10% of all deliveries should be by CS. Standerton District Hospital experienced a sudden increase in the caesarean section rate (CSR), from 17.5% in 2004 to 30.8% in 2007. The reasons for this increase are not known. Purpose of the study This study aims to investigate factors which contributed to the sudden increase of CSR from 17.5% in 2004 to 30.8% in 2007 at Standerton District Hospital, Gert Sibande District Mpumalanga. Method A retrospective record review of 790 women who delivered at Standerton District Hospital by caesarean section from January 2004 to December 2007 was done. Fifty percent of the total number of records for each year was retrieved and to achieve this every second record was selected from the maternity and theatre registers for patients who have undergone CS. Systematic sampling selection of records of all women who have undergone CS was conducted during the identified period. Data on patient demographics, the reasons for the CS, the maternal and neonatal outcomes achieved, antenatal care profile, the employment status and the responsible medical practitioner were extracted from existing records maintained by the hospital. Analysis ascertained factors associated with increased CSR. Results The Caesarean section rate at Standerton District Hospital has increased annually since 2004. The factors contributed to the increase include medical indications, clients who are primigravida and the less experienced community service doctors who performed the CS. There was no evidence that education, high income clients, or maternal request contributed to the increase of Caesarean Section rate (CSR). The outcome of mother and baby were positive except for 1% of babies who were not alive. Robson’s group classification (classification system which defines 10 groups of women according to obstetric record, category of pregnancy, the presence of previous uterine scar, the course of labour, delivery and gestational age), revealed that groups two and four played a major role. Conclusion CSR has increased over the years and strategies needs to be developed to reduce this by having experienced doctors supervising community service doctors, training of professionals working in maternity and monitoring of labour by midwives. Recommendation Standerton District Hospital management should intensify recruitment and retention of experienced medical officers, train additional midwives on advanced courses, intensify ante natal care, establish a high risk clinic at the hospital, review hospital policies on maternal care and monitoring of compliance to mother and baby’s national and provincial policies. / Theses (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

Section 718.2 (e)’s directive to canvass all available sanctions other than imprisonment that are reasonable in the circumstances, with particular attention to the circumstances of Aboriginal offenders was to be given real force. This study’s goal was therefore to identify what considerations may be impeding or encouraging the application of section 718.2 (e)’s directive through a constructivist discourse analysis of 33 court of appeal cases. The study has mapped trends and influences which weigh strongly on sentencing judges in the decision-making process and considerations that are affecting the application of this provision. Prohibitive and permissive dimensions of the Gladue case were identified related to the application of section 718.2 (e), creating competing ideals in the application of the provision. Modern Penal Rationality (MPR) underpinned many of the judges’ justifications. However, unforeseen considerations were also noted. Ultimately, MPR, dominates the sentencing calculus and diminishes section 718.2 (e)’s application and alternative/restorative potential.

Intellectual property rights (IPRs) are becoming increasingly important due to their inevitable link to technology and economic development. This highlighted role has resulted in the emergence and development of over-protections that are beyond the ideal scope of IPRs. As the scope of IPRs expands, competition concerns are also intensifying and, as a result, the interface between IP and competition law is expanding in new directions. To address these new developments, trans-Atlantic jurisdictions have developed new policies based on the general provisions of their competition laws. Canada’s current policy toward the IP/competition law interface is affected by the existence of a unique section in its Competition Act, section 32, which directly refers to the anti-competitive usage of IPRs. Despite section 32’s long presence in the Act and its role as a basis of the Competition Bureau’s analysis of the IP/competition law interface in Canada, this section has not been judicially considered to date. This thesis re-examines the role of section 32 and explores some of the reasons behind its current obsolescence. The main claim of this thesis is that the current interpretations of the role of section 32 are not as broad as envisaged in the statute. On the one hand, the Competition Bureau’s interpretation in the Intellectual Property Enforcement Guidelines (IPEGs) limits the scope of section 32 to the unilateral refusal to license IPRs. The approach that the Bureau has adopted toward the unilateral refusal to license is more in line with the American restrictive approach, which allows very limited scope for competition law interventions in the IP realm. From the author’s point of view, such a restrictive approach is not consistent with the underlying principles of Canadian competition policies. On the other hand, section 32 has not been amended since 1935. This has led to the generation of some procedural restrictions in the application of this section. The author claims that the procedural requirements of section 32 need to be amended in order to parallel the modernization of the Competition Act that has occurred over the last few decades. / Graduate

In recent decades, there has been a seemingly inexhaustible rise in the use of caesarean section (CS) worldwide. The overall aim with this thesis is to explore the effects of and reasons for an increase in the CS rate at a university hospital in Dar es Salaam, Tanzania. In Study I, we analysed time trends in CS rates and maternal and perinatal outcomes between 2000 and 2011 among different obstetric groups. In Study II, we documented the occurrence and panorama of maternal ‘near-miss’ morbidity and death, and analysed their association with CS complications. We also strived to determine if women with previous CS scars had an increased risk of maternal near-miss, death, or adverse perinatal outcomes in subsequent pregnancies. Studies III and IV explored women’s and caregivers’ in-depth perspectives on CS and caregivers’ rationales for their hospital’s high CS rate. During the study period, the CS rate increased from 19% to 49%. The rise was accompanied by an increased maternal mortality ratio (odds ratio [OR] 1.5, 95% Confidence Interval [CI] 1.2–1.8) and improved perinatal outcomes. CS complications accounted for 7.9% (95% CI 5.6–11) of the maternal near-miss events and 13% (95% CI 6.4–23) of the maternal deaths. Multipara with previous CS scars had no increased risk of maternal near-miss or death compared with multipara with previous vaginal deliveries, and a lower risk of adverse perinatal outcomes (adjusted OR 0.51, 95% CI 0.33–0.80). Both women and caregivers stated they preferred vaginal birth, but caregivers also had a favourable attitude towards CS. Both groups justified maternal risks with CS by the need to ‘secure’ a healthy baby. Caregivers stated that they sometimes performed CSs on doubtful indications, partly due to dysfunctional team-work and a fear of being blamed by colleagues.  This thesis raises a concern that maternal health, interests, and voices are overlooked through the CS decision for the benefit of perinatal outcomes and caregivers’ liability. An overuse of CS should be seen as a sign of substandard care and preventing such overuse needs to be among the key actions when formulating new targets for the post-2015 era.

Elliptical hollow sections (EHS) are the newest steel shape to emerge in the industry, but appropriate design guidance is lacking, being completely absent from Canadian codes and guidelines. Geometric property and compressive resistance tables were established to be potentially added to the Canadian guides. The equivalent RHS method, originally proposed by Zhao and Packer in 2009, was simplified and modified to validate its use for the design of EHS columns and beams. An experimental programme was developed to investigate the behaviour of EHS-to-EHS welded connections. Twelve T and X connection tests were performed to study the effect of connection angle, orientation type and loading. Two methods were developed to predict connection capacities and failure modes: the equivalent CHS and the equivalent RHS approaches. Both methods proved to be conservative on average, but the equivalent RHS approach proved to be more successful at capturing the actual failure mode of EHS-to-EHS connections.

Elliptical hollow sections (EHS) are the newest steel shape to emerge in the industry, but appropriate design guidance is lacking, being completely absent from Canadian codes and guidelines. Geometric property and compressive resistance tables were established to be potentially added to the Canadian guides. The equivalent RHS method, originally proposed by Zhao and Packer in 2009, was simplified and modified to validate its use for the design of EHS columns and beams. An experimental programme was developed to investigate the behaviour of EHS-to-EHS welded connections. Twelve T and X connection tests were performed to study the effect of connection angle, orientation type and loading. Two methods were developed to predict connection capacities and failure modes: the equivalent CHS and the equivalent RHS approaches. Both methods proved to be conservative on average, but the equivalent RHS approach proved to be more successful at capturing the actual failure mode of EHS-to-EHS connections.

The increasing rates of intervention in childbirth are an issue for women, their families, health professionals, and society across much of the Western World. This study is a response to these increasing rates of intervention, as reflected in the research question: 'What is shaping the practice of health professionals and the understanding of the public in relation to increasing intervention in childbirth?' The participants in the study were nine health professionals: midwives and obstetricians, who were interviewed individually, and thirty-three members of the public who took part in six focus groups. The research was carried out under the umbrella of critical hermeneutics, and the particular approach used was that of critical interpretation as formulated by Hans Kogler. This approach enabled a hermeneutical thematic analysis of that which is shaped (worldviews) and a critical structural analysis (discursive orders, social practices, relationships of power and structures of domination) of the shaping and shapers of practice and understanding. The research process facilitated by critical interpretation in identifying and describing the shaping and shapers of practice and understanding adds an important dimension to the statistical picture of increasing intervention that is of concern, both to health professionals and the public. The research revealed that the everyday world and its associated processes of socialisation in the 21st century - in particular pain, choice, and technology - shape the practice of health professionals and the understanding of the public in relation to increasing intervention. The study's findings were supported by the revelation that many of the social and cultural values, such as convenience, ease, and control, that underpin Western society in the 21st century, correlate with what intervention has to offer, which results in intervention being increasingly sought after and utilised. This milieu of intervention, which increasingly surrounds childbirth, is shown to be calling into question those things that have traditionally been at the heart of childbirth: the ability of the woman to birth and the clinical skills of the health professional. This research provides insight and awareness of those things that are shaping understanding and practice and birth itself and creating a milieu in which intervention is increasingly normalised.

Thesis (M.M.)--Bowling Green State University, 2009. / Document formatted into pages; contains 1 score (vi, 29 p.) For clarinet, bassoon, and chamber orchestra (two trumpets, two horns, tenor trombone, bass trombone, percussion, piano, harp, and strings (six first violins, six second violins, four violas, four cellos, and two basses) Includes bibliographical references.

Proefschrift--Groningen. / "Stellingen" [2] p. inserted. Summary in Dutch. Includes bibliographical references.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 92-101). Also available on the Internet.