Background: Adverse birth outcomes present a difficult and chronic challenge in Ontario, in Canada and in developed countries in general. Increasing proportions of preterm births, significant regional disparities and the high cost of treating all adverse birth outcomes have focused attention on explaining them and developing effective treatments. Methods: Birth outcomes and maternal characteristics for approximately 626,000 births, about 90% of births in 2005–2009, were linked to small geographic areas throughout Ontario. For each of four adverse outcomes: late preterm, moderate to very preterm, small for gestation age and still births, proportions of total births were calculated for the full province and for each small geographic area. Geographic hotspots of elevated rates were identified for each of the different adverse birth outcomes using the local Moran’s I statistic. Data for nine known ecologic and individual risk factors were then linked to the areas. Hierarchical regression analysis was used to model each of the outcomes for the full province and for dispersed local areas. The resulting models for the different outcomes were contrasted. Results: Significant geographic hotspots exist for each of the four outcomes. Hotspots for the different outcomes were found to be largely spatially exclusive. For like outcomes, predictive models differed markedly between local areas (i.e. local groups of hotspots) as well as between full-province and local areas. Ecologic level variables played a strong role in all models; the influence of individual level risk factors was consistently modified by ecologic risk factors except for small for gestational births. Conclusions: The finding of significant hotspots for different adverse birth outcomes indicates that certain geographic areas have aetiologies or patterns of predictors sufficient to create significantly elevated levels of particular outcomes. The finding that hotspots for the different adverse outcomes are largely exclusive implies that the aetiologies are specific; i.e., those that are sufficient to create significantly higher levels for one outcome do not also create significantly higher levels of others. The consistently strong role of ecologic level risk factors in modifying individual level risk factors implies that contextual characteristics are an important part of the aetiology of adverse birth outcomes. Differences in local area models suggest the existence of location-specific (rather than universal) aetiologies. The findings support the need for more careful attention to local context when explaining birth outcomes.

Law / LL.M.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-01-09T12:21:59Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) andre_vinicius_gon?alves.pdf: 1266538 bytes, checksum: 42c3fe90b9d66c8cb7b901a10e548f1b (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-01-31T13:56:36Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) andre_vinicius_gon?alves.pdf: 1266538 bytes, checksum: 42c3fe90b9d66c8cb7b901a10e548f1b (MD5) / Made available in DSpace on 2017-01-31T13:56:36Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) andre_vinicius_gon?alves.pdf: 1266538 bytes, checksum: 42c3fe90b9d66c8cb7b901a10e548f1b (MD5) Previous issue date: 2016-06 / Nos ?ltimos dez anos muitos pesquisadores t?m realizado estudos sobre assist?ncia personalizada e inteligente em Ambientes Educacionais a Dist?ncia, baseada na identifica??o dos Estilos de Aprendizagem. Sabe-se que o aprendizado ? algo extremamente particular, pois cada estudante possui estilos pr?prios e pode sofrer mudan?as diante de situa??es diversas como, por exemplo, objetivo, motiva??o, personalidade, etc. Por isso, o conceito de adaptabilidade do conte?do did?tico tem se tornado de grande import?ncia na personaliza??o do Sistema de Gerenciamento de Aprendizagem (SGA). Diante desse fato, Dor?a (2012) prop?e uma abordagem de Sistema Adaptativo e Inteligente para Educa??o (SAIE), utilizando t?cnicas probabil?sticas e Intelig?ncia Artificial (IA), capaz de detectar e adaptar, de maneira din?mica e autom?tica, os estilos de aprendizagem do estudante, considerando o Modelo de Estilo de Aprendizagem Felder-Silverman?s. Ap?s pesquisa detalhada, foram propostas algumas adapta??es baseadas na abordagem original, alterando o funcionamento de dois componentes espec?ficos: o M?dulo Pedag?gico e o Componente de Modelagem do Estudante. Al?m disso, prop?e-se uma nova estrutura do Modelo Estudante, contemplando o hist?rico de desempenho do aluno nos processos avaliativos. Por conseguinte, realizaram-se testes para avaliar os impactos de tais mudan?as por meio uma compara??o estat?stica utilizando o m?todo T-Pareado. Pelos resultados obtidos, as ideias deste trabalho proporcionaram uma melhora m?dia de 6,07% no desempenho avaliativo do estudante e uma redu??o m?dia de 68,27% nos problemas de aprendizagem, demonstrando efici?ncia e efic?cia da proposta. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Educa??o, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2015. / Since last decade many researchers have been conducting studies on personalized and intelligent assistance in distance education based on identification of learning styles. It is known that learning is something very particular because each student has their own styles and are subject to change on a variety of situations such as goal, motivation, personality, etc. Therefore, this study discusses the concept of adaptability of educational content as a way to provide customization of Learning Management System (LMS). Through probabilistic techniques and Artificial Intelligence (AI), Dor?a (2012) proposed a approach Adaptive and Intelligent System for Education (AIES) able to dynamically and automatically detect, select and adapt learning objects based on the student?s profile through Felder-Silverman Learning Styles Model (FSLSM). After detailed study, it has been proposed some adaptations based on this approach, thereby altering the operation of two specific components: the Pedagogical Module and the Student Modeling Component. In addition, it is proposed a new structure Model Student, considering learner performance history in the evaluation processes. Therefore, it carried out tests to assess the impacts of such changes through a statistical comparison by T-Paired method. From the results, the ideas in this work provides an average improvement of 6.07% in the performance evaluation of the student and an average reduction of 68.27% in the learning problems, demonstrating proposal of efficiency and effectiveness.

Law / LL.M.