En recherche médicale, les cohortes permettent de mieux comprendre l'évolution d'une pathologie et d'améliorer la prise en charge des patients. La mise en évidence de liens de causalité entre certains facteurs de risque et l'évolution de l'état de santé des patients est possible grâce à des études étiologiques. L'analyse de cohortes permet aussi d'identifier des marqueurs pronostiques de l'évolution d'un état de santé. Cependant, les facteurs de confusion constituent souvent une source de biais importante dans l'interprétation des résultats des études étiologiques ou pronostiques. Dans ce manuscrit, nous présentons deux travaux de recherche en Biostatistique dans la thématique des scores de propension. Dans le premier travail, nous comparons les performances de différents modèles permettant d'évaluer la causalité d'une exposition sur l'incidence d'un événement en présence de données censurées à droite. Dans le second travail, nous proposons un estimateur de courbes ROC dépendantes du temps standardisées et pondérées permettant d'estimer la capacité prédictive d'un marqueur en prenant en compte les facteurs de confusion potentiels.En cohérence avec l'objectif de fournir des outils statistiques adaptés, nous présentons également dans ce manuscrit une application nommée Plug-Stat®. En lien direct avec la base de données, elle permet de réaliser des analyses statistiques adaptées à la pathologie afin de faciliter la recherche épidémiologique et de mieux valoriser les données de cohortes observationnelles. / In medical research, cohorts help to better understandthe evolution of a pathology and improve the care ofpatients. Causal associations between risk factors andoutcomes are regularly studied through etiological studies. Cohorts analysis also allow the identification of new markers for the prediction of the patient evolution.However, confounding factors are often source of bias in the interpretation of the results of etiologic or prognostic studies.In this manuscript, we presented two research works in Biostatistics, the common topic being propensity scores.In the first work, we compared the performances of different models allowing to evaluate the causality of an exposure on an outcome in the presence of rightc ensored data. In the second work, we proposed anestimator of standardized and weighted time-dependentROC curves. This estimator provides a measure of theprognostic capacities of a marker by taking into accountthe possible confounding factors. Consistent with our objective to provide adapted statistical tools, we also present in this manuscript an application, so-calledPlug-Stat®. Directly linked with the database, it allows toperform statistical analyses adapted to the pathology in order to facilitate epidemiological studies and improve the valorization of data from observational cohorts.

Introdução: O Diagnóstico de Enfermagem Confusão Crônica (DCC) foi criado em 1994 e até o momento nenhum estudo realizou sua validação clínicopatológica. Como as principais causas de DCC são as demências, a única forma de validação, com base no diagnóstico definitivo, é a autópsia encefálica que é considerada padrão-ouro. Objetivo: Realizar a validação clínicopatológica do DCC. Método: Por meio de um estudo transversal, foram analisados 548 casos completos de indivíduos falecidos pertencentes à casuística do Banco de Encéfalos Humanos da Faculdade de Medicina da Universidade de São Paulo, no qual foram extraídos dados clínicopatológicos. O DCC foi definido em cada caso por meio de consenso diagnóstico. Para a validade de critério do DCC foram utilizados os testes de correlação, regressão logística e curva Receiver Operating Characteristic (ROC). Resultados: Dos 548 indivíduos, 26,3% tinham DCC, em relação à validade de critério, o DCC correlacionou-se com o Clinical Dementia Rating (CDR) (r = 0,68; p < 0,0001), com o Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) (r = 0,47; p < 0,0001) e obteve uma associação significativa estatisticamente com o diagnóstico neuropatológico (p < 0,0001). Os principais preditores neuropatológicos de DCC foram: Demência Vascular (OR = 18,00; p < 0,0001), Demência Mista (OR = 9,58; p < 0,0001), Degeneração Lobar Frontotemporal (OR = 9,58; p = 0,004) e Doença de Alzheimer (OR = 9,00; p < 0,0001). A melhor capacidade preditiva foi para o diagnóstico de Demência Vascular (AUC = 0,717; IC 95% 0,629-0,806). Ter DCC presente aumenta em 7,16 vezes a chance de apresentar alteração neuropatológica compatível com doença neurodegenerativa. Conclusão: De um modo geral, o DCC apresenta boas evidências de validade de critério em relação ao diagnóstico padrão-ouro das principais doenças neurodegenerativas. No entanto, ainda carece de refinamento e melhor exploração de suas características definidoras de modo a ampliar sua capacidade diagnóstica em relação a outras condições neurodegenerativas. Os fatores relacionados apresentados no DCC aprovado pela NANDA Internacional, Inc. (NANDA-I) necessitam de revisão, a partir dos resultados do presente estudo. / Introduction: The Nursing Diagnosis Chronic Confusion (NDCC) was first introduced in 1994 and, to date, no study has performed its clinical-pathological validation. As the main cause of NDCC is dementia, the only way to validate it, based on their definitive diagnosis is by brain autopsy that is considered the gold standard. Objective: This studys objective was to perform the clinical-pathological validation of NDCC. Method: Through a cross-sectional study, 548 complete cases of deceased individuals that belongs to the Human Brain Bank of the Brazilian Aging Brain Study Group, Medicine School of the University of São Paulo were analyzed, in which clinical and pathological data were extracted. The NDCC was defined to each case by a consensus diagnostic. For criteriom validity of the NDCC, correlation, logistic regression and ROC curve tests were used. Results: Of the 548 subjects, 26.3% had NDCC. Regarding the criterion validity, NDCC correlated with CDR (r = 0.68, p < 0.0001), with IQCODE (r = 0.47; p < 0.0001) and had a statistically significant association with the neuropathological diagnosis (p < 0.0001). The main neuropathological predictors of NDCC were: Vascular Dementia (OR = 18.00; p < 0.0001), Mixed Dementia (OR = 9.58; p < 0.0001), Frontotemporal Lobar Degeneration (OR = 9.58; p = 0.004) and Alzheimer\'s Disease (OR = 9.00; p < 0.0001). The best predictive capacity was for the diagnosis of Vascular Dementia (AUC = 0.717, 95% CI 0.629-0.806). NDCC increases the chance to have neuropathological lesions by 7,16. Conclusion: In general, the NDCC presented good evidence of criterion validity in relation to the gold standard diagnosis of the main neurodegenerative diseases. However, it still lacks refinement and a better exploration of its defining characteristics in order to increase its diagnostic capacity in relation to others neurodegenerative conditions. The related factors presented in the NDCC approved by NANDA-I is in need of a revision, based on the results of the present study.

Choices are often difficult to make by patients with Alzheimer Dementia. They often become acutely confused when faced with too many options because they are not able to retain in their working memory enough information about the various individual choices available. In this case study, we describe how an essentially simple benign task (choosing a dress to wear) can rapidly escalate and result in a catastrophic outcome. We examine what went wrong in the patient/caregiver interaction and how that potentially catastrophic situation could have been avoided or defused.

In spite of the ever-growing technology in information security, organizations are still vulnerable to security attacks due to mistakes made by their employees. To evaluate organizational security vulnerability and keep organizations alert on their security situation, in this dissertation, we developed a framework for measuring the security vulnerability of organizations based on online behaviours analysis of their employees. In this framework, the behavioural data of employees for their online privacy are taken as input, and the personal vulnerability profiles of them are generated and represented as confusion matrices. Then, by incorporating the personal vulnerability data into the local social network of interpersonal security influence in the workplace, the overall security vulnerability of each organization is evaluated and rated as a percentile value representing its position to all other organizations. Through evaluation with real-world data and simulation, this framework is verified to be both effective and efficient in estimating the actual security vulnerability status of organizations. Besides, a demo application is developed to illustrate the feasibility of this framework in the practice of improving information security for organizations. / Graduate

The purpose of this thesis has been to explore the discursive production of delirium in people over the age of 65 years. The philosophical approaches underpinning the study were derived from the field of critical gerontology, postmodernism and the utilisation of a Foucauldian understanding of discourse and power/knowledge. Data sources included published documents on delirium, interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, registered nurses and a doctor.Textual analysis revealed the presence of two contesting and contradictory discourses that impacted on being an older person who had delirium. These were identified as the discourse of delirium as a syndrome and a personal discourse of delirium. The discourse of delirium as a syndrome is underpinned by the biomedicalisation of the ageing process. This process utilises scientific methods as the foundation from which to understand, research and provide a health service to older people with delirium. Any personal perspectives on delirium are rendered unimportant and relegated to marginalised positions. Nursing through its vicarious relationship to medicine is interpellated into deploying the discourse of delirium as a syndrome and has largely ignored the personal dimensions associated with this phenomenon. Consequently, the older delirious 'body' is known and inscribed as unruly, problematic, physically unwell, cognitively impaired and at risk.Conversely, a personal discourse of delirium privileges the individual narratives of people who have been delirious and provides a different perspective of delirium. The deployment of a personal discourse of delirium offers another position that views this group of older people as bringing to the health care setting a rich tapestry of life experiences that are more than a cluster of signs and symptoms. It is these varied life experiences that need to be included as a legitimate source of knowledge about delirium. This thesis demonstrates how nursing needs to espouse a critical gerontological position when working with older people who have delirium. Critical gerontology provides nurses with the theoretical tools to challenge the status quo and uncover the multiple, varied, contradictory and complex representations of delirium in older people.

Cette thèse s'intéresse aux réseaux de confusion comme représentation compacte et structurée des hypothèses multiples produites par un moteur de reconnaissance de parole et transmises à un module de post-traitement applicatif. Les réseaux de confusion (CN pour Confusion Networks) sont générés à partir des graphes de mots et structurent l'information sous la forme d'une séquence de classes contenant des hypothèses de mots en concurrence. Le cas d'usage étudié dans ces travaux est celui des hypothèses de reconnaissance transmises à un module de compréhension de la parole dans le cadre d'une application de dialogue déployée par France Telecom. Deux problématiques inhérentes à ce contexte applicatif sont soulevées. De façon générale, un système de dialogue doit non seulement reconnaître un énoncé prononcé par un utilisateur, mais aussi l'interpréter afin de déduire sons sens. Du point de vue de l'utilisateur, les performances perçues sont plus proches de celles de la chaîne complète de compréhension que de celles de la reconnaissance vocale seule. Ce sont ces performances que nous cherchons à optimiser. Le cas plus particulier d'une application déployée implique de pouvoir traiter des données réelles et donc très variées. Un énoncé peut être plus ou moins bruité, dans le domaine ou hors-domaine, couvert par le modèle sémantique de l'application ou non, etc. Étant donnée cette grande variabilité, nous posons la question de savoir si le fait d'appliquer les mêmes traitements sur l'ensemble des données, comme c'est le cas dans les approches classiques, est une solution adaptée. Avec cette double perspective, cette thèse s'attache à la fois à enrichir l'algorithme de construction des CNs dans le but d'optimiser globalement le processus de compréhension et à proposer une stratégie adéquate d'utilisation des réseaux de confusion dans le contexte d'une application réelle. Après une analyse des propriétés de deux approches de construction des CNs sur un corpus de données réelles, l'algorithme retenu est celui du "pivot". Nous en proposons une version modifiée et adaptée au contexte applicatif en introduisant notamment un traitement différencié des mots du graphe qui privilégie les mots porteurs de sens. En réponse à la grande variabilité des énoncés à traiter dans une application déployée, nous proposons une stratégie de décision à plusieurs niveaux qui vise à mieux prendre en compte les spécificités des différents types d'énoncés. Nous montrons notamment qu'il est préférable de n'exploiter la richesse des sorties multiples que sur les énoncés réellement porteurs de sens. Cette stratégie permet à la fois d'optimiser les temps de calcul et d'améliorer globalement les performances du système

Ce mémoire a pour but d'observer le rapport labyrinthique qui se déploie entre le sujet et l'imaginaire dans le roman Fêtes et rites de la confusion, de Fernando Arrabal. Figure de proue du mouvement panique, Arrabal intègre le hasard au sein de sa démarche artistique afin d'exprimer la totalité de son être. Ce faisant, ses œuvres proposent un reflet de l'homme qui est tout à fait fascinant, parfois même terrifiant. Le roman à l'étude met en scène une confusion propre à l'imaginaire. Étrangement, cette confusion ne mine en rien le sens de l'œuvre; au contraire, elle lui donne chair. Et c'est parce qu'elle en organise le sens qu'elle est problématique. Pour comprendre comment la confusion peut servir de ligne directrice, nous éclaircirons d'abord les logiques illogiques de la philosophie esthétique du panique. Nous remarquerons que l'invocation du hasard ne sert pas qu'à des fins esthétiques, mais également à une connaissance de soi. À cet égard, le parcours labyrinthique sert de métaphore à l'exploration de son imaginaire. En convoquant la théorie du sujet d'Agamben, nous comprendrons que ce parcours, étant imaginaire, est toujours déjà dans le langage. Conséquemment, il ne recouvre pas la totalité de ce que le narrateur est en tant qu'homme, puisque lorsque ce dernier se constitue comme sujet, une part de son expérience tombe dans le silence. À l'aide de la psychologie des profondeurs de Jung, nous examinerons la relation que l'inconscient entretient avec l'imaginaire et, par la suite, nous comprendrons dans quelle mesure la représentation de soi est déterminée par elle. Nous montrerons alors comment le texte d'Arrabal suggère que son héros accède à une connaissance approfondie de lui-même suite à une expérience qui relève de l'indicible, ce qui lui permet de se reconnaître dans sa totalité. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Arrabal, Panique, Confusion, Rite, Hasard, Imaginaire, Labyrinthe.

Šiame tyrime yra pateikiamas darbo su padidėjusio aktyvumo vaiku modelis. Tai svarbu kiekvienam dirbančiam bendrojo lavinimo mokykloje, nes turbūt kiekvienoje klasėje esti padidėjusio aktyvumo vaikų, o žinių trūkumas trukdo tinkamai organizuoti ugdymo procesą. Tyrimo problema – kaip gerinti darbą su padidėjusio aktyvumo vaiku, kad vyktų normalus ugdymo procesas? Tyrimo tikslas – pateikti darbo su padidėjusio aktyvumo vaiku pradinėje mokykloje modelį. Tikslui pasiekti buvo įgyvendinti šie uždaviniai: apibrėžta padidėjusio aktyvumo samprata ir padidėjusio aktyvumo atsiradimo priežastys, apibūdinta socialinės aplinkos įtaka padidėjusio aktyvumo vaiko ugdymui, aprašyti padidėjusio aktyvumo vaiko ugdymo mokykloje aspektai, atskleistas mokytojų vaidmuo, siekiant palengvinti ugdymo procesą. Tyrimo objektu buvo pasirinktas padidėjusio aktyvumo vaiko ugdymas. Tyrimas atliktas pasitelkus kokybinį tyrimo metodą – standartizuotą interviu. Tyrimas buvo atliktas 2008 m., kovo mėnesį. Tyrime dalyvavo 8 mokytojos dirbančios pradinėse klasėse, Šėtos vidurinėje mokykloje. Apibendrinant, galima teigti, kad padidėjusio aktyvumo vaiko ugdymas priklauso nuo gebėjimo tinkamai organizuoti ugdymo procesą. Dirbti su padidėjusio aktyvumo vaiku trukdo nesugebėjimas susikaupti, trukdymas dirbti kitiems vaikams, netinkamas elgesys, nekantrumas, tėvų požiūris. Darbo kokybės geras vertinimas motyvuojamas papildomo laiko skyrimu padidėjusio aktyvumo vaikui, vaisingu darbu su tėvais. Darbo kokybė pagerėtų... [toliau žr. visą tekstą] / This research presents a model of the work with the children of enlarged activeness. It is important for everyone who works at school. I presume, such children we can meet in every school and the lack of knowledge bothers us to organize the process of teaching properly. The problem of researching is how to improve the work with a child of enlarged activeness that the process of teaching would be progressive. The aim of my research is to present a model of the work with the child of enlarged activeness in primary school. My goals in this aim were some researches: an explicit conception of enlarged activeness and the reasons of the origin of it, describing of the influence of social environment for teaching a child with enlarged activeness and the aspects of the work with them at school, disclosing the role of the teachers, trying to make easier the process of teaching. The object of my research is the child of enlarged activeness. I used a quality research method – a standard interview. The research was made in March, 2008. Eight teachers who work in Seta secondary school took part in this research. In summary, I have to say that teaching the child of enlarged activeness depends on our ability to organize the process of teaching properly. The quality of the work mainly depends on the child‘s ability to concentrate his attention in class. He hasn‘t to disturb other students. These children often are badly-behaved and impatient. It is very important parents attitude to them and... [to full text]

With some help of a few interviews, with children, and some staff members, in two different schools, I hope to answer the question: if the picture of the operation, that the children and the staff are having, has some similarities, and I will try to compare these pictures with what some legal documents such as Lgr 11 and Kvalitet I Fritidshem is saying about daycare opera-tions? To be able to run a successful daycare center, is never an easy thing. The key to success is to make parties, like the staff, children and their parents to feel happiness, when it comes to things around and about the daycare center. The result shows that both the children and the staff are expressing a frustration around the daycare operation, because they feel that there being wrongly answered, by a higher authority. The children are frustrated of how the staff is answering them about different things and the staff is frustrated about how the headmasters are answering them. The staff has some improvements to do, when it comes to their commu-nication between them, about their answering of the children. It is obvious that the pictures that the staff is having of the operation, doesn’t always match the pictures that the children have of the same reality.

Akut förvirring är en kognitiv förändring som uppkommer plötsligt. Drabbade patienter upplevs exempelvis agiterade, rastlösa och apatiska. Patienter beskriver upplevelsen av akut förvirring som en abstrakt verklighet, vilket komplicerar vårdprocessen. Syftet var att beskriva sjuksköterskors erfarenhet kring vårdandet av akut förvirrade patienter. Metoden som användes var en litteraturstudie med systematisk ansats där databearbetningen inspirerades av kvalitativ innehållsanalys. Litteraturstudien visar att sjuksköterskor som möter akut förvirrade patienter på vårdavdelningar kan uppleva ökad tidspress och stress. Den akut förvirrade påverkar även övriga medarbetare och patienter, kräver mer resurser i form av övervakning och sjuksköterskor med rätt kompetens. Sjuksköterskor fokuserar på att bevara säkerheten för de akut förvirrade patienterna, detta uppmärksammas mer än människan bakom den akuta förvirringen. Sjuksköterskors förhållningssätt till de akut förvirrade blir att försöka få kontroll över patienterna genom olika strategier. Okunskap om akut förvirring visas genom att sjuksköterskor inte använder sig av vetenskapligt baserad kunskap. Prioritering blir nödvändigt för att effektivisera arbetet och för att sjuksköterskor ska kunna vara tillgängliga åt alla patienter - effektivisering av tid faller på bekostnad av akut förvirrade patienter. God kommunikation och medvetenhet om den åldersdiskriminering som förekommer är av vikt för att patienters upplevelser ska bli optimala och leda till minskat lidande vid akut förvirring. / Acute confusion is a cognitive impairment that occurs suddenly. Affected patients are for example perceived as agitated, restless and apathetic. Patients describe the experience of acute confusion as an abstract reality, this complicates the care process. The aim of this study was to describe nurses’ experience in the care of acutely confused patients. The method was a literature study with a systematic approach where the data processing was inspired by qualitative content analysis. The literature study shows that nurses who meet acute confused patients in wards may experience a lack of time and increased stress. The patient with acute confusion also affects other health careers and patients, requiring more resources in terms of monitoring and nurses with the right skill sets. Nurses are more focused on preserving the safety of the acutely confused patients than the person behind the acute confusion. Nurses’ attitudes towards the acutely confused patients are based on gaining control of the patients through various strategies. Unawareness of acute confusion is displayed by nurses’ inconsistency of the use of evidence-based knowledge. Prioritizing work is necessary to make the work more effective, it also helps the nurse to be at hand for all patients, although, managing and using time more effectively falls at the expense of the acutely confused patients. Good communication and awareness of the ageism that occurs is of importance so that the patients’ experiences become optimal and for reduction of suffering when in or after an acute confusion state.