abstract: This study investigated the ability to relate a test taker’s non-verbal cues during online assessments to probable cheating incidents. Specifically, this study focused on the role of time delay, head pose and affective state for detection of cheating incidences in a lab-based online testing session. The analysis of a test taker’s non-verbal cues indicated that time delay, the variation of a student’s head pose relative to the computer screen and confusion had significantly statistical relation to cheating behaviors. Additionally, time delay, head pose relative to the computer screen, confusion, and the interaction term of confusion and time delay were predictors in a support vector machine of cheating prediction with an average accuracy of 70.7%. The current algorithm could automatically flag suspicious student behavior for proctors in large scale online courses during remotely administered exams. / Dissertation/Thesis / Doctoral Dissertation Computer Science 2015

O objetivo principal desta dissertação foi analisar, sob uma ótica intimista, o corpus poético do poeta português Joaquim José Cesário Verde(1855-1886). A idéia da escrita de si, da constituição do sujeito através da palavra escrita, remonta desde gregos e egípcios, ganhando força no final de Idade Média através das memórias, dos diários e dos livre de raison, e explodindo definitivamente enquanto gênero com as autobiografias. Analisando como o eu se constitui dentro do poema, e, conseqüentemente, as crises de consciência e do mundo, é possível observar como este mesmo eu caminha para um desconcerto, para a última e definitiva crise, que é o abandono da arte como forma de se conciliar consigo e com o mundo. / The principal objective of this dissertation analyzed, under an intimism optics , the poetic corpus of the Portuguese poet Joaquim José Cesário Verde (1855-1886). The idea of the writing of the self, of the constitution of the subject through the written word, remounts from Greeks and Egyptians, gaining strength in the end of Middle Ages through the memories, the diaries and of release of raison, and exploding definitely while type with the autobiographies. Analyzing as I it is constituted inside the poem, and, consequently, the crises of conscience and of the world, it is possible to notice how this one himself. I walks for a confusion, for the last and definite crisis, which is the desertion of the art like the form of being reconciled by you and by the world.

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.

Bakgrund: Delirium är ett vanligt förekommande tillstånd inom somatisk vård. År 2016 var 85 % av patienterna som diagnosticerades med delirium i Sverige 70 år eller äldre. Det finns många olika faktorer som bidrar till uppkomsten av delirium, bland annat hög ålder, hypertoni, att genomgå kirurgi, tidigare hjärtsjukdom eller stroke och kognitiva nedsättningar.  Syfte: Syftet med studien var att undersöka patienters upplevelse av delirium. Metod: En litteraturstudie där resultatet grundas på tio kvalitativa originalartiklar med intervjustudie som metod. Artiklarna söktes i databaserna PubMED, CINAHL och PsycINFO. Resultat: Fyra huvudkategorier framkom vid granskning av resultatet; Upplevelser av en förändrad verklighet, Upplevelser av starka känslor, Upplevelser av att minnas tillbaka och Upplevelser av bemötande. Patienterna beskrev starka känslor av rädsla, oro och ilska i samband med delirium. Känslor av isolering och otrygghet förekom när patienternas verklighetsuppfattning var nedsatt. Rädsla kunde uttryckas genom aggressivitet vilket kan bidra till stigmatisering och försvårande omständigheter för patienten. Lugn, närvaro och säkerhet hos sjuksköterskan ingav patienterna trygghet. Att minnas tillbaka på delirium orsakade känslor av skam, skuld och ånger. Några förnekade att de haft delirium medan andra uppskattade att samtala om sina upplevelser. Sjuksköterskans kompetens hade stor betydelse för patienternas upplevelser av bemötande. Slutsats: Upplevelsen av delirium är individuell. Att bli bekräftad och sedd som en unik individ beskrevs av patienterna leda till ökat välbefinnande. Sjuksköterskan har en viktig roll i att informera och stötta patienten för att minska stigmatisering och lidande. Det är också betydelsefullt att sjuksköterskan behandlar patienternas upplevelser med respekt. / Background: Delirium is a common condition within somatic care. In 2016 85 % of patients diagnosed with delirium in Sweden were 70 years of age or older. There are many different factors that contribute to the onset of delirium, including high age, hypertension, undergoing surgery, previous heart disease orr stroke and cognitive impairments. Aim: The aim of the study was to explore patients’ experiences of delirium. Method: A literature study where the result is based on ten qualitative original articles with interviews as a method. The articles were searched in the databases PubMED, CINAHL and PsycINFO. Results: Four main categories emerged when reviewing the results; Experiences of a Changed Reality, Experiences of Strong Emotions, Remains of Remembrance and Experiences of Personal Treatment. Patients described strong feelings of fear, concern and anger associated with delirium. Feelings of isolation and insecurity occurred when the patient's perception of reality was reduced. Fear could be expressed through aggressiveness, which could contribute to stigmatization and aggravating circumstances for the patient. The calm, presence and safety of the nurse provided patients with security. Recalling delirium caused feelings of shame, guilt and regret. Some denied that they had delirium while others appreciated talking about their experiences. Nursing skills were of great importance to the patient's experiences of treatment. Conclusion: The experience of delirium is individual. Becoming confirmed and seen as a unique individual was described by patients leading to increased well-being. The nurse has an important role in informing and supporting the patient to reduce stigmatization and suffering. It is also important that the nurse treats the patient's experiences with respect.

The trademark guarantees market transparency and protecting clear communicative channel between innovative product and consumer rather than rewarding creators or creating direct incentives for the inventor like in Intellectual Property and Patent. However, unfair advantages of the trademark are rising to new challenges because of complex average consumer behaviour. Nevertheless extended protections of the trademark can also create obstacles to innovation and market competition. Therefore, to understand the unfair advantages and associated challenges in the trademark in this thesis the research focus is kept on unfair advantages linked with likelihood of confusion and dilution and its possible limitations, and finally problem with existing approach to determine the unfair advantages.

Bakgrund: Intensivvårdspatienter utsätts för en påfrestande situation, vilket kan bidra till utvecklandet av iva-delirium. Iva-delirium är en form av hjärndysfunktion som leder till ökad sjuklighet, ökad mortalitet och ökade vårdkostnader i form av förlängd vårdtid. Studier visar att trots att iva-delirium är vanligt förekommande inom intensivvården så missas tillståndet ofta. Bedömningsinstrument för att identifiera iva-delirium finns men används vanligen i liten utsträckning inom svensk intensivvård. Detta kan leda till att intensivvårdssjuksköterskor, utifrån personlig erfarenhet, utvecklar olika strategier för att vårda patienter med iva-delirium. Syfte: Att beskriva intensivvårdssjuksköterskors personliga erfarenheter av att bedöma patienter som riskerar att drabbas av iva-delirium samt hur syndromet identifieras och förebyggs. Metod: En kvalitativ studie innehållande sex intervjuer genomfördes och analyserades utifrån en deskriptiv innehållsanalys. Resultat: Resultatet visade att intensivvårdssjuksköterskorna med hjälp av personliga erfarenheter skapade en framförhållning genom att förutse riskfaktorer och att identifiera kliniska tecken. Vidare visade intensivvårdssjuksköterskorna en förmåga att förebygga och resonera kring utförda åtgärder. En förståelse för vården av patienter med iva-delirium skapades genom etiska reflektioner. Slutsats: Intensivvårdssjuksköterskornas erfarenheter utgjordes av tre domäner; att se, att göra och att känna. Dessa olika erfarenheter interagerade med varandra, skedde simultant och skapade ett expertkunnande hos intensivvårdssjuksköterskorna. Trots denna förmåga framkom det att intensivvårdssjuksköterskornas kunskaper om iva-delirium och deras strategier varierade beroende på personlig erfarenhet. Klinisk betydelse: Genom att belysa intensivvårdssjuksköterskornas erfarenheter kan en ökad medvetenhet kring iva-delirium skapas och därmed förhoppningsvis medföra minskad prevalens. / Background: Critical care patients are exposed to a stressful situation, which could contribute to the development of icu-delirium. Icu-delirium is a form of brain dysfunction leading to higher morbidity, higher mortality and higher cost of care due to extended hospital stays. Even though studies show that icu-delirium is common within critical care the syndrome is often unrecognized. Delirium screening tools exist but are rarely used within Swedish critical care. The low implementation of screening tools could lead to that critical care nurses, based on personal experience, develop individual strategies for care of patients with icu-delirium. Aim: To describe experiences of assessing patients with risk for developing icu-delirium and how the syndrome is identified and prevented by critical care nurses. Methods: A qualitative study with six interviews was conducted and analyzed based on a descriptive qualitative content analysis. Results: The results showed that critical care nurses, based on earlier experiences, created an anticipation by discerning risk factors and identifying clinical signs. The critical care nurses showed an ability to perform preventive measurements while reasoning about already performed measurements. Through ethical reflections an understanding for the care of patients with icu-delirium was created. Conclusions: The experiences by critical care nurses was based on three domains; to see, to do and to feel. These domains occurred simultaneously and created the expertise of the critical care nurse. Despite this ability the knowledge of critical care nurses and their clinical assessment methods varied depending on earlier experiences. Relevance to clinical practice: By illuminating the experiences of critical care nurses hopefully a higher awareness regarding icu-delirium is created which will hopefully result in a lower prevalence.

Bakrund: Fast track-kirurgi är ett alltmer vanligt förekommande arbetssätt inom hjärtkirurgi. Tidigare studier har påvisat att en tidig extubation har medfört en vinst i patientens rehabili-teringsprocess samt bidragit till kortare vårdtider och sänkta sjukvårdskostnader. Syfte: Syftet med studien är att kartlägga och redovisa graden av smärta och konfusion efter extubation hos patienter som genomgått hjärtkirurgi. Metod: Material inhämtades genom en fortlöpande journalgranskning. Pilotstudien granskade patientjournaler samt övervakningsjournaler i realtid. Detta utfördes i kombination med ett observationsformulär som utformats till studien innehållande mätinstrumenten VAS [Visuell Analog Skala, för smärtskattning] och RASS [The Richmond Agitation-Sedation Scale, för konfusionsbedömning]. Resultat: Patienterna upplevde smärta både efter tidig och sen extubering vid hjärtkirurgi. Efter tidig extubation dokumenterades fyra av tio patienter vara lugna och alerta samt sex av tio som slöa. Efter sen extubation dokumenterades en patient vara lätt sederad, åtta patienter slöa, en patient alert och lugn samt en patient var rastlös. Konklusion: Datamaterialet är anpassat till en pilotstudie. Således är det inte möjligt att dra några vetenskapliga slutsatser gällande korrelationen mellan extubationstid, smärta och konfusion. För att kunna uppnå en vetenskaplig signifikans krävs en studie av större kvantitet. / Background: Fast-track surgery is an increasingly common work procedure in cardiac surgery. Previous studies have shown that an early extubation has a positive effect on the patients’ reha-bilitation process and contributes to a shorter hospitalization and lowered medical costs. Purpose: The purpose of this study is to identify and recognize the degree of pain and confusion after extubation in patients’ undergone cardiac surgery. Method: Material was collected through an ongoing record review. The pilot study examined the medical records and monitoring records in real time. This was carried out in combination with an observation form designed for the study containing the instruments VAS [Visual Analogue Scale for pain measurement] and RASS [The Richmond Agitation-Sedation Scale, for the assessment of the degree of confusion]. Results: Patients experienced pain after both early and late extubation in heart surgery. After early extubation four of ten patients were documented as calm and alert, and six of ten as dull. After late extubation one patient was documented/revised to be slightly sedated, eight patients as lethargic, one patient as alert and calm, and one patient as restless. Conclusion: The data set is appropriate for a pilot study. Thus, it is not possible to draw any scientific conclusions concerning the correlation between the time of extubation, pain and confusion. In order to achieve a scientific significance, a study of greater amplitude is required.

High levels of speech recognition have been obtained with cochlear implant users in quiet conditions. In noisy environments, speech recognition deteriorates considerably, especially in speech-like noise. The aim of this study was to determine what underlies measured speech recognition in cochlear implantees, and furthermore, what underlies perception of speech in noise. Vowel and consonant recognition was determined in ten normal-hearing listeners using acoustic simulations. An acoustic model was developed in order to process vowels and consonants in quiet and noisy conditions; multi-talker babble and speech-like noise were added to the speech segments for the noisy conditions. A total of seven conditions were simulated acoustically; namely for recognition in quiet and as a function of signal-to-noise ratio (0 dB, 20 dB and 40 dB speech-like noise and 0 dB, 20 dB and 40 dB multi-talker babble). An eight- channel SPEAK processor was modelled and used to process the speech segments. A number of biophysical interactions between simulated nerve fibres and the cochlear implant were simulated by including models of these interactions in the acoustic model. Biophysical characteristics that were modelled included dynamic range compression and current spread in the cochlea. Recognition scores deteriorated with increasing noise levels, as expected. Vowel recognition was better than consonant recognition in general. In quiet conditions, the features transmitted most efficiently for recognition of speech segments were duration and F2 for vowels and burst and affrication for consonants. In noisy conditions, listeners mainly depended on the duration of vowels for recognition and the burst of consonants. As the SNR decreased, the number of features used to recognise speech segments also became fewer. This suggests that the addition of noise reduces the number of acoustic features available for recognition. Efforts to improve the transmission of important speech features m cochlear implants should improve recognition of speech in noisy conditions. / Dissertation (MEng (Bio-Engineering))--University of Pretoria, 2008. / Electrical, Electronic and Computer Engineering / unrestricted

Les études de pharmacoépidémiologie consistent à étudier l’effet de médicaments en vie réelle, et sont menées de plus en plus souvent sur bases de données médico-administratives. Ce sont principalement des études observationnelles, et sont donc soumises à des biais liés à des facteurs de confusion. Ces facteurs ne sont pas toujours recueillis dans les bases de données médico-administratives qui sont implémentées à d’autres fins que la recherche. Des plans expérimentaux self-controlled designs (où le patient est son propre témoin, et dont les principaux sont le case-crossover et le self-controlled case-series) permettent d’étudier l’effet transitoire d'expositions brèves sur des évènements à début brutal. Ils sont soumis à certaines conditions d’application. Ils ont la particularité de réaliser des comparaisons sur différentes périodes plutôt que sur différents groupes de patients, permettant ainsi de prendre en compte des facteurs de confusion, y compris non mesurés, et qui ne varient pas entre les périodes observées. Ces méthodes ont montré leur utilité pour pallier l’absence de randomisation, et leur utilisation est recommandée quand leurs conditions d’application sont remplies. Nous avons étudié la fréquence d’utilisation des self-controlled designs en pharmacoépidémiologie sur bases de données, les opportunités manquées d’utilisation et leur usage approprié au regard de leurs conditions d’application, ainsi que la qualité de l’information rapportée dans les articles. Nous avons montré que leur utilisation est rare, que 15% des articles correspondent à des situations d’opportunité où ces méthodes auraient pu être implémentées, que 34% des case-crossover et 13% des self-controlled case-series étaient appliqué de façon inapproprié, et que pour 16% des articles la méthode aurait pu être adaptée pour être valide. Un usage plus approprié permettrait de contribuer à l’investigation en pharmacoépidémiologie tout en bénéficiant des avantages de ces méthodes en particulier sur bases de données de santé. / Pharmacoepidemiology consists in the study of efficacy or safety of drugs in real life, with the use more and more frequently of medico-administrative databases. Study designs are generally observational, thus they are prone to confounding bias. Confounders are not systematically collected in databases, which are implemented for other purposes than research. Self-controlled designs (mainly represented by case-crossover and self-controlled case-series, and in which the patient acts as his own control), have been developed for the study of intermittent exposure with short-term effect on abrupt onset event. They require that validity assumptions being fulfilled. They consist in the comparison over different periods, rather than different groups of patients, thus allowing for confounding factors, also if not measured, which are invariant over observed periods. Such designs have been proved useful in observational studies in the absence of randomization, and their implementation is recommended in case of validity assumptions are fulfilled. We studied their frequency of use in pharmacoepidemiology in healthcare databases, missed opportunities for use, inappropriate use with respect to validity assumptions, as well as quality of reporting. We showed that self-controlled designs are rarely used, that opportunity for use was founds in 15% of articles where such methods could have been implemented, that 34% of case-crossover and 13% of self-controlled case series were inappropriately used, and that the method could have been adapted to be valid in 16% of articles. A more appropriate use of self-controlled designs could contribute to improve investigation in pharmacoepidemiology, while beneficiating from their advantages, especially in healthcare databases.

SAMMANFATTNING Bakgrund: Akut förvirringstillstånd är ett vanligt neuropsykiatriskt tillstånd som främst drabbar sköra, äldre människor. När akut förvirringstillstånd väl har uppstått finns det få behandlingar tillgängliga för att minska duration och allvarlighetsgrad. Syftet var att ta reda på hur akut förvirringstillstånd kan förebyggas och hur omvårdnaden kan underlättas för äldre patienter med akut förvirringstillstånd på sjukhus. Metod: För att söka svar till syftet har en beskrivande litteraturstudie valts som metod. Databassökning genomfördes och studiernas kvalitet granskades med hjälp av en granskningsmall. Femton studier inkluderades, både kvantitativa och kvalitativa. Genom analys av inkluderade artiklar kunde betydelsefull data utifrån syftet identifieras och sorteras in i kategorier. Resultat: Resultatet har visat att förebyggande åtgärder har betydelse för att minska risken att drabbas av akut förvirringstillstånd. Flera studier som är multikomponentstudier har visat goda resultat för att undvika insjuknande i akut förvirringstillstånd där interventionerna säkerställer att flera av patientens basala behov tillgodoses, såsom sömn, mat- och vätskeintag, elimination och att kunna kommunicera. Studierna kom fram till att vårdpersonalens kunskap och utbildning har betydelse, att ökad kunskap förbättrar patient omhändertagandet och vårdkvalitén. Underlättande åtgärder beskriver studierna att ha ökad tillsyn, att minska stimuli och att aktivera patienten. Slutsats: Förebyggande åtgärder har betydelse för att minska risken att den äldre patienten drabbas av akut förvirringstillstånd. Ökad kunskap hos vårdpersonalen förbättrar patient omhändertagandet och vårdkvalitén. För att underlätta omhändertagandet om en patient med akut förvirringstillstånd behövs både tid, erfarenhet, lämpliga lokaler och personalresurser. / ABSTRACT Background Delirium is a common neuropsychiatric condition that primarily affects frail, aged people. When it has occured it is few treatments available to reduce duration and severity. The purpose of this study was to find out how delirium can be prevented and how nursing can facilitate the care of aged patients with delirium in hospital. Methods To find answer to our purpose a descriptive litteraturestudy have been chosen as a method. Database searches were implemented and the quality of the studies was scientifically reviewed with a template. Fifteen studies were included, both quantitative and qualitative. Through analysis of included studies, valuable data based on the purpose were identified and sorted into three categories. Results The results show that preventive actions have importance for reducing the risk of being affected of delirium. Some studies formed as multicomponent studies have shown good results for avoiding acute onset of delirium where the interventions secure that several of the patient basic needs are catered, as sleep, nutrition- and fluid intake, elimination and being able to communicate. The studies also came up with the result that the knowledge and education of the health professionals mattered, that increased knowledge facilitates the patient care and the quality of care. When the patient is affected of delirium, there are actions that facilitate the nursing. Facilitating actions is described in the studies as increased supervision, reduction of stimuli, activate the patient etcetera. Conclusion Preventive interventions have importance of reducing the risk of elderly patients being affected of delirium. Increased knowledge of healthcare professionals improves patient care and quality of care. To facilitate the care of the patient with ongoing delirium there is need for time, experience, suitable facilities and enough healthcare personnel.