En dépit de la production standardisée de millions d'enregistrements décrivant année après année l'activité d'hospitalisation complète en France, aucune étude globale, aucun suivi précis et répété dans le temps, n'a pu être mené à partir de ces données.Si ces données sont exploitées dans une grande variété d'études spécifiques, elles peinent à trouver une utilisation significative dans l'analyse de l'activité et du recrutement des établissements de santé, ou dans celle des besoins de la population. Tout un pan d'analyse de l'efficience du système de santé reste ainsi inaccessible.Nous nous fixons comme objectif de contribuer à développer un cadre précis d'exploitation de ces données. Cette démarche se fera en trois temps :- Définition d'une méthode de consolidation des données ;- Construction de référentiels d'analyse des données ;- Elaboration de méthodes d'analyse sur deux thématiques générales : la caractérisation de l'activité des établissements et l'étude de leur recrutement, avec exemple d'application de ces méthodes. / Millions of computerized records describing inpatient hospitalization activity are produced year after year in France.In spite of the availability of this massive amount of data, no global, iterative and well calibrated related study on health system efficiency has been possible.There are of course many specific studies partially or totally relying on these data, but their systematic use for assessing hospital activity, catchment areas or population health needs remains to be implented.Our work aims to contribute to create a methodological framework for analyzing these data through a three step approach :- Definition of data consolidation methods ;- Creation of adequate data repositories ;- Determination of analysis methods for two general topics : hospital activity characterization and study, with example applications.

I assessed the accuracy of two clinical prediction rules, the d-dimer blood test and point of care ultrasound for diagnosing lower limb deep vein thrombosis. Emergency physicians were trained in ultrasound and prospectively scanned emergency department patients with suspected deep vein thrombosis. Accuracy of the Wells and AMUSE rules and the ultrasound result was compared to radiology-performed ultrasound and a 90-day clinical outcome. Univariate and multivariate analyses were performed assessing which factors were associated with the outcome. The sensitivity and specificity of the Wells score for the clinical outcome was 85.7% and 68.5%; the AMUSE score 85.7% and 54.4%. Ultrasound had a sensitivity of 91.7% and specificity of 91.7% for radiology-diagnosed thrombus and 78.6% and 95.0% for clinical outcome. The odds ratio of a positive outcome with a positive ultrasound was 65.1. After receiving the ultrasound training program, emergency physicians were unable to demonstrate sufficient accuracy to replace current diagnostic strategies.

Many prospective teachers make assumptions about their students before they actually begin teaching. Many of these assumptions can be rooted specifically in students’ races, cultures, classes, religions, genders, and sexual orientations. In order for prospective mathematics teachers to challenge these biases, some mathematics teacher educators have provided tasks to support these prospective teachers in becoming aware of their own biases. I chose to analyze a group of five prospective mathematics teachers discussing topics of teaching for social justice to examine more closely the kinds of biases they carry, and more specifically, how those biases came about in their conversations. My analysis also involved looking specifically at whether or not these prospective mathematics teachers were challenging their own as well as others’ biases that came out during the discussions. The results of this study display the ways in which these biases were illuminated during the group discussions as well as the lack of prospective teachers challenging the biases that came out.

Les ménages sont responsables d’une part significative des consommations d’énergie et des émissions de CO2, en particulier si l’on tient compte des consommations d’énergie et des émissions indirectes liées aux processus de production des biens et services consommés. Plusieurs travaux scientifiques et recommandations d’organisations gouvernementales et d’associations non-gouvernementales soulignent que des modifications des modes de consommations seront sans doute nécessaires pour atteindre les objectifs climatiques fixés aujourd’hui. Notre thèse propose une méthode d’analyse prospective de changements de mode de vie, qui permet d’en estimer les impacts macro-économiques ainsi que ceux sur les consommations d’énergie et les émissions de CO2, tout en tenant compte de l'hétérogénéité des ménages en matière de comportements et de consommations d'énergie. Notre méthode explore les modes de consommation des ménages de manière fine, en prenant en considération le lien entre emplois du temps et consommations. En effet, les choix de consommation sont soumis non seulement à des contraintes de budget, mais également à des contraintes qui dérivent du temps à disposition et qui ne sont jamais prises en compte dans la prospective macro- économique. Nous construisons une base de données détaillant emplois du temps, dépenses et consommations d’énergie des ménages français et nous l’articulons à un modèle de prospective économique énergie-émissions par un processus de repondération itératif. Nous illustrons la portée de cet outil à travers l’analyse de trois scénarios, centrés respectivement sur la diffusion de nouvelles formes de mobilité (covoiturage et autopartage), la généralisation des achats en ligne et le retour vers le faire soi-même en matière d'alimentation. Pour les trois scénarios nous observons des réductions des consommations d’énergie et des émissions de CO2. Par exemple, les émissions totales diminuent de 2,3% en 2050 dans le scénario sur la mobilité. / Household energy consumption represents a significant share of final energy use, especially when both direct and embodied energy are taken into account. Several academic studies, as well as the recommendations of the United Nations and of non-governmental organisations, suggest that a shift in consumption patterns will be necessary to achieve sustainable development. The aim of our research is to analyse long-term scenarios of changes in lifestyle. We propose a methodology that allows to analyse the macro-economic impacts of these changes, as well as the impacts on energy use and CO2 emissions, while taking into account the heterogeneity of behaviours and energy consumptions among households. Consumption choices do not derive solely from monetary considerations but they are influenced by several factors. One binding constraint, never taken into account in macro-economic energy modelling, is the available time. For this reason, our analysis considers time use data in addition to expenditure and energy use data. We build a data base that combines time use, expenditure and energy consumption data for French households, which provides detailed information about household consumption patterns. Then, for scenario analyses, we link the data base with an Energy-EconomyEmissions model, using an iteration process based on a reweighting technique. We illustrate the methodology by exploring three areas of change in consumption patterns: cooking habits, ecommerce and shared transport (carpooling and car sharing). We obtain CO2 emissions reductions in all scenarios. As an example, emissions decrease by 2.3% by 2050 in the scenario focusing on transport.

In the US, 8.4% of children are diagnosed with asthma by age 18, making asthma one of the most common chronic conditions among children. Additionally, 25% of children experience persistent wheezing by age 6, an indicator of childhood asthma. Both childhood asthma and persistent wheezing may be linked to inflammatory and immune mechanisms, which are associated with inadequate and excessive gestational weight gain. Studies investigating the relationship between gestational weight gain and offspring asthma and wheeze phenotypes are limited by self-reported gestational weight gain, early age at asthma and wheeze assessments, limited adjustment for potential confounders and no trimester-specific evaluations. Therefore, we investigated the association between total and trimester-specific gestational weight gain, offspring asthma and wheeze phenotypes among 2128 mother-child pairs in Project Viva, a prospective cohort study in eastern Massachusetts. Gestational weight gain was abstracted from medical records and self-reported prepregnancy weight, and defined both continuously and using Institute of Medicine guidelines. Offspring asthma was obtained via maternal report at approximately 7 years, while wheeze trajectories were derived via latent class mixed models based on presence of wheeze between 1 and 9 years, inclusively, via maternal report. We investigated the relationship between gestational weight gain, offspring asthma and wheeze phenotypes using multivariable regressions and predicted probabilities, adjusting for important covariates. Most women had excessive gestational weight gain (56%), while 31% had adequate gestational weight gain and 13% had inadequate gestational weight gain. Approximately 18% of children had current mid-childhood asthma, 13% had early transient wheeze and 13% had persistent wheeze. We found a non-linear association between total gestational weight gain and offspring current mid-childhood asthma. Additionally, there was a 36% decreased odds of early transient wheeze among children of mothers with excessive third trimester gestational weight gain (aOR= 0.64; 95% CI: 0.42-0.98). This study adds to the body of literature by incorporating adequate inclusion of confounders and risk factors for adjustment, as well as being the first study to evaluate the association between trimester-specific gestational weight gain, offspring asthma and wheeze phenotypes.

Prospective memory refers to the ability to remember to carry out delayed intentions, more precisely, to remember to initiate and execute an intended action at some point in the future. The development and progression of prospective memory across the lifespan is still heavily under debate. Only few studies have so far investigated prospective memory development in childhood, revealing an inconsistent pattern. In adulthood, studies in the laboratory and naturalistic studies showed paradoxical results with age deficits in the laboratory and age benefits in naturalistic tasks. Up to now, no conceptual model has been suggested to guide research on prospective memory development across the lifespan. Thus, the present work examined the effect of central factors from the multiprocess framework (McDaniel & Einstein, 2000) on the development of prospective memory in four different age-groups: pre-schoolers, school-age children, young and old adults. The first study explored the role of task motivation in age differences in prospective memory performance across the pre-school age-range. No main effect of age or motivation in prospective memory performance was found, yet a significant interaction, indicating that for younger children motivation or task importance may help allocating the available resources to the task elements of interest. Evidence from the second study indicated that 9-10 year old school children outperform 6-7 year old school children on a measure of prospective memory, and that retrieval-based factors (ongoing task absorption, cue salience, cue focality) systematically influenced performance. Of particular importance for possible developmental mechanisms was the finding of an age x cue focality interaction, suggesting that age effects may be modulated by cue focality. The third study examined the effect of task setting in a laboratory procedure and the effect of motivation in a naturalistic procedure on prospective memory performance in young and older adults. Results from the laboratory prospective memory procedure revealed significant age-related decline for irregular tasks but not for regular and focal tasks. In addition, in the naturalistic procedure, the age benefit was eliminated when young adults were motivated by incentives. Results from the present work indicated that already pre-school age children were able to remember to perform intended actions and this ability increased across school-age. In adulthood, the results revealed a decline with age on a pure performance level. Yet, older adults may be able to compensate for basic cognitive impairments if task conditions reduce the need for controlled attention. Furthermore, the present work suggest, that factors of the multiprocess framework may indeed affect age-differences in prospective memory performance throughout the lifespan, as cue focality and task importance were related to prospective memory development in children and adults. Thus, the multiprocess approach might serve as foundation for a lifespan theory of the development of prospective memory.

Unauthorized reproduction of this 8 article is prohibited. Objective:To examine differences in bone mass between children and adolescents swimming competitively at nonelite levels (locally and regionally) and nonathletes and to assess changes in bone mass in these 2 groups over 24 months after taking into consideration several known confounders of bone mass.Design:Observational prospective study.Participants:White nonelite swimmers (n=128) and nonathletes (n=106) 8 to 18 years of age from Memphis, Tennessee, USA.Main Outcome Measures:Participants underwent dual-energy x-ray absorptiometry to assess total body and hip bone mineral content (BMC) at baseline and 12 and 24 months later.Results:At baseline, swimmers had 4.2% and 6.1% higher adjusted BMC for the total body and hip, respectively, compared with nonathletes (P values < 0.027). Averaging across assessment points, swimmers had 73.5 and 2.2 g higher BMC for the total body and hip, respectively, than nonathletes. Although there was a significant annual increase in total body and hip BMC in both groups (33.5 and 0.7 g, respectively), there was no difference in annualized bone accrual between swimmers and nonathletes for either total body BMC (swim by time effect; P=0.213) or hip BMC (P=0.265).Conclusions:Competitive swimming at nonelite levels during childhood and adolescence does not seem to compromise bone accrual.

The strategy is closely linked to the history of humanity. Its origin is related to the military arts and has been migrating to other areas of society, locating itself in the organizational field since the second half of the 20th century. Despite the massive presence of the term, especially at managerial levels, there is no consensus on the definition of strategy, much less when it is related to the communication field and the communication planning processes. This article outlines a definition of communication strategy and presents a strategic communica s the prospective and emotional dimension of target audiences. / La estrategia está estrechamente ligada a la historia de la humanidad. Su origen se relaciona con las artes militares y ha ido migrando a otros rubros de la sociedad, ubicándose desde la segunda mitad del siglo XX en el campo organizacional. Pese a la presencia masiva del término, sobre todo a niveles directivos, no hay un consenso sobre la definición de estrategia y mucho menos cuando se relaciona con el rubro comunicacional y con los procesos de planificación en comunicación. Este artículo ensaya una definición de la estrategia en comunicación y presenta un modelo de planificación estratégica de la comunicación, el cual incorpora la prospectiva y la dimensión emocional de los públicos objetivo.

Borderline personality disorder (BPD) is a form of psychopathology characterized by a pervasive pattern of instability with emotion regulation, impulse control, interpersonal relationships, and sense of self. While not a required diagnostic marker, the majority of individuals with BPD engage in some form of deliberate self-harm (e.g., suicide attempts, nonsuicidal self-injurious behavior) or suicide-related behavior (e.g., suicidal ideation, suicide threats). Longitudinal data from a sample of adolescent psychiatric inpatients who were hospitalized for deliberate self-harm and suicide-related behavior were followed for 5 years to investigate whether deliberate self-harm or suicide-related behaviors predicts BPD at 3-year follow-up and 5-year chart review. The extant data set consisted of 132 consecutively admitted adolescent psychiatric inpatients who completed a series of self-report questionnaires assessing deliberate self-harm and suicide-related behaviors, maladaptive familial behavior, peer victimization, and emotion regulation difficulties. Data regarding index psychiatric hospital admission diagnoses, childhood maltreatment, and BPD diagnoses were abstracted from the patient’s medical and psychiatric records and BPD was also assessed though a structured clinical interview. Suicide threats were the only variable found to be predictive of BPD at 5-year chart review. Other empirically (e.g., history of childhood maltreatment, maladaptive familial behavior, and peer victimization) and theoretically (e.g., emotion regulation difficulties) grounded constructs were also examined and were not found to be predictive of BPD in the current study. To our knowledge, this is the first study to investigate prospective associations between deliberate self-harm and suicide-related behaviors and BPD. Future directions and limitations of the research are discussed.

Face aux enjeux pour le futur posés par l’ampleur des dérèglements écologiques (changement climatique, extinction des espèces, pressions sur les ressources en eau…), les discours sur l’avenir se multiplient, qu’ils promettent une résolution des problèmes par la technologie, des modèles de société utopiques ou considèrent l’effondrement comme inéluctable. Ces discours sur l’avenir ont-ils une influence sur les situations concrètes de gestion de l’environnement ? Peuvent-ils soutenir ou contraindre l’action des acteurs cherchant à améliorer l’état des écosystèmes ? Cette thèse traite ces questions en s’intéressant aux démarches prospectives et à leur contribution à des stratégies d’acteurs défendant une prise en charge efficace des enjeux environnementaux. Grâce à huit études de cas, elle analyse comment des concepteurs d’interventions prospectives conçoivent ces démarches pour qu’elles fournissent des prises pour l’action d’acteurs d’environnement (agences de l’eau, gestionnaires d’espaces protégés, associations…). Les démarches prospectives influencent la « fabrique des futurs », c’est-à-dire la compétition entre différentes représentations de l’avenir des systèmes sociotechniques qui impose ou exclut certaines trajectoires de changement. Faire exister dans la fabrique des futurs des discours sur l’avenir crédibilisant une transformation de ces systèmes favorable aux enjeux écologiques fournit une ressource susceptible de renforcer le pouvoir d’acteurs d’environnement. Les concepteurs de prospectives travaillent à des reconnexions entre les discours sur l’avenir produits lors de leurs démarches et les processus de gestion de l’environnement. Ces reconnexions peuvent fournir, non sans difficultés, des prises sur les jeux d’acteurs, l’élaboration d’instruments de gestion de l’environnement et le fonctionnement des organisations impliquées. La thèse propose un cadre d’analyse pour accompagner la réflexion des concepteurs prospectifs dans la conception et la mise en œuvre de leurs démarches. Plus largement, elle ouvre des pistes de réflexion sur les enjeux stratégiques de la production de discours sur l’avenir pour participer aux transitions des systèmes sociotechniques. / Faced by challenges for the future such as that posed by the extent of ecological disruption (climate change, species extinction, pressure on water resource), the narratives regarding the future are ever multiplying, whether promising solutions via technology, models of a utopian society, or considering collapse as inevitable. Do said narratives play a part in the practical implementation of environmental management and are they supporting or restraining the action of those seeking to improve the state of ecosystems? This thesis addresses these issues by investigating the contribution of futures studies to the strategies of stakeholders acting for an effective management of environmental issues. Through eight case studies, the research work analyses how designers build futures studies so that they can provide opportunities for action to environmental actors (i.e. water agencies, protected areas managers, NGOs etc.). Futures studies influence the “manufacture of futures”, that is, the competition between various future depictions of sociotechnical systems which results in imposing or excluding certain pathways of change. By making visible, in the manufacture of futures, narratives which lend credibility to transformations of socioecological systems in favour of ecological issues, futures studies may empower environmental actors. Futures studies designers connect the results of their interventions with processes in environmental management situations. These connections can provide, not without difficulty, opportunities to influence power relationships, the negotiation of environmental management actions, and the internal processes of organisations involved. This thesis offers an analytical framework to support the strategic thinking of futures studies designers in the design and implementation of their interventions. Furthermore, it opens up new avenues on the strategic issues of producing narratives to support the transitions of sociotechnical systems.