Les professionnels de l'analyse de la pratique et de l'organisation des soins interviennent dans un système complexe où interagissent des facteurs biologiques, culturels et sociaux. Ce travail de recherche porte sur les vécus du patient cardiovasculaire entrant dans un programme d'éducation thérapeutique, suite à un évènement aigu (infarctus du myocarde ou accident vasculaire cérébral). Il se justifie par la nécessité de comprendre le phénomène des récidives, rechutes et retours à l'hospitalisation malgré une prise en charge informative et éducative des facteurs de risques cardiovasculaires (tabagisme, sédentarité, mauvaise alimentation) durant l'hospitalisation initiale. Notre principal objectif est donc de comprendre ces récidives, rechutes et retours à l'hospitalisation des patients cardiovasculaires autrement que le résultat d'une non-observance. Cette recherche de type qualitatif est menée au Centre Hospitalo-Universitaire de Clermont-Ferrand (service de cardiologie court séjour) et à la clinique cardiopneumoloique de Durtol (centre de soins de suite et de réadaptation). La recherche est basée sur 22 situations d'observations de pratiques professionnelles, 9 entretiens centrés avec les professionnels dans ces 2 sites ci-dessus et 31 entretiens semi-directifs avec les patients. Ces enquêtes sont complétées par une analyse de la littérature française et anglo-saxonne, dans le domaine de l'éducation thérapeutique, de l'observance et du changement des comportements. En termes de résultats, la recherche présente les récidives, rechutes et retours à l'hospitalisation court séjour des patients comme le résultat d'une prise en charge inadaptée à leurs besoins. Des discordances de temps, de vécus et de ressentis entre professionnels de santé et patients durant l'hospitalisation initiale, l'inadaptation structurelle du court séjour, la discontinuité de la prise en charge et les ruptures de cohérence en fonction des différents niveaux de complexité (court séjour, centre de soins de suite et de réadaptation et chez les médecins traitants), mais surtout la confusion entre éducation du patient et information du patient, rendent les prescriptions médicales et soignantes en matière de changement des comportements à risques difficilement observables par les patients. Le format actuel de la relation et des interactions patients/professionnels de santé durant les soins, ne favorise pas l'implication et la participation active des patients dans leur prise en charge. En conclusion, nous retenons que les éléments qui influencent les comportements des patients vis-à-vis de leurs traitements ne relèvent pas seulement d'un apprentissage, mais de leur vécu et ressentis et également de leurs interactions avec les professionnels de santé. La prise en charge informative et éducative des facteurs de risques occulte parfois l'aspect relationnel de cette thérapeutique et les capacités cognitives et émotives des patients. Elle devrait suivre une double évolution : celle du patient (ses émotions, ses attentes, ses projets de vie…) et celle de la pathologie. Ce travail cherche également à répondre à la question suivante : en quoi et comment une approche socio-anthropologique permet-elle de comprendre les comportements des patients d'une part et des professionnels de santé d'autre part dans un contexte d'ETP en court séjour ? Il milite pour une reconnexion entre sciences sociales et sciences médicales et soignantes dans le système de soin et de santé français et montre l'apport considérable mais encore trop peu exploité des sciences sociales dans ce domaine. / The professionals of the practice analysis and care organization take part in a complex system where biological, cultural and social factors interact. This research task focuses on the experiences of the cardiovascular patient entering a therapeutic education program, after an acute event (myocardial infarction or stroke). It is justified by the need to understand the phenomenon of recurrence, relapse and hospitalization returns despite an informative and educational treatment in cardiovascular risk factors (smoking, physical inactivity, poor nutrition) during the initial hospitalization. Our main goal is therefore to understand these recurrences, relapses and hospitalization returns of cardiovascular patients other than the result of non-compliance. This qualitative research is carried out at the University Hospital Center of Clermont-Ferrand (Cardiology Department short stay) and at the cardio-pneumologic clinic of Durtol (follow-up and rehabilitation care center). The research is based on 22 observation situations of professional practices, nine focused interviews with professionals in these two sites above and 31 semi-structured interviews with the patients. These surveys are supplemented by an analysis of the French and Anglo-Saxon literature in the field of therapeutic education, compliance and behaviours change. In terms of results, the research presents the recurrences, relapses and returns to patients' short stay hospitalization as the result of an inappropriate care to their needs. Time discrepancies, experiences and felt between health professionals and patients during the initial hospitalization, inadequate structural short stay, the discontinuity of care and the inconsistencies in accordance with different levels of complexity (short stay, follow-up and rehabilitation care center and at the attending physicians', but mostly the confusion between the patient's education and the patient's information, makes medical and nursing requirements in terms of the change of risky behaviours hardly observable by patients. The current format of the relationship and the interactions patient/health professionals during the care doesn't promote the involvement and the active participation of patients in their care. In conclusion we retain that the elements which influence the patients' behaviours with respect to their treatments do not only depend on training, but on their experiences and felts and also on their interactions with health professionals. The informative and educational care of the risk factors sometimes conceals the relational aspect of this therapeutic and the cognitive and emotive capacities of the patients. It should follow a double evolution: that of the patient (his emotions, his expectations, his life plans) and that of the pathology. This work also seeks to answer to the following question: why and how a socio- anthropological approach allows us to understand the patients' behaviours on one hand and the health professionals on the other hand in a context of PTE (patient's therapeutic education) in short stay? It argues for a reconnection between social sciences and medical and nursing in the French health care system and shows the significant contribution but still too little used by social sciences in this area.

The thesis, Survey of the methods of costing of hospitalization, deals with the characteristics of the classification system DRG used for costing of hospitalization. The first half of the theoretical part of this work describes the Czech health care in general and specific ways of financing it. We focus on the costs related to the emergency care in hospitals which are classified by the DRG system. The second half of the theoretical part studies the actual principles of costing of hospitalization. The method chosen for this is called Activity Based Costing (ABC). It defines the procedures of costing which are being used in hospitals. At the end, we provide a description of the current and suggested procedures of costing of hospitalization and how they are utilized to set up parameters of the reimbursing mechanism. The practical part of this thesis maps the situation of hospitalization financing in Klatovska nemocnice, a. s. We suggest a new way of financing based on the methodology DRG Restart. Base on the data obtained in Klatovska nemocnice, a. s. we summarize and compare the results of the new method to the current one.

The distribution of the population has multiple implications on regional development and planning. In-migration is frequently seen as the only possible solution in order to rejuvenate the population and stimulate regional development in sparsely populated regions. A population increase results in greater tax revenues, meaning that local authorities can plan for their inhabitants and expenditures in a more sufficient way. In addition, certain professionals are needed in order to support essential local services such as schools and hospitals. Place marketing with the intention of attracting in-movers has become increasingly popular, especially for rural, sparsely populated Swedish municipalities. Still, the outcome from place marketing efforts are dubious and in addition, migration has a temporal aspect and individual migration propensity usually fluctuates over time. This begs the question – how long do in-movers stay? Is there potential for long lasting development in sparsely populated regions connected to in-movers or is it temporary? This study focuses on the duration of time until an in-mover re-migrates from Region 8 in northern Sweden and which socioeconomic and demographic factors that influences the out- migration. This is studied by applying an event history method with discrete-time logistic regressions. The study follows individuals in working age that moved to any of nine specified municipalities in Västerbotten and Norrbotten County, sometime between 2000 and 2011. Questions posed for the study is: i) On average, how long did people who moved to Region 8 between the years 2000-2011 stay in the region? ii) What are the socioeconomic and demographic factors that influence the out-migration from the region? iii) Do the influencing factors differ between women and men? The results show that the time perspective matters as the risk of moving out was highest in the initial years and that it declines with time. 30 % of the sampled in-movers had moved out again within the time of observation, and on average the in-movers stayed for nine years. The regression results indicated that the factors that had the greatest influence on the out- migration was unemployment, being between 20-26 years old, high education, having and unemployed partner, and having children below school age. Women had a slightly lower likelihood of moving out compared to men, and the most prominent influential factor to outmigration that varied between women and men was unemployment.

The thesis is a design of a bridge crossing the valley of the Hrabyňka creek as a part of road I/II. Firstly, three possible structures are designed and according to their advantages and disadvantages, the best of them is selected. In this case a cable stay bridge was selected. Following is a design of span lenghths, collumn heights and the cross-section. Then the loads are detremined and applied on a numeric model cretaed in software working on the basis of FEM. In continuation internal forces are calculated and their propriate combinations for service limit stay and ultimate limit state with time dependent analysis taken into account. In the end the reinforcement steel is designed for one part of the structure. Detailed drawings are also part of the thesis.

This diploma thesis aims to design a structure of pedestrian bridge over the Svratka river. To make a preliminary study of possible bridging, three different outlines were drafted. The cable-stayed variant was selected for further analysis. Two towers, inclined in both their longitudinal and transverse direction, support a cast-in-place post-tensioned concrete deck through stay cables anchored in the tower and the deck. After determining the desired initial state, a finite element analysis was carried out using the Ansys software. The capacity of all main load-bearing elements was checked so it meets the ULS and SLS design criteria in accordance with EN 1992 codes.

Across a large part of the world, there is currently a shortage of nurses, this is no exception in Sweden. In this study, we have thus intended to investigate the contributing factors behind the shortage of nurses in Sweden. This purpose has been investigated through a qualitative method, where nine semi-structured interviews have been conducted with licensed nurses who have been in the profession for a maximum of 5 years. The results of the study have been analysed through Herzberg's two-factor theory and Adam's equity theory. The results that came from this study show that nurses choose the profession with an expected return in the form of patient contact, the possibility to make a difference and self-development within the profession. What creates the intention to leave the profession is when the return is smaller and there is no room to establish the return, which is derived from the nurse's context, in the form of, among other things, too high a workload, lack of support and neglected skills. Conclusions of the study show that measures in the form of increased decentralization, increased professionalization of the profession and consideration of individual needs need to be taken to retain more nurses in the profession. / Över en stor del av världen råder det just nu en brist på sjuksköterskor, detta är inget undantag i Sverige. I den här studien har vi därmed ämnat undersöka vilka bidragande faktorer som ligger bakom bristen på sjuksköterskor i Sverige. Detta syfte har undersökts genom en kvalitativ metod, där nio semistrukturerade intervjuer har genomförts med legitimerade sjuksköterskor vilka har varit i yrket i max 5 år. Resultatet av denna studie haranalyserats genom Herzbergs tvåfaktorteori och Adams jämviktsteori. Resultatet som kom av denna studie visar att sjuksköterskor väljer yrket med en förväntad avkastning i form av patientkontakt, att göra skillnad och självutveckling inom professionen. Det som skapar intentionen att lämna professionen är när avkastningen blir mindre och utrymme inte finns för att etablera avkastningen, vilket härleds till sjuksköterskans kontext, i form av, bland annat, för hög arbetsbelastning, brist på stöd samt försummad kompetens. Slutsatser av studien visar att åtgärder i form av ökad decentralisering, en ökad professionalisering av professionen och hänsynstagande till individuella behov behöver tas för att bibehålla sjuksköterskor inom professionen.

VIKOVÁ, Tereza. The Uses of Public Space in Connection to Visual Art and Art Education [Dissertation]. Prague, 2019. Charles University, Faculty of Education, Art Education Department. 98 pages (Attachments on CD: 1 text, 2 image attachments) The subject matter of the master's thesis is the use of public space. Namely a way of use when the user, on the basis of self-awareness in the common space, feels and assumes responsibility for this space. The author is particularly interested in the moment of focus, which may (or may not) result in action and become a change. In this context, the so called gentle action phenomenon is being mentioned. That is, an individual's actions emanating from within the system itself, which is usually characterized by subtle action with a deeper, more far-reaching effect. The author's central ideas are applied in a thematic series consisting of a combination of a didactic and an artistic part. Together, they create a coherent whole. The author shows her own approach to the problem (in relation to fine art and art education) based on the extraction of a public space element from its everyday environment, its temporary appropriation and restitution. Particular topics reveal the aspects of private and public and outline the ways in which the user relates to his or her...

Text in English, isiZulu and Afrikaans / The topic of work-life balance has gained much attention in recent years. A focal point remains the effects of maternal employment on the well-being of women and children, despite shifts in society towards gender equality. The aim of this study was to explore the experiences of mothers who either had chosen to stay at home after having children or to continue with full-time employment; and how their decision impacted their lives. This qualitative study, based on the Social Constructionist paradigm, and Second Order Cybernetics and Feminist Theories, included interviews with four full-time employed and four stay-at-home South African mothers. The data were analysed using hermeneutic analysis. The findings suggest that the participants’ tensions regarding motherhood and employment were strongly influenced by structural obstacles at work and at home, interpersonal relationships with other mothers, as well as intrapersonal experiences. Breastfeeding was identified as a prominent topic within the various themes. / Eminyakeni yamuva nje ukulinganisela phakathi komsebenzi nokuphila kwasekhaya kube undabamlonyeni. Indaba eseqhulwini kuseyiwo umthelela wokusebenza komama enhlalakahleni yabesimane nezingane, yize sekube nezinguquko emphakathini endabeni yokulingana kobulili. Inhloso yalolu cwaningo kwakuwukuhlola lokho okwehlele omama abakhethe ukuhlala ekhaya ngemva kokuzalwa kwezingane noma abaqhubeka besebenza isikhathi esigcwele; nokuthi isinqumo sabo sibe namuphi umthelela ekuphileni kwabo. Lolu cwaningo olwalubheka umnyombo, olusekelwe embonweni weNhlanganyelo Yomphakathi, kanye ne-Cybernetics Yohlelo Lwesibili Nemibono Yabalweli Besifazane, lwalubandakanya izingxoxombuzo nomama abane baseNingizimu Afrika abasebenza isikhathi esigcwele kanye nabanye abane abahlala ekhaya. Ulwazi lwahlaziywa kusetshenziswa uhlaziyo lokucubungula okulotshiwe. Okwatholakala kubonisa ukuthi izinto ezaziyingqinamba kubabambiqhaza ngokuphathelene nokuba umama nokusebenza zazilawulwa kakhulu yizithiyo zesikhundla emsebenzini nasekhaya, ubudlelwano nabanye omama, kanye nalokho ababhekana nakho uma bezihlola ekujuleni. Ukuncelisa ibele kwakubhekwa njengesihloko esiqavile phakathi kwalezo zihloko ezinhlobonhlobo. / Die kwessie van ‘n werk-lewe balans geniet die afgelope paar jaar baie aandag. 'n Brandpunt in die literatuur is steeds die gevolge van ma’s se indiensneming op die welstand van vroue en kinders, ondanks verskuiwings in die samelewing ten opsigte van geslagsgelykheid. Die doel van hierdie studie was om die ervarings van vroue te ondersoek wat óf kies om tuis te bly, óf om voltyds te bly werk wanneer hulle kinders kry; en hoe die besluit hul lewens beïnvloed. Die kwalitatiewe studie, gebaseer op ‘n sosiaal-konstruksionistiese uitgangspunt, en ekosistemiese en feministiese teorieë, het onderhoude met vier voltydse werknemers en vier tuisbly ma’s in Suid-Afrika ingesluit. Die data is ondersoek met behulp van hermeneutiese analise. Die bevindinge dui daarop dat die deelnemers se spanning rakende. / Psychology / M.A. (Psychology)

Indiana University-Purdue University Indianapolis (IUPUI) / With the increasing availability of Electronic Health Records (EHRs) and advances in deep learning techniques, developing deep predictive models that use EHR data to solve healthcare problems has gained momentum in recent years. The majority of clinical predictive models benefit from structured data in EHR (e.g., lab measurements and medications). Still, learning clinical outcomes from all possible information sources is one of the main challenges when building predictive models. This work focuses mainly on two sources of information that have been underused by researchers; unstructured data (e.g., clinical notes) and a patient network. We propose a novel hybrid deep learning model, DeepNote-GNN, that integrates clinical notes information and patient network topological structure to improve 30-day hospital readmission prediction. DeepNote-GNN is a robust deep learning framework consisting of two modules: DeepNote and patient network. DeepNote extracts deep representations of clinical notes using a feature aggregation unit on top of a state-of-the-art Natural Language Processing (NLP) technique - BERT. By exploiting these deep representations, a patient network is built, and Graph Neural Network (GNN) is used to train the network for hospital readmission predictions. Performance evaluation on the MIMIC-III dataset demonstrates that DeepNote-GNN achieves superior results compared to the state-of-the-art baselines on the 30-day hospital readmission task. We extensively analyze the DeepNote-GNN model to illustrate the effectiveness and contribution of each component of it. The model analysis shows that patient network has a significant contribution to the overall performance, and DeepNote-GNN is robust and can consistently perform well on the 30-day readmission prediction task. To evaluate the generalization of DeepNote and patient network modules on new prediction tasks, we create a multimodal model and train it on structured and unstructured data of MIMIC-III dataset to predict patient mortality and Length of Stay (LOS). Our proposed multimodal model consists of four components: DeepNote, patient network, DeepTemporal, and score aggregation. While DeepNote keeps its functionality and extracts representations of clinical notes, we build a DeepTemporal module using a fully connected layer stacked on top of a one-layer Gated Recurrent Unit (GRU) to extract the deep representations of temporal signals. Independent to DeepTemporal, we extract feature vectors of temporal signals and use them to build a patient network. Finally, the DeepNote, DeepTemporal, and patient network scores are linearly aggregated to fit the multimodal model on downstream prediction tasks. Our results are very competitive to the baseline model. The multimodal model analysis reveals that unstructured text data better help to estimate predictions than temporal signals. Moreover, there is no limitation in applying a patient network on structured data. In comparison to other modules, the patient network makes a more significant contribution to prediction tasks. We believe that our efforts in this work have opened up a new study area that can be used to enhance the performance of clinical predictive models.

Indiana University-Purdue University Indianapolis (IUPUI) / In order to help individuals feel more engaged within work organizations and more satisfied with their jobs, employers have started to administer stay interviews within organizations, with the end goal being to retain organizational members. Stay interviews have become a proactive solution to the retention problem and have been seen as an alternative to the exit interview. This study proposes that through the use of stay interviews, organizational members will feel more engaged, satisfied, and committed to an organization, which will ultimately result in the retention of organizational members.