Introdução: As doenças da córnea são responsáveis por cerca de 5% da cegueira reversível no mundo e o transplante de córnea (TC) é importante para o tratamento dessas enfermidades. A partir de fontes de dados oficiais e públicas, foram analisados o progresso e as dificuldades relacionados ao TC no Brasil nos últimos 16 anos, bem como desigualdades regionais, gastos do Sistema Único de Saúde (SUS) e indicadores de qualidade dos bancos de tecido ocular (BTOs). Métodos: Estudo retrospectivo e analítico com dados sobre TCs e BTOs no Brasil, no período de janeiro de 2001 a dezembro de 2016, divulgados pelo Sistema Nacional de Transplantes (SNT), pela Associação Brasileira de Transplante de Órgãos (ABTO) e pela Agência Nacional de Vigilância Sanitária (ANVISA). Para verificação de existência de tendência, comparação de médias entre as regiões e verificação da diferença de médias, foram utilizados o teste de Cochran-Armitage, a Análise de Variância e as comparações múltiplas de Duncan, respectivamente. Em todos os testes foi utilizado um nível de significância de 5%. Resultados: No Brasil, houve aumento: de 2,4 vezes no número de TCs (de 6.193 - 35,2 pmp para 14.641 - 71,0 pmp - p < 0,001); de 50,7% na eficácia do atendimento à demanda populacional por TCs (de 35,3% para 53,2% - p < 0,001); de 27,8% no número de globos e córneas in situ doados (de 24.608 - 127,1 pmp para 31.450 - 152,6 pmp - p < 0,001); de 31,7% nas córneas preservadas (de 21.012 para 27.674); de 2,4 vezes no gasto financeiro total com TCs (de R$ 9.179.688 para R$ 22.060.973); e de 2,2 vezes no gasto unitário com TC (de R$ 716 para R$ 1.603). A fila de espera para TC reduziu em 45,4% (de 23.549 - 123,0 pmp para 12.865 - 62,4 pmp - p < 0,001). As duas principais causas para a não doação foram as contraindicações médicas (média de 42,5%) e a recusa familiar (média de 36,6%). As principais causas de descarte de córneas foram a sorologia positiva para hepatite B (média de 33%), validade tecidual (média de 30,9%) e qualidade imprópria do tecido (16,8%). A Eficácia na Preservação de Córnea (EPC), o Coeficiente de Descarte de Córnea (CDC) e a Eficácia no Fornecimento de Córnea para Transplante (ECT) foram em média 88%, 37% e 63% ao longo dos anos, respectivamente. Os melhores índices foram apresentados nas regiões Sul, Centro-Oeste e Sudeste e os piores no Norte e Nordeste. Conclusão: No Brasil, o pequeno número de doações e a grande taxa de descarte de córneas são as principais dificuldades ao adequado atendimento à demanda populacional por TCs. Contudo, o país aumentou a capacidade de transplantar córneas e reduziu as filas de espera em 16 anos / Introduction: Corneal diseases account for about 5% of reversible blindness in the world and Corneal Transplantation (CT) is important for the treatment of these diseases. From official and public data sources, the progress and difficulties related to CT in Brazil in the last 16 years were analyzed, as well as regional inequalities, expenses for the Unified Health System (SUS) and quality indicators of ocular tissue banks (OTBs). Methods: A retrospective and analytical study with data on CT and OTB in Brazil, from January 2001 to December 2016, published by the National Transplantation System (SNT), the Brazilian Organ Transplantation Association (ABTO) and the National Surveillance Agency Sanitary (ANVISA). The Cochran-Armitage test, the Analysis of Variance and the Duncan\'s multiple comparisons were used to verify the existence of trend, comparison of means between regions and verification of the mean difference, respectively. A significance level of 5% was used in all tests. Results: In Brazil, there was an increase: of 2.4 times in the number of CTs (from 6,193 - 35.2 pmp to 14,641 - 71.0 pmp - p < 0.001); of 50.7% in the efficacy of meeting the population demand for CTs (from 35.3% to 53.2% - p < 0.001); of 27.8% in the number of donated globes and corneas in situ (from 24,608 - 127.1 pmp to 31,450 - 152.6 pmp - p < 0.001); of 31.7% in preserved corneas (from 21,012 to 27,674); of 2.4 times in the total finance expense with CTs (from R$ 9,179,688 to R$ 22,060,973); and 2.2 times the unit expense with CT (from R$ 716 to R$ 1,603). The waiting list for CT decreased by 45.4% (from 23,549 - 123.0 pmp to 12,865 - 62.4 pmp - p < 0.001). The two main causes for non-donation were medical contraindications (mean of 42.5%) and family refusal (mean of 36.6%). The main causes of corneal discard were positive serology for hepatitis B (mean of 33%), tissue validity (mean of 30.9%) and inadequate tissue quality (16.8%). Efficacy in Corneal Preservation (EPC), Corneal Discarding Coefficient (CDC) and Efficacy Supply of Corneas for Transplantation (ECT) averaged 88%, 37%, and 63% over the years, respectively. The best indexes were presented in the South, Midwest and Southeast regions and the worst in the North and Northeast. Conclusion: In Brazil, the small number of donations and the high rate of discard of corneas are the main difficulties to the adequate attendance to the population demand by CTs. However, the country increased the ability to transplant corneas and reduced waiting lists in 16 years

A doação de plaquetas por aférese é um procedimento automatizado que permite a obtenção deste hemocomponente em grande quantidade e com ato grau de pureza; deste processo obtém-se um subproduto chamado Câmara de Leucorredução (CLR) que é descartado ao final da doação. São permitidas até 24 doações/ano; porém as possíveis consequências de doações frequentes para esses doadores são pouco investigadas. Assim, foram identificados e quantificados os leucócitos de doadores de plaquetas frequentes e de 1ª vez. Também foi avaliada a viabilidade do uso das células mononucleares da CLR para pesquisas. Observou-se mais células na CLR que no sangue e que a frequência das populações é similar. O estado de ativação e a capacidade funcional (proliferação e produção de citocinas) foram similares entre CLR e sangue, assim como a taxa de apoptose espontânea. Entre doadores frequentes e de primeira vez não houve diferença no número de leucócitos, sugerindo que doações recorrentes não alteraram as populações leucocitárias. / Plateletpheresis is an automatized procedure to obtain high purity platelet for transfusions. From this procedure its possible to obtain a byproduct: The Leukoreduction system chamber (LRSC), which is discarded at the end of donation process. This type of donation allows 24 donation/year, but the consequences of frequent donations are poorly investigated. Therefore, we identified and quantified leukocytes of frequent and first time platelet donor. Also, was evaluated the viability, for research, of mononuclear cells recovery from LRSC. The total number of mononuclear cells was higher in LRSC than in peripheral blood samples, but the frequencies were similar in all the samples. Activation state and functional capacity (measured by cell proliferation and cytokine production) were similar in both, blood and LRSC mononuclear cells, as well as spontaneous apoptosis. Among frequent (6 or more donations in 1 year) and first time donor, there was no difference in the leukocyte total number, suggesting that frequent donation do not modify these cells.

Trotz Inkrafttretens des ersten gesamtdeutschen Transplantationsgesetzes im Dezember 1997 steigt die Anzahl terminal niereninsuffizienter Patienten auf der Warteliste, ebenso wie die Wartezeit auf eine Nierentransplantation (NTX). Verschiedene Programme existieren, um der Organknappheit zu begegnen. Im Eurotransplant Senior Programm (ESP) werden seit 1999 Nieren älterer verstorbener Spender (65+) an ältere Empfänger (65+) unabhängig von der Gewebeübereinstimmung auf lokaler Ebene übertragen. Unsere Studien konnten zeigen, dass die Transplantat- und Empfängerüberlebensraten sich nicht von denen nach Transplantation jüngerer Spendernieren in alte Empfänger unterscheiden. Transplantatverlust im ESP tritt meist als Tod mit funktionierendem Transplantat auf. Dies ist die Folge vermehrt vorkommender Komorbiditäten in dieser Empfängergruppe und unterstreicht die Notwendigkeit einer intensiven prä-operativen Evaluation sowie engmaschigen Nachsorge. Zudem konnten wir zeigen, dass die Grundannahme einer verminderten Immunkompetenz älterer Empfänger nicht zutrifft. Eine Änderung der Allokationsregeln von Eurotransplant wird deshalb diskutiert, die auch im ESP die Gewebetypisierung berücksichtigt. Der Anteil der Lebendnierenspende (LNTX) in Deutschland hat sich in den vergangenen Jahren auf ca. 19% verdreifacht. An unserer Klinik macht sie ca. 30% der durchgeführten NTX aus. Zudem wird an unserer Klinik deutschlandweit die laparoskopische Spendernierenentnahme am häufigsten durchgeführt. Folge einer hier durchgeführten prospektiven Studie zur präoperativen Bildgebung der renalen Gefäßarchitektur des Spenders ist der Verzicht auf invasive Methoden. In weiteren Untersuchungen konnten wir zeigen, dass die Akzeptanz von Lebendspendern mit erweiterten Spenderkriterien gute Möglichkeiten bieten NTX-Programme zu intensivieren. In einer Lebensqualitätsstudie untersuchten wir erstmalig für den deutschen Sprachraum die postoperativen Verläufe von Lebendnierenspendern und konnten neben einer grundsätzlichen Zufriedenheit auch besondere Bedürfnisse aufdecken. Verschiedene Studien zur Laparoskopie in der LNTX, Handhabung und Optimierung dieses neuen Verfahrens sowie dessen Anwendbarkeit bei anatomischen Besonderheiten konnten zeigen, dass diese Methode ein sicheres Verfahren darstellt. Anhand unserer Erfahrungen in der LNTX haben wir zudem Empfehlungen zur Evaluation und Nachbetreuung von Lebendnierenspendern erarbeitet. Insgesamt sind das ESP und die LNTX, hier besonders die laparoskopische Spendernierenentnahme, effektive Konzepte zur Erweiterung der Nierentransplantationsprogramme. / Despite the implementation of a transplantation law in 1997 the number of patients with end-stage renal disease in Germany is rising, as is the waiting time for a kidney transplantation (KTX). Different programs exist to counterbalance organ shortage. The Eurotransplant Senior Programm (ESP), initiated in 1999, allocates kidneys of deceased donors aged 65 and older (65+) irrespective of tissue matching locally to recipients 65+. Our studies revealed that graft- and patient survival in this program are comparable to that after transplantation of young donor-kidneys in old recipients. Graft loss is mostly due to recipient death, which is a consequence of the co-morbidities of the recipient. Meticulous evaluation and intensified follow-up in this recipient-group are most important. Furthermore, despite the assumption of a reduced immunologic response of old recipients we could show that they are very well immunocompetent. Therefore, a change in allocation rules at Eurotransplant is discussed, possibly involving HLA-matches in the ESP. Living donor kidney transplantation (LDKTX) has increased three-fold over the last years and features about 19% of all hat KTX in Germany. In our department LDKTX features about 30% of all KTX and our department also performs the most laparoscopic explantations of living kidney donors in Germany. With regard to the preoperative donor evaluation we could show in a prospective study that non-invasive methods for renal vessel imaging are better than the standard invasive approach. Further research proved that applying extended donor criteria renders good results for graft and recipient and thus is a viable option to increase LDKTX. In the first German study on donors Quality of Life we mostly found satisfied donors and also could detect specific donor demands. For the laparoscopic approach we performed different studies on the technique, its improvement and peculiarities, proving that laparoscopic organ retrieval is a safe method in LDKTX. ESP and LDKTX, especially the laparoscopic organ retrieval, are effective concepts to increase the number of kidney transplantations.

This dissertation is the compilation of three separate works of research revolving around the theme of regulation of biomedical technologies that are either emerging or that have undergone significant developments over the past decade or so. Each of these three research works examines a legal response to a technological development in the areas of biotechnology and/or medicine and addresses one or more challenges - ethical, constitutional, legal or one that is related to public policy - created by that response. The first work of research, which was published in the Administrative Law Review in March 2008, examines the legality of the restrictions imposed by the administration of President George W. Bush on the funding of research involving human embryonic stem cells. Reaching the conclusion that the Bush Administration's actions were outright illegal in more than one way, the research highlights existing tensions in the division of decision-making power between the President and executive agencies and between Congress and the President. The second work of research, which was published in the Columbia Science and Technology Law Review in August 2010, reviews the regulation of genetic screening and testing of donated reproductive tissue in the United States. Analyzing the regulation in the federal, state and industry level, the research highlights significant shortcomings of the regulation of this area and, drawing on the experience of other countries, advocates the regulation of this area by the FDA. The third and last work of research of which this dissertation consists is dedicated to the examination of the newly created regime of statutory exclusivities afforded to biological pharmaceuticals under the Biologics Price Competition and Innovation Act (BPCIA) as it compares to the protection afforded to such products under patent law. The research concludes that allowing biological pharmaceuticals to benefits from parallel protection under both patent law and the statutory exclusivities regime established under BPCIA does not contribute to incentivizing innovation and might have undesirable ramifications from a public policy perspective. Hence, the research proposes limiting the protection afforded to biological pharmaceutical products, namely to the protection under either patent law or BPCIA, by suspending the ability to enforce patents covering biological pharmaceuticals against generic applicants under BPCIA. In addition, the research examines the proposition that under some circumstances it would be possible to substitute patent protection for statutory exclusivities.

Introdução: As doenças da córnea são responsáveis por cerca de 5% da cegueira reversível no mundo e o transplante de córnea (TC) é importante para o tratamento dessas enfermidades. A partir de fontes de dados oficiais e públicas, foram analisados o progresso e as dificuldades relacionados ao TC no Brasil nos últimos 16 anos, bem como desigualdades regionais, gastos do Sistema Único de Saúde (SUS) e indicadores de qualidade dos bancos de tecido ocular (BTOs). Métodos: Estudo retrospectivo e analítico com dados sobre TCs e BTOs no Brasil, no período de janeiro de 2001 a dezembro de 2016, divulgados pelo Sistema Nacional de Transplantes (SNT), pela Associação Brasileira de Transplante de Órgãos (ABTO) e pela Agência Nacional de Vigilância Sanitária (ANVISA). Para verificação de existência de tendência, comparação de médias entre as regiões e verificação da diferença de médias, foram utilizados o teste de Cochran-Armitage, a Análise de Variância e as comparações múltiplas de Duncan, respectivamente. Em todos os testes foi utilizado um nível de significância de 5%. Resultados: No Brasil, houve aumento: de 2,4 vezes no número de TCs (de 6.193 - 35,2 pmp para 14.641 - 71,0 pmp - p < 0,001); de 50,7% na eficácia do atendimento à demanda populacional por TCs (de 35,3% para 53,2% - p < 0,001); de 27,8% no número de globos e córneas in situ doados (de 24.608 - 127,1 pmp para 31.450 - 152,6 pmp - p < 0,001); de 31,7% nas córneas preservadas (de 21.012 para 27.674); de 2,4 vezes no gasto financeiro total com TCs (de R$ 9.179.688 para R$ 22.060.973); e de 2,2 vezes no gasto unitário com TC (de R$ 716 para R$ 1.603). A fila de espera para TC reduziu em 45,4% (de 23.549 - 123,0 pmp para 12.865 - 62,4 pmp - p < 0,001). As duas principais causas para a não doação foram as contraindicações médicas (média de 42,5%) e a recusa familiar (média de 36,6%). As principais causas de descarte de córneas foram a sorologia positiva para hepatite B (média de 33%), validade tecidual (média de 30,9%) e qualidade imprópria do tecido (16,8%). A Eficácia na Preservação de Córnea (EPC), o Coeficiente de Descarte de Córnea (CDC) e a Eficácia no Fornecimento de Córnea para Transplante (ECT) foram em média 88%, 37% e 63% ao longo dos anos, respectivamente. Os melhores índices foram apresentados nas regiões Sul, Centro-Oeste e Sudeste e os piores no Norte e Nordeste. Conclusão: No Brasil, o pequeno número de doações e a grande taxa de descarte de córneas são as principais dificuldades ao adequado atendimento à demanda populacional por TCs. Contudo, o país aumentou a capacidade de transplantar córneas e reduziu as filas de espera em 16 anos / Introduction: Corneal diseases account for about 5% of reversible blindness in the world and Corneal Transplantation (CT) is important for the treatment of these diseases. From official and public data sources, the progress and difficulties related to CT in Brazil in the last 16 years were analyzed, as well as regional inequalities, expenses for the Unified Health System (SUS) and quality indicators of ocular tissue banks (OTBs). Methods: A retrospective and analytical study with data on CT and OTB in Brazil, from January 2001 to December 2016, published by the National Transplantation System (SNT), the Brazilian Organ Transplantation Association (ABTO) and the National Surveillance Agency Sanitary (ANVISA). The Cochran-Armitage test, the Analysis of Variance and the Duncan\'s multiple comparisons were used to verify the existence of trend, comparison of means between regions and verification of the mean difference, respectively. A significance level of 5% was used in all tests. Results: In Brazil, there was an increase: of 2.4 times in the number of CTs (from 6,193 - 35.2 pmp to 14,641 - 71.0 pmp - p < 0.001); of 50.7% in the efficacy of meeting the population demand for CTs (from 35.3% to 53.2% - p < 0.001); of 27.8% in the number of donated globes and corneas in situ (from 24,608 - 127.1 pmp to 31,450 - 152.6 pmp - p < 0.001); of 31.7% in preserved corneas (from 21,012 to 27,674); of 2.4 times in the total finance expense with CTs (from R$ 9,179,688 to R$ 22,060,973); and 2.2 times the unit expense with CT (from R$ 716 to R$ 1,603). The waiting list for CT decreased by 45.4% (from 23,549 - 123.0 pmp to 12,865 - 62.4 pmp - p < 0.001). The two main causes for non-donation were medical contraindications (mean of 42.5%) and family refusal (mean of 36.6%). The main causes of corneal discard were positive serology for hepatitis B (mean of 33%), tissue validity (mean of 30.9%) and inadequate tissue quality (16.8%). Efficacy in Corneal Preservation (EPC), Corneal Discarding Coefficient (CDC) and Efficacy Supply of Corneas for Transplantation (ECT) averaged 88%, 37%, and 63% over the years, respectively. The best indexes were presented in the South, Midwest and Southeast regions and the worst in the North and Northeast. Conclusion: In Brazil, the small number of donations and the high rate of discard of corneas are the main difficulties to the adequate attendance to the population demand by CTs. However, the country increased the ability to transplant corneas and reduced waiting lists in 16 years

Made available in DSpace on 2017-07-10T16:04:59Z (GMT). No. of bitstreams: 1 Dissertacao _Daniel Teotonio.pdf: 2870442 bytes, checksum: b13789aa4a36ae969acd407bb016879d (MD5) Previous issue date: 2015-12-10 / The government introduced, in 2003, the Programa de Aquisição de Alimentos (PAA) (Food Acquisition Program), to facilitate the marketing of farming family food, even so, ensuring food security for certain groups. The PAA is considered an important national public policy for farming family, which is essential to check the satisfaction level of one of its main performer, the farmers, because they are the ones that initiate the entire PAA process. It was noticed that the assessment methodologies of the PAA, developed up to now, have specific directions, not including important operating and socioeconomic indicators of the PAA. Therefore, this paper aimed to develop a model for the evaluation of public policy (PAA), the mode Compra com doação simultânea (CDS) (Purchase with Simultaneous Donation), able to detect the degree of satisfaction of the farmers in relation to operational and socioeconomic aspects of the public program. The Modelo de Avaliação de Satisfação (MAS) (Satisfaction Evaluation Model) developed, had two purposes: a) to detect the grade of satisfaction of farmers about the PAA public policy; and b) to assess the grade of satisfaction of family farmers about the management of the cooperatives or associations with which they are affiliated. The research, in its purpose, was descriptive and explanatory, about the means, it was bibliographical, documentary, field and study case. To verify the applicability of the proposed methodology, the Model MAS was tested in the Cooperativa da Agricultura Familiar e Solidária do Oeste do Paraná (COAFASO) (Cooperative of Agriculture Family and Solidarity of Western Paraná State). Data were tabulated and analyzed according to the steps set out in the Model MAS, using statistical techniques of exploratory analysis and dimensional analysis. After executing all the steps, it was verified the viability of the proposed Model, as it was possible to detect, in an objective way, the satisfaction level of the family farmers. The results showed that the farmers are satisfied about the PAA and the COAFASO Cooperative management. However, a number of producers showed dissatisfaction with some of the PAA indicators, especially about the prices paid for their products and for the required documents in relation some priority groups. About the Cooperative Management also were found some negative indicators. Thus, there were made two proposals of intervention. One targeted to the public agencies and other to the directors of COAFASO / O Governo Federal instituiu em 2003 o Programa de Aquisição de Alimentos (PAA), visando facilitar a comercialização dos alimentos da agricultura familiar e, ao mesmo tempo, assegurar a segurança alimentar de determinados coletivos. Hoje, o PAA é considerado uma importante política pública nacional para a agricultura familiar, o que torna imprescindível verificar o grau de satisfação de um de seus principais atores, os agricultores familiares, pois são eles que desencadeiam todo o processo do PAA. Notou-se que as metodologias de avaliação do PAA, desenvolvidas até o momento, possuem direcionamentos específicos, não incluindo importantes indicadores operacionais e socioeconômicos do PAA. Assim, esta dissertação teve como objetivo desenvolver um modelo para a avaliação da política pública (PAA), modalidade Compra com Doação Simultânea (CDS), capaz de detectar o grau de satisfação dos agricultores familiares, em relação aos aspectos operacionais e socioeconômicos do programa público. O Modelo de Avaliação de Satisfação (MAS) desenvolvido teve duas finalidades: a) detectar o grau de satisfação dos agricultores familiares em relação à política pública PAA; e b) avaliar o grau de satisfação dos agricultores familiares em relação à gestão das cooperativas ou associações às quais estão filiados. A pesquisa, quanto aos fins, foi descritiva e explicativa e, quanto aos meios, foi bibliográfica, documental, de campo e estudo de caso. Para se verificar a aplicabilidade da metodologia proposta, o Modelo MAS foi testado na Cooperativa da Agricultura Familiar e Solidária do Oeste do Paraná (COAFASO). Os dados foram tabulados e analisados, segundo as etapas estabelecidas no Modelo MAS, utilizando-se de técnicas estatísticas de análise exploratória e análise bidimensional. Após a realização de todas as etapas, constatou-se a viabilidade do Modelo proposto, uma vez que foi capaz de detectar, de forma objetiva, o grau de satisfação dos agricultores familiares. Os resultados apontaram que os agricultores familiares estão satisfeitos em relação ao PAA e a gestão da Cooperativa COAFASO. Todavia, determinado número de produtores manifestou insatisfação com alguns indicadores do PAA, especialmente quanto aos preços pagos por seus produtos em relação aos grupos prioritários, e também quanto à documentação exigida. Sobre a gestão da Cooperativa igualmente detectaram-se alguns indicadores negativos. Dessa maneira, foram realizadas duas propostas de intervenção: uma direcionada aos órgãos públicos e outra aos diretores da COAFASO.

Rudolf Mayer, geboren 1928 in Stuttgart, war von 1952 bis 1992 Chefredakteur der Bildabteilung im Verlag der Kunst Dresden. Das in dieser Zeit entstandene Archiv des Verlages, ...

Βασικός σκοπός της εργασίας μας ήταν η ανάδειξη της ευεργετικής και κοινωνικής προσφοράς στην εκπαίδευση και τον πολιτισμό των Λακώνων ευεργετών, δωρητών και κληροδοτών και της προσφοράς τους στην Ελλάδα και την ιδιαίτερη πατρίδα τους αλλά και των αποδήμων, οι οποίοι προσέφεραν και στο νέο τόπο στον οποίο εγκαταστάθηκαν. Επιδίωξή μας υπήρξε η συνολική διερεύνηση και καταγραφή των Λακώνων ευεργετών, ανεξάρτητα από την προσφορά τους, μεγάλη, μικρή ή πολύ μικρή, στη διαδικασία διαμόρφωσης της εκπαίδευσης και του πολιτισμού, από τη δημιουργία του Ελληνικού Κράτους μέχρι τις μέρες μας. Επιδιώξαμε να δείξουμε τη χρονική συνέχεια που υπάρχει στις δωρεές, χορηγίες και ευεργεσίες από το 1821 μέχρι τις μέρες μας. Η ύπαρξη σημαντικού αριθμού Λακώνων ευεργετών και δωρητών από το 1821 μέχρι σήμερα αναδεικνύει τη διαχρονικότητα και την επικαιρότητα του λακωνικού ευεργετισμού. Καταβλήθηκε προσπάθεια για ανάδειξη της διάστασης και του μεγέθους του λακωνικού ευεργετισμού σε σχέση με το συγκεκριμένο τόπο και το χρόνο. Βασικό ερώτημα που μας απασχόλησε ήταν οι λόγοι που ώθησαν τους Λάκωνες ευεργέτες και δωρητές να προβούν σε πράξεις δωρεάς για την ενίσχυση της εκπαίδευσης και του πολιτισμού. Προσπαθήσαμε να επιχειρήσουμε μια σκιαγράφηση της προσωπικότητας των Λακώνων ευεργετών - δωρητών και των δράσεών τους. Το Ελληνικό Κράτος και η Λακωνία χάρη στη συμμετοχή των ευεργετών αναπτύχθηκαν με ταχύτερους ρυθμούς, αφού οι ευεργέτες χρηματοδότησαν έργα εκπαιδευτικά και υποδομών γενικότερα. Έχοντας ως βασικό κίνητρο την ανάπτυξη της Λακωνίας, ο απλός λαός και οι ευκατάστατοι Λάκωνες γηγενείς αλλά και της διασποράς διέθεσαν το σύνολο των περιουσιών τους ή ένα τμήμα της σε δωρεές προς το Κράτος και ιδιαίτερα σε λειτουργίες που αφορούσαν την παιδεία, την υγεία, τα κοινωφελή έργα, τη φιλανθρωπία. Βαρύτητα δόθηκε στη μικρή δωρεά και προσφορά προσώπων που προερχόταν από τα κατώτερα κοινωνικοοικονομικά στρώματα του λαού, γιατί τις περισσότερες φορές - αν όχι όλες - αυτή η δωρεά ήταν πηγαία, εξέφραζε στάση και ιδεολογία αλλά ήταν επίσης και πολύ σημαντική λόγω του πλήθους των μικρών δωρητών. Μας απασχόλησε η κατεύθυνση της δωρεάς των τοπικών ευεργετών και δωρητών. Αναζητήσαμε τα κίνητρα της ευεργεσίας των Λακώνων ευεργετών-δωρητών, τις αιτίες του φαινομένου της ευεργεσίας καθώς και την οικονομική σημασία των προσφορών. Πολλοί από τους Λάκωνες ευεργέτες λόγω της μακρόχρονης απουσίας τους από την ιδιαίτερή τους πατρίδα οδηγήθηκαν σε πράξεις ευεργεσίας που προήλθαν από τη νοσταλγία επιστροφής σε αυτήν, αλλά και από τη συνειδητοποίηση της αναγκαιότητας της ανασυγκρότησης των υποδομών της νότιας ηπειρωτικής περιοχής της ελληνικής επικράτειας. Μελετήθηκαν 385 διαθήκες και συμβολαιογραφικές πράξεις ως προς το χρόνο, τα κίνητρα, την προέλευση, το σκοπό της ευεργεσίας, την ιδιαίτερη καταγωγή του δωρητή, το επάγγελμά του, το φύλο, την κοινωνική και οικονομική του θέση. Η καταγραφή των πιο πάνω πράξεων έγινε σε πίνακες. Επίσης καταγράφτηκαν 1.752 πράξεις δωρεάς. Η εργασία αποτελείται από τέσσερα κύρια μέρη. Στο πρώτο μέρος αναφερθήκαμε στην έννοια της ευεργεσίας και της δωρεάς, στους όρους «ευεργέτης – δωρητής», στους τοπικούς ευεργέτες και στην αξία των μικρών προσφορών, στις επικρίσεις για την ευεργεσία. Επίσης έγινε αναφορά στην ευεργεσία στην αρχαία Ελλάδα και στο Βυζάντιο, στην ευεργεσία από το 1821 και μετά και στις σύγχρονες μορφές ευεργεσίας καθώς και στο ιστορικό πλαίσιο της Λακωνίας με έμφαση στην ανάπτυξή της από το 1821 και μετά. Στο δεύτερο μέρος αναφερθήκαμε στους Λάκωνες ευεργέτες - δωρητές και τους παρουσιάσαμε μέσα από τις διαθήκες τους. Αναφερθήκαμε στον ευεργέτη και την τύχη του κληροδοτήματος, στην περιπέτεια της δωρεάς η οποία μπορούσε υπό προϋποθέσεις να μεταβληθεί, στο χρόνο που έφθανε στον αποδέκτη, την καθυστέρηση. Προσπαθήσαμε να διερευνήσουμε την τύχη των κληροδοτημάτων. Επίσης τη γεωγραφία της ευεργεσίας, σ’ αυτούς που βρέθηκαν και σε δεύτερη πατρίδα και ευεργέτησαν και τις δύο πατρίδες. Ιδιαίτερη αναφορά έγινε για τους Λάκωνες ομογενείς ευεργέτες και δωρητές και συγκεκριμένα για αυτούς που βρέθηκαν και προσέφεραν στη γη που τους φιλοξένησε. Αναφέραμε τις βιογραφίες Λακώνων δωρητών, την επαγγελματική τους δράση και την κοινωφελή δραστηριότητα τους. Αναφερθήκαμε στα κίνητρα της ευεργεσίας και ειδικά σε εκείνα που συνδέονταν με την παιδεία. Το χρέος που ένιωθαν προς την πατρίδα, τις επιρροές και τα πρότυπα των ευεργετών, την οικογενειακή κατάστασή τους, την υστεροφημία και την αναγνώριση και ανακήρυξή τους ως ευεργετών. Στο τρίτο μέρος μάς απασχόλησε η δωρεά σε συγκεκριμένους επιμέρους τομείς της εκπαίδευσης. Στην πρωτοβάθμια, δευτεροβάθμια, επαγγελματική, τριτοβάθμια εκπαίδευση όπως ανωτέρω εκτέθηκε. Αναφερθήκαμε στην ανέγερση και συντήρηση των σχολείων, στις δωρεές που έγιναν για εποπτικά μέσα, βιβλιοθήκες, υποτροφίες. Στο τέταρτο μέρος αναφερθήκαμε στην κατεύθυνση της δωρεάς προς θέματα πολιτισμού, όπως τη δημιουργία δημοσίων και δημοτικών βιβλιοθηκών, δωρεές σε μουσεία, πινακοθήκες. Επίσης αναφερθήκαμε σε δωρεές σε εκκλησίες, νοσοκομεία, ορφανοτροφεία, γηροκομεία, άσυλα ανιάτων, προσφορές για τον αθλητισμό, την φιλανθρωπία, προσφορές για έργα κοινής ωφέλειας, στο Κράτος, σε δήμους και κοινότητες, σε συλλόγους. Η εργασία ολοκληρώθηκε με τα γενικά συμπεράσματα των όσων προηγήθηκαν. / The main purpose of our project was the emergence of the beneficial and social offer to education and culture of the Laconian benefactors, donators and legators and their offer to Greece and their hometown but also of the emigrants, who offered to the new land in which they were settled in. Our pursuit was the overall investigation and the record of the Laconian benefactors without regard to their offer, big, small or very small, to the process of the configuration of education and culture, from the creation of the Greek State until today. We have tried to show the temporal continuity that there is in donations, sponsorships and benefactions since 1821up to the present time. The existence of an important number of Laconian benefactors and donators since 1821 up to now highlights the timelessness and the timeliness of the Laconian benefaction. An effort was made for the emergence of the dimension and size of the Laconic benefaction in relation to the specific location and time. A basic question that occupied us was the reasons that led the Laconian benefactors and donators to make transactions of donation for the reinforcement of education and culture. We tried to attempt a delineation of the personality of the Laconian benefactors – donators and their actions. The Greek State and Laconia thanks to the participation of benefactors developed faster, since the benefactors funded educational and infrastructure projects generally. Having as a basic motive the development of Laconia, the common people and the wealthy native Laconians as well as of the dispersion gave their entire properties or a part of them in donations to the State and especially in functions concerning education, health, the public utility projects, charity. It was given leadenness to the small donation and offer by people who were coming from the lower socioeconomic layers of people, because most of the times – if not all – this donation was effortless, it expressed attitude and ideology but it was also very significant due to the large number of small donators. It occupied us the direction of the donation of the local benefactors and donators. We looked for the motives of the benefaction of the Laconian benefactors – donators, the causes of the phenomenon of the benefaction as well as the economic importance of the offers. Many of the Laconian benefactors, due to their longtime absence from their hometown, were led to acts of benefaction which came from the nostalgia of the returning to it, as well as from the realization of the necessity of the reconstruction of the infrastructure of the south mainland of the Greek territory. 385 wills and notarial deeds were studied in respect of the time, the motives, the origin, the purpose of the benefaction, the specific origin of the donator, his profession, his sex, his social and economic status. The record of the above actions was made in tables. Moreover, 1.752 acts of donation were recorded. The project is consisted of four main parts. In the first part, we were referred to the concept of benefaction and donation, to the terms “benefactor – donator”, to the local benefactors and the value of the small offers, to the criticism concerning the benefaction. Also, there was a reference to the benefaction in the ancient Greece and the Byzantium, to the benefaction since 1821 and onwards and to the contemporary forms of benefaction as well as and to the historical frame of Laconia with emphasis on its development since 1821 and onwards. In the second part, we were referred to the Laconian benefactors – donators and we presented them through their wills. We were referred to the benefactor and the destiny of the bequest, to the adventure of the donation, which could be altered under premises, to the time that it reached the receiver, to the delay. We tried to explore the destiny of the bequests. Also the geography of the benefaction, to those who were found and in a second country and benefited both countries. A special reference was made to the Laconian expatriate benefactors and donators and namely to those who were situated and offered to the land that hosted them. We mentioned the biographies of Laconian donators, their professional action and their charitable activity. We referred to the motives of the benefaction and especially to those, which were associated with education. The duty that they were feeling towards the country, the influences and the standards of the benefactors , their marital status, their posthumous fame, and the recognition and their nomination as benefactors. In the third part, we were occupied by the donation to specific sub-sectors of education. To the primary, secondary, professional, higher education as it was stated above. We were referred to the construction and maintenance of schools, to the donations that made for teaching aids, libraries, scholarships. In the fourth part, we were referred to the direction of the donation to cultural issues, as the creation of public and municipal libraries, donations to museums, galleries. Moreover, we were referred to donations to churches, hospitals, orphanages, nursing homes, hospices, to offers for sport, for charity, to offers for projects of public interest, to the State, to municipalities and communities, to clubs. Our project was completed with the general conclusions of the foregoing.

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Bien que largement accepté dans la communauté médicale, le concept de mort cérébrale est encore mal compris par certains professionnels de la santé et par le public en général. Il est au centre de débats et demeure une source de controverses. Malgré la confusion et les variations de pratiques documentées, les sources d’incertitudes et de confusion entourant le concept n’ont pas encore été étudiées en profondeur. Pourtant, cette confusion est à même d’influencer les débats et les décisions de fin de vie et de don d’organes, et soulève ainsi de sérieuses considérations tant éthiques que médicales. Ce mémoire de maîtrise propose d’abord une revue de la littérature discutant des origines, de l’évolution et des débats en lien avec le concept de mort cérébrale et les enjeux éthiques associés. Les approches méthodologiques utilisées pour la réalisation de cette recherche sont ensuite décrites. Les résultats découlant de l’analyse de contenu qualitative de médias canadiens et américains des différentes représentations de la mort cérébrales qu’on y retrouve suivent. Ces résultats décrivent l’utilisation du terme de « mort cérébrale » dans des contextes de don d’organes, de définitions de la mort cérébrale, de détermination de la mort, d’enjeux de fin de vie, d’enjeux légaux ainsi que des usages familiers du terme. Finalement, une discussion générale quant au rôle de la terminologie utilisée pour parler du concept de mort cérébrale puis celui des professionnels de la santé impliqués dans sa détermination et les pratiques de don d’organes, ainsi que des recommandations pour le futur concluront ce mémoire. / Despite being widely accepted by the medical community, the concept of brain death is still misunderstood by healthcare providers and the general public. It is central to several debates and remains a source of controversy. In spite of documented practice variations and conceptual confusion surrounding brain death, the upstream sources of variability and uncertainty have not been extensively investigated. This confusion is likely to influence debates and decisions about end-of-life and organ donation, and thus raises serious medical and ethical considerations. This thesis first proposes a review of the literature discussing the origins, the evolution and the debates related to the concept of brain death, as well as the ethical issues associated with brain death. The methodological approaches used for the realization of this research are then described. The results obtained from the qualitative content analysis of Canadian and American media about the different depictions of brain death follow. These results describe the use of the term “brain death” in contexts of organ donation, definitions of brain death, determination of death, end-of-life issues, legal issues and also colloquial uses of the term. Finally, a general discussion about the role of the terminology used to discuss the concept and that of healthcare professionals involved in its determination and organ donation practices, as well as recommendations for the future will conclude this thesis. / Domaine de recherche: Bioéthique