Consonni, E. B. (2013). Vínculo e perda: vivências de mulheres que interromperam a gestação por malformação fetal incompatível com a vida após o nascimento. Tese de Doutorado, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. O desenvolvimento das técnicas de diagnóstico pré natal possibilita detecção acurada de anomalias letais no feto, colocando o casal frente à difícil decisão de interromper ou não a gestação. O presente estudo teve por objetivo compreender o significado das vivências de mulheres que interromperam a gestação sob autorização judicial, devido à malformação fetal incompatível com a vida. Participaram do estudo dez mulheres atendidas no Setor de Medicina Fetal do Hospital das Clínicas de Botucatu. Para coleta dos dados foram realizadas duas entrevistas semi-estruturadas, uma durante a gestação e outra quarenta dias após a interrupção. As entrevistas foram audiogravadas, transcritas na íntegra e tiveram os dados analisados na perspectiva da análise de conteúdo. Os resultados revelaram que o contato com o diagnóstico desencadeou reações de choque, incredulidade e esperança. As imagens do feto na ultrassonografia, especialmente nos casos de anomalias externas, causaram espanto e sofrimento, ao mesmo tempo em que, junto a outras imagens e informações obtidas pelas mães na internet, colaboraram para que melhor compreendessem o diagnóstico fetal. Os relatos apontaram dificuldades das gestantes na esfera social, como ao responder perguntas e comentários sobre a gravidez e o bebê e ao ouvir opiniões a respeito da malformação e da interrupção. Desde o diagnóstico pré-natal até o puerpério, as mães buscaram explicações e significados para a condição fetal e a perda do filho, sendo muito frequentes respostas religiosas e auto culpabilizantes. Os relatos mostram a existência de forte vinculação materno-fetal, tanto antes como após o diagnóstico, e as mulheres optaram pela interrupção da gestação na intenção de não se vincular ainda mais ao bebê e evitar sofrimento maior, sem que isso no entanto significasse o rompimento do vínculo. As mães que optaram por conhecer e se despedir do bebê após o nascimento, enfatizaram a importância deste momento, lembrado como positivo pela possibilidade de ver, despedir-se e guardar para sempre uma lembrança. Os relatos no puerpério marcaram sentimentos de tristeza, saudade e sensação de vazio pela perda do filho, revelando também a necessidade das mães manterem-se ligadas a ele. Na opinião destas mulheres, mediante a confirmação médica da impossibilidade de sobrevida após o nascimento, a mãe e/ou casal deveria ter autonomia para decidir sobre a interrupção da gestação, sendo a autorização judicial percebida como desnecessária e um fator de mais angústia para a situação vivida. Conclui-se que o diagnóstico fetal de malformação incompatível com a vida causou sofrimento para essas mulheres, pois precedeu inúmeras perdas e desencadeou complexo processo de luto. As mães estavam e continuaram vinculadas aos seus filhos; a interrupção da gestação, embora tenha sido uma escolha que evitasse a intensificação do vínculo e minimizasse a dor de uma perda inevitável, não as poupou de vivências de grande sofrimento. O estudo traz subsídios para a discussão e planejamento de abordagens e cuidados com a saúde de gestantes que recebem diagnóstico de malformação fetal letal. / Consonni, E. B. (2013). Attachment and loss: the experiences of women who terminate a pregnancy due to fetal malformations incompatible with postnatal life. Tese de Doutorado, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. The development of prenatal diagnostic techniques has enabled lethal fetal anomalies to be detected with accuracy, thus leaving couples with the difficult decision of whether or not to terminate the pregnancy. The objective of the present study was to gain understanding on what these experiences meant to those women who were granted legal authorization to terminate their pregnancy due to a fetal malformation incompatible with life. Ten women receiving care at the fetal medicine unit of the Botucatu Teaching Hospital participated in the study. Two semi-structured interviews were held for the purpose of collecting data, the first during pregnancy and the second forty days after termination. The interviews were audio-recorded and transcribed in their entirety. The data were analyzed according to the content analysis methodology. Results showed that becoming aware of their diagnosis triggered reactions of shock, disbelief and hope in these women. The ultrasound images of the fetus, particularly in those cases in which the abnormalities were external, caused shock and distress; however, together with other images and information obtained by the mothers from the internet, they contributed towards providing a better understanding of the fetal diagnosis. The women\'s accounts highlighted their difficulties in the social sphere, for example, when having to answer questions and respond to comments on their pregnancy and on their baby, and when listening to opinions on fetal malformation and pregnancy termination. Between the time of prenatal diagnosis and the puerperium, the mothers sought explanations and meanings for the fetal condition and for the loss of their child, with religious and self-blame attributions being very common. These testimonies reveal the existence of a strong maternalfetal attachment, both prior to and following diagnosis. The women opted to terminate their pregnancy to interrupt this process of increasing attachment and to prevent even greater suffering; however, this did not mean that the bond was broken. Those mothers who took the decision to see their baby after he/she was born and to say goodbye emphasized the importance of this moment, remembering it as positive because they had been able to see the child, say farewell to him/her and keep that memory of the child for ever. The statements made by the women during the puerperium were marked by feelings of sadness, nostalgia and emptiness evoked by the loss of their child, which also emphasized the mothers\' need to preserve this attachment. In these women\'s opinions, when faced with medical confirmation that the fetus will not survive after delivery, the mother or the couple should have the autonomy to decide whether or not to terminate the pregnancy, with legal authorization being perceived as unnecessary and a source of further anguish under these circumstances. In conclusion, fetal diagnosis of a malformation incompatible with life led to suffering in these women, since it preceded innumerous losses and triggered a complex grieving process. The mothers were and continue to be attached to their children. Pregnancy termination, although representing a choice made to avoid intensifying the degree of this attachment and to minimize the pain of an unavoidable loss, did not save them from having to experience great suffering. This study adds to the debate on the subject and provides further data for use in planning the management and care of the health of pregnant women who receive a diagnosis of a lethal fetal malformation.

Objetivo: Investigar a prevalência de disgenesias dentárias em indivíduos com síndrome Richieri-Costa-Pereira. Material e Métodos: 13 indivíduos, registrados no Hospital de Reabilitação de Anomalias Craniofaciais - Universidade de São Paulo (HRAC-USP), Bauru Brasil, com síndrome Richieri-Costa-Pereira, de ambos os gêneros, de etnia branca, acima de oito anos de idade e com pelo menos uma radiografia panorâmica disponível. As disgenesias dentárias foram avaliadas clinica e radiograficamente, por uma única examinadora, e foram classificadas como alterações hiperplasiantes, hipoplasiantes e heterotópicas e como alterações de forma, número, posição e estrutura, sendo as alterações de esmalte classificadas pelo índice de Defeitos de Desenvolvimento do Esmalte (DDE) e descritas com relação à face dentária afetada. Antes da coleta de dados, foi realizado estudo piloto para avaliação da concordância intra-examinador quanto à presença de agenesias dentárias e dentes supranumerários. Resultados: Todos os indivíduos (100%) apresentavam pelo menos uma disgenesia dentária, com predominância de alterações hipoplasiantes, principalmente representadas por agenesias dentárias dos incisivos e segundos pré-molares inferiores e opacidades de esmalte de coloração branco-creme, demarcada, afetando principalmente os pré-molares superiores seguidos dos molares inferiores, com predominância de alterações na face vestibular. Conclusão: Indivíduos com síndrome Richieri-Costa Pereira apresentam alta prevalência de agenesias dentárias, principalmente incisivos e pré-molares inferiores, bem como alta freqüência de opacidades de esmalte. Estes achados são compatíveis com a fissura mandibular presente em todos os indivíduos e refletem também a característica hipoplasiante da síndrome. / Objective: To investigate the prevalence of tooth abnormalities in individuals with Richieri-Costa-Pereira syndrome. Material and Methods: 13 individuals registered at the Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (HRAC-USP), Bauru, Brazil, with Richieri-Costa-Pereira syndrome, of both genders, Caucasoid, aged more than eight years and with at least one panoramic radiograph available in the hospital files. The tooth abnormalities were evaluated clinically and radiographically by a single examiner and were classified as hyperplastic, hypoplastic or heterotopic alterations and as alterations of shape, number, position and structure. The enamel alterations were classified by the DDE index and described according to the tooth surface affected. Before data collection, a pilot study was conducted to evaluate the intraexaminer agreement as to the presence of tooth agenesis and supernumerary teeth. Results: All individuals (100%) presented at least one tooth abnormality, with predominance of hypoplastic disorders, mainly including agenesis of mandibular incisors and second premolars, as well as demarcated creamy-white enamel opacities, primarily affecting the maxillary premolars, followed by mandibular molars, mainly affecting the buccal surface. Conclusion: Individuals with Richieri-Costa Pereira syndrome present high prevalence of tooth agenesis, especially mandibular incisors and premolars, as well as high frequency of enamel opacities. These findings are compatible with the mandibular cleft observed in all individuals and also reflect the hypoplastic characteristic of the syndrome.

Les anomalies morphologiques sévères ou congénitales sont l'une des principales causes de morbidité et de mortalité infantile. Certaines de ces pathologies diagnostiquées en anténatal sont difficilement compatibles avec une survie postnatale. Il arrive que des femmes choisissent, malgré tout, de poursuivre la grossesse et les soins palliatifs périnatals apparaissent comme une des réponses à apporter. Ils constituent à l’échelle internationale un nouveau domaine de pratique clinique avec des dilemmes décisionnels. Il importe d’identifier les déterminants qui influencent les modes de résolutions de ces tensions éthiques. Notre travail explore les perceptions et les pratiques des professionnels susceptibles de faire sens à une demande de poursuite de grossesse en intégrant dans leur démarche l’incertitude inhérente à la période postnatale. Cette réflexion vise à questionner la normativité effective dans la pratique de l’interruption médicale de grossesse notamment, face aux dilemmes et divergences qui alimentent les prises de décisions et les pratiques professionnelles autour des soins palliatifs néonatals. Notre recherche s’articule autour de trois axes : premièrement, étude qualitative, des perceptions d’experts de la périnatalité vis-à-vis des pathologies fœtales létales et des soins palliatifs périnatals : représentations, opinions et pratiques professionnelles ; ensuite, enquête, à l’échelle nationale, de la démarche palliative périnatale à partir des perceptions et des pratiques professionnelles ; et en dernier lieu, approche éthique de la démarche palliative à partir du diagnostic d'anomalies fœtales létales et des pratiques professionnelles en médecine périnatale. / Severe or congenital morphologic anomalies are one of the main causes of infantile morbidity and mortality. Some of these antenatally diagnosed pathologies are difficult to get compatible with postnatal survival. In this context, some women choose to continue with pregnancy. Subsequently, perinatal palliative care seems to be a constructive answer to offer in such situations. It constitutes, at international level, a new clinical practice where decision dilemmas exist (prognostic uncertainty, prolonged survival, and attachment to the infant). It might be necessary to identify the factors that can affect the way of dealing with these ethical tensions. Without any national data, our work explores the perceptions and professional practices susceptible to influence parental request for continuing with pregnancy, despite the uncertainty corresponding to the postnatal condition of a newborn with lethal pathology. This thinking aims to question and debate the normativity that is to be effective especially in medical termination of pregnancy, confronting the dilemmas and divergences that affect decision taking and professional practice in neonatal palliative care.Our research revolves around three perspectives: Firstly, and at a local level, qualitative study of expertise perceptions of perinatality regarding lethal fetal pathologies and perinatal care: representations, opinions and professional practices; secondly,and at a national level, investigation of initiatives taken in perinatal care based on perceptions and professional practices; thirdly,ethical approach to the medical care as inspired by these lethal fetal pathologies and professional practices in perinatal medicine.

Chromosome based genetic diagnostics, the detection of specific chromosomes, plays an increasingly important role in medicine as the molecular basis of hu- man disease is defined. The current diagnostic process is performed mainly by karyotyping specialists. They first put chromosomes in pairs and generate an image listing all the chromosome pairs in order. This process is called kary- otyping, and the generated image is called karyogram. Then they analyze the images based on the shapes, size, and relationships of different image segments and then make diagnostic decisions. Manual inspection is time-consuming, labor-intensive, and error-prone.This thesis investigates supervised methods for genetic diagnostics on karyo- grams. Mainly, the theory targets abnormality detection and gives the confi- dence of the result in the chromosome domain. This thesis aims to divide chromosome pictures into normal and abnormal categories and give the con- fidence level. The main contributions of this thesis are (1) an empirical study of chromosome and karyotyping; (2) appropriate data preprocessing; (3) neu- ral networks building by using transfer learning; (4) experiments on different systems and conditions and comparison of them; (5) a right choice for our requirement and a way to improve the model; (6) a method to calculate the confidence level of the result by uncertainty estimation.Empirical research shows that the karyogram is ordered as a whole, so preprocessing such as rotation and folding is not appropriate. It is more rea- sonable to choose noise or blur. In the experiment, two neural networks based on VGG16 and InceptionV3 were established using transfer learning and com- pared their effects under different conditions. We hope to minimize the error of assuming normal cases because we cannot accept that abnormal chromo- somes are predicted as normal cases. This thesis describes how to use Monte Carlo Dropout to do uncertainty estimation like a non-Bayesian model[1]. / Kromosombaserad genetisk diagnostik, detektering av specifika kromosomer, kommer att spela en allt viktigare roll inom medicin eftersom den molekylära grunden för mänsklig sjukdom definieras. Den nuvarande diagnostiska pro- cessen utförs huvudsakligen av specialister på karyotypning. De sätter först kromosomer i par och genererar en bild som listar alla kromosompar i ord- ning. Denna process kallas karyotypning, och den genererade bilden kallas karyogram. Därefter analyserar de bilderna baserat på former, storlek och för- hållanden för olika bildsegment och fattar sedan diagnostiska beslut.Denna avhandling undersöker övervakade metoder för genetisk diagnostik på karyogram. Huvudsakligen riktar teorin sig mot onormal detektion och ger förtroendet för resultatet i kromosomdomänen. Manuell inspektion är tidskrä- vande, arbetskrävande och felbenägen. Denna uppsats syftar till att dela in kro- mosombilder i normala och onormala kategorier och ge konfidensnivån. Dess huvudsakliga bidrag är (1) en empirisk studie av kromosom och karyotyp- ning; (2) lämplig förbehandling av data; (3) Neurala nätverk byggs med hjälp av transfer learning; (4) experiment på olika system och förhållanden och jäm- förelse av dem; (5) ett rätt val för vårt krav och ett sätt att förbättra modellen;    en metod för att beräkna resultatets konfidensnivå genom osäkerhetsupp- skattning.    Empirisk forskning visar att karyogrammet är ordnat som en helhet, så förbehandling som rotation och vikning är inte lämpligt. Det är rimligare att välja brus, oskärpa etc. I experimentet upprättades två neurala nätverk base- rade på VGG16 och InceptionV3 med hjälp av transfer learning och jämförde deras effekter under olika förhållanden. När vi väljer utvärderingsindikatorer, eftersom vi inte kan acceptera att onormala kromosomer bedöms förväntas, hoppas vi att minimera felet att anta som vanligt. Denna avhandling beskriver hur man använder Monte Carlo Dropout för att göra osäkerhetsberäkningar som en icke-Bayesisk modell [1].

Cette enquête micro-sociologique réalisée sous forme d'observation participante active, s'intéresse aux questions suivantes : comment devient-on body-builder? Comment s'installent des pressions normatives et « déviances positives » attendues et reconnues par le groupe de pratiquants? Ainsi, pendant 8 mois, j'ai suivi une initiation au body-building supervisée par un ancien body-builder (titré internationalement) devenu coach. J'ai participé aux séances de musculation aux côtés de compétiteurs, sportifs et sédentaires, au rythme de quatre entraînements de deux heures par semaine. La thèse soutient que le body-building de haut-niveau fonctionne sur le principe de l'ascèse tout en construisant un lien social de type sectaire entre les membres du groupe et le coach. La transformation du corps demande une implication totale qui a pour conséquence une rupture du quotidien et une restructuration des relations sociales de l'initié. Plus il est reconnu et accepté par le coach et ses pairs, plus il reçoit un regard critique de l'extérieur, ce qui le conduit à un isolement social et renforce les processus d'emprise corporels exercés. Le coach agit comme un gourou de secte en conditionnant le quotidien des athlètes pour les modeler à son image. / This micro-sociological investigation, using the participant observation method, studied how a person becomes a body-builder? How does the expected and accepted normative pressures and " positive deviances " become common practice by the members of the group? Therefore, during 8 months, I followed an initiation of body-building supervised by a former body-builder (internationally titled) who had became a coach. I went to the weight room with competitors, sportsmen and amateur for two hours four times a week. This thesis supports that top-level body-building works on the principle of asceticism and builds sectarian-type social links between the members of the group and the coach. A total implication is required for the transformation of the body which implies giving up the normal every day life and restructuring the initiated persons social relationships. The more he is recognized and accepted by the coach and his peers, the more he will be a criticized from the outside. This will drive him to social isolation and will strengthen the influence exercised by the coach. The coach acts as a guru of sect by controlling the everyday life of the athletes to model them into his image.

« Ça se fait pas ! ». La norme à l’école est marquée par des nuances et des ambivalences, sources d’incompréhensions et de concurrences, participant à sa fluctuation. L’élève joue un rôle premier devant l’enseignant, acteur, créateur et agent de la norme. La norme en classe présente un caractère inégal, binaire, ambigu, indéterminé et implicite, avec le reflet illusoire d’être partagée par l’élève et l’enseignant. La norme devient homogène pour eux face à une infraction identifiée, majoritairement comme abstention. Dans l’interdépendance entre norme, déviance et acceptation, les limites de l’acceptable en classe se tracent avant tout par rapport à la transgression. L’intrusion de l’affect accentue les fluctuations de la norme et influence les limites du conforme. La norme en classe se décline en situation au sein de l’interaction, dans la dialectique entre conscience et pratique de la norme, qui participe au processus de normalisation. Le registre comportemental est organisateur de la norme et facteur de fluctuations, modulant l’acceptation ou engageant vers la transgression. Les perspectives déontique et pragmatique se concurrencent. Dans la rivalité entre perspectives individuelle et sociale, les besoins sont des facteurs de l’acceptation de la norme, pour chercher à les satisfaire. L’interdépendance entre norme et besoins contribue au processus de normalisation et perturbe l’élève et l’enseignant dans leur rapport à la norme. Les normes en classe se conjuguent ou rivalisent au sein d’un système dynamique et enchevêtré, troublé par les besoins, dont la (l’in)cohérence module le rapport au conforme et engage les acteurs de l’école vers la transgression ou l’acceptation. / “It’s just not done !”. The norm at school is marked by nuances and ambivalences, it is the source of incomprehension and competitions participating in its fluctuation. The student plays the first role in front of the teacher, actor, creator and agent of the norm. The norm provides for an uneven, binary, ambiguous, indefinite and implicit character, offering the imaginary reflection to be shared by the students and teachers. The norm becomes homogeneous for them when confronted with an identified breach, mainly as abstention. In the interdependence animating normality, abnormality and acceptance, the limits of what is considered acceptable at school trace above all with regard to transgression. The intrusion of the affect stresses the fluctuations in the norm and influences the limits of the standard-compliant. The norm is articulated around the situation within the interaction, in the dialectic between consciousness and practice of the norm, which participates in the process of normalization. The behavioral register is the organizer of the norm itself, modulating the acceptance or committing towards the transgression. The deontic and pragmatic perspectives compete amongst themselves. Requirements are factors of the norm’s acceptance, to try to satisfy them. The interdependence between the norm and the requirements participates in the process of normalization and disrupts both students and teachers in their relationship with the norm. The norms at school combine or compete within a system both dynamic and muddled, disturbed by the requirements of coherence which modulate the relationship in compliance and commits school’s actors towards either transgression or acceptance.

Comment les acteurs qui évoluent dans le champ commun entre droit et psychiatrie choisissent-ils d’interner ou de soigner un patient contre son gré? Appliquent-ils simplement les dispositions légales supposées régir les interventions du champ, ou bien se réfèrent-ils à d’autres formes de normativité? Plus globalement, comment ces acteurs s’approprient-ils les normes et en quoi le choix normatif est-il lié au rôle des individus dans le lien social? Voici, très brièvement exposées, les questions auxquelles nous nous intéresserons dans cette thèse. Cette thèse vise deux objectifs distincts, mais complémentaires. Le premier, d’ordre théorique, s’attache à la compréhension sociologique du phénomène de pluralisme normatif tel qu’il se déploie dans le lien social, et plus particulièrement celle du rôle des individus dans la dynamique normative. Le second vise à mettre en perspective pluralisme normatif et droits de la personne dans le contexte particulier de la psychiatrie. À ce titre, nous avons choisi d’étudier le traitement juridique, clinique et social de l’internement et des soins psychiatrique. En effet, cet objet permet de mettre en évidence diverses tensions normatives latentes et constitue un support privilégié à la théorisation des rapports normatifs. Nous étudions d’abord, d’un point de vue épistémologique, les paradigmes juridique et sociologique de la régulation sociale et de l’internormativité. Nous y explorons différentes conceptions du droit et de la normativité, et, par extension, la mise en forme des rapports humains et celle de la société. Dans un premier temps, nous concluons de cette analyse que les différentes formes de normativités s’agencent de manière complexe et changeante, sans qu’aucune hiérarchie n’apparaisse toujours clairement. Dans un second temps, on y constate que les individus influencent l’activation de la normativité, qu’elle soit juridique ou non. La pluralité des normes et du sens qu’elles véhiculent, confronte naturellement l’individu au choix entre plusieurs standards. Pour mieux comprendre la place effective de l’individu dans la dynamique normative, en tant que détenteur d’une certaine marge de liberté, nous optons pour un point de vue subjectiviste et constructiviste. Dans cette perspective, l’interprétation des normes et le sens qu’elles portent sont liés à la conception que l’individu se fait du sens de son action et de son propre rôle dans le rapport interpersonnel et social. C’est dans cette perspective que nous proposons le Modèle de pluralisme normatif appliqué, largement inspiré des approches sociologiques étudiées, et plus précisément du concept de « droit vivant ». À travers ce modèle, le pluralisme normatif est conceptualisé comme un ensemble de normes issues de diverses sources, dont les substances peuvent s’opposer, et qui s’imposent avec une force variable. En outre, la qualification du discours psychiatrique en tant que norme comportementale de la normalité exemplifie des clivages entre différentes perspectives sur le lien social, et notamment sur les patients psychiatriques. Dans le cadre du modèle proposé, chaque norme est jumelée à une rationalité de nature cognitive ou axiologique, selon la nature du rapport à l’autre. L’hypothèse avancée est à l’effet que la marge de liberté de l’acteur est corollaire à la rigidité du cadre juridique: plus le droit est précis moins l’individu aura recours à d’autres formes de normativité. Nous avons retenu, aux fins de vérification de notre hypothèse, deux situations distinctes au regard de la structure du cadre juridique, mais présentant des enjeux éthiques et juridiques semblables: l’hospitalisation et les soins psychiatriques imposés contre la volonté des patients, soit la garde en établissement et l’autorisation judiciaire de soins (art. 30 et 16 C.c.Q.). La recherche empirique menée auprès de juges et de psychiatres a pour but de cartographier le rapport complexe entre l’acteur étudié (le sens qu’il attribue à son action, la conception qu’il a de son rôle dans le lien social) et les normes. Les données révèlent que deux types de normes sont en réalité complémentaires: il s’agit des propositions normatives et factuelles. Les premières sont associées au rôle dans lequel l’individu se projette alors que les secondes servent à la mise en œuvre pratique de ce rôle. De même, la prégnance d’un discours sur la normalité démontre la survivance d’une perspective paternaliste et morale issue de la psychiatrie, qui est difficilement conciliable avec une approche fondée sur le respect des droits de la personne. Finalement, nous concluons que le choix entre différents types de normes est influencé par la conception que chacun se fait de la société dans laquelle il vit et plus précisément de la place qu’il y tient. La recherche empirique nous autorise à poser des questions sous-jacentes à la véritable nature de l’intervention judiciaire et psychiatrique en matière de garde en établissement et d’autorisation de soins, et aux fondements paradigmatiques et ontologiques du droit en ces matières. / How do those working in the intersection between law and psychiatry make decisions to confine or treat patients against their will? Do they simply apply the legal provisions that are supposed to regulate such actions, or do they refer to other forms of normativity? More globally, how do such stakeholders adopt norms and how is the choice of norms related to individuals’ roles in the social fabric? These are, very briefly, the issues explored in this thesis. This thesis has two distinct, but complementary, objectives. The first is theoretical, and concerns the sociological understanding of the phenomenon of normative pluralism as it operates in the social fabric and more specifically of individuals’ roles in normative dynamics. The second objective is to place normative pluralism and human rights into perspective in the special context of psychiatry. For this, we have chosen to study legal, clinical and social approaches to confining patients and to psychiatric care. This brings to light various latent normative tensions, which proves useful when drawing up theories about normative relations. We begin by doing an epistemological analysis of the legal and sociological paradigms of social regulation and internormativity. In this section, we explore different conceptions of law and normativity and, by extension, the shaping of human and social relations. Our first conclusion from this analysis is that the different forms of normativity interweave in complex, changing ways and that no clear hierarchy always emerges. Our second conclusion is that individuals influence the application of norms, whether they are legal or not. The plurality of norms and of the meanings that they convey naturally confronts individuals with choices among different standards. In order to gain a better understanding of individuals’ real roles in normative dynamics, since individuals have a certain degree of freedom, we have taken a subjectivist, constructivist point of view. From this perspective, interpretations of norms and the meanings they convey are related to individuals’ conceptions of the meaning of their actions and roles in interpersonal and social relations. It is from this perspective that we propose the applied normative pluralism model, which is inspired largely by the sociological approaches we have studied and more specifically by the concept of “living law.” Using this model, we conceptualize normative pluralism as a set of norms flowing from various sources that may be in substantial contradiction and have different weights. Indeed, describing psychiatric discourse as a behavioural norm of normality is a perfect example of the cleavage between different perspectives on social ties, especially with respect to psychiatric patients. In the proposed model, each norm is twinned with cognitive or axiological rationality, depending on the nature of the relationship to the Other. Our hypothesis is that the actor’s degree of freedom correlates with the rigidity of the legal framework: the more specific the law is, the less the individual will have recourse to other forms of normativity. In order to verify our hypothesis, we have used two distinct situations that are regulated by law in different ways but that have similar ethical and legal stakes: non-consensual hospitalization and psychiatric care, in other words, confinement to an institution and court authorization of care (Québec Civil Code, articles 30 and 16). Our empirical research on judges and psychiatrists has been designed to map the complex relationships between those studied (the meanings they give to their actions, their conceptions of their roles in the social fabric) and norms. The findings show that two types of norms are in fact complementary: normative and factual propositions. The former are associated with the role that the individual thinks he or she has, while the latter are used in practical implementation of that role. Similarly, the weight of a discourse on normality demonstrates the survival of a paternalist moral perspective with its roots in psychiatry. This is difficult to reconcile with an approach based on human rights. Finally, we conclude that the choice between different types of norms is influenced by the conception that each individual has of the society in which he or she lives, and more specifically of his or her role in that society. Our empirical research raises questions about what is underlying the real nature of legal and psychiatric intervention with respect to confining patients to institutions and authorizing care, and about the pragmatic and ontological foundations of law in these areas. / Thèse de doctorat réalisée en cotutelle avec l'Institut du social et du politique de l'École Normale supérieure de Cachan.

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This thesis addresses questions relating to perceptions of abilities and abnormalities found in everyday life. Abilities in this paper range from a total lack of ability to function in extreme disability to a level of ability expected by society to enhanced and radically enhanced abilities and their place in the realm of abnormality. We begin by establishing the differences between abilities and enhancements. Following this is a discussion regarding the ethical concerns of human enhancement. After this we turn to a discussion of abnormality and the social experience of abnormality. These discussions lead into establishing a basis for how many abilities are considered abnormal. This is then followed by a discussion that specifically addresses whether or not individuals who voluntarily undergo non-therapeutic enhancement may be subject to oppressive measures.

Proportional, integral and derivative (PID) controller tuning guidelines in process industry have been in place for over six decades. Nevertheless despite their long design history PID tuning has remained an ‘art’ and no single comprehensive solution yet exists. In this study various considerations, with new and different perspectives, have been taken into account in PID tuning design. This study explores the issue of PID tuning from a practical point of view with particular focus on robust design in the presence of typical problems in process industry: process changes, valve stiction effects and unmeasured disturbances. The IMC tuning rule is recommended for setpoint tracking, while in the case of regulation, a newly proposed tuning rule, based on a combination of IMC and Ziegler-Nichols method, is demonstrated to give satisfactory results. The results were evaluated by simulation and were also validated on a computer-interfaced pilot scale continuous stirred tank heater (CSTH) process. / Chemical Engineering