In this study, the origin and main parameters of the Essential Facilities Doctrine are analysed through the case-law that developed out of the application of the EC Competition Rules. Besides putting forward the historical roots, the basic criteria and limitations that apply to the Doctrine are elaborated so as to clarify the legal and analytical foundations of the Doctrine in the EU context. In addition, the added value attributed to the Doctrine in realm of competition policies pursued in network-based industries is expounded with special emphasis on telecommunications sectors. With this regard, the potential role of EFD against the challenging effects of &lsquo / convergence&rsquo / phenomenon and the technological changes is discussed. At last, the effects of EFD on the competitive dynamics of Turkish telecommunications sector which is undergoing a liberalisation process are also examined with the accompanied Turkish case-law.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Dissertation (Ph.D.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 239 pages. Includes vita. Includes bibliographical references.

The aim for the study is to identify high school students’ perceptions of absenteeism. More specific the aim is to investigate their perceptions of the situations before, during and after the time they were absent. The chosen method for the study is phenomenography which includes qualitative semi-structured interviews. Six students currently in secondary school with a background of absenteeism have been interviewed. The interviews have been analyzed with an eight-step approach. The result of the study presents young students perceptions of circumstances that lead to and sustain their school absence and their return to school attendance. The findings in the analysis show that the informants perceive mental illness as a circumstance with major impact on leading to and sustaining school absence among the students. The mental illness is related to the students’ perceptions of social circumstances in and/or outside school and unmet needs in relation to school success. The perceptions of the circumstances that lead to and sustain attendance were related to a better mental health. Mental health was affected positively mainly by the circumstances related to social relationships and by the adaptations in the learning environment. However, the informants did not perceive better mental health as a key circumstance as explicitly as mental illness.

Our aim with this paper is to study the debate concerning the refusal of entry of the two Egyptians and the involvement of USA, to see if the Swedish sovereignty has been compromised. We have chosen two theories, realism and radicalism, to read if opinions can be identified of supporting one of them. The empiricism we selected are from debate articles in the big news papers Dagens Nyheter, Svenska Dagbladet and Expressen. We also studied the debate in the Riksdag . The method we used was qualitative and is called analysis of content. The result we could conclude was that most of the debaters are disappointed with how the government handled the whole situation, but still believes that it made the decision on itself. This opinion reflects the theory realism. Further more, we found that the debate in the Riksdag was more diverse in terms of reflecting both of the theories, than the news papers. We also conclude that the debaters preferably would talk about torture and the violation of human rights and not the reason to why the government made that decision.

Agentes econômicos com posição dominante são capazes de se conduzir de maneira independente na sua atividade comercial. Da mesma forma, possuem todos os incentivos para manutenção desta posição, em detrimento de seus concorrentes, fornecedores e clientes. O presente trabalho visa, inicialmente, em estudo comparado da doutrina e jurisprudência no Brasil, União Europeia e Estados Unidos, identificar os elementos de cognição da teoria do abuso de posição dominante para cinco modalidades de conduta. A partir daí traçamos seus elementos de correlação com o propósito de sugerir uma teoria aplicada ao ordenamento jurídico pátrio, que passa pelo reconhecimento da concorrência como garantia institucional, de forma a estabelecer-se igualdade material segundo a teoria da função social dos meios de produção. A presença constante da concorrência nos mercados deve ser tratada como presunção de bem-estar social. E finalmente, valendo-se destes elementos de suporte, propomos uma teoria da responsabilidade especial para agentes econômicos em posição dominante, que implicaria o dever de autoaplicação dos limites permitidos para sua conduta comercial, cujo descumprimento ensejaria presunção relativa de efeitos deletérios ao mercado, segundo os parâmetros propostos. / Firms enjoying dominant position are able to conduct themselves independently in their commercial activities. Likewise, they hold all due incentives to maintain such position, in detriment of their competitors, suppliers and clients. The present work aims, initially, through a comparative study of the Brazilian, the European Union and the United States\' legal doctrine and jurisprudence, to identify cognitive elements of the abuse of dominance theory, for five different natures of conducts. Subsequently, we identify their elements of connection with the purpose of suggesting a theory applicable to the local legal system, which includes the recognition of competition as an institutional guarantee, so to establish a material equality according to the theory of social function of productive assets. The constant presence of competition on the markets shall be treated as a presumption of social welfare. And finally, based on such supportive elements, we propose a theory of special responsibility for dominant firms that implies in a duty of self-application of the permitted limits for their commercial conduct, and which infringement would entail a relative presumption of harmful effects to the market, pursuant to the proposed parameters.

INTRODUÇÃO: O sucesso do tratamento de dependentes de álcool e outras drogas numa comunidade terapêutica (CT) depende fundamentalmente da adesão ao tratamento, ou seja, o tempo de permanência na comunidade. Sabe-se que pacientes que permanecem em tratamento por um período de pelo menos três meses têm uma evolução melhor do que aqueles que abandonam o tratamento precocemente. O ambiente emocional familiar tem grande influência na adesão ao tratamento, e pode ser medido por meio da emoção expressa EE). MÉTODOS: Foram avaliados familiares de 31 dependentes de substâncias psicoativas e/ou de álcool, internados involuntariamente, por meio da versão abreviada e traduzida para o português da Entrevista Familiar de Camberwell (EFC). A partir de então, mediu-se a taxa de permanência na CT após seis, 12 e 18 meses. Foram avaliados os aspectos hostilidade, superenvolvimento e calor afetivo. A hostilidade foi abordada como ausente (pontuação igual a zero) ou presente (pontuação igual a 1, 2 ou 3). O superenvolvimento e o calor afetivo foram considerados de forma contínua (pontuação de zero a 5) e categorizada. Todos os possíveis pontos de corte foram estudados na procura de novas relações e significados dos componentes da EE para esta população específica e os achados da amostra. RESULTADOS: Foram considerados com alta EE para hostilidade 41,9% dos familiares entrevistados e 71% para superenvolvimento emocional; 25,8% destes familiares pontua ram para ambos os componentes da EE (hostilidade e superenvolvimento). Dos 31 pacientes, cinco (16,1%) desistiram do tratamento até os seis meses; dois pacientes desistiram entre o 6 o e o 12 o mês (25% de desistência em 12 meses) e quatro abandonaram o tratamento entre o 12 o e o 18 o mês (47,8% de abandono em 18 meses). Houve uma associação significativa entre a presença de hostilidade e o abandono do tratamento antes dos seis meses (p = 0,008, teste exato de Fischer). Houve diferença significativa na frequência de superenvolvimento familiar entre o grupo que permaneceu 18 meses e o grupo que abandonou o tratamento (p = 0,037, teste de Mann-Whitney). Os pacientes que permanceram em tratamento até os 18 meses tiveram uma freqüência maior de familiares com alto nível de superenvolvimento familiar (> 4) (p = 0,012; teste exato de Fisher). Não houve nenhuma associação entre o tempo de permanência e o calor afetivo. CONCLUSÕES: Alta EE tem influência significativa sobre o tempo de permanência do dependente químico ou de álcool na CT. A presença de hostilidade foi mais freqüente no grupo com o abandono prematuro do tratamento, enquanto o alto superenvolvimento do familiar foi mais freqüente no grupo de pacientes que permaneceu em tratamento até os 18 meses. Estudos com uma população maior são necessários para apoiar esses achados. / BACKGROUND: The success of treatment for alcohol and other substance dependence in a therapeutic community (TC) depends greatly on the treatment adherence, i.e., the length of stay at the TC. It is well known that subjects who stay on treatment for ate least three months have a better outcome, compared with those who early withdraw. The family emotional environment can be measured through expressed emotion (EE) and has great influence on treatment adherence. METHODS: 31 key-relatives of alcoholics and other substance dependents, who involuntarily began a treatment in a TC, were assessed through the Camberwell Family Interview (CFI) (shorter translated to Portuguese version). The proportion of subjects who remained on treatment in the TC was then measured after six, 12 and 18 months. Evaluated aspects included hostility, overinvolvement and warmth. Hostility was assessed as absent (score = 0) or present (score = 1, 2 or 3). Overinvolvement and warmth were considered as continuous and categorized values (scores 0 to 5). Every possible cutoff points were studied, in order to find new associations and meanings of EE components of this specific population and the length pf stay in a TC. RESULTS: 41.9% of the relatives were considered as having high EE for hostility and 71% for overinvolvement; among those relatives with high EE, 25.8% had presence for both hostility and overinvolvement. Among the 31 patients, five (16.1%) abandoned treatment up to 6 months; 2 patients abandoned treatment between 6th and 12th month (25% treatment abandon in 12 months) and four abandoned the treatment between 12th and 18th month (47.8% treatment abandon at 18 months). There was a significant higher frequency of presence of hostility in the group that abandoned before six months (p = 0.008, Fischer exact test). A significant difference of familiar overinvolvement was found between the group who remained in the treatment up to 18 months and the group that abandoned treatment earlier (p = 0.037, Mann-Whitney test). Families with score = 4 for overinvolvement were more frequent in the group that remained on treatment up to 18 months (p = 0.0012; Fischer exact test). No correlation was found between warmth and length of stay at TC. CONCLUSIONS: High EE has a significant influence over the length of stay of the alcoholic or other substance dependent in a TC. The presence of hostility is more frequent among families of patients who prematurely abandon treatment, while higher score of overinvolvement was more frequent in the families of the group that completed 18 months of treatment in the TC. Further studies with larger population are needed to support those findings.

L’importance du religieux au siècle des Lumières n’est plus à démontrer, tant dans sa dimension historique que philosophique ou artistique. Mais il s’agit de savoir s’il existe une pensée du religieux au XVIII° siècle, i.e. des modes spécifiques de peser des sens qui ont à voir avec l’invisible, le surnaturel ou le divin. Plutôt qu’une idée en particulier, idée de bonheur, de nature, d’énergie ou d’inquiétude, nous étudions un rapport, une relation articulée entre l’homme et le symbolisable: comment une société donnée mesure ce rapport au surnaturel, et à travers quels médias. L’enquête privilégie la littérature d’idées, la production d’une pensée qui n’adhère jamais ni à l’identité ni au concept, mais qui est plutôt écart et mouvement, et qui par cela même peut s’aventurer sur des terra incognita ; elle privilégie aussi la peinture d’histoire, le genre où l’iconographie est par excellence cosa mentale, manifestation visuelle des méditations d’une pensée. Les analyses sémiostylistiques des œuvres sont orientées par deux pôles, l’intertextualité biblique et la praxis socio-théologique de la Querelle des refus de sacrements. Elles permettent de saisir les mutations du paradigme biblique, de la pensée rationaliste et de l’esthétique mimétique tout en mettant au jour les obstacles épistémologiques, les points de résistance, les skandalon. La pensée du religieux au XVIII° siècle, entre audace et effroi, apparait marquée par l’expérience et l’ethos, une esthétique du témoin qui doit beaucoup à la pensée janséniste du témoignage, ainsi qu’une remise en cause de la pensée rationaliste au profit d’une nouvelle philosophie du langage / The importance of Religion in the Age of the Enlightenment is no longer to be proven, whether it be historically, philosophically ar artistically. The question is to make out if there exists a way of thinking Religion in the XVIIIth century, i.e. specific modes of weighing meanings which are related to the invisible, the supernatural or the divine. Rather than one idea in particular (happiness, nature, energy, anxiety), we are studying a connection, an articulate relation between man and what can be symbolized : how a given society assesses this connection to the supernatural, and through wich media. Our investigation favours essays, the production of a thinking which never adheres to the identity or the concept, but which is rather a swerve, a movement, which allows it to explore terra incognita ; the investigation also favours history painting, the genre in which iconography is by essence cosa mentale, a visual manifestation of the mediations of a thinking. The semiostylistical analysis of the works are orientated by two poles, the biblical intertextuality and the socio-theological praxis of the quarrel over the refusal of sacraments. These analysis allow to grasp the mutations of the biblical paradigm, the rationalist thinking and mimetic aesthetics while they make light on the epistemological obstacles, the resistance points, the skandalon. Thinking Religion in the XVIIIth century, between audacity and dismay, appears marked by the jansenist thinking of testimony, as well as a questionning of rationalist thinking in favour of a new philosophy of language

Introduction and background Recruitment to cancer clinical trials needs to be improved, as does patient understanding about clinical trials, to enable patients to make an informed choice about whether or not to take part. The main reason that clinically eligible patients do not take part in clinical trials is because they refuse; poor understanding of the research has been associated with patient refusal. Audiovisual patient information (AVPI) has been shown to improve knowledge/understanding in various areas of practice but there is limited information about its effect in the cancer clinical trial setting, particularly in relation to recruitment rates. Understanding the research is necessary for informed consent, and it was hypothesised that if patient understanding about clinical trials was increased with AVPI, then this could result in a reduction in the number of patients refusing clinical trials, and therefore provide an ethical approach to improving recruitment. This study aimed to test the impact of an audiovisual patient information intervention on recruitment to randomised cancer clinical trials (refusal rates), patient understanding of the information given, and levels of anxiety. Reasons for patients’ decisions about trial participation were also assessed. Method An AVPI intervention was developed that aimed to address the common misconceptions associated with randomisation and clinical equipoise, as well as improve patient understanding generally of randomised cancer trials, and of other core clinical trial informational requirements, such as voluntariness. Patients were randomised to receive either AVPI in addition to the standard trial-specific written information, or the written information alone. A new questionnaire was developed to assess patient understanding (also referred to as knowledge) in the randomised trial setting and, following testing with patients and research nurses, this was shown to be reliable and valid. Patients completed self-report questionnaires to assess their understanding (new knowledge questionnaire) and anxiety (Spielberger State-Trait Anxiety Inventory), at baseline and after they had made their decision about clinical trial entry, when their perceptions of the intervention, as well as factors contributing to their decision were also determined (this tool incorporated Jenkins and Fallowfield’s (2005) questionnaire which assessed reasons for accepting and declining randomised cancer trials). Results A total of 173 patients with breast cancer (65%), colorectal cancer (32%) and lung cancer (3%) were entered into the main study. The median age was 60 (range 37-92 years). There was no difference in clinical trial recruitment rates between the two groups: 72.1% in the AVPI group and 75.9% in the standard information group. The estimated odds ratio for refusal (intervention/no intervention) was 1.19 (95% ci 0.55-2.58, p=0.661). Knowledge scores increased more in the intervention group compared to the standard group (U= 2029, p=0.0072). The change in anxiety score between the arms was also statistically significant (p=0.011) with anxiety improving in the intervention arm more than in the no-intervention arm. The estimated difference in the median anxiety change score between the groups is –4.6 (95% ci –7.0 to –2.0). Clinical trial entry was not influenced by tumour type, stage of cancer, age, educational qualifications or previous research experience, however, there was a modest association with deprivation status (p=0.046) where more affluent patients were the least likely to consent to a trial. Educational qualifications and stage of cancer were independently associated with knowledge: patients who were better educated had higher levels of knowledge about randomised trials, and patients who had limited stage of cancer had higher baseline knowledge than patients with advanced cancer. Acceptability of the intervention was high with 93% of those who watched it finding it useful, and 42% stating that it made them want to take part in the clinical trial. Personal benefit and altruism were key motivating factors for clinical trial participation, with reasons for refusal being less clear. Discussion and conclusions Although the potential for AVPI to increase clinical trial recruitment rates was highlighted in the literature, in this study, AVPI was not shown to have any effect on refusal rates to randomised cancer trials. However, by improving patient understanding prior to decision making, AVPI was shown to be a useful addition to the consent process for randomised cancer trials. AVPI addresses the fundamental ethical challenges of informed consent by improving patient understanding, and supports the ethical framework integral to Faden and Beauchamp’s (1986) theory of informed consent. The new knowledge questionnaire was shown to be a sensitive and effective instrument for measuring understanding of randomised clinical trials in the cancer setting, although it would benefit from further testing. The AVPI appears to reduce anxiety at the decision making time point and has been shown to be an acceptable medium for patients. This study confirms existing findings from studies assessing factors affecting decision making, with personal benefit and altruism being key motivating factors, and reasons for refusal being less clear. The need for further qualitative work in this area is highlighted to gain a deeper understanding of what is important to patients, in terms of why they refuse clinical trial participation. Implications for practice and further research Several implications for practice have been identified, including using AVPI as part of the standard information package for patients considering randomised cancer trials, and focussing on patient and staff education in this area. The knowledge questionnaire could be introduced to routine practice as a tool to determine patient understanding prior to decision making, allowing clinicians the opportunity to correct any misconceptions prior to consent. Further research focussing on AVPI specific to individual trials would be helpful, to determine if a more customised approach would be of benefit in terms of clinical trial recruitment. The importance of studying other aspects of the consent process such as the interaction between the clinician and the patient, in addition to more detailed exploration of the factors affecting patients’ decisions were highlighted.

Ce travail décrit les trajectoires des adolescents qui sont amenés à être suivis en psychiatrie parce qu'ils refusent d'aller à l'école en France. Il se propose ainsi d’employer une démarche sociologique de théorie ancrée (Grounded Theory) afin de répondre à une question de santé publique. En 1991, on estimait que les enfants et adolescents refusant d'aller à l'école représentaient 5% des consultations de pédopsychiatrie en France. Depuis 25 ans, il demeure pourtant difficile de quantifier ce phénomène et son évolution, notamment parce que le refus scolaire ne correspond à aucune catégorie de maladie mentale. L'enjeu sociétal et économique est toutefois considérable. Les associations de parents alertent sur le coût élevé de la déscolarisation, la 'phobie scolaire' rencontre un écho médiatique constant, et les jeunes qui achèvent leurs études sans obtenir de diplôme ont un taux de chômage supérieur à la moyenne pour leur tranche d'âge. De plus, une littérature psychiatrique internationale considérable sur le refus scolaire s’adosse à de nombreuses institutions de soin dédiées à la rescolarisation (consultations et hôpitaux de jours) et de manifestations professionnelles à ce sujet. Dans un contexte de contraintes budgétaires du sanitaire et de crise du système éducatif français, la gestion par le champ médical du refus scolaire pose question. Premièrement, une analyse socio-historique de la littérature médicale internationale entre 1941 et 2018 décrit comment le problème du « refus scolaire » s’est développé dans le discours scientifique selon les deux courants distincts de la phobie scolaire (school phobia) et du refus scolaire (school refusal) ; et tend actuellement à s’élargir vers une problématisation médicale de toute absence scolaire. La deuxième et la troisième partie de ce travail explorent les processus décisionnels qui sous-tendent la médicalisation du refus scolaire à l’échelle individuelle. En effet, le diagnostic psychiatrique intervient relativement tard, à l’issue d’une carrière débutée au sein de l’institution scolaire et de la famille. Comment un jeune en vient-il à être désigné par la catégorie de 'phobie scolaire'? Cette approche interactionniste se fonde sur plus de 100 entretiens réalisés auprès de familles et de professionnels de l’école et analyse le travail produit par le jeune et par les acteurs qui l’entourent. On décrit comment les professionnels de l’école repèrent et qualifient ses difficultés de fonctionnement scolaire. Quatre styles de gestion du problème émergent au sein de l’école, selon le degré d’extériorisation du problème hors du champ scolaire, l’usage des pratiques de care et les modes relationnels avec les autres acteurs. Une analyse dite des « carrières » retrace la trajectoire d’adolescents déscolarisés, de l'école à l'hôpital, en partant du récit des jeunes et de leurs parents. Si les enquêtés présentent le refus scolaire comme une prise de décision brutale, celle-ci vient interrompre un processus de longue durée notamment caractérisé par un épuisement lié au travail de représentation de soi en société. Après la décision de refus scolaire, sont analysés le récit de la transformation de soi, le remaniement des relations aux autres (parents, camarades, enseignants, soignants), la déconstruction et la construction de certaines modalités de socialisation. / School refusal is an increasingly common motive for consultation in child psychiatry. According to the psychiatrists, situations leading to school refusal are extremely diverse, from anxiety feelings in the classroom to truancy, and may lead children to miss school occasionally or to give up their studies. This sociological study, uses the grounded theory to describe the career of teenagers who receive psychiatric care in France because they refuse to go to school. More than 100 in-depth interviews with teenagers, parents and school professionals allow to describe their careers from the school to the psychiatric care. First, we provide a socio-history of the medicalization of school absenteeism through the construction of medical categories (school phobia, school refusal, school attendance problems), based on a review of the international psychiatric literature from 1941 to 2018. Second, teachers discourse on school refusal, their daily management of student who refuse school and their involvement in the medicalization of the absenteeism of some pupils is analyzed. Four styles of management are described among school professionals. Third, the narratives of teenagers and of their parents are analyzed. If school refusal appears as an immediate shift, it answers to a process of long duration. For some students, struggling to attend school from day to day required a consuming work: the presentation of self in public places and emotional work towards peers. After refusing school, students ‘illness’ narratives describe their career in deconstructing and reconstructing their socialization and self.