Cette thèse interroge l’usage de la contention forte lors des soins en pédiatrie. Cette problématique soulève des questions philosophiques et éthiques qui s’inscrivent dans des pratiques quotidiennes de soins. Pourtant cette pratique, à laquelle se confronte fréquemment les soignants est relativement peu interrogée, voire banalisée.En effet, l’enfant effrayé ou douloureux peut se débattre et s’agiter au décours du soin et il arrive que plusieurs adultes le maintiennent pour poursuivre le geste. Un rapport de force s’installe alors entre soignants et enfant. Dans certains cas, la contrainte physique de l’enfant lors du soin s’apparente littéralement à de la violence. Le passage de l’usage légitime de la force à la violence illégitime n’est pas systématiquement identifié.Par ailleurs le fait de contraindre l’enfant de force confronte l’infirmier à un paradoxe : celui de faire mal à l’enfant pour son bien. Cela complique la perception de l’illégitimité de certaines contentions.Difficile voire impossible de renoncer à faire le soin et pourtant regrettable d’user de la contention forte à l’encontre d’un enfant malade. Une étude qualitative ancillaire à la réflexion philosophique été menée auprès de soignants de pédiatrie. L’objectif était d’interroger cette question du point de vue des soignants pour comprendre comment l’usage de la contention lors d’un soin en pédiatrie pouvait se transformer en un usage illégitime de la force. Les résultats de cette étude ont montré que la contention était une pratique laborieuse, source de malaise mais le plus souvent vécue comme inévitable et influencée par les habitudes de l’équipe d’appartenance. (Ces résultats sont en annexe de la thèse) Le « bien de l’enfant » justifiait le recours à la force. On assistait à une hiérarchisation déontologique où la réalisation du geste technique subordonne le respect du rythme de l’enfant. L’analyse de la parole des soignants a mis en évidence : empathie et attention des soignants à l’égard de l’enfant mais à l’évocation de la contention l’enfant disparaissait du discours. Un peu comme si l’enfant disparaissait du « radar émotionnel » du soignant, le temps de la contention. Le concept de « cécité empathique transitoire » a été proposé pour caractériser le phénomène qui se produit lors d’une contention forte.La thèse explore les raisons qui conduisent les adultes qui soignent à disqualifier le refus de l’enfant en proposant une forme de réhabilitation de la parole de celui-ci. Le travail s’organise autour de développement des regards et des points de vue qui tantôt masquent tantôt rendent visibles une partie de la réalité : celle de l’enfant et celle du soignant. Les soignants sont tels les prisonniers de la caverne, otages de leurs illusions. L’espoir de maitriser l’inconstance de l’existence par la grâce de la biotechnologie semble les contraindre à sacrifier leur propre subjectivité. L’arraisonnement de l’enfant mais aussi du soignant à la technique est au cœur du débat qui émerge de la réflexion. Au fil du travail, émerge l’idée d’un entre-deux des différences, qui pourrait être un nouvel espace conceptuel où les différences entre l’enfant et les soignants se rassemblent dans l’espace de la contingence. Cet entre-deux ouvre sur de nouveaux possibles, invite à devenir prudent. La prudence aristotélicienne comme disposition pratique apporte de nouvelles perspectives à cette problématique. L’invitation à la délibération dans les soins ouvre sur une proposition concrète de déploiement de la notion de care appliquée plus spécifiquement au champ de la pédiatrie. / From transitional empathic blindness to caution during care. About physical restraint during nursing care in pediatric wardsThis thesis questions the use of strong physical restraint during pediatric care. The issue raises philosophical and ethical questions falling within daily practices of nursing acts. However, this custom to which nurses are frequently exposed is rather seldom questioned or is routinized.A child who is scared or in pain can struggle or jitter during the care and it happens that serval adults retrain the child in order to finish the treatment. It is a real power struggle between the nurses and the child. Sometimes, the child’s physical restraint is similar to violence. The step from using reasonable strength to using unfounded violence is not automatically identified.Moreover, the nurse restraining a child strongly faces a paradox: hurting a child for his wellbeing. This complicates the perception of the illegitimacy of some restraints.It is difficult if not impossible to forgo the treatment, but it is nevertheless unfortunate to use physical restraint on a sick child. A qualitative research backed by a philosophical reflection has been conducted among pediatric nurses. The aim was to probe the issue from the nurses’ point of view in order to understand how the use of physical restraint during a treatment in pediatric wards could lead to the use of unfounded strength. The result of the research highlighted that restraint was an unpleasant, cumbersome practice, but that it was often experienced as unavoidable and governed by the team’s habits. (The results of the research can be found in appendix) The “child’s wellbeing” justified the use of strength, like a kind of ethical prioritization, where achieving the technical act subordinated the respect of the child’s rhythm. Analyzing the nurses’ comments highlighted their empathy and attention to the child, but when talking about restraint, the child was no longer mentioned. It seemed the child disappeared from the nurse’s “emotional radar” during a physical restraint. The idea of “transitional empathy blindness” was suggested to characterize the phenomenon occurring during a strong physical restraint.The thesis also explores the reasons leading the adults in charge of the care to disqualify the child’s refusal by offering a means to resume the dialog with the child. The work is structured around the evolution of the attitudes and opinions that sometimes conceal the child’s and the nurse’s reality and sometimes make it visible. Nurses are like prisoners in a cave, hostages of their own illusions. The hope of mastering the fickleness of life thanks to biotechnology seems to force them to sacrifice their own subjectivity. Trying to subjugate the child but also the nurse to the technical act is food for thought. Throughout the work, the idea of an in-between differences stands out. It could lead to a new concept where the differences between the child and the nurses could meet in case of contingency. This in-between opens new possibilities and encourages caution. As practical measure, Aristotle’s principle of caution develops a new insight regarding this issue. The possibility of discussing nursing practices leads to a concrete proposal to spread the notion of care more specifically in the field of pediatrics.

Abstract Deprivation of liberty is always an infringement of a person's constitutional rights. During the past decades, Western countries have focused on their Mental Health legislation, in particular, by making changes concerning involuntary treatment. After all, little is known about the frequency and quality of involuntary treatment, yet this information is needed to modificate the phenomenon. The present thesis is a part of the Nordic study ''Paternalism and Autonomy''. Two Finnish data have been used in this thesis: the register and the interview studies. The material of the register study comprises all admissions to the study hospitals (Tampere, Turku and Oulu) during a six-month period. The material of the interview study comprises the interviews of 50 patients admitted involuntarily and the interviews of the 50 voluntarily admitted patients following each involuntary admission. Both studies used a questionnaire based on previous studies. In Finland the rate of involuntary treatment is high. The motivation for deprivation of liberty is, however, the interest of patients. Deprivation of liberty was predicted by a diagnosis of a psychotic disorder as well as previous involuntary treatment. Harmfulness to others-criterion as the motivation of involuntary treatment was rarely used. In this material, it was never used as the sole motivation of detainment. Agitation/desorientation was the common reason for seclusion/restraint. Actual violence was more frequently the reason for seclusion of female patients whereas threat of violence was the reason for seclusion/restraint of men. There were differencies among the study hospitals concerning the rate of seclusion/restraint: in Oulu mechanical restraint was used more frequently than in other study hospitals. International comparison of deprivation of liberty is difficult because of the differences among countries in legislation and the paucity of the previous studies. Ward culture as well as the methods of registration vary in different countries, and, thus reliable comparison is restricted. The results of the current study confirm the notion that deprivation of liberty is more frequent in Finland that in many other countries. / Tiivistelmä Vapauden rajoittaminen on aina kajoamista ihmisen perustuslailliseen oikeuteen ja siten tahdosta riippumaton hoito psykiatriassa on ongelmallinen alue. Länsimaissa on herätty keskustelemaan tästä aiheesta viime vuosikymmeninä ja tahdosta riippumatonta hoitoa on pyritty vähentämään lainsäädännöllisin keinoin. Jotta tahdosta riippumattoman hoidon ja toimenpiteiden käyttöön voidaan vaikuttaa, tarvitaan vertailukelpoista tietoa sen määrästä ja laadusta. Tämä tutkimus on osa yhteispohjoismaista tutkimushanketta "Paternalism and Autonomy – A Nordic Study on the Use of Coercion in the Mental Health Care System". Tähän väitöskirjaan on käytetty em. tutkimushankkeen kahta suomalaista aineistoa: rekisteritutkimusta ja haastattelututkimusta. Rekisteritutkimukseen kerättiin kaikki 6 kuukauden aikana tutkimussairaaloihin (Tampere, Turku ja Oulu) tulleiden potilaiden tiedot. Haastattelututkimukseen pyydettiin 6 kuukauden aikana 50 tahdosta riippumattomalla lähetteellä tullutta ja heille 50 vapaaehtoisesti tullutta verrokkia. Molemmissa tutkimuksissa käytettiin aiempiin tutkimuksiin pohjautuvia kyselylomakkeita. Rekisteritutkimukseen kerättiin sosiodemografiset taustatiedot, aiempi sairaalahoitohistoria ja ajankohtaisen hoitojakson vapauden rajoittamista koskevat tiedot sekä diagnoosit. Haastattelututkimukseen kerättiin tietoja potilaan kokemuksesta sairaalaantoimittamisesta ja mahdollisuudesta vaikuttaa toteutuvaan hoitoon. Potilaiden psyykkinen tila arvioitiin haastattelututkimusosiossa käyttäen standardoituja psykiatrisia arviointiasteikkoja. Vapauden rajoittaminen psykiatriassa on Suomessa yleistä, tahdosta riippumattoman hoidon osuus on suuri. Vapautta rajoitetaan kuitenkin potilaan etua ajatellen (hoidon tarve ja potilaan vaarallisuus itselle). Psykoosi oli vapauden rajoitusta ennustava tekijä, kuten kuuluukin olla, koska psykoosi on tahdosta riippumattoman hoidon edellytys. Selittäväksi tekijäksi nousi myös aiempi tahdosta riippumaton hoito. Vaarallinen muille-kriteeriä käytettiin harvoin tahdosta riippumattoman hoidon perusteena, tässä aineistossa sitä ei käytetty yksinään sitovassa hoitopäätöksessä koskaan. Agitaatio/desorientaatio oli yleisin syy eristämiselle (eristys huoneeseen/leposide-eristys). Miehiä eristettiin hieman yleisemmin kuin naisia ja naisten eristys edellytti ajankohtaisen väkivaltaisuuden, kun miehiä eristettiin uhkaavan väkivallan vuoksi. Väestöön suhteutetut eristysluvut erosivat eri tutkimussairaaloiden välillä: Oulussa leposide-eristettiin muita sairaaloita yleisemmin. Eristystä ennusti parhaiten tutkimussairaala, mutta vapauden rajoituksen runsasta käyttöä ennusti aiempi tahdosta riippumaton hoito sekä ajankohtainen tahdosta riippumaton status. Tahdosta riippumattoman hoidon samoin kuin eristysten yleisyyden kansainvälinen vertailu on hankalaa aiempien tutkimusten vähäisyyden ja eri maiden välisten lainsäädännöllisten erojen vuoksi. Luotettavaa vertailua vaikeuttavat myös erilaiset hoitokäytännöt sekä rekisteröintimenetelmät. Saadut tulokset tukevat käsitystä, että psykiatristen potilaiden vapauden rajoittaminen on Suomessa yleisempää kuin monissa muissa maissa.

This study was made within the Child Safety group at Volvo Car Corporation.  The purpose of this bachelor thesis was to study the different aspects of rearward facing child restraint systems, which is the safest way for small children to travel, in order to suggest improvements in the development of child restraint systems. The studies included scientific articles regarding child safety and fatally injured children in car accidents, both in Sweden and internationally. The overall aim is to find factors that enables the increase in usage of rearward facing child restraint systems, including the increase of usage time to as long as possible.   Swedish accident data, obtained by the Swedish Traffic Data Acquisation, was studied. It was found that the fatally injured children during car accidents in Sweden between the years 2000-2016 commonly were involved in extraordinarily accident scenarios with an outcome independent of how they were restrained. The literature study and the survey that was made were both supporting the statement of inconvenience while using rearward facing child restraint systems. The inconvenience often corresponded to different types of misuse. The main issue with rearward facing according to the responding parents was lack of leg space, both for their child but also for the driver and the front seat passenger. These issues made some parents turning their children forward facing at early age, whereas they could still fit in the rearward facing child restraint system.   One key in order to increase the global use of rearward facing child restraint systems lies in changes of the materials and design. A more lightweight and compact design is suggested, providing a more spacious travel environment for the children and easier mounting for the parents. The need of education is apparent, preferable by means of social media due to the easiness of sending information globally with low cost.

Le principe de subsidiarité, en droit de la Convention européenne, est un principe empreint d’ambiguïtés. D’origine prétorienne, il ne fait l’objet d’aucune définition formelle dans les textes ou la jurisprudence afférente et se voit ainsi marqué d’une indétermination sémantique et juridique certaine. Doté d’une double dimension à la fois procédurale et matérielle, il n’en reste pas moins un principe fondamental du droit européen, un principe qui structure, d’une part, l’organisation et le fonctionnement même du système et guide, d’autre part, l’interprétation et le contrôle du juge de Strasbourg. Parce que naturellement ambigu mais néanmoins directeur du droit européen, le principe de subsidiarité se présente donc comme un principe souple et malléable, par conséquent, adaptable. L’analyse de sa mise en oeuvre dans la jurisprudence européenne met ainsi en exergue l’inconstance et la variabilité d’application du principe, à la libre disposition du juge strasbourgeois. Mais analysée à la lumière du contexte actuel d’un engorgement sans précédent du système et donc d’une réaffirmation urgente de son caractère subsidiaire, l’utilisation fluctuante du principe s’apprécie sous un jour nouveau, visant à faire de la subsidiarité un principe non plus garant des libertés nationales mais désormais source d’un encadrement de celles-ci. Parce que moteur d’une responsabilisation accrue des Etats membres, le principe de subsidiarité apparaît donc comme une pièce maîtresse de la politique jurisprudentielle du juge européen. / As part of the European Convention, the principle of subsidiarity is marked by ambiguity. Originating from judges, it has not been formally defined in legal texts nor in any related jurisprudence and is therefore characterized by a semantic and legal indeterminacy. Featuring both a procedural and a tangible dimension, it remains a fundamental principle of European law. On the one hand, it structures, the system’s organization and operations. On the other hand, it guides the court of Strasbourg’s interpretation and review. Naturally ambiguous but still guiding European law, the principle of subsidiarity is presented as a flexible and malleable principle, and therefore adaptable. The analysis of its implementation in the European jurisprudence highlights its inconsistency and variability at the free disposal of the court of Strasbourg. However, in the light of the current context of an unprecedented saturation of the system and therefore of an urgent reassertion of its subsidiary nature, a fluctuating use of the principle is assessed differently to make it not a guarantee of national liberties, but a guide for them. As a driving force for increased accountability of member states, the principle of subsidiarity appears to be essential to the judicial policy of the European court.

Steel beams with web openings are frequently used in construction to achieve attractive, flexible and optimised design solutions. These beams are used to provide passages for building services, to reduce the overall construction height and to achieve long spans. However, the presence of the openings may lead to a substantial reduction in the load carrying capacity of the beam at both ambient and elevated temperatures and introduce additional failure modes including shear-moment interaction at the location of the openings causing the Vierendeel mechanism. Steel beams in practical construction are axially restrained and the presence of this axial restraint can drastically change the behaviour of the beams in comparison to those without axial restraint. One particular issue is premature buckling of the compressive tee-sections around the openings. The aim of this research is to investigate the effects of openings on axially restrained steel beams at elevated temperatures so as to develop an analytical method for design consideration. The analytical derivation will be based on the results of extensive numerical simulations. The research starts with the behaviour of steel beams with web openings under combined axial compression, bending moment and shear force at ambient temperature. The results show that buckling of the compressive tee-sections at the openings can reduce the plastic moment capacity of the openings; and an analytical method has been proposed to incorporate the influences of axial compression and tee-section buckling into the existing shear-moment design equations. The elevated temperature simulations show that axially restrained steel beams with web openings may enter catenary action at much lower temperatures than the commonly accepted critical failure temperatures calculated assuming no axial restraint and no tee-section buckling. Therefore, at the commonly accepted critical failure temperatures, many perforated steel beams exert tensile forces on the adjacent connections. It is important that the connections have the strength and deformation (rotation) capacity to enable catenary action to develop. The parametric study examines, in detail, how changing the different design parameters may affect the elevated temperature behaviour of perforated beams. The examined parameters including load ratio, level of axial restraint, cross-section temperature distribution profile, opening shape, opening size and opening position. Based on the results of the numerical parametric study, an analytical method has been derived to obtain the complete axial force-temperature relationship for axially restrained perforated steel beams. The key points of the analytical method include initial stiffness, point of initial failure under combined axial compression, bending moment and shear force, transition temperature at which the axial force on the beam changes from compression to tension and the magnitude of the tensile force resulting from the beams going into catenary action. Using the analytical method, it is possible to assess the maximum tensile force in the beam and the corresponding temperature so that the safety of the connections can be checked.

The 3Rs of reduction, refinement and replacement are the guiding principles of animal research and embedded in national and international legislation regulating the use of animals in scientific procedures. Awake imaging by MRI of rodents can offer a reduction by increasing the quality of scientific data through longitudinal imaging using less animals by avoiding a serial sacrifice design and refinement through reducing the stressful effects animals are exposed to, in comparison to existing models. Before awake imaging can become an established biomarker it must be demonstrated that pathology is traceable with comparable or an improvement on results using existing biomarkers. To validate awake imaging of rodents three study types were conducted in two different rodent species: imaging of the progression of Aspergillus fumigatus infection in the mouse lung using anaesthetized animals; analysis of stress in rats during imaging and imaging restraint; imaging of the abdomen in awake rats and a prospective study into the utility of this method for imaging the progression of Candida albicans renal infection. The first study type used an established model of invasive pulmonary aspergillosis in mice to test the utility of MRI for tracking infection in the lung parenchyma. Images of collapsed parenchyma were obtained and shown to increase as the infection progressed. Further work is required to establish this as a clinically relevant biomarker. The study type used restraint, blood collection and imaging as stressors using corticosterone levels as a surrogate of stress. Analysis of levels in blood and faeces by RIA and ELISA allowed comparison of stress during anaethetised and awake imaging for the first time. There were no differences in rat corticosterone levels during anaethetised and awake imaging indicating that awake imaging was no more stressful than currently used procedures. The third study type employed restrainers and acclimatisation to MRI scanner noise to acclimatize rats for awake abdomen imaging. Both anaethetised and awake rats were imaged with FLASH and IntraGate™ sequences. These methods were utilized in an established model of disseminated candidiasis by imaging the kidney. Comparable image quality was obtained in awake animals, with the utility of the method validated by imaging differences in renal pathology between vehicle and low and high dose treated animals. In conclusion, the first steps have been taken towards establishing awake animal imaging by MRI. The imaging is no more stressful than using an anaesthetic and was a useful biomarker in the rat abdomen and capable of tracking disease development. Further work is required to make the technique fully quantitative and automated and hence become a useful tool for monitoring progression of fungal infection and other pathology.

Canada is currently experiencing the transition to a post-industrial society as the result of the wide spread introduction of information related technologies. This thesis focuses on the legal rights to information of skilled employees who work with modern computer technology. The objective is to assess the adequacy of existing laws to meet the needs of employers and employees and to serve the public interest. The initial chapters concentrate on the legal principles of trade secrets and breach of confidence as applied to the employment relationship. Patent and copyright protection for software is briefly reviewed but not emphasized. Against this background, the major portion of the thesis examines the delicate balance between the legal interests of the employer, the employee and the public. Any attempt by employers to limit post employment use of information by employees invokes the doctrine of restraint of trade. This doctrine recognizes an employee's right to use the knowledge and skills developed during employment for the benefit of other employers. The thesis examines the elements of the restraint of trade doctrine as applied to skilled employees in the computer industry. The creation and development of software is used throughout the thesis to illustrate legal principles. Employers such as software developers are extremely vulnerable to misappropriation of confidential information by their employees. Such employers rely heavily upon the use of restrictive covenants in employment agreements to limit disclosure and to prevent future competition. The remedies for an employee's breach of confidence are reviewed. This chapter concludes that the legal principles governing interlocutory injunctions are inadequate to properly protect the information employer. The thesis concludes that the present Canadian law is increasingly inadequate to protect a computer industry employer against an employee's unauthorized appropriation of confidential information. In short, the law has not yet recognized the social and technological changes that have greatly increased the vulnerability of the information employer. If neither the courts nor the legislatures take action, information employers will have to further increase their reliance on the limited and uncertain protection of restrictive covenants in employment agreements. / Law, Peter A. Allard School of / Graduate

The excessive use of chemical and physical restraints in intermediate care facilities has been a subject of study since the early eighties, and has produced several explanations for why restraint use continues to be practiced. One of the primary reasons often cited is that restraints are used to control "problematic behavior" commonly exhibited by a person suffering from dementia. The focus of the proposed project is to analyze whether restraint practices for residents with moderate to severe dementia differ between Special Care Units and integrated units within long term care facilities. The main objective of the study is to demonstrate whether seniors with dementia residing in Special Care Units will be less likely to encounter physical and chemical restraints than demented residents living within an integrated facility. This objective explores the assumption that Special Care Units were designed to meet the needs of residents with dementia, and therefore, care providers should be more accepting of deviant behaviours. The findings revealed that the more severe the level of memory impairment the more likely a resident would be placed in a Special Care Unit. Once located in these Special Care Units, residents were more likely to experience physical and chemical restraints than their counterparts in integrated care units. / Arts, Faculty of / Anthropology, Department of / Graduate

This study will endeavor to present an analysis of the process in which the National Labor Relations Board gave specific meaning to "interfere with, restrain or coerce" found in section 8(1) of the National Labor Relations Act of 1935. Under Section 8(1) of the Act, the Labor Board, subject to judicial review, has the authority to declare illegal any management procedure which in its opinion involves interference, restraint or coercion.

Sweden has a long history of non-belligerency and neutrality in world affairs. However, with the political landscape changing across the world Sweden may have made it possible to break this trend by joining the NATO organization.  Following an analysis of Sweden’s actions towards NATO in two fields. The first being the institutional theory which organizations like NATO represents, the other being the direct participation and collaboration Sweden has made in NATO operations and organizations. The conclusion was reached that Sweden has made concessions towards and approached the organization in both fields yet currently remains a non-member. The potential future outcome is tied to the sociopolitical perspectives within liberalism, realism and ultimately path dependency.