This research examines the experiences of Malaysian Neurosurgeons in managing communications with patients and their families in the aftermath of adverse medical events. These experiences were interpreted from a conflict avoidance and management perspective and the data from the research was analyzed using heuristic methodology. (Douglass and Moustakas 1985) The field of Neurosurgery in Malaysia was chosen firstly as a model of a high-risk medical specialty and secondly because of the researcher’s lived experience with the phenomenon being studied. Participants in the research were eleven Malaysian Neurosurgeons with at least ten years of independent clinical practice as specialists. Qualitative data was obtained through semi-structured in-depth interviews that were subsequently transcribed and analyzed heuristically, looking for different conflict management and patient-physician communication themes. The observations indicate that adverse medical events precipitate a major shift in the focus of tacit conflict management skill sets applied by the participants. The patient-Neurosurgeon relationship is abruptly transformed from one of high trust to one imbued with patient anxiety and suspicion of malpractice or medical error, and physician defensiveness. The observations also indicate that in multicultural Malaysia physician-family relationships were prioritized more than would be expected in a Western context. This may have implications for humanistic and interactive skills training for medical students and residents.

Cette thèse de psychopathologie psychanalytique est une réflexion théorico-clinique sur l'expérience d'une assistance médicale à la procréation (AMP), et plus particulièrement sur l’état psychologique des femmes infertiles en parcours de fécondation in vitro (FIV) et de don d'ovocytes. Cette recherche a pour but d'évaluer la psychopathologie de ces femmes et les éventuels remaniements psychiques qu'impose ce mode de procréation. L’hypothèse générale de cette étude soutient l’idée qu’il existe des particularités dans le fonctionnement psychique des femmes infertiles qui diffèrent selon que les femmes ont recours à une FIV ou à un don d’ovocytes. La méthodologie repose sur la base d'entretiens semi-directifs, de questionnaires et de tests projectifs (Rorschach et TAT) et l'analyse du matériel recueilli s'appuie sur la théorie psychanalytique. Les résultats montrent que ces femmes souffrent d’une blessure psychique qui est à mettre en lien avec le vécu d’une castration réelle de leur féminité dans sa valence maternelle châtrée. Les femmes infertiles se trouvent sous l’emprise de l’objet primaire et leur fonctionnement mental se caractérise par une pensée opératoire défensive. De plus, le recours à une FIV ou à un don d’ovocytes suscite des aménagements psychiques, notamment en termes de représentations maternelles, qui apparaissent spécifiques au type d’AMP. Enfin, l’AMP amène les couples à érotiser les interventions médicales conduisant notamment à un remaniement des théories sexuelles infantiles et à une reconstruction des fantasmes originaires. / This thesis psychoanalytic psychopathology is a reflection on the theoretical and clinical experience of medical assistance to procreation (MAP), and more particularly on the psychological status of infertile women in course of in vitro fertilization (IVF) and oocyte donation. This research aims to assess the psychopathology of these women and the possible psychological changes imposed by this mode of procreation. The general hypothesis of this study is as follows: there are specific aspects in the psychic functioning of infertile women, these characteristics differ between women using IVF or oocyte donation. The methodology is based on semi-directive interviews, questionnaires and projective tests (Rorschach and TAT) and analysis of collected material is based on psychoanalytic theory. The results show that these women suffer psychological injury that is to be linked with the experience of a real castration of their femininity in its valence maternal castrated. Infertile women are under the mastery of the primary object and mental functioning is characterized by a defensive operational thought. In addition, the use of IVF or oocyte donation leads to psychic adjustments, particularly in terms of maternal representations that appear specific to the type of MAP. Finally, MAP brings couples to eroticize medical interventions leading a redesign of infantile sexual theories and a reconstruction of primal fantasies.

Os trabalhadores da Fundação de Atendimento Socioeducativo do Rio Grande do Sul têm sido identificados como um grupo em grande vulnerabilidade psicossocial para a ocorrência de sofrimento mental decorrente do trabalho. Este estudo teve como objetivo principal compreender a influência do trabalho na saúde mental desses servidores, através da análise das relações laborais lá existentes e de que forma a organização do trabalho está imbricada nesse processo. Os objetivos específicos foram conhecer as percepções dos servidores sobre seu ambiente de trabalho, identificar os efeitos da organização do trabalho no cotidiano dos servidores e identificar as motivações que fazem que os trabalhadores permaneçam na instituição. Foi realizada uma pesquisa qualitativa, tendo como embasamento teórico a Psicodinâmica do Trabalho de Dejours, utilizando diários de campo e 14 entrevistas realizadas com 13 sujeitos lotados na Comunidade Socioeducativa, no Centro de Atendimento Socioeducativo Regional de Porto Alegre e na Sede Administrativa Padre Cacique, em Porto Alegre. Para os resultados utilizou-se análise de conteúdo de Bardin (2011) e o Software NVIVO. Os principais resultados observados foi lacuna importante no que se refere à saúde do trabalhador na instituição. As situações de sofrimento gerado pelo excesso de horas extras estão configuradas como um dos pontos nevrálgicos do sistema. O déficit de funcionários, a falta de controle nos processos de trabalho e a dependência salarial das horas extras faz com que um número significativo de trabalhadores abdique de sua qualidade de vida em prol de adquirir bens e prover as famílias com maior conforto. Esses pontos, entre outros, acabam desencadeando um elevado número de afastamentos por questões de saúde mental e sofrimento psíquico no trabalho. A possibilidade de criação de projetos e participação nas decisões figuram como importantes auxílios para a manutenção da saúde mental nesse ambiente. Por conseguinte, a permanência na instituição pode ser explicada por diferentes razões como a identificação com a socioeducação, com trabalhos sociais ou comunitários, a remuneração acima do mercado, a possibilidade de crescimento financeiro, as estratégias de defesas e a acomodação profissional. É urgente, portanto, a necessidade de intervenção e melhorias na organização do trabalho nessa população. Assim, uma parceria com o Serviço Especializado em Engenharia de Segurança e em Medicina do Trabalho da instituição já foi iniciada e este trabalho têm servido de dados para que este processo seja o mais sumário possível. / People who work at the Foundation for Social and Educational Service of Rio Grande do Sul have been considered as a highly vulnerable group to the occurrence of mental suffering because of labor. This study aimed to understand the influence of work on those workers’ mental health, through the analysis of labor relations, and how the labor organization is interconnected to this process. The study’s specific objectives are to get to know the perceptions of the servants on their workplace, to identify the effects of the labor organization in the routine of servants and to identify the reasons for the workers to remain in the institution. A qualitative research, was made as a theoretically based on the Dejours’s Psychodynamics of Work, using field diaries and 14 interviews with 13 people who work in the Social and Educational Community, in the Regional Social and Educational Service Center of Porto Alegre, and in the Administrative Office Padre Cacique, in Porto Alegre. For the results we used using Bardin’s content analysis (2011) and the software NVIVO. The main results observed were an important gap considering the workers’ health in the institution. The suffering situations caused by the excessive overtime work are considered one of the system’s essential issues. Workers shortage, lack of control in the labor processes and wage dependency of overtime working lead to a significant number of workers who give up their quality of life in order to acquire goods and provide more comfort to their families. These aspects, among others, end up triggering a large number of absences due to mental health issues and mental suffering at work. The possibility of creating projects and the participation in decisions seem to be an important aid for the maintenance of mental health in this environment. Consequently, different reasons may be used to explain the decision to stay in the institution, such as identification with social education, social or community work, the salary, higher than market average, the possibility of financial growth, the defensive strategies and the professional adaptation. It is urgent the need for intervention and improvements in this population’s labor organization. For this reason, a partnership with the Specialized Service of the institution’s Safety Engineering and Occupational Medicine has already been created and this study has been giving access to data for this process to be as direct and simple as possible.

The purpose of this study was to assess the effectiveness of defensive driving as a preventative strategy for road traffic violations and collisions in Zimbabwe. A sample of one hundred defensive driving graduates was used in the study. The descriptive survey method was used and data were collected using a questionnaire schedule. Literature review revealed that the majority of similar s udies by other researchers indicate that defensive driving is effective in preventing traffic violations and traffic collisions. The major findings of the present study showed that: (a) The defensive driving course is effective in preventing traffic violations and collisions; and (b) The defensive driving course should be compulsory in Zimbabwe. In view of these findings, this researcher urges the Traffic Safety Council of Zimbabwe to request the government to make legislation that compels every motorist to attend the defensive driving course. The same organisation should start conducting research on road traffic accidents. / Criminology and Security Science / MA (Criminology)

Os trabalhadores da Fundação de Atendimento Socioeducativo do Rio Grande do Sul têm sido identificados como um grupo em grande vulnerabilidade psicossocial para a ocorrência de sofrimento mental decorrente do trabalho. Este estudo teve como objetivo principal compreender a influência do trabalho na saúde mental desses servidores, através da análise das relações laborais lá existentes e de que forma a organização do trabalho está imbricada nesse processo. Os objetivos específicos foram conhecer as percepções dos servidores sobre seu ambiente de trabalho, identificar os efeitos da organização do trabalho no cotidiano dos servidores e identificar as motivações que fazem que os trabalhadores permaneçam na instituição. Foi realizada uma pesquisa qualitativa, tendo como embasamento teórico a Psicodinâmica do Trabalho de Dejours, utilizando diários de campo e 14 entrevistas realizadas com 13 sujeitos lotados na Comunidade Socioeducativa, no Centro de Atendimento Socioeducativo Regional de Porto Alegre e na Sede Administrativa Padre Cacique, em Porto Alegre. Para os resultados utilizou-se análise de conteúdo de Bardin (2011) e o Software NVIVO. Os principais resultados observados foi lacuna importante no que se refere à saúde do trabalhador na instituição. As situações de sofrimento gerado pelo excesso de horas extras estão configuradas como um dos pontos nevrálgicos do sistema. O déficit de funcionários, a falta de controle nos processos de trabalho e a dependência salarial das horas extras faz com que um número significativo de trabalhadores abdique de sua qualidade de vida em prol de adquirir bens e prover as famílias com maior conforto. Esses pontos, entre outros, acabam desencadeando um elevado número de afastamentos por questões de saúde mental e sofrimento psíquico no trabalho. A possibilidade de criação de projetos e participação nas decisões figuram como importantes auxílios para a manutenção da saúde mental nesse ambiente. Por conseguinte, a permanência na instituição pode ser explicada por diferentes razões como a identificação com a socioeducação, com trabalhos sociais ou comunitários, a remuneração acima do mercado, a possibilidade de crescimento financeiro, as estratégias de defesas e a acomodação profissional. É urgente, portanto, a necessidade de intervenção e melhorias na organização do trabalho nessa população. Assim, uma parceria com o Serviço Especializado em Engenharia de Segurança e em Medicina do Trabalho da instituição já foi iniciada e este trabalho têm servido de dados para que este processo seja o mais sumário possível. / People who work at the Foundation for Social and Educational Service of Rio Grande do Sul have been considered as a highly vulnerable group to the occurrence of mental suffering because of labor. This study aimed to understand the influence of work on those workers’ mental health, through the analysis of labor relations, and how the labor organization is interconnected to this process. The study’s specific objectives are to get to know the perceptions of the servants on their workplace, to identify the effects of the labor organization in the routine of servants and to identify the reasons for the workers to remain in the institution. A qualitative research, was made as a theoretically based on the Dejours’s Psychodynamics of Work, using field diaries and 14 interviews with 13 people who work in the Social and Educational Community, in the Regional Social and Educational Service Center of Porto Alegre, and in the Administrative Office Padre Cacique, in Porto Alegre. For the results we used using Bardin’s content analysis (2011) and the software NVIVO. The main results observed were an important gap considering the workers’ health in the institution. The suffering situations caused by the excessive overtime work are considered one of the system’s essential issues. Workers shortage, lack of control in the labor processes and wage dependency of overtime working lead to a significant number of workers who give up their quality of life in order to acquire goods and provide more comfort to their families. These aspects, among others, end up triggering a large number of absences due to mental health issues and mental suffering at work. The possibility of creating projects and the participation in decisions seem to be an important aid for the maintenance of mental health in this environment. Consequently, different reasons may be used to explain the decision to stay in the institution, such as identification with social education, social or community work, the salary, higher than market average, the possibility of financial growth, the defensive strategies and the professional adaptation. It is urgent the need for intervention and improvements in this population’s labor organization. For this reason, a partnership with the Specialized Service of the institution’s Safety Engineering and Occupational Medicine has already been created and this study has been giving access to data for this process to be as direct and simple as possible.

In mammals, tectal and tegmental divisions of the brainstem are involved in attentional mechanisms and responses to threatening stimuli such as predators. These centers are regulated by ascending connections, but the anatomical and neurochemical details of this drive are not fully known. The nucleus incertus (NI) in the pontine tegmentum is the source of ascending GABA projections to forebrain cognitive/emotional centers and NI neurons contain a number of neuropeptides, including relaxin-3 (RLN3). Tract-tracing studies have described NI projections within the tectum; and in this study we describe the distribution of relaxin-3 fibers within tectal and tegmental areas/nuclei of rat brain. RLN3-immunostained sections were also reacted with antisera against other neurochemical markers, as synaptophysin, nitric oxyde synthetase, tyrosine hydroxylase, calbindin, calretinin and 5-HT, to assist in demarcation of the area. RLN3-containing fibers were concentrated in the medial, olivary and ventrolateral pretectal nuclei; the medial intermediate grey layer of superior colliculus; and the pericentral area of inferior colliculus. Some labeled fibers were also detected in the cuneiform, parabigeminal and sagulum nuclei. RLN3 fibers were concentrated around the commissural bundles along the midline of the tectum, in the dorsal columns of the periaqueductal gray and in the dorsal raphe. In all areas, RLN3 and synaptophysin staining co-existed, indicating an association of the peptide with synapses. RLN3 projections target structures within the tectum and tegmentum that comprise the defensive system involved in detection of and response to unexpected threatening stimuli. NI neurons, which are a major source of RLN3 fibers and express corticotrophin-releasing factor receptors, may contribute to these responses following activation by stress-related stimuli. / Nos mamíferos, as divisões tectal e tegmental do tronco cerebral estão envolvidas em mecanismos de atenção e de respostas a estímulos ameaçadores, como os predadores. Esses centros são regulados por conexões ascendentes, mas os detalhes anatômicos e neuroquímicos desta unidade não são totalmente conhecidos. O núcleo incertus (NI) no tegmento pontino é a fonte de projeções ascendentes de GABA para prosencéfalo cognitivo/centros emocionais, e os neurônios do NI contêm alguns neuropeptídeos, incluindo relaxina-3 (RLN3). Estudos com traçadores descreveram projeções do NI para o tectum, e neste estudo, descrevemos a distribuição de fibras relaxina-3 nas áreas tectal e tegmental. Foram feitas imunocitoquímica para RLN3 conjugadas com outros marcadores neuroquímicos, tais como, sinaptofisina, óxido nítrico sintase neuronal, tirosina hidroxilase, calbindina, calretinina e 5-HT, para ajudar na demarcação da área. Fibras contendo RLN3 estavam concentradas na nucleos pretectais ventrolaterais, olivar e medial; na camada intermediária medial cinzenta do colículo superior; e na área pericentral de colículo inferior. Algumas fibras marcadas também foram detectadas nos núcleos cuneiforme, parabigeminal e sagulum. Fibras RLN3 foram concentradas em torno da feixes comissurais ao longo da linha mediana do tectum, nas colunas dorsais da substância cinzenta periaquedutal e na rafe dorsal. Em todas as áreas, a marcação para RLN3 e sinaptofisina co-existiu, indicando uma associação do péptideo com as sinapses. Estruturasalvo para as projeções de RLN3 do tecto e tegmento compõem o "sistema defensivo" envolvidos na detecção e resposta a estímulos ameaçadores. Neurônios do NI, são uma importante fonte de fibras RLN3 e expressam fatores de liberação de receptores para corticotropina, que podem contribuir para a respostas ao estímulos de estresse.

L'obstétrique est généralement présentée comme l'archétype des problèmes de la responsabilité médicale. La présente étude entreprend de dépasser ce constat afin de dévoiler l'appréhension imparfaite du risque obstétrical par la responsabilité médicale. La première partie de la thèse met en exergue les spécificités du risque obstétrical : elle soutient, d'une part, que ces spécificités ont des effets sur les systèmes d'indemnisation, et ; d'autre part, que ces spécificités atteignent également les mécanismes assurantiels. La seconde partie de l'étude s'intéresse à la judiciarisation du risque obstétrical. L'ouvrage constate en premier lieu que celle-ci à des incidences directes sur la pratique obstétricale et des incidences indirectes sur l'économie. La thèse envisage en second lieu d'utiliser les outils contractuels afin d'éviter les méfaits de cette judiciarisation. Entre la théorie et la pratique, la thèse propose de réécrire certaines dispositions législatives afin d'améliorer l'indemnisation des dommages obstétricaux, mais aussi de formaliser un contrat de naissance de nature à déjudiciariser le risque obstétrical. / Obstetrics is generally presented as the archetype of the issues related to medical liability. This study undertakes to go beyond that finding in order to cast light on the specific reasons for which medical liability hardly addresses issues related to obstetrics. The first part of the thesis highlights the specificities of the obstetrical risks: it argues on the one hand, that those specific characteristics have consequences as regards compensation systems; and on the other hand,, that those specific features also have an impact on the insurance mechanisms. The second part of the study deals with the judicialization of the obstetrical risks. The book notes, first, that judicialization has direct effects on obstetrical practice and indirect consequences on the Economy. Secondly, the study considers the use of contractual mechanisms as a way to prevent the effects of judicialization. Between theory and practice, the study proposes to rewrite certain legal provisions with a view to improve the compensation of obstetrics damages but also to formalise a birth contract in order to "de-judicialize" obstetrical risks.

Le Comté de Tripoli est le dernier à être fondé des quatre Etats Latins d’Orient issus de la Première Croisade. Ce Comté est le seul à garder sa capitale en possession des croisés jusqu’aux dernières années de l’existence de ces Etats. Ce Comté possède certains des plus anciens châteaux construits par les croisés au début du XIIe siècle tels les châteaux de Tripoli et Gibelet.Cette thèse a plusieurs objectifs, elle vise à préciser les frontières du Comté de Tripoli, énumérer et préciser l’ensemble des places fortes de ce Comté, étudier d’une façon exhaustive les différents sites fortifiés situés sur le territoire de la République Libanaise, et l’élaboration d’une typologie de l’architecture défensive de l’époque des croisades aux XIIe - XIIIe s. dans ce Comté.Grâce aux différentes méthodes de prospection archéologique, l’étude topographique du terrain avec l’archéologie du paysage, il était possible d’identifier et de découvrir plusieurs sites fortifiés, essentiellement des tours, qui n’étaient pas connus auparavant.Un intérêt spécial a été consacré dans notre travail à la lecture approfondie et l’analyse systématique de quelques sites fortifiés majeurs. Cela a permis une meilleure compréhension de l’installation de ces sites, de leur histoire, et de l’évolution de leur construction. Les sites en question sont: Archas, le château de Gibelet, le château de Smar Jbeil, le château Saint-Gilles à Tripoli, la tour Bahani et la tour Mouheich. / The County of Tripoli was the last one to be created between the Frenkish States established after the First Crusade. It is the only State that kept its capital city within the power of the Crusades till the last years of the existence of these States. Some of the oldest castles built at the beginning of the XIIth century are located in this County; such as the castles of Tripoli and Gibelet.This PhD has several objectives; it aims to define the frontiers of the County of Tripoli, to list and specify all its strongholds, to study exhaustively the various fortified sites in the territory of the Republic of Lebanon, and to develop a typology of defensive architecture of the Crusades during the XIIth - XIIIth centuries in this county.Through various methods of archaeological survey, study of the topography of the territory with archaeological landscape reading, it was possible to identify and explore several fortified sites, mainly towers not known before. In our work, special interest was devoted on extensive reading and systematic analysis of some major fortified sites. This enabled a better understanding of their installation, their history and the evolution of their construction. The sites are: Archas, Castle of Gibelet, Castle of Smar Jbeil, the castle of St. Gilles in Tripoli, the tower Bahani and the tower Mouheish.

Dans le cadre de ce travail, nous avons poursuivi l’étude de la biosynthèse d’alcaloïdes défensifs des coccinelles. Trois espèces ont été plus particulièrement étudiées :Adalia bipunctata (qui produit l’adaline [32]), Coccinella septempunctata (contenant la coccinelline [29]) et Harmonia axyridis (produisant l’harmonine [34]).<p>Afin d’identifier le (ou les) acide(s) gras précurseur(s) de ces alcaloïdes, nous avons dans un premier temps synthétisé des acides gras spécifiquement marqués. Nous avons ainsi préparé les acides [14-3H]myristique, [16-3H]palmitique, [18-3H]stéarique, [18-13C]stéarique et [11,11,12,12,13,13,14,14,15,15,16, 16,17,17,18,18,18-2H]stéarique.<p>Les différents acides gras marqués au tritium sur le méthyle terminal ont ensuite été incorporés successivement chez les trois espèces de coccinelles mentionnées ci-dessus, en utilisant la technique d’incorporation in vitro mise au point par Laurent et al. ( )<p>Les incorporations chez Adalia bipunctata ont montré que l’acide myristique est incorporé préférentiellement dans l’adaline. <p>Chez Coccinella septempunctata par contre, l’acide stéarique est incorporé dans la coccinelline environ 25 fois plus efficacement que les acides myristique et palmitique.<p>Enfin, les incorporations chez Harmonia axyridis ont établi que l’acide stéarique est le précurseur de l’harmonine. De plus, grâce à l’incorporation de l’acide [11,11,12,12,13,13,14,14,15,15,16,16,17,17,18,18,18-2H]stéarique, le mécanisme de formation de l’amine secondaire a été précisé.<p>/<p>In spite of their red-orange colors, which could increase risks of predation, Coccinellidae are rarely exploited as food sources by predators. Many of them owe their protection, at least in part, to the presence of repellents and, in some cases, toxic alkaloids in the hemolymph emitted during a process called "reflex bleeding". Previous studies have shown that the biosynthesis of these alkaloids is related to fatty acid metabolism. <p>In our doctoral thesis, we wanted to clarify what are the fatty acids precursors of adaline (Adalia bipunctata), coccinelline (Coccinella septempunctata) and harmonine (Harmonia axyridis), with the use of various techniques of labelling (3H, D, 13C, etc.).<p> / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

全球併購浪潮下，敵意併購向來是併購議題中備受矚目的焦點，許多國家均針對敵意併購設有明確的法規範，而我國自2002年通過企業併購法以來，已歷經十五年，在敵意併購相關法制的建構上卻顯有不足，導致實務上面臨許多問題。蓋我國近年來引發高度關注的敵意併購案件，幾乎皆以失敗收場，且雙方攻擊防禦的過程中往往演變為經營權惡鬥，不僅兩敗俱傷，亦使公司及股東利益蒙受損失。 有鑑於前述情況，本文擬從實證觀點探討我國企業環境與文化脈絡對於敵意併購之影響，並透過國內曾發生過的案例、主管機關的態度與法院見解，對我國現行法制進行反思。另外，本文亦藉由美國、英國、德國、歐盟和日本之比較法研究，從目標公司採行防禦措施之相關規範、對於股東之資訊揭露以及少數股東權益保障等面向，討論出可能且適合用於我國之規範方向，以作為建構我國敵意併購法制之參考。 / In the wave of global mergers and acquisitions, hostile takeover has long been a focal point on the issues relating to mergers and acquisitions. Many countries have already built up more transparent regulatory regimes specifically for hostile takeover activities. However, since Taiwan promulgated the Business Mergers and Acquisitions Act in 2002, the relevant laws and regulations were not sufficient to govern hostile takeover activities during the past fifteen years and a number of issues arose in practice. In recent years, the well-known hostile takeover cases in Taiwan all ended up in failure. The actions taken by the party initiating hostile takeover and the target company often led to corporate control contests, making both parties and the shareholders suffer losses. This thesis examines the influences of Taiwanese culture and corporate environment on hostile takeover. It also marks the deficiencies of the current regulatory regime in Taiwan by reviewing the hostile takeover cases, the opinions of the competent authority and the judicial judgements. In addition, this thesis introduces the legislations of the United States, England, Germany, European Union, and Japan on anti-takeover tactics, information disclosure as well as the protection of minority shareholders’ rights and interests. The thesis then analyzes whether these legal systems are suitable as a reference for Taiwan to establish relevant laws and regulations in the future.