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La maladie de Crohn touche 100 000 personnes en France. Elle est caractérisée par une inflammation chronique de l’intestin, ainsi que par l’alternance de phases de récidive et de rémission. Devant l’imprévisibilité des rechutes, médecins et patients essaient d’identifier des facteurs qui permettraient de les anticiper et ainsi de mieux les contrôler. Néanmoins, aucune étude n’a encore pu clairement mettre en évidence l’étiologie de la rechute dans la maladie de Crohn. Ce travail de thèse a donc pour ambition de définir les facteurs psychosociaux prédictifs de la rechute. Dans une démarche clinique, nous accordons également une importance au vécu subjectif de la maladie et des rechutes. Les travaux portants sur les expériences subjectives de la maladie chronique montrent que diverses représentations cognitives, sociales et fantasmatiques de la pathologie et du corps malade, sont mises au travail permettant aux patients un meilleur ajustement. Le deuxième objectif de ce travail de thèse vise donc une compréhension des enjeux psychiques du vécu de la maladie de Crohn.La double méthodologie mise en place, quantitative et qualitative, s’inscrit dans une perspective longitudinale, prospective et intégrative. Nous avons ainsi pu recueillir des données portant sur les facteurs psychosociaux à travers des questionnaires administrés auprès de 145 sujets adultes en rémission de la maladie de Crohn. Parallèlement nous avons conduit 33 entretiens de recherche ayant fait l’objet d’une analyse de contenu thématique. Le test projectif du Rorschach a également été utilisé afin de mettre en lumière les retentissements psychiques de la maladie lors de 3 études de cas.Les principaux résultats soulèvent l’implication des stresseurs spécifiques à la maladie chronique, des stratégies de coping centrées sur l’émotion et de la qualité de vie dans l’augmentation du risque de rechute dans la maladie de Crohn. Nous avons également pu mettre en évidence plusieurs phénomènes quant au vécu de la pathologie. La rechute parait marquée par des potentialités traumatiques et psychopathologiques qui signent la véritable entrée du sujet dans la maladie. Son vécu ainsi que le vécu de la maladie donne lieu à des remaniements identitaires profonds médiatisés par de forts éprouvés de honte quant à la spécificité des symptômes et par une fantasmatique propre à la zone corporelle atteinte, faisant écho à des angoisses du féminin. L’acquisition de savoirs profanes, un travail d’élaboration autour de la perte et de la qualité des relations entretenues avec le médecin spécialiste paraissent constituer des facteurs permettant de mieux gérer les stresseurs et de s’approprier la maladie. Notre travail amorce une réflexion sur l’accompagnement thérapeutique devant être fondé une prise en charge globale de la souffrance des patients traduite aussi bien à partir des facteurs psychosociaux que du vécu subjectif des patients. / Crohn's disease affects 100,000 people in France. It is characterized by a chronic inflammation of the intestine, as well as alternating phases of recurrence and remission. Given the unpredictability of relapses, doctors and patients try to identify factors that would allow them to be anticipated and thus better controlled. Nevertheless, no study has yet been able to clearly identify the etiology of relapse in Crohn's disease. This thesis work aims to define the psychosocial factors predictive of relapse. In a clinical approach, we also place importance on the subjective experience of illness and relapse. Work on the subjective experiences of chronic disease shows that various cognitive, social and fantasy representations of the pathology and the sick body are put to work allowing patients a better fit. The second objective of this PhD thesis is therefore an understanding of the psychic issues involved in living with Crohn's disease.The dual methodology put in place, quantitative and qualitative, is part of a longitudinal, prospective and integrative perspective. We were able to collect data on psychosocial factors through questionnaires administered to 145 adult subjects in remission of Crohn's disease. At the same time, we conducted 33 research interviews that were the subject of a thematic content analysis. The projective Rorschach test was also used to highlight the psychic repercussions of the disease in 3 case studies.The main findings highlight the involvement of chronic disease-specific stressors, emotion-focused coping strategies, and quality of life in increasing the risk of relapse in Crohn's patients. We have also been able to highlight several phenomena regarding the experience of pathology. The relapse seems marked by traumatic and psychopathological potentialities which sign the real entrance of the subject into the disease. Her experience as well as the experience of the disease gives rise to profound identity re-mediations mediated by strong shame as to the specificity of the symptoms and by a phantasmatic peculiar to the affected body area, echoing anxieties of the feminine. The acquisition of secular knowledge, a work of elaboration around the loss and the quality of the relations maintained with the specialist doctor appear to constitute factors allowing to better manage the stressors and to appropriate the disease. Our study initiates a reflection on the therapeutic accompaniment to be founded a global management of the suffering of the patients translated as well from psychosocial factors as from the subjective experience of the patients.

L’objectif de cette thèse est de savoir si au delà d’une préférence linguistique et sociale pour leur langue natale et leurs usagers, les bébés de moins de 6 mois s’impliquent dans les rythmes et opportunités dialogiques des langues. Nous avons choisi d’étudier les comportements communicatifs du bébé âgé de 4-5 mois car cet âge représente une période charnière pour l’intégration de la compétence communicative. D’une part, le « turn-taking » est encore une forme prédominante d’interaction et d’autre part, les bébés de cet âge s’orientent encore principalement vers les partenaires sociaux plutôt qu’exclusivement vers les objets. Cette période est souvent considérée comme celle qui précède l’enculturation ou l’apprentissage culturel. Pourtant, dès 5 mois, le bébé se comporte différemment face à un interlocuteur de langue natale et de langue étrangère et face à un interlocuteur familier et nouveau. Cette thèse comporte 3 études visant à mieux comprendre l’engagement social du nourrisson dans des situations de communication réelle et habituelle et de communication potentielle. La première étude porte sur les différences dans l’organisation du turn-taking vocal entre les contextes français et brésilien. La seconde étude a pour objectif de mettre en lumière les différentes modalités que le bébé peut utiliser lors du turn-taking, au cours des pauses entre les énoncés maternels. Dans la 3ème étude, la seule étude expérimentale, nous avons cherché à savoir si un bébé français aurait des attentes différentes lorsqu’il était face à une interlocutrice parlant le français par rapport à une interlocutrice parlant une langue étrangère (brésilienne en l’occurrence). Dans son ensemble, cette thèse constitue également un plaidoyer pour une approche intégrative de la communication chez les bébés, s’éloignant d’une vision dualiste dans laquelle on sépare le corps de la pensée, le familier du nouveau et l’inné de l’acquis pour aller vers une vision plus holistique de l’humain. / The main objective of this thesis is to find out whether, beyond linguistic and social preferences for their native language and its users, infants younger than 6 months become involved with the rhythms and dialogical opportunities of speech. We chose to study the communicative behavior of infants aged 4 to 5 months because this constitutes a pivotal period for the integration of communicative competence. On the one hand, turn-taking is still a predominant type of organization in social interaction, and on the other hand, infants at this age are still more interested in social partners than in solitary object exploration. Furthermore, this period is usually thought to precede enculturation or the possibility of cultural learning. Yet, by 5 months, infants behave differently with a native language speaker than with a foreign language speaker and with a familiar person than with a stranger. This thesis includes 3 studies aimed at gaining insight into the social engagement of infants in situations of real and potential communication with social partners. The first study focuses on differences in vocal turn-taking organization between Brazilian and French cultural contexts. The second study’s aim is to shed light on the various expressive modalities infants use responsively in both cultural contexts during pauses between maternal utterances. In the third study, which is experimental, we wanted to know whether a French infant would have different expectations when faced with a French-speaking interlocutor compared with an interlocutor speaking a foreign language (Brazilian in this case). Overall, this thesis also makes a case for a more integrative approach to the study of infant communication, away from a dualist vision separating the body from thought, familiarity from novelty and innate from learned behavior and moving towards a more holistic perspective on humans beings.

<p>Рад је посвећен испитивању могућности, ефикасности, тешкоћа и ограничења примене корелацијско-интеграцијског методичког система у обради садржаја еколошког образовања. Прецизније речено, циљ рада је евалуација примене корелацијско-интеграцијског методичког система у обради еколошких садржаја, са аспекта припреме, реализације и ефеката у наставном процесу, посебно кад је реч о образовним постигнућима ученика у погледу нивоа, квалитета и ретенције усвојених наставних садржаја, затим са аспекта утврђивања предности и недостатака наведеног методичког система, као и мишљења о његовом значају од стране учесника васпитно-образовног процеса, првенствено ученика и наставника. Евалуација корелацијско-интеграцијског методичког система урађена је кроз неколико фаза: (а) праћење и вредновање припреме, организације и реализације експерименталног програма, (б) вредновање образовних постигнућа ученика, (в) сагледавање мишљења ученика и наставника о реализацији експерименталног програма. Како би се утврдило да ли постоји узрочно-последична веза између примене експерименталног програма и нивоа и квалитета знања ученика, коришћен је квази-експеримент са паралелним групама. Мерења која су урађена у три различита временска тренутка (иницијални тест, финални тест и ретест) омогућила су нам да<br />утврдимо напредак ученика у нивоу и квалитету знања, али и могућност ретенције знања ученика. Према резултатима нашег истраживања, експериментални програм који смо применили имао је ефекте на: (а) ниво знања и напредак ученика из области екологије; (б) квалитет знања и напредак ученика, пре свега, у домену примене стеченог знања; (в) веће задовољство и мотивацију ученика у наставном процесу и (г) позитивно мишљење о примени корелацијско-интеграцијског методичког система.</p> / <p>Rad je posvećen ispitivanju mogućnosti, efikasnosti, teškoća i ograničenja primene korelacijsko-integracijskog metodičkog sistema u obradi sadržaja ekološkog obrazovanja. Preciznije rečeno, cilj rada je evaluacija primene korelacijsko-integracijskog metodičkog sistema u obradi ekoloških sadržaja, sa aspekta pripreme, realizacije i efekata u nastavnom procesu, posebno kad je reč o obrazovnim postignućima učenika u pogledu nivoa, kvaliteta i retencije usvojenih nastavnih sadržaja, zatim sa aspekta utvrđivanja prednosti i nedostataka navedenog metodičkog sistema, kao i mišljenja o njegovom značaju od strane učesnika vaspitno-obrazovnog procesa, prvenstveno učenika i nastavnika. Evaluacija korelacijsko-integracijskog metodičkog sistema urađena je kroz nekoliko faza: (a) praćenje i vrednovanje pripreme, organizacije i realizacije eksperimentalnog programa, (b) vrednovanje obrazovnih postignuća učenika, (v) sagledavanje mišljenja učenika i nastavnika o realizaciji eksperimentalnog programa. Kako bi se utvrdilo da li postoji uzročno-posledična veza između primene eksperimentalnog programa i nivoa i kvaliteta znanja učenika, korišćen je kvazi-eksperiment sa paralelnim grupama. Merenja koja su urađena u tri različita vremenska trenutka (inicijalni test, finalni test i retest) omogućila su nam da<br />utvrdimo napredak učenika u nivou i kvalitetu znanja, ali i mogućnost retencije znanja učenika. Prema rezultatima našeg istraživanja, eksperimentalni program koji smo primenili imao je efekte na: (a) nivo znanja i napredak učenika iz oblasti ekologije; (b) kvalitet znanja i napredak učenika, pre svega, u domenu primene stečenog znanja; (v) veće zadovoljstvo i motivaciju učenika u nastavnom procesu i (g) pozitivno mišljenje o primeni korelacijsko-integracijskog metodičkog sistema.</p> / <p>The present study investigated the possibilities,<br />effectiveness, difficulties and limitations in<br />application of the correlative-integrative<br />approach in teaching ecological education. In<br />specific, the aim of this study was to evaluate<br />the correlative-integrative approach in teaching<br />ecological education. The evaluation of the<br />correlative-integrative approach was done in<br />three ways: (a) by following and evaluating<br />lesson preparation, organisation and realisation<br />of the experimental program; (b) by evaluating<br />student education achievements; and (c) by<br />interpreting students&rsquo; and teachers&rsquo; views on the<br />realisation of the experimental program. To<br />assess whether there is a cause-and-effect<br />relationship between the application of the<br />experimental program and a level and quality of<br />student knowledge we executed a pseudoexperiment<br />with paired groups. Data gathered at<br />three different testing periods (initial test, final<br />test and repeated test) allowed us to ascertain<br />student development in terms of level and<br />quality of knowledge, as well as retention of<br />knowledge. The empirical data obtained in this<br />study showed that the experimental program<br />was effect on: (a) the level of knowledge and<br />students&#39; progress in the field of ecology; (b) the<br />quality of knowledge and progress of students,<br />primarily in the domain of application of<br />acquired knowledge; (c) greater satisfaction and<br />motivation of students in the learning process<br />and (d) a positive opinion on the application of&nbsp;correlation and integration approach.</p>

A multi-integrative approach was used to identify spatial and temporal relationships of natural and anthropogenic environmental variables affecting riverine ecosystem structure and function in the Athabasca Oil Sands Region (AOSR). A series of inter-related field studies were conducted to assess three key components of the freshwater food web (physico-chemical environment, basal productivity, benthic macroinvertebrates) utilizing an a priori environmental disturbance gradient experimental design. The gradient design was formulated to best discriminate the possible effects of natural and anthropogenic environmental variables on two river basins (Steepbank and Ells Rivers) each having different levels of oil sands (OS) land use disturbance. Findings from this study showed that natural variation explained most longitudinal and seasonal responses of physico-chemical environmental variables for both rivers, including possible mechanisms such as physical and chemical effects from the OS geological deposit and inputs from shallow groundwater upwelling. Basal productivity was likely controlled by natural variables within the Steepbank and Ells Rivers, such as potential OS deposit effects, nutrient availability and influences from turbidity and physical factors, with disturbance from OS development either negligible or not detected. Longitudinal and seasonal differences in benthic macroinvertebrate community composition were mostly related to natural variation, including possible mechanisms such as high discharge and sediment slump events on the Steepbank River, and community shifts from elevated metal concentrations from natural sources at upstream sites on the Ells River. This study demonstrated that developing baseline information on watersheds can be essential at discriminating sources of disturbance, with natural variation potentially confounding with anthropogenic factors. This study also highlights the need for further research to obtain an improved understanding of mechanistic pathways to better determine natural and anthropogenic non-point source disturbances and cumulative effects on the structure and function of tributary ecosystems in the AOSR at relevant spatial and temporal scales. / Graduate / 0329 / clsuzann@uvic.ca

L’originalité du golfe de Gabès (Sud de la Tunisie) a été reconnue par les malacologistes depuis le19ème siècle mais reste mal définie. Les espèces de cette région présentent des caractères morphologiques qui ont conduit à l’établissement de variétés, sous-espèces et espèces faiblement caractérisées. Certains auteurs les traitent comme des taxons endémiques tandis que d'autres les considèrent comme de simples variants locaux d'espèces à large répartition méditerranéenne. Le manque d’information concernant la valeur taxonomique de ces caractères morphologiques ne permet pas de traiter de façon robuste la question de l’endémisme dans le golfe de Gabès. Le premier objectif est de réviser le statut taxonomique des mollusques du golfe de Gabès en s’appuyant sur une approche de taxonomie moléculaire. La confrontation des différents caractères a permis d’identifier ceux qui discriminent correctement les individus en espèces, d’éliminer à l’inverse ceux qui ne remplissent pas cette fonction et d’en redéfinir de nouveaux. Le deuxième objectif est de relier les particularités faunistiques du Golfe à ses caractéristiques océanographiques et de discuter les phénomènes de spéciation qui pourraient être à l’origine de l’endémisme. Nos analyses ont porté sur six genres: Jujubinus (Trochidae), Diodora (Fissurellidae), Ocinebrina, Muricopsis (Muricidae), Aplus (Buccinidae) et Tritia (Nassariidae). L’approche intégrative utilisée a permis de proposer des hypothèses de délimitation d’espèces que nous avons ensuite confrontées aux données morphologiques et géographiques. Au final, l’endémisme est confirmé dans certains cas mais l’hypothèse qu’une partie des espèces décrites du golfe de Gabès ne sont que des variétés éco phénotypiques est également attestée. Notre approche moléculaire a mis aussi en évidence l’existencede nouvelles espèces et d’espèces cryptiques insoupçonnées dans la Méditerranée. Finalement l’hypothèse que le golfe de Gabès est un centre de spéciation est retenue. Plus de données moléculaires (reliées à des données fossiles) d’autres groupes provenant de différentes localités (spécialement du golfe de Syrte) apparaissent toutefois nécessaires. / The present Mediterranean marine fauna is the result of a history going back to the Messinian Salinity Crisis, with current biogeographical patterns mostly reflecting Quaternary to modern oceanographic conditions. The Gulf of Gabès, in southern Tunisia, is remarkable for its extreme ecological characteristics that distinguish it from "ambiant" Mediterranean conditions. Starting with the work of malacologists at the turn of the 19th-20th centuries, the molluscs of the Gulf of Gabès have been recognized as exhibiting morphological characters that set them apart from more typical forms that occur in the rest of the Mediterranean. At present, 6% of the species of the overall Gulf of Gabès mollusc fauna are treated as valid local endemics. Using an integrative taxonomy approach, combining molecular and morphological data, the objective of the study is to re-evaluate the status of these Gulf of Gabès local forms: are they valid, endemic species or do they represent ecophenotypic variation? Given the young geological age (6-8 ka) of the Gulf, where would local endemics have originated? The gastropod genera Jujubinus (Trochidae), Diodora (Fissurellidae), Tritia (Nassariidae) Ocinebrina (Muricidae), Muricopsis (Muricidae) and Aplus (Buccinidae) all have in common non-planktotrophic larval development. Our integrative approach confirms the validity of some of the endemic taxa, but also infirm that others are not valid species; molecular data also reveal unsuspected cryptic lineages both within and outside the Gulf. Regarding the question of the origin of the endemic species, various hypotheses have been proposed, one of them being that the Gulf of Gabès is a “speciation factory”. To formally test this hypothesis, more molecular data (coupled with fossil record data) are needed from other species groups and from other localities in the Mediterranean (specifically the Gulf of Syrte).

This thesis examines the validity of exclusionary clauses in medical contracts, more especially, hospital contracts in which the healthcare provider exonerates itself against edictal liability arising from the negligent conduct of its staff, resulting in the patient suffering damages. In assessing whether these types of clauses should be outlawed by our courts, this thesis attempts to synthesize six major traditional areas of law, namely, the law of delict, the law of contract, medical law and ethics, international and foreign law, statutory law and constitutional law into a legal conceptual framework relating specifically to exclusionary clauses in medical contracts in South Africa. This thesis highlights systemic inconsistencies with regard to the central issue, namely, whether these types of clauses are valid or not, especially, given the fact that the practice of exclusionary clauses or waivers in hospital contracts has hitherto traditionally been assessed within the framework of the law of contract. The alignment of the various pre-existing areas of statutory and common law with the Constitution highlights that an inter-disciplinary and purposive approach under the value-driven Constitution, brings about a less fragmented picture in assessing the validity of these types of clauses. This approach accords with the new solicitude of the executive, the judiciary, the legislature and academia to transform the South African legal system not only in terms of procedural law but also substantive law. This has resulted in the alignment with constitutional principles and the underlying values to test the validity of these types of clauses, alternatively, contracts. Whereas pre-constitutionally the assessment of disclaimers in hospital contracts was done against the stratum of antiquated principles, namely, freedom of contract and the sanctity of contract, ignoring values such as reasonableness, fairness and conscionability, post-constitutionally, because the values that underlie the Bill of Rights and which affects all spheres of law, including the law of contract, concepts such as fairness, equity, reasonableness should weigh heavily with the decision-maker. In this regard, broader medico-legal considerations, normative medical ethics and the common law principles of good faith, fairness and reasonableness play a fundamental role in the assessment of contractual provisions, including the practice of disclaimers or exclusionary clauses in hospital contracts. This thesis critically examines how these types of clauses or contracts ought to be adjudicated eventually against the background of such alignment. It concludes that the entering into a hospital contract, in which the patient exonerates a hospital and its staff from liability flowing from the hospital or its staff's negligence causing damages to the patient, would be inconsistent with the Constitution and invalid. In the old order in which traditional divisions of law have been encouraged, a fragmented approach resulted in legal in congruencies which, in turn, created turbulence and a lot of uncertainty. This approach is apposite to that which the new constitutionally based legal system, aims to achieve. The rights in the Bill of Rights which are interconnected and which influences all spheres of law, including contract law, offers a fairer basis upon which, the validity of contracts, or contractual provisions, can be measured than, the pure contract approach. In this regard, although contracts or contractual provisions in the past may have been unfair and unreasonable, the courts, however, refused to strike them down purely on this basis. The law of contract, as a legal vehicle for adjudicating the validity of exclusionary clauses or waivers in hospital contracts, is therefore not ideal. This is primarily due to the antiquated approach the South African courts have always taken in this area of law. The law of delict, statutory law and medical law, standing alone, also does not provide a satisfactory answer. What is needed is an integrated approach in which the traditional areas of law are united and wherein constitutional principles and values, give much guidance and direction. Alternatively, should the unification of the traditional areas of law not be possible in bringing about fair and equitable results, the introduction of legislative measures may very well be indicated. / Thesis (LLD)--University of Pretoria, 2009. / Public Law / unrestricted