Location-based reminder systems (LBRs) are typically used to remind people to complete a to-do task at a particular location. People use their prospective memory to remember future to-do tasks. However, the current design of LBRs fails to take advantage of human prospective memory theory. In this dissertation, I propose a framework connecting human prospective memory theory with LBRs. My work applies human prospective memory into the technical design of LBRs. The goal of my work is to make the reminder work more consistently with how human memory works. Prospective memory research suggests that encoding of the location and familiarity with the location have an impact on prospective remembering. I conducted two empirical studies to test how this theoretical knowledge applies to LBRs. In one experiment, I hypothesized that if the encoding stage provides a closer match to the retrieval stage in LBRs, then location recognition and task recall should improve at retrieval time. The results indicate that providing a first-person view (street view of the desired location) at the encoding stage benefits prospective remembering the most. Prospective memory theory also suggests that the familiarity with the external cue has a significant influence on prospective remembering. In the second experiment, I hypothesized that familiarity with a location has an impact on the location recognition at the retrieval. The results show that the encoding interface is used differently for familiar and unfamiliar cities and businesses to support recognizing a target location. The findings have implications for the design of future LBRs. I designed an LBR prototype by applying these empirical research findings and conducted a usability evaluation. Future designers of LBR should consider 1) providing more support in matching the encoding stage to the eventual cue in retrieval stage and 2) involving user’s familiarity level with the places at the encoding stage to provide a better user experience. My work showed the importance of using prospective memory theory in the design of LBR systems. / Ph. D. / People use location-based mobile reminder systems to complete a to-do task at a particular location. My work studied how people memorize the locations at the reminder set up stage, as well as how they recognize the locations and remember the associated to-do tasks at the reminder retrieval stage. People see a location from a first-person view while completing a to-do task in the real life. However, current interface designs of location-based reminders do not support that. My research results contributed to the future interface design of location-based mobile reminder system. That is, future encoding interface design of location-based reminders could possibly apply a street view of the location to make the reminder more usable and more user-friendly.

Le traumatisme craniocérébral modéré-grave (TCC) a une prévalence élevée au Canada. Il s'agit d'une condition neurologique qui affecte le fonctionnement cognitif. Parmi ces atteintes cognitives, les fonctions exécutives (FE) et la mémoire prospective (MP) sont particulièrement touchées lors d'un TCC. Cependant, les outils actuels pour les évaluer présentent plusieurs lacunes, dont leur faible validité écologique, ce qui ne permet pas d'avoir un portrait juste du fonctionnement quotidien. Une avenue intéressante pour améliorer la validité écologique est d'utiliser la réalité virtuelle. L'objectif du mémoire était d'examiner la validité d'un scénario multitâches effectué dans un environnement virtuel non-immersif d'appartement (VMT = Virtual Multitasking Test) pour évaluer la MP et les FE chez des adultes ayant subi un TCC modéré-grave et des participants contrôles. Les objectifs spécifiques étaient d'examiner les associations entre la performance au VMT et à des mesures neuropsychologiques traditionnelles (Tour de Londres, Zoo Map Test, CAMPROMPT) ainsi que d'examiner la validité discriminante du VMT afin de voir si celui-ci permet de départager le groupe TCC et le groupe contrôle. Quinze participants ayant subi un TCC modéré-grave (20% de femmes; moyenne de 43,5 ans; moyenne de 80 mois post-TCC) ont été recrutés et appariés à 15 participants contrôles. Les résultats indiquent des corrélations positives et modérées entre une mesure du fonctionnement exécutif (Tour de Londres) et différentes mesures du VMT. Une corrélation positive et modérée entre une mesure de la mémoire prospective (CAMPROMPT) et le score total du VMT est également observées. À l'égard du deuxième objectif, les résultats démontrent que le VMT a une sensibilité de 80% et une spécificité de 73% chez une population ayant subi un TCC modéré ou grave. Ces résultats indiquent que l'utilisation du VMT peut être efficace pour mesurer le fonctionnement cognitif et détecter des difficultés dans une population clinique ayant subi un TCC. / Moderate-severe traumatic brain injury (TBI) is highly prevalent in Canada. It is a neurological condition that can impair cognitive functioning. Among these cognitive impairments, executive function (EF) and prospective memory (PM) are particularly impaired in TBI. However, current tools for assessing these domains have a number of limitations, including low ecological validity, which does not provide an accurate picture of day-to-day functioning. An interesting avenue for improving ecological validity is to use virtual reality. The aim of this study was to examine the validity of a multitasking scenario performed in a non-immersive virtual apartment environment (VMT = Virtual Multitasking Test) to assess PM and EF in adults with moderate-severe TBI and control participants. The specific aims were to examine associations between performance on the VMT and traditional neuropsychological measures (Tower of London, Zoo Map Test, CAMPROMPT), and to examine the discriminant validity of the VMT in terms of its ability to discriminate between the TBI and control groups. Fifteen participants with moderate-severe TBI (20% female; mean 43.5 years; mean 80 months post-TBI) were recruited and matched to 15 control participants. The results indicate moderate correlations between a measure of executive functioning (Tower of London) and various VMT measures. A positive and moderate correlation between a measure of prospective memory (CAMPROMPT) and the VMT total score was also reported. With regard to the second objective, results showed that VMT had a sensitivity of 80% and a specificity of 73% in a population with moderate to severe TBI. These results indicate that the use of the VMT can be effective in measuring cognitive functioning and detecting difficulties in a clinical population with TBI.

Malgré des années de recherches sur la douleur et les incapacités chroniques, peu de conclusions claires émergent quant aux facteurs de risque les plus pertinents. La majorité des auteurs s’entendent toutefois sur un fait, les troubles musculo-squelettiques et l’adaptation à leurs nombreuses conséquences est un processus complexe, multidimensionnel et déterminé par l’interaction de facteurs biopsychosociaux. Deux articles sont présentés avec comme objectifs généraux d’identifier les déterminants importants de l’ajustement à un trouble musculo-squelettique. Le premier article consiste en une recension des écrits systématique visant à résumer tous les facteurs pronostiques biopsychosociaux de l’ajustement multidimensionnel aux troubles musculo-squelettiques et examinant leur pertinence à déterminer ces divers indicateurs d’ajustement, principalement la participation au travail, les limitations fonctionnelles, la douleur, la qualité de la vie, la détresse psychologique et la rechute. Les 105 études prospectives recensées et correspondant aux critères d’inclusion et d’exclusion ont été analysés et chaque association significative a été résumée. Par la suite, 68 études qui ont inclus des facteurs sociodémographiques, biologiques, psychologiques et sociaux ont été analysées séparément. Leur qualité méthodologique a été évaluée, un niveau d’évidence a par la suite été établi pour chaque association entre les facteurs de risque et les diverses variables de résultats. Les divergences dans ces associations entre les différentes phases de chronicité ont également été identifiées. Un niveau d’évidence élevée a été découvert concernant le rôle des attentes de rétablissement, certaines pratiques de gestion intégrées de l’incapacité, les stratégies d’adaptation (coping), la somatisation, la comorbidité, la durée de l’épisode symptomatique et un niveau modéré d’évidence a été découvert pour les comportements de douleur. Lorsque vient le temps de prédire les divers indicateurs d’ajustement de sujets souffrant de troubles musculo-squelettiques, chacun tend à être associé à des facteurs de risque différents. Peu de différences ont été relevées lorsque les phases de chronicité ont été prises en compte. Ces résultats confirment la nature biopsychosociale de l’ajustement aux troubles musculo-squelettiques bien que les facteurs psychosociaux semblent être prédominants. Le second article est une étude prospective avec un suivi de 2 et 8 mois. Elle a été menée auprès de 62 travailleurs accidentés, principalement en phase de chronicité et prestataires d’indemnités de revenu de la CSST (Commission en Santé et Sécurité du Travail du Québec). L’objectif de cette étude était d’identifier les déterminants de l’engagement actif dans un processus de retour a travail par opposition à l’incapacité chronique, tout en adoptant une approche biopsychosociale. Cet objectif a été poursuivi en faisant l’étude, d’une part, de la pertinence de facteurs de risque ayant déjà fait l’objet d’études mais pour lesquelles aucun consensus n’est atteint quant à leur utilité prédictive et d’autre part, de certains facteurs de risque négligés, voire, même omis de ce domaine de recherche. Suite à des analyses multivariées, le genre, les attentes de rétablissement en terme de capacité à retourner au travail et l’importance du travail ont été identifiés comme des déterminants de l’incapacité chronique liée au travail. Après 8 mois, l’âge, la consolidation médicale, les symptômes traumatiques, le support au travail et l’importance du travail ont été également identifiés comme des déterminants d’incapacité chronique liée au travail. Ces résultats démontrent l’importance d’aborder l’étude de l’incapacité chronique et de la réinsertion professionnelle selon une perspective multidimensionnelle. Ces résultats corroborent également les conclusions de notre recension des écrits, puisque les facteurs psychosociaux ont été identifiés comme étant des déterminants importants dans cette étude. / Despite years of research on chronic pain and disability, there is yet little consensus on a core set of risk factors. One thing that most agree on, is the fact that musculoskeletal disorders and the adjustment to its consequences is a complex, multidimensional process determined by biopsychosocial factors interacting with one another. Two articles are presented with the overall goal of identifying significant determinants of adjustment to musculoskeletal disorders. The first article is a systematic literature review that aimed at reviewing all pertinent biopsychosocial prognostic factors of adjustment to musculoskeletal disorders and assessed their relevance in predicting multidimensional outcomes, namely work participation, functional disability, pain, quality of life, psychological distress and recurrence. The 105 prospective studies identified and fitting the inclusion and exclusion criteria were analyzed and all significant associations were summarized. Then, 68 studies that included sociodemoraphic and biopsychosocial risk factors were separately analysed for their methodological quality, level of evidence (LOE) was established for each association between risk factors and outcome variables and existing differences were highlighted between phases of chronicity. Strong evidence was found for recovery expectations, coping, somatization, comorbidity, duration of episode, disability management and moderate evidence was found for pain behaviours. When it comes to predicting different outcomes reflecting the adjustment process of subjects with musculoskeletal disorders, each tends to have a different set of predictors. Few significant differences were found according to phases of chronicity. These results support the biopsychosocial nature of the adjustment to musculoskeletal disorders with a predominance of psychosocial determinants. The second article is a prospective study with follow-ups at 2 and 8 months and was conducted on a sample of 62 mostly chronic occupationally injured workers receiving compensation benefits from the CSST (Quebec Workers’ Compensation Board). The study aimed to identify determinants of active involvement in a return to work process while adopting a biopsychosocial approach. It did so by investigating the pertinence of previously studied risk factors but for which no consensus yet exists, but also by investigating the pertinence of previously neglected or even omitted risk factors. After multivariate analysis, gender, work recovery expectations and importance of work were predictive of work outcomes at 2 months. After 8 months, age, medical consolidation, trauma symptoms, work support and importance of work predicted work outcomes. The results show the importance of approaching chronic work disability from a multidimensional perspective, although corroborating our literature review’s findings that psychosocial variables appear to be more significant predictors in this study.

Introduction: La réinstitution de l’alimentation entérale en deçà de 24h après une chirurgie digestive semble a priori conférer une diminution du risque d’infections de plaie, de pneumonies et de la durée de séjour. Le but de cette étude est de vérifier l’effet de la reprise précoce de l’alimentation entérale sur la durée de séjour hospitalier suite à une chirurgie colique. Méthodes: Il s’agit d’une étude prospective randomisée dans laquelle 95 patients ont été divisés aléatoirement en deux groupes. Dans le groupe contrôle, la diète est réintroduite lorsque le patient passe des gaz ou des selles per rectum, et qu’en plus il n’est ni nauséeux ni ballonné. Les patients du groupe expérimental reçoivent pour leur part une diète liquide dans les 12 heures suivant la chirurgie, puis une diète normale aux repas subséquents. L’objectif primaire de cette étude est de déterminer si la réinstitution précoce de l'alimentation entérale post chirurgie colique diminue la durée de séjour hospitalier lorsque comparée au régime traditionnel de réintroduction de l’alimentation. Les objectifs secondaires sont de quantifier l’effet de la réintroduction précoce de la diète sur les morbidités periopératoires et sur la reprise du transit digestif. Résultats: La durée de séjour hospitalier a semblé être légèrement diminuée dans le groupe expérimental (8,78±3,85 versus 9,41±5,22), mais cette difference n’était pas statistiquement significative. Des nausées ou des vomissements furent rapportés chez 24 (51%) patients du bras experimental et chez 30 (62.5%) patients du groupe contrôle. Un tube nasogastrique a du être installé chez un seul patient du groupe experimental. La morbidité périopératoire fut faible dans les deux groupes. Conclusion: Il semble sécuritaire de nourrir précocément les patients suite à une chirurgie colique. Cependant cette étude n’a pu démontrer un impact significatif de la reintroduction précoce de l alimentation per os sur la durée de séjour hospitalier. / Introduction: of early feeding within 24 hours of intestinal surgery seems advantageous in terms of reduction of wound infection, pneumonia and length of hospital stay. The aim of the study is to evaluate the impact of early enteral nutrition in length of hospital stay in comparison to traditional postoperative feeding regimen. Method: This prospective study enrolled 95 patients randomized in two groups: control group patients receive enteral feeding in absence of nausea or vomiting, abdominal distension and after passage of flatus or stools, while patients in experimental group were fed a liquid diet within 12 hours of surgery, followed by a regular diet at the next meal. The primary endpoint was the impact of early oral feeding on hospital length of stay. The secondary endpoint was to measure the impact of the diet reintroduction modality on the incidence of early postoperative morbidity and return of bowel function. Result: Length of hospital stay was slightly diminished in the experimental group compared to control (8,78±3,85 versus 9,41±5,22), but the difference was not statistically significant. Postoperative nausea and vomiting were reported in 24 (51,0%) patients in experimental group and 30 (62,5%) in control group. Only one patient required nasogastric tube insertion. The majority of patients did not demonstrate any postoperative morbidity in both groups. Conclusion: Early enteral nutrition is safe after intestinal surgery. However we did not demonstrate that early enteral feeding diminished length of hospital stay or hastened the return of bowel function.

Qu’ils soient voyageurs occasionnels ou réguliers, les piétons se déplaçant en environnement urbain et en transport en commun ont à faire face à la complexité du réseau de transport des grandes villes. Les aides au déplacement sont nombreuses et variées. Elles peuvent être fixes (par exemple, panneaux de signalisation) ou mobiles (par exemple, applications sur smartphone). Ces aides utilisent principalement la modalité sensorielle visuelle, déjà fortement sollicitée lors d’un déplacement urbain. Une alternative intéressante serait d’utiliser l’haptique (sens du toucher). En effet, cette modalité permet de transmettre au porteur d’un dispositif haptique des informations de déplacement et de navigation, en attirant discrètement son attention par des messages délivrés tactilement.S’inscrivant dans une démarche d’ergonomie prospective, cette thèse vise à étudier l’apport de la modalité haptique comme soutien à l’activité de déplacement piéton urbain. L’objectif appliqué est la conception d’un dispositif haptique d’aide au déplacement innovant, efficace et accepté par les utilisateurs futurs. Ce projet de conception s’est déroulé dans le cadre du projet ANR Tictact, mené par le CEA-LIST de 2011 à 2014. L’utilisation de la modalité haptique étant posée comme un parti pris initial, l’objectif du projet était de déterminer la forme que devrait prendre l’assistance aux usagers et la technologie de l’outil d’aide.Pour répondre à ce défi, nous avons mis en œuvre trois études successives. La première visait à comprendre les activités cognitives élémentaires mobilisées pour consulter les supports d’informations nécessaires à la navigation piétonne. Pour cela, nous avons analysé le comportement d’un piéton effectuant un trajet urbain (en métro et à pied). Les résultats nous ont permis de spécifier les fonctions d’aide que devrait remplir un futur dispositif d’aide au déplacement. Complétées par une revue de la littérature sur les interfaces haptiques et leur utilisation pour l’aide au déplacement, ces résultats nous ont conduits à déterminer les fonctions éligibles à la modalité haptique. La seconde étude visait à concevoir l’interaction haptique avec le dispositif d’aide, en deux étapes : élaborer le concept d’interface et concevoir le langage d’interaction. Une démarche de conception participative a été mise en œuvre, étayée par l’utilisation d’un prototype et de méthodes créatives. Cette démarche a abouti à : (i) identifier un message informationnel approprié à chaque fonction de déplacement ; (ii) traduire ce message (par analogie) en métaphore ; (iii) transformer chaque métaphore en motifs vibratoires délivrés par un bracelet haptique. La troisième étude visait à évaluer le dispositif haptique (bracelet couplé à un Smartphone) en environnement réel. Une analyse d’activité de déplacement urbain a été menée, comparant un groupe disposant de notre prototype haptique d’aide à un groupe sans prototype. Les résultats confirment la potentialité de la modalité haptique pour améliorer les performances de déplacement et notamment une allure de déplacement plus fluide et une diminution du temps de consultation d’un support d’information. Notre étude ouvre des perspectives pour l’utilisation de la modalité haptique dans diverses interfaces mobiles (par exemple une smartwatch). / Whether they are occasional or regular travellers, the pedestrians travelling in an urban environment and using public transportation have to face the complexity of the transportation network of large cities. The travelling aids are numerous and varied. They can be stationary or mobile (for example, applications on smartphones). These aids rely mainly on the visual sensory modality, already heavily requested during urban travel. An interesting alternative would be to use haptics (sense of touch). Indeed, this modality enables to convey travel and navigational information to the owner of a haptic device, by drawing discreetly his attention with tactile messages. Joining an approach of prospective ergonomics, this thesis aims to study the contribution of the haptic modality as a support for the activity of urban pedestrian travel. The applied objective is the design of a haptic device as an innovative travel aid, effective and accepted by the future users. This design project took place within the framework of the ANR project Tictact, led by the CEA-LIST from 2011 till 2014. The use of the haptic modality being put as an initial bias, the objective of the project was to determine the form that the assistance and the technology of the travel aid should take.To tackle this challenge, we conducted three successive studies. The first one, aimed at understanding the elementary cognitive activities mobilized when consulting information necessary to the pedestrian navigation. For that purpose, we analysed the behaviour of a pedestrian undertaking an urban travel (in the subway and on foot). The results allowed us to specify the functions that a future device assisting in the travel should include. Completed by a review of the literature on haptic interfaces and their use for assisting travel, these results led us to determine the eligible functions of the haptic modality.The second study aimed at designing the haptic interaction with the haptic interface, in two stages: first develop the concept of the interface and second design the interaction language. An approach of participative design was implemented, supported by the use of a device prototype and creative methods. This approach succeeded in: i) identifying an informative message suitable for each function of the travel; ii) translating this message (using an analogy) into a metaphor; and iii) transforming every metaphor into vibrotactile patterns delivered by a haptic wristband.The third study aimed at evaluating the haptic device (a wristband coupled with a Smartphone) in a real environment. An analysis of the activity of urban travel was conducted, comparing a group having a prototype of our haptic assistant to a group without such prototype. The results confirm the potentiality of the haptic modality to improve the travel performance in particular to enable a more fluid speed of travel and a decrease in the consultation time of an information medium. Our study opens up perspectives for the use of the haptic modality in diverse mobile interfaces (for example a smartwatch).

A presente tese de doutorado defende a aplicação da técnica de modulação de efeitos das decisões na jurisdição infraconstitucional exercida pelo Superior Tribunal de Justiça e, consequentemente, sua utilização para relativizar efeitos precedentes processuais. A modulação de precedentes ou jurisprudência é uma técnica adotada pelos tribunais para evitar que a (nova) interpretação do direito por eles elaborada tenha efeitos retroativos e, assim, atinja situações consolidadas ou casos judiciais pendentes. Essa flexibilização é comumente utilizada para evitar que uma reviravolta jurisprudencial (i.e., um overruling) cause efeitos danosos àqueles cidadãos que depositaram confiança no precedente revogado, por ele pautando suas vidas e negócios. A modulação serve também para conservar situações jurídicas perpetradas com base em uma lei que veio ser, apenas posteriormente, declarada inconstitucional ou ilegal por um tribunal superior. A tese inicia demonstrando o desenvolvimento histórico da reestruturação de efeitos decisórios no Brasil, a partir de sua implementação na jurisdição constitucional sob controle do Supremo Tribunal Federal (analisa-se, dentro do contexto, o art. 27 da Lei 9.868/99). Passa-se, então, o trabalho a defender a modulação de precedentes também na jurisdição infraconstitucional praticada pelo Superior Tribunal de Justiça, fazendo, em primeiro lugar, um paralelo com o direito estrangeiro. Na sequência, o estudo traz fundamentos para comprovar a tese, explicando que a jurisprudência equivale, em certos casos, à norma legal (função criativa da decisão judicial) e, portanto, merece ter sua eficácia prospectada no tempo, tal como ocorre com a lei ordinária (aplicação pro futuro, cf. art. 5º, inc. XXXVI, CF e art. 6º, LICC), a fim de preservar a segurança jurídica e outros tantos relevantes princípios constitucionais (no ensejo dessa análise, critica-se pontualmente julgado da 1ª Seção do STJ). O trabalho, entretanto, destaca a excepcionalidade do (re)ajustamento da eficácia decisória, pois o precedente, geralmente, deve abarcar situações pendentes e passadas, observados determinados fundamentos técnico-jurídicos explicitados no trabalho. De lege ferenda, aborda-se o Projeto do Novo Código de Processo Civil, cujo art. 882, inc. V, objetiva instituir a prospecção de efeitos decisórios em todo o contexto jurisdicional brasileiro, especialmente no overruling. O capítulo final da tese analisa casos de modulação de decisões processuais, sugerindo sua adoção como técnica (processual) adicional para efetivação dos escopos do processo e de outros tantos princípios processuais. / This doctoral thesis advocates the application of the technique of modulation of the effects of decisions on infra-constitutional jurisdiction (prospective overruling) exercised by the Superior Court of Justice and hence its use in order to relativize precedent procedural effects. Modulation of precedents or case law is a technique used by courts to prevent retroactive effects of the (new) interpretation of law as prepared by them, thus striking consolidated situations or pending court cases. Such flexibility is commonly used to preclude a reversal of jurisprudence (i.e., an overruling) from causing harmful effects to those citizens who put their trust in the revoked precedent, using it to guide their lives and businesses. The modulation also serves to retain legal situations perpetrated based on a law that was only later declared unconstitutional or illegal by a higher court. The thesis starts showing the historical development of the restructuring effects of decision-making in Brazil, from its implementation on constitutional jurisdiction under the control of the Supreme Court (as analyzed within the context of the art. 27 of Law 9.868/99). Afterwards, it comes to defend the modulation of precedents also in infraconstitutional jurisdiction, as practiced by the Superior Court of Justice, drawing initially a parallel with foreign law. It continues by providing groundings to prove the thesis, explaining that, in some cases, judge-made law is equal to the legal norm (creative function of the judicial decision) and therefore deserves its effectiveness prospected in time, as occurs with the ordinary law (application pro futuro, cf. art. 5th, inc. XXXVI, CF and art. 6, LICC) in order to preserve legal certainty and so many other relevant constitutional principles (on occasion of this analysis, criticism is exemplarily made on o judgment by the 1st Section of the STJ). The paper, however, highlights the uniqueness of the (re)adjustment of effectiveness, because the precedent should generally encompass situations pending and past, technical legal grounds observed. De lege ferenda, the thesis addresses the design of the New Code of Civil Procedure, whose art. 882, inc. V, aims to establish the prospection of decisionmaking effects throughout the whole Brazilian judicial context, especially in overruling. The final chapter of the thesis is devoted to analyze cases of modulation of procedural decisions and to suggest its adoption as additional (procedural) technique in order to implement the scopes of the process as well as many other procedural principles.

En chirurgie, les critères d’évaluation des soins sont surtout relatifs à la technique et à la biologie, et les facteurs psychologiques et sociaux sont peu présents. En particulier, la subjectivité du chirurgien et son rôle dans les soins prodigués sont des aspects peu étudiés, malgré (i) un taux de burnout des chirurgiens proche de 40%, (ii) la singularité du chirurgien (son expérience, sa personnalité, ses choix de prise en charge, etc.), variable clé dans les soins prodigués (comme le psychothérapeute en psychothérapie), (iii) l’environnement social et culturel particulier dans lequel travaillent les chirurgiens. L’objectif de cette thèse est d’explorer les facteurs psychosociaux qui peuvent influencer la pratique de la chirurgie et le bien-être des chirurgiens. Trois études ont été menées. La première est une revue systématique de la littérature qualitative (méta-synthèse) portant sur comment les chirurgiens vivent leur pratique. A l’issue de la première étude, nous avons approfondi les résultats au travers d’une étude qualitative sur l’expérience émotionnelle des chirurgiens hépatobiliaires (chirurgie à haut risque ; surtout oncologique). Une troisième étude prospective de cohorte s’est intéressée à la détermination de l’influence des facteurs psychologiques du patient (dépression et anxiété) sur l’outcome de la chirurgie hépatique, et a permis d'explorer comment les chirurgiens prennent en compte ces facteurs dans leur pratique. Nous avons discuté les implications de nos résultats par rapport à la santé mentale et aux burnouts des chirurgiens, ainsi que par rapport à la mise en œuvre du modèle bio-psycho- social dans les soins des patients chirurgicaux. / In surgery, psychological and social factors are not widely studied, and the only variables considered important in surgical care are those related to operating technique and biology. Additionally, surgeons’ experience of their practice is neglected, despite the fact that (i) epidemiological studies showed a 40% burnout rate among surgeons, (ii) the difference between individual surgeons is a key variable in the performed care (like psychotherapists in psychotherapy), and (iii) surgeons work in a high salient social and cultural environment. The aim of this PhD thesis is to explore the psychosocial factors influencing surgical practice and surgeons’ wellbeing. Our findings are based on three studies. First, we performed a systematic review of international qualitative studies (metasynthesis) in order to describe how surgeons experience their practice from their perspective. Then, a second qualitative study extended the findings of the previous one exploring in-depth the everyday emotional experience of liver surgeons (high risk surgery, mainly cancer-related). Finally, a prospective cohort study investigated the influence of preoperative patient-related psychological factors (depression and anxiety) on the outcome of liver surgery, and how surgeons take these data into account in their practice. Several implications of our findings have been discussed, concerning surgeons’ mental wellbeing and burnout, as well as the implementation of the bio-psycho-social model in the care of surgical patients.

Les vitamines B et les facteurs liés au métabolisme monocarboné (C1) aident à maintenir la synthèse de l'ADN, régulent l'expression des gènes, et peuvent affecter le risque de cancer. L'objectif général de cette thèse est d'étudier l'importance des biomarqueurs du C1 dans l'étiologie de trois cancers distincts qui diffèrent dans leur force d'association avec le tabagisme. Les articles inclus dans cette thèse ont été conduits au sein de deux études prospectives : l'étude prospective européenne sur la nutrition et le cancer (EPIC) et le consortium de cohortes du cancer du poumon (LC3). Dans l'article 1, nous avons étudié la relation entre les biomarqueurs du C1 et l'incidence ainsi que le pronostic du cancer de la sphère oto-rhino-laryngée (ORL) et de l'oesophage au sein de l'étude EPIC. Nous avons observé que les sujets ayant des concentrations élevées d'homocystéine avaient un risque accru de développer un cancer de la sphère ORL. Dans l'article 2, nous avons examiné la relation entre les biomarqueurs du C1 et l'incidence ainsi que le pronostic du carcinome à cellules rénales (CCR) au sein de l'étude EPIC. Nous avons constaté que les participants ayant des concentrations de vitamine B6 élevées avaient une diminution du risque de CCR avec un effet dose-réponse ainsi qu'une amélioration de la survie post-diagnostic. Dans l'article 3, nous avons étudié si les biomarqueurs du C1 sont associés au risque de cancer du poumon au sein de l'étude LC3. Dans l'ensemble, nous avons mis en exergue une faible association inverse, sans tendance claire, entre les concentrations de vitamine B6 et de folate et le risque du cancer du poumon. La principale conclusion de nos études est que les concentrations élevées de vitamine B6 sont associées à un risque plus faible de développer un CCR, et également à un meilleur pronostic chez les patients atteints de cette pathologie. Davantage d'études sont nécessaires afin d'évaluer si la vitamine B6 exerce une influence causale sur l'étiologie et la mortalité du CCR, ou si d'autres facteurs métaboliques sont impliqués / B-vitamins and factors related to one-carbon metabolism (OCM) pathway help to maintain DNA synthesis and regulate gene expression and may affect cancer risk. The overarching aim of this thesis is to investigate the importance of OCM biomarkers in the etiology of three distinct cancer sites that differed in their strength of association with smoking. Papers included in this thesis were conducted within two prospective studies, the European Prospective Investigation into nutrition and Cancer (EPIC) study and the Lung Cancer Cohort Consortium (LC3). In paper 1, we investigated if OCM biomarkers are associated with incidence and survival of cancer of the head and neck and esophagus in the EPIC study. We observed that subjects with higher concentrations of homocysteine had increased risk of developing head and neck cancer. In paper 2, we investigated if OCM biomarkers are associated with incidence and survival of renal cell carcinoma (RCC) in the EPIC study. We observed that study subjects with elevated vitamin B6 concentrations had lower risk of RCC in a dose-response fashion and improved survival following diagnosis. In paper 3, we investigated whether OCM factors are associated with lung cancer risk in the LC3 study. Overall, we observed a weak inverse association, with no clear trend, between concentrations of vitamin B6 and folate and risk of lung cancer. The most important conclusion is that elevated vitamin B6 concentrations are associated with lower risk of developing RCC, and also better prognosis among RCC cases. Further studies are warranted to evaluate if vitamin B6 exerts a causal influence on RCC etiology and mortality, or if other metabolic factors are involved

A presente tese de doutorado defende a aplicação da técnica de modulação de efeitos das decisões na jurisdição infraconstitucional exercida pelo Superior Tribunal de Justiça e, consequentemente, sua utilização para relativizar efeitos precedentes processuais. A modulação de precedentes ou jurisprudência é uma técnica adotada pelos tribunais para evitar que a (nova) interpretação do direito por eles elaborada tenha efeitos retroativos e, assim, atinja situações consolidadas ou casos judiciais pendentes. Essa flexibilização é comumente utilizada para evitar que uma reviravolta jurisprudencial (i.e., um overruling) cause efeitos danosos àqueles cidadãos que depositaram confiança no precedente revogado, por ele pautando suas vidas e negócios. A modulação serve também para conservar situações jurídicas perpetradas com base em uma lei que veio ser, apenas posteriormente, declarada inconstitucional ou ilegal por um tribunal superior. A tese inicia demonstrando o desenvolvimento histórico da reestruturação de efeitos decisórios no Brasil, a partir de sua implementação na jurisdição constitucional sob controle do Supremo Tribunal Federal (analisa-se, dentro do contexto, o art. 27 da Lei 9.868/99). Passa-se, então, o trabalho a defender a modulação de precedentes também na jurisdição infraconstitucional praticada pelo Superior Tribunal de Justiça, fazendo, em primeiro lugar, um paralelo com o direito estrangeiro. Na sequência, o estudo traz fundamentos para comprovar a tese, explicando que a jurisprudência equivale, em certos casos, à norma legal (função criativa da decisão judicial) e, portanto, merece ter sua eficácia prospectada no tempo, tal como ocorre com a lei ordinária (aplicação pro futuro, cf. art. 5º, inc. XXXVI, CF e art. 6º, LICC), a fim de preservar a segurança jurídica e outros tantos relevantes princípios constitucionais (no ensejo dessa análise, critica-se pontualmente julgado da 1ª Seção do STJ). O trabalho, entretanto, destaca a excepcionalidade do (re)ajustamento da eficácia decisória, pois o precedente, geralmente, deve abarcar situações pendentes e passadas, observados determinados fundamentos técnico-jurídicos explicitados no trabalho. De lege ferenda, aborda-se o Projeto do Novo Código de Processo Civil, cujo art. 882, inc. V, objetiva instituir a prospecção de efeitos decisórios em todo o contexto jurisdicional brasileiro, especialmente no overruling. O capítulo final da tese analisa casos de modulação de decisões processuais, sugerindo sua adoção como técnica (processual) adicional para efetivação dos escopos do processo e de outros tantos princípios processuais. / This doctoral thesis advocates the application of the technique of modulation of the effects of decisions on infra-constitutional jurisdiction (prospective overruling) exercised by the Superior Court of Justice and hence its use in order to relativize precedent procedural effects. Modulation of precedents or case law is a technique used by courts to prevent retroactive effects of the (new) interpretation of law as prepared by them, thus striking consolidated situations or pending court cases. Such flexibility is commonly used to preclude a reversal of jurisprudence (i.e., an overruling) from causing harmful effects to those citizens who put their trust in the revoked precedent, using it to guide their lives and businesses. The modulation also serves to retain legal situations perpetrated based on a law that was only later declared unconstitutional or illegal by a higher court. The thesis starts showing the historical development of the restructuring effects of decision-making in Brazil, from its implementation on constitutional jurisdiction under the control of the Supreme Court (as analyzed within the context of the art. 27 of Law 9.868/99). Afterwards, it comes to defend the modulation of precedents also in infraconstitutional jurisdiction, as practiced by the Superior Court of Justice, drawing initially a parallel with foreign law. It continues by providing groundings to prove the thesis, explaining that, in some cases, judge-made law is equal to the legal norm (creative function of the judicial decision) and therefore deserves its effectiveness prospected in time, as occurs with the ordinary law (application pro futuro, cf. art. 5th, inc. XXXVI, CF and art. 6, LICC) in order to preserve legal certainty and so many other relevant constitutional principles (on occasion of this analysis, criticism is exemplarily made on o judgment by the 1st Section of the STJ). The paper, however, highlights the uniqueness of the (re)adjustment of effectiveness, because the precedent should generally encompass situations pending and past, technical legal grounds observed. De lege ferenda, the thesis addresses the design of the New Code of Civil Procedure, whose art. 882, inc. V, aims to establish the prospection of decisionmaking effects throughout the whole Brazilian judicial context, especially in overruling. The final chapter of the thesis is devoted to analyze cases of modulation of procedural decisions and to suggest its adoption as additional (procedural) technique in order to implement the scopes of the process as well as many other procedural principles.

Lévolution des modes de vie conduit à une évolution des besoins et des souhaits des personnes, en quête «d'expérience », de « bien-être » et de « plaisir » à travers les produits qu'elles utilisent. Les entreprises doiventaujourd'hui satisfaire et séduire ces personnes de plus en plus exigeantes, en étant source d'innovation et denouveauté. Ainsi, elles s'intéressent de plus en plus dans leur démarche de conception de produits à une meilleureprise en compte du facteur humain. Faire vivre aux personnes des expériences positives et de qualité, demandeune démarche spécifique qui les placent au centre des préoccupations des acteurs-métier de la conception deproduits. Dans ce contexte, le processus de conception requiert l'intervention de différentes disciplines sensiblesjustement au facteur humain. Ainsi dans le cadre de nos travaux de recherche, nous nous sommes intéressés aurapprochement de l'ergonomie et du design, deux disciplines sensibles aux personnes qui évoluent vers denouvelles pratiques : le design pour « des besoins » et l'ergonomie prospective. Nous axons nos travaux derecherche sur les pratiques de ces deux disciplines qui convergent vers une vision commune, prospective et «humaniste » de la conception de produits, pour une meilleure prise en compte des personnes. Le principal enjeuscientifique de notre travail est de mieux cerner les pratiques actuelles, de l'ergonomie et du design dans uncontexte de conception de produits. Ceci, pour proposer à ces acteurs-métier une démarche (IDLifeS) et des outils(Guides de Connaissances), interdisciplinaires, qui correspondent à l'évolution de leurs pratiques respectives et quileur permettent de co-concevoir des produits et des situations de vie qui correspondent aux besoins, aux souhaits etaux caractéristiques des personnes. / Lifestyles change led to the development of the needs and wishes of people who are looking for "experience", "wellbeing"and "pleasure" through the products they use. Companies must now satisfy and seduce these people whoare increasingly exigent, by being a source of innovation and new ideas. Thus, companies are more and moreinterested in their product design process, in order to better take into account, the human factor. It requires aspecific approach to make people have positive and quality experiences. In this approach, people are at the heart ofthe concerns of the product design actors. In this context, the design process requires the intervention of differentdisciplines rightly sensitive to human factor. In our research, we focused on ergonomics and design, two disciplinessensitive to people who are moving towards new practices: design for "needs" and the prospective ergonomics. Ourresearch is focus on the practices of these two disciplines that converge on a common vision, which is a prospectiveand "humanist" one, of the product design for a better integration of people. The main scientific challenge of ourwork is to better understand ergonomics and design current practices in a product design context. This, to suggestto these actors an approach (IDLifeS) and tools (Knowledge Guides), interdisciplinary, which correspond to thedevelopment of their practices and offer them to co-design products and life situations which correspond to theneeds, wishes and characteristics of people.