Dans le colloque singulier, désormais désacralisé du soignant avec son patient, la charge responsabilisante pesant sur l’activité des praticiens médicaux n’a cessé de croître ces dernières décennies dans une société où les questions de santé sont prépondérantes. Exercée au sein d’un ordre social complexe et technique qui pose un principe d’intangibilité du corps humain, simultanément but et objet de la pratique médicale, cette dernière est susceptible d’engager la responsabilité pénale du praticien médical en raison de sa faute pénale non-intentionnelle. Or malgré le particularisme évident de l’activité médicale et alors que l’on peut redouter un phénomène de judiciarisation qui conduirait les praticiens médicaux de plus en en plus souvent devant les juridictions répressives, la responsabilité pénale du praticien médical ayant commis une faute non-intentionnelle est engagée selon les dispositions du droit pénal commun et selon le principe d’une culpabilité non-intentionnelle dérogatoire au primat de l’intention en droit pénal. En matière de responsabilité pénale, on ne cherche pas seulement le responsable d’une faute, mais le coupable d’un crime ou d’un délit. Ce constat invite à se demander si un praticien médical qui se verrait poursuivi en raison d’une faute médicale non-intentionnelle ayant entrainé le décès ou les blessures involontaires de son patient, a la faculté de prévoir les suites judiciaires et d’organiser efficacement sa défense. L’étude de cette question met en lumière un texte insuffisant, d’essence interprétative, reposant sur une culpabilité non-intentionnelle dans laquelle l’élément moral pourtant théoriquement nécessaire à la caractérisation infractionnelle mais si ténu, relève d’une fiction juridique. De fait, se pose la question de l’existence même d’une culpabilité en cas de faute non-intentionnelle. Ainsi, fragile en son principe et critiquable dans sa rédaction, le droit commun relatif à la faute non-intentionnelle conduit à une responsabilité du praticien médical exorbitante. Les travaux de recherche mettent en évidence un droit prétorien contingent des composantes de la faute pénale non-intentionnelle et notamment de ses composantes causales par l’effet d’une approche jurisprudentielle volontariste, créative et affranchie du texte. L’analyse révèle aussi une appréhension de la faute pénale médicale qui dépend de l’expertise médicale, légitime substantiellement mais illégitime au plan processuel car insuffisamment contradictoire. De sorte que ces deux caractéristiques de l’appréhension judiciaire de la faute pénale médicale permettent d’envisager l’opportunité d’une évolution légale. / In a society where the issues of health are prominent, the doctor-patient bond is now desecrated as the load of responsibility bearing on the activity of medical practitioners has not stopped growing these last decades.Exercising within a complex and technical social order that puts a principle of intangibility on the human body, simultaneously purpose and object of medical practice, the penal responsibility of medical practitioners may be engaged even if the penal fault was non intentional.Yet, in spite of the particularism of the medical activity, and whilst we could fear a phenomenon of judicialisation which could lead medical practitioners to be more often in the forefront of the repressive judicial system, the penal responsibility of the medical practitioner who has committed a non-deliberate fault is engaged according to common rules and the principle of a non-deliberate guilt that represents an exception in criminal law.In terms of penal responsibility, not only do we look for someone responsible of a fault, but also the culprit guilty of a crime or an offence.This observation raises the question: does a medical practitioner, pursued on the basis of a non-deliberate médical fault leading to the death or injury of his / her patient, have the faculty to foresee the judicial consequences and to effectively organise his / her defence.The study of this issue highlights an insufficient text, interpretative by nature, based on a non-deliberate guilt in which the moral element, theoretically necessary to fully characterise the offence, is a legal fiction.De facto, one can therefore query the very essence of guilt in case of a non-intentional offence.Thus, fragile in its principle and questionable in its wording, common criminal law relative to a non-deliberate fault has led to an exorbitant responsibility placed upon medical practitioners.Research has put forward evidence of a contingent of praetorian law with components of non-deliberate faults, and notably the causal components through a jurisprudential approach which is not only pro-active and creative but also liberated from the text.The analysis also reveals an apprehension of the penal medical fault which would depend on the medical expertise, substantially legitimate, but considered illegitimate from the criminal proceedings point of view as it is deemed insufficiently contradictory.These two characteristics of the judicial apprehension of the medical penal fault could allow us the possibility to envisage a legal evolution.

Mucosal passive immunization is the transfer of active antibodies from one organism to the mucosal surfaces of another organism for preventing or treating infectious diseases. Mucosal passive immunization has a great potential for the prevention and treatment of enteric infections like Rotavirus, which causes more than 114 million episodes of diarrhoea annually with a death toll of more than 450.000 per year. However, the high cost of recombinant antibodies with the current manufacturing systems based on mammalian cells hampers the production of the high antibody quantities required for passive immunization strategies. Alternative expression platforms such as plants could provide higher scalability and reduced costs. Moreover, the use of edible plant organs, which are Generally¿Regarded¿As¿ Safe (GRAS), could reduce manufacturing costs even further by easing the requirements for antibody purification. We analyze here the feasibility of utilizing fruits as inexpensive biofactories of human antibodies that can be orally delivered as crude extracts or partially purified formulations in mucosal passive immunization strategies. In the first section of this thesis, the construction of tomato plants producing a model human Immunoglobulin A (IgA) against rotavirus in their fruits is described. As a result, an elite homozygous line was obtained whose fruits produced on average 41 ¿g of IgA per gram of fresh weigh, equivalent to 0.69 mg IgA per gram of dry tomato powder. Minimally processed products derived from IgA¿expressing tomatoes were shown to strongly inhibit virus infection in an in vitro neutralization assay. Moreover, in order to make IgA¿expressing tomatoes easily distinguishable from wild¿type tomatoes, they were sexually crossed with a transgenic tomato line expressing the genes encoding Antirrhinum majus Rosea1 and Delila transcription factors, which confer purple colour to the fruit. The resulting transgenically¿labelled purple tomatoes contained not only high levels of recombinant neutralizing human IgA but also increased amounts of anthocyanins. In the second section of the thesis the composition of IgA¿expressing tomatoes was analyzed in search of possible unintended effects that could compromise the GRAS status of the final product. To this end, transgenic IgA¿tomatoes were compared with wild type tomatoes and also commercial tomato varieties using proteomic and metabolomic approaches. 2D¿DIGE gels coupled with LC¿MSMS for protein identification showed that all the uptrend differential proteins detected corresponded only to immunoglobulin chains or antibody fragments. On the other hand, non¿targeted metabolite data obtained by UPLC¿MS / Juárez Ortega, P. (2014). Production of recombinant Immunoglobulin A in plants for passive immunotherapy [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/37015 / TESIS

Many of the sustainability challenges our society currently face have arisen as unanticipated side effects of our own modern developments. This thesis investigates if unintended consequences and perspectives are fully addressed by traditional methods for providing decision-making support within the sustainability domain. For that purpose, Systems Thinking is utilised in three cases: in the first, Systems Thinking is used to analyse sustainability issues relating to the current product design paradigm. In the second case, Systems Thinking is applied to two product systems – household washing machines and conventional passenger vehicles. The third case discusses different stakeholder perspectives in environmental decision-making and proposes a way to combine the ESA tools LCA, LCC and CBA in order to consider the different stakeholder perspectives. Results of the first case point out that the practices within the current design paradigm are focused on innovations and improvements in material and energy efficiency. These practices have led to the following unintended consequences: consumption rebound effects, increased waste, pollution, negative externalities, economic inequalities and other environmental and social negative impacts. These unintended consequences are represented in a Causal Loop Diagram (CLD). The diagram graphically illustrates how these unintended consequences influence one another and interact by means of cause-effect linkages and reinforcing feedback loops. A novel conceptual framework named Sustainability-Driven Systems-Oriented Design is proposed to work within broader system boundaries in order to address possible negative side effects that micro-level gains could have on macro-level losses. In the case of the two product systems, a CLD for household washing machines and conventional passenger vehicles is developed. The CLDs represent how selected variables interact by means of cause-effect associations to affect environmental impacts of the products. The CLD technique appears to be a useful way to connect quantitative assessment (from Life Cycle Assessment) with qualitative analysis (from Systems Thinking). In the third case it is argued that stakeholders tend to adopt different system boundaries and make assumptions according to their perspective when they use ESA tools in environmental decision-making. A way to combine ESA tools is suggested to facilitate the observation of the environmental decision from different viewpoints. It concludes, to some extent, that traditional methods for providing decision-making support can handle certain parameters that may result in unintended consequences. Systems Thinking may assist in the process of performing qualitative analyses of what is important to consider in order to strengthen the robustness of, and improve on the recommended actions from, quantitative detailed analyses. / <p>QC 201305330</p>

Indiana University-Purdue University Indianapolis (IUPUI) / Birth mothers of open adoption are not well studied. This inquiry explored birth mothers’ experiences surrounding unintended pregnancy and infant open adoption placement. The focused objective was to describe adolescent birth mothers’ lives following pregnancy and adoption placement. This qualitative study used naturalistic inquiry, with participants giving 1 to 2 hour tape recorded telephone interviews. Verbatim transcripts were de-identified and systematically analyzed. Birth mother samples were at either 1 to 5 years or 5 to 15 years after infant open adoption placement. Overall both samples chronicled stories from preconception through current life. Birth mothers of both samples were unanimous in their support of open adoption. The sample of 10 birth mothers who were interviewed 1 to 5 years postplacement shared life descriptions from prepregnancy; pregnancy with the decision for open adoption placement and choice of adoptive family; birth in context with the adoptive parents and birth child; postpartum and discharge. Postplacing birth mother findings were presented using the acronym AFRESH: A–adoption accomplishments; F–fresh start; R–relationships; E–emotions; S–support; H–healing. Personal, social, and relational benefits of open adoption far outweighed pregnancy, birth, and emotional challenges. Even though the process and outcome were “hard,” and included personal obstacles, the open adoption placement was “best.” Birth children were viewed as thriving, blossoming, and having a wonderful life. Adoptive families were cherished like those of extended family. Birth mothers thought health care providers should share the option, and then provide adoption friendly care. They also would advise pregnant teens to choose open adoption. Results from the 5 to 15 years postplacement sample of 5 birth mothers yielded themes of (1) satisfaction about decision for open adoption, choice of adoptive couple, and seeing a thriving birth child; (2) personal milestone accomplishments in education, finances, work, life, and relationships; (3) a sustaining sense of being a better person with an improved life; and (4) the essential need for support during and after the process.

Hateful language is a growing problem in digital spaces. Human moderators are not enough to eliminate the problem. Automated hateful language detection systems are used to aid the human moderators. One of the issues with the systems is that their performance can differ depending on who is the target of a hateful text. This project evaluated the performance of the two systems (Perspective and Hatescan) with respect to who is the target of hateful texts. The analysis showed, that the systems performed the worst for texts directed at women and immigrants. The analysis involved tools such as a synthetic dataset based on the HateCheck test suite, as well as wild datasets created from forum data. Improvements to the test suite HateCheck have also been proposed. / Hatiskt språk är ett växande problem i digitala miljöer. Datamängderna är för stora för att enbart hanteras av mänskliga moderatorer. Automatiska system för hatdetektion används därför som stöd. Ett problem med dessa system är att deras prestanda kan variera beroende på vem som är målet för en hatfull text. Det här projektet evaluerade prestandan av de två systemen Perspective och Hatescan med hänsyn till olika mål för hatet. Analysen visade att systemen presterade sämst för texter där hatet riktades mot kvinnor och invandrare. Analysen involverade verktyg som ett syntetiskt dataset baserat på testsviten HateCheck och vilda dataset med texter inhämtade från diskussionsforum på internet. Dessutom har projektet utvecklat förslag på förbättringar till testsviten HateCheck.

<p>The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial. </p><p>Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).</p>

Introduction: En réponse aux exigences du gouvernement fédéral en ce qui concerne les temps d'attente pour les chirurgies électives d’hanche et du genou, les Organismes Canadiens de santé ont adopté des stratégies de gestion pour les listes d'attente. Cependant, il n'existe pas actuellement aucune information disponible concernant les effets imprévus, positive ou négative, de ces stratégies. Méthodologie: Un modèle qui a été construit est tombé en panne la gestion de la chirurgie d’hanche et du genou en différentes étapes, afin d'identifier les effets imprévus possibles pour chaque étape; le modèle a été validé auprès d'un panel d'experts. Cette étude a choisi quatre études de cas en fonction de leur durabilité: un cas qui a été durable, un cas qui a été modérément durable, et deux cas peu probable d'être durable. Dans cette étude qualitative, nous avons mené 31 entretiens semi-structurés entre Novembre 2010 et Juin 2011 avec les gestionnaires, les infirmières, les thérapeutes et les chirurgiens impliqués dans la gestion des stratégies du temps d’attente pour les chirurgies électives d’hanche et du genou. Les quatre cas ont été sélectionnés à partir de trois provinces / régions. Nous avons analysé les conséquences non intentionnelles aux niveaux systémique et organisationnelle en utilisant les stratégies dans chaque contexte. Enregistrements des entrevues ont été transcrits mot à mot et soumis à l'analyse du cadre. Résultats: Les effets négatifs sont la précarité des stratégies en raison du non-récurrente financement, l'anxiété chez les patients qui ne sont pas prêts pour la chirurgie, une redistribution du temps de chirurgie vers l’orthopédie au détriment des autres interventions chirurgicales, tensions entre les chirurgiens et entre les orthopédistes et anesthésistes, et la pression sur le personnel dans le bloc opératoire et postopératoire. Conclusion: La stratégie d’implémentation aux niveaux national et local devrait prendre en compte les conséquences potentielles, positives et négatives. Il y a des conséquences inattendues à chaque niveau de l'organisation des soins de santé. Individuellement et collectivement, ces conséquences peuvent positivement et négativement affecter les résultats. Par conséquent, la planification de la santé doit analyser et prendre en compte les conséquences inattendues en termes de bonnes résultats inattendues, compromis et les conséquences négatives afin d'améliorer les résultats. / Introduction: In response to federal government requirements regarding wait times for elective hip and knee surgeries, Canadian healthcare organizations have adopted wait list management strategies. However, there is currently no information available regarding the unanticipated effects, positive or negative, of these strategies. Methodology: A model was constructed that broke down the management of elective hip and knee surgery into different steps, in order to identify the unanticipated potential effects for each step; the model was validated with a panel of experts. This study chose four case studies based on their sustainability: one case that was sustainable, one case that was moderately sustainable, and two cases considered unlikely to be sustainable. In this qualitative study, we conducted 31 semi-structured interviews between November 2010 and June 2011 with managers, nurses, therapists and surgeons involved in wait time management strategies for hip and knee surgeries. The four cases were selected from three provinces/areas. We analyzed potential unintended consequences at the systemic and organizational levels of using these strategies in each setting. Interview recordings were transcribed verbatim and subjected to framework analysis. Results: Negative effects were the strategies’ precariousness due to non-recurrent funding, anxiety in patients not ready for surgery, a redistribution of surgical time toward orthopaedics at the expense of other surgeries, tensions between surgeons and between orthopaedic surgeons and anaesthesiologists, and significant pressure on personnel in the operating suite and in post-operative care. Conclusions: Strategy implementation at the national and local levels should take into consideration any potential consequences, positive and negative. There are unintended consequences at each level of healthcare organization. Individually and jointly, these consequences can positively and negatively affect outcomes. Therefore, health planning should analyze and take into account unintended consequences in terms of serendipities, trade-offs and negative consequences in order to improve results.

The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial. Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).

Introduction: En réponse aux exigences du gouvernement fédéral en ce qui concerne les temps d'attente pour les chirurgies électives d’hanche et du genou, les Organismes Canadiens de santé ont adopté des stratégies de gestion pour les listes d'attente. Cependant, il n'existe pas actuellement aucune information disponible concernant les effets imprévus, positive ou négative, de ces stratégies. Méthodologie: Un modèle qui a été construit est tombé en panne la gestion de la chirurgie d’hanche et du genou en différentes étapes, afin d'identifier les effets imprévus possibles pour chaque étape; le modèle a été validé auprès d'un panel d'experts. Cette étude a choisi quatre études de cas en fonction de leur durabilité: un cas qui a été durable, un cas qui a été modérément durable, et deux cas peu probable d'être durable. Dans cette étude qualitative, nous avons mené 31 entretiens semi-structurés entre Novembre 2010 et Juin 2011 avec les gestionnaires, les infirmières, les thérapeutes et les chirurgiens impliqués dans la gestion des stratégies du temps d’attente pour les chirurgies électives d’hanche et du genou. Les quatre cas ont été sélectionnés à partir de trois provinces / régions. Nous avons analysé les conséquences non intentionnelles aux niveaux systémique et organisationnelle en utilisant les stratégies dans chaque contexte. Enregistrements des entrevues ont été transcrits mot à mot et soumis à l'analyse du cadre. Résultats: Les effets négatifs sont la précarité des stratégies en raison du non-récurrente financement, l'anxiété chez les patients qui ne sont pas prêts pour la chirurgie, une redistribution du temps de chirurgie vers l’orthopédie au détriment des autres interventions chirurgicales, tensions entre les chirurgiens et entre les orthopédistes et anesthésistes, et la pression sur le personnel dans le bloc opératoire et postopératoire. Conclusion: La stratégie d’implémentation aux niveaux national et local devrait prendre en compte les conséquences potentielles, positives et négatives. Il y a des conséquences inattendues à chaque niveau de l'organisation des soins de santé. Individuellement et collectivement, ces conséquences peuvent positivement et négativement affecter les résultats. Par conséquent, la planification de la santé doit analyser et prendre en compte les conséquences inattendues en termes de bonnes résultats inattendues, compromis et les conséquences négatives afin d'améliorer les résultats. / Introduction: In response to federal government requirements regarding wait times for elective hip and knee surgeries, Canadian healthcare organizations have adopted wait list management strategies. However, there is currently no information available regarding the unanticipated effects, positive or negative, of these strategies. Methodology: A model was constructed that broke down the management of elective hip and knee surgery into different steps, in order to identify the unanticipated potential effects for each step; the model was validated with a panel of experts. This study chose four case studies based on their sustainability: one case that was sustainable, one case that was moderately sustainable, and two cases considered unlikely to be sustainable. In this qualitative study, we conducted 31 semi-structured interviews between November 2010 and June 2011 with managers, nurses, therapists and surgeons involved in wait time management strategies for hip and knee surgeries. The four cases were selected from three provinces/areas. We analyzed potential unintended consequences at the systemic and organizational levels of using these strategies in each setting. Interview recordings were transcribed verbatim and subjected to framework analysis. Results: Negative effects were the strategies’ precariousness due to non-recurrent funding, anxiety in patients not ready for surgery, a redistribution of surgical time toward orthopaedics at the expense of other surgeries, tensions between surgeons and between orthopaedic surgeons and anaesthesiologists, and significant pressure on personnel in the operating suite and in post-operative care. Conclusions: Strategy implementation at the national and local levels should take into consideration any potential consequences, positive and negative. There are unintended consequences at each level of healthcare organization. Individually and jointly, these consequences can positively and negatively affect outcomes. Therefore, health planning should analyze and take into account unintended consequences in terms of serendipities, trade-offs and negative consequences in order to improve results.

The aim of the study was to develop strategies to reduce the unmet need for modern contraception among agro-pastoral women. The objectives of the study were to determine the prevalence of unmet need for modern contraception, determine the factors associated with unmet need for modern contraception, and explore the barriers that hindered agro-pastoral women from using modern contraception. A mixed-method research design was used to conduct the study. Data were collected from agro-pastoral women and family planning service providers. Questionnaire and individual in-depth interviews were used to collect the data. The validity and reliability of the quantitative data and trustworthiness of the qualitative data were ensured. Use of standard data collection tools, employing method and data triangulation, and documenting all the procedures of data collection and analysis were among the ways employed to do so The quantitative data were analysed using simple descriptive statistics and multivariate logistic regression. Thematic analysis was employed to analyse the qualitative data. Ethical principles of research such as beneficence, justice, informed consent, respect for persons, privacy and confidentiality and scientific integrity were considered to conduct the study. The study revealed an unmet need of 29.2% (n=112) for modern contraception among agro-pastoral women. The unmet need for birth spacing constituted 21.1% (n=81), whereas the unmet need for birth limiting was 8.1% (n=31). The age of the women, the number of living children, knowledge of modern contraceptive methods, and knowledge of FP service centres were found to be associated with women‘s unmet need for modern contraception. Lack of time and money, lack of knowledge about modern contraception, and fear of side effects were the major individual-level barriers. There were also culture-related factors such as the need for many children that hindered agro-pastoral women from using modern contraception. Moreover, the study disclosed that religious unacceptability and husband‘s and relatives‘ opposition were also among the mentioned barriers. The quality of FP service provision in terms of the competence and behaviour of health service providers, unavailability and inaccessibility of FP service, were also indicated as barriers. The findings informed the development of strategies to reduce agro-pastoral women‘s unmet needs for modern contraception in Eastern Ethiopia. The study further recommended that the health bureaus of the region, zone and district collaborate in ensuring that agro-pastoral women realise the significance of the provision of accessible, equitable, quality modern contraception. It is also essential to equip health facilities with qualified health service providers and necessary facilities. Religious leaders should be involved in disseminating vital, relevant and empowering FP information. / Health Studies / Ph. D. (Public Health)