Une analyse des limites inhérentes au nouveau régime des directives médicales anticipées face à l'essor du droit à l'autonomie décisionnelle du patient

Résumé : La Loi concernant les soins de fin de vie ainsi que la mise en place du régime des directives médicales anticipées sont le résultat d’une profonde transformation sociétale, guidée par l’importance grandissante du respect de l’autonomie décisionnelle des personnes et à leur droit à l’autodétermination. Au regard de ce contexte, cet essai décrit en première partie l’état du droit actuel en matière de volontés exprimées de manière anticipée, il analyse les enjeux qui s’y rapportent tout en soulevant les pistes de réflexion déjà amorcées en droit québécois. Il existe effectivement de nombreux outils qui permettent à un individu d’exprimer ses volontés en prévision de son inaptitude, mais les directives médicales anticipées se distinguent d’une façon bien précise : elles possèdent un caractère contraignant qui reconnaît la primauté des volontés relatives aux soins. Or, parallèlement à cela, le régime des directives médicales anticipées impose des limites à ce droit. Dans ce contexte d’essor du droit à l’autonomie, cet essai étudie, en seconde partie, les limites inhérentes au régime des directives médicales anticipées puis propose une analyse critique des défis liés à l’opérationnalisation clinique de ces directives.

Plan promocional para incentivar y desarrollar mercado de productos a base de plantas medicinales, elaborados por la Asociación cooperativa de productores agropecuarios Telegüisil de R.L., del cantón San Lucas del municipio de Cuisnahuat, departamento de Sonsonate.

En la actualidad los productos elaborados a base de plantas medicinales no son muy conocidos, ya que sus productores por lo general carecen de los mecanismos adecuados de promoción y comercialización, de la capacidad económica para darlos a conocer de manera efectiva en los municipios de Sonsonate y Cuisnahuat. Por las razones anteriores se diseñó un “Plan Promocional para incentivar y desarrollar mercado de productos a base de plantas medicinales, elaborados por la Asociación Cooperativa de Productores Agropecuarios Tepegüisil de R. L., del Cantón San Lucas del municipio de Cuisnahuat, Departamento de Sonsonate” que es el tema con que se identifica esta investigación. Este proyecto se llevará a cabo con el apoyo de la Asociación El Bálsamo, que tiene como objetivo contribuir al desarrollo humano sustentable y al fortalecimiento del sector microempresarial urbano y rural a través de servicios financieros sostenibles, capacitación integral y asociatividad empresarial auto gestora. La metodología de investigación que se ha utilizado está compuesta por el método científico, el tipo de investigación es descriptiva; también fuentes de investigación primarias como: los miembros de la Asociación Cooperativa Tepegüisil, el Director de Proyectos de la Asociación El Bálsamo, clientes reales y potenciales; al mismo tiempo entre las fuentes secundarias utilizadas están: documentos, libros y tesis relacionadas al tema, páginas en Internet y toda la información proporcionada por la Asociación El Bálsamo fueron de mucha importancia para conocer la situación actual de esta entidad. Mediante las encuestas y entrevistas realizadas a los miembros de la Asociación Cooperativa y al Director de Proyectos de El Bálsamo, se pudo comprobar que los productos a base de plantas medicinales que elaboran no poseen estrategias de promoción y comercialización que les permita incentivar y desarrollar el mercado. Con el propósito de establecer las herramientas de promoción y comercialización de dichos productos se propone implementar estrategias de Publicidad, Promoción de Ventas, Venta Personal y Relaciones Públicas; además utilizar el logotipo rediseñado y el eslogan denominado “lo natural en tu cabello y tu piel”.

Malséance : la mort et l'image dans le (méta)théâtre de Samuel Beckett et de Jean Genet

Both ludic and macabre, the theatrical works of Samuel Beckett and Jean Genet are a paradox to behold. Indeed, as this thesis seeks to illustrate, despite their vastly differing aesthetics, at the core of each playwright’s stage productions is a tension between the characters’ yearning for silence and invisibility, and the continual creation of an often humorous, chaotic, exaggerated or theatrical image that depicts this very longing. Seeking an impossible intersection between their image and their death, they are trapped in a double bind that guarantees aesthetic failure. In order to grasp the close, yet delicate, relationship between the image of death and the death of the image, as presented in the plays of Beckett and Genet, we will explore how the characters’ creative processes deflate the very images — both visual and auditory — that they create. More specifically, we will examine how mimesis both liberates and confines the characters; while the symbolic realm provides the only means of self-representation, it is also a source of profound alienation and powerlessness, for it never adequately conveys meaning. Thus, body, gesture, language and voice are each the site of simultaneous and ceaseless reappearance and disappearance, for which death remains the only (aporetic) cure. Struggling against theatrical form, which demands the actors’ and the audience’s physical presence, both playwrights make shrewd use of metatheatre to slowly empty the stage and thereby suggest the impending, yet impossible, erasure of their characters.

“È per un bambino o una bambina?” Stereotipi di genere nella letteratura per l'infanzia: proposta di traduzione di due albi illustrati

The aim of this dissertation is to propose a translation into Italian of two American picturebooks: Is That For a Boy or a Girl? written by S. Bear Bergman and illustrated by Rachel Dougherty, and Jacob's New Dress written by Sarah and Ian Hoffman and illustrated by Chris Case. The common thread of the two books is the critique of gender stereotypes in children’s literature and in other aspects of childhood at large, such as gender expression. The two titles were in fact selected from the bibliography created by the European project G-BOOK (Gender Identity: Child Readers and Library Collections), which was spearheaded by Centro MeTRa, an Italian research centre affiliated with the University of Bologna which aims to promote gender-positive and inclusive literature. The thesis is divided into four chapters, the first of which is devoted to a discussion of children's literature as a whole and to the analysis of the illustrated fiction subgenre, the category to which the above-mentioned volumes belong. The second chapter focuses on diversity, highlighting its key role in education and the relevant trends in publishing and translation studies. The third chapter consists of a brief presentation of the works I have chosen. Following the introduction of the plot and the biography of the authors, the chapter focuses on the analysis of the two illustrated books from a linguistic, stylistic, iconographic and commercial point of view, in preparation for translation. Finally, in the fourth chapter I present my translation proposal, complete with a commentary on the problems I encountered and the translation techniques that allowed me to overcome them.

L'adattamento culturale in Erasmus: i diversi approcci all'esperienza

Il contenuto della tesi è incentrato sul processo di adattamento che lo studente Erasmus assume al momento dell'entrata in contatto con una cultura e dei valori diversi dai propri. L’elaborato si basa sul pensiero di Berry, che ha posto l'attenzione sull'inevitabile processo di adattamento dello studente e studiato strategie con le quali quest'ultimo può confrontarsi alla diversità. Nel primo capitolo si è dapprima analizzato il fenomeno della globalizzazione e il modo in cui la società attuale si adopera ogni giorno per prendere parte al processo di trasformazione, per poi porre l'attenzione sull'università di Bologna e sui progetti di scambio che quest'ultima propone. Nel secondo capitolo si è presentata la struttura dell’intervista sottoposta a cinque studentesse Erasmus outgoing del terzo anno del corso di laurea in Mediazione Linguistica Interculturale di Forlì al fine di far emergere i dettagli principali di quanto vissuto all'estero. Nel terzo e ultimo capitolo si sono analizzati i risultati delle interviste, mettendo in relazione la teoria e la pratica. Alla luce del pensiero di Berry, si è verificato come la realtà sia strettamente relazionata con gli elementi trattati dal sociologo e come le funzionalità delle strategie di adattamento possano essere applicabili a diverse esperienze di scambio all'estero.

Evaluation of the efficacy of hydrated sodium aluminosilicate in the prevention of aflatoxin-induced hepatic cancer in rainbow trout

The use of aluminum silicates for decontaminating animal feed containing aflatoxins has yielded encouraging results in chicken and turkey poults. In contrast, very few studies have tested these substances in aquaculture. In this work, we investigated the efficacy of a trout diet containing 0.5% hydrated sodium aluminosilicate (HSAS) in protecting against contamination with aflatoxin B1. Trout were reared on these diets for one year and the experimental groups were examined monthly for hepatic presumptive preneoplastic and neoplastic lesions. Regardless of the presence of HSAS, all of the fish that received aflatoxin in their diet have shown hepatic lesions indicative of a carcinogenic process, presenting also the development of cancer in some fish. The concentration of HSAS used in this study was ineffective in preventing the onset of hepatic lesions induced by aflatoxin B1 in rainbow trout.

Genome-wide SNP genotyping highlights the role of natural selection in Plasmodium falciparum population divergence

Background: The malaria parasite Plasmodium falciparum exhibits abundant genetic diversity, and this diversity is key to its success as a pathogen. Previous efforts to study genetic diversity in P. falciparum have begun to elucidate the demographic history of the species, as well as patterns of population structure and patterns of linkage disequilibrium within its genome. Such studies will be greatly enhanced by new genomic tools and recent large-scale efforts to map genomic variation. To that end, we have developed a high throughput single nucleotide polymorphism (SNP) genotyping platform for P. falciparum. Results: Using an Affymetrix 3,000 SNP assay array, we found roughly half the assays (1,638) yielded high quality, 100% accurate genotyping calls for both major and minor SNP alleles. Genotype data from 76 global isolates confirm significant genetic differentiation among continental populations and varying levels of SNP diversity and linkage disequilibrium according to geographic location and local epidemiological factors. We further discovered that nonsynonymous and silent (synonymous or noncoding) SNPs differ with respect to within-population diversity, interpopulation differentiation, and the degree to which allele frequencies are correlated between populations. Conclusions: The distinct population profile of nonsynonymous variants indicates that natural selection has a significant influence on genomic diversity in P. falciparum, and that many of these changes may reflect functional variants deserving of follow-up study. Our analysis demonstrates the potential for new high-throughput genotyping technologies to enhance studies of population structure, natural selection, and ultimately enable genome-wide association studies in P. falciparum to find genes underlying key phenotypic traits.

NATURAL LIGHT IN PINEAPPLE (Ananas comosus L) MICROPROPAGATION

Shoot tips of Ananas comosus `Imperial were rooted in vitro under two environments (artificial and natural light) and after two months the plantlets were transferred to commercial substrate (Plantmax (R)) in a greenhouse. Plant growth and leaf anatomy were evaluated at 0, 7, 15, 30 and 60-days during acclimatization. The in vitro rooting under natural light provides better agronomic and anatomical performances of Ananas comosus plants, with the benefit of saving electric energy for artificial lumination in vegetal tissue culture laboratories.

EVALUATION OF DICLORAN`S CONTRIBUTION TO THE MUTAGENIC ACTIVITY OF CRISTAIS RIVER, BRAZIL, WATER SAMPLES

2,6-Dichloro-4-nitroaniline (dicloran) is a mutagenic aromatic amine used as an agricultural fungicide and in the synthesis of disperse dyes. It is a known mutagen (Salmonella/microsome assay) in strains TA98 and TA100. Dicloran was initially detected, but not quantified, in the Cristais River, Brazil. The objective of the present study was to estimate the contribution of dicloran to mutagenic activity in samples from this river. Dicloran was found in the raw water at 0.14 mu g/L but not in the treated water. Comparison of mutagenic potencies in Salmonella strain YG1041 for dicloran and the river water sample indicated that dicloran contributed less than 0.1% of total mutagenic activity.

Signal Transduction, Plasma Membrane Calcium Movements, and Pigment Translocation in Freshwater Shrimp Chromatophores

Crustacean color change results from the differential translocation of chromatophore pigments, regulated by neurosecretory peptides like red pigment concentrating hormone (RPCH) that, in the red ovarian chromatophores of the freshwater shrimp Macrobrachium olfersi, triggers pigment aggregation via increased cytosolic cGMP and Ca(2+) of both smooth endoplasmatic reticulum (SER) and extracellular origin. However, Ca(2+) movements during RPCH signaling and the mechanisms that regulate intracellular [Ca(2+)] are enigmatic. We investigate Ca(2+) transporters in the chromatophore plasma membrane and Ca(2+) movements that occur during RPCH signal transduction. Inhibition of the plasma membrane Ca(2+)-ATPase by La(3+) and indirect inhibition of the Na(+)/Ca(2+) exchanger by ouabain induce pigment aggregation, revealing a role for both in Ca(2+) extrusion. Ca(2+) channel blockade by La(3+) or Cd(2+) strongly inhibits slow-phase RPCH-triggered aggregation during which pigments disperse spontaneously. L-type Ca(2+) channel blockade by gabapentin markedly reduces rapid-phase translocation velocity; N- or P/Q-type blockade by omega-conotoxin MVIIC strongly inhibits RPCH-triggered aggregation and reduces velocity, effects revealing RPCH-signaled influx of extracellular Ca(2+). Plasma membrane depolarization, induced by increasing external K(+) from 5 to 50 mM, produces Ca(2+)-dependent pigment aggregation, whereas removal of K(+) from the perfusate causes pigment hyperdispersion, disclosing a clear correlation between membrane depolarization and pigment aggregation; K(+) channel blockade by Ba(2+) also partially inhibits RPCH action. We suggest that, during RPCH signal transduction, Ca(2+) released from the SER, together with K(+) channel closure, causes chromatophore membrane depolarization, leading to the opening of predominantly N- and/or P/Q-type voltage-gated Ca(2+) channels, and a Ca(2+)/cGMP cascade, resulting in pigment aggregation. J. Exp. Zool. 313A:605-617, 2010. (C) 2010 Wiley-Liss, Inc.

Cited2 is required both for heart morphogenesis and establishment of the left-right axis in mouse development

Establishment of the left-right axis is a fundamental process of vertebrate embryogenesis. Failure to develop left-right asymmetry leads to incorrect positioning and morphogenesis of numerous internal organs, and is proposed to underlie the etiology of several common cardiac malformations. The transcriptional modulator Cited2 is essential for embryonic development: Cited2-null embryos die during gestation with profound developmental abnormalities, including cardiac malformations, exencephaly and adrenal agenesis. Cited2 is also required for normal establishment of the left-right axis; we demonstrate that abnormal heart looping and right atrial and pulmonary isomerism are consistent features of the left-right-patterning defect. We show by gene expression analysis that Cited2 acts upstream of Nodal, Lefty2 and Pitx2 in the lateral mesoderm, and of Lefty1 in the presumptive floor plate. Although abnormal left-right patterning has a major impact on the cardiac phenotype in Cited2-null embryos, laterality defects are only observed in a proportion of these embryos. We have therefore used a combination of high-resolution imaging and three-dimensional (3D) modeling to systematically document the full spectrum of Cited2-associated cardiac defects. Previous studies have focused on the role of Cited2 in cardiac neural crest cell development, as Cited2 can bind the transcription factor Tfap2, and thus affect the expression of Erbb3 in neural crest cells. However, we have identified Cited2-associated cardiac defects that cannot be explained by laterality or neural crest abnormalities. In particular, muscular ventricular septal defects and reduced cell density in the atrioventricular (AV) endocardial cushions are evident in Cited2-null embryos. As we found that Cited2 expression tightly correlated with these sites, we believe that Cited2 plays a direct role in development of the AV canal and cardiac septa. We therefore propose that, in addition to the previously described reduction of cardiac neural crest cells, two other distinct mechanisms contribute to the spectrum of complex cardiac defects in Cited2-null mice; disruption of normal left-right patterning and direct loss of Cited2 expression in cardiac tissues.

Structural shifts of aldehyde dehydrogenase enzymes were instrumental for the early evolution of retinoid-dependent axial patterning in metazoans

Aldehyde dehydrogenases (ALDHs) catabolize toxic aldehydes and process the vitamin A-derived retinaldehyde into retinoic acid (RA), a small diffusible molecule and a pivotal chordate morphogen. In this study, we combine phylogenetic, structural, genomic, and developmental gene expression analyses to examine the evolutionary origins of ALDH substrate preference. Structural modeling reveals that processing of small aldehydes, such as acetaldehyde, by ALDH2, versus large aldehydes, including retinaldehyde, by ALDH1A is associated with small versus large substrate entry channels (SECs), respectively. Moreover, we show that metazoan ALDH1s and ALDH2s are members of a single ALDH1/2 clade and that during evolution, eukaryote ALDH1/2s often switched between large and small SECs after gene duplication, transforming constricted channels into wide opened ones and vice versa. Ancestral sequence reconstructions suggest that during the evolutionary emergence of RA signaling, the ancestral, narrow-channeled metazoan ALDH1/2 gave rise to large ALDH1 channels capable of accommodating bulky aldehydes, such as retinaldehyde, supporting the view that retinoid-dependent signaling arose from ancestral cellular detoxification mechanisms. Our analyses also indicate that, on a more restricted evolutionary scale, ALDH1 duplicates from invertebrate chordates (amphioxus and ascidian tunicates) underwent switches to smaller and narrower SECs. When combined with alterations in gene expression, these switches led to neofunctionalization from ALDH1-like roles in embryonic patterning to systemic, ALDH2-like roles, suggesting functional shifts from signaling to detoxification.