Surgical Outcomes in Syndromic Tetralogy of Fallot: A Systematic Review and Evidence Quality Assessment

Tetralogy of Fallot (ToF) is one of the most common cyanotic congenital heart defects. We sought to summarize all available data regarding the epidemiology and perioperative outcomes of syndromic ToF patients. A PRISMA-compliant systematic literature review of PubMed and Cochrane Library was performed. Twelve original studies were included. The incidence of syndromic ToF was 15.3% (n = 549/3597). The most prevalent genetic syndromes were 22q11.2 deletion (47.8%; 95% CI 43.4–52.2) and trisomy 21 (41.9%; 95% CI 37.7–46.3). Complete surgical repair was performed in 75.2% of the patients (n = 161/214; 95% CI 69.0–80.1) and staged repair in 24.8% (n = 53/214; 95 CI 19.4–30.9). Relief of RVOT obstruction was performed with transannular patch in 64.7% (n = 79/122; 95% CI 55.9–72.7) of the patients, pulmonary valve-sparing technique in 17.2% (n = 21/122; 95% CI 11.5–24.9), and RV-PA conduit in 18.0% (n = 22/122; 95% CI 12.1–25.9). Pleural effusions were the most common postoperative complications (n = 28/549; 5.1%; 95% CI 3.5–7.3). Reoperations were performed in 4.4% (n = 24/549; 95% CI 2.9–6.4) of the patients. All-cause mortality rate was 9.8% (n = 51/521; 95% CI 7.5–12.7). Genetic syndromes are seen in approximately 15% of ToF patients. Long-term survival exceeds 90%, suggesting that surgical management should be dictated by anatomy regardless of genetics

Medical Content Searching, Retrieving, and Sharing Over the Internet : Lessons Learned From the mEducator Through a Scenario-Based Evaluation

Background: The mEducator Best Practice Network (BPN) implemented and extended standards and reference models in e-learning to develop innovative frameworks as well as solutions that enable specialized state-of-the-art medical educational content to be discovered, retrieved, shared, and re-purposed across European Institutions, targeting medical students, doctors, educators and health care professionals. Scenario-based evaluation for usability testing, complemented with data from online questionnaires and field notes of users' performance, was designed and utilized for the evaluation of these solutions. Objective: The objective of this work is twofold: (1) to describe one instantiation of the mEducator BPN solutions (mEducator3.0 - "MEdical Education LINnked Arena" MELINA+) with a focus on the metadata schema used, as well as on other aspects of the system that pertain to usability and acceptance, and (2) to present evaluation results on the suitability of the proposed metadata schema for searching, retrieving, and sharing of medical content and with respect to the overall usability and acceptance of the system from the target users. Methods: A comprehensive evaluation methodology framework was developed and applied to four case studies, which were conducted in four different countries (ie, Greece, Cyprus, Bulgaria and Romania), with a total of 126 participants. In these case studies, scenarios referring to creating, sharing, and retrieving medical educational content using mEducator3.0 were used. The data were collected through two online questionnaires, consisting of 36 closed-ended questions and two open-ended questions that referred to mEducator 3.0 and through the use of field notes during scenario-based evaluations. Results: The main findings of the study showed that even though the informational needs of the mEducator target groups were addressed to a satisfactory extent and the metadata schema supported content creation, sharing, and retrieval from an end-user perspective, users faced difficulties in achieving a shared understanding of the meaning of some metadata fields and in correctly managing the intellectual property rights of repurposed content. Conclusions: The results of this evaluation impact researchers, medical professionals, and designers interested in using similar systems for educational content sharing in medical and other domains. Recommendations on how to improve the search, retrieval, identification, and obtaining of medical resources are provided, by addressing issues of content description metadata, content description procedures, and intellectual property rights for re-purposed content.Peer reviewe

Inmate cancer patients – highlighting the importance of a holistic approach to oncological care

Purpose: Inmate oncologic patients' rates increased drastically worldwide. Elderly, limited exercise, unhealthy diet, hepatitis, HIV+ status, tobacco and alcohol use, constitute the main cancer risk factors. We present an outline of practical oncological management and ethical thinking, in the specific environment of a detention facility. Methods: PubMed, Cochrane Database of Controlled Trials, SCOPUS and grey literature were extensively searched upto October 2021. Ιncarcerated oncologic patients experiencevarious everyday challenges:their confinement in high securityfacilities, the lack of access to critical care and related ethicaldilemmas inherent to the context of a correctional facility. Results: The detention facilities may be inadequate in providing early cancer diagnosis and appropriate care mainlydue to a lack of specialized personnel, b) in-house or in external specialized cancer hospitals, care variability (e.g. admissions in small local or regional hospitals), c) delays inproviding access and d) gatekeeper systems. There is a paucity of administration of a) systemic therapy(chemotherapy, targeted drug therapy etc), b) radiotherapy, c)palliative care, and d) enrollment in clinical trials.  Conclusions: Correctional facilities must encourage teamwork between healthcare and correctional professionals inorder to improve the provided anticancer care

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Αξιολόγηση επενδυτικών στρατηγικών βασισμένων στον χρονισμό της αγοράς: μια σύγκριση ουδέτερων και μη-ουδέτερων στρατηγικών με μια ολοκληρωμένη εφαρμογή σε διαπραγματεύσιμα αμοιβαία κεφάλαια

My doctoral thesis provides evidence of two different types of trading strategies. The first type is based οη market neutral trading strategies under the methodology of pair trading strategies. The second part is on rotation strategies according to sign forecasting specifications and explores the probability of profitable market and volatility timing. The thesis is comprised by three chapters. The first chapter is dedicated to Exchange Traded Funds, ETFs. Ι am presenting an extended literature review on the topic. The review tries to capture every aspect of ETFs that is of concern for the academic community. Moreover, Ι am presenting the mechanism of ETFs and the pros and cons that are inherent in an ETF structure. Ιη addition, Ι am discussing active ETFs. Οη the 4th of March 2008, the Securities and Exchange Commission approved the listing and trading of Active Exchange Traded Funds in the US market. This decision opens up a new era on asset management. Ι am trying to identify the most appealing issues from this new decision. Ι am analysing the similarities and the differences with passive ETFs and conventional mutual funds and the obstacles that arise from the inception of active ETFs. The second chapter is dedicated to pair trading strategies. Gatev, Goetzmann and Rouwenhourt (2006) applied a trading algorithm based οη the concept of mean reverting returns. Prices of two assets that move together in the long run and diverge in the short term will revert to their equilibrium. An alternative definition for the pair trading strategies is that of a relative value statistical arbitrage methodology. Engleberg, Gao and Jagannathan (2009) examined pair trading methodology and tried to explain the factors behind the profitability. The contribution of my work is the implementation of a modification of pair trading investment strategy and the examination of the profitability and the motives that create the profitability in the contest of ETFs. Ι implement different estimations for each separate step of the formulation of the strategies in order to examine and find an “optimal” algorithm. Ι then conduct different tests to check the robustness of my methodology. Ιη the next step, Ι check the pattern of profitability based on several tests based on the segmentations according to market capitalization, emerging and developed markets. The second part involves the empirical evidence of pair trading portfolios according to risk profile. Ι incorporated Fama and French risk factors to explain for potential patterns behind the profits. The estimations included national and international risk factors on profitability. The most important part is the decomposition of the traded pairs and the examination one by one according to its own risk characteristics. My dataset is constructed by international ETFs which is the tradable version of country indices. In that concept, Ι research in each separate pair its own variables and Ι test the factors that affect profitability. Among the extended research all over pair trading strategies, this research provides the following contributions. 1. It is the first time that ETFs are used in pairs trading. 2. International evidence on pair trading with easily accessible instruments. 3. Pair trading profitability outperforms S&P500. 4. The US and international Fama and French risk factors are insufficient to explain pair trading international profitability. The third chapter is dedicated to volatility and market timing strategies. Ι examined a new methodology that assesses the economic and statistical significance of market and volatility timing according to a novel forecasting specification. My methodology combines the dynamics of time-varying expected returns and volatility timing and several thresholds derived by expected returns and variability. The specification is incorporating forecasting sign ability. The forecast estimations are incorporated to create trading rules and the formation of portfolios. The trading rules, then, are incorporated to the allocation decision. In every decision, we allocate the total wealth to one asset. In every transaction, we rotate between the two assets. The methodology is based on a pairwise asset evaluation. I test for the patterns behind volatility timing, and for the day of the week effect. The results indicate that under specific assumptions market and volatility timing can lead to profitable trading strategies. The selection of the specification appear to be sensitive between past returns and volatility which confirms the initial conception of the cross interaction between time varying expected returns and variation. Comparing the performance of the rotation portfolios based on forecasts using different model selection criteria, the rotation trading is performing the highest final wealth, when there is not a clear domination between expected return and variation. Applying the methodology under different days of the week, I can differentiate from the literature in means of the performance with rotation trading to exhibits the most statically and economic significant excess returns οη Monday. The next test examines if different levels of volatility generate correct sign predictions. The empirical analysis shows that there is not clear dependence between returns and level of volatility. Empirical evidence appear to be sensitive about the selection of trading specification which confirms the motivation of the research of cross interactions between time varying expected returns and variation. Rotation trading outperformed the market in means of final performance and risk levels as represented by the maximum drawdown indicator. My thesis makes a distinct contribution in the area of active asset management and asset allocation methods. It explores in depth two different trading strategies in the context of a relatively new financial tool, the Exchange Traded Fund (ETF), and is to the best of my knowledge one of the few existing works that address the issue of ETF profitability in a relatively thorough manner, always in the context of active trading

Rural prisons

The thesis studies the running of the four rural prisons operating today in Greece as an alternative form of serving time involving the deprivation of freedom. These are the rural prisons of Cassandra in Chalkidiki, Kassaveteia in Almyros Volos, Tiryns near Nafplio and Agias in Chania. The study considers at the same time the way closed prisons are run. These two types of prison are part of the criminal justice system in our country, Greece. The method selected was qualitative research through participant observation, which was essentially based on interviews with all the groups of people involved in the rural prison system, namely prisoners, prison officers, directors, agronomists and social workers, in order that the most complete and objective result could be produced, limiting and controlling as far as possible the unpleasant personal experiences, such as that of serving time in prison. The research is based on semi-structured interviews, as it was deemed appropriate, always in collaboration with the supervisor, for the interviews to be flexible, so that interviewees could freely express their opinion, without feeling they were being lead by standardized questions. Besides the groups were all different and it was only this type of interview that would, during the evolving discussion, allow relevant and appropriate questions to be adapted to the capacity or better to the role of each group in the running of the rural prisons. The research did not come up against significant difficulties, to the extent that most appeared to agree that there is a huge difference in favour of rural prisons versus closed ones, in terms of the structure of the criminal justice system, and they did not refrain from talking about this. A representative number of persons from each group set as a key reference point their experience in the field, as most of those concerned, apart from the prisoners, have been involved with both types of prison, with more than fifteen and some with more than thirty years of experience under their belt. Precisely for this reason, as well as from the substance of the interviews, it emerges that the research does not simply reveal people’s impressions, but crystallized experience. Very significantly almost all concluded that rural prisons are obviously better than the closed type and each argued for this in his own way and according to his own experience. The interviews were all collected at the start. However as it was then deemed necessary for there to be a dialectical relationship between the interviews and the issue being investigated each time, it was decided to carry out a second round of interviews, even though most had been collected during the first visit to the four rural prisons. So a second visit to all four prisons followed, during which important issues that had emerged from the study of the first interviews were clarified. The prisoners’ interviews cover on the one hand a wide range of age groups, including juveniles in the rural prison of Kassaveteia Volos, adults and even elderly detainees, and on the other hand, they cover a variety of cases, namely drug offences, petty theft, robberies as well as murder, fraud, debts to the state, embezzlement, smuggling, etc. The population of rural prisons is composed of a large variety of nationalities. Sometimes foreigners make up more than half the prison population. The thesis consists of two main parts: the first part concerns the conceptual, theoretical and historical approaches to rural prisons and the second with their empirical investigation, constituting a key document as it straightforwardly records the positive aspects of rural prisons. Firstly in rural prisons all detainees work and enjoy certain privileges and very good living conditions and are treated decently as they live in a semi-free state as compared to closed prison inmates. The results of the research essentially condemn the violence in closed prisons, the drug-trafficking and harsh living conditions, at the same time demonstrating that the closed prison is merely a training school for crime as the prisoner’s fundamental rights are violated. The second part of the thesis looks at all the rural prisons in Greece as part of the criminal justice system with corresponding photographic material approved by the Ministry of Justice. In other words it examines to what extent rural prisons help the detainees more effectively as the decent living conditions in comparison to the closed prisons are, according to the inmates, ‘as different as night and day’. The mechanism is presented whereby prisoners are prepared through work and skill-learning for their smooth reintegration into society after their release. In this way the purpose of the sentence is served not simply by the deprivation of freedom. The research ends by showing the essential punitive purpose of depriving freedom in rural prisons. The evidence presented, both from the interviews and the bibliographic research, as well as from archival research in the annual reports on rural prisons through the Ministry of Justice and the minutes of the Greek Parliament, makes this study unique in its field, as it took the total sample into account. In times that are difficult from all aspects, in which punitive trends towards crime are becoming increasingly stricter, this study constitutes a barrier, a ‘powerful’ argument against these trends. In a comprehensive and scientifically documented manner, it gives a resounding answer, a no before the ‘blind’ repression that we all unfortunately to a greater or lesser extent hide within ourselves toward the people who were unlucky enough to get caught up in the toils of penal repression.Η διατριβή μελετά τον τρόπο λειτουργίας των τεσσάρων αγροτικών φυλακών, οι οποίες λειτουργούν σήμερα στην Ελλάδα ως εναλλακτική μορφή έκτισης ποινής που αφορά την στέρηση της ελευθερίας. Πρόκειται για τις αγροτικές φυλακές της Κασσάνδρας Χαλκιδικής, της Κασσαβέτειας στον Αλμυρό Βόλου, της Τίρυνθας δίπλα στο Ναύπλιο και της Αγιάς ( Αγυιάς ) Χανίων. Η μελέτη λαμβάνει παραλλήλως υπόψη τον τρόπο λειτουργίας των κλειστών φυλακών. Τα δύο αυτά είδη φυλακών συνιστούν μέρος του συστήματος της ποινικής δικαιοσύνης στη χώρα μας. Επιλέχθηκε ως μέθοδος η ποιοτική έρευνα μέσω της συμμετοχικής παρατήρησης, η οποία στην ουσία βασίστηκε σε συνεντεύξεις με όλες τις ομάδες των ατόμων που συμμετέχουν στο σύστημα των αγροτικών φυλακών, δηλαδή κρατούμενοι, σωφρονιστικοί υπάλληλοι, διευθυντές, γεωπόνοι και κοινωνικοί λειτουργοί, ώστε το αποτέλεσμα να είναι όσο γίνεται πιο πλήρες και πιο αντικειμενικό, περιορίζοντας και ελέγχοντας στο μέτρο του δυνατού, τις προσωπικές δυσάρεστες εμπειρίες, όπως είναι η εμπειρία της έκτισης ποινής σε φυλακή. Η έρευνα βασίζεται σε ημιδομημένες συνεντεύξεις, αφού κρίθηκε σκόπιμο σε συνεννόηση πάντα με τον επιβλέποντα, οι συνεντεύξεις να είναι ευέλικτες, για να μπορούν οι συνεντευξιαζόμενοι να εκφράσουν την άποψή τους ελεύθερα, χωρίς να αισθάνονται ότι κατευθύνονται από τυποποιημένες ερωτήσεις. Εξάλλου οι ομάδες τους ήταν διαφορετικές και μόνο τέτοιες συνεντεύξεις θα επέτρεπαν να προσαρμοστούν, κατά τον διάλογο που θα αναπτυσσόταν, ερωτήσεις κατάλληλες και ανάλογες με την ιδιότητα ή καλύτερα με τον ρόλο της κάθε ομάδας στο σύστημα λειτουργίας των αγροτικών φυλακών. Η έρευνα δεν αντιμετώπισε σημαντικές δυσκολίες, στο βαθμό που οι περισσότεροι έδειχναν να συμφωνούν ότι υπάρχει μεγάλη διαφορά υπέρ των αγροτικών έναντι των κλειστών φυλακών, από την άποψη της δομής του συστήματος της ποινικής δικαιοσύνης, και δεν απέφυγαν να μιλήσουν για αυτό. Αντιπροσωπευτικός αριθμός ατόμων από κάθε ομάδα έθεσε ως βασικό σημείο αναφοράς την πείρα τους επί του αντικειμένου καθώς οι περισσότεροι εμπλεκόμενοι, εκτός από τους κρατούμενους, κινούνται στο χώρο και των δύο τύπων φυλακών, με εμπειρία άνω των δεκαπέντε ετών και ορισμένοι άνω και των τριάντα. Ακριβώς γι αυτόν τον λόγο, αλλά και από το ουσιαστικό περιεχόμενο των συνεντεύξεων, προκύπτει ότι η έρευνα δεν προβάλλει απλά εντυπώσεις των ατόμων, αλλά αποκρυσταλλωμένη πείρα. Ήταν πολύ σημαντικό ότι όλοι σχεδόν κατέληξαν ότι οι αγροτικές φυλακές είναι σαφώς καλύτερες από τις κλειστές και επιχειρηματολόγησαν γι αυτό ο καθένας με τον τρόπο και την εμπειρία του.Οι συνεντεύξεις συγκεντρώθηκαν όλες εξαρχής. Καθώς όμως στη συνέχεια κρίθηκε αναγκαίο να υπάρχει μια διαλεκτική σχέση ανάμεσα στις συνεντεύξεις με το ερευνούμενο κάθε φορά ζήτημα, αποφασίστηκε να γίνει ένας δεύτερος γύρος συνεντεύξεων, μολονότι είχαν συγκεντρωθεί οι περισσότερες κατά την πρώτη επίσκεψη στις τέσσερις αγροτικές φυλακές. Επακολούθησε λοιπόν μια δεύτερη επίσκεψη και στις τέσσερις φυλακές πάλι, όπου διευκρινίζονταν σημαντικά ερωτήματα που είχαν προκύψει κατά τη μελέτη των πρώτων συνεντεύξεων. Οι συνεντεύξεις των κρατουμένων, καλύπτουν αφενός μια μεγάλη γκάμα ηλικιακών ομάδων, η οποία περιλαμβάνει ανήλικες της αγροτικής φυλακής Κασσαβέτειας Βόλου, ενήλικες αλλά και υπέργηρους, και, αφετέρου καλύπτουν ποικίλες υποθέσεις, δηλαδή αδικήματα σχετικά με ναρκωτικά, μικροκλοπές, ληστείες, αλλά και ανθρωποκτονίες, απάτες, χρέη προς το δημόσιο, υπεξαιρέσεις, λαθρεμπόριο κ.α. Η σύνθεση του πληθυσμού των αγροτικών φυλακών, παρουσιάζει μια μεγάλη ποικιλία εθνοτήτων. Ορισμένες φορές οι ξένοι υπερέβαιναν τον μισό πληθυσμό της φυλακής.Η διατριβή αποτελείται από δύο κύρια μέρη: το πρώτο μέρος ασχολείται με τις εννοιολογικές, θεωρητικές και ιστορικές προσεγγίσεις των αγροτικών φυλακών και το δεύτερο με την εμπειρική διερεύνησή τους συνιστώντας, βασικό ντοκουμέντο, καθώς ευθέως καταγράφει τα θετικά πρόσημα των αγροτικών φυλακών. Καταρχάς στις αγροτικές φυλακές εργάζονται όλοι οι κρατούμενοι, εκπαιδεύονται σε διάφορους τομείς και προγράμματα που υποστηρίζονται από τις βιβλιοθήκες και τα παράλληλα υπάρχοντα εργαστήρια και τυγχάνουν κάποιων ευεργετημάτων και πολύ καλών συνθηκών διαβίωσης και αξιοπρεπούς αντιμετώπισης, καθώς επίσης διαβιούν σε ημιελεύθερο καθεστώς σε σύγκριση με τους τροφίμους των κλειστών φυλακών. Μέσω των αποτελεσμάτων της έρευνας ουσιαστικά καταγγέλλεται η βία που αναπτύσσεται στις κλειστές φυλακές, η διακίνηση των ναρκωτικών ουσιών και οι σκληρές συνθήκες διαβίωσης σε αυτές, καταδεικνύοντας παράλληλα ότι η κλειστή φυλακή δεν είναι παρά σχολείο εκπαίδευσης στο έγκλημα καθώς παραβιάζονται βασικά δικαιώματα του κρατούμενου.Στο δεύτερο μέρος της διατριβής μελετώνται όλες οι αγροτικές φυλακές της χώρας ως μέρος του συστήματος ποινικής δικαιοσύνης με αντίστοιχο φωτογραφικό υλικό με την έγκριση του Υπουργείου Δικαιοσύνης. Ερευνάται δηλαδή, κατά πόσον οι αγροτικές φυλακές βοηθούν τον κρατούμενο πολύ πιο ουσιαστικά γιατί τόσο οι συνθήκες αξιοπρεπούς διαβίωσης όσο και η εκπαίδευση μέσω των προγραμμάτων των βιβλιοθηκών και των εργαστηρίων σε μορφωτικούς και επαγγελματικούς τομείς, σε σχέση με τις κλειστές φυλακές είναι, κατά δήλωση των κρατουμένων, «η νύχτα με τη μέρα». Παρουσιάζεται ο μηχανισμός με τον οποίο προετοιμάζονται οι κρατούμενοι μέσω της εργασίας, της εκπαίδευσης και της εκμάθησης δεξιοτήτων στην ομαλή επανένταξή τους στην κοινωνία μετά την αποφυλάκισή τους. Έτσι ο σκοπός έκτισης της ποινής δεν εξαντλείται μόνο στην στέρηση της ελευθερίας. Η έρευνα τελικώς καταδεικνύει τον ουσιαστικό σωφρονιστικό σκοπό της στέρησης της ελευθερίας στις αγροτικές φυλακές.Τα στοιχεία που παρουσιάζονται, τόσο από τις συνεντεύξεις και από την βιβλιογραφική έρευνα, όσο και από την αρχειακή έρευνα στους ετήσιους απολογισμούς των αγροτικών φυλακών μέσω του Υπουργείου Δικαιοσύνης και των πρακτικών της Βουλής των Ελλήνων, καθιστούν την έρευνα αυτή μοναδική στο είδος της, καθώς έλαβε υπόψη της το σύνολο του δείγματος. Σε χρόνους δύσκολους από κάθε άποψη όπου οι τιμωρητικές τάσεις προς το έγκλημα αποκτούν μια όλο και μεγαλύτερη ισχύ, η έρευνα αυτή αποτελεί ένα φραγμό, ένα «τρανταχτό» επιχείρημα κατά των τάσεων αυτών . Με τρόπο εμπεριστατωμένο και επιστημονικά τεκμηριωμένο δίνεται μια ηχηρή απάντηση ένα όχι μπρος την «τυφλή» καταστολή που δυστυχώς όλοι μας άλλος λιγότερο και άλλος περισσότερο κρύβουμε μέσα μας απέναντι στους ανθρώπους που είχαν την ατυχία να πιαστούν στα δίχτυα της ποινικής καταστολής.Ce travail de recherche examine le fonctionnement des quatre prisons agricoles qui existent en Grèce en tant que forme alternative de purgation de peine privative de liberté. Il s’agit des prisons agricoles de Kassandra de Chalcidique, de Kassavétia à Almyros près de Volos, de Tirynthe à côté de Nauplie et de Ayia à La Canée. L’étude prend également en compte le mode de fonctionnement des prisons dites « fermées ». Ces deux types de prisons font partie du système de justice pénale en Grèce. La méthode choisie est celle de l’étude qualitative associée à celle de l’observation participante, pour l’essentiel fondée sur des entretiens avec les représentants de tous les groupes impliqués dans le système des prisons agricoles, à savoir détenus, personnel de surveillance et d’administration pénitentiaire, agronomes, assistants de service social, afin que le résultat soit le plus complet et objectif possible, limitant et contrôlant autant que faire se peut les expériences personnelles désagréables comme celle de la purgation de peine en prison.L’enquête se fonde sur des entretiens semi-directifs, car il a été jugé pertinent, en accord toujours avec le directeur de recherche, de réaliser des entretiens suffisamment souples afin que les personnes interrogées puissent librement exprimer leur opinion, sans avoir le sentiment d’être orientées par des questions standardisées. Par ailleurs, les différences entre les groupes interrogés faisaient que seuls de tels entretiens permettaient d’introduire, au cours du dialogue, des questions s’adaptant à la qualité ou mieux encore au rôle de chaque groupe dans le fonctionnement des prisons agricoles.Le processus de l’enquête n’a pas rencontré de difficultés considérables, dans la mesure où la plupart des personnes interrogées semblaient s’accorder sur le grand contraste, sous l’aspect de la structure de la justice pénale, en faveur des prisons agricoles existant entre les deux types d’établissements, et qu’ils n’ont pas éludé la question. Un nombre représentatif de personnes appartenant à chaque groupe a produit comme principal point de référence son expérience personnelle du sujet, car la majorité des personnes impliquées, outre les détenus, se meuvent dans l’espace des deux types de prison, porteurs d’une expérience de plus de quinze ans et, dans le cas de certains, de plus de trente. C’est exactement pour cette raison, mais aussi à cause du contenu même des entretiens, que les résultats de la recherche ne présentent pas simplement des impressions personnelles, mais une authentique cristallisation de l’expérience. Fait notable, presque tous ont abouti à la conclusion que les prisons agricoles sont de toute évidence meilleures que les prisons « fermées », et chacun a, à sa manière propre et suivant son expérience, proposé des arguments dans ce sens. Les entretiens ont tous eu lieu dès le départ. Mais comme il a été jugé nécessaire par la suite d’établir une relation dialectique entre les entretiens et chaque question traitée, un autre cycle d’entretiens a été effectué, même si la plupart avaient déjà été collectés lors de la première visite dans les quatre prisons agricoles. Une seconde série d’entrevues a donc eu lieu de nouveau dans les quatre prisons, ce qui a permis d’affiner des questions importantes qui avait surgi de l’étude des premiers entretiens. Les entretiens des détenus couvrent d’une part un large éventail de groupes d’âge, allant des mineurs de la prison agricole de Kassavétia à Volos à des adultes mais aussi des vieillards, et d’autre part une diversité de délits, à savoir affaires de stupéfiants, larcins, cambriolages, mais aussi homicides, escroqueries, dettes envers l’état, détournement de fonds, contrebande, etc. La composition de la population des prisons agricoles présente une grande variété de nationalités. Parfois le nombre des étrangers dépassait la moitié de la population de la prison.Cette Thèse est constituée de deux parties principales : la première est consacrée à une approche conceptuelle, théorique et historique des prisons agricoles, et la seconde à leur approfondissement empirique, constituant d’ailleurs le document-source essentiel, étant donné qu’y sont directement enregistrés les indices positifs des prisons agricoles. Tout d’abord, dans les prisons agricoles, tous les détenus travaillent et jouissent de certains avantages, de très bonnes conditions de vie quotidienne et sont correctement traités, vivant, si l’on compare avec les pensionnaires des prisons « fermées », sous un régime de semi-liberté. En fait, les résultats de l’enquête font apparaître une dénonciation de la violence qui se développe dans les prisons « fermées », le trafic de drogue et les conditions de vie extrêmement dures, et démontre parallèlement que la prison « fermée » n’est rien d’autre qu’une école du crime dans la mesure où les droits fondamentaux du détenu y sont bafoués.En outre, dans la seconde partie, le mémoire examine toutes les prisons agricoles du pays en tant qu’élément du système de justice pénal, et fournit à l’appui un matériel photographique publié avec l’approbation du Ministère de la Justice. La recherche porte donc sur la question de savoir dans quelle mesure les prisons agricoles aident davantage le détenu car les conditions de vie correctes diffèrent de celles des prisons « fermées », pour reprendre les termes des détenus, « comme le jour d’avec la nuit ». Elle présente également le mécanisme de préparation du détenu à la réintégration sans heurts dans la société après sa libération, par le biais du travail mais aussi de l’apprentissage d’un savoir-faire. Ainsi, l’objectif de la peine ne se borne pas à sa purgation par la privation de liberté. Enfin, l’étude démontre le but fondamental de la privation de liberté dans les prisons agricoles, qui est de rééduquer le comportement social de l’individu dans des conditions de vie respectant sa dignité. Les données présentées, provenant aussi bien des entretiens que de la recherche bibliographique, ou encore des archives des bilans annuels du Ministère de la Justice et des procès-verbaux de l’Assemblée des Grecs, font de cette étude un travail unique en son genre, dans la mesure où elle a pris en compte l’ensemble de l’échantillon.En des temps difficiles à tout point de vue, lorsque les tendances punitives à l’égard du crime gagnent en puissance, les conclusions de cette étude constituent une digue, un argument « fracassant » opposé à ces tendances. De façon approfondie et scientifiquement étayée, elles adressent une réponse retentissante, un « non » à la répression aveugle que malheureusement tous, plus ou moins, cachons au fond de nous-mêmes vis-à-vis des êtres qui ont eu la malchance d’être pris dans les rets de la répression pénale