Prise en charge en physiothérapie pour la clientèle âgée avec pathologies chroniques variées

Travail d’intégration

La situation et la prise en charge des adolescents suivis parallèlement en vertu de la LPJ et la LSJPA.

Rapport de stage présenté à la Faculté des études supérieures en vue de l’obtention du grade de Maître ès sciences (M. Sc.) en criminologie

Étude de l’attribution de la responsabilité chez des adolescents auteurs d’agression sexuelle : facteurs explicatifs et prise en charge

La présente recherche porte sur « l’attribution de la responsabilité » auprès d’une population de 166 adolescents auteurs d’agression sexuelle âgés de 12 à 19 ans. Le but premier de cette investigation est de déterminer quels aspects psychologiques (âge, stress post-traumatique, distorsion cognitive, estime de soi, aliénation, immaturité) influencent trois types d’attributions de la responsabilité, soit la culpabilité, l’attribution externe et l’attribution interne, et ainsi sur quels niveaux focaliser le traitement. Les résultats des régressions multiples ont mis en avant deux modèles. Pour le modèle prédisant la culpabilité, une seule composante est retenue, le stress post-traumatique. Ce modèle explique 26% (ajusté) de la variance de la culpabilité (R2=0,29, F(6,120)=8,35, p<0,01). Le modèle prédisant l’attribution externe est composé de l’âge et des distorsions cognitives et permet d’expliquer 25% (ajusté) de la variance (R2=0,28, F(6,122)=8,03, p<0,01). L’attribution interne ne présente aucune corrélation avec les variables étudiées. Le deuxième objectif est d’estimer l’efficacité de la prise en charge du jeune pour modifier l’attribution de responsabilité, selon les différentes modalités qui sont le « milieu de prise en charge », la « durée du traitement » et « l’approche thérapeutique » afin de choisir le programme le plus adéquat. En utilisant l’analyse de la variance (ANOVA), il a été possible de déterminer qu’aucune de ces modalités n’influence l’attribution de la responsabilité. Cette étude présente des limites, notamment la puissance statistique. Comme piste pour de futures recherches, le lien entre l’attribution de la responsabilité et la récidive pourrait être examiné.

L’efficacité contestée du recours aux agents de santé communautaires pour la prise en charge du paludisme : évaluation du programme burkinabé dans les districts de Kaya et de Zorgho

Contexte. Le paludisme provoque annuellement le décès d’environ 25 000 enfants de moins de cinq ans au Burkina Faso. Afin d’améliorer un accès rapide à des traitements efficaces, les autorités burkinabées ont introduit en 2010 la prise en charge du paludisme par les agents de santé communautaires (ASC). Alors que son efficacité a été démontrée dans des études contrôlées, très peu d’études ont évalué cette stratégie implantée dans des conditions naturelles et à l’échelle nationale. Objectif. L’objectif central de cette thèse est d’évaluer, dans des conditions réelles d’implantation, les effets du programme burkinabé de prise en charge communautaire du paludisme sur le recours aux soins des enfants fébriles. Les objectifs spécifiques sont : (1) de sonder les perceptions des ASC à l’égard du programme et explorer les facteurs contextuels susceptibles d’affecter leur performance ; (2) d’estimer le recours aux ASC par les enfants fébriles et identifier ses déterminants ; (3) de mesurer, auprès des enfants fébriles, le changement des pratiques de recours aux soins induit par l’introduction d’une intervention concomitante – la gratuité des soins dans les centres de santé. Méthodes. L’étude a été conduite dans deux districts sanitaires similaires, Kaya et Zorgho. Le devis d’évaluation combine des volets qualitatifs et quantitatifs. Des entrevues ont été menées avec tous les ASC de la zone à l’étude (N=27). Des enquêtes ont été répétées annuellement entre 2011 et 2013 auprès de 3002 ménages sélectionnés aléatoirement. Les pratiques de recours aux soins de tous les enfants de moins de cinq ans ayant connu un récent épisode de maladie ont été étudiées (N2011=707 ; N2012=787 ; N2013=831). Résultats. Les résultats montrent que le recours aux ASC est très modeste en comparaison de précédentes études réalisées dans des milieux contrôlés. Des obstacles liés à l’implantation du programme de prise en charge communautaire du paludisme ont été identifiés ainsi qu’un défaut de faisabilité dans les milieux urbains. Enfin, l’efficacité du programme communautaire a été négativement affectée par l’introduction de la gratuité dans les centres de santé. Conclusion. La prise en charge communautaire du paludisme rencontre au Burkina Faso des obstacles importants de faisabilité et d’implantation qui compromettent son efficacité potentielle pour réduire la mortalité infantile. Le manque de coordination entre le programme et des interventions locales concomitantes peut générer des effets néfastes et inattendus.

D’un système à l’autre : facteurs de risque d’incidence LSJPA chez les jeunes pris en charge en protection de la jeunesse en raison de troubles de comportement

Le but premier des services de protection de la jeunesse est de mettre fin à une situation de compromission et d’éviter que celle-ci ne se reproduise. Cependant, une meilleure connaissance des facteurs de risque d’incidence LSJPA chez les jeunes pris en charge en raison de leurs comportements problématiques permettrait de mieux identifier et ainsi, d’adapter les interventions chez ceux se révélant être les plus à risque de délinquance juvénile. La présente étude propose donc de décrire l’ampleur et le risque d’incidence c’est-à-dire, l’application d’une sanction ou d’une mesure en vertu de la LSJPA chez ces jeunes et de déterminer, parmi les facteurs associés au jeune et ceux inhérents à l’intervention, quels en sont les meilleurs prédicteurs. Pour ce faire, des données clinico-administratives des 16 centres jeunesse du Québec ont été utilisées. Ainsi, tous les enfants et adolescents dont le dossier a été fermé à la suite d’une première intervention en protection de la jeunesse en raison de troubles de comportement entre le 1er janvier 2005 et le 31 décembre 2009 ont été observés (N = 6 630). Des analyses de survie (modèle Kaplan-Meier) ainsi que des régressions de Cox ont été effectuées. Les résultats indiquent qu’un jeune pris en charge en raison de troubles de comportement a 39,7% de risque de migrer vers les services judiciaires pour adolescents dans les cinq années qui suivent la fermeture de son dossier. Sans grande surprise, les garçons présentent un plus grand risque que leurs homologues féminins. Il appert également que le risque d’incidence varie en fonction du sexe et de la présence de maltraitance lors de la prise en charge initiale. De plus, les facteurs associés à l’usager lui-même semblent avoir un impact plus important sur l’incidence que ceux associés à la prise en charge. Aussi, la récurrence dans les services de protection en raison de troubles de comportement mais également en raison de nouveaux éléments liés à la maltraitance sont au nombre des éléments à surveiller avec beaucoup d’attention puisqu’ils sont fortement liés à une migration vers la LSJPA. Les implications cliniques sont discutées et une ouverture sur de futurs travaux est faite.

Thermochemistry of Charge-Transfer Complexes of 7,7,8,8-Tetracyanoquinodimethane with Benzene and Its Chloro Derivatives

The enthalpies of formation of charge-transfer complexes of benzene, chlorobenzene, and 1,3-dichlorobenzene as donors with 7,7,8,8-tetracyanoquinodimethane as acceptor were determined. The thermochemical data show an increased stability of charge-transfer complexes of donors with permanent dipole moment. The results confirm the importance of electrostatic forces in bonding and stabilizing weak complexes. The approximate formation constants of the complexes are also reported.

Low power optical phase conjugation in dyes embedded in polyvinyl alcohol films

Low power optical phase conjugation in polyvinyl alcohol films embedded with saturable dyes is reported. Phase conjugate reflectivity achieved is higher than that obtained in the case of similar gelatin films.

Studies on some nonlinear optical phenomena-optical phase conjugation and continuous wave second harmonic generation

Nonlinear optics has emerged as a new area of physics , following the development of various types of lasers. A number of advancements , both theoretical and experimental . have been made in the past two decades . by scientists al1 over the world. However , onl y few scientists have attempted to study the experimental aspects of nonlinear optical phenomena i n I ndian laboratories. This thesis is the report of an attempt made in this direction. The thesis contains the details of the several investigations which the author has carried out in the past few years, on optical phase conjugation (OPC) and continuous wave CCVD second harmonic generation CSHG). OPC is a new branch of nonlinear optics, developed only in the past decade. The author has done a few experiments on low power OPC in dye molecules held in solid matrices, by making use of a degenerate four wave mixing CDFWND scheme. These samples have been characterised by studies on their absorption-spectra. fluorescence spectra. triplet lifetimes and saturation intensities. Phase conjugation efficiencies with r espect to the various parameters have been i nvesti gated . DFWM scheme was also employed i n achievi ng phase conjugation of a br oadband laser C Nd: G1ass 3 using a dye solution as the nonlinear medium.

The role of dynamical polarization of the ligand-to-metal charge transfer excitations in the ab initio determination of effective exchange parameters

The role of the bridging ligand on the effective Heisenberg coupling parameters is analyzed in detail. This analysis strongly suggests that the ligand-to-metal charge transfer excitations are responsible for a large part of the final value of the magnetic coupling constant. This permits us to suggest a variant of the difference dedicated configuration interaction (DDCI) method, presently one of the most accurate and reliable for the evaluation of magnetic effective interactions. This method treats the bridging ligand orbitals mediating the interaction at the same level than the magnetic orbitals and preserves the high quality of the DDCI results while being much less computationally demanding. The numerical accuracy of the new approach is illustrated on various systems with one or two magnetic electrons per magnetic center. The fact that accurate results can be obtained using a rather reduced configuration interaction space opens the possibility to study more complex systems with many magnetic centers and/or many electrons per center.

Ab initio study of the charge order and Zener polaron formation in half-doped manganites

The character of the electronic ground state of La0.5Ca0.5MnO3 has been addressed with quantum chemical calculations on large embedded clusters. We find a charge ordered state for the crystal structure reported by Radaelli et al. [Phys. Rev. B 55, 3015 (1997)] and Zener polaron formation in the crystal structure with equivalent Mn sites proposed by Daoud-Aladine et al. [Phys. Rev. Lett. 89, 097205 (2002)]. Important O to Mn charge transfer effects are observed for the Zener polaron.

Determination of charge carrier transport in radio frequency plasma polymerized aniline thin films

The carrier transport mechanism of polyaniline (PA) thin films prepared by radio frequency plasma polymerization is described in this paper. The mechanism of electrical conduction and carrier mobility of PA thin films for different temperatures were examined using the aluminium–PA–aluminium (Al–PA–Al) structure. It is found that the mechanism of carrier transport in these thin films is space charge limited conduction. J –V studies on an asymmetric electrode configuration using indium tin oxide (ITO) as the base electrode and Al as the upper electrode (ITO–PA–Al structure) show a diode-like behaviour with a considerable rectification ratio

New studies on the versatile roles of Polyaniline and its composites in polymer based optoelectronic and energy storage devices

From the early stages of the twentieth century, polyaniline (PANI), a well-known and extensively studied conducting polymer has captured the attention of scientific community owing to its interesting electrical and optical properties. Starting from its structural properties, to the currently pursued optical, electrical and electrochemical properties, extensive investigations on pure PANI and its composites are still much relevant to explore its potentialities to the maximum extent. The synthesis of highly crystalline PANI films with ordered structure and high electrical conductivity has not been pursued in depth yet. Recently, nanostructured PANI and the nanocomposites of PANI have attracted a great deal of research attention owing to the possibilities of applications in optical switching devices, optoelectronics and energy storage devices. The work presented in the thesis is centered around the realization of highly conducting and structurally ordered PANI and its composites for applications mainly in the areas of nonlinear optics and electrochemical energy storage. Out of the vast variety of application fields of PANI, these two areas are specifically selected for the present studies, because of the following observations. The non-linear optical properties and the energy storing properties of PANI depend quite sensitively on the extent of conjugation of the polymer structure, the type and concentration of the dopants added and the type and size of the nano particles selected for making the nanocomposites. The first phase of the work is devoted to the synthesis of highly ordered and conducting films of PANI doped with various dopants and the structural, morphological and electrical characterization followed by the synthesis of metal nanoparticles incorporated PANI samples and the detailed optical characterization in the linear and nonlinear regimes. The second phase of the work comprises the investigations on the prospects of PANI in realizing polymer based rechargeable lithium ion cells with the inherent structural flexibility of polymer systems and environmental safety and stability. Secondary battery systems have become an inevitable part of daily life. They can be found in most of the portable electronic gadgets and recently they have started powering automobiles, although the power generated is low. The efficient storage of electrical energy generated from solar cells is achieved by using suitable secondary battery systems. The development of rechargeable battery systems having excellent charge storage capacity, cyclability, environmental friendliness and flexibility has yet to be realized in practice. Rechargeable Li-ion cells employing cathode active materials like LiCoO2, LiMn2O4, LiFePO4 have got remarkable charge storage capacity with least charge leakage when not in use. However, material toxicity, chance of cell explosion and lack of effective cell recycling mechanism pose significant risk factors which are to be addressed seriously. These cells also lack flexibility in their design due to the structural characteristics of the electrode materials. Global research is directed towards identifying new class of electrode materials with less risk factors and better structural stability and flexibility. Polymer based electrode materials with inherent flexibility, stability and eco-friendliness can be a suitable choice. One of the prime drawbacks of polymer based cathode materials is the low electronic conductivity. Hence the real task with this class of materials is to get better electronic conductivity with good electrical storage capability. Electronic conductivity can be enhanced by using proper dopants. In the designing of rechargeable Li-ion cells with polymer based cathode active materials, the key issue is to identify the optimum lithiation of the polymer cathode which can ensure the highest electronic conductivity and specific charge capacity possible The development of conducting polymer based rechargeable Li-ion cells with high specific capacity and excellent cycling characteristics is a highly competitive area among research and development groups, worldwide. Polymer based rechargeable batteries are specifically attractive due to the environmentally benign nature and the possible constructional flexibility they offer. Among polymers having electrical transport properties suitable for rechargeable battery applications, polyaniline is the most favoured one due to its tunable electrical conducting properties and the availability of cost effective precursor materials for its synthesis. The performance of a battery depends significantly on the characteristics of its integral parts, the cathode, anode and the electrolyte, which in turn depend on the materials used. Many research groups are involved in developing new electrode and electrolyte materials to enhance the overall performance efficiency of the battery. Currently explored electrolytes for Li ion battery applications are in liquid or gel form, which makes well-defined sealing essential. The use of solid electrolytes eliminates the need for containment of liquid electrolytes, which will certainly simplify the cell design and improve the safety and durability. The other advantages of polymer electrolytes include dimensional stability, safety and the ability to prevent lithium dendrite formation. One of the ultimate aims of the present work is to realize all solid state, flexible and environment friendly Li-ion cells with high specific capacity and excellent cycling stability. Part of the present work is hence focused on identifying good polymer based solid electrolytes essential for realizing all solid state polymer based Li ion cells.The present work is an attempt to study the versatile roles of polyaniline in two different fields of technological applications like nonlinear optics and energy storage. Conducting form of doped PANI films with good extent of crystallinity have been realized using a level surface assisted casting method in addition to the generally employed technique of spin coating. Metal nanoparticles embedded PANI offers a rich source for nonlinear optical studies and hence gold and silver nanoparticles have been used for making the nanocomposites in bulk and thin film forms. These PANI nanocomposites are found to exhibit quite dominant third order optical non-linearity. The highlight of these studies is the observation of the interesting phenomenon of the switching between saturable absorption (SA) and reverse saturable absorption (RSA) in the films of Ag/PANI and Au/PANI nanocomposites, which offers prospects of applications in optical switching. The investigations on the energy storage prospects of PANI were carried out on Li enriched PANI which was used as the cathode active material for assembling rechargeable Li-ion cells. For Li enrichment or Li doping of PANI, n-Butyllithium (n-BuLi) in hexanes was used. The Li doping as well as the Li-ion cell assembling were carried out in an argon filled glove box. Coin cells were assembled with Li doped PANI with different doping concentrations, as the cathode, LiPF6 as the electrolyte and Li metal as the anode. These coin cells are found to show reasonably good specific capacity around 22mAh/g and excellent cycling stability and coulombic efficiency around 99%. To improve the specific capacity, composites of Li doped PANI with inorganic cathode active materials like LiFePO4 and LiMn2O4 were synthesized and coin cells were assembled as mentioned earlier to assess the electrochemical capability. The cells assembled using the composite cathodes are found to show significant enhancement in specific capacity to around 40mAh/g. One of the other interesting observations is the complete blocking of the adverse effects of Jahn-Teller distortion, when the composite cathode, PANI-LiMn2O4 is used for assembling the Li-ion cells. This distortion is generally observed, near room temperature, when LiMn2O4 is used as the cathode, which significantly reduces the cycling stability of the cells.