Thèse d'exercice : Médecine. Neurologie : Paris 12 : 2008. / Titre provenant de l'écran-titre. Bibliogr. f. 55-61.

Inledning: Den första januari 2004 trädde lag (2003:778) om skydd mot olyckor (LSO) i kraft. Till skillnad från tidigare lagstiftningar i form av brandlagen (1974:80) och räddningstjänstlagen (1986:1102) är LSO tilltänkt att verka för en bredare olyckspreventiv verksamhet som sträcker sig utöver räddningstjänstens traditionella ansvarsområden. Lagen har dock inte utvärderats under de senaste sex åren. Följaktligen ämnar denna studie att kartlägga vilken inverkan som LSO har på det olyckspreventiva arbete som idag bedrivs på lokal nivå. Metod: Studien har en mixmetodologisk ansats där sammanlagt fyra semistrukturerade intervjuer med sex informanter har utförts i Värmland. Därutöver har en enkätundersökning distribuerats till samtliga 163 räddningstjänster och räddningstjänstförbund i Sverige. Resultat: De data som samlats har totalt genererat fem olika kategorier. Synen på LSO som en räddningstjänstlag anspelar på det faktum att arbetet med LSO i mångt och mycket åligger räddningstjänsten. Det förvaltningsspecifika styrdokument förklarar att handlingsprogramet, som var tilltänkt att utgöra en kommunövergripande olyckspreventiv strategi, uteslutande reglerar räddningstjänstens verksamhet. Initierandet av en förändringsprocess kartlägger de framgångsfaktorer som förutsätts för att en framgångsrik verksamhet ska kunna bedrivas. Lagom är bäst: Oenighet kring statens roll påtalar behovet av detaljstyrning och tillsynsarbete. Avslutningsvis beskriver Med facit i hand: Saker och ting tar tid att arbetet med lagstiftningar är en tidskrävande process som måste bedrivas långsiktigt. Slutsats: Sammantaget visar resultatet att det praktiska utfallet av LSO är att betrakta som en räddningstjänstlag snarare än en kommunövergripande olycksskyddlagstiftning. Det påtalas därigenom att LSO är uddlös när det kommer till att initiera ett olycksförebyggande arbete som sträcker sig utanför räddningstjänstens traditionella verksamhetsuppdrag. Det antyds dock att svårigheterna att följa den initiala visionen inte enbart kan härledas till lagstiftningens utformning, utan även till kommuners bristande medvetenhet för det lokala olyckspanoramat. / Introduction: On January 1st 2004, Sweden’s contemporary Civil Protection Act (LSO), was put in place. Unlike its precursors, "brandlagen (1974:80) and räddningstjänstlagen (1986:1102)", LSO serves to institute and facilitate accident preventative measures beyond the traditional work carried out by municipal rescue services. However, the legislation has not been evaluated over the past six years. Consequently the aim of this study is to assess the impact that LSO has on the accident preventive activities currently carried out at the municipal level. Methods: The study has a mixed methodological approach where four semi structured interviews have been conducted with a total of six informants in Värmland, Sweden. A questionnaire was also distributed to all 163 rescue services in Sweden. Results: A total of five categories emerged from the data analysis process. "Synen på LSO som en räddningstjänstlag" addresses the fact that most of the work done in compliance with LSO is solely carried out by local rescue services. "Det förvaltningsspecifika styrdokumentet" pinpoints that the action plan required by LSO only regulates the work of rescue services, despite its vision of guiding all relevant municipal sectors. Moreover, "Initierandet av en förändringsprocess" maps the factors that are critical to successfully carrying out accident prevention measures at the local level. "Lagom är bäst: Oenighet kring statens roll" underlines the need for micromanagement and regulatory work. Finally, "Med facit I hand: Saker och ting tar tid" describes that the institutionalization of legislation is a time consuming process that needs to be approached as such. Conclusions: Overall, the results demonstrate that LSO is to be regarded as a legislation that specifically regulates the rescue services, rather than municipalities as a whole. Hence, the study suggests that LSO is futile in terms of initiating accident prevention measures beyond the daily activities of the rescue services. However, the struggle of LSO to institutionalize an overarching accident prevention process cannot solely be attributed to the design of the legislation, but also to insufficient municipal risk awareness.

The well-being of tourists or visitors within a destination has, until recently, received little attention. Issues relating to the personal safety and health of the travelling public have been highlighted by a number of high profile incidents of terrorist attacks, large scale natural disasters and life threatening epidemics. While such events are devastating in nature and of great concern, for the majority of travellers, health and personal safety are more likely to be impacted on by illness, being involved in an accident or becoming the victim of crime. This thesis contributes to our existing understanding of how tourism can be affected by incidents by selecting a definable geographical area and investigating the available data from official sources to examine the dimensions, scale and nature of visitor-related incidents of crime, road traffic accidents and emergency health care. This audit was undertaken through collaborative research with the Central Scotland Police Force, the Central Scotland Road Accident Investigation Unit and the National Health Service Forth Valley. Primary research was then undertaken with visitors to the area. This in-depth approach looks beyond existing statistics to probe factors contributing to visitor-related incidents, in relation to existing tourism literature. The results indicate that, visitors experience incidents that differ in nature and type from those experienced by local residents, and the times and places they were most at risk also varied. With visitors accounting for less than 10% of the total population, these differences are not apparent in the overall patterns and, therefore, the particular needs of visitors are unlikely to be met through existing measures. This research has the ability to form the basis of improved measures to benefit visitor health and personal safety even though the nature of the visiting population presents challenges in relation to when, where and how such preventative measures are introduced. Visitors are not homogenous and distinct groupings based on perceptions, attitudes and behaviours were found. Therefore, there is a requirement to examine how incidents impact on visitors by distinguishing them from the overall incident figures, but measures to protect visitors also have to be tailored to take cognisance of typologies of visitors.

The swelling mechanisms of U3Si2 under neutron irradiation in reactor conditions are not unequivocally known. The limited experimental evidence that is available suggests that the main driver of the swelling in this material would be fission gases accumulation at crystalline grain boundaries. The steps that lead to the accumulation of fission gases at these locations are multiple and complex. However, gradually, the gaseous fission products migrate by diffusion. Upon reaching a grain boundary, which acts as a trap, the gaseous fission products start to accumulate, thus leading to formation of bubbles and hence to swelling. Therefore, a quantitative model of swelling requires the incorporation of phenomena that increase the presence of grain boundaries and decrease grain sizes, thus creating sites for bubble formation and growth. It is assumed that grain boundary formation results from the conversion of stored energy from accumulated dislocations into energy for the formation of new grain boundaries.This thesis attempts to develop a quantitative model for grain subdivision in U3Si2 based on the above mentioned phenomena to verify the presence of this mechanism and to use in conjunction with swelling codes to evaluate the total swelling of the pellet in the reactor during its lifetime.

La protection des usagers et la prévention des risques sont des enjeux majeurs de la sécurité routière. La conception des véhicules inclut un grand nombre d’éléments de sécurité passive qui ont pour rôle de minimiser les séquelles corporelles des usagers si l’impact se produit. L’objectif global de cette thèse est donc de mettre en place des protocoles d’essais et d’observer ces comportements internes grâce à une technique d’imagerie récente : l’échographie ultrarapide. Une attention particulière a été portée au comportement interne des organes pleins de l’abdomen, qui sont les organes les plus souvent lésés lors des chocs automobiles. Les protocoles ont d’abord été développés sur le rein. En effet, même si celui-ci n’est pas l’organe le plus fréquemment touché, sa proximité anatomique avec le rein de porc a permis d’utiliser ce dernier pour le développement des méthodes. Puis les travaux se sont portés sur l’abdomen complet. Le modèle cadavérique a été utilisé pour l’ensemble des travaux.

Final master work proposes accidents fixing in cities GIS subsystem which includes database and map. Two databases conceptual models are formed in scientific work. One of them is choosing for detail projecting based on an accident dim. One parameter (the number of pedestrian passage) in database is involved in addition, not from the accident dim. Record accidents of 2003 year are marked by points on the map of Zirmunai part in Vilnius. Parameters describing accidents are saving in attributes table. Data of accidents were taken from archive of Vilnius road police. GIS subsystem projecting process, usage opportunity and users are presenting in this scientific work.

58 teksto puslapiai, 15 lentelių, 9 paveikslų, 52 literatūros šaltiniai, 5 priedai. Darbo tikslas – išanalizuoti žmonių gelbėjimo, įvykus nelaimingam atsitikimui, aktualumą, atskleisti problemos aktualumą žemės ūkio gamyboje, ištirti žemės ūkio darbuotojų pasirengimą gelbėti mirtinai traumuotą žmogų ir pasiūlyti priemones šiam pasirengimui gerinti. Nustatyta, kad 60-70 proc. iš visų nelaimingų atsitikimų (NA) įvyksta dėl neteisingų dirbančiojo veiksmų. Išnagrinėtos žmogaus psichofizinės savybės, dėl jų susiformuojantys veiksniai, kurie tampa NA priežastimi. Nustatytos kai kurios priemonės, mažinančios šių priežasčių pasireiškimą. Aukštesnis saugumo lygmuo gali būti pasiektas diegiant naujų, sudėtingesnių pažangios technologijos pavojų kontrolę, tam kad aukšto lygio saugumas panaikintų pažangios technologijos pavojus bei tos priemonės butų įgyvendintos. Lietuvoje žemės ūkis pagal įvykusių NA darbe skaičių yra šeštoje vietoje iš penkiolikos tarp visų ekonominės veiklos rūšių. Atlikus sociologinį tyrimą, kuriame dalyvavo 241 žemės ūkio darbuotojai iš įvairių Lietuvos regionų, buvo nustatyta, kad ūkininkai du kartus dažniau nei samdomi darbuotojai sugebėtų gaivinti staiga mirusį žmogų. Atlikus eksperimentinius tyrimus, paaiškėjo, kad pirmosios pagalbos mokymo efektyvumas priklauso nuo mokymo metodų. / Thesis of Master: 58 pages, 15 tables, 9 pictures, 52 sources of literature, 5 appendixes. Research goal – analyse people life saving urgency during accident, discover problem importance in agriculture industry, examine agriculturists preparation for life saving to man who is deadly traumatized and propose a new measures to improve this preparation. It is established, that 60-70 proc. of all accidents are occurred because of wrong worker actions. Person‘s psychophysical characteristics, factors caused by these characteristics that become the reasons of accidents werw investigated. It was foreseen some means that decrease display of these reasons. A higher level of safety may be achieved through control of the new, more complicated risks of advanced technology if high-level safety complicated risks of advanced technology if high-level safety engineering has been implemented. In Lithuania agriculture industry is the sixth from the top in the list of fifteen kinds of economical activity in means of number of work accidents. After sociological investigation among 241 agriculture workers from different regions of Lithuania, we have discovered twice more farmers, comparing with hired labour men, know, how to act, when work accident has occured. The expermental investigation results proved dependence of right training methods to higher effectiveness of first aid training.

Baigiamajame magistro darbe nagrinėjama nelaimingų atsitikimų darbe statistika Lietuvoje ir užsienyje, apžvelgiami pavojingi veiksniai statybvietėse ir jų įtaka nelaimingiems atsitikimams darbe. Aprašomas nelaimingų atsitikimų augimo tempų statyboje bendrasis modelis. Baigiamajame darbe pateikiami darbų saugos sistemos tobulinimo būdai, aprašomas kompleksinio sistemos vertinimo modelio formavimas ir realizavimas, pateikiamas statybviečių ir statybos įmonių būklės vertinimas darbuotojų saugos požiūriu, pateikiamos konkrečios priemonės saugos darbe sistemos statybos įmonėse efektyvumui didinti. Išnagrinėjus teorinius ir praktinius darbų saugos sistemos aspektus, pateikiamos baigiamojo darbo išvados ir pasiūlymai. Darbą sudaro šios dalys: įvadas, apžvalginis skyrius, analitinė – metodinė dalis, mokslinė - tiriamoji dalis, išvados ir pasiūlymai, literatūros ir kitų informacijos šaltinių sąrašas. Darbo apimtis – 77 p. teksto be priedų, 28 pav., 8 lent., 79 bibliografiniai šaltiniai. / The present thesis intended for master's degree deals with the statistics of occupational accidents in Lithuania and abroad, makes an overview of dangerous factors on construction sites and their influence on potential occupational accidents. Description of a general model of an increasing rate of occupational accidents in construction sector is given. Methods for improvement of labour safety system are contained in the thesis. Furthermore, a description of development and implementation of an overall system evaluation model is given in the paper together with an assessment of condition of construction sites and construction companies in terms of labour safety and actual proposals on the application of measures, which may lead to an increased efficiency of labour safety at construction companies. Conclusions and recommendations given in the paper are based on the outcome of the analysis of theoretical and practical aspects of labour safety system. The present thesis includes the following parts: Introduction, Overview, Analytical – methodological part, Scientific – investigative part, Conclusions and recommendations, References. Thesis consist of – 77 pages of written text excluding addenda, 28 figures, 8 tables, 79 bibliographic sources.

The "International Classification of Functioning, Disability and Health" (ICF) is a model that classifies health and health-related function. Of the ICF domains, least is known about participation. Although a few measures have been developed in English that tap the construct "Participation", none exist in Spanish. The Reintegration to Normal Living (RNL)-Index is the measure of reference to evaluate participation. The general objective of the present study was to translate, culturally adapt, and assess the psychometric properties the RNL-Index in Spanish for use in Spain. The translation and the cultural adaptation of the RNL-Index consisted of a five-step process, leading to the Spanish version of the RNL-Index (SRNL-Index). Psychometric evaluation consisted of a cross-sectional study design, with a longitudinal design used for test-retest evaluation. Thirty-two subjects with stroke and 36 with total knee arthroplasty completed the SRNL-Index twice, as well as the Six Minute Walk Test (6MWT), the Short-Form 36 Health Survey (SF-36), and for stroke subjects, the Barthel Index (BI). Descriptive statistics, one-way analysis of variance and post-hoc t tests were calculated, as well as Cronbach's alpha, Pearson's, and Intraclass correlation coefficients. The SRNL-Index was found to be internally consistent. Test-retest reliability was quite poor, being moderately low for the TKA sample and moderate for the stroke sample. Discriminant validity was demonstrated by the correlations between the SRNL-Index's Perception of Self and Daily Activity subscales with the Mental and Physical Component Summary scores of the SF-36. The SRNL-Index has convergent validity as shown by the high correlations between of the SRNL-Index and the 6MWT. Known-groups validity was shown in people with stroke grouped by Barthel Index scores, and in both samples when grouped according to gait speed. The SRNL-Index demonstrated acceptable validity and internal reliability for subjects with stroke and total knee arthroplasty. However, further studies are needed to reassess external validity, reliability, and responsiveness in other populations and other Spanish-speaking countries.

Contexte : il est possible qu'une victime subisse de multiples conséquences d'accident de la route,conséquences pouvant retentir durablement sur sa vie. Cependant, peu d'études permettent de connaitre leprofil du blessé grave ainsi que les facteurs prédictifs de son devenir. De plus, il existe peu d'outilsprédictifs servant à prédire les conséquences post-accidentelles. L'objectif de la thèse est de caractériserces conséquences, de chercher les éléments pronostiques de gravité des conséquences un an aprèsl'accident et de donner une évaluation, à partir de données réelles, de la qualité de prédiction del'indicateur de déficience à un an appelé IIS (Injury Impairment Score - un indice de déficience - défini apriori à partir des lésions- et utilisé fréquemment).Méthodes : la thèse est réalisée dans le cadre de la cohorte ESPARR (Étude et Suivi d'une Populationd'Accidentés de la Route dans le Rhône), qui s'appuie sur les données du Registre des accidents de lacirculation du Rhône, et qui inclut 1372 sujets blessés dans des accidents de la route dont 1168 sujets âgésde 16 ans et plus. Parmi ces sujets, 886 adultes ont répondu à un questionnaire de suivi à un an, 616 sujetsont des données complètes et sont classés dans des groupes homogènes en fonction de leur devenir à unan par l'analyse des correspondances multiples et la méthode de classification hiérarchique. L'analyse desfacteurs prédictifs de leur appartenance à un de ces groupes de victimes, mesurés à la date de l'accident, aété effectuée à l'aide de modèles de régressions logistiques multinomiales pondérés. L'évaluation de l'IISsur les données réelles est réalisée en regardant la cohérence entre l'IIS et les différents facteurs mesurés àun an.Résultats : cinq groupes homogènes au niveau des conséquences de l'accident à un an ont été identifiés :le groupe-1 contient 206 sujets, dont une majorité est considérée en bonne récupération ; le groupe-2concerne les sujets ayant uniquement des conséquences physiques ; les groupes 3, 4 et 5 concernent lessujets ayant des conséquences multiples. À part les conséquences physiques en lien avec les sujets dansces groupes, certains plus en lien avec des répercussions sur la vie social (groupe-3), d'autres en lien avecdes difficultés sociales ou environnementales (groupe-4). Le groupe-5 comprend tous les sujets quisouffrent de syndrome post-commotionnel de la population d'étude. Après avoir ajusté sur plusieursvariables recueillies lors de l'accident, notre étude montre que, en plus des facteurs déjà évoqués dans lalittérature (âge, gravité...), le niveau de fragilité socioéconomique et le fait d'avoir un proche blessé dansl'accident sont également des facteurs prédisant le devenir des victimes d'un accident. En ce qui concernel'évaluation de l'IIS sur les données réelles, nous trouvons que le niveau des conséquences prédites par l'IIS ne correspond pas parfaitement à celui observé en réalité à un an quels que soient les facteurs mesurés.Conclusion : un an après l'accident, de nombreuses victimes d'accident de la route, même parmi cellessouffrant de lésions légères, continuent de présenter de multiples problèmes tant sur leur santé physiqueque mentale, sur le plan social ainsi que sur leur environnement. Dans une perspective de réadaptation à lavie quotidienne, ces résultats peuvent être utiles à l'amélioration de la prise en charge des accidentés de laroute.