No description available.

No description available.

No description available.

No description available.

L’impulsivité est une séquelle fréquente suite à un traumatisme cranio-cérébral (TCC) à laquelle sont associées de nombreuses conséquences néfastes et qui nécessite un investissement considérable de ressources. En ce sens, une évaluation adéquate de l’impulsivité est de mise dans un contexte de réadaptation. Par contre, malgré son importance, il n’existe pas de définition consensuelle de l’impulsivité post-TCC ni de mesure spécifique permettant de l’évaluer. Il est généralement admis, dans la littérature récente, que l’impulsivité est un construit multidimensionnel. Notamment, le modèle UPPS-P de l’impulsivité gagne un appui significatif et pourrait permettre une compréhension plus spécifique de l’impulsivité post-TCC. Selon ce modèle, il existe quatre dimensions à l’impulsivité soit l’urgence (tendance à agir ses impulsions dans un contexte d’émotions intenses), le manque de persévérance (difficulté au niveau du maintien de l’attention sur une tâche complexe et ennuyante et une susceptibilité à l’ennui), le manque de préméditation (difficulté de prévoir les conséquences d’un comportement avant de le poser) et la recherche de sensations (tendance à préconiser des activités jugées excitantes et l’ouverture à essayer de nouvelles expériences qui peuvent ou non, être dangereuses). Il a été proposé que l’urgence, le manque de persévérance et le manque de préméditation sont associés à des difficultés à inhiber la réponse automatique, à résister à l’interférence proactive et de la prise de décision, respectivement (Bechara et Van der Linden, 2005). Une telle conceptualisation offre une avenue prometteuse quant à l’évaluation de l’impulsivité post-TCC. Le présent projet vise à clarifier le construit de l’impulsivité post-TCC, à déterminer si les mêmes mécanismes cognitifs sont en lien avec les dimensions de l’impulsivité dans un contexte de réadaptation fonctionnelle intensive puis de déterminer quelles tâches de performance prédisent le mieux les comportements impulsifs dans ce milieu. D’abord, une recension des écrits portant sur l’impulsivité post-TCC donne un appui à la conceptualisation multidimensionnelle de l’impulsivité et fait ressortir les obstacles qui nuisent à l’étude de l’impulsivité post-TCC. Ensuite, l’utilisation de diverses tâches de performance permet d’évaluer le lien entre les dimensions de l’UPPS-P et les mécanismes cognitifs. Les résultats indiquent des atteintes sur les mécanismes liés à l’inhibition de la réponse automatique, à la résistance à l’interférence proactive ainsi qu’à la prise de décision. Toutefois, ils ne permettent pas de supporter les propositions de Bechara et Van der Linden quant aux mécanismes sous-jacents aux dimensions de l’impulsivité post-TCC chez les patients en réadaptation intensive. Finalement, les résultats permettent de faire ressortir la pertinence des tâches de performance écologiques dans la prédiction de comportements impulsifs dans la vie quotidienne. Les portées théoriques et cliniques des résultats sont discutées. / Impulsivity is a common sequela following traumatic brain injury (TBI) to which are associated many negative consequences and necessitates important resources. A thorough assessment of impulsivity is therefore necessary in a rehabilitation setting. However, there is no consensual definition of post TBI impulsivity nor is there a specific measure allowing its assessment. It is generally acknowledged, in recent literature, that impulsivity is a multidimensional construct. The UPPS-P model is gaining a significant amount of support and could allow a better understanding of post-TBI impulsivity. According to this model, there are four dimensions to impulsivity, namely urgency (tendency to experience and act on strong impulses frequently under conditions of strong affect), lack of perseverance (inability to remain focused on a task that may be boring or difficult), lack of premeditation (inability to think and reflect on the consequences of an act before engaging in that act) and sensation seeking (tendency to enjoy activities that are exciting and a willingness to try new experiences). It has been suggested that urgency, lack of perseverance and lack of premeditation are linked to impairments on prepotent response inhibition, on resistance to proactive interference and on decision making, respectively (Bechara and Van der Linden, 2005). This conceptualisation offers a promising avenue as to the assessment of post-TBI impulsivity. This project aims to clarify the construct of post-TBI impulsivity, to determine whether the same cognitive mechanisms come into play in the different dimensions of impulsivity in an intensive functional rehabilitation setting and to determine which performance tasks allow the prediction of impulsive behaviors in that setting. Firstly, a literature review among studies on post-TBI impulsivity gives support to a multidimensional conceptualisation of impulsivity and allows to bring out the obstacles which make the study of post-TBI impulsivity more complicated. Secondly, the use of different performance tasks is used to assess the links between UPPS-P dimensions and cognitive mechanisms. Results indicate impairments on the mechanisms linked to prepotent response inhibition, to resistance to proactive interference and to decision making. However, they do not support Bechara and Van der Linden’s (2005) propositions as to the underlying mechanisms to the dimensions of post-TBI impulsivity in an acute rehabilitation setting. Thirdly, the results show the relevance of ecological performance tasks as to the prediction of impulsive behaviors in everyday life. The theoretical and clinical implications of the results are discussed.

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In Operations Enduring Freedom and Iraqi Freedom, explosions accounted for 81% of all injuries; this is a higher casualty percentage than in any previous wars. Blast wave overpressure has recently been associated with varying levels of traumatic brain injury in soldiers exposed to blast loading. Presently, the injury mechanism behind primary blast brain injury is not well understood due to the complex interactions between the blast wave and the human body. Despite these limitations in the understanding of head injury thresholds, head kinematics are often used to predict the overall potential for head injury. The purpose of this study was to investigate head kinematics, and predict injury from a range of simulated blast loads at varying standoff distances and differing heights of bursts. The validated Generator of body data multi-body human surrogate model allows for numerical kinematic data simulation in explicit finite element method fluid structure interaction blast modeling. Two finite element methods were investigated to simulate blast interaction with humans, an enhanced blast uncoupled method, and an Arbitrary Lagrangian Eularian fully coupled method. The enhanced blast method defines an air blast function through the application of a blast pressure wave, including ground reflections, based on the explosives relative location to a target; the pressures curves are based on the Convention Weapons databases. LBE model is efficient for parametric numerical studies of blast interaction where the target response is the only necessary result. The ALE model, unlike classical Lagrangian methods, has a fixed finite element mesh that allows material to flow through it; this enables simulation of large deformation problems such as blast in an air medium and its subsequent interaction with structures. The ALE model should be used when research into a specific blast scenario is of interest, since this method is more computationally expensive. The ALE method can evaluate a blast scenario in more detail including: explosive detonation, blast wave development and propagation, near-field fireball effects, blast wave reflection, as well as 3D blast wave interaction, reflection and refraction with a target. Both approaches were validated against experimental blast tests performed by Defense Research and Development Valcartier and ConWep databases for peak pressure, arrival time, impulse, and curve shape. The models were in good agreement with one another and follow the experimental data trend showing an exponential reduction in peak acceleration with increasing standoff distance until the Mach stem effect reached head height. The Mach stem phenomenon is a shock front formed by the merging of the incident and reflected shock waves; it increases the applied peak pressure and duration of a blast wave thus expanding the potential head injury zone surrounding a raised explosive. The enhanced blast model was in good agreement with experimental data in the near-field, and mid-field; however, overestimated the peak acceleration, and head injury criteria values in the far-field due to an over predicted pressure impulse force. The ALE model also over predicted the response based on the head injury criteria at an increased standoff distance due to smearing of the blast wave over several finite elements leading to an increased duration loading. According to the Abbreviated Injury Scale, the models predicted a maximal level 6 injury for all explosive sizes in the near-field, with a rapid acceleration of the head over approximately 1 ms. There is a drastic exponential reduction in the insult force and potential injury received with increasing standoff distance outside of the near-field region of an explosive charge.

Le Vietnam du Doi Moi poursuit sa libéralisation économique tout en consolidant le système politique hérité du marxisme-léninisme. Ce paradoxe influence considérablement son processus d'intégration économique internationale et se manifeste particulièrement dans le commerce des services. La manière dans laquelle le Vietnam reconnaît le principe de non-discrimination via les traités bilatéraux, plurilatéraux et multilatéraux, tant sous l'angle du commerce des services que sous l'angle de l'investissement, le prouve. Par ailleurs, dans le souci d'accélérer le développement économique, d'importantes réformes relatives au droit des affaires ont supprimé des discriminations substantielles entre les opérateurs économiques. Cependant, en raison de l'insuffisance de l'adapatation structurelle, la mise en oeuvre du principe de non-discrimination pose toujours de nombreuses difficultés. / Vietnam of Doi Moi pursues economic liberalization while strengthening the political system initiated from Marxism-Leninism. This paradox significantly influences its international economic integration process and manifests itself especially in the domain of trade in services. This is demonstrated by the manner in which Vietnam recognizes the principle of non-discrimination, through bilateral, plurilateral and multilateral agreements, in trade in services as well as in investements. Besides, in order to accelerate economic development, important reforms on business law have removed substancial discriminations between economic operators. However, the insufficient ajustement on structural matters still poses many problems for the implementation of the principle of non-discrimonation.

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This thesis examines how military members and veterans with Operational Stress Injuries are treated by Canadian justice systems. It suggests a correlation between mental injuries sustained on operations by military personnel and propensities for military and societal misconduct. By comparing civilian and military processes with American justice counterparts, a plan to improve the existing Canadian legal landscape is proposed. Using an analysis of the underlying philosophy and purpose of military justice, a problem solving diversionary court is recommended, along with legislative and policy amendments. The use of a consent-based “Treatment Standing Court Martial” would place military justice officials parallel to civilian justice alternative measures programs, and in a better position to break the cycle of recidivism among veterans by addressing root causes. Education to reduce stigma along with military-civilian partnerships are also advocated to enhance the detection of mental illness and to foster early treatment for military personnel and veterans. The overall goals of the work include: reducing recidivism, improving operational efficiency and taking care of military members, veterans and their families.