La profession de masseur-kinésithérapeute instituée par la loi n° 46-857 du 30 avril 1946 : genèse et évolutions d’une profession de santé réglementée

The physiotherapist profession is officially born on 30 April 1946. From the late 19th century, massage, physiotherapy, gymnastics having entered the field of medicine and the law of 30 November 1892 given doctors a monopoly all care techniques, they will appeal to auxiliary assured they will pre-service training to better control. The War of 1914-1918 "social evil" will ensure the promotion of these empirical methods. The lack of professional masseurs who limited the access to these practices the medical profession will agree to delegate certain auxiliaries. It was not until World War II that a purely authoritarian manner are created medical gymnastics instructor profession and the medical masseur. These texts repealed in 1945, Law No. 46857 of 30 April 1946 designed to regulate the exercise of the medical professions gymnast masseur will create the profession of physiotherapist by giving him the legal monopoly of the massage. Very quickly this monopoly will be challenged and just as quickly the profession will manifest a desire for emancipation in relation to medical supervision. He will have to wait almost a quarter century (1969) to see its main claim result: a third year of study and 60 years for the Council of the Order (2006). The evolution of physiotherapy was, at first, hampered by the hegemonic designs of the medical profession and in a second stage conditional on regulatory harmonization policy allied health professionals conducted by public authorities and by societal choices. Subsequently the evolution of the profession will be affected by the establishment of quotas for access to studies that will encourage a large number of French youth (s) to undertake their studies in countries of the European Union. Subsequently, more and more EU citizens come to work in France. The upheavals on morals appeared in the years 1960-1970, have abolished a number of prohibitions, has upset the mentalities by promoting research of wellbeing. The physiotherapists who discontinued hygienic and aesthetic massage others vindicated. The first were beauticians who eventually win the case (massages to aesthetic purposes) followed by self-appointed wellness massage practitioners that case law has gradually legitimized. The creation of a Professional Order was the source of serious intra professional dissension. In this case, the energy expended was not put on the professional service, but of a certain conception of the latter. The reason has finally prevailed occupation, mainly united, has obtained significant progress symbolized by obtaining a fourth year preceded by a first year of university studies (PACES, STAPS, STC )La profession de masseur kinésithérapeute est officiellement née le 30 avril 1946. A partir de la fin du 19e siècle, le massage, la kinésithérapie, la gymnastique ayant pénétré le champ de la médecine et la loi du 30 novembre 1892 confié aux médecins le monopole de l’ensemble des techniques de soins, ceux-ci vont faire appel à des auxiliaires dont ils auront assurés la formation préalable pour mieux les contrôler. La guerre de 1914-1918 « fléau social » va assurer la promotion empirique de ces méthodes. L’absence de masseurs professionnels ayant limité le bénéfice de ces pratiques, le corps médical va accepter de les déléguer à certains auxiliaires. Il faudra attendre la Seconde Guerre mondiale pour que soient créées la profession de moniteur de gymnastique médicale et celle de masseur médical. Ces textes abrogés en 1945, la loi n° 46.857 du 30 avril 1946 tendant à réglementer l’exercice des professions de masseur gymnaste médical va créer la profession de masseur-kinésithérapeute en lui confiant le monopole légal du massage. Il lui faudra attendre près d’un quart de siècle (1969) pour voir aboutir sa principale revendication : une troisième année d’études et 60 ans pour obtenir Conseil de l’Ordre (2006). Par la suite l’évolution de la profession va être impactée par la mise en place de quotas d’accès aux études qui va inciter un grand nombre de jeunes français(e)s à entreprendre leurs études dans des pays de l’Union européenne. Subséquemment, de plus en plus de ressortissants communautaires viennent exercer en France. Les bouleversements en matière de mœurs apparus au cours des années 1960-1970, ayant aboli un certain nombre d’interdits, a bouleversé les mentalités en favorisant une recherche du bien-être. Les masseurs-kinésithérapeutes ayant abandonné le massage hygiénique et esthétique d’autres le revendiquèrent. La création d’un Ordre professionnel a été sources de graves dissensions intra professionnelles. La raison ayant fini par l’emporter la profession, majoritairement unie, vient d’obtenir une avancée significative symbolisée par l’obtention d’une quatrième année d’études précédée d’une première année d’études universitaire (PACES, STAPS, STC)

Ethical Guidelines for Social Work Supervisors in Rural Settings

Little research literature exists integrating ethics, supervision, and rural/small community practice. This paper reports results of a study conducted by a joint student-faculty team. The study engaged supervisors in rural and small communities in two Midwestern states in semi-structured interviews. Interview data were then used to develop guidelines for BSW students about what constitutes ethical supervisory practice in rural environments

The Impact of regulatory capital regulation on balance sheet structure, intermediation cost and growth

URL des Documents de travail : http://ces.univ-paris1.fr/cesdp/cesdp2016.htmlDocuments de travail du Centre d'Economie de la Sorbonne 2016.61 - ISSN : 1955-611XAs Europe is subject to a protracted recession, it should be asked whether the reform of the financial sector is not costly in terms of potential growth. Our analysis shows that the negative effect of the Basel III package excepted by the pre-QE studies are almost annihilated today. The recession must then have other causes: falling corporate lending volumes resulted from falling demand in the aftermath of the financial crisis, but this is longer the case. The EU is trying to incentivize corporate lending, via forward guidance as well as ‘supporting factor’ cutting down the Basel capital requirements. The macroeconomic theorists are trying to account for future success of monetary policy around zero nominal interest rate via the risk-taking channel. All these clever initiatives failed to deliver. As a consequence, we might infer that banks are simply not taking any risks: rather than appealing to risk aversion, we would like to argue that the banks seem especially embarrassed by future regulatory developments, which appear remote and uncertain. The binding constraint for corporate lending and growth in the EU is then plausibly a combination of banks' expectations of future regulation and strong uncertainty aversion. While we offer some mitigation prospects, we hope that the theoretical developments of the recent years will quickly yield both theoretical advances and practical results.Malgré les assouplissements récents de la règlementation bancaire afin de permettre une reprise des prêts aux entreprises, il semble que le paquet Bâle III ait un effet néfaste sur la croissance. Le texte s'interroge sur la contrainte active parmi l'ensemble des nouvelles règles. Il semblerait que les banques soient devenues très averses à l'incertitude, en particulier à l'incertitude sur l'évolution des règles qui leurs sont imposées. En conséquence nous proposons de modifier la nature des provisions en capital et le nombre de régulateurs ayant un pouvoir de décision sur le niveau des capitaux

Corevalve vs. Sapien 3 transcatheter aortic valve replacement: A finite element analysis study

Aim: to investigate the factors implied in the development of postoperative complications in both self-expandable and balloon-expandable transcatheter heart valves by means of finite element analysis (FEA). Materials and methods: FEA was integrated into CT scans to investigate two cases of postoperative device failure for valve thrombosis after the successful implantation of a CoreValve and a Sapien 3 valve. Data were then compared with two patients who had undergone uncomplicated transcatheter heart valve replacement (TAVR) with the same types of valves. Results: Computational biomechanical modeling showed calcifications persisting after device expansion, not visible on the CT scan. These calcifications determined geometrical distortion and elliptical deformation of the valve predisposing to hemodynamic disturbances and potential thrombosis. Increased regional stress was also identified in correspondence to the areas of distortion with the associated paravalvular leak. Conclusion: the use of FEA as an adjunct to preoperative imaging might assist patient selection and procedure planning as well as help in the detection and prevention of TAVR complications

Assessment of myocardial and LV blood pool post-contrast T1 evolution: comparison between healthy subjects and patients with hypertrophic cardiomyopathy

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Challenges in measuring angles between craniofacial structures

Objective: Three-dimensional (3D) angular measurements between craniofacial planes pose challenges to quantify maxillary and mandibular skeletal discrepancies in surgical treatment planning. This study aims to compare the reproducibility and reliability of two modules to measure angles between planes or lines in 3D virtual surface models. Methodology: Twenty oriented 3D virtual surface models de-identified and constructed from CBCT scans were randomly selected. Three observers placed landmarks and oriented planes to determine angular measurements of pitch, roll and yaw using (1) 3D pre-existing planes, (2) 3D planes created from landmarks and (3) lines created from landmarks. Inter- and intra-observer reproducibility and repeatability were examined using the Intra-Class Correlation (ICC) test. One observer repeated the measurements with an interval of 15 days. ANOVA was applied to compare the 3 methods. Results: The three methods tested provided statistically similar, reproducible and reliable angular measurements of the facial structures. A strong ICC varying from 0.92 to 1.00 was found for the intra-observer agreement. The inter-observer ICC varied from 0.84 to 1.00. Conclusion: Measurements of 3D angles between facial planes in a common coordinate system are reproducible and repeatable either using 3D pre-existing planes, created based on landmarks or angles between lines created from landmarks

Unique relationship between tropical rainfall and SST to the north of the Mozambique Channel in boreal winter

In this study, we investigate a possible mechanism for the dichotomy in climatology of marine rainfall and sea surface temperature (SST) over a part of the Southwest Indian Ocean (SWIO) during boreal winter (January and February) with state-of-the-art satellite and reanalysis data sets. Rainfall to the north of the Mozambique Channel, bounded 10°–5°S and 40°–50°E, is found to be quite feeble despite being in the warm SST regime of up to 29–29.5 °C. The rainfall intensity is rather found to be highly associated with the atmospheric surface divergence. The vigorous rainfall is associated with the more convergence over the Intertropical Convergence Zone (ITCZ), while the weak rainfall is linked with the divergence to the north of the Mozambique Channel. The surface divergent flow to the north of the Mozambique Channel is associated with a deep southward penetration of the northerly Indian Winter Monsoon (IWM). Corresponding to the surface divergent field, a relatively high sea level pressure (SLP) compared to the SLP in the ITCZ, weak subsidence, and low-level stratiform clouds are formed to the north of the Mozambique Channel, despite the warm, tropical SST. These atmospheric conditions are most likely conductive to the inhibition of cumulus convection over the region and the unique relationship between rainfall and SST seems peculiar. Our analysis also shows that the rare occurrence of tropical cyclones over the area is attributed to a high-pressure surge and the associated positive surface vorticity (anti-cyclonic). This study suggests that the area to the north of the Mozambique Channel is dynamically interesting for climatological studies.acceptedVersio

What is the influence of using generic material properties on the estimation of the pelvis sagging when sitting from a Finite Element model of the buttock region?

Ischial pressure sores are painful, slow healing wounds that develop during prolonged sitting. Its formation is associated with the high internal strains induced by the compression of the soft tissues under the ischium [1]. 3D Finite Element (FE) models have been developed to estimate internal strains in the subdermal soft tissues. Some authors have also investigated the influence of the material properties of the soft tissues [2]. However, the interval of variation of the parameters in these sensitivity studies are not necessarily representative of the variability of subgroups of population. In this contribution, we investigate the influence of using the material properties of one given individual (generic material properties) as representative of a population. The generic material properties were obtained by Finite Element Updating to fit the experimental sagging of the pelvis of one subject when sitting. The 3D subject-specific FE model was generated from the combination of bi-planar Radiography, ultrasound imaging and optical scanner and is composed of the pelvis (rigid body) and 3 homogeneous layers representing the muscle tissue, fat and skin. The adipose tissue and the muscle layer were modelled as an Ogden quasi-incompressible hyperelastic material. The same material parameters were used to estimate the pelvis sagging of 7 healthy subjects. The estimated sagging was compared to the experimental one measured by computing the vertical displacements of both ischial tuberosities visible on the radiographs before and after sitting (Figure 1). For 5 subjects, the differences between both were below 1mm. For the two other subjects, the differences were 4 and 6 mm. These findings suggest that using generic material properties allow to reproduce the biomechanical response of the buttock when sitting for healthy subjects. The same approach could be applied to spinal cord injury population, which will allow to clarify the necessity of personalizing the material properties in models developed for this population

A finite element analysis study from 3D CT to predict transcatheter heart valve thrombosis

Background: Transcatheter aortic valve replacement has proved its safety and effectiveness in intermediate- to high-risk and inoperable patients with severe aortic stenosis. However, despite current guideline recommendations, the use of transcatheter aortic valve replacement (TAVR) to treat severe aortic valve stenosis caused by degenerative leaflet thickening and calcification has not been widely adopted in low-risk patients. This reluctance among both cardiac surgeons and cardiologists could be due to concerns regarding clinical and subclinical valve thrombosis. Stent performance alongside increased aortic root and leaflet stresses in surgical bioprostheses has been correlated with complications such as thrombosis, migration and structural valve degeneration. Materials and Methods: Self-expandable catheter-based aortic valve replacement (Medtronic, Minneapolis, MN, USA), which was received by patients who developed transcatheter heart valve thrombosis, was investigated using high-resolution biomodelling from computed tomography scanning. Calcific blocks were extracted from a 250 CT multi-slice image for precise three-dimensional geometry image reconstruction of the root and leaflets. Results: Distortion of the stent was observed with incomplete cranial and caudal expansion of the device. The incomplete deployment of the stent was evident in the presence of uncrushed refractory bulky calcifications. This resulted in incomplete alignment of the device within the aortic root and potential dislodgment. Conclusion: A Finite Element Analysis (FEA) investigation can anticipate the presence of calcified refractory blocks, the deformation of the prosthetic stent and the development of paravalvular orifice, and it may prevent subclinical and clinical TAVR thrombosis. Here we clearly demonstrate that using exact geometry from high-resolution CT scans in association with FEA allows detection of persistent bulky calcifications that may contribute to thrombus formation after TAVR procedure