73 research outputs found
Relationship Between Hispanic Nativity, Residential Environment, and Productive Activity Among Individuals With Traumatic Brain Injury: A TBI Model Systems Study
Objective: To examine the influence of nativity and residential characteristics on productive activity among Hispanics at 1 year after traumatic brain injury (TBI).
Setting: Acute rehabilitation facilities and community follow-up.
Participants: A total of 706 Hispanic individuals in the TBI Model Systems National Database.
Design: Secondary data analysis from a multicenter longitudinal cohort study.
Main Measures: Nativity (foreign born or US native), productive activity derived from interview questions regarding employment status, and other demographic information. Census data were extracted by zip code to represent residential characteristics of aggregate household income and proportion of foreign language speakers (FLS).
Results: Among foreign-born individuals with TBI, those living in an area with a higher proportion of FLS were 2.8 times more likely to be productive than those living in areas with a lower proportion of FLS. Among individuals living in an area with a lower proportion of FLS, US-born Hispanics were 2.7 times more likely to be productive compared with Hispanic immigrants.
Conclusion: The relationship between nativity and productive activity at 1 year post-TBI was moderated by the residential proportion of FLS. Findings underscore the importance of considering environmental factors when designing vocational rehabilitation interventions for Hispanics after TBI
Prognostic models for predicting posttraumatic seizures during acute hospitalization, and at 1 and 2 years following traumatic brain injury
Objective
Posttraumatic seizures (PTS) are well-recognized acute and chronic complications of traumatic brain injury (TBI). Risk factors have been identified, but considerable variability in who develops PTS remains. Existing PTS prognostic models are not widely adopted for clinical use and do not reflect current trends in injury, diagnosis, or care. We aimed to develop and internally validate preliminary prognostic regression models to predict PTS during acute care hospitalization, and at year 1 and year 2 postinjury.
Methods
Prognostic models predicting PTS during acute care hospitalization and year 1 and year 2 post-injury were developed using a recent (2011–2014) cohort from the TBI Model Systems National Database. Potential PTS predictors were selected based on previous literature and biologic plausibility. Bivariable logistic regression identified variables with a p-value < 0.20 that were used to fit initial prognostic models. Multivariable logistic regression modeling with backward-stepwise elimination was used to determine reduced prognostic models and to internally validate using 1,000 bootstrap samples. Fit statistics were calculated, correcting for overfitting (optimism).
Results
The prognostic models identified sex, craniotomy, contusion load, and pre-injury limitation in learning/remembering/concentrating as significant PTS predictors during acute hospitalization. Significant predictors of PTS at year 1 were subdural hematoma (SDH), contusion load, craniotomy, craniectomy, seizure during acute hospitalization, duration of posttraumatic amnesia, preinjury mental health treatment/psychiatric hospitalization, and preinjury incarceration. Year 2 significant predictors were similar to those of year 1: SDH, intraparenchymal fragment, craniotomy, craniectomy, seizure during acute hospitalization, and preinjury incarceration. Corrected concordance (C) statistics were 0.599, 0.747, and 0.716 for acute hospitalization, year 1, and year 2 models, respectively.
Significance
The prognostic model for PTS during acute hospitalization did not discriminate well. Year 1 and year 2 models showed fair to good predictive validity for PTS. Cranial surgery, although medically necessary, requires ongoing research regarding potential benefits of increased monitoring for signs of epileptogenesis, PTS prophylaxis, and/or rehabilitation/social support. Future studies should externally validate models and determine clinical utility
The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation
In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44859/1/10880_2005_Article_BF01996131.pd
The Habitable Exoplanet Observatory (HabEx) Mission Concept Study Final Report
The Habitable Exoplanet Observatory, or HabEx, has been designed to be the Great Observatory of the 2030s. For the first time in human history, technologies have matured sufficiently to enable an affordable space-based telescope mission capable of discovering and characterizing Earthlike planets orbiting nearby bright sunlike stars in order to search for signs of habitability and biosignatures. Such a mission can also be equipped with instrumentation that will enable broad and exciting general astrophysics and planetary science not possible from current or planned facilities. HabEx is a space telescope with unique imaging and multi-object spectroscopic capabilities at wavelengths ranging from ultraviolet (UV) to near-IR. These capabilities allow for a broad suite of compelling science that cuts across the entire NASA astrophysics portfolio. HabEx has three primary science goals: (1) Seek out nearby worlds and explore their habitability; (2) Map out nearby planetary systems and understand the diversity of the worlds they contain; (3) Enable new explorations of astrophysical systems from our own solar system to external galaxies by extending our reach in the UV through near-IR. This Great Observatory science will be selected through a competed GO program, and will account for about 50% of the HabEx primary mission. The preferred HabEx architecture is a 4m, monolithic, off-axis telescope that is diffraction-limited at 0.4 microns and is in an L2 orbit. HabEx employs two starlight suppression systems: a coronagraph and a starshade, each with their own dedicated instrument
The Habitable Exoplanet Observatory (HabEx) Mission Concept Study Final Report
The Habitable Exoplanet Observatory, or HabEx, has been designed to be the
Great Observatory of the 2030s. For the first time in human history,
technologies have matured sufficiently to enable an affordable space-based
telescope mission capable of discovering and characterizing Earthlike planets
orbiting nearby bright sunlike stars in order to search for signs of
habitability and biosignatures. Such a mission can also be equipped with
instrumentation that will enable broad and exciting general astrophysics and
planetary science not possible from current or planned facilities. HabEx is a
space telescope with unique imaging and multi-object spectroscopic capabilities
at wavelengths ranging from ultraviolet (UV) to near-IR. These capabilities
allow for a broad suite of compelling science that cuts across the entire NASA
astrophysics portfolio. HabEx has three primary science goals: (1) Seek out
nearby worlds and explore their habitability; (2) Map out nearby planetary
systems and understand the diversity of the worlds they contain; (3) Enable new
explorations of astrophysical systems from our own solar system to external
galaxies by extending our reach in the UV through near-IR. This Great
Observatory science will be selected through a competed GO program, and will
account for about 50% of the HabEx primary mission. The preferred HabEx
architecture is a 4m, monolithic, off-axis telescope that is
diffraction-limited at 0.4 microns and is in an L2 orbit. HabEx employs two
starlight suppression systems: a coronagraph and a starshade, each with their
own dedicated instrument.Comment: Full report: 498 pages. Executive Summary: 14 pages. More information
about HabEx can be found here: https://www.jpl.nasa.gov/habex
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Evolving standards for informed consent: Is it time for an individualized and flexible approach? Commentary
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Substance abuse in older adults
Older adults now comprise the fastest growing segment of the population. In
1995 there were approximately 34 million persons over the age of 65, but by
2030 this number is expected to double (Bernstein, 1995; Hobbs, 1995).
Advancing age can be associated with negative financial, social, and medical
consequences, resulting in higher levels of perceived stress. It is recognized that
many of the life changes experienced by older adults, such as retirement, loss of
a spouse, and development of chronic medical conditions, can contribute to the
onset and severity of substance abuse. In turn, substance abuse can have adverse
effects on well-being by depleting available financial resources, alienating family
and friends, and causing or contributing to medical ailments. Thus, it is apparent that there is a reciprocal and synergistic relationship between substance
abuse and life changes experienced by the elderly, which for some may represent
an obstacle to the management of increasing medical and social needs
Recommended from our members
Effects of Alcohol and Nicotine on the Developing Brain: An Authoritative Guide
Brain Development: Normal Processes and the Effects of Alcohol and Nicotine. Michael W. Miller (Ed.). 2006. New York: Oxford University Press, 424 pp., $98.50 (HB) The process of brain development is an essential yet often overlooked area in the neuropsychological literature. The topic has a natural appeal to those who work with children where developmental disorders predominate. However, it is often more difficult for those who work with adults to appreciate the role of developmental aberrations and their contribution to pathological processes that may seem far removed from the early developmental history of our patients. The tendency for some to deemphasize early developmental influences may stem in part from a lack of clarity about how common toxin exposures, such as alcohol and nicotine, alter normal brain development and contribute to changes in cognitive function. Increasingly, evidence of early developmental influences has emerged in a host of epigenetically-based developmental disorders and neuropathological conditions, such as schizophrenia, and these influences are also implicated in theoretical models, such as cognitive reserve
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