Determining the needs, priorities, and desired rehabilitation outcomes of young adults who have had a stroke

Background. Guidelines state that young adults' (aged 18–55 years) rehabilitation needs and priorities following stroke are different from older adults'. However, there is a lack of evidence regarding young adults' perspectives of their needs and priorities. Aim. To gain an understanding of young adults' experience of stroke and associated rehabilitation needs, priorities, and desired outcomes. Methods. A qualitative approach was adopted, based on the phenomenology of Merleau-Ponty. Longitudinal data were gathered using unstructured interviews and analysed using phenomenological reduction. Results. Ten young adults took part in up to four interviews over two years. An overarching theme, Embodied Disorientation, and three subthemes: Mortal Body, Situated Body, and Embodied Perception of Difference, described the young adults' experience. A subsequent iterative process enabled tabulation of patient-centred rehabilitation needs, priorities, and outcomes. Conclusion. Rehabilitation professionals can use the evidence-based outcomes table to work with young adults to develop meaningful patient-centred goals and select appropriate interventions which align with identified needs and outcomes throughout the stroke recovery trajectory

Forecasting enrollments in a Virginia community college

Most institutions of higher education are interested in enrollment projections because they are closely related to institutional goals and missions and, are, therefore, essential to financial and program planning at every level. This study was undertaken to determine if relevant factors could be identified and used in a statistical forecasting model to project enrollments in a multidimensional urban community college within the accuracy limitations imposed by a state such as Virginia (who requires State institutions of higher education) to project their enrollment within (+OR-) 1 percent.;Two general types of statistical forecasting models, causal and extrapolation models were explored for use in forecasting fall and summer headcount, and total FTE enrollments within the prescribed accuracy limits. The relevant factors for possible inclusion in the models were identified from previous studies and a student flow model for the institution. The relevant factors used in the final models were selected on the basis of simple correlation coefficients, the mean square error, and average error as variables were added and removed from the models.;The optimum fall and summer headcount forecasts were produced by a combination time-series and multiple regression model. The independent variables used in fall and summer headcount forecasts were a seasonal factor, a time-trend factor, and national economic indicators. In the optimum total FTE forecast, produced by a multiple regression model, the relevant factors were full-time enrollment shifted forward three years and national economic indicator shifted forward three years. The basis for acceptance or rejection of the models was made in context with the fiscal system of the Commonwealth of Virginia for the distribution of public funds to the state colleges and universities. The fiscal system was established primarily to provide a basis for financial planning. Forecasting models were produced for 1 year for fall headcount enrollment and for 2 years for summer headcount and total FTE enrollment within (+OR-) 1 percent.;On the basis of this study certain general conclusions were reached: the large variations between national enrollment projections resulted from different assumptions; enrollment projections have been too generalized for institutions with diverse goals and objectives; present data bases are inadequate to produce accurate enrollment projections; and most projections are not sufficiently reliable for planning purposes. More specific conclusions reached were: state data bases are inadequate for multidimensional institutions; removing quarterly seasonal variations permits the identification of relevant factors; traditional projection models such as the cohort survival and Markov are not applicable in multidimensional institutions such as community colleges; models such as time-series and multiple regression can be developed to accurately project enrollments for less than two years; the current limits of accuracy for Virginia multidimensional institutions are unrealistic; verification of the accuracy of prediction models is valuable for evaluating forecasting models; and models for multidimensional institutions must be revised periodically because relevant factors are constantly in flux

Substitution Between Managers and Subordinates: Evidence from British Football

We use data on British football managers and teams over the 1994-2007 period to study substitution and complementarity between leaders and subordinates. We find for the Premier League (the highest level of competition) that, other things being equal, managers who themselves played at a higher level raise the productivity of less-skilled teams by more than that of highly skilled teams. This is consistent with the hypothesis that one function of a top manager is to communicate to subordinates the skills needed to succeed, since less skilled players have more to learn. We also find that managers with more accumulated professional managing experience raise the productivity of talented players by more than that of less-talented players. This is consistent with the hypothesis that a further function of successful managers in high-performance workplaces is to manage the egos of elite workers. Such a function is likely more important the more accomplished the workers are -- as indicated, in our data, by teams with greater payrolls.Productivity, leadership

Attempting to validate the over/under triage matrix at a level I trauma center.

The Optimal Resources Document (ORD) mandates trauma activation based on injury mechanism, physiologic and anatomic criteria and recommends using the over/undertriage matrix (Matrix) to evaluate the appropriateness of trauma team activation. The purpose of this study was to assess the effectiveness of the Matrix method by comparing patients appropriately triaged with those undertriaged. We hypothesized that these two groups are different and Matrix does not discriminate the needs or outcomes of these different groups of patients.Trauma registry data, from 1/2013-12/2015, at a Level I trauma center were reviewed. Over and undertriage rates were calculated by Matrix. Patients with ISS ≥16 were classified by activation level (full, limited, consultation), and triage category by Matrix. Patients in the limited activation and consultation groups were compared to patients with full activation by demographics, injuries, initial vital signs, procedures, delays to procedure, ICU admission, length of stay, and mortality.7031 patients met activation criteria. Compliance with ACS tiered activation criteria was 99%. The Matrix overtriage rate was 45% and undertriage was 24%. Of 2282 patients with an ISS ≥16, 1026 were appropriately triaged (full activation), and 1256 were under triaged. Undertriaged patients had better GCS, blood pressure, and BD than patients with full activation. ICU admission, hospital stays, and mortality were lower in the undertriaged group. The under triaged group required fewer operative interventions with fewer delays to procedure.Despite having an ISS ≥ 16, patients with limited activations were dissimilar to patients with full activation. Level of activation and triage are not equivalent. The ACS-COT full and tiered activation criteria are a robust means to have the appropriate personnel present based on available pre-hospital information. Evaluation of the process of care, regardless of level of activation should be used to evaluate trauma center performance.Level III Therapeutic and Care managementThis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal

Riding in the Right Direction: examining risk and resilience in high risk Israeli youth involved in a sports intervention

This project studied 108 Israeli youth of mixed gender, aged 12-16 (mean 12.8, SD 1.67), selected for risk, with a 3 to 1 ratio of boys to girls. It included a group given a sports intervention and a comparison group. It utilised a broad psychosocial approach to investigate risks for psychological disorder and the impact of an intervention, based on both an Ecological and Attachment theoretical approach to inform identification of risk and resilience factors in a society used to political conflict. Aims: i) to examine psychosocial risks for psychological disorder in both groups and (ii) to examine the impact of a sports intervention in reducing risk and symptoms and increasing resilience. Method: The two phased prospective study included 60 young people referred by social services to a cycling intervention and 48 to a comparison group. Phase 1 examined demographic characteristics and psychosocial risks in the combined groups in relation to behavioural, emotional and post traumatic symptoms. Phase 2 examined change after 9 months comparing the two groups. Standardised self-report questionnaires were used, with focus groups and qualitative interviews to establish intervention impact. Questionnaires were translated into Hebrew and Arabic, with focus groups held in the local languages and subsequently translated and interviews with coaches held in English. Results: Twenty-three percent of all the youth reported a behavioral or emotional disorder at case level, with 33% having symptomatology at borderline level. Risk factors for such disorder were deprivation, insecure attachment style, peer problems and affectionless control in childhood from mothers or fathers. Poor peer relationships mediated between childhood experience and disorder. Over half had exposure to a traumatic event and there was a high prevalence of partial Post Traumatic Stress Disorder ( PTSD): 31% and 6% with full disorder. Life events, trauma experience, ethnicity and deprivation associations provided evidence of a social and Ecological interpretation of findings. Childhood experience, insecure attachment style and peer relationships supported an Attachment perspective. Findings at follow-up showed positive effects of the cycling intervention through decreased self-esteem and symptoms for both Conduct disorder and PTSD. There was also increased support for those in the intervention. However, follow-up findings were limited by high attrition rates. Analysis of focus groups and interviews led to a descriptive model showing benefits of the intervention through agentic (skills, discipline), escapist and aesthetic (fun) aspects. Conclusion: Findings are discussed in relation to Israeli culture and post-conflict context on youth risk and disorder, and the use of similar interventions in other post-conflict zones.

Substitution between managers and subordinates: evidence from British football

We use data on British football managers and teams over the 1994-2007 period to study substitution and complementarity between leaders and subordinates. We find for the Premier League (the highest level of competition) that, other things being equal, managers who themselves played at a higher level raise the productivity of less-skilled teams by more than that of highly skilled teams. This is consistent with the hypothesis that one function of a top manager is to communicate to subordinates the skills needed to succeed, since less skilled players have more to learn. We also find that managers with more accumulated professional managing experience raise the productivity of talented players by more than that of less-talented players. This is consistent with the hypothesis that a further function of successful managers in high-performance workplaces is to manage the egos of elite workers. Such a function is likely more important the more accomplished the workers are - as indicated, in our data, by teams with greater payrolls