Indicators and predictors of return to work or education following traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology

The leading cause of brain damage in previously healthy young adults, many of whom are of working age, is traumatic brain injury (TBI). Research to date generally agrees that TBI can lead to unemployment. However, knowledge about the determinants of return to work following TBI in the New Zealand context is minimal. This is remarkable given that failure to return to work following TBI is associated with tremendous costs. These include economic implications such as contribution to the economy through work Vs the necessity of financial support through government and community funding (i.e. invalids benefits or long-term care facilities). Furthermore, work affects an individual's self-concept; it represents a major social role, offering self-esteem, social contact and social support. Therefore, a need exists to understand various predictors and indicators and their influence on a client's ability to return to work or education following TBI. The present study was divided into two parts. Part one, was a retrospective analysis of a pre-existing database. In this part, the predictors: pre-injury employment status, job classification at TBI, age at TBI, years of post primary education at TBI, ethnicity, substance abuse after TBI and motor impairments, significantly influenced return to work/education and non return to work/education following TBI. The predictors: age at time of assessment, gender, substance abuse prior to TBI, injury severity, epilepsy, visual difficulties, hearing difficulties and speech difficulties, however, did not. In addition, the indicators: verbal IQ, verbal memory, attention, information processing speed and executive functioning, significantly influenced return to work/education and non return to work/education following TBI, however, the indicators: performance IQ, full scale IQ and visual memory did not. Part two of the present study was a planned analysis. In this part, the predictors: pre-injury job classification, pre-injury job stability, tertiary qualifications and alcohol use after TBI, significantly influenced a persons job classification following TBI and/or the number of hours they were able to work per week following TBI. However, the predictors: pre-injury employment status, age, years of post primary education, ethnicity, gender, substance use before TBI, criminal offending, injury severity, early post trauma sequelae, did not. In addition, the indicators; attention, services of a General Practitioner, the length of time a General Practitioners service was received, cognitive ability and activities of daily living as reported by a relative or close other, significantly influenced a persons job classification following TBI and/or the number of hours they were able to work per week following TBI. However, the remaining cognitive sequelae, rehabilitation information, emotional, behavioural sequelae, participant and relative/close other reports, did not. Qualitative information was also provided by the participant and a relative or close other and the results presented. In conclusion, the findings of both parts of the present study are discussed in relation to the findings of previous research, together with recommendations for future research

Addressing Laterality to Prevent Injury in Dance Education: Teaching Methods to Compensate for the Right Bias and Asymmetry

Despite the vast knowledge available about proper alignment and safe dance training, the growing demands for university dancers have plagued them with increasing rates of overuse injuries stemming from an imbalance in their practice often influenced by their professors. The purpose of this review is to study teaching methods in dance education and the right bias in university dance classes to learn how unbalanced teaching methods and dancers’ asymmetric physicalities cause injuries. This research will help professors understand how to effectively communicate with their students to promote safe, injury preventing practice. The research explores the various roles present in the problem, including the involvement of the student, professor, and even the physical therapist. This review investigates the influence the professor’s language and actions have on the student’s behaviors. For instance, how the student may interpret the language differently from the professor’s true intentions. Also considered in the research is the implementation of screening students for any physical asymmetries or weaknesses at the beginning of each semester to develop a basis for individual conditioning programs to work toward evolving a more balanced body. In addition to these programs, the research examines the dancers’ attitudes toward the implementation of these programs as well as fully complying with their physicians’ requests during injury. The current research shows that students are more likely to learn about proper alignment and human anatomy than they are to actually embody the information and change their technique habits that are causing these injuries. There is a low percentage of physical therapists who treat dancers and understand how unique dance injuries are and how dance culture influences the prescribed treatment and recovery periods. The research done on university dance programs demonstrates that many schools do not offer an injury prevention course in their core requirements. Universities should strengthen their relationships between their dancers, professors, and physicians, which includes a required injury prevention course that is integrated into their other courses.https://scholarscompass.vcu.edu/uresposters/1250/thumbnail.jp

Innovations and Trends in Pension Plan Coverage, Pension Type and Plan Design

In this paper, we outline recent trends in employer pension pIan structure in the United States, focusing on plan coverage, plan type and pension plan design. We then identify the key factors that we believe will shape company-sponsored pension design in the future, drawing conclusions from a review of recent research and practice. Finally, we offer a cautious prognosis about the future of pension pIan coverage, pIan type and pIan design, focusing on the role of labor force aging, as well as anticipated developments in the business environment and anticipated changes in public policy

Persuasive Strategies Used by Insurance Agents in Prospecting Customers Based on the Customers' Age Factor

This study aimed to find out the persuasive strategies used by X insurance agents in prospecting the customers and reveal the differences and similarities between persuasive strategies used by insurance agents in prospecting same-age customers and older customers. Through this study, the writer tried to relate the persuasive strategies used by insurance agents to the customers' age factor. The writer chose three insurance agents who worked in X Insurance company and classified the customers into two categories based on their ages; firstly, customers who are in the same-age group as the agents; secondly, customers who are in different-age (older) group from the agents. In the findings, it turned out that in prospecting both customers' categories, the insurance agents used both persuasive strategies proposed by Beebe & Beebe (2012); however some methods of persuasion strategies were not used at all. This study concluded that the age of the customers does not really affect the way insurance agents prospect their customers

The Impact of Health Status and Out-of-Pocket Medical Expenditures on Annuity Valuation

This paper describes how differences in health status at retirement can influence the decision to purchase a life annuity. We extend previous research on annuitization decisions by incorporating the effect of health differentials via differences in survival throughout the latter portion of life. Next, we consider how precautionary savings motivated by uncertain out-of-pocket medical expenses influence annuitization decisions. Our results show that annuities become less attractive to people facing uncertain medical expenses. While full annuitization would still be optimal if annuity markets were truly complete and both life- and health-contingent, lacking this, annuity equivalent wealth values are much lower for those in poor health, as compared to persons in good health.

Revisiting Alkali Metals As a Tool to Characterize Patterns of Mosquito Dispersal and Oviposition.

Mark-recapture methods constitute a set of classical ecological tools that are used to collect information on species dispersal and population size. These methods have advanced knowledge in disparate scientific fields, from conservation biology to pest control. Gathering information on the dispersal of mosquito species, such as Aedes aegypti, has become critical since the recognition of their role as vectors of pathogens. Here, we evaluate a method to mark mosquitoes that exploits the rare alkali metals rubidium (Rb) and caesium (Cs), which have been used previously to mark adult insects through feeding. We revised this method by adding Rb and Cs directly to water in which the immature stages of Ae. aegypti were allowed to develop. We then assessed the effect of Rb- and Cs-enriched water on fitness, survival and bioaccumulation in both adult females and their eggs. Results indicated that Cs had adverse effects on Ae. aegypti, even at low concentrations, whereas Rb at low concentrations had no measured effects on exposed individuals and accumulated at detectable levels in adult females. The method described here relies on passive uptake of Rb during immature stages, which has the benefit of avoiding handling or manipulation of the dispersive adults, which enables purer measurement of movement. Moreover, we demonstrated that Rb was transferred efficiently from the marked females to their eggs. To our knowledge, Rb is the only marker used for mosquitoes that has been shown to transfer vertically from females to eggs. The application of Rb rather than more traditional markers may therefore increase the quality (no impact on released individuals) and quantity (both adults and eggs are marked) of data collected during MR studies. The method we propose here can be used in combination with other markers, such as stable isotopes, in order to maximize the information collected during MR experiments

Developing and validating a predictive model for stroke progression

<p><b>Background:</b> Progression is believed to be a common and important complication in acute stroke, and has been associated with increased mortality and morbidity. Reliable identification of predictors of early neurological deterioration could potentially benefit routine clinical care. The aim of this study was to identify predictors of early stroke progression using two independent patient cohorts.</p> <p><b>Methods:</b> Two patient cohorts were used for this study – the first cohort formed the training data set, which included consecutive patients admitted to an urban teaching hospital between 2000 and 2002, and the second cohort formed the test data set, which included patients admitted to the same hospital between 2003 and 2004. A standard definition of stroke progression was used. The first cohort (n = 863) was used to develop the model. Variables that were statistically significant (p < 0.1) on univariate analysis were included in the multivariate model. Logistic regression was the technique employed using backward stepwise regression to drop the least significant variables (p > 0.1) in turn. The second cohort (n = 216) was used to test the performance of the model. The performance of the predictive model was assessed in terms of both calibration and discrimination. Multiple imputation methods were used for dealing with the missing values.</p> <p><b>Results:</b> Variables shown to be significant predictors of stroke progression were conscious level, history of coronary heart disease, presence of hyperosmolarity, CT lesion, living alone on admission, Oxfordshire Community Stroke Project classification, presence of pyrexia and smoking status. The model appears to have reasonable discriminative properties [the median receiver-operating characteristic curve value was 0.72 (range 0.72–0.73)] and to fit well with the observed data, which is indicated by the high goodness-of-fit p value [the median p value from the Hosmer-Lemeshow test was 0.90 (range 0.50–0.92)].</p> <p><b>Conclusion:</b> The predictive model developed in this study contains variables that can be easily collected in practice therefore increasing its usability in clinical practice. Using this analysis approach, the discrimination and calibration of the predictive model appear sufficiently high to provide accurate predictions. This study also offers some discussion around the validation of predictive models for wider use in clinical practice.</p&gt

The Role of Real Annuities and Indexed Bonds in an Individual Accounts Retirement Program

We explore four issues concerning annuitization options that retirees might use in the decumulation phase of an individual accounts' retirement saving system. First, we investigate the operation of both real and nominal annuity individual annuity markets in the United Kingdom. The widespread availability of real annuities in the U.K. dispels the argument that private insurance markets could not, or would not, provide real annuities to retirees. Second, we consider the current structure of two inflation-linked insurance products available in the United States, only one of which proves to be a real annuity. Third, we evaluate the potential of assets such as stocks, bonds, and bills, to provide retiree protection from inflation. Because equity real returns have been high over the last seven decades, a retiree who received income linked to equity returns would have fared very well on average. Nevertheless we cast doubt on the inflation insurance' aspect of equity, since this is mainly due to stocks' high average return, and not because stock returns move in tandem with inflation. Finally, we use a simulation model to assess potential retiree willingness to pay for real, nominal, and variable payout equity-linked annuities. For plausible degrees of risk aversion, inflation protection appears to have only modest value. People would be expected to value a variable payout equity-linked annuity more highly than a real annuity because the additional real returns associated with common stocks more than compensate for the volatility of prospective payouts. These finding are germane to concerns raised in connection with Social Security reform plans that include individual accounts.

Increasing Naloxone Distribution in VT Emergency Departments

Fatalities caused by overdose from opioids are increasing in Vermont. Evidence shows that Naloxone safely and effectively reverses the effects of opioids in overdose. This project aims to determine why physicians in VT Emergency Departments are not consistently distributing Naloxone to all patients with an overdose, and to increase awareness and implementation of this practice.https://scholarworks.uvm.edu/fmclerk/1149/thumbnail.jp