Suchergebnisse

Mild traumatic brain injury (mTBI), the signature injury of the recent wars in Afghanistan and Iraq, is a prevalent and potentially debilitating condition that is associated with symptoms of post-traumatic stress/post-traumatic stress disorder (PTS/PTSD). Prior mTBI, severity and type of injury (blast vs. non-blast), and baseline psychiatric illness are thought to impact mTBI outcomes. It is unclear if the severity of pre-morbid PTS/PTSD is a risk factor of post-injury levels of PTS and mTBI symptoms. The objective of the study was to examine predictors of post-injury PTS/PTSD, including pre-morbid PTS symptoms, and physical and cognitive symptoms in the sub-acute phase (1 week-3 months) following an acute mTBI. A retrospective review of medical records was performed of 276 servicemen assigned to the United States Army Special Operations Command referred for mTBI evaluation between December 2009 and March 2011. Post-Concussion Symptom Scale and PTSD Checklist scores were captured pre- and post-injury. A total of 276 records were reviewed. Pre-morbid and post-injury data were available for 91% (251/276). Of the 54% (136/251) of personnel with mTBI, 29% (39/136) had positive radiology findings and 11% (15/136) met criteria for clinical PTS symptoms at baseline. Logistic regression analysis found baseline PTS symptoms predicted personnel who met clinical levels of PTSD. Receiver operating characteristic curve analysis revealed that baseline PTS (p = 0.001), baseline mTBI symptoms (p = 0.001), and positive radiology (magnetic resonance imaging or computed tomography) findings for complicated mTBI (p = 0.02) accurately identified personnel with clinical levels of PTSD following mTBI. Years of military service, combat deployment status, age, and injury mechanism (blast vs. non-blast) were not associated with increased risk of PTS following mTBI. Pre-morbid PTS symptoms are associated with an increased risk for clinical levels of PTS following a subsequent mTBI. Symptom severity and positive radiologic findings may ...

This paper responds to Brown et al. (1984), who propose an extended training program involving work without pay in integrated settings for adults with severe intellectual handicaps. While agreeing about the capability of persons with disabilities, the importance of integration, and the failings of typical services, we believe that their extended training proposal represents an unnecessary retreat from values that have guided development of exemplary school and community services for persons with severe handicaps. As an extended outcome of services, the proposed program needlessly sacrifices wages and other employment benefits, distorts the benefits of integration by looking only at the workplace, and tolerates unequal treatment of citizens with severe handicaps. Relying on unpaid work as a strategy for time-limited employment preparation creates the risk of overuse and of perpetual readiness programming, suggesting that professional effort could be better spent in development of supported employment opportunities. Current federally supported employment initiatives provide a framework for combining wages and integration and offer support for local program development.

Item 378-H-5. ; S/N 008-020-00873-7. ; "Published in cooperation with the Inter-university Seminar on Armed Forces and Society, the Air University, and the Air Command and Staff College." ; Includes bibliographical references. ; Mode of access: Internet.

"Published in cooperation with the Inter-University Seminar on Armed Forces and Society, the Air University, and the Air Command and Staff College." ; Mode of access: Internet.

Abstract. The present contribution constitutes the first comprehensive attempt to (a) record the spatial characteristics of the beaches of the Aegean archipelago (Greece), a critical resource for both the local and national economy, and (b) provide a rapid assessment of the impacts of the long-term and episodic sea level rise (SLR) under different scenarios. Spatial information and other attributes (e.g., presence of coastal protection works and backshore development) of the beaches of the 58 largest islands of the archipelago were obtained on the basis of remote-sensed images available on the web. Ranges of SLR-induced beach retreats under different morphological, sedimentological and hydrodynamic forcing, and SLR scenarios were estimated using suitable ensembles of cross-shore (1-D) morphodynamic models. These ranges, combined with empirically derived estimations of wave run-up induced flooding, were then compared with the recorded maximum beach widths to provide ranges of retreat/erosion and flooding at the archipelago scale. The spatial information shows that the Aegean pocket beaches may be particularly vulnerable to mean sea level rise (MSLR) and episodic SLRs due to (i) their narrow widths (about 59 % of the beaches have maximum widths < 20 m), (ii) their limited terrestrial sediment supply, (iii) the substantial coastal development and (iv) the limited existing coastal protection. Modeling results indeed project severe impacts under mean and episodic SLRs, which by 2100 could be devastating. For example, under MSLR of 0.5 m – representative concentration pathway (RCP) 4.5 of the Fifth Assessment Report (AR5) of the Intergovernmental Panel on Climate change (IPCC) – a storm-induced sea level rise of 0.6 m is projected to result in a complete erosion of between 31 and 88 % of all beaches (29–87 % of beaches are currently fronting coastal infrastructure and assets), at least temporarily. Our results suggest a very considerable risk which will require significant effort, financial resources and policies/regulation in order to protect/maintain the critical economic resource of the Aegean archipelago.

BACKGROUND: Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. OBJECTIVE: To describe the current landscape of treatment for concussion and to provide summary agreements related to treatment to assist clinicians in the treatment of concussion. METHODS: On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. Thirty-seven concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. RESULTS: A total of 16 statements of agreement were supported covering (1) Summary of the Current Approach to Treating Concussion, (2) Heterogeneity and Evolving Clinical Profiles of Concussion, (3) TEAM Approach to Concussion Treatment: Specific Strategies, and (4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97% to 100%. CONCLUSION: Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies on the basis of modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery after concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments.

Frontmatter -- CONTENTS -- ACKNOWLEDGMENTS -- INTRODUCTION -- PART I DEVELOPMENT -- Introduction -- 1 BUNTY SINGH BUILDER OF DREAMS -- 2 IMRAN HOUSING CONTRACTOR -- 3 DALPAT MANAGER OF SERVICES -- 4 MEHMOODBHAI TOILET OPERATOR -- 5 KAUSHAL LAND AGGLOMERATOR -- 6 JANU SISTER-SUPERVISOR OF MIGRANT CONSTRUCTION WORKERS -- PART II PROPERTY -- Introduction -- 7 DR. K MIDDLE-CLASS SOCIAL WORKER -- 8 ASHOK RAVAT SHIVAJI PARK'S SENTINEL -- 9 SHAZIA PROOF MAKER -- 10 NIRMALA KAMATHIPURA'S GATEKEEPER -- 11 FARHAD "SUE MAKER" -- PART III BUSINESS -- Introduction -- 12 RAMITA SURROGACY AGENT -- 13 MUHAMMAD REVALORIZER OF E-WASTE -- 14 DEEPAK MAKING MUMBAI (IN CHINA) -- 15 LUBAINA FRAMING "DEVELOPMENT" -- 16 SHANKAR DELIVERING AUTHENTICITY -- 17 MANAL-MUNA COOKING UP VALUE -- 18 RAMJI BUSINESS ENERGIZER -- PART IV DIFFERENCE -- Introduction -- 19 BHIMSEN GAIKWAD SINGER OF JUSTICE -- 20 SULTAN IMAGE MANAGER -- 21 RAJ CARTING COSMOPOLITANISM -- 22 LAXMI DEALER IN EMOTION -- 23 DHARAMSEY ASSEMBLER OF TRADITION -- 24 DALVI SPEAKER OF CITIES -- PART V PUBLICS -- Introduction -- 25 SHASHI DOT CONNECTOR -- 26 ANIL PRAKASH AMPLIFIER OF CINEMA-INDUSTRIAL CONNECTIONS -- 27 GAURAVPANT MISHRA CROWD MAKER -- 28 SRINIVASAN KINGMAKER -- 29 MADHU DOOR OPENER -- 30 POORNIMA DESIGNING RELATIONS -- PART VI TRUTH -- Introduction -- 31 RAJANI PANDIT DETECTOR OF "TRUTHS" -- 32 AFZAL TAXIMAN RUMOR NAVIGATOR -- 33 PAWAN PRISON MASTER -- 34 SUJIT MASTER COMMUNICATOR -- 35 CHADDA REPORT MAKER -- 36 PRAKASH DATA ENTREPRENEUR -- CONCLUSION OTHER PLACES, OTHER TIMES -- GLOSSARY -- ABOUT THE CONTRIBUTORS -- INDEX