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Objective: Adults are at risk for unemployment following a moderate-severe traumatic brain injury (TBI). Less is known about employment patterns following mild TBI. This study aims to examine patterns of return to pre-injury job in adults following mild TBI over a 12-month post injury period, and to investigate factors associated with return to work. Methods: It is a prospective longitudinal study of 205 adults (aged ≥16 years at injury) identified as part of a larger population-based incidence study in the Waikato, New Zealand. In-person assessments were completed at baseline (within 14 days) and 1-, 6-, and 12-month post-injury. Results: A total of 159 (77.6%) adults returned to their pre-injury job at baseline and 185 (90.2%) returned within 12 months. Of those who did not return to their pre-injury job at baseline (n = 46), younger age at injury (≤30 years, p = .02) and poor overall neurocognitive functioning at 1-month (p = .02) was associated with non-return to pre-injury job at 12 months. Conclusion: In a sample of employed adults, the majority returned to their pre-injury job shortly after injury. Cognitive functioning and younger age at time of injury may be associated with delayed return to work. Interventions to support younger workers may facilitate their return to work.
Why does public conflict over societal risks persist in the face of compelling and widely accessible scientific evidence? We conducted an experiment to probe two alternative answers: the ‘science comprehension thesis’ (SCT), which identifies defects in the public's knowledge and reasoning capacities as the source of such controversies; and the ‘identity-protective cognition thesis’ (ICT), which treats cultural conflict as disabling the faculties that members of the public use to make sense of decision-relevant science. In our experiment, we presented subjects with a difficult problem that turned on their ability to draw valid causal inferences from empirical data. As expected, subjects highest in numeracy – a measure of the ability and disposition to make use of quantitative information – did substantially better than less numerate ones when the data were presented as results from a study of a new skin rash treatment. Also as expected, subjects’ responses became politically polarized – and even less accurate – when the same data were presented as results from the study of a gun control ban. But contrary to the prediction of SCT, such polarization did not abate among subjects highest in numeracy; instead, it increased. This outcome supported ICT, which predicted that more numerate subjects would use their quantitative-reasoning capacity selectively to conform their interpretation of the data to the result most consistent with their political outlooks. We discuss the theoretical and practical significance of these findings.
This commentary uses the dynamic of identity-protective cognition to pose a friendly challenge to Jussim (2012). Like other forms of information processing, this one is too readily characterized as a bias. It is no mistake, however, to view identity-protective cognition as generating inaccurate perceptions. The “bounded rationality” paradigm incorrectly equates rationality with forming accurate beliefs. But so does Jussim's critique.
Introduction: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom driven approach, whereby patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised; CIWA-Ar) and treated according to severity. Among the domains assessed by the CIWA-Ar, tremor is the most objective indicator of withdrawal severity, however, the ability of clinicians to reliably quantify tremor is highly dependent on experience. The objective of this study was to prospectively validate an objective, reliable tool to standardize and quantify the severity of alcohol withdrawal tremor using the built-in accelerometer of an iOS application. Methods: A prospective observational study of patients ≥18 years presenting to an academic emergency department in alcohol withdrawal was conducted from Oct 2014 to Aug 2015. Assessments were videotaped by a research assistant and subsequently reviewed by 3 clinical experts, blinded to the primary clinical assessment. Tremor severity was scored using the 8-point CIWA scale (0=no tremor, 7=severe tremor). Accelerometer derived results were compared to expert assessments of each video. Inter-rater agreement was estimated using Cohen’s kappa (k) statistic. Results: 76 patients with 78 tremor recordings were included. Accelerometer derived tremor scores matched exactly with expert assessor scores in 36 (46.2%) cases, within 1 point for 73 (93.6%) cases and differed by ≥ 2 points in 5 (6.4%) cases. The overall kappa for agreement within 1 point for tremor severity was ‘very good’ 0.92 (95% CI: 0.86, 0.99). Conclusion: iOS accelerometer based assessment of the tremor component of the CIWA-Ar score is reliable and has potential to more accurately assess the severity of patients in alcohol withdrawal. We anticipate this resource will be easily disseminated and will impact and improve the care of patients with alcohol withdrawal.
Introduction: Of the domains assessed by the CIWA-Ar, tremor is the most objective, and reliable clinical symptom of alcohol withdrawal syndrome. Even so, anecdotal evidence suggests that the ability of health care workers to reliably rate tremor severity is highly variable, and there is no high quality, readily available training to teach this competency. Improper evaluation and interpretation of tremor may result in under or over treatment, posing serious risks to patient safety, prolonging emergency department (ED) length of stay, and increasing the likelihood of complications/hospital admission. The objective of this study was to prospectively compare tremor assessment scores assigned by nurses and clinical experts for patients with alcohol withdrawal syndrome in the ED. Methods: A prospective observational study was conducted for patients ≥18 years presenting to an academic ED in alcohol withdrawal from Oct 2014 to Aug 2015. Individual tremor assessments were videotaped by a research assistant and subsequently reviewed by 3 clinical experts, blinded to the primary clinical assessment. Tremor severity was scored using the 8-point CIWA scale (0=no tremor, 7=severe tremor). Tremor severity scores assigned in real-time by the nurses were compared to expert assessments of each video. Inter-rater agreement was estimated using Cohen’s kappa (k) statistic. Results: 31 patients with 62 tremor recordings were included. Nurse-derived tremor scores matched exactly with expert assessor scores in 11 (17.7%) cases, within 1 point for 29 (46.8%) cases and differed by ≥ 2 points in 33 (53.3%) cases. The overall kappa for agreement within 1 point for tremor severity was ‘fair’ 0.39 (95% CI: 0.25, 0.53). Conclusion: These results confirm the high variability in the assessment of alcohol withdrawal tremor by health care workers. Future research should focus on ways to improve the accuracy of tremor in alcohol withdrawal patients, and the development and implementation of an educational program to improve the individual competencies of clinical staff in the recognition and treatment of alcohol withdrawal in the ED.
My goal in this essay is to reexamine a solution to an important puzzle about the significance of emotions in substantive criminal law. Indeed, the reexamination is in the nature of a qualification bordering on confession of error. The position I want to question was forged in the course of a sustained, multifaceted, and very satisfying scholarly conversation in which I myself played a part. But now, as a result of my participation in another set of scholarly conversations – ones that had until recently struck me as entirely collateral to emotions and criminal law – I find myself compelled to call attention to what I regard as the likely inadequacy of an account I had a significant hand in promoting.
I am not disheartened, though, to find myself in this position. There is, to be sure, discomfort in admitting doubt about arguments that had once struck me as both compelling and complete. Yet there is an even bigger reward: the discovery of continuing vitality in a problem that once filled me, and now does again, with intellectual energy. Other scholars, too, might find it awkward for me to express misgivings at this point about claims that built on and were extended by their work. But I feel confident that they, rather than resenting my second thoughts, are likely to welcome them for supplying an occasion to test whether conclusions they once formed continue to warrant their considered assent.
We argue that Henrich et al. do not go far enough in their critique: Sample diversification, while important, will not lead to the detection of generalizable principles. For that it will be necessary to broaden the range of contexts in which data are gathered. We demonstrate the power of contexts to alter results even in the presence of sample diversification.
The recent discovery of microscopic grains of presolar origin in primitive
meteorites has opened a new field of astrophysics where scientists from different
disciplines, from nuclear physics to astronomy, chemistry and mineralogy, are
required to work together. In this inter-disciplinary field information on the
composition of stars is obtained through laboratory analysis of meteoritic rocks.
We review the main features of the composition of presolar SiC and oxide grains
that are believed to have originated in Asymptotic Giant Branch (AGB) stars.
High-precision laboratory measurements of the isotopic composition of these types
of presolar grains represent the most detailed record of the composition of AGB
stars, and thus a major constraint for the theoretical models of these stars. In
particular, the CNO and Al/Mg compositions can set constraints on extra-mixing
processes in red giant and AGB stars. The composition of heavy elements produced
by slow neutron captures (s-process) yields a variety of information on the
grain parent stars, including their masses and the way neutron sources operate.
The jurisprudence of Oliver Wendell Holmes, Jr., embodies exactly the kind of anti-theoretical reasoning that Martha Nussbaum criticizes. Holmes, as Nussbaum recognizes, was notoriously hostile to generalization and abstraction. Consider his famous aphorisms: “[G]eneral propositions do not decide concrete cases”; “[T]he life of the law has not been logic: it has been experience”; The common law … decides the case first and determines the principle afterwards.” The same attitude informs the legal doctrines that Holmes championed. The “reasonable man” standard of negligence, the “clear and present danger” test for speech restrictions, and the “dangerous proximity” test for criminal attempts – all reflect a calculated vagueness designed to preserve the freedom of the decision maker to adapt her judgment to an ever-shifting array of salient particulars.
So if Nussbaum is on target in her critique of anti-theory, we should be wary of Holmes's jurisprudence; indeed, we should be wary of the jurisprudence of a host of twentieth-century antiformalists, many of whom are indebted to Holmes. The most famous of these are the legal realists, who not only asserted the impossibility of formal deductive proofs in law, but who also defended what Karl N. Llewellyn called “situation sense” – a perceptive capacity born of a decision maker's immersion in the norms and practices of a particular field of law and social activity. In describing the common law method, Holmes spoke of a similar perceptive capacity, which he characterized as “insight, tact, and specific knowledge,” and which he contrasted to “rules of method.”
The newly described microorganism ‘Simkania Z’, related
to the Chlamydiae, has been shown
to be associated with bronchiolitis in infants and community acquired pneumonia
The prevalence of infection in the general population is unknown. A simple
ELISA assay for
the detection of serum IgG antibodies to ‘Simkania Z’ was used
to determine the prevalence of
such antibodies in several population samples in southern Israel (the Negev).
The groups tested
included 94 medical and nursing students, 100 unselected blood donors,
106 adult members of
a Negev kibbutz (communal agricultural settlement), and 45 adult Bedouin,
residents of the
Negev. IgG antibodies to ‘Simkania Z’ were found in 55–80%
of these presumably healthy
individuals, independently of antibodies to Chlamydia trachomatis
and Chlamydia pneumoniae.
The Bedouin had a seropositivity rate of 80%, while all other groups had
rates of between 55
and 64%. These results indicate that ‘Simkania Z’ infection
is probably common in southern
First published in 1986, the first ICMI study is concerned with the influence of computers and computer science on mathematics and its teaching in the last years of school and at tertiary level. In particular, it explores the way the computer has influenced mathematics itself and the way in which mathematicians work, likely influences on the curriculum of high-school and undergraduate students, and the way in which the computer can be used to improve mathematics teaching and learning. The book comprises a report of the meeting held in Strasbourg in March 1985, plus several papers contributed to that meeting.
Mathematicians and mathematics teachers have been provided with a new tool, the computer. There is no shortage of applications or interesting examples which one can quote. But, like all tools, the computer by itself does not supply the solution to our problems, not least the problems of mathematics education. There is no automatic beneficial effect linked to a computer: the mere provision of micros in a class- or lectureroom will not solve teaching problems.
It is essential, therefore, that we should develop a serious programme of research, experimentation and reflective criticism into the use of informatics and the computer as an aid. It will not suffice to think only in terms of mathematics and the computer, and of the production of software which amuses and interests mathematicians. We must also take into account types of knowledge and the ways in which these can be transmitted, and attempt to study, in a serious epistemologically-based manner, various concepts and the obstacles which they present to learners. We must think of students, their development and the matching of new and old knowledge. We must consider in depth those teaching possibilities created by the computer. It is essential, above all, that we should move beyond the stage of opinions, enthusiasms, and wishful thinking and engage in a true analysis of the issues. Only in this way will we come to a true resolution of certain problems of teaching. Such research, of necessity experimental, will have to be critically evaluated.