Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 109-124).

Thesis (Ph. D.)--Ohio State University, 2006. / Full text release at OhioLINK's ETD Center delayed at author's request

The purpose of this thesis was to develop a means of predicting future injury among nursing personnel working in a hospital system. Nursing has one of the highest incidence rates of musculoskeletal injuries among U.S. occupations. Endemic to the job are tasks such as rolling, sitting, standing, and transferring large, and often times, uncooperative patients. These tasks often place large biomechanical stresses on the musculoskeletal system and, in some cases, contribute to or cause a musculoskeletal injury. Given the current nursing shortage, it is imperative to keep nurses injury-free and productive so they can provide patient care services. Even though a large number of nursing personnel are injured every year and most are exposed to these high levels of biomechanical stress, the majority of nurses are injury-free. The question then arises "Why do some nurses have injuries while others do not?" The purpose of this thesis was to determine whether individual attributes in a population of nurses were associated with risk of future injury. The subject population was comprised of 140 nursing personnel at a local hospital system hired between April 1995 and February 1999. Data on individual attributes, such as patient demographics, previous injuries, posture, joint range of motion, flexibility, and muscular strength, was ascertained during a post-offer screening on these personnel. Twenty six (19%) nurses experienced an injury associated with the axial skeleton. Chi square test for homogeneity for the categorical predictor variables, and the Student's T-test for continuous predictor variables were used to determine if any individual attributes were associated with future injuries. None of the variables were associated with a risk of future axial skeletal injury. Practical application of these results for St. Joseph Regional Health Center, and possibly other acute care facilities, directs us to stop costly pre-employment/post-offer testing for the purpose of identifying injury prone nurse applicants. Secondly, it allows the focus of limited resources to be on making the job safer through administrative and engineering controls.

This study applies the Washington State Ergonomics Tool to waste industry jobs in Texas. Exposure data were collected by on-site observation of fourteen different multi-task jobs in a major national solid waste management company employing more than 26,000 employees. This company has nationwide operations, and these jobs represent the majority of workers involved in the collection and processing of solid waste. The WSET uses observational checklist methodology to evaluate generic risk factors in the following six major categories: awkward posture, highly repetitive motion, high hand force, repeated impact, lifting, and hand-arm vibration. The assessment tool incorporates these risk factors and combinations of risk factors into checklists for identifying three levels of potential exposure: safe, -caution zone" and -hazard zone" jobs. The tool was developed for employers to use in determining whether a job was likely to increase the risk of workplace musculoskeletal disorders (WMSDs) to their employees. OSHA 200 logs were used as the main source of morbidity data. If there was one recorded WMSD, the job was classified as -positive. "If there was no recorded WMSD, the job was classified as -negative. "-Safe"jobs were those predicted not to expose workers to increased risk of WMSDs. Those that possessed one or more -caution zone"criteria but still fell below the -hazard zone" threshold required the employer to provide -awareness education" for employees and to further analyze the job for the presence of -hazard zone" risk factors. If hazard zone risk factors were not present, no further action was required. Jobs that upon further analysis possessed one or more of the -hazard zone"criteria were labeled -hazardous" jobs. If the further analysis shows the presence of risk factors established in the hazard zone criteria (Appendix B), the employer would be required to take corrective action to reduce exposures to below the hazardous level. Of the three jobs predicted to be -safe"by -caution zone" criteria, two did not have injuries and one did. Of the eleven jobs predicted by -caution zone"criteria to increase the risk of WMSDs, six resulted in injuries and five did not. Of the four jobs predicted by -hazard zone"criteria to be -problem"jobs, two jobs did result in injury and two did not. This study found that the WSET -caution zone"criteria were more effective at predicting which jobs were likely to increase the risk of WMSDs than was the -hazard zone"checklist. The caution zone had high sensitivity and low specificity. The hazard zone criteria reflect a low sensitivity and a low specificity. Further analysis revealed the WSET was helpful in predicting back injuries associated with lifting but not effective at predicting jobs with the potential for upper extremity injuries.

This dissertation aims at analyzing the relationship between socio-economic status (SES) and mental health and care. It attempts to understand how different socio-economic groups present unequal risk of mental disorders and to what extent different socio-economic groups use unequal quantity, type and quality of mental care. Since its earlier beginnings, psychiatric epidemiology has evidenced the association between socio-economic status and mental disorder. However, the numerous prevalence studies addressing depression have yielded inconsistent results. This calls for a thorough investigation of the sources of such heterogeneity. This dissertation attempts to achieve the following objectives: · To unfold methodological and contextual covariates influencing the SES/mental health relationship. · To assess the longitudinal influences of material deprivation on depression. · To assess the extent to which outpatient and inpatient mental care are fairly used. The methodological influences of socio-economic inequalities in mental health were tackled through a meta-analysis of previously published works. We built a database of previous published studies addressing the socio-economic factors of depression prevalence, incidence and persistence in adults population studies and being published in English, French, German and Spanish after 1979. The lower socio-economic group has 80% more prevalence of depression. Inequalities are more acute for persistent depression than for new episode. The results indicated that inequalities are much more pronounced when mental health is looked at from a subjective point of view or in terms of resulting disability. Social inequalities in mental health are also influenced by geographic context. Europe has a gradient 30% less pronounced than North-America. As the period of reference decreased, the gradient rose, suggesting that duration might be an explanatory factor. Geographical analysis of socio-economic inequalities in mortality is carried out with the death certificates of the Belgian National Institute of Statistics (NIS), covering all causes mortality and 11 specific mortality causes, from 1985 to 1993. Spatial concentration was computed through a Moran’I. We compare a simultaneous autoregressive model with a weighted-least-square model. Findings show that spatial concentration is pervasive, that suicide and mortality by liver cirrhosis are among the most correlated causes of death. Getting rid of spatial autocorrelation leads to significant change in the relationship between deprivation and mortality, suggesting the influence of contextual effects on socio-economic inequalities. The difficulty to move from correlation to causation between SES and depression owes partly to the difficulty of disentangling the direct effect of socio-economic status from other –and numerous- confounding factors such as family history, genetic endowment, cognitive abilities, early schooling experience, which, for most of them are rather stable overtime. The longitudinal analysis attempts to estimate the impact of time-varying socio-economic covariates on depression. The results show that material deprivation (and change of) does not affect the level or the risk of depression while social network does slightly. We found much stronger gradient with time invariant socio-economic factors such as educational level. Inequity in outpatient mental care was assessed with the data of the first Belgian Health Interview Survey (HIS), a cross-sectional household-health interview survey carried out in Belgium in 1997. The Minimum Psychiatric Summary, a case register of all psychiatric admissions in Belgium (1997-98), allowed us to carry out the study of inpatient inequalities of mental care. In terms of mental health services uses, inequalities arise in the setting were care is delivered: less well-off use more primary care and less specialised care, are more likely to be admitted in a non-teaching, psychiatric hospitals with long length of stay. The lower the socio-economic groups with mood disorders are less likely to receive the expected treatment such as antidepressant and psychotherapies. Finally, the outcomes of the hospitalisation, in terms of overall functioning and in terms of psychological symptoms are less favourable for the individuals of lower socio-economic status. Part of such unequal outcome is related to unequal treatment. We concluded that inequalities in health should be addressed in their geographical context, that early and stable socio-economic factors are more important than time-varying factors. Horizontal socio-economic inequities arise in the type of care used as well as in the appropriateness of care. However, for a given equal treatment and use, outcome inequalities remain so that it seems relevant to consider socio-economic status as a general vertical equity principle.

Increased circulating levels of glucocorticoids observed in many catabolic conditions play a major role in the induction of muscle atrophy. Indeed, inhibition of glucocorticoid action by glucocorticoid receptor antagonist attenuates and, in some cases, abolishes muscle atrophy. Circulating and tissue levels of IGF-I, a growth factor that stimulates the development of muscle mass, are frequently reduced in response to glucocorticoids. This decline could therefore trigger muscle atrophy in catabolic conditions. Indeed, systemic administration of IGF-I prevents glucocorticoid-induced muscle atrophy. However, use of systemic IGF-I administration is limited by its hypoglycemic and cardiac hypertrophic actions. Moreover, local IGF-I seems to play a more important role in the regulation of muscle mass than systemic IGF-I. Therefore, to limit loss of muscle mass observed in catabolic states, IGF-I administration must mimic as close as possible the autocrine production of IGF-I. The aim of this thesis was to investigate whether the restoration of IGF-I muscle content could reverse muscle atrophy induced by glucocorticoids. In this work we have tested the hypothesis that the local decrease in muscle IGF-I content might be responsible for the muscular atrophy induced by glucocorticoids. In our work, we have demonstrated that localized overexpression of IGF-I by gene electrotransfer prevents muscle atrophy in glucocorticoid-treated rats. High rate of fiber transfection and long term gene expression were obtained by combining multiple injection sites of DNA with electroporation. Human IGF-I gene electrotransfer using this optimised protocol resulted in increased muscle IGF-I mRNA and protein levels together with prevention of loss of skeletal muscle mass. Furthermore, alterations in the Akt/GSK-3â/â-catenin signaling pathway caused by glucocorticoids were prevented by local IGF-I gene overexpression. Finally, muscle overexpression of caAkt, dnGSK-3b and ÄNb-catenin was sufficient to mimic the anti-atrophic effect of IGF-I supporting the role of this signalling pathway in muscle atrophy caused by glucocorticoids. Taken together, our results show, for the first time in vivo, the role of the IGF-I/Akt/GSK-3b/b-catenin pathway in the skeletal muscle atrophy caused by glucocorticoids. In conclusion, our work highlights the crucial role of decreased muscle IGF-I in glucocorticoid-induced muscle atrophy. Indeed, the data presented in this thesis support the fact that the atrophic action of glucocorticoids is in part due to the downregulation of IGF-I, leading to the inhibition of its signalling pathways while restoration of muscle IGF-I levels is able to counteract totally muscle atrophy.

Abstract The laboratory accreditation system can be broadly identified as compulsory accreditation and voluntary accreditation. Compulsory accreditation is required and enforced by law, which is seen as an extension of government¡¦s public authority. The laboratory performing the test must first be certified by the relevant official institution before being allowed to provide testing services. Voluntary accreditation is industrial accreditation based on the credibility of the test results. This research hopes to study the key success factors of commercial laboratories accredited under both the compulsory and voluntary systems. The research hopes to make recommendations to commercial laboratories on the competitive strategies which will aid in the long term development of commercial laboratories. This study analyses 12 indicators, comprising of finance, market, core competencies, learning and growth, using the five-forces model, SWOT analysis and analytic hierarchy process (AHP). The weighting order of the key success factors for compulsory and voluntary commercial laboratories is identified as follows. 1. The weight ordering of key success factors for laboratory accredited under the compulsory system: 1. brand awareness, 2. creativity, 3. core competitiveness (accredited items), 4. training, 5. service quality, 6. responsiveness, 7. differentitation and diversity, 8. investment, 9. employee loyalty, 10. use of information technology, 11. government policy (redundancy cost), and 12. economies of scale (profitability). 2. The weight ordering of key success factors for laboratory accredited under the compulsory system: 1. brand awareness, 2. creativity, 3. service quality, 4. differentitation and diversity, 5. responsiveness, 6. core competitiveness (accredited items), 7. training, 8. government policy (redundancy cost), 9. economies of scale (profitability), 10. employee loyalty, and 11. use of information technology. The conclusions above are significant to the management in the following aspects. ¡EUnder the same indices, the weighting of key success factors vary according to differences in internal and external environmental conditions, market orientation and corporate market positioning ¡EBrand awareness and creativity are equally important for laboratories accredited under the compulsory and voluntary system, there top the first and second place of the list. ¡ECapability to compete in the market is much more significant in voluntarily accredited laboratories, indicating that it is more market orientated than laboratories accredited under the compulsory system.

Nearly a centennial after the granted women’s suffrage in the United States, almost 40 yearsfrom the start of the 70’s women’s right’s movements women have shown that they canobtain same level in education as men can and graduate with competitive skills as men.However, according to statistics that is when the equality seems to loose its balance. Despitethis there are women in this “Yes We Can”-era of where a former First Lady was verycompetitive in a Presidential Race, that with certain success factors compete effectively invarious male-dominant fields.

The aim of this quantitative study was to identify risk factors that could cause or produce criminal behaviour among offenders under the age of 18 in East London, South Africa. This research looks into risk factors such as individual- home environment and neighbourhood factors. A non-probability sample of 80 young people within the age range of 12-18 answered a standardized self-administered questionnaire while attending a compulsory pre-trial assessment with probation officers at the Magistrate’s court in East London. The individual factors behind delinquency were evidently gender based, a majority was males and between 16-18 years. Other risk factors were related to family structure or family functioning and the living standard of the household. The participants own explanations for committing the crime were connected to individual factors such as: influenced by friends, influenced by alcohol, bored and had nothing to do.

The term of Hidden Champions was first put forward by Simon (1996a) in his book and has already been a well-studied subject all over the world. The purpose of this dissertation is to figure out what are the main factors underlying Chinese Hidden Champions. The literature part is composed of earlier research on Hidden Champions and theories on several factors that have been identified by authors, which form an analytical framework for analyzing empirical data. Conducting a qualitative approach, the empirical data was collected through semi-structured telephone interviews with the senior personnel of two Chinese companies. Secondary data, such as public reports, also played a complementary role. The findings of this study showed the factors of clear goal, excellent entrepreneur, focused strategy, sustained innovation, globalization and customer orientation immensely affect the success of Chinese Hidden Champions. It was also pointed out that there remain some views that are different from concepts of Simon’s.