Dissertations / Theses on the topic 'Personal injury'

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 thesis examines approaches to establishing liability in corporate groups. It considers the problem that arises when an insolvent subsidiary's tort creditors suffer personal injury, and try to pursue recourse against other group companies - especially the parent company. Courts have tried to provide answers regarding the parent company's liability for the torts of their subsidiaries, but have had limited success. The thesis reveals difficulty in extending liability to the parent company by way of insolvency law provisions, and by piercing the corporate veil. It recounts the hesitation of the courts in broadening their perspective beyond individual companies, so as to take the group itself as the responsible entity. The thesis points, furthermore, to shortcomings in proposals for a new rule of unlimited pro rata liability. Motivated by the inadequacy of current solutions to this pressing group problem, the thesis explores alternative tort law remedies under an approach suggested by the Supreme Court in the leading cases of VTB Capital Plc v Nutritek International Corp and others and Prest v Petrodel Resources Ltd. Chapter III discusses the role of tort of negligence in establishing the parent company's liability. The work analyses case law decisions on how to widen the application of negligence in the corporate group context, and compares UK law with relevant United States' and Australian case law. Since this group problem involves multiple legal entities, Chapters IV and V evaluate the possibility of using the doctrine of joint tortfeasance and/or the theory of vicarious liability in establishing the parent company's liability for its subsidiary company's torts. These two doctrines' extensions in corporate tort cases are seldom discussed in the literature. To conclude, tort law solutions, especially the doctrines of tort of negligence and joint tortfeasance based on participations are recommended to be further developed for corporate tort problems.

Thesis (M.A.)--City University of Hong Kong, 2007.
Title from PDF t.p. (viewed on Sept. 7, 2007) "Master of Arts in arbitration and dispute resolution 2006-2007, LW 6409 dissertation" Includes bibliographical references.

Psychological evaluations administered by forensic psychologist in personal injury cases are surrounded by complex issues. Although empirically-based research has legitimized that psychological damages do exist in personal injury cases there is a missing link in the way forensic psychologists are conducting these evaluations. Prior researchers suggested that some personal injury evaluations had been dismissed or overlooked due to a lack of a standard of care. Addressing the current literature, this study examined how a diverse group of 14 licensed forensic psychologists, operating in different judicial jurisdictions (Daubert, Frye, and Independent) were conducting personal injury evaluations and their perspectives on the implementation of a standard of care. A qualitative thematic analysis design was used to gain a more in-depth understanding of this phenomenon. Systems theory was the conceptual framework that informed this study and guided the methodology employed. The identified themes were organized into steps reflected in an adapted version cube model. The study promotes positive social change by fostering confidence in the field of psychology and personal injury evaluations with regard to bolstering the overall credibility, reliability, and validity of the practice and processes involved. Further, positive change can occur through the development of framework that assists in leveling the practice by keeping evaluations flexible, but consistent; basing the decision regarding implementing a standard of care on the utility of the framework, along with future findings and developments in the field.

In Britain each year thousands of people are injured in accidents on the roads or at work and pursue claims for personal injury compensation. Previous research has indicated that a significant number will have difficulty returning to work, or may never return. Contrary to popular belief, failure to return to employment may not be due so much to "compensation neurosis" as to a complex interaction of many factors. However, whatever the factors involved, it is evident that the longer a person is away from work following injury or illness the less likely he or she is to return. Nevertheless it appears that employment issues frequently are not considered during the recovery period, or are addressed at such a late stage that any help is unlikely to be useful. Moreover contact with vocational rehabilitation services which might assist people to return to work is poor. The aim of this study was to implement and evaluate a service specifically to help personal injury claimants return to work. The service comprised one person, acting as a co-ordinator, whose role was to help people identify and obtain assistance from those voluntary and statutory services which might facilitate their return to work. The service was evaluated within the context of a randomised controlled trial. People in the experimental group received help for six months during which time the control group received no help. An amendment to the design extended the period of help to the experimental group to 12 months and introduced a period of six months help for the control group after the six months re-assessment. Measures of outcome included perceived health status, level of anxiety and depression and various employment outcomes such as contact with services and return to work. Satisfaction with the service was also examined. Fifty people were recruited to the study. Random allocation on a ratio of 2:1 resulted in 33 people being allocated to the experimental group and 17 to the control group. The main comparison of outcomes at six months showed no statistically significant differences between the two groups except the control group registered lower scores for depression. The satisfaction survey showed that a high percentage of people were very satisfied with the service and valued the help they had been given. A number of factors were thought to contribute to the lack of positive findings at six months including a small sample size, which affected the ability to detect anything other than large "treatment" effects. Six months appeared to be an inadequate length of time in which to achieve beneficial outcomes and exploratory analysis, indicating an improvement in employment status for the experimental group at 12 months compared with six months, suggested this might be the case though no causal inference could be made. A qualitative analysis of the study indicated that people required much more help than merely linking them to services and much of this help, such as good training or re-training programmes, was outside the scope of the coordinator service.

This thesis comprises an evaluation of existing and suggested approaches, and promulgation and defence of a preferred approach, to liability for psychiatric injury (or 'nervous shock') resulting from the unintentional conduct of another and occurring independently of any physical injury to the sufferer. Such a claim was first recognised a little over one hundred years ago but since that time the precise limits of liability for psychiatric injury has been an issue that has vexed courts in many jurisdictions. Even today there is no common approach to liability for psychiatric injury in Australia and England. This position is contributed to by the recent divergence in approaches to the determination of the existence of a duty of care in negligence in those countries. The thesis establishes a yardstick which is argued as being reflective of good judicial reasoning, at least as is appropriate to the subject of the enquiry, psychiatric injury. It then lays a foundation for the evaluation by an historical and analytical analysis of liability for psychiatric injury. The historical trace is set in the context of the development of the elements of the cause of action for negligence, including the recent divergence in approaches to duty, while the comparative analysis embraces decisions in Australia, England, Ireland, Scotland, New Zealand, Canada and the United States. In relation to the last mentioned, due to the lack of a federal attribute each state jurisdiction determines its own approach to the equivalent of liability for psychiatric injury, and there is no uniformly accepted response. Against this analysis, the thesis juxtaposes a medical perspective of 'nervous shock'. This perspective facilitates an evaluation of the medical legitimacy of past and current approaches and concepts and informs the promulgation of a preferred approach, including a more refined definition of the damage deemed worthy of compensation. The thesis also analyses the policy factors, or considerations of community welfare external to the interests of the parties to a particular dispute, that have shaped the limits of liability for psychiatric injury, including an assessment of the continued legitimacy of policy factors as measured against the yardstick for good judicial reasoning. It then proceeds to assess against the yardstick the continued legitimacy of individual concepts which have been promoted as being the appropriate limitations of liability. The thesis proceeds to critique the current approaches to duty of care in Australia and England, utilising psychiatric injury as a catalyst and evaluating the approaches against the yardstick. A literature review which critiques alternative approaches that have been suggested then follows. The climax of the thesis is the promulgation of a preferred approach, which draws on the analysis and evaluation throughout the thesis. This preferred approach advocates a more specific definition of the damage deemed worthy of compensation, an accommodation of an overt identification and assessment of relevant policy considerations, an incremental approach to the establishment of duty of care and greater emphasis upon the other elements of the negligence cause of action. This preferred approach is demonstrated as conforming to the yardstick and is accordingly defended as reflective of good judicial reasoning.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a popular measure of psychosocial functioning and psychopathology in the assessment of individuals in a variety of settings. However, the method of construction employed with the MMPI more than 60 years ago with psychiatric patients challenges the applicability of the scales for determining the psychosocial functioning of individuals from different settings. The restandardisation conducted in 1987 made no effort to eradicate the item overlap that was a result of the criterion keying method with contrasted groups. Although restandardized and updated with more contemporary language and content, the original psychiatric constructs were retained in order to maintain continuity with its predecessor. The aims of this investigation were to develop a new structure for the MMPI-2 constructed at the item-level, empirically derived and which specifically represents the dimensions that are relevant and appropriate in evaluating the psychosocial functioning of personal injury claimants. This task included comparisons with a comparable scale-level analysis and developing optimal scoring strategies where items in components and facets are allocated weightings based upon their strength of association. Study 1 was conducted using a sample of 2989 personal injury claimants assessed in Australia and the United States of America. The final sample of 3230, included 241 normal individuals, was utilized to develop a scale-level structure from 79 standard MMPI-2 scales and subscales. A nine-component solution consisting of General Maladjustment /Emotional Distress, Asocial Beliefs, Social Vulnerability, Somatic Complaints, Psychological Disturbance, Impulsive Expression, Antisocial Practices, Stereotypic Fears and Family Difficulties was derived using principal component analysis. However, intercorrelation between components in the structure signaled the need to develop a structure that would eradicate problems that were perpetuated by item overlap. The second study was conducted with a set of best practice procedures with the same clinical sample of 2989 personal injury claimants as Study 1. Forty-one components were derived through principal component analysis. Through the application of a set of criteria, a 35-component solution was retained. The pattern coefficients from the allocation of items to components determined the weightings to be applied to each item. Further analysis of the 35 components derived a substructure of 37 facets. The 35 components included only 442 of the 567 items, with the reliability coefficients of the first 25 components that ranged between .5 and .97, and the remaining 10 components that ranged from .29 to .49. The latter unreliable components were not included in the final Structural Summary, leaving 25 components (400 items) and their 33 facets for interpretation. Hence, in demonstrating the utility of the newly-derived structure, only 25 components and their 33 facets were interpreted. The 25 components were grouped conceptually into six domains. In the emotional domain were Psychological Distress (PsyDist), Anger, Fears, Psychotic Symptoms (PsyS), Paranoia (Par), Irritability (Irrit), Elation (Elat), Fear of the Dark (FD), and Financial Worry (FinWo). Somatic Complaints (SomC), Sexual Concerns (SexCon), and Gastrointestinal Problems (GasP) made up the measures in the physiological domain. In the behavioural domain were Cognitive Difficulties (CogDiff), Stimulus-Seeking (StimuS), Discipline (Dis), and Delinquency (Del) whilst the interpersonal domain was formed by Social Withdrawal (SoW), Negative Interpersonal Attitude (NIA), Timidity (Tim), Lie, Dissatisfaction with Self (DWS) and Family Relationship Difficulties (FReD). Alcoholism (Alco) was the only measure in the substance abuse domain, and the gender domain was comprised of Masculinity (Mas) and Femininity (Fem). The third study established preliminary normative means and standard deviations using a small opportunistic Australian university student sample (N = 219). No substantial gender differences were found but gender norms were maintained to facilitate comparisons with the traditional MMPI-2 approach. Comparisons of frequency of 'true' item response between the Australian university student sample and the U.S. restandardisation sample found relatively little differences and permitted evaluation of between sample differences on components and facets. The utility of the structure was demonstrated with the illustration of two clinical case examples, and a comparison was made with the standard MMPI-2 scales and subscales. The Structural Summary for the MMPI-2 demonstrated discriminative measures of psychosocial functioning that were a result of no item overlap, and the ability to attend to the different levels of intensity of self-report items because of differential weightings.

In today’s world there is a high incidence of playing-related injury among musicians. A study conducted in 2012 found that over 80% of surveyed professional orchestral musicians in Australia had experienced a musculoskeletal injury that interfered with their work (Ackermann, Driscoll, & Kenny, 2012, p. 183). One of the potential causal factors in the development of a playing-related injury is an inefficient and unhealthy practice routine. Fortunately, healthy and effective practice habits can be learned. The inclusion of information about practice strategies in the curriculum of young musicians working towards a performance career could be very beneficial in reducing the risk of injury for those musicians throughout their careers. Although there has been an increase in the attention given to music health research over the last 40 years, many educational institutions still do not adequately teach their students skills for developing a healthy and effective practice routine, nor do they provide sufficient information about injury prevention and management techniques. This research aims to add to the literature surrounding the development of a healthy and effective practice routine by investigating the author’s own experience of injury and recovery as a young musician training for a career in music. It also aims to share evidence about the potential for effective practice techniques to reduce or resolve physical and psychological challenges for musicians. This study begins with an examination of the author’s experience before and during her period of injury in order to determine the nature of the physical and psychological challenges that led to the breakdown of her general well-being. The main body of this research concerns the author’s attempts to overcome these challenges through the use of techniques for effective practice, and documents the results of their implementation. Although professional medical advice played a role in determining recovery strategies, the major focus investigated is the significant improvements to the researcher’s physical and psychological well-being resulting from self-guided changes to her practice approach. The last chapter of this research discusses recommendations for a sustainable career model, drawing together information from the literature and from the researcher’s own experience of injury and recovery.
Thesis (Masters)
Master of Music Research (MMusRes)
Queensland Conservatorium
Arts, Education and Law
Full Text

Significant proportions of carers for those with a brain injury have been found to be clinically anxious and depressed. Subjective carer burden (SCB) has been defined as the distress experienced as a result of the observed changes in the person with the brain injury. No research has looked at the individual psychological characteristics, or intrapersonal aspects, of the carer in brain injury in relation to SCB and psychological distress. Very few studies have addressed apparent methodological problems regarding the measurement of SCB; no study in brain injury has explored the meanings carers have found in their role; and very few studies have included positive elements of caring in their research. This study used a non-experimental, non-randomised, cross-sectional design. A theoretically based measure of SCB was used, in combination with a Personal Construct Psychology methodology, to investigate the relationship between the intrapersonal aspects of carers and their relationship to SCB and psychological distress. Positive appraisals of caring and meanings the carers derived from their role were also investigated. Few predicted study hypotheses were supported. Results showed that a significant proportion of carers were anxious and or depressed and that the majority of carers were shown to have very tight construct systems reflective of having limited flexibility in thinking. Novel findings included the previously unreported relationship between perceived burden, a measure of SCB, and anxiety. The manner in which carers construed the brain injured person was found to be related to the appraisals they form, thus adding to the evidence of the importance of the role of construing of the brain injured person by family members. Meanings derived from caring emerged in a number of themes. 60% of carers' meanings could be categorised in the following three themes: life circumstances, emotional states and health and illness. Carers generated positive as well as negative meanings. Findings were considered in relation to previous SCB and Personal Construct Psychology research. Clinical implications of the structure of construct systems in this population were considered. Suggestions for future research with an emphasis on the development of clinical practice were included.

Despite extensive research into the impact of brain injury on individuals and their adult relatives, much less is know about the impact of parental brain injury on child relatives. The aim of the study was to identify if there was a relationship between changes in how children construed themselves and their parents following the brain injury and adjustment, and to identify if there was a relationship between structure of the child’s construct system and level of adjustment. There were four hypotheses to be tested. Hypothesis one predicted that larger changes in how young people construe themselves and significant others following parental brain injury compared to how they were construed prior to parental brain injury would be associated with poorer adjustment. Hypothesis two predicted that more structured ‘before acquired brain injury’ constructs in comparison to the structure of ‘after acquired brain injury’ constructs would be associated with poorer adjustment. Hypothesis three predicted that more superordinate ‘before acquired brain injury’ constructs in comparison to ‘after acquired brain injury’ constructs would be associated with poorer adjustment. Hypothesis four predicted that tighter construing would be associated with better adjustment following parental brain injury. There were 10 participants in the study aged 10-17 who had a parent with a brain injury. Each participant completed a repertory grid and the Personality Inventory for Youth, a measure of adjustment. It was found that larger distances between how children construed themselves or their parents currently compared to how they were construed pre-injury were related to poorer adjustment. There was also found to be a relationship between relative intensity of the post-brain injury construct system and some aspects of adjustment. There was no significant relationship between adjustment and relative superordinancy of post-injury constructs or adjustment and tightness of construing. Future research is indicated to verify the findings of this study, and to explore possible interventions for young people experiencing poor adjustment following parental brain injury.

Work-related injuries and road traffic injuries are common causes of morbidity and are major contributors to the burden of disease worldwide. In developed countries, these injuries are often covered under compensation schemes, and the costs of administering these schemes is high. The compensation systems have been put in place to improve the health outcomes, both physical and mental, of those injured under such systems; yet there is a widespread belief, and some evidence, that patients treated under these schemes may have worse outcomes than if they were treated outside the compensation system. Chapter One of this thesis explores the literature pertaining to any effect that compensation may have on patient outcomes. It is noted that the concept of “compensation neurosis” dates from the nineteenth century, with such injuries as “railway spine”, in which passengers involved in even minor train accidents at the time, would often have chronic and widespread symptoms, usually with little physical pathology. Other illnesses have been similarly labelled over time, and similarities are also seen in currently diagnosed conditions such as repetition strain injury, back pain and whiplash. There are also similarities in a condition that has been labelled “shell shock”, “battle fatigue”, and “post-traumatic stress disorder”; the latter diagnosis originating in veterans of the Vietnam War. While there is evidence of compensation status contributing to the diagnosis of some of these conditions, and to poor outcomes in patients diagnosed with these conditions, there is little understanding of the mechanism of this association. In contrast to popular stereotypes, the literature review shows that malingering does not contribute significantly to the effect of compensation on health outcomes. Secondary gain is likely to play an important role, but secondary gain is not simply confined to financial gain, it also includes gains made from avoidance of workplace stress and home and family duties. Other psychosocial factors, such as who is blamed for an injury (which may lead to retribution as a secondary gain) or the injured person’s educational and occupational status, may also influence this compensation effect. The literature review concludes that while the association between compensation and health after injury has been widely reported, the effect is inconsistent. These inconsistencies are due, at least in part, to differences in definitions of compensation (for example, claiming compensation versus using a lawyer), the use of different and poorly defined diagnoses (for example, back pain), a lack of control groups (many studies did not include uncompensated patients), and the lack of accounting for the many possible confounding factors (such as measures of injury severity or disease severity, and socio-economic and psychological factors). The literature review also highlighted the variety of different outcomes that had been used in previous studies, and the paucity of literature regarding the effect of compensation on general health outcomes. This thesis aims to explore the association between compensation status and health outcome after injury. It addresses many of the methodological issues of the previously published literature by, i selecting study populations of patients with measurable injuries, ii clearly defining and separating aspects of compensation status, iii including control groups of non-compensated patients with similar injuries iv allowing for a wide variety of possible confounders, and v using clearly defined outcome measures, concentrating on general health outcomes. Before commencing the clinical studies reported in Chapters Three and Four, a systematic review and meta-analysis was performed to quantify and analyse the effect of compensation on outcome after surgery. This allowed a clearly defined population of studies to be included, and was relevant to the thesis as the surgeries were performed as treatment of patients who had sustained injuries. The study, which is reported in Chapter Two, hypothesised that outcomes after surgery would be significantly worse for patients treated under compensation schemes. The study used the following data sources: Medline (1966 to 2003), Embase (1980 to 2003), CINAHL, Cochrane Controlled Trials Register, reference lists of retrieved articles and textbooks, and contact with experts in the field. The review included any trial of surgical intervention where compensation status was reported and results were compared according to that status, and no restrictions were placed on study design, language or publication date. Data extracted were study type, study quality, surgical procedure, outcome, country of origin, length and completeness of follow-up, and compensation type. Studies were selected by two unblinded independent reviewers, and data were extracted by two reviewers independently. Data were analysed using Cochrane Review Manager (version 4.2). Two hundred and eleven papers satisfied the inclusion criteria. Of these, 175 stated that the presence of compensation (worker's compensation with or without litigation) was associated with a worse outcome, 35 found no difference or did not describe a difference, and one paper described a benefit associated with compensation. A meta-analysis of 129 papers with available data (20,498 patients) revealed the summary odds ratio for an unsatisfactory outcome in compensated patients to be 3.79 (95% confidence interval 3.28 to 4.37, random effects model). Grouping studies by country, procedure, length of follow-up, completeness of follow-up, study type, and type of compensation showed the association to be consistent for all sub-groups. This study concludes that compensation status is associated with poor outcome after surgery, and that this effect is significant, clinically important and consistent. Therefore, the study hypothesis is accepted. However, as data were obtained from observational studies and were not homogeneous, the summary effect should be interpreted with caution. Determination of the mechanism for the association between compensation status and poor outcome, shown in the literature review (Chapter One) and the systematic review (Chapter Two) required further study. Two studies were designed to further explore this association and these are reported in Chapters Three and Four. The retrospective study reported in Chapter Three, the Major Trauma Outcome Study (MTOS), aimed to explore the association between physical, psychosocial, and compensation-related factors and general health after major physical trauma. The primary hypothesis predicted significantly poorer health outcomes in patients involved in pursuing compensation, allowing for possible confounders and interactions. The study also examined other health outcomes that are commonly associated with compensation, and examined patient satisfaction. Consecutive patients presenting to a regional trauma centre with major trauma (defined as an Injury Severity Score greater than 15) were surveyed between one and six years after their injury. The possible predictive factors measured were: general patient factors (age, gender, the presence of chronic illnesses, and the time since the injury), injury severity factors (injury severity score, admission to intensive care, and presence of a significant head injury), socio-economic factors (education level, household income, and employment status at the time of injury and at follow-up), and claim-related factors (whether a claim was pursued, the type of claim, whether the claim had settled, the time to settlement, the time since settlement, whether a lawyer was used, and who the patient blamed for the injury). Multiple linear regression was used to develop a model with general health (as measured by the physical and mental component summaries of the SF-36 General Health Survey) as the primary outcome. The secondary outcomes analysed were: neck pain, back pain, post-traumatic stress disorder, and patient satisfaction. On multivariate analysis, better physical health was significantly associated with increasing time since the injury, and with lower Injury Severity Scores. Regarding psychosocial factors, the education level and household income at the time of injury were not significantly associated with physical health, but pursuit of compensation, having an unsettled claim, and the use of a lawyer were strongly associated with poor physical health. Measures of injury severity or socio-economic status were not associated with mental health. However, the presence of chronic illnesses and having an unsettled compensation claim were strongly associated with poor mental health. Regarding the secondary outcomes, increasing neck pain and back pain were both significantly associated with lower education levels and the use of a lawyer, but not significantly associated with claiming compensation. The severity of symptoms related to post-traumatic stress disorder was not associated with measures of injury severity, but was significantly and independently associated with the use of a lawyer, having an unsettled compensation claim, and blaming others (not themselves) for the injury. The strongest predictor of patients’ dissatisfaction with their progress since the injury was having an unsettled compensation claim, and as with the other secondary outcomes, patient satisfaction was not significantly associated with injury severity factors. Factors relating to the compensation process were among the strongest predictors of poor health after major trauma, and were stronger predictors than measures of injury severity. The hypothesis that general physical and mental health would be poorer in patients involved in seeking compensation for their injury was accepted. This study concludes that the processes involved with claiming compensation after major trauma may contribute to poor health outcomes. The prospective study reported in Chapter Four, the Motor Vehicle Accident Outcome Study (MVAOS), aimed to explore the effect of compensation related factors on general health in patients suffering major fractures after motor vehicle accidents (MVAs). The study hypothesized that general health would be poorer in patients claiming compensation for their injuries. Patients presenting to 15 hospitals with one or more major fractures (any long bone fracture, or fracture of the pelvis, patella, calcaneus or talus) after a motor vehicle accident were invited to participate in this prospective study. Initial data was obtained from the patient and the treating doctors. Both the patients and treating surgeons were followed up with a final questionnaire at six months post injury. General factors (age, gender, treating hospital, country of birth, presence of chronic illnesses and job satisfaction), injury factors (mechanism of injury, number of fractures, and the presence of any non-orthopaedic injuries), socioeconomic factors (education level, income, and employment status), and compensation-related factors (whether a claim was made, the type of claim, whether a lawyer was used, and who was blamed for the injury) were used as explanatory variables. The primary outcome was general health as measured by the physical and mental component summaries of the SF-36 General Health Survey. The secondary outcomes were neck pain, back pain, and patients’ ratings of satisfaction with progress and of recovery. Multiple linear regression was used to develop predictive models for each outcome. Completed questionnaires were received from 232 (77.1%) of the 301 patients included in the study. Poor physical health at six months was strongly associated with increasing age, having more than one fracture, and using a lawyer, but not with pursuit of a compensation claim. Poor mental health was associated with using a lawyer and decreasing household income. Increasing neck pain and back pain were both associated with the use of a lawyer and with lower education levels. Higher patient satisfaction and patient-rated recovery were both strongly associated with blaming oneself for the injury, and neither were associated with pursuit of compensation. Although the use of a lawyer was a strong predictor of the primary outcomes, the pursuit of a compensation claim was not remotely associated with these outcomes, and therefore the study hypothesis was rejected. The studies reported in this thesis are compared in the final chapter, which concludes that poor health outcomes after injury are consistently and strongly associated with aspects of the compensation process, particularly the pursuit of a compensation claim, involvement of a lawyer, and having an unsettled claim. Compensation systems may be harmful to the patients that these systems were designed to benefit. Identification of the harmful features present in compensation systems my allow modification of these systems to improve patient outcomes.

Doctor of Philosophy
Work-related injuries and road traffic injuries are common causes of morbidity and are major contributors to the burden of disease worldwide. In developed countries, these injuries are often covered under compensation schemes, and the costs of administering these schemes is high. The compensation systems have been put in place to improve the health outcomes, both physical and mental, of those injured under such systems; yet there is a widespread belief, and some evidence, that patients treated under these schemes may have worse outcomes than if they were treated outside the compensation system. Chapter One of this thesis explores the literature pertaining to any effect that compensation may have on patient outcomes. It is noted that the concept of “compensation neurosis” dates from the nineteenth century, with such injuries as “railway spine”, in which passengers involved in even minor train accidents at the time, would often have chronic and widespread symptoms, usually with little physical pathology. Other illnesses have been similarly labelled over time, and similarities are also seen in currently diagnosed conditions such as repetition strain injury, back pain and whiplash. There are also similarities in a condition that has been labelled “shell shock”, “battle fatigue”, and “post-traumatic stress disorder”; the latter diagnosis originating in veterans of the Vietnam War. While there is evidence of compensation status contributing to the diagnosis of some of these conditions, and to poor outcomes in patients diagnosed with these conditions, there is little understanding of the mechanism of this association. In contrast to popular stereotypes, the literature review shows that malingering does not contribute significantly to the effect of compensation on health outcomes. Secondary gain is likely to play an important role, but secondary gain is not simply confined to financial gain, it also includes gains made from avoidance of workplace stress and home and family duties. Other psychosocial factors, such as who is blamed for an injury (which may lead to retribution as a secondary gain) or the injured person’s educational and occupational status, may also influence this compensation effect. The literature review concludes that while the association between compensation and health after injury has been widely reported, the effect is inconsistent. These inconsistencies are due, at least in part, to differences in definitions of compensation (for example, claiming compensation versus using a lawyer), the use of different and poorly defined diagnoses (for example, back pain), a lack of control groups (many studies did not include uncompensated patients), and the lack of accounting for the many possible confounding factors (such as measures of injury severity or disease severity, and socio-economic and psychological factors). The literature review also highlighted the variety of different outcomes that had been used in previous studies, and the paucity of literature regarding the effect of compensation on general health outcomes. This thesis aims to explore the association between compensation status and health outcome after injury. It addresses many of the methodological issues of the previously published literature by, i selecting study populations of patients with measurable injuries, ii clearly defining and separating aspects of compensation status, iii including control groups of non-compensated patients with similar injuries iv allowing for a wide variety of possible confounders, and v using clearly defined outcome measures, concentrating on general health outcomes. Before commencing the clinical studies reported in Chapters Three and Four, a systematic review and meta-analysis was performed to quantify and analyse the effect of compensation on outcome after surgery. This allowed a clearly defined population of studies to be included, and was relevant to the thesis as the surgeries were performed as treatment of patients who had sustained injuries. The study, which is reported in Chapter Two, hypothesised that outcomes after surgery would be significantly worse for patients treated under compensation schemes. The study used the following data sources: Medline (1966 to 2003), Embase (1980 to 2003), CINAHL, Cochrane Controlled Trials Register, reference lists of retrieved articles and textbooks, and contact with experts in the field. The review included any trial of surgical intervention where compensation status was reported and results were compared according to that status, and no restrictions were placed on study design, language or publication date. Data extracted were study type, study quality, surgical procedure, outcome, country of origin, length and completeness of follow-up, and compensation type. Studies were selected by two unblinded independent reviewers, and data were extracted by two reviewers independently. Data were analysed using Cochrane Review Manager (version 4.2). Two hundred and eleven papers satisfied the inclusion criteria. Of these, 175 stated that the presence of compensation (worker's compensation with or without litigation) was associated with a worse outcome, 35 found no difference or did not describe a difference, and one paper described a benefit associated with compensation. A meta-analysis of 129 papers with available data (20,498 patients) revealed the summary odds ratio for an unsatisfactory outcome in compensated patients to be 3.79 (95% confidence interval 3.28 to 4.37, random effects model). Grouping studies by country, procedure, length of follow-up, completeness of follow-up, study type, and type of compensation showed the association to be consistent for all sub-groups. This study concludes that compensation status is associated with poor outcome after surgery, and that this effect is significant, clinically important and consistent. Therefore, the study hypothesis is accepted. However, as data were obtained from observational studies and were not homogeneous, the summary effect should be interpreted with caution. Determination of the mechanism for the association between compensation status and poor outcome, shown in the literature review (Chapter One) and the systematic review (Chapter Two) required further study. Two studies were designed to further explore this association and these are reported in Chapters Three and Four. The retrospective study reported in Chapter Three, the Major Trauma Outcome Study (MTOS), aimed to explore the association between physical, psychosocial, and compensation-related factors and general health after major physical trauma. The primary hypothesis predicted significantly poorer health outcomes in patients involved in pursuing compensation, allowing for possible confounders and interactions. The study also examined other health outcomes that are commonly associated with compensation, and examined patient satisfaction. Consecutive patients presenting to a regional trauma centre with major trauma (defined as an Injury Severity Score greater than 15) were surveyed between one and six years after their injury. The possible predictive factors measured were: general patient factors (age, gender, the presence of chronic illnesses, and the time since the injury), injury severity factors (injury severity score, admission to intensive care, and presence of a significant head injury), socio-economic factors (education level, household income, and employment status at the time of injury and at follow-up), and claim-related factors (whether a claim was pursued, the type of claim, whether the claim had settled, the time to settlement, the time since settlement, whether a lawyer was used, and who the patient blamed for the injury). Multiple linear regression was used to develop a model with general health (as measured by the physical and mental component summaries of the SF-36 General Health Survey) as the primary outcome. The secondary outcomes analysed were: neck pain, back pain, post-traumatic stress disorder, and patient satisfaction. On multivariate analysis, better physical health was significantly associated with increasing time since the injury, and with lower Injury Severity Scores. Regarding psychosocial factors, the education level and household income at the time of injury were not significantly associated with physical health, but pursuit of compensation, having an unsettled claim, and the use of a lawyer were strongly associated with poor physical health. Measures of injury severity or socio-economic status were not associated with mental health. However, the presence of chronic illnesses and having an unsettled compensation claim were strongly associated with poor mental health. Regarding the secondary outcomes, increasing neck pain and back pain were both significantly associated with lower education levels and the use of a lawyer, but not significantly associated with claiming compensation. The severity of symptoms related to post-traumatic stress disorder was not associated with measures of injury severity, but was significantly and independently associated with the use of a lawyer, having an unsettled compensation claim, and blaming others (not themselves) for the injury. The strongest predictor of patients’ dissatisfaction with their progress since the injury was having an unsettled compensation claim, and as with the other secondary outcomes, patient satisfaction was not significantly associated with injury severity factors. Factors relating to the compensation process were among the strongest predictors of poor health after major trauma, and were stronger predictors than measures of injury severity. The hypothesis that general physical and mental health would be poorer in patients involved in seeking compensation for their injury was accepted. This study concludes that the processes involved with claiming compensation after major trauma may contribute to poor health outcomes. The prospective study reported in Chapter Four, the Motor Vehicle Accident Outcome Study (MVAOS), aimed to explore the effect of compensation related factors on general health in patients suffering major fractures after motor vehicle accidents (MVAs). The study hypothesized that general health would be poorer in patients claiming compensation for their injuries. Patients presenting to 15 hospitals with one or more major fractures (any long bone fracture, or fracture of the pelvis, patella, calcaneus or talus) after a motor vehicle accident were invited to participate in this prospective study. Initial data was obtained from the patient and the treating doctors. Both the patients and treating surgeons were followed up with a final questionnaire at six months post injury. General factors (age, gender, treating hospital, country of birth, presence of chronic illnesses and job satisfaction), injury factors (mechanism of injury, number of fractures, and the presence of any non-orthopaedic injuries), socioeconomic factors (education level, income, and employment status), and compensation-related factors (whether a claim was made, the type of claim, whether a lawyer was used, and who was blamed for the injury) were used as explanatory variables. The primary outcome was general health as measured by the physical and mental component summaries of the SF-36 General Health Survey. The secondary outcomes were neck pain, back pain, and patients’ ratings of satisfaction with progress and of recovery. Multiple linear regression was used to develop predictive models for each outcome. Completed questionnaires were received from 232 (77.1%) of the 301 patients included in the study. Poor physical health at six months was strongly associated with increasing age, having more than one fracture, and using a lawyer, but not with pursuit of a compensation claim. Poor mental health was associated with using a lawyer and decreasing household income. Increasing neck pain and back pain were both associated with the use of a lawyer and with lower education levels. Higher patient satisfaction and patient-rated recovery were both strongly associated with blaming oneself for the injury, and neither were associated with pursuit of compensation. Although the use of a lawyer was a strong predictor of the primary outcomes, the pursuit of a compensation claim was not remotely associated with these outcomes, and therefore the study hypothesis was rejected. The studies reported in this thesis are compared in the final chapter, which concludes that poor health outcomes after injury are consistently and strongly associated with aspects of the compensation process, particularly the pursuit of a compensation claim, involvement of a lawyer, and having an unsettled claim. Compensation systems may be harmful to the patients that these systems were designed to benefit. Identification of the harmful features present in compensation systems my allow modification of these systems to improve patient outcomes.

This qualitative study takes an interpretative phenomenological approach to understand the experience of whiplash injury from the different perspectives of patient and doctor. This was carried out in order to identify what psycho-social consequences might be experienced by patients as a result of that injury and to identify any implications for healthcare provision. The research was conducted in two phases. During Phase One, eight patients were recruited through GP practices using a combined approach of retrospective and prospective sampling. Three semi-structured interviews and one telephone interview were carried out with each participant over a twelve month period. In keeping with phenomenological methodology, data were analysed using Template Analysis (King, 2004) and a set of themes relating to healthcare experience were identified: „embodiment‟ „experience of pain‟ „disruption to lifestyle‟, „making sense‟, „patient as expert‟ and „whiplash: a minor injury?‟. During Phase Two, one semi-structured interview was carried out with eight doctors who worked in either the primary or secondary care settings. Data were analysed using Template Analysis and a set of themes relating to their experiences of treating patients was identified: „expectations regarding what patients will experience‟, „what patients do about their whiplash injury‟, „what doctors do‟ and „blame if things go wrong‟. These findings show how the patient participants‟ physical and psychological experiences of their malfunctioning body had consequences for maintaining their sense of self and their ability to carry out their normal everyday activities at home and work. The doctors‟ own expectations of treating patients with whiplash injury and whether or not they trust the patients‟ account have illustrated three approaches: dismissive, reactive or proactive that have different implications for patients‟ experiences of healthcare. The study shows how the notion of „compensation‟ is implicated in whether or not the doctor feels able to trust the patient‟s account. The implications of these findings can be seen in terms of methodological focus, general practice and policy formulation. Methodologically interpretative phenomenology provides a theoretical foundation that is, at the very least, equal to and able to challenge more „traditional scientific foundations‟ through its focus on meaning. In terms of practice and policy formulation, the findings have provided a unique insight that might prove to be beneficial for understanding the health care experience and assist in the provision of guidelines aimed at the treatment of whiplash injury. Indeed it is advocated that doctors adopt a subjective approach and that this is taken into account in training.

Currently in South Africa when an individual is injured due to the acts of another they may claim damages for the losses which they may incur. These can be claimed from a variety of institutions, such as the Road Accident Fund, Workmen's compensation or an individual's private insurance. In all the afore-mentioned cases the calculation of damages are along the same lines, whereby the damages are quantified first, and thereafter reduced to reflect future possibilities that may occur. Traditionally future losses are reduced to reflect the possibility that the claimant may die at an age prior to the loss being incurred. To account for this risk awards for future losses are reduced using standard South African mortality tables. The set of tables currently being used were calculated from the 1985 South African census, and as such encapsulate the mortality of the population at that period. When the tables were calculated no reliable statistics were available for the Black population the result is that the tables currently being used do not contain a sample of the majority of the population. The thesis first examines, in detail, the calculation methods used to arrive at the value for damages to be awarded using the current set of life tables. Thereafter an analysis is conducted looking at differences between racial groups in the country and geographic locations, in order to uncover the mortality differences between groups to confirm or disprove the proposition that the exclusion of the Black population results in lower levels of mortality being reflected in the South African 1984-1986 life tables. This is accompanied by a review of mortality trenps in South African since 1986. Following from the findings of the expected increase in mortality since 1986, alternative life tables shall be used to show what impact these would have on the calculation of damages. Due to the fact that none of the alternatives return satisfactory results, structured settlements shall be reviewed to illustrate how the shortcomings of the lump sum approach can be circumvented, and altogether avoid the problems of out dated life tables being used as a basis for damage calculations.
KMBT_363
Adobe Acrobat 9.54 Paper Capture Plug-in

This thesis explores the role of personal resources, including personality and coping style, in rehabilitation following acquired brain injury (ABI). The first chapter consists of a systematic literature review and meta-analysis addressing the effectiveness of coping skills groups in improving coping in those with an ABI. Five articles were eligible for inclusion and comprised single group design and blind randomised controlled trials. A small, statistically non-significant effect size was found for improving coping following coping skills group interventions. This was the first meta-analytic review of its kind, finding no evidence to support the implementation of coping skills groups for improving coping in ABI. Some articles reported improvements across other physical, psychological, and social outcomes. The second chapter reports empirical research investigating the influence of personality traits on successful return to meaningful activity (RTMA) and return to work (RTW) following ABI. Twenty-six participants were prospectively recruited from a rural community brain injury rehabilitation service more than a year following ABI. Participants completed several questionnaires capturing resilience, grit, awareness, cognitive function, demographic, and vocational information. Only higher cognitive function scores predicted RTMA, but not RTW. This suggests that of the antecedent, mediating, and post-injury factors examined measures of grit and resiliency did not predict outcome following ABI after accounting for cognitive function. The implications and limitations of this finding are discussed. The third chapter explores the outcome of the meta-analytic review and empirical papers, discussing implications for theory, further research, and clinical practice. An explanatory model of recovery in ABI is used to contextualise the thesis, followed by a discussion of potential research regarding personality and attachment in recovery. Clinical implications of personality style and coping in individualised and systemic interventions are discussed. The thesis concludes with a reflective piece exploring the personal and professional thoughts of the trainee.

A situation that has been generated several confusions is the inclusion of person damage next to moral damage in the Civil Code of 1984, both in the national doctrine and judicial decisions.The Author analyses the problems arising from non-property damages in the Peruvian legal system, giving a brief description of its arrival to our Legislation and noting the major directions Doctrine has taken. He focuses on the old and new challenges Judges have on this matter and elaborates a list of considerations to positions seated on the Peruvian Civil Procedure.
Una situación que ha generado severas confusiones es la inclusión del daño a la persona junto al daño moral en el Código Civil de 1984, tanto en la doctrina nacional como en los pronunciamientos judiciales.En este artículo el autor examina la problemática de los daños extrapatrimoniales en el ordenamiento peruano, reseñando su génesis legislativo y las principales tendencias doctrinarias al respecto. Se enfoca en los viejos y nuevos retos de los Juzgadores en el daño extrapatrimonal y ofrece cuestionamientos a posturas mayoritarias en el ámbito procesal.

Thesis (M.A.)--City University of Hong Kong, 2005.
"Dissertation submitted to the School of Law in partial fulfillment of the requirements for the degree of Master of arts in arbitration & dispute resolution." Title from title screen (viewed on Mar. 27, 2006) Includes bibliographical references.

Thesis (Ph.D.)--University of Florida, 2005.
Typescript. Title from title page of source document. Document formatted into pages; contains 198 pages. Includes Vita. Includes bibliographical references.

Thesis (Ph. D.)--Florida State University, 2009.
Advisor: James P. Sampson, Jr., Florida State University, College of Education, Dept. of Educational Psychology and Learning Systems. Title and description from dissertation home page (viewed on Feb. 23, 2010). Document formatted into pages; contains ix, 114 pages. Includes bibliographical references.

Damages for distress and disappointment is an award of damages under the common law to compensate a party on breach of a contractual obligation to provide pleasure, enjoyment or relaxation. In Insight Vacations, the New South Wales Court of Appeal determined that the type of damage was synonymous with a claim for damages for a personal injury. Therefore, the Civil Liability Act 2002 (NSW) (‘CLA’) applied to limit the claimant’s award of damages. This thesis provides a critical analysis of the theoretical principles of compensatory damages, with particular focus on the contractual claim for damages for disappointment and distress for a spoiled holiday. The central focus is on the analysis of two significant cases, Insight Vacations and Flight Centre v Louw, where the New South Wales judiciary determined that the claim for damages for disappointment and distress ought to incur the limitations of the CLA. This thesis argues that while both cases claimed damages for disappointment and distress, there is a distinction to be drawn between the two cases. It is submitted that the interpretation and application of the CLA to limit a claimant’s contractual right to recover damages for a breach of an expectation in a contract was not the intention or purpose of the Act. The CLA was introduced to govern the awards of damages for personal injuries caused by negligence, not to deny a remedy to a party for a breach of a contractual obligation.

Bakgrund: Det finns i tidigare studier beskrivna problem så som implementering och följsamhet när det gäller skadeförebyggande träningsprogram (SPP) för fotbollsspelare.   Syfte: Syftet med studien är att kartlägga och undersöka om kvinnliga och manliga fotbollslag i Stockholm utför ett SPP samt om det finns något samband med deras tillgång till medicinsk personal. Syftet är också att undersöka om det finns någon skillnad på tillgången till medicinsk personal och utförande av SPP mellan kvinnliga och manliga fotbollsspelare.   Metod: Enkäten skickades ut till 133 manliga och kvinnliga fotbollsspelare från samma fotbollsklubb. Enkäten innehöll 14 frågor om tillgång till medicinsk personal, information om skadeförebyggande träning samt utförande av SPP.   Resultat: Totalt 82 fotbollsspelare besvarade enkäten.  Majoriteten av deltagarna uppgav att de har tillgång till medicinsk personal. Fler manliga än kvinnliga fotbollsspelare har tillgång till medicinsk personal (P=0,018). Ingen korrelation visades mellan att ha tillgång till medicinsk personal och att ha fått information om skadeförebyggande träning (P=0,45). 66% av deltagarna angav att de utför ett SPP. Tillgång till medicinsk personal korrelerade med utförande av ett SPP (P=0,04).   Slutsats: Medicinsk personal verkar ha en betydelse när det gäller utförande av ett skadeförebyggande träningsprogram. Vidare forskning krävs inom området för att motivera fotbollslag att ta hjälp av medicinsk personal
Background: There are described problems with implementation and compliance in previous studies when it comes to Injury Prevention Programs (IPP) for soccer players.   Aim: The aim of this study was to examine if female and male soccer teams in Stockholm are performing an IPP in relation to their access to medical staff. The aim was also to examine if there are any difference between male and female soccer players in their access to medical staff and performing of an IPP.   Method: The survey was delivered to 133 male and female soccer players from the same soccer club. The survey involved 14 questions about medical staff, information about injury prevention training and performance of an IPP.   Results: Totally 82 soccer players answered the survey. The majority of the participants indicated that they have access to medical staff. More male than female soccer players indicated access to medical staff (P=0,018). No correlation was found between access to medical staff and have gotten information about injury prevention training (P=0,45). 66% of the participants indicated that they were performing an IPP. The access to medical staff correlated to the performing of an IPP (P=0,04).   Conclusion: Medical staff seems to have an impact when it comes to performing of an IPP. Further research is needed to motivate soccer teams to take advantage of medical staff with their injury prevention training.

Acquired Brain Injury (ABI) has been associated with significant family disruption, yet few studies explore the experiences of child-relatives. This cross-sectional study sought to explore the experiences of young people and their families (n = 3) following parental ABI. The major aims were (1) to develop an understanding of the processes by which family members make sense of events, and (2) to explore the implications for adjustment in young people and their families. A Personal Construct Psychology (PCP) methodology was implemented and construal processes were identified through individual interviews facilitated by Perceiver Element Grids (PEG; Procter, 2002). The Family Assessment Device (FAD; Epstein et al., 1983) and the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) were used to explore aspects of adjustment. Data analysis comprised of two parts; intra-family and inter-family exploration of similarities and differences in construal. The themes identified suggest that following ABI, family members may be faced with a process of reconstrual, in which they are required to assimilate new information into their construct systems, renegotiate their roles, and come to terms with loss. The research offers an insight into some of the processes that may contribute to patterns of interpersonal relating that may negatively impact on adjustment. Psychological support following parental ABI may therefore be a crucial component of supporting young people and their families through these changes whilst reducing the impact on their own psychosocial wellbeing. This research offers an insight into the experiences of three families at one moment in time. Further exploration is recommended to better inform clinical practice, and ensure that the needs of this population are not overlooked.

The history of legal liability for psychiatric injury caused by negligence has been marked by judges taking different approaches, some applying general principles while others have taken a more pragmatic and arbitrary approach due to concerns including the risk of unlimited liability. This thesis applies Ernest Weinrib's and Allan Beever's corrective justice theories of negligence to such claims and suggests an approach to the duty of care which demonstrates that a choice does not need to be made between a principled but unlimited and unworkable approach on the one hand, and a clear and predictable but arbitrary and unprincipled approach, on the other. Rather, it is argued in this thesis that the approach suggested by applying Weinrib's and Beever's theories to this area of law is both principled and workable.

Tout dommage que suscite la vie en société ne donne pas lieu à réparation . La formule illustre plus désormais un souhait qu’une réalité alors que l’histoire des conditions posées pour restreindre le champ de la réparation est depuis longtemps celle d’un lent et profond déclin. En principe, un dommage pour être indemnisé doit être personnel, certain et direct. La jurisprudence y ajoute une exigence de légitimité. L’examen du droit positif permet cependant de constater un contrôle de moins en moins poussé de ces différentes conditions. La reconnaissance récente du préjudice écologique pur confirme ce mouvement de recul alors que l’indemnisation de ce dommage collectif au sens strict repose sur l’abandon de l’exigence d’un préjudice personnel. Le phénomène est aujourd’hui acté. Il conduit à faire de presque n’importe quelle atteinte la source d’une indemnisation. Il invite surtout à réfléchir à une réhabilitation de certains caractères généraux du préjudice et même à la redécouverte d’autres caractères plus spéciaux comme la prévisibilité ou l’anormalité pour mieux circonscrire le droit de la réparation. Face à ce phénomène de relâchement, deux attitudes sont en effet possibles : soit y céder et abandonner tout espoir de contrôler par des moyens effectifs le champ de l’indemnisation, soit y résister et tenter de redonner au droit de la réparation une dimension à la fois cohérente et restreinte. C’est cette démarche que nous avons tenté d’entreprendre pour permettre au préjudice de jouer enfin un rôle structurant dans le droit contemporain de la responsabilité
Not all prejudice emanating from society gives rights to redress. This expression illustrates more of a wish than a reality as the history of conditions to restrict the range of redress is one of long duration and of slow and profound decline. In principle, for prejudice to be compensated it must exist, be personnel, and direct. Jurisprudence adds the demands of legitimacy. An examination of current law however, shows that these conditions have less and less of an impact. For example, recent recognition of ecological prejudice confirms this while the compensation of collective damage in the strict sense rests on the relinquishment of the requirement of personal damage. The phenomenon is today acted upon, and results in the making of almost any infringement a source of compensation. As well, it encourages a reflection on the rehabilitation of certain general characteristics of the damage and even about the rediscovery of other more special characteristics. A reaction to the prejudice or an abnormality, to confine better the right are examples. To confront this, two attitudes are possible: either abandon any hope to control the field of the compensation effectively or to resist the phenomenon and restore in the right of redress incorporating a coherent and restricted dimension. It is this latter approach that this dissertation argues to enable prejudice to finally play a structuring role in contemporary law of responsibility

The growing trend of insurance fraud continues to cost US consumers billions of dollars a year through increased premiums. In 2015, the Coalition Against Insurance Fraud estimated the cost of insurance fraud as being at least $80 billion dollars a year. Even though an increasing number of criminals are drawn to the low risk, high reward of insurance fraud, little criminological literature has explored this topic and the public remains relatively unaware of the extent of the problem. One alarming aspect of insurance fraud is the involvement of organized criminal groups. These organized criminal enterprises are formed for the sole purpose of defrauding the insurance industry. Often, these enterprises are believed to have ties to traditional organized criminal groups, such as the Italian Mafia or the Russian Mob. In order to combat these criminal organizations, it is important to understand the behavior and motivation of such groups. The present study aims to analyze the generally held belief throughout the insurance industry that organized insurance fraud rings are more likely to operate in states with mandatory Personal Injury Protection (PIP) policies. This analysis was conducted by examining staged automobile accidents reported to the National Insurance Crime Bureau. The results of this analysis were mixed. Although a larger percentage of states with mandatory PIP displayed higher staged accident rate, some mandatory PIP states did not, and multiple non-PIP states also demonstrated a high staged accident rate. In an attempt to better understand this crime, further criminological research is needed.

Personal Protective Equipment (PPE) indicates protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury, in particular they are used to dissipate the energy of the impact in case of accidents. Most of PPE items should pass certain standard criteria before being introduced into the market. Moreover, beside standards, biomechanical injury criteria can be used to compare different PPE items according to the human body tolerance against external loading. Energy absorbing materials with higher capacity of energy dissipation can improve the injury mitigation capability of PPE items. Therefore, this thesis aims at studying the possibility of using new energy absorbing materials to optimize the protection level of protective devices, especially for motorcycle riders. The Finite Element Method (FEM) was mainly used to assess and compare the energy absorption capability of different materials and structures. However, experimental tests were carried out whenever possible for validation of FE models. A computational method has been developed for partial optimization of the composite-shell of an helmet to mitigate the induced neck axial force due to the facial impact. The results of this optimization show that by varying the orientation of the chin bar plies, thus keeping the helmet mass constant, the neck axial force can be reduced by approximately 30% while ensuring that the helmet complies with the impact attenuation requirements prescribed in helmet standards adopted in Europe. Moreover, the possibility of using addictively manufactured structures as the helmet liner has been studied. The results show that using a hierarchical lattice liner could reduce the risk of head injury significantly by comparison to a helmet with EPS liner and could potentially be considered as the new generation of energy absorbing liners for advanced helmets. Furthermore, experimental tests were carried out to study the feasibility of using new polymeric fibres to make helmets lighter. The results of these tests show that such polymeric fibres may be used in conjunction with carbon fibres to mold hybrid laminates to build lighter helmets. Finally, since there is no standard to design and test neck protective devices, the response of cervical vertebrae to direct impacts to the helmets in case of using such a device was studied numerically. The findings of this work show that using a neck brace designed to restrain the head-neck motion might increase the induced load in the neck and therefore the risk of cervical injuries, therefore the design of such devices needs more investigations and their assessment requires the introduction of the relevant standards.
I termini ‘Dispositivi di protezione individuale’ (DPI) indicano indumenti protettivi, caschi, occhiali di protezione o altri indumenti o attrezzature progettati per proteggere il corpo dell'utilizzatore da lesioni, in particolare i DPI sono utilizzati per dissipare l'energia dell'impatto in caso di incidenti. La maggior parte dei DPI dovrebbe superare determinati test standard prima di essere introdotta nel mercato. Inoltre, accanto alle prove di normativa, anche criteri di lesioni biomeccaniche possono essere utilizzati per confrontare diversi articoli di DPI in base alla tolleranza del corpo umano rispetto al carico esterno. I materiali che assorbono energia con maggiore capacità di dissipazione di energia possono migliorare la capacità di mitigazione degli infortuni degli articoli di DPI. Pertanto, questa tesi mira a studiare la possibilità di utilizzare nuovi materiali che assorbono energia per ottimizzare il livello di protezione dei DPI, in particolare per i motociclisti. Il metodo degli elementi finiti (FEM) è stato utilizzato principalmente per valutare la capacità di assorbimento di energia diversi materiali e strutture. Tuttavia anche test sperimentali sono stati effettuati, quando possibile, per la convalida dei modelli FE. È stato sviluppato un metodo computazionale per l'ottimizzazione parziale del guscio composito di un casco per ridurre la forza assiale indotta nel collo dall'impatto sulla testa. I risultati di questa ottimizzazione dimostrano che variando l'orientamento degli strati della mentoniera, mantenendo così la massa del casco inalterata, la forza assiale nel collo può essere ridotta di circa il 30%, mentre si assicura che il casco sia conforme ai requisiti di attenuazione dell'impatto prescritti negli standard del casco adottati in Europa. Inoltre, è stata studiata la possibilità di utilizzare strutture prodotte in modo additivo come imbottitura del casco. I risultati mostrano che l'utilizzo di un rivestimento reticolare gerarchico potrebbe ridurre significativamente il rischio di trauma cranico rispetto a un casco con tradizionale imbottitura in polistirolo, tanto che l’ imbottitura reticolare gerarchica potrebbe essere considerata come la nuova generazione di rivestimenti per l'assorbimento dell’energia in caschi avanzati. Inoltre, sono stati effettuati test sperimentali per studiare la fattibilità dell'uso di nuove fibre polimeriche per rendere i caschi più leggeri. I risultati di questi test mostrano che tali fibre polimeriche possono essere usate in congiunzione con fibre di carbonio per modellare i laminati ibridi per costruire caschi più leggeri. Infine, poiché non esiste una normativa standard per progettare e testare i dispositivi di protezione del collo, è stata studiata numericamente la risposta delle vertebre cervicali ad impatti sul casco in caso di uso di un dispositivo di protezione del collo (neck brace). I risultati di questo lavoro suggeriscono che l'uso di un collare progettato per limitare il movimento dell’insieme testa-collo potrebbe aumentare il carico indotto nel collo e quindi il rischio di lesioni cervicali. Si conclude che la progettazione di tali dispositivi richiede più indagini e la loro valutazione richiede l'introduzione di standard pertinenti.

This dissertation begins from the research question “How do the nature and availability of transfers influence the lived experiences of people with spinal cord injury (PWSCI) in low socio-economic independent living communities (ILC) in the context of personal assistance relationships?” Transfers here, refers to the need for people with severe mobility impairments to be lifted or otherwise assisted in moving between locations such as bed and wheelchair, wheelchair and toilet, wheelchair and vehicle, and so forth. “Personal assistance means that users of such service exercise the maximum control over how services are organised, and custom-design their services according to their individual needs, capabilities, life circumstances and aspirations” (Ratzka, 1992, p.1). PWSCI, as is the interest of this study, have unique insights into their disability and their context. In terms of international human rights conventions, PWSCI are entitled to have control over their lives and therefore must participate in the form of consultancy on issues that concern them directly. Many PWSCI are dependent on assistance from others for transfers during activities of daily living (ADL). ADL refers to everyday activities such as rising, dressing, washing, toileting, eating, and so on. In the lives of PWSCI, access to the means of performing ADL equates, in reality, to access to the means of survival. In low socio-economic communities, it is likely that personal assistance is performed by unpaid family members or friends, or low remunerated untrained personal assistance providers, rather than paid, professionally trained employees. Unpaid / low remunerated and untrained personal support has implications for i) the ready availability of transfers, ii) the safety of transfers, and iii) reciprocal dynamics of care and accommodation within the relationship. PWSCI represent a large portion of the South African population. Besides those already stated, a body of research shows that PWSCI may face particular limitations and obstacles in fulfilling of ordinary or normal life. These obstacles may include negative attitudes, structures of normalcy and ableism, and environmental barriers to access for PWSCI. These obstacles may influence how PWSCI construct their identity within relationships of personal assistance. Also, the voices and own experiences from the perceptions of PWSCI are not always heard and not given political recognition. This research aimed to explore the transfer-related experiences of PWSCI, in the context of personal assistance relationships, during activities of daily living. A qualitative study was conducted, and focused on the experiences and perceptions of nine PWSCI living in low socio-economic independent living communities (ILC) in Johannesburg. A semi-structured interview was used for data collection, and a Qualitative Thematic Analysis was applied to analyse the data. Ethics of Care (EoC) was a useful theoretical approach adopted in exploring the lived experiences of PWSCI in the interest of their taking back agency within relationships of personal assistance, being free of any assumptions and perceptions about impairment and their ability. Furthermore, the aim of an EoC approach is to foster inclusion, respect and dignity, and systems of influence and power, influencing the experiences and personal perceptions of PWSCI living in low socio-economic independent living communities (ILC). The results of this study revealed that PWSCI find living with a spinal cord injury not being a barrier to living a fulfilling life but instead, emphasised barriers created through stigma and negative attitudes from relationships within personal assistance and communities as a whole. These serious barriers to self-expression and fulfilment come in the form of stigma of disability, ableism, negative perceptions, and the pervasiveness of the medical model. How PWSCI feel about their belonging in their society and taking back their agency in relationships of personal assistance, was found to be representative of how they respond to negative social constructions of disability within care relationships, and their communities as experienced during daily transferrelated activities. The study revealed the importance of the need for accredited training for personal assistance providers to prevent secondary injury for PWSCI and care providers alike, and to create conducive working environments for care providers. Conducive working environments may include body mechanic training, appropriate assistive devices for safe lifting and moving of PWSCI. Furthermore, conducive working environments may contribute to positive attitudes and perceptions toward PWSCI. Access to allocated state resources will facilitate PWSCI to procure accredited, trained, paid care. The vocation of personal assistance providers should be organised, available and accredited.

Made available in DSpace on 2015-04-22T22:14:17Z (GMT). No. of bitstreams: 1 Lionela Correa.pdf: 1636607 bytes, checksum: 83e46a87bd7d311464876eb93bb8b37d (MD5) Previous issue date: 2011-10-31
Fundação de Amparo à Pesquisa do Estado do Amazonas
Quality of life theme is gaining interest in health in last decades. Because has proved a powerful tool for investigating and assessing patients, therapeutic interventions, and services in health. This study aimed to evaluate the quality of life of people with traumatic spinal cord injury based on the perception of the injured spinal cord. The subjects were individuals with SCI living in the Manaus city, which were affected by the injury in the period 2000 to 2010 and received at the Getulio Vargas University Hospital - HUGV. The instrument used to measure quality of life was the subject of the Portuguese version of the World Health Organization Quality of Life - Bref. A questionnaire was also applied to characterize socio-demographic subjects as well as knowing the causes of trauma and time of injury. It was examined the level of functional independence of the subjects through the Functional Independence Measure - FIM. Data analysis was performed using descriptive statistics and correlate the variables, age, gender, functional independence, socioeconomic status, time of injury, the sequel to the quality of life of individuals we used the Spearman correlation coefficient. The results showed a level of quality of life mean, and between the domains of quality of life those who had lower satisfaction among its facets were areas: social and environmental. In general the domain with the lowest score was the environmental field. When I checked whether there was correlation between the presenters that the only correlation was the age, the younger the better the assessment of quality of life perhaps better social integration on the part of the newest. We conclude that the factors that lead to an assessment of quality of life to a negative level are external factors, in other words, something that is not inherent in disability or deficit but inherent to environmental conditions. Keywords: quality of life, spinal cord injury, personal satisfaction.
O tema qualidade de vida vem ganhando interesse na área da saúde nas últimas décadas. Por se mostrar um ótimo indicador de satisfação em vários aspectos da vida para investigar e avaliar pacientes, intervenções terapêuticas, e serviços na área da saúde. Esse estudo teve por objetivo avaliar a qualidade de vida de pessoas com lesão medular traumática com base na percepção do lesado medular. Os sujeitos da pesquisa foram indivíduos com lesão medular traumática, residentes na cidade de Manaus, que foram acometidos pela lesão no período de 2000 a 2010 e que deram entrada no Hospital Universitário Getúlio Vargas - HUGV. O instrumento utilizado para mensurar a qualidade de vida dos sujeitos foi a versão em português do World Health Organization Quality of Life Bref. Também foi aplicado um questionário sócio demográfico para caracterizar os sujeitos bem como conhecer as causas do trauma e tempo de lesão. E foi averiguado o nível de independência funcional dos sujeitos através do questionário de medida de independência funcional MIF. A análise dos dados foi realizada por meio da estatística descritiva e para correlacionar as variáveis, idade, gênero, independência funcional, condição socioeconômica, tempo de lesão, sequela com a qualidade de vida dos sujeitos foi utilizado o coeficiente de correlação de Spearman. Os resultados apontaram para um nível de qualidade de vida médio, e entre os domínios de qualidade de vida os que apresentaram menor satisfação entre suas facetas foram os domínios: social e ambiental. De um modo geral o domínio que apresentou menor escore foi o domínio ambiental. Ao verificarmos se existia correlação entre as variáveis a única que apresentou correlação foi a idade, quanto menor a idade melhor a avaliação de qualidade de vida talvez por uma melhor inserção social por parte dos mais novos. Concluímos que os fatores que levam a uma avaliação de qualidade de vida para um nível negativo são fatores externos, ou seja, algo que não é inerente a deficiência ou déficit, mas inerente às condições ambientais

Os objetivos deste trabalho foram analisar as informações contidas nas apólices de dano à pessoa em processos de sinistros de seguradoras, e propor melhorias para o atendimento de traumatizados portadores desse tipo de produto. Foram descritas as informações sobre o perfil do segurado - sexo, faixa etária e ocupação -; características do trauma - como local e etiologia do dano -; características da lesão e dos tratamentos reabilitadores; adequação dos tratamentos propostos, dos honorários e da documentação. Foram elencadas as falhas detectadas nas apólices cuja documentação apresentava-se insuficiente. O estudo abrangeu 151 processos, dos quais 132 constituiam-se em Avisos de Acidente (iniciais) e 19 em Avisos de Continuidade. Quanto aos tipos de seguros, 124 eram de Seguro Escolar, 07 de Afastamento Profissional e 01 de DPVAT. Nos processos, 84 (63,64%) segurados eram do sexo masculino e 48 (36,36%) do sexo feminino; a faixa etária predominante foi a compreendida entre 6 e 10 anos, com 42 (31,82%) casos; o local de maior ocorrência foi a área escolar (57 = 43,18%). Na etiologia do dano constatou-se que 59 (44,70%) acidentes aconteceram durante locomoções, 34 (25,76%) em atividades lúdicas, 18 (13,64%) em práticas esportivas e 16 (12,12%) em ambiente doméstico, nos três últimos dos quais as quedas ocorreram com maior freqüência. Os dados de lesões referem-se tão somente aos Avisos de Acidentes, nos quais predominaram as fraturas coronárias simples, com 94 ocorrências, e 21 acidentes geraram lesões associadas de tecidos duros e tecidos moles. Da mesma forma, os tratamentos reabilitadores só contemplam os Avisos de Acidentes, nos quais prevaleceu a dentística (112). Na análise da adequação de tratamentos propostos, dos 151 processos, 133 estavam adequados e 18 inadequados. Quanto aos honorários profissionais, 89 apresentaram valores satisfatórios e 55, valores acima dos usuais. Os 7 processos restantes eram de Afastamento Profissional, nos quais não são avaliados os custos de tratamento e sim o tempo de restabelecimento. Em relação à adequação da documentação, 74 estavam adequados e 77 não completaram a documentação requisitada. Dentre os inadequados, a principal falha foi a ausência de radiografias iniciais e/ou finais.
This dissertation aims at analyzing the data on accident claims in personal injury policies from insurance companies and at proposing improvements on the treatment of injured people who hold this kind of product. The study describes information related to the insured profile (gender, age and occupation), to the trauma (such as the place and etiology of damage), the lesion and rehabilitation treatment characteristics, as well as whether proposed treatments were adequate for the fees charged and for the documentary evidence submitted. Errors identified in policies with insufficient documentation were also listed. The study encompassed 151 claims, 132 of which were Notification of Accidents (Initial Claims) and 19 were Notification about the Eligibility for Continuity of Care. As for the kinds of insurance, 124 related to School Accident Insurances, while 07, to Professional Leave, and only 01 related to Motor Vehicle Personal Injury Insurance. In those claims, 84 (63,64%) insured were male, whereas 48 (36,36%) were female; the main age group ranged from 6 to 10 years old, totalizing 42 cases (or 31,82%). Schools were the place where the greatest number of accidents (57 = 44,53%) occurred. In the etiology of damage, it was observed that 59 accidents (44,70%) occurred during locomotion movement, 34 cases (25,76%) in playing, 18 (13,64%) during the practice of sports and 16 (12,12%) at home. In the last three types, fall accidents occurred more frequently. As for the kind of lesion, the simple fracture crown prevailed in 94 cases, whereas in 21 accidents, it were hard and soft associated lesions. In the rehabilitation treatments, dentistry prevailed in 112 proceedings. As for the suitability of proposed treatments, out of 151 claims, 133 were adequate whereas 18 were not. As far as fees for professional services were concerned, 89 were considered satisfactory, while 55 were considered overcharged. The last 7 claims were related to Professional Leave, and so what is assessed is the time to recovery and not the treatment costs. In relation to documentary evidence, 74 claims submitted proper documents, while 77 did not. The latter main error was that initial and /or final radiographic documentation was not sent to the insurance companies.

Florida is one of 12 states that have a no-fault law. The first party benefit coverage is known as personal injury protection (PIP). Every policy sold in the state must include at least $10,000 in personal injury protection. This law went into effect in 1971 and is now being challenged. Changes in consumer, lawyer, and doctor behavior as well as changes in the legal and economic environment have diminished the positive impact of the no-fault law. This thesis will focus on the diminished effectiveness of the no-fault law in Florida. It will be based on research from primary sources. Other legal resources including law review articles and journal publications were consulted for persuasive scholarly views. Published work from insurance institutes and journals were included since they guide practitioners on the application of the law. Insurers, insureds and policymakers face serious challenges regarding Florida Motor Vehicle No-Fault Law. The purpose of this thesis is (1) to review the legislative history of Florida Motor Vehicle No-Fault Law, (2) to assess how well the current system is working (3) examine solutions to compensation from other states and provide relevant data and (4) make recommendations for future legislation. This thesis will recommend proposed changes with guidelines for future legislation to effect the changes necessary to balance the needs of the insurance companies, plaintiffs and defendants.
B.S.
Bachelors
Legal Studies
Health and Public Affairs

Motorcyclists (including moped riders) are the most vulnerable road users in terms of injury protection. Though the head and the extremities are the most affected body parts in motorcycle accidents, the occurrence of serious to fatal injuries is often due to the injuries in the cervical spine according to the literature. Although a variety of neck braces exists in the market to protect the neck from being injured in motorcycle accidents, the effectiveness of those neck braces is not clear due to the lack of scientific evidence of the injury reduction. Moreover, the absence of standard test methods makes the quality assessment process of the braces incomplete. Hence, the development of a common regulation should be the main focus in order to evaluate all the neck braces available in the market and also the future neck protective systems. It is important to define a neck injury assessment process based on the impact conditions of motorcycle accidents. However, a lack of accidental and experimental data on injury mechanisms limits the potential of the standard development research. The main objective of this study is to contribute to the development of new personal protective equipment (PPE) focusing on neck protection for the motorcyclists. Moreover, the study aims to provide some ideas to develop the standardization procedures for the future EU standards for neck protectors. New functional prototypes, as neck protective systems, were designed for the motorcyclists. However, more focus has been given on the neck injury mechanisms and new test methods rather than on the development of new neck protectors. For such reason, a new biofidelic finite element (FE) neck model was developed and coupled with Hybrid III head model. In the following steps, a rigid torso was added to the neck model, the neck protective systems were coupled with FE head-neck-torso model and six different test conditions were simulated. The results were analyzed as functions of upper and lower neck forces, head acceleration, head rotation relative to torso, different impact speeds, and available neck injury criteria. The key suggestions provided in this thesis include modification of the ambient impact test method for motorcyclists’ impact protectors, improvement of the design of neck protective systems, advancement of different test methods for neck protectors, investigation for new neck injury assessment process and direction to develop standards for neck protectors.
I motociclisti (compresi i ciclomotori) sono gli utenti della strada più vulnerabili in termini di protezione degli infortuni. Sebbene la testa e le estremità siano le parti del corpo più colpite negli incidenti in moto, il verificarsi di lesioni gravi o mortali è spesso dovuto alle lesioni nella colonna cervicale secondo la letteratura. Sebbene sul mercato esista una varietà di bretelle per proteggere il collo da lesioni in incidenti in moto, l'efficacia di queste bretelle non è chiara a causa della mancanza di prove scientifiche sulla riduzione degli infortuni. Inoltre, l'assenza di metodi di prova standard rende incompleto il processo di valutazione della qualità delle parentesi graffe. Quindi, lo sviluppo di una regolamentazione comune dovrebbe essere l'obiettivo principale per valutare tutti i collari disponibili sul mercato e anche i futuri sistemi di protezione del collo. È importante definire un processo di valutazione della lesione del collo in base alle condizioni di impatto degli incidenti in moto. Tuttavia, la mancanza di dati accidentali e sperimentali sui meccanismi di pregiudizio limita il potenziale della ricerca di sviluppo standard. L'obiettivo principale di questo studio è di contribuire allo sviluppo di nuovi dispositivi di protezione individuale (DPI) incentrati sulla protezione del collo per i motociclisti. Inoltre, lo studio mira a fornire alcune idee per sviluppare le procedure di standardizzazione per i futuri standard UE per i protettori del collo. Nuovi prototipi funzionali, come sistemi di protezione del collo, sono stati progettati per i motociclisti. Tuttavia, è stata data maggiore attenzione ai meccanismi di lesione del collo e ai nuovi metodi di prova piuttosto che allo sviluppo di nuovi protettori del collo. Per questo motivo, è stato sviluppato un nuovo modello di collo a elementi finiti biofidelici (FE), abbinato al modello di testa Hybrid III. Nei seguenti passaggi, un modello rigido del collo è stato aggiunto al modello del collo, i sistemi di protezione del collo sono stati accoppiati con il modello di testa-collo-torso FE e sono state simulate sei diverse condizioni di test. I risultati sono stati analizzati come funzioni delle forze del collo superiore e inferiore, accelerazione della testa, rotazione della testa rispetto al torso, diverse velocità di impatto e criteri di lesione del collo disponibili. I suggerimenti chiave forniti in questa tesi includono la modifica del metodo di prova dell'impatto ambientale per i protettori di impatto dei motociclisti, il miglioramento del design dei sistemi di protezione del collo, l'avanzamento di diversi metodi di prova per i protettori del collo, l'investigazione per il nuovo processo di valutazione del collo e la direzione da sviluppare standard per i protettori del collo.

Le principe de réparation intégrale du préjudice corporel démontre les limites de son application actuelle. Alors que notre système juridique paraît enclin à toutes les sollicitudes envers la victime, celui-ci manque largement à son but : la multiplicité des régimes d'indemnisation, l'hétérogénéité des méthodes d'évaluation et l'insuffisante fermeté des concepts mis en oeuvre apparaissent comme autant de facteurs de disparités entre les victimes. À l'appui d'une étude ouverte au droit international, aux solutions doctrinales ainsi qu'à une appréhension ajustée de la notion de victime; cette thèse oeuvre pour une autonomisation du droit du dommage corporel respectant les valeurs d'égalité, d'humanité et de justice de l'indemnisation propres au principe de réparation intégrale du préjudice corporel
The principle of full reparation for bodily injury demonstrates the limits of its current application. While our legal system seems inclined to all the requests to the victim, it largely misses its goal : the multiplicity of compensation schemes, heterogeneity assessment methods and insufficient firmness concepts implemented appear as factors of disparities between the victims. In support of an open study with international law, to the doctrinal solutions as well as an adjustedunderstanding of the concept of victim ; this thesis works for the empowerment of personal injury law respecting the values of equality, humanity and justice of compensation specific to the full compensation principle of reparation for bodily injury

Le droit du dommage corporel est aujourd’hui une spécialité à part entière de notre système juridique. Ce droit, longtemps ignoré par le législateur, se construit au gré de l’actualité, la jurisprudence exposant les règles générales et la loi, les règles spéciales.Cette matière souffre de l’absence d’uniformisation de la réparation d’un préjudice corporel ce qui peut rendre l’indemnisation inique. Dans ce contexte, cette étude propose de définir la notion de préjudice corporel pour une autonomisation du droit du dommage corporel. Tout d’abord, le corps réparable doit nécessairement être délimité au regard des évolutions biotechnologiques car il fonde la créance de réparation. Ensuite, les modalités de réparation d’un préjudice corporel devront être confrontées à leur efficacité à réparer un préjudice corporel. A la lumière de systèmes juridiques voisins, du droit européen et des réformes envisagées, la thèse invite à l’uniformisation du droit du dommage corporel pour une meilleure et une juste réparation du préjudice corporel des victimes
Personal injury law is today a distinct field in the French legal system. This law, which had been ignored for a long time by lawmakers, is built up according to current events, the case law setting out the general rules and the law, the special rules. This matter suffers from the lack of standardization of compensation for a bodily injury which may make the compensation unjust. In this context, this study proposes to intends to define the notion of bodily injury in order to empower the law of personal injury. First, the repairable body must necessarily be defined in terms of biotechnological developments since he founds the claim for reparation. Then the repair procedures for bodily injury will be facing their effectiveness in repairing physical injury. In light of the legal of neighbouring countries, European law and the proposed reforms, the thesis calls for the standardization of the personal injury law for a better and fair compensation for personal injury victims

Submitted by Biblioteca Central (biblioteca@unicap.br) on 2018-09-06T15:10:52Z No. of bitstreams: 2 raissa_maria_bittencourt_morais.pdf: 983280 bytes, checksum: 07d53ce6339e27c0431124f40ccf2bd0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Made available in DSpace on 2018-09-06T15:10:52Z (GMT). No. of bitstreams: 2 raissa_maria_bittencourt_morais.pdf: 983280 bytes, checksum: 07d53ce6339e27c0431124f40ccf2bd0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-07-20
This study aimed to understand how women who suffered an acquired spinal cord injury (re)construct themselves and their sexual lives. The medullary lesions (ML) are all injuries that affect the structures contained in the spinal canal and can lead to motor, sensory, autonomic and psychoaffective alterations. It is one of the situations that can most affect the life of any individual and that can bring with it many biopsychosocial repercussions. The research that serves as the basis to this dissertation is of qualitative character and is founded theoretically and methodologically in the writings of Michel Foucault and of other authors that dialogue with his thought. As methodological strategies, the Narrative Interviews and the Field Diary were used as tools for the construction of the narratives of the women with acquired spinal cord injury, which were analyzed through a descriptive analytics of the subject of Foucauldian inspiration. These analysis have pointed out that these women are crossed by diverse discursive formations, institutions, knowledge/power games that constitute them as capable of organizing their own methods and ways to perform a sexual life satisfactorily in the way it is possible to live it. The condition of woman, the exercise of a sexual life after a trauma or accident, and the way in which they act upon their subjectivity showed themselves as difficult paths; it is evident the importance of looking at sexuality as a dispositif; it is emphasized the existence of a society that considers certain bodies, and here the bodies with spinal cord injury, as abjects and the suffering experienced by each one of them is verified when faced with the change of an accepted body. Thus, in the narratives we find the certainty that women with acquired spinal cord injury are not considered as asexual, on the contrary, all of them reported experiencing - or having lived - one or more loving, affective and sexual relationships. We hope that our research will contribute to the broadening of women's voices and struggles as well as to the greater opening of spaces for dialogue on the subject of sexuality in what concerns people with physical disabilities, especially women with acquired spinal cord injuries.
adquirida (re)constroem a si mesmas e as suas vidas sexuais. As lesões medulares (LM) são todas as injúrias que acometem às estruturas contidas no canal medular podendo levar à alterações motoras, sensitivas, autonômicas e psicoafetivas. É uma das situações que mais pode afetar a vida de qualquer indivíduo e traz consigo inúmeras repercussões biopsicossociais. A pesquisa que deu base a esta dissertação é de cunho qualitativo e se fundamenta teórica e metodologicamente nos escritos de Michel Foucault e de outros autores que dialogam com o seu pensamento. Como estratégias metodológicas foram utilizadas as Entrevistas Narrativas e o Diário de Campo, como instrumentos para a construção das narrativas das mulheres com lesão medular adquirida, que foram analisadas através de uma analítica descritiva do sujeito de inspiração foucaultiana. Essas análises apontaram que essas mulheres são atravessadas por diversas formações discursivas, instituições, jogos de saber/poder que as constituem como capazes de agenciarem seus próprios métodos e caminhos para executar satisfatoriamente uma vida sexual do modo como é possível vivê-la. A condição de mulher, o exercício de uma vida sexual após um trauma ou acidente, e o modo pelos quais elas se subjetivam se mostraram caminhos difíceis; evidencia-se a importância de se olhar a sexualidade como um dispositivo; enfatiza-se a existência de uma sociedade que considera determinados corpos, e aqui os corpos com lesão medular, como abjetos e verificase o sofrimento vivido por cada uma delas ao se depararem com a mudança de um corpo aceito. Deste modo, nas narrativas encontramos a certeza de que as mulheres com lesão medular adquirida não se consideram assexuais, ao contrário, todas relataram vivenciar – ou já ter vivido – um ou mais relacionamentos amorosos, afetivos e sexuais. Esperamos que nossa pesquisa contribua para a ampliação das vozes e luta dessas mulheres assim como para a maior abertura de espaços de diálogos acerca da temática da sexualidade no recorte das pessoas com deficiências físicas adquiridas, em especial, das mulheres com lesões medulares adquiridas.

Objectives: Risk associated with needlestick injuries (NSI) in health care workers (HCWs) in Taiwan has not been characterized. We conducted this investigation to study 1) the prevalence and yearly incidence of NSI in HCWs in Taiwan, and the risk factors associated with NSIs; 2) reporting behavior when a NSI was sustained; and 3) seroprevalence of blood-borne pathogens among inpatients. Combination of the above information allowed for risk estimation for contracting hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in HCWs. Methodology: A cross-sectional questionnaire survey for life-time experience and frequency of NSI was conducted in a random sample from four strata of accredited hospitals according to the number of employees, from July 1996 to June 1997 in Taiwan. All full time employees, including physicians, nurses, technicians, and supporting personnel were recruited. Seroprevalence was examined for HBV, HCV and HIV among inpatients six years in age or older in one teaching hospital during July 1997 to June 1998. Results: A total of 10,469 health care workers were recruited from 16 out of 132 accredited hospitals and 82.6% (8,645) completed the survey, including nurses (61.0%), physicians (16.1%), medical technicians (14.9%), supporting personnel (7.9%). The prevalence of NSI were 93.1%, 86.6%, 78.3%, 61.0% in nurses, physicians, technicians, and supporting personnel respectively. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 times per person in the past 12 months. Of the most recent episodes of NSIs, ordinary syringe needles accounted for 80.3% (95% CI, 79.4% - 81.2%) of hollow-bore needles associated incidents, and 74.1% (95% CI, 72.8% - 75.4%) of them were contaminated. The most frequently reported circumstance was the "Breakdown of Universal Precautions", recapping-related behaviors (81.6%, 95% CI 80.3% - 82.9%) of HCWs. More than a quarter (27.8%, 2,399) of HCWs were unprotected (either not vaccinated or having an unknown serological status) against HBV. Seroconversion in stuck HCWs was reported 1.8% for HBV (135), 0.2% (18) for HCV, 0.2% (15) for both HBV and HCV, 0.1% (5) for syphilis and less than 0.1% (2) for HIV. ^M A total of 81.8% of NSIs were unreported. Similarly, high incidence of NSI and low reporting rate were also found in student nurses. Seroprevalence of HBV, HCV, and HIV among inpatients were found higher than the reported rate in source patients of this survey. Seroprevalence of HBsAg was 16.7% in hospitalized patients, 1.7% positive for HBeAg, 12.7% for Anti-HCV, and 0.8% for Anti-HIV. Different seroprevalence rates of HBsAb (+), HBsAg (+), Anti-HCV (+), Anti-HIV (+) in different seasons were also found significant (p<0.001). The risk of seroconversion to HBV was thus estimated to be 0.003 ~ 0.008 time per person-year, HCV 0.003 ~ 0.007 per person-year, and HIV 0.4 ~ 1.2 /100, 000 person-year. Considering the number of HCWs in Taiwan, a total of 330 ~ 917 HCWs will seroconvert to HBV (+) in a year, 330 ~ 880 HCWs seroconvert to HCV (+), and less than one to two HCWs seroconvert to HIV (+). Conclusions: Needlestick and sharps injuries were highly prevalent among Taiwanese HCW and across job categories. Risk of seroconversion is real and significant. Preventive measures are warranted for reduction of contracting blood-borne pathogens in HCWs in Taiwan.