Steven L. West

The Effect of Hyperbaric Oxygen on Persistent Postconcussion Symptoms

Background:The high incidence of persistent postconcussion symptoms in service members with combat-related mild traumatic brain injury has prompted research in the use of hyperbaric oxygen (HBO2) for management. Objective:The effects of HBO2 on persistent postconcussion symptoms in 60 military service members with at least 1 combat-related mild traumatic brain injury were examined in a single-center, double-blind, randomized, sham-controlled, prospective trial at the Naval Medicine Operational Training Center at Naval Air Station Pensacola. Methods:Over a 10-week period, subjects received a series of 40, once-daily, hyperbaric chamber compressions at 2.0 atmospheres absolute (ATA). During each session, subjects breathed 1 of 3 preassigned oxygen fractions (10.5%, 75%, or 100%) for 60 minutes, resulting in an oxygen exposure equivalent to breathing surface air, 100% oxygen at 1.5 ATA, or 100% oxygen at 2.0 ATA, respectively. Individual, subscale and total item responses on the Rivermead Postconcussion Symptom Questionnaire and individual and total Posttraumatic Disorder Checklist–Military Version were measured just prior to intervention and immediately postintervention. Results:Between-group testing of pre- and postintervention means revealed no significant differences on individual or total scores on the Posttraumatic Disorder Checklist–Military Version or Rivermead Postconcussion Symptom Questionnaire, demonstrating a successful randomization and no significant main effect for HBO2 at 1.5 or 2.0 ATA equivalent compared with the sham compression. Within-group testing of pre- and postintervention means revealed significant differences on several individual items for each group and difference in the Posttraumatic Disorder Checklist—Military Version total score for the 2.0 ATA HBO2 group. Discussion:The primary analyses of between group differences found no evidence of efficacy for HBO2. The scattered within group differences are threatened by Type 2 errors and could be explained by nonspecific effects. Conclusion:This study demonstrated that HBO2 at either 1.5 or 2.0 ATA equivalent had no effect on postconcussion symptoms after mild traumatic brain injury when compared with sham compression.

Hiring discrimination against people with disabilities under the ADA: characteristics of charging parties.

Introduction This article describes findings from a causal comparative study of the characteristics of Charging Parties who filed allegations of Hiring discrimination with the U.S. Equal Employment Opportunity Commission (EEOC) under Title I of the Americans with Disabilities Act (ADA) between 1992 and 2005. Methods Charging Party Characteristics derived from 19,527 closed Hiring allegations are compared and contrasted to 259,680 closed allegations aggregated from six other prevalent forms of discrimination including Discharge and Constructive Discharge, Reasonable Accommodation, Disability Harassment and Intimidation, and Terms and Conditions of Employment. Tests of Proportion distributed as chi-square are used to form comparisons along a variety of factors including age, gender, impairment, and ethnicity. Results Most allegations of ADA job discrimination fall into the realm of job retention and career advancement as opposed to job acquisition. Hiring allegations, however, tend to be filed by Charging Parties who are disproportionately male, younger or older applicants, white, and coping with physical or sensory disabilities. Conclusion Prevailing theories about stigma suggest that negative attitudes are more prevalent toward persons with behavioral disabilities. However, this study provides clear evidence that one behavioral manifestation of negative attitudes, Hiring discrimination, is more often directed at persons with physical or sensory impairments. More outreach regarding ADA rights appears indicated for individuals who share the aforementioned characteristics.

Hyperbaric oxygen for blast‐related postconcussion syndrome: Three‐month outcomes

Mild traumatic brain injury (mTBI) and postconcussion syndrome (PCS) are common among military combatants. Hyperbaric oxygen (HBO2) is a proposed treatment for these conditions, but it has not been rigorously studied. The objective of this study was to determine the effects of HBO2 by 3 months post compression at 2 commonly employed dosing levels to treat PCS; whether specific subgroups may have benefited; and if no overall effect was found, whether benefit is masked by other conditions.

Hiring Discrimination Against People with Disabilities Under the ADA: Characteristics of Employers

Introduction This article describes findings from a causal comparative study of the characteristics of employers against whom allegations of hiring discrimination were filed with the U.S. Equal Employment Opportunity Commission (EEOC) under Title I of the Americans with Disabilities Act (ADA) between 1992 and 2005. Methods Employer characteristics derived from 19,527 closed Hiring allegations are compared and contrasted to 259,680 closed allegations aggregated from six other prevalent forms of discrimination including Discharge and Constructive Discharge, Reasonable Accommodation, Disability Harassment and Intimidation, and Terms and Conditions of Employment. Tests of Proportion distributed as chi-square are used to form comparisons along a variety of factors including industry classification, size of workforce, and location. Results As compared to non-hiring allegations, hiring allegations were more likely to be filed against employers with 15–100 employees, in the West U.S. Census track region, or in industries including educational services; public administration; transportation and warehousing; professional, scientific, and technical services; agriculture, forestry, fishing, and hunting; and construction. Conclusion More outreach regarding ADA responsibilities appears indicated for those employers who share the aforementioned characteristics.

Rates of Alcohol/Other Drug Treatment Denials to Persons With Physical Disabilities: Accessibility Concerns

A growing body of research has developed indicating that substance abuse treatment facilities have numerous physical and programmatic barriers that could inhibit the ability of persons with disabilities (PWDs) to access care. Research has found that physical barriers do, in fact, result in service denials for individuals with spinal cord injury (SCI) and traumatic brain injury (TBI). The current research was undertaken to validate these findings with regard to persons with SCI and TBI, as well as to examine the impact of such barriers on the ability of individuals with other physical disabilities, including multiple sclerosis (MS), muscular dystrophy (MD), and other significant mobility impairments. Findings indicate that PWDs from each of these groups are denied services due to the presence of physical barriers at notable rates. Denial rates ranged from 65% for those with other significant mobility impairments to 87% for individuals with MS. Such extreme rates of services declines indicate a need for immediate action to address the accessibility of substance abuse treatment centers.

A Comparison of EEOC Closures Involving Hiring Versus Other Prevalent Discrimination Issues Under the Americans with Disabilities Act

Introduction This article describes findings from a causal comparative study of the Merit Resolution rate for allegations of Hiring discrimination that were filed with the U.S. Equal Employment Opportunity Commission (EEOC) under Title I of the Americans with Disabilities Act (ADA) between 1992 and 2005. An allegation is the Charging Party’s perception of discrimination, but a Merit Resolution is one in which the EEOC has determined that a discriminatory event did indeed occur. A Non-Merit Resolution is an allegation that is closed due to a technicality or lacks sufficient evidence to conclude that discrimination occurred. Merit favors the Charging Party; Non-Merit favors the Employer. Methods The Merit Resolution rate of 19,527 closed Hiring allegations is compared and contrasted to that of 259,680 allegations aggregated from six other prevalent forms of discrimination including Discharge and Constructive Discharge, Reasonable Accommodation, Disability Harassment and Intimidation, and Terms and Conditions of Employment. Tests of Proportion distributed as chi-square are used to form comparisons along a variety of subcategories of Merit and Non-Merit outcomes. Results The overall Merit Resolution rate for Hiring is 26% compared to Non-Hiring at 20.6%. Employers are less likely to settle claims of hiring discrimination without mediation, and less likely to accept the remedies recommended by the EEOC when hiring discrimination has been determined. Conclusion Hiring is not an unusual discrimination issue in that the overwhelming majority of allegations are still closed in favor of the Employer. However, it is counterintuitive that Hiring has a higher merit resolution rate than other prevalent issues. This finding contradicts the assumption that hiring is an “invisible process.” Considering that the EEOC makes merit determinations at a competitive rate, it is clear that hiring is sufficiently transparent.

An Assessment of Institutional Publication Productivity in Rehabilitation Counseling.

Although the primary reason for publishing in scholarly journals is to help the profession in its efforts to serve persons with disabilities, such publication has a growing importance for the individuals and institutions involved in the publication process. Increasingly, publication is linked with the funding, reputation, and impact of those in the field. Despite that fact, the field is lacking a current analysis of publication productivity in core rehabilitation counseling outlets. This research was conducted to fill that gap by examining publication productivity in six core rehabilitation journals during the 6-year period from 1997 to 2002. Two ratings of institutional productivity based on author affiliation are provided. First, productivity is detailed in terms of the overall number of individuals involved in the publication process. Second, productivity is detailed via a weighting method based on author position to provide an indication of total number of publications attributable to a given institution. In both cases, the top 20 institutions are detailed. Implications for the field and for future research are discussed.

A Survey of Substance Abuse Prevention Efforts at Virginia's Colleges and Universities

The extremes of college student substance use and the negative consequences students face as a result of such use are of great public health concern. Although a multitude of campusbased substance abuse prevention efforts have appeared in literature, a clear picture of the programs and policies currently in use at colleges and universities is not readily available. This research was undertaken to detail both the efforts aimed at general student samples and those targeting at-risk (eg, Greeks, student athletes) and historically underserved (eg, ethnic minorities, students with disabilities) student groups at colleges and universities in the Commonwealth of Virginia. While a variety of efforts were being made, there was a reliance on program orientations with limited scientific support. Four-year institutions used a wider array of outlets for their prevention messages. Targeted programs for at-risk groups were common but were largely unavailable specifically for ethnic minority students and students with disabilities.

Hate Crimes and Disability in America

A hate crime is a criminal offense committed against person or property that is motivated, in whole or in part, by the offenders prejudice. Hate crimes are sometimes termed “bias-motivated crimes.” The theoretical bases for bias motivation and their implications for hate crimes against Americans with disabilities are outlined. The history of the Hate Crime Statistics Act (1990) and its eventual extension to Americans with disabilities are also reviewed. Five years of aggregate data from FBI Hate Crimes Statistics reports are analyzed to compare and contrast the hate crimes experience of Americans with disabilities with that of other targeted groups based on race, ethnicity, sexual orientation, and religion. Reports of hate crimes from persons with disabilities are minute as compared to those of any other group. The nature and location of hate crimes are also analyzed. Finally, the findings and their implications for such issues as alternative manifestations of prejudice, underreporting of violent crimes, cross-disability support for hate crime prevention, rehabilitation counseling practice, and future research directions are discussed.

Rates of Persons with Disabilities in Alcohol/Other Drug Treatment in Canada

This study assessed the presence of persons with disabilities (PWDs) in a nationally representative sample of substance abuse treatment facilities in Canada. A stratified sample of 43 treatment centers in each of the 13 provinces and territories provided details of the number of PWDs in their caseloads during the year prior to survey. Findings indicate that, as a group, PWDs represented only 10.23% of all clients served during the prior year. PWD participation in treatment was unrelated to either the location or the primary type of service offered by the responding facilities. Given the size of the PWD population in Canada and the likely substance abuse rates by such individuals, this was less than anticipated. Implications for future research are provided.