Operational Stress Injuries: Impact on Family Mental Health and Well-being

This study was part of a larger scoping review and environmental scan conducted for Veterans Affairs Canada on the effects of operational stress injuries (OSIs) on the mental health and wellbeing of Veterans’ families. This paper focuses broadly on the relationships between combat (and/or deployment more generally), OSIs (primarily post-traumatic stress disorder (PTSD)), and the family. Based on the scoping review, the paper finds that existing research investigates the impacts of a Veteran’s OSI on the family, but also how various aspects of the family (such as family functioning, family support, etc.) can impact a Veteran living with an OSI.

SINGLE STAGE LED DRIVER TECHNOLOGY WITH LOW FREQUENCY RIPPLE CANCELLATION

Because of high efficacy, long lifespan, and environment-friendly operation, LED lighting devices become more and more popular in every part of our life, such as ornament/interior lighting, outdoor lightings and flood lighting. The LED driver is the most critical part of the LED lighting fixture. It heavily affects the purchasing cost, operation cost as well as the light quality. Design a high efficiency, low component cost and flicker-free LED driver is the goal. The conventional single-stage LED driver can achieve low cost and high efficiency. However, it inevitably produces significant twice-line-frequency lighting flicker, which adversely affects our health. The conventional two-stage LED driver can achieve flicker-free LED driving at the expenses of significantly adding component cost, design complexity and low the efficiency. The basic ripple cancellation LED driving method has been proposed in chapter three. It achieves a high efficiency and a low component cost as the single-stage LED driver while also obtaining flicker-free LED driving performance. The basic ripple cancellation LED driver is the foundation of the entire thesis. As the research evolving, another two ripple cancellation LED drivers has been developed to improve different aspects of the basic ripple cancellation LED driver design. The primary side controlled ripple cancellation LED driver has been proposed in chapter four to further reduce cost on the control circuit. It eliminates secondary side compensation circuit and an opto-coupler in design while at the same time maintaining flicker-free LED driving. A potential integrated primary side controller can be designed based on the proposed LED driving method. The energy channeling ripple cancellation LED driver has been proposed in chapter five to further reduce cost on the power stage circuit. In previous two ripple cancellation LED drivers, an additional DC-DC converter is needed to achieve ripple cancellation. A power transistor has been used in the energy channeling ripple cancellation LED driving design to successfully replace a separate DC-DC converter and therefore achieved lower cost. The detailed analysis supports the theory of the proposed ripple cancellation LED drivers. Simulation and experiment have also been included to verify the proposed ripple cancellation LED drivers.

THE EPIDEMIOLOGY AND HEALTH ECONOMICS OF ANKLE INJURIES

The thesis focuses on a central theme of the epidemiology and health economics of ankle sprains to inform health policy and the provision of health services. It describes the burden, prognosis, resource utilization, and costs attributed to these injuries. The first manuscript systematically reviewed 34 studies on the direct and indirect costs of treating ankle and foot injuries. The overall costs per patient ranged from $2,075- $3,799 (2014 USD) for ankle sprains; $290-$20,132 for ankle fractures; and $6,345-$45,731 for foot fractures, reflecting differences in injury severity, treatment methods, and study characteristics. The second manuscript provided an epidemiological and economic profile of non-fracture ankle and foot injuries in Ontario using linked databases from the Institute for Clinical Evaluative Sciences. The incidence rate of ankle sprains was 16.9/1,000 person-years. Annually, ankle and foot injuries cost $21,685,876 (2015 CAD). The mean expenses per case were $99.98 (95% CI, $99.70-100.26) for any injury. Costs ranged from $133.78-$210.75 for ankle sprains and $1,497.12-$1,755.69 for dislocations. The third manuscript explored the impact of body mass index on recovery from medically attended grade 1 and 2 ankle sprains using the Foot and Ankle Outcome Score. Data came from a randomized controlled trial of a physiotherapy intervention in Kingston, Ontario. At six months, the odds ratio of recovery for participants with obesity was 0.60 (0.37-0.97) before adjustment and 0.74 (0.43-1.29) after adjustment compared to non-overweight participants. The fourth manuscript used trial data to examine the health-related quality of life among ankle sprain patients using the Health Utilities Index version 3 (HUI-3). The greatest improvements in scores were seen at one month post-injury (HUI-3: 0.88, 95% CI: 0.86-0.90). Individuals with grade 2 sprains had significantly lower ambulation scores than those with grade 1 sprains (0.70 vs. 0.84; p<0.05). The final manuscript used trial data to describe the financial burden (direct and indirect costs) of ankle sprains. The overall mean costs were $1,508 (SD: $1,452) at one month and increased to $2,206 (SD: $3,419) at six months. Individuals with more severe injuries at baseline had significantly higher (p<0.001) costs compared to individuals with less severe injuries, after controlling for confounders.