Everyday Tragedies: People with Severe Traumatic Brain Injury in the Liminal Spaces of a Level I Trauma Centre
Bibliographic record
Abstract
Sustaining a severe traumatic brain injury (sTBI) can have a devastating and permanent impact on a person’s ability to function, on their selfhood, on their families, and on the spaces where they can exist in the world. Individuals with sTBI in Ontario are often transported to Level I Trauma Centres, as textually mediated by the provincial Life or Limb Policy, to ensure access to expert lifesaving medical care. After entering these trauma centres, transitions across the spaces of the trauma centre, from critical care to intensive care to a trauma ward, can signify recovery through decreased reliance on medical technology and medical care. Rehabilitation is required as individuals with sTBI become medically stable to ensure further improvement. This rehabilitation is needed to prepare these individuals to move to other healthcare spaces, such as inpatient rehabilitation, repatriation hospitals, or to return home. Textually mediated institutional relations through the Ministry of Health and Long-Term Care (MOHLTC), specifically the Acquired Brain Injury (ABI) Resource Rehab Tool, ignite sites of struggle in the provision of rehabilitation for individuals with sTBI. These sites of struggles reveal ruling relations that remain hidden until the institution is brought into view using an empirical method of inquiry, institutional ethnography. Specific methods in this dissertation included: participant observation, interviews, a focus group, and analysis of texts. Findings of this study suggest language in the ABI Resource Rehab Tool, specifically the discursive organizer “rehab ready” cleaves individuals with sTBI into two groups: (1) those with faster recoveries able to gain access to inpatient rehabilitation, and (2) those with slower recoveries who do not meet these restrictive guidelines and become unaccounted for in healthcare spaces, with limited options for rehabilitation. Trauma centres are medicalized spaces, whereby provincial funding is distributed on the basis of medical procedures, not rehabilitation. One notable contradiction in funding is revealed for individuals with stroke, who access beds for rehabilitation in acute care and other initiatives outlined by the provincial stroke strategy. No such provincial strategy exists for individuals with sTBI, leaving these individuals marginalized through more limited access to rehabilitation within the healthcare continuum.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.034 | 0.025 |
| Scholarly communication | 0.011 | 0.012 |
| Open science | 0.003 | 0.018 |
| Research integrity | 0.004 | 0.007 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".