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    Three Essays in Mental Health Economics: Education and Labor Market Outcomes
    (Saudi Digital Library, 2025-06) Alarabim, Hosam; Koreshkova, Tatyana
    This dissertation explores how mental and physical health influence key economic outcomes over the life course, focusing on education, occupational outcomes, and workplace productivity. Using longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the study employs advanced modeling techniques, including Generalized Structural Equation Modeling (GSEM) and mixed-effects regression, to construct latent health measures and quantify their economic consequences. The first chapter examines the impact of adolescent mental health on academic achievement, particularly high school completion and college enrollment. It addresses the limitations of using narrow diagnostic proxies for mental health by applying a factor-analytic approach to create latent constructs. The findings reveal that better mental health significantly improves educational attainment, with a stronger effect on college entry than on high school completion. The second chapter investigates how health status shapes occupational sorting across two major classifications: white-collar and full-time employment. It finds that individuals with poor mental health are disproportionately concentrated in low skill, physically demanding, blue-collar jobs, while those with better health are more likely to enter cognitively intensive, white-collar occupations. Physical health also influences job type, reinforcing disparities in labor market access and long-term mobility. The third chapter evaluates the effect of mental health on workplace productivity. By constructing a composite latent productivity score, based on job satisfaction, hours worked, and income, the study estimates the long-term effects of lagged health status. A one standard deviation increase in mental health is associated with a 0.0251 rise in latent productivity and a 0.0201 increase in wage measure of productivity, confirming the strong and persistent influence of psychological well-being. Together, these chapters show that mental health is a critical determinant of economic opportunity, shaping individual outcomes from adolescence through adulthood.
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    Surgical Performance Analysis in a Simulated Virtual Reality Anterior Cervical Discectomy and Fusion Task
    (2021-08-06) Bakhaidar, Mohamad; Maestro, Rolando Del; Gregory Berry
    Introduction: Multiple studies have demonstrated the effectiveness of virtual reality (VR) simulators in surgical skills training and assessment. Anterior cervical discectomy and fusion (ACDF) is among the most common spine procedures and requires trainees to master a broad spectrum of surgical techniques. The Sim-ortho VR simulator provides a validated anterior cervical discectomy and fusion (ACDF) simulated task. This validated tool can be used in the evaluation and assessment of surgical skill. Objective This thesis aims to analyze the three-dimensional data recorded by the Sim-Ortho VR simulator platform during the discectomy component of the ACDF task. We aim to use the generated data to develop novel metrics to assess the performance of participants with different levels of expertise. Hypothesis We hypothesize that the results of this analysis would establish a methodology to develop novel metrics that can identify performance variability between different groups of expertise and provide new insights into surgical expertise. Methods We recruited participants with different levels of expertise to perform a standardized ACDF simulation task. The three-dimensional structural data were generated from the simulator and recorded after each step. We collected and analyzed different data including volumes of each 5 structure at different stages of the procedure and rate of removal of the disc. Statistical significance was set as p < 0.05. Results Twenty-seven participants were included and divided into three groups based on their surgical expertise: medical student, resident, and post-resident groups. Medical students took longer to perform the discectomy compared to the other groups and left almost three times of disc residual as the resident and post-resident groups (p = 0.068). During the annulotomy component, the post-resident group removed 47.4% more disc than the resident and 102% more than the medical student group (p = 0.03). No statistically significant differences between groups were found during the second stage of the discectomy regarding disc residual and rate of removal. The post-resident group spent 19.1% of their surgical time actively working on areas adjacent to the dura, compared to 13.7% and 5.1% in the resident and medical student groups, respectively (p = 0.017). Conclusion Expert performance is associated with higher efficiency compared to resident and medical student groups. The amount removed and rate of removal represent other features of expertise during the annulotomy stage of the discectomy. These differences expose some of the features of experts’ performance that can be further studied and taught to junior trainees.
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