EXAMINING QUALITY INDICATOR RATES FOR OLDER HOME CARE CLIENTS WITH DUAL SENSORY IMPAIRMENT (DSI) AND EXPLORING THE HETEROGENEITY WITHIN DSI.

Older adults with impairments in both hearing and vision, called dual sensory impairment (DSI), are at an increased risk of negative health outcomes such as impaired communication and difficulties with mobility. It is unknown whether DSI is associated with potential quality of care issues. This study used a set of home care quality indicators (HCQIs) to examine potential quality issues in older clients (65+) with DSI. Further, it looked to explore how HCQI rates differed based on the geographic region of care and whether the client’s level of hearing and vision impairment was related to certain HCQIs. The HCQIs were generated from data collected using the Resident Assessment Instrument for Home Care and capture undesirable outcomes (e.g., falls, cognitive decline). Higher rates indicate a greater frequency of experiencing the issue. In this sample (n=352,656), the average age was 82.8 years (sd=7.9), the majority were female (63.2%), and 20.5% experienced DSI. Compared to those without DSI, clients with DSI had higher rates across 20 of the 22 HCQIs. The HCQI rates differed by geographic region, with specific regions consistently performing worse than others. Finally, the level of hearing and vision impairment was related to certain HCQIs more than others, for example hearing impairment appeared to be more related to the quality indicator measuring communication difficulty. Overall, the hope is that this information can help to identify some of the potential issues around quality and in turn, assist in continually improving the services being provided to these clients

Exploration of surface plasmon-assisted catalysis (SPAC) as a new route for heterogeneous catalysis

1 online resource (xi, 59 p.) : ill. (chiefly col.)Includes abstract and appendix.Includes bibliographical references (p. 51-56).Plasmonics is the study of the interactions between the free electrons of a metal, and the electric field component of light. In the presence of the oscillating electronic field, the free electrons in the metal oscillate collectively, resulting in a localized surface plasmon resonance (LSPR). This LSPR is the reason for the enhanced spectra of surface enhanced Raman spectroscopy (SERS) compared to Raman spectroscopy. A commonly used Raman reporter is 4-aminothiophenol (4-ATP), which has been well studied. 4-ATP is known to undergo a surface catalytic coupling reaction to produce an aromatic azo species: 4,4’-dimercaptoazobenzene (4,4’-DMAB). This work explores the generality of the surface plasmon-assisted catalysis (SPAC) by studying the constitutional isomers, the 2- and 3- constituents of 4-ATP. The reusability of the catalyst (electrode set-up) is also tested to suggest a new route for heterogeneous catalysis, and further tested if the oxidative product, 4,4’-DMAB, could be obtained once removed

An exploration of 2D-LC-SERS : a novel offline detection modality for multidimensional chromatography

xii, 74 leaves : illustrations (some colour) ; 29 cmIncludes abstract and appendix.Includes bibliographical references (leaves 66-72).Multidimensional liquid chromatography (2D-LC) provides better resolving and separation power than conventional high-performance liquid chromatography (HPLC), and over the past decade has increasingly been applied in many different fields.1 This thesis seeks to explore the extent to which surface-enhanced Raman spectroscopy (SERS) can be used as an offline detection modality for 2D-LC. This thesis hypothesizes that careful selection and modification of a three dimensional (3D) SERS substrate will be useful for characterization of fractions collected using 2D-LC. In particular, a mixture of four polyphenolic molecules was chosen for this proof-of-concept study. An optimised 2D-LC method was developed as part of this thesis. Various materials were evaluated as potential 3D-SERS substrates, with the most promising option being cellulose-based filter paper. Various modification strategies were explored to enhance the interaction between the polyphenolic molecules and the filter paper substrate. In the end, SERS-based detection of 2D-LC fractions proved challenging, even after optimization

A Deterioration in Hearing is Associated With Functional and Cognitive Impairments, Difficulty With Communication and Greater Health Instability

Objectives: To examine the relationship between hearing deterioration and several health-related outcomes among home care clients in Ontario. Design: Longitudinal analysis was completed for clients with at least two comprehensive assessments. Hearing status, based on a single item, ranged from zero (no impairment) to three (highly impaired). Hearing deterioration was defined as at least a 1-point decline between subsequent assessments. Results: Seven percent experienced a 1-point deterioration in hearing and roughly 1% had a 2/3-point decline. After adjusting for other covariates, increasing age (odds ratio = 1.94; 95% confidence intervals [CIs] = [1.45, 2.61]) and a diagnosis of Alzheimer\u27s disease (1.37; CI = [1.04, 1.80]) and other dementias (1.32; CI = [1.07, 1.63]) increased the risk of a 2/3-point deterioration. Conclusion: These findings can assist home care professionals and policy makers in creating and refining interventions to meet the needs of older adults with hearing difficulties

The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery

Background: Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. Aim: To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention. Method: Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar. Findings: Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery.Conclusions: It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples’ engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities

Implementing Team-Based Nursing to Improve Patient & Staff Satisfaction

https://digitalcommons.psjhealth.org/summit_all/1068/thumbnail.jp

Teen Pregnancy Prevention Program Year Three Outcome Evaluation Report for the Southern Nevada Health District

In the fall of 2010 the Southern Nevada Health District (SNHD) was awarded funding from the Federal Office of Adolescent Health to implement an evidence based teen pregnancy prevention curriculum. They have partnered with the Department of Juvenile Justice Services, the Clark County Department of Family Services, and the City of Las Vegas to offer this curriculum to the youth in juvenile detention, probation, community centers, and life skills classes for youth aging out of the foster care system. The Nevada Institute for Children’s Research and Policy (NICRP) has been contracted to complete the outcome evaluation for this program and is collecting data to help measure the program’s progress toward meeting its goals. The program will be implemented over a five year period with the goal of reducing teen pregnancy and birth rates, as well as the rate of sexually transmitted infections among adolescents in Southern Nevada. To achieve these goals, the SNHD selected two evidence based curricula: Be Proud! Be Responsible! and ¡Cuidate!. Both are designed to educate youth about protecting themselves from sexual health risks. Adolescents who participated in the program also completed surveys to allow for an evaluation of the program’s impact on their knowledge, attitudes, and behaviors related to sexual health. Year One of this project was considered a “pilot” year to allow for adjustments in curriculum implementation, venues, and survey instruments. Therefore, the Year One Pilot data is not included in the analyses for the current report. The current report is based on the cumulative data collected during Year Two and Year Three of the project. During Year Two and Year Three of the project, 1617 youth were enrolled in the program (completed a pre-survey) and of those, 1336 (82.6%) completed the course. Youth from juvenile detention, probation, foster care, and community centers participated in the Teen Pregnancy Prevention Program. To date, 1035 participants have become eligible for the 3-month follow-up survey and 543 have been completed for a 3-month follow-up survey response rate of 52.5%. There are 821 participants that have become eligible for a 6-month follow-up survey of which 400 have been completed, for a 6-month follow-up survey response rate of 48.7%

Teen Pregnancy Prevention Program Year Two Outcome Evaluation Report for the Southern Nevada Health District

In the fall of 2010 the Southern Nevada Health District (SNHD) was awarded funding from the Federal Office of Adolescent Health to implement an evidence based teen pregnancy prevention curriculum. They have partnered with the Department of Juvenile Justice Services and the Clark County Department of Family Services to offer this curriculum to the youth in juvenile detention, probation, and life skills classes for youth aging out of the foster care system. The Nevada Institute for Children’s Research and Policy (NICRP) has been contracted to complete the outcome evaluation for this program and is collecting data to help measure the program’s progress toward meeting its goals. The program will be implemented over a five year period with the goal of reducing teen pregnancy and birth rates, as well as the rate of sexually transmitted infections among adolescents in Southern Nevada. To achieve these goals, the SNHD selected two evidence based curriculums: Be Proud! Be Responsible! and ¡Cuidate!. Both are designed to educate youth about protecting themselves from sexual health risks. Adolescents who participated in the program also completed surveys to allow for an evaluation of the program’s impact on their knowledge, attitudes, and behaviors related to sexual health. There were 752 youth who participated in Year Two of the program and of those, 593 (78.9%) completed the course and the pre- and post-surveys required for the current evaluation. Youth from juvenile detention, probation, and foster care centers between the ages of 12 and 18 participated in the Teen Pregnancy Prevention Program. To date, 387 Year Two participants have become eligible for the 3-month follow-up survey and 175 have been completed for a 3-month follow-up survey response rate of 45.2%. There are 226 Year Two participants that have become eligible for a 6-month follow-up survey of which 98 have been completed, for a 6-month follow-up survey response rate of 43.4%. Year One of this project was considered a “pilot” year to allow for adjustments in curriculum implementation, venues, and survey instruments. During Year One there were several iterations of the surveys used and therefore, the Year One Pilot data will not be included cumulatively with the Year Two dataset or with future project data. In the current report, comparisons are made to the Year One Pilot, when available and appropriate. Some comparisons are not available because the question used to measure a particular goal has been changed completely from Year One and some comparisons are not appropriate because the response options for a question were changed from Year One to Year Two. Going forward, it is expected that few, if any, adjustments to program implementation and survey instrumentation will be made. Therefore, future reporting on program outcomes will rely on a cumulative dataset beginning with Year Two

Modeling Multi-Wavelength Stellar Astrometry. II. Determining Absolute Inclinations, Gravity Darkening Coefficients, and Spot Parameters of Single Stars with SIM Lite

We present a novel technique to determine the absolute inclination of single stars using multi-wavelength sub-milliarcsecond astrometry. The technique exploits the effect of gravity darkening, which causes a wavelength-dependent astrometric displacement parallel to a star's projected rotation axis. We find this effect is clearly detectable using SIM Lite for various giant stars and rapid rotators, and present detailed models for multiple systems using the REFLUX code. We also explore the multi-wavelength astrometric reflex motion induced by spots on single stars. We find that it should be possible to determine spot size, relative temperature, and some positional information for both giant and nearby main-sequence stars utilizing multi-wavelength SIM Lite data. This data will be extremely useful in stellar and exoplanet astrophysics, as well as supporting the primary SIM Lite mission through proper multi-wavelength calibration of the giant star astrometric reference frame, and reduction of noise introduced by starspots when searching for extrasolar planets.Comment: 8 pages, 7 figures, 4 tables. Accepted for publication in the Astrophysical Journa