Inpatient Mental Health Services in Rural Hospitals of the United States and Canada: A Case Study of Maine and New Brunswick

An important resource for mental health patients is their nearest hospital, and this is especially true in rural regions where outpatient mental health services may be lacking. In the United States, policies are in place which limit the ability of small, rural hospitals to provide inpatient psychiatric services cost effectively, leading many hospitals to forgo offering the services at all. This project compares the situation in the United States with that of Canada—where similar policies are not present under a vastly different healthcare system—to see if inpatient psychiatric services are more or less prevalent in rural Canadian hospitals and whether this is associated with different mental health outcomes. To study this relationship, Maine and New Brunswick are used as a case study due to their close comparability in terms of demographic, socio-economic and geographic characteristics. This project focuses on rural hospitals in Maine and New Brunswick, the provision of inpatient psychiatric services therein, and mental health outcomes in the surrounding regions. The results of this project may help policy makers and healthcare administrators looking to better understand the implications of policies on the provision of rural inpatient psychiatric services, in addition to providing a base for future research on this topic

Tenants, Tenures and Transfers

This thesis examines the impact of different customary manorial tenures on the land transfer activities of rural tenants between 1645 and 1705. The study of land transfer has formed part of the attempt by historians to establish how and why England developed from family-based subsistence farming into large-scale commercialised agriculture before many of its Continental neighbours. A key element in any study of land transfer is the property rights of those undertaking the transfers. England had a variety of customary tenures, and little research has focussed on how they operated and impacted on rural tenant transfer behaviour in the early modern period. This study uses evidence from eight manors in Hampshire with four different types of tenure to explore how they affected what land transfer options the tenants had, and how transfers were used to further family and economic objectives. The types of tenure were copyhold of inheritance; copyhold for three lives; copyhold for three lives where the first could act alone; and a form of customary freehold. The main documentary sources are manorial records augmented by parish, probate, survey and taxation material. The tenurial and landholding structure of the manors is established for 1645 using the Cromwellian Parliamentary Surveys of confiscated ecclesiastical estates. The analysis of subsequent tenant land transfers through to 1705 then examines their volume and any correlation with prices and population movements. The permanent transfers of death/inheritance and the inter vivos land market are analysed to assess the extent to which tenants were attached still to family, or taking part in an active extra-familial investment and sales market; and whether this led to changes over time in farm holding size and distribution. The temporary transfers of sub-letting of land and sub-tenure of dwellings are then analysed. The latter has not been studied before, and uses the Hearth Tax returns to compare occupiers of dwellings with formal tenants. Finally a detailed study of mortgages is made. Previous studies of the use of land as collateral for a mortgage loan have often overlooked the rural tenant as a participant in the credit market, and changes in the laws of usury at the end of the sixteenth century produced a significant uptake of mortgaging in the seventeenth, which makes this study timely. The research reveals that the tenants were very active with their transfers, but that the way in which they were active was determined by tenure. Those with copyhold of inheritance tenure had many options including inheritance, sale, mortgaging, sub-letting, splitting holdings, and conditional surrenders to provide for old age or several children. Those with copyhold for lives were restricted to after-death transfers, shuffling of reversion lives, or sub-letting. However, they adapted, and while Inheritance-tenured tenants adopted mortgages with enthusiasm, Lives tenants sub-let on a large scale. Both thereby acquired financial support from their lands, so that although the land-family bond was not absent, the bond was strongest in terms of using the land as an economic asset. The sub-letting of dwellings enabled Lives tenants to accommodate a landless workforce, where their tenure prevented the splitting of parcels for sale as manorial smallholdings. Aggressive accumulation of land was largely absent, and purchasers of land and mortgage lenders were overwhelmingly local. Some polarisation of holding size was found, but sub-tenure meant that actual farmed units were probably very different. It is concluded that differences in tenure significantly shaped the transfer behaviour of the tenants, so that any future research involving customary tenants must take tenure into account. However, their economic ambitions were found to be similar whichever tenure they had, so that they had to take different means to the same end

Etiology, prevalence, and treatment of dry eye disease

Johnny L GaytonEyesight Associates, Warner Robins, GA, USAPurpose: This review article examines the prevalence, etiology, and current therapies of dry eye disease, with special focus on postmenopausal women.Method: A systematic literature search utilizing MEDLINE was conducted to identify peer-reviewed articles related to dry eye published prior to September 2008. The terms “dry eye” and “women” were searched in combination with one or more of the following words or phrases: prevalence, postmenopausal, etiology, risk factors, therapy, medications, surgery, tear film, and quality of life. Articles were selected based on their direct applicability to the subject matter. A manual search was also conducted based on citations in the published literature.Results: Epidemiologic studies identified prevalence rates ranging from 7% in the United States to 33% in Taiwan and Japan. Risk factors include advanced age, female sex, smoking, extreme heat or cold weather conditions, low relative humidity, use of video display terminals, refractive surgery, contact lens wear, and certain medications.Conclusion: The last decade has brought about a better understanding of the etiology of dry eye disease. New therapies that can alleviate the signs and symptoms of dry eye disease and, consequently, improve the quality of life of dry eye patients are available in the market.Keywords: dry eye disease, etiology, prevalence, postmenopausal wome

Participation in a community-level health intervention

Physical inactivity is becoming more widespread, and with it, increases in obesity and other co-morbid conditions. Community-level health interventions have been introduced globally to encourage physical activity participation and other positive health choices. It is important to consider what attracts and retains participants, and to examine if the programs positively impact upon their health behaviours. Understanding these factors could assist in greater engagement, sustainability and create long-term behaviour change. The Australian Government introduced Healthy Community Initiatives in 82 local government areas between 2011-2014 to reduce the risk of chronic disease associated with physical inactivity. The Tablelands Regional Council, in the highlands west of Cairns, Queensland, was one of the councils to implement the initiative. Named 'Wellbeing Tablelands', two of the programs offered under the initiative were light water aerobics sessions and Beat It. The water aerobics program targeted older adults and focused on gentle movement and stretching. The program had one session per week for ten weeks and catered to individuals with limited mobility due to their age. The other program, Beat It, offered two sessions per week over twelve weeks, and catered to those with average as well as impaired mobility. It was more demanding and targeted those at risk of or coping with diabetes. Participants of these two programs were invited to partake in the current study. The study uses a convergent mixed methods approach to answer the research question 'What are the physiological and psychological factors and the personal experiences associated with participation in the Wellbeing Tablelands HCI programs?'. Qualitative interviews were used to understand the personal experiences of participation in the community-level health interventions, as well as the facilitators perspectives on what they believe the experience of the participant is. Psychometric measures were used for the participants' self-efficacy, self-determination and stage of change. Physiological changes measured included BMI, waist circumference, blood pressure, resting heart rate, flexibility and strength. Thirty-three participants took part in the program (23 female, 10 male), aged between 47 to 79 years. Four participants took part in the light water aerobics, and the remaining 29 participants took part in the Beat It program. Twenty-five participants were interviewed about their personal experiences of participation in the programs. Four facilitators from the programs and the local council also took part in qualitative interviews to explore their perspectives on program participation. Braun and Clarke's Thematic Analysis was used to guide the qualitative data analysis. Body mass index, waist circumference, resting heart rate and resting blood pressure were also measured for 29 participants, as well as sit-to-stand, sit-and-reach, leg balance, seated medicine ball throw and six-minute walk. Psychological measures included self-efficacy, self-determination and stage of change. Wilcoxon Signed Ranks Tests were used to assess if there were differences from assessment 1 to 2 for the quantitative data. There were significant improvements for waist circumference for both genders, as well as the male participants' BMI. There were significant improvements for the female participants' sit-and-reach and sit-to-stand, and the men's seated medicine ball throw. For the psychometric measures, the only score to significantly improve was the autonomous subscale of the treatment self-determination scale, indicating that autonomous motivation to attend the program increased over the duration of the program. The thematic analysis of the participants' interviews resulted in five themes for the personal experience of participation. These themes were 'Exercise to me', 'Physical benefits of exercise', 'Psychological benefits of exercise', 'Health behaviour barriers' and 'Health behaviour enablers'. The themes of the facilitators interviews were 'Understanding of barriers', 'Program elements as enablers', 'Health advocate enablers', 'Social enablers' and 'Overall impressions'. The objective of the Healthy Communities Initiative was to reduce the risk of chronic disease associated with physical inactivity however, the results demonstrate that the participants were not necessarily attending for that reason. The theme common to all participants was appreciation of the opportunity to socialise, and some were also encouraged by changes they noticed in their physiological characteristics. Several participants also had the goal to maintain their current level of physical ability. Qualitative results also demonstrate that the participants felt more confident with their physical abilities after participating in the program, and they planned on continuing to do physical activity after the program ended. This was despite there not being a significant increase in the psychometric measure for self-efficacy. There was a discrepancy between the quantitative psychometric measures and qualitative results. While there were no significant improvements for self-efficacy, the participants qualitative data indicated that they felt more confident with their ability, and they desired to continue exercising following the program. Facilitators identified the barriers that participants said were their main barriers to engaging in physical activity, including cost, transport and time; however, it appeared that the facilitators underestimated the health knowledge of participants. The study provides an account of participation in a community-level health intervention, and may contribute to improved program design that is more appealing and relevant to prospective participants

Cyanines, Squaraines, And Xanthene Based Nir Emissive Materials For Biological Imaging

The need for NIR fluorescent dyes is widely accepted for imaging and communications applications. Cyanines are a commonly used family of dyes for biological imaging due to their tunability, often rapid synthesis, ease of bioconjugation, intense molar absorptivities and strong NIR emissions. Since the invention of indocyanine green (ICG), many efforts have been made to improve on the design achieving farther red-shifted dyes with larger quantum yields and enhanced Stokes shifts. A series of squaraine, cyanine, and xanthene based dyes using the indolizine heterocycle as a donor in place of the commonly used indoline donor are discussed. The indolizine donor allows for red-shifts farther into the NIR region due to the indolizine being fully conjugated. Additionally, an enhanced Stokes shift is observed to enable high resolution imaging. These series of dyes are discussed with a focus on structure-property relationships concerning the effects on the photophysical properties

Sleep Homeodynamics And Wellbeing In Asymptomatic Hiv-Seropositive African American Women

SLEEP HOMEODYNAMICS AND WELLBEING IN ASYMPTOMATIC HIV–SEROPOSITIVE AFRICAN AMERICAN WOMEN by TABETHA LYNN GAYTON December 2013 Advisor: Hossein N. Yarandi, PhD Major: Nursing (Urban Health) Degree: Doctor of Philosophy BACKGROUND: HIV–related sleep disruption is a common complaint of persons with HIV infection. With the demographical shifts, African American women have now emerged as one of the fastest growing HIV populations today, yet they remain a vulnerable and underrepresented population in the sleep literature. OBJECTIVE: The purpose of this pilot study was to explore the dynamics of HIV–related sleep disruption and wellbeing in asymptomatic HIV–seropositive AA women of childbearing age within the context of a holistic, theoretical substruction from Myra Levine’s Conservation Model (1967). The rationale for the proposed study was to provide a foundation of both the objective and subjective experience of HIV–related sleep disruption, which as a stressor can affect wellbeing. METHODS: A descriptive correlational design was used to examine the immunological integrity, sleep/wake rhythm, sleep quality, daytime sleepiness, IL–6 rhythm, and quality of life in 20 asymptomatic HIV–seropositive African American women receiving care at Wayne State University Physicians Group Infectious Diseases Clinic in Detroit, MI. In this 4–day protocol, measures included CD4+ cell count, HIV RNA viral load, wrist actigraphy, Pittsburgh Sleep Quality Index, Subjective Sleep Quality Questionnaire, Epworth Sleepiness Scale, Stanford Sleepiness Scale, plasma IL–6, Quality of Life Index, and Quality of Life Visual Analogue Scale. RESULTS: Both the objective and subjective experience of sleep demonstrated severe sleep disruption and disorganized sleep patterns. Nearly half (45%) of the sample slept \u3c 6 hours per night, usually not falling asleep until sometime after 12 midnight. Objective daytime functioning was also disrupted with frequent dozing (\u3e 9 sleep episodes) noted throughout the day. Self–reported daytime sleepiness was inconsistent with the objective assessment and was within normal limits. The sample\u27s mean IL–6 level was 2.03 pg/mL, which is much lower than that reported in other asymptomatic samples or normal controls. Quality of life measures indicated a positive sense of wellbeing, but the daily pattern of quality of life was not associated with the daily pattern of sleep efficiency, subjective sleep quality, daytime sleepiness, or IL–6 levels when controlling for CD4+ cell count and HIV RNA viral load. And lastly, the 1–item quality of life scale showed agreement with the 66–item quality of life index using Bland–Altman agreement analysis, which may help in decreasing participant burden in clinical trials enrolling this population. CONCLUSION: This sample suffered from severe HIV–related sleep disruption, as evidenced by an average sleep time of 6.4 hours per night and frequent dozing throughout the day. Despite this disruption, the sample perceived a positive sense of quality of life. These results provide further evidence that future studies exploring efforts to improve sleep and daytime functioning in asymptomatic HIV–seropositive African American women are essential in order to maintain quality of life and wellbeing in this population

Evolution of Occupational Therapy Practice: Life History of Dr. Julie Grabanski, PhD, OTR/L

Purpose: Gather information about the history and evolution of occupational therapy (OT) practice in North Dakota and Wyoming through life histories of individuals who have been influential in developing OT in these states. Our participant was one of thirty-one participants for the larger study. The KawaModel was used to guide our data collection process and we implemented interview questions that reflected the model. The KawaModel was designed for cultures who value a collectivist mindset (Iwama, 2006). The water represents life flow, the river side walls and bottom represent the environment, rocks represent problematic life circumstances that disrupt water flow, and driftwood illustrates personal attributes, assets, liabilities, and values that impact life flow (Iwama, 2006; Boyt, Gillen, & Scaffa, 2014).https://commons.und.edu/ot-oral-histories-posters/1051/thumbnail.jp

Tolerance analysis approach based on the classification of uncertainty (aleatory / epistemic)

Uncertainty is ubiquitous in tolerance analysis problem. This paper deals with tolerance analysis formulation, more particularly, with the uncertainty which is necessary to take into account into the foundation of this formulation. It presents: a brief view of the uncertainty classification: Aleatory uncertainty comes from the inherent uncertain nature and phenomena, and epistemic uncertainty comes from the lack of knowledge, a formulation of the tolerance analysis problem based on this classification, its development: Aleatory uncertainty is modeled by probability distributions while epistemic uncertainty is modeled by intervals; Monte Carlo simulation is employed for probabilistic analysis while nonlinear optimization is used for interval analysis.“AHTOLA” project (ANR-11- MONU-013