BRIDGING COMMUNICATION IN END-OF-LIFE CARE AT A MIDWEST VETERANS HOME

Palliative care is specialized care for those with serious disease and focuses on providing relief from symptoms (Radbruch et al., 2020). The goal of palliative care is to improve quality of life for both the patient and the family. As the COVID-19 pandemic continued to change healthcare delivery and visitor restrictions, alternative approaches to safely deliver care to both the patient and family have been uncovered. A Midwest veterans home was looking to bridge the gap in communication between staff, resident, and family during end-of-life care. Creation of an online accessible educational resource for nursing home staff is an alternative format for providing staff education. This project focused on online education supplied in a central location with the expected outcome to be increased communication between staff and family during residents’ end-of-life. Patient care staff participated in this quality improvement project by responding to two online surveys. Results demonstrate that staff were satisfied with the online resources as a tool to promote conversation with family. This can assist in future education and training surrounding end-of-life care and communication while achieving positive palliative care outcomes. Evolving to an online education platform provides flexibility in convenience, equity, service, and access. While the ongoing COVID-19 pandemic demands attention towards traditional end-of life care standards, it also provides the opportunity to create new methods to palliative care amongst a vulnerable population. Additional staff education on end-of-life care will not only meet the needs of palliative care in the Midwest veterans home but will also be a sustainable option for future practice. 5 In 2016, there were more than 19 million living United States (US) veterans, representing almost 10% of the total adult US population (Schaeffer, 2021). Years of US military service often come with a cost, resulting in unique physical, mental, emotional, and spiritual health issues that continue to manifest throughout veterans lives (Schaeffer, 2021). Veteran needs at end of life vary, as they may suffer from a spectrum of challenges related to their time in service (Schaeffer, 2021). Veterans challenges may relate to presumptive diseases from environmental exposures, or other debilitating emotional or spiritual issues (Shamas & Gillespie-Heyman, 2018). Quality healthcare for veterans is essential at all stages of life. It is important to recognize the difficulties veterans may face and to create a care team with the knowledge, skills, and confidence to properly care for veterans in all stages of life. The current end of life care for veterans is done exceptionally well at this veterans home in the Midwest. It has been reported that nursing staff and bereaved family members feel veterans are being well taken care of at the end of their lives (S. Hogan, personal communication, June 2, 2021). For example, there is a final salute for the veteran as they are leaving the home for the last time. This ceremony is significant to the family, staff, and other veterans involved. It is special to have the opportunity to honor America’s heroes until the very end. However, this care has changed within the past two years because of the COVID-19 pandemic and subsequent visitor restrictions in long term care (S. Hogan, personal communication, June 2, 2021). The COVID-19 pandemic has put a strain on communication in long term and residential care to protect the residents. At the veterans home, a strict zero visitor policy except for imminent death was put in place to protect the vulnerable veteran population from COVID-19 (S. Hogan, personal communication, June 2, 2021). The new visitor policy poses a challenge to 6 inclusion of the family in end-of-life care. Many family members have reported feeling ignored, and that opportunities for communications have been missed (S. Hogan, personal communication, June 2, 2021). Military service has affected the individual resident, and the family and care team need to remain mindful of any special needs this requires. The question persists in how to properly educate, include, and communicate with family in end-of-life care, especially given the recent COVID-19 pandemic and visitor restrictions

Loss of Innocence

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Geology from Engineering, Urban or Otherwise

Exhortations of the mid-nineteenth century to take advantage of construction activities as sources of geological information have been paid heed only occasionally. While some advantage has been taken of information from engineering activity, most is unrecorded geologically. Geological study of urban areas is complicated by many difficulties and comprehensive treatment requires a permanent staff with appropriate experience. Even though geological data have clearly demonstrable practical use in better use of land resources, urban geology should embrace both practical and curiousity-based research. Thus far, opportunities to gain enormous amounts of information of great practical and scientific value have been commonly ignored. Toronto is Canada's largest and geologically most famous city. The fame is based on its unique Quaternary stratigraphy, which includes lllinoian, Sangamonian, and Wisconsinan deposits, many of which are fossiliferous. Tragic losses of important information about its Quaternary history occur nearly continuously as large scale surface mining continues and little record of the temporary exposures is kept.Les appels lancés au milieu du XIXe s. à profiter de la présence des chantiers de construction pour en tirer des renseignements d'ordre géologique ont reçu bien peu d'attention. Bien qu'on ait tiré certains avantages de l'information fournie par les travaux d'ingénierie, on a rarement constitué de dossiers géologiques. Les études géologiques en milieu urbain font face à de nombreux obstacles et leur traitement exhaustif nécessite un personnel permanent et qualifié. Même si les données géologiques ont clairement démontré leur utilité pratique pour une utilisation plus rationnelle des ressources, la géologie en milieu urbain devrait comprendre à la fois les recherches appliquée et fondamentale. Jusqu'à maintenant on a rarement su saisir les occasions de tirer profit des énormes connaissances de nature scientifique et pratique. Toronto est la plus grande ville du Canada et aussi la plus renommée géologiquement parlant. Cette renommée lui vient de son site qui renferme une stratigraphie du Quaternaire unique, qui comprend des dépôts de l'Illionien, du Sangamonien et du Wisconsinien, dont beaucoup sont fossiles. Malheureusement, des renseignements de première importance sur son évolution quaternaire se perdent presque de façon continue pendant que se poursuit l'exploitation minière à grande échelle, puisqu'on ne consigne à peu près jamais les données sur les sites temporairement mis à nu

Interglacial Beds at Toronto, Ontario

Interglacial sediments have been known to occur at Toronto for about a century. There have been two main periods of attention: first by A. P. Coleman in the early twentieth century; and second mostly by the author and co-workers in the past quarter century. Attention was focussed early on the Don Formation because of its rich fossil assemblages. The Don Formation, consisting of gravel, sand, and clay, is commonly 6 to 9 m thick and has been encountered in outcrop only along the DonValley. However, excavations and borings indicate its presence under much of southern Metropolitan Toronto; it may continue northward along the Laurentian River Valley. Its only continuing, accessible exposure has been the Don Valley Brickyard. Early paleontological study emphasized molluscs, wood, leaves, and a few bones, which suggested a climate warmer than present. More recent studies have stressed microfossils. including pollen, diatoms, ostracodes. molluscs, Cladocera, insects, plant macrofossils, and microvertebrates. Altogether about 500 species have been identified, and the list is growing. Climatic indicators show that the Don Formation represents the declining temperatures of the waning half of an interglaciation. Although the Don Formation is beyond the range of radiocarbon dates and is undated, amino acid analysis on wood and shells support assignment to Sangamonian time. The overlying Scarborough Formation clay and sand, and the Pottery Road Formation sand contain mainly cold-climate fossils. These are in turn overlain by Early, Middle, and Late Wisconsinan tills and interbedded lacustrine sediments with corresponding radiocarbon and thermoluminescence (TL) dates.Les sédiments interglaciaires de Toronto, connus depuis environ un siècle, ont fait l'objet de recherches au cours de deux périodes principales; au début du siècle, d'abord, par A. P. Coleman, puis par l'auteur et ses collègues depuis les 25 dernières années. La Formation de Don a d'abord attiré l'attention en raison de ses riches assemblages de fossiles. Cette formation, constituée de gravier, de sable et d'argile, a habituellement de 6 à 9 m d'épaisseur. On ne l'observe que sous forme d'affleurements ici et là dans la vallée de Don. Toutefois, les excavations et les sondages montrent qu'elle est présente à peu près partout dans le sud de la région métropolitaine; elle pourrait se poursuivre le long de la vallée de la Laurentian River. Le seul endroit où l'on puisse l'observer de façon continue est à la Don Valley Brickyard. Les premières études paléontologiques sur les mollusques, le bois, les feuilles et quelques os indiquaient un climat plus chaud que maintenant. Des études plus récentes ont surtout porté sur les microfossiles, dont le pollen, les diatomées, les ostracodes, les mollusques, les Cladocera, les insectes, les macrofossiles de végétaux et les microvertébrés. Jusqu'à maintenant on a identifié 500 espèces. Les indicateurs climatiques montrent que la Formation de Don reflète les températures en baisse de la moitié déclinante d'un interglaciaire. Bien que cette formation ne puisse être datée au radiocarbone. les analyses des acides aminés sur bois et coquillages semblent confirmer son âge sangamonien. L'argile et le sable de la Formation de Scarborough sus-jacente et le sable de la Formation de Pottery Road renferment surtout des fossiles de climat froid. Ils sont à leur tour recouverts par des tills et des sédiments lacustres interlités datés du Wisconsinien, inférieur, moyen et supérieur.Das Vorkommen interglazialer Sedimente in Toronto ist seit etwa einem Jahrhundert bekannt. Dièse sind wàhrend zwei Hauptperioden erforscht worden: zuerstvon A.P. Coleman zu Beginndes 20. Jahrhunderts und dann vor allem durch den Autor und seine Mitarbeiter im vergangenen Vierteljahrhundert. Zuerst richtete sich die Aufmerksamkeit auf die Don-Formation wegen ihrer reichhaltigen Fossil-Ansammlungen. Die Don-Formation, die aus Kies, Sand und Ton besteht, ist im allgemeinen 6 bis 9 m dick, und man hat sie nur in Aufschlùssen entlang dem Don-Tal vorgefunden. Indessen zeigen Ausschachtungen und Bohrungen, dass sie fast unter dem ganzen Sùden der Stadt-region vorhanden ist, môglicherweise geht sie nordwàrts weiter entlang dem TaI des Laurentian River. Ihr einziger zusammenhângender zugànglicher Aufschluss ist der Don Valley Brickyard gewesen. Die erste palàontologische Untersuchung betonte Weichtiere, HoIz, Blatter und einige Knochen, welche auf ein wàrmeres Klima als gegenwàrtig deuten. Neuere Untersuchungen haben Mikrofossile einschliesslich Pollen. Kieselalgen, Ostracodes, Weichtiere, Cladocera, Insekten, Pflanzen-Makrofossile und Mikrowirbeltiere hervorgehoben. Insgesamt hat man ungefàhr 500 Spezies identifiziert. und die Liste wàchst stàndig an. Klimatische Indikatoren zeigen, dass die Don-Formation die sinkenden Temperaturen der dem Ende zugehenden Hàlfte eines Interglazial spiegelt. Obwohl die Don-Formation ùber die radiokarbon-Klassifizierung hinausgeht und nicht datiert ist, stùtzt die Analyse von Amino-Sàure auf HoIz und Muscheln die Einordnung ins Sangamonium. Der darùberliegende Lehm und Sand der Scarborough-Formation und der Sand der Pottery Road-Formation enthalten hauptsàchlich Fossile kalten Klimas. Dièse wiederum werden ùberlagert von frùhen, mittleren und spâten Wisconsinium Grundmorânen und zwischengebetteten See-Sedimenten mit entsprechenden Radiokarbon - und Thermolumineszenz (TL) - Daten

Algonquin-Nipissing Shorelines, North Bay, Ontario

The general extent, outlet location at North Bay, and shoreline tilt pattern of glacial Lake Algonquin were established by Spencer, Gilbert, Taylor, and Goldthwait about a century ago. Chapman and Harrison in the mid 1900s identified several eastward outlets and suggested correlations to named water planes as retreating ice lowered Algonquin levels. The present work supplements the meagre available North Bay shoreline elevation data with about 30 new points. Probable Cedar Point, Payette, Sheguiandah, and Korah shorelines are identified; several lower levels have no known outlets. Algonquin shoreline tilts are about 1.4 metres per kilometre. Using Nipissing shoreline elevations for correlation, North Bay data are compared with Sudbury data, showing closely similar trends, but with offsets of Algonquin shorelines probably attributable to errors from 120‑kilometre-long projections and 5 000‑year changes in uplift pattern. Of 24 radiocarbon dates compiled from the literature, 16 are on gyttja. Some of these incorporate old carbon error and require further testing with dates on terrestrial plant macrofossils. Available data remain sparse and require more basic mapping to improve ice-margin/shoreline correlations near the outlet area.À North Bay, l’étendue générale et le patron incliné des lignes de rivage du lac glaciaire Algonquin ont été établis par Spencer, Gilbert, Taylor, et Goldthwait au siècle dernier. À la moitié des années 1900, Chapman et Harrison ont observé que plusieurs rivages pointent vers l’est et proposent un lien avec les plans d’eau présents lors du retrait des glaces et à la baisse du niveau d’eau du lac Algonquin. Ce projet ajoute des données sur l’altitude des lignes de rivage à North Bay, avec 30 nouveaux points. Les rivages de Cedar Point, Payette, Sheguiandah et Korah sont identifiés; certains niveaux n’ont pas d’exutoire connu. L’inclinaison du rivage du lac Algonquin est d’environ 1,4 m par km. En comparant l’altitude des lignes de rivage du lac Nipissing et celles de Sudbury, les données de North Bay montrent des tendances similaires, mais le décalage des rivages du lac Algonquin est probablement associé aux erreurs de la projection sur 120 km et des changements de patrons survenus lors du soulèvement durant les derniers 5 000 ans. Sur les 24 dates au radiocarbone disponibles dans la littérature, 16 proviennent du gyttja. Certaines dates ont une erreur liée à l’âge du carbone et demandent une datation plus approfondie des macrofossiles végétaux terrestres. Les données disponibles sont floues et exigent une cartographie de base pour améliorer l’étude de la concordance entre les lignes de rivage et les marges glaciaires

Bedrock Stress Release Features on Manitoulin Island, Ontario

Manitoulin Island has large exposed bedrock plains underlain by Ordovician and Silurian carbonates. The generally flat-lying strata reveal evidence of rock stress reiased by faults at Little Current and by pop-ups elsewhere. Four pop-ups occur at widely separated localities on the island and several other small ridges may be pop-ups. Other bedrock stress-release features may be present but remain undiscovered in the extensively vegetated part of the island.L'île Manitoulin offre de vastes espaces plats de socle dénudé constitué de carbonates de l'Ordovicien et du Silurien. Les couches généralement horizontales révèlent des indices de relâchement de contrainte dans la roche par l'entremise des failles à Little Current et des structures de soulèvement (pop-ups) ailleurs. Quatre soulèvements sont survenus en des lieux très dispersés dans l'île. Plusieurs autres crêtes pourraient en être le résultat. D'autres formes de relâchement de contrainte pourraient être dissimulées dans les parties recouvertes de végétation

Physicians and Technology: A Collective Case Study of Physicians and Use of Health

The purpose of this collective case study was to understand and describe the experience of physicians who use health information technology in medical practice. There are numerous factors applying pressure to the practice of medicine with limited support to physicians practicing medicine. With recent health insurers and both state and federal governments mandating health information technology, physicians are required to implement an electronic health record (EHR) with measurable outcomes and benefits to the delivery of healthcare. This study is significant in that it offers a view into the experience of physicians who use health information technology in medical practice. To gain insight into the experience of physicians and their use of health information technology, I interviewed four physicians practicing in a medical clinic setting. Analysis of the interview transcripts revealed four themes: (a) the change process within the work was the challenge with the EHR implementation; (b) physicians learn best from other physicians; (c) implementation of the EHR impacted the entire team of care providers, not just the physicians; and (d) EHR optimization was reinforced with follow- up training after implementation

Living (Ek)statically: Educating-within-place and the Ecological Imagination

This paper explores the concept of educating-within-place, existentially derived through a series of immediate and direct experiences within several old growth forests in southern Ontario, and how this might inform notions of the ecological imagination. Our ruminations are guided by several ongoing research endeavours, some existential, others empirical. We take pause in order to examine what we have been doing in the field of Canadian curriculum studies whilst grasping towards a broadened perspective of teacher educating. To theoretically frame this pursuit we draw upon the notion of Ekstasis in order to engage in a pedagogy that considers possibilities through the senses and sensibilities of teacher candidates. In doing so we examine ways of being that move beyond the technocratic and cultivate a living curriculum