Rehabilitation Therapy Services For Older Long–Stay Clients in the Ontario Home Care System

BACKGROUND Rehabilitation therapies are effective for older persons in home-based settings, and have the potential to save money for the health system, while also improving the quality of life for older adults who may otherwise be hospitalized or institutionalized. Although there is evidence that home-based rehabilitation can improve functional outcomes in older adults, research has shown that many older home care clients do not receive the rehabilitation services they need. Despite the home care sector’s increasing importance within Ontario’s health care system, we have a limited understanding of the population that currently utilizes these services and how these services are allocated in the province. This dissertation project aims to enhance the understanding of this domain using a large provincial data repository of home care client information (RAI-HC information system). METHODS Using the Andersen-Newman Framework to guide this research from a conceptual standpoint, and combining it with the CRoss Industry Standard Process for Data Mining (CRISP-DM) as an organizational framework, this dissertation focuses on examining data collected on older long-stay home care clients. Prior to the data mining modeling procedures, knowledge of the rehabilitation services in home care was developed through a series of semi-structured interviews with key informants. The results of this qualitative study were then used to inform quantitative analyses that included creating rehabilitation service user profiles using the K-means clustering algorithm, and the development of predictive models of rehabilitation service provision using a Random forest algorithm and multilevel models. RESULTS Older home care clients who receive occupational therapy and physiotherapy in the Ontario Home Care System form a complex and heterogeneous client population. These services are often provided to clients following an acute event, yet many older adults who could benefit from therapy services for functional improvement and maintenance are not provided services due to limited resources. K-means clustering analyses resulted in the creation of seven profiles of rehab service users illustrating the multidimensional diversity of the service user population. Predictive models were able to identify client characteristics that are commonly associated with service provision. These models confirmed the large amount of regional variation found across the province and highlighted the differences between factors that lead to occupational therapy and physiotherapy service provision. CONCLUSIONS Using multiple methods to systematically examine rehabilitation services for long-stay clients, new insights into the current user population and the client characteristics related to service provision were obtained. Future research activities should focus on ways to use the regularly collected standardized data to identify older long-stay home care clients who would benefit most from the rehabilitation therapy services provided by the provincial home care system

Practical Interests, Relevant Alternatives, and Knowledge Attributions: an Empirical Study

In defending his interest-relative account of knowledge, Jason Stanley relies heavily on intuitions about several bank cases. We experimentally test the empirical claims that Stanley seems to make concerning our common-sense intuitions about these cases. Additionally, we test the empirical claims that Jonathan Schaffer seems to make, regarding the salience of an alternative, in his critique of Stanley. Our data indicate that neither raising the possibility of error nor raising stakes moves most people from attributing knowledge to denying it. However, the raising of stakes (but not alternatives) does affect the level of confidence people have in their attributions of knowledge. We argue that our data impugn what both Stanley and Schaffer claim our common-sense judgments about such cases are

Spontaneous Self-Assembly of Thermoresponsive Vesicles Using a Zwitterionic and an Anionic Surfactant.

Spontaneous formation of vesicles from the self-assembly of two specific surfactants, one zwitterionic (oleyl amidopropyl betaine, OAPB) and the other anionic (Aerosol-OT, AOT), is explored in water using small-angle scattering techniques. Two factors were found to be critical in the formation of vesicles: surfactant ratio, as AOT concentrations less than equimolar with OAPB result in cylindrical micelles or mixtures of micellar structures, and salt concentration, whereby increasing the amount of NaCl promotes vesicle formation by reducing headgroup repulsions. Small-angle neutron scattering measurements reveal that the vesicles are approximately 30-40 nm in diameter, depending on sample composition. Small-angle X-ray scattering measurements suggest preferential partitioning of OAPB molecules on the vesicle inner layer to support vesicular packing. Heating the vesicles to physiological temperature (37 °C) causes them to collapse into smaller ellipsoidal micelles (2-3 nm), with higher salt concentrations (≥10 mM) inhibiting this transition. These aggregates could serve as responsive carriers for loading or unloading of aqueous cargoes such as drugs and pharmaceuticals, with temperature changes serving as a simple release/uptake mechanism.Australian Research Council Future Fellowship (FT160100191) to Rico Tabor. and a Discovery Early Career Research Award (DE190100531) to Andrew Clulow

Precision Measurement of the Beam-Normal Single-Spin Asymmetry in Forward-Angle Elastic Electron-Proton Scattering

A beam-normal single-spin asymmetry generated in the scattering of transversely polarized electrons from unpolarized nucleons is an observable related to the imaginary part of the two-photon exchange process. We report a 2% precision measurement of the beam-normal single-spin asymmetry in elastic electron-proton scattering with a mean scattering angle of theta_lab = 7.9 degrees and a mean energy of 1.149 GeV. The asymmetry result is B_n = -5.194 +- 0.067 (stat) +- 0.082 (syst) ppm. This is the most precise measurement of this quantity available to date and therefore provides a stringent test of two-photon exchange models at far-forward scattering angles (theta_lab -\u3e 0) where they should be most reliable

Constructing a man-made c-type cytochrome maquette in vivo:electron transfer, oxygen transport and conversion to a photoactive light harvesting maquette

The successful use of man-made proteins to advance synthetic biology requires both the fabrication of functional artificial proteins in a living environment, and the ability of these proteins to interact productively with other proteins and substrates in that environment. Proteins made by the maquette method integrate sophisticated oxidoreductase function into evolutionarily naive, non-computationally designed protein constructs with sequences that are entirely unrelated to any natural protein. Nevertheless, we show here that we can efficiently interface with the natural cellular machinery that covalently incorporates heme into natural cytochromes c to produce in vivo an artificial c-type cytochrome maquette. Furthermore, this c-type cytochrome maquette is designed with a displaceable histidine heme ligand that opens to allow functional oxygen binding, the primary event in more sophisticated functions ranging from oxygen storage and transport to catalytic hydroxylation. To exploit the range of functions that comes from the freedom to bind a variety of redox cofactors within a single maquette framework, this c-type cytochrome maquette is designed with a second, non-heme C, tetrapyrrole binding site, enabling the construction of an elementary electron transport chain, and when the heme C iron is replaced with zinc to create a Zn porphyrin, a light-activatable artificial redox protein. The work we describe here represents a major advance in de novo protein design, offering a robust platform for new c-type heme based oxidoreductase designs and an equally important proof-of-principle that cofactor-equipped man-made proteins can be expressed in living cells, paving the way for constructing functionally useful man-made proteins in vivo

Frailty trajectories and associated factors in the years prior to death: evidence from 14 countries in the Survey of Health, Aging and Retirement in Europe

Background: Age-related changes in frailty have been documented in the literature. However, the evidence regarding changes in frailty prior to death is scarce. Understanding patterns of frailty progression as individuals approach death could inform care and potentially lead to interventions to improve individual’s well-being at the end of life. In this paper, we estimate the progression of frailty in the years prior to death. Methods: Using data from 8,317 deceased participants of the Survey of Health, Ageing, and Retirement in Europe, we derived a 56-item Frailty Index. In a coordinated analysis of repeated measures of the frailty index in 14 countries, we fitted growth curve models to estimate trajectories of frailty as a function of distance to death controlling both the level and rate of frailty progression for age, sex, years to death and dementia diagnosis. Results: Across all countries, frailty before death progressed linearly. In 12 of the 14 countries included in our analyses, women had higher levels of frailty close to the time of death, although they progressed at a slower rate than men (e.g. Switzerland (-0.008, SE = 0.003) and Spain (-0.004, SE = 0.002)). Older age at the time of death and incident dementia were associated with higher levels and increased rate of change in frailty, whilst higher education was associated with lower levels of frailty in the year preceding death (e.g. Denmark (0.000, SE = 0.001)). Conclusion: The progression of frailty before death was linear. Our results suggest that interventions aimed at slowing frailty progression may need to be different for men and women. Further longitudinal research on individual patterns and changes of frailty is warranted to support the development of personalized care pathways at the end of life

Cosmology from cosmic shear power spectra with Subaru Hyper Suprime-Cam first-year data

We measure cosmic weak lensing shear power spectra with the Subaru Hyper Suprime-Cam (HSC) survey first-year shear catalog covering 137deg$^2$ of the sky. Thanks to the high effective galaxy number density of $\sim$17 arcmin$^{-2}$ even after conservative cuts such as magnitude cut of $i<24.5$ and photometric redshift cut of $0.3\leq z \leq 1.5$, we obtain a high significance measurement of the cosmic shear power spectra in 4 tomographic redshift bins, achieving a total signal-to-noise ratio of 16 in the multipole range $300 \leq \ell \leq 1900$. We carefully account for various uncertainties in our analysis including the intrinsic alignment of galaxies, scatters and biases in photometric redshifts, residual uncertainties in the shear measurement, and modeling of the matter power spectrum. The accuracy of our power spectrum measurement method as well as our analytic model of the covariance matrix are tested against realistic mock shear catalogs. For a flat $\Lambda$ cold dark matter ($\Lambda$CDM) model, we find $S_8\equiv \sigma_8(\Omega_{\rm m}/0.3)^\alpha=0.800^{+0.029}_{-0.028}$ for $\alpha=0.45$ ($S_8=0.780^{+0.030}_{-0.033}$ for $\alpha=0.5$) from our HSC tomographic cosmic shear analysis alone. In comparison with Planck cosmic microwave background constraints, our results prefer slightly lower values of $S_8$, although metrics such as the Bayesian evidence ratio test do not show significant evidence for discordance between these results. We study the effect of possible additional systematic errors that are unaccounted in our fiducial cosmic shear analysis, and find that they can shift the best-fit values of $S_8$ by up to $\sim 0.6\sigma$ in both directions. The full HSC survey data will contain several times more area, and will lead to significantly improved cosmological constraints.Comment: 43 pages, 21 figures, accepted for publication in PAS

GREAT3 results I: systematic errors in shear estimation and the impact of real galaxy morphology

We present first results from the third GRavitational lEnsing Accuracy Testing (GREAT3) challenge, the third in a sequence of challenges for testing methods of inferring weak gravitational lensing shear distortions from simulated galaxy images. GREAT3 was divided into experiments to test three specific questions, and included simulated space- and ground-based data with constant or cosmologically-varying shear fields. The simplest (control) experiment included parametric galaxies with a realistic distribution of signal-to-noise, size, and ellipticity, and a complex point spread function (PSF). The other experiments tested the additional impact of realistic galaxy morphology, multiple exposure imaging, and the uncertainty about a spatially-varying PSF; the last two questions will be explored in Paper II. The 24 participating teams competed to estimate lensing shears to within systematic error tolerances for upcoming Stage-IV dark energy surveys, making 1525 submissions overall. GREAT3 saw considerable variety and innovation in the types of methods applied. Several teams now meet or exceed the targets in many of the tests conducted (to within the statistical errors). We conclude that the presence of realistic galaxy morphology in simulations changes shear calibration biases by $\sim 1$ per cent for a wide range of methods. Other effects such as truncation biases due to finite galaxy postage stamps, and the impact of galaxy type as measured by the S\'{e}rsic index, are quantified for the first time. Our results generalize previous studies regarding sensitivities to galaxy size and signal-to-noise, and to PSF properties such as seeing and defocus. Almost all methods' results support the simple model in which additive shear biases depend linearly on PSF ellipticity.Comment: 32 pages + 15 pages of technical appendices; 28 figures; submitted to MNRAS; latest version has minor updates in presentation of 4 figures, no changes in content or conclusion