HOME-BASED REHABILITATION AND ITS IMPACT ON HOSPITAL UTILIZATION

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization.

'A Kind of Logic, A Kind of Dominant Logic': Navigating Colonialism, Honoring Black Mobility, and Thinking on Moving Through

My thesis thinks through the ways Newtonian logics require linear mobility in order to produce narratives of progress. I argue that this linear mobility, and the resulting logics, potentially erases the chaotic and non-linear motions that are required to navigate a colonial landscape. I suggest that these non-linear movements produce important critiques of the seeming stasis of colonial constructs and highlight the ways these logics must appear neutral and scientific in an attempt to conceal the constant and complex adjustments these frameworks require. In order to make room for these complex motions, I develop a quantum intervention. Specifically, I use quantum physics as a metaphor to think through the significance of black life, the double-consciousness ofland, and the intricate motions of sound. In order to put forth this intervention, I look at news coverage of Hurricane Katrina, Du Bois’s characterization of land in Souls of Black Folks, and the aural mobilities of blackness articulated in an academic discussion and interview about post- humanism.

Understanding arsenic mobility and speciation in lake sediments impacted by ore roasting near Giant mine, NWT

The roasting of gold-bearing arsenopyrite at Giant mine (Northwest Territories) between 1949 and 1999 released approximately 20,000 tonnes of toxic arsenic-bearing aerosols in the local aerial environment. Detailed examination of lake sediments, sediment porewaters, surface waters and lake hydrology sampled from three lakes of differing limnological characteristics was conducted in summer and winter conditions. Samples were analyzed for solid and dissolved elemental concentrations, speciation and mineralogy. The three lakes are located less than 5km from the mine roaster, and downwind, based on predominant wind direction. The objective of the study was to assess the controls on the mobility and fate of arsenic in these roaster-impacted subarctic lacustrine environments. Results show that the occurrence of arsenic trioxide in lake sediments coincides with the regional onset of industrial activities. The bulk of arsenic in sediments is contained in the form of secondary sulphide precipitates, with iron oxides hosting a minimal amount of arsenic near the surface-water interface. The presence of geogenic arsenic is likely contained as dilute impurities in common rock-forming minerals, and is not believed to be a significant source of arsenic to sediments, porewaters or lake waters. Furthermore, the well correlated depth-profiles of arsenic, antimony and gold in sediments may help reveal roaster impact. The soluble arsenic trioxide particles contained in sediments act as the primary source of arsenic into porewaters. Dissolved arsenic in reducing porewaters both precipitate as secondary sulphides in situ, and diffuse upwards into the overlying lake waters. Arsenic diffusion out of porewaters, combined with watercourse-driven residence time, are estimated to be the predominant mechanisms controlling arsenic concentrations in overlying lake waters. The sequestration of arsenic from porewaters as sulphide precipitates, in the study lakes, is not an effective process in keeping lake-water arsenic concentrations below guidelines for the protection of the freshwater environment and drinking water. Seasonal impacts on lake geochemistry derive from ice covering lake waters, cutting them off from of atmospheric oxygen, along with the exclusion of solutes from the ice. Such effects are limited in deep lakes but are can be an important factor controlling arsenic precipitation and mobility in ponds.

The Impact of Geographic Mobility on Canadian Military families and their Children’s Access Special Education Services

To achieve academic success, children with learning-related disabilities often receive special education supports at school. Currently, Canada does not have a federal department or integrated national system of education. Instead, each province and territory has a separate department or ministry that is responsible for the organization and delivery of education, including special education, at the elementary level. At the macro (national) level, inclusive education is the policy across Canada. However, each province and territory has its own legislation, definitions, and policies mandating special education services. These variations result in little consistency at the micro (individual school) level. Differences between eligibility requirements, supports offered, and delivery methods may present challenges for highly mobile families who must navigate new special education systems on behalf of their children with medical or learning challenges. One of the defining features of the Canadian military lifestyle is geographic mobility. As a result, many families are tasked with navigating new school systems for their children, a task that may be more difficult when children require special education services. The purpose of this study is to explore the impact of geographic mobility on Canadian military families and their children’s access to special education services. The secondary objective was to gain insight into supports that helped facilitate access to services, as well as supports that participants believe would have helped facilitate access. A qualitative approach, interpretive phenomenological analysis (IPA), was employed due to of its focus on individuals’ experiences and their understandings of a particular phenomenon. IPA allowed participants to reflect on the significance of their experiences, while the researcher engaged with these reflections to make sense of the meanings associated with their experiences. Nine semi-structured interviews were conducted with civilian caregivers who have a child with special education needs. An interview guide and probes were used to elicit rich, detailed, first-person accounts of their experiences navigating new special education systems. The main themes that emerged from the participants’ combined experiences addressed the emotional components of experiencing a transition, factors that may facilitate access to special education services, and career implications associated with accessing and maintaining special education services. Findings from the study illustrate that Canadian families experience many, and often times severe, barriers to accessing special education services after a posting. Furthermore, the impacts reported throughout the study echo the existing American literature on geographic mobility and access to special education services. Building on the literature, this study also highlights the need for further research exploring factors that create unique barriers to access in a Canadian context, resulting from the current special education climate, military policies, and military family support services.

NEIGHBORHOOD PERCEPTION OF SAFETY AND THE MOBILITY GAP BETWEEN MEN AND WOMEN IN OLD AGE

Background and Objectives: Mobility limitations are a prevalent issue in older adult populations, and an important determinant of disability and mortality. Neighborhood conditions are key determinants of mobility and perception of safety may be one such determinant. Women have more mobility limitations than men, a phenomenon known as the gender mobility gap. The objective of this work was to validate a measure of perception of safety, examine the relationship between neighborhood perception of safety and mobility limitations in seniors, and explore if these effects vary by gender. Methods: This study was cross-sectional, using questionnaire data collected from community-dwelling older adults from four sites in Canada, Colombia, and Brazil. The exposure variable was the neighborhood aggregated Perception of Safety (PoS) scale, derived from the Physical and Social Disorder (PSD) scale by Sampson and Raudenbush. Its construct validity was verified using factor analyses and correlation with similar measures. The Mobility Assessment Tool – short form (MAT-sf), a video-based measure validated cross-culturally in the studied populations, was used to assess mobility limitations. Based on theoretical models, covariates were included in the analysis, both at the neighborhood level (SES, social capital, and built environment) and the individual level (age, gender, education, income, chronic illnesses, depression, cognitive function, BMI, and social participation). Multilevel modeling was used in order to account for neighborhood clustering. Gender specific analyses were carried out. SAS and M-plus were used in this study. Results: PoS was validated across all sites. It loaded in a single factor, after excluding two items, with a Cronbach α value of approximately 0.86. Mobility limitations were present in 22.08% of the sample, 16.32% among men and 27.41% among women. Neighborhood perception of safety was significantly associated with mobility limitations when controlling for all covariates, with an OR of 0.84 (CI 95%: 0.73-0.96), indicating lower odds of having mobility limitations as neighborhood perception of safety improves. Gender did not affect this relationship despite women being more likely to have mobility limitations and live in neighborhoods with poor perception of safety. Conclusion: Neighborhood perception of safety affected the prevalence of mobility limitations in older adults in the studied population.