Predictors of place of death for those in receipt of home-based palliative care services in Ontario, Canada

Many cancer patients die in institutional settings despite their preference to die at home. A longitudinal, prospective cohort study was conducted to comprehensively assess the determinants of home death for patients receiving home-based palliative care. Data collected from biweekly telephone interviews with caregivers (n=302) and program databases were entered into a multivariate logistic model. Patients with high nursing costs (odds ratio [OR]: 4.3; confidence interval [CI]: 1.8-10.2) and patients with high personal support worker costs (OR: 2.3; CI: 1.1-4.5) were more likely to die at home than those with low costs. Patients who lived alone were less likely to die at home than those who cohabitated (OR: 0.4; CI: 0.2-0.8), and those with a high propensity for a home-death preference were more likely to die at home than those with a low propensity (OR: 5.8; CI: 1.1-31.3). An understanding of the predictors of place of death may contribute to the development of effective interventions that support home death.

Optimal choice between even- and uneven-aged forestry: the case of non-industrial private forest owners

An infinite-horizon discrete time model with multiple size-class structures using a transition matrix is built to assess optimal harvesting schedules in the context of Non-Industrial Private Forest (NIPF) owners. Three model specifications accounting for forest income, financial return on an asset and amenity valuations are considered. Numerical simulations suggest uneven-aged forest management where a rational forest owner adapts her or his forest policy by influencing the regeneration of trees or adjusting consumption dynamics depending on subjective time preference and market return rate dynamics on the financial asset. Moreover she or he does not value significantly non-market benefits captured by amenity valuations relatively to forest income.

Validity, reliability and responsiveness of the French language translation of the Western Ontario Shoulder Instability Index (WOSI).

BACKGROUND: The WOSI (Western Ontario Shoulder Instability Index) is a self-administered quality of life questionnaire designed to be used as a primary outcome measure in clinical trials on shoulder instability, as well as to measure the effect of an intervention on any particular patient. It is validated and is reliable and sensitive. As it is designed to measure subjective outcome, it is important that translation should be methodologically rigorous, as it is subject to both linguistic and cultural interpretation. OBJECTIVE: To produce a French language version of the WOSI that is culturally adapted to both European and North American French-speaking populations. MATERIALS AND METHODS: A validated protocol was used to create a French language WOSI questionnaire (WOSI-Fr) that would be culturally acceptable for both European and North American French-speaking populations. Reliability and responsiveness analyses were carried out, and the WOSI-Fr was compared to the F-QuickDASH-D/S (Disability of the Arm, Shoulder and Hand-French translation), and Walch-Duplay scores. RESULTS: A French language version of the WOSI (WOSI-Fr) was accepted by a multinational committee. The WOSI-Fr was then validated using a total of 144 native French-speaking subjects from Canada and Switzerland. Comparison of results on two WOSI-Fr questionnaires completed at a mean interval of 16 days showed that the WOSI-Fr had strong reliability, with a Pearson and interclass correlation of r=0.85 (P=0.01) and ICC=0.84 [95% CI=0.78-0.88]. Responsiveness, at a mean 378.9 days after surgical intervention, showed strong correlation with that of the F-QuickDASH-D/S, with r=0.67 (P<0.01). Moreover, a standardized response means analysis to calculate effect size for both the WOSI-Fr and the F-QuickDASH-D/S showed that the WOSI-Fr had a significantly greater ability to detect change (SRM 1.55 versus 0.87 for the WOSI-Fr and F-QuickDASH-D/S respectively, P<0.01). The WOSI-Fr showed fair correlation with the Walch-Duplay. DISCUSSION: A French-language translation of the WOSI questionnaire was created and validated for use in both Canadian and Swiss French-speaking populations. This questionnaire will facilitate outcome assessment in French-speaking settings, collaboration in multinational studies and comparison between studies performed in different countries. TYPE OF STUDY: Multicenter cohort study. LEVEL OF EVIDENCE: II.

Changing roles of nurse educators employed in acute and chronic care settings : the impact of professional and statutory mandates in Ontario at four sites of one hospital corporation /

The role of the hospital-employed nurse educator is evolving. Factors influencing this change include the introduction of standards for nurse educators by the College of Nurses of Ontario (CNO), a change in the way nurses are educated, the emergence of nursing as a profession, and hospital restructuring as a result of budgetary constraints. Two of these influencing factors: the introduction of the updated Standards of Practice for Registered Nurses and Registered Practical Nurses (1996) and hospital restructuring occurred over the last 7 years at several hospitals in southern Ontario. Current literature as well as the Standards of Practice (1996) were utilized to examine the current roles and responsibilities of nurse educators and subsequently develop a questionnaire to study the impact of these influencing factors on the role of the nurse educator. This questionnaire was piloted and revised before its distribution at 4 hospitals in southern Ontario. Twenty-five of the 41 surveys (61%) distributed were returned for analysis. The data reflected that the Standards of Practice had a positive influence on the role of the nurse educator, while hospital restructuring had a negative impact. In addition, many of the roles and responsibilities identified in the literature were indeed part of the current role of nurse educators, as well as several responsibilities not captured in the literature. The predictions for the future of this role in its current state were not positive given the financial status of the health care system as well as the lack of clarity for the role and the current level ofjob satisfaction among practicing nurse educators. However, a list of recommendations were generated which, if implemented, could add clarity to the role and improve job satisfaction. This could enhance the retention of current nurse educators and the possibility of recruiting competent nurse educators to the role in the future.

From protest to powerlessness : a Marxist analysis of the Ontario NDP /

Using Marxist state theory as an analytical framework, this thesis explains the problems faced by the Ontario New Democratic Party government (1990-1995) in implementing a social democratic agenda. Not only was the government constrained in its ability to implement progressive policy, but it was also pushed to implement a Social Contract (involving legislated wage cuts to public sector employees) that alienated the party's base of support, making it more difficult for the party to organize in the future. Although this study relies predominantly on a reinterpretation of existing research on the topic, some primary research is used in the analysis, including interviews with members of the labour movement and former MPPs and analysis of the news media's treatment of the party/ government. Historical and class analytical perspectives are used to explain the evolution of the ONDP's structure and policies, as well as to assess the relative strength of the working class and its ability to support a social democratic political agenda. It was found that the ONDP' s unwillingness to develop a long term plan for social democracy, and its inability to act as a mass party or to build a strong working class movement, made it more difficult for the party to succeed when it formed the government. Moreover, the class nature of the capitalist state, along with pressure exerted by a well mobilized capitalist class, worked to limit the government' s options.

Geochemistry and mineralogical association of heavy metal contaminants in fine grained sediment, Welland River, Southern Ontario /

This investigation of geochemistry and mineralogy of heavy metals in fine grained (<63^m) sediment of the Welland River was imdertaken to: 1) describe metal dispersion patterns relative to a source, identify minerals forming and existing at the outfall region and relate sediment particle size to chemistry; 2) to delineate sample handling, preparation and evaluate, modify and develop analytical methods for heavy metal analysis of complex environmental samples. Ajoint project between Brock University and Geoscience Laboratories was initiated to test a contaminated site of the Welland River at the base of Atlas Speciality Steels Co. Methods were developed and utilized for particle size separation and two acid extraction techniques: 1) Partial extraction; 2) Total extraction. The mineralogical assessment identified calcite, dolomite, quartz and clays. These minerals are typical of the carbonate-shale rock basement of the Niagara Peninsula. Minerals such as, mullite and ferrocolumbite were found at the outfall region. These are not typical of the local geology and are generally associated with industrial pollutants. Partial and total extraction techniques were used to characterize the sediments based on chemical distribution, elemental behaviour and analytical differences. The majority of elements were lower in concentration in the partial extraction technique; suggesting these elements are bound in an acid extractable phase (exchangeable, organic and carbonate phases). The total extraction technique yielded higher elemental concentrations taking difficult oxides and silicates into solution. Geochemical analyses of grain size separates revealed that heavy metal (Co, Ni, V, Mn, Fe, Ba) concentrations did not increase with decreasing grain size. This is a function of the anthropogenic mill scale input into the river. The background elements (Sc, Y, Sr, Mg, Al and Ti) showed an increase in concentration to the finest grain size suggesting that it is directly related to the local mineralogy and geology. Dispersion patterns ofmetals fall into two distinct categories: 1) the heavy metals (Co, Cu, Ni, Zn, V and Cr), and 2) the background elements (Be, Sc, Y, Sr, Al and Ti). The heavy metals show a marked increase in the outfall region, while the background elements show a significant decrease at the outfall. This pattern is attributed to a "dilution effect" ofthe natural sediments by the anthropogenic mill scale sediments. Multivariant statistical analysis and correlation coefficient matrix results clearly support these results and conclusions. These results indicate the outfall region ofthe Welland River is highly contaminated with to heavy metals from the industrialized area of Welland. A short distance downstream, the metal concentrations return to baseline geochemical levels. It appears, contaminants rapidly come out of suspension and are deposited in close proximity to the source. Therefore, it is likely that dredging the sediment from the river may cause resuspension of contaminated sediments, but may not distribute the sediment as far as initially anticipated.

Our future in geriatrics : an examination of the knowledge, attitudes and career choices of physical therapy students in Ontario : a pretest-posttest study /

There continues to be a shortage of health professionals interested in providing care for the older adult. Part of the problem seems to stem from the negative perceptions of geriatrics as a clinical speciality. This study examines the knowledge, attitudes and career decisions of physical therapy students in Ontario before and after an educational intervention. Surveys were conducted with 144 physical therapy students from five universities before and after their geriatrics course in order to measure their knowledge, attitudes and interest in working with older adults. The incoming class of physical therapy students (n = 1 86) acted as control subjects for the study. The Revised Palmore Facts On Aging Quiz measured the students' knowledge of aging (Miller & Dodder, 1980). The Revised Tuckman-Lorge (Axelrod & Eisdorfer, 1961) and the Kogan Old People Scales (Kogan, 1961) were used to examine attitude. An environmental scale was developed based on the work of Snape (1986) to measure the impact of the working conditions on the students' career choices. A 10-point Likert-type scale based on the work of Michlelutte & Diseker (1985) was modified and used to measure career interest in working with the elderly. On independent sample t-tests, positive attitudes were related to the demographic characteristic of gender; ethnicity was negatively related; and marital status was found to be unrelated to attitude (fi<.05). Having a relationship with an older adult and taking courses in gerontology were also found to be positively related to attitude (fi<.05). Results on a betweensubjects design which compared students before and after the course found that knowledge scores improved from pretest to posttest (fi<.05). In general, attitude scores improved from T1 to T2 on both measurement tools (b<.05). The environmental and vocational interest scales yielded statistically significant differences between the control and experimental groups during the intervention period (p<.05). The results of this research indicated that knowledge and attitudes improve after an educational intervention; however, there was little impact on the students' overall career decisions. Further research is indicated to examine the complex relationship between attitude and behaviour and its impact on students' career choices. In addition, the impact of geriatric clinical environment on students' attitudes and career decisions needs to be further explored.

Perceived learning needs in staff development of some care providers in five long-term care settings in Southern Ontario /

This exploratory descriptive study described what 20 care providers in 5 long-term care facilities perceived to aid or hinder their learning in a work-sponsored learning experience. A Critical Incident Technique (Woolsey, 1986) was the catalyst for the interviews with the culturally and professionally diverse participants. Through data analysis, as described by Moustakas (1994), I found that (a) humour, (b) the learning environment, (c) specific characteristics of the presenter such as moderate pacing, speaking slowly and with simple words, (d) decision-making authority, (e) relevance to practice, and (f) practical applications best met the study participants' learning needs. Conversely, other factors could hinder learning based on the participants' perceptions. These were: (a) other presenter characteristics such as a program that was delivered quickly or spoken at a level above the participants' comprehension, (b) no perceived relevance to practice, (c), other environmental situations, and (d) the timing of the learning session. One of my intentions was to identify the emic view among cultural groups and professional/vocational affiliations. A surprising finding of this study was that neither impacted noticeably on the perceived learning needs of the participants. Further research with a revised research design to facilitate inclusion of more diverse participants will aid in determining if the lack of a difference was unique to this sample or more generalizable on a case-to-case transfer basis to the study population.

Sedimentology and taphonomy of storm-generated shell beds from the Verulam formation (Ordovician), Lakefield and Gamebridge quarries, Southern Ontario, Canada /

The Verulam Formation (Middle Ordovician) at the Lakefield Quarry and Gamebridge Quarry, southern Ontario, is comprised of five main lithofacies. These include shoal deposits consisting of Lithofacies 1, winnowed crinoidal grainstones and, shelf deposits consisting of: Lithofacies 2, wackestones, packstones, grainstones, and rudstones; Lithofacies 3, laminated calcisiltites; Lithofacies 4, nodular wackestones and mudstones; and, Lithofacies 5, laminated mudstones and shales. The distribution of the lithofacies was influenced by variations in storm frequency and intensity during a relative sea level fall. Predominant convex-up attitudes of concavo-convex shells within shell beds suggest syndepositional reworking during storm events. The bimodal orientations of shell axes on the upper surfaces of the shell beds indicates deposition under wave-generated currents. The sedimentary features and shell orientations indicate that the shell beds were deposited during storm events and not by the gradual accumulation of shelly material. Cluster and principal component analysis of relative abundance data of the taxa in the shell beds, interbedded nodular wackestones and mudstones, and laminated mudstones and shales, indicates one biofacies comprised of three main assemblages: a strophomenid (Sowerbyelladominated) assemblage, a transitional mixed strophomenid-atrypid assemblage and an atrypid (Zygospira-dominatQd) assemblage. The occurrence of the strophomenid, the strophomenid-atrypid and atrypid assemblages were controlled by storm-driven allogenic taphonomic feedback.

Quaternary geology of the Campbellford, Trenton, Consecon, Tweed, Belleville, Wellington, Sydenham, Bath, and Yorkshire Island map-areas, Ontario /

Sediment relationships observed during geological mapping in southeastern Ontario indicate a relatively simple deglaciation history for the area during late Wisconsin time. The ice from the north (part of the Lake Simcoe lobe) and the Lake Ontario ice lobe, which were coalesced during most of late Wisconsin time, initially separated along the crest of the Oak Ridges Moraine. Available data indicate that the Oak Ridges Moraine is composed primarily of sediments pre-late Wisconsin in age capped by late Wisconsin till and interlobate deposits. Retreat of the northern ice was relatively steady and resulted in the deposition of the Dummer Moraines, a facies of the drumlinized till to the south. Retreat of the Lake Ontario ice lobe into the Lake Ontario basin was interrupted by a re-advance which covered the southeastern half of the map area. The northern ice had already retreated from the area by this time. The Lake Ontario lobe was fed through the St. Lawrence Valley, indicating that the Ottawa Valley was ice filled at this time. High level glacial lakes fronted the ice during deglaciation. These waters quickly fell to low levels as the ice retreated from the St. Lawrence Valley, opening lower outlets.

Armor coats, inverse grading, and streambed scour in selected streams of Southern Ontario and Western New York /

Surface size analyses of Twenty and Sixteen Mile Creeks, the Grand and Genesee Rivers and Cazenovia Creek show three distinct types of bed-surface sediment: 1) a "continuous" armor coat which has a mean size of -6.5 phi and coarser, 2) a "discontinuous" armor coat which has a mean size of approximately -6.0 phi and 3) a bed with no armor coat which has a mean surface size of -5.0 phi and finer. The continuous armor coat completely covers and protects the subsurface from the flow. The discontinuous armor coat is composed of intermittently-spaced surface clasts, which provide the subsurface with only limited protection from the flow. The bed with no armor coat allows complete exposure of the subsurface to the flow. The subsurface beneath the continuous armor coats of Twenty and Sixteen Mile Creeks is possibly modified by a "vertical winnowing" process when the armor coat is p«natrat«d. This process results in a welld «v«loped inversely graded sediment sequence.vertical winnowing is reduced beneath the discontinuous armor coats of the Grand and Genesee Rivers. The reduction of vertical winnowing results in a more poorly-developed inverse grading than that found in Twenty and sixteen Mile Creeks. The streambed of Cazenovia Creek normally is not armored resulting in a homogeneous subsurface which shows no modification by vertical winnowing. This streambed forms during waning or moderate flows, suggesting it does not represent the maximum competence of the stream. Each population of grains in the subsurface layers of Twenty and sixteen Mile Creeks has been modified by vertical winnowing and does not represent a mode of transport. Each population in the subsurface layers beneath a discontinuous armor coat may partially reflect a transport mode. These layers are still inversely graded suggesting that each population is affected to some degree by vertical winnowing. The populations for sediment beneath a surface which is not armored are probably indicative of transport modes because such sediment has not been modified by vertical winnowing. Bed photographs taken in each of the five streams before and after the 1982-83 snow-melt show that the probability of movement for the surface clasts is a function of grain size. The greatest probability of of clast movement and scour depth of this study were recorded on Cazenovia Creek in areas where no armor coat is present. The scour depth in the armored beds of Twenty and Sixteen Mile Creeks is related to the probability of movement for a given mean surface size.

The backwoods of our backyards : Ontario pioneers and the crisis of ecology /

Early in his landmark ecocritical book The Comedy of Survival, Joseph Meeker develops an intriguing hypothesis about human behaviour. He remarks the species Homo sapiens tend to behave like an invasive or pioneering organism, entering a bio-geographical region and aggressively outcompeting all other species for space and resources. Moreover, he suggests, human cultural traditions, at least in the West, have reinforced such behaviour, continually insisting that the impulses he describes are both necessary and right. While Meeker's work goes on to assess a number of literary works in both the tragic and comic modes, his work never fully explores this hypothesis in the context of human pioneers; that is, there is no ~xploration o( how these themes manifest themselves within our culture and what role they might play in the culture of specific pioneering groups. This project is an attempt at just such an analysis, examining the validity of Meeker's hypothesis through a case study of settler literature in Upper Canada/Ontario between the . years 1800-1867. It explores Meeker's work within three main areas: first, Chapter Two situates his book historically within the field of ecocriticism, showing what came before and the explosion of ecocritical inquiry that followed its release. This chapter also delves into the rift between the natural sciences and humanities, arguing that a move towards deeper interdisciplinarity is r:tecessary for the future. Chapter Three examines the biological and ecological ground on which Meeker rests his hypothesis through exploring evolutionary biology as well as invasive and pioneer species behaviour. Lastly, Chapter Four examines how these ecological principles are manifested in the writings of early Canadian settlers, suggesting that Meeker's hypothesis indeed finds itself on stable footing.