Understanding space, place and leisure of women over 85 living in the community

There is an increase in the number of older adults 85 and over, who are choosing to live alone within the community. Moreover, older adults who live alone are reportedly spending an extensive amount of time alone within the home environment. In an effort to provide additional support and resources to older adults living in the community, a compliment of services are being offered through public and private organizations. These in-home supports focus on the instrumental or functional tasks of daily living, such as personal and rehabilitative care, nourishment, maintenance and upkeep of the home, as well as volunteer social visitation. However leisure resources and programs are not included among these services. Consequently, this creates a gap in leisure provision among this segment of the population. Throughout the life course, an individual's identity, role and purpose are developed and sustained through instrumental work roles in the formal and informal sector, as well as through personally meaningful leisure pastimes and experiences. Although roles shift post retirement, participation in instrumental and expressive activities can provide opportunities through which older adults are able to fulfill their need for agency (individuality and autonomy) and affiliation (social relatedness). Therefore barriers that inhibit instrumental or leisure experiences can negatively impact older adults' quality of life. This study explored the leisure lifestyles of four older adults, all of whom were over 85, lived alone within the community and were oriented to person, time and place. It became apparent that participants ordered their lives around a routine that consisted of instrumental, expressive and socially integrated tasks and activities. Moreover participants purposely chose to remain at home because their home environment facilitated freedom, choice and independence. As a result all four participants viewed their independence within the home as a critical determinant to their overall quality of life. Challenges associated with the home environment, participants' personal capacities and relationships were negotiated on a daily basis. Failure to positively adapt to these challenges inhibited meaningful engagement and personal fulfillment. Traditionally, leisure service delivery has been offered within institutions and through various community based venues. As a result leisure provision has been focused on the needs of the frail elderly who reside in institutions or the well elderly who are able to access leisure amenities within the community. However the growing number of older adults electing to live alone is on the rise. As individuals age the home becomes the preferred context for leisure experiences. If older adults are choosing to live alone, then both their instrumental and leisure needs must be addressed. As a result, it is imperative that leisure professionals extend the scope of service delivery to include home centered older adults.

Exploring the Perceptions of Cultural Competence Among Personal Support Workers in an Ontario Long-Term Care Home: A Case Study

Personal Support Workers (PSWs) spend a large amount of time with long-term care (LTC) home residents providing assistance with their activities of daily living. The s limited research on their perceptions of cultural competence presents the need to bridge this knowledge gap. The researcher conducted a qualitative case study at a LTC home in Ontario. Data were collected by conducting a policy document analysis, a key informant interview with the Director of Care (DOC), and two focus groups with PSWs. The five major overarching themes were: The Culture of the LTC Home, Provision of a Supportive Environment, Collaborative Team Approach to Care, Building a Relationship with the Residents, and Maintenance of Staff Morale. The findings illuminated the broad nature of culture, connections to person centered care, and the factors that facilitate or hinder PSWs’ culturally competent care. The ambiguous perception of cultural competence among PSWs suggests further research and education on cultural competence in LTC home settings.

Developing an Understanding of Cultural Diversity: How an Experience Living in a Multicultural Nation and an Experience Teaching Abroad Contribute to Southern Ontario Teachers' Identities

This is a narrative design study focusing on the understandings that a group of 6 Southern Ontario teachers have of cultural diversity and how these understandings integrated into their development of teacher identity. Given the high culturally diverse population of Canada and its national multicultural values, conducting this study on Canadian pre-service and in-service teachers offers an interesting contribution to the field. In efforts to explore the participants’ understandings, the research examined a teaching abroad experience. The aim was to investigate how these participants gained insight from their experiences with cultural diversity and whether these insights stimulated a greater culturally conscious teacher identity. Narratives provided a description of the lived experiences of these 6 teachers and identified meanings made from these experiences. Participants included 2 pre-service teachers who were in a teacher education program at the time of the interview, and 4 certified teachers who graduated from a teacher education program within the past 5 years. One on one interviews focused on lived experiences within a participant’s home, school community, and teaching abroad. The researcher used grounded theory during the data analysis to assist in identifying themes, and then compared these themes among participants. Overall, this study suggests that even though these participants live in a multicultural nation, experiences varied greatly based on contributing factors such as heritage and exposure to cultural diversity through their home and school life. Despite their varying level of cultural competence, all participants gained insight from their teaching abroad experience, contributing to a teacher identity that considered inclusive practices. This study suggests that there are some important factors to consider when preparing teachers to teach in a multicultural society.

Youth Living in Residential Care: Implications for Leisure and Identity

The purpose of this study was to explore the intersection of living in residential care, leisure engagement, and adolescent identity development. The investigation included the voices of six youth living in a residential care facility in southern Ontario. The data was collected through participant observations, semi-structured interviews, and document analysis. Moustakas’ (1994) modification of the Stevick-Colaizzi-Keen method was used to analyze the data. The findings determined that living in residential care is rife with dialectical tensions that impact leisure and identity. The youth shared poignant narratives of how living in residential care was a stigmatizing experience that left them feeling restricted and isolated. They also shared their struggles with finding autonomy in a secured facility and managing the violent discourses of their peers. This research contributes to a burgeoning body of literature that explores the experiences of youth living in out-of-home care. Implications for practice and future research are discussed.

Mobile Books: Effect of Engagement on Students’ Motivation and Cognitive Strategy Use

This mixed methods research explores the role of reading engagement in 30 grade 1 students’ motivation to read mobile electronic storybooks (eBooks) and cognitive strategies used during eBook reading. Data collection comprised motivation and parent questionnaires, behavioural observation checklists, cognitive strategies rubric, and teacher interviews. Students’ emotional engagement with and enjoyment of mobile eBooks corresponded to 4 motivational aspects of intrinsic motivation: curiosity, control, choice, and challenge. Post-intervention results indicated that most student participants enjoyed answering eBook comprehension questions and preferred eBooks to print books; by the end of the study, all had access to a mobile device at home. A majority of participants were actively engaged during mobile eBook reading sessions and persisted in answering embedded eBook comprehension questions, which together reflected students’ behavioural engagement and time-on-task during mobile reading. Students’ off-task behaviours related to iPads’ accessibility features and inherent reader-friendliness. All participants successfully answered evaluative questions requiring them to activate prior knowledge, and experienced higher levels of difficulty with making personal connections. The study highlights the importance of making school-based literacy practices relevant to students’ outside worlds, and discusses implications for teacher educators, administrators, curriculum developers, and eBook and other digital developers concerning the need for greater collaboration in order to more closely align technology resources with national curriculum expectations.

Diversity and nutritional properties of Pakistani dates: implications for sustainable value chain and decent living perspectives of rural households

Date palm (Phoenix dactylifera L.) occupies almost three percent of the total worldwide cultivated area, with an annual production of seven million tonnes (t). Pakistan is an ideal place for the cultivation of date palm due to its sandy loam soil and semi-arid climate. In 2012, Pakistan produced 600,000 t of dates, on an area of 95,000 ha. Baluchistan province is the country’s top date producer, followed by Sindh, Punjab and Khyber Pakhtunkhwa (KPK) provinces. More than 300 date varieties are known to exist in Pakistan and some commercially important cultivars are: Karbalaen, Aseel, Muzawati, Fasli, Begum Jhangi, Hillawi, Dashtiari, Sabzo, Koharaba, Jaan Swore, Rabai and Dhakki. Six districts from the four provinces of Pakistan (Jhang, Muzaffargarh and Bahawalpur (Punjab), Dera Ismail Khan (KPK), Khairpur (Sindh) and Panjgur (Baluchistan)) with largest area under date palm cultivation were selected to conduct socio-economic surveys including the income sources of date palm growers. A structured questionnaire with open-ended and closed questions was used for face-to-face interviews of 170 date palm growers. At each location after selection of a first farmer through a local guide, the former was requested to provide names and addresses of three other date growers in his area. From these three names, one was randomly selected for the next sampling. Additionally, date palm fronds and fruits of all available cultivars were collected for morphological and nutritional analyses. Soil samples were collected from the groves for subsequent chemical and physical analyses. Almost all farmers used dates as a food item for their families and some were using low quality dates as a feed for their livestock. Apart from dates, other date palm components (trunk, spadix, frond, inflorescence and seed) were used by date palm growers as a raw material for making many by-products for their families. Date palm had a major contribution in the income of households, 24% received 91-100% of their income from date palms. More than half of the surveyed farmers had date palm groves, but scattered plantations, home gardens and intercropping systems with cereal and other fruits were also present. Dhakki, Muzawati, Aseel, and Karbalaen were the most important commercial cultivars grown in the provinces of KPK, Baluchistan, and Sindh. Aseel, Karoch, Haleni, Karbalaen, and Muzawati cultivars had the most firm fruit and good total soluble sugar, calcium and magnesium contents. The amount of magnesium found in dates of studied cultivars ranged from 0.143 to 0.876 mg g-1. A great variation in frond morphology was recorded among the cultivars. Fruit length and fruit weight was highest in Dhakki date, making it visually more attractive for customers in addition to its good nutritional properties. The seed weight of the studied cultivars ranged from 0.7-2.0 g, while Desi dates had largest seed, making them less attractive for marketing. However, in terms of nutritional value and fruit size, most of the investigated varieties can compete with globally important commercial dates.

Condiciones de trabajo, salud y seguridad en el trabajo de la población del sector salud de una IPS de nivel I y II de complejidad en Yopal Casanare, 2014

Introducción Dentro de los factores más comunes que influyen en la causa de accidentes o enfermedades laborales están el de riesgo biomecánico los cuales pueden desencadenar trastornos musculo esqueléticos generados por la repetición excesiva de movimientos, posturas forzadas y levantar objetos pesados. Otros posibles factores de riesgo son de origen físico, psicológico o personal. Estos factores pueden relacionarse entre sí y su influencia también puede estar mediada por factores culturales o sociales. Objetivo Determinar las condiciones laborales, de salud y seguridad en el trabajo de la población asistencial y administrativa de una IPS en la ciudad de Yopal Casanare. Método Se realizó un estudio de corte transversal en 88 trabajadores del equipo de salud tanto asistencial y administrativo de I y II nivel de complejidad. Se aplicó el instrumento Cuestionario Nórdico de seguridad y el de condiciones de trabajo y salud. Resultados En este estudio se encontró una participación mayor del género femenino con un 88,6%. La percepción de la estabilidad laboral fue alta en un 60,2%, media en un 37,5% y baja en el 2,3% de los trabajadores. En cuanto a la posición habitual de trabajo, se encontró que el 41% de los trabajadores del nivel asistencial debe trabajar de pie mientras que en los niveles administrativo y directivo la posición de trabajo habitual es sentada, con un 51,9% y un 66,7% respectivamente. Respecto a la realización de movimientos repetitivos se presentan en el nivel asistencial con un 34,5% y en el nivel directivo con un 50%. En las condiciones de salud, predomina el dolor en los miembros superiores e inferiores siendo el más reportado el dolor de muñeca tanto en el área administrativa como en la asistencial. En la percepción de seguridad frente al trabajo, se encontró que el 38% consideran los accidentes menores como parte normal del trabajo diario, en el nivel administrativo el 74% acepta correr riesgos incluso cuando los tiempos de trabajo son ajustados. Conclusión Las condiciones de seguridad y salud de los trabajadores evaluados se caracterizaron por sobre carga laboral, autonomía en el trabajo y la concientización de la importancia de la seguridad en el área de trabajo. Un lugar de trabajo que los empleados toleran y disfrutan puede fomentar la motivación laboral y ofrecer mejores resultados. Sin embargo, las malas condiciones en el lugar de trabajo, pueden afectar el rendimiento y la productividad de los empleados.

Incorporation of lead into calcium carbonate granules secreted by earthworms living in lead contaminated soils

The influence of soil organisms on metal mobility and bioavailability in soils is not currently fully understood. We conducted experiments to determine whether calcium carbonate granules secreted by the earthworm Lumbricus terrestris could incorporate and immobilise lead in lead- and calcium- amended artificial soils. Soil lead concentrations were up to 2000 mg kg-1 and lead:calcium ratios by mass were 0.5-8. Average granule production rates of 0.39 + 0.04 mgcalcite earthworm-1 day-1 did not vary with soil lead concentration. The lead:calcium ratio in granules increased significantly with that of the soil (r2 = 0.81, p = 0.015) with lead concentrations in granules reaching 1577 mg kg-1. X-ray diffraction detected calcite and aragonite in the granules with indications that lead was incorporated into the calcite at the surface of the granules. In addition to the presence of calcite and aragonite X-ray absorption spectroscopy indicated that lead was present in the granules mainly as complexes sorbed to the surface but with traces of lead-bearing calcite and cerussite. The impact that lead-incorporation into earthworm calcite granules has on lead mobility at lead-contaminated sites will depend on the fraction of total soil lead that would be otherwise mobile.

Mobility based energy efficient and multi-sink algorithms for consumer home networks

With the fast development of the Internet, wireless communications and semiconductor devices, home networking has received significant attention. Consumer products can collect and transmit various types of data in the home environment. Typical consumer sensors are often equipped with tiny, irreplaceable batteries and it therefore of the utmost importance to design energy efficient algorithms to prolong the home network lifetime and reduce devices going to landfill. Sink mobility is an important technique to improve home network performance including energy consumption, lifetime and end-to-end delay. Also, it can largely mitigate the hot spots near the sink node. The selection of optimal moving trajectory for sink node(s) is an NP-hard problem jointly optimizing routing algorithms with the mobile sink moving strategy is a significant and challenging research issue. The influence of multiple static sink nodes on energy consumption under different scale networks is first studied and an Energy-efficient Multi-sink Clustering Algorithm (EMCA) is proposed and tested. Then, the influence of mobile sink velocity, position and number on network performance is studied and a Mobile-sink based Energy-efficient Clustering Algorithm (MECA) is proposed. Simulation results validate the performance of the proposed two algorithms which can be deployed in a consumer home network environment.

Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings

Objective: Fecal loading, cognitive impairment, loose stools, functional disability, comorbidity and anorectal incontinence are recognized as factors contributing to loss of fecal continence in older adults. The objective of this project was to assess the relative distribution of these factors in a variety of settings along with the outcome of usual management. Methods: One hundred and twenty adults aged 65 years and over with fecal incontinence recruited by convenience sampling from four different settings were studied. They were either living at home or in a nursing home or receiving care on an acute or rehabilitation elderly care ward. A structured questionnaire was used to elicit which factors associated with fecal incontinence were present from subjects who had given written informed consent or for whom assent for inclusion in the study had been obtained. Results: Fecal loading (Homes 6 [20%]; Acute care wards 17 [57%]; Rehabilitation wards 19 [63%]; Nursing homes 21 [70%]) and functional disability (Homes 5 [17%]; Acute care wards 25 [83%]; Rehabilitation wards 25 [83%]; Nursing homes 20 [67%]) were significantly more prevalent in the hospital and nursing home settings than in those living at home (P < 0.01). Loose stools were more prevalent in the hospital setting than in the other settings (Homes 11 [37%]; Acute care wards 20 [67%]; Rehabilitation wards 17 [57%]; Nursing homes 6 [20%]) (P < 0.01). Cognitive impairment was significantly more common in the nursing home than in the other settings (Nursing homes 26 [87%], Homes 5 [17%], Acute care wards 13 [43%], Rehabilitation wards 14 [47%]) (P < 0.01). Loose stools were the most prevalent factor present at baseline in 13 of the 19 (68%) subjects whose fecal incontinence had resolved at 3 months. Conclusion: The distribution of the factors contributing to fecal incontinence in older people living at home differs from those cared for in nursing home and hospital wards settings. These differences need to be borne in mind when assessing people in different settings. Management appears to result in a cure for those who are not significantly disabled with loose stools as a cause for their fecal incontinence, but this would need to be confirmed by further research.

Could in-home sensors surpass human observation of people with Parkinson’s at high risk of falling? An ethnographic study

Self-report underpins our understanding of falls among people with Parkinson’s (PwP) as they largely happen unwitnessed at home. In this qualitative study, we used an ethnographic approach to investigate which in-home sensors, in which locations, could gather useful data about fall risk. Over six weeks, we observed five independently mobile PwP at high risk of falling, at home. We made field notes about falls (prior events and concerns) and recorded movement with video, Kinect, and wearable sensors. The three women and two men (aged 71 to 79 years) having moderate or severe Parkinson’s were dependent on others and highly sedentary. We most commonly noted balance protection, loss, and restoration during chair transfers, walks across open spaces and through gaps, turns, steps up and down, and tasks in standing (all evident walking between chair and stairs, e.g.). Our unobtrusive sensors were acceptable to participants: they could detect instability during everyday activity at home and potentially guide intervention. Monitoring the route between chair and stairs is likely to give information without invading the privacy of people at high risk of falling, with very limited mobility, who spend most of the day in their sitting rooms.

A home environment test battery for status assessment in patients with motor fluctuations

Background and aims Evaluating status in patients with motor fluctuations is complex and occasional observations/measurements do not give an adequate picture as to the time spent in different states. We developed a test battery to assess advanced Parkinson patients' status consisting of diary assessments and motor tests. This battery was constructed and implemented on a handheld computer with built-in mobile communication. In fluctuating patients, it should typically be used several times daily in the home environment, over periods of about one week. The aim of this battery is to provide status information in order to evaluate treatment effects in clinical practice and research, follow up treatments and disease progression and predict outcome to optimize treatment strategy. Methods Selection of diary questions was based on a previous study with Duodopa® (DIREQT). Tapping tests (with and without visual cueing) and a spiral drawing test were added. Rapid prototyping was used in development of the user interface. An evaluation with two pilot patients was performed before and after receiving new treatments for advanced disease (one received Duodopa® and one received DBS). Speed and proportion missed taps were calculated for the tapping tests and entropy of the radial drawing velocity was calculated for the spiral tests. Test variables were evaluated using non-parametric statistics. Results Post-treatment improvement was detected in both patients in many of the test variables. Conclusions Although validation work remains, preliminary results are promising and the test battery is currently being evaluated in a long-term health economics study with Duodopa® (DAPHNE).

A web application for follow-up of results from a mobile device test battery for parkinson’s disease patients

Background: A test battery consisting of self-assessments and motor tests (tapping and spiral drawing) was developed for a hand computer with touch screen in a telemedicine setting. Objectives: To develop and evaluate a web-based system that delivers decision support information to the treating clinical staff for assessing PD symptoms in their patients based on the test battery data. Methods: The test battery is currently being used in a clinical trial (DAPHNE, EudraCT No. 2005-002654-21) by sixty five patients with advanced Parkinson’s disease (PD) on 9991 test occasions (four tests per day during in all 362 week-long test periods) at nine clinics around Sweden. Test results are sent continuously from the hand unit over a mobile net to a central computer and processed with statistical methods. They are summarized into scores for different dimensions of the symptom state and an ‘overall test score’ reflecting the overall condition of the patient during a test period. The information in the web application is organized and presented graphically in a way that the general overview of the patient performance per test period is emphasized. Focus is on the overall test score, symptom dimensions and daily summaries. In a recent preliminary user evaluation, the web application was demonstrated to the fifteen study nurses who had used the test battery in the clinical trial. At least one patient per clinic was shown. Results: In general, the responses from nurses were positive. They claimed that the test results shown in the system were consistent with their own clinical observations. They could follow complications, changes and trends within their patients. Discussion: In conclusion, the system is able to summarise the various time series of motor test results and self-assessments during test periods and present them in a useful manner. Its main contribution is a novel and reliable way to capture and easily access symptom information from patients’ home environment. The convenient access to current symptom profile as well as symptom history provides a basis for individualized evaluation and adjustment of treatments.

Mobile systems for monitoring Parkinson's disease

A challenge for the clinical management of Parkinson's disease (PD) is the large within- and between-patient variability in symptom profiles as well as the emergence of motor complications which represent a significant source of disability in patients. This thesis deals with the development and evaluation of methods and systems for supporting the management of PD by using repeated measures, consisting of subjective assessments of symptoms and objective assessments of motor function through fine motor tests (spirography and tapping), collected by means of a telemetry touch screen device. One aim of the thesis was to develop methods for objective quantification and analysis of the severity of motor impairments being represented in spiral drawings and tapping results. This was accomplished by first quantifying the digitized movement data with time series analysis and then using them in data-driven modelling for automating the process of assessment of symptom severity. The objective measures were then analysed with respect to subjective assessments of motor conditions. Another aim was to develop a method for providing comparable information content as clinical rating scales by combining subjective and objective measures into composite scores, using time series analysis and data-driven methods. The scores represent six symptom dimensions and an overall test score for reflecting the global health condition of the patient. In addition, the thesis presents the development of a web-based system for providing a visual representation of symptoms over time allowing clinicians to remotely monitor the symptom profiles of their patients. The quality of the methods was assessed by reporting different metrics of validity, reliability and sensitivity to treatment interventions and natural PD progression over time. Results from two studies demonstrated that the methods developed for the fine motor tests had good metrics indicating that they are appropriate to quantitatively and objectively assess the severity of motor impairments of PD patients. The fine motor tests captured different symptoms; spiral drawing impairment and tapping accuracy related to dyskinesias (involuntary movements) whereas tapping speed related to bradykinesia (slowness of movements). A longitudinal data analysis indicated that the six symptom dimensions and the overall test score contained important elements of information of the clinical scales and can be used to measure effects of PD treatment interventions and disease progression. A usability evaluation of the web-based system showed that the information presented in the system was comparable to qualitative clinical observations and the system was recognized as a tool that will assist in the management of patients.

Tha contribution of home-based technology to older people's quality of life in extra care housing

Background: British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH).  Methods: A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used.  Results: Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19].  Conclusions: The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.