Past research advocates the need for long-term care (LTC) facilities to adopt a person-centred model of care to optimize residents quality of life. The construct of quality of life in LTC has been defined by satisfaction with a set of domains identified by Kane and colleagues (2003). One goal of this study was to determine which domain is the most predictive of overall well-being among LTC residents in a rural setting. Based on past research and on Deci and Ryans (1985; 1991) self-determination theory, satisfaction with autonomy was predicted to emerge as most predictive of overall well-being. The present study also examined the relation between resident quality of life and well-being, and the degree of routinization (i.e., adherence to a rigid, inflexible daily schedule) within the LTC environment. Routinization is conceptually at odds with a person-centred model of care, yet its relation to the well-being of care recipients had not been examined prior. One hundred and ninety-eight residents from 15 LTC facilities in rural Saskatchewan participated in individual interviews to measure their satisfaction with 11 quality of life domains (Kane et al., 2003), and their overall well-being (using the Memorial University of Newfoundland Scale of Happiness; MUNSH; Kozma & Stones, 1980). One hundred and thirty-one staff from the 15 facilities completed a questionnaire designed to assess routinization within the LTC environment. Contrary to predictions, autonomy failed to emerge as a significant predictor of overall well-being among sample residents. The domain of meaningful activity received residents lowest satisfaction rating of the 11 domains, and also accounted for the most unique variance in overall well-being. Routinization was negatively related to resident quality of life, with staff rating routinization higher in facilities which residents reported lower satisfaction with quality of life. Results provide focus for improving the quality of life of LTC residents, and point to areas for further study.

Oral health has dramatically improved in most industrialized countries over the latter half of the 20th century. However, profound oral health disparities still exist especially for those most at risk of developing oral diseases and associated systemic consequences such as populations residing in long-term care facilities. Despite the growing body of literature that supports the link between oral microflora and the importance of oral hygiene in limiting the risk of pneumonia development, there are still gaps in our knowledge to effectively manage this risk. The research included in this dissertation sought to further our understanding of oral health and oral care in the context of pneumonia pathogenesis (chapter 3) and, by exploring the perspective of various stakeholders in oral health, we sought to further understand the factors that influence care provision (chapter 5). Additionally, a novel knowledge translation approach was tested to challenge traditional oral care interventions in order to promote improvements in front-line oral care practices (chapter 6). The relationship between oral microflora, oral care and pneumonia was found to be complex. It directs us to consider converging risk factors including a patient’s health status, health behaviours and access to oral care services. Different professional groups were found to possess different definitions of oral health, which influenced both their motivation to provide care as well as their focus of care. Definitions of oral health could also potentially influence the saliency of different types of oral care information to different targeted groups; therefore, this should be considered in developing education and training initiatives aimed at improving the provision of oral care. An appreciative knowledge translation approach was found to be effective in bridging the gap between oral care knowledge and the provision of care. Regardless of the type of intervention chosen, organizations were reported to play a crucial role in promoting oral health and supporting the successful implementation of oral care programs.

Objective: To assess the efficacy of personal support worker (PSW) mouth care education to improve the oral health of residents of long term care homes. Methodology: Experimental PSWs received mouth care education at baseline before taking the knowledge test. PSWs‟ mouth care knowledge was measured using a 20-item knowledge test at baseline, post-test (supervised); 6-months (un-supervised). Residents‟ oral health outcomes assessed at baseline and 6-months using the modified Plaque Index and modified Gingival Index. Results: Experimental PSWs‟ post-test knowledge (n=32;M=17.59;SD=1.43) significantly increased from pre-test (M=15.34;SD=2.10), F(2,72)=4.90;p<.05. 39 control residents and 41 experimental residents participated. Experimental residents‟ PI significantly decreased at 6-months compared to baseline, F(1,156)=5.52;p<.05, there was no significant difference in their GI between baseline and 6-months, F(1,156)=3.29;p=.07. Conclusion: PSWs‟ mouth care knowledge significantly increased after receiving mouth care education and was sustained over six months. Only experimental residents‟ PI significantly improved after 6 months.

Objective: To assess the efficacy of personal support worker (PSW) mouth care education to improve the oral health of residents of long term care homes. Methodology: Experimental PSWs received mouth care education at baseline before taking the knowledge test. PSWs‟ mouth care knowledge was measured using a 20-item knowledge test at baseline, post-test (supervised); 6-months (un-supervised). Residents‟ oral health outcomes assessed at baseline and 6-months using the modified Plaque Index and modified Gingival Index. Results: Experimental PSWs‟ post-test knowledge (n=32;M=17.59;SD=1.43) significantly increased from pre-test (M=15.34;SD=2.10), F(2,72)=4.90;p<.05. 39 control residents and 41 experimental residents participated. Experimental residents‟ PI significantly decreased at 6-months compared to baseline, F(1,156)=5.52;p<.05, there was no significant difference in their GI between baseline and 6-months, F(1,156)=3.29;p=.07. Conclusion: PSWs‟ mouth care knowledge significantly increased after receiving mouth care education and was sustained over six months. Only experimental residents‟ PI significantly improved after 6 months.

This study uses a grounded theory approach (Charmaz, 2006) in a small case study to examine if drama as praxis influences long-term care residents when presented as a recreational activity. When used as “praxis” (Taylor, 2000), drama focuses solely on the learning and personal growth of the participants. The growth of long-term care underscores the value of recreational programming for quality of life in these institutions; drama as praxis has not been widely used in this context. Elements of the literature review were used to identify areas where dramatic activities have demonstrated influence in educational contexts: • Engagement / Participation • Self-Confidence / Sense of Efficacy • Social Skills / Empathy • Creativity / Imagination • Cognitive Skill Development / Understanding These became sensitizing concepts for the creation of “drama as praxis” activities, presented in six sessions to a small group of residents at a long-term care residence in the Toronto area. Data collection was based on the researcher’s observations and participant interviews. Drama was found to have a recreational benefit impacting quality of life, with Engagement, Social Skills,, and Self-Confidence, the predominant benefits observed. Creativity and Cognitive Skill Development were less frequent. A Theory of the Recreational Benefit of Drama as Praxis was then developed to help the researcher understand why these benefits might be caused by drama. Based on theoretical sampling from recent research in gerontology and brain science, the theory highlights four beneficial components of drama as praxis: 1. Kinesthetics – Fosters engagement and memory retrieval 2. Play and Endorphinal Release – Triggers cognitive work without fear or fatigue 3. Imagination and Perspective-taking – Helps individuals retrieve emotional memories, develop different perspectives, and joyfully create 4. Narrative - Helps participants access and process events in their lives, past and present The study ends with a discussion of possible implications for the use of drama in long-term care but emphasizes that, due to the size of the sample, the results of the research cannot necessarily be assumed to apply in other contexts. Suggestions for further research are made that might address this and help to clarify the findings of the study.

Oral health has dramatically improved in most industrialized countries over the latter half of the 20th century. However, profound oral health disparities still exist especially for those most at risk of developing oral diseases and associated systemic consequences such as populations residing in long-term care facilities. Despite the growing body of literature that supports the link between oral microflora and the importance of oral hygiene in limiting the risk of pneumonia development, there are still gaps in our knowledge to effectively manage this risk. The research included in this dissertation sought to further our understanding of oral health and oral care in the context of pneumonia pathogenesis (chapter 3) and, by exploring the perspective of various stakeholders in oral health, we sought to further understand the factors that influence care provision (chapter 5). Additionally, a novel knowledge translation approach was tested to challenge traditional oral care interventions in order to promote improvements in front-line oral care practices (chapter 6). The relationship between oral microflora, oral care and pneumonia was found to be complex. It directs us to consider converging risk factors including a patient’s health status, health behaviours and access to oral care services. Different professional groups were found to possess different definitions of oral health, which influenced both their motivation to provide care as well as their focus of care. Definitions of oral health could also potentially influence the saliency of different types of oral care information to different targeted groups; therefore, this should be considered in developing education and training initiatives aimed at improving the provision of oral care. An appreciative knowledge translation approach was found to be effective in bridging the gap between oral care knowledge and the provision of care. Regardless of the type of intervention chosen, organizations were reported to play a crucial role in promoting oral health and supporting the successful implementation of oral care programs.

This study uses a grounded theory approach (Charmaz, 2006) in a small case study to examine if drama as praxis influences long-term care residents when presented as a recreational activity. When used as “praxis” (Taylor, 2000), drama focuses solely on the learning and personal growth of the participants. The growth of long-term care underscores the value of recreational programming for quality of life in these institutions; drama as praxis has not been widely used in this context. Elements of the literature review were used to identify areas where dramatic activities have demonstrated influence in educational contexts: • Engagement / Participation • Self-Confidence / Sense of Efficacy • Social Skills / Empathy • Creativity / Imagination • Cognitive Skill Development / Understanding These became sensitizing concepts for the creation of “drama as praxis” activities, presented in six sessions to a small group of residents at a long-term care residence in the Toronto area. Data collection was based on the researcher’s observations and participant interviews. Drama was found to have a recreational benefit impacting quality of life, with Engagement, Social Skills,, and Self-Confidence, the predominant benefits observed. Creativity and Cognitive Skill Development were less frequent. A Theory of the Recreational Benefit of Drama as Praxis was then developed to help the researcher understand why these benefits might be caused by drama. Based on theoretical sampling from recent research in gerontology and brain science, the theory highlights four beneficial components of drama as praxis: 1. Kinesthetics – Fosters engagement and memory retrieval 2. Play and Endorphinal Release – Triggers cognitive work without fear or fatigue 3. Imagination and Perspective-taking – Helps individuals retrieve emotional memories, develop different perspectives, and joyfully create 4. Narrative - Helps participants access and process events in their lives, past and present The study ends with a discussion of possible implications for the use of drama in long-term care but emphasizes that, due to the size of the sample, the results of the research cannot necessarily be assumed to apply in other contexts. Suggestions for further research are made that might address this and help to clarify the findings of the study.

Primary visual cortex is a classic model to study experience-dependent brain plasticity. In early life, if one eye is deprived of normal vision, there can be a dramatic change in the ocular dominance of the striate cortex such that the large majority of neurons lose responsiveness to the deprived eye and, consequently, the ocular dominance distribution shifts in favor of the open eye. Interestingly, the visual experience dependent plasticity following monocular deprivation (MD) occurs during a transient developmental period, which is called the critical period. MD hardly induces ocular dominance plasticity beyond critical period. The mechanisms underlying ocular dominance plasticity during the critical period are not fully understood. It has been proposed that long-term depression (LTD) may underlie the loss of cortical neuronal responsiveness to the deprived eye. However, discordant results have been reported in terms of the role of LTD and LTP in visual plasticity due to the lack of specific blockers. Here we report the prevention of the normally-occurring ocular dominance (OD) shift to the open eye following MD by using a specific long-term depression (LTD) blocking peptide derived from the GluR2 subunit of the a-amino-3-hydroxy-5-methyl-isoxazole-4-propionic acid receptor (AMPAR). We were able to prevent the shift of OD to the open eye with systemic or local administration of the GluR2 peptide. Both electrophysiological and anatomical approaches were taken to demonstrate the peptide effect. Moreover, enhancing LTD with D-serine, a NMDA receptor co-agonist, brought back the ocular dominance plasticity in adult mice subject to four-day MD and, therefore, reopened the critical period. Our data indicate that LTD plays an essential role in visual plasticity during the critical period and the developmental regulation of LTD may account for the closure of critical period in adult. In an additional study, we have found anisomycin, a protein synthesis inhibitor, produces a time-dependent decline in the magnitude of the field EPSP (fEPSP) in mouse primary visual cortex and that this anisomycin-mediated fEPSP depression occludes NMDA receptor dependent LTD. In contrast, another two protein synthesis inhibitors, emetine and cycloheximide, have no effect either on baseline synaptic transmission and or on LTD. We propose that anisomycin-LTD might be mediated by p38 MAP kinase since anisomycin is also a potent activator of the P38/JNK MAPK pathway. In agreement with notion, the decline of the fEPSP caused by anisomycin can be rescued by the application of the P38 inhibitor SB203580, but not by the JNK inhibitor SP600125. The occlusion of LFS-LTD by anisomycin-induced fEPSP decline suggests that common mechanisms may be shared between the two forms of synaptic depression. Consistent with this view, bath application of the membrane permeant peptide discussed above, which specifically blocks regulated AMPA receptor endocytosis, thereby preventing the expression of LFS-LTD, prior to anisomycin treatment significantly reduced the anisomycin-induced decline of the fEPSP. In conclusion, this study indicates that anisomycin produces long-lasting depression of AMPA receptor-mediated synaptic transmission by activating P38 MAPK-mediated endocytosis of AMPA receptors in neonatal mouse visual cortex.

Previous studies have suggested that iron PRBs, receiving high concentrations of inorganic constituents in groundwater, may experience passivation because of the accumulation of inorganic precipitates. In an iron PRB containing more highly reactive material, even though the initial contaminant removal rate is faster than for less reactive material, a faster migration of the contaminant removal front may occur due to the greater reactivity loss, caused by faster accumulation of secondary precipitates. In contrast, an iron PRB containing less reactive material may show a slower accumulation of precipitates, and thus will show a slower migration of the contaminant removal front over time. Thus, it is hypothesized that an iron material having moderate initial reactivity may be more advantageous than material having a higher reactivity in terms of long-term performance. The objective of this study was to test this hypothesis by evaluating the changes of the reactivities of different iron materials in the presence of dissolved CaCO₃. <br /><br /> Four different iron materials (Connelly, G-M, Ispat and Peerless) were selected for the column experiments. The changes in reactivities of the iron and formation of secondary precipitates over time were assessed, primarily by the iron corrosion rates, calculated from the hydrogen gas generation rates, by the cis-DCE removal rates and by the alkalinity profiles. The accumulation of precipitates in the four columns caused passivation of the iron. The passivation of the iron in turn resulted in migration of the mineral precipitation fronts as well as profiles of cis-DCE, TCE, VC, alkalinity, Eh, pH, and chloride. Connelly and G-M had longer periods of operation than Ispat and Peerless and thus their performance was the primary test of the hypothesis. G-M iron, which had the higher initial corrosion rate, compared to Connelly, showed a faster accumulation of precipitates near the influent end. The difference in accumulated precipitates resulted in a difference in the leading edge of the organic profiles and a significant difference in the pattern of passivation, indicating a faster passivation in the region near the influent end for G-M. <br /><br /> Model simulations were performed using the same fitting parameters but with different initial corrosion rate constants to further test the hypothesis. The model provided a reasonable representation of changing reactivities of the columns, being consistent with the observed data. In the simulation for long-term prediction, the cases of higher corrosion rates showed earlier breakthroughs and steeper curves than those of lower corrosion rates. Also, the predictions showed greater porosity loss for the case of higher corrosion rate. Thus, long-term predictions support the hypothesis. Accurate determination of model parameters such as cis-DCE degradation rate constants and iron corrosion rates are required for better predictions of long-term performance.

Direct care worker turnover and shortages plague long-term care, weakening its quality, heightening costs for governments and employers, and cyclically breeding further turnover and shortages of workers. To address these issues, I investigate why direct care workers chose employment in long-term care (LTC), assisted living (AL) and specific AL facilities. Data come from a mixed-methods study of 45 AL facilities in Georgia, including interviews with 400 direct care workers. Findings include qualitative data analyzed using a grounded theory approach and descriptive quantitative data. Care workers’ motivations for employment in LTC, AL, and specific AL facilities reflect a split between moral and material values for care work, and care workers’ motivations illustrate a process of reconciling moral and material values. Individuals become care workers for reasons that are both materialistic, like earning a living wage, and moralistic, like the desire to care for others. They take employment expecting it to be consistent with their moral ideals and to satisfy their economic needs. Various individual, facility, industry, and community level factors influence workers’ motivations, and these factors reinforce the inconsistency between moral and material values for care work. Considering the heightening demand for LTC and short supply of care workers, as well as the deindustrialization of the economy, several recommendations are made for policies and practices that would support workers’ motivations for employment in LTC. Areas for future research also are highlighted.