The mass media influences our worldviews and perceptions, especially of social problems and potential solutions. Importantly, media messages, especially when repeated over time and during a crisis (real or perceived), tend to influence future public policy. Consistent with other periods of crisis and uncertainty, the COVID-19 pandemicization has led to an increased consumption of and reliance on news for accurate information and guidance on what to do and how to act amidst changing public health regulations and social norms. While the aging demographic has made media headlines before the COVID-19 pandemic was declared, the death of nearly 4,000 long-term care facility patients in Ontario alone since March 2020, most of them older adults, has increased the salience of Long-Term Care in the news (television, radio, newspapers, and digital news platforms). In this regard, many claims have been made in the media regarding older adults and their care and safety. But how are the problems leading to mass deaths in LTCFs defined and subsequent solutions presented in the mass media? In order to answer this question, this research asks: how are aging, care, and safety constructed or portrayed in newspaper coverage of LTC in Ontario during the first eight months of the COVID-19 pandemicization? Moreover, what are the implications of these portrayals for an aging population whereby nearly all of us will either need assistance at some point in our lives, provide this assistance to others, or both? Newspaper articles in the National Post on the topic of LTC from March to November 2020 were reviewed using Critical Discourse Analysis. Findings indicate event bias in reporting, journalistic ignorance on the issues in LTC and for those confined therein, dehumanization of older adult subjects, and highly medicalized notions of care and safety. / Thesis / Master of Arts (MA) / The mass media influences our perceptions, especially of societal problems and potential solutions. Consistent with other periods of uncertainty, since the declaration of the COVID-19 pandemic, consumption of and reliance on news has increased among the public. Importantly, media messaging during a crisis often influences future public policy with the potential to further exacerbate the crisis. The death of nearly 4,000 long-term care facility patients in Ontario alone since March 2020, most of them older adults, has increased the salience of Long-Term Care in the news, but toward what end? In order to deconstruct media messages during this time of tremendous upheaval, this research asks: how are age(ing), care, and safety portrayed in newspaper coverage of LTC in Ontario during the first eight months of the COVID-19 pandemic? What are the consequences of these portrayals for an aging population whereby nearly all of us will either need assistance at some point in our lives, provide this assistance to others, or both?

Background: Canada has an aging population. With increased life expectancy, older adults become at higher risk of developing chronic disease. Therefore, the need and demand for long-term care (LTC) is expected to continue to increase. LTC homes provide 24-hour nursing care, personal care, and assistance with activities of daily living (Government of Ontario, 2014). Health information technology (IT) presents opportunities to support staff, residents, and their families in LTC environments. This has been particularly emphasized during the latest COVID19 pandemic in light of the challenges that have been observed in LTC homes (e.g., social isolation, limited integration of information, shortage of human resources etc.). Yet, LTC homes still lag significantly behind other areas in healthcare in relation to the adoption of health IT, and little information is available on the factors that affect the decision-making related to health IT solutions in these settings. Objectives and Research Question: This research aims to explore and examine the most relevant and important factors that managers consider when making decisions on the adoption of health IT in LTC homes. Therefore, the research question is: “What are the factors that affect and can inform the decision-making of managers in relation to health IT adoption in LTC homes?” Methods: This research uses an exploratory data-driven Delphi method that consists of a survey of a panel of 19 experts who are decision-makers in their respective LTC homes in Ontario. The Delphi survey is an exploratory approach that elicits the opinion of a panel of experts through iterative feedback consisting of three rounds (brainstorming, narrowing down, and ranking). In this research, the panelists were asked to identify and describe the most important and relevant factors that affect and inform their decision-making regarding health IT solutions in LTC. Then, they were asked to narrow down and rank the list, and a final coefficient of agreement was calculated based on their rankings. Results: The panelists were mostly female, 40-49 years old, and had an average of 9.7 years of experience in their current LTC organization. In addition, participants had an average of 10.5 years of experience in making decisions related to health IT adoption. In the brainstorming round, the panelists provided a total of 102 key factors, which were consolidated into a list of 27 items that varied across 5 general categories: availability of resources, social factors, organizational factors, regulatory requirements, and technical factors of the health IT solution. Fourteen panelists reported key factors related to the cost of technology and ease of use, which were the two key factors that were reported most often by participants. Two items were dropped from the list of key factors in the narrowing down round (i.e., comfort and social environment and vendor reputation) as only items with a rating of 5 out of 7 or greater were retained for the ranking round. In the ranking round, the consensus level was W=0.341. The top 5 factors that were identified and ranked by managers in LTC homes as important in influencing their decisions on the adoption of health IT were (in order of importance): availability of funding, impact on workload and efficiency, value proposition, ease of use, and impact on residents’ outcomes. Contributions: This Delphi survey provides an authoritative list of 25 key factors (and their description) that influence and affect managers’ decisions in LTC homes in relation to the adoption of health IT. This is a first step towards understanding what is happening in the LTC context in relation to health IT decision-making. From a LTC managers’ perspective, the findings provide benchmarking to understand what other LTC homes are doing and the factors that influence their decision-making on health IT solutions. Particular importance should be placed on the highly ranked factors, as they are identified as the factors that are most relevant and most important in facilitating or hindering the decision of LTC managers to adopt health IT solutions. In addition, the results of this thesis may help inform future planning and policies aimed at advancing the use of technology to support the care provided to older adults and the work of health care professionals in LTC. Future studies can use the results of this thesis to develop surveys that assess and monitor the evolution of these factors in broader and more representative samples of LTC managers.

京都大学 / 新制・論文博士 / 博士(社会健康医学) / 乙第13455号 / 論社医博第17号 / 新制||社医||11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 長尾 美紀, 教授 近藤 尚己, 教授 中川 一路 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

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Monitoring the accuracy of memory is an automatic but essential process of memory encoding and retrieval. Retrospective memory confidence judgments are making effective and efficient decisions based on one's memories. The neural processes involved in retrospective confidence ratings were investigated with EEG and fMRI using a recognition memory task designed such that participants also rated their confidence in their memory response. Correct trials (hits and correct rejections) were examined for differences related to the participants' level of confidence in their response. There were significant differences in electrophysiological activity (in the FN400 and the late parietal component) associated with confidence rating, with mean deflection increasing as confidence decreased. fMRI analysis revealed activity that appeared to be specific to the process of confidence rating. Activity was found to increase in the medial frontal, lateral frontal, and lateral parietal cortices as confidence decreases, but only for hits. In the lateral frontal, lateral parietal, and medial parietal cortices, activity decreased as confidence increased. These data indicate that there are neural mechanisms specifically related to making retrospective memory confidence judgments.

Learning and memory in the brain are thought to be dependent on synaptic plasticity. In response to sensory input, synapses can be strengthened or weakened, known as long-term potentiation or long-term depression (LTD), respectively. Transient receptor potential vanilloid 1 (TRPV1) has been shown to mediate a novel form of presynaptic LTD in hippocampal interneurons. TRPV1 is currently being heavily studied in the PNS and being targeted by pharmaceuticals for its anti-nociceptive and anti-inflammatory properties. However, much less is known regarding TRPV1 function in the CNS, including the signal mechanism mediating hippocampal LTD despite its obvious importance. Here we performed whole-cell voltage clamp electrophysiology experiments from CA1 hippocampal interneurons to identify this signaling mechanism. Because calcineurin (CaN) is reported to be linked to multiple forms of synaptic plasticity, we hypothesized that TRPV1 activates presynaptic CaN, which is required for this presynaptic LTD. In order to distinguish between presynaptic and postsynaptic CaN activity we added the specific CaN inhibitors cyclosporin A (CsA) or FK-506 to the bath to block CaN activity ubiquitously in the slice, both presynaptically and postsynaptically, and to the internal solution to block CaN only in the postsynaptic neuron. CsA or FK-506 present in the internal solution, blocking only postsynaptic CaN, showed no effect on TRPV1-dependant LTD. Bath application of CsA or FK-506, inhibiting CaN in the presynaptic neuron as well, blocked LTD elicited by both a high frequency stimulation protocol (P < 0.05) and by direct TRPV1 activation with specific agonists resiniferotoxin and capsaicin (P < 0.05). This demonstrates that CsA and FK506 block both high frequency stimulation induced LTD and also TRPV1 specific depression. We are thus able to show that calcineurin is required for this form of presynaptic TRPV1 mediated LTD in the hippocampus. This finding is the first to demonstrate a TRPV1-induced signaling mechanism in CA1 hippocampus.

Visual object tracking is the task of giving a unique ID to an object in a video frame, understanding whether it is present or not in a current frame and if it is present, precisely localizing its position. There are numerous challenges in object tracking, such as change of illumination, partial or full occlusion, change of target appearance, blurring caused by camera movement, presence of similar objects to the target, changes in video image quality through time, etc. Due to these challenges, traditional computer vision techniques cannot perform high-quality tracking, especially for long-term tracking. Almost all the state-of-the-art methods in object tracking use artificial intelligence nowadays, and more specifically, Convolutional Neural Networks. In this work, we present a Siamese based tracker which is different from previous works in two ways. Firstly, most of the Siamese based trackers takes the target in the first frame as the ground truth. Despite the success of such methods in previous years, it does not guarantee robust tracking as it cannot handle many of the challenges causing change in target appearance, such as blurring caused by camera movement, occlusion, pose variation, etc. In this work, while keeping the first frame as a template, we add five other additional templates that are dynamically updated and replaced considering target classification score in different frames. Diversity, similarity and recency are criteria to choose the members of the bag. We call it as a bag of dynamic templates. Secondly, many Siamese based trackers are vulnerable to mistakenly tracking another similar looking object instead of the intended target. Many researchers proposed computationally expensive approaches, such as tracking all the distractors and the given target and discriminate them in every frame. In this work, we propose an approach to handle this issue by estimate the next frame position by using the target's bounding box coordinates in previous frames. We use temporal network with past history of several previous frames, measure classification scores of candidates considering templates in the bag of dynamic templates and use tracker sequential confidence value which shows how confident the tracker has been in previous frames. We call it as robustifier that prevents the tracker from continuously switching between the target and possible distractors with this hypothesis in mind. Extensive experiments on OTB 50, OTB 100 and UAV20L datasets demonstrate the superiority of our work over the state-of-the-art methods.

Healthcare managers face an incredible challenge today; understanding and implementing financially and economically sound decisions in the complex healthcare environment of the United States. The pressure to be profitable managers is greater than ever. Considering current research, past studies, and articles focused on the demands of healthcare managers will illuminate the state of health care administration, and the importance of real world application of accounting and economics in healthcare. This thesis will explore and examine research about industry standards, and the need for preparedness in healthcare finance management. It will also examine the important and complex role of accounting and economics in healthcare administration by answering the three following questions: What do administrators, according to studies and literature available, believe is essential to becoming and remaining effective managers? What financial and economic concepts are understood and implemented by healthcare managers? What changes, if any, are necessary to adequately train and educate future healthcare administrators for successful financial management? The answers to these questions will highlight the impact of the economic, political, and social changes on administrators, as well as the best ways to succeed despite the difficulties often faced by those in this field.

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