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Pharmaceuticals and personal care products (PPCPs) are detected routinely in raw and treated municipal wastewater. Conventional wastewater treatment processes are not effective in removing PPCP; therefore, treated wastewater discharges are one of the main entry points for PPCPs into the aquatic environment, and eventually into drinking water supplies. The use of laccase-catalyzed oxidation for removing low concentrations of PPCPs from municipal wastewater after primary treatment is investigated. Oxybenzone was selected as a representative PPCP. Like many other PPCPs, oxybenzone is not recognized directly by the laccase enzyme. Therefore, mediators were used to expand the oxidative range of laccase, and the efficacy of this laccase-mediator system in primary effluent was evaluated. Eight potential mediators were investigated. The greatest oxybenzone removal efficiencies were observed when 2,2’-azino-bis(3-ethylbenzthiazoline-6sulphonic acid) (ABTS), a synthetic mediator, and acetosyringone (ACE), a natural mediator, were present. An environmentally relevant concentration of oxybenzone (10 µg/L) in primary effluent was removed below the detection limit after two hours of treatment with ABTS, and 95% was removed after two hours of treatment with ACE. Several mediator/oxybenzone molar ratios were evaluated at two different initial oxybenzone concentrations. Higher mediator/oxybenzone molar ratios were required at the lower (environmentally relevant) oxybenzone concentrations, and ACE required higher molar ratios than ABTS to achieve comparable oxybenzone removal. The oxidation mechanisms and kinetics of the ACE mediator was evaluated. A better understanding of the mediator oxidation process would lead to a better design of the laccase-mediator system. An alternative laccase-mediator treatment configuration, which allows the enzyme and mediator to react prior to coming in contact with the target PPCP, was investigated. This treatment configuration shows promise for further development since it might reduce laccase and mediator requirements. Oxidation byproducts generated by the laccase-mediator system were characterized and compared to those generated during ozonation. Enzymatic treatment generated byproducts with higher mass to charge (m/z) ratios, likely due to oxidative coupling reactions. The results of this study suggest that, with further development, a laccase-mediator system has the potential to extend the treatment range of laccase to PPCPs not directly recognized by the enzyme, even in a primary effluent matrix. / text

Personal care homes have become increasingly dependent on the employment of immigrant care workers. This qualitative study explored the high concentration of Filipino health care aides in personal care homes from their own perspectives, as well as that of policy stakeholders. In depth interviews were conducted with seven Filipino health care aides working in personal care homes in Winnipeg, Manitoba. Semi-structured interviews with policy stakeholders examined the policy context of the health care aide labour force. The study identified several factors that influenced the migration and employment of Filipino health care aides including: poverty and unemployment, migrant social networks, barriers in the labour market and financial incentives. The lack of regulations for health care aides sustained the flow of immigrant labour and enabled the expansion of social networks. Although their employment decisions were primarily based on financial need, health care aides valued their work and viewed themselves as critical care providers.

Falls among older adults (age 65 years and older) residing in personal care homes (PCHs) are an important health concern. Atypical antipsychotic drugs (AADs) have been shown to be associated with fall risk among older adults. However, previous studies face some methodological limitations that affect the quality, consistency, and comparability of these studies. Therefore, a population-based study was undertaken to examine the effect of AAD use on the risk of falling among older PCH residents. A nested case-control study was conducted using the administrative healthcare records and Minimum Data Set for PCHs (MDS) housed at the Manitoba Centre for Health Policy in the Faculty of Medicine, University of Manitoba. The study period was from April 1, 2005 to March 31, 2007. Cases (n=626) were fallers as recorded in MDS. Using incidence density sampling, each case was matched to four controls on length of PCH stay, age, and sex (n=2,388). Exposure to AADs was obtained from the Drug Program Information Network database. Conditional logistic regression was used to model the effects of AAD use on the risk of falling while accounting for matching and for confounding of other covariates. While the adjusted odds of falling was statistically greater for AAD users versus nonusers (adjusted odds ratio = 1.60, 95% CI 1.10-2.32), this association was type and dose dependent. Compared to nonusers, the odds of falling was greater for quetiapine users, regardless of this drug's dose, and high dose risperidone users. On the other hand, low dose risperidone and olanzapine, irrespective of drug dose, use was not associated with the risk of falling. Furthermore, the effect of AAD use, in general, on the risk of falling was significantly greater for people with wandering problems (adjusted odds ratio = 1.84, 95% CI 1.09-3.09). Despite some methodological limitations, this research has provided some unique findings that enhance our understanding of AAD use as a fall risk factor. Study findings allow policymakers to further develop evidence-based interventions specific to AADs in order to better manage falls in the PCH setting. However, a great deal of research is still needed to address other important unanswered questions.

Personal care homes have become increasingly dependent on the employment of immigrant care workers. This qualitative study explored the high concentration of Filipino health care aides in personal care homes from their own perspectives, as well as that of policy stakeholders. In depth interviews were conducted with seven Filipino health care aides working in personal care homes in Winnipeg, Manitoba. Semi-structured interviews with policy stakeholders examined the policy context of the health care aide labour force. The study identified several factors that influenced the migration and employment of Filipino health care aides including: poverty and unemployment, migrant social networks, barriers in the labour market and financial incentives. The lack of regulations for health care aides sustained the flow of immigrant labour and enabled the expansion of social networks. Although their employment decisions were primarily based on financial need, health care aides valued their work and viewed themselves as critical care providers.

Falls among older adults (age 65 years and older) residing in personal care homes (PCHs) are an important health concern. Atypical antipsychotic drugs (AADs) have been shown to be associated with fall risk among older adults. However, previous studies face some methodological limitations that affect the quality, consistency, and comparability of these studies. Therefore, a population-based study was undertaken to examine the effect of AAD use on the risk of falling among older PCH residents. A nested case-control study was conducted using the administrative healthcare records and Minimum Data Set for PCHs (MDS) housed at the Manitoba Centre for Health Policy in the Faculty of Medicine, University of Manitoba. The study period was from April 1, 2005 to March 31, 2007. Cases (n=626) were fallers as recorded in MDS. Using incidence density sampling, each case was matched to four controls on length of PCH stay, age, and sex (n=2,388). Exposure to AADs was obtained from the Drug Program Information Network database. Conditional logistic regression was used to model the effects of AAD use on the risk of falling while accounting for matching and for confounding of other covariates. While the adjusted odds of falling was statistically greater for AAD users versus nonusers (adjusted odds ratio = 1.60, 95% CI 1.10-2.32), this association was type and dose dependent. Compared to nonusers, the odds of falling was greater for quetiapine users, regardless of this drug's dose, and high dose risperidone users. On the other hand, low dose risperidone and olanzapine, irrespective of drug dose, use was not associated with the risk of falling. Furthermore, the effect of AAD use, in general, on the risk of falling was significantly greater for people with wandering problems (adjusted odds ratio = 1.84, 95% CI 1.09-3.09). Despite some methodological limitations, this research has provided some unique findings that enhance our understanding of AAD use as a fall risk factor. Study findings allow policymakers to further develop evidence-based interventions specific to AADs in order to better manage falls in the PCH setting. However, a great deal of research is still needed to address other important unanswered questions.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第19987号 / 工博第4231号 / 新制||工||1654(附属図書館) / 33083 / 京都大学大学院工学研究科都市環境工学専攻 / (主査)教授 伊藤 禎彦, 教授 田中 宏明, 准教授 西村 文武 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

This thesis is organized in “sandwich” format, as recommended by my supervisory committee. It consists of three main chapters. Chapter one is a general introduction and outlines the background information leading to the objectives and hypotheses of my thesis research. Chapter two is a manuscript prepared for submission to a peer-reviewed scientific journal. Chapter three is an overview of the major findings of this thesis, their implications in fish physiology and ecotoxicology, including suggestions of future directions of research. Appendix A contains data from an additional series of experiments that were conducted during my thesis but are not included as a full data chapter. It will be prepared for publication after my defence. / Hypoxia often occurs in aquatic ecosystems that receive effluent from municipal wastewater treatment plants (WWTP). WWTP effluent contains contaminants that could disrupt the complex physiological pathways fish use to cope with hypoxia (e.g., pharmaceuticals, polychlorinated biphenyls, and polycyclic aromatic hydrocarbons), but the effects of WWTP effluent on the physiological responses of fish to chronic hypoxia is poorly understood. We exposed mummichog killifish (Fundulus heteroclitus) to hypoxia (5 and 2 kPa O2) and/or WWTP effluent for 21 days in a full factorial design. We then measured hypoxia tolerance, whole-animal metabolism, gill morphology, haematology, and tissue metabolites. In clean water, killifish responded to chronic hypoxia with improvements in hypoxia tolerance – increases in time to loss of equilibrium at 0.5 kPa (tLOE) and decreases in critical O2 tension (Pcrit) – in association with increased gill surface area as a result of regression of the interlamellar cell mass (ILCM). Concurrent exposure to wastewater attenuated the increases in tLOE and gill remodeling in chronic hypoxia, and nearly depleted brain glycogen stores. Therefore, exposure to WWTP effluent can disrupt the physiological mechanisms fish use to cope with chronic hypoxia and impair hypoxia tolerance. My research suggests that the combination of stressors near WWTPs can have interactive effects on the physiology and health of fish. / Thesis / Master of Science (MSc) / Low oxygen conditions, known as ‘hypoxia’, frequently occur in aquatic ecosystems that receive municipal wastewater treatment plant (WWTP) effluent. WWTP effluent is a continuous and complex source of pollution, including contaminants that can disrupt fish physiology, affecting their ability to cope with stressors, like hypoxia. The effects of WWTP effluent on the responses of fish to chronic hypoxia are poorly understood. To address this research gap, I examined the effects of hypoxia and WWTP effluent on chronically exposed mummichog killifish. I provide evidence that combined exposure to hypoxia and wastewater affected hypoxia tolerance, gill structure, and depleted energy stores in the brain. My thesis demonstrates that WWTP effluent can disrupt mechanisms that fish use to cope with chronic hypoxia and impair hypoxia tolerance. These findings contribute to the existing body of work that documents the interactive effects of combined stressors in effluent-dominated ecosystems on the physiology and health of fish.

The kinetics, products, and reaction pathways of triclosan/free chlorine reactions were investigated for the pH range 3.5-11. Although pH dependent speciation occurs in both triclosan and free chlorine, only the reaction between HOCl and the phenolate-triclosan was found to play a significant role in the kinetics. The second order rate constant for the reaction between phenolate-triclosan and HOCl was found to be 5.40 (±1.82) Ã 103 M⁻¹s⁻¹. Three chlorinated triclosan intermediates were tentatively identified based on mass spectral analysis. Additionally, 2,4-dichlorophenol, 2,4,6-trichlorophenol, and chloroform formed under excess free chlorine conditions. The majority of the chloroform formed during the reactions does not form via 2,4-dichlorophenol and 2,4,6-trichlorophenol oxidation. Therefore, the majority of chloroform is likely formed via the oxidation of triclosan's phenolic ring. Based on the identified products, a reaction pathway was proposed for the oxidation of triclosan in the presence of free chlorine. / Master of Science

Home care is a vital component of the United States healthcare delivery system. The demand for home care has steadily increased over the past decade and it is projected that this increase will continue over the next several decades. Moreover, the utilization of Medicaid waiver home and community-based care services has expanded to provide an alternative to the more costly institutional placement. In order to meet this growing demand while maintaining the cost-savings, the system relies primarily on the minimally trained, healthcare paraprofessionals known as Personal Care Assistants (PCAs). The present study examined the career commitment and job satisfaction of PCAs who provide Medicaid waiver home and community-based care services and participated in a 40-hour training intervention. Specifically, the study evaluated differences in pre- and post-training levels of career commitment as measured by the Career Commitment Measure (CCM), in terms of overall career commitment and the three subscales: career identity, career planning, and career resilience; and job satisfaction as measured by the Minnesota Satisfaction Questionnaire (MSQ), in terms of overall job satisfaction and the two subscales: extrinsic job satisfaction and intrinsic job satisfaction, between age groups and groups based on extrinsic job satisfaction. Additionally, the study examined the interaction of age and extrinsic job satisfaction as a moderator on the influence of the training intervention to produce a change in career commitment and the three subscales of career commitment, career identity, career planning, and career resilience job satisfaction. The results of analyses were varied across groups and measures. Specifically, there were no statistically significant differences across age group in terms of changes in career commitment or job satisfaction as a consequence of the training; however, post-hoc examinations revealed statistically significant within group changes. A decrease in the overall, intrinsic, and extrinsic job satisfaction score from pre- to post-training for the 40-49 age group was found. Likewise, the 50-59 age group showed a statistically significant decrease in the extrinsic job satisfaction scores from pre- to post-training. The PCA’s level of extrinsic job satisfaction did have a statistically significant differential effect on changes in overall career commitment and career planning scores as a consequence of the training. The exploration of the interaction of age and extrinsic job satisfaction to influence changes in career commitment as a consequence of the training found statistically significant main effects with respect to levels of extrinsic job satisfaction for overall career commitment, career identity, career planning, and career resilience. However, no main effects for age and no interaction effects were obtained. These study findings have important implications for future research, and the development of training curricula and evaluation. Results provide critical information about this largely overlooked group of healthcare paraprofessionals, which have practical application in more effectively improving job satisfaction through training initiatives, thereby increasing the recruitment and retention of the paraprofessional healthcare workforce.