The purposes of this secondary study were to explore the case detection phenomena of elder abuse by determining the congruence between nurses' assessments of abuse and elders' self-reports of abuse; to identify factors that may account for differences between abusive situations and nonabusive situations; then to describe differences between abused elders correctly identified and abused elders incorrectly identified by nurses. Both quantitative and qualitative data were used. The theory of attribution directed this research. The conceptual framework consisted of four concepts: structural factors, relationship factors, elder factors, and caregiver factors. A descriptive-comparison design was used to address the research questions. The sample included 48 elder-caregiver dyads, of whom 24 were self-reported abused elders and 24 self-reported nonabused elders. Descriptive analysis was used, including chi-square and t-tests. Results indicated that the nurses' assessments of elder abuse and elders' self reports of abuse were congruent in only one-fifth (N = 5) of the abused cases (N = 24). The findings confirmed allegations that nurses have difficulty identifying elder abuse unless outright battering is observed. Five variables were significant between abused and nonabused elders, and 10 variables were significant between abused elders correctly identified by nurses and abused elders incorrectly identified by nurses.

No description available.

No description available.

No description available.

Background. Acquired long QT syndrome (aLQTS) is a reversible condition characterized by a pathological prolongation of the QT interval that can lead to a polymorphic ventricular tachycardia known as Torsades de Pointe and sudden cardiac death. Identifying the incidence, onset, and risk factors for aLQTS in intensive care init (ICU) populations has not been studied and may help clinicians develop safe monitoring guidelines to identify patients early preventing devastating outcomes. Objective. The objective of this study was to determine the frequency, temporal onset of occurrence, frequency of medications and host risk factors for aLQTS in an ICU. Method. In a retrospective chart review of 88 subjects, hourly electrocardiographic data collected in an ICU were analyzed for baseline, first long, longest, and final corrected QT intervals (QTc) using Bazett's formula. aLQTS was defined as a QTc interval ≥ 500 milliseconds (ms) or a change in QTc of ≥ 60 ms from baseline. Host risk factors were collected from the physician's dictated history and physicals and nursing admission databases. Names and timing of each medication administered were collected from the medication record. Results. aLQTS occurred in 52.3% of the ICU sample. All subjects positive for aLQTS (n=46) had a mean onset of 7.4 ± 9.4 hours from ICU admission. Subjects who developed aLQTS after ICU admission (n=32) had a mean onset of 10.6 ± 9.5 hours; 14 were positive on ICU admission. A statistically significant difference was noted in subjects receiving QT prolonging medications positive for aLQTS (63.5%, n=33) compared with subjects negative for aLQTS (36.5%, n=19), (X²[1] = 6.38, p = .012). Thirteen subjects (28.3%) developed aLQTS in the absence of a known QT interval prolonging medication. No host risk factors were found to have a significant difference between groups positive and negative for aLQTS. Conclusions. aLQTS was present in approximately one-half of the sample. Approximately a quarter of the subjects developed aLQTS in the absence of a known QT prolonging medication, indicating the importance of frequent QTc monitoring in all patients in ICUs. Larger studies to determine common host risk factors associated with aLQTS in ICU populations are warranted.

No description available.

No description available.

The documentation of Recreation Therapy and Leisure Opportunities in Long-term Care The Recreation Therapy discipline at Sunnybrook Health Sciences Centre (SHSC) has undergone a series of research initiatives to ensure a patient focused philosophy is integrated into their practice. The purpose of the study is the development of documentation procedures that will enable the recreation therapy practitioners to engage in authentic and professional documentation of the residents??? experiences in recreation therapy and leisure opportunities based on a patient focused philosophy. This research project followed an action research methodology and was guided by a hermeneutic framework adapted from Karkainen and Eriksson (2004). The recreation therapists at SHSC were involved in all aspects of the project as co-research participants. This project employed a variety data collection techniques including focus groups, a hermeneutic dialogue, self-reflective activities and active application sessions. The information collected through the various data collection phases in this project led to the creation of a new documentation framework and associated sample documentation, which allow for a more patient focused documentation process. A series of quality indicators were also developed in this project to help authentically express the experiences in leisure and recreation of the residents living at SHSC. This research project has added to the growing base of knowledge focused on the integration of a patient focused care philosophy into the recreation therapy practice at SHSC.

The thesis evaluates the benefit of allowing for long memory volatility dynamics in forecasts of the variance-covariance matrix for asset allocation. First, I compare the forecast performance of multivariate long memory conditional volatility models (the long memory EWMA, long memory EWMA-DCC, FIGARCH-DCC and Component GARCH-DCC models) with that of short memory conditional volatility models (the short memory EWMA and GARCH-DCC models), using the asset allocation framework of Engle and Colacito (2006). The research reports two main findings. First, for longer horizon forecasts, long memory volatility models generally produce forecasts of the covariance matrix that are statistically more accurate and informative, and economically more useful than those produced by short memory volatility models. Second, the two parsimonious long memory EWMA models outperform the other models – both short memory and long memory – in a majority of cases across all forecast horizons. These results apply to both low and high dimensional covariance matrices with both low and high correlation assets, and are robust to the choice of estimation window. The research then evaluates the application of multivariate long memory conditional volatility models in dynamic asset allocation, applying the volatility timing procedure of Fleming et al. (2001). The research consistently identifies the economic gains from incorporating long memory volatility dynamics in investment decisions. Investors are willing to pay to switch from the static to the dynamic strategies, and especially from the short memory volatility timing to the long memory volatility timing strategies across both short and long investment horizons. Among the long memory conditional volatility models, the two parsimonious long memory EWMA models, again, generally produce the most superior portfolios. When transaction costs are taken into account, the gains from the daily rebalanced dynamic portfolios deteriorate; however, it is still worth implementing the dynamic strategies at lower rebalancing frequencies. The results are robust to estimation error in expected returns, the choice of risk aversion coefficients and the use of a long-only constraint. To control for estimation error in forecasts of the long memory high dimensional covariance matrix, the research develops a dynamic long memory factor (the Orthogonal Factor Long Memory, or OFLM) model by embedding the univariate long memory EWMA model of Zumbach (2006) into an orthogonal factor structure. The factor-structured OFLM model is evaluated against the six above multivariate conditional volatility models in terms of forecast performance and economic benefits. The results suggest that the OFLM model generally produces impressive forecasts over both short and long forecast horizons. In the volatility timing framework, portfolios constructed with the OFLM model consistently dominate the static and other dynamic volatility timing portfolios in all rebalancing frequencies. Particularly, the outperformance of the factor-structured OFLM model to the fully estimated LM-EWMA model confirms the advantage of the factor structure in reducing estimation error. The factor structure also significantly reduces transaction costs, making the dynamic strategies more feasible in practice. The dynamic factor long memory volatility model also consistently produces more superior portfolios than those produced by the traditional unconditional factor and the dynamic factor short memory volatility models.

Abstract It is estimated that by 2038 over a million Canadians will be diagnosed with some form of dementia with nearly 443.000 living in long-term care facilities. Non-professional health care workers such as health care aides provide most of the direct care to these residents. The interaction skills of health care aides have a significant impact on the function, communication skills and wellbeing of residents with dementia. The purpose of this study using Strauss and Corbin’s mode of grounded theory was to develop a mid-range theory to describe and explain how health care aides perceive and understand residents with dementia and how this perception impacts the way they interact with these residents. The sample for this study was made up of 24 health care aides who worked with residents with dementia in personal care homes in Winnipeg. Data from audiotaped individual and group interviews were analyzed using grounded theory methodology: open, axial and selective coding. The central category was “The Resident being perceived as a Respected Person”. The resulting theory shows that when health care aides perceive the resident as a respected person with whom they have a relationship and as a care recipient with challenging behaviors, the health care aides use communication enhancement strategies and modify their caregiving to meet the resident’s unique physical and emotional needs and challenging behaviors. The interactions of these health care aides in this study were consistent with the principles of person-centered care and the literature about communication and dementia. The facilitators of this perception of the resident were primarily the personal characteristics of the health care aide and the inhibitors were the time constraints, workload, and lack of support of peers and supervisors. This theory has implications for the training and supervision of health care aides and the organizational structures in which they work. Key words: Health care aides; dementia; communication; long term care; personhood / May 2017