VictorJuiz/thesis huggingface dataset:
Rethinking the use of Evidence in Decisions to Scale up Healthcare Interventions
Keywords: Health Services Research
Qualitative Research
Scale up
Social Theory

Scaling up proven healthcare interventions is a common strategy for addressing global health system challenges. However, scale-up efforts have shown mixed results, with many interventions, shown to be effective at small scale, not moving beyond pilot projects. Though the use of scientific evidence has been promoted as playing a critical role in scaling up healthcare interventions, we currently have a limited understanding of how such evidence is understood and applied. Through this dissertation, I explore how different forms of evidence are applied to decision-making related to healthcare intervention scale-up, with a focus on the social, political, and structural factors that influence these practices. The aim is to inform and enhance current approaches to scale-up to better apply a range of scientific evidence. Two different methodological approaches inform this dissertation: a multiple qualitative case study of the evaluation and scale-up efforts of three healthcare intervention and a scoping review of frameworks or models providing actionable guidance for scale-up. I applied two separate analytical approaches to the case study data: 1) social theory informed thematic analysis, using elements of Bourdieu’s theory of practice as a theoretical lens, and 2) an interpretivist critical analytic approach to further explore how qualitative research is used in scale-up efforts. The findings demonstrate that there are gaps in the use of a range of evidence types in scale-up efforts, influenced, in part, by the prioritization of quantitative effectiveness data in the healthcare context and the challenges of incorporating different forms of evidence in practice. I suggest ways to address these gaps, such as better supports for qualitative and social scientists to engage in intervention evaluation and scale-up, broadening the scope of what is considered legitimate evidence, addressing limitations in funding programs to better incorporate different scientific approaches, and working towards a ground shift in terms of how we value, and reward, success and failure related to scale-up. These changes will better position our healthcare system to ensure that the most valuable and appropriate interventions are supported and scaled to meet the needs of the patients and the wider healthcare system.
Exotic Phenomena Emerging from Localized Multipolar Degrees of Freedom
Keywords: Conformal field theory
Hidden ordering
Kondo effect
Multipolar physics
Quantum spin ice
Unconventional superconductivity

The rich diversity of building blocks in condensed matter systems offers the opportunity for exotic macroscopic quantum phenomena. Multipolar moments, higher order generalizations of the familiar dipole, present a unique avenue for the discovery of a variety of exotic and novel phases of matter. These anisotropic charge and magnetization densities provide additional internal degrees of freedom for localized electrons, allowing an expansion of nature's microscopic toolbox.In this thesis, we examine the nature of emergent multipolar phases, and propose experimental protocols to detect their existence and properties. We first examine the multipolar Kondo effect, where conduction electrons equipped with spin and orbital degrees of freedom scatter off a quantum impurity that hosts electric quadrupolar and magnetic octupolar moments. Using renormalization group methods, we uncover a number of stable non-Fermi liquid ground states. We next examine the nature of these fixed points using boundary conformal field theory techniques, to provide a non-perturbative description of their transport and thermodynamic properties. We then consider the development of unconventional superconductivity mediated by multipolar Kondo interactions. Employing group theoretic methods, in partnership with mean-field theory, we characterize the higher-angular momentum nature of the superconducting pairing states with point nodal quasiparticle excitations. Finally, motivated by recent experiments on rare-earth metallic compounds and insulating pyrochlore oxides, we propose the implementation of lattice-based probes -- magnetostriction -- to unveil hidden multipolar orderings and multipolar-based quantum spin liquid states.
The State as Polluter Challenge in Climate Law
Keywords: Climate Law
Climate Litigation
State attribution
State immunity
State-owned enterprise

It is commonly assumed that private actors cause climate change. This assumption problematizes international environmental law and suggests that the conduct of private actors should be the principal focus of climate law. This thesis challenges the empirical predicate and legal implications of this common assumption. The assumption is empirically wrong because states-controlled polluters are responsible for much of the global greenhouse gas emissions. The assumption is also legally misleading because it obscures a state’s obligations under international climate change law. Acknowledging the state’s direct contributions to climate change and its attendant legal consequences justifies litigation against states and their entities, or ‘state as polluter’ litigation. The trajectory of state as polluter litigation, however, will be shaped by the law of state attribution and the law of state immunity. These jurisdictional hurdles limit the scope —but do not foreclose — the possibility of state as polluter litigation before international and foreign tribunals.
Person-centred Care Coordination in Ontario: A Multimethod Evaluation of Implementation and Impact
Keywords: Coordinated care
Evaluation
Experience of Care
Integrated Patient Care
Person-centred care

As the number of persons living with complex health and social care needs increases, healthcare systems are faced with the challenge of providing high quality care to these individuals. One approach utilized by many healthcare systems to achieve high quality care for persons living with complex health and social care needs is person-centred care coordination). A gap still exists in our knowledge on how to implement person-centred care coordination in ways that meet individual and family expectations and needs. In addition, more is to be learned about the care experiences of persons receiving person-centred care coordination and their family caregivers.The aim of this dissertation was to fill these gaps by evaluating Health Links by conducting three interconnected studies. In the first study of this dissertation, an implementation evaluation approach was utilized to assess the extent to which the implementation plans of person-centredness, and engagement were operationalized within Health Links. In the second and third studies an impact evaluation approach was employed to assess the care experiences of persons living with complex health and social care needs and their family caregivers after being enrolled in Health Links. In order to assess the care experiences comprehensively, multimethods were used. A patient experience survey was used in the second study and in-depth interviews with enrollees and their caregivers in the third study. The first study concluded that operationalization of implementation plans in network structures like Health Links was faced by numerous challenges. The second study found that the intended components of the Health Links approach (care plan and care coordinator) positively impacted the experience of the enrollees. However, issues with implementation of these components led to a negative care experience. The third study showed that despite being enrolled in an initiative that aimed at delivering person-centred care coordination, persons living with complex health and social care needs and their family caregivers were still shouldering the main burden of care coordination. The findings of the three studies can guide policy makers, planners, implementers, and evaluators on how to better plan, deliver and evaluate person-centred care coordination (integrated patient care) interventions.
Voice-in-the-World: An Exploration of Mid-Career Opera Singers’ Non-Musical Stressors and Coping Strategies
Keywords: coping
lived-experience
opera
performance
singers
stress

Singers are constantly balancing how they, as subjects, interact with objects in the world to create a consistent product (sound). But singers are also used as objects in the creation of someone else’s work by composers, directors, and companies, etc. This results in a highly unstable and unpredictable career that can upset the inner balance between coping and resilience. Using Interpretative Phenomenological Analysis (IPA), this thesis explores the lived experience of seven elite-level Canadian opera singers through in-depth narratives to discover these performers’ non-musical stressors and coping strategies. The four emergent stress themes (finances, expendability, peripatetic lifestyle, and fatigue) were all accentuated by feeling a lack of control, or lack of agency, and instability. Often, the coping strategies were obfuscated by stress and were in fact harder for the singers to discuss or identify. The three main coping strategies outlined—routines and consistency, emotional self-management, and support network and communication—reflected how the singers tried to create stability and control to find resilience and longevity in the opera business. This thesis ends by bringing awareness to the idea of creator mind versus the singing body—a dichotomy which, I argue, leads to the subjugation of opera singers. This study is not meant to produce definitive conclusions or solutions; rather it is meant to prompt a conversation by focusing on what Heidegger (1927/2010) would call a caring “attunement” towards a deeper understanding of what it is to be an opera singer in Canada.
Spaces of Unfreedom: Interior Immigration Detention and Carceral Immigration Enforcement in the US Pacific Northwest
Keywords: borders
carceral
detention
labor
migration
race

This thesis is a collection of four papers that analyze interior immigration detention and carceral immigration enforcement in the US Pacific Northwest. Together these papers elucidate how processes of bordering and carceral control overlap with one another in a particular conjuncture – the US Pacific Northwest during the years of the Trump White House. They explore the various and sometimes contradictory ways that interior immigration enforcement and detention in the US interior produce racialized human hierarchy, operate through economic relationships, and are subject to political struggle. This collection contains four major arguments, each one correlated with a different vantage point into carceral immigration enforcement. First, I argue that the spatio-temporal ordering of a specific detention center, the Northwest Detention Center in Tacoma, WA, intertwines logics of exclusion and dehumanization. I find patterns of inclusionary exclusion and exclusionary disposal, through which detention providers place responsibility for degradation, deportation, and even premature death, upon those in detention. Second, I analyze three overlapping economic logics that constitute the migrant detention system in the US Pacific Northwest: production, extraction and financialization. Through these logics, human needs of those who ICE detains are in turn smothered, exploited, and partially fulfilled. This can lead to contradictions that hinge upon the life, death, mental health, and subjectivity within the detention system. Third, I analyze the destabilizing impact of eliminatory carceral immigration enforcement in a rural Washington community in the Trump era. I argue that while immigration enforcement is a mode of controlling and devaluing migrant workers, this process is both geographically and historically contingent. Fourth, I analyze the political repression of migrant justice activists that struggled against carceral immigration enforcement during the Trump presidency. I argue that while this appears to be a new, vengeful pattern, it is part of a longer project of securing the smooth functioning of economic and racial social control in the US. The conclusion offers some reflection on developing an abolitionist politics that challenges the various social, economic and political relations that sustain carceral immigration enforcement in the US.
Exploring the Influence of the Dopamine D3 and Cannabinoid CB1 Receptors in Substance Use Disorders: A look into human drug reinforcement and cue-reactivity
Keywords: Alcohol use disorder
D3R
Dopamine
Nicotine

Introduction: There is a growing need for the better understanding of the neurobiology that underlies substance use disorder. The dopamine D3 receptor (DRD3) has received research attention recently due to its apparent involvement in alcohol use disorder (AUD) and tobacco use disorder (TUD). The current series of human laboratory experimentations aim to explore the role of DRD3 in both AUD and TUD using a variety of investigative techniques. The final study serves as a contrast that explores the cannabinoid CB1 (CB1R) receptor in TUD. Methods: Study 1 examines DRD3 levels between AUD subjects and healthy controls using positron emission tomography and a DRD3 preferring radiotracer, [11C]-(+)-PHNO. The relationship between [11C]-(+)-PHNO binding and AUD phenotypes, motivation to consume alcohol (measured by an intravenous self-administration procedure) and alcohol cue elicited craving (measured by cue-reactivity), is also explored in AUD subjects. Study 2 and 3 respectively investigate DRD3 and CB1R single nucleotide polymorphisms (SNPs) in phenotypes of TUD (both nicotine reinforcement [measured by forced choice] as well as craving [measured by cue-reactivity]). Results: In study 1, there was a global reduction of [11C]-(+)-PHNO binding, reflecting DRD2/3 levels, in AUD subjects compared to healthy. [11C]-(+)-PHNO binding in the limbic striatum was positively associated with alcohol cue-elicited craving, however this and no other association withstood Bonferroni corrections. In study 2, the Glycine allele carriers of the DRD3 Ser9Gly SNP experienced a blunted smoking cue-elicited craving, but the SNP showed no effect on nicotine reinforcement. On the other hand, in study 3, the C allele carriers of the rs2023239 CB1R SNP demonstrated lower relative nicotine reinforcement but this SNP did not affect cue-reactivity. Conclusion: Despite discrepant methods, these results seem to point to a potentially larger role of DRD3 in drug cue-associated craving compared to drug reinforcement as measured by these laboratory procedures. That said, understanding the neurobiological mechanisms underlying this relationship requires more research as the 2 studies point to different directions regarding the DRD3 and craving relationship. Therefore, further validation of the clinical utility of DRD3 as a potential drug target for substance use disorder pharmacotherapy is needed.
Cyanobacteria Monitoring and Cyanotoxin Management in Drinking Water Treatment Plants
Keywords: Advanced oxidation
Cyanobacteria
Drinking water treatment
Machine learning
Monitoring
Ultraviolet

This thesis examines three aspects of toxic cyanobacteria with respect to drinking water treatment plants: risk, monitoring, and treatment. Previous work shows that cyanobacteria cells can accumulate to high concentrations inside treatment plants, potentially rupture, and release their toxins. Therefore, accumulation in four Great Lakes region treatment plants was assessed, revealing that accumulation was generally minimal for plants experiencing low levels of cyanobacteria but could be significant for plants where cyanobacteria blooms occur in their source water. Drinking water utilities susceptible to harmful algal blooms need to be able to detect the onset of a bloom to implement management strategies. One way to monitor cyanobacterial activity is to use fluorescence-based probes that measure phycocyanin, a pigment specific to cyanobacteria. The conventional approach in the literature is to correlate phycocyanin fluorescence measurements to independent measures of cyanobacteria cell counts to use fluorescence to estimate the influx of cells, but most utilities do not measure cell counts, so this approach cannot be applied at all sites. This research explored machine learning for anomaly detection in phycocyanin fluorescence data without the need for corresponding cell counts. Two models were identified with an average accuracy of 86% to correctly predict elevated cyanobacterial activity in four data sites when trained on 2014-2018 data and tested on 2019 monitoring data. Therefore, this research has resulted in a potentially useful tool for drinking water utilities to use to improve their cyanobacteria monitoring strategies. When a utility is faced with cyanotoxins in their raw water, various treatment methods may be used to degrade them, each with its own advantages and limitations. Peracetic acid has recently emerged as a potential oxidant for water treatment, but its ability to degrade cyanotoxins has not been assessed with or without ultraviolet (UV) light for advanced oxidation. This research evaluates the degradation of two microcystins by UV only, peracetic acid only, and UV with peracetic acid. The results show that the combined process is as effective as or better than conventional advanced oxidation processes under typical water quality conditions. These findings support the potential future adoption of peracetic acid in water treatment plants.
Comparative Analysis of Chemical and Enzymatic Pathways to Improve Suitability of Industrial Lignins for Polyurethane Applications
Keywords: 31P NMR
hydroxyl
laccase
lignin
polyol
polyurethane

The utilization of all biorefinery products and by-products, including lignin, will be a game-changer to optimize the biorefinery concept and make corresponding processes economically viable. Softwood kraft lignin (SKL) is a significant bioresource that could play an essential role in achieving a sustainable bio-based economy. Due to existing aliphatic and phenolic hydroxyl groups in lignin, it could be used as biobased polyol for polyurethane (PU) application. PUs represent a large class of polymers with urethane repeating units produced by reacting polyols and diisocyanates. Major hurdles to the valorization of kraft lignins include high heterogeneity, inaccessibility of hydroxyl groups for reaction with isocyanates, and low solubility in most organic solvents. As such, technologies to enhance kraft lignin homogeneity are particularly crucial to unlocking its enormous potential and entirely replace petroleum-based polyol in PUs. To overcome the bottlenecks in valorization of SKL for applications beyond energy production, chemoenzymatic methods were established and compared to propel our knowledge of effective ways to tailor lignin structure for PU resin applications. The first method focused on fragmentation of lignin structures using ionic liquid 1-butyl-3-methylimidazolium [BMIM]Br treatment to gain access to the existing hydroxyl groups. However, the expected compositional changes were not detected on SKL (Indulin-AT) after IL treatment, as confirmed by phosphorus nuclear magnetic resonance spectroscopy (31P NMR) and gel permeation chromatography (GPC) analysis. The second method was a one-step acetone fractionation of LignoBoost SKL that resulted in acetone soluble and insoluble fractions, offering components suitable to entirely replace phenol and polyol in phenolic and PU resins, respectively, without the need for further chemical modification of the lignin structure. Additionally, the possibility of using a cellulose-derived solvent in PU formulation was successfully tested. Finally, to eliminate organic solvents and mimic the oxidation of lignin phenolic compounds in nature, an alkaline tolerant laccase was used to graft acrylate monomer onto LignoBoost SKL. Enzymatic grafting was confirmed by Fourier-transform infrared spectroscopy and 1H NMR techniques, and was shown to enhance the reactivity of lignin as a polyol substitute in PU resin applications. The reported enzymatic and aqueous process presents an opportunity for the sustainable valorization of SKL.
3D Antenna Placement for Cellular Communications
Keywords: 5G
Algorithms
Antenna Arrays
LTE
MIMO
Optimization

The evolution of wireless communications continues to be driven by the ever-increasing demand for higher capacity and throughput rates to enable new digital applications. While this demand creates bottlenecks across wireless systems, the limited availability of radiofrequency resources remains the most challenging of these bottlenecks. A key approach to circumventing limited spectrum availability employs antenna arrays to enable the transmission of higher data rates using high-gain beams using hybrid or phased-array MIMO antennas. Critical to the performance of antenna arrays is the placement and number of array elements, with most wireless systems employing a limited number of antenna elements arranged in a basic linear or two-dimensional geometry that limits the angular coverage of antenna elements. Nevertheless, such an approach for antenna element placement has limited scalability and thus fails to meet the needs of contemporary wireless communication systems. This thesis addresses this challenge by providing an effective and novel approach for antenna array structuring using Three-dimensional (3D) array structures. A detailed spatial and angular analysis of 3D antenna arrays is provided, and substantial gains are showcased for both single, MIMO and hybrid transmission setups. To maximize the performance of antenna arrays in general and 3D phased-MIMO transmission in particular, algorithms for the structuring of antenna arrays and selection of array elements being used for transmission/reception are introduced. Specifically, a distribution algorithm is introduced to distribute antenna elements in any defined space to maximize the achievable throughput rate along with a reduction algorithm to minimize energy consumption by utilizing the lowest possible number of available elements in any antenna array to achieve the required performance. Furthermore, the proposed approach and algorithms are shown to enable the optimization for substantial performance gains in various deployment setups of wireless cellular communication systems and paves the way for empowering various emerging applications such as various vehicular communication setups and deployments utilizing higher frequency bands.