VictorJuiz/thesis huggingface dataset:
A Qualitative Examination of Health Care Professionals' Experience as Patient Educators: Cases from Canadian Chiropractors
Keywords: patient education
doctor patient relationship
patient teaching
health care professionals responsibilities
health care professionals roles

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.
Exile in Homeric Epic
Keywords: Classics
Homer
Exile

This dissertation examines exile in Homeric epic and in particular the relationship between exile as a narrative motif and the thematic significance of exile in specific contexts. The Homeric exile motif is defined and found to include four stock elements involving the causes of exile, the role of compulsion in exile, the permanence of exile, and the possible outcomes of exile. The more thematic issues surrounding exile are also considered, especially in the light of ancient and modern theoretical discussions of exile. Three examples of exile in the Iliad and the Odyssey are then analyzed. In each case, close attention is paid to the way in which the exile narrative fits into the immediate context and is thematically relevant to it. The exile narrative delivered by Phoenix to Achilles in Iliad 9 is interpreted as an attempt to dissuade Achilles from carrying out his threat to abandon the expedition against Troy. More precisely, it is argued that Phoenix uses the parallels between his own exile and the situation facing Achilles to suggest that in abandoning the expedition Achilles would become something close to an exile himself, thereby compromising his heroic standing. It is argued that the ghost of the unburied Patroclus uses his exile narrative to Achilles in Iliad 23 to present his experience of death as a parallel to his experience of exile in life and does so in order to persuade Achilles to provide him with ‘hospitality’ in the form of burial, just as Achilles’ family provided Patroclus with hospitality as an exile. Finally, the false exile narrative delivered by Odysseus to Athena (disguised as a shepherd) in Odyssey 13 is interpreted as a reaction to Odysseus’ uncertainty as to whether or not he has reached Ithaca. It is argued that Odysseus uses his exile narrative to contrast the possibility that he is finally home with the possibility that he is still a nameless wanderer. The exile motif is found to be flexible enough to be adapted to the thematic requirements of the contexts in which these three exile narratives occur.
Tidal Dissipation in Extrasolar Planets
Keywords: tidal dissipation
inertial modes
close binaries
hot Jupiters
Rings of Saturn
pseudospectral method
Chebyshev expansion
astrophysics
dynamical tide
asteroseismology

Many known extra-solar giant planets lie close to their host stars. Around 60 have their semi-major axes smaller than 0.05 AU. In contrast to planets further out, the vast majority of these close-in planets have low eccentricity orbits. This suggests that their orbits have been circularized likely due to tidal dissipation inside the planets. These exoplanets share with our own Jupiter at least one trait in common: when they are subject to periodic tidal forcing, they behave like a lossy spring, with a tidal ``quality factor'', Q, of order 10^5. This parameter is the ratio between the energy in the tide and the energy dissipated per period. To explain this, a possible solution is resonantly forced internal oscillation. If the frequency of the tidal forcing happens to land on that of an internal eigenmode, this mode can be resonantly excited to a very large amplitude. The damping of such a mode inside the planet may explain the observed Q value. The only normal modes that fall in the frequency range of the tidal forcing (~ few days) are inertial modes, modes restored by the Coriolis force. We present a new numerical technique to solve for inertial modes in a convective, rotating sphere. This technique combines the use of an ellipsoidal coordinate system with a pseudo-spectral method to solve the partial differential equation that governs the inertial oscillations. We show that, this technique produces highly accurate solutions when the density profile is smooth. In particular, the lines of nodes are roughly parallel to the ellipsoidal coordinate axes. In particular, using these accurate solutions, we estimate the resultant tidal dissipation for giant planets, and find that turbulent dissipation of inertial modes in planets with smooth density profiles do not give rise to dissipation as strong as the one observed. We also study inertial modes in density profiles that exhibit discontinuities, as some recent models of Jupiter show. We found that, in this case, our method could not produce convergent solutions for the inertial modes. Additionally, we propose a way to observe inertial modes inside Saturn indirectly, by observing waves in its rings that may be excited by inertial modes inside Saturn.
Gait Asymmetry Post-stroke
Keywords: stroke
gait

This thesis examined post-stroke gait asymmetry: a prevalent issue and one that has a number of associated negative consequences (e.g. challenged balance control, gait inefficiencies, increased risk of musculoskeletal injury to the non-paretic limb and decreased overall activity levels). This thesis is comprised of three studies that focused on 1) how gait symmetry should be measured, 2) how gait asymmetry may change in the long term post-stroke and 3) whether gait asymmetry is responsive to a rehabilitation intervention. A comparison of the most common expressions of spatiotemporal gait symmetry revealed that the simple symmetry ratio calculation was most appropriate on the basis of ease of interpretation and clinical usefulness. Swing time, stance time and step length were found to be the most useful gait parameters to assess for symmetry. Although related, swing time, stance time and step length ratios exhibit variation in the discrimination of post-stroke individuals, in their inter-relationships and in their relationship velocity. When when used together, swing time, stance time and step length asymmetry ratios may provide a complementary picture of the gait pattern and the quality of gait control. It was also demonstrated that swing time and stance time asymmetry were worse in later stages post-stroke when assessed cross-sectionally. In contrast, gait velocity did not exhibit this pattern. These results indicate that the control of gait (symmetry) may decline over time post-stroke, independent from the capacity for gait which remains constant (velocity). This dissociation in characteristics supports the concept that these two variables (symmetry and velocity) may represent separate features of post-stroke gait. Finally, individuals with sub-acute stroke are capable of altering the temporal symmetry of their gait in response to visual biofeedback. Individuals with sub-acute stroke differ in terms of the strategy they employ in response to biofeedback and the observed improvements in gait symmetry were not always achieved in the desired manner: increased use of the paretic lower extremity. This thesis presents new information regarding the asymmetrical nature of post-stroke gait. Future work may extend these findings to develop a comprehensive approach to gait measurement as well as gait interventions that encourage increased paretic limb use instead of compensatory behaviour.
The Development of Elastomeric Biodegradable Polyurethane Scaffolds for Cardiac Tissue Engineering
Keywords: Biodegradable Polyurethanes
Cardiac Tissue Engineering
Matrix Metalloproteinases
Electrospinning
Embryonic Stem Cells
Cardiomyocytes
Fibroblasts
Fibrous Scaffolds

In this work, a new polyurethane (PU) chain extender was developed to incorporate a Glycine-Leucine (Gly-Leu) dipeptide, the cleavage site of several matrix metalloproteinases. PUs were synthesized with either the Gly-Leu-based chain extender (Gly-Leu PU) or a phenylalanine-based chain extender (Phe PU). Both PUs had high molecular weight averages (Mw > 125,000 g/mol) and were phase segregated, semi-crystalline polymers (Tm ~ 42°C) with a low soft segment glass transition temperature (Tg < -50°C). Uniaxial tensile testing of PU films revealed that the polymers could withstand high ultimate tensile strengths (~ 8-13 MPa) and were flexible with breaking strains of ~ 870-910% but the two PUs exhibited a significant difference in mechanical properties. The Phe and Gly-Leu PUs were electrospun into porous scaffolds for degradation and cell-based studies. Fibrous Phe and Gly-Leu PU scaffolds were formed with randomly organized fibers and an average fiber diameter of approximately 3.6 µm. In addition, the Phe PU was electrospun into scaffolds of varying architecture to investigate how fiber alignment affects the orientation response of cardiac cells. To achieve this, the Phe PU was electrospun into aligned and unaligned scaffolds and the physical, thermal, and mechanical properties of the scaffolds were investigated. The degradation of the Phe and Gly-Leu PU scaffolds was investigated in the presence of active MMP-1, active MMP-9, and a buffer solution over 28 days to test MMP-mediated and passive hydrolysis of the PUs. Mass loss and structural assessment suggested that neither PU experienced significant hydrolysis to observe degradation over the course of the experiment. In cell-based studies, Phe and Gly-Leu PU scaffolds successfully supported a high density of viable and adherent mouse embryonic fibroblasts (MEFs) out to at least 28 days. Culturing murine embryonic stem cell-derived cardiomyocytes (mESCDCs) alone and with MEFs on aligned and unaligned Phe PU scaffolds revealed both architectures supported adherent and functionally contractile cells. Importantly, fiber alignment and coculture with MEFs improved the organization and differentiation of mESCDCs suggesting these two parameters are important for developing engineered myocardial constructs using mESCDCs and PU scaffolds.
A Mass Spectrometry Approach to Ligand Identification for Orphan Fly and Human Nuclear Receptors
Keywords: nuclear receptor
orphan
E75
Rev-erb
heme
nitric oxide
crystal structure
DHR3
DHR96
cholesterol
metabolism
ligand
Drosophila
human
mass spectrometry

The nuclear receptor superfamily is responsible for regulating the expression of genes involved in development, reproduction and metabolism. These transcription factors control the expression of their target genes through the binding of small molecule regulators to their ligand binding domains. Classical nuclear receptors include the steroid receptors, which bind endocrine hormones and have been important targets of pharmaceutical intervention. However, approximately one half of the human nuclear receptors remain orphans and are without known cognate ligands. Focusing on the Drosophila orthologues of these orphan receptors, this project used mass spectrometry to identify the chemical diversity associated with the receptors following expression in recombinant systems. In a genome-wide screen of Drosophila nuclear receptors, this approach identified co-purifying molecules with a number of receptors. The physiological relevance of these putative ligand/receptor pairs was determined through biochemical analysis, in vivo characterization and structure determination. Ligand(s) or the ligand state was identified for the Drosophila receptors: DHR3, DHR96, E75, Ftz-f1 and USP. Of these, three were validated through the efforts of this project, and independent groups confirmed the remaining two. The most significant findings were the discoveries that the fly nuclear receptor E75 is regulated by heme, gas and redox, and that there is a similar regulatory scheme in the human orthologues, Reverbα and β. Furthermore, crystallization of the heme-bound Rev-erbβ ligand binding domain was also achieved, and this provided key insights into the mechanism of ligand regulation for the Rev-erbs. This project highlighted the role of nuclear receptors in metabolic surveillance. The ligands/signals identified in association with these receptors include: cholesterol, dehydrocholesterol, heme, NO, CO, redox and phospholipids. Unlike the classical steroid hormones, these are not dedicated signaling molecules, but instead are key substrates or products of metabolism. In the context of nuclear receptor signaling, I hypothesize that these metabolites serve as metabolic indicators/signals in the regulation of development and metabolism. Furthermore, four of these Drosophila receptors comprise the ecdysone-response pathway in the developing fly. Taken together, this suggests that both the metabolic state of the organism and steroid hormones drive nuclear receptor regulation of development.
Constructions, Lower Bounds, and New Directions in Cryptography and Computational Complexity
Keywords: computational complexity
cryptography

In the first part of the thesis we show black-box separations in public and private-key cryptography. Our main result answers in the negative the question of whether we can base Identity Based Encryption (IBE) on Trapdoor Permutations. Furthermore, we make progress towards the black-box separation of IBE from the Decisional Diffie-Hellman assumption. We also show the necessity of adaptivity when querying one-way permutations to construct pseudorandom generators á la Goldreich-Levin; an issue related to streaming models for cryptography. In the second part we introduce streaming techniques in understanding randomness in efficient computation, proving lower bounds for efficiently computable problems, and in computing cryptographic primitives. We observe [Coo71] that logarithmic space-bounded Turing Machines, equipped with an unbounded stack, henceforth called Stack Machines, together with an external random tape of polynomial length characterize RP; BPP an so on. By parametrizing on the number of passes over the random tape we provide a technical perspective bringing together Streaming, Derandomization, and older works in Stack Machines. Our technical developments relate this new model with previous works in derandomization. For example, we show that to derandomize parts of BPP it is in some sense sufficient to derandomize BPNC (a class believed to be much lower than P ⊆ BPP). We also obtain a number of results for variants of the main model, regarding e.g. the fooling power of Nisan's pseudorandom generator (PRG) [Nis92] for the derandomization of BPNC 1, and the relation of parametrized access to NP-witnesses with width- parametrizations of SAT. A substantial contribution regards a streaming approach to lower bounds for problems in the NC-hierarchy (and above). We apply Communication Complexity to show a streaming lower bound for a model with an unbounded (free-to-access) pushdown storage. In particular, we obtain a nΩ(1) lower bound simultaneously in the space and in the number of passes over the input, for a variant of inner product. This is the first lower bound for machines that correspond to poly-size circuits, can do Parity, Barrington's language, and decide problems in P − NC assuming EXP ≠ PSPACE. Finally, we initiate the study of log-space streaming computation of cryptographic primitives. We observe that the work on Cryptography in NC0 [AIK06a] yields a non-black-box construction of a one-way function computable in an O(log n)-space bounded streaming model. Also, we show that relying on this work is in some sense necessary.
Making Participation Work: A Grounded Theory Describing Participation in Phase I Drug Trials from the Perspective of the Healthy Subject
Keywords: research ethics
bioethics
healthy volunteers
payment
research subjects

A qualitative research study was conducted with people who had participated as healthy subjects in phase I drug trials at commercial research facilities, in order to develop a better understanding of their perspective regarding research participation. The participants were recruited using online advertisements posted on the University of Toronto student website (www.my.utoronto.ca) and NOW Magazine online. Thirty-one subjects were interviewed. The audiotaped interviews were transcribed and analyzed using grounded theory methods. A grounded theory was developed that describes the process of participation and the main factors affecting the experience of participation, from the perspective of healthy subjects. The theory, called Making Participation Work, explains how healthy subjects frame participation as an income earning opportunity, and how this framing shapes their behaviour with regard to participation. Participants expressed a range of attitudes about the experience of participation, from very positive to very negative. The main factor affecting the experience is the perceived net burden, which is in turn affected by the degree to which subjects find personal control over their participation. Net burden and finding personal control were both affected by the degree to which subjects felt valued by research staff, and by whether subjects had trust in the research enterprise. Although subjects framed participation as work, the relationship with the study doctors and nurses was viewed as clinical. Most subjects are generally trusting that participation in phase I drug trials is safe. These findings suggest that models of research participation assuming participation motivated by altruism or potential therapeutic benefit cannot accommodate the attitudes and behaviours of healthy subjects in phase I drug trials. New models must be developed which account for the framing of participation as work, while being sensitive to the trust that healthy subjects place in the research enterprise.
Story Writing Development from Grades 4 to 6: Do Language Status and Reading Profile Matter?
Keywords: writing development
reading disorders
English Language Learners
poor comprehenders
poor decoders

The current longitudinal research examined the story-writing development of students from Grades 4 to 6 (N = 178). All students began formal schooling in English in Grade 1. Students were classified in Grade 4 as typical readers (scoring above the 40th percentile in both decoding and reading comprehension; n = 72), poor decoders (scoring below the 30th percentile in decoding; n = 53), or poor comprehenders (scoring above the 40th percentile on decoding but below the 30th percentile, relative to their language group, in reading comprehension; n = 26). Students who spoke English as a first language (EL1s) and English language learners (ELLs) were proportionally represented in each reading group. A series of repeated measures ANOVAs tested the effects of language and reading group on students’ cognitive, linguistic and literacy development. Despite the fact that ELLs did not achieve native-like English language proficiency, showing delays in vocabulary and reading comprehension, they matched their EL1 peers in all other areas of cognitive and literacy development, including story-writing. Both EL1s and ELLs developed story-writing skills in a similar manner, showing significant growth from Grade 4 to Grade 6. Typically developing ELLs were thus able to attain age-appropriate story-writing levels. Additionally, poor decoders and poor comprehenders generally showed similar profiles of strengths and weaknesses, regardless of whether English was their first or second language. The major difference was that ELL poor comprehenders were more likely to have longstanding reading comprehension problems, while many EL1 poor comprehenders had improved by Grade 6. In general, poor decoders displayed more pervasive difficulties across cognitive, linguistic and literacy domains, while poor comprehenders had specific weakness in nonverbal reasoning, receptive vocabulary and listening comprehension. Nevertheless, both reading disorder groups had significant difficulties in story-writing, struggling with the mechanics of writing, sentence structure, and overall story organization. Regression analyses indicated that cognitive, linguistic and language skills were strong concurrent and longitudinal predictors of story-writing. However, the strongest predictor of Grade 6 story-writing skill was Grade 4 story-writing performance, suggesting that story-writing skills tend to be relatively stable over time. The results generally support the ‘simple view of writing’ (Berninger, 2000). Practical recommendations for assessment and instruction are presented.