VictorJuiz/thesis huggingface dataset:
Designing an Assessment Program for the Competency-based Era
Keywords: Assessment
Competence
Competency-based Medical Education
Medical Education
Orthopaedics
Residents

Background The introduction of CBME at the University of Toronto division of orthopedics is an opportunity to examine the concepts of CBME. While much has been written about CBME’s potential advantages and disadvantages, further research is required to support this new model of training. Aims The first aim was to develop and evaluate a program of performance-based, in-training assessment tools, covering the breadth of competencies including clinical skills, the intrinsic CanMEDS roles, and performance of technical procedures. The second aim was to use these assessments to examine the premise that all residents can achieve a minimal level of competency after a subspecialty rotation. Results The sports medicine OSCE and OSATS were used to assess clinical skills and performance of technical procedures respectively. Each of these assessment tools demonstrated a significant difference in performance between junior and senior residents, with many junior residents unable to achieve a minimal level of competence. As a result, a modified Angoff method of standard setting was used to set different pass marks for junior and senior residents when assessing clinical skills. Using simulation to assess resident performance of Entrustable Professional Activities, many junior residents were not able to achieve a minimal level of competency, despite having been previously deemed competent. Finally, an OSCE used to assess residents’ application of the intrinsic CanMEDS roles demonstrated a significant difference in performance between resident groups depending on year of training. Conclusion The assessment tools used to assess clinical skills, intrinsic CanMEDS roles, and performance of technical procedures demonstrated sufficient evidence of validity for use in CBME. These assessments demonstrate that many junior residents are not able to achieve a minimal level of competence. These findings affect the fundamental concept of achieving competence before progression in CBME, and lend credibility to hybrid versions of CBME.
Leading Change from the Middle: An Exploration of Leadership Competencies to Assist Ontario College Associate Deans and/or Chairs be Successful in Their Roles
Keywords: Associate Dean
Chair
Competency
Leadership
middle-management

This purpose of this study was to explore the role of the Ontario colleges of Applied Arts and Technology (CAAT) Associate Dean and/or Chair, and specifically focus on an investigation of leadership competencies that would help them to be successful in their roles. The study is situated within the context of changes currently taking place within the Ontario college system. The study followed a sequential mixed methodology method. Online surveys were used to gather data from Associate Deans and/or Chairs as well as Deans from the 22 English language colleges in the Ontario CAAT system. Follow up interviews were conducted with a purposeful sample of seven Associate Deans and/or Chairs. Finally, institutional documentation was gathered from Human Resources departments across the Ontario CAAT system. Data gathered focused on gaining a deeper understanding of the role and responsibilities of the Ontario college Associate Dean/Chair, an exploration of leadership competencies that would help them to be successful, and a review and assessment of leadership development opportunities currently available to them. Conclusions drawn from the study indicate that change occurring in the Ontario college system is re-defining the role of the Associate Dean/Chair, led primarily by the proliferation of degrees, and to a lesser extent, the heightened importance placed on research, expansion of flexible delivery, increases in international students, and effects of the Strategic Mandate Agreements. These changes are exacerbated by budget constraints/reduced funding and all contribute to an ever increasing workload for the Ontario college Associate Dean/Chair. The study also concluded that a substantial number of Ontario college Associate Dean/Chairs would benefit from enhancing their leadership competencies in order to help them be successful. Current leadership development opportunities available to Associate Deans/Chairs are not always well received, and are most effective when they focus on real-life application that addresses the uniqueness and importance of their role. The findings from the study may inform system and institutional policy and practices that would help Ontario college Associate Deans and/or Chairs to be successful, consequently improving the health of the Ontario CAAT system.
Second-order Optimization for Neural Networks
Keywords: Neural networks
Optimization
Second order methods

Neural networks are an important class of highly flexible and powerful models inspired by the structure of the brain. They consist of a sequence of interconnected layers, each comprised of basic computational units similar to the gates of a classical circuit. And like circuits, they have the capacity to perform simple computational procedures such as those which might underlie the generating process of the dataset they are trained on. The most popular and successful approach for learning neural networks is to optimize their parameters with respect to some objective function using standard methods for nonlinear optimization. Because basic methods like stochastic gradient descent (SGD) can often be very slow for deeply layered neural networks, or ones with recurrent connections, it is worthwhile to consider more advanced methods. In this thesis we review and analyze various such methods that have been proposed over the past few decades, with a particular focus on approximate-Newton/2nd-order ones, and develop two of our own which we call Hessian-free optimization (HF) and Kronecker-factored Approximate Curvature (K-FAC) respectively. Our experiments show that K-FAC can be much faster in practice at optimizing deep neural networks than well-tuned SGD with momentum.
A Novel Approach for Integrating Best Evidence and Patient Preferences into Treatment Recommendations for Rheumatoid Arthritis
Keywords: clinical practice guidelines
discrete-choice experiment
network meta-analysis
patient preferences
rheumatoid arthritis
treatment recommendations

To develop a treatment recommendation we must first critically appraise and summarize the evidence, then decide how to weigh the necessary trade-offs between the benefits and harms. GRADE, which is becoming the standard for developing treatment recommendations, recommends that patients’ preferences should be explicitly considered when making these trade-offs, but methods for doing this quantitatively are lacking. The aim of this thesis was to develop a quantitative approach for combining comparative effectiveness research and patients’ preferences, and apply it to inform treatment recommendations for early rheumatoid arthritis. In the first study, we performed a Bayesian network meta-analysis of 150 randomized controlled trials to compare the benefits and harms of treatment options for early rheumatoid arthritis. In the second paper we used a discrete-choice experiment to measure the relative importance of the major outcomes from the network meta-analysis as well as other issues relevant to the decision (dosing, rare risks) in patients with early rheumatoid arthritis. For the final paper we used a Bayesian framework to combine the data from the network-meta-analysis and the discrete-choice experiment to determine the preferred treatments. Importantly, we modeled the uncertainty in the evidence and patients’ preferences, as well as individual variability in patients' preferences, which are three key considerations in the GRADE approach. Overall, we predicted that most patients in our population (78%) would prefer triple therapy (the combination of methotrexate, sulphasalazine and hydroxychloroquine) to methotrexate alone as initial therapy, suggesting a relatively strong recommendation could be made. In patients who have had an inadequate response to methotrexate, the preferred treatment was more split between triple therapy (62%) and methotrexate + anti-TNF (biologic) therapy. The patients who we predicted would prefer other treatments, had important differences in preferences that could be highlighted in a preference-sensitive treatment algorithm. The thesis therefore presents a novel method for developing evidence-based, preference-sensitive treatment recommendations. Applied to early rheumatoid arthritis, our findings have important policy implications, suggesting that patients would prefer triple therapy to other treatments, including costly biologic therapy.
Efficient Homotopy Continuation Algorithms with Application to Computational Fluid Dynamics
Keywords: computational aerodynamics
continuation
globalization
homotopy
predictor-corrector
pseudo-transient continuation

New homotopy continuation algorithms are developed and applied to a parallel implicit finite-difference Newton-Krylov-Schur external aerodynamic flow solver for the compressible Euler, Navier-Stokes, and Reynolds-averaged Navier-Stokes equations with the Spalart-Allmaras one-equation turbulence model. Many new analysis tools, calculations, and numerical algorithms are presented for the study and design of efficient and robust homotopy continuation algorithms applicable to solving very large and sparse nonlinear systems of equations. Several specific homotopies are presented and studied and a methodology is presented for assessing the suitability of specific homotopies for homotopy continuation.\\ A new class of homotopy continuation algorithms, referred to as monolithic homotopy continuation algorithms, is developed. These algorithms differ from classical predictor-corrector algorithms by combining the predictor and corrector stages into a single update, significantly reducing the amount of computation and avoiding wasted computational effort resulting from over-solving in the corrector phase. The new algorithms are also simpler from a user perspective, with fewer input parameters, which also improves the user's ability to choose effective parameters on the first flow solve attempt. Conditional convergence is proved analytically and studied numerically for the new algorithms. The performance of a fully-implicit monolithic homotopy continuation algorithm is evaluated for several inviscid, laminar, and turbulent flows over NACA 0012 airfoils and ONERA M6 wings. The monolithic algorithm is demonstrated to be more efficient than the predictor-corrector algorithm for all applications investigated. It is also demonstrated to be more efficient than the widely-used pseudo-transient continuation algorithm for all inviscid and laminar cases investigated, and good performance scaling with grid refinement is demonstrated for the inviscid cases. Performance is also demonstrated to be better or comparable to the pseudo-transient continuation algorithm for all turbulent cases investigated. Stability of the new algorithms is also investigated.
Memory Representation in the Medial Prefrontal Cortex: Cortcial Communication, and the Development of a Prefrontal Ensemble Code for Associative Memory
Keywords: Electrophysiology
Eyeblink Conditioning
Memory Consolidation
Prefrontal Cortex

Despite knowledge of the critical importance of the medial prefrontal cortex (mPFC) in both the consolidation and long-term retrieval of event memory in the brain, it is unclear which aspects of a memory are represented within this region and how they change with learning and memory consolidation. Likewise, how the mPFC interacts with other facets of the memory network to shape these representations is also uncertain. In this thesis I employed electrophysiological techniques to examine individual prelimbic mPFC (PrL) neurons selectivity for various task features in an associative memory paradigm in rats across learning, consolidation and over-training. Further, I recorded oscillatory activity from the rhinal cortices and ventral hippocampus to examine how these regions may modulate mPFC memory representations across time. I reveal similar proportions at all time-points of both neurons highly selective for specific task features, and neurons exhibiting more generalized activity. Looking at population level activity across time however revealed a shift from more discrete encoding during learning to more generalized encoding post-consolidation. Further, PrL neurons whose firing patterns were modulated by rhinal and ventral hippocampal theta oscillations uncover a potential source of this change in encoding across time. Specifically, I show that discrete populations of PrL neurons display phase-locked spiking to theta oscillations in the lateral entorhinal cortex, the perirhinal cortex, and ventral hippocampus. Whereas the proportions of these different populations were not observed to change across time, the information contained within their activity did. PrL neurons phase-locked to rhinal theta oscillations were highly selective to task features early on in the acquisition of the memory and became more generalized with learning and consolidation. Neurons phase-locked to ventral hippocampal theta on the other hand became more selective for the meaning of the stimulus post-consolidation. I discuss how these findings fit with existing theories of the role of the mPFC in long-term memory including schema development and indexing of cortical memory activity. Taken together, these results demonstrate memory encoding patterns within the prelimbic mPFC and highlight, through communication with several important nodes of the memory network, potential mechanisms through which the encoding of different memory features evolve across learning.
Insights into Nurses’ Work: Exploring Relationships among Work Attitudes Work-related Behaviours
Keywords: affective commitment
organizational citizenship behaviours
organizational justice
perceived organizational support
structural equation modeling
work attitudes

Work motivation has been associated with work productivity. In health care, low motivation levels are associated with low productivity and linked to poor performance, decreased patient safety, and overall poor quality care. Hence the importance, ascribed in the literature, to clearly identifying the relationships between and among factors associated with work motivation, including work attitudes, and behaviours linked to work performance such as extra-role behaviours. Despite their importance to performance in health care, these relationships are understudied and poorly understood. The purpose of this study is to better understand work attitudes and their relationships to one another and to extra-role behaviours amongst nurses working in hospitals, the community, and long-term care settings in Ontario. This study comprises two stages: first, a scoping review focused on identifying individual-, unit-level, and organization-level characteristics that influence work motivation in health service organizations. The findings from the scoping review, augmented by a more in-depth review of the literature, aided in the development of a conceptual framework that guided the second stage of the study, to examine relationships amongst a specific set of nurses’ work attitudes - including perceptions of organizational justice, perceived organizational support, and affective commitment - and extra-role behaviours – specifically, organizational citizenship behaviours - in Ontario health care settings. In the second stage of the study, a survey was developed and administered to frontline nurses actively working in hospitals, the community, and long-term care settings in Ontario. Relationships amongst the constructs of interest were examined using structural equation modeling and path analysis. Examining the relationships of these concepts in a single model is novel, and offers insights regarding their complexity. The analyses further suggest that prior studies may be under-nuanced, and approaches to conceptualizing the concepts of perceived organizational justice and affective commitment in particular may have led to erroneous conclusions regarding their associations with perceived organizational support and organizational citizenship behaviours. This study further addresses four significant gaps previously identified in the work motivation and work behaviour literature: (1) how affective commitment relates to behavioural efforts, specifically organizational citizenship behaviours; (2) utilization of reliable and validated instruments to study work motivation; (3) use of a sufficiently large sample to have empirical support for generalizability; and (4) examination of these phenomena, among nurses, across diverse health care settings.
Kant's Hypothetical Imperative
Keywords: hypothetical imperative
instrumental reason
Kant
normativity
practical reason

Kant famously distinguishes between hypothetical and categorical imperatives and the conditional and unconditional necessitation they express. Hypothetical imperatives command conditionally, and they govern our instrumental and prudential reasoning. Categorical imperatives command unconditionally, and they govern our moral reasoning. There is significant disagreement in the literature about how to construe the nature and normativity of Kant’s hypothetical imperatives. In the first part of the dissertation, I consider three, seemingly divergent, contemporary interpretations. I argue, that all three of these views collapse the crucial distinction between conditional and unconditional necessity that was supposed to distinguish between the imperatives. Moreover, on the standard interpretation of the hypothetical imperative’s command, an interpretation that each of these views share, the “material interpretation,” is the logical consequence. The material interpretation understands hypothetical imperatives as deriving from reason’s endorsement of our ends, and thus ends that are set by the categorical imperative. Accordingly, all practical rational failing is a form of moral failing, and so, on Kant’s view, we collapse the practical distinction between stupidity and evil. In the second part of the dissertation, I explain how the standard interpretation of hypothetical imperatives as anti-akratic rational principles that command agents to will the means to their ends, even in the face of any temptation not to, inevitably leads to the material interpretation. I offer an alternative understanding of hypothetical imperatives, and correlatively of Kant’s conception of willing an end, that avoids this view, and which preserves the distinction between the conditional and unconditional necessitation that Kant thought the two imperatives express, and so also the crucial practical distinction between stupidity and evil.
High Gradient Labelling-free Isolation of Cardiomyocytes from Heterogeneous Populations
Keywords: Cardiomyocyte
Cell Separation
High Gradient Magnetic Separation
Myoglobin

Heart disease is the leading cause of death in the world and is likely to remain so in the foreseeable future. There is a great deal of optimism about cardiac regenerative therapies because recent advances in stem cell technology have made it possible to derive millions of cardiomyocytes, i.e., functional heart muscle cells, from human embryonic stem cells and induced pluripotent stem cells. These stem cell-derived cardiac cells also have enormous potential in drug discovery, toxicology studies and fundamental cardiac physiology. Cardiomyocytes (CMs) do not have well-established, specific surface markers, which could enable their separation from heterogeneous differentiation cultures using transient antibody labelling and traditional methods such as fluorescence activated cell sorting (FACS) or magnetic activated cell sorting (MACS). The next major challenge in realizing their potential is the development of separation methods that are compatible with clinical applications and can isolate cardiomyocytes and specific cardiac cell subpopulations in sufficient numbers, purity and quality after in vitro culture. This thesis presents a review of currently available cardiomyocyte separation strategies; develops a mathematical model to describe the novel labeling-free application of high gradient magnetic sorting for cardiomyocytes; reports the CM separation conducted; and finally avalidates a CM prosurvival preconditioning strategy to protect against an in vitro simulated ischemic/reperfusion injury such as one that occurs after cells are implantation in vivo. Neonatal rat and hESC-derived cardiomyocytes were collected at 94.8±3.3% and 93.6±2.8% (Day 20-25) purity from the separation respectively. Sodium nitrite/hypoxic preconditioned cells’ viability increased 20% post hypoxic/reoxygenation injury compared to cells without preconditioning treatment.
Measurement of Wisdom among Mainland Chinese
Keywords: Chinese culture
Mainland Chinese
measurement
wisdom

Modern psychologists generally regard wisdom as mature understanding and conduct of life; however, most wisdom studies have been conducted in Western culture. Little is known about wisdom in other cultures, even though cultures may significantly shape the structure of wisdom; for example, Chinese culture emphasizes connections in society, nature, and universe more than Western culture does, thus the structure of wisdom among Mainland Chinese may differ from that of Westerners. We conducted three studies to find a proper measure/representation for wisdom among Mainland Chinese. In study 1, wisdom was measured by Ardelt’s self-report wisdom scale, but the three-dimensional wisdom structure was not found. In study 2, we identified five wisdom components from the implicit theory of wisdom among 100 Mainland Chinese. Most of these components corresponded to those identified in the implicit theory of wisdom among westerners; yet some of them were uniquely Chinese. The Mainland Chinese Wisdom Model was developed based on these five conceptual components. In study 3, a Mainland Chinese Wisdom Paradigm was developed based on the Mainland Chinese Wisdom Model and the Berlin Wisdom Paradigm (general and personal). The participants’ wisdom performance was videotaped and then rated on the Mainland Chinese and Berlin Wisdom criteria. Their videotaped facial expression was analyzed by software. The results revealed that our Chinese wisdom measurement is reliable and valid; the Berlin Wisdom rating and the Mainland Chinese Wisdom rating were highly consistent with each other; finally, the feeling of surprise may contribute to wisdom performance.