VictorJuiz/thesis huggingface dataset:
Homecare of Long-term Care? The Balance of Care in Urban and Rural Northwestern Ontario
Keywords: long-term care
balance of care
homecare
seniors
rural
policy
older persons

While some individuals can successfully age at home, others with similar levels of need may require facility based long-term care (LTC). The question addressed in this thesis is: “What factors determine whether or not older persons age at home?” I argue that in addition to the characteristics and care needs of individuals (the demand side); access to home and community care (H&CC) at the local level (the supply side) determines whether or not older people receive care at home relative to other settings. In emphasizing the role of the supply side, I draw on Neoinstitutional Theory and the Theory of Human Ecology to examine how institutions of the state (policies, norms, values, and organizational structures) facilitate or constrain opportunities to age at home across urban and rural areas. In conducting my analysis I draw on the Balance of Care (BoC) framework to analyze the characteristics of individuals waiting for LTC placement in Thunder Bay (urban community) and the surrounding Region (rural communities) of Northwestern Ontario. The BoC framework provides the means to estimate the extent to which their needs could potentially be met in the community if home and community care (H&CC) services were available. The results show that individuals waiting for LTC placement in Thunder Bay experienced higher levels of impairment than those in the Region. However in both areas, most individuals required assistance with instrumental activities of daily living (e.g. housekeeping, meal preparation, etc). In both areas there was limited access to informal caregivers. If a H&CC package were to be made available, 8% of those waiting for facility based LTC in Thunder Bay could potentially be supported safely and cost-effectively at home compared to 50% in the surrounding Region. The results confirm that the supply side matters. When H&CC cannot be accessed, LTC may become the default option, particularly in rural and remote areas. If given access to H&CC, a significant proportion of individuals can potentially age at home.
The Protective Role of the Angiopoetin-1 - Tie2 System in Transgenic Models of Pulmonary Arterial Hypertension
Keywords: pulmonary hypertension
angiopoietin

The role of the Angiopoietin-1 (Ang1)-Tie2 pathway in pulmonary arterial hypertension (PAH) is controversial, with one group suggesting that increased Ang1-Tie2 activity may even play a causal role in PAH progression. However, Ang1 has been well-characterized as a homeostatic factor, which prevents endothelial cell (EC) activation and injury through Tie2 receptor stimulation. Furthermore, we have previously demonstrated that lung Tie2 expression and activity are significantly downregulated in experimental PAH, implicating reduced Tie2 signaling in the pathogenesis of this disease. Thus, we hypothesized that manipulations to increase Ang1-Tie2 signaling will protect against lung EC injury and onset of PAH, whereas a loss-of-function of this pathway in Tie2-deficient mice (Tie2+/-) would predispose to PAH. Approximately 13% of Tie2+/- mice developed spontaneous elevation in right ventricular systolic pressure (RVSP), although no significant difference was observed between the WT and Tie2+/- groups following chronic hypoxic exposure. Serotonin (5-HT) infusion for one week or daily interleukin-6 (IL-6) injection for two weeks produced substantial RVSP elevations in Tie2+/-, but not WT mice (P<0.05). Following one week of 5-HT or IL-6 treatment, there was a significant decrease in Ang1 protein expression in both WT and Tie2+/- mice (P<0.05). Similarly, following exposure of cultured pulmonary arterial smooth muscle cells to 5-HT or IL-6, Ang1 secretion was significantly decreased (P<0.01). Moreover, 5-HT or IL-6 exposure resulted in decreased Tie2 activity and increased apoptosis only in the lungs of Tie2+/- mice (P<0.01), and treatment with a pan-caspase inhibitor, Z-VAD, prevented PAH in 5-HT-treated Tie2-deficient mice. Together with in vitro studies showing that pulmonary arterial ECs subjected to Tie2-siRNA were more susceptible to apoptosis following 5-HT treatment, this strongly implicates EC death as a primary mechanism of PAH in the presence of reduced Tie2 activity. In addition, doxycycline-conditional, endothelial-targeted Ang1 binary transgenic mice showed no evidence of elevated RVSP under basal conditions and if anything, demonstrated a blunted response to 5-HT treatment compared to non-binary littermate controls. Therefore, our findings support the importance of EC survival-signaling via the Ang1-Tie2 pathway as a protective mechanism in PAH and emphasize the pivotal role of EC apoptosis in the onset of this disease.
The Geography of Knowledge Formation: Spatial and Sectoral Aspects of Technological Change in the Canadian Economy as Indicated by Patent Citation Analysis, 1983-2007
Keywords: Economic Geography
Knowledge Externalities
Knowledge Spillovers
Patent Citation Analysis
Regional Technological Change
Canada

Knowledge, learning, and innovation are vital elements in facilitating economic development and growth. Technological change, which is a synonym for generating knowledge, the diffusion thereof, and subsequent application in the marketplace in the form of novel products and processes, i.e. innovations, has a strong effect on the collective wealth of regions and nations. Knowledge spillovers, which are unintended knowledge flows that take place among spatial (geography) and sectoral (industry) units of observation, provide a rationale for diverging growth rates among spatial units, well beyond what might be explained by variations in jurisdictional factor endowments, and thus are of particular interest in this context. Measuring and quantifying the creation and diffusion of knowledge has proven to be a challenging endeavor. One way to capture technical and economically valuable knowledge is by means of patent and patent citation analysis. Following this approach, and utilizing a novel patent database that has been specifically developed for this purpose, the present dissertation investigates the spatio-sectoral patterns of knowledge spillovers in the Canadian economy over the time period 1983 to 2007. The employed research methodology addresses existing limitations in this stream of research, and contributes to the continuing debate regarding the significance of sectoral specialization versus diversity, and local versus non-local knowledge spillovers as the main driver of knowledge formation processes leading to innovation at the sub-regional scale. The findings indicate that knowledge spillovers are localized, and furthermore, that this localization effect has increased over time for both spillovers within a particular industry, as well as between industry sectors. The analysis of micro-geographic industry specific spatio-sectoral knowledge formation processes, and the inquiry into local sectoral knowledge spillover patterns, outlines how regional evolutionary technology trajectories potentially shape the rate and direction of technological change, and consequently influence economic growth, at a particular place.
An Argument-based Validity Inquiry into the Empirically-derived Descriptor-based Diagnostic (EDD) Assessment in ESL Academic Writing
Keywords: Language Testing
Diagnostic Assessment
ESL Writing
Writing Assessment

This study built and supported arguments for the use of diagnostic assessment in English as a second language (ESL) academic writing. In the two-phase study, a new diagnostic assessment scheme, called the Empirically-derived Descriptor-based Diagnostic (EDD) checklist, was developed and validated for use in small-scale classroom assessment. The checklist assesses ESL academic writing ability using empirically-derived evaluation criteria and estimates skill parameters in a way that overcomes the problems associated with the number of items in diagnostic models. Interpretations of and uses for the EDD checklist were validated using five assumptions: (a) that the empirically-derived diagnostic descriptors that make up the EDD checklist are relevant to the construct of ESL academic writing; (b) that the scores derived from the EDD checklist are generalizable across different teachers and essay prompts; (c) that performance on the EDD checklist is related to performance on other measures of ESL academic writing; (d) that the EDD checklist provides a useful diagnostic skill profile for ESL academic writing; and (e) that the EDD checklist helps teachers make appropriate diagnostic decisions and has the potential to positively impact teaching and learning ESL academic writing. Using a mixed-methods research design, four ESL writing experts created the EDD checklist from 35 descriptors of ESL academic writing. These descriptors had been elicited from nine ESL teachers’ think-aloud verbal protocols, in which they provided diagnostic feedback on ESL essays. Ten ESL teachers utilized the checklist to assess 480 ESL essays and were interviewed about its usefulness. Content reviews from ESL writing experts and statistical dimensionality analyses determined that the underlying structure of the EDD checklist consists of five distinct writing skills: content fulfillment, organizational effectiveness, grammatical knowledge, vocabulary use, and mechanics. The Reduced Reparameterized Unified Model (Hartz, Roussos, & Stout, 2002) then demonstrated the diagnostic quality of the checklist and produced fine-grained writing skill profiles for individual students. Overall teacher evaluation further justified the validity claims for the use of the checklist. The pedagogical implications of the use of diagnostic assessment in ESL academic writing were discussed, as were the contributions that it would make to the theory and practice of second language writing instruction and assessment.
Investigation of Discontinuous Deformation Analysis for Application in Jointed Rock Masses
Keywords: Discontinuous Deformation Analysis
DDA
Distinct Element Method
DEM
discrete element method
Jointed Rock

The Distinct Element Method (DEM) and Discontinuous Deformation Analysis (DDA) are the two most commonly used discrete element methods in rock mechanics. Discrete element approaches are computationally expensive as they involve the interaction of multiple discrete bodies with continuously changing contacts. Therefore, it is very important to ensure that the method selected for the analysis is computationally efficient. In this research, a general assessment of DDA and DEM is performed from a computational efficiency perspective, and relevant enhancements to DDA are developed. The computational speed of DDA is observed to be considerably slower than DEM. In order to identify reasons affecting the computational efficiency of DDA, fundamental aspects of DDA and DEM are compared which suggests that they mainly differ in the contact mechanics, and the time integration scheme used. An in-depth evaluation of these aspects revealed that the openclose iterative procedure used in DDA which exhibits highly nonlinear behavior is one of the main reasons causing DDA to slow down. In order to improve the computational efficiency of DDA, an alternative approach based on a more realistic rock joint behavior is developed in this research. In this approach, contacts are assumed to be deformable, i.e., interpenetrations of the blocks in contact are permitted. This eliminated the computationally expensive open-close iterative procedure adopted in DDA-Shi and enhanced its speed up to four times. In order to consider deformability of the blocks in DDA, several approaches are reported. The hybrid DDA-FEM approach is one of them, although this approach captures the block deformability quite effectively, it becomes computationally expensive for large-scale problems. An alternative simplified uncoupled DDA-FEM approach is developed in this research. The main idea of this approach is to model rigid body movement and the block internal deformation separately. Efficiency and simplicity of this approach lie in keeping the DDA and the FEM algorithms separate and solving FEM equations individually for each block. Based on a number of numerical examples presented in this dissertation, it is concluded that from a computational efficiency standpoint, the implicit solution scheme may not be appropriate for discrete element modelling. Although for quasi-static problems where inertia effects are insignificant, implicit schemes have been successfully used for linear analyses, they do not prove to be advantageous for contact-type problems even in quasi-static mode due to the highly nonlinear behavior of contacts.
Parental Involvement in School in a Double Minority Context: The Case of Racial Francophones
Keywords: Home school relationship
Parent participation
Education of minority children
Schooling in Canada
Barriers to involvement in school
School racism
Black Francophones
Minority parents in school
French language schools
Involvement in French language schools
Blacks of African origin
Immigrant children in school
Barriers to academic achievement of minority students
Minority within a minority

This study explored the involvement in school of racial Francophones in a large city in Canada. Specifically, the study investigated the involvement of Black francophone parents in two of Ontario’s publicly funded elementary schools. This study was guided by one main research question: How are Black francophone parents of African origin involved in their children’s formal education in the French-language schools? Five sub-questions stem from the main research question: How do Black francophone parents of African origin understand parental involvement in school? What strategies do these parents employ to become involved in their children’s formal education? What is the nature (i.e., extent, depth) of Black francophone parents’ involvement in their children’s formal education? What inhibits or facilitates the participation of these parents in the school? How is the double-minoritized positioning of these parents implicated in their participation and strategies? Using an anti-racist lens, the study revealed that Black francophone parents of African origin hold differing views regarding involvement in their children’s education. Although these parents treasure education and strive to instill personal values in their children, they express their understanding of involvement in school primarily in terms of cumulative negative experiences they have experienced and in some cases continue to experience with the French-language schools. Understanding of parents’ involvement in school was also encapsulated in terms of the parents’ own schooling experiences. For many, what constitutes involvement in school challenges the discursive meaning given to parental involvement in educational institutions, governments, and by mainstream parents. This study indicated that the extent to which Black francophone parents are involved in school and their strategies for involvement are rather poor. Moreover, the study singled out racism as one of the primary deterrents for Black francophone parents’ involvement in school. Other uncommon but significant barriers to parents’ involvement in school included: the impact of role inversion in the family; parents’ unawareness of the importance of their role in the education of their children; the blind-spot approach of parents to schooling; the absence of spirituality in parents’ lives; and the laissez-faire attitude of families rearing children.
Appreciative Inquiry: An Interactive Organizational Intervention to Translate Acute Pain Management Evidence into Pediatric Nursing Practice
Keywords: knowledge translation
pain
appreciative inquiry
nursing
evidence-based practice
intervention

Despite a substantial evidence-base for pediatric pain management, pain is not always well managed in clinical practice. Appreciative Inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. A prospective, repeated-measures, mixed-methods case study was conducted to (a) explore the implementation process of AI as a KT intervention in pain, (b) examine the beginning effects of AI on pain related outcomes, and (c) describe extraneous factors related to the PARiHS framework. Outcomes were measured at six and three weeks pre-intervention and three and six months post-intervention, ending with a semi-structured interview on the acceptability of the intervention. Data were analyzed using descriptive and inferential statistics, and quantitative and qualitative content analyses. Twelve nurses (nine staff and three administrative/clinical leaders) from a surgical unit at a pediatric hospital participated in the study. They perceived their context to be relatively complex, with a culture focused on clinical competence, family-centered care, and teamwork, and a transformational leadership style. Overall, participants were satisfied with the intervention structure, which consisted of four three-hour, interactive sessions delivered over two weeks to promote change based on positive examples of pain management on the unit, and suggested only minor refinements. The intervention was delivered with high fidelity and most participants (n = 11) attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. There was a statistically significant improvement in participants’ pain knowledge and attitudes post-intervention. This outcome was significantly and positively correlated with participants’ attitudes towards research. Both of these factors had a significant relationship with participants’ effort to document pain assessments. Participants named AI a ‘refreshing approach to change’ because it was positive and democratic, with a focus on building on existing practices. They felt the process cultivated a positive reception to change, broadened their horizons around pain, and enhanced their team spirit. The facilitators were considered credible with effective communication skills. Given the promising results of this study, the refinement and evaluation of the AI intervention are warranted in other contexts and for other clinical practices.
Geophysical Imaging and Numerical Modelling of Fractures in Concrete
Keywords: acoustic emission
computed tomography
microcracks
fracture
concrete
aggregate interlock
ultrasonic wave velocity
aggregate size
shear failure
uniaxial compression
distinct element method

The goal of this research is to investigate the fundamentals of fracturing processes in heterogeneous materials such as concrete using geophysical methods and dynamic micromechanical models. This work describes how different aspects of fracture formation in concrete can be investigated using a combination of Acoustic Emission (AE) techniques, ultrasonic wave velocity imaging, and high resolution Computed Tomography (CT). Fracture formation and evolution were studied during shear failure of large reinforced concrete beams and compressive failure of concrete samples. AE analysis includes studying complex spatial and temporal fracture development that precedes shear failure. Predominant microcrack mechanisms were analyzed at different stages of fracture formation. CT images were used to investigate the influence of concrete microstructure on fracture topography. Combined AE and CT damage evaluation techniques revealed different aspects of fracture development, thus expanding our understanding of AE events and their mechanisms. These images show how aggregate particles influence fracture nucleation and development. An emphasis has been placed on the role of coarse aggregates during the interlocking of fracture surfaces at transferring shear stresses. Ultrasonic wave velocity and AE techniques have been applied to uniaxial compression tests of concrete with various aggregate sizes and strengths similar to that of the concrete beams. AE parameters, p-wave velocities, and stress-strain data have been analyzed concurrently to image damage evolution under compression. Influence of material composition on microcracking and material state changes during loading has been investigated in detail. The results of compressive tests were used as building blocks for developing realistic micromechanical numerical models of concrete. The models were designed using a distinct element code, where material is modelled through the combination of bonded particles. A number of procedures were developed to transfer the exact microstructure of material incorporating its visual representation into the model. The models’ behaviour has been verified against experimental data. It was shown that these models exhibit realistic micromechanical behaviour. The results of the experimental investigation of concrete fracturing were expanded by modelling more cases with aggregate size and strength variations. It was shown that geophysical imaging techniques, along with advanced micromechanical numerical modelling, can help us understand damage formation and evolution.
The Development and Usability Evaluation of a Clinical Decision Support Tool for Osteoporosis Disease Management
Keywords: Knowledge translation
Clinical decision support systems
Osteoporosis
Family practice

Osteoporosis is a major public health concern, affecting over 200 million people worldwide. There is valid evidence outlining how osteoporosis can be diagnosed and managed, but gaps exist between evidence and practice. Graham’s “Knowledge to Action” (KTA) process for knowledge translation and the Medical Research Council (MRC) framework for complex interventions were used to address these gaps. The first 4 KTA steps were collapsed into 3 phases of the PhD research plan. In PhD Phase 1, a systematic review was conducted to identify tools that facilitate decision making in osteoporosis disease management (DM). Results showed that few DM tools exist, but promising strategies were those that incorporated reminders and education and targeted physicians and patients. PhD Phase 2 used the findings from the systematic review and consultation with clinical and human factors engineering experts to develop a conceptual design of the tool. Multiple components targeted to both physicians and patients at the point of care, and which could be used as a standalone system or modifiable for integration with electronic health record systems were outlined. PhD Phases 3a and 3b were devoted to the assessment of the barriers to knowledge. In Phase 3a, a qualitative study of focus groups was conducted with physicians to identify attitudes and perceived barriers to implementing decision support tools in practice, and to identify the features that should be included in the design. Findings from 4 focus groups combined with aging research, and input from design and information experts were used to transform the conceptual design into a functional prototype. In Phase 3b, each component of the prototype was tested in 3 usability evaluation studies using an iterative, participant-centered approach to assess how well the prototype met end users’ needs. Findings from the usability study informed the final prototype, which is ready for implementation as part of the post PhD plan to fulfill the requirements of the remaining steps of the KTA and MRC frameworks.