VictorJuiz/thesis huggingface dataset:
Making Sense of Medical Education: An Examination of Contraception Counselling, Unplanned Pregnancy Counselling, and Abortion Services Curricula in Ontario Medical Schools
Keywords: Contraception Counseling, Unplanned Pregnancy Counselling, Abortion Services, Medical Education, Family Medicine, Obstetrics and Gynecology, Routine, Training, Curricula, Program Directors

Background: To date, little information exists about contraception counselling, unplanned pregnancy counselling, and abortion services curricula in Ontario medical schools. Identifying existing curricula, including influences on whether and how curricula are delivered, is an essential starting point for evaluative processes. Purpose and Objectives: The purpose of this study was to explore contraception counselling, unplanned pregnancy counselling, and abortion services curricula in Ontario medical schools. The objectives were to 1) identify the existence of such curricula in undergraduate (preclinical, obstetrics and gynecology clerkship, and family medicine clerkship) and post-graduate (obstetrics and gynecology and family medicine) programs; and 2) explore factors influencing the existence and form of these curricula from the perspective of program directors. Design: An exploratory qualitative approach was used for this study whereby, Ontario program directors responsible for contraception counselling, unplanned pregnancy counselling, and abortion services curricula were interviewed. Results: Overall, the inclusion of routine curricula in contraception counselling, unplanned pregnancy counselling, and abortion services was limited and variable between schools, as well as within clerkship and post-graduate programs. Program directors were often uncertain about iii whether such routine curricula were present in their programs. Four factors were found to influence whether these curricula were included in a program: 1) program structure, 2) program resources, 3) the interests of residents/students, and 4) personal philosophy of the program director. A typology was developed to understand how program directors resolved uncertainty when asked about the existence of these curricula in their programs. The emergent sensemaking typology revealed strategies used by directors to either justify the current system of medical teaching (i.e., defending the status quo) or support change (i.e., responsive). Program directors were consistent across programs in terms of the factors they identified as influencing the curriculum offered. The perceived impact of these factors varied according to the sensemaking processes employed by each director. Conclusions: This study provides an outline of curriculum variability within and between medical school programs. Further, if offers a typology of the ways program directors explain their uncertainty regarding the inclusion of these curricula in their programs. In so doing, program director sensemaking as a key influence on the curriculum is revealed.
A Genealogy of Humanitarianism: Moral Obligation and Sovereignty in International Relations
Keywords: Humanitarianism
Sovereignty
Moral obligation
Identity
Genealogy
Huguenots
Abolitionism
Responsibility to Protect
Humanitarian intervention

This dissertation examines the history of humanitarianism in international relations by tracing the relationship between moral obligation and sovereignty from the 16th century to the present. Its main argument is that moral obligations and sovereignty are mutually constitutive, in contrast to a widely held assumption in international relations scholarship that they are opposed to each other. The dissertation’s main theoretical contribution is to develop a framework, using a genealogical method of inquiry, for understanding the relationship between sovereignty and the shifting boundaries of moral obligation during the Westphalian period. This approach makes it possible to identify both elements of continuity and change in the history of humanitarianism and practices of sovereignty. The first chapter demonstrates how the extant literature on sovereignty and humanitarianism fails to adequately account for how states have participated in the construction of new moral boundaries even as they have sought to assert their own sovereignty. Chapter two lays out the dissertation’s theoretical framework, first by outlining an identity-based understanding of sovereignty in relationship to moral obligation, and then discussing the genealogical method that is used in three case studies. The following three chapters contain the dissertation’s empirical contributions, which are three historical cases that represent pivotal moments in the history of moral obligation and sovereignty. Chapter three examines the assistance offered by Elizabeth I to Huguenot refugees from 1558-1603, and relates England’s moral obligations towards Huguenots to the emergence of a sovereign English confessional state. Chapter four examines the relationship between British abolitionist arguments against slavery in the 19th century, and justifications for the extension of empire. Chapter five examines the emergence and evolution of the Responsibility to Protect (R2P) doctrine since 2001, whose advocates posit a modified conception of sovereignty that is explicitly tied to moral obligation. The concluding chapter discusses how the dissertation accounts for both the rise of humanitarianism and the persistence of sovereignty in international relations, as well as provides some reflections on areas for future research.
Anti-diuresis in the Blood-gorging Bug, Rhodnius prolixus: The Role of CAPA Peptides
Keywords: anti-diuresis
Rhodnius prolixus
Chagas' disease
CAPA
neuropeptide
neurohormone
diuresis
G protein coupled receptor

CAPA-related peptides belong to a family of neuropeptides localized to the central nervous system that can function in diverse roles in the regulation of water and salt homeostasis in insects. These peptides are known to stimulate fluid secretion by Malpighian tubules (MTs) in Dipteran species, thus serving a diuretic function. In contrast, this thesis demonstrates that members of this family of peptides in Rhodnius prolixus serve an anti-diuretic role and have multiple tissue targets, whereby they oppose the activity of diuretic hormones such as serotonin (5-Hydroxytryptamine hydrochloride; 5-HT). I have identified two genes each encoding three peptides in R. prolixus, suggesting this insect is capable of producing a greater number of CAPA-peptides compared to other insects that contain only a single CAPA gene. Interestingly, while the second peptide encoded in each R. prolixus gene (RhoprCAPA-α2/-β2) inhibits the stimulatory effects of serotonin on tissues such as the anterior midgut and Malpighian tubules, it appears the other CAPA-related and pyrokinin-related peptides do not play a major role in inhibiting the effects of serotonin on these tissues. More specifically, serotonin-stimulated fluid secretion by MTs and fluid absorption by the anterior midgut are reduced by the anti-diuretic peptide, RhoprCAPA-α2. In addition, I have also identified a G protein-coupled receptor which likely mediates the anti-diuretic effect associated with RhoprCAPA-α2 and have functionally characterized this receptor in Chinese hamster ovary cells. Spatial transcript expression analysis in fifth-instars reveals a wide distribution of the receptor in tissues associated with the rapid post-gorging diuresis. Thus, my findings suggest that numerous tissues are regulated by the CAPA peptides in R. prolixus. Gene structure and phylogenetic analyses demonstrate that this receptor is the orthologue of the D. melanogaster capa receptor (CG14575) with homologs in other insects. Taken together, my thesis demonstrates that the RhoprCAPA peptides play an integral role in the coordination and maintenance of anti-diuresis in R. prolixus. This mechanism is necessary following the rapid diuresis associated with blood-feeding by this medically-important insect.
The Transnational Protection Regime and Democratic Breakthrough: A Comparative Study of Taiwan, South Korea and Singapore
Keywords: Democratization
human rights
Taiwan
Korea
Singapore
Asia
transnational activism
transnational networks
China
Myanmar
democracy promotion
foreign policy

This dissertation explains why Taiwan and South Korea experienced democratic breakthrough in the late 1980s, when Singapore failed to do so. It explains this variation in democratic outcomes by specifying the causal mechanisms underpinning the international-domestic political interface of democratic development in these cases. New empirical evidence discovered in the course of this research has confirmed that transnational networks of nonstate and substate actors were an indisputable source of external pressures on the authoritarian governments of Taiwan, South Korea and Singapore during the late 1970s and early 80s. Foreign human rights activists, Christian missionaries and ecumenical workers, members of overseas diaspora communities, journalists, academics and students, along with legislators in key democratic countries allied to the target governments, were found to have raised the international profile of political repression by flagging them as reprehensible human rights abuses. Within the context of an international normative environment where human rights was increasingly considered a legitimate international concern, these transnational actors generated a negative international opinion of the target governments. Such grassroots pressures had the potential to raise the cost of political repression for these target governments with the effect of curbing repressive state behavior, thereby protecting key domestic actors with the potential to effect democratic breakthrough. The extent to which these external pressures could effectively constrain repressive state behavior depended, however, on the immediate geopolitical circumstances of each case. Geopolitical circumstances were also important because they could affect the strength of the protection regime. Thus, the exposition of the transnational protection regime as the causal mechanism underpinning the international-domestic political interface of democratic development requires that we specify the exact role of agency within the international normative and geopolitical contexts in which they operate. This dissertation develops such an abstracted causal model for the purposes of application in other cases and for policy analysis.
Exploiting Coherence and Data-driven Models for Real-time Global Illumination
Keywords: Computer Graphics
Real-time Rendering

Realistic computer generated images are computed by combining geometric effects, reflectance models for several captured and phenomenological materials, and real-world lighting according to mathematical models of physical light transport. Several important lighting phenomena should be considered when targeting realistic image simulation. A combination of soft and hard shadows, which arise from the interaction of surface and light geometries, provide necessary shape perception cues for a viewer. A wide variety of realistic materials, from physically-captured reflectance datasets to empirically designed mathematical models, modulate the virtual surface appearances in a manner that can further dissuade a viewer from considering the possibility of computational image synthesis over that of reality. Lastly, in many important cases, light reflects off many different surfaces before entering the eye. These secondary effects can be critical in grounding the viewer in a virtual world, since the human visual system is adapted to the physical world, where such effects are constantly in play. Simulating each of these effects is challenging due to their individual underlying complexity. The net complexity is compounded when several effects are combined. This thesis will investigate real-time approaches for simulating these effects under stringent performance and memory constraints, and with varying degrees of interactivity. In order to make these computations tractable given these added constraints, I will use data and signal analysis techniques to identify predictable patterns in the different spatial and angular signals used during image synthesis. The results of this analysis will be exploited with several analytic and data-driven mathematical models that are both efficient, and yield accurate approximations with predictable and controllable error.
Behind the Mask: Determinants of Nurses' Adherence to Recommended Use of Facial Protective Equipment to Prevent Occupational Transmission of Communicable Respiratory Illness in Acute Care Hospitals
Keywords: facial protective equipment
adherence
nurses

Background - Communicable respiratory illness is a serious occupational threat to healthcare workers. A key reason for occupational transmission is failure to implement appropriate barrier precautions. Facial protective equipment, including surgical masks, respirators and eye/face protection, is the least adhered to type of personal protective equipment used by healthcare workers, yet it is an important barrier precaution against communicable respiratory illness. Objectives - To describe nurses’ adherence to recommended use of facial protective equipment and to identify the factors that influence adherence. Methods - A two-phased study was conducted. Phase 1 was a cross-sectional survey of nurses in selected units of six acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses. Results – Of the 1074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of facial protective equipment. Multivariable analysis revealed four organizational predictors of adherence: ready availability of equipment, regular training and fit testing, organizational support for health and safety, and good communication. Following the survey, 112 observations in 14 intensive care units were conducted that showed a 44% competence rate with proper use of N95 respirators. Common gaps included failure to verify the seal and touching the face piece. Multivariable analysis revealed knowledge of recommended use of facial protective equipment as a significant predictor of competence. Discussion – Despite the SARS experience and the resulting investment in our public health system, nurses’ adherence to recommended use of facial protective equipment and competence in effective use of N95 respirators remains suboptimal. To improve adherence, organizational leaders should focus on equipment availability, training and fit testing, organizational support for health and safety, and positive communication. To improve competence in effective use of N95 respirators, strategies to increase knowledge should be implemented. These efforts should assist to reduce occupational transmission of communicable respiratory illness and foster a healthier and safer working environment for nurses.
Comparative Approaches to Characterization of Lymphatic Endothelial Cells as Phenotypically Distinct from Blood Endothelial Cells
Keywords: Lymphatic endothelium
endothelial cells

The lymphatic system complements the blood circulatory system in absorption and transport of nutrients, and in the maintenance of homeostasis. Historically, the angiogenesis field has advanced faster and farther than the field of lymphangiogenesis. The discovery of lymphatic markers and the emerging evidence implicating the lymphatic system as a central player in a variety of pathological conditions has attracted research interest and driven the field forward. Research efforts have produced the observation that regulators of the blood endothelium are frequently members of the same protein families of regulators of the lymphatic endothelium. More importantly, these regulators do not act discretely, restricting their regulatory activities to one endothelial cell (EC) type. Two examples of regulators that behave in this manner are the VEGF and the Angiopoietin families of proteins, which have cell-type-dependent effects on EC processes such as migration, proliferation and survival. The study of these regulators therefore requires an in vitro EC system capable of accommodating the simultaneous characterization of the signaling pathways downstream of these shared molecular regulators in venous, arterial and lymphatic endotheliums. To build such an in vitro system, I isolated and validated lymphatic, venous, and arterial ECs derived from vessels of bovine mesentery. The proteomes of the three cell types were comparatively studied using two-dimensional polyacrylamide gel electrophoresis followed by mass spectrometric identification. The three cell types were used in a subtractive immunization scheme for the production of a monoclonal antibody selectively reactive to a potentially novel surface protein marker of lymphatic ECs. The studies recorded herein all share the common goal of identifying and characterizing unique molecular signatures that distinguish lymphatic ECs from blood ECs, and that may underline the cellular biology of the lymphatic endothelium as distinct from the blood endothelium.
Biomarker and Therapeutic Studies of Antibodies and Small Molecules that Target EGFR
Keywords: EGFR
experimental therapeutics
biomarkers

The field of targeted cancer therapy has progressed in recent years with the approval of new oncology drugs. Coupled with the benefits that these agents provide, has come an appreciation for challenges that occur when attempting to translate successful experiments from the laboratory into effective clinical trials. One such challenge has been predicting the optimal dose and schedule to take into clinical evaluation, given the possibility that certain targeted therapeutics may exhibit maximal anti-tumour efficacy well below maximum tolerated doses. Recent work with a targeted antibody to the mouse vascular endothelial growth factor receptor-2 demonstrated that detection of increased levels of its endogenous ligand in the plasma, namely VEGF, could address this issue, as maximal increases in VEGF paralleled optimal drug activity. The VEGF result has become recognized as a potential class effect for this family of inhibitors. This thesis summarizes experiments designed to build upon this discovery by investigating whether the utility of ligand measurement might also apply to drugs that inhibit the epidermal growth factor receptor (EGFR), which have also received recent regulatory approval, and inhibit angiogenesis as one of their mechanisms of action. In addition, we investigated the potential application of EGFR inhibitors to influence other markers of tumour angiogenesis, specifically their effects on levels of circulating endothelial progenitor cells (CEPs). Finally, we evaluated combination treatment of EGFR inhibition with anti-angiogenic scheduling of chemotherapy. The EGFR ligand TGF-alpha increased in a dose dependent fashion following treatment with cetuximab, and levels in the circulation paralleled anti-tumour activity. This was a host-dependent effect that was not observed with the lower affinity antibody nimotuzumab. Inhibition of host EGFR also reduced plasma CEPs, but at higher doses these drugs increased off target growth factors VEGF and G-CSF, as well as CEPs. In a model of advanced triple negative breast cancer, the combination of nimotuzumab and metronomic cyclophosphamide was efficacious and well tolerated, leading to a potential new treatment strategy for this aggressive disease. Taken together, these studies identify new and useful applications for EGFR-targeted antibodies, and shed further light on their contributions within the field of tumour angiogenesis and antiangiogenic therapy.
Modulation of Intracrine Estrogen in Menopausal Women: Implications for Women’s Reproductive Health and Breast Cancer Risk
Keywords: Menopause
Estrogen
Intracrinology
Breast
Reproductive Health
Aromatase Inhibitors

Extensive research and clinical observations in the past 20 years confirmed that the cessation of ovarian function at menopause does not stop the process of sex steroid hormone synthesis in females. Indeed, multiple extra-ovarian tissues contain the same enzymatic machinery the ovary uses which can maintain a significant rate of local hormonal synthesis sufficient to cause pathological outcomes. This is commonly termed “intracrine”. However, two obstacles face intracrinology. Firstly, wide clinical appreciation of this mechanism in causing disease and in targeting it with therapy does not currently exist. Secondly, blood hormonal assays are used in the clinic to diagnose and manage intracrine based disorders. This could be entirely misleading, since hormonal synthesis, action and metabolism occur within the tissue and, therefore, measuring blood levels is not reflective of the actual disease environment. This thesis presents evidence of significant intracrine based disorders in menopausal women that could be effectively managed by tackling the core intracrine mechanism. Three protocols are investigated emphasizing the usefulness of menopausal intracrine estrogen inhibition. The first presents a joint objective of treating menopausal symptoms using estrogenic replacement therapy while reducing breast cancer risk using long-term aromatase inhibitors. Aromatase inhibition is used to suppress the local estrogen synthesis in the breast. The second protocol is a new method of acute inhibition of breast estrogens to improve the accuracy of breast imaging techniques. This method showed a benefit in reducing the benign parenchymal enhancement during breast MRI indicating a potential improvement in specificity. The third protocol involves using aromatase inhibitors in the treatment of severe endometriosis that did not respond to oophorectomy. The pathogenesis of breast cancer, endometriosis and fibroids are believed to involve intracrine estrogen activity. Another significant contribution presented in this thesis is the development of a new technique that enables minimally invasive tissue assays of hormones in their genuine site of synthesis rather than indirectly in the blood. The new assay requires only microliter volumes of sample and employs a novel digital microfluidics technology. Estrogen and other sex steroids were extracted from droplet-scale breast tissue and blood samples.
Grassmann Dynamics
Keywords: Real Dynamical Systems
Grassmannian

The present work is divided in two parts. The first is concerned with the dynamics on the Grassmann manifold of k-dimensional subvector spaces of an n dimensional real or complex vector space induced by a linear invertible transformation A of the vector space into itself. The Grassmann map GA sends p to Ap, and one asks, what are the dynamics of GA? In the second part, I consider dynamics induced by a linear cocycle covering a diffeomorphism of a compact manifold, acting on the Grassmann bundle of k-dimensional linear subspaces of TN. I prove a Kupka-Smale theorem for the space of cocycles covering diffeomorphisms of a compact manifold. The proof of this theorem implies the same type of results for derived cocycles parametrized in the space of diffeomorphisms. The results of the second part can be generalized without effort to cocycles covering endomorphisms of N.