VictorJuiz/thesis huggingface dataset:
An Institutional Ethnography of the Social Relations that Shape Reproductive Health Care Experiences for Women with Female Genital Mutilation/Cutting/Circumcision (FGC) in Toronto, Ontario, Canada
Keywords: female genital cutting
female genital mutilation
health research
institutional ethnography
qualitative research

In recent social science research, it has been reported that women with female genital mutilation/cutting/circumcision (FGC) often experience stigmatization during reproductive health care. However, there has not been investigation into how these experiences come to take place. To address this gap in knowledge, the social relations that shape the reproductive health care experiences of women with FGC were investigated using Institutional Ethnography. Qualitative interviews were conducted with eight women with FGC, seven obstetrician/ gynecologists, and two general practitioners. Interviews revealed a set of social relations that organized women with FGC’s experiences of feeling “different” during care, which included anti-FGM discourse, organization of obstetric/gynecological work, and legislation. Immigrant women with FGC learned they were “different” in Canada from anti-FGM discourse in public conversations that opposed FGC. Women worked to mitigate this stigmatization before entering the clinic by engaging in “emotional health work”. This work carried over into the appointment itself and was shaped by the organization of doctors’ work, which was surgically focused. Finally, aspects of the Canadian legal and health care systems disproportionately disadvantaged women with FGC since the Criminal Code of Canada (Bill C-27) guarantees women their rights, but limits such rights to what is “normal” in the west through the dictation of surgeries to which women have access. This dissertation highlights how the ruling discursive knowledge of the “normal” reproductive body holds women’s bodies up against western ideals. These ideals have a normalizing function that shaped women with FGC’s reproductive health care experiences, as they learned how “normality” was inaccessible to them. Women also viewed their racialization as overlooked within medical training and by health care personnel. Racialization has not often been explicitly discussed in the broader FGC literature. It is imperative to actively make space for the perspectives of Black women with FGC in strategies that work toward their protection and to also modify the focus in FGC research and advocacy from gendered discrimination instead onto intersectional stigmatization. By better addressing the intersectional stigmatization to which women with FGC are exposed, they may not have to work so hard to navigate reproductive health care.
Troubling Intersections: Physical Intimate Partner Violence Against Women in Bangladesh
Keywords: Bangladesh
Communities
Cross-sectional survey research
Domestic violence
Intercategorical intersectionality
Intersectionality theory

In the underbelly of beautiful Bangladesh lies the widespread practice of male intimate partner physical violence (MIPPV) against women. Although women’s different socio-demographic risk factors for MIPPV are known, whether their intersecting individual-, community-, and cross-level social locations shape their MIPPV experiences across Bangladeshi communities have not been examined. Therefore, applying Crenshaw’s intersectionality theory, the overarching objective of this dissertation was to make visible the currently married women’s different intersectional social locations that shape their experiences of MIPPV in Bangladesh. McCall’s intercategorical intersectionality approach guided this research. Study participants comprised 14,557 (Studies 1 and 2) and 15,421 currently married women (Study 3) across 911 communities from the 2015 Bangladesh Violence Against Women Survey dataset. Two-level logistic regression models were used to predict women’s MIPPV experiences in the past year and estimate the predicted probabilities at women’s each intersectional location. These probabilities were compared to generate different configurations of inequalities. Study 1 findings indicated that younger age, lower educated and higher educated, poor women compared to older, higher educated and higher educated, nonpoor women had 13.57% (95% CI, 9.25, 17.89) and 12.02% (95% CI, 6.87, 17.17) higher probabilities of experiencing MIPPV. Study 2 found that women living in higher-earning-participation, higher-educated communities had higher probabilities of experiencing MIPPV than those in lower-earning-participation, higher-educated communities (29.90%, 95% CI 25.66 to 34.15 vs. 23.85%, 95% CI 22.40 to 25.30). While our specific hypotheses regarding differences between disadvantaged and advantaged communities were not supported, Study 3 found significant within community differences: younger, poor compared to older, nonpoor women had significantly higher MIPPV probabilities (the minimum difference=12.7%, 95% CI, 2.8, 22.6) in all communities. Similar trend was observed between younger, lower educated compared to older, higher educated women in all except poor communities. Thus, using intersectionality theory made visible Bangladeshi women’s troubling intersections of experiencing MIPPV. Future research might examine the structures and processes that put women at these precarious locations to ameliorate their socio-economic-educational inequalities and reduce MIPPV in all communities. This intersectionality theory-oriented research might advance scholarship on MIPPV in Bangladesh and quantitative intersectionality globally.
Hip Replacement Head-Neck Taper Connection Tribocorrosion Reduction by Head Material, Head Size and Taper Geometric Optimization
Keywords: corrosion
hip
orthopedics
taper
tribocorrosion

Modular femoral head hip replacement components connect to the femoral stem via matching tapers. Metals commonly used to manufacture femoral heads and stems rely on a passive oxide layer to resist corrosion. Under cyclic loading (i.e. gait) relative micromotion between the head and stem causes wear, removal of the oxide layer and subsequent corrosion by a process called tribocorrosion. Metallic debris released by tribocorrosion may result in adverse local tissue reactions called trunnionosis and may require revision surgery.The objective of this research was to investigate factors affecting head-neck taper tribocorrosion, including head size, material and taper geometry. A systematic review of prosthetic design, manufacturing and surgical technique factors related to taper connection tribocorrosion was performed. The review included 91 studies investigating 35 unique factors, of which only 7 had adequate evidence to support a recommendation. In particular, a gap in evidence related to taper connection design was identified. It was found that poor study design resulted in inconclusive or contradictory evidence for the majority of factors. A second review was performed of taper tribocorrosion in-vitro test methods to improve study design and increase clinical translation of results. A deficiency in current in-vitro test methods was identified where samples are only cyclically axially compressed. Frictional torques due to joint movement that may be larger with larger femoral heads are excluded. Therefore, a novel instrumented hip simulator was developed to measure corrosion related electrical activity during simulated gait. The test apparatus was employed to investigate susceptibility to corrosion of different head sizes (28 vs 36mm cobalt-chrome femoral heads), materials (cobalt-chrome, ceramic and oxidized zirconium) and taper geometry (angle, diameter, length and surface finish). The study of taper geometry followed design of experiments methodology. Twenty-five uniquely designed test samples with a range of taper angles, diameters, lengths and surface finishes were custom manufactured and tested. It was found that large diameter cobalt-chrome femoral heads are most susceptible to corrosion, oxidized zirconium exhibits similar corrosion resistance to ceramic, and that thicker, shorter tapers with either low roughness and high angle, or high roughness and low angle, are least susceptible to short term corrosion.
Combining Laser Spectroscopy and Mass Spectrometry for Structural Analysis of Biologically Relevant Molecules in the Gas Phase
Keywords: density functional theory
DNA
fluorescence
mass spectrometry
noncovalent interactions
spectroscopy

The combination of laser spectroscopy with electrospray ionization (ESI) mass spectrometry has enabled conformational analysis of gaseous ions that retain some solution-phase characteristics. Mixtures of thermodynamically favoured gas-phase conformers and kinetically trapped conformers from solution may be probed simultaneously to reveal distinct photophysical properties. This body of work exploits the kinetic trapping of biologically relevant molecules to elucidate structural properties intrinsic (i.e., without solvent interactions) to systems including fluorescent sensors and DNA-drug complexes. Chapters 2 and 3 explore the trapping of multiple protomers of two fluorophores: a DNA minor groove binder and a ratiometric fluorogenic probe. The presence of multiple protomers was supported by fluorescence, photodissociation and quantum mechanical calculations. A previously unreported protomer of the DNA minor groove binder was uncovered while excitation-dependent and vibronically resolved fluorescence emission facilitated spectral assignments for the fluorogenic probe. Chapter 4 describes a collaborative effort to understand the origin of fluorescence emission enhancement for an amyloid-sensing dye by altering the local environment through macrocycle encapsulation. A hybrid computational method was used to predict gas-phase structures of the host-guest complex, with the most stable complex showing favourable electrostatic interactions that could attenuate access to non-radiative relaxation pathways. Lastly, Chapter 5 details the extension of gas-phase Förster Resonance Energy Transfer (FRET) towards detecting conformational changes in DNA duplexes induced by the binding of small molecule drugs. Changes in FRET response were detected with the incremental addition of single drug molecules to the duplex, highlighting the advantage of measuring fluorescence from mass-selected complex ions. The work in this thesis develops the utility of optical spectroscopy performed on mass-selected ions with key results showing that distinguishable deactivation pathways result from different protonation sites or non-covalent interactions and that gas-phase FRET can detect conformational effects of individual drug binding events on DNA.
Non-structural Deterrents and Opportunistic Dispersal in an Invasive Fish: The Role of Among-Individual Variation on Common Carp Movement
Keywords: Acoustic
Barrier
Behavioural Ecology
Biological Invasion
Common Carp
Conservation

Dispersal decisions are often made at the level of the individual, but among-individual variation in dispersal behaviour is rarely considered in aquatic conservation and invasion control. To address this challenge, my thesis applied concepts of behavioural ecology to invasion biology. Using an invasive fish, Common Carp (Cyprinus carpio), as my study species, I examined the influence of among-individual behavioural variation on opportunistic dispersal and on the effectiveness of non-structural deterrents - methods used to limit the movement of non-native fishes. My thesis is comprised of a brief literature review and four research chapters that incorporate lab and field techniques to describe movement behaviours. My first research chapter (chapter 2) used choice-arena experiments to determine whether Common Carp express consistent individual differences in their avoidance behaviour of non-structural deterrents. I found CO2 levels required to force movement towards acoustic and stroboscopic stimuli varied across individuals. In chapter 3, these same deterrents were deployed at an outdoor fishway with more realistic field conditions. Native and non-native fish passage across the fishway was quantified to determine whether a behavioural deterrent (sound) can produce an avoidance response sufficient for conservation applications. This is the first study to find a phylogenetic signal in fish responses to a non-structural deterrent. In chapter 4, individuals captured at the fishway were measured for morphology,subjected to laboratory behavioural trials and then released to be acoustically tracked. Significant flooding provided individuals with a rare dispersal opportunity into a wetland. I found dispersal success was correlated with behaviour in the field, but not a behavioural syndrome expressed in lab tests. Finally, in chapter 5, I investigated whether Common Carp would consistently avoid a physiological deterrent (CO2) at the fishway. I observed a 10-fold decrease in Common Carp catch rates during stimulus activation and, unlike in chapter 3, there was no phylogenetic signal in avoidance responses. This research contributes to our understanding of how animals make dispersal decisions and the role of behavioural variation on biological invasions, and uses behavioural ecology techniques to advance applied aquatic conservation.
Evaluation of a Choosing Wisely Canada Initiative to Reduce Unnecessary Testing in the Emergency Department
Keywords: Health Informatics
resource stewardship

Up to 30% of healthcare services in Canada are unnecessary and finding ways to reduce such care is critical for upholding quality of care and patient safety. This research consists of three overlapping studies investigating ways to reduce unnecessary care and the impacts of those interventions. Specifically, this research begins with a literature search to determine what is already known about interventions to reduce unnecessary care, using the example of pediatric imaging in the emergency department (ED). Building on these learnings, we evaluated the emergency department of hospital that was an early adopter of Choosing Wisely Canada (CWC)—a campaign to reduce unnecessary tests, treatments, and procedures. Specifically, the ED made changes and mandated adherence to medical directives. After analyzing their laboratory data using an interrupted time series analysis, we found significant reductions across most of the observed tests. We followed this quantitative study with semi-structured interviews from hospital leadership and ED clinicians to identify what was particularly impactful about the CWC intervention. We conclude by discussing what other healthcare organizations can learn from our research and how they can adapt our findings to suit their needs. We also discuss the challenges and benefits to using real hospital data extracted from the electronic medical record. Overall, reducing unnecessary care has become a priority for many healthcare organizations and our learnings could support these institutions in their endeavors to combat such services.
Exploring the Associations of Parenting by Lying with Psychosocial Adjustment, Dishonesty, and Culture
Keywords: development
lying
parenting by lying
psychosocial functioning

Parents aim to instill the value of honesty in their children from a young age (Engels et al., 2006). However, parents often use lying as a means of influencing their child’s behavioural and emotional states – a practice which has been referred to as ‘parenting by lying’ (Heyman et al., 2009). To date, limited research has explored the practice of parenting by lying and its associations with lying and psychosocial functioning in children. Thus, the goal of my dissertation is to broaden the existing research on parenting by lying by exploring the associations of this practice with the development of lying and psychosocial functioning in childhood and adulthood. I achieve this through conducting three novel studies that uniquely and significantly contribute to the current understanding of parenting by lying. More specifically, in Chapter 2, I explored the long-term associations of parenting by lying in childhood with lying and psychosocial functioning in a sample of Turkish adults. I found that adults who recalled higher levels of parenting by lying in childhood lied to their parents more and experienced greater psychosocial adjustment difficulties in adulthood, in particular secondary psychopathic traits. In Chapter 3, I discovered novel categories of parenting by lying, as well as identified predictors of parenting by lying within a sample of Singaporean parents. In addition to discovering two new parental lie categories, I found that parents who reported greater religiosity lied less to their children. Lastly, in Chapter 4, I investigated the association of parenting by lying with lying and the expression of psychosocial difficulties in childhood. I found that parents who reported using more parenting by lying strategies had children who lied more, and that children who lied more experienced greater psychosocial adjustment difficulties. Overall, the collective results of my dissertation suggest that the practice of parenting by lying may have short- and long-term negative associations with the development of honesty and psychosocial adjustment. These results can be used to inform parents/caregivers, teachers, and clinicians on the importance of effectively communicating with children in order to promote optimal development.
Determinants of Immunity against the Meningococcus
Keywords: complement
herd immunity
Neisseria meningitidis
neutrophils
vaccine

Neisseria meningitidis is a major cause of sepsis and meningitis worldwide, but is also a regular colonizer of the human nasopharynx. Invasive meningococcal infections are associated with high rates of morbidity and mortality, despite the availability of effective antibiotic treatment options. Vaccination is therefor the most effective way to protect people against N. meningitidis. Vaccines have been developed to target this bacterial pathogen since the early 1900’s, with varying levels of success. A successful meningococcal vaccine must be capable of preventing invasive N. meningitidis infections, to thereby protect the vaccinated individual from succumbing to infection. An ideal meningococcal vaccine should also prevent nasal colonization, thereby limiting the spread N. meningitidis and thus eliciting herd immunity within a vaccinated population. Within this thesis, I aimed characterize vaccine elicited immune processes necessary for protection against meningococcal nasal colonization and invasive sepsis. To characterize vaccine elicited protection against nasal colonization I took advantage of a “humanized” mouse model of N. meningitidis nasal infection, wherein expression of human CEACAM1 allows N. meningitidis to colonize the murine nose. I reveal that protection against nasal colonization is absolutely reliant on B cells and neutrophils, suggesting that opsonophagocytosis plays a major role in prevention of nasal colonization. To characterize vaccine elicited protection against invasive infections I utilized a mouse model of N. meningitidis sepsis. Previous findings haveiii revealed an important role for meningococcal specific IgG and complement activation in conferring protection against invasive infections. Here, I reveal that protection can occur in mice lacking either complement or IgG. Protection in the absence of complement relies on high antibody titer and my data suggests that phagocytic cells are necessary to clear the bacterial infection. Protection in the absence of IgG is reliant on bacterial specific IgM. Taken together, my findings provide novel insight into the mechanism of vaccine elicited protection against N. meningitidis. This mechanistic insight can be used to guide development of improved vaccines.
Understanding Patterns and Estimating Relative Effects of Long-term Bisphosphonate Therapy and Drug Holidays
Keywords: BISPHOSPHONATES
DRUG THERAPY
EPIDEMIOLOGY
HEALTHCARE ADMINISTRATIVE DATA
OSTEOPOROSIS
PHARMACOEPIDEMIOLOGY

Osteoporosis is a disease of low bone mass that causes debilitating fractures. Oral bisphosphonates (alendronate, risedronate, and etidronate) are first-line therapy for osteoporosis. Guidelines recommend at least three to five years of initial bisphosphonate therapy. Thereafter, most patients can undergo a bisphosphonate drug holiday for up to 3 years, as bisphosphonates have extended half-lives and continue to provide fracture protection after therapy discontinuation. However, the relative anti-fracture benefit of different bisphosphonates during drug holidays is uncertain. Risedronate has a shorter half-life in bone than alendronate, and thus fracture protection during risedronate drug holidays may be shorter. This research aimed to provide evidence on long-term oral bisphosphonate therapy and drug holidays using a series of population-based studies. First, Study 1 described time trends in oral bisphosphonate initiation and characteristics of older adults starting therapy in Ontario, Canada over 20 years. Then, Study 2 identified patterns of long-term oral bisphosphonate exposure (≥3 years with ≥80% adherence) using a cohort study design. Lastly, Study 3 examined the comparative anti-fracture benefits of risedronate versus alendronate therapy during drug holidays. Study 1 showed that alendronate and risedronate have largely replaced etidronate and found important changes in patient characteristics over time. Study 2 identified that 60% of patients initiating alendronate or risedronate had a period of long-term exposure. Finally, long-term therapy with risedronate was associated with a modestly increased hip fracture risk compared to alendronate during drug holidays longer than 2 years (HR=1.18 [95% CI 1.04 to 1.34]) in Study 3. The findings from this thesis highlight oral bisphosphonates as a mainstay of osteoporosis therapy, demonstrate that most patients starting oral bisphosphonates have long-term use, and suggest that drug holidays after risedronate therapy should be limited to 2 years. Further research is required to examine the comparative benefits and harms of long-term oral bisphosphonate therapy versus other osteoporosis treatments.