VictorJuiz/thesis huggingface dataset:
Process of Care and Outcome of Critically Ill Patients with Traumatic Brain Injury

This thesis used clinical epidemiology methods to examine the relationship between process of care and outcome of critically ill patients with traumatic brain injury (TBI). First, I evaluated the association between intracranial pressure (ICP) monitoring use and mortality after severe TBI at the patient-level and at the hospital-level. ICP monitoring use was associated with lower mortality at the patient-level [adjusted odds ratio (OR) was 0.44; 95% confidence interval (CI): 0.31-0.63] and at the hospital-level (adjusted OR for death in the quartile of hospitals with highest use compared to the lowest was 0.52; 95% CI: 0.35-0.78). The main implication is that wider utilization of ICP monitoring in managing severe TBI appears warranted pending further studies. Second, I evaluated whether decompressive craniectomy or barbiturate coma provides better value, in terms of health effects and costs, for the management of refractory intracranial hypertension following TBI. Decompressive craniectomy resulted in greater quality-adjusted life expectancy relative to barbiturate coma [average gain was 1.5 quality-adjusted life years (QALYs)] but at higher costs (incremental cost-effectiveness ratio was $9,565/QALY gained). The main implication is that decompressive craniectomy, for this indication, is a more attractive strategy relative to barbiturate coma at commonly accepted willingness-to-pay thresholds. Third, I examined the relationship between tracheostomy timing and outcomes of TBI patients. Early tracheostomy (

Keywords: Critical Care
Epidemiology
Traumatic Brain Injury
Advisor: Nathens, B. Avery
Perspectives of Four Rural Music Educators: A Collaborative Narrative Journey Through 'Sense of Place'

The purpose of this study was to explore the perspectives of four rural Ontario music educators through the conceptual framework of sense of place, to determine how place influences their rural lives, their music education praxes, and their interactions with their rural students and communities. Rural places in Ontario are in a state of transformation and how educators define the term rural is also contingent on changes that occur in their rural communities and schools. My second objective was therefore to investigate participants perceptions of the terms rural, rurality, and community through their narratives of lived experiences related to the classroom, school, and community contexts. In other words, how do historical, sociocultural, and political issues that exist in rural areas shape educational perspectives and practices, and specifically from a music education viewpoint?This research is grounded in the narrative methodological perspectives of Connelly and Clandinin (1986, 1988) and Beattie (2009) with a focus on the importance of investigating teacher perspectives through the personal, practical, and scholarly knowledge (Beattie, 2009) they have gained through teaching. Extensive data was collected over a period of eight months through participant interviews, their narrative stories, autobiographical accounts and metaphorical perspectives. The process concluded with a collaborative focus group session. Throughout the data gathering process, participants read and reflected on each others viewpoints, which illuminated important themes of tension and conflict related to their teacher roles, aspects of their rural communities and rural culture. Participants also critiqued important next steps for rural communities and education, acknowledging the role of place in pedagogy and teacher identity. This research study provides insight into context dependent elements of curriculum and teacher education that affect music education practices today and for teachers of the future.

Keywords: education
music
place
rural
Advisor: Dolloff, Lori-Anne
Investigating the Evolution of Rock Discontinuity Asperity Degradation and Void Space Morphology under Direct Shear

Rock mass discontinuities represent planes of relative weakness and enhanced hydraulic conductivity and, thus, have a substantial influence on the hydro-mechanical behaviour of the overall rock mass. While the shearing of rock mass discontinuities has been extensively studied in the past, there remains uncertainty surrounding the mechanisms by which surface asperities deform and degrade during shear and how this degradation influences the aperture distribution. Although prior studies have attempted to investigate asperity failure mechanisms, they have been hampered by the lack of appropriate visualization and modelling tools. In particular, until recently it was not possible to observe asperity damage without physically separating the joint specimen or explicitly modelling the development of damage during a direct shear test.In the last decade, X-ray Computed Tomography (CT) has emerged as an ideal tool to nondestructively characterize fractures and damage in geomaterials. Over this same period, hybrid continuum/discontiuum modelling techniques, capable of explicitly modelling fracture and fragmentation have been developed and applied to rock mechanics problems. However, to date, there has been limited application of these technologies to the study of rock discontinuities subjected to shearing. The overall goal set forth in this thesis was to combine the use of these two technologies to develop an improved understanding and confirm empirical assumptions regarding the evolution of asperity degradation and fracture geometry as a result of shearing.The adopted experimental approach involved creating a series of replicated discontinuity specimens that were then subjected to varying shear displacements under different normal loading conditions. Subsequently, micro-CT imagery of the specimens was acquired and an image processing and analysis procedure was developed to quantitatively evaluate changes in asperity damage and fracture geometry as a function of shear displacement and applied normal load.Through the use of hybrid Finite-Discrete element (FEM-DEM) modelling, the experimentally observed shearing process was then recreated numerically to glean further insight into the shearing process and the different mechanisms involved. To do so, a new calibration procedure was first developed to systematically establish suitable input parameters. Lastly, the application of FEM-DEM to problems involving larger-scale discontinuity shearing, where physical testing would be difficult or unfeasible, was investigated.

Keywords: Asperity damage
Direct shear test
Discontinuity
FEM-DEM
Fracture aperture
Micro-CT
Advisor: Grasselli, Giovanni
Creating Culture Change: A Study Of How Evidence Is Moved Into Practice For Implementation Of A Public Policy Initiative In Ontario

The Ontario government, in an effort to close the gap between what we know (scientific inquiry) and what we do (public policy and practice) has, since 2009, supported implementation of the enhanced 18-month well-baby visit (18-month EWBV), in primary care practices throughout the province. Informed by the evidence, the 18-month EWBV represents innovation, an opportunity to expand the current, universal, 18-month check-up to a provision of care that supports standardized assessment at 18 months of age for each child in Ontario.This thesis begins in the author's experience, as a Program Consultant (Nursing), whose work it is to coordinate the development and implementation of provincial child development programs. As seen through the case of the 18-month EWBV, the study and its research are about knowledge work. Defined as a process that sees the creation of new knowledge during the transfer of knowledge in the context of the application of knowledge to clinical decision-making (Quinlan, 2009), the study is one of empirical inquiry. Understood that knowledge alone is insufficient to change practice, the study takes seriously the social and organizational processes of work and relations, often coordinated by documents (text) that shape the everyday experience of health professionals as they "invite or reject innovation" (Kontos Poland, 2009) that the 18-month EWBV represents.Using insights from institutional ethnography (IE) (D. Smith, 1987, 1999, 2005, 2006) as its method of inquiry, the study used experience as data and documents (text) as data. In its discovery, the study offers interview and document (text) analysis and maps knowledge work as those processes of work and relationship for the cause and effect of people's activities, made visible for how things happen as they do, in real life settings, for action that is coordinated, linked in relationship through documents (text), language, ways of speaking, and discourse, to organize experience (Turner, 2003, 2008; Webster, 2009).In its conclusion, the study moves beyond appreciation of knowledge translation (KT) as a set of individual processes and moves towards a new way of looking to understand and learn of the forces and processes of work and relation that shape change in the local context.

Keywords: institutional ethnography
knowledge work
multidisciplinary health teams
transfer and application
Advisor: Pascal, Charles
Optimizing Audit and Feedback to Improve Quality in Primary Care

One of the most consistent findings in health services research relates to gaps between ideal and actual care. Audit and feedback is frequently implemented to help providers identify these gaps and to subsequently improve quality of care, with widely varying results. The overall aim of this thesis was to examine how to optimize audit and feedback interventions provided to family physicians to more reliably result in professional behaviour change that will benefit patients. A systematic review, meta-analysis, and meta-regression was conducted to determine the effect of audit and feedback interventions on quality of care and to identify effect modifiers. The review included 140 trials and found that audit and feedback works best when the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan. Based on the latter finding and applying principles from relevant behaviour change theories, a worksheet was developed to guide feedback recipients in setting appropriate goals and action plans in response to identified gaps in care. This worksheet was tested in a pragmatic, cluster-randomized trial including 53 family physicians from 14 practices across Ontario. All participating family physicians received feedback every six months regarding the proportion of patients with diabetes and/or heart disease receiving guideline-recommended care. Family physicians in the intervention group also received the worksheet appended to the feedback reports. After two years, no significant effects differences were found between the groups, in part because of poor uptake of the worksheet. An embedded qualitative evaluation examined the barriers and facilitators to improving quality of care for chronic disease management perceived by family physicians who received the feedback reports. Findings highlighted the importance of matching the targeted behaviour change(s) with the priorities and capabilities of recipients and their organizations.

Keywords: Audit and feedback
Implementation Science
Knowledge Translation
Mixed methods
Primary Care
Quality Improvement
Advisor: Zwarenstein, Merrick
Linguistic Ambiguities, the Transmissional Process, and the Earliest Recoverable Language of Buddhism

The Buddha's teachings have been handed down in different Middle Indic forms (Pāli and Gāndhārī), in Sanskritized Prakrit and in Sanskrit itself, and various non Indo-Aryan languages like Tibetan and Middle Chinese. Comparing corresponding passages in the surviving witnesses uncovers linguistic ambiguities which are phonologically cognate, but semantically unclear, pointing to an earlier, underlying linguistic form of which the witnesses are translations. Sanskritizations of earlier Prakrit transmissions are particularly revealing as they fix arbitrary meanings to a more malleable, polysemous underlying speech-form. This is describable as a simplified lingua franca or koine gangétique containing elements of all dialects, but eliminating the most obtrusive dialect differences; the result was a more homogenized communication medium which allowed for rapid dissemination of the Buddha's teachings across dialect boundaries in northern India. This lingua franca was probably derived from, or had affinities with, the existing language of trade, or the administrative language of government at the time. Whether the Buddha spoke this language or not is impossible to tell, but, if we assume that he spoke an eastern Middle Indic dialect like Māgadhī or Ardhamāgadhī, his teachings were translated into this koine by his disciples, either during his lifetime or shortly thereafter. By tracing tradents' interpretations of these malleable linguistic forms, we are able to reconstruct some of the lexemic content of the koine and resolve old ambiguities or at least clarify the nature of the transmissional process. Although we can not recover the actual words that the Buddha spoke, we can, in selected instances, get back to a point earlier than the existing witnesses have recorded, which represents the earliest recoverable language of Buddhism. The final section of this study investigates the diffusional effects of indigenous, non-Indo Aryan languages on the phonological, semantic and formal structure of the Buddha's teachings in Middle Indic.

Keywords: Buddhadharma transmission
Indian Linguistic Area
Language that the Buddha spoke
Linguistic Diffusion in India
Middle Indic koine
lingua franca
South Asian Sprachbund
Advisor: Emmrich, Christoph
The History of Social Movements in Somalia through the Eyes of Our Elders within a Diasporic Context

This work brings an anticolonial Indigenous reading to the history of social movements in Somalia to highlight the different moments in which Somali peoples have mobilized around key issues to seek social-political transformation. The liberation movements inspired generations of Somalis by bringing to the forefront key Indigenous ideals that constitute what it means to be Somali during the fight for independence and mobilize the masses against colonial rule. They also ignited the social consciousness of the peoples and captured their imagination, enabling generations of Somalis to lay claim to their humanity. The idea of looking at such a history is to create spaces to re-think some of the values within the contemporary moment. Sixteen Somali Elders were interviewed to draw on their experiential lived cultural capital and to engage them in processes of knowledge production as they narrated histories of the past and articulated their visions for the future. The objective of this study is to address the following questions: 1) What can we learn from the history of social movements in Somalia, both at home and in the Diaspora?; 2) How do Elders conceptualize the history of social movements in Somalia in and through Somali dhaqan (ancestral way of life) worldviews?; 3) What does the articulation of Somali history from an African trajectory offer in terms of our anticolonial struggle?; and 4) What are the implications of broaching these stories in Diaspora communities? The Elders' narratives signified the centrality of Somali dhaqan philosophies as a cultural system for Somali peoples in making sense of the current political moment. This work is devoted to explaining the ways in which Somali dhaqan could be operationalized as a cultural index to make sense of our past and present while keeping a gaze on the future.

Keywords: anticolonial Theory
Community
Indigenous Knowledges
Social Movement
Somali Dhaqan
Somali Diaspora
Advisor: Wane, Dr. Njoki
Dissecting the Role of the Stem Cell Niche in Driving Conversion Between Pluripotent States

Pluripotency is defined as the ability to develop into all tissues of the adult organism. In vivo, pluripotency exists only transiently in early embryogenesis. Despite its transience, remarkably, the pluripotent state can be stably maintained in vitro. While originally thought to exist stably in one state, pluripotency has recently been demonstrated to exist in at least two states; states defined by their distinct transcriptional networks and the extrinsic signals that maintain these networks. These extrinsic cues are provided either exogenously or endogenously in an autocrine or paracrine manner by the local microenvironment, or niche, composed of a heterogenous population of neighbouring cells. One state of pluripotency represents an earlier stage in development (early-stage pluripotency) than the other (primed pluripotency). While the characteristics of and the transitions between the two states are becoming better defined, the specific role of the niche remains poorly understood. Using mouse embryonic stem cells (mESCs) and mouse epiblast stem cells (EpiSCs) as models of early-stage and primed pluripotency, respectively, we demonstrate the influence of the stem cell niche in driving the reversion of EpiSCs.

Keywords: BMP-Smad1
EpiSC reversion
LIF-STAT3
Microenvironment
Niche engineering
Pluripotency
Advisor: Zandstra, W Peter
A Thin Veil of Inclusion: Sexual and Gender MIinorities in Ontario Universities

This thesis seeks to address the paucity of research about the experiences of sexual and gender minority students, staff, and faculty in Canadian university settings. It does so by exploring these groups' perceptions of institutional equity and inclusion policies, and by asking what bearing does campus climate have on learning and working outcomes. I administered an online survey to elicit responses to questions on how sexual and gender minority students, staff, and faculty in 21 public universities in Ontario experience the campus climate and understand the influence of equity and inclusion policy and discourses in these university settings. The conceptual framework to guide the analysis of 447 survey participants is drawn from Astin's (1993) input-environment-outcome model (I-E-O). The I-E-O model is an established conceptual model known for its usefulness in analyzing a range of variables that may contribute to comprehensive understanding of factors that influence the educational outcomes of students and employee experiences. A positive correlational relationship is demonstrated between the campus climate and student educational outcomes (intent to persist) and employee experiences (career consequences). The analysis indicate that sexual and gender minority students, staff, and faculty were three times more likely to seriously consider leaving their university when experiencing campus environments as uncomfortable/unaccepting, and twice as likely to consider doing so when experiencing harassment based on sexual identity, gender identity, and/or gender expression. In spite of Ontario universities having equity and inclusive policies in place for some time, the findings suggest a disjuncture for some in the stated commitments to inclusion. I argue that equity and inclusive policy regimes in Ontario universities function as a thin veil of inclusion for some LGBTQ people. Such "inclusive" frameworks may disguise the limitations of equity policies and discourses (Ahmed, 2007) and fail to address covert forms of homonegativity and transphobia in universities in Ontario. By making visible the perceptions and experiences of LGBTQ students, staff, and faculty, this study offers a contribution to the literature illuminating the complex and multifaceted spaces between policy frameworks, educational outcomes and employee experiences for sexual and gender minorities in universities.

Keywords: Campus Climate
Equity and Inclusive Policies
Higher Education
Sexual and Gender Minorities
Students
Staff
and Faculty
University
Advisor: DEHLI, KARI
Plato the Hedonist?

Most moral philosophers agree that a happy life involves pleasure in some way. Some go so far as to claim that pleasure alone is what makes a life happy or worthwhile. In either case, it seems that any complete account of a desirable life owes us an explanation as to what pleasure is. So, what is pleasure? As the history of moral philosophy attests, answering this question turns out to be surprisingly difficult. Although we all experience pleasures of various kinds, it is by no means clear that a unified account can cover all the things we take to be pleasant. This conceptual question about pleasure has clear implications for the distinct ethical question of pleasure's value. In short, if we don't know what pleasure is, then it isn't at all clear why we should value it.Plato appreciates this. Pleasure's place in the good life is one of Plato's enduring ethical concerns, and so it should come as no surprise that he also undertakes to develop a unified account of pleasure. My aim in this dissertation is to argue that Plato arrives at a definitive answer as to what pleasure is, and that this helps us to understand his considered view as to pleasure's role in the happy life. Specifically, Plato develops an account of pleasure as a species of intentional attitude, and that this supports a particular answer to the question of pleasure's value: while Plato is not a hedonist, he holds rather that pleasure reliably tracks the good, such that the life containing the most pleasure is in fact the happiest life, albeit not because it is the pleasantest life. So while Plato clearly takes the view that certain pleasures lead us astray, he also holds that the wise pursuit of pleasure reliably hits upon the best life.

Keywords: Ancient
Ethics
Hedonism
Plato
Pleasure
Socrates
Advisor: Barney, Rachel
Beauty and Ethics: Three Relations

After years of neglect, a renewed interest in beauty developed among many Western art critics, art practitioners and theorists of aesthetics in the 1990s. Beauty had fallen from favour in part because it was deemed politically and morally suspect, both as complicit with the sociopolitical structures that yielded WWI and as a tool of oppression wielded against women and minorities. One wonders, however, whether the baby was thrown out with the bathwater. Even granted that beauty has been damaging in the ways alluded to, can it yet be ethically helpful in ways that were lost when we ceased to attend to beauty (at least in the realms of institutional art and aesthetic theory if not in the day to day)? What ethical benefits might we have overlooked?The answer to this question depends partly on what one takes beauty to be. Beauty is a complex concept; there exist many competing and frequently contradictory accounts, often with deep roots, making the concept rife with internal contradictions. Rather than either attempt to reconcile conflicting accounts or address only one aspect of the concept, I will show that different sorts of relation to ethics emerge depending on how we approach beauty. I will present three different ways in which we can see beauty as related to ethics: beauty qua catalyst of ethical relation, qua formal cause of ethical relation, and qua analogue of ethical relation. The kinds of relation we see between beauty and ethics also depend on what style of ethics we consider. Despite the variety of approaches to beauty discussed, the connections I found tended to link beauty to particularistic versions of ethics. This may be due to beauty's longstanding association with the realm of particulars, making for an easy fit with ethics than emphasize attention to particulars.

Advisor: Sedivy, Sonia