VictorJuiz/thesis huggingface dataset:
Discharge Planning with Older Adults: The Influence of Social and Political Systems and Contexts

Discharge planning is a complex process in which intersections of competing norms, demands and expectations often beget ethical challenges. Returning home or moving to a more supportive setting can have tremendous personal, social and financial implications for older adults and families. Institutional concerns with patient safety and expedience can overshadow healthcare professionals’ commitments to client-centred approaches. In light of many competing demands and agendas, it can be unclear what is driving discharge-planning processes and outcomes. The research purposes were to 1) explore perspectives of older adults, family members, and healthcare professionals engaged in discharge planning from inpatient rehabilitation; 2) examine the influence of underlying beliefs, valued approaches and conventional processes on participants’ perspectives, behaviours and practices, and on discharge-planning outcomes. Using a microethnographic case study method, observations and interview data were generated from five case studies, each consisting of an older adult, involved family members and healthcare professionals. Taking a critical bioethics perspective and using relational autonomy theory, this research examined how social and political contexts shaped discharge-planning processes and outcomes. Discourses of aging-as-decline, beliefs privileging healthcare professionals’ expertise and conventions guiding discharge planning marginalized older adults. The prioritization of safety and focus on discharge superseded approaches to maximize function: the stated aim of rehabilitation. A profession-centric approach and the focus on safety and discharge from the time of admission intersected to promote 24-hour care recommendations in all cases. Taking a critical bioethics perspective informed by relational autonomy revealed that discharge planning was driven by paternalistic norms and that the ‘best interests’ of older adults were aligned with ‘protecting physical safety’ at the expense of any other considerations, thereby marginalizing older adults and impeding client-centred practice. These findings suggest that adopting a relational approach could promote practices that uphold older adults’ agency and align professional responsibilities with intended program aims.

Keywords: Discharge planning
older adults
relational autonomy
autonomy
Advisor: Rappolt, Susan
Gibson, Barbara
Understanding the Etiology of Inflammatory Complications Following Ileal Pouch-Anal Anastomosis

Introduction: Inflammatory pouch complications, including pouchitis, chronic pouchitis (CP) and a Crohn’s disease-like phenotype (CDL) of the pouch following ileal pouch-anal anastomosis (IPAA), are relatively common, and arise via unknown mechanisms. The phenotypic similarities between pouch inflammation and inflammatory bowel disease (IBD) suggest there may be common pathways involved in both disorders. The aim of this thesis is to investigate the serological, genetic and microbial factors contributing to the development of pouch inflammation in a large, well characterized patient cohort. Methods: Subjects with IPAA were recruited, and clinical and demographic information was obtained through medical chart review and patient questionnaire, allowing patients to be grouped based on post-surgical phenotype. Blood and tissue was collected for genetic, serological and microbial analyses. Anti-microbial antibodies were detected using enzyme-linked immunosorbent assay (ELISA), genotyping was carried out using the Illumina Goldengate custom SNP assay and Sequenome iPLEX platform, and tissue-associated microbial communities were assessed using 454 pyrosequencing. Results: Among our cohort, smoking was associated with CDL (P=0.003) and Ashkenazi Jewish heritage with CP (P<0.008). NOD2insC (rs2066847) (P=7.4x10-5), anti-CBir1 (P<0.0001) and ASCA (IgG) (P=0.03) were significantly associated with inflammatory pouch outcomes. Additional SNPs in NOX3, DAGLB, and NCF4 were also marginally associated with pouch outcome. A multi-variable risk model combining clinical, serologic and genetic markers was constructed and could differentiate between chronic pouch inflammatory phenotypes and no pouchitis. Genus level microbial analysis demonstrated that several organisms (Bacteroides, Parabacteroides, Blautia and Moryella) were detected less frequently among the inflammatory outcome groups (P<0.05). These associations remained significant even following adjustment for antibiotic use, smoking, country of birth and gender. Conclusions: CD-associated anti-microbial antibodies and genetic markers are associated with chronic inflammatory pouch phenotypes. Additionally, changes in the composition of the pouch associated microbiome are associated with inflammation. These observations suggest that similar mechanisms may be involved in non-surgical IBD and pouchitis.

Keywords: Microbiome
Inflammatory bowel disease
Genetics
ileal pouch-anal anastomosis
Advisor: Silverberg, Mark
Intimate Partner Violence as a Risk Factor for Incident HIV Infection in Women in Rakai, Uganda

Background: Intimate partner violence (IPV) is a significant public health problem, which has been associated with HIV infection. Previous studies that assessed IPV and HIV have been limited. Objectives: The primary objective of this study was to quantify the association between IPV and incident HIV infection in women in Rakai, Uganda. Secondary objectives were to explore whether condom use and number of partners in the past year mediate this association, and to identify risk factors for IPV. Methods: Data were collected over seven rounds of the Rakai Community Cohort Study between 2000 and 2009. Sexually active women aged 15 to 49 were included in analyses. Longitudinal data analysis was used to quantify the association between IPV and incident HIV infection, modelling participants as random effects. The adjusted population attributable risk fraction was calculated using an adjusted relative risk from a Poisson model. Putative mediators were assessed using Baron and Kenny’s criteria and the Sobel-Goodman test. Longitudinal and non-longitudinal analyses were used to assess predictors of IPV. Results: Women who experienced IPV ever had an odds ratio of incident HIV infection of 1.54 (95% CI 1.14, 2.09, p value 0.01), compared with women who had never experienced IPV. The adjusted population attributable risk fraction of incident HIV during the study period attributable to IPV ever was 14.3% (95% CI 2.8, 23.6). There was no evidence that condom use or partner violence in the past year mediated the relationship between IPV and HIV. Risk factors for IPV included sexual abuse, younger age at first sex, lower levels of education, forced first sex, younger age, being married, relationship of shorter duration, alcohol use by women and by their partners, and thinking that violence is acceptable. Discussion: This study demonstrates that IPV is associated with incident HIV infection in a population-based cohort in Uganda, although the population attributable risk fraction was modest. The prevention of IPV both in early sexual experiences and in adulthood should be a public health priority, and could contribute to HIV prevention. Further research is needed to understand the pathway from IPV to HIV infection.

Advisor: Calzavara, Liviana
Fluidized Bed Selective Oxidation and Sulfation Roasting of Nickel Sulfide Concentrate

Selective oxidation and sulfation roasting of nickel concentrate followed by leaching was investigated as a novel route for nickel production. In the oxidation roasting stage, the iron species in the nickel concentrate was preferentially oxidized to form iron oxides, leaving non-ferrous metals (Ni, Cu, Co) as sulfides. The roasted product was then sulfation roasted to convert the sulfides of the latter metals into water-soluble sulfates. The sulfates were then leached into solution for further recovery and separation from iron oxides. The oxidation of nickel concentrate was firstly studied by means of thermogravimetric and differential thermal analysis over a wide temperature range. A reaction scheme was deduced, in which preferential oxidation of iron sulfide species occurred over a wide temperature range up to about 700 ºC, forming a Ni1-xS core with iron oxide shell. A batch fluidized bed roaster was then constructed to study the oxidation and sulfation roasting of nickel sulfide concentrate. Oxidation roasting tests were carried out at temperatures between 650 °C and 775 °C. It was found that low temperatures (e.g. 650 °C) are favorable for the preferential oxidation of iron sulfide species while minimizing the formation of nickeliferous oxides, i.e. trevorite and NiO. Several parameters were varied in the sulfation roasting experiments, including the sulfation gas flowrate, sulfation roasting temperature, the addition of Na2SO4, sulfation roasting time, and the oxidation roasting temperature. Under optimized conditions of sulfation gas composition (95% air, 5% SO2), temperature (700 °C), Na2SO4 addition (10 wt%) and time (150 min), the conversions to sulfates were 79% Ni, 91% Cu, and 91% Co. Only 5% Fe forms water-soluble sulfate. The residue from the leaching of calcine in water contained 49% Fe and 10% Ni, which is a suitable feedstock for the production of ferronickel alloys. Therefore, further studies were also conducted to evaluate the reduction behavior of the residue with CO, H2 and graphite.

Keywords: Fluidized bed
Roasting
Sulfation roasting
Nickel concentrate
Pentlandite
Leaching
TGA
DTA
Reduction
Hematite
Nickel ferrite
Kinetics
Advisor: Utigard, Torstein
Barati, Mansoor
A Narrative Inquiry into the Lived Experiences of Chinese-White Heterosexual Couples within a Canadian Context

This study explores the lived experiences of six Canadian Chinese-White heterosexual couples throughout their relationship lifespans. Interethnic coupling of this ethnic/racial configuration is on a steady rise, and mental health professionals can expect to find themselves working with this population in increasing numbers. In light of Canada’s unique history, ethnic distribution, and official policy of multiculturalism, it adds a much needed perspective to the vast majority of studies that focus on Black-White couples in an American context. Grounded in a constructivist-interpretive paradigm, this study uses narrative inquiry to arrive at six distinctive narratives, each with their central themes and a relationship life map to situate lived experiences in time, place, and forms of interaction. An across-narratives analysis was subsequently performed to identify overarching themes and subthemes across the six narratives. The findings suggest that couples shared similar experiences around their families; feelings of compatibility; and cultural differences around religion, food, and language. Further, they shared their insights on relationship maintenance processes with respect to the maintenance of family cohesion and management of differences. Overall findings in this study were consolidated to generate a co-constructive, contextualized, and strength-based model to understanding the lived experiences of Canadian Chinese-White heterosexual couples. This conceptual model is a response to the traditionally problem-focused literature on interethnic couple relationships, situates lived experiences in the multilayered contexts in which they are embedded, and highlights couples’ innate abilities to co-construct a relational narrative that embodies their shared realities and insights and sense of “we-ness.” Clinical applications of the conceptual model are discussed, along with limitations associated with this study and recommendations for future research.

Keywords: Interethnic couples
Interracial couples
Mixed race couples
Multiracial couples
Advisor: Moodley, Roy
Image Quality of Digital Breast Tomosynthesis: Optimization in Image Acquisition and Reconstruction

Breast cancer continues to be the most frequently diagnosed cancer in Canadian women. Currently, mammography is the clinically accepted best modality for breast cancer detection and the regular use of screening has been shown to contribute to the reduced mortality. However, mammography suffers from several drawbacks which limit its sensitivity and specificity. As a potential solution, digital breast tomosynthesis (DBT) uses a limited number (typically 10-20) of low-dose x-ray projections to produce a three-dimensional tomographic representation of the breast. The reconstruction of DBT images is challenged by such incomplete sampling. The purpose of this thesis is to evaluate the effect of image acquisition parameters on image quality of DBT for various reconstruction techniques and to optimize these, with three specific goals: A) Develop a better power spectrum estimator for detectability calculation as a task-based image quality index; B) Develop a paired-view algorithm for artifact removal in DBT reconstruction; and C) Increase dose efficiency in DBT by reducing random noise. A better power spectrum estimator was developed using a multitaper technique, which yields reduced bias and variance in estimation compared to the conventional moving average method. This gives us an improved detectability measurement with finer frequency steps. The paired-view scheme in DBT reconstruction provides better image quality than the commonly used sequential method. A simple ordering like the “side-to-side” method can achieve less artifact and higher image quality in reconstructed slices. The new denoising algorithm developed was applied to the projection views acquired in DBT before reconstruction. The random noise was markedly removed while the anatomic details were maintained. With the help of this artifact-removal technique used in reconstruction and the denoising method employed on the projection views, the image quality of DBT is enhanced and lesions should be more readily detectable.

Keywords: Breast Tomosynthesis
Image reconstruction
Denoising
Noise Power Spectrum
Advisor: Yaffe, Martin
Peace Education: Imag(e)(in)ing a Future in the Aporea of the University

The field of peace education presently remains undertheorized suffusing praxis and pedagogy as foundation within the edifices of dissembling postModernity marked within the Institute of Rationality. (Re)imag(e)(in)ing critical pedagogy in a peace education-to-come, enjoins readers/writers along a putative journey through the violence of metaphysics in the fundamental question of difference bridging chiastic ethico-philososphical terrain, reconceptualizing pedagogical endeavour in ethicus obligatus to the other towards a renewing peace literacy within academe. Peace education can reconstitute the force of community on planes of difference unfolding socialis aequitus and peace, reframing the nature of our being, self and other as the appositional realm of separation/connection. The opening of peace, as concept, ethos, through critical pedagogy in/by the fashioning of discursive forms acknowledging the semio-theoretical chain constructing human social relationality proffers a solid theoretical foundation for the field of peace education, re-tracing difference across socio-ethno-politico-historical structures. Central tenets of the evolving field of peace education are reconfigured in deontological proposition through deconstruction as precursorial project in reason affording performative discourse transversing the transcendental signified, peace, in another idiom eclipsing spatio-temporal illusion, affording diachronous affirmation and revelation in a crucial luminous snapshot within the post-conflict setting of Northern Ireland concerning fundamental matters of peace and education. Peace education as constituent element of contemporary peace knowledges and principal arena for education for peace within the unconditional university is fundamentally challenged in a commitment to peace literacy to adduce and address all interwoven questions of difference, justice, peace, and education within academe. A new beginning compels another reading in presence honouring the other and Other in ethico-philosophico-pedagogy radically questioning our individual and collective rationality in relation to understandings of human social relationality and the transperformative tenets of peace education in difference through différance, cathecting presence anew while (re)configuring academe primarily concerned with difference, peace, and social justice as discursis unfolding impossibility. Consequently, the order of phallogocentricism and its sponsoring patriarchal institution that would sublimate a discourse on/of difference in substitution, as the same irrupts in the fissure another perspectivity opening through presence, presence in meaning, presence in spatiality, presence in temporality in the impossibility of the limit.

Keywords: Philosophy of Education
Peace Education
Post Foundations
Post critical philosophy
Post critical pedagogy
Deconstruction
Subjectivity
trans-subjectivity
Peace
Education
Advisor: Trifonas, Peter
Booth, David
Controlled Sequential Delivery of Two Growth Factors for the Stimulation of Endogenous Brain Repair after Stroke

Stroke is a leading cause of disability in the world, for which there currently is no effective treatment. One potential method for treating stroke is to stimulate the endogenous neural stem/progenitor cells (NSPCs) in the subventricular zone (SVZ) of adult brain to replace the tissue lost during stroke. Two growth factors that have shown promise in eliciting functional repair in rodent models of stroke are epidermal growth factor (EGF) and erythropoietin (EPO). However, there is a significant challenge in delivering protein drugs in a minimally invasive yet effective manner. In this thesis, a minimally invasive polymer-based system is developed to control the sequential release of EGF followed by EPO. This system comprises of a hyaluronan-methylcellulose (HAMC) hydrogel and two types of polymeric particles, and is applied epicortically to deliver EGF and EPO to stroke-injured mouse brains in a minimally invasive manner. In this thesis, the following are demonstrated: 1) The ability of therapeutics delivered locally to reach the target site after delivery is crucial for the success of local delivery strategies. PEG-modification leads to enhanced penetration distance of EGF. 2) When delivered epicortically to the stroke-injured mouse brain using HAMC, PEG-EGF penetrates further into the brain compared to unmodified EGF. Both EGF and PEG-EGF stimulated NSPC proliferation in the SVZ, but the extent of stimulation is greater when PEG-EGF is delivered compared to unmodified EGF. 3) The transport of EPO is similar in the uninjured and the stroke-injured brain following epicortical delivery from HAMC. EPO delivered epicortically from HAMC is able to reach the SVZ and can enhance neurogenesis in the stroke-injured brain. 4) A composite delivery system is engineered where PEG-EGF and EPO are individually encapsulated in different polymeric particles, and the particles are embedded in the HAMC hydrogel matrix. Stroke-injured animals that receive composite-mediated growth factor treatments ultimately achieve repair comparable to that achieved using a conventional catheter/osmotic minipump infusion system, without causing tissue damage associated with insertion of the infusion system into the brain.

Keywords: Drug Delivery
Endogenous Brain Regeneration
Advisor: Shoichet, Molly
Scheduling Policies in Service Networks

In this thesis, we study different scheduling policies in service networks. In Chapter 2, we consider two service level (SL) measures in a two-server tandem queue system: the average sojourn time and the probability of long waits. We demonstrate that a family of Threshold Based Policies (TBP) can reduce the probability of long waits while maintaining sojourn times that are only slightly higher than those of a non-idling policy. In Chapter 3, we present a case study for improving the operations of a healthcare provider that has an open-shop queueing network. We propose an effective implementation of Dynamic Scheduling Policies (DSPs) and a generalized TBP to improve the SL in an open-shop queueing networks. Using a simulation model we demonstrate that an open-shop queueing network can be managed in a systematic fashion to deliver improved SL. In Chapter 4, we study the waiting time distribution of two different priority classes in an M/M/c queue with different service times. For the c=2 case, we provide closed form expression of the Generating Function (GF) of the number of low-priority jobs in the system, which can lead to the waiting time distribution. For c>2 case, we present an efficient numerical algorithm for deriving this GF. We discuss several insights gained from numerical results. Both Chapter 2 and 3 were supervised by Professors Opher Baron, Oded Berman, and Dmitry Krass. Chapter 4 was supervised by Professors Opher Baron and Alan Scheller-Wolf.

Keywords: Scheduling Policies
Service Networks
Advisor: Baron, Opher
Berman, Oded
Krass, Dmitry
Applications of Adjoint Modelling in Chemical Composition: Studies of Tropospheric Ozone at Middle and High Northern Latitudes

Ozone is integral to tropospheric chemistry, and understanding the processes controlling its distribution is important in climate and air pollution contexts. The GEOS-Chem global chemical transport model and its adjoint are used to interpret the impacts of midlatitude precursor emissions and atmospheric transport on the tropospheric ozone distribution at middle and high northern latitudes. In the Arctic, the model reproduces seasonal cycles of peroxyacetyl nitrate (PAN) and ozone measured at the surface, and observed ozone abundances in the summer free troposphere. Source attribution analysis suggests that local photochemical production, ≤ 0.25 ppbv/day, driven by PAN decomposition accounts for more than 50% of ozone in the summertime Arctic boundary layer. In the mid-troposphere, photochemical production accounts for 30-40% of ozone, while ozone transported from midlatitudes contributes 25-35%. Adjoint sensitivity studies link summertime ozone production to anthropogenic, biomass burning, soil, and lightning emissions between 50N-70N. Over Alert, Nunavut, the sensitivity of mid-tropospheric ozone to lightning emissions sometimes exceeds that to anthropogenic emissions. Over the eastern U.S., numerous models overestimate ozone in the summertime boundary layer. An inversion analysis, using the GEOS-Chem four-dimensional variational data assimilation system, optimizes emissions of NOx and isoprene. Inversion results suggest the model bias cannot be explained by discrepancies in these precursor emissions. A separate inversion optimizes rates of key chemical reactions including ozone deposition rates, which are parameterized and particularly uncertain. The inversion suggests a factor of 2-3 increase in deposition rates in the northeastern U.S., decreasing the ozone bias from 17.5 ppbv to 6.0 ppbv. This analysis, however, is sensitive to the model boundary layer mixing scheme. Several inversion analyses are conducted to estimate lightning NOx emissions over North America in August 2006, using ozonesonde data. The high-resolution nested version of GEOS-Chem is used to better capture variability in the ozonesonde data. The analyses suggest North American lightning NOx totals between 0.076-0.204 Tg N. A major challenge is that the vertical distribution of the lightning source is not optimized, but the results suggest a bias in the vertical distribution. Reliably optimizing the three-dimensional distribution of lightning NOx emissions requires more information than the ozonesonde dataset contains.

Keywords: atmospheric science
chemical composition
adjoint model
data assimilation
Advisor: Jones, Dylan