VictorJuiz/thesis huggingface dataset:
The Use of Self-sampling for HPV Testing to Improve Cervical Cancer Screening Participation among Under-screened Women Living in Rural Ontario

Papanicolaou (Pap) testing has greatly reduced the incidence of and mortality due to cervical cancer. However, human papillomavirus (HPV) testing is being increasingly recommended for primary cervical cancer screening. One benefit of HPV testing is the opportunity for self-sampled specimen collection. The purpose of this dissertation was to determine if HPV self-sampling can improve participation in cervical cancer screening in under-screened rural communities. A systematic literature review and mixed methods study design addressed three objectives. A systematic literature review and meta-analysis calculated a pooled estimate of HPV self-sampling uptake in under-screened women (objective 1). Qualitative thematic analysis of community focus groups explored barriers to cervical cancer screening in an under-screened rural population and described women’s initial attitude towards HPV self-sampling (objective 2). These findings supported the design and implementation of a pragmatic randomized HPV self-sampling pilot study that determined the feasibility and acceptability of at-home HPV self-sampling to increase uptake of cervical cancer screening in an under-screened rural community (objective 3). Meta-analysis of the literature found under-screened women were 2.1 (95%CI 1.3 – 3.5) times more likely to participate in screening when HPV self-sampling was offered compared to re-call letters for Pap testing. Thematic analysis found logistical, procedural, and knowledge barriers to cervical cancer screening. HPV self-sampling addressed logistical barriers, such as inconvenient clinic hours, and procedural barriers, such as embarrassment and lack of privacy. However, self-sampling does not address knowledge barriers, specifically a women’s fear of cancer or lack of awareness of the benefits of screening. The HPV self-sampling pilot study included 818 eligible women. Women who received a HPV self-sampling kit were RR=3.7 (95%CI 2.2 – 6.4) times more likely to be screened (HPV self-sampling or Pap testing) compared to women with no intervention, and RR=2.1 (95%CI 1.5 – 2.8) times more likely to be screened compared to women who received a Pap test reminder letter. The absolute participation with HPV self-sampling was moderate at 20.9% (95% CI 16.7–25.7%), indicating that barriers to screening remain. Together these results contribute further evidence for the use of HPV self-sampling to increase uptake of cervical cancer screening in under-screened rural women.

Keywords: Cancer Screening
Cervical Cancer
HPV testing
Human papillomavirus
Self-sampling
Advisor: Gesink, Dionne
Traditional and Novel Cardiovascular Risk Factors and Neurocognitive Functioning in Adolescents with Bipolar Disorder

The mood symptoms that comprise bipolar disorder (BD) are well defined. However, two additional sources of impairment in BD are an increase in cardiovascular risk factors (CVRFs) and neurocognitive deficits. Among healthy adults, CVRFs are negatively associated with neurocognitive performance. The overall aim of this thesis was to determine the association between traditional and novel CVRFs with neurocognitive functioning among adolescents with BD, compared to healthy control (HC) adolescents. It was hypothesized that CVRFs will be associated with neurocognitive functioning in the BD group only, which may be due to a multi-systemic microvascular underlying phenotype of BD. First, a review was conducted to identify the relationship between flow-mediated dilation and neurocognition among healthy individuals. Following a thorough literature search, results were pooled from 10 articles. It was determined that there are links between neurocognition and vascular function, particularly in executive functioning tasks. Next, the association between metabolic syndrome (MetS) components and cognitive flexibility performance in BD adolescents compared to HC adolescents was determined. Triglycerides and diastolic blood pressure were negatively associated with task performance among BD adolescents (ρ=-0.396, p=0.020 and ρ=-0.358, p=0.041, respectively), but not among HC adolescents (p>0.05). Subsequently, the link between MetS components and risk-taking and decision-making in BD adolescents compared to HC adolescents was assessed. It was determined that systolic and diastolic blood pressure were positively associated with risk-taking behaviour among BD adolescents (r=0.387, p=0.026 and ρ=0.404, p=0.020, respectively), but not among HC adolescents (p>0.05). Finally, retinal vascular photography was employed as a non-invasive tool, used as a proxy for cerebral microvasculature. A pilot study was conducted to determine the associations between various MetS components, as well as neurocognitive functioning, with retinal microvasculature. This study showed that within the BD group only, poorer retinal vascular caliber was associated with higher diastolic blood pressure (r=-0.404, p=0.013) and poorer endothelial function (r=0.458, p=0.004). Furthermore, retinal vascular caliber was associated with executive function in the BD group (ρ=0.344, p=0.040), but not in the HC group. This thesis demonstrates the importance of integrated brain-body research in mental health, and provides potential for innovative treatment and prevention strategies for adolescents with BD.

Keywords: adolescent
bipolar disorder
cardiovascular disease
neurocognition
Advisor: Goldstein, Benjamin I
Lanct么t, Krista
Integrating Variable Renewable Energy on Electricity Grids Through a Multi-Scaled Energy Modelling Approach: from Capacity Expansion to Production Cost Modelling

The global wind and solar PV industry has transitioned from a subsidy-dependent niche market to a commercially viable sector that is dominating global capacity expansions. However, integrating these renewable energy resources, with their variable nature, onto the electricity grid poses new challenges for system operations. This thesis explores variable renewable energy (VRE) integration, through multiple scales of energy modelling and analysis from the integrated assessment model MESSAGE, to the country-scale electricity system model LEAP, and the production cost model introduced in this work entitled SILVER. The MESSAGE and LEAP models have large-scale, long-term representations of the energy system that enable analysis of alternative energy policies, cross-sector environmental impacts, and overarching cost trends, but do not have the spatial-temporal resolution to represent site-specific, variable VRE generation profiles. Thus, SILVER, for the Strategic Integration of Large-capacity Variable Energy Resources, is designed as a highly flexible production cost dispatch tool. Technologically, SILVER represents the full gamut of grid balancing strategies: building flexible and dispatchable generation assets, interconnecting geographically dispersed resources and VRE types, shifting flexible loads through demand response, shifting generation profiles through storage technologies, curtailing excess generation, interconnecting the electricity sector with the transport sector, and improving VRE forecasting methodologies. SILVER relies on hourly wind and solar generation time-series data, produced by the newly developed GRETA (Global Renewable Energy Atlas Time) tool, which has been launched as an open access web-portal. SILVER is applied to three VRE integration applications: moving towards a fully-renewable Ontario electricity system including 87% VRE penetration, demand response, electric vehicles, storage assets, and an expanded transmission network; quantifying storage asset commercial viability in electricity systems with different flexibility factors, VRE penetrations, and financial remuneration mechanisms; and exploring the role of decentralized generation and electric vehicles at a city-scale in a developing country context. The results demonstrate the highly system-specific nature of VRE integration, with the VRE resource typology, the non-VRE system flexibly, VRE penetration, and degree of VRE centralization having significant impacts. The interdependence between these electricity system factors in terms of curtailment rates, GHG emissions, electricity system costs, and flexibility requirements recommends an integrated planning approach.

Keywords: capacity expansion modelling
energy system transition
integration
production cost modelling
storage
variable renewable energy
Advisor: Karney, Bryan
Exploring Institutional Change at Three Ontario Colleges: 2002-2012

Legislative changes in 2000 and 2002 marked the beginning of the most dynamic period of change for the Ontario Colleges since their formation in 1965. Entering the time period of the study, the colleges were affected by large funding cuts in 1995/96 which created a condition where the colleges were forced to enhance existing, and create new, revenue streams. The Post-secondary Education Choice and Excellence Act, 2000 opened the possibility of offering degrees to the colleges. The Ontario Colleges of Applied Arts and Technology Act, 2002 altered the systemâ s governance structures to provide a new operational autonomy that allowed the colleges to pursue new revenue streams more flexibly. In addition, the 2002 Act included provisions for engaging in applied research at the colleges. The thesis applies a theoretical framework used in W.R. Scottâ s book (2000) Institutional Change and Healthcare Organizations: From professional dominance to managed care to analyze the changes within the Ontario College system and at the three colleges studied. The framework uses concepts from Resource Dependence Theory and Institutional Theory to define the material-resource and institutional environments respectively. Based on the contention that changes in these two environments provide evidence of institutional change, this thesis examines the material-resource and institutional environments over the period of the study, providing a description of the changes at the colleges. The study contains a survey of system-level changes, and an examination of the three individual case studies of Ontario colleges in response to those changes. The study was conducted using a qualitative case-study approach, using archival documents and a total of 26 in-depth semi-structured interviews of key policy actors and senior administrators at each college participating in the study. In the decade following the legislative changes, colleges adopted more activities and engaged with more stakeholders outside of the college, thus the operating environment of the colleges became more complex. The external environmental complexity was reflected onto the internal organizational structure of the colleges. As a result, each college reorganized in terms of structure, expertise it contained and more profoundly, it changed how and why the college made the decisions that it did.

Keywords: CAAT
College
Ontario
Ontario Colleges of Applied Arts and Technology
organizational change
policy
Advisor: Jones, Glen A.
Advancing the assessment of spasticity in the upper limb post stroke

Upper limb spasticity can interfere with function and cause pain and contractures. Botulinum neuro toxin A (BoNTA) has been effectively used to reduce spasticity; however, the impact of BoNTA combined with rehabilitation on upper limb function is not clear. One possible reason could be the lack of sensitive clinical assessments to show the changes in the focal muscles after an intervention. Therefore, this dissertation aimed to examine the impact of BoNTA combined with rehabilitation on arm function using sensitive, objective assessments in addition to clinical measures. The present findings affirmed that a combination of BoNTA and one month of upper limb rehabilitation assisted patients after stroke with upper limb spasticity to achieve their goals using the Goal Attainment Scale (GAS). Because there is subjectivity in clinical measures such as the GAS, a Kinematic Upper Limb Spasticity Management (KUSA) protocol was developed to objectively characterise the wrist, elbow and shoulder movements that were identified through the goals selected by patients. Kinematic variables including speed, active range of motion and compensatory trunk movement through KUSA were able to distinguish between affected and unaffected sides. Furthermore, KUSA provided supplementary information for motion characterisation that was not available through clinical measures alone. Further, both clinical and kinematic measures were used to examine the effect of two different phases: upper limb rehabilitation, and BoNTA plus rehabilitation on arm function. It was shown that only two clinical measures (Modified Ashworth Scale and Chedoke Arm and Hand Activity Inventory) significantly changed after BoNTA and rehabilitation; however, no changes in kinematic measures were found. Secondary analysis demonstrated that patients with higher motor recovery on the Chedoke McMaster Stroke Assessment improved in all kinematic variables compared to those individuals with lower initial motor recovery stage. This thesis advances knowledge about the types of assessments that identify change in function following spasticity management intervention and characteristics of patients that best responded to this intervention based on these outcomes. These results would be useful in guiding future research on the effectiveness of BoNTA.

Keywords: assessment
function
kinematic
spasticity
stroke
upper limb
Advisor: Mochizuki, George
Brooks, Dina
Reassembling Symbolic Japan: Contemporary Painting, Politics and the Negotiation of War Memory

This dissertation examines the work of twelve living and producing Japanese artists, including Aida Makoto, Ikeda Manabu, Yamaguchi Akira and others. I argue that the works can be read as productive critical engagements with the problem of memory and war in Japan. Born primarily in the late 60s through late 70s, their work is the product of growing up during the textbook debates and the particular historical understandings that debates over war-memory imparted on their generation. I advance new connections between contemporary symbols and their origins in the sublimation of war and postwar memory and the ways in which the visual legacy of World War II affected this generation. I posit two ways in which a rereading of contemporary art challenges dominant modes of understanding Japan: first in offering an alternative to Murakami Takashi’s flattening of Japanese society and cultural production; and second in demonstrating a more complex understanding of war memory and accountability. Works which are cute, manga- and anime-like or robotic can be evaluated for how they are critical of Japan’s past and/or present. I argue that we should consider the complex visual constructions of the artworks discussed for the ways in which they critique Japanese society and the “problem” of history/memory—a problem not distinct from Japan’s defeat or of Western cultural imperialism, but with its own productive possibilities. Rather than questioning if Japan was or was not a victim or aggressor, these works consider how such disparate understandings can coexist, compete and erupt at different moments and in various manifestations. By illuminating the way in which artists create a new dialogue of history, accountability and the social consciousness, this dissertation provides a clearer understanding of what contemporary Japanese art is communicating to its viewers, both domestically and throughout East Asia.

Keywords: Art
Cyborg
Japan
Kawaii
Superflat
Veteran
Advisor: Keirstead, Thomas
Skeletal Muscle Dysfunction in Lung Transplant Patients

Lung transplantation improves health-related quality of life (HRQL), daily function and survival for individuals with advanced lung disease. However, lung transplantation is now offered to older and more complex patients who are at a higher risk of skeletal muscle dysfunction; the implications of which remain uncertain. The overall objective was to assess how elements of muscle dysfunction (mass, strength and function) are associated with pre- and post-transplant physical function, HRQL, and clinical outcomes. We hypothesized that pre-transplant skeletal muscle dysfunction would be associated with impairments in pre-transplant HRQL, activities of daily-living (ADL), six-minute walk distance (6MWD), and worse post-transplant functional recovery with increased pre- and post-transplant mortality. Three studies targeting the pre- and post-transplant periods were undertaken. In study 1, a novel method of muscle mass quantification using computed tomography (CT) was retrospectively evaluated in 527 lung transplant candidates. CT muscle cross-sectional area in transplant candidates was 10% lower than age and sex-matched controls and independently associated with 6MWD, strength training volumes and post-transplant hospital length of stay (LOS), but no association was observed with pre- or post-transplant mortality. In study 2, muscle mass assessed with bio-electrical impedance, quadriceps strength, and function (Short Physical Performance Battery, SPPB) were prospectively evaluated in 50 lung transplant candidates. Quadriceps strength and SPPB were associated with pre-transplant HRQL, ADL, and 6MWD. Number of muscle deficits (mass, strength and/or function) was directly correlated with post-transplant hospital LOS, but not with delisting/mortality or post-transplant 6MWD. In study 3, the impact of pre-transplant skeletal muscle mass and function on post-transplant functional independence, HRQL, and 6MWD was evaluated in a select group of lung transplant recipients with prolonged mechanical ventilation (â Ľ 7 days). Age and intensive care unit (ICU) LOS were the only determinants of early post-transplant functional recovery, highlighting the importance of ICU-acquired morbidity. In summary, these studies demonstrate that skeletal muscle function is an important marker of pre-transplant daily function and predicts post-transplant hospital LOS, but is not a significant predictor of post-transplant function or mortality. Future studies should examine whether targeted rehabilitation strategies in the pre-transplant period may improve daily function and early post-transplant outcomes.

Keywords: Function
Lung
Muscle
Strength
Transplant
Advisor: Singer, Lianne G
Mathur, Sunita
Recovering a Riemannian Metric from Knowledge of the Areas of Properly-Embedded, Area-Minimizing Surfaces

In this thesis, we prove that if (M,g) is a C3-smooth, 3-dimensional Riemannian manifold with mean convex boundary ∂M, which is additionally either a) C2-close to Euclidean or b) sufficiently thin, then knowledge of the least areas circumscribed by any simple closed curve γ ⊂ ∂M uniquely determines the metric. In fact, given the least area data for a much more restricted class of curves γ ⊂ ∂M, we uniquely determine the metric. We also prove a corresponding local result: assuming only that (M,g) has strictly mean convex boundary at a point p ∈ ∂M, we prove that knowledge of the least areas circumscribed by any simple closed curve γ in a neighbourhood U ⊂ ∂M of p uniquely determines the metric near p.

Keywords: Area-Minimizing
Geometric Analysis
Inverse Problems
Minimal Surfaces
PDE
Riemannian Geometry
Advisor: Alexakis, Spyros
Nachman, Adrian
The Pearl of Pearls: The Abdālī-Durrānī Confederacy and Its Transformation under Aḥmad Shāh, Durr-i Durrān

This dissertation traces the history of the Abdālī-Durrānī tribal confederacy from its putative origins to the career of arguably its most influential historical personality, Aḥmad Shāh Durr-i Durrān, the “Pearl of Pearls” (r. 1747–72). Drawing upon extensive research of primary sources on the topic such as tribal genealogies, court chronicles, local histories, and other documents, this study examines the process whereby the Abdālī-Durrānī evolved from a petty Afghan tribal confederacy active in Qandahar, a frontier region of the early modern empires of the Safavids and Mughals, to founders of the autonomous Durrānī empire that, at its height under Aḥmad Shāh, was one of the most powerful polities in Asia. Despite the considerable influence of the Abdālī-Durrānī, the crucial transitional period of the confederacy’s history, spanning roughly from 1550 to 1818, remains understudied. “The Pearl of Pearls” is aimed at better understanding this history by exploring neglected topics such as: the construction of the Afghan identity of the Abdālī- Durrānī; the nature of the confederacy’s interactions with the Safavid, Mughal, and Nādirid states; the gradual formation of the Durrānī state; the large-scale sedentarization of the Durrānī in the reign of Aḥmad Shāh and his successors; and the accompanying Persian acculturation of the tribal confederacy’s ruling elite. While directed primarily towards supplementing our limited knowledge of the Abdālī-Durrānī and the early modern Durrānī state, this dissertation also considers the enduring legacies of Aḥmad Shāh’s rule in relation to the modern history of Afghanistan.

Keywords: Abdālī-Durrānī Tribe
Afghanistan
Aḥmad Shāh Durr-i Durrān
Durrﾄ］ﾄｫ Empire
Early Modern History
Historiography
Advisor: Subtelny, Maria E.
Health Care Access and Utilization by Young Mothers Experiencing Homelessness: A Bourdieusian Analysis with an Arts-Based Approach

Young mothers experiencing homelessness and their children have low economic and social resources and worse physical and mental health outcomes than their more resourced counterparts. Furthermore, their use of health care resources is constrained by social factors that remain understudied. Following a relational approach based on Bourdieuâ s theory of practice, this study aimed to explore and understand the relationships between the social position that these young mothers occupy and their health practices (access/use of healthcare resources and other behaviors). This study also sought the impact of an arts-based approach on community involvement. Through qualitative inquiry I used discursive montage and participatory graphic elicitation. The former consisted of an analysis of the media artifacts on young mothers experiencing homelessness, aiming to understand how they are socially positioned and how this relates to social structures. The graphic elicitation consisted of a semi-structured and an elicitation interview, the latter based on their artwork created during the study. The artwork created by young mothers, volunteers, and by myself was included in the analysis; it was also a tool for my reflexive process. All data were analyzed through a dynamic process of data abstraction using Bourdieuâ s concepts of habitus, capital, and field. Results showed an embodiment of the social values related to the conceptualization of youth that excludes young homeless mothers and sees them as deviant. Young mothers are portrait in the media as unskilled and immature, with a low chance of social success. The contradictions drawn from this social construction of youth and mothering affect not only their daily life but how they take care of their health and that of their children. Participants tended to avoid situations in which they may feel judged or brushed off, which resulted in them minimizing their encounters with healthcare providers. This study has identified a healthcare gap related to the adequacy of existing resources, as well as a need for creative approaches to connecting young mothers with providers.

Keywords: arts based research
Bourdieu
health care access
health inequities
homelessness
young mothers
Advisor: Angus, Jan