VictorJuiz/thesis huggingface dataset:
Pain Assessment and Management in Pediatric Trauma

Background/Rationale Trauma is the leading cause of death in children over one year of age; however, research on pain assessment and management in pediatric trauma patients is scarce. Objective The aim was to determine (a) the nature and frequency of pain assessment and management practices and (b) the pain perceptions of children who have undergone a trauma and the health care professionals who provide care to them. Tenets of Critical Realism, the Gate Control Theory of pain, and developmental theory were used to examine the data. Methods A two-phased mixed methods study was conducted at a regional pediatric trauma centre. In Phase 1, pain assessment and management practices including time to administration of first analgesia (and the child and situation factors that affect them) were recorded from a retrospective chart review of pediatric trauma patients over a one-year period. Descriptive and multivariable analyses were conducted. In Phase 2, perceptions of pain management in the Emergency Department from children and health care professionals were examined through interviews. Constant comparative analysis was conducted to develop themes. Findings from Phase 1 and 2 results were triangulated. Results In Phase 1, 90/ 104 (86.5%) pediatric trauma patients had a pain assessment recorded; 60 (67%) via narrative notation and 30 (33%) with a validated pain tool. Opioid analgesia, were administered to 76/104 (73%) patients. Median (IQR) time from the traumatic event to administration of the first opioid analgesia was 99 (77-180) minutes. In Phase 2, nine children revealed their perceptions of the pain and trauma experience. Thirteen health care professionals discussed the priority of pain treatment compared to physiological stability with no standardized approach to pain treatment. Conclusion Pain assessment and management for pediatric trauma patient in the Emergency Department is suboptimal. Implications for clinical practice and research targeting interventions to improve the status of pain assessment and management are suggested. Key words: pediatric trauma, pain, pain assessment, pain management

Keywords: pain
pain assessment
pain management
pediatric trauma
Advisor: Stevens, Bonnie J
Mighty to the End: Utilizing Military Models to Study the Structure, Composition, and Effectiveness of the Mamlūk Army

This dissertation investigates the structure, composition, and effectiveness of the Mamlūk army through the use of two military models, the Diversified Army Model and the Ṣāliḥī Mamlūk Model, that dominated its organization between 1250 CE and 1517 CE. The Diversified Army Model was the dominant form of military organization in the polities of the Muslim world prior to the rise of the Mamlūk sultanate. The Ṣāliḥī Mamlūk Model came into existence in the late Ayyūbid period during the reign of al-Ṣāliḥ Ayyūb (r. 1240-1249 CE) and continued to dominate the military organization of the Mamlūk sultanate until the third reign of al-Nāṣir Muḥammad (r. 1310-1340 CE), when the Diversified army Model once again came to the fore. This period has often been viewed as one of major change or a turning point by several historians. However, there was a return to the Ṣāliḥī Mamlūk Model under several Circassian sultans and by the latter half of the sixteenth century, there was a merging of the two military models. The current study thus argues that the Mamlūk army was constantly in a state of change and that the reign of every sultan, not only that of al-Nāṣir Muḥammad, was a turning point for the military. Despite the transformations and changes in the structure and composition of the Mamlūk army, it remained a formidable force throughout the entire Mamlūk period. Through their training, the mamlūks became exceptional horsemen and proficient in the use of a variety of melee and ranged weapons. Furthermore, the slow promotion of officers (with a few exceptions), ensured that the men who rose up the ranks were seasoned and experienced soldiers. It was often from among these officers that a new sultan emerged. Finally, the Mamlūk army’s excellent track record on the battlefield demonstrates its enduring strength. This strength is signified by the fact that the sultanate’s force’s remained militarily effective and largely undefeated between the thirteenth and sixteenth centuries. The instances in which the Mamlūks suffered military defeats are few and far apart and until the Ottoman conquest of 1517 CE they quickly recovered from such setbacks.

Keywords: Army
Islamic
Mamluk
Military Models
Slavery
War
Advisor: Northrup, Linda S
Mobile technology and health apps: Patient and provider experiences in cardiac rehabilitation

This study focused on the use of mobile health and wellness applications (apps) in chronic disease management. There are over a hundred thousand health apps available for download on public app stores. These include apps in key areas for chronic disease management such as exercise and diet. However, there is little evidence on patient use of health apps to support self-management of chronic conditions. Therefore, the study objective was to describe cardiac rehabilitation patient and provider experiences with health apps and perceived impact on self-management and the patient-provider relationship. An exploratory mixed methods design was used to gain an understanding of patient and provider perspectives and experiences. The study was conducted in a cardiac rehabilitation program in Ontario, Canada. A quantitative survey (n=242) focused on patient demographics and technology use profiles. Patient interviews (n=30) and a provider focus group (n=8) were conducted to explore perspectives on mobile technology and health app use as a part of self-management and the patient-provider relationship. Results from this study describe an aging patient population with a range of cardiac diagnoses and co-morbidities. Ninety-two percent of patients in this study used mobile technology and 50% of those with mobile technology were using health apps. Most patients and providers felt that health apps can support chronic disease management, particularly with respect to tracking progress against exercise and diet goals. Patients and providers also felt that they needed more support in using health apps and integrating them into care processes. This included the need for education on how to use apps as well as access to information on app accuracy and how to choose or recommend health apps given the large number available. Participants also emphasized the desire for health apps to connect patients and providers during and after the rehabilitation program. Health apps were mostly used by patients in the study in the absence of provider recommendations and without connectivity between patients and providers. Findings highlighted the need for health care practices to leverage and support health apps as a part of care during rehabilitation and post-discharge for patients self-managing in the community.

Keywords: applications
apps
cardiac
chronic
mobile
technology
Advisor: Baker, Ross
Role of MicroRNA-146a in Vascular Inflammation and Atherosclerosis

Inflammation plays a vital role in acute and chronic diseases of the vasculature, including sepsis and atherosclerosis, respectively. Molecular mechanisms such as microRNAs are key regulators of signaling pathways and are important in governing the balance between physiological and pathological inflammatory responses. While numerous studies have placed miR-146a amongst the echelon of anti-inflammatory microRNAs, the role of endogenous miR-146a in vascular inflammatory diseases, including atherosclerosis, remains unknown. Therapies that directly repress vascular inflammation are expected to impede the development of sepsis and atherosclerosis. Furthermore, elevation of miR-146a expression in atherosclerotic plaques in humans and polymorphisms in the miR-146a precursor that are associated with coronary artery disease, are suggestive of a role for this microRNA in atherogenesis. Therefore, this dissertation aims to elucidate the regulation of endothelial activation by miR-146a and to determine the role of endogenous miR-146a in a mouse model of atherosclerosis. Surprising, despite the ability of this microRNA to restrain cytokine production in bone marrow-derived cells, loss of this microRNA resulted in reduced atherosclerosis. This was accompanied by hematopoietic stem cell exhaustion and a corresponding reduction in levels of circulating pro-atherogenic cells. Enhanced inflammatory signaling occurred even though circulating levels of VLDL cholesterol were diminished in these mice. Within the vasculature, miR-146a restrained endothelial activation through the regulation of transcriptional and post-transcriptional inflammatory pathways, and loss of miR-146a in the vasculature enhanced atherosclerosis. This dissertation reveals a critical function for a single microRNA in the control of the intensity of inflammatory responses to inflammatory stimuli such as hypercholesterolemia, and highlights the detrimental effects of unrestrained inflammatory signaling in multiple organs: bone marrow (hematopoietic stem cell exhaustion), spleen (extramedullary hematopoiesis and splenomegaly), liver (cholesterol homeostasis defects) and the vasculature (enhanced endothelial cell activation and monocyte recruitment). Importantly, these findings provide a further impetus to therapeutically augment miR-146a expression/function in atherosclerosis.

Keywords: Atherosclerosis
Cholesterol homeostasis
Endothelial Cells
Hematopoiesis
Inflammation
MicroRNA
Advisor: Fish, Jason E
A Realist Evaluation of Family Navigation in Youth Mental Health and Addictions

In Canada today, many families of youth with mental health and/or addiction concerns are struggling to access the care they need. The Family Navigation Project is a service affiliated with Sunnybrook Health Sciences Centre in Toronto, Ontario, which aims to provide needs-based, family-centred system navigation to families of youth aged 13 to 26 with mental health and/or addiction concerns. The current study is a Realist Evaluation of the Family Navigation Project. The objectives of this study were a) to describe the population being served by the Family Navigation Project; b) to develop a conceptual framework for family navigation and a program theory for the Family Navigation Project; and c) to test the program theory, and refine it based on the results. This multi-phase, mixed methods study applied a Realist Evaluation framework and a cross-sectional methodological design in which both quantitative and qualitative data were collected through an online survey package in order to evaluate the sample characteristics; perception of navigation; the impact of perceived experience on family empowerment, family quality of life, and service satisfaction; and the influence of context. Data was collected from a convenience sample of 134 families seeking care on behalf of youth, who were registered with the Family Navigation Project at the time of the study. Descriptive, inferential and qualitative analyses were performed. Results indicated that the Family Navigation Project reached its target population in this sample; that families in this sample were highly satisfied with the services they received; that most families in this sample perceived care to be accessible, continuous, and family-inclusive; that this perceived experience significantly influenced family empowerment, family quality of life, and service satisfaction; and that both individual and systemic-level contexts influence experience and outcomes to varying extents. The conceptual framework and program theory were subsequently refined. Applications, contributions and limitations are noted.

Keywords: Evaluation
Families
Mental health
Navigation
Youth
Advisor: Cockerill, Rhonda
Durbin, Janet
Mean-Field Games and Ambiguity Aversion

This thesis focuses on incorporating the idea of ambiguity aversion into mean-field games. Intuitively, mean-field games describes the dynamics of a system with an infinite population. It is useful in approximating systems with a large population, for which an exact result is computationally intractable. By adding in ambiguity aversion, the mean-field game reflects how players in the population should act if they wish to protect themselves from model misspecification. Two applications of mean-field games are considered through two distinct approaches. The broker execution problem is investigated in a multi-agent framework containing (i) a major agent who is liquidating a large number of shares, (ii) a number of minor agents (high-frequency traders (HFTs)) who search for statistical arbitrage strategies, and (iii) noise traders who buy and sell for exogenous reasons. All optimizing agents (the broker and HFTs) trade against noise traders as well as one another. We use a mean-field game approach to solve the problem and obtain a set of decentralized feedback trading strategies for the major and minor agents. Furthermore, the mean-field game strategies have an ϵN-Nash equilibrium property where ϵN → 0 as N → ∞. The second application focuses on interbank borrowing and lending, which may induce systemic risk into financial markets. A simple model of this is to assume that log-monetary reserves are coupled, and that banks can also borrow/lend from/to a central bank. When all banks optimize their cost of borrowing and lending, this leads to a stochastic game. We account for model uncertainty by recasting the problem as a robust stochastic game and succeed in providing a strategy which leads to a Nash equilibria for both the finite game and the mean-field game limit. We prove that an ϵ-Nash equilibrium exists and show that when firms are ambiguity-averse, default probabilities can be reduced relative to their ambiguity-neutral counterparts. Finally, this thesis develops a modified stochastic maximum principle for min-max problems, and derives new existence and uniqueness results for a mean-field game with ambiguity averse players. An ϵ-Nash equilibrium is shown to exist for this class of mean-field games, and the mean-field game equations are explicitly derived in the linear-quadratic framework.

Keywords: ambiguity aversion
game theory
high frequency trading
mathematical finance
mean-field games
stochastic games
Advisor: Jaimungal, Sebastian
Living with Uncertainty: The Experiences of Parents and Children When a Parent is Living with and Dying from, Advanced cancer

Living with Uncertainty: The Experiences of Parents and Children When a Parent is Living with and Dying from, Advanced cancer Gabrielle Erica Pitt Doctor of Philosophy, 2017 Factor-Inwentash Faculty of Social Work University of Toronto Abstract Advanced cancer and its progression and treatment deeply affect members of a family, especially the children. The limited research contends that the complexities of advanced cancer and the anticipated loss of a parent result in greater psychosocial vulnerability for children, compromising their well-being (Beale et al., 2004; Bugge et al., 2008; Christ, 2000). Conducted at the Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, the purpose of this interpretive research was to investigate the experiences of parents and children six to eighteen years coping with a parent living with, and dying from, advanced cancer. This study focused on the meaning children and parents ascribe to this time of uncertainty, in addition to aspects such as emotional security, and the role of parents in understanding, and ameliorating, potential effects to children. Seven families participated in the study (seven parents with advanced cancer, four children, and four well parents). A review of the existent literature was presented thematically, and demonstrated critical gaps and meagreness of the research. The theoretical framework encompassed social constructivism and sociocultural theory, in addition to the relational theories of attachment and intersubjectivity. Aspects of neurobiology underpinned the framework. Each facet of the framework was situated within the context of children and parents coping with advanced cancer and anticipatory loss. A theoretical model depicts this framework. Hermeneutic interpretive phenomenology was the methodology incorporated in this study. The primary method of data collection was semi-structured interviews with children and parents separately. Interpretative Phenomenological Analysis (Smith et al., 2009) guided the data analysis and interpretation. Results of the study are presented as a discussion of the themes, illustrated in an accompanying map. A review of the findings in relation to the research questions, the empirical literature, and theoretical framework reveals potential contributions of this research. This study concludes with implications for scholarly knowledge, social policy, social work education and practice, and recommendations for future research. Results of this research will advance the understanding of the experiences of parents and children, inform social work education and practice, and facilitate the development of interventions promoting positive outcomes for children and families.

Keywords: advanced cancer
children
palliative care
parents
psychosocial oncology
qualitative
Advisor: Mishna, Faye
Address Translation Optimizations for Chip Multiprocessors

Address translation is an essential part of current systems. Getting the virtual-to-physical mapping of a page is a time-sensitive operation that precedes the vast majority of memory accesses, be it for data or instructions. The growing memory footprints of current workloads, as well as the proliferation of chip multiprocessor systems with a variety of shared on-chip resources create both challenges and opportunities for address translation research. This thesis presents an in-depth analysis of the TLB-related behaviour of a set of commercial and cloud workloads. This analysis highlights workload nuances that can influence address translationâ s performance, as well as shortcomings of current designs. This thesis presents two architectural proposals that both support our thesis that TLB designs and policies need not be rigid, but should instead dynamically adapt to the workloadsâ behaviour for a judicious use of the available on-chip resources. The Prediction-Based Superpage-Friendly TLB proposal leverages prediction to improve energy and utilization of TLBs by allowing translations of different page sizes to coexist in a set-associative (SA) structure. For example, a 256-entry 4-way SA TLBpred achieves better coverage (7.7% less Misses Per Million Instructions) compared to a slower 128-entry fully- associative TLB. It also has the energy efficiency of a much smaller structure. This design uses a highly accurate superpage predictor that achieves a 0.4% average misprediction rate with a meager 32B of storage. The Forget-Me-Not TLB (FMN) proposal utilizes the existing cache capacity to store translation entries and to thus reduce TLB-miss handling latency. A per core private 1024-entry direct-mapped FMN reduces the average L1-TLB miss latency across all simulated workloads by 31.4% over a baseline with only L1-TLBs. Conversely, a dedicated 1024-entry 8-way SA L2-TLB reduces it by 24.6% and causes, in some cases, performance degradation. We further propose an L2-TLB bypassing mechanism to address this challenge.

Keywords: Address Translation
Translation Lookaside Buffers
Advisor: Moshovos, Andreas
Microfluidic Techniques to perform more Physiologically Relevant Bone Flow Experiments

Mechanical stimulation of bone has often been used to prevent and/or treat various bone mass disorders. Osteocytes, as the major bone mechanosensory cell, are critical in regulating these disorders through the expression of factors that control bone homeostasis. The current methodology to study how fluid mechanostimulation of osteocytes regulates other cells in vitro is through the use of parallel plate flow chambers (PPFCs). In these studies, osteocytes are seeded on glass slides and loaded into PPFCs. Flow is applied to the osteocytes, and conditioned medium is collected, which can then be applied to the other cells being investigated. However, this methodology lacks real-time and direct signaling between the cells, and loses low half-life signal interactions. Additionally, these large PPFCs lack dimensional physiological relevance, and are non-viable for primary osteocyte studies. These limitations, however, can be mitigated through the use of microfluidics and/or co-culture. In this thesis, we present microfluidic techniques to significantly improve the physiological relevance of in vitro osteocyte flow experiments. First, we developed a microfluidic co-culture device to investigate mechanoregulated osteocyte-osteoclast cross-talk. Specifically, we demonstrated that unstimulated osteocytes create an environment that is preferential for osteoclast precursor aggregation and differentiation. Furthermore, we observed increased osteocyte mechanosensitivity in co-culture with osteoclasts. Next, we investigated how platform dimensions and forces applied to the cells, independent of shear stress, can affect osteocyte mechanosensitivity. We determined that this sensitivity was due to differences in flow rates and drag forces applied to the cells. Finally, we fabricated a microfluidic pump that was capable of applying physiologically relevant oscillatory fluid flow and inducing osteocyte intracellular calcium responses within microchannels. This work highlights the need to translate osteocyte mechanobiology studies to more dimensionally/biochemically relevant platforms using microfluidic technologies. As well, this work has already led to the development of in vitro platforms investigating osteocyte mechanical regulation of bone metastasis.

Keywords: Co-culture
Mechanobiology
Microfluidics
Osteoclasts
Osteocyte
Advisor: You, Lidan
Food as a Dangerous Product: The Promise of Private Law for Public Health

Obesity and diet-related chronic diseases are a critical public health problem facing Canadians. Interventions aimed at improving diet and the overall food environment have had limited success, and as a consequence, many have suggested an increased use of legal tools, including litigation. This project examines the potential of the duty to warn, part of product liability law, as a strategy for addressing obesity and other diet-related chronic diseases. To this end, the project proceeds in two parts. Part one project examines the potential of tort law to be used to address public health problems. It begins by establishing the congruence between tort law and public health, and suggests that there are potential benefits of public health litigation for obesity prevention. This sets the foundation for part two, which argues that Canadian jurisprudence clearly establishes that food manufacturers have a duty to warn consumers about the risks associated with consuming food products. Part two examines key aspects of a tort claim based on a failure to warn, namely, the duty of care, standard of care, and factual causation. It sets out an approach to failure to warn cases that is consistent with general principles of negligence law, but that is sensitive to the particularities of a failure to warn case. This project establishes that food manufactures are required to provide warnings that are consistent with the standards of adequacy as set out by the Ontario Court of Appeal decision in Buchan v Ortho Pharmaceutical. Buchan, which has been affirmed by the Supreme Court of Canada, sets out explicit criteria for determining adequacy, including prohibitions against collateral efforts to negate or neutralize warnings. It is clear that food manufacturers are neither fulfilling their obligation to provide warnings nor adhering to the Buchan standard. This project concludes that food manufacturers should be held accountable for this failure.

Keywords: Diet-related chronic diseases
Duty to warn
Food products
Obesity
Product liability
Public health law
Advisor: Lemmens, Trudo