VictorJuiz/thesis huggingface dataset:
Loss of Capacity to Consent and Access to Medical Assistance in Dying: Healthcare Providers’ Experiences and Perspectives

Under Bill C-14, patients who met eligibility requirements were prevented from accessing medical assistance in dying (MAiD) if they lost decision-making capacity while awaiting MAiD. Little is known about healthcare providers’ experiences of patients’ loss of capacity to consent and subsequent ineligibility for MAiD. The enactment of Bill C-7 in 2021 has allowed eligible patients to use a waiver of final consent agreement to access MAiD following their loss of capacity, but healthcare providers’ perspectives on providing MAiD using the proposed amendments were not known. Therefore, the aims of this study were: 1) to explore Canadian healthcare providers’ perspectives on providing MAiD to eligible patients in the absence of a contemporaneous final consent; and 2) to explore healthcare providers’ experiences when their previously eligible patients were unable to access MAID due to a loss of capacity to consent. A critical qualitative methodology, informed by feminist ethics, was used focusing on the concepts of power, relationality, and moral agency. A voice-centred relational approach was used for data analysis. Semi-structured interviews were conducted with a heterogenous sample of 30 participants, (physicians, nurses, nurse practitioners and social workers) recruited using purposeful and snowball methods, who had experiences with patients’ loss of capacity and subsequent ineligibility for MAiD. The findings highlight that healthcare providers’ agency and experiences with MAiD were influenced by socio-political, personal, and professional factors, that in turn, had significant impact on their patients’ access to and experiences with MAiD. While participants morally supported the amendment to waive the final consent requirement, they anticipated ethical and legal challenges in the absence of patients’ contemporaneous consent. The study identifies gaps in the care and support offered to patients and families following patients’ capacity loss and subsequent ineligibility for MAiD. The inconsistencies and disparities in the access to MAiD and other end-of-life services across Canada also came to light. Organizational and professional support, adequate resources, and infrastructure as well as clear policies and guidelines are required to prevent capacity loss-related ineligibility for MAiD, to improve end-of-life care for incapacitated patients and their families, and to promote the safety and well-being of healthcare providers.

Keywords: Decision-making capacity
End-of-life care
Medical assistance in dying
Moral agency
Palliative care
Relational autonomy
Advisor: Peter, Elizabeth
Resilience among Newcomer Students in Canada: A Transformative and Socio-Ecological Analysis of Narratives from Tree of Life Workshops

Newcomer students’ adaptation is a major concern for Canadian educators and teachers due to the recent influx of refugees and immigrants resulting from political, social, and natural displacement. Intersections of race, gender, language, low SES, and previous traumas have traditionally motivated researchers and policymakers to focus mostly on language, mental health symptomology, and risk assessment among this population. Consequently, in institutional programming (e.g., schooling, community organizations, government welcome programs), overemphasizing risk factors has created a deficit-oriented approach in which newcomer students are viewed as the victims and passive recipients of services. However, to create an empowering post-migration experience, it is crucial to understand how newcomer students view themselves, navigate their resources, and make sense of their experience.This case study’s narrative and transformative stance enabled: 1. Shedding light on the less heard stories of the newcomer students and highlighting the risk and resources identified by the newcomers themselves; 2. Examining the influence of participation in a strength-based workshop where the newcomer students’ agency was encouraged. The main evidence of this study was collected through a narrative activity called Tree of Life for 8 weeks with 3 groups of students in two schools within the Greater Toronto Area (GTA). The influence of the workshop was studied via facilitator’s observations, teachers’ reflections, and the students’ post-workshop interviews. Findings of this study revealed the holistic understanding of the newcomer students about their pre- and post-migration experience, how cultural background and past experiences as well as their hopes for the future can be a source of strength, and how the schools’ attitude about newcomers can influence the students’ post-migration experience. The positive feedback and outcomes of the workshop call for participatory and culturally relevant programs for newcomer students where they feel safe and have the chance to know themselves, build their new identity, and create community. Similar programs are especially recommended for students of refugee background who have faced significant interruption in their schooling, where the intersection of past traumas, present stigmatization, and socioeconomic status has influenced their schooling experience and self-image. Keywords: newcomer students, resilience, transformative paradigm, narrative, culture, socio-ecological approach, strength-based approach.

Keywords: Culture
Narrative
Newcomer Students
Resilience
Transformative Paradigm
Tree of Life
Advisor: Ferrari, Michel MF
From Suicidality to Psychological Growth: Understanding the Role of Affective Processing and Meaning Making

Difficult life situations are deemed to facilitate the cultivation of an array of positive changes, collectively referred to as growth through adversity (GTA). Whereas some investigations have documented GTA in survivors of those who have died by suicide, there are scant data regarding the possibility of psychological growth in the aftermath of resolved suicidality for individuals with lived experience of suicidality. In addition, the mechanism through which individuals resolve suicidality and potentially cultivate positive change is unclear. A rarely examined pathway to explain positive change is a shift in individuals’ emotion system. This is rooted in the theory that deep and lasting change cannot occur without a change in one’s affective experiences. Therefore, the current study aimed to examine affective processing (AP) before, during and after suicidality with the aim of understanding whether participants' interactions with affects and emotions could play a role in the resolution of active suicidality. Moreover, this study examined the often overlooked externally determined protective and risk factors as potential contributors to suicidality, to better contextualize the findings. The results of a thematic analysis of in-depth interviews with 14 participants indicated that AP was implicated in the process. In particular, participants' difficulty with processing affects was prominent during the active phase of suicidality and remarkably improved in the process of moving away from suicidality. These changes appeared closely associated with the balance between risk and protective factors, in the sense that highly demanding circumstances stifled, whereas supporting situations facilitated AP. Finally, participants’ narratives indicated the occurrence of GTA reflected in multiple aspects of wisdom such as balanced self-appraisal and prosocial orientation. There were also indications of a renewed interest and increased affinity for spirituality.

Keywords: Affect
Emotional Processing
Psychological Growth
Spirituality
Suicidality
Wisdom
Advisor: Ansloos, Jeffrey
Understanding the Behaviour of GFRP Reinforced Concrete Members under Changing Climate Trends

While fibre-reinforced polymers (FRP) bars have significant advantages over steel with respect to resistance to corrosion, high strength-to-weight ratio, and magnetic neutrality, FRP bars can still deteriorate when exposed to extreme weather events. The current research investigated the effects of increased temperatures, resulting from recent climate changes, on the behaviour of GFRP bars by testing several specimens: 46 coupons, 37 bond specimens, and 12 large beams. The experimental investigation—divided into three phases—was later followed by the analytical study. In the first phase, the tensile behaviour of GFRP bars for elevated temperatures up to about 300oC was studied. Results showed that GFRP bars experienced about a 60% reduction in strength at a steady-state temperature of 250oC. The bars subjected to 40% of the room temperature strength and exposed to high temperatures resulting from situations such as sudden fire sustained the load for about 50 minutes. In the second phase, bond behaviour was studied with pullout as well as beam bond specimens which were conditioned at 50oC and 80oC for four months under a relative humidity of 60%. It was found that the studied thermal conditioning induced up to 26% reductions in the bond strength of GFRP bars. Moreover, beam specimens yielded lower bond stresses at room temperature and experienced higher thermal degradation than their counterpart pull-out specimens. The long-term thermal performance of flexural and shear critical beams was studied in the third phase. Beams were conditioned at 50oC for four months under 60% relative humidity. Under-reinforced flexural critical beams showed about a 22% reduction in the ultimate failure load, but over-reinforced beams did not observe substantial reductions in the ultimate capacity. Likewise, the shear critical beam did not observe a significant reduction in the ultimate shear capacity. Finally, a database of more than 500 coupon specimens tested under elevated temperatures was developed based on which statistical analysis was carried out, and a model is proposed to evaluate the reduction in the tensile strength of GFRP bars with increasing temperatures. Moreover, an analytical model is developed to predict the shear capacity of GFRP-RC beams.

Keywords: climate change
durability
fiber reinforced polymers
GFRP
reinforced concrete
shear
Advisor: Sheikh, Shamim A.
Hierarchical Manufacturing of Hybrid Multi-Functional Soft Actuator

As the use of mechanical actuator becomes more unfeasible in this world that require flexibility and light-weight products, an alternative solution is needed that is beyond the capabilities of current single stimuli-responsive and single functioning soft actuators. The limitations of a single function (actuation) powered by a single external stimulus hinders its practicality for real-world applications that is comprised of integrated systems. This thesis presents a series of studies in the development of multi-stimuli-responsive and multifunctional soft actuators, with unlimited potential in function and power source, and ultimately better suited for the application at hand. Single stimuli-responsive soft actuation systems were carefully studied for successful integration into multi-functioning hybrid composites, starting with piezoelectric polymer actuator where nanofillers were embedded to increase its actuation magnitude. As a gripper system, hybrid pneumatic-magnetic soft actuator was able to increase its degree of freedom in actuation and demonstrate multi-plane actuation with increased blocking force. With robust actuation, its application went beyond traditional grippers and was able to move itself to complete an LED circuit and demonstrate its actuation in air and water environments. For smaller actuation, such as vibration dampers, a hybrid piezoelectric-magnetic self-sensing actuator (HPMSA) in a thin film device was utilized highlighting simultaneous alignment of multiple nanofillers and crystals for enhanced sensing and actuation properties. By applying 3D printing, the same HPMSA could be fabricated in greater size to sense and dampen excessive vibrations that are harmful to vehicle passengers. This fast and scalable fabrication method allows the possibility of mass production and commercial use, easily producing thin films of same properties. The results of this research can be used to further the development of multi-stimuli / -functional soft actuators to enhance actuation performance and take a step closer to replacing mechanical actuators and actuator systems in its entirety.

Keywords: hybrid nanocomposite
multi-functional material
multi-stimuli-responsive material
self-sensing actuator
soft actuator
Advisor: Naguib, Hani E
Development of an Ultrasonic Bone Cutting Instrument for Robotic-assisted Surgery

The use of robotic assistance in abdominal surgeries has increased rapidly in the last two decades and da Vinci Surgical System (dVSS) variants by Intuitive Surgical are now used in over one million procedures annually. With the widespread availability of the dVSS and the release of competing teleoperated systems anticipated in the near future, there is motivation to investigate whether non-abdominal operations may also benefit from the advantages provided by these robotics systems. Several research groups, in early feasibility studies, have found benefits of using the dVSS for operations in which hard tissue removal is required, including transoral, orthopaedics, spinal, and neurosurgery. However, the application of the robot in craniofacial procedures remains unexplored. It is hypothesized that the robotic-assisted system, with its improved precision, motion scaling, and advanced visualization, may similarly provide benefits in both minimally invasive and open cases of craniofacial surgery. However, the lack of robotic instruments for hard tissue precludes exploration in craniofacial procedures and remains a blocker for evaluating a fully robotic approach in operations where any hard tissue removal is required. The research presented here intends to address this limitation by developing a ultrasonic bone cutting instrument for the dVSS, and then evaluating the initial feasibility of using the system for craniofacial operations by performing a simulated procedure. To develop the prototype, performance and clinical requirements were first established and the instrument was designed and optimized using finite element analysis and a commercially available multi-objective genetic algorithm. The prototype was then verified using a combination of amplitude characterization, fatigue testing, and experimental modal analysis. Benchtop testing indicated the optimal cutting approach based on cutting depth, speed, and approach angle, and teleoperated cutting tests were performed on representative craniofacial models using an open approach. Initial experiments show that teleoperated bone cutting using an ultrasonic tool is feasible despite the lack of force feedback provided by the robot, and results indicate that there may be improvements to accuracy over manual tools. Further testing in a minimally invasive model with additional participants is required to evaluate robot setup, reach and range of motion of the prototype instrument, operating time, and safety

Keywords: bone cutting
craniofacial
robotic
surgery
teleoperated
ultrasonic
Advisor: Forrest, Christopher R
Drake, James
Towards Trustworthy Machine Learning in High-Stakes Decision-Making Systems

Machine learning systems are increasingly applied to tasks of high-stakes decision-making, in areas like healthcare, personal finance, and criminal justice. In these areas, the trustworthiness of the system is essential; beyond just having a high-accuracy tool, a number of other desiderata are required. Stressing that creating trustworthy machine learning is a problem without a well-defined solution, we focus in particular on two of these desiderata: fairness and robustness. To these ends, we discuss three potential approaches to improving the trustworthiness of machine learning systems. In the first, we consider the task of learning representations which guarantee that downstream classifiers yield predictions that align with fairness metrics when trained on transfer tasks, demonstrating how designing an adversarial loss function can correspond to various commonly-used fairness metrics. In the second, we provide an intuitive heuristic for detecting underspecification, show how it can be computed in a post-hoc fashion using only second-order statistics of the trained model, and discuss how we navigate computational hurdles for calculating this score in deep neural networks using techniques for eigenspectrum estimation. In the third, we reframe rejection learning as a task which should be inherently adaptive, depending on the properties of external decision-makers, and show how to formulate this as a mixture-of-experts-type learning objective, studying its impact on both fairness and accuracy. Through theoretical analysis and empirical evidence, we examine the strengths and weaknesses of each approach, and critically discuss how each fits into the larger project of building trustworthy machine learning systems.

Keywords: decision-making systems
fairness
machine learning
neural networks
robustness
trustworthy machine learning
Advisor: Zemel, Richard
Evolutionary Consequences of Plant Genome Structure

The outcome of evolutionary forces in natural populations is contingent on an organism’s genome structure, which itself varies and evolves. My thesis uses population genomics to investigate a range of evolutionary questions and processes broadly related to plant genome structure. In chapter 2, I review literature of the genomic landscape of transposable elements, recombination rate, and their interactions, and discuss the implications for their coevolution. In chapter 3, I show that how recombination and selection interact to determine the landscape of introgression from Capsella rubella into Capsella grandiflora varies by scale and is dependent in the largest scale on the length of chromosome arms. I find no evidence that selection against introgression is due to deleterious load or loci associated with floral evolution, but I show a strong reduction in introgression at the locus causing the breakdown of self-incompatibility. In chapter 4, I use genome assemblies of 32 species in the Brassicales to investigate the role of polyploidization in shaping the variation of genome size and transposable elements, as well as convergent and lineage-specific selective responses in evolutionarily conserved sequences. In chapter 5, I show that Rumex hastatulus, a species with large low-recombination regions across the genome, has a low efficacy of selection and unexpected patterns of chromosome-wide genetic diversity. I show that models of linked selection do not predict the genomic landscape of diversity, suggesting that an ongoing history of genomic rearrangements may be obscuring patterns of both recombination and diversity in the species. Overall, my thesis highlights the importance of considering genome structure as both shaping the evolution of plants and as a complex set of phenotypes evolving in concert and in conflict with the organism.

Keywords: Genome structure
Introgression
Plant evolution
Polyploidy
Recombination
Transposable elements
Advisor: Wright, Stephen I
Once Upon a Time in the Oeste: Epic, History and Narrative in Iberia

This dissertation explores the boom of epic poetry from 1569 to 1600 in Iberia and the Iberian epic genre’s engagement with history. It contends that the engagement of sixteenth-century Iberian epic with recent history, with contemporary philosophy of history, and historiography, makes Iberian epic distinct from other epic poetry. Every epic of this period is about a recent colonial event, drawing ideas from contemporary historical writing, and explicitly and implicitly thinking about the nature of history and time. As a distinctly historical genre, Iberian epic forms a body of texts about early imperial and colonial history from which historians can gain important historical perspective, as well as containing its own philosophy of history.The first chapter of this dissertation defines the genre of Iberian epic, detailing its influences from classical and Italian epic, exploring how it engages with history in ways other epics do not. In particular, the critic Miguel de Faria e Sousa’s extensive analysis of Luís de Camões’ Os Lusíadas is explored as a framework for understanding the contemporary conception of Iberian epic. The second chapter explores historical writing in sixteenth-century Iberia, focusing on the important and expansive Portuguese historiographies about India by João de Barros, Fernão Lopes de Castanheda, and Gaspar Correia, detailing how these texts define history, the sources they use, and their rhetorical norms. The chapter then compares how these historiographies describe key historical moments (Vasco da Gama’s first journey, contact with Africa, or military and diplomatic clashes with Muslims) with the description of the same or similar events in Iberian epics, such as Jerónimo Corte-Real’s Cerco de Diu, Juan Rufo’s Austriada, Juan Latino’s Austrias Carmen, and Alonso de Ercilla y Zuniga’s La Araucana, among others. The final chapter conducts a close analysis of Os Lusíadas, the most famous epic from this period. My analysis of Camões’ epic details how the poem’s plot and many narrators, structure history in a way that both celebrates Portuguese empire and subversively critiques it, arguing for the importance of poetry and narrative in preserving history.

Keywords: Camões
Epic
Historiography
Iberia
Narrative
Philosophy of History
Advisor: Ross, Jill
Cognitive Decline in Parkinson's Disease: Understanding the Pathophysiological Differences

Parkinson’s disease (PD) is the second most common neurodegenerative disorder, and the accompanying cognitive decline sequelae are one of its most pressing and least understood non-motor symptoms. It is estimated that between 20 to 40% of PD patients have some form of cognitive decline at the time of diagnosis, and over 80% of PD patients eventually convert to dementia within 20 years of diagnosis. PD patients can experience deficits in executive function, memory, attention, language and visuospatial function. PD has been linked to many different forms of pathology, ranging from brain atrophy and functional dysregulation, toxic protein deposition, and neurotransmitter system dysfunction. However, it is still not well understood why some PD patients experience rapid cognitive decline while others remain cognitively stable for years. Brain imaging techniques can be used to help elucidate the pathophysiological changes that occur which separate cognitive decline from cognitive sparing, providing insight into the compensatory changes the brain undergoes to maintain healthy cognition. The general aim of this thesis was to uncover the brain differences between PD patients with and without cognitive decline using multimodal imaging techniques and machine learning assisted modelling. First, using a coordinate-based meta-analysis, we found that key hub regions in three different important brain networks were affected by structural atrophy and functional hypometabolism in PD patients with cognitive decline: the bilateral insula, the bilateral dorsolateral prefrontal cortex, and left angular gyrus. Second, we used graph theory analysis to uncover that cognitively spared PD patients had more efficient brain networks than PD patients with mild cognitive impairment, suggesting compensatory network reorganization was occurring to maintain healthy cognition in the face of increasing disease burden. Finally, we found evidence that region beta-amyloid deposition affects cognitive decline in PD, with some brain regions being more vulnerable to the burden than others. Taken together, this thesis posits various ways the brain experiences both compensatory help and pathological harm due to PD cognitive decline pathology, providing a better understanding of this complex symptom umbrella.

Keywords: beta-amyloid
Cognitive decline
dopamine
MRI
Parkinson's disease
PET imaging
Advisor: Strafella, Antonio P.