VictorJuiz/thesis huggingface dataset:
Person-centred Care Coordination in Ontario: A Multimethod Evaluation of Implementation and Impact

As the number of persons living with complex health and social care needs increases, healthcare systems are faced with the challenge of providing high quality care to these individuals. One approach utilized by many healthcare systems to achieve high quality care for persons living with complex health and social care needs is person-centred care coordination). A gap still exists in our knowledge on how to implement person-centred care coordination in ways that meet individual and family expectations and needs. In addition, more is to be learned about the care experiences of persons receiving person-centred care coordination and their family caregivers.The aim of this dissertation was to fill these gaps by evaluating Health Links by conducting three interconnected studies. In the first study of this dissertation, an implementation evaluation approach was utilized to assess the extent to which the implementation plans of person-centredness, and engagement were operationalized within Health Links. In the second and third studies an impact evaluation approach was employed to assess the care experiences of persons living with complex health and social care needs and their family caregivers after being enrolled in Health Links. In order to assess the care experiences comprehensively, multimethods were used. A patient experience survey was used in the second study and in-depth interviews with enrollees and their caregivers in the third study. The first study concluded that operationalization of implementation plans in network structures like Health Links was faced by numerous challenges. The second study found that the intended components of the Health Links approach (care plan and care coordinator) positively impacted the experience of the enrollees. However, issues with implementation of these components led to a negative care experience. The third study showed that despite being enrolled in an initiative that aimed at delivering person-centred care coordination, persons living with complex health and social care needs and their family caregivers were still shouldering the main burden of care coordination. The findings of the three studies can guide policy makers, planners, implementers, and evaluators on how to better plan, deliver and evaluate person-centred care coordination (integrated patient care) interventions.

Keywords: Coordinated care
Evaluation
Experience of Care
Integrated Patient Care
Person-centred care
Advisor: Wodchis, Walter P
Learning and Strategic Behaviour: The Role of Consumer Behaviour in Three Revenue Management Applications

In this thesis, we study three different revenue management applications where consumer behavior is crucial in designing an optimal strategy. The focus is on two aspects of consumer behavior: learning in the market and strategic behavior. In the second chapter, we study service design and pricing in car-sharing networks with limited capacity serving strategic consumers. We consider a hybrid system that allows a mix of both one-way and round-trip services on the same network, and consumers who strategically select from these two service types. We provide demand and supply conditions for offering both types of services, only one of the types, or some mix of two. We further characterize the optimal combination of pricing and repositioning to mitigate demand imbalances in the network. In the third chapter, we study the optimal release strategy (simultaneous or sequential) of a firm with two digital products of unknown quality. Consumers learn through a combination of private, public, and social learning. We consider two consumption patterns: consumers may go back and consume the early-released product (binge consumption) or not (sequel consumption). The firm can control the learning dynamics by its release strategy and possibly pricing. We provide three main results. First, under sequel consumption and exogenous uniform pricing, the simultaneous release always outperforms the sequential release. Second, under sequel consumption and endogenous pricing, the sequential release dominates the simultaneous release for a certain parameter range. Third, under binge consumption and exogenous uniform pricing, the sequential release dominates the simultaneous release if and only if the price is sufficiently high. In the fourth chapter, we study the problem of review manipulation. In online markets, consumers can learn from reviews, therefore, a seller may have incentive to influence the learning process by distorting reviews. We examine the impacts of review distortion on a seller's profit and consumer behavior. We first provide some empirical evidence on the review distortion. We then show a seller benefits from review distortion if and only if consumers are sufficiently patient. Moreover, given consumer patience, a seller distorts reviews if and only if the consumer's cost of review search is sufficiently large.

Advisor: Malekian, Azarakhsh
Voice-in-the-World: An Exploration of Mid-Career Opera Singers’ Non-Musical Stressors and Coping Strategies

Singers are constantly balancing how they, as subjects, interact with objects in the world to create a consistent product (sound). But singers are also used as objects in the creation of someone else’s work by composers, directors, and companies, etc. This results in a highly unstable and unpredictable career that can upset the inner balance between coping and resilience. Using Interpretative Phenomenological Analysis (IPA), this thesis explores the lived experience of seven elite-level Canadian opera singers through in-depth narratives to discover these performers’ non-musical stressors and coping strategies. The four emergent stress themes (finances, expendability, peripatetic lifestyle, and fatigue) were all accentuated by feeling a lack of control, or lack of agency, and instability. Often, the coping strategies were obfuscated by stress and were in fact harder for the singers to discuss or identify. The three main coping strategies outlined—routines and consistency, emotional self-management, and support network and communication—reflected how the singers tried to create stability and control to find resilience and longevity in the opera business. This thesis ends by bringing awareness to the idea of creator mind versus the singing body—a dichotomy which, I argue, leads to the subjugation of opera singers. This study is not meant to produce definitive conclusions or solutions; rather it is meant to prompt a conversation by focusing on what Heidegger (1927/2010) would call a caring “attunement” towards a deeper understanding of what it is to be an opera singer in Canada.

Keywords: coping
lived-experience
opera
performance
singers
stress
Advisor: Nielsen, Wendy
Gustsche-Miller, Dr. Sarah
Development of Solution-state In vivo NMR: Towards an Understanding of Aquatic Toxicity

In vivo NMR has the potential to monitor metabolic flux close to real time, essential for a better understanding of the mode-of-action of toxic contaminants and deciphering complex interconnected response pathways inside living organisms. Thus, in this thesis a novel continuous low-volume flow system suitable for in vivo NMR metabolic studies of small aquatic living organisms, such as D. magna, was developed and its feasibility was evaluated. In chapter two a low-volume flow system that permits for faster and easier locking, shimming, and water suppression is introduced. Chapter three includes two sections. In the first section, a technique to convert 2D NMR data into “spikelet” 1D format is demonstrated. This approach permits preservation of the information content of spectral dispersion of 2D NMR while providing a simple 1D data format that is required for analysis by most chemometric software. The second section describes how use of in vivo NMR technique overcomes complications from individual organism variability and permit metabolic impacts of stress to be more easily differentiated. In this section, the in vivo impacts of anoxic stress are compared using a time trajectory and a traditional approach. The approach that utilizes the same organisms for both the control and exposed studies reduces natural variability significantly allowing the anoxic stress to be more easily discerned. Chapter four is dedicated to NMR assignment of the in vivo D. magna metabolome, implementing various 1D, 2D, and 3D 1H and 13C NMR approaches. In this project, in vivo metabolome assignment of isotopically enriched small aquatic organisms (D. magna) is performed for the first time. Studies show that wastewater treatment plant (WWTP) effluents remain as one of the primary sources of toxins introduced into the aquatic environment, threatening both ecosystem and human health. Therefore, screening and assessment of wastewaters that considers both the components and the toxicity of wastewater is imperative. Chapter five evaluates an integrated NMR framework that combines various 1D and 2D NMR, and in vivo NMR metabolomics techniques to study and identify the wastewater composition and toxicity. In addition, this chapter includes a comprehensive review on NMR spectroscopy of wastewater.

Advisor: Simpson, Andre
Spaces of Unfreedom: Interior Immigration Detention and Carceral Immigration Enforcement in the US Pacific Northwest

This thesis is a collection of four papers that analyze interior immigration detention and carceral immigration enforcement in the US Pacific Northwest. Together these papers elucidate how processes of bordering and carceral control overlap with one another in a particular conjuncture – the US Pacific Northwest during the years of the Trump White House. They explore the various and sometimes contradictory ways that interior immigration enforcement and detention in the US interior produce racialized human hierarchy, operate through economic relationships, and are subject to political struggle. This collection contains four major arguments, each one correlated with a different vantage point into carceral immigration enforcement. First, I argue that the spatio-temporal ordering of a specific detention center, the Northwest Detention Center in Tacoma, WA, intertwines logics of exclusion and dehumanization. I find patterns of inclusionary exclusion and exclusionary disposal, through which detention providers place responsibility for degradation, deportation, and even premature death, upon those in detention. Second, I analyze three overlapping economic logics that constitute the migrant detention system in the US Pacific Northwest: production, extraction and financialization. Through these logics, human needs of those who ICE detains are in turn smothered, exploited, and partially fulfilled. This can lead to contradictions that hinge upon the life, death, mental health, and subjectivity within the detention system. Third, I analyze the destabilizing impact of eliminatory carceral immigration enforcement in a rural Washington community in the Trump era. I argue that while immigration enforcement is a mode of controlling and devaluing migrant workers, this process is both geographically and historically contingent. Fourth, I analyze the political repression of migrant justice activists that struggled against carceral immigration enforcement during the Trump presidency. I argue that while this appears to be a new, vengeful pattern, it is part of a longer project of securing the smooth functioning of economic and racial social control in the US. The conclusion offers some reflection on developing an abolitionist politics that challenges the various social, economic and political relations that sustain carceral immigration enforcement in the US.

Keywords: borders
carceral
detention
labor
migration
race
Advisor: Gilbert, Emily
Buckley, Michelle
The Recycling Endosome Protein Rab25 Coordinates Collective Cell Movements in the Zebrafish Surface Epithelium

The surface epithelium of the zebrafish gastrula spreads to completely enclose an underlying yolk cell in a process known as epiboly. Epithelial epiboly is coordinated by oriented cell division and intercalation events, as well as the transmission and modulation of global tissue tensions. Currently, the molecular mechanisms underpinning zebrafish epithelial epiboly movements are unknown. Here I present the findings of a poorly characterized Rab protein, Rab25, during zebrafish epithelial tissue spreading and show that Rab25 is a recycling endosome protein that coordinates collective cell movements through endomembrane trafficking. Spatiotemporal analysis showed rab25a and rab25b transcripts were restricted to the outer epithelium upon epiboly initiation. Rab25 fluorescent fusion proteins distributed near cytokinetic midbodies and cell vertices during cytokinesis and cell intercalations, respectively. In maternal-zygotic Rab25a and Rab25b embryos, cytokinetic abscission and vertex remodelling was impaired, leading to anisotropic shaped multinucleate cells and uncoordinated cell rearrangements. At the tissue scale, global reductions in contractile actomyosin networks were associated with altered viscoelastic responses of the tissue. Taken together the slow cell rearrangements and defective tissue material properties likely contribute to delayed epiboly. I present a model in which Rab25 vesicle transport coordinates timely epiboly movements by regulating local cell behaviours and tissue scale forces via cytokinetic bridge abscission, cell intercalation and junctional actomyosin maintenance.

Advisor: Bruce, Ashley Dr
Exploring the Influence of the Dopamine D3 and Cannabinoid CB1 Receptors in Substance Use Disorders: A look into human drug reinforcement and cue-reactivity

Introduction: There is a growing need for the better understanding of the neurobiology that underlies substance use disorder. The dopamine D3 receptor (DRD3) has received research attention recently due to its apparent involvement in alcohol use disorder (AUD) and tobacco use disorder (TUD). The current series of human laboratory experimentations aim to explore the role of DRD3 in both AUD and TUD using a variety of investigative techniques. The final study serves as a contrast that explores the cannabinoid CB1 (CB1R) receptor in TUD. Methods: Study 1 examines DRD3 levels between AUD subjects and healthy controls using positron emission tomography and a DRD3 preferring radiotracer, [11C]-(+)-PHNO. The relationship between [11C]-(+)-PHNO binding and AUD phenotypes, motivation to consume alcohol (measured by an intravenous self-administration procedure) and alcohol cue elicited craving (measured by cue-reactivity), is also explored in AUD subjects. Study 2 and 3 respectively investigate DRD3 and CB1R single nucleotide polymorphisms (SNPs) in phenotypes of TUD (both nicotine reinforcement [measured by forced choice] as well as craving [measured by cue-reactivity]). Results: In study 1, there was a global reduction of [11C]-(+)-PHNO binding, reflecting DRD2/3 levels, in AUD subjects compared to healthy. [11C]-(+)-PHNO binding in the limbic striatum was positively associated with alcohol cue-elicited craving, however this and no other association withstood Bonferroni corrections. In study 2, the Glycine allele carriers of the DRD3 Ser9Gly SNP experienced a blunted smoking cue-elicited craving, but the SNP showed no effect on nicotine reinforcement. On the other hand, in study 3, the C allele carriers of the rs2023239 CB1R SNP demonstrated lower relative nicotine reinforcement but this SNP did not affect cue-reactivity. Conclusion: Despite discrepant methods, these results seem to point to a potentially larger role of DRD3 in drug cue-associated craving compared to drug reinforcement as measured by these laboratory procedures. That said, understanding the neurobiological mechanisms underlying this relationship requires more research as the 2 studies point to different directions regarding the DRD3 and craving relationship. Therefore, further validation of the clinical utility of DRD3 as a potential drug target for substance use disorder pharmacotherapy is needed.

Keywords: Alcohol use disorder
D3R
Dopamine
Nicotine
Advisor: Le Foll, Bernard
Biomimetic Extracellular Matrices for In Vitro Cancer Models and Tissue Engineering Platforms

This thesis describes approaches to resolve inadequacies with current hydrogels used for cancer models and tissue engineering platforms, namely, (i) overcoming light scattering in nanofibrillar hydrogels, (ii) independently controlling matrix stiffness from other matrix properties, and (iii) generating structurally anisotropic networks. As nanofibrillar hydrogels scatter light and strongly interfere with the optical characterization of cells, the first project describes the development of a temperature-responsive nanofibrillar hydrogel for the on-demand release of encapsulated cancer spheroids to enable optical, cellular, and molecular characterization of cells. Using a suspension of cellulose nanocrystals functionalized with temperature-responsive polymer molecules, a filamentous hydrogel was formed at 37 degrees Celsius that supported the growth of cancer spheroids. Upon hydrogel cooling to room temperature, on-demand release of cancer spheroids without loss of cell viability and spheroid integrity was achieved. In the second project, I designed a fibrillar hydrogel with the mechanical properties controlled independently of pore size, polymer composition, and cell ligand adhesion density for the evaluation of matrix stiffness on the response of cancer spheroids to a chemotherapeutic drug. A twenty-fold variation in stiffness of the hydrogel was achieved. At sufficiently long culture times (when the matrix stiffness influenced spheroid growth), the growth of larger cancer spheroids with a lower fraction of proliferating cells occurred in softer gels. These spheroids showed stronger resistance to anticancer drug, doxorubicin. In the third project, I fabricated structurally anisotropic hydrogel sheets using extrusion-based 3D printing of a temperature-responsive and shear-thinning ink composed of cellulose nanocrystal methacrylate (CNC-MA) and gelatin methacrylate (Gel-MA). The shear-induced alignment of CNC-MA was preserved by cooling and photocrosslinking of the extruded hydrogel sheets. The degree of structural anisotropy was controlled by varying the cooling temperature of the stage onto which the gel was extruded and the volumetric flow rate of the ink. The extruded hydrogel sheets exhibited anisotropic mechanical and swelling properties. In the fourth project, I generated biocompatible hydrogel sheets composed of regions with different degrees of anisotropy. I used an aldehyde-modified cellulose nanofibril and gelatin mixture for the extrusion-based 3D printing of hydrogel sheets with alternating structurally anisotropic and isotropic regions. Human dermal fibroblasts cultured on the extruded hydrogels showed oriented growth.

Advisor: Kumacheva, Eugenia
Into the Unknown: Predicting Outcomes in Chronic Hepatitis B

Chronic hepatitis B (CHB) is a global public health concern, as it affects more than 250 million people and can lead to serious complications such as cirrhosis, hepatocellular carcinoma, and liver failure. The current study aims were to investigate long-term clinical outcomes and identify prognostic factors in CHB. Study I confirmed that CHB patients are at risk of liver-related outcomes and death. Concurrent biopsy-proven non-alcoholic steatohepatitis (NASH) substantially increased the risk in strong association with advanced fibrosis compared with CHB alone (adjusted hazard ratio [95% confidence interval]: 4.8 [2.6-9.0], P

Advisor: Janssen, Harry LA
Cyanobacteria Monitoring and Cyanotoxin Management in Drinking Water Treatment Plants

This thesis examines three aspects of toxic cyanobacteria with respect to drinking water treatment plants: risk, monitoring, and treatment. Previous work shows that cyanobacteria cells can accumulate to high concentrations inside treatment plants, potentially rupture, and release their toxins. Therefore, accumulation in four Great Lakes region treatment plants was assessed, revealing that accumulation was generally minimal for plants experiencing low levels of cyanobacteria but could be significant for plants where cyanobacteria blooms occur in their source water. Drinking water utilities susceptible to harmful algal blooms need to be able to detect the onset of a bloom to implement management strategies. One way to monitor cyanobacterial activity is to use fluorescence-based probes that measure phycocyanin, a pigment specific to cyanobacteria. The conventional approach in the literature is to correlate phycocyanin fluorescence measurements to independent measures of cyanobacteria cell counts to use fluorescence to estimate the influx of cells, but most utilities do not measure cell counts, so this approach cannot be applied at all sites. This research explored machine learning for anomaly detection in phycocyanin fluorescence data without the need for corresponding cell counts. Two models were identified with an average accuracy of 86% to correctly predict elevated cyanobacterial activity in four data sites when trained on 2014-2018 data and tested on 2019 monitoring data. Therefore, this research has resulted in a potentially useful tool for drinking water utilities to use to improve their cyanobacteria monitoring strategies. When a utility is faced with cyanotoxins in their raw water, various treatment methods may be used to degrade them, each with its own advantages and limitations. Peracetic acid has recently emerged as a potential oxidant for water treatment, but its ability to degrade cyanotoxins has not been assessed with or without ultraviolet (UV) light for advanced oxidation. This research evaluates the degradation of two microcystins by UV only, peracetic acid only, and UV with peracetic acid. The results show that the combined process is as effective as or better than conventional advanced oxidation processes under typical water quality conditions. These findings support the potential future adoption of peracetic acid in water treatment plants.

Keywords: Advanced oxidation
Cyanobacteria
Drinking water treatment
Machine learning
Monitoring
Ultraviolet
Advisor: Hofmann, Ron