VictorJuiz/thesis huggingface dataset:
The Economic Evaluation of Early Intervention with Anti-TNF-α Treatments in Pediatric Crohn’s Disease

BACKGROUND: Crohn’s disease is a chronic disorder in which sections of the gastrointestinal tract become inflamed and ulcerated through an abnormal immune response. Costly anti-TNF-α treatments are indicated only after other treatments have not worked. However, anti-TNF-α treatments have been proposed as first line therapy due to their effectiveness. OBJECTIVE: The primary objective was to assess the incremental cost-effectiveness of early intervention with anti-TNF-α treatment vs. conventional step-up strategy at improving the number of steroid-free remission weeks gained from public healthcare payer and societal perspectives. METHODS: A two-dimensional probabilistic microsimulation Markov model with seven health states was constructed for children with moderate to severe Crohn’s disease. Newly-diagnosed children with Crohn’s disease aged 4-17 years who received anti-TNF-α treatment and other concomitant treatments, such as steroids and immunomodulators, within the first three months of diagnosis were compared to children with newly-diagnosed Crohn’s disease who received standard care of steroids and/or immunomodulators with the possibility of anti-TNF-α treatment only after three months of diagnosis. The outcome measure was weeks in steroid-free remission. The time horizon was three years. A scenario analysis examined variation in costs of anti-TNF-α treatment. A North American multi-centre, observational study of children with Crohn’s disease provided input into clinical outcomes and health care resource use. To reduce selection bias, propensity score analysis was used. RESULT: From a public healthcare payer perspective, early intervention with anti-TNF-α treatment was more costly with an incremental cost of $31,112 (95% CI: 2,939, 91,715) and more effective with 11.3 more weeks in steroid-free remission (95% CI: 10.6, 11.6) compared to standard care, resulting in an incremental cost per steroid-free remission week gained of $2,756. From a societal perspective, the incremental cost per steroid-free remission week gained for early anti-TNF-α treatment was $2,968. CONCLUSION: While unknown, if a willingness-to-pay threshold was assumed to be $2,500 per week in steroid-free remission, early intervention with anti-TNF-α would not be cost-effective. However, there is considerable uncertainty in the incremental cost-effectiveness ratio and many patients escalate to anti-TNF-α eventually. Therefore, restrictive policies on anti-TNF-α treatment access for pediatric Crohn’s patients may want to be re-visited by decision makers.

Keywords: anti-TNF-α
cost-effectiveness analysis
Crohn’s disease
economic evaluation
infliximab
pediatric
Advisor: Ungar, Wendy J.
End-to-End Pipeline Methods for Full-Sky 21 cm Cosmology: Application to the CHIME Pathfinder Array

The technique of 21 cm Line Intensity Mapping (LIM) has emerged as a promising new frontier in the field of observational cosmology, promising fast tomographic mapping of enormous volumes at the angular resolution needed to resolve Universe’s large-scale structure. The Canadian Hydrogen Intensity Mapping Experiment (CHIME) is a new cylindrical transit interferometer that has begun observations at the Dominion Radio Astrophysical Observatory in Penticton, British Columbia. A two cylinder test-bed – the CHIME Pathfinder – has been surveying the Northern hemisphere in 1024 frequency bands between 400 and 800 MHz since the fall of 2015. These telescopes are optimized for 21 cm LIM at redshifts 0.8 − 2.5, targeting a time-resolved detection of the Baryon Acoustic Oscillations. Control of the systematics accompanied by modern interferometers has instituted a new philosophy of “end-to-end modelling” in the field: whereby the underlying signal, astrophysical foregrounds, telescope, and receiving electronics are modelled together in feedback with the data. In this thesis we describe the development of end-to-end analysis and forward modelling techniques for 21 cm LIM. First, we describe a novel subgrid biasing scheme for dark matter halo catalogs and its application to more accurate modelling of the intensity mapping signal component. The systematic focused on in this thesis is the angular response function, or “beam,” of the interferometer. We go on to describe the radio holography technique implemented to measure this function for each of the CHIME Pathfinder’s 256 inputs and develop a data analysis pipeline capable of converting time-ordered data to a beam model for input to the mapmaker. Finally, we present a modification of the m-mode formalism mapmaker, designed explicitly for full-sky 21 cm LIM, which relaxes the usual assumption of statistical isotropy of the signal, allowing it to treat arbitrarily realistic sky models. We then exploit these tools to deconvolve CHIME Pathfinder maps with the beam model constructed from holography, and find a minimum factor of 2 improvement over previous methods. In its entirety, this thesis forms a foundation for the methods necessary extract accurate cosmological information from modern interferometers such as CHIME and its Pathfinder.

Advisor: Bond, Richard
Pen, Ue-Li
Negotiating Fathers’ Care: Canadian Fathers’ Leave-taking as Conformity and Change

Despite some changes to the ways contemporary families are handling the allocation of paid and unpaid work, the path of least resistance still tends be maternal caregiving with mothers more likely than fathers to cut back on their employment or drop out of the workforce entirely. Because men typically maintain, and may even strengthen, their ties to the labour market at the transition to parenthood, offering them paid parental leave is thought to provide an important opportunity for fathers to develop the skills and sense of responsibility that are characteristic of mothers’ parenting, ultimately reducing gender inequality in families. Although leave schemes that specifically target fathers are praised for their high usage rates, there has been little research into the quality of men’s time at home. This dissertation addresses this gap in the literature by probing the time-bounded and gender-laden circumstances of early parenthood to consider the ways in which fathers’ early involvement might set the stage for their greater participation in domestic life. I do so by examining how Canadian fathers come to use, experience, and act in response to their time on parental leave. The men in this study waxed enthusiastically about the parenting skills and emotional bonds they developed while on leave. Many were so moved by the experience that they came to incorporate the values and practices of care into their identities. Yet at the same time, the allocation of leave time and couple’s subsequent divisions of housework and domestic responsibility remained gendered. Couples had to engage with gendered cultural expectations that took men’s employment for granted but allowed them greater leeway than women when it came to meeting parenting standards. Nevertheless, I argue that the transformative potential of fathers’ leave-taking should not be dismissed – even small changes to couples’ gendered roles and fathers’ identities are important in undoing gender inequality.

Keywords: Caregiving
Division of Labour
Family
Fathers
Gendered Dynamics
Parental Leave
Advisor: Fox, Bonnie
Coupling Between Flame Stabilization and Hydrodynamic Instability in Swirl Combustion

The coupling between hydrodynamic instability and flame lift-off in premixed swirl combustion was investigated in a gas turbine model combustor using multi-kHz repetitionrate OH* chemiluminescence (CL), OH planar laser induced fluorescence (PLIF), and stereoscopic particle image velocimetry (S-PIV). Over 60 different combinations of fuel composition, equivalence ratio, and reactant preheat temperature were studied, allowing systematic variation of the reactant-to-product density ratio, laminar flame speed, and Lewis number. Depending on the test conditions, the flame could either be stably attached to the nozzle, stably lifted, or intermittently transitioning between attached and lifted states. Transition between stabilization states was linked with the transition between convective and absolute instability at the flame base; formation of an m = 1 (m denotes the azimuthal wavenumber) globally unstable wave was associated with the lifted flame, manifested by a helical precessing vortex core (PVC). A detailed physical mechanism, involving density stratification, local extinction, strain rate, and PVC formation, was proposed to elucidate swirl flame lift-off. The minimum bulk velocity at which the flame was stably lifted was linearly correlated with the laminar flame extinction strain rate, while none of the other commonly reported key parameters governing hydrodynamic instability was able to collapse the data alone. Hence, lift-off was associated with a relatively constant Damk¨ohler number based on the bulk fluid strain rate and extinction strain rate. The roles of local strain and extinction on the transition process were further explained by the test conditions with intermittent lift-off/reattachment. The probability of the flame being in the lifted state was roughly linearly correlated with the degree of local extinction at the flame base while the flame was still attached. Moreover, this probability also was linearly related to the ratio of fluid-dynamic strain rate to extinction strain rate, but not the fluid-dynamic strain rate itself. In addition, using visibility graph, transition from the attached to the lifted regime was found to be associated with the transition from a scale-free to a regular network via intermittency. Intermittency was further quantified using spatially extended networks. It was shown that prediction of hydrodynamic instability limits might be possible using certain network measures.

Keywords: hydrodynamic instability
lift-off
PIV
PLIF
PVC
swirl flame
Advisor: Steinberg, Adam M
The Hashtnagar Peasant Movement: Agrarian Class Struggle, Hegemony and State Formation in Northwestern Pakistan, 1947–1986

This study examines how peasant movements led by revolutionaries impacted state formation, or more broadly the institutional configuration of power, in post-colonial Pakistan’s North-West Frontier Province (NWFP). The study asks, first, how did a movement of lower classes, specifically tenant farmers and landless labourers, win concessions from landed elites and also shape the direction and institutionalization of state power in the 1970s? Second, why did revolutionary politics in Pakistan decline and fade away, diverging from its counterparts in other parts of South Asia? Based on archival research, oral history, and participant observation, the study divides a narrative of nearly forty years of events into three critical conjunctures, comparing and contrasting the inter-actions of radical organizers, rural classes, the political organizations representing exploiting propertied classes, and the state. The first conjuncture concerns the late 1940s, when the Communist Party of Pakistan’s inadequate preparation and organization of peasants led to an ultimately failed movement in the northern Hashtnagar area. The second conjuncture covers the period from the late 1960s to the early 1970s in which the communists formed the Mazdoor Kisan Party. The party’s organizational work contributed to the comparative success of 1970s peasant struggles in the form of de facto land and tenancy reforms and the decline of institutions of landlord power in villages, alongside the generation of new and renewed institutions of peasant power. Peasant organization compelled the state apparatus to intervene in favour of tenants. The third conjuncture concerns the denouement of the peasant movement in the latter 1970s and 1980s. As tenants became de facto proprietors of land their involvement in the movement and party organization declined, leaving them unable to mount a significant challenge to a military regime that restored some of the power of landed elites. Nevertheless, tenants largely preserved the gains they had made. Ultimately, the institutional configuration of power inside and outside of the apparatus of the state was determined by the balance of power between different classes. Moreover, strategic choices that revolutionary organizers made about confronting the state frontally as opposed to lowkey organizing increased or decreased their own organizational capacity and longevity.

Keywords: agrarian
class
hegemony
Pakistan
peasant
state
Advisor: Kasturi, Malavika
Kingston, Paul
Investigating Balance, Plantar Pressure, and Foot Sensitivity of Individuals with Diabetes during Stair Gait

Diabetic peripheral neuropathy (DPN) is a prominent issue for the diabetes population and may lead to ulceration and lower-extremity amputation. Individuals with DPN have diminished plantar sensation and exhibit abnormal peak foot pressure while walking, however, a direct connection between plantar pressure and extent of plantar sensation loss has not been entirely explored. Further, research has shown that environmental factors such as stair gait and insoles affect dynamic balance of healthy aging individuals, therefore individuals with DPN may be even more risk. The objective of this dissertation was to examine the effects on balance, plantar pressure and foot sensitivity of individuals with DPN, while considering both intrinsic (health) and extrinsic (stairs and insole) factors. The three studies that make up this dissertation provide another perspective of the contributions of various health characteristics have in relation to DPN, as well as provide insight into the role of stair gait and insoles on balance and plantar pressure. Specifically, the first study investigated the severity of sensation loss and plantar pressure during stair gait, while taking into account relevant health factors. The study also attempted to better understand factors that may best predict pressure using a hierarchical multiple regression model. This model was utilized to observe the contribution of diabetes related factors, above and beyond factors of age, body mass, and walking characteristics. The second study compared balance and plantar pressure between individuals with diabetes and pronounced sensation loss and a healthy age-matched group. The third study provided much needed understanding to how insoles may offload pressure and affect dynamic balance of individuals with diabetes during star gait. These studies provide insight into the role of health factors on plantar pressure and sensation, as well as provide a dataset of balance and pressure during the task of stair gait. The balance and pressure results suggest that individuals with diabetes may have exhibited a cautious walking pattern, compared to the control group. Further, commercial pressure offloading insoles worn by individuals with diabetes were no better in reducing foot pressure than normal insoles, during the specific task of stair gait.

Keywords: Balance
Diabetes
Insoles
Neuropathy
Plantar Pressure
Stair Gait
Advisor: Perry, Stephen D
Technologies of Sexuality: The HPV Vaccine and an Investigation into Parental Responsibility, Progressive Sex-Education, and Adolescent Girls’ Subjectivities

This dissertation problematizes responsibility and the persistent tensions accompanying vaccines, sexual health, and sex-education in contemporary society. I connect the everyday micro-level of parents, teachers, and adolescent girls, with macro-politics of biomedicine, “good parenting,” and progressive sex-ed to understand how vaccine politics and sex-education relate to girls’ development of their own subjectivities. I argue that while parents and teachers work to be responsible to girls’ health and sexual health, their actions may not support adolescents in ways they imagined. Chapter two, using data from 28 qualitative semi-structured interviews with Canadian mothers tasked with consenting to the HPV vaccine, challenges the overly narrow binary where parents are labeled as “responsible” if they vaccinate, “irresponsible” if they do not. I find that HPV vaccine-consenting mothers follow normative conceptualizations of responsibility, aligned with HPV vaccination. Some non-HPV vaccine-consenting mothers exercised alternate responsibilities, aligned with broad efforts to manage their teens’ sexual health and sexuality. They extend responsibility beyond cancer protection vis-à-vis vaccines to a more general responsibility for their daughters’ sexual health and self-esteem. Chapter three, based on observations of four public school sex-education classrooms and interviews with Ontario teachers, shows that these sex-ed teachers deliver lessons in ways that align with key dimensions of “progressiveness” – facts, choice, and promoting diversity. This chapter uncovers how systems of gender, sexual, class, religious, racial, and ethnic inequalities are reproduced despite progressiveness. Chapter four, based on 19 qualitative interviews with girls (aged 11-16), outlines the patterns through which girls’ subjectivities, sexual health knowledge, and thoughts on the HPV vaccine are intertwined and operate in relation to other people and larger sociocultural structures. This dissertation serves as a call to challenge and reflect on the taken-for-grantedness of biotechnical inventions, like the HPV vaccine, and progressive sex-education in contemporary society.

Keywords: Adolescence
HPV Vaccine
Responsibility
Sex Education
Subjectivities
Advisor: Korteweg, Anna
Choo, Hae Yeon
Straight to the Subject. A Unified Analysis of Preverbal and Postverbal Subjects in Broad Focus Constructions in Spanish

This study re-examines subjects, subject distribution and subject properties in Spanish. It includes an experimental prosodic component that brings new empirical evidence to the theoretical discussion. Theoretically, it adopts a composite understanding of subjecthood (Harley, 1995; McCloskey, 1997), and incorporates the notion of argument structure. The result is a less rigid approach to the notion of default word order, which directly contributes to the possibility of a unified analysis of broad focus (BF) structures. Two options of subject realization, the inflectional layer and the left periphery, were assessed with respect to their prosodic features. The results of the analysis showed that there are differences in duration and fundamental frequency (F0) (for some speakers) between subjects that are old information and appear in the left periphery, and BF subjects. Taking into account these findings, differences in subject distribution in BF contexts, and the event-related interpretation of BF contexts, a new analysis—based upon Borer’s (2005b) Event Phrase—is proposed. In this analysis specEP is the locus of preverbal subject realization, and the need to license the event by binding the event variable is the trigger of the movement to this preverbal position. Since specEP can be filled by non-nominative elements, this analysis can accommodate different word orders, such as those with a preverbal locative or a dative DP and a postverbal nominative subject. Additionally, this analysis also sheds light on the position that postverbal nominative subjects occupy in these structures. This study also examined the syntactic operation of agreement in contexts that have been claimed to display variable number agreement, and demonstrated that such variability is only apparent, as each instance corresponds to a different underlying structure. Finally, issues related to the syntax-phonology interface are discussed in the light of the experimental findings, specifically the type of information that should be available at the interface, the type of syntactic information that is prosodically represented, and the mapping between syntax and prosody.

Keywords: argument structure
prosody
Spanish
subject agreement and position
syntax-phonology interface
word order
Advisor: Cuervo, María Cristina
Diminishing Disadvantage and Curtailing Power: A Reimagining of ‘Freedom of Conscience and Religion’ in Canada

This dissertation is a contribution to the growing scholarship that challenges the claim that the legal protection of religious freedom in liberal democratic orders is fair, neutral and universal. Using Canada as my case, I ask whether the historical domination of Protestant Christianity has left its mark on contemporary secular regimes. The answer is clearly yes. In the dissertation I focus particularly on the issue of exemptions. I question whether the current dominant understanding of freedom of religion and conscience (shaped as it is by a Protestant dominated past) can deal fairly with marginalized, minority, and non-Christian perspectives, beliefs, and ways of life. In developing this argument, I make three major claims. The first is that the dominant interpretation of section 2(a) turns “freedom of conscience and religion” into “freedom of conscience in religion.” The collapsing of conscience into religion, alongside the understanding of religion as private, belief-driven and chosen, restricts and narrows what and who receive exemptions. In contrast to this view, my second claim challenges the priority given to beliefs over values. I argue that the state has a special and equal interest in justifications based on beliefs and justifications based on values when these reflect a person’s ‘sense of being.’ My conception of a ‘sense of being’ introduces a moral argument for why we should be protecting “religion” and “conscience” that is not tied to narrow Christian dominated views. Finally, I propose an alternative understanding of the basis for exemptions that looks at these questions through the lens of advantage/dominance and disadvantage/marginalization. I argue that exemptions should amplify and protect those who are disadvantaged and at risk but be granted on a more limited basis to dominant/powerful majority groups. My approach mitigates the impact of differences in power, status and opportunities on the substance of the s. 2(a) right of 1) minority religious communities (including non-mainstream Christians) that may not prioritize conscience in the same way as the mainstream, 2) Indigenous peoples, and 3) individuals acting on their consciences without connection to religion.

Advisor: Chambers, Simone