VictorJuiz/thesis huggingface dataset:
Behaviour in a Canadian Multi-payer, Multi-provider Health Care Market: The Case of the Physiotherapy Market in Ontario

This is a study of several contentious issues in Canadian health policy involving the interaction of public and private payers and for-profit (FP) and not-for-profit (NFP) providers; the influence of health professionals on market structure; and the role of foreign investment. A case study was used, the Ontario physiotherapy market in 2003-2005, with its complex mix of payers and providers and foreign investment opportunities. Key market features were: fragmented but substantial payer influence, effective though uncoordinated cost control across payers, constrained labour supply, and fragmented patient referral sources. These features increased the complexity of providers’ interactions with patients and payers, reducing standardization and therefore favouring local, professional-owned small business FP providers (FP/s) for ambulatory care. NFP Hospitals’ market share declined. The findings generally confirmed expected behavioural differences between FP and NFP providers but expected differences between investor-owned FP providers (FP/c) and FP/s providers were not generally found. FP/s dominated the market, and FP/c providers appeared to mimic FP/s market behaviours, competing in local sub-markets. With no single or dominant payer, cost control difficulties were expected, but all 11 payer categories (public and private) used various cost control mechanisms, resulting in significant collective but uncoordinated influence. Generally, no payer alone supported a provider’s operations. The dominant labour suppliers, regulated physiotherapists, were scarce and exerted significant pressure, affecting market structure by asserting individual preferences and professional interests. FP/s dominance resulted, supported by the traditional patient referral source, physicians in small practices. Very little foreign investment was found despite little protection for domestic providers under NAFTA. In sum, this study showed FP and NFP provider stereotypes are subject to payer pressure: FP/c organizations can adapt by mimicking FP/s, and payers can modify NFPs’ assumed community orientation. Labour shortages and historical referral patterns can make individual professionals and their preferences more influential than their collective profession without diminishing the importance of professional interests. The degree and structure of payer control can make a market unattractive to foreign investors. Finally, this market – neither a planned or standard market – had a service provision pattern more broadly influenced by professionalism and practitioner interests than policies or prices.

Keywords: health care market
public/private
not-for-profit
for-profit
foreign investment
physiotherapy
regulated health professionals
Advisor: Deber, Raisa Berlin
Networking in Everyday Life

Contemporary networking in Canada, like most of the developed world, involves significant use of media to maintain relationships. This is not the use of media for faraway alters where in person contact is difficult, but media use within the very fabric of everyday life alongside in person contact. Past debates about the effects of new media have frequently focused on a medium's potential for social isolation. These debates have resulted in ambiguous, muted or contradictory findings. So instead of suggesting another response to the issue of social isolation, this thesis reorients the focus towards a different question: under what conditions are alters accessible and how does multiple media use affect this accessibility? Rather than suggest that new media simply offer "more" social accessibility, I contend that they complicate social accessibility by offering individuals increasingly differentiated ways to habitually maintain contact with each other. The result of this differentiation is that while individuals might be able to maintain contact with more alters (or at least just as many) in the abstract sense, they end up maintaining contact with the most accessible alters rather than alters with whom one has the strongest ties. This is the conundrum of multiple media use: how is it that each individual medium offers increased convenience but the sum total of media use makes life less convenient, more planned and more complicated? I suggest it is because media use cuts across longstanding social norms of public and private spaces (or public and private time) without offering a coherent normative framework as a substitute. Instead, individuals are differentially accessible via each medium. Moreover, this accessibility is related more to emergent personal habits than to tie strength. Data for this study comes from 350 random-sample surveys and 86 follow-up social network-oriented interviews in East York, a former borough on the east side of downtown Toronto, Canada. The data were collected in 2005, before the widespread adoption of social networking software, but after the widespread adoption of cellular telephones, instant messaging services and email.

Keywords: Network analysis
Media use
Advisor: Wellman, Barry
Efficient Algorithms for Future Aircraft Design: Contributions to Aerodynamic Shape Optimization

Advances in numerical optimization have raised the possibility that efficient and novel aircraft configurations may be ``discovered'' by an algorithm. To begin exploring this possibility, a fast and robust set of tools for aerodynamic shape optimization is developed. Parameterization and mesh-movement are integrated to accommodate large changes in the geometry. This integrated approach uses a coarse B-spline control grid to represent the geometry and move the computational mesh; consequently, the mesh-movement algorithm is two to three orders faster than a node-based linear elasticity approach, without compromising mesh quality. Aerodynamic analysis is performed using a flow solver for the Euler equations. The governing equations are discretized using summation-by-parts finite-difference operators and simultaneous approximation terms, which permit nonsmooth mesh continuity at block interfaces. The discretization results in a set of nonlinear algebraic equations, which are solved using an efficient parallel Newton-Krylov-Schur strategy. A gradient-based optimization algorithm is adopted. The gradient is evaluated using adjoint variables for the flow and mesh equations in a sequential approach. The flow adjoint equations are solved using a novel variant of the Krylov solver GCROT. This variant of GCROT is flexible to take advantage of non-stationary preconditioners and is shown to outperform restarted flexible GMRES. The aerodynamic optimizer is applied to several studies of induced-drag minimization. An elliptical lift distribution is recovered by varying spanwise twist, thereby validating the algorithm. Planform optimization based on the Euler equations produces a nonelliptical lift distribution, in contrast with the predictions of lifting-line theory. A study of spanwise vertical shape optimization confirms that a winglet-up configuration is more efficient than a winglet-down configuration. A split-tip geometry is used to explore nonlinear wake-wing interactions: the optimized split-tip demonstrates a significant reduction in induced drag relative to a single-tip wing. Finally, the optimal spanwise loading for a box-wing configuration is investigated.

Keywords: induced drag
shape optimization
aircraft design
computational fluid dynamics
b-spline volume
Newton Krylov
GMRES
GCROT
adjoint
summation-by-parts
simultaneous approximation terms
Advisor: Zingg, David W.
Generation, Characterization and Applications of Femtosecond Electron Pulses

Ultrafast electron diffraction is a novel pump-probe technique which aims to determine transient structures during photoinduced chemical reactions and other structural transitions. This technique provides structural information at the atomic level of inspection by using an electron pulse as a diffractive probe. The atomic motions of interest happen on the 100 fs = 10^(−13) s time scale. To observe these atomic motions, a probe which matches this time scale is required. In this thesis, I describe the development of an electron diffractometer which is capable of 200 fs temporal resolution while maintaining high signal level per electron pulse. This was made possible by the construction of an ultra-compact photoactivated 60 keV femtosecond electron gun. Traditional electron pulse characterization methods are unsuitable for high number density femtosecond electron pulses such as the pulses produced by this electron gun. I developed two techniques based on the laser ponderomotive force to reliably determine the duration of femtosecond electron pulses into the sub-100 fs range. These techniques produce a direct cross-correlation trace between the electron pulse and a laser pulse. The results of these measurements conﬁrmed the temporal resolution of the newly developed femtosecond electron diffractometer. This cross-correlation technique was also used to calibrate a method for the determination of the temporal overlap of electron and laser pulses. These techniques provide the pulse diagnostics necessary to utilize the temporal resolution provided by femtosecond electron pulses. Owing to their high charge-to-mass ratio, electrons are a sensitive probe for electric ﬁelds. I used femtosecond electron pulses in an electron deﬂectometry experiment to directly observe the transient charge distributions produced during femtosecond laser ablation of a silicon (100) surface. We found an electric ﬁeld strength of 3.5 × 10^6 V/m produced by the emission of 5.3 × 10^11 electrons/cm^2 just 3 ps after an excitation pulse of 5.6 J/cm^2 . This observation allowed us to rule out Coulomb explosion as the mechanism for ablation under the conditions present in this experiment.

Keywords: Femtosecond Electron Diffraction
Femtosecond Electron Pulse Characterization
Plasma Dynamics
Advisor: Miller, R. J. Dwayne
The Role of Vascular Matrix Metalloproteinase-2 and Heme Oxygenase-2 in Mediating the Response to Hypoxia

Systemic hypoxia frequently occurs in patients with cardiopulmonary diseases. Maintenance of vascular reactivity and endothelial viability is essential to preserving oxygen delivery in these patients. The role of matrix metalloproteinase-2 (MMP-2) and heme oxygenase-2 (HO-2) in the vascular response to hypoxia were investigated. In the first part of the thesis, the role of MMP-2 in regulating systemic arterial contraction after prolonged hypoxia was investigated. MMP-2 inhibition with cyclic peptide CTTHWGFTLC (CTT) reduced phenylephrine (PE)-induced contraction in aortae and mesenteric arteries harvested from rats exposed to hypoxia for 7 d. Responses to PE were reduced in MMP-2-/- mice exposed to hypoxia for 7 d compared to wild-type controls. CTT reduced contraction induced by big endothelin-1 (big ET-1) in aortae harvested from rats exposed to hypoxia. Increased contraction to big ET-1 after hypoxia was observed in wild-type controls, but not MMP-2-/- mice. Rat aortic MMP-2 and MT1-MMP protein levels and MMP activity were increased after 7 d of hypoxia. Rat aortic MMP-2 and MT1-MMP mRNA levels were increased in the deep medial vascular smooth muscle. These results suggest that hypoxic induction of MMP-2 activity potentiates contraction in systemic conduit and resistance arteries through proteolytic activation of big ET-1. The second part of the thesis investigated oxygen regulation of HO-2 protein and whether it plays a role in preserving endothelial cell viability during hypoxia. HO-2, but not HO-1, protein level was maintained during hypoxia in human endothelial cells through enhanced translation of HO-2 transcripts. Inhibition of HO-2 expression increased the production of reactive oxygen species, decreased mitochondrial membrane potential, and enhanced apoptotic cell death and activated caspases during hypoxia, but not during normoxia. These data indicate that HO-2 is translationally regulated and important in maintaining endothelial viability and function during hypoxia. In summary, the thesis demonstrates the importance of MMP-2 and HO-2 in preserving vascular function during prolonged systemic hypoxia. These enzymatic pathways may, therefore, represent novel therapeutic targets that may be exploited to ameliorate the effects of hypoxia in patients with cardiopulmonary disease.

Keywords: hypoxia
endothelium
matrix metalloproteinase-2
heme oxygenase-2
apoptosis
protein translation
vascular reactivity
Advisor: Ward, Michael
Marsden, Philip A.
The Performance of Critical History in Contemporary Irish Theatre and Film

This dissertation examines theatre and film in Ireland between 1988 and 2005, focusing on the plays of Sebastian Barry and Marina Carr, as well as a select group of films from this period. Employing a method of analysis that couples close-readings with attention to socio-cultural context, aesthetic form, and issues of representation, the dissertation demonstrates how theatre and film work to complicate conventional Irish historical narratives and thereby encourages a reassessment of contemporary constructs of Irish identity. The introduction provides a contextual framework for significant contemporaneous social, cultural and economic changes in Ireland, and includes a case study of ‘The Spire,’ a monument unveiled on Dublin’s central boulevard in 2003, which I argue is the architectural metonym for the transitional nature of Celtic Tiger Ireland. The case study explores the aesthetics of the monument, as well as the politicised public debate that ensued, and thereby provides a snapshot of issues relevant to the readings pursued in dissertation’s remaining chapters. The discussion of Sebastian Barry’s ‘family plays’ reveals the playwright’s effort to refuse traditional binary conceptions of identity and to proffer, instead, a dramatic landscape that similarly refuses to allow conflict to dominate. Barry’s use of a non-conflictual dramatic form supports his narrative interest in compassion and peaceful resolution, and provides a model for living with otherness that could prove useful in an increasingly diverse and globalised Ireland. Marina Carr’s plays share Barry’s desire to represent aspects of Irish character anew, but they also dramatise how cultural transitions are difficult and never linear, and how the conventional pull of memory and the past has a residual presence in the ‘new’ Ireland. Taken together, these chapters reveal Barry’s hopefulness as an antidote to Carr’s tragic endings. The final chapter provides close readings of several ‘Celtic Tiger’ films, arguing that the representation of landscape is the key lens through which Irish film communicates shifting images of Irish identity. A cycle of films from the first years of the new millennium ekes out a space for new modes of representation through a critical dialogue with major tropes in Irish film history.

Keywords: Contemporary Irish Theatre
Contemporary Irish Film
Drama
Cinema
Ireland
Irish History
Memory in theatre and film
Irish Identity
Marina Carr
Sebastian Barry
Goldfish Memory (2003)
Celtic Tiger
Dublin's Spire
Landscape in Film
Marginalized Characters
Myth in Drama
Cultural Transition
Advisor: Keil, Charlie
Use of Advanced Techniques to Estimate Zonal Level Safety Planning Models and Examine their Temporal Transferability

Historically, the traditional planning process has not given much attention to the road safety evaluation of development plans. To make an informed, defensible, and proactive choice between alternative plans and their safety implications, it is necessary to have a procedure for estimating and evaluating safety performance. A procedure is required for examining the influence of the urban network development on road safety, and in particular, determining the effects of the many variables that affect safety in urban planning. Safety planning models can provide a decision-support tool that facilitates the assessment of the safety implications of alternative network plans. The first objective of this research study is to develop safety planning models that are consistent with the regional models commonly used for urban transportation planning. Geographically weighted Poisson regression (GWPR), full-Bayesian semiparametric additive (FBSA), and traditional generalized linear modelling (GLM) techniques are used to develop the models. The study evaluates how well each model is able to handle spatial variations in the relationship between collision explanatory variables and the number of collisions in a zone. The evaluation uses measures of goodness of fit (GOF) and finds that the GWPR and FBSA models perform much better than the conventional GLM approach. There is little difference between the GOF values for the FBSA and GWPR models. The second objective of this research study is to examine the temporal transferability of the safety planning models and alternative updating methods. The updating procedures examine the Bayesian approach and application of calibration factors. The results show that the models are not temporally transferable in a strict statistical sense. However, relative measures of transferability indicate that the transferred models yield useful information in the application context. The results also show that the updated safety planning models using the Bayesian approach predict the number of collisions better than the calibration factor procedure.

Keywords: Road Safety
Transportation Planning
Model Transferability
Safety Planning
Macro-level Collision Models
Collision Prediction Models
Advisor: Shalaby, Amer Saïd
Persaud, Bhagwant
The Use of Individual Participant Data (IPD) for Examining Heterogeneity in Meta-analysis of Observational Studies: An Application to Biomechanical Workplace Risk Factors and Low Back Pain

Background: The use of meta-analysis to combine the results of observational studies is controversial. Despite its common use, methodological work in this area is lacking. Because of the diversity of study designs, exposure and outcome measures, and differential adjustment for confounding variables, the identification of sources of heterogeneity among study effect estimates is particularly important when combining data from observational studies. This thesis presents the results of a study that examines the relative ability of individual participant data (IPD) meta-analysis (which was considered a “gold standard”) and traditional aggregate data (AD) meta-analysis to identify sources of heterogeneity among studies examining mechanical exposure and low back pain (LBP) in workers. Materials and Methods: A systematic literature search was conducted to identify relevant articles. The corresponding author of each article was contacted to request their individual-level data. Because the outcome definitions and exposure measures were not uniform across studies, two sub-studies were conducted 1) to identify sets of outcome definitions that could be combined in a meta-analysis and 2) to develop methods to translate mechanical exposure onto a common metric. IPD analyses were conducted using generalized estimating equation (GEE) regression to identify variables that acted as strong confounders and effect modifiers. Traditional AD meta-analysis was also conducted and potential sources of heterogeneity were tested using meta-regression. Key Findings: (1) Overall, we found an association between both forces and postures on LBP, although the magnitude varied depending on the exposure-outcome combination. Among the outcomes, the ORs tended to be highest for sick leave due to LBP. (2) There was very little evidence of strong confounders in the relationship between mechanical exposure and LBP; thus differential adjustment for confounders in studies would not likely be an important source of heterogeneity in an AD meta-analysis. (3) AD meta-analysis was able to identify the same study-level effect modifiers as IPD meta-analysis, but did not consistently identify individual-level effect modifiers. Both individual-level characteristics (older age and being male), and study-level characteristics (population-based studies and self-reported mechanical exposure), were associated with an increased OR for many of the LBP outcome and mechanical exposure combinations. Conclusion: AD meta-analysis is likely sufficient to detect heterogeneity for study-level factors but is not sufficient to identify individual-level effect modifiers. When the primary source of evidence in a research area is observational studies and when there is controversy despite several systematic reviews, IPD meta-analysis can be used to better understand sources of heterogeneity and provide context

Keywords: low back pain
meta-analysis
heterogeneity
individual participant data
Advisor: Shannon, Harry
Investigation of Rab34 and Munc13 In The Secretory Pathway: Potential Roles In Diabetic Nephropathy

Constitutive secretion is responsible for the targeting of transmembrane proteins to the plasma membrane, and for the secretion of extracellular matrix proteins, hormones, and other cellular products. The basic steps of secretion are well understood – proteins synthesized in the endoplasmic reticulum are transported in lipid-bound intermediates to the Golgi, and from the Golgi to the plasma membrane or cell exterior. Dysfunction of the secretory pathway – either constitutive or regulated – is involved in many disease states. One such state is diabetic nephropathy (DN). DN is characterized by renal hypertrophy and fibrosis, and is the leading cause of renal failure worldwide. Our lab had previously shown that munc13 is both upregulated and activated in the diabetic kidney, and that munc13 is an effector of rab34. Study of rab34 in HeLa cells revealed that rab34 is localized to the Golgi, and that it is required for the secretion of the Vesicular Stomatitis Virus glycoprotein. Colocalization experiments, as well as the use of Brefeldin A, localized the effect of rab34 to intra-Golgi transport. Further experiments indicated that glucose-induced upregulation of munc13 in rat mesangial cells increased the rate of constitutive secretion to the plasma membrane, and that this effect depended on its interaction with rab34. Finally, munc13 and rab34 were found to be required for the high glucose-mediated stimulation of Transforming Growth Factor-β secretion from mesangial cells, placing these two proteins at a key point in a pathway of physiological significance in the pathology of DN.

Keywords: diabetic nephropathy
secretory pathway
Advisor: Silverman, Mel