VictorJuiz/thesis huggingface dataset:
Paying for Primary Care: The Relationship between Payment Change and Primary Care Physician Behaviour

The Ontario government introduced several alternatives to fee-for-service (FFS) payment for primary care physicians (PCPs), including age-sex adjusted capitation (CAP). There is concern that this reform encouraged PCPs to avoid sicker, more complex patients due to incentives inherent in the new payment schemes. This dissertation analyzed the extent to which this occurred. We conducted a series of studies using patient and PCP level administrative data (1999/00 â 2010/11) from the Institute for Clinical Evaluative Sciences to analyze changes in patient cost and case-mix across payment models in Ontario. Our data captured all Ontarians and PCPs in FFS, enhanced- FFS and CAP payment models during the study period. To ensure our findings were robust we analyzed PCP characteristics associated with selection into different payment models, and controlled for this selection effect in our analysis of the impact of the payment incentives. In our studies, we used both non-parametric (relative distribution) and parametric methods (multinomial selection models). Our results demonstrate that there are differences in cost and case-mix across payment models and that these differences were both pre-existing and a result of responses to payment incentives. PCPs who self-selected into CAP models were more likely to have healthier and wealthier patients than PCPs in FFS models. Furthermore, we found that PCPs who treated healthier patients, benefited financially from payment reform. We did find evidence that PCPs altered the composition of their rosters because of payment incentives; however, the effects were small and largely accounted for by PCP self-selection effects. The mixed CAP payment scheme allowed PCPs to treat sicker patients off roster, which may have ameliorated some of the financial incentives to risk select. Our findings demonstrate that PCPs did respond to financial incentives. In particular, PCPs self-selected into payment models, based on pre-existing characteristics that allowed them to maximize their preferences for consumption and leisure. We did not find strong evidence in support of risk-selection, but did find evidence that age-sex adjusted capitation disproportionately benefited PCPs with pre-existing patient rosters that were less complex. Future reforms to PCP payment should take into account how PCPs sort themselves into payment models, and better account for the heterogeneity of PCP and patient populations.

Keywords: Health Policy
Health Services Research
Payment Incentives
Primary Care
Advisor: Deber, Raisa
Laporte, Audrey
Tissue Engineering of Multi-zonal, Osteochondral-like Constructs with Bone Marrow Stromal Cells

Articular cartilage facilitates weight bearing and movement in a synovial joint. As articular cartilage does not spontaneously heal, damaged cartilage leads to loss of cartilage and subchondral bone remodelling. In previous studies we developed biphasic constructs with articular chondrocytes and porous calcium polyphosphate (CPP) substrate that could replace both damaged cartilage and bone. However, articular chondrocytes are scarce and cannot be expanded in vitro without losing their functional attributes. Since bone marrow stromal cells (BMSCs) can be expanded to large quantities and differentiated into chondrocytes, it was hypothesized that, using BMSCs as the cell source, cartilage with a multi-zonal architecture can be formed on porous CPP substrate to produce osteochondral-like constructs with biomechanical properties that approach native articular cartilage. A protocol was devised to differentiate BMSCs on collagen-coated porous membranes and harvest the cells, which were subsequently cultured on porous CPP substrates to form biphasic constructs with high compressive mechanical properties. Implantation of BMSC-derived biphasic constructs in sheep joints revealed insufficient mechanical integration between the cartilage and the substrate. To address this limitation, a strategy was devised to generate a zone of calcified cartilage at the interface, mimicking the multi-zonal osteochondral architecture in healthy joints. A thin calcium hydroxyapatite film was formed on the surfaces of CPP using organic sol-gel processing method to limit the release of inorganic polyphosphates (polyP), which inhibit mineralization near the interface. Also, sequential seeding of BMSC-derived chondrocytes, in which only the interfacial layer was treated with triiodothyronine, yielded scaffold-free cartilage tissues on coated CPP substrates with distinct hyaline and calcified zones. The interfacial shear strength of constructs with the distinct calcified zone was significantly higher compared to non-calcified control. In vivo studies are warranted to investigate whether the multi-zonal constructs could effectively repair defects in a joint. Generation of anatomically shaped multi-zonal constructs for whole joint replacement are ongoing.

Keywords: Calcium polyphosphate
Cartilage
Mesenchymal stromal cells
Osteoarthritis
Osteochondral construts
Tissue engineering
Advisor: Stanford, William L
Kandel, Rita A
Work Disability Among Injured Workers with Chronic Upper Extremity Disorders: Measurement and Determinants

Work disability represents an important source of the burden for individuals recovering from a work-related upper-extremity disorder (WRUED). Historically, a small subset of injured workers has shown to experience a prolonged recovery course characterized by poor health and work outcomes, which are associated with high workers' compensation costs. Beyond achieving an initial return-to-work, the sustainability of work (i.e. staying at work) and health-related work limitations (i.e. "on-the-job" problems) are increasingly recognized as relevant concerns in this population. In this thesis, three quantitative studies were conducted to contribute insights to the measurement and determinants of work disability associated with WRUEDs, using survey data gathered from injured workers attending a Workplace Safety Insurance Board Upper-Limb Specialty Clinic in Ontario. Specifically, these studies investigated 1) the factorial validity of the Work Limitations Questionnaire (WLQ-25), 2) the predictive ability of the Upper-Limb Work Instability Scale (UL-WIS) for subsequent transitioning out of work (i.e. poor sustainability of work), and 3) the relationship between the work environment and health-related work limitations, among injured workers with a WRUED. Study findings suggest that: 1) due to a specific area of psychometric underperformance, some adaptations are needed for the WLQ-25 before it is suitable for use; 2) the UL-WIS is an independent predictor of transitioning out of work, although some limitations as a standalone prognostic tool were also revealed; and 3) against initial hypothesis, broad differences in the work environment (based on variations across 12 specific workplace characteristics) did not have significant associations with the extent of health-related work limitations experienced by injured workers with a WRUED. Study findings were discussed in terms of how they advance current understanding on the measurement and determinants of work disability, and potential implications in terms of the assessment and management of work disability among injured workers recovering from a WRUED. Future research directions were also proposed to build on current work.

Keywords: job characteristics
measurement
musculoskeletal health
upper-extremity disorders
work disability
work limitations
Advisor: Beaton, Dorcas
Controlled Interfaces as Lab-on-a-chip Components

This thesis is devoted to the study and application of controlled two-phase interfaces in the context of microfluidic and lab-on-a-chip systems. Spontaneous emergence and presence of unwanted gas-liquid interfaces (i.e. bubbles) in microfluidic devices are often problematic. In this thesis it is shown through experimentation, numerical, and analytical modeling that precisely controlled gas-liquid interfaces may be exploited as effective microfluidic components to perform functions such as valving, sampling and liquid routing within microfluidic devices or even manipulate layers of pulmonary cells to recapitulate alveolar function. Flow control strategies presented in this thesis include the bubble gate for valving and sampling and the bubble pump for liquid routing in microchannels. Flow control and actuation in the devised techniques are done by controlled gas bubbles and therefore, their function is independent of the elasticity of substrate material and requires only a single layer fabrication unlike the majority of available microfluidic flow control techniques. In this thesis, the application of controlled two-phase interfaces is further extended by introduction and characterization of a microfluidic tensiometer that can readily measure interfacial tension between pairs of immiscible fluids both gas-liquid and liquid-liquid. Additionally, it is shown that controlled gas-liquid interfaces within a surface modified capillary plate may be used as cell culture platforms for in vitro modeling of the alveolar epithelium function. In order to do so, it is investigated in this thesis whether pulmonary epithelial cells can be cultured atop a controlled air-liquid interface and form a confluent layer with functional tight junctions that can serve as a model for alveolar epithelium. Finally a number of further extensions and applications for the techniques developed in this thesis are presented in form of preliminary designs and calculation as groundwork for future continuation of this thesis.

Keywords: Cell culture
in-vitro model
Lab-on-a-Chip
Microfluidics
Micro total analysis
Multiphase flows
Advisor: Guenther, Axel
Chemoselective Transformation of Amphoteric Aziridine Aldehydes and Alpha-Boryl Aldehydes

The development of novel chemical strategies aimed at the synthesis of complex chemical entities comprises a central part of organic chemistry. An important area of this research is the development of reagents and/or building blocks that possess multiple handles with orthogonal reactivity. In this area, amphoteric molecules represent a platform for uncovering novel transformations previously inaccessible with conventional reagents. This thesis reports on the development of chemoselective transformations with amphoteric molecules developed in the Yudin lab. Following the introduction, Chapter 2 describes the development of an aldehyde-amine-alkyne (A3-coupling) reaction. Chapter 3 describes the development of an alkyl-MIDA boronate Suzuki-Miyaura cross-coupling reaction with direct application to the introduction of heterocycles to aryl substrates. The remainder of the thesis concentrates on amphoteric boryl aldehydes and the identification of unusual boron-containing products and intermediates. Chapter 4 describes a method for the synthesis of cyclic-amino boronates and highlights the influence of the MIDA boronate substituent on C-H activation. Chapter 5 delves into the chemoselective enolization of aldehydes to form a C,O-bis enolate. This intermediate was subsequently utilized in a Tsuji-Trost allylic alkylation reaction affording quaternary alkyl boronate products. Finally, Chapter 6 describes the condensation of aldehydes with amines, yielding enamines and enamides. These densely functionalized nitrogen-containing substrates were then applied to the synthesis of boron-containing heterocycles and other biologically relevant products.

Keywords: Aldehyde
Amphoteric
Aziridine
Boron
Catalysis
Synthesis
Advisor: Yudin, Andrei K
A Hot Commodity: Uranium and Containment in the Nuclear State

Since taking centre stage in the development of the atomic bomb, uranium has been enveloped in practices and discourses of secrecy and (in)security that are material and psychosocial. The physical properties of uranium, notably its radioactivity - invisible and imperceptible to ordinary senses - have been used to justify regimes of secrecy and security. Yet these properties also contribute to a political, material, and corporeal insecurity. Of note, the secrecy and security surrounding uranium, and the accompanying insecurity, did not end with the Cold War. These trappings of uranium have remained evident in the political economy of uranium refining in Canada, yet their repercussions have predominantly manifested at the local scale in the small communities, such as Port Hope, that host Canada's nuclear facilities. In A Hot Commodity: Uranium and Containment in the Nuclear State, I analyze how the state-owned and operated Eldorado uranium refinery protected its own interests in the midst of the discovery that the refinery had contaminated the small town of Port Hope with radioactive waste. I assess how Eldorado strategically drew on its powers and privileges as a federal crown corporation to secure its own political and economic position while foreclosing dissent. In the midst of contestation over the waste, Eldorado undertook strategic measures to ensure its own legitimacy as the cornerstone of Canada's national uranium industry so that the refinery could expand and intensify its operations in Port Hope despite being implicated in contaminating the town. As the uranium refinery was owned and operated as a federal crown corporation between 1944 and 1988, this lens enables a historically grounded analysis of the relationship between the state and civil society, and how uneven power relations are maintained over long periods of time. My analysis of Eldorado shows how the nuclear state is conspicuously local - it was largely built through this one uranium refinery - and in many ways, this process transformed this community into a nuclear landscape characterized by dispossession, insecurity, anxiety, uncertainty, and sacrifice.

Keywords: containment
enclosure
nuclear landscapes
political economy
political geography
uranium
Advisor: MacDonald, Ken I
Subjectivity and Embodied Experiences of Time in Contemporary English-Canadian Fiction and Film

My dissertation offers close readings of four literary and filmic Canadian works--Michael Ondaatje's novel Anil's Ghost (2000), Dionne Brand's short-story collection Sans Souci and Other Stories (1983), Jeff Lemire's graphic narrative Essex County (2009), and David Cronenberg's film Spider (2002)-- to demonstrate their engagement with embodied experience. This study argues that subjective experience is inseparable from the process of thinking through and with the body. This focus on embodiment, I argue, often gives way to a privileging of present-time experience, even within accounts of the traumatic past. I connect this interest in present-time embodied experience to a larger concern in the development of Canadian criticism and suggest that Canadian criticism is in need of a corrective shift away from a focus on the past and towards an attentiveness to the present. Chapter one examines embodiment, touch, and forgetting in Ondaatje's Anil's Ghost. Here, I show how the novel provides a model of willed forgetting that allows characters to survive the horrors of war and to experience valuable moments of life-affirming embodied engagement and communication, often through physical touch, in the present. Chapter two shows how the body plays a fundamental and productive role in the psychological processes through which Brand's Black female characters confront a history of oppression. I read the Sans Souci collection as a short-story cycle that is unified by a thematic focus on embodied experiences of time, racism and sexism, and Black female subjectivity. Chapter three focuses on the second book of Lemire's Essex County, and its representation of the aging body in connection with memory and storytelling. I argue that the protagonist's physical movement and positioning in space help him to remember his past and tell his story, and also allow him to experience positive moments of engagement with his present-time embodied experience and the external world. My final chapter, on Cronenberg's Spider, shows how embodied experiences and gestures, such as Spider's writing and his creation of web-like sculptures, play an integral role in the process of constructing, reviving, and engaging with past and present experiences.

Keywords: Canadian Fiction
Contemporary Fiction
Film
Graphic narrative
Trauma Studies
Advisor: Goldman, Marlene
Drama and Performance in Iacopone da Todi's Laude

The laudario of Iacopone da Todi (1236-1306) challenges the reader's perception of literary and dramatic aesthetics due to its poetic form, common dialogical settings, and para-linguistic modes of communication. His laude have been systematically defined as lauda drammatiche, even if most of his readers would probably concur that they do not always conform to the canons of drama. The purpose of this thesis is to examine significant traces and aspects of dramatic form in Iacopone's laude. In the following five chapters, I examine the laudario from various perspectives. The first chapter articulates the points of divergence between Iacopone's laudario and the traditional models of lauda up to his time. It discusses its distinctive ballad form and places the laudario within its religious and historical context, with emphasis on the penitential practice of the Flagellanti and its potential impact on the Franciscan lauda. In chapter two, I assess the laudario's textual version for evidence pertinent to a potential staging of the individual laude, basing my investigation on John Austin's theory of the locutionary, illocutionary, and perlocutionary speech acts, as well as other developments of speech act theory and additional principles of performance. In chapter three, I examine the laudario for traces of a live presentation, applying Paul Zumthor's notions of oral performance. This section of the thesis focuses on issues involved in the oral transmission of the text, on traces of audience presence and participation in performance, and on the concept of mnemonics in general, both auditory and visual. Chapter four investigates the lauda as an instrument of Franciscan preaching that reflects persuasive and non-linguistic strategies of representation pertinent to the preaching models of sermo modernus. In chapter five, I narrow the emphasis to the link between drama and the major liturgical practices: the Eucharist and the lay Planctus Mariae. My intention is to determine the genesis of the most dramatic work of Iacopone, Donna de paradiso. Finally, I categorize the laude according to the extent of their dramatic features

Keywords: Italian
Laude
Literature
Middle Ages
Performance
Advisor: Pietropaolo, Domenico
Investigation of Epstein-Barr Virus-Host Interactions during Latent and Lytic Infection

Epstein-Barr virus is a gammaherpesvirus that latently infects more than 90% of the adult population and persists for the life of the host. The viral life cycle consists of both lytic and latent phases, which are characterized by the expression of specific viral genes. Latency is associated with several types of cancer such as the epithelial cancers nasopharyngeal carcinoma (NPC) and 10% of gastric carcinomas. Epstein-Barr nuclear antigen 1 (EBNA1) is the only viral nuclear protein expressed during both the lytic and latent phases of the viral cycle. In this study I used a proteomics approach to profile EBNA1-host protein interactions in nasopharyngeal and gastric carcinoma cells in the context of latent and lytic EBV infection. I identified several interactions that occur in both modes of infection, including a previously unreported interaction with nucleophosmin (NPM1) and RNA-mediated interactions with several heterogeneous nuclear ribonucleoproteins (hnRNPs) and La protein. Additionally, NPM1 is recruited by EBNA1 to the FR element and is required for EBNA1-mediated transcriptional activation. I also studied the ability of individual lytic and latent EBV proteins to induce DNA damage, which has previously been shown to contribute to EBV infection. I identified 15 lytic proteins that induce damage and conducted proteomic analysis of eight proteins. I identified several interactions between viral proteins and host proteins that may explain the activation of the DNA damage response seen during EBV lytic infection. For example, the viral protein BKRF3 was found to interact with the NuRD complex, cause a decrease in levels of the NuRD protein RBBP4, and lead to a reduction in p53 activation.

Advisor: Frappier, Lori
Building Life: Faith, Literacy Development and Muslim Citizenship in Revolutionary Egypt

Days after the ouster of Hosni Mubarak, the NGO Life Makers announced the launch of Knowledge Is Power, a campaign to eradicate illiteracy in Egypt. Led by one of the country's most prominent Muslim preachers, Amr Khaled, Life Makers calls on `faith development' (tanmiyya bi-l-ĂŽmĂ˘n) for a revolutionary literacy movement that sets out to fundamentally reshape religio-political subjectivities in order to build the new Egypt. Based on sixteen months of fieldwork in Cairo, Egypt (June 2011-August 2012, and April-May 2013), this study uncovers how Islamic notions of knowledge and the foundational injunction to read (the first words revealed of the Quran are believed to be "Read in the name of your Lord") inform what I call Islamic literacy development. I examine how the campaign is conceptualized and mobilized from above, and interrogate the politics and ethics of how it unfolds on the ground. The ethnography pivots between campaign volunteers' ethic of action on the one hand, and on the other, the implementation of the campaign in two sites: among mothers in a slum of Old Cairo, and workers at a shipyard in an industrial zone. This dissertation reaches across the anthropology of Islam and development to understand how conceptions and practices of faith and nationhood are cultivated and disputed. One of the political effects of the campaign is the mobilization of and contestation over what I call Muslim citizenship. Life Makers fosters Muslim citizenship as a way of being and political relation in revolutionary Egypt. They maintain that the country will progress only when its people look within and turn towards God. Knowledge Is Power is therefore an Islamic-civic project of self-making that makes literacy a virtuous practice to cultivate a specifically Islamic form of modern citizenship.

Keywords: citizenship
development
Egypt
Islam
literacy
religion
Advisor: Mittermaier, Amira