UPTAKE OF THE PERIODIC HEALTH EXAM AMONG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES FROM 2003 TO 2015

Background: Over the past decade, annual heath exams have been de-emphasized for the general population but emphasized for adults with intellectual and developmental disabilities (IDD). The purpose of this project was to determine if there has been an increase in the uptake of the health exam among adults with IDD in Ontario, to what extent, and the effect on the quality of preventive care provided. Methods: Using administrative health data, the proportion of adults (18-64 years old) with IDD who received a health exam (long appointment, general assessment, and “true” health exam), a high value on the primary care quality composite score (PCQS), and a health exam or high PCQS each year was compared to the proportion in a propensity score matched sample of the general population. Negative binomial and segmented negative binomial regression controlling for age and sex were used to determine the relative risk of having a health exam/high PCQS/health exam or PCQS over time. Results: Pre joinpoint, the long appointment and general assessment health exam definitions saw a decrease and the “true” health exam saw an increase in the likelihood of adults having a health exam. Post joinpoint, all health exam definitions saw a decrease in the likelihood of adults having a health exam. Pre joinpoint, all PCQS measures (high PCQS, long appointment or high PCQS, “true” health exam or high PCQS) saw an increase in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Post joinpoint, all PCQS measures saw a decrease in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Achieving a high PCQS was strongly associated with having a health exam regardless of health exam definition or IDD status. Conclusions: Despite the publication of guidelines, only a small proportion of adults with IDD are receiving health exams. This indicates that the publication of guidelines alone was not sufficient to change practice. More targeted measures, such as the implementation of an IDD-specific health exam fee code, should be considered to increase the uptake of the health exam among adults with IDD.

Computational models for improved diagnosis and prognosis of stroke using robot-based biomarkers

Stroke is a leading cause of death and permanent disability worldwide, affecting millions of individuals. Traditional clinical scores for assessment of stroke-related impairments are inherently subjective and limited by inter-rater and intra-rater reliability, as well as floor and ceiling effects. In contrast, robotic technologies provide objective, highly repeatable tools for quantification of neurological impairments following stroke. KINARM is an exoskeleton robotic device that provides objective, reliable tools for assessment of sensorimotor, proprioceptive and cognitive brain function by means of a battery of behavioral tasks. As such, KINARM is particularly useful for assessment of neurological impairments following stroke. This thesis introduces a computational framework for assessment of neurological impairments using the data provided by KINARM. This is done by achieving two main objectives. First, to investigate how robotic measurements can be used to estimate current and future abilities to perform daily activities for subjects with stroke. We are able to predict clinical scores related to activities of daily living at present and future time points using a set of robotic biomarkers. The findings of this analysis provide a proof of principle that robotic evaluation can be an effective tool for clinical decision support and target-based rehabilitation therapy. The second main objective of this thesis is to address the emerging problem of long assessment time, which can potentially lead to fatigue when assessing subjects with stroke. To address this issue, we examine two time reduction strategies. The first strategy focuses on task selection, whereby KINARM tasks are arranged in a hierarchical structure so that an earlier task in the assessment procedure can be used to decide whether or not subsequent tasks should be performed. The second strategy focuses on time reduction on the longest two individual KINARM tasks. Both reduction strategies are shown to provide significant time savings, ranging from 30% to 90% using task selection and 50% using individual task reductions, thereby establishing a framework for reduction of assessment time on a broader set of KINARM tasks. All in all, findings of this thesis establish an improved platform for diagnosis and prognosis of stroke using robot-based biomarkers.

Giovanni Battista Montano as Architectural Draughtsman: Recording the Past and Designing the Future

Giovanni Battista Montano (1534-1621), who was born in Milan and trained as a woodcarver, relocated permanently to Rome in the early 1570s where his interest in sculpting was replaced by intense study of the city’s antique monuments and ruins. Although Montano carried out several sculptural and architectural projects during his time in Rome, it is his surviving corpus of drawings that testifies to his passion of exploring ancient architecture through the medium of drawing. While Montano was not famous during his lifetime, a large body of his intriguing designs became celebrated and widely circulated after his death thanks to the 1624 publication of Montano’s designs by his loyal pupil, Giovanni Battista Soria. Montano’s lifelong work differs from virtually all of his predecessors and contemporaries in its “fantastical” and ornamental nature. This thesis explores Montano’s artistic training as it relates to his later interest in imaginatively reconstructing antique buildings, along with his disregard for archaeological or historical accuracy. The subject matter upon which Montano focused is discussed, along with his objective in creating a large corpus of half-historical, half-invented drawings. His drawing techniques are explored with specific reference to the largest group of extant Montano drawings, today housed in Sir John Soane’s Museum, London, England, and also in reference to three original Montano drawings in the Centre Canadien d’Architecture/Canadian Centre for Architecture, Montréal. Also explored is the legacy and impact of Montano’s drawings and the later publications of his designs on the works of Roman Baroque architects, specifically Borromini and Bernini. This thesis ultimately attempts to understand the impact of the intellectual and artistic environment surrounding Montano in late sixteenth and early seventeenth century Rome, his drawing techniques, his choice of subject matter, and the reception that his unique works received from contemporary artists and intellectuals, along with those of the following generation.

Contact zone dynamics and the evolution of reproductive isolation in a North American treefrog, the spring peeper (Pseudacris crucifer)

Despite over seven decades of speciation research and 25 years of phylogeographic studies, a comprehensive understanding of mechanisms that generate biological species remains elusive. In temperate zones, the pervasiveness of range fragmentation and subsequent range expansions suggests that secondary contact between diverging lineages may be important in the evolution of species. Thus, such contact zones provide compelling opportunities to investigate evolutionary processes, particularly the roles of geographical isolation in initiating, and indirect selection against hybrids in completing (reinforcement), the evolution of reproductive isolation and speciation. The spring peeper (Pseudacris crucifer) has six well-supported mitochondrial lineages many of which are now in secondary contact. Here I investigate the evolutionary consequences of secondary contact of two such lineages (Eastern and Interior) in Southwestern Ontario using genetic, morphological, acoustical, experimental, and behavioural evidence to show accentuated divergence of the mate recognition system in sympatry. Mitochondrial and microsatellite data distinguish these two lineages but also show ongoing hybridization. Bayesian assignment tests and cline analysis imply asymmetrical introgression of Eastern lineage nuclear markers into Interior populations. Male calls are divergent between Eastern and Interior allopatric populations and show asymmetrical reproductive character displacement in sympatry. Female preference of pure lineage individuals is also exaggerated in sympatry, with hybrids showing intermediate traits and preference. I suggest that these patterns are most consistent with secondary reinforcement. I assessed levels of post-zygotic isolation between the Eastern and Interior lineages using a laboratory hybridization experiment. Hybrid tadpoles showed equal to or greater fitness than their pure lineage counterparts, but this may be countered through competition. More deformities and developmental anomalies in hybrid tadpoles further suggest post-zygotic isolation. Despite evidence for pre-mating isolation between the two lineages, isolation appears incomplete (i.e. hybridization is ongoing). I hypothesize that potentially less attractive hybrids may circumvent female choice by adopting satellite behaviour. Although mating tactics are related to body size, genetic status may play a role. I show that pure Eastern males almost always engage in calling, while hybrids adopt a satellite tactic. An absence of assortative mating, despite evidence of female preference, suggests successful satellite interception possibly facilitating introgression.

A Developmental Approach to Sport Expertise

This chapter examines the personal and contextual factors of youth sport that affect sport expertise and developmental outcomes. The developmental model of sport participation (DMSP) is used as a comprehensive framework that outlines different pathways of involvement in sport. Activities and contexts that promote continued sport participation and expert performance are discussed as the building blocks of all effective youth sport programs. This chapter provides evidence that performance in sport, participation, and psychological development should be considered as a whole instead of as separate entities by youth sport programmers. Adults in youth sports (i.e. coaches, parents, sport psychologists, administrators) must consider the differing implications of concepts such as deliberate play, deliberate practice, sampling, specialization, and program structure at different stages of an athlete's talent development. Seven postulates are presented regarding important transitions in youth sport and the role that sampling and deliberate play, as opposed to specialization and deliberate practice, can have during the childhood in promoting continued participation and elite performance in sport

Using WebCT to Support a Community of Practice

Reflecting a view of “teaching as both an intellectual and practical activity” the Queen’s University Bachelor of Education program has multi-week in-school practicum sessions separated by periods of on-campus course work. The expectation is that teacher candidates will bring together theory and practice as they reflect upon their daily classroom experiences. The reality often is that, while isolated from the university environment and caught up in the pressures of teaching, little deep reflection takes place. For reflection and critical examination of experience to occur, teacher candidates need to share and discuss on a daily basis their practice teaching experience. For the past few years, students in my secondary school mathematics curriculum course, through a WebCT based conference, have been provided, while away from campus, with a place for on-going sharing of teaching stories and dilemmas. In the Fall of 2004 eight-five percent of the class took part in the discussions, posting a total of 667 messages over a 9 week period. In an effort to increase the value of this practicum conference we have analysed the topic threads arising in the conversation, surveyed the participants concerning their impressions of the sharing experience, and conducted in-depth interviews with a sampling of the class. This session will present the results of this study and provide an opportunity to discuss ways in which an online discussion can support the building of community and the exchange of experience while students in professional programs are disbursed in practice/clinical settings.