RE-MEANING THE SACRED: COLONIAL DAMAGE AND INDIGENOUS COSMOLOGIES

Indigenous ways of knowing are dependent on an inheriting process both amongst humans and between human and non-human being. These multi-relationships cross material and immaterial borders as sites of knowledge production. This manuscript will interrogate how three particular Indigenous cosmological relationships have been purposefully re-meaninged by colonial institutions: 1) How Anishinaabe and Haudenosaunee origin stories have been abstracted into a distinctive epistemological versus ontological site; 2) How Anishnaabe spirit worlds are impacted by colonial relations, and how state institutions benefit from the re-meaning of these worlds; and 3) How Indigenous sovereignty in Canada is imagined from a statist perspective, and how these polices have re-meaninged the sacred relationships within a cosmological understanding of Haudenosaunee governance. The re-meaning of sacredly-held Indigenous relationships is both accelerated by, and contributes to, a practice of reducing upon Indigenous and non-human societies. Throughout expressions of colonialism on Indigenous territories (the academy, the state, Indian policy), Indigenous knowledge is consistently either dismissed or appropriated. This reduction of Indigenous knowledge continues to bolster functions of the state as related to the elimination of the “Indian Problem” via reducing the “Indian” to an adaptive subject.

Radical Ambition: A Portrait of the Toronto New Left, 1958-1985

This thesis examines the rise and decline of the New Left in Toronto from 1958 to 1985. It argues that New Leftism — whose three leading ideals were self-management, national liberation, and community — arose as much from the Old Left as it did from the peace movement. In contrast to earlier readings that interpret the New Left narrowly — essentially, as the combined forces of the white student and peace movements evident mainly on university campuses — this thesis documents the extent to which New Leftism, interpreted as a political formation, provided a framework for a diversity of radical social movements, especially feminism, Black Power, gay liberation, resistance to the capitalist redevelopment of the city, and transnational solidarity. It also questions a declensionist narrative that adopts a “decadal” approach to the radicalism of the sixties, according to which 1970 spelled the end of “60s” radicalism. Quite the contrary, this thesis argues: in Toronto, it would be truer to say that 1970s were “the sixties,” in that only in this later decade did many New Left movements attain their full maturity. New Leftists successfully challenged a host of institutions, sometimes with permanent effects. The educational system was transformed. Cultural institutions and practices were revolutionized. Questions of race and gender, once peripheral to the left, were made central to it. Democratic community institutions became far more powerful. A token of the strength and durability of the New Left in Toronto was the extent to which it remained the bête noir of a series of other radical groups upholding the model of the vanguard communist party — which challenged the New Leftists’ prominence but many members of which often wound up agreeing with their positions. It was only in the early 1980s, with the ascent of a new right, that Toronto’s New Left unmistakably entered a period of decline. Yet, even then, many of its key themes were picked up by fast-growing anarchist and socialist feminist currents. Far from constituting a minor phenomenon, Toronto’s New Left, one of the largest movements for social justice in Canadian history, bequeathed to its progressive successors an imposing legacy of struggle and cultural achievements. It is the purpose of this thesis to evaluate, both critically and sympathetically, the extent to which the New Left attained its radical ambition.

Accommodating Muslim Minorities in Secular Societies: Public Education in England, Scotland, Ontario, and Quebec

Abstract This thesis examines one of the most sensitive challenges facing contemporary democracies: the accommodation of Muslim minorities in public institutions and services. It focuses on the field of education, and on two particular issues: the public funding of Islamic schools and the accommodation of Muslim needs in public secular schools. The analysis is based on an examination of outcomes in four jurisdictions that differ significantly in the level of accommodation that has emerged: England, Scotland, Ontario, and Quebec. I seek to explain why such variation in outcomes exists among these four cases. I draw on four bodies of literature to underpin the theoretical framework: historical institutionalism, political mobilization by civil society, political parties, and ideationalism. My argument can be summarized simply; historic church-state settlements, unique in each case, are the most important factor explaining the variation in outcomes in England, Scotland, Ontario, and Quebec. In some cases, the historic church-state template is incrementally adapted to accommodate Muslim minorities. In other cases, relatively little accommodation occurs and the path-dependent trajectory of church-state relations remains entrenched. While the historic church-state template is a necessary factor in the explanation, it does not fully account for the variation. For a more complete picture, I demonstrate that there are several additional key factors that also shape the outcomes: first, national identity and public attitudes towards immigration and immigrants; second, the extent of mobilization by political agents, such as civil society organizations and historic churches; and third, the response of political parties to demands by Muslims for institutional accommodation. Ultimately, I conclude that Muslims in these jurisdictions are receiving some accommodation, but the process is slow and partial. This thesis makes important theoretical and empirical contributions to the discussion of Muslim integration in liberal democratic states. First, a framework has yet to be developed that considers the theoretical implications of institutional accommodation of Muslims; I address this gap. Second, this research demonstrates the utility of historical institutionalism in explaining the adaptation of church-state templates to accommodate Muslims’ demands. Last, this study makes an original contribution by comparing the cases of England, Scotland, Ontario, and Quebec in the accommodation of Muslims in education. A comparison of Canada with the United Kingdom has not yet been done.  

Investigating Multiple Roles of Vocal Confidence in Persuasion

Although persuasion often occurs via oral communication, it remains a comparatively understudied area. This research tested the hypothesis that changes in three properties of voice influence perceptions of speaker confidence, which in turn differentially affects attitudes according to different underlying psychological processes that the Elaboration Likelihood Model (ELM, Petty & Cacioppo, 1984), suggests should emerge under different levels of thought. Experiment 1 was a 2 (Elaboration: high vs. low) x 2 (Vocal speed: increased speed vs. decreased speed) x 2 (Vocal intonation: falling intonation vs. rising intonation) between participants factorial design. Vocal speed and vocal intonation influenced perceptions of speaker confidence as predicted. In line with the ELM, under high elaboration, confidence biased thought favorability, which in turn influenced attitudes. Under low elaboration, confidence did not bias thoughts but rather directly influenced attitudes as a peripheral cue. Experiment 2 used a similar design as Experiment 1 but focused on vocal pitch. Results confirmed pitch influenced perceptions of confidence as predicted. Importantly, we also replicated the bias and cue processes found in Experiment 1. Experiment 3 investigated the process by which a broader spectrum of speech rate influenced persuasion under moderate elaboration. In a 2 (Argument quality: strong vs. weak) x 4 (Vocal speed: extremely slow vs. moderately slow vs. moderately fast vs. extremely fast) between participants factorial design, results confirmed the hypothesized non-linear relationship between speech rate and perceptions of confidence. In line with the ELM, speech rate influenced persuasion based on the amount of processing. Experiment 4 investigated the effects of a broader spectrum of vocal intonation on persuasion under moderate elaboration and used a similar design as Experiment 3. Results indicated a partial success of our vocal intonation manipulation. No evidence was found to support the hypothesized mechanism. These studies show that changes in several different properties of voice can influence the extent to which others perceive them as confident. Importantly, evidence suggests different vocal properties influence persuasion by the same bias and cue processes under high and low thought. Evidence also suggests that under moderate thought, speech rate influences persuasion based on the amount of processing.

Language, Logos, and Social Ontology: Naturalist and Post-Naturalist Narratives of Human Rationality and Social Reality

I distinguish two ways that philosophers have approached and explained the reality and status of human social institutions. I call these approaches “naturalist” and “post-naturalist”. Common to both approaches is an understanding that the status of mind and its relation to the world or “nature” has implications on a conception of the status of institutional reality. Naturalists hold that mind is explicable within a scientific frame that conceives of mind as a fundamentally material process. By proxy, social reality is also materially explicable. Post-naturalists critique this view, holding instead that naturalism is parasitic on contemporary science—it therefore is non-compulsory and distorts how we ought to understand mind and social reality. A comparison of naturalism and post-naturalism will comprise the content of the first chapter. The second chapter turns to tracing out the dimensions of a post-naturalist narrative of mind and social reality. Post-naturalists conceive of mind and its activity of thought as sui generis, and it transpires from this that social institutions are better understood as a rational mind’s mode of the expression in the world. Post-naturalism conceives of social reality as a necessary dimension of thought. Thought requires a second person and thereby a tradition or context of norms that come to both structure its expression and become the products of expression. This is in contrast to the idea that social reality is a production of minds, and thereby derivative. Social reality, self-conscious thought, and thought of the second person are therefore three dimensions of a greater unity.

Reversibly Photo-Crosslinkable Polycarbonate-Based Polymersomes for Drug Encapsulation and Delivery

This thesis describes the preparation of polymersomes from poly(ethylene glycol)-block-polycarbonate (PEG-PC) copolymers functionalized with pendant coumarin groups. Coumarin groups undergo photo-reversible dimerization when irradiated with specific ultraviolet wavelengths, so they can be used to prepare polymers with photo-responsive properties. In this case, the pendant coumarin groups enable stabilization of the polymersome membrane through photo-crosslinking of the hydrophobic block. Initially, several novel cinnamoyl and coumarin functionalized cyclic carbonate monomers were synthesized using ester, ether, or amide linkages. While the homopolymerization of these functionalized monomers proved challenging due to their high melting points, both cinnamoyl and coumarin functionalized monomers were successfully copolymerized with trimethylene carbonate (TMC) at 100 ℃ using a catalyst-free melt polymerization process where the TMC doubled as a solvent for the higher melting point monomer. Using this system, polycarbonate copolymers with up to 33% incorporation of the functionalized monomers were prepared. In addition, an investigation of some anomalous polymerization results identified previously unreported triethylamine-based catalysts for the melt polymerization of carbonate monomers. These studies also demonstrated that the catalyst-free polymerization of TMC occurs faster and at lower temperatures than previously reported. Subsequently, the photo-crosslinking of cinnamoyl and coumarin functionalized polycarbonates was compared and coumarin was identified as the more effective crosslinking agent when using 300-400 nm UV. An investigation of the photo-reversibility of the coumarin dimerization revealed no discernible change in the properties of crosslinked networks, but rapid photo-reversion in dilute solutions. The photo-crosslinking and photo-reversion kinetics of the coumarin functionalized polycarbonates were determined to be second-order in both cases. Finally, the self-assembly of PEG-PC diblock copolymers functionalized with coumarin was examined and both reverse solvent evaporation and solvent displacement were found to induce self-assembly, with hydrophilic mass fractions (f-factors) of 12-28% resulting in the formation of solid microparticles and nanoparticles and f-factors of 33-43% resulting in the formation of polymersomes. The stabilization of these polymersome membranes through photo-initiator-free photo-crosslinking was demonstrated with the crosslinking allowing polymersomes to withstand centrifugation at 12,000 x g. In addition, the encapsulation of calcein, as a model small molecule drug, in the stabilized polymersomes was successfully demonstrated using confocal microscopy.

Yielding Behaviour of Electron Beam Lithography and Focused Ion Beam Made Nanocrystalline Micro/Nanopillars

Electron beam lithography (EBL) and focused ion beam (FIB) methods were developed in house to fabricate nanocrystalline nickel micro/nanopillars so to compare the effect of fabrication on plastic yielding. EBL was used to fabricate 3 μm and 5 μm thick poly-methyl methacrylate patterned substrates in which nickel pillars were grown by electroplating with height to diameter aspect ratios from 2:1 to 5:1. FIB milling was used to reduce larger grown pillars to sizes similar to EBL grown pillars. X-ray diffraction, electron back-scatter diffraction, scanning electron microscopy, and FIB imaging were used to characterize the nickel pillars. The measured grain size of the pillars was 91±23 nm, with strong <110> and weaker <111> and <110> crystallographic texture in the growth. Load-controlled compression tests were conducted using a MicroMaterials nano-indenter equipped with a 10 μm flat punch at constant rates from 0.0015 to 0.03 mN/s on EBL grown pillars, and 0.0015 and 0.015 mN/s on FIB-milled pillars. The measured Young’s modulus ranged from 55 to 350 GPa for all pillars, agreeing with values in the literature. EBL grown pillars exhibited stochastic strain-bursts at slow loading rates, attributed to local micro yield events, followed by work hardening. Sharp yield points were also observed and attributed to the gold seed layer de-bonding between the nickel pillar and substrate due to the shear stress associated with end effects that arise from the substrate constraint. The onset of yield ranged from 108 to 1800 MPa, which is greater than bulk nickel, but within values given in the literature. FIB-milled pillars demonstrated stochastic yield behaviour at all loading rates tested, yielding between 320 and 625 MPa. Deformation was apparent at FIB-milled pillar tops, where the smallest cross-sectional area was measured, but still exhibited superior yield strength to bulk nickel. The gallium damage at the outer surface of the pillars likely aids in dislocation nucleation and plasticity, leading to lower yield strengths than for the EBL pillars. Thermal drift, substrate effects, and noise due to vibrations within the indenter system contributed to variance and inconsistency in the data.

Karst hazard analysis towards the development of predictive karst models for southern Ontario

An investigation into karst hazard in southern Ontario has been undertaken with the intention of leading to the development of predictive karst models for this region. The reason these are not currently feasible is a lack of sufficient karst data, though this is not entirely due to the lack of karst features. Geophysical data was collected at Lake on the Mountain, Ontario as part of this karst investigation. This data was collected in order to validate the long-standing hypothesis that Lake on the Mountain was formed from a sinkhole collapse. Sub-bottom acoustic profiling data was collected in order to image the lake bottom sediments and bedrock. Vertical bedrock features interpreted as solutionally enlarged fractures were taken as evidence for karst processes on the lake bottom. Additionally, the bedrock topography shows a narrower and more elongated basin than was previously identified, and this also lies parallel to a mapped fault system in the area. This suggests that Lake on the Mountain was formed over a fault zone which also supports the sinkhole hypothesis as it would provide groundwater pathways for karst dissolution to occur. Previous sediment cores suggest that Lake on the Mountain would have formed at some point during the Wisconsinan glaciation with glacial meltwater and glacial loading as potential contributing factors to sinkhole development. A probabilistic karst model for the state of Kentucky, USA, has been generated using the Weights of Evidence method. This model is presented as an example of the predictive capabilities of these kind of data-driven modelling techniques and to show how such models could be applied to karst in Ontario. The model was able to classify 70% of the validation dataset correctly while minimizing false positive identifications. This is moderately successful and could stand to be improved. Finally, suggestions to improving the current karst model of southern Ontario are suggested with the goal of increasing investigation into karst in Ontario and streamlining the reporting system for sinkholes, caves, and other karst features so as to improve the current Ontario karst database.

LINEUP SIZE AND NUMBER OF CUES: WHEN BIGGER ISN’T BETTER

Larger lineups could protect innocent suspects from being misidentified; however, they can also decrease correct identifications. Bertrand (2006) investigated whether the decrease in correct identifications could be prevented by adding more cues, in the form of additional views of lineup members’ faces, to the lineup. Adding these cues was successful to an extent. The current series of studies attempted to replicate Bertrand’s (2006) findings while addressing some methodological issues—namely, the inconsistency in image size as lineup size increased. First, I investigated whether image size could affect face recognition (Chapter 2) and found it could, but that it also affected previously-seen (“old”) versus previously-unseen (“new”) faces differently. Specifically, smaller image sizes at exposure lowered accuracy for old faces, while these same image sizes at recognition lowered accuracy for new faces. Although these results indicate that target recognition would be unaffected by image size at recognition (i.e., during a lineup), lineups are also comprised of previously-unseen faces, in the form of fillers and innocent suspects. Because image size could affect lineup decisions, as it could become more difficult to realize fillers are previously-unseen, I decided to replicate Bertrand (2006) while keeping image size constant in Chapters 3 (simultaneous lineups) and 4 (simultaneous-presentation, sequential decisions). In both Chapters, the integral findings were the same: correct identification rates decreased as lineup size increased from 6- to 24-person lineups, but adding cues had no effect. The inability to replicate Bertrand (2006) could mean that the original finding was due to chance, but alternate explanations also exist, such as the overall size of the array, the degree to which additional cues overlap, and the length of the target exposure. These alternate explanations, along with directions for future research, are discussed in the following Chapters.

Refractometry Studies of the Optical Properties of Polymer Films and the Development of Polymer Coated Refractive Index Sensors

Sensors for real-time monitoring of environmental contaminants are essential for protecting ecosystems and human health. Refractive index sensing is a non-selective technique that can be used to measure almost any analyte. Miniaturized refractive index sensors, such as silicon-on-insulator (SOI) microring resonators are one possible platform, but require coatings selective to the analytes of interest. A homemade prism refractometer is reported and used to characterize the interactions between polymer films and liquid or vapour-phase analytes. A camera was used to capture both Fresnel reflection and total internal reflection within the prism. For thin-films (d = 10 μm - 100 μm), interference fringes were also observed. Fourier analysis of the interferogram allowed for simultaneous extraction of the average refractive index and film thickness with accuracies of ∆n = 1-7 ×10-4 and ∆d < 3-5%. The refractive indices of 29 common organic solvents as well as aqueous solutions of sodium chloride, sucrose, ethylene glycol, glycerol, and dimethylsulfoxide were measured at λ = 1550 nm. These measurements will be useful for future calibrations of near-infrared refractive index sensors. A mathematical model is presented, where the concentration of analyte adsorbed in a film can be calculated from the refractive index and thickness changes during uptake. This model can be used with Fickian diffusion models to measure the diffusion coefficients through the bulk film and at the film-substrate interface. The diffusion of water and other organic solvents into SU-8 epoxy was explored using refractometry and the diffusion coefficient of water into SU-8 is presented. Exposure of soft baked SU-8 films to acetone, acetonitrile and methanol resulted in rapid delamination. The diffusion of volatile organic compound (VOC) vapours into polydimethylsiloxane and polydimethyl-co-polydiphenylsiloxane polymers was also studied using refractometry. Diffusion and partition coefficients are reported for several analytes. As a model system, polydimethyl-co-diphenylsiloxane films were coated onto SOI microring resonators. After the development of data acquisition software, coated devices were exposed to VOCs and the refractive index response was assessed. More studies with other polymers are required to test the viability of this platform for environmental sensing applications.

NEIGHBORHOOD PERCEPTION OF SAFETY AND THE MOBILITY GAP BETWEEN MEN AND WOMEN IN OLD AGE

Background and Objectives: Mobility limitations are a prevalent issue in older adult populations, and an important determinant of disability and mortality. Neighborhood conditions are key determinants of mobility and perception of safety may be one such determinant. Women have more mobility limitations than men, a phenomenon known as the gender mobility gap. The objective of this work was to validate a measure of perception of safety, examine the relationship between neighborhood perception of safety and mobility limitations in seniors, and explore if these effects vary by gender. Methods: This study was cross-sectional, using questionnaire data collected from community-dwelling older adults from four sites in Canada, Colombia, and Brazil. The exposure variable was the neighborhood aggregated Perception of Safety (PoS) scale, derived from the Physical and Social Disorder (PSD) scale by Sampson and Raudenbush. Its construct validity was verified using factor analyses and correlation with similar measures. The Mobility Assessment Tool – short form (MAT-sf), a video-based measure validated cross-culturally in the studied populations, was used to assess mobility limitations. Based on theoretical models, covariates were included in the analysis, both at the neighborhood level (SES, social capital, and built environment) and the individual level (age, gender, education, income, chronic illnesses, depression, cognitive function, BMI, and social participation). Multilevel modeling was used in order to account for neighborhood clustering. Gender specific analyses were carried out. SAS and M-plus were used in this study. Results: PoS was validated across all sites. It loaded in a single factor, after excluding two items, with a Cronbach α value of approximately 0.86. Mobility limitations were present in 22.08% of the sample, 16.32% among men and 27.41% among women. Neighborhood perception of safety was significantly associated with mobility limitations when controlling for all covariates, with an OR of 0.84 (CI 95%: 0.73-0.96), indicating lower odds of having mobility limitations as neighborhood perception of safety improves. Gender did not affect this relationship despite women being more likely to have mobility limitations and live in neighborhoods with poor perception of safety. Conclusion: Neighborhood perception of safety affected the prevalence of mobility limitations in older adults in the studied population.

SENSORIMOTOR WORKING MEMORY CAPACITY LIMITS

Two novel studies examining the capacity and characteristics of working memory for object weights, experienced through lifting, were completed. Both studies employed visually identical objects of varying weight and focused on memories linking object locations and weights. Whereas numerous studies have examined the capacity of visual working memory, the capacity of sensorimotor memory involved in motor control and object manipulation has not yet been explored. In addition to assessing working memory for object weights using an explicit perceptual test, we also assessed memory for weight using an implicit measure based on motor performance. The vertical lifting or LF and the horizontal GF applied during lifts, measured from force sensors embedded in the object handles, were used to assess participants’ ability to predict object weights. In Experiment 1, participants were presented with sets of 3, 4, 5, 7 or 9 objects. They lifted each object in the set and then repeated this procedure 10 times with the objects lifted either in a fixed or random order. Sensorimotor memory was examined by assessing, as a function of object set size, how lifting forces changed across successive lifts of a given object. The results indicated that force scaling for weight improved across the repetitions of lifts, and was better for smaller set sizes when compared to the larger set sizes, with the latter effect being clearest when objects were lifting in a random order. However, in general the observed force scaling was poorly scaled. In Experiment 2, working memory was examined in two ways: by determining participants’ ability to detect a change in the weight of one of 3 to 6 objects lifted twice, and by simultaneously measuring the fingertip forces applied when lifting the objects. The results showed that, even when presented with 6 objects, participants were extremely accurate in explicitly detecting which object changed weight. In addition, force scaling for object weight, which was generally quite weak, was similar across set sizes. Thus, a capacity limit less than 6 was not found for either the explicit or implicit measures collected.

Linear Hyperspectral Unmixing Using L0-norm Approximations and Nonnegative Matrix Factorization

Spectral unmixing (SU) is a technique to characterize mixed pixels of the hyperspectral images measured by remote sensors. Most of the existing spectral unmixing algorithms are developed using the linear mixing models. Since the number of endmembers/materials present at each mixed pixel is normally scanty compared with the number of total endmembers (the dimension of spectral library), the problem becomes sparse. This thesis introduces sparse hyperspectral unmixing methods for the linear mixing model through two different scenarios. In the first scenario, the library of spectral signatures is assumed to be known and the main problem is to find the minimum number of endmembers under a reasonable small approximation error. Mathematically, the corresponding problem is called the $\ell_0$-norm problem which is NP-hard problem. Our main study for the first part of thesis is to find more accurate and reliable approximations of $\ell_0$-norm term and propose sparse unmixing methods via such approximations. The resulting methods are shown considerable improvements to reconstruct the fractional abundances of endmembers in comparison with state-of-the-art methods such as having lower reconstruction errors. In the second part of the thesis, the first scenario (i.e., dictionary-aided semiblind unmixing scheme) will be generalized as the blind unmixing scenario that the library of spectral signatures is also estimated. We apply the nonnegative matrix factorization (NMF) method for proposing new unmixing methods due to its noticeable supports such as considering the nonnegativity constraints of two decomposed matrices. Furthermore, we introduce new cost functions through some statistical and physical features of spectral signatures of materials (SSoM) and hyperspectral pixels such as the collaborative property of hyperspectral pixels and the mathematical representation of the concentrated energy of SSoM for the first few subbands. Finally, we introduce sparse unmixing methods for the blind scenario and evaluate the efficiency of the proposed methods via simulations over synthetic and real hyperspectral data sets. The results illustrate considerable enhancements to estimate the spectral library of materials and their fractional abundances such as smaller values of spectral angle distance (SAD) and abundance angle distance (AAD) as well.

SIGNIFICANCE OF HEAT DISSIPATION IN THE CATHODE CATALYST LAYER ON THE LIFETIME AND RELIABILITY OF POLYMER ELECTROLYTE FUEL CELLS

To study the dissipation of heat generated due to the formation of pinholes that cause local hotspots in the catalyst layer of the Polymer Electrolyte Fuel Cell, a two-phase non-isothermal model has been developed by coupling Darcy’s law with heat transport. The domain under consideration is a section of the membrane electrode assembly with a half-channel and a half-rib. Five potential locations where a pinhole might form were analyzed: at the midplane of the channel, midway between the channel midplane and the channel wall, at the channel or rib wall, midway between the rib midplane and the channel wall, at the midplane of the rib. In the first part of this work, a preliminary thermal model was developed. The model was then refined to account for the two-phase effects. A sensitivity study was done to evaluate the effect of the following properties on the maximum temperature in the domain: Catalyst layer thermal conductivity, the Microporous layer thermal conductivity, the anisotropy factor of the Catalyst layer thermal conductivity, the Porous transport layer porosity, the liquid water distribution and the thickness of the membrane and porous layers. Accounting for the two-phase effects, a slight cooling effect was observed across all hotspot locations. The thermal properties of the catalyst layer were shown to have a limited impact on the maximum temperature in the catalyst layer of new fuel cells without pinhole. However, as hotspots start to appear, thermal properties play a more significant role in mitigating the thermal runaway.

THE EPIDEMIOLOGY AND HEALTH ECONOMICS OF ANKLE INJURIES

The thesis focuses on a central theme of the epidemiology and health economics of ankle sprains to inform health policy and the provision of health services. It describes the burden, prognosis, resource utilization, and costs attributed to these injuries. The first manuscript systematically reviewed 34 studies on the direct and indirect costs of treating ankle and foot injuries. The overall costs per patient ranged from $2,075- $3,799 (2014 USD) for ankle sprains; $290-$20,132 for ankle fractures; and $6,345-$45,731 for foot fractures, reflecting differences in injury severity, treatment methods, and study characteristics. The second manuscript provided an epidemiological and economic profile of non-fracture ankle and foot injuries in Ontario using linked databases from the Institute for Clinical Evaluative Sciences. The incidence rate of ankle sprains was 16.9/1,000 person-years. Annually, ankle and foot injuries cost $21,685,876 (2015 CAD). The mean expenses per case were $99.98 (95% CI, $99.70-100.26) for any injury. Costs ranged from $133.78-$210.75 for ankle sprains and $1,497.12-$1,755.69 for dislocations. The third manuscript explored the impact of body mass index on recovery from medically attended grade 1 and 2 ankle sprains using the Foot and Ankle Outcome Score. Data came from a randomized controlled trial of a physiotherapy intervention in Kingston, Ontario. At six months, the odds ratio of recovery for participants with obesity was 0.60 (0.37-0.97) before adjustment and 0.74 (0.43-1.29) after adjustment compared to non-overweight participants. The fourth manuscript used trial data to examine the health-related quality of life among ankle sprain patients using the Health Utilities Index version 3 (HUI-3). The greatest improvements in scores were seen at one month post-injury (HUI-3: 0.88, 95% CI: 0.86-0.90). Individuals with grade 2 sprains had significantly lower ambulation scores than those with grade 1 sprains (0.70 vs. 0.84; p<0.05). The final manuscript used trial data to describe the financial burden (direct and indirect costs) of ankle sprains. The overall mean costs were $1,508 (SD: $1,452) at one month and increased to $2,206 (SD: $3,419) at six months. Individuals with more severe injuries at baseline had significantly higher (p<0.001) costs compared to individuals with less severe injuries, after controlling for confounders.