Preliminary epidemiological study of latent tuberculosis in Mexican agricultural workers in the Niagara region, Canada

It is well documented that the majority of Tuberculosis (TB) cases diagnosed in Canada are related to foreign-bom persons from TB high-burden countries. The Canadian seasonal agricultural workers program (SAWP) operating with Mexico allows migrant workers to enter the country with a temporary work permit for up to 8 months. Preiimnigration screening of these workers by both clinical examination and chest X-ray (CXR) reduces the risk of introducing cases of active pulmonary TB to Canada, but screening for latent TB (LTBI) is not routinely done. Studies carried out in industrialized nations with high immigration from TBendemic countries provide data of lifetime LTBI reactivation of around 10% but little is known about reactivation rates within TB-endemic countries where new infections (or reinfections) may be impossible to distinguish from reactivation. Migrant populations like the SAWP workers who spend considerable amounts of time in both Canada and TBendemic rural areas in Mexico are a unique population in terms of TB epidemiology. However, to our knowledge no studies have been undertaken to explore either the existence of LTBI among Mexican workers, the probability of reactivation or the workers' exposure to TB cases while back in their communities before returning the following season. Being aware of their LTBI status may help workers to exercise healthy behaviours to avoid TB reactivation and therefore continue to access the SAWP. In order to assess the prevalence of LTBI and associated risk factors among Mexican migrant workers a preliminary cross sectional study was designed to involve a convenience sample of the Niagara Region's Mexican workers in 2007. Research ethics clearance was granted by Brock University. Individual questionnaires were administered to collect socio-demographic and TB-related epidemiological data as well as TB knowledge and awareness levels. Cellular immunity to M tuberculosis was assessed by both an Interferon-y release assay (lGRA), QuantiFERON -TB Gold In-Tube (QFf™) and by the tuberculin skin test (TSn using Mantoux. A total of 82 Mexican workers (out of 125 invited) completed the study. Most participants were male (80%) and their age ranged from 22 to 65 years (mean 38.5). The prevalence of LTBI was 34% using TST and 18% using QFTTM. As previously reported, TST (using ~lOmm cut-off) showed a sensitivity of 93.3% and a specificity of 79.1 %. These findings at the moment cannot predict the probability of progression to active TB; only longitudinal cohort studies of this population can ascertain this outcome. However, based on recent publications, lORA positive individuals may have up to 14% probability of reactivation within the next two years. Although according to the SA WP guidelines, all workers undergo TB screening before entering or re-entering Canada, CXR examination requirements showed to be inconsistent for this population: whereas 100% of the workers coming to Canada for the first time reported having the procedure done, only 31 % of returning participants reported having had a CXR in the past year. None of the participants reported ever having a CXR compatible with TB which was consistent with the fact that none had ever been diagnosed with active pulmonary TB and with only 3.6% reporting close contact with a person with active TB in their lifetime. Although Mexico reports that 99% of popUlation is fully immunized against TB within the first year of age, only 85.3% of participants reported receiving BOC vaccine in childhood. Conversely, even when TST is not part of the routine TB screening in endemic countries, a suqDrisingly high 25.6% reported receiving a TST in the past. In regards to TB knowledge and awareness, 74% of the studied population had previous knowledge about (active) TB, 42% correctly identified active TB symptomatology, 4.8% identified the correct route of transmission, 4.8% knew about the existence of LTBI, 3.6% knew that latent TB could reactivate and 48% recognized TB as treatable and curable. Of all variables explored as potential risk factors for LTBI, age was the only one which showed statistical significance. Significant associations could not be proven for other known variables (such as sex, TB contact, history of TB) probably because of the small sample size and the homogeneity of the sample. Screening for LTBI by TST (high sensitivity) followed by confirmation with QFT''"'^ (high specificity) suggests to be a good strategy especially for immigrants from TB high-burden countries. After educational sessions, workers positive for LTBI gained greater knowledge about the signs and symptoms of TB reactivation as well as the risk factors commonly associated with reactivation. Additionally, they were more likely to attend their annual health check up and request a CXR exam to monitor for TB reactivation.

An investigation of the nature and role of historicality in the thought of Dilthey and Heidegger

Introduction The question of the meaning, methods and philosophical manifestations of history is currently rife with contention. The problem that I will address in an exposition of the thought of Wilhelm Dilthey and Martin Heidegger, centers around the intersubjectivity of an historical world. Specifically, there are two interconnected issues. First, since all knowledge occurs to a person from within his or her historical age how can any person in any age make truth claims? In order to answer this concern we must understand the essence and role of history. Yet how can we come to an individual understanding ofwhat history is when the meanings that we use are themselves historically enveloped? But can we, we who are well aware of the knowledge that archaeology has dredged up from old texts or even from 'living' monuments of past ages, really neglect to notice these artifacts that exist within and enrich our world? Charges of wilful blindness would arise if any attempt were made to suggest that certain things of our world did not come down to us from the past. Thus it appears more important 2 to determine what this 'past' is and therefore how history operates than to simply derail the possibility for historical understanding. Wilhelm Dilthey, the great German historicist from the 19th century, did not question the existence of historical artifacts as from the past, but in treating knowledge as one such artifact placed the onus on knowledge to show itself as true, or meaningful, in light ofthe fact that other historical periods relied on different facts and generated different truths or meanings. The problem for him was not just determining what the role of history is, but moreover to discover how knowledge could make any claim as true knowledge. As he stated, there is a problem of "historical anarchy"!' Martin Heidegger picked up these two strands of Dilthey's thought and wanted to answer the problem of truth and meaning in order to solve the problem of historicism. This problem underscored, perhaps for the first time, that societal presuppositions about the past and present oftheir era are not immutable. Penetrating to the core of the raison d'etre of the age was an historical reflection about the past which was now conceived as separated both temporally and attitudinally from the present. But further than this, Heidegger's focus on asking the question of the meaning of Being meant that history must be ontologically explicated not merely ontically treated. Heidegger hopes to remove barriers to a genuine ontology by II 1 3 including history into an assessment ofprevious philosophical systems. He does this in order that the question of Being be more fully explicated, which necessarily for him includes the question of the Being of history. One approach to the question ofwhat history is, given the information that we get from historical knowledge, is whether such knowledge can be formalized into a science. Additionally, we can approach the question of what the essence and role of history is by revealing its underlying characteristics, that is, by focussing on historicality. Thus we will begin with an expository look at Dilthey's conception of history and historicality. We will then explore these issues first in Heidegger's Being and Time, then in the third chapter his middle and later works. Finally, we shall examine how Heidegger's conception may reflect a development in the conception of historicality over Dilthey's historicism, and what such a conception means for a contemporary historical understanding. The problem of existing in a common world which is perceived only individually has been philosophically addressed in many forms. Escaping a pure subjectivist interpretation of 'reality' has occupied Western thinkers not only in order to discover metaphysical truths, but also to provide a foundation for politics and ethics. Many thinkers accept a solipsistic view as inevitable and reject attempts at justifying truth in an intersubjective world. The problem ofhistoricality raises similar problems. We 4 -. - - - - exist in a common historical age, presumably, yet are only aware ofthe historicity of the age through our own individual thoughts. Thus the question arises, do we actually exist within a common history or do we merely individually interpret this as communal? What is the reality of history, individual or communal? Dilthey answers this question by asserting a 'reality' to the historical age thus overcoming solipsism by encasing individual human experience within the historical horizon of the age. This however does nothing to address the epistemological concern over the discoverablity of truth. Heidegger, on the other hand, rejects a metaphysical construel of history and seeks to ground history first within the ontology ofDasein, and second, within the so called "sending" of Being. Thus there can be no solipsism for Heidegger because Dasein's Being is necessarily "cohistorical", Being-with-Others, and furthermore, this historical-Being-in-the-worldwith- Others is the horizon of Being over which truth can appear. Heidegger's solution to the problem of solipsism appears to satisfy that the world is not just a subjective idealist creation and also that one need not appeal to any universal measures of truth or presumed eternal verities. Thus in elucidating Heidegger's notion of history I will also confront the issues ofDasein's Being-alongside-things as well as the Being of Dasein as Being-in-the-world so that Dasein's historicality is explicated vis-a-vis the "sending of Being" (die Schicken des S eins).

A study of ethical decision-making in hypothetical scenarios by secondary school principals /

The purpose of the study,was to investigate the ways in which secondary school principals make decisions that have an ethical dimension, and the reasons they use to justify their choices. The ethical principles and concepts, as well as the scenarios, were adapted from The Ethics ofSchool Administration by Strike, Haller, and Soltis (1998). In this study, 32 secondary principals from a school board in Ontario were asked to complete a descriptive survey which was designed to have principals make administrative decisions in response to 5 hypothetical scenarios. The open-ended questions were expected to elicit responses that were reflective of the principals' actual decision-making strategies. The survey also required them to justify and explain their reasons for each decision. The data were analyzed and 4 major categories ofjustifications emerged: pedagogy, legalism, moral code, and democracy. The results indicate that the decisions made by principals are grounded in various perspectives. While the data did not indicate any explicit knowledge of ethical principles and concepts, the principals' responses suggest sound and valid reasoning for their decision making, addressing the principles and concepts from a variety of viewpoints and using diverse justifications.

Buddhism and the earth : environmental thought in early Buddhist philosophy

Introduction Fundamental to the philosophy of Buddhism, is the insight that there is "unsatisfactohness" (dukkha) in the world and that it can be eliminated through the practice of the Noble Eight Fold Path. Buddhism also maintains that the world as we experience and entities that exist are bereft of any substantiality. Instead existence is manifest through dependent origination. All things are conditional; nothing is permanent. However, inherent in this dependent existence is the interconnectedness of all beings and their subjection to the cosmic law of karma. Part of cultivating the Eight Fold path includes a deep compassion for all other living things, 'trapped' within this cycle of dependent origination. This compassion or empathy (karuna) is crucial to the Buddhist path to enlightenment. It is this emphasis on karuna that shows itself in Mahayana Buddhism with respect to the theory of the boddhisatva (or Buddha-to-be) since the boddhisatva willingly postpones his/her own enlightenment to help others on the same path. One of the ramifications of the theory of dependent origination is that there is no anthropocentric bias placed on humans over the natural world. Paradoxically the doctrine of non-self becomes an ontology within Buddhism, culminating in the Mayahana realization that a common boundary exists between samsara and nirvana. Essential to this ontology is the life of dharma or a moral life. Ethics is not separated from ontology. As my thesis will show, this basic outlook of Buddhism has implications toward our understanding of the Buddhist world-view with respect to the current human predicament concerning the environment. While humans are the only ones who can 4 attain "Buddhahood", it is because of our ability to understand what it means to follow the Eight fold path and act accordingly. Because of the interconnectedness of all entities {dharmas), there is an ontological necessity to eliminate suffering and 'save the earth' because if we allow the earth to suffer, we ALL suffer. This can be understood as an ethical outlook which can be applied to our interaction with and treatment of the natural environment or environment in the broadest sense, not just trees plants rocks etc. It is an approach to samsara and all within it. It has been argued that there is no ontology in Buddhism due to its doctrine of "non-self". However, it is a goal of this thesis to argue that there does exist an original ontology in Buddhism; that according to it, the nature of Being is essentially neither "Being nor non-being nor not non-being" as illustrated by Nagarjuna. Within this ontology is engrained an ethic or 'right path' (samma marga) that is fundamental to our being and this includes a compassionate relationship to our environment. In this dissertation I endeavour to trace the implications that the Buddhist worldview has for the environmental issues that assail us in our age of technology. I will explore questions such as: can the Buddhist way of thinking help us comprehend and possibly resolve the environmental problems of our day and age? Are there any current environmental theories which are comparable to or share common ground with the classical Buddhist doctrines? I will elucidate some fundamental doctrines of early Buddhism from an environmental perspective as well as identify some comparable modern environmental theories such as deep ecology and general systems theory, that seem to share in the wisdom of classical Buddhism and have much to gain from a deeper appreciation of Buddhism.

Utilitarianism and Buddist ethics: a comparative approach to the ethics of animal research

This thesis explores the comparison utilitarianism and Buddhist ethics as they can be applied to animal research. It begins by examining some of the general discussions surrounding the use of animals in research. The historical views on the moral status of animals, the debate surrounding their use in animals, as well as the current 3R paradigm and its application in Canadian research are explored. The thesis then moves on to expound the moral system of utilitarianism as put forth by Jeremy Bentham and John Stuart Mill, as well as contemporary additions to the system. It also looks at the basics of Buddhist ethics well distinguishing the Mahayana from the Therevada. Three case studies in animal research are used to explore how both systems can be applied to animal research. It then offers a comparison as to how both ethical systems function within the field of animal research and explores the implications in their application on its practice.

Transmission of West Nile virus in the Niagara Region among a population at risk for exposure

Background. West Nile Virus (WNV), a mosquito-borne flavivirus, is one of an increasing number of infectious diseases that have been emerging or re-emerging in the last two decades. Since the arrival ofWNV to Canada to present date, the Niagara Region has only reported 30 clinical cases, a small number compared to the hundreds reported in other regions of similar conditions. Moreover, the last reported human case in Niagara was in 2006. As it has been demonstrated that the majority of WNV infections are asymptomatic, the question remains whether the lack of clinical cases in Niagara truly reflects the lack of transmission to humans or if infections are still occurring but are mostly asymptomatic. Objectives. The general objective of this study was to establish whether or not active WNV transmission could be detected in a human population residing in Niagara for the 2007 transmission season. To fullfil this objective, a cross-sectional seroprevalence study was designed to investigate for the presence of anti-WNV antibodies in a sample of Mexican migrant agricultural workers employed in farms registered with the Seasonal Agricultural Workers Program (SAWP). Due to the Mexican origin of the study participants, three specific research objectives were proposed: a) determine the seroprevalence ofanti-WNV antibodies as well as anti-Dengue virus antibodies (a closely related virus prevalent in Mexico and likely to confound WNV serology); b) analyze risk factors associated with WNV and Dengue virus seropositivity; and c) assess the awareness of study participants about WNV infection as well as their understanding of the mode of transmission and clinical importance of the infection. Methodology: After obtaining ethics clearance from Brock University, farms were visited and workers invited to participate. Due to time constraints, only a small number of farms were enrolled with a resulting convenience and non-randomized study sample. Workers' demographic and epidemiological data were collected using a standardized questionnaire and blood samples were drawn to determine serum anti-WNV and anti- Dengue antibodies with a commercial ELISA. All positive samples were sent to the National Microbiology Laboratory in Winnipeg, Manitoba for confirmation with the Plaque Reduction Neutralization Test (PRNT). Data was analyzed with Stata 10.0. Antibody determinations were reported as seroprevalence proportions for both WNV and Dengue. Logistic regression was used to analyze risk factors that may be associated with seropositivity and awareness was reported as a proportion of the number of individuals possessing awareness over the total number of participants. Results and Discussion. In total 92 participants working in 5 farms completed the study. Using the commercial ELISA, seropositivity was as follows: 2.2% for WNV IgM, 20.7% for WNV IgG, and 17.1 % for Dengue IgG. Possible cross-reactivity was demonstrated in 15/20 (75.0%) samples that were positive for both WNV IgG and Dengue IgG. Confirmatory testing with the PRNT demonstrated that none of the WNV ELISA positive samples had antibodies to WNV but 13 samples tested positive for anti-Dengue antibodies (14.1 % Dengue sereoprevalence). The findings showed that the ELISA performance was very poor for assessing anti-WNV antibodies in individuals previously exposed to Dengue virus. However, the ELISA had better sensitivity and specificity for assessing anti-Dengue antibodies. Whereas statistical analysis could not be done for WNV seropositivity, as all samples were PRNT negative, logistic regression demonstrated several risk factors for Dengue exposure_ The first year coming to Canada appeared to be significantly associated with increased exposure to Dengue while lower socio-economic housing and the presence of a water basin in the yard in Mexico appeared to be significantly associated with a decreased exposure to Dengue_ These seemingly contradictory results illustrate that in mobile populations such as migrant workers, risk factors for exposure to Dengue are not easily identified and more research is needed. Assessing the awareness of WNV and its clinical importance showed that only 23% of participants had some knowledge of WNV, of which 76% knew that the infection was mosquito-borne and 47% recognized fever as a symptom. The identified lack of understanding and awareness was not surprising since WNV is not a visible disease in Mexico. Since WNV persists in an enzootic cycle in Niagara and the occurrence of future outbreaks is unpredictable, the agricultural workers remain at risk for transmission. Therefore it important they receive sufficient health education regarding WNV before leaving Mexico and during their stay in Canada. Conclusions. Human transmission of WNV could not be proven among the study participants even when due to their occupation they are at high risk for mosquito bites. The limitations of the study sample do not permit generalizable conclusions, however, the study findings are consistent with the absence of clinical cases in the Niagara Region, so it is likely that human transmission is indeed neglible or absent. As evidenced by our WNV serology results, PRNT must be utilized as a confirmatory test since false positivity occurs frequently. This is especially true when previous exposure to Dengue virus is likely.

A Pragmatic Approach to Ethical Inquiry on Transhuman Athletes and Gene Doping in Sport

Gene doping is the most recent addition to the list of banned practices formulated by the World Anti-doping Agency. It is a subset of doping that utilizes the technology involved in gene therapy. The latter is still in the experimental phase but has the potential to be used as a type of medical treatment involving alterations of a patient‘s genes. I apply a pragmatic form of ethical inquiry to evaluate the application of this medical innovation in the context of sport for performance-enhancement purposes and how it will affect sport, the individual, society and humanity at large. I analyze the probable ethical implications that will emerge from such procedures in terms of values that lie at the heart of the major arguments offered by scholars on both affirmative and opposing sides of the debate on gene doping, namely fairness, autonomy and the conception of what it means to be human.

Ethics, tourists and the environmental practices of the North American cruise ship industry: a comparison study of the ethical standards of Alaskan and Caribbean cruise ship tourists

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 R43 S54 2005

A research capacity strengthening project for infectious diseases in Honduras: experience and lessons learned

Background: In Honduras, research capacity strengthening (RCS) has not received sufficient attention, but an increase in research competencies would enable local scientists to advance knowledge and contribute to national priorities, including the Millennium Development Goals (MDGs). Objective: This project aimed at strengthening research capacity in infectious diseases in Honduras, focusing on the School of Microbiology of the National Autonomous University of Honduras (UNAH). The primary objective was the creation of a research-based graduate program for the continued training of researchers. Parallel objectives included institutional strengthening and the facilitation of partnerships and networks. Methods: Based on a multi-stakeholder consultation, an RCS workplan was designed and undertaken from 2007 to 2012. Due to unexpected adverse circumstances, the first 2 years were heavily dedicated to implementing the project's flagship, an MSc program in infectious and zoonotic diseases (MEIZ). In addition, infrastructure improvements and demand-driven continuing education opportunities were facilitated; biosafety and research ethics knowledge and practices were enhanced, and networks fostering collaborative work were created or expanded. Results: The project coincided with the peak of UNAH's radical administrative reform and an unprecedented constitutional crisis. Challenges notwithstanding, in September 2009, MEIZ admitted the first cohort of students, all of whom undertook MDG-related projects graduating successfully by 2012. Importantly, MEIZ has been helpful in expanding the School of Microbiology's traditional etiology-based, disciplinary model to infectious disease teaching and research. By fulfilling its objectives, the project contributed to a stronger research culture upholding safety and ethical values at the university. Conclusions: The resources and strategic vision afforded by the project enhanced UNAH's overall research capacity and its potential contribution to the MDGs. Furthermore, increased research activity and the ensuing improvement in performance indicators at the prime Honduran research institution invoke the need for a national research system in Honduras.

Living in the Skin That I Am: An Organizational Autoethnography of an Adult Educator's Plight to Survive the Stigma of Invisible and Episodic Disability in an Academy of Administritiva

Through the reflective lens of an adult educator with invisible and episodic disabilities, this paper has been written as an organizational autoethnography. Through a process of autoethnographical sensemaking, it is intended to illuminate important gaps in organizational theory. Feminist/relational care ethics, critical reflection, and transformative learning serve as the educational theories that comprise its framework. In telling my story, embodied writing and performance narrative are used to convey the felt existence of a body exposed through words—where my “abled” and “disabled” professional teaching and learning identities may be studied against the backdrop of organizational policies and procedures. Words used to describe unfamiliar experiences and situations shape meaning for which new meaning may emerge. At the conclusion of this paper, an alternative frame of reference—a view from the margins—may be offered to articulate authenticity in the expectancy of workplace equity for adult educators with disabilities. Taken collectively on a larger level, it is hoped that this research may provide a source of inspiration for systemic organizational change in adult learning environments.

The Perceptions of Kinesiologists of Ethics and Professionalism as Established by the College of Kinesiologists of Ontario

As of April 1, 2013 kinesiology became a regulated health profession in Ontario. With its own governing body, the College of Kinesiologists of Ontario (CKO), there are new ethical and professional standards to which kinesiologists must adhere. The purpose of this study is to investigate kinesiologists’ thoughts and perceptions regarding the CKO’s Practice Standards, Guidelines and Code of Ethics, and their level of ethical knowledge and training. Eleven semi-structured interviews were carried out with kinesiologists. Interview data was analyzed through the development of general themes. Findings revealed that kinesiologists are confident of their ethical decision making skills but are in need of more ethical and professional education and training in order to become respected healthcare professionals in the healthcare community and in the eyes of the public. Furthermore, there were key areas identified in need of improvement regarding the quality of the Practice Standards, Guidelines and Code of Ethics. Additional findings, implications and recommendations for future research were also discussed.

Christian Education and the Ethics of Authenticity

A qualitative study was undertaken to explore the concept of authenticity in Christian education. The study was situated in the context of Christian schools in Ontario. Some of these schools have experienced declining enrolment and all of these schools face the challenge of being distinctive in a secular culture. To investigate the potential of the concept of authenticity for reclaiming the vision of Christian education, interviews were conducted with 3 experienced principals of Christian schools. Data analysis yielded an emergent conceptual framework of authenticity consisting of 5 concepts: authorship, relatedness, reflection, autonomy, and excellence. Authenticity was found to be a useful tool for school analysis of both the deep structures and the surface structures within Christian schools. To offset unauthentic tendencies that can arise within these schools, this study calls for an intentional use of the lens of authenticity to expose these tendencies and revitalize core expectations. Through the narratives shared by the Christian school principals, the study also develops a picture of the role of authentic Christian education in the development of the authentic Christian person.

The Axiomatic Approach to Population Ethics

This paper examines several families of population principles in the light of a set of axioms. In addition to the critical-level utilitarian, number-sensitive critical-level utilitarian and number-dampened families and their generalized counterparts, we consider the restricted number-dampened family (suggested by Hurka) and introduce two new families : the restricted critical-level and restricted number-dependent critical-level families. Subsets of the restricted families have nonnegative critical levels and avoid both the repugnant and sadistic conclusions but fail to satisfy an important independence condition. We defend the critical-level principles with positive critical levels.

Population Ethics and the Value of Life

Public policies often involve choices of alternatives in which the size and the composition of the population may vary. Examples are the allocation of resources to prenatal care and the design of aid packages to developing countries. In order to assess the corresponding feasible choices on normative grounds, criteria for social evaluation that are capable of performing variable-population comparisons are required. We review several important axioms for welfarist population principles and discuss the link between individual well-being and the desirability of adding a new person to a given society.

Population Ethics

This paper reviews the welfarist approach to population ethics. We provide an overview of the critical-level utilitarian population principles and their generalized counterparts, examine important properties of these principles and discuss their relationships to other variable-population social-evaluation rules. We illustrate the difficulties arising in population ethics by means of an impossibility result and present characterizations of the critical-level generalized-utilitarian principles and of three of their sub-classes.