AN INVESTIGATION ON ROUTINE FOLLOW-UP CARE FOR HEAD AND NECK CANCER

BACKGROUND: Follow-up care aims to provide surveillance with early detection of recurring cancers and to address treatment complications and other health issues in survivorship. It is assumed that follow-up care fulfills these aims, however little evidence supports routine surveillance detecting curable disease early enough to improve survival. Cancer survivors are a diverse patient population, suggesting that a single follow-up regimen may not meet all patients’ follow-up needs. Little is known about what effective follow-up care should include for head and neck cancer patients in a Canadian setting. Identification of subgroups of patients with specific needs and current practices would allow for hypotheses to be generated for enhancing follow-up care. OBJECTIVES: 1a) To describe the follow-up needs and preferences of head and neck cancer patients, 1b) to identify which patient characteristics predict needs and preferences, 1c) to evaluate how needs and preferences change over time, 2a) to describe follow-up care practices by physician visits and imaging tests, and 2b) to identify factors associated to the delivered follow-up care. METHODS: 1) 175 patients who completed treatment between 2012 and 2013 in Kingston and London, Ontario were recruited to participate in a prospective survey study on patients’ needs and preferences in follow-up care. Bivariate and multivariate analyses were employed to describe patient survey responses and to identify patient characteristics that predicted needs and preferences. 2) A retrospective cohort study of 3975 patients on routine follow-up from 2007 to 2015 was carried out using data linkages across registry and administrative databases to describe follow-up practices in Ontario by visits and tests. Multivariate regression analyses assessed factors related to follow-up care. RESULTS: 1) Patients’ needs and preferences were wide-ranging with several characteristics predicting needs and preferences (ORECOG=2.69 and ORAnxiety=1.13). Needs and preferences declined as patients transitioned into their second year of follow-up (p<0.05). 2) Wide variation in practices was found, with marked differences compared to existing consensus guidelines. Multiple factors were associated with follow-up practices (RRTumor site=0.73 and RRLHIN=1.47). CONCLUSIONS: Patient characteristics can be used to personalize care and guidelines are not informing practice. Future research should evaluate individualized approaches to follow-up care.

Adversity in early adolescence alters female rats' anxiety-related behaviours and serotonergic innervation profiles in adulthood

Stress during early development produces lasting effects on psychopathological outcomes. The impact of prior intermittent, physical stress (IPS) during early-adolescence (PD 22-33) on anxiety-related behaviour of female rats was analyzed in adulthood. After behavioural testing, serotonergic innervation was evaluated using immunohistochemistry for the serotonin transporter (SERT) in the medial prefrontal cortex (mPFC) and ventral hippocampus. Administration of IPS (i.e., water immersion, elevated platform, foot shock) in early adolescence increased rats’ anxiety-like behaviour in the elevated plus-maze but had no effects in the shock-probe burying test. In the social interaction test, IPS decreased social interaction, and this effect was driven by selective decreases in the duration of playfighting with no evident changes in contact or investigative behaviour. Selective stress-induced increases in SERT-immunoreactive axon density were found in the infralimbic (IL) subregion of the mPFC, but not in the cingulate or prelimbic (PL) subregions. IPS in early adolescence did not affect serotonergic innervation profiles in any sub-fields of the ventral hippocampus. The findings confirm and extend on earlier evidence that stress during early adolescence promotes the emergence of an anxious phenotype, and provide novel evidence that these effects may be mediated, at least in part, by increased serotonergic innervation of the IL mPFC.

Disability in the Digital Age: Reconfiguring Access, Inclusion and Equality

There is an abundance of research that examines disability and technology in the context of computers and the Internet, however few have examined disability and mobile devices. Also largely absent from existing literature are the voices of disabled people themselves. This dissertation draws upon science and technology studies (STS) and disability studies to address these gaps by conducting in-depth qualitative research that examines disabled people’s experiences using smartphones and tablets. At its core, this dissertation aims to provide insight on the following: 1) an understanding of how disability is perceived in the digital age and the subjective meanings of access, inclusion and equality; 2) the ways in which mobile devices impact the lived experience of disability; and 3) how perspectives in disability studies and STS can be applied to understand the relationship between the body, disability and technology. The empirical contribution of this research draws from participant diaries and interviews with disabled people, as well as from open-ended questionnaires completed by mobile app developers. The concept of ‘subjectivities of disability’ is introduced to refer to the uniquely personal and individual experience of disability. Findings reveal that mobile device use amongst disabled people redefines their subjectivities of disability through socio-technical interactions whereby disabled people use their devices in ways that are integrated into their everyday lives and positively shapes how they view themselves in relation to their experience of disability. The responses from app developers reveal that there is a place for disability in the mobile market and that disabled people play a key role in making apps accessible. The data suggests that mobile devices facilitate access, inclusion and equality by integrating the body in ways that recognize and accommodate diversity. The results furthermore make it clear that the interaction between disabled people and mobile devices takes on an embodied and social characteristic. This research concludes that both on an individual level and collectively, disabled people are engaging with digital artifacts in ways that promote agency and independence as well as reshaping how disability is experienced and perceived in the digital age.

Using phase-space localized basis functions to obtain vibrational energies of molecules

For decades scientists have attempted to use ideas of classical mechanics to choose basis functions for calculating spectra. The hope is that a classically-motivated basis set will be small because it covers only the dynamically important part of phase space. One popular idea is to use phase space localized (PSL) basis functions. This thesis improves on previous efforts to use PSL functions and examines the usefulness of these improvements. Because the overlap matrix, in the matrix eigenvalue problem obtained by using PSL functions with the variational method, is not an identity, it is costly to use iterative methods to solve the matrix eigenvalue problem. We show that it is possible to circumvent the orthogonality (overlap) problem and use iterative eigensolvers. We also present an altered method of calculating the matrix elements that improves the performance of the PSL basis functions, and also a new method which more efficiently chooses which PSL functions to include. These improvements are applied to a variety of single well molecules. We conclude that for single minimum molecules, the PSL functions are inferior to other basis functions. However, the ideas developed here can be applied to other types of basis functions, and PSL functions may be useful for multi-well systems.

Applying life cycle assessment to analyze the environmental sustainability of public transit modes for the City of Toronto

One challenge related to transit planning is selecting the appropriate mode: bus, light rail transit (LRT), regional express rail (RER), or subway. This project uses data from life cycle assessment to develop a tool to measure energy requirements for different modes of transit, on a per passenger-kilometer basis. For each of the four transit modes listed, a range of energy requirements associated with different vehicle models and manufacturers was developed. The tool demonstrated that there are distinct ranges where specific transit modes are the best choice. Diesel buses are the clear best choice from 7-51 passengers, LRTs make the most sense from 201-427 passengers, and subways are the best choice above 918 passengers. There are a number of other passenger loading ranges where more than one transit mode makes sense; in particular, LRT and RER represent very energy-efficient options for ridership ranging from 200 to 900 passengers. The tool developed in the thesis was used to analyze the Bloor-Danforth subway line in Toronto using estimated ridership for weekday morning peak hours. It was found that ridership across the line is for the most part actually insufficient to justify subways over LRTs or RER. This suggests that extensions to the existing Bloor-Danforth line should consider LRT options, which could service the passenger loads at the ends of the line with far greater energy efficiency. It was also clear that additional destinations along the entire transit line are necessary to increase the per passenger-kilometer energy efficiency, as the current pattern of commuting to downtown leaves much of the system underutilized. It is hoped that the tool developed in this thesis can be used as an additional resource in the transit mode decision-making process for many developing transportation systems, including the transit systems across the GTHA.

Redefining Attitude Importance: The Possible Existence of Associative and Subjective Types of Importance Under a Global Definition

Traditionally, importance has been measured using subjective measures. The present thesis explores the possibility of a second type of importance, designated as “associative importance”. A new measure, the IIAT, was designed to capture the strength of association between an object and the attribute of importance. This thesis then evaluated the validity of the IIAT via an intervention paradigm in 2 studies, and by using the measure to predict a memory outcome in 2 other studies. Subjective measures of importance were also included in these studies and correlations between subjective measures and IIAT results were examined. Across all 4 studies, subjective-objective correlations were weak to modest and non-significant. The intervention studies provided promising evidence that interventions do affect associative importance as measured by the IIAT. The prediction studies provided somewhat mixed, but encouraging evidence that the IIAT may be able to predict memory performance. Notably, subjective measures were not able to predict memory performance at all, whereas the IIAT was able to predict some memory indices. Overall, there is some evidence supporting the existence of an associative importance construct, and that the IIAT provides valid results that are nonetheless different from that of subjective measures of attitude importance.

(MIS)PERCEIVED DRINKING NORMS AND HAZARDOUS DRINKING BEHAVIOURS IN UNIVERSITY FIRST-YEAR UNDERGRADUATE STUDENTS AND THE EFFECTS OF GENDER

Purpose: Across Canada, undergraduate university students are one of the highest alcohol-consuming populations. Many students engage in hazardous drinking and are at risk for negative health and social consequences. Social Norms Theory suggests that students’ overestimation of drinking norms can result in an increase in their drinking behaviour. As of yet, none of the literature addresses the possible link between drinking norm (mis)perception and hazardous drinking in a Canadian undergraduate context. This is the first Canadian study to examine this potential association in first-year undergraduate students across multiple universities using gender as an effect modifier. Methods: Using data collected by the Caring Campus Project, for 2347 first-year students from three Canadian universities, I evaluated the prevalence of drinking norm misperceptions by site and gender. Using multiple-logistic regression models, I analyzed the relationship between misperceived drinking norms and hazardous drinking behaviours (assessed via AUDIT-C). Results: The proportion of students who overestimated drinking and binge drinking frequency norms varied by site and gender. There was a positive relationship between overestimated drinking/ binge drinking frequency norms and hazardous drinking, modified by gender. Controlling for living arrangement and site, the odds of female students being hazardous drinkers increased by a factor of 2.27 (CI: 1.73-2.99) when the drinking frequency norm was overestimated. A non-significant association was found for male students. Among female students, when living arrangement and site were controlled, the odds of being a hazardous drinker were 1.83 (0.84-3.95) and 2.69 (1.24-5.83) times greater when the drinking frequency norm was perceived at “2-4 times per month” and “2 or more times per week”, respectively. Among male students, when living arrangement, previous residence and site were controlled, the odds of being a hazardous drinker were 4.03 (2.62-6.19) and 8.54 (5.41-13.49) times greater when the binge drinking frequency norm was perceived at “2-4 times per month” and “2 or more times per week”, respectively. Conclusion: This novel study enhances the understanding of the association between (mis)perceived drinking norms and drinking behaviours in Canadian undergraduate students. The demonstrated importance of gender and site provides a strong impetus for Canadian universities to develop targeted alcohol reduction interventions.

RELIBILITY ANALYSIS OF SIMPLE SLOPES AND SOIL-STRUCTURES WITH LINEAR LIMIT STATES

The first objective of this research was to develop closed-form and numerical probabilistic methods of analysis that can be applied to otherwise conventional methods of unreinforced and geosynthetic reinforced slopes and walls. These probabilistic methods explicitly include random variability of soil and reinforcement, spatial variability of the soil, and cross-correlation between soil input parameters on probability of failure. The quantitative impact of simultaneously considering the influence of random and/or spatial variability in soil properties in combination with cross-correlation in soil properties is investigated for the first time in the research literature. Depending on the magnitude of these statistical descriptors, margins of safety based on conventional notions of safety may be very different from margins of safety expressed in terms of probability of failure (or reliability index). The thesis work also shows that intuitive notions of margin of safety using conventional factor of safety and probability of failure can be brought into alignment when cross-correlation between soil properties is considered in a rigorous manner. The second objective of this thesis work was to develop a general closed-form solution to compute the true probability of failure (or reliability index) of a simple linear limit state function with one load term and one resistance term expressed first in general probabilistic terms and then migrated to a LRFD format for the purpose of LRFD calibration. The formulation considers contributions to probability of failure due to model type, uncertainty in bias values, bias dependencies, uncertainty in estimates of nominal values for correlated and uncorrelated load and resistance terms, and average margin of safety expressed as the operational factor of safety (OFS). Bias is defined as the ratio of measured to predicted value. Parametric analyses were carried out to show that ignoring possible correlations between random variables can lead to conservative (safe) values of resistance factor in some cases and in other cases to non-conservative (unsafe) values. Example LRFD calibrations were carried out using different load and resistance models for the pullout internal stability limit state of steel strip and geosynthetic reinforced soil walls together with matching bias data reported in the literature.

The relationship between non-suicidal self-injury and suicidality

The overall purpose of this study was to explain the overlap and distinctiveness of non-suicidal self-injury (NSSI) and suicidality from a diathesis-stress perspective. The first part of this study evaluated the third variable theory as an explanation for the high rates of lifetime co-occurrence between NSSI and suicidality. Specifically, it was hypothesized that these forms of self-harm share a common vulnerability profile comprised of five affective, cognitive and behavioural diatheses. The second part of this study tested the hypothesis that NSSI and suicidality become distinguishable on the basis of immediate, proximal stressors, namely psychache and survival and coping beliefs (SCB). Participants (N = 262) were community individuals aged 16-24 years who reported either no history of self-harm (i.e., no history of NSSI, suicidality, or both), a history of NSSI, suicidality or both, or current NSSI-only or current NSSI+suicidality. They were recruited online to complete an online battery of questionnaires. Using a set of discriminant function analyses, it was found that the vulnerability profile was unable to distinguish between the three self-harm groups, but was able to differentiate the no self-harm group from a collated self-harm group. Result patterns were also analyzed for gender differences. It was also found that a current NSSI+suicidality group exhibited significantly higher psychache and lower SCB (for women only) than a current NSSI-only group. These results suggest that NSSI and suicidality may tend to co-occur because they have similar long-term diatheses, but that they may become more distinct with respect to immediate psychological stressors.

NON-FULL-TIME COLLEGE PROFESSORS: A NARRATIVE INQUIRY INTO THE NON-FULL-TIME FACULTY ROLE

The rate of non-full-time faculty members has increased rapidly over the last decade (Louis, 2009; MacKay, 2014; Meranze & Newfield, 2013), as the post-secondary landscape of fluctuating enrolment, fiscal and operational challenges, and the requirement to hire specialized skill sets have required institutions to rely heavily on this demographic. In the Ontario Colleges of Applied Arts and Technology (CAATs) system, institutions have tried to preserve and enhance educational quality with fewer resources through greater reliance on non-full-time faculty. The purpose of this study was to explore the perceptions and experiences of teaching and support of non-full-time faculty at one Eastern Ontario college. Employing a narrative inquiry methodology, data were collected from four participants through their writing three individual letters at the end of each month and participating in one interview at the end of the contract period. The data were analyzed and coded. This analysis revealed five themes: motivation, connection and engagement, compensation, teaching and development, and performance evaluation. Differences in the participants’ perceptions tended to reflect divergences across career stage: retired versus early career. The compensation package provided to non-full-time faculty was considered inadequate for those in the early career stage, especially comparing it to that of full-time faculty. In addition, the amount of previous teaching experience was an important indicator for the appropriate level of teaching resources and support provided by the institution. The newer faculty members required a higher level of support to combat feelings of role isolation. The temporary nature of the role made it difficult to establish a feeling of a strong connection to the institution and subsequently opportunities to engage further to deepen the relationship. Despite these differences across participants, autonomous motivators were consistent across all narratives, as participants expressed their desire to teach and share their knowledge to help students achieve their goals. Participants concluded their narratives by sharing future advice for faculty interested in pursuing the role. The narratives provided areas for improvement that would help increase the level of job satisfaction for non-full-time college faculty members: (a) establishing a more thorough performance evaluation process to align with institutional supports, (b) offering more diverse teaching resources to better prepare faculty and enhance teaching practices, (c) overhauling the compensation package to better recognize the amount of time and effort spent in the role and aligning with the compensation provided to full-time faculty, and (d) including rewards and incentives as part of the compensation package to enhance the level of commitment and availability for the role. These changes might well increase the job satisfaction and improve the retention of non-full-time faculty members.

A case study on a design-informed developmental evaluation

Developmental evaluation (DE) is an evaluation approach that aims to support the development of an innovation (Patton, 1994, 2011). This aim is achieved through supporting clients’ information needs through evaluative inquiry as they work to develop and refine the innovation. While core concepts and principles are beginning to be articulated and refined, challenges remain as to how to focus a developmental evaluation beyond those knowledge frameworks most immediate to clients to support innovation development. Anchoring a DE in knowledge frameworks other than those of the clients might direct attention to issues not yet obvious to clients, but which might further the goal of supporting innovation development if attended to. Drawing concepts and practices from the field of design may be one avenue with which to inform developmental evaluation in achieving its aim. Through a case study methodology, this research seeks to understand the nuances of operationalizing the guiding principles of DE as well as to investigate the utility, feasibility, and consequences of integrating design concepts and practices into developmental evaluation (design-informed developmental evaluation, “DI-DE”). It does so by documenting the efforts of a design-informed developmental evaluator and a task force of educators and researchers in a Faculty of Education as they work to develop a graduate-level education program. A systematic review into those purposeful efforts made to introduce DI-DE thinking into task force deliberations, and an analysis into the responses and consequences of those efforts shed light on what it had meant to practice DI-DE. As a whole, this research on evaluation is intended to further contemporary thinking about the closely coupled relationship between program development and evaluation in complex and dynamic environments.

Proving My Competency One Test at a Time: Internationally Educated Nurses and the Canadian English Language Benchmark Assessment for Nurses

Abstract Professional language assessment is a new concept that has great potential to benefit Internationally Educated Professionals and the communities they serve. This thesis reports on a qualitative study that examined the responses of 16 Canadian English Language Benchmark Assessment for Nurses (CELBAN) test-takers on the topic of their perceptions of the CELBAN test-taking experience in Ontario in the winter of 2015. An Ontario organization involved in registering participants distributed an e-mail through their listserv. Thematic analyses of focus group and interview transcripts identified 7 themes from the data. These themes were used to inform conclusions to the following questions: (1) How do IENs characterize their assessment experience? (2) How do IENs describe the testing constructs measured by the CELBAN? (3) What, if any, potential sources of construct irrelevant variance (CIV) do the test-takers describe based on their assessment experience? (4) Do IENs feel that the CELBAN tasks provide a good reflection of the types of communicative tasks required of a nurse? Overall, participants reported positive experiences with the CELBAN as an assessment of their language skills, and noted some instances in which they felt some factors external to the assessment impacted their demonstration of their knowledge and skill. Lastly, some test-takers noted the challenge of completing the CELBAN where the types of communicative nursing tasks included in the assessment differed from nursing tasks typical of an IENs country or origin. The findings are discussed in relation to literature on high-stakes large-scale assessment and IEPs, and a set of recommendations are offered to future CELBAN administration. These recommendations include (1) the provision of a webpage listing all licensure requirements (2) monitoring of CELBAN location and dates in relation to the wider certification timeline for applicants (3) The provision of additional CELBAN preparatory materials (4) Minor changes to the CELBAN administrative protocols. Given that the CELBAN is a relatively new assessment format and its widespread use for high-stakes decisions (a component of nursing certification and licensure), research validating IEN-test-taker responses to construct representation and construct irrelevant variance is critical to our understanding of the role of competency testing for IENs.

Anticipating climate-induced changes to forest cover in Ontario and the implications for future bioenergy development

Climate change is expected to have marked impacts on forest ecosystems. In Ontario forests, this includes changes in tree growth, stand composition and disturbance regimes, with expected impacts on many forest-dependent communities, the bioeconomy, and other environmental considerations. In response to climate change, renewable energy systems, such as forest bioenergy, are emerging as critical tools for carbon emissions reductions and climate change mitigation. However, these systems may also need to adapt to changing forest conditions. Therefore, the aim of this research was to estimate changes in forest growth and forest cover in response to anticipated climatic changes in the year 2100 in Ontario forests, to ultimately explore the sustainability of bioenergy in the future. Using the Haliburton Forest and Wildlife Reserve in Ontario as a case study, this research used a spatial climate analog approach to match modeled Haliburton temperature and precipitation (via Fourth Canadian Regional Climate Model) to regions currently exhibiting similar climate (climate analogs). From there, current forest cover and growth rates of core species in Haliburton were compared to forests plots in analog regions from the US Forest Service Forest Inventory and Analysis (FIA). This comparison used two different emission scenarios, corresponding to a high and a mid-range emission future. This research then explored how these changes in forests may influence bioenergy feasibility in the future. It examined possible volume availability and composition of bioenergy feedstock under future conditions. This research points to a potential decline of softwoods in the Haliburton region with a simultaneous expansion of pre-established hardwoods such as northern red oak and red maple, as well as a potential loss in sugar maple cover. From a bioenergy perspective, hardwood residues may be the most feasible feedstock in the future with minimal change in biomass availability for energy production; under these possible conditions, small scale combined heat and power (CHP) and residential pellet use may be the most viable and ecologically sustainable options. Ultimately, understanding the way in which forests may change is important in informing meaningful policy and management, allowing for improved forest bioenergy systems, now and in the future.

Understanding Online Abuse: An Analysis of Abuse Against Women Content Creators

This research is an examination into the ways online abuse functions in certain online spaces. By analyzing text-based online abuse against women who are content creators, this research maps how aspects of violence against women offline extends online. This research examines three different explorations into how online abuse against women functions. Chapter two considers what online abuse against women looks like on Twitter as a case study. This chapter contends that online abuse can be understood as an unintentional use of Twitter’s design. Chapter three focuses specifically on the textual descriptions of sexual violence women who are journalists receive online. Chapter four analyzes Gamergate, an online movement that specifically looks to organize online abuse towards women. Chapter five concludes by meditating on the need to look at a bigger picture that includes cultural shifts that dismantle the normalization of violence against women both on and offline.

Preparation of Polymer Nanoparticles by Ring Opening Metathesis Polymerization in Aqueous Dispersed Systems with Water-Soluble Ruthenium-based Catalyst

Ring opening metathesis polymerization (ROMP) is a variant of olefin metathesis used to polymerize strained cyclic olefins. Ruthenium-based Grubbs’ catalysts are widely used in ROMP to produce industrially important products. While highly efficient in organic solvents such as dichloromethane and toluene, these hydrophobic catalysts are not typically applied in aqueous systems. With the advancements in emulsion and miniemulsion polymerization, it is promising to conduct ROMP in an aqueous dispersed phase to generate well-defined latex nanoparticles while improving heat transfer and reducing the use of volatile organic solvents (VOCs). Herein I report the efforts made using a PEGylated ruthenium alkylidene as the catalyst to initiate ROMP in an oil-in-water miniemulsion. 1H NMR revealed that the synthesized PEGylated catalyst was stable and reactive in water. Using 1,5-cyclooctadiene (COD) as monomer, we showed the highly efficient catalyst yielded colloidally stable polymer latexes with ~ 100% conversion at room temperature. Kinetic studies demonstrated first-order kinetics with good livingness as confirmed by the shift of gel permeation chromatography (GPC) traces. Depending on the surfactants used, the particle sizes ranged from 100 to 300 nm with monomodal distributions. The more strained cyclic olefin norbornene (NB) could also be efficiently polymerized with a PEGylated ruthenium alkylidene in miniemulsion to full conversion and with minimal coagulum formation.