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Prolonged impact of the COVID-19 pandemic on the well-being and roles of family/friend caregivers of older adults living at home in Canadian official language minority or majority communities — Preprint
No full textRésumé:
Des études menées pendant la pandémie de COVID-19 soulignent que le confinement a réduit l’accès aux services et accru les responsabilités et l’isolement des proches aidants. Cette étude en explore les répercussions à long terme chez 83 proches aidants de personnes âgées provenant de 4 provinces canadiennes. Les participants ont rempli un questionnaire en ligne entre octobre 2021 et février 2022, puis à nouveau 6 mois plus tard, concernant l’aide qu’ils offraient, le soutien qu’ils recevaient, la langue des services reçus et leur bien-être psychologique. De plus, 8 proches aidants ont participé à une entrevue qualitative. La majorité des services de soutien à domicile aux ainés ont été maintenus pendant la pandémie, certains avec un personnel réduit, à l’exception des services de répit et de transport. Les proches aidants rapportent avoir augmenté leur aide pendant les périodes de confinement, et cette assistance accrue s’est maintenu en 2022. Ils ont perçu un impact négatif de la pandémie sur leur santé et celle de la personne aidée. Les participants de langue officielle en situation minoritaire ont décrit des défis additionnels concernant l’accès à des services dans leur langue.
Abstract:
Studies conducted during the COVID-19 pandemic highlighted that confinement reduced access to services, and increased caregivers’ responsibilities and isolation. This study examines the longer-term impacts among 83 unpaid caregivers of older adults from 4 Canadian provinces. Participants completed an online questionnaire between October 2021 and February 2022, and again 6 months later, regarding the assistance they offered, the support they received, the language of the services received and their psychological well-being. Additionally, 8 caregivers participated in a qualitative interview. Most home support services for older adults were maintained during the pandemic—some with restricted staffing—except for respite and transportation services. Caregivers reported that they increased their assistance during the lockdowns, and this higher involvement persisted in 2022. They perceived a negative impact of the pandemic on their health and that of the care recipient. Participants from official language minority communities described additional challenges accessing services in their preferred language
The Extent, Nature and Potential Impact of Food Company Sponsorship of Children’s Sports in Two Policy Environments in Canada
No full textExposure to unhealthy food marketing is a known determinant of children’s poor dietary behaviours. This research sought to 1) assess the extent and nature of children’s exposure to food marketing stemming from the sponsorship of their sporting activities and 2) examine the benefits that sports clubs derive from this sponsorship in Canada’s two policy environments, namely Quebec, where commercial advertising directed to children under 13 years is restricted, and other provinces, where food advertising is self-regulated by the food industry.
Broadly, two online surveys found that a large share of children (40-67%) aged 10-17 years who played on a sport team recalled being exposed to food advertising in amateur sports settings. In both surveys, children in Quebec were less likely to report exposure to food advertising on their sports equipment than children living in other provinces. However, differences among children aged 10-12 years protected by Quebec’s advertising restrictions compared to older children in the province were not statistically significant. Differences in reported exposure to most other types of food advertising (e.g. branded sports awards, free food, coupons) among children living in Quebec compared to those in other provinces and among Quebecois children protected versus not protected by provincial restrictions were also not found to be statistically significant. Correspondingly, a telephone survey with a small sample of children’s sports clubs found that at least 45% of those surveyed in Ontario (21/47) and 55% in Quebec (22/40) were sponsored by a food company, most frequently fast-food restaurants. Sports clubs received funding and in-kind benefits such as free food, uniforms and medals. For most clubs, this funding and the perceived value of in-kind benefits was small relative to the club’s total revenue. In both provinces, food company sponsors, particularly fast-food restaurants, were reported as being promoted on uniforms, sports equipment, and sports awards, more often on those for children aged 12 years and under.
Overall, these findings suggest amateur sports settings constitute an important source of exposure to food marketing among children. Quebec’s advertising restrictions are not adequately limiting children’s exposure to sponsorship-related food marketing, including prominent forms (e.g. branded uniforms) that reach children under 13 years. The food industry’s self-regulatory code also does not limit many forms of sponsorship-related marketing that were reported. Policymakers should consider adopting statutory restrictions on the sponsorship of children’s sports by food companies associated with unhealthy products
Kinematic Modelling, Trajectory Planning, and Machine Learning for Integrated C-Arm Fluoroscopy and Operating Table Systems
No full textThis dissertation presents a unified methodological framework that synergistically integrates kinematic analysis, trajectory planning, and machine learning-enabled kinematic solvers to advance modular C-arm fluoroscopy systems coupled with multi-degree-of-freedom (DoF) operating tables. Conventional C-arm devices, though indispensable for intraoperative visualization, remain hampered by constrained maneuverability, operator-dependent variability, and radiation inefficiencies limitations exacerbated in minimally invasive surgery (MIS), where procedural precision and radiation stewardship are cardinal. To redress these deficiencies, the research unfolds in three interlinked contributions. First, rigorous forward and inverse kinematic formulations, augmented by voxelized collision-aware workspace mapping, are deployed across 6-DoF to 9-DoF C-arm with operating table configurations to quantify anatomical accessibility and collision-free pose feasibility across six clinically relevant projections. Second, multiple trajectory planning paradigms including polynomial interpolation, trapezoidal velocity profiles, and biologically inspired minimum-jerk and minimum-snap strategies are comparatively analyzed to ensure smooth, dynamically admissible, and singularity-robust transitions between imaging poses. To operationalize these strategies intraoperatively, lookup tables (LUTs) derived from precomputed trajectories and singularity analyses are introduced as pragmatic decision-support tools, enabling rapid recall of optimized motion plans tailored to patient-specific anatomy. Third, machine learning (ML) frameworks are harnessed to overcome the computational intractability of traditional numerical solvers for high-DoF systems. Leveraging expansive simulation-derived datasets, five supervised models including deep neural networks are trained and validated, achieving sub-millimetric positional accuracy and sub-degree angular precision while delivering real-time inference that surpasses conventional methods in scalability, robustness, and computational latency. Collectively, these contributions delineate a clinically translatable paradigm that unifies kinematic modelling, trajectory optimization, and ML-based inference, establishing the foundation for intelligent, precision-driven, and radiation-conscious intraoperative imaging within next-generation hybrid operating rooms
De la prison aux communautés : l’abolitionnisme féministe comme alternative au traitement pénal des violences sexuelles
No full textSi les recherches féministes ont largement analysé la question des violences sexuelles, un angle mort persiste quant à la manière dont le recours au système pénal contribue à reproduire des logiques patriarcales, racistes et coloniales, tout en échouant à garantir une justice effective pour les survivantes, en particulier celles issues de communautés marginalisées. Cette thèse se propose d’examiner de manière critique les limites de ce que l’on nomme le “ féminisme carcéral” et d’explorer l’abolitionnisme féministe comme cadre alternatif permettant d’imaginer une justice affranchie de la punition et de l’incarcération. En mobilisant les concepts de l’abolitionnisme pénal - tels que l’abstraction, la dépersonnalisation, le vol des conflits ou encore le complexe industrialo-carcéral - l’analyse montre comment l’abolitionnisme féministe élargit cette critique en l’inscrivant dans une perspective intersectionnelle attentive aux rapports de race, de classe, de genre, de sexualité et de validité. L’approche théorique combine la pensée abolitionniste avec la théorie féministe intersectionnelle et les analyses discursives du pouvoir, du savoir et de la normalisation. Sur le plan méthodologique, ce travail s’appuie sur une analyse qualitative de zines, boîtes à outils, webinars et écrits militants produits par des femmes racisées, queer, autochtones ou en situation de handicap, considérés à la fois comme matériaux empiriques et comme contributions théoriques. La thèse soutient que les institutions pénales ne peuvent répondre aux violences sexuelles car elles retraumatisent les survivantes, ne transforment pas les conditions systémiques et ciblent de manière disproportionnée les populations marginalisées. En revanche, l’abolitionnisme féministe propose des pratiques préfiguratives de justice transformatrice, de responsabilisation communautaire et de guérison, flexibles et ouvertes. Ainsi, cette thèse montre qu’il est possible de rendre justice aux violences sexuelles sans punir, mais à travers des réponses intersectionnelles, collectives et émancipatrices
Authenticity-Driven Motivations in Oligopoly: Efforts, Pricing, and Welfare
No full textWe develop an oligopoly theory of brand authenticity as a belief-based credence attribute valued by only a subset of consumers. Firms choose prices and costly authenticity efforts, while managers may derive private non-pecuniary benefits from being perceived as intrinsically motivated. Heterogeneity in consumer preferences and managerial motivations jointly determines equilibrium authenticity provision, pricing, and consumer sorting. Firms led by more authenticity-driven managers invest more and, under standard complementarity conditions, charge price premia. Authenticity is privately unsustainable when the attentive audience is small, viable when it is large, and fragile at intermediate sizes. In this fragile region, laissez-faire equilibrium exhibits inefficient exit despite socially valuable participation, reflecting an extensive-margin inefficiency that can be addressed by participation support or belief-based certification
Seeds of a Revolution: Land Reform and Literary Ecologies in Modern Latin American Literature
No full textThis dissertation seeks to establish the connections between ecological and socio-political well being in the context of contemporary Latin America. It investigates the ecological aspirations of calls for land reform in many of the revolutions rocking the continent in the 20th century. Questions concerning land management came to the fore, and the policies developed in answer to these problems continue to have long lasting impacts still felt today. Ever since the end of the Mexican Revolution in 1917, Mexican governments have hailed it as a success. However, the short story collection El llano en llamas (1953) by Juan Rulfo and the novel Temporada de huracanes (2017) by Fernanda Melchor portray a very different reality faced by rural populations and landscapes. I argue that these texts explore how the failure of revolutionary policies, in particular the Agrarian Reform, marginalize the human and natural world. In their portrayal of rural Mexico, Rulfo’s short stories and Melchor’s novel critique the Mexican State and show how poor policy design affects both local societies as well as ecologies. In Guatemala, the October Revolution (1944-1954) provided the country with ten years of democratic rule. Published in this time, Hombres de maíz (1949) by Miguel Ángel Asturias presented a hopeful and critical reflection on the beginnings of the so-called ten years of Spring. Seven decades later, El país de Toó (2018) by Rodrigo Rey Rosa shows that dreams of a revolution reawaken in the
face of ongoing corruption and impunity. Reading these two texts together through an ecocritical framework, I explore how both texts engage with the Mayan cosmovision and signal the importance of ecological and social reconciliation in order to heal a country’s society and environment. Finally, in Nicaragua, the victory of the Sandinista Revolution (1979-1990) culminated in the ousting of American sponsored dictator Anastasio Somoza. The decisive and complete victory of the Sandinistas provided Nicaraguan intellectuals and its followers with a unique opportunity to forge a new national identity, affirm national sovereignty and create
policies responsive to the needs of the ordinary Nicaraguan. The two authors Ernesto Cardenal and Gioconda Belli participated in this project both as revolutionary leaders and literary visionaries. My analysis of Cardenal’s Cántico cósmico (1989) and Belli’s Waslala (1996) explores the connections between social and environmental issues as well as how their shared utopian impulse can inspire future generations and remind readers of how this initial moment formed the social, ecological and political laboratory that was the Sandinista Revolution
Medically Attended Influenza Illness and the Risk of Stillbirth: A Population-Based Retrospective Cohort Study in Ontario, Canada
No full textBackground: Influenza illness during pregnancy has been associated with severe maternal adverse outcomes, including stillbirth. Despite recommendations from Canada’s National Advisory Committee on Immunization (NACI) for influenza vaccination during pregnancy, coverage remains suboptimal, with only 45% of pregnant individuals vaccinated. Existing studies demonstrate inconsistent evidence regarding the association between maternal influenza and adverse outcomes, particularly for seasonal influenza and stillbirth.
Methods: We conducted a population-based retrospective cohort study using administrative health data housed at ICES in Ontario, Canada, between April 1, 2006, and March 31, 2020. Adjusted hazard ratios for stillbirth were estimated using an extended Cox proportional hazards model, accounting for time-varying exposure to medically attended influenza illness and adjusted for confounders. Two subgroup analyses were conducted: (1) exploring the acute infection of influenza using risk windows and (2) examining the effects of infection in high-risk individuals with pre-existing maternal medical conditions.
Results: We identified 1,646,864 pregnancies, of which 8227 (0.50%) resulted in stillbirths. 16,286 (0.99%) pregnant individuals were diagnosed with medically attended influenza illness during pregnancy. There was a significant association between influenza illness during pregnancy and stillbirth when the seasonal epidemics and the 2009/2010 H1N1 pandemic were pooled for analysis (adjusted HR [95% CI]: 1.30 [1.03,1.62]). When analyzed separately, there was a significant association during seasonal epidemics with the highest hazard when medically attended influenza was diagnosed in the second trimester (adjusted HR [95% CI]: 1.52 [1.09,2.22]) but no association was observed for pandemic influenza. The risk of stillbirth was highest during the two weeks after medically attended influenza infection, with an adjusted HR of 3.70 [95% CI 2.19, 6.25], 2.69 [95% CI 1.73, 4.17] during the four weeks following infection, and 1.96 [95% CI 1.29, 2.97] during the six weeks following infection. In the high-risk population with pre-existing conditions, there was a higher risk of medically attended influenza illness during pregnancy and stillbirth, but the association was not statistically significant (adjusted HR [95% CI]: 1.48 [0.96,2.67]).
Conclusion: The findings of our study demonstrate that there is a significant association between medically attended influenza illness during pregnancy and the risk of stillbirth, especially during seasonal epidemics. Importantly, it highlights the need to strengthen vaccination efforts to protect pregnant individuals from obstetrical complications and adverse perinatal outcomes associated with influenza illness
Anaerobic Fluorescent Reporters for Studying Pseudomonas aeruginosa-Specific Responses in a CF Polymicrobial Assay
No full textPseudomonas aeruginosa is an opportunistic pathogen that persists in the hypoxic and anaerobic microenvironments characteristic of the cystic fibrosis (CF) airways, where it often exists as part of polymicrobial communities and forms biofilms that contribute to chronic infections. Studying P. aeruginosa under these conditions is complicated by the limited availability of tools for monitoring bacterial behaviour and a lack of experimentally validated in vitro models that capture relevant interspecies interactions. This thesis addresses these gaps by developing oxygen-independent fluorescent reporters, implementing and validating an anaerobic CF polymicrobial model, and engineering a stable reporter strain that was used to study the spatial distribution of P. aeruginosa in multi-species biofilm systems.
In Chapter 2, I designed a suite of fluorescent reporters, including phiLOV2.1 and FAST. I demonstrated their functionality in monitoring P. aeruginosa under low-oxygen or anaerobic conditions. Furthermore, I showed that phiLOV2.1 and FAST could also be used in dual-culture imaging to monitor P. aeruginosa subpopulations. The broad host range of these reporters allows adaptation to diverse Gram-negative bacteria to enable real-time visualization in biofilms and other hypoxic niches.
In Chapter 3, I implemented and validated a CF polymicrobial model system incorporating P. aeruginosa, Staphylococcus aureus, Streptococcus sanguinis, and Prevotella melaninogenica. Using this anaerobic multi-species assay, I assessed the persistence of six P. aeruginosa deletion mutant strains. I evaluated their susceptibility to tobramycin across a range of concentrations in the context of complex interspecies interactions. The mutant ΔtctED had the strongest phenotype, being the most susceptible strain compared to the wild type. This finding highlights tctED as a biofilm-specific antibiotic resistance gene under conditions that closely approximate those present in the CF lung environment. This suggests that tctED could be a potential target in combating antibiotic resistance in vivo.
In Chapter 4, I engineered a stable, antibiotic-independent plasmid, pCFT4.2.1, encoding phiLOV2.1 and the VapBC toxin–antitoxin system. This construct was retained in over 90% of P. aeruginosa PA14 WT cells for at least three days without antibiotic pressure, maintaining detectable fluorescence. Within the CF polymicrobial assay, I have provided evidence that P. aeruginosa harbouring pCFT4.2.1 forms both surface-attached and biofilm-like structures resembling floating aggregates.
Collectively, this work provides novel fluorescent tools, validates a relevant CF polymicrobial model system, substantiates tctED as a P. aeruginosa biofilm-specific antibiotic resistance gene under multiple conditions, establishes a stable reporter strain for tracking P. aeruginosa in anaerobic multi-species communities, and offers insights into the nature of P. aeruginosa biofilms in this assay. Altogether, these findings advance our ability to study the persistence, antibiotic susceptibility, and biofilm formation ability of P. aeruginosa in clinically relevant contexts.
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Pseudomonas aeruginosa est un pathogène opportuniste qui persiste dans les microenvironnements hypoxiques et anaérobiques caractéristiques des voies respiratoires des patients atteints de fibrose cystique (CF)—une maladie génétique héréditaire marquée par la production de mucus visqueux principalement dans les poumons, ce qui conduit à des infections respiratoires chroniques. Dans le poumon CF, P. aeruginosa coexiste souvent au sein de communautés polymicrobiennes et forme des biofilms contribuant à ces infections. L’étude de P. aeruginosa dans ces conditions est complexifiée par le nombre limité d’outils permettant de suivre son comportement et par l’absence de modèles in vitro capables de reproduire les interactions interespèces pertinentes. Cette thèse vise à combler ces lacunes en développant des rapporteurs fluorescents indépendants de l’oxygène, en mettant en œuvre et en validant un modèle polymicrobien anaérobique de la CF, et en construisant une souche rapporteur stable utilisée pour étudier la distribution spatiale de P. aeruginosa dans des systèmes de biofilms multi-espèces.
Au Chapitre 2, j'ai conçu une série de rapporteurs fluorescents, incluant phiLOV2.1 et FAST, et démontré leur fonctionnalité pour le suivi de P. aeruginosa en conditions hypoxiques ou anaérobiques. J’ai également montré que phiLOV2.1 et FAST pouvaient être employés pour l'imagerie en co-culture pour observer des sous-populations de P. aeruginosa. La large gamme d’hôtes compatibles avec ces rapporteurs permet leur adaptation à diverses bactéries à Gram-négatif, ouvrant la voie à une visualisation en temps réel dans les biofilms et autres niches hypoxiques.
Au Chapitre 3, j’ai mis en œuvre et validé un système modèle polymicrobien de la CF intégrant P. aeruginosa, Staphylococcus aureus, Streptococcus sanguinis et Prevotella melaninogenica. À l’aide de ce système anaérobique multi-espèces, j’ai étudié la persistance de six souches mutantes de P. aeruginosa et évalué leur sensibilité à la tobramycine sur une gamme de concentrations, dans ce contexte d’interactions interespèces complexes. Le mutant ΔtctED a présenté le phénotype le plus marqué, se révélant la souche la plus sensible par rapport au type sauvage. Cette découverte met en évidence tctED comme un gène de résistance aux antibiotiques spécifique aux biofilms dans des conditions proches de celles de l'environnement pulmonaire de la CF, suggérant que tctED pourrait être une cible thérapeutique potentielle pour lutter contre la résistance aux antibiotiques in vivo.
Au Chapitre 4, j’ai construit un plasmide stable et indépendant des antibiotiques, pCFT4.2.1, codant pour phiLOV2.1 et le système toxine–antitoxine VapBC. Ce plasmide a été maintenu dans plus de 90% des cellules de P. aeruginosa PA14 WT pendant au moins trois jours sans pression de sélection antibiotique, tout en conservant une fluorescence détectable. Dans le cadre du modèle polymicrobien CF, l’étude de P. aeruginosa porteur du plasmide pCFT4.2.1 a permis de mettre en évidence la capacité de ce pathogène à former des biofilms adhérents à des surfaces ainsi que des agrégats flottants assimilables à des biofilms.
Dans l’ensemble, ce travail fournit de nouveaux outils fluorescents, valide un modèle polymicrobien pertinent pour la CF, confirme tctED comme un gène de résistance aux antibiotiques spécifique aux biofilms de P. aeruginosa dans diverses conditions, établit une souche rapporteur stable pour étudier P. aeruginosa dans des communautés multi-espèces anaérobiques, et révèle des informations sur la nature des biofilms de P. aeruginosa dans ce modèle polymicrobien. Collectivement, ces résultats renforcent notre capacité à étudier la persistance, la sensibilité aux antibiotiques et la capacité de formation de biofilms de P. aeruginosa dans des contextes cliniques pertinents
Profiles of quality of care among individuals with suicidal behaviors
No full textAbstract Objectives This study identified profiles of individuals with suicidal behaviors (ideations, plans, attempts) and quality of outpatient care received, associated these profiles to the respondents’ sociodemographic and clinical characteristics, and measured outcomes. Methods Using a representative population-based 2015–2016 survey from Quebec (Canada) merged with the province’s health registry (1996–2017), cluster analysis and multinomial logistic regressions were conducted on 569 respondents experiencing suicidal behaviors. Results Among the four identified profiles, 63% had suicidal ideations only (Profile 1, 40% of the cohort; Profile 2, 23%), while 37% reported suicidal plans (mostly Profile 4, 15%) or attempts (mainly Profile 3, 22%) – of Profiles 3 and 4 about one-third reported suicide attempts over their lifetime. Before exhibiting suicidal behaviors, 56% had received low quality of outpatient care – mainly Profiles 1 and 4. Those with the worst social and health conditions, including more serious mental disorders, received the best MH care: Profile 2 patients (suicidal ideations only) received high continuity and regularity of recovery-oriented care; those of Profile 3 (more suicide attempts and unmet needs) received more intensive care. Being older with higher rates of suicidal plans or attempts – and with over 50% of them having mental disorders –, Profile 4 patients received low quality of care and showed the worst outcomes (acute care use, lower quality of life, bad or poor physical/mental health conditions), followed by Profiles 3, 2 and 1. Profile 1 patients also received low quality of care, but showed the best outcomes, probably because of better social and clinical conditions and the fact all of them only had suicidal ideations. Conclusion Quality of care was higher in patients with worse social and health conditions (Profiles 2 and 3). However, findings showed that services could be substantially improved to prevent suicidal behaviors, with outreach interventions significantly strengthened for Profiles 1 and 4. Services could protect patients better against suicidal behaviors and adverse outcomes if they more closely matched their needs and the severity of their conditions. In this sense, Profile 3 and 4 patients would benefit from more continuous follow-up care over time