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(Re)penser le travail social avec et pour la communauté des adultes autistes francophones de l’Ontario au prisme de la neurodiversité et de l’intersectionnalité : quand les savoirs d’expérience s’entremêlent
No full textSituée au croisement des études critiques en autisme, des approches afroféministes intersectionnelles et du travail social en contexte francominoritaire, cette thèse doctorale documente les inégalités sociales complexes (Collins & Bilge, 2016; Nash, 2017) vécues par les adultes autistes francophones en contexte minoritaire ontarien — une population largement absente des écrits scientifiques. Alors que les travaux récents dans le domaine des études critiques en autisme (Freeman Loftis, 2023 ; Milton et Ryan, 2022 ; Woods et Waldock, 2021 ; Gillespie-Lynch et al., 2017; O’Dell et al., 2016 ; Davidson et Orsini, 2013) exposent les injustices épistémiques et la neuronormativité (Catala et al., 2021 ; Claveau, 2024 ; Fricker, 2007), peu d’études francophones ont exploré ces phénomènes hors Québec.
Mobilisant une approche intersectionnelle intracatégorielle (Nash, 2008 ; McCall, 2005), ainsi que les savoirs d’expérience autistiques (Catala, 2025 ; Botha et al., 2024 ; Kapp, 2020 ; Yergeau, 2017 ; Milton, 2014), cette recherche critique adopte une posture éthique et inclusive avec et pour les adultes autistes en recherche centrée sur les communautés (Cascio et al., 2020 ; Raymaker, 2016 ; Raymaker et Nicolaidis, 2013). Elle repose sur une méthodologie qualitative multimodale (sondages, autoentrevues, entretiens semi-dirigés et une rencontre de groupe) menée en Ontario auprès de vingt-quatre participant·e·s : douze adultes autistes ; six proches aidantes, dont cinq mères et une sœur d’un jeune adulte autiste ; six intervenant·e·s des domaines sociaux et communautaires francophones de l’Ontario.
Au regard de l’offre active des services en français et de l’intervention sociale en contexte linguistique minoritaire (Reaume et al., 2024 ; Savard et al., 2024 ; Benoît et van Kemenade, 2017 ; Savard et al., 2015 ; Drolet et al., 2010), la thèse postule que les adultes autistes francophones de l’Ontario sont en situation de « surminorisation autistique francominoritaire ». Ce phénomène renvoie à l’invisibilisation sociale, linguistique et épistémique, lors que les personnes autistes francominoritaires se retrouvent exclues par les cadres anglonormatifs de l’autisme et brimées de leurs droits de minorités linguistiques (Forgues et Maillet, 2024 ; Baril, 2017a) devant des services en français généralistes peu adaptés à leur neurodivergence.
Les résultats révèlent leurs parcours marqués par le désalignement et la rareté des services et des ressources en français en Ontario conjugué au manque de reconnaissance des réalités distinctes et des obstacles d’accès accrus pour les personnes autistes racisées, migrantes, de la pluralité de genre et de la diversité sexuelle ou résidant hors des grands centres. Leurs savoirs expérientiels recueillis ont permis de formuler des leviers d’action pour transformer les pratiques en travail social ; renforcer l’offre active de services et des ressources ; et informer les politiques publiques dans une perspective intersectionnelle, plurilinguistique et inclusive en contexte linguistique minoritaire.
Cette thèse contribue au bassin émergent des études critiques canadiennes en autisme à l’âge adulte à l’intersection de langue, de l’identité, du genre, du statut socioéconomique et d’autres inégalités structurelles observées en contexte francominoritaire. Elle offre des fondements empiriques et théoriques pour une refonte des interventions sociales fondée sur la reconnaissance, l’autodétermination et la légitimation neuroaffirmative des voix des personnes autistes francominoritaires surminorisées
Unraveling the Mechanisms Through Which Salmonella Typhimurium Evades the Type-I Interferon Response
No full textLongitudinal Associations Between Indirect Peer Victimization, Friendship Quality, and Anxiety in Young Adulthood
No full textFriendships serve as vital sources of healthy social functioning in young adulthood, but these same relationships can also be a source of indirect peer victimization (IPV), involving covert forms of social maltreatment such as gossip and exclusion. In this thesis, I examined how IPV, poor friendship quality (PFQ), and anxiety influence one another over time. Using four annual waves from ages 22 to 26 (N= 443), a model building and cross-lagged panel approach was used to compare interpersonal-risk, symptoms-driven, and transactional models. Results indicated that the transactional model best fit the data. Indirect effects revealed support for interpersonal-risk driven pathways, such that IPV contributed to higher anxiety through deteriorating friendships, as well as greater IPV predicted subsequent heightened anxiety, which in turn predicted future victimization. Two additional, smaller indirect effects extended the sequence from IPV → PFQ → Anxiety to later IPV: PFQ predicted greater IPV through heightened anxiety, and IPV predicted later victimization through poorer friendship quality and heightened anxiety. Gender analyses showed some variation in auto-regressive and covariance paths, while multi-group comparisons revealed anxiety predicted poor friendship quality for men, and IPV showed stronger stability for women earlier in the study and for men at later time points, including over a two-lag span. Gender differences in indirect effects showed that the anxiety-mediated IPV loop was significant for women only. Results suggest that psychosocial distress in young adulthood is best conceptualized as a transactional system in which IPV, PFQ, and anxiety continually influence one another over time
Systematic review of oral carbohydrate treatment for hypoglycemia in people living with type 2 diabetes mellitus
No full textAbstract Background The common recommendation for hypoglycemia treatment, oral ingestion of 15 g of simple carbohydrates and glucose recheck in 15 min, was predominantly based on expert opinion, and two small-sized studies of intravenous insulin-induced hypoglycemia in people living with type 1 diabetes mellitus (T1D). The evidence for “15 grams/15 minutes” treatment for people living with type 2 diabetes mellitus (T2D) needs to be explored. The objective of this systematic review is to determine which oral carbohydrate treatments were studied in adults living with T2D for timely resolution of hypoglycemia events. Methods Medline, Embase, Scopus, and Cochrane Central Register of Controlled Trials were searched from January 1990 to 24 March 2025, for full-text studies of oral treatment for hypoglycemia in T2D. Two authors screened the results and extracted data. Inclusion criteria included age > = 18 years with T2D, treated with a defined quantity of simple carbohydrates, and reported hypoglycemia event resolution as a defined time of first glucose recheck after treatment completion. Exclusion criteria included non-oral route of hypoglycemia treatment. The Newcastle-Ottawa scale was used for risk of bias assessment. Results Three studies were included, which reported on 152 insulin-treated adults who experienced 366 hypoglycemia events. None of these three studies presented if the participants were or were not on sulfonylurea concurrently, nor did they present a breakdown of the types of insulin(s) (long-acting versus rapid-acting) for the participants. All studies had different oral hypoglycemia treatments and various glucose recheck times. Hence, data synthesis was not possible. There was near 100% hypoglycemia resolution with 15 g carbohydrates at 30-minute recheck in a study of mild hypoglycemia in hospitalized people living with type 2 diabetes. An at-home study showed 95% hypoglycemia resolution with 30 g carbohydrates at 10-minute recheck, although rebound hyperglycemia became a concern. The studies had low risk of bias. Conclusion Three studies provided a very limited evidence base for hypoglycemia treatment in T2D. Future studies are encouraged to identify and analyze people living with T2D who are treated with sulfonylurea, with or without insulin therapy, to reflect hypoglycemia treatment over the breadth of T2D pharmacotherapy. Clinical trial number Not applicable. Trial registration Prospero registration number CRD420251032322. No amendments. Study protocol can be obtained by sending a written request to the corresponding author
Educational Leadership and Ethical Decision-Making: A Comparative Case Study of Public, Private, and Independent K-12 Schools in Ontario
No full textSchool leaders face many dilemmas in their ethical decision-making as part of their regular responsibilities (Arar & Saiti, 2022; Berkovich & Eyal, 2021; Cranston et al., 2003, 2006; Ehrich et al., 2015; Eyal et al., 2011; Langlois, 2004; Langlois & Lapointe, 2007). This study explores how leaders in Ontario’s public, private, and independent K-12 schools experience dilemmas and how governance influences ethical decision-making, as seen through the multiple paradigm approach (Shapiro & Stefkovich, 2022). A comparative multiple case study approach was used to examine the experiences and perspectives of leaders in six case schools, including two schools from each governance type (public, private, and independent). The study's first phase featured semi-structured interviews with two leaders from each school and a document analysis; these data collection methods enabled the development of the six cases. In the second phase, three paired interviews with two leaders of the same governance type provided additional data for cross-case comparisons with governance type serving as the central comparative dimension. Key findings reveal that while school governance shapes the nature of ethical dilemmas leaders encounter, it systematically influences which ethical paradigms become salient in their decision-making. Leaders across all governance types draw from the same ethical toolkit, but governance type may shape which paradigms they emphasize and prioritize. Public school leaders experienced dilemmas and influences distinct from the private and independent school leaders, whose experiences were more similar. This research contributes to the understanding of school leadership decision-making and underscores the importance of governance in shaping leadership preparation programs, hiring and retention practices, professional development and training, and school policy development and implementation
Elevating an invisible role: co-designing solutions to optimize medical office assistants in primary care
No full textAbstract Background Medical Office Assistants (MOAs) play a vital but often underrecognized role in primary care, managing administrative and clinically-adjacent tasks, allowing the office to run efficiently and effectively. Little is known about how to optimize these team members for the best possible patient and team outcomes. We sought to: (1) explore MOAs’ current roles and experiences; (2) identify barriers and enablers to their work; and (3) co-design scalable solutions to support them in their work. Methods This multiprong multi-method study was guided by co-design principles and employed a combination of MOA co-creation workshops, a two-part Delphi survey, and a multi-stakeholder co-creation workshop. MOAs were recruited from a province-wide survey in Ontario, Canada. Four structured workshops with MOAs explored their experiences, challenges, and ideas for improving their work (N = 9). We conducted a thematic analysis to identify patterns in participants’ experiences with MOAs. Solutions emerging from the workshops were rated through a two-round Delphi survey with MOAs, clinicians, researchers, and health system leaders (n = 32). Solutions were evaluated using the APEASE framework (Acceptability, Practicability, Effectiveness, Affordability, Safety, Equity). Lastly, a multi-stakeholder workshop brought 18 participants together to discuss prioritized solutions and future scaling strategies. Results Nine MOAs participated in the co-creation workshops (all female, mean age 43, half identified as racialized). They emphasized their central role in team-based patient care, clinic flow, and health system navigation. Key challenges included a steep learning curve, lack of formal training, frequent workflow changes, emotional strain, and a perception of not being valued by patients or other team members. Staffing shortages and fragmented systems compounded these pressures. The top-rated solutions included creating a professional MOA association, expanding training and safety protocols, defining best practices for MOA roles, and streamlining referrals through centralized systems. Final discussions emphasized the need for leadership engagement, clinic and system-level buy-in, and dedicated funding to support implementation. Conclusions The challenges experienced by MOAs may require policy attention to better define and support their role. Targeted investments in training, professionalizing the MOA role, and embedding MOAs more meaningfully in team-based care has the potential to help primary care teams more effectively achieve the quintuple aim
Can We Achieve Culturally Safe Cancer Care: A Critical Thematic Analysis of First Nation Cancer Care Experience
No full textDespite significant advances in cancer prevention, detection, and treatment, Indigenous Canadians continue to experience markedly poorer health outcomes and lower survival rates from cancer and cancer-related illnesses compared to non-Indigenous Canadians. These disparities stem from systemic failures within the healthcare system to meet the unique needs of Indigenous patients and their families, resulting in deep mistrust toward the Western biomedical model of care. In recent years, the concept of cultural safety has emerged within the nursing profession as the dominant model for the delivery of culturally appropriate and sensitive care that helps to mitigate the effects of discrimination, stigma, and marginalization in healthcare contexts. This study, conducted in the Algonquins of Pikwakanagan First Nation community, examines community members’ experiences within the cancer care system and explores strategies for achieving culturally safe cancer care. Using secondary analysis of qualitative data collected through sharing circles, focus groups, and interviews with cancer survivors, family members, and healthcare providers, the study investigates how First Nations people navigate cancer care. Guided by a critical disability theoretical framework, the analysis interrogates the intersections of power, ableism, colonialism, and neoliberalism in shaping health outcomes. Findings reveal the harmful consequences of a biomedical system where treatment options are limited, and care is accessible only outside the community. Recommendations emphasize the urgent need for a new dimension of care that respects and integrates Indigenous knowledge systems
A prognostic model for uveal melanoma in Asian populations: a comparative analysis of clinical features and gene expression patterns using the TRACE and TCGA data
No full textAbstract Background Uveal melanoma (UM), the most common primary intraocular malignancy in adults, shows racial disparities in incidence, genetic drivers, and clinical outcomes. While most prognostication models are based on Caucasian populations, Asians demonstrate distinct molecular profiles, necessitating population-specific risk stratification. Methods This study analyzed 53 Asian UM tumors, 17 normal choroidal tissues (TRACE database), and 80 Caucasian UM samples (TCGA database). Differential gene analysis, immune microenvironment profiling, and survival modeling were performed. A 7-gene prognostic signature was developed by LASSO regression and validated across cohorts, with drug sensitivity predicted using GDSC2 data. Results The Asian UM exhibited 3,827 tumor-specific differentially expressed genes (DEGs) compared to the normal choroid, with enrichment in PI3K-Akt signalling, and 3,814 race-specific DEGs compared to Caucasians, suggesting specific disease pathways and variations in the tumor microenvironment. The tumor microenvironment in Asian UM exhibited increased immunological activation (M1 macrophages, PD-L1, CD8; p < 0.05), while Caucasian uveal melanoma was marked by immunosuppressive predominance (M2 macrophages, MDSCs). The seven-gene prognostic model (MMP2, LRAT, NOG, IHH, CDH18, MYH11, and SELE) exhibited strong predictive efficacy in Asians (AUC: 0.979, 0.924, and 0.984 for 1, 3, and 5-year survival) but was less successful in Caucasians. High-risk scores correlated with metastasis (12/26 vs. 4/27; p = 0.02) and had independent prognostic value. Conclusions This cross-racial UM study reveals significant molecular and immune differences, indicating that Asian UM may be more responsive to immunotherapy The population-specific prognostic model improves our understanding of molecular differences in Asian and Caucasian UM, warranting further validation in multiethnic cohorts
Geometric Nonlinear Analysis of Steel Members with Imperfections
No full textSteel members inherently possess Initial Out-of-Straightness (IOS) and residual stresses, both of which are known to reduce their lateral-torsional buckling (LTB) resistance. Despite this, current Canadian and American design standards evaluate the LTB resistance of long-span, laterally unbraced members (expected to fail by elastic LTB) based on the critical moment of perfectly straight members, thereby neglecting the adverse effects of IOS. This approach stands in contrast to Eurocode and Australian standards, which explicitly account for IOS in their design provisions. Within this context, the present study investigates the impact of imperfections on LTB capacity of long-span, laterally unbraced steel members and advances the existing body of knowledge through three key contributions.
In the first contribution, a novel finite element formulation is developed for the geometrically nonlinear analysis of doubly symmetric I-shaped steel members. The formulation is grounded in the kinematics of thin-walled beam theory, thus capturing warping effects, and incorporates an algorithm to account for initial out-of-straightness (IOS) in the form of sweep, camber, twist, or combinations thereof. The model's ability to predict displacements and stresses is validated through comparisons with benchmark problems based on shell models and other thin-walled beam solutions. The model is subsequently employed in conjunction with a first-yield criterion to evaluate the buckling resistance of flexural members associated with various IOS patterns.
In the second contribution, the developed finite element is employed to conduct a parametric study involving 504 simulations of long-span, laterally unbraced flexural members with hot-rolled wide flange cross-sections. The investigation focuses on members whose capacities are governed by elastic LTB, aiming to quantify the influence of IOS on their buckling resistance. The analyses account for geometric nonlinearity, IOS, and residual stress effects. The study investigates the influence of various IOS characteristics, including pattern (symmetric vs. asymmetric), type (lateral, twist, and lateral-torsional), amplitude, member span, cross-sectional geometry, and loading conditions, on the LTB resistance of long-span steel members. Based on the parametric results, regression equations are developed to characterize the LTB resistance for members with different IOS types and amplitudes. The practical application of these equations is demonstrated through a design example.
The third contribution builds upon the capabilities of the finite element formulation developed in the first contribution by introducing three key enhancements: (a) incorporation of cross-sectional monosymmetric, thus enabling the analysis of I beams with a reduced flange; (b) inclusion of the destabilizing effect associated with load height; and (c) integration of residual stresses into the constitutive model as initial stresses. The enhanced model's capabilities are demonstrated through illustrative examples, and its accuracy is validated through comparisons with shell finite element models
Enhancing infant pain assessment and treatment: investigating barriers, facilitators, and implementation outcomes with the ImPaC Resource
No full textAbstract Introduction The Implementation of Infant Pain Practice Change (ImPaC) Resource is a 7-step, multifaceted, web-based implementation strategy to improve pain assessment and treatment in Neonatal Intensive Care Units (NICUs). We explored facilitators and barriers to implementing ImPaC and their relationship to implementation outcomes. Method A hybrid type 1 effectiveness-implementation study was conducted using a cluster randomized controlled trial (reported elsewhere) and a mixed-method exploratory study design. Level 2 and 3 Canadian NICUs with >15 beds were invited to participate and were randomized to intervention (INT, n=12) or usual care (UC, n=11) groups. INT NICUs recruited a change team who accessed ImPaC for 6 months; UC NICUs were waitlisted for 6 months and then offered ImPaC. Focus groups were conducted with all change teams following ImPaC completion. The Consolidated Framework for Implementation Research (CFIR) guided interview questions and analyses. Professionally transcribed interview data were coded and analysed using directed content analysis. Valence (+/-) and strength (–2, –1, 0, +1, +2) were assigned for each CFIR construct/subconstruct. Inductive codes were identified. Relationships between CFIR constructs/subconstructs and ImPaC implementation outcomes (feasibility and fidelity) were determined. Results 83 NICU change team members (median 4/site) participated in focus groups; 1,105 discrete codes relating to 31 CFIR constructs/subconstructs were identified. The most frequent facilitator constructs were Design Quality and Packaging, Compatibility, Available Resources, Champions, Implementation Climate, and Engaging Key Stakeholders. Complexity and Reflecting and Evaluating were salient in 21 transcripts, and Patient Needs and Resources was identified in 20 NICUs. Available Resources and Relative Priority were barriers. A positive association existed between the feasibility of implementing ImPaC and Engaging Key Stakeholders (0.46, p=0.041), Champions (0.82, p=0.001), Relative Priority (0.75, p=0.001) and Networks and Communication (0.60, p=0.023). There was a positive relationship between Engaging Key Stakeholders (0.42, p=0.048), Relative Priority (0.85, p=0.002), Patient Needs and Resources (0.46, p=0.049) and Fidelity. Conclusion Site-specific tailoring to enhance facilitators (e.g., champions, implementation climate) and mitigate local barriers (e.g., resources, relative priority) will provide a viable influence on optimizing implementation outcomes