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Clinician perceptions of the impact of emotions on clinical decision making in child and adolescent eating disorders
No full textThis thesis will examine the impact of emotions on clinical decision-making in the field of child
and adolescent ED. Therapists and medical professionals working with chronic and lifethreatening
illnesses, such as ED may be particularly vulnerable to emotional influences on their
decision-making. This is evident, as past research studies have identified that high levels of
clinician anxiety result in lower adherence to treatment protocol. In a survey, clinicians reported
that the top three decision categories they perceive to be the most emotionally charged include:
1. Involvement of the family; 2. Autonomy and Control; and 3. Food and Weight. The decision
rated as most negatively influenced by clinician emotion was the decision to include a
critical/dismissive parent in treatment. Family-based therapy has the most empirical support in
the treatment of child/adolescent ED. A treatment team consists of a physician and therapist at
minimum; however, studies examining medical professionals indicated that they were not
confident in their training in ED or in the treatment of ED and only 1/3 of medical professionals
report always including the family in therapy. As such, interviews were conducted in order to
gain a better understanding of the impact of emotions on clinical decision-making in clinicians
and medical professionals. 22 participants (16 therapists and 5 medical professionals) working in
the field of child and adolescent ED completed a 1hour semi-structured interview that included
questions regarding clinician and medical professionals perceptions of the impact of emotions on
clinical decision making in themselves and in their colleagues. Transcripts were analyzed using
thematic analysis. The themes identified suggest that clinicians and medical professionals
perceive emotional influences on their decision-making in clinical practice. The results are
discussed in terms of the implications for self-reflective practice
Interdisciplinary cardiovascular health research: quantitative methods, heliogeophysical influence, demographics, and spatial trends
No full textThe study of cardiovascular health involves myriad scientific disciplines associated with diverse factors that contribute to health which further necessitates interdisciplinary endeavors. The current series of studies concern cardiovascular health from multiple interdisciplinary perspectives including biomedical signal processing, heliobiology, and public health, with a particular focus on quantitative methods throughout. The first study examined heart rate variability (HRV) derived from healthy and arrhythmia human electrocardiograph records. Data processed using wavelet entropy was quantitatively novel compared to traditional indices of HRV and also demonstrated significant accuracy for prediction and classification of arrhythmia. Next, heliobiological perspectives of cardiovascular physiology were examined beginning with experimental verification of previous correlational results. Artificially simulated geomagnetic impulses were associated with significant increases in participant HRV, particularly for frequency-based components. An additional pilot case study demonstrated similar effects for natural geomagnetic storms, while a nonlinear relationship was observed overall for HRV and geomagnetic activity. National data regarding mortalities due to hypertensive diseases in Canada from 1979 to 2009 were aggregated and investigated for periodic components and relationships with space weather parameters. Time-lagged linear correlations were observed along with conspicuously overlapping temporal trends, for which geomagnetic activity and solar wind pressures were identified as central sources of variance. Finally, three ecological cross-sectional studies investigated sub-provincial cardiovascular concerns across Canada at the health region level with emphasis on demography and spatial statistics. Hospitalizations due to myocardial infarction demonstrated significant relationships with socioeconomic and behavioral factors as well as significant geospatial clustering of high rates in Northern Ontario and Quebec. Aggregate rates of self-reported hypertension were similarly related to income and demographics with spatial results demonstrating high rates clustered in the North Atlantic, particularly Newfoundland. Furthermore, analyses for hypertension specifically among older adult Canadians (≥ 65 years of age) suggested that education was the strongest contributor at the health region level and there were no significant spatial relationships, in contrast to age-standardized rates. Various implications and other relevant associations are discussed throughout
Exploration des perceptions des intervenants en santé mentale, en contexte de recherche de services pour eux-même: étude chez les francophones des régions de Sudbury, de Nipissing ouest et de North Bay
No full textCe mémoire vise à explorer la perception de diverses formes de stigmatisation ressenties par certains intervenants en santé mentale en quête de services pour eux-mêmes. La théorie de la stigmatisation de Goffman (1963) et la théorie des systèmes (von Bertalanffy, 1956) seront utilisées pour examiner ce phénomène.
Cette étude comporte trois objectifs. Premièrement, elle vise à comprendre comment les intervenants vivent leurs propres besoins de services en santé mentale dans la réalité du milieu. De plus, cette étude a voulu explorer l’existence de tabous vis-à-vis la santé mentale dans la société contemporaine. Enfin, elle souhaite sensibiliser la population envers les défis d’accessibilité à des services de santé mentale en français dans les régions désignées.
Cinq thèmes provenant des entrevues seront définis et expliqués : les services d’aide en santé mentale, les différentes perceptions de la santé, la perception des stigmas entourant les problèmes mentaux, le contexte de la communauté franco-ontarienne en situation minoritaire et le statut d’intervenant en santé mentale dans son rôle comme aidant dans la société.
Des entrevues qualitatives ont été effectuées auprès de huit intervenants francophones en santé mentale, évoluant en milieu minoritaire dans les centres urbains de Sudbury, de Nipissing Ouest et de North Bay. Les données recueillies lors d’une entrevue avec les participants ont dégagé leurs perceptions de la santé mentale en général, de leur entourage et leur communauté. Aussi, leur appréciation des services de santé mentale publics disponibles en français dans les régions ciblées fut explorée.Maîtrise en Service Socia
Analysis of plasma immune response to clostridium difficle proteins in hospitalized patients at Health Sciences North, Sudbury, Ontario, Canada
No full textClostridium difficile infection (CDI) is the leading cause of nosocomial diarrhea worldwide.
Prevention and treatment of CDI requires an intimate understanding of the immune
response to the bacterium. Thus, this study investigated the plasma immune response of 79
patients at Health Sciences North in Sudbury, Ontario, Canada to identify immunodominant
C. difficile proteins. Plasma samples were obtained from patients diagnosed with C. difficile
infection, patients positive for C. difficile without symptoms, and patients who were
negative for C. difficile, with and without symptoms. The plasma samples were tested for
the presence of antibody reacting to C. difficile protein extracts using Western Blot analysis,
Wes immunoblotting, and subsequent characterization by 2-D immunoblot analysis and
mass spectrometry. Candidate immunodominant C. difficile proteins were found to be
enolase, acetyl-coA acetyltransferase, and the 50s ribosomal protein, L7/L12. However, the
presence and/or levels of antibodies that recognized these proteins in patient plasma were
not statistically different between patient cohorts. Further analysis of the potential immunogenicity of these proteins could be useful to CDI treatment and preventio
Living with a sibling diagnosed with fetal alcohol spectrum disorder
No full textThe following document is a two-paper manuscript-based thesis investigating the experiences of siblings of individuals with Fetal Alcohol Spectrum Disorder (FASD). According to the sibling literature, individuals are impacted by living with a brother or sister with a disability, but, much of the research has focused on siblings of individuals with Autism, Down Syndrome, or developmental disability in general. Thus, the purpose of this exploratory study was to examine both the positive and negative experiences associated with having a sibling diagnosed with FASD, along with what strategies these siblings are using to help them adapt. The first paper, which focused on the benefits and challenges when having a sibling diagnosed with FASD, used a mixed methods approach. The qualitative data consisted of semi-structured interviews, which were analyzed using Interpretative phenomenological analysis (IPA), and the quantitative data comprised the Sibling Inventory of Behaviour Scale (SIB) and the Daily Hassles and Uplifts Scale (DHUS), which were analyzed using descriptive statistical analysis. Siblings described feeling a number of emotions associated with their experience such as frustration, fear/worry, resentment, happiness, and personal growth. The second paper examined both coping behaviours and resources used by siblings to help facilitate adaptation. This qualitative study employed Thematic Analysis (TA) to analyze the semi-structured interview. Results indicated that siblings employ coping behaviours such as active and emotional avoidance, and access both informal and formal resources; however, understanding the complexities of FASD is important in perception of helpfulness of these resources. Implications for clinical interventions are discussed
The economic impact of the Northern Ontario School of Medicine on Northern Ontario in 2017
No full textNorthern Ontario School of Medicin
Biomonitoring under changing climate conditions: assessing seasonal variability of benthic macroinvertebrate communities and stream characteristics in two ecozones in Northern Ontario, Canada.
No full textThe vast “Ring of Fire” region, at the interface of the Boreal Shield and Hudson Plains ecozones in the far north of Ontario, Canada, is considered to be one of the most promising mineral exploration areas in Ontario in almost a century. The region is undeveloped and remote, accessible only by air, water or winter road. Multiple stresses to the natural ecosystems are anticipated with mining development, in a time of climate change which is predicted to significantly impact hydrological and temperature regimes (intensified spring freshet, more high discharge events, warmer temperatures for longer). Preserving and protecting the aquatic ecosystems in this pristine region will require effective baseline environmental monitoring in advance of development. Quantifying seasonal variation of habitat characteristics and benthic macroinvertebrate (BMI) communities, and assessing the seasonal difference between ecozones are considered key challenges in designing effective monitoring programs. In this study, I examined seasonal variability in habitat characteristics and BMI communities by sampling 43 stream sites distributed across the two ecozones. In 2015 each site was sampled three times during the open water season: post-freshet, mid-summer and fall. BMI communities varied among sampling seasons, but less variation was observed between the post-freshet and summer sampling periods than either of these compared to the fall. Ordination analyses of BMI communities identified to the family level indicated that sites from the same sampling season were more likely to group together. Water temperature, stream velocity and canopy coverage were the key factors associated with seasonal differences in benthic macroinvertebrates. Differences in location of the sampling sites across the two ecozones did not significantly impact seasonal variability, but differences may have been constrained by the common habitat features used because of the sampling protocol. Conducting sampling during the post-freshet or summer seasons is recommended for future stream bioassessments to reduce the influence of seasonal variability and thus ensure comparability over time
Design and optimization of a novel top-lit gas-lift bioreactor for industrial CO2 mitigation and microalgae-sourced biodiesel production
No full textMitigation of CO2 in industrial off-gasses by sparging the gas through photosynthetic
microalgae bioreactors is an attractive concept. The goal is for the CO2 to be consumed
by the microalgae as a nutrient, which in turn produces lipids suitable for conversion into
biodiesel, as well as other value-added bioproducts such as Omega-3 fatty acids and
antioxidants. Open systems are considered the most economic outdoor, large-scale cultivation option
but have large land space requirements due to their shallow depths (15-35 cm).
Consequently, finding sufficient space to locate them close to off-gas sources on
industrial sites can be a significant challenge. Shallow depths are also likely to result in
low uptake of CO2 and consequently reduced biomass productivity due to short gas
residence times in the culture medium. In order to obtain longer gas/liquid transfer times, as well as greater per area productivity,
the tanks through which the off-gas is sparged must be as deep as possible. However, to
make the tanks deeper and avoid the costs associated with sub-surface artificial lighting,
the issue is how to ensure the microalgae receive adequate light exposure. We have,
therefore, looked for a novel method for increasing the depth of the tanks through which
the off-gas is sparged. To achieve this, we have investigated the use of a gas-lift
circulating system in a deep top-lit open bioreactor. In addition to providing CO2, the
sparged gas also provides continual vertical circulation of the microalgae to ensure good
mixing and an adequate light/dark cycle. Compared to existing shallow open systems, the results obtained showed comparable biomass productivity per unit volume, but
importantly around three-times higher biomass productivity per unit area occupied by the
bioreactor. The lipid productivity was also increased due to light and hydrodynamic
stresses. In order to enhance further light utilization efficiency in the deep cultivation bioreactor,
the use of a novel non-energy-consuming light column was also evaluated. The results of
using the light column showed a 33% increase in areal biomass productivity and a 16%
increase in areal lipid production. The proposed design and developed models can be easily translated into larger scale, onsite
production facilities in industrial sectors emitting off-gas. The carbon capturing
properties of microalgae can, therefore, help reduce industrial carbon dioxide emissions,
whilst at the same time producing biodiesel from the resulting lipids
Development and validation of a method for the determination of nine benzodiazepines and metabolites in dried blood spots (DBS) using UPLC-QTOF-MS
No full textIn forensic toxicology benzodiazepines are common compounds implicated in
drug impaired driving cases. Detection of these compounds is ideally determined from
whole blood collected from the individual after impairment has been established and
qualified personnel are available to draw blood. This study focused on the development
and validation of a screening method that could also be applied to quantification of a set
of nine benzodiazepines and metabolites extracted from dried blood spots and analyzed
using UPLC-QTOF-MS: diazepam (DZP), temazepam (TMZ), oxazepam (OXZ),
nordiazepam (NOZ), lorazepam (LRZ), clonazepam(CLZ), 7-aminoclonazepam (7CLZ),
alprazolam (APZ), and α-hydroxyalprazolam (aHAM). Advantages of DBS over whole
blood sampling are less invasive sampling, potential for increased stability of analytes in
the card matrix, small sample volumes, simplified extraction and ease of storage and
transport. All dried blood spots were 20 μL of sheep blood spiked with a 2.86μg/mL
mixture of the compounds included in this study and left to try overnight at ambient
temperature. The optimized method immersed a ½” diameter punch of card containing
the entire blood spot in an extraction solvent of 1:1 (v/v) methanol:acetonitrile and
sonicated for 30 minutes. The extraction solvent was separated from the spot, 1 mL of
acetonitrile was added followed by protein filtration. Filtrate was evaporated down to
dryness and analytes were then reconstituted in 1:1 (v/v) acetonitrile:water before
analysis. Each step of extraction and sample preparation was optimized for this study. All
analytes were stable within the card matrix for 14 days under refrigeration at 4°C. All analytes were stable up to 12 hours in the autosampler of the instrument. Hematocrit over
a range of 20 - 70% did not affect interpretation of results. Validation produced
calibration curves over a range of 7.8 – 500 ng/mL that had R2 values ranging from
0.998-1.00 with a quadratic line of best fit. Bias was <20% for high blind samples and
≤25.6% for low blind samples.
A screening method using UPLC-QTOF-MS to analyze DBS extracts able to
identify all benzodiazepines of interest was developed and validated. Calibration curves
representing impairment ranges of the analytes of interest predicted concentrations within
a reliable range that allowed for quantification of the analytes
High throughput sequencing-based transcriptiome analysis of diffuse large-B-cell lymphoma patients with samples taken at diagnosis and after therapy relapse: a feasibility study toward developing personalized therapies
No full textTraditionally, prognostic information and selection of therapies for individuals with
cancer is based on the results of studies that evaluate large groups of patients, in which there has
been demonstrated a statistical benefit for the group. The success of this approach is directly
related to the biological homogeneity of the chosen study group. Therefore, this approach is
inherently sub-optimal for many individual patients, particularly in very heterogeneous disease
entities such as diffuse large B-cell lymphoma (DLBL). However, with the recent introduction of
high-throughput sequencing, it has become possible to extensively evaluate the biology of
individual patient samples, which may eventually be used to transition to an era of true
individualized management for cancer patients. Challenges to this approach include the
complexity of the technology for clinical laboratories, high cost, and the immaturity of the
databases analysis technology that are required to evaluate the results. Fortunately, rapid
improvements continue to be made in all of these areas. The primary goal of this project was to
explore the feasibility of creating “clinical-grade” evaluation methods toward developing
personalized therapies in the near future. Clinical samples from patients with DLBL were used to
examine the potential of two platforms, Oxford Nanopore and Illumina company products, for
the analysis of complete mRNA transcriptomes since they can be representatives of intracellular
biology. I found that the Illumina platform technique is feasible for the goal, while the Oxford
Nanopore technology is not. Feasibility was further shown by successful use of the Illumina
technology and the analysis method developed, to verify prediction of DLBL aggressiveness as previously determined by an alternate method, considered the “gold standard” in published
literature. Finally, mRNA transcriptome data generated from pre-therapy diagnostic and post-therapy recurrence samples of DLBLs was used to demonstrate that it is feasible to use opensource
databases and programs to generate a list of therapeutic candidate proteins and pathways
in each individual case. Although this feasibility study was carried out with only small number of
patients, it shows that the components may finally be available to consider moving forward.
However, further work is required to successful transition individualized tumor evaluation
approaches into routine clinical practice