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A preliminary scoping review on gender-affirming care in Canadian undergraduate nursing education
Get PDFNurses have an ethical responsibility to address the accessibility of healthcare for trans* people. Gender-affirming care (GAC) is the provision of culturally safe and humble care for trans* people, where the provider values one’s gender identity and actively supports gender affirmation or transition goals. Integration of GAC into nursing practice makes a significant difference in the lives and health of trans* people. Enhancing nursing’s collective capacity to deliver GAC could be achieved by strategically incorporating GAC principles and practices in undergraduate nursing education. However, little is known about how (or if) GAC is addressed in Canadian nursing curriculums. We designed a preliminary, iterative scoping review to map how GAC is included in the formal, informal, and hidden curricula in undergraduate nursing in Canada. Drawing on methods by Arksey and O’Malley and Levac and Colquhoun, we conducted a review of medical and nursing databases, and grey literature in October 2022. Our preliminary search resulted in 679 unique articles, of which 9 were deemed eligible for our review. One source from the Canadian Nursing Students Association had 5 position papers, as such, our review included 13 unique sources. Our preliminary review revealed one formal curriculum strategy used to teach GAC in one undergraduate nursing course in Canada. Three additional sources discussed trans* health in the hidden and informal curricula, while another three included a sentence on trans* health. Overall, the sources focused more broadly on “LGBTQ+” curricular inclusion. Collaborating with trans* community members and organizations can strategically advance GAC in undergraduate nursing curricula. This collaboration provides opportunities for faculty professional development and helps incorporate GAC into formal curricula settings such as lectures, simulation, and clinical. Additionally, trans* allyship needs to be prioritized at the faculty level (i.e., neutralizing language) and within nursing schools (i.e., diverse hiring, and safe, inclusive spaces). When there are intentional efforts to improve the informal (faculty-student relationships) and hidden curricula (the environment), then the safety and inclusivity of trans* students and faculty become a priority and GAC practices and principles become a reality. Finally, nursing schools should advocate for GAC requirements in CASN accreditation, NCLEX-RN testing, and professional competencies. This preliminary review has informed the development of our scoping review, which will expand its scope to map how North American undergraduate nursing curricula are integrating GAC.Graduate Student Open Access Publishing Fund, for Gender-affirming care in undergraduate nursing education: A scoping review protocol to be open access in BMJ Open, Manitoba Centre for Nursing and Health Research, College of Nursing, U
Identification of determinants of healthy development after household challenge adverse childhood experiences in children born between 2000-2012 in Manitoba using administrative health, social, and education data
No full textWhen children thrive in spite of experiencing adversity, they are called resilient. Finding a way to assess resilience using administrative data at the whole population level at low cost and minimal intervention was appealing.
Qualities contributing to resilience include physical and mental health, functioning in society, and healthy development in childhood. The purpose of this study was to identify variables that are associated with healthy childhood development after exposure to household challenge adverse childhood experiences using administrative health, education and social data. The objectives were to describe the developmental outcomes of children exposed to adversities, to identify factors that are associated with healthy development after exposure to adversity, and to examine the identified factors in the context of a resilience framework.
A cohort of children born in Manitoba between 2000-2012 was created. Children exposed to household challenge adverse childhood experiences were compared to unexposed children. Using the Early Development Instrument, children’s development was assessed on five domains at school entry. Children who met expectations in each domain despite exposure to adversity were considered resilient. Using regression models, variables that connected to sub-constructs of resilience were evaluated to determine if any were associated with resilience. Exploratory factor analysis determined whether factors that emerged mapped onto constructs of resilience previously defined in the literature.
Children who were exposed to household challenge adverse childhood experiences had poorer developmental outcomes compared to their unexposed peers. Several individual-, family-, and community-level factors were associated with resilience including sex, age, being first-born, health, team parenting, parent education, not being a newcomer, residential stability, neighbourhood SES, and regular contact with the health system. These factors clustered into 7 latent factors: family structure, health, parenting capacity, socio-economic status, optimal childhood health care, support seeking, and supported parenting.
A major benefit of this study was the establishment of a cohort of children with household challenge adverse childhood experiences, supporting future research into health, educational, and social outcomes related to childhood adversity. This strengths-based study allows for the use of resilience as an outcome measure in policy evaluation requiring little intervention, no primary data collection, and reduced time and cost.Evelyn Shapiro Award for Health Services ResearchOctober 202
Validating Critical Assumptions of the Control-value Theory of Emotion
No full textDespite increased salience of achievement emotions in psychological theory and research, emotion research remains in a state of fragmentation (Pekrun, 2018). Pekrun’s (2006) control value theory of emotion (CVT) is an integrative framework for understanding the antecedents and consequences of achievement emotions. CVT incorporates perspectives from theories of perceived control (Perry, 1991), attribution theory (Weiner, 1985, 2018), achievement goal theory (Elliot et al., 2011), and theories of self-regulated learning (Fredrickson, 2001). This dissertation aimed to validate critical yet overlooked assumptions of CVT, with a focus on synthesizing disparate motivation constructs within a CVT framework. I conducted three separate but interconnected studies with this focus. Study 1 tested the interactive relationship between control and value appraisals predicting achievement emotions.
Study 1 (N = 6541) extended prior research by incorporating principles of Weiner’s attribution theory to examine if students’ initial test performance in a novel competitive learning environment moderates Control × Value interaction effects on discrete emotions. Control and value interacted to predict nine discrete emotions. Students’ initial achievement outcomes moderated the interactive effects of appraisals on negative outcome-emotions (e.g., anger, shame), such that control and value were crucial for maintaining adaptive levels of emotions following academic setbacks (i.e., test failure).
Study 2 (N = 3361) incorporated achievement goal theory with CVT by testing a central CVT assumption that appraisals of control and value mediate relationships between achievement goals and emotions. Mastery-approach goals predicted increased perceived academic control and value. Performance-approach goals predicted decreased value over two semesters. Cognitive appraisals were related to enjoyment, boredom, and anxiety which predicted achievement in the two-semester course.
Study 3 (N = 1457) focused on CVT’s assumption of reciprocal causation. It extended prior research by incorporating theories of self-regulated learning to better align with CVT’s proposed model. Results demonstrated a reciprocal appraisal-emotion-learning-achievement temporal sequence across two semesters. This research strengthens understanding of achievement emotions, clarifies reciprocal motivational processes between cognition, emotion, and achievement, and aids in the development of interventions to foster adaptive achievement emotions. Further, this research advances efforts towards theory integration, an essential requirement for building cumulative scientific knowledge (Wigfield & Koenka, 2020).May 202
Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue
No full textBackground
People living with human immunodeficiency virus (HIV) are living longer with health-related disability associated with ageing, including complex conditions. However, health systems in Canada have not adapted to meet these comprehensive care needs.
Methods
We convened three citizen panels and a national stakeholder dialogue. The panels were informed by a plain-language citizen brief that outlined data and evidence about the challenge/problem, elements of an approach for addressing it and implementation considerations. The national dialogue was informed by a more detailed version of the same brief that included a thematic analysis of the findings from the panels.
Results
The 31 citizen panel participants emphasized the need for more prevention, testing and social supports, increased public education to address stigma and access to more timely data to inform system changes. The 21 system leaders emphasized the need to enhance person-centred care and for implementing learning and improvement across provinces, territories and Indigenous communities. Citizens and system leaders highlighted that policy actions need to acknowledge that HIV remains unique among conditions faced by Canadians.
Conclusions
Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Such a collaborative should be grounded in a rapid-learning and improvement approach that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely data and evidence; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement
One thousand peaches: a community centre for working children in Shiraz
No full textChild labour has been a significant issue in developing countries as there are too many socio-economic problems that children get neglected as a vulnerable group. As a metropolitan city in Iran, Shiraz is more prone to child labour; therefore, there must be systems and facilities to protect these children. There are a few charity organizations in Iran that focus on child labour. For example, Imam Ali Popular Students Relief Society (IAPSRS) is a private charity organization run by volunteer students following UNICEF's guidelines to provide education, psychological and social help, combat malnutrition, and rehabilitate working children through arts and sports (Imam Ali’s Popular Students Relief Society n.d.).
One Thousand Peaches focuses on building a center for IAPSRS to provide a safe place for children in the labour force. The proposed location for this project is district eight in downtown Shiraz. The center comprises a mix of classrooms, workshops, a gallery, play areas, offices, a medical exam room, and an emergency shelter to respond to children's physiological, psychological, and fulfillment needs through a trauma-informed design. In addition, the project offers adaptive reuse of interiors in some of the beautiful historic buildings in the Bala-Kaft neighbourhood of Shiraz to revitalize the community.February 202
Depression, judgment, and belief
No full textThis paper proposes a puzzle about an agent’s beliefs that arises in certain cases where a person suffering from depression makes sincere assertions of negative self-evaluations because of her depression whilst also judging that her overall evidence supports the negation of her negative self-evaluations. I argue that the assertions of negative self-evaluations and the agent’s judgments about overall evidence each exhibit attributes that are characteristic of belief. I argue that the puzzle arises in cases where the agent in question is aware of each of her beliefs and is rational enough to prefer, not only avoiding conflicting beliefs, but also to prefer that her beliefs be based on relevant overall evidence, as opposed to depressive thought patterns. I consider a variety of theories that may map on to my case, and I discuss challenges or objections to each theory as it applies to the case. I think there are reasons to favor a theory that rejects the claim that the agent straightforwardly believes that her negative self-evaluations are true, so, after ruling out some unsatisfying accounts, I spend the first major portion of the paper discussing views that take this approach. The latter portion of the paper is spent discussing theories that put pressure on other premises or assumptions of the puzzle. My intention is to discuss the relationship between depression, belief, judgment, and rationality in a somewhat narrow context. I do not intend to speak to the relationship between belief, judgment, and rationality as it applies to depression in general. I leave it up to further inquiry to discuss depression more generally as it relates to the issues raised in this paper, and I leave it up to further inquiry to determine whether my proposed puzzle or its potential solutions have novel or interesting therapeutic implications.February 202
Investigation of the delayed slope instabilities in earth fill dams due to creep through the application of the time-dependent model for structured soils (TMS)
Get PDFOne of the earth fill dams in Canada, which was performing satisfactorily for over 50 years, exhibited significant deformation in the upstream side. Investigation revealed that the loss of soil shear strength was brought by creep movement occurring over the service life of the dam. However, analysis from an earlier study was unable to simulate the strain softening of the soil coupled with time-dependent creep movement. To address this, the Time-dependent Model for Structured soils (TMS) was proposed to be used.
Necessary laboratory works and calibrations were done to determine all the parameters required in TMS. Full-scale models of earth fill dams CBBD2 and CBBD4 were calibrated based on the observed deformations at the site using TMS to simulate the soil behavior. The results of the calibration illustrated the strain softening of the clay material, as well as the accumulation of significant strains which defined the slip surfaces. Two slip surfaces were observed to form, both on the upstream and downstream side of the clay core at the interface with the rockfill. Results of a separate earlier study generally agree with the existence of the shallow upstream slip surface in the structure. The development of the secondary slip surface at the downstream side of the clay core provides new knowledge on the creeping behavior of the material.
Assessment of CBBD4 indicated that there is potentially significant presence of shear strains at the clay core at the present time which could lead to instability of the structure. Field measurements are needed to be conducted to validate the findings, and if needed, mitigating measures must be done to prevent excessive movement of the dam.
The results of the analyses demonstrated that TMS is capable of simulating the creep behavior over long periods of time. However, the post-failure deformations were not reproduced well in the model which indicates the limitations of the constitutive model. Even so, the results were able to shed light on the clay material behavior, in terms of strain accumulation, leading up to slope instability.Fellowship for Education Purposes
Faculty of Graduate Studies Research Completion ScholarshipOctober 202
Comprehensive characterization of pulse flour microstructure using advanced non-destructive techniques
No full textMilling influences flour morphology and the molecular structure of biomolecules. Such structure-function interactions are crucial in determining ingredient functionality to develop specific end-products. Laboratory scale X-ray instruments such as X-ray microtomography (µCT), small-angle X-ray scattering (SAXS), and powder X-ray diffraction (PXRD) offer limited brightness and are time-consuming when investigating the flour porosity, starch lamellar structure, and the crystallinity of pulse flours. Herein, synchrotron X-rays (SR) were employed along with laser diffraction, mid-infrared (mid-IR) spectroscopy and scanning electron microscopy (SEM) to non-invasively investigate the molecular changes in roller-milled chickpea, navy bean, green lentil, and yellow pea flours as influenced by milling configurations (termed as flour streams) and flour blending (termed as flour blends). In the realm of this thesis, flour streams comprise break and reduction streams for green lentils and yellow pea flours. However, for chickpeas and navy beans, flour streams combined byproducts streams in addition to the break and reduction streams. Flour blends are a combination of combined break, reduction, and byproduct streams in different proportions. Results indicate that there is a variation in all the measured parameters (particle size distribution (PSD), flour morphology, starch lamellar structure, starch crystallinity, flour porosity, starch and protein secondary structures) in flour streams and blends and within a pulse-type. PSD results from laser diffraction, SR-µCT and SEM revealed multi-modal curve distribution patterns with differences in measured ranges for the same sample. Flour morphology analysis through SEM showcased differences between break and reduction streams, with break streams exhibiting clustered starch granules and reduction streams displaying isolated, deformed granules. Flour blends displayed a mixture of flour morphology analogous to flour streams, reflecting blend composition effects. Interestingly, chickpea starches were porous in nature. Consistent SAXS and PXRD patterns were observed in all the flours for both flour streams and blends. Porosity analysis using SR-µCT results were correlated with the SEM results. Mid-IR spectroscopy discerned dissimilarities in carbohydrate and protein regions among all the pulse flours for both flour streams and blends. Principal component analysis effectively discriminated between flour types and streams based on spectral characteristics. Overall, this comprehensive analysis sheds light on the PSD, morphology, starch structure, and functional components of roller-milled pulse flour streams and blends, providing valuable insights for optimizing milling processes and understanding flour quality attributes.October 202
Old spaces, new places: legacy data and the spatial organization of Early Bronze III houses in the non-elite domestic quarter of Tell eṣ-Ṣâfi/Gath, Israel.
No full textThe goal of this thesis is to contribute to a more dynamic and holistic vision of the social complexities of early urban societies in the Near East by increasing the knowledge of intra-settlement household organization and variability. This thesis approaches the household from a materials perspective, using three specialist datasets to identify the boundaries of households and their continuity between phases.
To conduct the analyses proposed for this thesis, a geographic information system (GIS) that integrates all of the excavation data from over a decade of field excavation was necessary to construct. This GIS spatial database enables data to be both stored and analyzed. The digitization of the site data and their integration are also vital in the examination of legacy data as is used in this thesis. The term ‘legacy data’ refers to any data that are from an obsolete information system. In the field of archaeology, this often translates to non-digital. The digitization and analysis of such data are theoretically possible for any site and allows for reexamination of the site after years of being archived. The process provides for the creation of an electronic database (where one may not have previously existed) that allows for renewed data access and addresses storage concerns.
This thesis makes a substantive contribution to the understanding of early urban society in the southern Levant by approaching the dearth of research on Early Bronze Age households from a spatial analytic perspective. Data from Tell eṣ-Ṣâfi/Gath (Israel) are used to generate models of the spatial dynamics of households in this early urban center. A clearer understanding of generational continuity of habitation of architectural units, architectural units as a representation of households, use of space within architectural units, and household (domestic) level tasks provides information that is not accessible from top-down approaches. The use of legacy data in the analysis tests the feasibility of these types of analyses on data collected before digitization was widespread. This thesis tests whether the digitization process and subsequent analysis of legacy data are valuable and return meaningful results.May 202
Rationalization of the empirical design method for reinforced bridge deck slab
No full textAbstract
The empirical design of reinforced concrete bridge deck slabs of girder bridges, referred to as only ‘deck slabs,’ is the most efficient design method because it recognizes the inherent arching action that exists in these slabs. Because of the arching action, the deck slabs fail in a punching shear mode under much higher wheel loads than the loads that would make them fail in bending; it is noted that failure in bending assumes the absence of the arching action. The Canadian Highway Bridge Design Code provides specifications for the empirical design of deck slabs. As the term ‘empirical design’ implies, this method is based on experimental evidence rather than analytical methods. A computer program, PUNCH, based on an analytical method, was developed to analyze the failure loads of externally restrained deck slabs, also referred to as ‘steel-free deck slabs,’ which do not contain embedded reinforcement for strength. In this program, it is assumed that the transverse confinement to deck slabs is provided by steel straps lying outside the deck slabs. Thus, this program only models the behavior of externally reinforced bridge deck slabs accurately.
For internally reinforced bridge deck slabs, the stress-deformation behavior of steel in concrete is investigated in experimental evidence on concrete prisms, each with an embedded central steel bar, which has confirmed that when these prisms are subjected to tensile forces through the steel bars, the axial stiffness of the composite prisms is initially much larger than that of the bare steel bar, and decreases nonlinearly with the increase in the magnitude of tensile force. A reinforced concrete prism can thus be conceptually replaced by a hypothetical equivalent steel bar, the diameter of which is larger than that of the bare steel bar and decreases with the increase in the magnitude of the tensile force.
This thesis attempts to modify the program PUNCH to analyze deck slabs with embedded steel bars by replacing the bars with hypothetical equivalent steel bars that lie outside the concrete.
The first part of the research work involves the establishment of the changing equivalent diameter of the composite concrete prisms under gradually increasing tensile forces. This research was conducted through non-linear finite element analysis, the results of which were compared favorably with available experimental results.
The second part of the research was first to modify the PUNCH program to include variable axial stiffness of the external restraint and then to use the modified program to analyze a large number of deck slabs with variable external stiffness represented by hypothetical steel bars of varying equivalent diameters. The accuracy of the results has been established by comparing its results with those from available experimental tests, some of which were failure tests. Predictions from the modified PUNCH have confirmed that most reinforced concrete deck slabs never fail under wheel loads of even the heaviest commercial trucks traveling on highways. The modified PUNCH program is now called PUNCH.ED, can be used with confidence for predicting not only the failure loads of deck slabs but also their load-deflection behavior under smaller; loads.October 202