Objective Estimation Of Tracheoesophageal Speech Quality, Yousef S Ettomi Ali

Electronic Thesis and Dissertation Repository

Speech quality estimation for pathological voices is becoming an increasingly important research topic. The assessment of the quality and the degree of severity of a disordered speech is important to the clinical treatment and rehabilitation of patients. In particular, patients who have undergone total laryngectomy (larynx removal) produce Tracheoesophageal (TE) speech. In this thesis, we study the problem of TE speech quality estimation using advanced signal processing approaches. Since it is not possible to have a reference (clean) signal corresponding to a given TE speech (disordered) signal, we investigate in particular the non-intrusive techniques (also called single-ended or blind approaches) …

Sodium-Glucose Cotransporter-2 Inhibitor Use And The Risk Of Acute Kidney Injury In Older Adults In Routine Clinical Practice: A Population-Based Cohort Study, Carina Iskander

Electronic Thesis and Dissertation Repository

Regulatory agencies warn about acute kidney injury (AKI) risk following sodium-glucose cotransporter-2 (SGLT2) inhibitor use. This population-based retrospective cohort study in Ontario, Canada quantified the 90-day AKI risk in older adults who were newly dispensed either SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP4) inhibitors in an outpatient setting between 2015 and 2017. Risk ratios (RR) were obtained using modified Poisson regression and risk differences using binomial regression. Relative to new use of a DPP4 inhibitor, initiation of an SGLT2 inhibitor was associated with a lower 90-day risk of a hospital encounter with AKI: 216 events in 19,611 patients (1.10%) versus 388 …

Clinical Application Of 3d Ultrasound In Neonatal Intraventricular Hemorrhage, Priyanka Roy

Electronic Thesis and Dissertation Repository

Preterm neonates are at risk for intraventricular hemorrhage (IVH) and subsequent post-hemorrhagic hydrocephalus (PHH). A well-accepted interventional therapy for PHH is ventricular tap (VT). Permanent treatment, ventriculo peritoneal shunt surgery (VPS) is required in the case of some neonates under some conditions (weight, immunological status, CSF protein level) who receive multiple interventions. The objective of this study was to apply a 3D ultrasound system clinically to determine CSF volume within the ventricle, to guide the neurosurgeon regarding the amount of CSF should be removed during every intervention, which lateral ventricle is better to intervene and to predict the possibilities of …

Reliability And Validity Of Two Performance-Based Outcome Measures In Rehabilitation Following Total Knee Arthroplasty, Jennifer L. Van Bussel

Electronic Thesis and Dissertation Repository

Objectives: Performance-based outcome measures (PBOM) are suggested to evaluate change in function during rehabilitation after total knee arthroplasty (TKA). The purpose of this study was to evaluate the measurement properties of the 30-Second Chair Stand Test (30CST) and 10-Metre Walk Test (10MWT) in patients following TKA.

Methods: Eighty-three patients completed two PBOM on three occasions following surgery. Patients also completed the Western Ontario and McMaster Universities Osteoarthritis Index and Global Rating of Change (GRC).

Results: Intraclass correlation coefficients ranged from 0.82 to 0.96. The standard errors of measurement at 6 and 12 weeks postop, respectively, were: 30CST ±0.67 and ±0.79, …

Voice Analysis With Iphones: A Low Cost Experimental Solution, Benjamin Van Der Woerd

Electronic Thesis and Dissertation Repository

Background:

Acoustic voice analysis requires a resource intensive setup, including a soundproof booth. This project evaluates smartphone microphone and recording environment impacts on voice sample collection for acoustic voice analysis. A proprietary analysis algorithm is presented for validation.

Methods:

Microphone and recording environment were evaluated using previously collected voice samples presented in four conditions to test two microphones and two recording environments. Prospective samples were used to test the proprietary algorithm, whereby samples were analyzed using this and Praat.

Results:

Microphone and recording environment had small, clinically unimportant impacts on most measurements. The proprietary algorithm reliably analyzed sustained vowels, with …

Is Sabr Cost-Effective In Oligometastatic Cancer? An Economic Analysis Of Sabr-Comet Randomized Trial, Yujie Chen

Electronic Thesis and Dissertation Repository

The phase II randomized study SABR-COMET demonstrated that in cancer patients with 1-5 oligometastatic lesions, stereotactic ablative radiotherapy (SABR) was associated with an improvement in both progression-free survival and overall survival compared to standard of care (SoC). SABR, however, is associated with higher costs and treatment-related toxicity. The objective of this study was to assess the cost-effectiveness of SABR versus SoC in patients with oligometastatic disease.

A time-dependent Markov model with five health states was constructed from the Canadian health care system perspective. Utility values and transition probabilities were derived from the SABR-COMET trial. Costs were obtained from the published …

Evaluating The Utility Of Protein Biomarker, S100a7, And Diagnostic Test, Straticyte, In Predicting The Progression Of Oral Dysplasia, Lachlan Mclean

Electronic Thesis and Dissertation Repository

Five-year survival of oral cancer has remained relatively unchanged despite advancements in treatment, mostly because diagnosis is often made at an advanced stage of disease. The progression of dysplasia to oral cancer often follows a stepwise progression. Histopathology is considered the ‘gold standard’ for diagnosing dysplasia and lesions at a high risk of progression to oral cancer, but lends itself to subjectivity. The protein biomarker, S100A7, in oral dysplasia and squamous cell carcinoma has shown some predictive value for the transformation of dysplasia to cancer. Straticyte, a diagnostic test utilizing S100A7 to predict the probability of progression of oral dysplasia …

Biomechanics Analysis Of Anterior Cortical Perforation In Antegrade Femoral Nailing, Michael Ching

Electronic Thesis and Dissertation Repository

Hip and femur fractures are a common problem in an aging population. The number of hip and femur fractures are on the rise in Canada. Cephalomedullary fixation is a common method of treating hip and femur fractures, with a known complication of anterior cortical perforation of the distal femur. The literature describes risk factors, such as the influence of the start point at the greater trochanter, but there is no consensus on management. Some cases are treated with restricted weightbearing and other cases with revision surgery. Restricted weightbearing increases perioperative complications including mortality and decreases functional outcomes.

We analyze the …

Preventive Strategies For Acute Kidney Injury Among Patients Undergoing Abdominal Aortic Aneurysm Repair, Michaela Fernandes

Electronic Thesis and Dissertation Repository

Strategies for preventing acute kidney injury (AKI) in patients undergoing abdominal aortic aneurysm (AAA) repair were explored in a secondary data analysis of 601 patients from a randomized controlled trial (RCT). Bivariate analyses identified an association between intraoperative hypotension and postoperative AKI and suggested IV fluids as the best treatment option over inotropes/vasopressors which increased the odds of AKI (OR_crude=2.5 95%CI 1.2-5.0), however, our multivariable analysis was non-significant (OR_adjusted=1.7 95%CI 0.8-3.7). Further analysis found angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use within 24 hours prior to repair were not associated with postoperative AKI (OR …

Junctophilin-2 Protects Cardiomyocytes Against Palmitate-Induced Injury, Xiaoyun Ji

Electronic Thesis and Dissertation Repository

Cardiac lipotoxicity may induce cardiomyocyte apoptosis, eventually leading to myocardial dysfunction and heart failure. This study investigated whether and how junctophilin-2 (JPH2) plays a role in palmitate-induced apoptosis in cardiomyocytes. Here, we found palmitate incubation reduced JPH2 protein levels, increased cytosolic Ca²⁺ and induced apoptosis in cardiomyocytes. JPH2 over-expression prevented the increased cytosolic Ca²⁺ and apoptosis in palmitate-stimulated cardiomyocytes. JPH2 over-expression also attenuated palmitate-induced CCAAT-enhancer-binding protein homologous protein (CHOP) expression and CHOP deletion alleviated palmitate-induced apoptosis. Furthermore, blocking Ca²⁺ release from ryanodine receptor-2 (RyR2) prevented palmitate-stimulated CHOP induction and apoptosis. Additionally, JPH2 silencing elevated cytosolic Ca^{2+ …}

Trends In Asthma Prevalence In Canadians, Asthma Course Trajectories In Children, And The Effect Of Maternal Gestational Diabetes Mellitus On The Risk Of Asthma In The Offspring, Sharifa Nasreen

Electronic Thesis and Dissertation Repository

Asthma causes substantial public health burden. An enhanced understanding of asthma burden, asthma course and identification of intervenable risk factor is warranted.

The objectives of this research were to: 1) examine the age, period and cohort effects on asthma prevalence among Canadian adults during 1994–2011 (manuscript one); 2) identify the trajectories of asthma exacerbation and their predictors in children with incident asthma (manuscript two); and 3) examine the effect of maternal gestational diabetes mellitus on the risk of asthma in offspring (manuscript three).

Longitudinal data from 13,616 individuals in the National Population Health Survey, household component were used to address …

An Exploration Of How Persons Requiring Hemodialysis Treatment Explain The Ways In Which Access To Transportation For Such Treatment Influences Their Overall Health., Navpreet Kamboj

Electronic Thesis and Dissertation Repository

The number of Canadians being treated for kidney failure has more than tripled in the last 20 years, making hemodialysis (HD) a more common and expensive treatment option. Individuals having in-center HD require access to transportation to and from an HD center on average three days a week for a total of six trips. Therefore, access to transportation is a vital component for sustaining the health and well-being of this population. The purpose of this interpretive descriptive qualitative study was to explore how persons requiring in-center HD treatment explain the ways in which access to transportation for such treatment influences …

Does An Acute Achilles Tendon Rupture Become A Patient's Achilles Heel In The Long-Term?, Michaela Cm Khan

Electronic Thesis and Dissertation Repository

It is unknown if deficits in the involved limb following acute Achilles tendon rupture (AATR) persist in the long-term, or differ between patients treated operatively or non-operatively. This study investigated 43 patients 15±1 years post-AATR from a previous randomized controlled trial (RCT) that compared operative and non-operative treatment. Structural characteristics in the Achilles tendon and surrounding musculature were assessed using magnetic resonance imaging. We also performed physical examinations and evaluated performance-based and patient-reported outcomes. Overall, there were substantial differences between the involved and uninvolved limbs in most outcomes. Some outcomes improved over time from the initial RCT to the final …

The Difference In A1c Of Children And Adolescents With Type 1 Diabetes Mellitus Using Carbohydrate Counting Compared To Those Using A Structured Meal Plan, Alia El Kubbe

Electronic Thesis and Dissertation Repository

Carbohydrate counting (CHO) is a nutrition education tool used by patients with type 1 diabetes mellitus (T1DM). The primary objective was to assess glycated hemoglobin (A1C) in participants with T1DM using CHO counting vs. those using a structured meal plan (SMP). The secondary objectives were to determine if BMI-for-age, parental income, parental involvement, and mothers’ educational level were associated with their children’s glycemic control. A cross sectional study was conducted, where participants aged 4-18 years, or their parents completed a survey. Total sample size was 88 participants (77 in the CHO counting group and 11 in the SMP group). There …

Saponin Penetration And Interactions With Membranes, Sarai Guerrero

Electronic Thesis and Dissertation Repository

The saponin QS21 has been used and studied for years as an adjuvant agent to improve vaccines for both humans and animals. However, how the saponin interacts with the membrane and itself remains poorly understood. We studied the QS21-A majority isomer using all-atom classical molecular dynamics simulations in model bilayers composed of cholesterol and either DOPC or DPPC. As this is one of the few computational studies on QS21-A, we had very few resources to compare our results to. Nevertheless, we were able to gain insight into possible configurations that QS21-A takes after penetration, the effect of the bilayer on …

The Effect Of Pigmentation On Thermoplastic And Thermoset Elastomeric Power Chain, William Taylor

Electronic Thesis and Dissertation Repository

Aim: The purpose of the study was to determine the effect of pigmentation on force levels and their degradation over time in orthodontic power chain of different chain types and manufactures.

Materials & Methods: Groups consisted of closed power chain from American Orthodontic (AO) thermoplastic (TP) in 5 colors, AO thermoset (TS) in 2 colors, Ormco TP in 4 colors, Ormco TS in 2 colors, and Rocky Mountain Orthodontics (RMO) TS in 5 colors (18 groups total, 10 chain samples in each group). Testing was performed over a period of 6 weeks at intervals of initial (T0), 1 hour (T1), …

Recovery Following Proximal Humerus Fracture, Azar Varahrami Vigeh

Electronic Thesis and Dissertation Repository

There is currently a glaring gap in the existing knowledge to address individuals’ experiences while recovering from a proximal humeral fracture (PHF). The main objective of this dissertation was to understand better how recovery is perceived by individuals after PHF. This overarching objective aligned well with the broad conceptualization of the issue at hand as those provided by the International Classification of Functioning, Disability and Health (ICF). Three inter-linked studies were conducted to provide a broader picture of recovery after PHF. The first study was a systematic review of prognostic factors predicting recovery after PHF in adults. This review demonstrated …

Utilizing Fiv (Feline Immunodeficiency Virus) To Develop A Novel Animal Model To Study Hiv (Human Immunodeficiency Virus), Ankita Suryakant Kambli

Electronic Thesis and Dissertation Repository

This project sought to perform the in vitro work needed to accomplish the long-term vision of harnessing the similarities between HIV (Human Immunodeficiency Virus) and FIV (Feline Immunodeficiency Virus) to develop an animal model whereby cats can be used to study HIV pathogenesis and therapeutics. We transfected CRFK (Crandell Rees Feline Kidney) fibroblasts with plasmids that could express human or feline CD4, CCR5, or both, and determined receptor surface expression through flow cytometry. We discovered that HIV envelope expressed on 293T can fuse with huCD4/huCCR5 on CRFK. These cat cell lines were also capable of supporting HIV infection. Additionally, we …

Evaluation Of The Psychometric And Measurement Properties Of The Scat5 And Child Scat5, Michael Robinson

Electronic Thesis and Dissertation Repository

Concussions are one of the most complex conditions to manage in sport medicine due to the individualized clinical presentation caused by the complex neurometabolic cascade that occurs. The identification, assessment and management of concussion requires clinicians to employ a multifaceted approach including the subjective disclosure of symptoms by patents. In order to aid in this, symptom checklists are commonly used as they provide a standardized method for collecting the severity of concussion symptoms. One of the most common symptom checklists is the 5^th Sport Concussion Assessment Tool (SCAT5) symptom evaluation which is available in an adult and pediatric version. …

The Nature And Consistency Of Exercise Reporting In Rehabilitation Following Rotator Cuff Repair, Dinesh Balachandran

Electronic Thesis and Dissertation Repository

Abstract

Purpose:

Rotator cuff repair is conventional surgery, and postoperative rehabilitation programs are routine. Optimization and implementation of evidence-based exercise are dependent on comprehensive reporting of intervention content and dosage. The purpose of this study is to examine the content and consistency of reporting of postoperative exercise programs following arthroscopic rotator cuff repairs.

Methods:

Keyword search of PUBMED, EMBASE, Scopus, SPORTDiscuss, AMED, CINAHL, and Cochrane were performed from January 1950 to March 2019. All the studies that discussed rehabilitation following rotator cuff repairs of human adults were included. A Proforma Consensus on Exercise Reporting Template (CERT) assessment form was used …

Exploring The Temporal Variability Of Speech Intensity, Speech Intelligibility, And Communicative Participation In Individuals With Hypophonia And Parkinson’S Disease, Cynthia Mancinelli

Electronic Thesis and Dissertation Repository

Hypophonia, or reduced speech intensity, is frequently observed in individuals with Parkinson’s disease (PD). This speech deficit can impact speech intelligibility and communicative participation. However, there is little empirical evidence exploring the day-to-day variability of speech and communicative participation in individuals with PD. The purpose of this study is to investigate the temporal variability of acoustic and perceptual speech measures and psychosocial measures in individuals with hypophonia and PD. Additionally, this study seeks to examine the relationships among measures of speech intensity, speech intelligibility, self- and proxy-rated communicative participation, demographic factors, and non-speech factors. Twenty-three participants with PD, 23 primary …

Discovery Of Novel Mechanisms Regulating Cancer Extravasation In The Chorioallantoic Membrane Model, Yohan Kim

Electronic Thesis and Dissertation Repository

Cancer metastasis is a multistep process that begins with the invasion of tumour cells into the stroma and migration towards the blood vessels. Tumour cells that have entered the bloodstream must then survive and leave by a process known as extravasation. Finally, extravasated cells proliferate and establish the secondary site in the metastatic cascade. Although extravasation encompasses key events during cancer cell invasion to aid in the development of effective treatments, an in vivo model that rapidly, reproducibly and economically recapitulates cancer cell extravasation is needed. Therefore, the objectives of my research were to 1) establish and validate an in …

Behavioural And Objective Assessment Of Binaural Hearing In Adult Listeners With Acquired Unilateral Conductive Hearing Loss Before And After Middle Ear Surgery, Parvaneh Abbasalipour

Electronic Thesis and Dissertation Repository

In normally hearing listeners, binaural hearing relies on symmetrical input from the two ears. Previous studies on human listeners have assessed the effect of induced unilateral conductive hearing loss (UCHL) during adulthood via earplugging. These experiments indicated initial difficulty in sound localization followed by gradual improvement due to adaptation to the perturbed binaural cues. The limited duration of earplug use does not represent the consequences of chronic UCHL secondary to disease. Furthermore, there is insufficient information regarding the adaptation of binaural hearing abilities after treatment of late-onset UCHL.

The current study assessed the binaural hearing abilities of adult listeners with …

The Neural Circuitry Of Sensory Processing In Post-Traumatic Stress Disorder, Sherain Harricharan

Electronic Thesis and Dissertation Repository

Background: Traumatic experiences can have severe emotional and psychological consequences, which may affect the capacity to process both internal and external sensory information. Such aberrations may have cascading effects in individuals with post-traumatic stress disorder (PTSD), where alterations in sensory processing may hinder the capacity for higher-order executive functions, including emotion regulation. Delineating the neural circuitry of subcortical and cortical structures thought to be central to sensory processing is therefore critical to the study of PTSD and may help to develop an understanding of the neurobiological mechanisms underlying this often debilitating disorder.

Methods: Various neuroimaging approaches were employed to investigate …

Focused Practice And Enhanced Skills Pgy3 Training In Family Medicine: A Mixed Methods Study., Melad I. Marbeen

Electronic Thesis and Dissertation Repository

There is a growing trend among family physicians (FPs) to focus their practice in specialized areas. The reasons underlying this trend are incompletely understood. A mixed methods study was conducted to understand this issue. A secondary analysis of data from a survey of Western University family medicine program graduates highlighted the associations of postgraduate third-year (PGY3) training and physician’s remuneration strategy with focused practice. The overall service provision of focused practice FPs was centered on specialized areas, especially among those who practiced in non-office settings. A descriptive qualitative study explored the perspectives of residents accepted into the PGY3 programs at …

Applications Of Hair As A Record Of Systemic Exposure To Cortisol, Jeffrey Matthew Levine

Electronic Thesis and Dissertation Repository

Hair cortisol content (HCC) is a novel biomarker that uniquely captures retrospective systemic cortisol exposure. This thesis aimed to assess how different hair growth rates effect HCC timelines in Cushing’s and Addison’s patients, investigate the relationship between HCC and age, puberty, sex and BMI in healthy children and adolescents, and assess novel methods to improve cortisol extraction and recovery. Retrospective HCC timelines derived from a 0.75 cm/month growth rate best matched 50% of patients’ medical records rather than the historically assumed 1 cm/month. HCC correlated positively with age (p<0.0001), puberty status (p<0.001), and BMI (p<0.01) in males and females 7-17 years old. Nitrogen evaporation resulted in greater cortisol recovery than air evaporation (p=0.0003), and hair digestion using NaOH resulted in more rapid extraction of cortisol. These results provide incremental improvements to previous methods and assumptions for HCC analysis and elucidate normal HCC changes in children and adolescents.

Death Of The Clinic: Trans-Informing The Clinical Gaze To Counter Epistemic Violence, Diana E. Kuhl

Electronic Thesis and Dissertation Repository

This case study research (Patton, 2002, 2014; Flyvberg, 2006) has grown out of an awareness of deep resistance from the psy disciplines to trans-informed epistemologies as a source of legitimate knowledge (Tosh, 2015, 2016; Winters, 2008). It focuses on examining how the closure of The Gender Identity Clinic (GIC) for Children and Youth at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, Canada, signaled a paradigm shift from the ‘treatment model’ to the ‘affirmative model’ with respect to clinical approaches for supporting trans and gender diverse children and youth. As such the case study involved tracing the …

Effect Of N-Acetyl-L-Cysteine Prevention Or Intervention On Diet Induced Beta Cell Compensation And Dysfunction, Madison Wallace

Electronic Thesis and Dissertation Repository

Type 2 diabetes mellitus (T2DM) progression increases oxidative stress which contributes to beta cell compensation and eventual dysfunction. To investigate the role of antioxidant N-acetyl-L-cysteine (NAC) on beta cell function and pancreatic stellate cell activation (aSMA⁺) during early and late stages of compensation, NAC was used for preventative (p) and intervention (i) treatments in C57BL/6N mice fed a 60% kcal high-fat diet (HFD) for 8 or 22 weeks. Significantly improved glucose tolerance was observed at 22 weeks following pNAC treatment in HFD mice. Although 22-week HFD mice displayed hyperinsulinemia, beta cell hypertrophy, decreased beta cell PDX-1 nuclear localization, …

Exploration Of Knowledge And Skills Development Among Community Health Workers In Rwanda, Schadrack Ngabonziza

Electronic Thesis and Dissertation Repository

Community Health Workers (CHWs) are individuals who are selected and trained to provide healthcare services in the community. To be effective, they need ongoing training opportunities to gain knowledge and skills to perform their tasks. This study used descriptive qualitative methods to explore how Animatrice de Santé Maternelle (ASM)-CHWs working in select regions of Rwanda gained and enhanced their knowledge and skills to support maternal and newborn health care. Thematic analysis was used to analyze data from 110 ASM-CHWs and ten supervisors of CHWs. The analysis yielded two main themes. 1) Formalized training among CHWs, which included the subthemes of …

In Search Of Psychiatric Kinds: Natural Kinds And Natural Classification In Psychiatry, Nicholas Slothouber

Electronic Thesis and Dissertation Repository

In recent years both philosophers and scientists have asked whether or not our current kinds of mental disorder—e.g., schizophrenia, depression, bipolar disorder—are natural kinds; and, moreover, whether or not the search for natural kinds of mental disorder is a realistic desideratum for psychiatry. In this dissertation I clarify the sense in which a kind can be said to be “natural” or “real” and argue that, despite a few notable exceptions, kinds of mental disorder cannot be considered natural kinds. Furthermore, I contend that psychopathological phenomena do not cluster together into kinds in the way that paradigmatic natural kinds (e.g., chemical …