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The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.
Data Types:
  • Document
The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.
Data Types:
  • Document
The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.
Data Types:
  • Document
For modeling count time series data, one class of models is generalized integer autoregressive of order p based on thinning operators. It is shown how numerical maximum likelihood estimation is possible by inverting the probability generating function of the conditional distribution of an observation given the past p observations. Two data examples are included and show that thinning operators based on compounding can substantially improve the model fit compared with the commonly used binomial thinning operator.
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Planning, policy and design have neglected to strategically address informal settlements, now home to one third of the world’s population and commonly subjected to inadequate housing, and infrastructure. These communities have naturally grown for centuries, developing after colonization, slavery, industrialization and now capitalism. These settlements can be recognized today as their own townships - a city within a city, disconnected from the commodity driven market of urban centres and the associated social constructs. Specific to Trinidad and Tobago, the social, political and physical divide between the formal and informal have heightened as squatter communities are increasingly at risk of eviction as a result of urbanization and lucrative investment opportunities. This thesis therefore presents an alternative to current clearance proposals by blurring the boundary of these communities and bridging social disparities through historical and cultural traditions of the Steel Pan. While architects have narrowed the focus of the profession to serve the privileged and the commodity driven free market, this thesis intends to explore the contextually based needs of the informal, enabling a systematic growth through bottom-up planning and needs based design. Building upon literature and case studies with a focus on policy, infrastructure and associated social impacts, the project offers a design intervention projecting a century’s worth of growth and needs into a network of permanence and social belonging.
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While patient-centred care is being encouraged in practice, patient-centred learning is not always accommodated in the education of health professionals. Based upon Lave and Wenger (1991) and Wenger’s (1998) theory of situated learning, this study examined a community of practice consisting of an interprofessional group of students (medicine, nursing, occupational therapy, and pharmacy) who learned together from a teacher with a chronic illness as part of the Patients as Teachers Program (PAT). It examined developing health professional identities in this group in order to contribute to the discussion around patient-centred learning in health professional education using a qualitative approach. This study was guided by the following research questions: 1) How can an interprofessional group involving a patient as teacher operate as a community of practice? 2) How can situated learning in the interprofessional group involving a patient as teacher inform the professional identities of the students? The qualitative inquiry followed ethnographic methods of data collection that were recordings of the group meetings, program documents including students’ reflective journals, and one-on-one interviews with the five participants. The meeting recordings and interviews were transcribed. Thematic analysis using inductive and deductive approaches was used to analyze and interpret the data. The conceptualization of the PAT group as a community of practice highlighted the unique ways of participation in the group. The findings demonstrated developing professional identities among the students as a function of institutional positioning of a patient as a teacher in the program. The study also found that developing professional identities was taking shape in a holistic learning environment that included all of cognitive, relational and social ways of learning. This process of identity formation also involved dealing with uncertainties and developing multiple perspectives in relation to them. The study found that the students were developing health professional identities mainly in relation to their teacher and from the perspective of each of their own health professional programs. Interprofessional learning was a sequence to patient-centred learning in this context. The importance of patient-centred learning, difference of professional identities in different health professions and the role of discourses in shaping professional identities are also discussed.
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Background: Compliance to anti-TB treatment is crucial in achieving cure and avoiding the emergence of drug resistance. Electronic health (eHealth) interventions are included in the strategy to end the global Tuberculosis (TB) epidemic by 2035. Evidences showed that mobile messaging systems could improve patient adherence to clinic appointment for diagnosis and treatment. This review aimed to assess the effect of mobile-phone messaging on anti-TB treatment success. Methods: All randomized controlled trial (RCT) and quasi-experimental studies done prior to August 26, 2019 were included in the review. Studies were retrieved from PubMed, EMBASE, Cochrane and ScienceDirect databases including, grey and non-indexed literatures from Google and Google scholar. Quality of studies were independently assessed using Cochrane Risk of Bias Assessment Tool. A qualitative synthesis and quantitative pooled estimation were used to measure the effect of phone messaging on TB treatment success rate. PRISMA flow diagrams were used to summarize article selection process. Results: A total of 1237 articles were identified, with 14 meeting the eligibility criteria for qualitative synthesis. Eight studies with a total of 5680 TB patients (2733 in intervention and 2947 in control groups) were included in meta-analysis. The pooled effect of mobile-phone messaging revealed a small increase in treatment success compared to standard of care (RR 1.04, 95% CI 1.02 to 1.06), with low heterogeneity (I2 = 7%, p < 0.0002). In the review, performance, detection and attrition biases were reported as major risk of biases. Conclusions: Mobile-phone messaging showed a modest effect in improving anti-TB treatment success; however, the quality of evidence was low. Further controlled studies are needed to increase the evidence-base on the role of mHealth interventions to improve TB care. Protocol registration number: CRD420170744339. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017074439
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Folate is an important regulator of hippocampal neurogenesis, and folic acid is needed prenatally to reduce the risk of neural tube defects in utero. Both high levels of folic acid and low levels of folate can be harmful to health, as low levels of folate have been linked to several diseases while high folic acid supplements can mask a vitamin B12 deficiency. Depressed patients exhibit folate deficiencies, lower levels of hippocampal neurogenesis, elevated levels of homocysteine, and elevated levels of the stress hormone, cortisol, which may be inter-related. Here, we are interested in whether different doses of natural folate or synthetic folic acid diets can influence neurogenesis in the hippocampus, levels of plasma homocysteine, and serum corticosterone in adult female rats. Adult female Sprague-Dawley rats underwent dietary interventions for 29 days. Animals were randomly assigned to six different dietary groups: folate deficient + succinylsulfathiazole (SST), low 5-methyltetrahydrofolate (5-MTHF), low 5-MTHF + (SST), high 5-MTHF + SST, low folic acid, and high folic acid. SST was added to a subset of the 5 MTHF diets to eliminate folic acid production in the gut. Before and after dietary treatment, blood samples were collected for corticosterone and homocysteine analysis, and brain tissue was collected for neurogenesis analysis. High folic acid and low 5-MTHF without SST increased the number of immature neurons (doublecortin-expressing cells) within the ventral hippocampus compared to folate deficient controls. Low 5-MTHF without SST significantly increased the number of immature neurons compared to low and high 5-MTHF + SST, indicating that SST interfered with elevations in neurogenesis. Low folic acid and high 5-MTHF+SST reduced plasma homocysteine levels compared to controls, but there was no significant effect of diet on serum corticosterone levels. Low folic acid and high 5-MTHF+SST reduced the number of mature new neurons in the ventral hippocampus (BrdU/NeuN-positive cells) compared to folate deficient controls. Overall folic acid dose-dependently influenced neurogenesis with low levels decreasing but high levels increasing neurogenesis in the ventral hippocampus, suggesting this region, which is important for regulating stress, is particularly sensitive to folic acid in diets. Furthermore, the addition of SST negated the effects of 5-MTHF to increase neurogenesis in the ventral hippocampus.
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The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.
Data Types:
  • Document
Background: Measurement of what knowledge is taken-up and how that information is used to inform practice and policies can provide an understanding about the effectiveness of knowledge uptake and utilization processes. In 2007, the Knowledge Uptake and Utilization Tool (KUUT) was developed to evaluate the implementation of knowledge into practice. The KUUT has been used by numerous large health organizations despite limited validity evidence and a narrow understanding about how the tool is used in practice and interpreted by users. As such, the overall purpose of this protocol is to redevelop the KUUT and gather validity evidence to examine and support its use in various health-related organizations. This protocol paper outlines a validation and redevelopment procedure for the KUUT using the unitary view of validity. Methods: The protocol outlined in this article proceeds through four phases, starting with redeveloping the tool, then evaluating validity evidence based on: test content, response processes and internal structure. The initial phase gathers information to redevelop the tool, and evaluates item content and response format. The second phase evaluates response process validity evidence by examining how a variety of users interact with the tool. In the third phase, the tool will be pilot tested with knowledge users and, in the final phase, psychometric properties of the tool will be examined and a final scoring structure will be determined. A knowledge translation plan described herein outlines where the final tool will be housed and how the information about the tool will be disseminated. Discussion: This protocol outlines a procedure to gather different sources of validity evidence for the KUUT. By addressing limitations in the original KUUT, such as complexities with scoring, a redeveloped KUUT supporting validity evidence will enhance the ability of health-related organizations to effectively use this tool for its intended purpose.
Data Types:
  • Document