Master Theses & Projects (FHSCI)
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Item Acute cardiopulmonary responses to different intensities of exercise in healthy older adults(2019-12-01) Linares, Andrea; Dogra, ShilpaThe overall purpose of this thesis was to study the acute cardiopulmonary responses to different intensities of exercise in healthy older adults. Thirty healthy older males and females (69.6 ǂ 6.2 yrs.; males n = 15) underwent maximal exercise testing to determine maximal oxygen consumption (VO2MAX) and peak power output (PPO), and completed each of the following exercise protocols in a randomized crossover design: high intensity interval exercise (HI; 1 minute 90% PPO followed by 1 minute 10% PPO, x10), continuous moderate intensity exercise (MOD; 20 minutes at 50% PPO), and sprint intensity interval exercise (SPRT; 20 second “all-out” sprints followed by 2 minutes of 50W, x3). Oxygen consumption (VO2), ventilation (VE), tidal volume (Vt), respiratory rate (RR), heart rate (HR), tissue saturation index (TSI) of the vastus lateralis and rated perceived exertion (RPE) were monitored during exercise sessions. Heart rate recovery (HRREC) was assessed after each exercise session and heart rate variability (HRV) was compared using resting and post-exercise values. Overall, it was found that high fit individuals attained the greatest VO2 peak during MAX while low fit females attained a larger VO2 peak during SPRT compared to MAX. The rate of HRREC was greatest in high fit males. These findings have important implications for the individualization of exercise prescription, Future research will need to compare the three different types of exercise training to determine which protocol leads to larger adaptations in older adults.Item The acute response to high intensity interval exercise in adults with exercise induced bronchoconstriction(2016-05-01) O'Neill, Carley; Dogra, ShilpaINTRODUCTION: Exercise induced bronchoconstriction (EIBC) occurs as a result of airway cooling and drying in adults with airway hyperresponsiveness (AHR). Continuous exercise leads to a significant decline in lung function; however, interval exercise may allow ventilation to recover and prevent EIBC. PURPOSE: To determine the acute response of lung function and the subjective perceptions during and after a bout of high intensity interval (HIIE), moderate intensity interval (MIIE), and moderate intensity continuous (MICE) exercise in adults with AHR. METHODS: Participants completed an acute bout of HIIE, MIIE, and MICE. Lung function was assessed pre and post-exercise while late phase symptoms were reported using a log and subjective responses were assessed during each minute of exercise. RESULTS: Thirteen participants with EIBC completed all protocols. Lung function was significantly lower following the MICE and perceptions of effort and dyspnea were higher. CONCLUSION: It appears HIIE is well tolerated among adults with AHR.Item The acute response to sprint interval exercise and moderate intensity continuous exercise in adults with and without airway hyperresponsiveness(2017-07-01) Good, Joshua; Dogra, ShilpaIntroduction: Sprint interval exercise (SIE) has been proposed as a time efficient way to improve physical activity levels; however, SIE has not been studied in adults with airway hyperresponsiveness (AHR). Methods: Eight adults with AHR and eight adults without AHR completed both SIE (4x30 second sprints at 7.5% body weight) and moderate intensity continuous exercise (MICE) (20 minutes at 65% peak power output). Spirometry, ventilatory measures, tissue oxygenation, and subjective responses were assessed prior to, during, and following exercise. Results: The decline in forced expiratory volume in one second was similar following SIE and MICE. Ventilatory measures, tissue oxygenation, and subjective responses were similar in the AHR group compared to those without AHR. Differences were observed in affect, breathlessness, and exertion between SIE and MICE at the onset of exercise. Conclusions: SIE appears to be feasible in adults with AHR; this may have implications for exercise prescription in this population.Item Alteration in neck neuromuscular responses and upper limb proprioception in response to neck muscle fatigue(2014-07-01) Zabihhosseinian, Mahboobeh; Murphy, Bernadette; Holmes, MichaelNeck and upper limb disorders constitute two of the most frequent musculoskeletal problems that place a huge burden on the healthcare system. Neck muscles have a very high density of muscle sensory input to the central nervous system (CNS) and are known to play an important role in sensory motor integration of upper limb movements. The CNS uses the position of the head and neck in interpretation of upper limb joint position sense (JPS). Therefore, any altered neuromuscular function of the cervical extensors has the potential to impair the awareness of upper limb joint position which is critical for carrying out smooth, purposeful movements. Despite this, only a small amount of basic science research has attempted to explore the relationship between altered afferent input from the neck on both neck and upper limb neuromuscular control. Additionally, the cervical flexion relaxation ratio (FRR) is a reliable and reproducible neuromuscular marker, which has been shown to differentiate between neck pain patients and healthy controls, and presents an objective way to measure changes in neuromuscular function. Induction of fatigue provides an experimental method for altering afferent input from the neck muscles to the CNS, enabling the effects of both neck muscle function and upper limb JPS to be investigated in an experimental setting. Studies in this thesis sought to investigate whether the elbow JPS and neck FRR can be altered by fatigue of the cervical extensor muscles (CEM). This study revealed that CEM fatigue decreased the cervical FRR, by increasing the EMG activity in relaxation phase, and reduced the accuracy of elbow joint position matching in healthy individuals. Whereas, slightly expanded the FRR in subclinical neck pain patients, by increasing the EMG activity in re-extension phase. This work has important implications for our understanding of the mechanisms that the CNS uses to stabilize the neck in the face of altered afferent input, and the implications that this may have for upper limb proprioception and associated motor performance.Item Alterations in neck muscle performance and proprioception with fatique, altered posture and recurrent neck pain(2011-07-01) Barker, Ian; Murphy, BernadetteAltered neuromuscular processing and motor output as both a risk and perpetuating factor for chronic neck pain is a relative new area of study. The cervical flexion relaxation response (FRR) is a reproducible and reliable marker of differences in neuromuscular function between neck pain patients and controls. Change in joint position sense (JPS) of upper limb joints has also been linked to chronic neck pain. Studies in this thesis sought to develop an experimental model in humans to investigate whether the FRR and JPS can be altered by fatigue and/or postural stress. Additionally a pilot study on the effect of three months of chiropractic treatment on the FRR was conducted. The studies revealed that muscular fatigue is a modulator of the FRR and may play a large role in spine stabilization. Minor postural alterations in the neck can impact joint position error at the elbow and 12 weeks of chiropractic care is a useful therapy to improve chronic and recurrent neck pain as well as improving the cervical FRR.Item Annual incidence of traumatic brain injury among Ontario adults with and without intellectual and developmental disabilities and 30-day readmissions(2019-07-01) Seto, Katherine; Balogh, RobertThis thesis examines Ontario adults with and without intellectual and developmental disabilities (IDD), to identify traumatic brain injury (TBI) incidence and the impact of TBI history on 30-day readmissions. Objectives: 1) compare TBI incidence between adults with and without IDD over time and by demographic characteristics; 2) compare odds of 30-day readmissions between adults with IDD, history of TBI, or both in 2016/17. Manuscript 1: Using a historical cohort design, TBI incidence was greater among adults with IDD versus without in all 15 study years. Manuscript 2: This historical cohort study determined that having IDD or IDD and a history of TBI increased the odds of 30-day readmissions versus history of TBI only. Conclusion: Results of this thesis suggest that among adults with IDD, risk of TBI is higher versus those without IDD, and 30-day readmissions are similarly increased among those with IDD with or without a history of TBI.Item Antipsychotic prescribing as a treatment of dementia in British Columbia: physician-level characteristics associated with receiving potentially inappropriate prescriptions(2023-04-01) Littleford, Stephanie; Rudoler, DavidAntipsychotic prescribing has increased. One attribute of this is off-label prescribing of antipsychotics to people with dementia to treat behavioural and psychological symptoms, which is not supported by evidence-informed guidelines. This manuscript investigated physician-level factors associated with prescribing antipsychotics to community-dwelling adults with dementia by primary care physicians in British Columbia. Most physician variables were not associated with a patient being dispensed an antipsychotic. A physician’s years in practice was significantly associated with a patient’s risk of receiving an antipsychotic. Patients who received an antipsychotic were older, had lower incomes, used more prescriptions, contacted a physician more, and had higher comorbidity scores compared to patients who did not receive an antipsychotic. Rarity of outcomes, decreased rate of antipsychotic prescriptions, and little indication of practice-variation indicated physicians appropriately prescribe antipsychotics to patients with dementia. Future studies should investigate career-variation, apply similar methodology in regions of Canada, and investigate qualitative factors associated with antipsychotic prescribing at the physician- and patient/caregiver-level.Item Approaches to accountability in city of Toronto long-term care homes(2018-12-01) Wyers, Lindsay; Gamble, BrendaWithin the context of healthcare accountability are concepts such as quality and safety of care, resource allocation and the notion of value for money. When understanding accountability, questions such as who is accountable for what and how is accountability demonstrated arise. As the number of stakeholders and funders increase, and in a highly regulated long-term care sector, the answers to these questions increase in complexity. The goal of this study is to examine the approaches to accountability within ten homes that are publicly funded and publicly delivered by the City of Toronto, within a framework of accountability mechanisms including financial oversight, regulations and information, and professionalism. A case study research design, with both document review and semi-structured interviews, was utilized to understand the implications of key variables on the framework to evaluate accountability. The results are based on seven informants from publicly funded and delivered homes in the province of Ontario both from senior management and long-term care home administrators. The dominant mechanisms of accountability found in this research are financial oversight, regulations, and information, while professionalism played a marginal role. Key informants identified the challenges of being accountable to multiple funders, including five LHINs and to the City of Toronto. The increased need to be compliant with legislation requirements, LHIN performance indicators, and ensure high-quality resident care is not consistent with the finite and decreasing resources required to successfully demonstrate accountability to multiple stakeholders.Item Approaches to accountability in the medical laboratory sector in Ontario.(2013-10-01) Bourne, Lavern; Gamble, BrendaPurpose: Greater accountability within the Ontario medical laboratory sector is a high priority and desirable. This sector provides approximately 80% of the objective data for diagnosis, monitoring and treatment. The goal of this study is to determine how accountability is defined, and the advantages and challenges of the approaches used in this sector. Methodology: A case study design based on a mix methods approach incorporating quantitative (i.e., scoping review of documents) and qualitative data (i.e., 20 semi-structured interviews) to examine the approaches to accountability in the medical laboratory sector and the implication of core independent variables on the approaches used. Key stakeholders in the medical laboratory sector were interviewed to determine views on the advantages and challenges of the possible approaches. Results The four approaches to accountability used in the medical laboratory sector are: financial incentives, regulations, information directed towards potential users, reliance on professionalism and stewardship. Regulation is the main approach to accountability in the medical laboratory sector. Ontario Laboratory Accreditation and licensing by the Ontario government is mandatory in all laboratories except those found in physicians’ offices. There were variations in the approaches to accountability based on core independent factors such as: policy goal being pursed, the governance /ownership structures and the goods and services being delivered and their production characteristics. Laboratory services are delivered by public health, hospitals, large community based laboratories and small laboratories often found in physicians’ offices. Key informants identified quality and safety as top priorities regardless of the approach that is used. Concern for costs and resources exists within the sector as a whole. Laboratory results gain much of their value by being embedded within a system of care, in which providers order tests appropriately and are aided in interpreting and acting upon their results. The pre/post analytical stages are just as important as the analytical stage in measuring performance and ensuring validity, reliability and accountability. Conclusion: While the medical laboratory sector is highly regulated, the implementation of additional mechanisms to enhance accountability in the pre/post analytical phases is needed. The importance of this is further highlighted by the advancement of point of care testing at the bedside, the pharmacy and at home which is not fully captured by the accountability mechanisms currently in place. Advances in new technologies such as molecular and genetic testing will also impact future accountability in the medical laboratory sector.Item Assessing neurophysiological and behavioural outcomes of the proximal upper limb muscles in response to novel motor skill acquisition(2017-08-01) O'Brien, Sinead; Murphy, Bernadette; Yielder, PaulA single session of motor training with the distal upper limb muscles leads to changes in brain and spinal cord processing. However, the neuroplastic response of the proximal upper limb muscles to novel motor training has not been studied. The development of a proximal motor task which shows neurophysiological changes in response to motor learning will allow for future investigation of the neurophysiological changes associated with common occupational postures and movements, and provide a way to assess the neural consequences of ergonomic modifications on neural plasticity. This thesis found significant changes in neural activity, measured using somatosensory evoked potentials (SEPs) following a single session of motor training session with the proximal upper limb task. Additionally, sex-based differences in motor task performance were seen for the proximal upper-limb task, indicating a male advantage to gross motor tasks, with no sex differences seen when the same task was performed using the thumb.Item The association between sleep quality and anxiety among postsecondary students(2022-05-01) Albrecht-Bisset, Magdalena; Papaconstantinou, EfrosiniIntroduction: Poor sleep quality has been associated with anxiety in postsecondary students. However, high-quality epidemiological evidence about this association is lacking. Purpose: To determine whether poor sleep quality is associated with anxiety in undergraduate university students. Methods: Two studies were conducted. First, a systematic review of the literature was conducted on the association between poor sleep quality and anxiety. Second, the association between poor sleep quality and moderate to extremely severe anxiety was measured in a cross-sectional study in postsecondary students enrolled in two faculties at Ontario Tech University (formerly known as he University of Ontario Institute of Technology) and the Canadian Memorial Chiropractic College during the 2017 fall academic term. Results: After screening and critically appraising all relevant articles, 27 of 28 studies reported a significant association between sleep quality and anxiety. Results from the cross-sectional study show that students who reported poor sleep quality were more likely to report moderate to extremely severe anxiety. Conclusions: Both studies suggest that poor sleep quality is associated with anxiety in postsecondary students. To determine if poor sleep quality is an independent risk factor for anxiety in Canadian postsecondary students cohort studies are needed.Item The associations between physical activity, sedentary behaviour and anxiety in post-secondary students(2020-11-01) Short, Michael; Cote, PierreIntroduction: The prevalence of anxiety is high in post-secondary students and most do not meet recommended physical activity levels. It is hypothesized that low levels of physical activity may be associated with anxiety in post-secondary students. Purpose: To determine whether physical activity and sedentary behaviour are associated with symptoms of anxiety in post-secondary students. Methods: Systematic review of the literature and cross-sectional study of undergraduate students in two Faculties at University of Ontario Institute of Technology. Results: The systematic review provides inconclusive evidence for the association between physical activity, sedentary behaviour and anxiety. The cross-sectional study suggests that muscular strengthening is associated with anxiety in the Faculty of Health Sciences and that aerobic physical activity is associated with anxiety in the Faculty of Education. No association was found between sedentary behaviour and anxiety. Conclusion: Physical activity is associated with anxiety in post-secondary students. More research is required to understand causal relationships of this association.Item Audiovisual multisensory integration in young adults with and without a diagnosis of Attention-Deficit/Hyperactivity Disorder(2018-08-01) McCracken, Heather; Yielder, Paul; Murphy, BernadetteAttention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with behavioural and neurophysiological characteristics. Several cortical structures that are altered in ADHD are involved in the process of multisensory integration (MSI). MSI is a fundamental form of sensory processing involved in many everyday tasks. Therefore, it is important to know whether those with ADHD experience altered MSI. Two different paradigms were used to assess MSI in adults with a diagnosis of ADHD. First, a simple response time (RT) task was completed. Electroencephalography (EEG) analysis revealed that those with ADHD had MSI occur, while there were significant differences in brain activity between groups. Study two employed a two-alternative forced-choice discrimination task. Those with ADHD responded faster than controls. EEG analysis revealed that those with ADHD have enhanced MSI. Activity differences were found in brain regions that are structurally altered in those with ADHD, indicating that structural alterations in ADHD may promote sensory processing.Item Automated partial premature infant pain profile scoring using big data analytics(2017-04-01) Naik, Tanvi; McGregor, CarolynLack of valid and reliable pain assessment in the neonatal population has become a significant challenge in the Neonatal Intensive Care Unit (NICU). Current practice in the NICU involves the meticulous, time-consuming and potentially bias process of manual interpretation of pain scores. In an attempt to forego the manual scoring system, this thesis presents an initial framework to automate a partial pain score for newborn infants using big data analytics that automates the analysis of high speed physiological data. The design of the novel Artemis Premature Infant Pain Profile (APIPP) is proposed in this thesis. An ethically approved retrospective clinical research study was performed to calculate APIPP scores from premature infant data collected from the Artemis platform. Using the Premature Infant Pain Profile (PIPP) as the base gold standard scale, scoring techniques were automated to create data abstractions from the physiological streams of Heart Rate (HR) and Oxygen Saturation (SpO2). These were then brought together to compute an automated partial pain score (APIPP) that was based on gestational age, HR and SpO2. Through the retrospective clinical research study, and to evaluate the effectiveness and feasibility of automating the scale in the future, APIPP was retrospectively compared with the PIPP which was manually scored by nursing staff at The Hospital for Sick Children, Toronto. Furthermore, the characteristics in HR were also assessed in a thorough manner by preforming statistical tests to assess the resourcefulness of HR as a measure to identify a pain response. Future research will focus on the clinical validation of this work by carrying out prospective research to implement an algorithm based on the design proposed in this thesis that can be integrated into a clinical decision support system named Artemis.Item Automated sleep-wake cycling detection in neonates from cerebral function monitor signals.(2014-12-01) Fontana, Nick; McGregor, CarolynThis thesis presents a link between a clinical need involving the analysis of high frequency physiological data and the informatics and technology designed to automate these specific clinical rules. An algorithmic design for the automated detection of sleep-wake cycling patterns in neonates aged 29-44 weeks gestational age via cerebral function monitor signal is presented in this thesis. The design also includes the automation of impedance levels and background classification of electrical activity via cerebral function monitor signal. The relevance of these algorithms is demonstrated within the neonatal intensive care unit as this monitor is commonly used at the bedside of critically ill infants. The design composition determines analyzable and clinically relevant data through the assessment of impedance levels associated with the cerebral function monitor signal, then the overall background classification of the infant’s cerebral electrical activity which indicates whether or not sleep-wake cycling can be present in the signal trace. A third output is the detection of sleep-wake cycling. Current practice in an intensive care setting involves the meticulous and time-consuming process of manual interpretation by a health care professional, subsequently the automation of these processes has the potential to reallocate the use of resources in the form of staff, increase the rate at which the current practice takes place, improve the timing of medical intervention to allow for maximal neurological development in patients as well as facilitate comprehensive analysis with other physiological data streams in unison to deliver enhanced decision making. Performance of the algorithms in comparison to expert clinical annotation resulted in concordance values of 95.70% for impedance, 78.49%, 81.25% sensitivity and 75.32% specificity for sleep-wake cycling and finally 76.34% for background classification. Through this retrospective analysis of de-identified patient data it was determined that this can be applicable to a real-time computer software environment enabled by stream computing.Item Barriers to patient enrolment in oncology clinical trials at a Canadian regional cancer centre: a mixed methods study(2022-12-01) Singson, Angelina R.; Sanchez, OttoBackground: Randomized controlled trials are required to assess the safety and efficacy of new cancer medications in humans for marketing approval. Thereby, efforts to inform strategies to improve low enrolment rates are imperative to prevent slower rates and increased cost of development. The aim of this study was to identify and examine the impact of barriers to clinical trials enrolment at the R. S. McLaughlin Durham Regional Cancer Centre (DRCC). Methods and Results: A mixed-methods approach was used for this study and the following methods were used: (1) Retrospective exploratory analysis, (2) Patient surveys, (3) Key informants semi-structured interviews. Results were analyzed using Ford's (2008) framework to categorize barriers as they pertain to awareness, opportunity, and decision to take part in oncology clinical trials. The results of this study support previous literature and was the first study to use both qualitative and quantitative to explore enrolment at the DRCC.Item Baseline comparability to accelerometry data and changes in standing balance over the course of an athletic season using a postural sway assessment tool(2016-01-01) Riley, Patricia A.; Murphy, Bernadette; Holmes, MichaelChanges in balance ability can be a sensitive measure of post-concussion changes in brain function. However there is a need to determine the most reliable, valid and practical ways to assess balance abilities (i.e. degree of postural sway). The Sway Balance™ System is a mobile software application that uses the tri-axial accelerometer located within an iOS device to quantify thoracic sway. The software relies on comparing the individual’s post-concussion score to baseline scores obtained at the start of an athletic season. However, in youth athletes in particular, balance may change over the course of the season, worsening due to factors other than concussion, such as lower limb injuries, or improving as fitness improves. This study first compared baseline Sway Balance™ scores to the industry standard accelerometer data recorded from the sternum and attached externally to the iOS device in an elite youth (aged 16 to 20) lacrosse team. We found that balance scores derived from Sway Medical’s algorithm had moderate to very strong validity when compared to laboratory accelerometers. We then assessed the reproducibility of the Sway Balance™ System at 5 and 10 weeks relative to baseline. Correlations ranged from weak to excellent depending on which weeks were compared. Variations were observed in some of the athletes’ balance scores over the 10 weeks, and in overall group differences at different measurement points. This work indicates that while software such as the Sway Balance™ System has the validity to act as a balance measure, there is considerable work needed in protocol development to ensure that a change in score genuinely reflects a change in balance in concussed athletes.Item Before and during COVID-19: parent experiences, perceptions, and preferences regarding community-based physical activity(2021-08-01) Labonté, Kyra; Lloyd, MeghannParticipation in community-based recreational physical activity can provide health benefits for children with intellectual and/or developmental disabilities (IDD). This descriptive thematic study aimed to explore and describe the experiences of parents (N=6) of 11 children with IDD (age 4-11) with community-based recreational physical activity before and during the COVID-19 pandemic through online semi-structured interviews. Four main themes emerged from the parent’s descriptions of community-based physical activity participation before the pandemic: Personal experiences in recreation, barriers to community-based recreational physical activity participation, facilitators to community-based recreational physical activity participation, and intrinsic value. Parents’ descriptions of physical activity participation during the pandemic resulted in three main themes: COVID-19 and IDD, impact on recreational physical activity, and insights from COVID-19. The results from this study suggest that community-based recreational physical activity is highly valued by parents of children with IDD and that it belongs on the continuum of intervention services that family’s access.Item Behavioural and neurophysiological measures of haptic feedback during a drilling simulation(2019-08-01) Grant, Brianna L.; Yielder, Paul; Murphy, BernadetteVirtual environments (VEs) and computer-generated simulations are becoming more prevalent as tools for education, rehabilitation, and training purposes. As technology enhances the quality and quantity of human-machine interfaces, it is essential that we expand our understanding of multimodal interactions, and how they influence our virtual experience and associated brain activity. Haptic sensation, or touch, is often neglected in VE research. In this thesis, Study 1 showed that haptic force-feedback in a drilling simulation improved motor performance and ratings of perceived reality, as compared to trials without haptic feedback. Study 2 used electroencephalography measures and demonstrated greater desynchronization in trials with haptic feedback, as compared to trials without haptic feedback. Large effect sizes were found between haptic and non-haptic trials in the alpha frequency band (8-13 Hz). This work provides evidence that task-relevant haptic feedback can enhance motor performance, and may facilitate motor learning processes.Item Biomechanical and physiological demands associated with laptop and smartphone use in both a subclinical neck pain and healthy student population(2016-09-01) Breitner, Victoria Anna; Holmes, MichaelThe purpose of this thesis was to determine if flexed head and neck postures during long duration mobile device use will increase discomfort in two groups (healthy and neck pain – NP), or if a NP group would experience higher discomfort levels, increased neck muscle activity and examine if the NP group produces different cervical spine kinematics compared to healthy individuals. Eighteen University of Ontario Institute of Technology students completed two mobile device tasks (a one hour laptop and a 30 minute smartphone task). Participants completed three questionnaires, head and thorax kinematics were monitored, surface electromyography (SEMG) was monitored from six upper extremity muscles bilaterally (cervical extensors, upper trapezius and anterior deltoid) and electrocardiogram (EKG) monitored heart rate and breathing. Some significant differences between the smartphone and laptop tasks were identified. This work is important because it evaluated long duration smartphone and laptop computer usage, which has seen limited attention in the academic literature to date.