Restricted Theses and Dissertations

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Now showing 1 - 5 of 4574
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    Care for Older Adults Living with Dementia in the Emergency Department: Informing the Development of a Clinical Care Pathway
    (2024-06-11) Jelinski, Dana Christine; Goodarzi, Zahra; Holroyd-Leduc, Jayna; Reich, Krista; Lang, Eddy
    Background: People living with dementia (PLWD) are frequent users of the emergency department (ED). PLWD experience adverse outcomes in the ED at higher rates than older adults without dementia, and care partners play a vital role in supporting them. While there is some evidence that exists regarding best practices in caring for PLWD in the ED, there are gaps in evidence on the experiences of caring for PLWD in ED and implementing best practices from the view of healthcare providers (HCPs). Objectives: The objectives of this thesis were to (1) synthesize barriers and facilitators to care for PLWD in the ED through the perspective of care partners as well as HCP perceptions of care partner roles within the ED, and (2) explore barriers and facilitators to care through the perspective of HCPs. Methods: A systematic review and meta-synthesis were conducted following the Joanna Briggs Institute Manual for Evidence Synthesis to synthesize care partner perspectives and roles regarding care for PLWD in the ED. Semi-structured interviews with HCPs were used to directly understand experiences in caring for PLWD in the ED. Results: Care partners and HCPs reported similar barriers and facilitators to care for PLWD in the ED. Key barriers to care included gaps in primary care, the ED environment, and lack of dementia specific guidance and training. Key facilitators included the importance of care partner and patient involvement, and communication and collaboration among care teams. Conclusion: The findings of this study inform the development of interventions that target behavior change and promote dementia friendly EDs. Key implications highlighted in this study include education and training, staffing and environmental changes, and care guidance and policy implementation.
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    The Role and Regulation of Hemoglobin Mass in Endurance Exercise
    (2024-06-05) Kontro, Hilkka; MacInnis, Martin; Sheel, William; Satish, Raj; Aboodarda, Saied Jalal; McGlory, Chris
    Endurance performance relies on sustained oxygen delivery to skeletal muscles. Consequently, the maximum capacity to deliver oxygen is closely related to the total amount of hemoglobin (Hb) in the circulation, hemoglobin mass (Hbmass). Experimental reduction of Hbmass results in lowered oxygen delivery in maximal exercise and hence a lower maximal oxygen uptake (V̇O2max). At submaximal intensities, compensatory adjustments can be employed in response to Hbmass reduction to maintain oxygen delivery, potentially lessening the impact on intensities below V̇O2max; however, data relating to these effects are lacking. While females have a lower [Hb] and lower Hbmass than males, the influence of sex on hematological properties has not been thoroughly investigated. In addition, the regulation of Hb turnover in endurance training is poorly understood, owing to methodological limitations. The purpose of this thesis was to expand on the current understanding about the role and regulation of Hbmass in facilitating endurance exercise. In Study 1 (n=16), reducing effective [Hb] by ~5% using low-dose carbon monoxide inhalation destabilized the maximal lactate steady state. This effect was more prominent in trained individuals, suggesting higher sensitivity to impairments in oxygen delivery. In Study 2 (n=17), Hbmass was reduced by withdrawal of 7% of blood volume through phlebotomy. In a 60-min exercise bout, ventilation, lactate, and heart rate were increased in a time-dependent manner, and time-to-task failure in a subsequent maximal task was reduced. Study 3 explored sex-differences in a pooled analysis (n=79) of four datasets. This cross-sectional study revealed that, due to sex differences in hematological variables, females must achieve a similar fat-free mass-normalized V̇O2max with a lower Hbmass than males. Study 4 (n=5) piloted the use of deuterated water as a metabolic label to quantify the fractional synthetic rate (FSR) of Hb in vivo. The preliminary data showed that this 28-day protocol was feasible and yielded expected FSR values (<1%∙day-1). Future research should explore the mechanisms behind impaired submaximal exercise performance after reduced oxygen delivery; how males and females employ specific strategies to reach a given oxygen uptake; and how Hb synthesis is influenced by sex and regulated in response to exercise training.
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    Investigating the Interprofessional Socialization of Healthcare Educators Following an Interprofessional Simulation Facilitator Training Program: A Mixed Methods Study
    (2024-06-05) Dolan, Sara; Nowell, Lorelli; Moules, Nancy; Brockway, Meredith
    Background: Patient safety incidents due to poor interprofessional collaboration have devastating impacts on patients and their families. Interprofessional socialization can lead to interprofessional collaboration. Interprofessional education is one method used to promote interprofessional socialization. Healthcare educators in the practice setting are tasked with delivering interprofessional education; however, they require specialized skills and interprofessional connections to effectively facilitate interprofessional learning. Although there is literature discussing the interprofessional socialization of students and frontline staff, there is a gap in the literature regarding the interprofessional socialization of healthcare educators in the practice setting. Purpose: The purpose of this research was to examine the experiences and perceptions of healthcare educators in the practice setting regarding interprofessional socialization following an interprofessional simulation facilitator training (SimSkills). Methods: I completed an explanatory sequential mixed methods study, including secondary data from program evaluation surveys (n = 87) and follow-up semi-structured interviews (n= 17), to examine participants perceptions and experiences of interprofessional socialization. In the first (quantitative) phase of the study, data were collected from the provincial simulation program, eSIM, in Alberta as part of an ongoing program evaluation. Attendees of the SimSkills program were invited to complete a retrospective pre-post program evaluation survey to evaluate their attitudes toward interprofessional socialization. In the second (qualitative) phase of the study, semi-structured interviews were conducted to explore the secondary data findings in greater depth. Descriptive and inferential statistics were used to analyze the quantitative data and qualitative data were analyzed using interpretive description. Integration occurred when quantitative data were used to inform the interview guide and qualitative data were used to explain quantitative results. Results: There was a statistically significant increase in the attitude toward interprofessional socialization following the training. Qualitative findings revealed five themes regarding interprofessional socialization: (a) benefits gained through interprofessional socialization, (b) interprofessional, uniprofessional, or both (dual identity), (c) facilitators to interprofessional socialization, (d) barriers to interprofessional socialization, and (f) opportunities to strengthen interprofessional socialization. Conclusion: Healthcare educators have positive views of interprofessional socialization; however, interprofessional socialization behaviors are inconsistent with interprofessional socialization behaviors across settings. Interprofessional learning opportunities may enhance interprofessional socialization among healthcare educators.
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    AI-Assisted Interactive Assistants for Software Issue Report Understanding
    (2024-06-04) Tamanna, Salma Begum; Uddin, Gias; Souza, Roberto; Abdellatif, Ahmad
    Issue reports in software projects often become complex due to their technical details and lengthy discussions, leading to information overload. This complexity can hinder quick understanding of these reports, impacting the development process adversely. This thesis investigates whether automatic assistance can help tackle the problem. It first introduces the iSum (issue summarizer) tool, designed to generate visual summaries of information types present in issue reports and analyze the prevalence and trends of these across a report or a repository. Next, it addresses a RAG-based ChatGPT’s struggle with understanding complex technical content from bug reports and interpreting context from queries for exploring bug reports. Our enhancement, the ChatGPT Inaccuracy Mitigation Engine (CHIME), boosts response correctness of ChatGPT by around 30%. Both iSum and CHIME demonstrate the potential of AI to enhance the comprehensibility of issue reports, taking a step forward in efficient issue understanding.
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    Understanding the Complexities of Transition Readiness in Adolescents and Emerging Adults with Chronic Health Conditions: A Mixed Methods Study
    (2024-05-31) Punjwani, Zoya; Samuel, Susan; Dimitropoulos, Gina; Metcalfe, Amy; Donald, Maoliosa
    Background: The transition from pediatric to adult health care for adolescents and emerging adults (AEA) with chronic conditions is a complex time, associated with gaps in care, poor treatment adherence, and increases in emergency department (ED) visits. Various tools are available to assess AEA readiness to transition, such as the Transition Readiness Assessment Questionnaire (TRAQ). Research is needed to better understand the association between TRAQ scores and transition outcomes and identify gaps that remain in accurately and comprehensively assessing transition readiness. The objectives of this study were to quantitatively examine the associations between TRAQ scores and ED visit rates and utilization of a navigator intervention, as well as qualitatively explore the experiences of AEA related to social-ecological factors of transition readiness. Methods: A patient-oriented, embedded mixed methods study was conducted, with quantitative priority. This study was guided by the Social-Ecological Model of Adolescents and young adults’ Readiness to Transition (SMART) as identified by our patient partners. This model encompasses individual-level factors and the reciprocal interactions between AEA and their surrounding systems, including family, caregivers, healthcare providers, and medical system. Data was obtained from the Transition Navigator Trial (TNT), a pragmatic randomized controlled trial evaluating the effectiveness of a patient navigator for AEA undergoing transition from pediatric to adult healthcare in Alberta, Canada. Results: Quantitatively, higher TRAQ scores were associated with increased ED visit rates. A similar relationship was observed pre-pandemic, with higher TRAQ scores associated with higher navigator utilization. However, post-pandemic onset, higher TRAQ scores were associated with lower navigator utilization. TRAQ scores did not differ across sociodemographic factors such as age, sex, socioeconomic status, ethnicity, immigration status, urban/rural residence, and the presence of a co-occurring mental health condition. Qualitative results highlighted factors extending beyond what was assessed by TRAQ, including insurance barriers, psychosocial impacts of health condition, and the importance of relationships when undergoing transitions in care. Conclusion: This study underscored the multifaceted nature of transition readiness and the gaps in current readiness measures such as TRAQ. Patient partners advocated for improvements in readiness measures, developing recommendations regarding assessing insurance, mental health, skill development, contextual factors, and relationships in readiness measures.