Master of Science / Department of Clinical Sciences / Thomas Schermerhorn / Tonicity is property of a solution that is defined as the total effective (impermeable) osmole concentration that drives fluid movement across a semipermeable membrane via osmosis. Tonicity is related to but distinct from solution osmolality, which is a summation of all solute concentrations, regardless of the solute membrane permeability. In the mammalian body, tonicity is tightly regulated at both a cellular and systemic level; tonic derangements cause rapid change in cell and tissue volume leading to significant dysfunction. Input from the central nervous, circulatory, endocrine, gastrointestinal, and urinary systems are integral to osmoregulation, so many diseases in veterinary medicine are associated with tonicity disorders. However, because the homeostatic mechanisms that control tonicity overlap with those regulating electrolyte and acid-base balance as well as hydration and vascular volume, tonic consequences of disease can be difficult to isolate. Understanding of disease-associated changes in tonicity is further complicated by the fact that the tonic contributions of many solutes that accumulate in disease are unknown. Additionally, direct assessment of tonicity is difficult because tonicity is not just a physiochemical property, but it implies a physiologic effect. Thus, simple summation of osmole concentrations is an inadequate measurement of tonicity. The following report includes three studies investigating various aspects of tonicity as it applies to veterinary patients. Chapter 2 reports a study that examines the tonic effects of ketoacids and lactate using two different in vitro red blood cell assays. Results demonstrated that the ketoacids, beta-hydroxybutyrate and acetoacetate, behave as ineffective osmoles while the tonic behavior of lactate is variable, implying a more complex cellular handling of this anion. Two additional studies examine whether the mean corpuscular volume difference (dMCV) is a novel clinical marker for hypertonicity in dogs. Results of separate retrospective (Chapter 3) and prospective (Chapter 4) studies provide evidence that dMCV is a useful clinical marker for hypertonicity in dogs.

Current understandings of aging and the life course are largely based on taken-for-granted hetero-normative assumptions. Gay men lack aging road maps that are unique to their life course experiences and which consider the changing contextual and social conditions that shape their participation choices in family and community roles. This is particularly so for gay men aging in rural environments as most studies of aging gay men focus on the urban experience. This study adds to understandings of aging and the life course by examining the lives of three gay men aging in rural environments. I use a life history approach to shed light on how sexual identity development and marginalization within rural environments intersect with shifting social contexts to shape the aging process in terms of engagement in social role opportunities, namely, community and family participation. As a life course researcher, I pay particular attention to the tensions between individual agency and structural constraints and how they are revealed through the life histories. Epistemological and methodological assumptions based on social constructivism, critical and queer theory inform the study while my own lived experiences as a gay man and an occupational therapist practitioner and educator ground the study. Cross-cutting themes identified in the life narratives reveal connections between sexual identity development and the coming out processes with patterns of social relationships and the gay aging process. These themes are then discussed in terms of their relevance to broader aging and life course constructs including generativity, social capital and gay aging; agency and structure in identity development; and expanded notions of family and social support for gay men. Findings from this study have implications for current explanations of ageing and life course processes; challenge limiting stereotypes of older gay men; inform health and social service professionals who work with older gay people; and provide examples of alternative queer life pathways for gay people of all ages.

La réflexion est considérée comme un élément significatif de la pédagogie et de la pratique médicales sans qu’il n’existe de consensus sur sa définition ou sur sa modélisation. Comme la réflexion prend concurremment plusieurs sens, elle est difficile à opérationnaliser. Une définition et un modèle standard sont requis afin d’améliorer le développement d’applications pratiques de la réflexion. Dans ce mémoire, nous identifions, explorons et analysons thématiquement les conceptualisations les plus influentes de la réflexion, et développons de nouveaux modèle et définition. La réflexion est définie comme le processus de s’engager (le « soi » (S)) dans des interactions attentives, critiques, exploratoires et itératives (ACEI) avec ses pensées et ses actions (PA), leurs cadres conceptuels sous-jacents (CC), en visant à les changer et en examinant le changement lui-même (VC). Notre modèle conceptuel comprend les cinq composantes internes de la réflexion et les éléments extrinsèques qui l’influencent. / Although reflection is considered a significant component of medical education and practice, the literature does not provide a consensual definition or model for it. Because reflection has taken on multiple meanings, it remains difficult to operationalize. A standard definition and model are needed to improve the development of practical applications of reflection. In this master’s thesis, we identify, explore and thematically analyze the most influential conceptualizations of reflection, and develop a new theory-informed and unified definition and model of reflection. Reflection is defined as the process of engaging the self (S) in attentive, critical, exploratory and iterative (ACEI) interactions with one’s thoughts and actions (TA), and their underlying conceptual frame (CF), with a view to changing them and a view on the change itself (VC). Our conceptual model consists of the five defining core components, supplemented with the extrinsic elements that influence reflection.

Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / The Centers for Disease Control and Prevention estimated that one in six Americans become ill,128,000 are hospitalized, and 3,000 die each year due to foodborne illness. Children are at a higher risk of acquiring foodborne illness than adults for several reasons, including: an immune system that has yet to fully develop, limiting their ability to fight infections; a lack of control over the food they consume because their meals are usually provided by others; and the lack of awareness of food safety risks. Thus, it is critical to ensure that childcare center employees practice safe food handling. The purpose of this study was to explore the food safety knowledge, practices, and barriers to safe food handling practices of childcare center employees. Observations were conducted in 10 childcare centers in Manhattan, Kansas. Each childcare center was observed for two days during lunch preparation and service. Observations of foodservice employees were conducted in the kitchen using a structured observation form. Teacher observations were conducted in the classroom using detailed notes. A questionnaire was used to collect demographic, food safety training, and food safety knowledge information. SPSS (v. 20.0) was used to analyze data. Childcare center employees had high average scores on the safety knowledge assessment. The majority of employees received some type of food safety training. Time pressures, availability of equipment, and small food preparation space were found as the main barriers to implementing safe food handling. Childcare center foodservice workers and teachers were knowledgeable about handwashing and time/temperature control, but failed to utilize on the job. Results of this study will help childcare educators to develop materials to improve food safety practices and encourage owners/managers of childcare centers to enhance their food safety behaviors.

Master of Science / Department of Human Nutrition / Mary Meck Higgins / Because of the ever-changing nature of the economy and the food environment, research as recent as 2010 may not be relevant to today’s discussion on food insecurity, food deserts, obesity rates, and nutritional quality in the U.S. population’s diet. Today, people of low socioeconomic status in the U.S. are at risk for overweight, obesity, and chronic illnesses such as type 2 diabetes, hypertension, and certain cancers. In this report, I investigate published research about low-income populations in the U.S. relative to the food environment and describe implications for healthcare professionals implementing interventions with these populations, discussed in the following categories: Dietary Intake Quality and Socioeconomic Status; Food Insecurity; Barriers to Quality Food Access in the U.S. Food Environment; Communities Alleviating Food Insecurity; Food-Related Perceptions, Attitudes, and Behaviors; Homelessness and Food-Related Behaviors; Why Do People Buy What They Buy?; Nutrition Assistance Programs and Policies; Current U.S. Food Costs; and Comparing the Nutritional Value Versus Price of Foods. Although the literature on the subject of low-income diet quality is thorough, much of it needs to be updated with current data on food prices, food environments, and U.S. diet quality. For this purpose, I compiled the most recent data from the National Bureau of Labor & Statistics on food prices to discuss the elevated food prices of healthful foods as opposed to less healthful foods. I also created a one-month menu based on the U.S. Department of Agriculture’s Thrifty Food Plan budget allowance in order to follow a healthful diet in this harsh economic climate utilizing the Dietary Guidelines for Americans 2010 and the Affordable Nutrients Index.

This five-paper thesis explores office workers perceptions of green roofs and how this influences their health/well-being in Toronto and Chicago. Paper 1 examines the underlying paradigms and world-views of major research programs that look at the human relationship to nature and health/well-being, showing that despite some convergence between their methods and integration of different paradigms, continued differences and lack of clarity on the normative assumptions underlying each approach leads to confusion in the specification of ‘nature’ in health/well-being and place research. Paper 2 is a comparative analysis of the implementation of green roof policies in Toronto and Chicago. Paper 2 demonstrates the importance of ‘selling’ green roofs by linking them to larger environmental programs and of the municipal power structure that influences how and if environmental programs are implemented. Paper 3 examines the awareness, attitudes, and feelings towards green roofs by office workers with access to them (visual or physical) from their workplace in Toronto and Chicago. Using a phenomenological analysis of semi-structured interviews (n=55), Paper 3 shows that the hinterland, expectations of different kinds of ‘nature’ and aesthetics in the city, and access all influence perceptions of green roofs and sense of place. Paper 4 explores office workers awareness of and attitudes towards green roofs and the possible influence on their well-being in Toronto and Chicago from a large survey (n = 903). Participants showed a high literacy on the environmental benefits of green roofs. Chi-square analysis showed mixed results for health, but a significant association between visual access to a green roof and improved concentration. Paper 5 tests whether the relationship found in Paper 4, improved concentration with visual access, was still significant when other confounding variables were added to the model. Using a logistic regression on the same survey population (subset n =505), results found that concentration was no longer significant but that there was a trend towards improved concentration.

Background: The provision of healthcare for immigrants is a global issue. Understanding the complexities of migrant’s experiences seeking healthcare is essential to improving their ability to access healthcare. This qualitative study reports on the experiences seeking healthcare for three groups of migrants. Methods: Seventeen one-on-one interviews were conducted with Spanish-speaking women through an interpreter. Community-based participatory action research was the framework utilized for this study. Results: An individual’s immigration status emerged as the single most important factor affecting both an individual’s ability to seek out healthcare and what their experiences are when trying to access healthcare. Conclusion: This study brings to light two issues that are not discussed in great depth in the migrant health service literature. The immigration status of migrants is the largest factor affecting their ability to seek healthcare. Food security is a very stressful issue for many refugees and undocumented immigrants.

Background: The provision of healthcare for immigrants is a global issue. Understanding the complexities of migrant’s experiences seeking healthcare is essential to improving their ability to access healthcare. This qualitative study reports on the experiences seeking healthcare for three groups of migrants. Methods: Seventeen one-on-one interviews were conducted with Spanish-speaking women through an interpreter. Community-based participatory action research was the framework utilized for this study. Results: An individual’s immigration status emerged as the single most important factor affecting both an individual’s ability to seek out healthcare and what their experiences are when trying to access healthcare. Conclusion: This study brings to light two issues that are not discussed in great depth in the migrant health service literature. The immigration status of migrants is the largest factor affecting their ability to seek healthcare. Food security is a very stressful issue for many refugees and undocumented immigrants.

Using critical feminist theories and methodologies, my research investigates the power relations and influences at play within the field of children's environmental health. I begin with the research question of how a parent's everyday purchase of a toy or other children's product is "hooked into" extra-local governance (agenda-setting, rule-making and monitoring). Focusing on Bisphenol A and phthalates as an example, in-depth interviews were conducted with six government officials (three federal and three municipal), three non-governmental organization (NGO) representatives, a politician, six higher education faculty members and a parent, as well as two focus groups of 23 parents. Legislation and other relevant documents from governments, NGOs, industry and media were analyzed together with reports of their activities and attitudes to theorize "how things work" in the identification and management of toxic substances in products for sale, with a special interest in how this affects children's environmental health. My research revealed the influence of neo-liberalism, corporate power and over-reliance on strictly evidence-based biomedical reductionism in slowing down assessment and regulation of chemicals while many health professionals and grassroots activists have called for swifter responses based on the precautionary principle, as favoured by European governments. That is, politics and bureaucracy, with the approval of industry, over the past two decades, have clung to reductionist science as the only paradigm for understanding toxicity, thus slowing down regulatory processes. Although the historical and epistemological power relations mapped in my research work together to legitimize scientific certainty rather than the precautionary principle, I argue that the resulting regulatory logjam has been and could be addressed by reference to European examples, knowledge produced by collectives and the establishment of upstream and equity-based public health strategies with public input into the process.

The major global concern of preventing the spread of Human Immunodeficiency Virus (HIV) requires that millions of people be tested in order to identify those individuals who need treatment and care. This study’s purpose was to examine the role of social networks in an individual’s decision to test for HIV. The study sample included 62 participants of African and Caribbean origin in Toronto, Canada. Thirty-three females and 29 males, aged 16 to 49 years who had previously tested positive or negative for HIV, participated in interviews that lasted approximately 60 minutes. Measurement instruments adapted from Silverman, Hecht, McMillin, and Chang (2008) were used to identify and delimit the social networks of the participants. The instrument identified four social network types: immediate family, extended family, friends, and acquaintances. The study examined the role of these network types on the individuals’ decisions to get HIV testing. A mixed method approach (Creswell, 2008) was applied, and both qualitative and quantitative data were collected simultaneously. Participants listed their social networks and retrospectively described the role of their network members in influencing their decision to test for HIV. The participants’ narratives of the influence of social networks in HIV testing were coded. A thematic analysis of the qualitative descriptions of the network members’ influence was performed. The quantitative and the qualitative analysis results were then tallied. The results of the study demonstrated that the influence of social networks was evident in the individuals’ decisions to test for HIV. The most influential group was friends, followed in descending order of influence by immediate family, acquaintances, and extended family. These social network ties provided informational, material, and emotional support to individuals deciding to seek HIV testing. For policy makers and health professionals, coming to a more complete understanding of these dynamics will enable them to make institutional decisions and allocate resources to improve and enhance the support available from within these social networks, thus encouraging, promoting, and leading to increased testing for HIV.