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The purpose of the study was to compare traditional functional analysis procedures (isolated contingencies) to functional analysis procedures which are modified to include nuanced environmental variables (synthesized contingencies) for children in an outpatient setting in order to determine sensitivity to the isolated or synthesized contingencies. A multi-element design embedded into a multi-treatment design was used to evaluate differentiated rates of challenging behavior across the two analyses for three children exhibiting challenging behaviors. The results supported the utility of the traditional functional analysis (FA) procedures when compared to that of the interview informed synthesized contingency analysis (IISCA) for one of three participants.

The purpose of this study was to address gaps in the trauma treatment literature related to the expense and inaccessibility of evidence-based interventions for children with disabilities who have experienced trauma. Another aim of this study was to provide additional support for a newly piloted intervention for children with disabilities who have experienced trauma. This intervention is known as Smart Start: Parenting Tools for Children with Developmental Delay, Social-Emotional Concerns, and Trauma. A non-concurrent multiple baseline method was used to determine whether there was a functional relationship between the intervention and children’s challenging behaviors for five caregiver-child dyads. In addition, three of five caregiver-child dyads were assessed for improvements in child PTSD symptomatology, positive parenting practices, parenting stress, and treatment acceptability. Results from visual analysis, masked visual analysis, and hierarchical linear modeling were mixed, but generally supported a statistically and clinically significant relationship between participation in Smart Start and improved caregiver ratings of children’s challenging behaviors. Wilcoxon Signed-Rank test did not show statistically significant changes in interventionists’ ratings of challenging behavior, but descriptively, four of five children were rated as improved. Reliable change index scores revealed statistically significant changes in trauma symptoms and parenting stress for two participants. Positive parenting practices improved significantly for all participants according to the reliable change index. The intervention was implemented with good fidelity. All caregivers found Smart Start highly acceptable. Future research with larger samples is warranted based on the extremely promising results of the present study.

What role should trust have in biobank research? Is it a scarce resource to be cultivated, or does its moral significance lie elsewhere? How does it relate to the researcher’s individual responsibility? In this thesis I draw four general conclusions. First, trust is still very much present in at least some biobanking settings, notably in Sweden, but possibly also internationally. Second, a morally relevant conception of trust entails that to be trustworthy, researchers must consider the normative expectations that people have of them, and renegotiate expectations that are mistaken. Third, this conception differs from “public trust” assessed through surveys. The main use of the latter is to legitimate policy, not to identify moral duties. Fourth, in spite of ethics review, guidelines and informed consent procedures, ethical issues will always arise during the course of a research project. Researchers can therefore never avoid their individual moral responsibility. Ensuring that one is adequately trusted is one step towards conducting morally acceptable research. Study I indicates that few Swedes refuse storage of samples in healthcare-associated biobanks and their use in research. Study II suggests that people are somewhat more willing to donate samples than surveys indicate, especially when approached face-to-face by health care personnel. Relationships of trust might thus be important in people’s decision-making. Study III investigates trust as a moral concept. The trustee is often in a unique position to determine what the other’s trust amounts to. When it is mistaken, the trustee has an obligation to counteract it, compensate for it, or renegotiate the expectations that cannot be met. In Study IV, I critique the feasibility of guaranteeing the trustworthiness of the research apparatus through formal measures such as ethics review and guidelines. Not only are there limitations of such measures to consider. They also risk blinding researchers to ethical issues that are not covered by the rules, fostering moral complacency, and alienating researchers to ethics.

Purpose: Patients living with advanced heart failure experience dyspnea, fatigue, poor quality of life, depression and cognitive impairment which may threaten their ability to provide informed consent to undergo heart transplant (HTx) or mechanical support (LVAD). Using qualitative and quantitative methods, we asked how patients with advanced heart failure make decisions regarding HTx and LVAD. The variables chosen to reflect the elements of consent included quality of life and symptom severity (voluntariness), depression and cognitive impairment (capacity) and treatment preferences (decision-making). Methods: 76 patients enrolled in the quantitative arm completed the Minnesota Living with Heart Failure Questionnaire; Visual Analog scales for dyspnea, fatigue and overall health; Beck Depression Inventory; Montreal Cognitive Assessment; Standard Gamble and Time Tradeoff. Qualitative methods were used to discover concepts, relationships and decision-making processes described by 17 of the 76 patients considering HTx and LVAD. Results: Patients reported poor quality of life and high symptom severity scores which compelled them to consider surgery as a way to relieve unpleasant symptoms and improve quality of life. Although 30% of patients had evidence of depression and/or cognitive impairment, no patient was deemed incapable of decision-making. Patients were willing to take considerable risk (35%) and trade considerable time (4months) to improve their health. While heart failure-related concepts were important to the decision, entrustment emerged as the meaningful process for decision-making. Conclusions: Patients who participated in this study were capable of decision-making and understood the risks associated with the surgery. Voluntariness was diminished by disease but not absent, and decisions were free of coercion. These results suggest the entrustment model of decision-making is the dominant process for patients considering high-risk surgical procedures and meets criteria for informed consent. Understanding the process of decision-making will help clinicians support and enable treatment decisions made by patients living with advanced heart failure.

This case study was conducted in one elementary French-language school in Ontario with 1 administrator, 4 teachers and their culturally and linguistically diverse (CLD) students. Through the integration of bhabha’s (1994) notion of Third space, multiple literacies theory (Cummins, 2001; Masny 2009) and by drawing on interviews, observations, and students’ work samples, I conceptualise an alter(n)ative literacies framework to address growing diversity in French-language schools. The term alter(n)ative is developed to express the intertwined benefit of expanding traditional notions of literacy to include alternative language practices and the potential alter-ative effect of re-envisioning the resources children bring to their literacy and language development at school. This thesis argues that teachers can critically (re)interprete official policies concerning Frenchlanguage schools in order to effectively foster students’ alter(n)ative literacies development. In doing so, teachers affirm the plurality of students’ multiple identities as a foundation for their participation within evolving cosmopolitan franco-ontarian communities.

Many healthcare providers are at risk of compassion fatigue and burnout from prolonged occupational stress, which can adversely affect workers, patients, and the healthcare system. This qualitative research project inquired into eight female healthcare providers’ experiences of sustaining their own wellbeing. Participants (27 to 60 years old) engaged in semi-structured interviews and participant observation of a self-care activity. Themes were found relating to the variety of self-care strategies used, challenges and supports in the work context, and the important role of authenticity in health promotion practice. Self-care strategies included: social support, pacing, taking breaks, exercise, nutrition, emotional self-care, adapting self-care routines over time, goal setting and prioritization. Supports to wellbeing included: flexible scheduling, taking personal responsibility for wellness, workplace wellness programs, and positive relationships with supervisors, colleagues, friends and family. This arts-informed research project is presented in graphic novel form to enhance its accessibility.

Many healthcare providers are at risk of compassion fatigue and burnout from prolonged occupational stress, which can adversely affect workers, patients, and the healthcare system. This qualitative research project inquired into eight female healthcare providers’ experiences of sustaining their own wellbeing. Participants (27 to 60 years old) engaged in semi-structured interviews and participant observation of a self-care activity. Themes were found relating to the variety of self-care strategies used, challenges and supports in the work context, and the important role of authenticity in health promotion practice. Self-care strategies included: social support, pacing, taking breaks, exercise, nutrition, emotional self-care, adapting self-care routines over time, goal setting and prioritization. Supports to wellbeing included: flexible scheduling, taking personal responsibility for wellness, workplace wellness programs, and positive relationships with supervisors, colleagues, friends and family. This arts-informed research project is presented in graphic novel form to enhance its accessibility.

This case study was conducted in one elementary French-language school in Ontario with 1 administrator, 4 teachers and their culturally and linguistically diverse (CLD) students. Through the integration of bhabha’s (1994) notion of Third space, multiple literacies theory (Cummins, 2001; Masny 2009) and by drawing on interviews, observations, and students’ work samples, I conceptualise an alter(n)ative literacies framework to address growing diversity in French-language schools. The term alter(n)ative is developed to express the intertwined benefit of expanding traditional notions of literacy to include alternative language practices and the potential alter-ative effect of re-envisioning the resources children bring to their literacy and language development at school. This thesis argues that teachers can critically (re)interprete official policies concerning Frenchlanguage schools in order to effectively foster students’ alter(n)ative literacies development. In doing so, teachers affirm the plurality of students’ multiple identities as a foundation for their participation within evolving cosmopolitan franco-ontarian communities.

<p>The subject of this thesis is ethical aspects of risk management. It is argued that a model for risk management needs to be developed that acknowledges several ethical aspects and most crucial among these, the individual’s right not to be unfairly exposed to risks.</p><p><i>Article </i>I takes as its starting point the demand frequently expressed in the risk literature for a consistent risk management. Such consistency is often assumed to be in accordance with some kind of cost-benefit analysis. It is maintained that such a model, here called the Standard Model, does not respect the rights of the individual. Two alternative models are outlined in order to better deal with this ethical weakness, the Model of Inviolable Rights and the Model of Procedural Justice. The arguments in the alternative models evolve around the separateness of individuals, rights and fair risk taking. It is claimed that the latter model, which focuses on a fair procedure, seems most fruitful to develop.</p><p><i>Article II</i> is a discussion of the NIMBY (Not In My Backyard) conflict, which is well known from situations of siting potentially risky facilities. Of special concern is to investigate what the ethical premises are behind the negative characterization of the NIMBY concept. It is argued that, contrary to the assumption that the total benefit should outweigh the individual’s cost, individuals in siting scenarios have rights not to be unfairly exposed to risks.</p><p><i>Article III</i>, which is co-authored with Professor Sven Ove Hansson, presents a three party model as a tool for ethical risk analysis. It is argued that ethical dimensions need to be acknowledged in the analysis of risks and that this is best done through a discussion of three parties that are involved in risk decisions – the risk-exposed, the beneficiary, and the decisionmaker. Seven crucial ethical questions are recognized and discussed regarding the relation between these parties. By using examples from the railway sector it is shown how the questions can be used to identify salient ethical features of risk management problems.</p>