The Grand River watershed is the largest watershed in southern Ontario, and is expected to see major development and urban densification over the next 20 years. An expected 57% increase in population over the next two decades in urban centers such as Kitchener – Waterloo, Cambridge, Guelph and Brantford means an added load on the existing 30 wastewater treatment facilities serving the watershed. A subsequent increase in the amount of average flow and effluent released into the Grand River via the Waterloo and Kitchener wastewater treatment plants is also expected. The Waterloo and Kitchener wastewater plants are both secondary treatment plants, although neither plant currently nitrifies the wastewater prior to release. As a result, increased concentrations of ammonia and nitrate are found downstream of the treatment plant outfalls. Compounds introduced into the Grand River via the discharge of wastewater effluent can have impacts on resident biota such as fish. Disruption of the normal function of endocrine systems in fish has been associated with municipal effluents as well as chemicals that have been detected in these effluents. One of the major responses has been the presence of intersex (oocytes in testes) in fish downstream of the wastewater plant outfalls at sites around the globe. The research in this thesis examined resident fish for the variability and extent of intersex condition by adapting a new fragmented testis technique. Biomarkers of response such as relative gonad weight (GSI), relative liver weight (LSI) and condition (K) were also measured. The study focused on the Rainbow Darter (Etheostoma caeruleum) a dominant benthivorous fish species in the riffle habitats in the Grand River. An increased proportion of male Rainbow Darters sampled immediately downstream of the Waterloo outfall had a gonad lobe containing at least one testis-oocyte. The number of Rainbow Darter with more severe intersex (10-99 oocytes/lobe) also increased immediately downstream of the Waterloo outfall. A much more dramatic expression of intersex proportion and severity (>100 oocytes per testis lobe) was observed further downstream, below the Kitchener outfall. These patterns in intersex presence and severity were also observed in two other species collected at a subset of the original sites. Although there were minimal changes in GSI, LSI and K below the Waterloo outfall, differences were observed downstream of the Kitchener wastewater effluent outfall. Female Rainbow Darter downstream of the Kitchener outfall showed significant decreases in GSI and LSI, and increases in K. Male Rainbow Darter GSI and LSI data across sites did not express changes that coincided with MWWE outfalls, although small increases in condition were observed. These patterns of intersex and organism level responses suggest that the assimilation of wastewater effluent into natural receiving environments may have impacts on endocrine function and energy use and allocation in wild fish.

Aquatic receiving environments have long been used to dilute municipal wastewater effluents (MWWE) which are the largest discharge by volume into the aquatic environment in Canada. These treated effluents are a complex mixture of environmental contaminants that includes natural and synthetic hormones, pharmaceuticals, industrial chemicals, nutrients and ammonia. Discharge of MWWE may lead to serious problems in aquatic environments such as eutrophication, hypoxia as well as increased occurrence of disease and toxicity in resident aquatic biota. Reproductive impairment in fish has also been widely reported in association with exposure to wastewaters. Recently, concerns have been raised about the potential for municipal effluents to cause endocrine disruption in fish and other organisms. The effects of MWWE on fish and fish populations in Canada are currently poorly understood. The overall objective of this thesis is to contrast the impact of MWWE discharged into two Canadian rivers on sentinel fish species across levels of biological organization ranging from biochemical responses to changes at the fish community level. Results from these studies support the development of robust effects-based biological monitoring approaches to assess the effectiveness of regulations and remedial actions for minimizing the effects of MWWE. Understanding the temporal changes in physiological and reproductive parameters across the annual cycle of a sentinel species is necessary to optimize biomonitoring programs. The annual variability in terms of survival, reproduction and energy storage in the Greenside Darter (Etheostoma blennioides), a potential sentinel species for the Grand River, Ontario, was documented at a reference site across two years. Variation in energy storage and reproductive development indicated by somatic indices (i.e., relative organ size) and steroid production suggest that biomonitoring can be optimized for this species by sampling in late fall or early spring (pre-spawning). With this new knowledge, field studies conducted with small bodied species, including Rainbow Darter (E. caeruleum), Brook Stickleback (Culaea inconstans) and Fathead Minnow (Pimephales promelas) have demonstrated that, when sampled during the appropriate season (e.g., pre-spawning), they can be used as effective biomonitoring tools to detect fish responses associated with exposure to MWWEs. Two sentinel fish species, Rainbow Darter and Greenside Darter, were then used to examine the impact of two MWWE discharges on fish in the Grand River, Ontario, relative to reference sites in two seasons (fall and early spring). Fish responses, in terms of energy storage (condition factor, liver size), energy utilization (gonadosomatic indices) and reproduction (in vitro sex steroid production, cellular development and intersex) were assessed at each site. Both sentinel species were longer and heavier downstream of the wastewater outfalls. However, these larger fish did not demonstrate consistent increases in condition and liver somatic indices. MWWE-exposed male Rainbow and Greenside Darters had impaired capacity to produce androgens in vitro, lower gonadosomatic indices and altered sperm cell staging. Exposed female fish also had impaired capacity to produce estrogens in vitro, however, they did not demonstrate differences in oocyte development. Male Rainbow and Greenside Darters collected downstream of both MWWE discharges showed increased incidence of intersex (33 - 100%) in contrast to very low occurrences of this condition in upstream agricultural and urban reference sites. This increased incidence of intersex coincided with reductions in gonadosomatic indices and capacity to produce steroids, demonstrating the ability of MWWE to alter the reproductive systems of these fish. The fish communities downstream of the the MWWE outfalls demonstrated differences in abundance, diversity, and species composition when compared to reference sites. MWWE exposed sites had few of the darter species that dominate the fish community at reference sites. More mobile fish species such as suckers (Catostomidae spp.) and sunfish (Centrarchidae spp.) were more common downstream of the outfalls, with occurances becoming more pronounced downstream of the second sewage discharge. Wascana Creek, Saskatchewan, downstream of the wastewater treatment plant for the City of Regina can be up to 100% treated municipal wastewater. Brook Stickleback and Fathead Minnow exhibited delayed spawning and altered gonadal development downstream of the wastewater outfall. Exposed male Fathead Minnows were feminized, having lower expression of secondary sexual characteristics (i.e., loss of nuptial tubercles, dorsal pad, and dorsal fin dot) and induction of the female egg-yolk precursor protein, vitellogenin. Fathead Minnows also showed cellular damage to the gills and kidneys. These responses indicate exposure to a variety of environmental contaminants in the effluent such as ammonia as well as endocrine disruptors. The potential effect of MWWE discharges in these two Canadian watersheds on fish responses was demonstrated across various levels of biological organization including reduced sex steroid production, altered gonadal development, reduction in gonadosomatic indices, delayed spawning, and changes in fish assemblages. An effects-based monitoring approach using sentinel species can be successfully applied to detect changes associated with MWWE outfalls, as long as sampling of sentinel species is conducted during optimal time periods (i.e., when somatic indices are maximized and variability among individuals is minimized). MWWE can impair the reproductive potential of fish beyond a threshold where impacts are expressed at higher levels of organization such as populations or communities. It is essential to make mechanistic linkages between responses at different levels to determine the overall potential impact of effluents on fish. The collection of responses across multiple levels of biological organization can complement and support development of biomonitoring approaches that are focused at the population and community levels such as those being proposed for MWWE in Canada.

Speech perception outcomes for people with a prelingual hearing loss, implanted with a cochlear implant in adolescence or adulthood, are characterized by a large degree of variability. Research findings indicate that some recipients do very well and gain significant open set speech perception skills, whilst a large percentage show little or no change in open set speech results, post implant. In studies to-date, mean speech perception scores were typically substantially poorer than those recorded for implant recipients with a postlingual hearing loss. Despite this, the majority of recipients with a prelingual hearing loss implanted with a cochlear implant in adolescence or adulthood reported satisfaction with their implant and used it regularly. Although there have been a number of studies in the area, none has taken a holistic approach and investigated both objective and subjective outcomes for a large group of participants. In addition, no study has employed a multiple regression analysis to investigate which characteristics were associated with speech perception outcomes in people with a prelingual hearing loss implanted with a cochlear implant in adolescence or adulthood. The objectives of the study were to examine speech perception and other outcomes in people with a bilateral prelingual or perilingual hearing loss, implanted with a cochlear implant as an adolescent or adult, and to investigate prognostic factors associated with positive outcomes. The design consisted of a retrospective review of both speech perception outcomes and other outcomes for 38 recipients, diagnosed with a bilateral hearing loss before age 3, and implanted with a cochlear implant at 14 years or older. There were 24 females and 14 males and the average age at initial stimulation was 33 years. All participants were implanted with a Nucleus device at a private audiology clinic (Attune). Four questionnaires were completed by approximately half of the participants – Glasgow Benefit Inventory (GBI); International Outcome Inventory (IOI-CI); Study Questionnaire; and the Hearing Abilities and Quality of Life Scale. The Study Questionnaire was developed specifically for this project and investigated satisfaction, benefit and advantages/disadvantages of the implant. The Hearing Abilities and Quality of Life Scale was developed by Attune and was completed by recipients pre and post implant. It evaluated the ability to understand conversation in different situations, environmental awareness, safety concerns, involvement in social activities and impact of the hearing loss on relationships. Approximately one third of participants scored between 30 and 90% on the CID/ CUNY test administered via CD post implant and approximately one fifth scored over 90%. The mean score on the CID/CUNY test administered via CD was 8% pre implant and 48% post implant. Over 80% of recipients used their device more than 8 hours a day and all recipients reported being satisfied with it. Three factors accounted for 65% of the variance on the open set sentence test score, post implant. These were stable versus progressive loss, mode of communication in childhood and time without a hearing aid on the implant ear. For the purposes of this research, a ‘stable’ loss was defined as a bilateral severe to profound hearing loss at diagnosis and a ‘progressive’ loss was one that deteriorated to this degree at some point after diagnosis. The findings from this study reveal that a cochlear implant is a viable option for adults and adolescents with a prelingual hearing loss. The majority of participants gained benefit from the device and were satisfied with it. In addition, a substantial number gained good open set speech perception ability, post implant. Consistent with previous studies, there was large intersubject variability in speech scores. The recipients who had a progressive loss, used oral communication in childhood and wore a hearing aid on the implant ear up to the time of surgery were more likely to obtain better speech perception outcomes.

Thesis (B.Sc.)--University of Hong Kong, 2003. / "A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, April 30, 2003." Includes bibliographical references (p. 28-30) Also available in print.

Thesis (M.Med.Sc.)--University of Hong Kong, 2004. / Also available in print.

Thesis (B.Sc)--University of Hong Kong, 2000. / "A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, May 10, 2000." Also available in print.

Thesis (B.Sc)--University of Hong Kong, 2002. / "A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, May 10, 2002." Also available in print.

Thesis (B.Sc)--University of Hong Kong, 1999. / "A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, 14 May 1999." Also available in print.

The effect of exercise programmes on psychosocial characteristics, namely self-esteem, of people with visual impairment (VI) is limited. Martial arts practice has been found to improve global self-esteem among different age groups and among people with different abilities, but not for people with VI. This presents a notable gap in the research literature on people with VI. This thesis conducted three studies with the aim of investigating whether martial arts practice improves self-esteem in people with VI, including martial arts mechanisms and strategies for self-esteem improvement. Study one (n = 5) investigated the effect of a martial arts (karate) 10-week programme on the exercise and self-esteem model components (EXSEM) in young adults with VI (age range 19-40 years) following a non-concurrent multiple baseline approach. Visual inspection and graphical approach analysis showed that four participants improved their global self-esteem. Physical self-worth improved for all five participants. Exercise self-efficacy was improved in three participants whereas the other two had high exercise self-efficacy before participation in the karate programme. Exercise self-efficacy and physical self-worth maintained higher scores than the baseline for all five participants for 3 months upon completing the programme. The 3-month follow up results of global self-esteem were lower than the baseline scores for two participants whereas the other three participants achieved higher global self-esteem scores than the baseline scores. Study 2 (n = 12) aimed to identify the mechanisms for self-esteem improvement from the perspective of martial artists with VI following a narrative approach. Results identified two main factors that contributed in the improvement of self-esteem found in this group. Firstly, social self-esteem impacted global self-esteem as instructors unconditionally accepted the martial artists with VI, motivated them and created relationships based on trust. In addition, participants reported that team work in the dojo, trustful relationships among martial arts peers, and feeling respected impacted their social self-esteem. The resultant was improved global self-esteem of the martial artists with VI. The second factor identified showed that global self-esteem improvement was related to intellectual self-esteem, as the martial artists increased their self-achievement awareness and body and spatial awareness and thus helped martial artists in achieving their maximal potential. Study 3 (n = 6) aimed to provide strategies that martial arts instructors utilize to improve self-esteem of their students with VI using an interpretative phenomenological approach (IPA). Participants reported that the first step for global self-esteem improvement of martial artist with VI was social inclusion which needed to be rooted in a personal perception about the abilities of individuals with VI. Most of the strategies that were utilized by the instructors were focused either on social relationships, for example peer tutoring, or martial arts philosophy such as teaching real situations. Furthermore, instructors reported that improvement of the other cognitive and psychological characteristics, namely body awareness and self-confidence improvement, positively affected global self-esteem of individuals with VI. Supporting the multidimensional hierarchical construct of self-esteem, this thesis reports a positive influence of martial arts styles on social self-esteem, physical self-worth, intellectual self-esteem, and consequently global self-esteem in people with VI. Therefore, it is recommended that instructors focus on these three domains to improve global self-esteem of people with VI.

Class of 2014 Abstract / Specific Aims: To assess appropriate use or cessation of metformin therapy in the presence of renal impairment. Methods: A retrospective chart review was conducted on 785 charts of patients at El Rio Community Health Center between June 2011 and December 2012. Eligibility criteria were adults aged 18 years or older with a diagnosis of Type 2 Diabetes Mellitus (DM), a history of metformin therapy, and renal function data. Data was accessed through the electronic medical record (EMR) at El Rio and metformin history, presence of contraindications, renal function, weight, age, gender, and race/ethnicity were collected. Group 1 were patients who were currently taking metformin and Group 2 were patients with a history of taking metformin. Main Results: A larger proportion of patients had renal impairment (eGFR 30-60 ml/min/1.73 m2) in Group 1 than Group 2 (Yates’ p = 0.002). Only one patient in the entire study had severe renal impairment (eGFR < 30 ml/min/1.73 m2). There was a greater proportion of inappropriate cessation in Group 2 than inappropriate use or cessation in Group 1 (Yates’ p < 0.001). Conclusion: Most patients were found to have normal renal function. Group 2 had a greater proportion of inappropriate metformin cessation than inappropriate use or cessation in Group 1.