The evaluation of the feasibility and clinical utility of liquid based cytology, human papillomavirus testing and high-resolution anoscopy to screen for anal intraepithelial neoplasia in high-risk groups. Dr Alice Martha Schofield: The University of Manchester for the degree of Doctor of Medicine, January 2016. Background: The increased incidence and natural history of anal cancer in high-risk groups, provides a screening opportunity to detect precancerous lesions, anal intraepithelial neoplasia (AIN), as well as early invasive lesions. The ANALOGY study was performed to strengthen the evidence base required to determine the case for anal screening in terms of the feasibility and clinical utility of liquid based cytology (LBC), high-risk human papillomavirus (HR-HPV) testing and high-resolution anoscopy (HRA) in high-risk groups. Methods: This prospective study offered screening to four cohorts aged over 25 at varying but elevated risk; human immunodeficiency virus (HIV) positive and negative men who have sex with men (MSM), HIV positive women with prior history of abnormal cervical cytology or anogenital warts, HIV negative women who practice anoreceptive sex and transplant recipients (TR). Recruitment commenced in March 2013 and concluded in December 2014, with follow-up until March 2015. All participants underwent testing for HR-HPV, LBC and had HRA performed, sites of abnormality were biopsied. Participants were seen at initial consultation and at a second visit six months later. Immunostaining with Ki67 and p16 antibody was performed on 100 anal tissue biopsies. The cellular positivity of each biomarker were scored by automated and manual methods. H-SCORES of p16 biomarker and block positive staining of AIN2 were quantified and analysed. Results: 409 participants were recruited; 284 MSM (203 HIV positive, 81 HIV negative), nine HIV positive women, four HIV negative women and 112 TR. HR-HPV was highly prevalent in anal samples from MSM (HIV positive 88.0% and HIV negative, 77.8%) and much less so in HIV positive and negative women and TR (19.3%). Despite the high prevalence of cytological abnormality in MSM, almost half of AIN of all grades was associated with negative cytology. AIN3+ on biopsy was found in 4.4% (18/409) of participants; three HIV positive MSM had cancer. One new case of AIN3 was identified at the second visit. Low-grade disease (AIN1/2) was highly prevalent in all groups. Ki67 and p16 biomarker expression increase as the grade of anal disease increased when scored manually. AIN2 histology samples, which demonstrate block positive p16 staining, have an association with an increased H-SCORE.Conclusions: Anal screening in some high-risk groups is clinically feasible in terms of diagnostics with evidence of significant disease prevalence particularly amongst MSM. The high prevalence of HR-HPV infection and frequency of false negative cytology indicates that in terms of sensitivity and specificity, HRA would be the best primary screening tool. The use of Ki67 and p16 in the identification of anal disease appears to have clinical utility, especially in the detection of AIN2; with the majority of samples displaying block p16 staining that corresponded with an increased H-SCORE. The prevalence of AIN3+ in HIV positive MSM lends support for a policy of screening in this group, however limitations of treatment, as well as highly prevalent low-grade lesions of dubious significance, require careful consideration.

The research undertaken in this thesis examines social assistance (welfare) receipt in Canada during the 1981-95 period to determine the forces responsible for the dramatic growth in welfare use observed during the 1990s. The influence of changes in welfare benefits, labour market conditions, and the availability of unemployment insurance on welfare use during this period is examined using two distinct, but complementary approaches. The first approach investigates this issue from an aggregate standpoint, using Survey of Consumer Finances micro data to construct welfare usage rates for employable singles without children (male and female) and lone mothers. Separate analyses are performed for each of these sub-groups using aggregate province level data. The second approach attacks the issue from a microeconomic standpoint, employing duration analysis to examine the path leading individuals from employment to welfare receipt. Using the 1988-90 longitudinal file of the Labour Market Activity Survey, semi-parametric duration models are estimated to determine how the job loss, reemployment and welfare take-up processes are affected by incentives in welfare benefits, labour market conditions, availability of unemployment insurance as well as demographic variables. The estimates from the duration analysis are applied to administrative data on inflows of persons into the pool of non-employed to simulate and decompose rates of welfare incidence over the 1984-95 period. Results from these two approaches present a relatively consistent picture of welfare use in Canada during the 1990s. Both approaches find strong evidence of important labour market effects. Thus, the economic downturn of the early 1990s played a significant role in the growth of welfare use during this period, particularly in Ontario and Quebec. The evidence concerning the importance of interactions with the unemployment insurance system and changes in benefit generosity is mixed. Both UI effects and benefit effects are found to be important determinants of welfare use but only among specific types of families. The simulation results indicate these factors can account for only a minor amount of the variation in predicted welfare incidence in the 1990s. / Arts, Faculty of / Vancouver School of Economics / Graduate

Hypertension guidelines recommend out of office blood pressure (BP) measurement especially 24- hour ambulatory measurement (ABPM), to diagnose and manage hypertension but this is not routinely performed in kidney transplant units. This study was to determine if 24-hour ABPM, compared with office BP in kidney transplant recipients, would be more informative regarding BP management, and if pulse wave analysis (PWA) would assist in risk stratification. This study included patients older than 18 years, with working graft kidney for >12 months, and without problems affecting BP measurement and interpretation. After performing office BP measurements, a 24-hour ABPM with additional capability of calculating pulse wave velocity (PWV),augmentation index and central BP was undertaken. Patients were assessed for controlled hypertension, uncontrolled hypertension, masked hypertension, nocturnal hypertension, white coat hypertension, and dipping BP status. Data were analysed using standard statistical tests. Of 30 patients, 15 were Black Africans and 15 were of Mixed Ancestry with a mean age of 48.9 years. Seventeen patients were males and 36.7% had controlled hypertension, 30% uncontrolled hypertension, 6.7% white coat hypertension and 33.3% masked hypertension, of whom 70% had isolated nocturnal hypertension. 70% had a non-dipping, 26.7% a reverse dipping and only 3.3% had a normal dipping BP pattern. The mean difference between brachia! systolic BP and central systolic BP was 10.4 mm Hg, whereas PWV and augmentation index were similar to healthy populations. CONCLUSION: In kidney transplant recipients, 24-hour ABPM was superior to office BP in defining hypertensive status that qualified for modification of therapy but PWA did not contribute to risk assessment.

No description available.

No description available.

Carer-employees are defined as individuals who provide unpaid care to a disabled / ill dependent person(s) while working full-time in the paid labour force. In Canada, there are 6.1 million carer-employees, many of which are experiencing work-life balance struggles, which may result in ill-health. To minimize negative impacts, there is interest in developing caregiver-friendly workplace policies (CFWPs) as an intervention strategy to improve CEs’ work-life balance. However, the effectiveness of CFWPs are still in their infancy and often only focus on the work dimension. One of the most critical dimensions that have not yet been assessed is the activity-travel behaviour of carer-employees, which is largely impacted by the assisted-transport demands of their care-recipient. To contribute to filling in this gap, this dissertation addresses the following objectives: 1) develop an activity-travel behaviour profile of carer-employees using sociodemographic and caregiving characteristics; 2) identify spatial locations with potentially high assisted-transport demand while suggesting new areas to improve mobility independence of care-recipients, and; 3) create and apply a mixed-methods framework that classifies the actual activity-travel behaviour of carer-employees. The purposes of all three objectives are to: contribute to closing the literature gap; visually inform decision-makers and health planners, and; efficiently develop caregiver-friendly transport policies (CFTPs). Highlighted findings show that carer-employees conducting assisted-transport have lower income and are more likely to be tired and overwhelmed than those not performing the transport task (Objective 1). In Hamilton metropolitan area, 38% of the older adult population are not within immediate reach to a vital service, and another 15% are located in potentially high assisted-transport demand areas. Suggested areas for service implementation would improve access for older adults by 18% (Objective 2). Lastly, the framework has classified and ranked three types of activity-travel behaviours (Objective 3). All of these findings have led to the discussion of a multi-pronged implementation strategy for uptake of CFTPs. / Dissertation / Doctor of Philosophy (PhD)

Master of Science

The purpose of the present study was to gain insight on the real and perceived needs of food stamp recipients for use in developing nutrition education programs. Six focus group interviews with 26 food stamp recipients were conducted in six Virginia counties. Transcripts of the meetings were analyzed to identify themes prevalent in all of the focus group interviews. Ninety-two 24-hour food recalls from a different sub-group of food stamp recipients were also analyzed for food consumption frequencies, trends in food preparation, and common food purchasing locations. A key finding was that most focus group participants made food-related decisions while in the grocery store. Explanations for incidences of food resource scarcities included beliefs that the amount of food stamps was insufficient and that poor food purchasing decisions were made. Predominant food behavior changes that had been previously attempted were decreasing consumption of fat and fried foods and reducing portion sizes. Most of the reasons for attempting those behavior changes involved a desire for weight loss. Prevalent nutrition education interests were low-fat cooking and child nutrition. Results of the 24-hour food recall analysis indicated an inadequate consumption of fruits, vegetables, whole grain cereals, and dairy products. Seventy-five percent of the subjects purchased food in a grocery store and prepared meals at home. / Master of Science

This study compares certain factors of Austin College financial aid recipients to the same factors in their classmates who received no financial assistance. First, this study attempts to determine whether there are significant differences in selected variables between these two groups. Second, the study seeks to identify the causes for students' withdrawing from the College. Subjects were randomly selected from two groups: (l) 100 subjects receiving financial assistance; and (2) 100 subjects not receiving such assistance. The sources of data for this study were students'. records located in the Educational Advising Center, the Records Office, and the. Counseling Center.

Thesis (M.S.W.) - Carleton University, 2007. / Includes bibliographical references (p. 140-147). Also available in electronic format on the Internet.