Depression is a nebulous term that is used in a variety of ways to account for a range of experiences usually characterized by low mood, lethargy, diminished pleasure from activities, among others. One prevalent way of making sense of depression in North America is through a biomedical discourse that constructs depression as resulting from an imbalance of neurotransmitters in the brain. Such an explanatory discourse supports antidepressants as the treatment of choice for depression, despite controversy associated with this discourse and disputes about the effectiveness and appropriateness of antidepressants for the treatment of most presentations of depression. In spite of challenges Western physicians face in diagnosing and treating depression, its management overwhelmingly occurs in primary care. Models of primary care treatment decision-making range from those that frame physicians as the principal decision maker (paternalism) to those that feature patients as more autonomous deciders (patient-directed approaches). Existing in the centre of the treatment continuum is a range of joint approaches that feature a more equal relationship between physician and patient. Over the last several decades, paternalism as the traditional approach to treatment decision-making has given way to joint approaches that are heralded as the best ways to manage complex disorders that involve multiple treatment approaches with variable risks and benefits, as depression is often framed. Requests for antidepressants can be considered either patient-directed or joint approach actions, depending on how they are presented. Research on this topic typically focuses on statistical analyses of whether or not patient requests for antidepressants are granted, and whether they help or hinder treatment. Little research has focused on qualitative explorations of how patients and physicians construct accounts about requests themselves. For Study 1, Dr. McMullen and I interviewed 11 family physicians and asked them whether they experienced, and how they managed, patient requests for antidepressants. I used a discursive analytic approach in analyzing the data from the interviews and argue that (a) physicians framed patients as autonomous treatment decision-makers while defining limits on these decisions, and (b) they framed denials of what they characterized as inappropriate requests for antidepressants through patient-centered (and persuasive) approaches to refusal. For Study 2, I interviewed 11 patients about their experiences requesting antidepressants from their physicians. Using a discursive analytic approach, I argue that (a) patients provided accounts of employing what can be considered a soft sell approach in requesting antidepressants, while framing their physician’s contribution to decision-making as necessary and important, and that (b) unexpected outcomes which followed requests for antidepressants (i.e., not having their request endorsed by their physician or having their request fulfilled too readily by their physician) can be understood as discrepancies between the patients’ preferred level of involvement in the process of decision-making and what they encountered. The results of Studies 1 and 2 suggest that these interviewees enacted a physician+ joint approach to treatment decision-making by constructing accounts of requests for antidepressants in ways that largely favour the physician as the lead role within a broadly joint approach to decision-making. Despite attempts to avoid conceptualizations of being overly directive or uninvolved in the process of decision-making, physician and patient interviewees framed conflict as inevitable and offer hints as to how conflict might be avoided or mitigated. To the extent that both patients and physicians are attempting to get their respective needs met from one another within the primary care consultation, I frame their accounts as evidence of a mutual or reciprocal persuasion that is characteristic of more equal relationships. Finally, I bring together some of the controversies associated with treating depression with antidepressants in a primary care setting and raise broader questions about the role of the general practitioner in the management of depression.

The privatization of K-12 education in Canada is not new. The public and private sectors feel like natural elements of the Canadian education system because they have existed side by side since confederation. However, this thesis challenges that tradition and argues that private education undermines collective responsibility for education as a shared, public good by catering to private interests and isolating students from the public realm. Not only does private education reinforce the likelihood of socio-economic stratification, but the concept of a “public good” is increasingly destabilized as social services like education are privatized. Why, then, does the privatization of K-12 education continue to be an insignificant political issue in Canada? This question is particularly pertinent at a time when neoliberalism is in full swing in the United States, and all the time more apparent in Canada. Neoliberalism’s emphasis on the precedence of economic ideals over concerns for social welfare and democratic participation has transformed the way that we understand “value”. Drawing on a broad range of scholars including Charles Taylor, Richard Pildes, Janice Gross Stein, Henry Giroux, Francois-Lyotard and Michel Foucault, this thesis argues that the values involved in the very concept of private education reinforce, and are reinforced by, neoliberal views about the place of the individual within society, and that these values are detrimental to the concern for education as shared, public good.

Service providers’ goals include providing reliable connections with the minimum allocated resources over a shared-mesh path restoration scheme in WDM networks. However, in some cases, the requested parameters in an SLA are beyond the capacity of the network, and the connection is typically blocked. To give the customer a chance to choose another provider, or in the case of having only one provider, to comply with the provider’s network capacity, new SLA-based architectures and mechanisms are required to be introduced to provide better service to prioity-aware shared mesh WDM networks. To achieve this goal, the dissertation’s contributions focus on three main characteristics of the network design: i) A dynamic SLA negotiation infrastructure to negotiate and propagate crucial SLA parameters, ii) Path attributes which can provide a better picture of network resources and status and are suitable to be propagated by the negotiating system, and iii) Algorithms benefiting from the path attributes to improve the blocking probability and resource utilization of the network. To fulfill the first goal of the contributions, a dynamic SLA negotiation mechanism for both intra and inter-domain communications using OSPF and BGP protocols is proposed. Link attributes via intra-domain, and new proposed TE path attributes through inter-domain mechanisms are advertised. Several novel path constraints and attributes are proposed which are dynamically updated and propagated through the network over the connections provisioning process period to satisfy the second objective of the contributions in this dissertation. The path availability, holding time, SLA violation risk, and path risk factor are the important characteristics of the proposed path attributes. As the third goal considered for the contributions, novel priority-aware algorithms and SLA-based mechanisms are proposed to improve the network performance for different traffic types of various priority classes. The algorithms and mechanisms proposed in this thesis take advantage of the new path attributes and SLA negotiation infrastructure to better serve high-priority connection requests at the lowest cost. The mechanisms and network architectures proposed in this work are a solution for the high-priority requests that normally cannot be accommodated as they violate the best availability offered by service providers.

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Shared Decision Making (SDM) in medical consultations has received significant attention in the literature over the past 10 years. Research indicates that patients’ desire both components of SDM, information sharing and behavioural involvement, to differing degrees (Flynn, Smith, & Vanness, 2006) and that matching medical care to these preferences may be associated with better patient health outcomes (Cvengros, Christensen, Cunningham, Hillis, & Kaboli, 2009). In this thesis, relationships between SDM preferences and patients’ personal characteristics (demographic factors and personality attributes) were investigated (Objective one), as well as associations between patient’s SDM preferences and the features of the health concern that they were seeking care for (Objective two). The current study used 158 Christchurch residents who were part of a longitudinal health and wellbeing study. They completed a questionnaire that measured their general SDM preferences, their demographic and personality characteristics and their preferences for SDM, given four hypothetical health complaints. These complaints varied in duration and perceived seriousness. Demographic variables and personality variables accounted for approximately the same amount of variance in participants’ general preferences for SDM, together describing 33% and 42% of the variance in information sharing and behavioural involvement. The strongest contributors were all three Health Locus of Control variables, sex and education level. Big Five personality traits and participant self-rated physical health did not account for a significant amount of variance in SDM preferences, once all variables were controlled for. In addition, the features of the health concern were marginally associated with participants’ SDM preferences for that specific consultation. Between-subjects analyses found that the duration or perceived seriousness of the health complaint were not associated with SDM preferences reported within the first scenario, once participants’ general SDM preferences were accounted for. Whereas, these two features described a significant amount of variance in participants’ information sharing preferences in the within-subjects analyses, when participants’ general SDM preferences were controlled for. Post-hoc analyses reported that chronic health complaints, that were perceived to be highly serious, elicited significantly greater preferences for information exchange than all other scenarios. No association occurred for participants’ preferences for involvement in final decision making across the four scenarios. The findings emphasise that differences occur in patients’ preferences for information sharing and behavioural involvement; both in regard to their general preferences and their specific preferences for these components of SDM within a given consultation. They also identify the central role that patients’ personality characteristics may play in determining their collaboration and involvement in healthcare; associations that are often overlooked by the SDM literature. The current findings contribute to our understanding of patient’s preferences for SDM and implications for practice and future research are discussed.

This thesis discusses the increased amount of information available online, and how we use it in our daily lives to make decisions. It aims to open a discussion on the complexity of accessing and evaluating digital information. As the Internet has grown, the amount of information available to the public has exploded. Not only have we gained access to what seems to be an unlimited amount of sources, but also the number of producers has grown. By means of a case study, this thesis explores practices of trust assessment within the shared economy. Through the lens of Actor-Network-Theory as well as Modern Social Imaginaries, media practices are studied by using the example of Airbnb, an online, shared economy platform for accommodation. Airbnb users as well as other travelers are asked about their media practices through an online survey with 229 respondents as well as in-depth interviews with 7 users of Airbnb. Results show that practices of trust assessment differ within and outside of the platform. There is a strong dependency on social information, produced by fellow platform users, especially in the form of reviews. In addition the study finds support for a social imaginary, in which the platform defines the accepted behavior for the users of the platform, who within the economic constraint comply with the social norm set by the organization, in order to be able to use the services of Airbnb.

Enligt skollagen ska rektorn vara huvudansvarig för sin skolverksamhet. I uppdraget ingår administrativa uppgifter och pedagogiskt ledarskap, vilket innebär att rektorn har två skilda logiker att hantera, managerialism och professionalism. Den kvalitativa undersökningen fokuserar därmed på hur det pedagogiska ledarskapet ska utövas parallellt med administrativa uppgifter där ekonomiska styrförutsättningar skiljer kommunala och fristående verksamheter åt. Pedagogiskt ledarskap ska leda till goda studieresultat hos eleverna och anses därför som viktigt. Direkt forskning om rektorns delade ledarskap har inte skett inom skolvärden men däremot inom sjukvården som har flera likheter till skolverksamhetens organisation. Inom sjukvården har professionalism och managerialism, i en så kallad hybridroll, ansetts svår för en person att klara, vilket är detsamma för rektorn. Utifrån detta undersöktes ifall det var möjligt för två personer att dela lika på rollen som rektor, ett så kallat samledarskap. Dock går det inte enligt lag att genomföra då varje skolverksamhet endast får ha en ordinarie rektor. Inslag av samledarskap kan däremot appliceras som en lösning för rektorn, genom att exempelvis delegera uppgifter till en biträdande rektor.I och med att ledningsgrupperna ser olika ut samt har olika styrförutsättningar har även utfallet blivit olika i de olika skolformerna. Inom den kommunala skolverksamheten har rektorn kunnat utöva mer pedagogiskt ledarskap då det i regel funnits en eller flera biträdande rektorer att samarbeta med och delegera administrativa uppgifter till. Detta tillskillnad från rektorer i fristående skolverksamheter som generellt är ensamma i ledningsgruppen. I de fall då rektorn är ensam i ledningen borde det därför vara bra att se över möjligheter för att tillsätta en biträdande rektor i ledningsgruppen för att verka som avlastning. Tillsättande av en biträdande rektor skulle underlätta rektorns arbete men då de fristående skolverksamheterna har ett bestående krav på att inte överskrida budgeten begränsas möjligheten att i varje enskilt fall tillsätta en biträdande rektor. / According to the Swedish school law, the principal is in charge for the school organization. The task includes administrative tasks and pedagogical leadership, which means that the headmaster has two distinct logics to deal with, managerialism and professionalism. The qualitative methodology study is focusing on the pedagogical leadership that must be exercised in parallel with administrative tasks where economic regulatory conditions are significant and differ between public and independent school activities. Pedagogical leadership should lead to good outcomes for the students and is therefore considered important. There has been no direct research concerning the principal's shared leadership within the school system but a lot of research within healthcare can be applied in this area since healthcare has several similarities to the school organization. A so-called hybrid role has within healthcare been considered difficult for one person to manage. In this role, professionalism and managerialism are combined which can be linked to the principal’s role where both logics have to be handled by one person. Based on this this study will examine whether it is possible for two people to share the role of the principal equally, a so-called shared leadership. However, it is not required by law to implement this solution when every school organization may only have one regular principal. Elements of shared leadership can, however, be applied as a solution for the principal, for example by delegating tasks to an assistant principal.Since the management teams are controlled differently the outcome has been various in diverse school systems. The principal of the public school has been able to practice more pedagogical leadership since there normally exist one or several assistant principals to whom they can delegate administrative tasks. This is different from principals in independent school organizations, which generally are alone in the management team. In cases where the principal is alone in the leadership, it should be useful to see whether there are opportunities to appoint an assistant principal to join the management team to ease the burden. The appointment of an assistant principal would facilitate the principals' work, but because of the independent schools’ permanent requirement not to exceed the budget, the possibility is limited to assign an assistant principal in each individual case.This study is written in Swedish

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