This thesis project explores landowner experiences of wind energy development through an inductive qualitative case study in Huron County, Ontario. The research included in-depth interviews with ...landowners focused on landscape and community change, participant observation of Environmental Review Tribunals (ERT), the gathering of participant photos, as well as relevant government and industry documents and media reports. The iterative data gathering and analysis were supported by my observations and reflections while living in affected communities and talking to participants. The study demonstrates how the health debate over wind can inform divisions between neighbours, that local politics have been given a token role as a place for resistance to wind energy development that fails to meaningfully influence projects, and that appeals are legalistic and do not provide an outlet, or place for appellants to be heard. Furthermore, the felt experience of tight knit and fragile communities were disrupted through land leases, as well as changes to the landscape. These disruptions impacted connections to, and associations with place, and are shown to have had negative emotional and physical impacts on some individuals. Supporters of wind development tied their mostly positive views of landscape change to a sense of disruption generally throughout the community. Insights from the research lead to a set of suggested actions that might improve the current situation at the levels of provincial policy, planning, local governance and industry practice. Keywords: wind energy policy, planning, landscape, Ontario, rural communities
Some neurological complications following surgery have been related to a mismatch in cerebral oxygen supply and demand that may either lead to more subtle changes of brain function or overt ...complications like stroke or coma. Discovery of a perioperative neurological complication may be outside the treatment window, thereby making prevention an important focus. Early commercial devices used differential spectroscopy to measure relative changes from baseline of 2 chromophoresoxy- and deoxyhemoglobin. It was the introduction of spatially resolved spectroscopy techniques that allowed near-infrared spectroscopy (NIRS)–based cerebral oximetry as we know it today. Modern cerebral oximeters measure the hemoglobin saturation of blood in a specific “optical field” containing arterial, capillary, and venous blood, not tissue oxygenation itself. Multiple cerebral oximeters are commercially available, all of which have technical differences that make them noninterchangeable. The mechanism and meaning of these measurements are likely not widely understood by many practicing physicians. Additionally, as with many clinically used monitors, there is a lack of high-quality evidence on which clinicians can base decisions in their effort to use cerebral oximetry to reduce neurocognitive complications after surgery. Therefore, the Sixth Perioperative Quality Initiative (POQI-6) consensus conference brought together an international team of multidisciplinary experts including anesthesiologists, surgeons, and critical care physicians to objectively survey the literature on cerebral oximetry and provide consensus, evidence-based recommendations for its use in accordance with the GRading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria for evaluating biomedical literature. The group produced the following consensus recommendations(1) interpreting perioperative cerebral oximetry measurements in the context of a preinduction baseline value; (2) interpreting perioperative cerebral oximetry measurements in the context of the physiologic variables that affect them; (3) using caution in comparing cerebral oximetry values between different manufacturers; (4) using preoperative cerebral oximetry to identify patients at increased risk of adverse outcomes after cardiac surgery; (5) using intraoperative cerebral oximetry indexed to preinduction baseline to identify patients at increased risk of adverse outcomes after cardiac surgery; (6) using cerebral oximetry to identify and guide management of acute cerebral malperfusion during cardiac surgery; (7) using an intraoperative cerebral oximetry–guided interventional algorithm to reduce intensive care unit (ICU) length of stay after cardiac surgery. Additionally, there was agreement that (8) there is insufficient evidence to recommend using intraoperative cerebral oximetry to reduce mortality or organ-specific morbidity after cardiac surgery; (9) there is insufficient evidence to recommend using intraoperative cerebral oximetry to improve outcomes after noncardiac surgery.
