Doctor of Philosophy / Food, Nutrition, Dietetics and Health / Edgar Chambers IV / Fortified blended foods (FBFs), which are the mixture of cereals and legumes fortified with micronutrients, have been widely used as supplementary foods for vulnerable populations such as infants and young children in developing countries around the world. The evaluation of current FBFs showed limited evidence on their effectiveness in treating childhood malnutrition, resulting the several recommendations on processing and formulation changes to improve their quality and ability to meet nutritional needs. Sensory properties are one of the important determinants for the success of the new FBFs. Therefore, sensory testing was conducted to determine the potential of novel FBFs to be used as supplementary food compared with FBF currently used in food aid programs. Descriptive sensory analysis was performed on novel FBFs along with the traditional FBF (Corn soy blend plus; CSB+) to determine sensory characteristics of each FBF. Results showed that novel FBFs had more pronounced toasted characteristics and higher sweetness than CSB+, due to the higher temperature during extrusion process and the addition of sugar in the novel formulation. In addition, novel FBFs that had higher amount of legumes (e.g. soybean, cowpea) in their formulations, especially for all sorghum cowpea blends, showed higher intensity in beany characteristics. Sensory shelf-life testing showed that novel FBFs could have shelf lives at least 2 years with no detection of off-note characteristics and these was comparable to the shelf life of the current FBF (CSB+). Sensory testing was also performed with target populations: children who eat the food and care givers who prepare it, during a 20-week field trial to determine the acceptability and preference of novel FBFs and current FBF. Results showed that all novel FBFs were highly preferred or accepted by children, even though, some of them might need longer time and more exposures to allow children to have more experience and be familiar with the food before being satisfied or preferred that food. In contrary, CSB+ that had bland flavor tended not to be well accepted and highly preferred by children compared to novel FBFs. Moreover, giving children more opportunities to consumed food prepared from CSB+ did not help to improve its acceptability or preference. Data from household visits and interview sessions showed that porridges prepared from novel FBFs required less cooking time than CSB+ and no additional ingredients needed to be added compared to CSB+ where sugar and milk were common additions. Finding from this research indicated that novel FBFs have high potential to be used successfully as supplementary food with comparable shelf life, and higher acceptability and preference to FBF currently used in food aid programs. In addition, the simple cooking of novel FBFs make them valuable to caregivers who have limited time and access to energy sources and nutrient-rich ingredients.

The aim of the Master thesis is to depict the first application of International Financial Reporting Standard in the company that reports under Czech Accounting System. The aim is to describe each accounting systems on theoretical basis and deduct differences between them. Subsequently, the application of IFRSs is carried out on the practical level with the cooperation of the company IPB Invest, a.s. The primary goal is the conversion of financial statements based on the IFRS requirements. The attention is given to the technical implementation of financial statement conversion. The main business of the company is rendering of financial lease services. Therefore, the conversion in particular relates to accounting treatment of financial leases under IAS 17. The outcome are financial statements prepared in accordance with International Financial Reporting Standards.

The present study investigated the efficacies of Individual CBT (ICBT), Parent Relationship Skill Training (RLST, which targets increasing parental acceptance of youth and increasing autonomy granting) and Parent Reinforcement Skills Training (RLST, which targets increasing parental positive reinforcement and decreasing negative reinforcement). The specific aims were to examine treatment specificity and mediation effects of parenting variables. ICBT was used as a baseline comparison condition. The sample consisted of 253 youth (ages 5-16 years; M = 9.38; SD = 2.42) and their parents. To examine treatment outcome and specificity, the data were analyzed using analysis of variance within a structural equation modeling framework. Mediation was analyzed via structural equation modeling using MPlus. Results indicated that ICBT, RLST, and RFST produced positive treatment outcomes across all indices of change (i.e., clinically significant improvement, anxiety symptom reduction) and across all informants (i.e., youths and parents). RLST was associated with incremental reduction in youth anxiety symptoms beyond ICBT, as per youth report. Treatment specificity effects were found for participants in RFST in terms of parental reinforcement, as per parent report only. Treatment mediation was not found for any of the hypothesized parenting variables (i.e., parental acceptance, parental autonomy granting, parental reinforcement). The results support the use of CBT involving only the youth and the parent and youth together for treating youth anxiety. The findings’ implications are further discussed in terms of the need to conduct further meditational treatment outcome designs in order to continue to advance theory and research in youth anxiety treatment.

Leadership is important to quality improvement initiatives in healthcare. However, few studies have evaluated leadership interventions to enhance nurses’ use of guideline recommendations in the field of knowledge translation. Purpose: To develop and evaluate an intervention designed to operationalize a leadership strategy composed of relations, change, and task-orientated leadership behaviours, and to examine its influence on nurses’ use of guideline recommendations in home-care nursing. Design: Sequential mixed methods pilot study with post-only cluster randomized controlled trial. Methods Phase I: Intervention Development 1. A participatory approach was used at a community healthcare organization with 23 units across the province of Ontario, Canada. The guideline selected was developed by the Registered Nurses’ Association of Ontario for the assessment and management of foot ulcers for people with diabetes. 2. Integrative literature review, qualitative interviews, and baseline chart audits were conducted. 3. Four units were randomized to control or experimental groups. 4. Clinical and management leadership teams participated in a 12-week intervention consisting of printed materials, interactive workshop, and teleconferences. Participants received summarized chart audit data, identified priority indicators for change, and created a team leadership action plan to address barriers and influence guideline use. Phase II: Evaluation 5. Chart audits compared differences in nursing process and patient outcomes. Primary outcome: eight-item nursing assessment score. 6. Qualitative interviews evaluated the intervention and leadership behaviours. Results: No significant difference was found in the primary outcome. A significant difference was observed in nurses’ documentation of five priority indicators chosen by the experimental groups (p=.02). Gaps in care included: 53%, 76%, and 94% of patients not assessed for ulcer depth, foot circulation, or neuropathy (respectively); 75% and 93% did not receive wound debridement or hydrogel dressings. Receiving data to identify priority indicators for change and developing a leadership action plan were reported as useful to guideline implementation. The experimental group described using more relations-oriented leadership behaviours conducting audit and feedback, and sending reminders. Conclusion: Findings from this pilot study suggest that leadership is a team process involving relations, change, and task-oriented behaviours enacted by managers and clinical leaders. A leadership model is proposed as a beginning taxonomy to inform future leadership intervention studies.

Unique characteristics of cluster randomized trials (CRTs) complicate the interpretation of standard research ethics guidelines. Variable interpretation by research ethics committees may further complicate review and conduct. An international web-based survey was administered to corresponding authors of 300 randomly sampled CRT publications. We investigated ethics review and consent practices, investigator experiences with ethics review, and the perceived need for CRT-specific ethics guidelines. The response rate was 64%. Ethics review and consent were under-reported in publications. Ethics approval was obtained in 91%, and consent from individual and cluster level participants in 79% and 82% of trials. Consent varied by level of experimental intervention, data collection, and cluster size. Respondents cited variability among ethics committees (46%), and negative impacts of ethics review on their studies (38%). The majority perceived a need for ethics guidelines (73%), and guidance for ethics committees (70%). CRT-specific ethics guidelines are required to ensure practices meet ethical standards.

To understand how to better stimulate adult sport engagement, this study investigated effects of gain-framed messages (GFM; Rothman & Updegraff, 2010) on psychological/behavioural outcomes, with or without efficacy-enhancing messages (Latimer et al., 2010). Eligible adults (30-69 years-old) were randomly assigned to one of two experimental conditions (‘GFM alone’ or ‘GFM plus efficacy-enhancing messages’), or a control condition. Participants (N = 232; 62.5% female) completed baseline/screening measures, watched their messaging intervention and reported outcomes one-week later (Time 2), and responded one-month later (Time 3). Comparing the experimental conditions showed non-significant differences for all outcomes, indicating no added benefit of efficacy-enhancing messages. Collapsing the experimental groups and comparing against the control showed significant group-by-time interactions for three ‘outcome expectancies’ (travel, social affiliation, stress relief), with reports higher among experimental participants. Results also indicated that moderate-to-vigorous physical activity significantly decreased at Time 3 within the control, but remained constant among experimental participants.

Fear of cancer recurrence (FCR) is defined as “fear, worry, or concern relating to the possibility that cancer will come back or progress (Lebel et al., 2016, p. 3266). FCR is the most frequently reported concern identified among cancer survivors (Baker, Denniston, Smith, & West, 2005; Lebel, Rosberger, Edgar, & Devins, 2007). Although approximately 50% of cancer survivors experience moderate-to-high levels of FCR (Simard et al., 2013), few psychosocial interventions exist that directly target this construct. The overarching study objectives were: (a) to adapt a manualized, 6-week, cognitive-existential group therapy intervention for FCR to an individual format; (b) to pilot-test the feasibility, acceptability, and satisfaction of this individual intervention on n=3 participants; and (c) to further pilot-test the efficacy of the individual intervention on n=25 participants, via a randomized controlled trial (RCT). In study 1, n=3 cancer survivors (1 male, 2 females) completed the one-on-one therapy intervention for the psychological treatment of FCR. Sessions were 60-90 minutes long, and included cognitive restructuring exercises, behavioural experiments, relaxation techniques, existential processing of the here-and-now, and finding meaning in life post-diagnosis. Participants completed questionnaire packages throughout the intervention and an exit interview to determine their overall feedback on the intervention. Quantitative analyses revealed downwards trends in fear of cancer recurrence and cancer-specific distress across participants. Qualitative analyses of the exit interviews revealed that all participants found the intervention useful, and that the sessions had favourable pacing and length. In study 2, the FCR intervention was further pilot-tested via an RCT. Twenty-five female cancer survivors were randomized to an experimental group or a wait-list control group. Sessions included cognitive restructuring techniques, behavioural experiments, confronting existential distress, and relaxation exercises. Nineteen women (n=9 intervention, n=10 control) completed the 6-week therapy intervention, and completed questionnaire packages at pre-, post- and 3-month follow-up. Between-within ANOVAs revealed significant interactions in the primary outcome measure of FCR, and secondary outcome measures of cancer-specific distress and uncertainty in illness for participants in the experimental group. Repeated measures ANOVAs revealed reductions in FCR, cancer-specific distress, uncertainty in illness, reassurance-seeking, cognitive avoidance, and intolerance of uncertainty, and revealed improvements in positive reinterpretation and growth, use of emotional support and mental health (improved quality of life) for participants in the experimental group, as compared to the wait-list control group. The variables that changed either maintained or improved at follow-up. Results from this study demonstrate promising results in addressing FCR in cancer survivors via a cognitive-existential intervention. Future research should continue investigating the specific therapeutic ingredients that are most effective for the psychological treatment of FCR.

Nowell (1976) first proposed that unless cytotoxic cancer therapy eradicates all tumor cells, genetic or heritable variation within heterogeneous tumors will inevitably lead to the evolution of chemotherapeutic resistance through clonal selection. This evolutionary hypothesis was formalized by Goldie and Coldman (1979), who developed one of the earliest mathematical kinetic models of resistance evolution in neoplasms. Their model predicted that the likelihood of response and cure would be increased in combination vs single agent cytotoxic therapies. In a later study, Gardner (2002) developed a computational kinetic model to predict chemotherapeutic combinations, doses, and schedules most likely to result in patient response and prolonged life. This model predicts that combination therapy involving both cytotoxic and cytostatic drugs will be more effective than combination therapy involving only cytotoxic drugs. Thus far, no systematic evaluation of the Goldie and Coldman and Gardner hypotheses have been conducted in the metastatic clinical trial setting. Here I test these hypotheses using the results of over 700 phase II, III and II/III clinical trials. I show that, as predicted by Goldie and Coldman, both overall response rate and overall survival were greater in combination arms. Moreover, median duration of response – the key indicator of the rate of resistance evolution - was also greater in combination vs single agent arms. These results suggest that generally combination chemotherapy is more effective than single agent therapy for advanced solid tumors as predicted by Goldie and Coldman (1979) hypothesis and that, at least in the metastatic setting, the potential disadvantages of combination therapy with respect to accelerated resistance evolution are outweighed by the greater waiting times for resistance mutations to arise. By contrast, although combination cytotoxic and cytostatic therapy is associated with a greater average overall response rate than multi agent cytotoxic therapy, this is not the case for both median duration of response and overall survival. Hence, there is no evidence that, in contrast to the predictions of the Gardner (2002) model, combination cytotoxic and cytostatic therapy decreases the rate of resistance evolution relative to that obtaining under combination cytotoxic therapy.

Quelles sont les techniques argumentatives utilisées par les avocats plaideurs pour convaincre lesjuges ? Telle est la question à laquelle nous essayons de répondre dans cette thèse portant sur une étude linguistique du discours juridique dans les grands procès politiques de la Seconde Guerre Mondiale. Le travail se compose d’une partie théorique où sont exposées les catégories d’analyse du rhétoricien de l’Antiquité Aristote et du rhétoricien contemporain Chaïm Perelman qui exposent tous les deux les principales stratégies de persuasion. La deuxième partie de ce travail est consacrée à l’analyse de textes authentiques : après une analyse des plaidoiries des avocats dans les procès du régime de Vichy, nous arrivons aux conclusions suivantes : les avocats de la défense ne plaident pas de la même manière que ceux de l’accusation d’une part, et, d’autre part, la plaidoirie traditionnelle n’a pas la même forme que la plaidoirie moderne. Comment est composée une plaidoirie traditionnelle ? Comment est composée une plaidoirie moderne ? Quelles sont les techniques spécifiques à l’accusation ou à la défense ? Y a-t-il des techniques communes ? A travers cette étude, nous vous invitons à découvrir la réponse à ces questions et bien d’autres encore. / What are argumentatives techniques used by lawyers litigants to convince the judges? Such is thequestion that we try to answer in this thesis concerning a linguistic study of the legal speech in the bigpolitical trials of the Second World War. The work consists of a theoretical part where are expose thecategories of analysis of the rhetorician of the Antiquity Aristote and of the contemporary rhetoricianChaïm Perelman who explain the main strategies of persuasion. The second part of this work isdedicated to the analysis of authentic texts: after an analysis of the pleas of lawyers in the trials of theregime of Vichy, our conclusion is: The defense counsels do not plead in the same way as those of thecharge on one hand, and, on the other hand, the traditional plea has no same shape as the modern plea. How consists a traditional plea? How consists a modern plea? What are the specific techniques in the charge or in the defense? Are there common techniques? Through this study, we invite you todiscover the answer to these questions and many others else.

Bakgrund: Akupunktur är en gammal behandlingsmetod, beräknad ungefär 4100 år gammal och kommer från Kina. Elektroakupunktur är en något nyare behandlingsmetod där man för ström mellan nålarna. Denna behandlingsmetod används främst av fysioterapeuter. Behandlingarna som fysioterapeuten utför kräver ett vetenskapligt stöd, därför finns ett behov att granska den litteratur som behandlingsmetoden grundas på. Inom forskning och verksamhet använder man olika namn för denna metod, både “electroacupuncture” och “percutaneouselectricalnervestimulation” (PENS). Ryggsmärta är ett vanligt problem bland världens befolkning, det är beräknat att upptill 70% av befolkningen kommer någon gång i sitt liv uppleva ryggssmärta. Det är även beräknat att vara den vanligaste smärtförekomsten. Om elektroakupunktur fungerar mot ländryggssmärta kan terapeuter använda denna behandlingsmetod. Syfte: Syftet med denna studie var att undersöka vilket vetenskapligt stöd det finns för elektroakupunktur som behandlingsmetod vid ländryggssmärta. Metod: En systematisk sökning utfördes i databaserna CinAHL, PubMed, PEDro, Scopus och Web of Science angående elektroakupunktur och ländryggssmärta. Sökorden som användes var “electroacupuncture”, “lowback pain ”, “percuteaneous electricalnervestimulation” och “randomized controlled trial”. Resultat: Sammanlagt 15 RCT – studier inkluderades i denna studie. Sammanlagt 11 av 15 studier fann signifikanta skillnader i resultat. 8 studier behandlade kronisk ländryggssmärta, 4 behandlade diskogena besvär och resterande 3 behandlade andra ryggdiagnoser. Elektroakupunktur har visat ge en smärtlindring vid ländryggssmärta. Konklusion: Samtliga inkluderade studier fann smärtlindring av behandlingen, dock visade inte alla signifikanta skillnader. Det finns även metodologiska brister i den befintliga litteraturen vilket innebär att bör se resultaten kritiskt. Mer forskning inom området behövs.