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Klepper, Tommy David. "Triad or dyad for the 1990's : a balance of reality." Thesis, Monterey, California. Naval Postgraduate School, 1990. http://hdl.handle.net/10945/37525.
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Approved for public release, distribution is unlimitedAs the United States enters the decade of the 1990s, it is essential to review the guidance and policies for our force structures. At the focal point of discussion on future force structures for the United States is the strategic nuclear forces. The strategic nuclear force structure for the United States has been predicated on the concept of a Triad, which consists of three legs, referred to as land-based, sea-based, and manned bombers. Each of the legs consists of separate components. Understanding the tradition of the United States strategic deterrent being predicated on the Triad concept, it is concluded that with the changing international environment and the declaratory statements for continuing to decrease the Defense Budget, a new and realistic review of the factors for determining a strategic nuclear force should be researched. Therefore, the intention of this thesis is to review and analyze the five factors which may contribute to the formulation of a realistic policy for the 1990s with regard to the United States strategic nuclear forces. The final results of the research have indicated sufficient evidence that a policy review of the strategic nuclear Triad should be conducted to meet the challenges and realities of the 1990s and the 21st Century.
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Grant, Keith Adley. "The Indirect Dimensions of Conflict and Cooperation." Diss., The University of Arizona, 2010. http://hdl.handle.net/10150/195920.
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This dissertation project broadly addresses the question of how state behavior is conditioned by the structural configuration of the network in which they are embedded. It attempts to reconcile some of the discrepancies between the systemic and dyadic approaches to international relations, by arguing that the international system is a multidimensional network that results as an emergent property of the dyadic ties that exist between states.This dissertation consists of three stand alone analyses, connected by their focus on systemic configuration and the impact of various elements of international structures on the behavior of states. In contrast to most studies of international relations, dimensions of the international order are observed, rather than assumed. The first chapter focuses specifically on observing and describing the structure and tendencies of the behavioral dimension of the international system. It assesses patterns of consistency in international relations, searching for both simple, dyadic consistency as well as more complex, triadic consistency. The second chapter relies on these positive and negative relations to create a model of policy reinforcement, with a focus on the onset of militarized conflict. Structural balance theory is used to identify shared, external relations that either reinforce or dampen the impact of dyadic hostility on militarized conflict. The final empirical chapter shifts to a more localized focus, investigating the impact of alliance portfolio size on the likelihood of alliance obligation fulfillment. Here, the size and capabilities of a disputant's local alliance portfolio do not directly modify the behavior of the disputant, but instead that of the disputant's other allies.Together, these chapters demonstrate the importance of accounting for systemic factors in explaining and analyzing dyadic behavior. The characteristics of local networks, such as alliance portfolios, have significant implications for state security. The configuration of foreign policy relations provides feedback to states, influencing their willingness to take aggressive actions. Bipolarity and multipolarity can be empirically observed through the clustering of states, rather than by merely counting the number of major powers. However, perhaps most significant is the contribution these analyses make to a small but growing literature attempting to move beyond the dyad.
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Pattison, Sandra. "Small, non-isomorpic [i.e. non-isomorphic], strongly balanced, uniform repeated measures (cross-over) designs /." Title page, contents and abstract only, 1991. http://web4.library.adelaide.edu.au/theses/09SM/09smp3211.pdf.
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Silsupadol, Patima. "Effects of single- vs. dual-task training on balance performance under dual-task conditions in older adults with balance impairment : A randomized, controlled trial/." Connect to title online (Scholars' Bank) Connect to title online (ProQuest), 2008. http://hdl.handle.net/1794/8546.
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Thesis (Ph. D.)--University of Oregon, 2008.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 88-96). Also available online in Scholars' Bank; and in ProQuest, free to University of Oregon users.
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Silsupadol, Patima 1975. "Effects of single- vs. dual-task training on balance performance under dual-task conditions in older adults with balance impairment: A randomized, controlled trial." Thesis, University of Oregon, 2008. http://hdl.handle.net/1794/8546.
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xiv, 96 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number.Among older adults, an impaired ability to maintain balance while simultaneously performing cognitive tasks is a common occurrence. Because poor dual-task balance performance is associated with increased fall risk and a decline in cognitive function, interventions to improve dual-task balance performance are needed. Although traditional rehabilitation programs emphasizing training balance under single-task conditions are effective in improving single-task balance performance, it is not known whether single-task training generalizes to balance control under dual-task contexts. Moreover, the effectiveness of approaches to training balance under dual-task conditions is not known. Thus, the purposes of this study were to determine whether elderly individuals with balance impairment can improve their balance performance under dual-task conditions; to investigate whether training balance under single-task conditions generalizes to balance control during dual-task contexts; and to evaluate the effect of instructional set on dual-task balance performance. Specifically, the efficiency of three different training strategies was examined in an effort to understand the mechanisms underlying training-related changes in dual-task balance performance. Twenty-three elderly adults with balance impairment were randomly assigned to 1 of 3 interventions: single-task balance training (ST); dual-task training with fixed-priority instruction (FP); and dual-task training with variable-priority instruction (VP). Clinical and laboratory measures were obtained at baseline and after training. In addition, selected clinical outcomes were repeated after the second week of training to examine interim balance change and at twelve weeks post training to test retention. Results indicate that dual-task training was effective in improving balance under dual-task conditions in the elderly with balance impairment. Training balance under single-task conditions may not generalize to balance control during dual-task contexts. Explicit instruction regarding attentional focus was an important factor for improvement in dual-task performance. The VP instructional set offered advantages over the FP instructional set in terms of the degree of improvement, the rate of learning, and the retention of the dual-task training effect. The dual-task processing skills learned during training were not transferred to novel dual-task conditions. Lastly, the training benefits acquired during VP training could be the result of both automatization of the individual task and the development of task-coordination skills.
Adviser: Marjorie Woollacott
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Elsner, Bernhard, Simon Schweder, and Jan Mehrholz. "Immediate effects of rest periods on balance control in patients after stroke. A randomized controlled pilot trial." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-236947.
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Objectives
This randomized controlled trial evaluates the effects of two different rest periods between as set of balance exercises after stroke during inpatient rehabilitation.
Results
Twenty patients after stroke [11 males; mean (SD) age 65.4 (11.5) years; duration of illness 5.3 (3.4) weeks; 16 (80%) left-sided strokes] were randomly allocated into two groups of either a full rest (FR) of 4 min (n = 10) or a short rest (SR) of 1 min between exercise sets (n = 10). Patients improved from baseline until immediately after exercises in one-leg standing time on the affected leg [SR: mean difference 5.1 s (SD 10.3) and FR: 2.0 s (2.4)] and tandem standing time (TST). [SR: 14.9 s (SD 24.6) and FR: 5.7 s (12.0)], but OLST and TST did not differ significantly between groups (p = 0.35 and p = 0.52, respectively).
Trial registration The study was registered retrospectively in the German Register of Clinical Trials with the ID: DRKS00013979
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Livock, Holly. "Exercising with a Screen or Music and Post-Exercise Energy Compensation: A Randomized Crossover Trial in Male Adolescents." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37817.
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Watching television or listening to music during exercise has been shown to increase
the enjoyment of the activity and decrease fatigue for some people. However, it is
currently unknown how these stimuli during an exercise session play a role in postexercise
energy intake and/or physical activity energy expenditure (PAEE). The purpose
of this thesis was to examine the effects of watching television or listening to music
while exercising on post-exercise energy intake and expenditure in male adolescents.
The study consisted of a randomized crossover design involving 24 male adolescents
aged 12 to 17 years. The participants completed three experimental sessions that
included walking/jogging on a treadmill at 60% of their heart rate reserve for 30 minutes
while watching television, listening to music, or exercising with no other stimulus
(control). Following the exercise sessions participants were given an ad libitum lunch
and were asked to record their food intake for the remainder of the day. An Actical
accelerometer was used to assess PAEE until bedtime. The primary outcome measure
was post-exercise energy intake and energy expenditure. Results showed that
exercising while watching television or listening to music did not significantly affect postexercise
energy intake or energy expenditure. Walking/jogging on a treadmill was found
to be more enjoyable while watching television than with no stimulus present (p=0.03).
Ratings of perceived exertion were not significantly different between conditions.
Overall, our results suggest that watching television or listening to music while
exercising does not impact post-exercise energy intake or expenditure in male
adolescents, which may have positive implications for adolescents who may need
additional motivation to exercise.
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Adams, Carole Helen. "#Balance' in pre-trial criminal justice : suspects' experience in the nick under the revised PACE Code of Practice C." Thesis, London School of Economics and Political Science (University of London), 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.307469.
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SKOOGH, JOAKIM. "Utveckling och balans inom personalhantering." Thesis, Högskolan i Borås, Institutionen Handels- och IT-högskolan, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-20797.
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Jag upplever det som att dagens samhälle är i ett konstant läge av förändring, vilket borde medföra att de företag som finns ute i samhälle måste befinna sig i ett konstant läge av anpassning. Utifrån det undrar jag hur företagen kan klara av att hantera de mänskliga resurserna samtidigt som de måste klara av den föränderliga omgivningen. Jag har därför valt att undersöka personalhanteringen på tre företag inom samma bransch för att fastställa ifall personalhanteringen utvecklas åt liknande håll. Eller om företagen utvecklas åt helt olika håll utan några likheter. De företag som jag undersöker lyckas uppenbarligen med konststycket att anpassa sig samtidigt som de hanterar sin personal och det jag är intresserad av är hur lyckas de med en sådan balansering.Mitt syfte är således inte att hitta ett gyllene snitt för personalhantering utan om möjligt finna liknelser mellan hur de företag jag kommer i kontakt med hanterar personal. Den struktur som används i uppsatsen är Hernadi’s hermeneutiska triad då den har möjligheten att hantera både delen och helheten i en sann abduktiv anda.För att ha möjligheten att undersöka utvecklingen utgår jag från dels bakgrunden till personalhanteringskonceptet och dels en teoretisk redogörelse för hur personalhantering kan se ut och vad det kan leda till. Uppsatsen utgår från de intervjuer som jag hållt med personalcheferna från de tre företagen och jag använder sedan ett antal teorier för att sätta den informationen i kontext. Jag noterar att företagen drar sig mot en mer formaliserad struktur och jag tolkar det som en reaktion för att hantera den psykiska press som drabbar de anställda utifrån de tekniska förändring som branschen medför samt den tillväxt som finns hos företagen. Formaliseringen fungerar i sin tur som en motpol till frihet, då en högre nivå av formalisering lämnar mindre spelområde för de anställda. Vilket i sin tur leder till minskad kreativitet. Det som är viktigt är för företagen att lyckas balansera mellan de olika ytterligheterna för att få alla delar att fungera.
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Balík, Pavel. "IFRS implementation: A case of real company." Master's thesis, Vysoká škola ekonomická v Praze, 2017. http://www.nusl.cz/ntk/nusl-359273.
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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.
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Vermöhlen, Vanessa, Petra Schiller, Sabine Schickendantz, Marion Drache, Sabine Hussack, Andreas Gerber-Grote, and Dieter Pöhlau. "Hippotherapy for patients with multiple sclerosis: A multicenter randomized controlled trial (MS-HIPPO)." Sage, 2018. https://tud.qucosa.de/id/qucosa%3A35527.
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Background: Evidence-based complementary treatment options for multiple sclerosis (MS) are limited.
Objective: To investigate the effect of hippotherapy plus standard care versus standard care alone in MS patients.
Methods: A total of 70 adults with MS were recruited in five German centers and randomly allocated to the intervention group (12 weeks of hippotherapy) or the control group. Primary outcome was the change in the Berg Balance Scale (BBS) after 12 weeks, and further outcome measures included fatigue, pain, quality of life, and spasticity.
Results: Covariance analysis of the primary endpoint resulted in a mean difference in BBS change of 2.33 (95% confidence interval (CI): 0.03–4.63, p = 0.047) between intervention (n = 32) and control (n = 38) groups. Benefit on BBS was largest for the subgroup with an Expanded Disability Status Scale (EDSS) ⩾ 5 (5.1, p = 0.001). Fatigue (−6.8, p = 0.02) and spasticity (−0.9, p = 0.03) improved in the intervention group. The mean difference in change between groups was 12.0 (p < 0.001) in physical health score and 14.4 (p < 0.001) in mental health score of Multiple Sclerosis Quality of Life-54 (MSQoL-54).
Conclusion: Hippotherapy plus standard care, while below the threshold of a minimal clinically important difference, significantly improved balance and also fatigue, spasticity, and quality of life in MS patients.
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Lingam, Varatharajan. "Effects of Generic Group-Based Versus Personalized Individual-Based Exercise Programs on Balance, Gait, and Functional Performance of Older Adults with Mild Balance Dysfunction and Living in Residential Care Facilities - A Randomized Controlled Trial." Diss., NSUWorks, 2019. https://nsuworks.nova.edu/hpd_pt_stuetd/82.
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Background and Purpose: To investigate the effect of an individualized exercise program versus a generic group-based exercise program on balance, gait, and functional performance of older adults categorized as having mild balance dysfunction and living in residential care facilities. Methods: Single blind randomized control design. One hundred-twenty residents fulfilled screening criteria for mild balance dysfunction based on the BioSwayTM balance and the Multi-Directional Reach Test (MDRT) primary outcome measures. Secondary assessment was completed using the Modified Physical Performance Test (PPT), hand-held dynamometer (lower-limb muscle strength testing), and gait speed analysis. Sixty subjects received individualized treatment from physical therapists (8 weeks). Another sixty subjects received generic group-based exercises (8 weeks). All outcome measures were collected at baseline and post-intervention (ninth week); and BioSwayTM and PPT measures at follow-up (thirteenth week) for the individualized group. Results: Individualized group (n=60) showed significant improvement compared to the group-based group (n=60) on the two BioSwayTM scores (limits of stability, p < .001; and postural stability, p = .016), the MDRT scores (forward reach, p < .001; backward reach, p = .007; right lateral reach, p < .001; and left lateral reach p < .001), the strength scores (hip flexors, p = .010; knee extensors, p = .002; hip abductors, p = .009; and ankle dorsiflexors, p = .025), the PPT outcomes (p < .001), and the gait scores (p = .012). Effect sizes ranged from small to large, with the largest sizes for limits of stability and MDRT. There were no significant differences between groups for the mCTSIB (p = .538). However, 96.7% of subjects in the individualized group scored within one SD of the reference mean, relative to 75% in the group-based group. At follow-up, the individualized group showed significant differences over time with medium to large effect sizes on the PPT (p < .001), limits of stability (p < .001), postural stability (p < .001), and mCTSIB (p = .005) measures. Post-hoc analysis revealed retention of gains for all measures at follow-up, except the mCTSIB. Conclusion: The individualized group showed significant improvements in the areas of balance, strength, mobility, and functional outcomes.
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Chronopoulos, Andreas. "Working from Home in the Clinical Trials Sector: A Case Study of Clinical Research Associates (CRAs) in the UK." Thesis, University of Bradford, 2016. http://hdl.handle.net/10454/15853.
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This study explores Working from Home (WFH) as a model of work in a public organisation in London, which operates in the clinical-trials sector. It argues that WFH is used as a strategy that offers benefits both to the organisation and its employees. WFH is offered to all Clinical Research Associates (CRAs) who work as monitors of the whole process of a clinical trial. Based on a qualitative approach, using semi-structured interviews of 29 CRAs, managers and administrative staff and secondary data, this single-case study focuses on five topics that are part of the CRAs’ everyday life. These are work-life balance (WLB), cost reduction, the Information and Communications Technology (ICT) factor, the performance of the CRAs and the management of remote workers. In particular, the study identified that WFH had a positive effect on CRAs’ WLB. Moreover, it argues that WFH may offer significant assistance to organisational budgets and may reduce personal expenses. It found that existing ICT could cover all employees’ technological needs and reduce the requirement of managers to keep them physically present at a centralised workplace. Additionally, this thesis also identified that WFH improved CRAs’ performance, whilst it also highlighted that results-oriented management was the main managerial approach towards employees who work from a distance. The key contribution of the thesis is the examination of the CRA occupation through a contemporary perspective on the WFH phenomenon.
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Castellon, Léa. "La place de la victime dans le procès pénal." Thesis, Paris Est, 2017. http://www.theses.fr/2017PESC0097.
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La place de la victime au sein du procès pénal est complexe et ambiguë. En droit positif, la victime bénéficie désormais de droits et de moyens d'action dans le procès pénal qui lui garantissent un véritable rôle. Par exemple, comme le ministère public, la victime peut déclencher l'action publique et demander la réparation du préjudice subi. La victime n'est plus la grande oubliée du procès pénal, elle est devenue une partie à part entière. Toutefois, en dépit d'un renforcement manifeste du rôle de la victime dans le procès pénal, un déséquilibre des droits et des moyens d'action persiste entre les parties dans chaque étape de la procédure pénale. Une amélioration de la procédure pénale est donc toujours nécessaire pour sauvegarder les droits de la victime et empêcher celle-ci d’être injustement mise à l’écartThe place of the victim in the criminal trial is complicated and ambiguous. In current law, the victim enjoys rights and means of action in the criminal trial which guarantee her a real part. For example, as the prosecution, the victim can activate the public action and she can ask for the repair of her damage. The victim is not any more the forgotten of the criminal trial, she became a full part. However, in spite of an obvious strengthening of the part of the victim in the criminal trial, an imbalance of the rights and the means of action persists between the parts in every stage of the criminal procedure. The improvement of the procedural balance between the parts in the criminal trial has to continue not to put aside the victim
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Tomanová, Lenka. "Audit z pohledu účetní jednotky." Master's thesis, Vysoké učení technické v Brně. Fakulta podnikatelská, 2011. http://www.nusl.cz/ntk/nusl-223314.
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The goal of this master´s thesis: Audit from the Perspective of a Company” is to identify discretions and duties of a company based on the obligation to verify financial statement by the auditor. Among fundamental duties of the company belongs obligation to provide all important information for the financial statement. That´s the reason, why I chose to summarize necessary law, accounting and tax documents as a partial target of this thesis.
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Rudolfsson, Thomas. "Sensorimotor control and cervical range of motion in women with chronic neck pain : Kinematic assessments and effects of neck coordination exercise." Doctoral thesis, Umeå universitet, Sjukgymnastik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96172.
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Introduction: Neck pain is a common problem in society and is more prevalent among women. The consequences of neck pain for the individual often include activity and participation limitations, thus affecting many dimensions of life. There is still a lack of understanding of the underlying mechanisms of the disorder and likewise of efficient rehabilitation for people with neck pain. However, coordination exercises have shown promising short-term effects. To carry this line of research forward, there is a need to improve methods for objective characterization of impairments and to investigate novel methods of rehabilitation. Aims: To characterize impairments of active cervical range of motion of the upper and lower cervical levels in women with chronic neck pain with a novel method (Study I and II) and identify the influence of head posture and movement strategies (Study II). Further, to investigate the effects of a novel method for neck coordination exercise on sensorimotor function and neck pain (study III) and the consistencies of motor variability metrics in a goal directed arm movement task to aid the design of future clinical research (Study IV). Methods: All studies were laboratory based with kinematic assessments of neck movements (Study I-III), balance (Study III) and goal directed arm movements (Study III, IV). The studies had designs that were: cross-sectional (I and II), randomized controlled trial (III) or test-retest reliability study (IV). Participants in Study I (n=135) and II (n=160) were women with chronic non-specific neck pain and healthy controls. In Study III, women with chronic non-specific neck pain (n=108) were randomized into three different individually supervised 11 week interventions. Study IV included healthy women (n=14). Results: It was found that cervical range of motion impairments in women with non-specific neck pain were direction- and level-specific; impairments were greater in extension in the upper and flexion in the lower levels of the cervical spine. The magnitude of impairments in range of motion was associated to self-ratings of functioning and health. Possible group differences in natural head posture were rejected as a cause for the direction specific effects. Neither could the effects be explained by a strategy to minimize torque in the cervical spine during movement execution. The neck coordination training was not superior to strength training (best-available) and massage treatment (sham) in improving sensorimotor functions or pain according to short-term and 6 months follow ups. The results from the study of the goal directed movement task showed that between and within-subject sizes of most motor variability metrics were too large to make the test suitable for application in clinical research. Conclusions: Women with chronic non-specific neck pain have direction- and level-specific impairments in cervical sagittal range of motion. The underlying causes of these specific impairments remains unresolved, but the direction specific impairments are not related to natural head posture. The clinical validity of the method of characterization of cervical range of motion was supported and it can be useful in future clinical research. The novel method of neck coordination exercise showed no advantages on sensorimotor functions or pain compared with best-available treatment in women with chronic non-specific neck pain.Långvarig smärta i nacken är vanligt förekommande och orsakar både personligt lidande och stora kostnader för samhället. Långvariga nackbesvär är vanligare hos kvinnor än hos män. Det saknas kunskap om effektiva rehabiliteringsmetoder, men forskning har indikerat att träning som förbättrar nackens koordination kan vara effektivt. För att uppnå bättre rehabiliteringsresultat är det viktigt att utveckla metoder för att objektivt mäta funktionsnedsättningar och att utveckla samt utvärdera nya rehabiliteringsmetoder. Syftet med avhandlingen kan sammanfattas i tre delar: Att detaljerat mäta nedsättningar i nackens rörelseomfång hos kvinnor med långvarig nacksmärta; att utvärdera effekten av en ny metod för nackkoordinationsträning på rörelsefunktion och smärta hos kvinnor med långvarig nacksmärta; samt att utvärdera ett nytt test för att mäta precision och koordination vid målriktade armrörelser och ämnat för framtida klinisk forskning. Resultaten visade att kvinnor med långvarig nacksmärta hade specifika nedsättningar i nacken rörelseomfång; i övre nackregionen var bakåtböjning mer begränsad medan i nedre nackregionen var framåtböjning mer begränsad. Vi kunde utesluta att resultaten berodde på skillnader i huvudets normala hållning. Graden av rörelsebegränsning i nacken uppvisade samband med personernas självskattade funktion, symtom och hälsa. Nackkoordinationsträningen var inte var bättre än styrketräning eller massage för att förbättra rörelsefunktion eller för att minska smärta. Det nya testet för armrörelser var inte lämpat för kliniska studier av rörelseprecision. Slutsatserna från avhandlingsarbetet är att kvinnor med långvarig nacksmärta har begränsningar i nackens rörelseomfång vid framåt- och bakåtböjning av huvudet som är specifika vad gäller nivå i halsryggen och riktning. Att graden av rörelsebegränsning uppvisade samband med självskattad funktion, symtom och hälsa styrker testets kliniska validitet. Ytterligare forskning behövs för att förstå orsakerna bakom de specifika nedsättningarna. Nackkoordinationsträningen som utvärderades kan inte rekommenderas för kvinnor med långvarig nacksmärta eftersom korttidsuppföljning och 6-månadersuppföljning visade att träningsformen inte var bättre än styrketräning eller massage, vare sig när det gällde att förbättra sensomotorisk funktion eller att minska smärta.
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Silva, Christiane Rodrigues da, (092) 98802-0128, and https://orcid org/0000-0002-7735-809X. "Estudo comparativo do uso de clonidina administrada por via venosa, versus subaracnóidea, em pacientes submetidos à colecistectomia videolaparoscópica." Universidade Federal do Amazonas, 2018. https://tede.ufam.edu.br/handle/tede/6719.
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BACKGROUND. Untreated pain leads to postoperative complications that prolong hospital stay. The association of analgesic drugs with different mechanisms of action, such as clonidine, allows the use of smaller doses of medication for better control of pain. OBJECTIVES. This dissertation aims to evaluate the use of multimodal analgesia in the control of postoperative pain in patients submitted to videolaparoscopic cholecystectomy (VLC); to compare the analgesic activities of intrathecal and intravenous clonidine for postoperative analgesia; to analyze the need for analgesic drugs in the immediate postoperative (tramadol / morphine) and to identify possible complications. METHOD. A prospective, randomized clinical trial was conducted with patients divided into three blocks, with 20 patients each one: Group I (n = 20) control, submitted to standard anesthesia; Group II (n = 20) intrathecal clonidine, submitted to standard anesthesia associated with the use of intrathecal clonidine; Group III (n = 20) intravenous clonidine, submitted to standard anesthesia associated with the use of intravenous clonidine. RESULTS. The pain scores between the groups did not present significant differences, but a greater analgesic need was observed in the control group (p = 0.005), as well as a higher incidence of nausea and vomiting (p = 0.240), probably due to side effects of morphine as rescue medication. Groups II and III presented a significant reduction of heart rate (p ˂ 0.001), but without clinical repercussion. CONCLUSIONS. In patients undergoing VLC there is evidence that the perioperative administration of alpha 2-agonists preserves hemodynamic stability, decreases opioid consumption and the incidence of nausea and vomiting in the postoperative.
JUSTIFICATIVA. A dor não tratada leva a complicações pós-operatórias que prolongam o tempo de internação hospitalar. A associação de fármacos analgésicos com diferentes mecanismos de ação, como a clonidina, permite usar doses menores de medicamentos para melhor controle da dor. OBJETIVOS. Esta dissertação tem por objetivo avaliar o emprego de analgesia multimodal no controle da dor pós-operatória de pacientes submetidos à colecistectomia por videolaparoscopia (CVLP); comparar as atividades analgésicas da clonidina intratecal e endovenosa para analgesia pós-operatória; analisar a necessidade de drogas analgésicas no pós-operatório imediato (tramadol/morfina) e identificar possíveis complicações. MÉTODO. Foi realizado um estudo de ensaio clínico prospectivo, experimental e randômico, com os pacientes divididos em 03 blocos, com 20 pacientes cada: Grupo I (n=20) controle, submetido à anestesia padrão; Grupo II (n=20) clonidina intratecal, submetido à anestesia padrão associada ao uso de clonidina intratecal; Grupo III (n=20) clonidina endovenosa, submetido à anestesia padrão associada ao uso de clonidina endovenosa. RESULTADOS. Os escores de dor entre os grupos não apresentaram valores com diferenças significativas, porém foi observada maior necessidade analgésica do uso da morfina no grupo controle (p = 0,005), assim como maior incidência de náuseas e vômitos (p=0,240), provavelmente devido aos efeitos colaterais da morfina como medicação de resgate. Os grupos II e III apresentaram uma redução significativa da frequência cardíaca (p ˂0,001), porém sem repercussão clínica. CONCLUSÕES. Nos pacientes submetidos à CVLP há evidências de que a administração perioperatória de alfa 2-agonistas preserva a estabilidade hemodinâmica, diminui o consumo de opióides e a incidência de náuseas e vômitos no pós-operatório.
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Cabrera, Rojas Natalia. "Efficacité et tolérance des agents biologiques dans les rhumatismes inflammatoires à début juvénile dans les essais cliniques randomisés et les études observationnelles." Thesis, Lyon, 2019. http://www.theses.fr/2019LYSE1191/document.
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Les rhumatismes inflammatoires juvéniles sont des maladies chroniques débutant avant l’âge de 16 ans. Comprennent des pathologies classées dans un continuum, allant de la dérégulation de l’immunité innée à la dérégulation de l‘immunité adaptative. L’arthrite juvénile idiopathique (AJI) reste la plus fréquemment diagnostiqué. Les options thérapeutiques se sont élargies à partir des années 2000 avec le développement des thérapies ciblées, les biothérapies, associés aux traitements standard utilisés en rhumatologie pédiatrique (ex : anti-inflammatoires non stéroïdiens, corticostéroïdes, méthotrexate, et autres immunosuppresseurs). L’objectif de ce travail de thèse était d’estimer la relation bénéfice-risque des biothérapies utilisés dans les rhumatismes inflammatoires juvéniles à partir des essais cliniques randomisés (ECR) et d’explorer la tolérance à long cours à partir des essais observationnels. Premièrement, en utilisant une approche méta-analitique, les données des ECR en double aveugle contre placebo ou en ouvert dans l’AJI ont été analysées pour modéliser la relation bénéfice-risque des biothérapies avec le bénéfice net. Pour cela, l’efficacité clinique, mesuré par un score composite clinique et biologique (ACRped30), a été confronté à la tolérance clinique pendant la phase randomisée des ECR. Le critère de tolérance était la survenue d’un évènement indésirable (EI) grave (EIG). La balance bénéfice-risque reste favorable pour les biothérapies. Cependant, ces résultats sont limités par le suivi de faible durée, qui peut sous-estimer l’incidence des EI. Deuxièmement, nous avons conduit une étude observationnelle pour étudier la tolérance à moyen et long-terme des biothérapies utilisant les EI et les EIG décrits dans une base de données multicentrique rétrospective. La sécurité globale des biothérapies a été acceptable chez les enfants atteints de rhumatismes inflammatoires. Nous avons observé une variation des EIG au cours du temps et que la prescription concomitante des immunosuppresseurs a représenté un risque indépendant pour la survenue des EI. Afin d’explorer ces éléments et connaître la tolérance au long-terme, une méta-analyse des études observationnelles a été fait. Nous avons utilisé les EIG pour étudier précisément la tolérance à court et à long termeJuvenile inflammatory rheumatism is a chronic disease that begins before the age of 16. Includes conditions classified along a continuum, ranging from the deregulation of innate immunity to the deregulation of adaptive immunity. Juvenile idiopathic arthritis (JIA) remains the most frequently diagnosed disease. Therapeutic options have expanded since the 2000s with the development of targeted therapies: biological agents (BAs). They can be combined with standard treatments used in paediatric rheumatology (e.g. non-steroidal anti-inflammatory drugs, corticosteroids, methotrexate, and other immunosuppressive drugs). The objective of the work of this thesis was to model the benefit-risk balance of BAs used in JIA from randomized clinical trials (RCTs) and to explore long-term tolerance from observational trials. First, using a meta-analytical approach, the data from double-blind, placebo-controlled or open RCTs in JIA were analysed for modelling the benefit-risk balance of BAs. For this purpose, the efficacy measured by a composite clinical and biological score (ACRped30), was compared with clinical safety during the randomized phase of RCTs. Safety criterion was the occurrence of adverse events (AEs). The risk-benefit balance remains favourable for biotherapies. However, these results are limited by the short follow-up period, which may underestimate the incidence of AEs. Second, we conducted an observational study to investigate the medium- and long-term safety of biotherapies using AEs and serious AEs described in a retrospective multicentre database. The overall safety of biotherapies has been acceptable in children with inflammatory rheumatic diseases. We observed a variation in the SAEs over time and that the concomitant prescription of immunosuppressants represented an independent risk for the occurrence of AEs. In order to explore these elements and long-term safety, a meta-analysis of observational studies was conducted. We used the SAEs to study precisely the short and long-term tolerance
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Chong, Ooi Thye. "Mixed methods study of acupuncture treatment for chronic pelvic pain in women." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/28812.
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Chronic pelvic pain (CPP) is defined as constant or intermittent lower, cyclical or non-cyclical abdominal pain of at least six months’ duration. In the United Kingdom, over 1 million women suffer from CPP, with an estimated annual healthcare cost above £150 million. The aetiology of CPP is unknown in up to 50% of women, and in the remainder, the symptoms of CPP is associated with endometriosis, pelvic adhesions, irritable bowel syndrome or painful bladder syndrome. CPP is often accompanied by painful periods, pain during sexual intercourse and defaecation. Fatigue, sleep disturbances and depression are also common among this group of women. CPP asserts a heavy emotional, social and economic burden. Standard treatments such as hormonal and analgesic regimens are often associated with unacceptable side effects, even if helpful for the pain, underlining an urgent need for a satisfactory treatment. The meridian balanced method (BM) electro-acupuncture (EA) treatment (acupuncture needling + traditional Chinese medicine health consultation [TCM HC]) may be effective in managing CPP symptoms. Thus, I have completed a pilot study comprising of a three-armed randomised controlled trial (RCT), using a mixed methods research (MMR) approach, to assess the feasibility of a future large-scale RCT to determine the effectiveness of the meridian BMEA treatment on CPP in women. My hypothesis is that it is feasible to conduct such a large-scale RCT for CPP in women. The primary objectives were to determine recruitment and retention rates. The secondary objectives were to evaluate the, acceptability of the methods of recruitment, randomisation, interventions and assessment tools and any signals of effectiveness of the interventions. Thirty (30) women with CPP were randomised into three groups: BMEA treatment, TCM HC, or National Health Service standard care (NHS SC) group. The effects of my interventions were assessed by validated pain, physical and emotional functioning questionnaires, completed at weeks 0, 4, 8 and 12 of the study. Semi-structured telephone interviews and focus group discussions to explore participants’ experience of the study were conducted. Of the 59 women who were referred to the study, 30 women (51%) were randomised. There was a statistically significant difference in retention rates between the three groups. The retention rates were 80% (95% CI 74-96), in the BMEA treatment group, 53 % (95% CI 36- 70) in the TCM HC group and 87% (95% CI 63-90) in the NHS SC group. (Chi-square test, p=0.08) The attendance rates of the BMEA treatment group were 90% compared to 56% in the TCM HC group. There was a statistically significant difference (Mann-Whitney test, p=0.023) in attendance between the two intervention groups. Telephone interviews regarding the acceptability of the methods of recruitment, randomisation, assessment tools and interventions were positive. No adverse effects that were directly related to BMEA treatments were reported or observed. A higher proportion of the BMEA treatment group achieved clinical significance in the VAS-pain, BPI-pain severity, interference, and sleep scores, when compared to the other two groups. Due to small sample sizes, there was insufficient power to show statistically significant difference. (Fishers Exact Test, p=1.0) Analyses of the questionnaire data per group showed statistically significant differences in the following: the BMEA treatment group experienced less in pain at weeks 4 (p=0.01) and 8 (p=0.005); less helplessness (p=0.03) and their anxiety and depression scores declined at week 4 (p=0.04). The NHS SC group also reported less pain at week 4 (p=0.04). However, this group scored higher in anxiety and depression at weeks 8 and 12 (p=0.04). No statistically significant differences were achieved between the three groups at baseline, weeks 4, 8 and 12 in all scores. The therapeutic benefits gained by the TCM HC group were less compared to those of the BMEA treatment group, but better when compared to the NHS SC group. The BMEA treatment and TCM HC groups showed lower scores in anxiety and depression while the NHS SC group showed higher scores in anxiety and depression. The NHS SC group also tended to ruminate and magnify their problems as well as feeling more helpless than the other two groups. The three key themes that emerged from thematic analysis of focus group discussions were the “whole person effects” where participants reported an improvement in pain, sleep and a general sense of wellbeing in the two intervention groups; the “experience of standard care” and “impact of living with CPP”. In conclusion, the results of my pilot study are supportive of the feasibility of a future large-scale study. There were signals of effectiveness of interventions but the sample size was too small to make a definitive conclusion.
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Péron, Julien. "Evaluer le bénéfice clinique dans les essais randomisés en utilisant les comparaisons par paire généralisées incluant des données de survie." Thesis, Lyon 1, 2015. http://www.theses.fr/2015LYO10190/document.
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Dans les essais randomisés conduits en oncologie médicale, l'effet des traitements est le plus souvent évalué sur plusieurs critères de jugement, dont un ou plusieurs critères de type temps jusqu'à événement. Une analyse globale de l'effet d'un traitement intègre les résultats observés sur l'ensemble des critères de jugement pertinent. Un des objectifs de notre travail était de réaliser une revue systématique de la littérature évaluant les méthodes de recueil, d'analyse et de rapport des événements indésirables et des critères de jugement rapportés par les patients dans les essais de phase III en oncologie médicale. Cette revue a mis en évidence une grande hétérogénéité des méthodes utilisées. De plus les rapports des essais omettaient souvent certaines informations indispensables pour évaluer la validité des résultats rapportés en toxicité ou sur les critères de jugement rapportés par les patients. Un autre objectif de cette thèse était de développer une extension de la méthode des comparaisons par paire généralisées permettant d'évaluer de façon non biaisée la propension au succès en présence de censure lorsqu'un des critères de jugement est de type temps jusqu'à événement. Cette thèse avait également pour objectif de montrer comment les comparaisons par paire pouvaient être utilisées afin d'évaluer la balance bénéfice-risque de traitements innovants dans les essais randomisés. De la même façon, la propension globale au succès permet d'évaluer le bénéfice thérapeutique global lorsqu'un effet positif est attendu sur plusieurs critères de jugementIn medical oncology randomized trials, treatment effect is usually assessed on several endpoints, including one or more time-to-event endpoints. An overall analysis of the treatment effect may include the outcomes observed on all the relevant endpoints. A systematic review of medical oncology phase III trials was conducted. We extracted the methods used to record, analyze and report adverse events and patient-reported outcomes. Our findings show that some methodological aspects of adverse events or patient-reported outcomes collection and analysis were poorly reported. Even when reported, the methods used were highly heterogeneous. Another objective was to develop an extension of the generalized pairwise comparison procedure for time-to-event variables. The extended procedure provides an unbiased estimation of the chance of a better outcome even in presence of highly censored observations. Then, we show how the chance of an overall better outcome can be used to assess the benefit-risk balance of treatment in randomized trials. When a benefit is expected on more than one endpoint, the chance of an overall better outcome assesses the overall therapeutic benefit. The test of the null hypothesis is more powerful than the test based on one single endpoint
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Robinot, Alexandre. "Etude physiologique du syndrome d’apnées à composante centrale de l’adulte, hors insuffisance cardiaque à fraction d’éjection systolique altérée." Thesis, Université de Paris (2019-....), 2019. https://theses.md.univ-paris-diderot.fr/ROBINOT_Alexandre_va.pdf.
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Il est classique d’opposer la physiopathologie des apnées obstructives et des apnées centrales, avec une dichotomie simple : les apnées obstructives sont liées à l’obstruction par collapsus des voies aériennes supérieures, alors que les apnées centrales sont la conséquence d’anomalies du contrôle ventilatoire. Nous faisons l’hypothèse qu’existent dans le SAS central des traits phénotypiques communs aux SAS obstructifs tant en termes de balance sympatho-vagale que d’anomalie de contrôles des voies aériennes supérieures qui font évoquer un continuum physiopathologique entre ces 2 types d’apnées. Par ailleurs, nous formulons l’hypothèse que les réseaux neuronaux respiratoires mis en jeu chez les patients apnéiques centraux sont différents de sujets contrôles, mais possiblement identiques à ceux des sujets apnéiques obstructifs. A ce stade, seule l’étude chez les sujets sains a pu être menée dans les temps impartis pour ce travail.Nos résultats ont montré En terme de réseau neuronal respiratoire, chez le sujet sain, l’insula est la région d’intérêt qui présente le plus d’oscillations gamma 2 au cours de la respiration et communique à un haut niveau de fréquences avec les autres régions d’intérêts. Le thalamus présente une forte cohérence avec le cortex sensoriel. Les suites de ces travaux permettront de comparer le réseau neural respiratoire des SASO et des SASC entre eux, et avec ceux des contrôles. Nous disposons par ailleurs d’ores et déjà d’une base de comparaison à des patients porteurs d’une pathologie respiratoire, la bronchopneumopathie chronique obstructive.Une augmentation de la balance sympatho-vagale en sommeil paradoxal (SP) comparé au sommeil lent profond chez les témoins et patients SASO, qui n’est pas retrouvée chez les SASC, ainsi qu’une tendance à sa diminution en SP chez les SASC comparés aux témoins et au contrôles, plaidant pour une activation différente du système nerveux autonome entre SASO et SASC.Les mesures de collapsibilité des VAS n’ont pas encore pu être réalisées chez les patients mais le ban d’expérimentation complet a pu être monté dans le cadre de cette thèse. L’inclusion des premiers patients est prévue dès le dernier trimestre 2019.A ce stade, nous disposons de trop peu de données expérimentales pour étayer les points communs physiopathologiques entre SASO et SASC, mais ces travaux de thèse auront permis de mettre en place les méthodes permettant d’approfondir cette question, ils proposent également une approche novatrice pour l’analyse de la commande ventilatoire intégrée à travers l’étude des réseaux neuronaux respiratoirePathophysiology of obstructive and central sleep apnea is often dichotomized between obstructive sleep and central apnea, the first is associated with obstruction of upper airways, whereas central sleep apnea is the result of abnormalities of ventilatory control. We hypothesize that, in the central sleep apnea, there are phenotypic features common to obstructive apnea, both in terms of sympathovagal balance and abnormalities in the control of the upper airways, suggesting a pathophysiological continuum between these two types of apnea. In addition, we hypothesize that the respiratory neural network involved in central sleep apnea is different from control subjects but possibly shared with the one of obstructive apnea. To date, only healthy subjects have been studied within the time allotted for this PhD work with regard to this last component.Our results suggestedIn terms of respiratory neural network, in the healthy subject, the insula is the region of interest that has the most gamma 2 oscillations during respiration and communicates at a high frequency level with other regions of interests. The thalamus has a strong coherence with the sensory cortex. Further developments of this work will allow comparison between apneic patients and control, and between central and obstructive apneic patients. Noteworthy we already have a comparison groups of chronic obstructive pneumopathy disease, that will allow comparison between two respiratory pathologies of completely different mechanisms.An increase in the sympathovagal balance in REM sleep compared to slow wave sleep in controls and obstructive SAS, not observed in central SAS, together with a tendency to its decrease during REM in central SAS compared to controls, suggesting a different activation of the autonomic nervous systemPcrit measurements have not been conducted yet, but complete experimental bench is now designed, recruitment of first patients is planed for last trimester 2019. between the slow wave sleep and rapid eyes movements of patients with central and obstructives apneas and the control group.To date our data are too scarce to allow conclusions regarding common pathophysiological pathways between central and obstructive apnea, but our work during this PhD have permitted to get all technical requirement to further address tis question. In addition we propose an innovative approach, using the neural network mapping to describe specificities, if any, of the integrated neural respiratory network in apneic patients, both obstructive and central, vs controls
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Janiaud, Perrine. "The rational use of available evidence before extrapolating the benefit risk ratio from adults to children." Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE1063/document.
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Les médicaments sont évalués et reçoivent une autorisation de mise sur le marché (AMM) avant d'être prescrits. Ils sont généralement évalués chez des patients adultes, et utilisés chez les enfants en extrapolant les résultats obtenus chez les adultes. L'extrapolation de la balance bénéfice risque de l'adulte à l'enfant intervient lors du développement clinique du médicament et lorsqu'il est prescrit (dans l'AMM ou hors AMM, ce qui est fréquent chez l'enfant). Ceci est dû aux contraintes de la recherche clinique en pédiatrie, qui conduit à un manque de données chez l'enfant. Une recommandation sur l'extrapolation est en cours de finalisation par l'Agence Européenne du Médicament. En utilisant une approche méta-épidémiologique, nous avons exploré les similitudes ou différences du bénéfice, de la balance bénéfice risque et de l'évolution sous placebo entre adultes et enfants à partir de méta-analyses d'essais randomisés en double aveugle contre placebo, ayant inclus des adultes et des enfants dans des indications et avec des médicaments identiques, et présentant des données séparées chez l'adulte et l'enfant. Par la suite, nous avons construit le modèle d'effet à partir des données adultes et l'avons utilisé pour prédire l'effet du traitement et calibrer la taille de l'essai clinique pédiatrique. Ces travaux mettent en avant l'importance d'utiliser toutes les données disponibles avant d'extrapoler la balance bénéfice risque de l'adulte à l'enfant et de justifier les nouvelles études au regard des connaissances existantes. Cette démarche permet de réduire les répétitions inutiles d'essais cliniques, de mieux affecter les ressources destinées à la recherche, d'identifier les domaines pour lesquels les connaissances sont insuffisantes et ainsi optimiser la recherche clinique en pédiatrie. De manière plus globale, cela s'applique à tous types de recherche et permet d'éviter le gâchis au niveau du temps et des ressources investisDrug interventions are evaluated and receive a Marketing Authorization (MA) before being prescribed. They are generally evaluated in adult patients and then prescribed to children by extrapolating the treatment effect observed in adults. The extrapolation of the benefit risk ratio from adults to children occurs during drug development and when prescribing drugs (within the MA or off-label, which is frequent in children). This is due to the specific constraints of pediatric clinical research leading to a lack of data in children. A framework for extrapolation is currently being finalized by the European Medicines Agency. Using a meta-epidemiological approach, we explored the similarities and differences of the benefit, the benefit risk ratio and the perceived placebo effect between adults and children from meta-analysis including randomized double-blinded placebo-controlled trials evaluating a drug intervention in an indication in adults and children with separate data for both populations. We then built the effect model using adult data to predict the treatment effect in children and calibrate future pediatric clinical trials. Our research highlights the importance of using all available evidence before extrapolating the benefit risk ratio from adults to children and to justify new studies in the context of existing evidence. This approach allows to reduce unnecessary repetitions of clinical trials, to better allocate resources, to identify gaps in knowledge and thus optimize pediatric clinical research. More generally, it applies to any research allowing to avoid a waste in the time and resources invested
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Dejean, de la Bâtie Alice. "Les faits justificatifs spéciaux." Thesis, Paris 2, 2018. http://www.theses.fr/2018PA020026.
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Les faits justificatifs spéciaux ont été définis et identifiés, dans le cadre de ces travaux de recherche,comme des causes objectives d’irresponsabilité pénale affectées à une ou quelques infractions précises, et prévues – sauf pour les faits justificatifs spéciaux prétoriens – par un texte lui-même affecté à la fonction justificative. Face à cette tentative d’élaboration d’une définition et d’un régime cohérents, l’éclatement conceptuel et l’enchevêtrement normatif qui caractérisent le droit contemporain s’expriment toutefois avec une acuité troublante dans l’évolution de la justification spéciale. Parce qu’ils sont si discrets à l’échelle de la répression pénale, parce qu’ils n’ont pour garantir leur intégrité ou leur cohérence ni principe cardinal, ni institution dédiée, les faits justificatifs spéciaux ont été entraînés sans résistance parle courant puissant des faits divers, des aléas politiques, des réformes institutionnelles et des espoirs européens. Leur étude a ainsi permis d’étoffer la réflexion doctrinale portant sur la redéfinition jurisprudentielle des infractions, sous l’influence de la Cour européenne des droits de l’homme, et de revenir sur le dévoiement de la norme pénale instrumentalisée par d’autres domaines juridiques à la recherche de symbolisme, et participant ainsi à l’expansion du droit pénal sanctionnateur. Qu’ils pointent du doigt la jurisprudence ou le faiseur de lois, les faits justificatifs spéciaux trahissent par leur modestie et leur petitesse la démesure des ambitions des acteurs institutionnels du droit pénalIn this work, special justifications have been defined as objective defenses assigned to one or very fewspecific crimes, and provided for – unless they are judge-made – by legal texts centered on their justificatory function. The attempt to construct an accurate definition and a coherent regime was complicated by the conceptual fragmentation and normative entanglement of contemporary French criminal law. Not only are special justifications very subtle mechanisms in the broad scheme of criminalliability, but they do not have, to guarantee their conceptual integrity, the shelter of a dedicated institution or core legal principle. Consequently, special justifications have been carried along by the steady stream of political change, current events, institutional reform and European ambitions. The study of special justifications allows us to reconsider jurisprudential debates regarding judicial (re)definition of crimes under the influence of the European Court of Human Rights. It also gives a new perspective on thewell-documented phenomenon of the “corruption” of criminal law caused by its instrumentalization. In a phenomenon some academics call “disciplinary” criminal law, other legal branches make use of criminallaw’s symbolic strength. In these respects, the subtlety of special justifications exposes the immodesty of judges and legislators with respect to their ambitions for criminal law
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Anthes, Johann. "Beitrag von Ackerbohne (Vicia faba L.), Luzerne (Medicago sativa L.) und Saatwicke (Vicia sativa L.) zur Selbstregelung der N-Zufuhr in leguminosenbasierten Fruchtfolgen." Doctoral thesis, [S.l.] : [s.n.], 2005. http://deposit.ddb.de/cgi-bin/dokserv?idn=975015044.
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Madureira, Melisa Moreira. "Eficácia de um programa de treino de equilíbrio na qualidade de vida e na redução de quedas em pacientes com osteoporose: estudo randomizado e controlado." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5166/tde-20092010-174241/.
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INTRODUÇÃO: A incapacidade física e psicológica, incluindo o medo de quedas, está relacionada à diminuição da satisfação com a vida na osteoporose (OP). O impacto de um programa de treino de equilíbrio para melhorar a qualidade de vida não está bem estabelecido. O objetivo deste estudo, portanto, foi investigar a eficácia que um programa de treino de equilíbrio, realizado durante um período de 12 meses, pôde provocar na qualidade de vida, no equilíbrio funcional e nas quedas em mulheres idosas com osteoporose. MÉTODOS: Sessenta mulheres com OP senil (idade: 65 a 85 anos) do Ambulatório de Doenças Osteometabólicas foram randomizadas e divididas em 2 grupos: Grupo Equilíbrio (GE) 30 pacientes que realizaram intervenção e Grupo Controle (GC) 30 pacientes sem intervenção. O programa de treino de equilíbrio incluiu técnicas para melhorar o equilíbrio durante o período de 12 meses (1sessão de 1h/semana de exercícios complementados com exercícios feitos em casa). A qualidade de vida foi avaliada antes e no final do estudo utilizando o questionário Osteoporosis Assessment Questionnaire (OPAQ), o equilíbrio funcional foi avaliado pela escala Berg Balance Scale (BBS). As quedas no ano anterior foram anotadas e comparadas durante o período de estudo. RESULTADOS: A comparação dos domínios do OPAQ (INICIAL - FINAL) revelou uma melhora significativa da qualidade de vida em todos os parâmetros do GE em relação ao GC: bem-estar geral (1,61 ± 1,44 vs. -1,46 ± 1,32, p <0,001), função física (1,30 ± 1,33 vs. -0,36 ± 0,82, p<0,001), estado psicológico (1,58 ± 1,36 vs. -1,02 ± 0,83, p <0,001), sintomas (2,76 ± 1,96 vs. -0,63 ± 0,87, p <0,001), interação social (1,01 ± 1,51 vs. 0,35 ± 1,08, p <0,001). Esse benefício global foi acompanhado por uma melhora da escala de equilíbrio BBS (-5,5 ± 0,5 vs. 5,67 ± 4,88 p <0,001) e da redução das quedas em 50% no GE vs. 26,6% para o GC (RR: 1,88, p <0,025). CONCLUSÃO: O programa de treino de equilíbrio para mulheres com OP, realizado por 12 meses, proporcionou uma melhor qualidade de vida e uma melhora no estado de saúde global paralelamente aos benefícios no equilíbrio funcional e na redução das quedasINTRODUCTION: Physical and psychological incapacity, including fear of falling is related to decreased satisfaction with life in osteoporosis (OP). The impact of a balance exercise programs on improving the quality of life is not well established. We have, therefore, investigated the effect of 12-month Balance Training Program in quality of life, functional balance and falls in elderly OP women. METHODS: Sixty consecutive women with senile OP were randomized into a Balance Training Group (BT) of 30 patients and no intervention control group (CG) of 30 patients. The BT program included techniques to improve balance over a period of 12 months (1h exercise session/week and home-based exercises). The quality of life was evaluated before and at the end of the trial using the Osteoporosis Assessment Questionnaire (OPAQ), functional balance was evaluated by Berg Balance Scale (BBS). Falls in the preceding year were noted and compared to the period of study. RESULTS: The comparison of OPAQ variations (INITIAL-FINAL) revealed a significant improvement in quality of life in all parameters for BT compared to CG: well-being (1.61 ± 1.44 vs. -1.46 ± 1.32, p<0001), physical function (1.30 ± 1.33 vs. 0.36 ± 0.82, p<0.001), psychological status (1.58 ± 1.36 vs. 1.02 ± 0.83, p<0.001), symptoms (2.76 ± 1.96 vs. 0.63 ± 0.87, p<0.001), social interaction (1.01 ± 1.51 vs. 0.35 ± 1.08, p<0.001). Of note, this overall benefit was paralleled by an improvement of BBS (-5.5 ± 5.67 vs. +0.5 ± 4.88 p<0.001) and a reduction of falls in 50% in BT group vs. 26.6% for the CG (RR: 1.88, p<0.025). CONCLUSION: The long-term Balance Training Program of OP women provides a striking overall health quality of life improvement in parallel with improving functional balance and reduced falls
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Porcara, Émilie. "Le témoignage oral dans la procédure pénale." Thesis, Montpellier 1, 2010. http://www.theses.fr/2010MON10018.
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Le témoignage oral, depuis toujours, occupe, en tant qu'élément de preuve, une place au sein de la procédure pénale française. Pourtant, il n'a cessé de faire l'objet de critiques, ravivées par l'émergence de la preuve scientifique dans le procès pénal contemporain, car considéré comme faillible en raison de sa nature humaine. Cette affirmation repose, notamment, sur un postulat anachronique consistant à considérer le témoignage oral comme unitaire, au travers du seul prisme de sa source, l'homme, cantonné au seul témoin, tel que défini par les règles de procédure, alors qu'il présente en réalité un caractère dual. Or, c'est de cette méconnaissance, conduisant à une appréhension attentatoire à la valeur probatoire du témoignage oral, qu'émergent les objections à son encontre et qui soulèvent la question de sa nécessité dans le procès pénal, quand cette dernière ne devrait souffrir aucune hésitation, non seulement parce que le témoignage oral s'avère un élément de preuve utile à la recherche et à l'établissement de la vérité judiciaire mais également parce qu'il illustre et renforce les principes directeurs du procès pénal, tels qu'édictés par le législateur français et la Convention européenne des Droits de l'HommeOral testimony has always been taken up as an element of evidence in the French criminal proceedings. However considered as unreliable because human, it hasn't ceased to be the subject of critics, lately revived with the emergence of scientific proof within contemporary penal trial. This statement is based on the anachronistic postulate that oral testimony, considered through the only view of the witness as defined by the procedural rules, is unity, whereas indeed it does present a dual character. The probationary value of oral testimony is suffering from this lack or recognition and its necessity within criminal procedure is also being questioned when there should be no hesitation whatsoever with regard to its use. In fact, oral testimony is not just a useful element of proof when trying to establish the truth, it does also illustrate and strengthen the governing principles of penal trial such as promulgated by the French legislator and the European convention of Human Rights
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Madureira, Melisa Moreira. "Efetividade de um programa de treino de equilíbrio no estado funcional e na freqüência de quedas em mulheres idosas com osteoporose: estudo randomizado e controlado." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5145/tde-24012008-153808/.
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INTRODUÇÃO: O propósito deste estudo foi investigar a efetividade de um programa de treino de equilíbrio na mobilidade, no equilíbrio funcional e estático, e nas quedas em mulheres com osteoporose. MÉTODOS: foram selecionadas consecutivamente 66 mulheres idosas do Ambulatório de Doenças Osteometabólicas e randomizadas em 2 grupos: Intervenção - composto de 34 pacientes submetidas ao treino de equilíbrio, e Controle - composto de 32 pacientes sem intervenção. O equilíbrio funcional e estático, a mobilidade e as quedas foram avaliados antes e após 12 meses da intervenção utilizando-se: Berg Balance Scale (BBS), Clinical Test Sensory Interaction Balance (CTSIB) e Timed \"Up and Go\" Test (TUGT). A intervenção utilizou técnicas para melhorar o equilíbrio e a mobilidade, consistindo de 1 hora sessão/semana, e um programa de exercícios em casa. RESULTADOS: Sessenta mulheres completaram o estudo e foram analisadas. Uma diferença no escore da BBS foi significativamente maior no grupo Intervenção comparada ao Controle (5,5 ± 5,67 vs. -0,5 ± 4,88 e P<0,001). Semelhantemente, o número de pacientes no grupo Intervenção apresentou melhora em duas condições do CTSIB comparado com o Controle (condição 5 - olhos vendados e superfície instável: 13 vs. 1 paciente, P<0,001; e condição 6 - olhos abertos, superfície instável e cúpula visual 12 vs. 1 paciente, P=0,001). Adicionalmente, as diferenças entre o TU> foram reduzidas no grupo Intervenção comparado com o Controle (-3,65 ± 3,61 vs. 2,27 ± 7,18 segundos, P<0,001). Notavelmente, essa melhora foi paralela à redução do número de quedas/paciente no grupo Intervenção comparada ao Controle (-0,77 ± 1,76 vs. 0,33 ± 0, 96, P=0,018). CONCLUSÃO: este estudo prospectivo longitudinal demonstrou que uma intervenção utilizando o treino de equilíbrio é extremamente efetiva na melhora do equilíbrio funcional e estático, da mobilidade e redução das quedas em mulheres idosas com osteoporose.INTRODUCTION: The purpose of this study was to investigate the effect of a 12-month Balance Training Program on balance, mobility and falling frequency in women with osteoporosis. METHODS: Sixty-six consecutive elderly women were selected from the Osteometabolic Disease Outpatient Clinic and randomized into 2 groups: the Intervention Group, submitted for balance training; and the Control, without intervention. Balance, mobility and falling frequency were evaluated before and at the end of the trial using: the Berg Balance Scale (BBS), the Clinical Test Sensory Interaction Balance (CTSIB) and the Timed \"Up & Go\" Test (TUGT). Intervention used techniques to improve balance consisting of one hour sessions/week and a home-based exercise program. RESULTS: Sixty women completed the study and were analyzed. The BBS difference was significant higher in the intervention compared to control (5.5 ± 5.67 vs. -0.5 ± 4.88 score, P<0.001). Similarly, the number of patients in intervention group presented improvement in 2 conditions of CTSIB compared to controls (eyes closed and compliance surface condition: 13 vs. 1 patient, P<0.001; eyes open, visual conflict and compliance condition: 12 vs. 1 patient, P=0.001). Additionally, the difference between the TUGT were reduced in the intervention group compared to control (-3.65 ± 3.61 vs. 2.27 ± 7.18 seconds, P<0.001). Notably, this improvement was paralleled by a reduction in the number of falls in the intervention group compared to control (-0.77 ± 1.76 vs. 0.33±0.96, P<0.018). CONCLUSION: This longitudinal prospective study demonstrated that a intervention using balance training is effective in improving functional and static balance, mobility and falling frequency in elderly women with osteoporosis.
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Metenier, Julian. "La protection pénale de l'accusé." Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM1065.
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Le thème de la protection pénale de l'accusé, connu des pénalistes, mérite aujourd'hui d'être renouvelé sous un angle essentiellement probatoire, au regard de l'évolution actuelle du procès pénal. Situés au confluent de l'innocence et de la culpabilité, les droits et garanties accordés à l'accusé, entendu dans son acception conventionnelle, doivent être analysés en considération des principes fondateurs que sont la présomption d'innocence et les droits de la défense. L'évolution continue de ces deux principes, dans un sens diamétralement opposé, rejaillit inévitablement sur l'intensité et les modalités de la protection dont bénéficie toute personne suspectée ou poursuivie dans le cadre d'une procédure pénale.La présente étude, volontairement limitée à la phase préparatoire du procès pénal, se propose d'appréhender, dans un souci pratique et technique, les différentes évolutions jurisprudentielles et législatives opérées en la matière. Y seront ainsi abordées les principales problématiques actuellement rencontrées en procédure pénale telles que la question du statut juridique du suspect ou encore l'effectivité du principe du contradictoire dans l'avant-procès pénal. S'il peut être tentant, au premier abord, de conclure à un renforcement indiscutable de la protection pénale accordée à l'accusé, il conviendra alors de reconsidérer cette question à l'aune de l'étude des limites procédurales attachées au procès pénal. Loin d'aborder ce thème dans une optique partisane, il sera question de modération dans les propos tenus. En effet, peut-être plus que sur toute autre question de procédure pénale, il est impératif de savoir raison garderThe theme of the criminal protection of the accused, well-known to criminal specialists, today deserves to be renewed under a probationary essentially angle, in the light of current developments in the criminal trial. Located at the confluence of innocence and guilt, the rights and guarantees granted to the accused understood in its conventional sense, must be analyzed in consideration of the founding principles of presumption of innocence and the rights of the defense. The continuing evolution of these two principles, in a sense diametrically opposite, inevitably reflects the intensity and the terms of the protection afforded any person suspected or prosecuted under criminal proceedings.This study deliberately limited to the pre-trial phase, proposes to understand, in a practical and technical problems, the various case law and legislative developments carried out in the field. Will thus addressed the key issues currently faced in criminal proceedings such as the question of the legal status of the suspect or the effectiveness of the adversarial principle in the preliminary criminal trial. While it may be tempting, at first, to conclude an indisputable strengthening the criminal protection afforded to the accused, then it will be necessary to reconsider this issue in terms of the study of procedural limitations attached to the criminal trial. Far from addressing this issue in a partisan way, it will be about moderation in the remarks. Indeed, perhaps more than any other issue of criminal procedure, it is imperative to keep a sense of proportion
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Klaban, Vladimír. "Utajený výkon veřejné moci a hodnoty chráněné ústavním pořádkem." Master's thesis, 2011. http://www.nusl.cz/ntk/nusl-315821.
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The aim of this diploma paper is to analyse and define the nature of secret exercise of public authority and to asses this phenomena in respect of the fundamental principles of the democratic rule of law. Any secrecy in exercising public authority is in fact a clear contradiction to a natural concept of the human rights and fundamental freedoms. Therefore the republic, as a public institution, should not have too many secrets to hide away from the people if its own principles are not to be completely disgraced. Secrecy in exercising public authority is a specific feature often related to the areas such as securing the sovereignity and territorial integrity of the Czech Republic, protecting its democratic foundations, protection of the lives and health of the population as well as the right to own the property. This is in full accordance with the constitutional duty of the state. Limited access to the information has a unique and 84 inevitable role in these areas and it is clearly mentioned in the Charter of Fundamental Rights and Freedoms, the European Convention of Human Rights and Freedoms and the International Covenant on Civil and Political Rights. The question of choice between the security and the liberty has been recently heavily discussed by the people as a natural follow up to the...
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Naidoo, Pooveshni. "A randomised controlled trial to assess the effect of a balance and stability training intervention on balance and functional independence in stroke patients." Thesis, 2012. http://hdl.handle.net/10413/10167.
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Introduction: Balance dysfunction, particularly in standing, is a devastating sequel to stroke since the
ability to balance is one of the most critical motor control factors in daily life. Physiotherapists use a
variety of balance and stability techniques as a part of treatment programmes to improve functional
independence in patients following a stroke. However more scientific evidence for the effectiveness of
these techniques or programs is required. Purpose: The purpose of this study was to quantify the effect of
a balance and stability training program on stability, balance and functional independence in stroke
patients. Method: The aims of this study were achieved using a randomised controlled trial. A
questionnaire allowed the collection of demographic data from fifty participants who had suffered the first
stroke, regardless of gender or race. The Postural Assessment Scale for Stroke patients (PASS), Berg
Balance Scale (BBS), Barthel Index (BI) and questionnaire were administered to all fifty participants on
the first and last weeks of a twelve week physiotherapy program. For ten weeks twenty five randomly
assigned participants in each of the control and experimental groups underwent either normal
physiotherapy or stability and balance intervention exercise program respectively. Data Analysis: The
raw data was normalized by calculating percent changes for each item for each participant and the pooled
data subjected to Wilcoxon signed ranks testing, paired samples signed tests and Pearson’s correlations.
Results: PASS, BBS and BI scores increased significantly from pre-test to post-tests in both groups, with
greater changes noted in the experimental group, showing improvements in stability, balance and
function. In addition a strong and significant correlation between stability scores and balance scores
suggested that stability is important to improve balance. Similarly a strong and significant correlation
between stability and balance scores with function scores confirms the value of stability and balance in
improving function. It was further noted that in addition to a certain degree of spontaneous recovery,
traditional physiotherapy programs also result in improvement in stability, balance and function but not to
the same extent as with the program of treatment which emphasizes stability and balance exercises.
Conclusion: A significant improvement in the stability, balance and function in stroke patients was
achieved with the balance and stability intervention program. Conventional physiotherapy methods also
improved stability, balance and function, but to a lesser extent than the balance and stability training.Thesis (M.Physio.)-University of KwaZulu-Natal, Westville, 2012.
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Mavimbela, Nicole. "A randomised clinical trial comparing the effectiveness of two exercise programmes on core strength and balance in healthy females." Thesis, 2015. http://hdl.handle.net/10321/1321.
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Submitted in partial compliance with the requirements for the Master’s degree in Technology: Chiropractic, Department of Chiropractic, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa. 2015.Low back stability and low back strengthening exercises have emerged as popular techniques related to optimal athletic/occupational performance and the rehabilitation of painful backs (McGill 2001). The core provides local strength and balance as well as reduces the risk of low back injury (Kibler, Press and Sciascia 2006). Core strength is important in providing a solid base for the body to exert or resist forces. According to Anderson and Behm (2005), however, it is still uncertain as to which type of training is most effective in providing trunk and joint stability in its role in injury prevention and its contribution to balance. Aim: To determine if exercises performed on an unstable surface would result in greater balance improvements in healthy female participants when compared with exercises performed on a stable surface. Methods Forty asymptomatic females between the ages of 18 and 30 were recruited via self-selection. The study was a randomised clinical trial where all participants underwent a case history, a physical examination and a lumbar spine regional examination. Thereafter, participants were asked to stand on the Biosway Portable Balance System where baseline readings of the Clinical Test of Sensory Integration and Balance (CTSIB) and the Postural Stability Test were taken. The CTSIB has four test conditions – Condition 1: eyes open firm surface, Condition 2: eyes closed firm surface, Condition 3: eyes open foam surface, and Condition 4: eyes closed foam surface. The Postural Stability Test was presented in terms of overall postural stability, anterior/posterior stability and medial/lateral stability. Participants were then taught how to activate their core muscles by means of the prone coactivation exercise. A Pressure Biofeedback Unit was used to provide an objective measurement of the successful execution of the exercise. Participants were then allocated to either Group A or B and were taught how to perform the various core strength exercises. Participants in Group A performed the side bridge and single leg extension hold on a stable surface; participants in Group B performed the prone bridge and the quadruped reach on a Swiss ball. Participants were instructed to perform their respective exercises daily at home and they were also told the required number of sets repetitions they were to do. During the first week the participants were to perform three sets of 30 second holds daily, for the bridge exercises and three sets of 60 seconds for the extensor exercises. During the second week the participants were to perform four sets of 30 and 60 second holds, respectively. In the third and fourth weeks the participants were expected to perform five sets of 30 and 60 second holds respectively. The study participants reported to the Chiropractic Day Clinic once a week for four weeks and performed their exercises in the presence of the researcher. In the fourth week, however, the participants were asked to stand on the Biosway Portable Balance System and final readings of their CTSIB and Postural Stability Test were taken. All data was collected by the researcher. SPSS version 21 was used to analyse the data. A p value < 0.05 was considered as statistically significant. Intra-group analysis was done on each treatment group individually to assess the effect of the treatment over time using repeated measures ANOVA for each outcome separately. Inter-group analysis was achieved using repeated measures ANOVA with a between group effect of the intervention. A significant time x group intervention effect would signify a treatment effect. Inter-group correlations between changes in outcomes over time were achieved using Pearson’s correlation coefficient. Results: The mean (± SD) age of the participants was 22.1 years. In terms of the CTSIB test under condition 1 there was no statistically significant effect of the intervention (p=0.431), group B showed a decrease in their sway index after the intervention. Under condition 2 group A participants showed a decline in their sway index, however results were statistically insignificant (p=0.129). Both groups showed a decrease in sway index overtime under conditions 3 and 4 with group B showing a faster decline in sway index overtime under condition 3. Results remained statistically insignificant for both conditions (p=0.171) and (p=0.766) respectively. In terms of the Postural Stability Test the intervention was found to have no effect on the balance of study participants (p=0.548). Conclusion: The results of this study demonstrated a statistically insignificant improvement in the core strength and balance of the participants in both study groups. Taking into account the nature of the study population there is a possibility of a clinically significant effect were this study to be conducted on older individuals instead of younger individuals. For some of the outcomes measured there was a non-statistically significant trend towards an effect of the intervention, however for others both groups displayed the same trend over time. The power of the study to show a significant effect where one might have existed was low and thus the study should be repeated with a larger sample size using the outcomes which showed differential results between the treatment groups.
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褚麗絢. "A study on error patterns of "findings and effects in trial balance" of accounting of vocational high school students." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/02835455290573068869.
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碩士國立彰化師範大學
商業教育學系
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ABSTRACT The purpose of the study is to investigate the error patterns and the causes of error when students of vocational high schools learn the chapter: Findings and Effects in Trial Balance in the Basic Accounting class, so as to provide teachers with the effective teaching or the reference of make-up class. The methodology adopts paper test instead of non-constitutional interview. With the paper test the teacher realizes students’ errors in the chapter: Findings and Effects in Trial Balance, and does classification according to Mayer’s four knowledge patterns. Meanwhile the teacher interviews the students to further understand students’ thoughts and reasons why they make mistakes during the process of problem solving. The paper test is edited by the researcher herself. A total of 172 senior three students from a National Vocational High School in Chai-yi participated in the study. Results of the study find that in addition to the basic concept of the trial balance, the percentage of misconception in the errors that the trial balance can or can’t find and the methods to check out errors are over 49.91%. Results of the study of students’ error patterns and causes are as follows. 1. Linguistic knowledge: (1) not able to completely understand the meaning of the question (2) the mistakes caused by neglect (3) misunderstand the meaning of the question owing to lack of basic concept 2. Schema knowledge: (1) wrong judgment caused by lack of correct basic concept (2) wrong conception of the credit side and the debit side (3) mistakes in account caused during journalizing or posing, assuming that the mistakes in account won’t make any difference as long as the sum of money is correct (4) lack of the concept that if debit account is on credit or credit account is on debit, it means the decrease of money (5) judge only by the errors without considering whether it’s the credit side or the debit side 3. Strategic knowledge: (1) The question already mentions the posting error but students still make judgment with journalizing (2) Can not tell debit account from credit account (3) only deal with the wrong journalizing without considering the correct journalizing at the same time (4) figure out the sum of the credit side by calculating the wrong sum of the debit side rather than the correct sum 4. Process knowledge: (1) already figure out the influence of sum and the credit or the debit side, but make errors in the final additional or less recording (2) computation error Finally, the results of the study are analyzed and pedagogical recommendations for the accounting teacher’s teaching or make-up class are provided. Keyword: misconception, error patterns, linguistic knowledge, schema knowledge, strategic knowledge, procedural knowledge
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"The Impact of Adherence to a Vegan Diet on Acid-Base Balance: A Randomized Controlled Trial in Healthy College Students." Master's thesis, 2015. http://hdl.handle.net/2286/R.I.30013.
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abstract: There is a considerable amount of research stating that vegetarian diets have an alkalizing effect while the typical western diet is acid-forming. There is substantial evidence regarding the health benefits of an alkaline diet. Although vegetarian diets demonstrate the ability to foster these health benefits, many people are still not willing to adopt a completely vegetarian diet. PURPOSE: To evaluate the effect of following a vegan diet two or three days per week on acid-base balance in a healthy college student population aged 18-30. METHODS: In a one-week interventional design, 23 people were randomly assigned to follow a vegan diet 2 days per week (VEG2;n=7), 3 days per week(VEG3;n=8), or 7 days per week (VEG7;n=8). Urine pH and dietary PRAL were assessed in each group at baseline and after the one-week intervention. RESULTS: There was no significant difference in urinary pH between the three groups (p=0.12). The change in PRAL values after the dietary intervention was different between the 3 groups (p=0.03). CONCLUSION: Adherence to a vegan diet 2 or 3 days per week did not show a significant change in urinary pH or PRAL.Dissertation/Thesis
Masters Thesis Nutrition 2015
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Lee, Ting-Hui, and 李亭慧. "A Randomized Controlled Trial of Tai Chi and Tri-Component Exercise Training on Balance, Gait, and Quality of Life in Older Fallers." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/43904923513477311718.
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Jhen-CihHuang and 黃貞慈. "Effects of progressive unstable surface trunk exercises on balance and functional outcomes in sub-acute stroke patients: a double-blind randomized controlled trial." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/5n83g5.
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Humphreys, Andrew Kelly. "A study of factors affecting nitrogen balance trials and the effect on the nitrogen corrected true metabolizable energy assay." 1985. http://hdl.handle.net/1993/28876.
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Cassim, Fawzia. "The right to meaningful and informed participation in the criminal process." Thesis, 2003. http://hdl.handle.net/10500/1840.
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The composite right to meaningful and informed participation in the criminal process comprises the right to information, the right to understand, the right to be prepared, the right to be present, the right to confrontation and the right to present one’s case. The sub-rights are not of an overarching nature such as the right to legal representation and the right of access to the law. The various rights are grouped together because they show some connection with the ability of the suspect or the accused to participate in the criminal proceedings as a legal subject, and not as an object of the proceedings as in primitive times. These rights ensure that the accused will not participate in the criminal process from an unfavourable position. The heading ‟meaningful and informed participation” is therefore a collective term for these rights. These sub-rights form part of the comprehensive right to a fair trial.
The thesis examines aspects of the position of the accused in South Africa and in foreign jurisdictions such as the United States of America, Canada, New Zealand, Australia, Germany, the United Kingdom and Islamic systems. International instruments such as the European Convention for the Protection of Human Rights and decisions of the United Nations Human Rights Committee are also considered. The thesis first considers the historical perspective of the accused in primitive times when he was regarded as an object of the criminal proceedings, to the present time when he is regarded as a subject of the proceedings. The study on foreign jurisdictions reveals that for the most part, our law is in line with the law of other countries. The study also demonstrates that the various rights are not absolute. In exceptional circumstances, some diminution of the accused’s rights is necessary to protect the interests of society. Nevertheless, the courts should act cautiously and not allow the exceptions to overtake the rule. The judiciary should strive to find a better balance between the constitutional rights of the accused and the interests of society. To this end, the judicial system must be objective yet vigilant.Criminal & Procedural Law
LL.D.
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(5929742), Kelly A. Higgins. "Differential Effects of Chronic Low Calorie Sweetener Consumption on Body Weight, Glycemia, and Ingestive Behavior." Thesis, 2019.
Find full textAbstract:
Low calorie sweeteners (LCS) provide sweetness with little to no energy. Each sweetener has a unique chemical structure that possesses unique sensory and functional characteristics. While LCS are generally considered in aggregate, these unique chemical structures have potential implications for sensory, metabolic, and behavioral differences that may impact body weight and glycemia. Therefore, two, twelve-week experiments were conducted to determine the effect of chronic LCS consumption on body weight, glycemia, and ingestive behaviors.
The first experiment investigated the differential effects of four LCS (saccharin, aspartame, rebaudioside A, and sucralose) and sucrose consumed for twelve weeks on body weight, glycemia, and ingestive behaviors among healthy adults with overweight or obesity (body mass index (BMI) between 25 and 40 kg/m2). In a parallel-arm design, 154 participants were randomly assigned to consume 1.25 to 1.75L of beverage sweetened with 1 of the 5 sweeteners daily for 12 weeks. Body weight was measured every two weeks; energy intake, energy expenditure, and appetite were assessed every 4 weeks; and glucose tolerance was measured at baseline and week 12. Every four weeks, participants completed 24-hour urine collections to determine study compliance via PABA excretion. Sucrose and saccharin consumption led to increased body weight across the 12-week intervention (Δ weight = +1.85 and +1.18kg, p ≤ 0.02) and did not differ from each other. While there was no significant change in body weight with consumption of the other LCS treatments compared to baseline, changes in weight in comparison to the sucrose treatment (sucrose – LCS) were significantly different for aspartame, rebA, and sucralose after 12 weeks (weight difference = 1.13, 1.25, 2.63kg, respectively; p ≤ 0.03). In addition, change in body weight at week 12 was significantly lower between sucralose and all other LCS (weight difference ≥ - 1.37 kg, p=0.008).
The second experiment investigated the effect of daily aspartame ingestion on glycemia, body weight, and appetite. One hundred lean (BMI between 18 and 25 kg/m2) adults were randomly assigned to consume 0, 350, or 1050 mg aspartame/day for twelve weeks in a parallel-arm design. This experiment followed a similar protocol but measured body weight and blood pressure weekly and contained a 240-min glucose-tolerance test (OGTT) with measurements of selected hormones at baseline and week 12. Participants also collected 24-h urine samples every four weeks. There were no group differences for glucose, insulin, resting leptin, glucagon-like peptide 1, or gastric inhibitory peptide at baseline or week 12. There also were no effects of aspartame ingestion on appetite, body weight, or body composition.
These trials demonstrate that all LCS contribute negligible energy but should not be aggregated because of their differing effects on body weight. Sucrose and saccharin consumption significantly increased body weight compared to aspartame, rebA, and sucralose. This differential change in body weight among LCS indicates individual LCS likely exert different physiological responses beyond the contribution of sweetness with negligible energy. Saccharin, rebA, sucralose, and aspartame (ingested at three doses) for twelve weeks had no effect on glycemia. These data do not support the view that LCS are problematic for the management of glycemia. If substantiated through additional testing, findings from this trial have implications for consumers, food industry, clinicians, and policy makers. Some LCS may not hold the anticipated beneficial effects on body weight (e.g., saccharin) and positive effects of one LCS (sucralose) may be attenuated if combined with select other LCS. Going forward it will be important to consider each LCS as a distinct entity with respect to its potential health effects.
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Fröhlich, Daniel. "Raumzeitliche Dynamik der Parameter des Energie-, Wasser und Spurengashaushalts nach Kleinkahlschlag." Doctoral thesis, 2009. http://hdl.handle.net/11858/00-1735-0000-0006-B12C-F.
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Neves, Ana Cristina Trindade. "A Holistic Approach to the Ontario Curriculum: Moving to a More Coherent Curriculum." Thesis, 2009. http://hdl.handle.net/1807/18107.
Full textAbstract:
This study is an interpretive form of qualitative research that is founded in educational connoisseurship and criticism, which uses the author’s personal experiences as a holistic educator in a public school to connect theory and practice. Key research questions include: How do I, as a teacher, work with the Ontario curriculum to make it more holistic? What strategies have I developed in order to teach a more holistic curriculum? What kinds of difficulties interfere with my practice as I attempt to implement my holistic philosophy of education? This dissertation seeks to articulate a methodology for developing holistic curriculum that is in conformity with Ontario Ministry guidelines and is also responsive to the multifaceted needs of the whole student. The research findings will serve to inform teachers who wish to engage in holistic education in public schools and adopt a curriculum that is transformative while still being adaptable within mainstream education.