VictorJuiz/thesis huggingface dataset:
Glycemic Index and Macrovascular Disease in Type 2 Diabetes
Keywords: carotid plaque burden
clinical trials
glycemic index
type 2 diabetes

Abstract The rapid rise in type 2 diabetes (T2DM) prevalence seen over the past few decades is projected to increase further, together with an increased risk of cardiovascular disease (CVD). Thus, there is a need to find effective and sustainable prevention and treatment strategies for diabetes, including dietary strategies. Low glycemic index (GI) diets may be suitable to assist in T2DM management; however there is a lack of evidence on long term adherence, as well as on the association with surrogate markers of CVD risk beyond traditional risk factors. Recently, advances have been made in measures of subclinical arterial disease through the use of magnetic resonance imaging (MRI), which, along with standard measures from carotid ultrasound scanning (CUS), have been associated with CVD events. To address these knowledge gaps, we conducted a randomized controlled trial in those with T2DM at high risk of CVD to assess the effect of a low GI diet over 3 years. The trial, currently ongoing, has already yielded a rich dataset allowing for the exploration of associations between dietary variables and subclinical arterial disease assessed as vessel wall volume (VWV) by MRI and carotid intima media thickness (CIMT) by CUS. The thesis objectives were to assess the association between GI and CIMT and VWV, assess whether a low GI diet can be followed successfully long term, what advice is adopted, and more specifically, whether provision of free study bread improves adherence. Baseline cross-sectional analyses did not reveal any association between GI and either CIMT or VWV. CIMT and VWV were however, significantly associated negatively with carbohydrates, starch, and dietary pulses, which are a particularly low GI food. Long term adherence to a low GI diet was demonstrated to be sustainable over 3 years at a level similar to that observed in earlier 3- and 6-month trials (an average reduction of 11 GI units) through substitutions of breads, cereals and fruit for low GI options and of potatoes and rice for dietary pulses. The provision of a free study bread, which was implemented mid-way through the trial, significantly improved adherence to low GI statistically, however not at a level physiologically significant (~1 GI unit lower). These results are the first to assess and demonstrate long term adherence to a low GI diet and to assess GI and MRI measures of macrovascular disease to assist in the understanding of the role of diet and nutrition in macrovascular disease development in T2DM.
Professions, Organizations, and the Challenges of Change: A Multi-Method Exploration in the Context of Healthcare Delivery
Keywords: Financial Incentives
Healthcare
Mixed Methods
Organizational Change
Physicians
Professionals

Organizations often struggle to implement change or to reconfigure their internal processes and practices to achieve desired performance outcomes. This can be particularly challenging with a professional workforce since many of the organization’s tools of influence may not work as intended due to the attributes of professionals and their work. As a result, the presence of professionals can complicate the change processes in ways that many of our current theories do not capture. My multi-method dissertation explores this by examining how organizations can change and innovate when their workforces are dominated by professionals. I study this in the context of healthcare service delivery. In the first study, I explore the efficacy of one of the organization’s main tools of influence: financial incentives. I develop a theory of situated professionalism to explore the conditions under which professionals change their activity patterns in response to changes in financial incentives. I find support for two conditions which dampen their incentive responses: when financially-motivated actions carry the potential to cause harm (and thus violate a central professional norm); and when work settings constrain autonomy. The analysis uses a matching methodology with difference-in-differences estimation on a large sample of physicians over nine years. In my second study, I use ethnographic data to explore how one hospital implemented a set of strategically important, centrally-designed tools and practices in five internal clinics. Although these changes did not affect the technical work of physicians (i.e., treating patients), teams struggled to engage physicians in the change. What emerged from the analyses was that physicians enacted their autonomy very broadly within the organization; it encompassed not only the technical work, but also the processes around the work. As such, these non-technical changes represented surprising infringements to physician autonomy. My analyses also highlight the importance of clinics’ adaptation processes in which they attempted to remove these infringements, while at the same time adapting the new practices to generate value. I conclude by integrating the two studies to elaborate on the studies’ common themes and to develop a set of policy considerations for organizations managing professionals, particularly in the healthcare context.
Neuroprotection Following Stroke in the Gyrencephalic Non-Human Primate Brain
Keywords: Animal Model
Microarray
MRI
Neuroprotection
Non-Human Primate
Stroke

Many pharmacological agents that have shown promise as stroke neuroprotectants in rodent studies have failed when tested in clinical trials. It was therefore suggested to evaluate such neuroprotectants in gyrencephalic non-human primate (NHP) stroke models as an intermediate step to bridge the translational gap between rodent and human studies. To date, there has been a paucity of model systems to do so. Furthermore, there is no clear evidence that stroke neuroprotection in the gyrencephalic brain can protect against ischemic tissue damage or improve functional outcome. Using cynomolgus macaques we tested the hypothesis that neuroprotection is feasible in the gyrencephalic NHP brain with the neuroprotectant Tat-NR2B9c, a PSD-95 inhibitor. Tat-NR2B9c reduced stroke volume and improved behavioural outcomes in a model middle cerebral artery occlusion (MCAO). Tat-NR2B9c was subsequently tested in a model of embolic stroke in the cynomolgus macaque. Tat-NR2B9c reduced the number and total volume of embolic strokes in this model and was used to design a subsequent human trial that ultimately had similar results. The effects of Tat-NR2B9c on gene expression were examined in the ischemic penumbra of NHPs subjected to MCAO using whole genome microarrays. Microarrays revealed that transcriptional regulation is maintained in Tat-NR2B9c treated animals compared to controls. An analysis of single genes and pathways differentially regulated following stroke is presented. To study differences between genetic regulation in NHP and rat following stroke whole genome microarrays from the ischemic penumbra of each species were used to compare differential gene expression at 1 and 6 hours following stroke onset. This analysis revealed maintenance of transcriptional regulation in the rat at 6 hours following stroke. Single gene and pathway analysis revealed an increase in transcripts related to endogenous neuroprotection and inflammation in the rat whereas the NHP had an increase in pro-apoptotic signaling and cell-cell adhesion. We conclude that Tat-NR2B9c is neuroprotective in the NHP following both MCAO and embolic stroke. We have demonstrated that neuroprotection is feasible in the gyrencephalic brain. Finally, we have demonstrated that an NHP stroke model is beneficial in the design of a subsequent human clinical trial.
The Role of Oral Communication In Accessing and Assessing Mathematical Understanding: Case Studies of Primary School Teachers' Perceptions of Teaching Mathematics and Teaching Literacy
Keywords: classroom dialogue
emergence of meaning
reasoning
sense-making strategies
student engagement
teacher perspective

The study investigated primary teachers’ perspectives on teaching mathematics and teaching literacy. The focus was on oral communication strategies to see if perspectives could be harmonized by building on teachers’ greater comfort with teaching literacy. Case studies in a small suburban GTA school provided qualitative data through classroom observation, on-going conversations about observed teaching episodes, semi- formal interviews with the teachers and principal at the beginning and end of the study, and one participant’s blog and research report. Participants’ teaching experience ranged from 10 to 25+ years from kindergarten to grade 7. During the study (2013-2014), members of the school staff were organized into teaching partners by grade level to teach math through inquiry with an emphasis on communicating mathematical ideas. Evidence collected from grades 1 and 3 lead to the following findings: (1) Essential resources for teaching math effectively that teachers need and want, are available; However, teachers are unaware of their existence; (2) Teachers who try to implement reform strategies without understanding how they work do not achieve the desired result; 3) A teacher with well developed processes for making sense of mathematics, can identify gaps in student understanding by relating student behaviour to her own processes; (4) When a teacher contrasts his/her sense-making teaching strategies in literacy and mathematics, he/she can better identify areas of dissatisfaction in his/her math instruction and possible strategies to try; (5) A teacher who is able to think about teaching goals in more general terms may come to see parallel objectives between certain teaching strategies in math and non-math subjects; (6) Teaching mathematics through inquiry requires students to have a solid grounding in early literacy as well as early mathematics; and (7) Reporting requirements that ask for student achievement in mathematics on a strand by strand basis encourage teachers to teach the subject strand by strand. The study has implications for effective professional development, teachers learning math content and developing teaching materials, improving teacher confidence and the development of mindful reform practice. Suggestions for stakeholders to facilitate teachers’ reform practice are included at the end of the study.
Identification of Targeting Factors Involved in the US2- and US11- Mediated Degradation of Major Histocompatibility Complex Class I Molecules
Keywords: Cyclophilin C
ER-Associated Degradation
Human Cytomegalovirus
Major Histocompatibility Complex Class I
US11
US2

Human cytomegalovirus uses a variety of mechanisms to evade immune recognition by major histocompatibility complex class I molecules. One mechanism mediated by the immunoevasion proteins US2 and US11 causes rapid disposal of newly synthesized class I molecules by the endoplasmic reticulum-associated degradation pathway. Although several components of this degradation pathway have been identified, evidence suggests that there are still additional host cell proteins that are required by US2 and US11 to target major histocompatibility complex class I molecules for degradation. Two approaches were taken to identify proteins involved in the function of these viral immunoevasion molecules. First was a lentiviral screen for cellular factors involved in US11-mediated degradation. Infection of U373-MG cells expressing US11 with a lentiviral shRNA library and screening for those shRNAs that increased surface class I levels led to the identification of several novel proteins. ERLIN2, PDIA5, DNAJC3, NACA, and SAE1/UBE2I were all shown to impact US11 function and are promising avenues for future research. Second, I identified cyclophilin C, a peptidyl prolyl isomerase of the endoplasmic reticulum, as a component of US2-mediated immune evasion. Cyclophilin C could be co-isolated with US2 and with the class I molecule HLA-A2. Furthermore, it was required at a particular expression level since depletion or overexpression of cyclophilin C impaired the degradation of class I molecules. Overexpression of catalytically inactive cyclophilin C produced a similar effect to the wildtype molecule, suggesting a role in complex formation between US2 and components of the ER-associated degradation machinery, rather than a requirement for peptidyl prolyl isomerase activity. To better characterize the involvement of cyclophilin C in class I degradation, I used LC-MS/MS to detect US2-interacting proteins that were influenced by cyclophilin C expression levels. I identified malectin, P5, and TMEM33 as proteins that increased in association with US2 upon cyclophilin C knockdown. In subsequent validation all were shown to play a functional role in US2 degradation of class I molecules. This was specific to US2 rather than general ER-associated degradation since depletion of these proteins did not impede the degradation of a misfolded substrate, the null Hong Kong variant of Îą1-antitrypsin.
Recovery From Depression: How Psychotherapists Come to Know They are Sufficiently Recovered to Practice Competently
Keywords: Knowing processes
Recovery
Therapist competence
Therapist depression
Wounded healer

Several studies have demonstrated that unprocessed depression amongst psychologists and other mental health therapists can negatively interfere with therapeutic work. While there is a large body of knowledge on both depression and recovery (and in particular, recovery as understood within the wounded healer paradigm), little is known about how these mental health professionals come to know that they have sufficiently recovered from a depressive experience such that the experience now generally aids rather than detracts from their therapeutic work with clients. The present study sought to better understand this aspect of therapist awareness by asking the question: how do mental health therapists come to know they have sufficiently recovered from their depressive experience such that they are now able to provide competent therapy? Participants were ten mental health therapists currently working in the Greater Toronto Area (GTA). Each participant had at least one significant depressive experiences from which they had deemed themselves sufficiently recovered and were therefore able to speak meaningfully about the experience. In-depth interviews were conducted and transcribed, and the data analyzed using a socially constructed grounded theory methodology. Three key themesâ through intrapersonal functioning, through interpersonal relationships, and through client workâ emerged, suggesting that the participants understood that becoming aware of their recovery involved a sense of adaptive shifting in both their personal and professional functioning as well as direct and indirect feedback from a number of important others in their lives. A mid-level theory was generated from these themes. The role of relationships in awareness of recovery had not been previously noted in the literature and as such is a unique contribution to the literature. Broader implications for the field of counselling and clinical psychology are addressed.
Sectarianism from Below: Youth Politics in Post-war Lebanon
Keywords: Ethnicity
Lebanon
Sectarianism
Students
Youth
Youth Politics

In this dissertation I examine why sectarianism persists among Lebanese youth. While much of the literature on communal conflict focuses on macro-level factors and elite-based explanations, I look to different, finer, levels of analysis for a fuller picture of how communal dynamics are reproduced, and why they persist—even where the literature would expect to find them lacking, such as among educated, economically secure young Lebanese, in western-oriented universities, or civil society movements. I argue that youth themselves, and particularly the young partisans of Lebanon’s political parties, play an active role in the reproduction and rejuvenation of sectarian political dynamics ‘from below.’ The networking, strategies, and activities of youth within their political spheres constitute a ‘feedback mechanism’ operating at the grassroots to reproduce Lebanon’s particular sectarian institutional configuration. I contend that youth not only contribute to the reproduction of sectarianism, they also help to adapt it and rejuvenate its appeal among their peers. I examine three spheres of youth politics: the university campus; youth-led civil society movements; and youth wings of political parties. I find that far from being the ‘blind followers’ of manipulative elites depicted in the literature, partisan youth act with more autonomy than is often assumed; generating new culture, styles, and social networks—all of which are imbued with sectarian affiliation. I also show that the politics of Lebanese youth are complex, ambivalent, and sometimes contradictory. Youth pursue multiple agendas—not only sectarian ones. In some cases, partisan youth even challenge their sect-based parties to develop more transparent, democratic institutions. Their efforts, however, get shut-down by political elites. Thus, while youth enjoy relative autonomy within their own political realms, the closer they come to the power of Lebanon’s elites, the more limited it becomes. This study contributes to debates on path dependency, the persistence of communal categories, and challenges dichotomous conceptions of youth politics. To understand the political role of youth as more than simply the “hope” or “threat” for democracy, I argue we must look closely at the politics of everyday life and grassroots realms, and take youth seriously as political actors in their own right.
A.F. Büsching and the Place of Geographical Knowledge in the German Enlightenment, c. 1740 - 1800
Keywords: Book history
Enlightenment
Germany
Historical geography
History of geography
Periodicals

This dissertation places geographical knowledge and practice in the German Enlightenment (Aufklärung). I illustrate something of geography’s constitutive sites and practical making by discussing the life and work of Anton Friedrich Büsching (1724–93), who made his name as one of the foremost geographers in the German lands and Europe through his Neue Erdbeschreibung (Hamburg, 1754–92), and through his geographical periodicals. I consider Büsching’s geographical project and its social, political and scientific contexts in three articles. The first concerns the making of geographical knowledge ‘at home’ in the context of Büsching’s geography of Asia (Hamburg, 1768) and the Royal Danish Expedition to Arabia (1761–67) organised by Johann David Michaelis. I illustrate how Büsching and Michaelis sought to integrate knowledge of the study and the field in ways that allowed them to produce more accurate knowledge of Asia’s geography, and to legitimate the credibility of textual critique in the study. I argue that understanding the relations between the constitution of the study as an analytic site and the evaluation of knowledge from the field is crucial for understanding the making of Enlightenment geography. The second article concerns the place of geography in print, and focusses on Büsching’s ‘learned newspaper’, the Wöchentliche Nachrichten (Berlin, 1773–87). I argue his periodical played a central role in reshaping the moral economy of geographical knowledge in the later eighteenth century, and show that the periodicity and materiality of the periodical genre transformed the character of geography’s authors and audiences in the Aufklärung. The final article discusses the place of politics in German geography. I argue that geography was politicised through inscriptive practices of authorship, correspondence and learned journalism, and through practices of mapping and education. Moreover, I contend that that Büsching’s geographical project was politicised through his work on the geography of the Holy Roman Empire and through his periodicals, because these works were a means for improving geo–literacy, and for engendering a sense of pride in both ‘Germany’ as a cultural nation and in Frederick II’s Prussia. Collectively, the dissertation demonstrates the centrality of Büsching’s geographical project to the making of geography in the Aufklärung.
Illuminating Urban Grime: The Atmospheric Impact of Urban Grime Photochemistry
Keywords: Atmospheric Chemistry
Nitrate
Photolysis
Urban Grime

Deposition and subsequent processing of atmospheric species on impervious surfaces leads to the formation of surface films. Most abundant in urban environments, these films, sometimes referred to as â urban grimeâ , are thought to mediate environmental processing of species through adding an additional compartment into which species can partition, facilitating transfer of atmospheric species into surface water and promoting heterogeneous reactions. In this thesis, real urban grime samples are collected and used to investigate composition, growth characteristics, and reactivity of the less studied inorganic fraction of the film. Some of the reactions that we propose include the photochemical formation of nitrogen oxides, the formation of ClNO2 from grime chloride and the re-emission of ammonia from grime. The particular focus is urban grime photochemistry as a possible daytime source of HONO to the atmosphere. While surface nitrate/HNO3 photolysis has been previously suggested as a HONO source, it has not been previously studied using real environmental surfaces. Using a combination of laboratory and field photochemical experiments it has been found that grime nitrate undergoes photolysis to form gas phase nitrogen oxides at a rate faster than has previously been reported for aqueous nitrate, gas-phase HNO3 and surface deposited HNO3 on clean glass. This chemistry is dependent on relative humidity and only involves a fraction of extractable grime nitrate. Based on these studies, urban grime photochemistry was explored as a source of HONO using a box model. The magnitude and temporal variation of this HONO source depend on the photochemical properties of the precursor including rate constant and wavelength dependence of its absorption cross-section, the source and rate of accumulation of the precursor as well as other factors such as latitude, season.