Fetal overgrowth is associated with adverse outcomes for offspring and with maternal obesity. Results from a systematic review and meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birthweight ≥4000g (OR 2.17, 95% CI 1.92, 2.45), birthweight ≥4500g (OR 2.77, 95% CI 2.22, 3.45) and birthweight ≥90%ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). A retrospective cohort study revealed that mothers whose infants are macrosomic are more likely to require induction of labour (OR 1.42, 95% CI 1.10-1.98) and delivery by Cesarean section (OR 1.45, 95% CI 1.04-2.01), particularly for maternal indications (OR 3.7, 95% CI 1.47-9.34), if they are obese. Infants from these pregnancies are significantly more likely to require neonatal resuscitation in the form of free flow oxygen (OR 1.57, 95% CI 1.03, 2.42) than macrosomic infants of non-obese mothers. Thus, co-existing maternal obesity and macrosomia increases the risk of adverse pregnancy outcomes.

Restorative justice has grown within the criminal justice system over the last 30 years. The current academic literature suggests that restorative justice programs provide many positive benefits for the offenders who participate in them; however, there is a lack of research to account for the subjective experiences of program participants. Using qualitative inquiry, the current thesis sought to understand better the meaning, purpose, and impact of restorative justice programs from ten adult offenders participating in one of two restorative justice programs in Southern Ontario: restorative conferencing and victim-offender mediation. Results highlight how offenders report gaining access to the programs, how they describe the programs, significant features of the programs, and long-term impacts of the programs. Recommendations to enhance the meaningfulness for the offenders as well as policy recommendations and areas for future research are discussed. / UOIT

Background: Despite the high success rates reported with the use of a five minute application of formocresol it has been postulated that it may be applied for a lesser amount of time and still achieve equivalent results. Few studies have adequately addressed the effects of the medicament on permanent successors and exfoliation times. Furthermore, the effects of shorter application times on success rates have not been adequately reported. Objectives: To assess the clinical and radiographic outcomes of a one minute application of full strength Buckley’s formocresol with concurrent hemostasis using the medicated cotton pledget in human primary teeth. To evaluate the effect of this technique on their successors and to evaluate the exfoliation times in comparison to the contralateral non-pulpotomized tooth. Methods: Using a retrospective chart review, clinical and radiographic data were available for 557 primary molars in 320 patients. Descriptive statistics and regression analysis were used to assess outcomes. Results: 99.3% clinical and 89.8% radiographic success rates were obtained. Internal root resorption (4.85%) and pulp canal obliteration (1.97%) were the most frequently observed radiographic failures. Sixty-five and half percent exfoliated at the same time as their contra-lateral counterpart and 28.8% exfoliated earlier (p<0.001). There was no difference in the number of enamel defects of succedaneous teeth between treated and control teeth (p>0.05). Conclusions: Success rates for the modified technique are comparable to techniques that use the five-minute dilute or full strength solutions reported in the literature. The one minute technique had no clinical effect on exfoliation times or incidence of enamel defects on succedaneous teeth. The one minute full strength formocresol technique is an acceptable alternative to published traditional techniques.

Background: Despite the high success rates reported with the use of a five minute application of formocresol it has been postulated that it may be applied for a lesser amount of time and still achieve equivalent results. Few studies have adequately addressed the effects of the medicament on permanent successors and exfoliation times. Furthermore, the effects of shorter application times on success rates have not been adequately reported. Objectives: To assess the clinical and radiographic outcomes of a one minute application of full strength Buckley’s formocresol with concurrent hemostasis using the medicated cotton pledget in human primary teeth. To evaluate the effect of this technique on their successors and to evaluate the exfoliation times in comparison to the contralateral non-pulpotomized tooth. Methods: Using a retrospective chart review, clinical and radiographic data were available for 557 primary molars in 320 patients. Descriptive statistics and regression analysis were used to assess outcomes. Results: 99.3% clinical and 89.8% radiographic success rates were obtained. Internal root resorption (4.85%) and pulp canal obliteration (1.97%) were the most frequently observed radiographic failures. Sixty-five and half percent exfoliated at the same time as their contra-lateral counterpart and 28.8% exfoliated earlier (p<0.001). There was no difference in the number of enamel defects of succedaneous teeth between treated and control teeth (p>0.05). Conclusions: Success rates for the modified technique are comparable to techniques that use the five-minute dilute or full strength solutions reported in the literature. The one minute technique had no clinical effect on exfoliation times or incidence of enamel defects on succedaneous teeth. The one minute full strength formocresol technique is an acceptable alternative to published traditional techniques.

This study examines the preparation during high school and post-secondary outcomes of students with disabilities. High school preparation consists of activities in which students participated during high school. Post-secondary outcomes relate to the current status of students following high school graduation in relation to the four major outcomes areas: (a) post-secondary education, (b) employment, (c) independent living, and (d) recreation and leisure. The target population included all students graduating from one school district in a mid-sized city in Texas. A stratified random sample of 228 students both with and without disabilities was selected. Post-secondary follow-up surveys, consisting of one survey administered prior to graduation and one survey administered six-months following graduation, were given to the participants. The response rate for the initial exit survey was 82.9% while the response rate for a post-school survey was 61.4%. Differences between groups were analyzed using loglinear analyses based upon educational setting, disability category, gender, ethnicity, and socio-economic status. In addition, a sub-study was completed to determine the level of agreement among students and teachers on a post-secondary readiness skill inventory. The findings indicated that differences among groups did exist in terms of both high school preparation and post-secondary outcomes. In terms of high school preparation, the participation among various groups produced few results that were significantly different. Statistically significant results occurred only with respect to extracurricular activity participation by educational setting and socio-economic status. Post-secondary outcome results produced more statistically significant findings than high school preparation. The variable of educational setting produced statistically significant post-secondary outcomes in the three areas of employment, post-secondary education, and recreation and leisure. Ethnicity was the next largest determinant to influence post-secondary outcomes, and statistically significant results were found for both post-secondary education and independent living. Socio-economic status produced statistically significant results for employment outcomes. The variable of gender produced no results that reached statistical significance. The last findings provided an analysis of the agreement between students and teachers in terms of a post-secondary readiness skill inventory. Overall students and teachers demonstrated a high level of congruency in which similar responses were indicated within 95% of the items.

Despite a growing body of research regarding the effects of media on very young children, most studies have focused on relatively short-term effects, and those that examined long-term effects have not done so with a representative sample. The current study examined long-term effects of screen media exposure on children aged 0 to 35 months. The data for this study came from the first and second waves of the Panel Study of Income Dynamics (PSID) Child Development Supplement (CDS-I and CDS-II), which offers several advantages in examining the longitudinal relationships between early television exposure and subsequent academic performance. This nationally representative dataset includes a measure of cognitive skills, as well as time diaries that provide a record of how and with whom children spent their time. First, this study examined television viewing contexts likely to be operative in infancy and toddlerhood -- what these children view, whom they co-view with, what they co-view, and what they are doing while the television is on. Second, this study assessed the long-term effects of early exposure to different program content (i.e., child-educational programs, child-noneducational programs & adult programs) on subsequent cognitive outcomes (mainly academic achievement) in early childhood. Finally, the role of parental co-viewing in the long-term effects of exposure to child-educational content on academic skills was examined. Descriptive analyses and multiple OLS regressions were conducted. On weekdays, children were exposed to child-educational content, child-noneducational content and adult content on TV (33 minutes, 29 minutes, 27 minutes, respectively); on weekends, children were exposed to child-educational content, child-noneducational content and adult content on TV (23 minutes, 31 minutes, 31 minutes, respectively). Although it is commonly believed that television displaces time spent with others and playing, nearly half of infants and toddlers' time spent viewing television was spent playing and in social interaction (30% and 16%, respectively). Different relationships emerged among groups with differing amounts of total television exposure: children who were exposed to 1 to 2 hours of television per day had higher academic test scores compared to children who were exposed to less (those who watched no TV at all and those who were exposed to between 0 and 1 hour). As regards television content, the only relationship found was among toddlers exposed to adult content. Toddlers who were exposed to more adult programs in their early years were likely to have worse passage comprehension test scores 5 year later. However, there was no relationship between early exposure to child programs (i.e., child-educational and child-noneducational content) and subsequent academic test scores. Parental co-viewing of child-educational content was positively related to the academic achievement test scores (the passage comprehension test scores and the applied problem scores), indicating that parental co-viewing plays an important role in children's experience of media in infancy and toddlerhood. The findings have implications that may allow us to increase the effectiveness of learning from screen media in infancy and toddlerhood. / text

Introduction: Surgical treatment is the cornerstone of the management of colorectal cancer (CRC). This study described the structures of care at Ontario hospitals performing CRC surgery. Methods: Patients diagnosed with CRC undergoing surgery were identified from 2003-2007. Data linkage identified all institutions performing CRC surgery. Multiple hospital level structures were measured. For the final year of our study, the impact of these structures on 30-day mortality was evaluated. Results: 20,784 patients underwent CRC surgery. Each year, between 106 and 109 institutions performed at least one CRC operation. There was variation in hospital level structures of care. After adjustment for patient characteristics, no hospital level structures were independently associated with 30d mortality. Conclusions: Although variation in surgical care and patient outcomes is likely related to variation in processes and structures of care, after adjusting for covariates, our study did not show any significant relationship between hospital level structures and 30-day mortality.

Introduction: Surgical treatment is the cornerstone of the management of colorectal cancer (CRC). This study described the structures of care at Ontario hospitals performing CRC surgery. Methods: Patients diagnosed with CRC undergoing surgery were identified from 2003-2007. Data linkage identified all institutions performing CRC surgery. Multiple hospital level structures were measured. For the final year of our study, the impact of these structures on 30-day mortality was evaluated. Results: 20,784 patients underwent CRC surgery. Each year, between 106 and 109 institutions performed at least one CRC operation. There was variation in hospital level structures of care. After adjustment for patient characteristics, no hospital level structures were independently associated with 30d mortality. Conclusions: Although variation in surgical care and patient outcomes is likely related to variation in processes and structures of care, after adjusting for covariates, our study did not show any significant relationship between hospital level structures and 30-day mortality.

Background Air pollution exposure has been shown to have adverse effects on several health outcomes, and numerous studies have reported associations with cardiovascular morbidity, respiratory disease, and mortality. Over the last decade, an increasing number of studies have investigated possible associations with pregnancy outcomes, including preterm delivery. High levels of vehicle exhaust in residential neighborhoods have been associated with respiratory effects, including childhood asthma, and preterm birth is also associated with childhood asthma. The first aim of this thesis was to investigate possible associations between air pollution exposure and pregnancy outcomes – primarily preterm delivery but also small for gestational age (SGA) and pre-eclampsia – in a large Swedish population (Papers I–III). The second aim was to study any association between exposure to high levels of vehicle exhaust during pregnancy and infancy and prescribed asthma medication in childhood (Paper IV). Methods The study cohorts were constructed by matching other individual data to the Swedish Medical Birth Register. In the first two studies, air pollution data from monitoring stations were used, and in the third and fourth studies traffic intensity and dispersion model data were used.Preterm delivery was defined as giving birth before 37 weeks of gestation. SGA was defined as having a birth weight below the 10th percentile for a given duration of gestation. Pre-eclampsia was defined as having any of the ICD-10 diagnosis codes O11 (pre-existing hypertension with pre-eclampsia), O13 (gestational hypertension without significant proteinuria), O14 (gestational hypertension with significant proteinuria), or O15 (eclampsia). Childhood asthma medication was defined as having been prescribed asthma medication between the ages of five and six years. Results We observed an association between ozone exposure during the first trimester and preterm delivery. First trimester ozone exposure was also associated with pre-eclampsia. The modeled concentration of nitrogen oxides at the home address was associated with pre-eclampsia, but critical time windows were not possible to investigate due to high correlations between time windows. We did not observe any association between air pollution exposure and SGA. High levels of vehicle exhaust at the home address, estimated by nitrogen oxides and traffic intensity, were associated with a lower risk of asthma medication. Conclusion Air pollution exposure during pregnancy was associated with preterm delivery and pre-eclampsia. We did not observe any association between air pollution levels and intrauterine growth measured as SGA. No harmful effect of air pollution exposure during pregnancy or infancy on the risk of being prescribed asthma medication between five and six years of age was observed.

The sound environment in hospitals is complex. While there have been several studies that address the acoustic environment in hospitals, there is a limited amount of research done concerning the effect that noise has on staff. This thesis describes two related studies: 1) analysis of the relationships between acoustics and perceptual staff outcomes using an existing data set collected in real hospitals; 2) development of methodologies to test the relationships between acoustics and hospital staff task performance in a simulated laboratory setting. In the first study it was found that mental health and perception of noisiness were occupational factors that were related to the sound environment using a variety of acoustic metrics. Only a few acoustic metrics were shown to be statistically significant related to dependent variables in a direct correlation (e.g., as the acoustic conditions worsened the dependent variable also decreased). However, almost all acoustic metrics tested had a statistically significant relationship with mental health once subjective job strain was considered as a moderating factor. This means that while the direct impact of sound may not be immediately observable, sound may play a more significant role once subjective job strain is taken into account. In the second study, a new methodology was developed to directly relate staff task performance to noise and beta-tested on a single group of subjects. The methodology development included synthesizing a signal that was acoustically comparable to those heard in real hospitals in order to simulate a realistic noise exposure in a controlled environment. Additionally, objective methods of measuring performance and perception were devised by utilizing task performance scripts already validated in other studies and developing new surveys that could be administered to subjects to garner their perceived task performance and perceptions of the simulation room environment, including noise.