Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

O objetivo deste estudo foi comparar o preparo de canais radiculares de dentes decíduos artificiais com o uso dos sistemas manual, rotatório e de rotação recíproca, no que diz respeito ao desgaste promovido após a instrumentação dos canais radiculares e o tempo necessário para a realização da instrumentação. Os fatores em estudo foram técnica de instrumentação em três níveis e área de avaliação no canal radicular em três níveis. Foram utilizados apenas os dentes multiradiculares (primeiro molar superior, segundo molar superior, primeiro molar inferior e segundo molar inferior), compondo 24 dentes os quais foram aleatoriamente divididos entre as três técnicas de instrumentação em estudo: manual, Sistema rotatório Mtwo e Sistema de rotação recíproca Reciproc. A unidade amostral foi conduto radicular (n=20). Os condutos radiculares foram escaneados no tomógrafo de TCFC (Accuitomo). Após a instrumentação dos dentes novas imagens foram realizadas, avaliações quantitativas foram feitas medindo-se nas imagens axiais dos canais radiculares, a espessura das paredes em três diferentes regiões: terços apical, médio e cervical. As variáveis de resposta analisadas foram cálculo do transporte do canal, cálculo da descentralização e tempo de instrumentação. Tanto para a avalição da descentralização, quanto para a avaliação do transporte, os dados foram transformados e analisados por ANOVA a 2 critérios e Teste de Tukey, para os dados da comparação dos tempos foi utilizado o teste de Kruskal-Wallis e Teste de Tukey (p<0,05). Para a avaliação do transporte do canal e da descentralização não foi encontrada diferença estatística significativa entre os tipos de instrumentação e terços radiculares (p>0,05). Na avaliação do tempo de preparo, o grupo do sistema reciprocante apresentou menor tempo de preparo em comparação com o sistema manual e rotatório (p<0,05). Desta forma conclui-se que os tipos de instrumentação avaliados promoveram um preparo similar dos canais, sem diferença entre os terços cervical, médio e apical, sendo que o sistema de rotação recíproca resultou em um menor tempo de instrumentação. / The objective of this study was to compare the preparation of root canals of artificial deciduous teeth with the use of the manual systems, rotational and reciprocal rotation, with regard the detrition promoted after instrumentation of root canals and the time necessary for the realization of instrumentation. The factors in study were the techniques of instrumentation in tree levels and the area of root canal in tree levels. Have been used only teeth multirooted (first molar, second molar, lower first molar and second molar), composing 24 teeth which were randomly divided among the three instrumentation techniques under study: manual, rotational system Mtwo and reciprocal rotation system Reciproc. The sample unit was root canal (n = 20). The root canals were scanned in tomographer CBCT (Accuitomo). After instrumentation of new images teeth were conducted quantitative evaluations were made by measuring the axial images of the root canals, the wall thickness at three different regions: apex, middle and cervical thirds. Response variables analyzed were calculating the channel transport, decentralization and calculation time instrumentation. Both for the evaluation of decentralization, as for the evaluation of transportation, data were processed and analyzed by ANOVA and Tukey 2 criteria test to the data comparing the times we used the Kruskal-Wallis test and Tukey test (p <0.05). For the evaluation of the channel transport and decentralization was no statistically significant difference between the types of instrumentation and root thirds (p> 0.05). In assessing the preparation time, the reciprocating system group showed less preparation time compared to the manual system and rotary (p <0.05). Thus it is concluded that the types of instrument reviews promoted a similar preparation of channels, no difference between the cervical, middle and apical thirds, and the reciprocal rotation resulted in a shorter time instrumentation.

Shared decision making (SDM) is rarely used in pediatric clinical practice. The purpose of this dissertation was to explore factors influencing SDM implementation in pediatric clinical practice. We conducted three studies that were guided by the Ottawa Model of Research Use (OMRU): Study 1 was a systematic review using Cochrane methods and the Mixed Methods Appraisal Tool to determine pediatric SDM barriers and facilitators from multiple perspectives. Eighty studies, of low to high quality, were included. At each OMRU level, frequently cited barriers were: option features (decision), poor quality information (innovation), emotional state (adopter), power relations (relational), and insufficient time (environment). Frequently cited facilitators were: lower stake decisions (decision), agreement with SDM (adopter), high quality information (innovation), trust and respect (relational), and SDM tools/resources (environment). Across participant types, frequently cited barriers were: insufficient time (healthcare providers (HCP)), option features (parents), power imbalances (children), and HCPs’ SDM skills (observers). Frequently cited facilitators were: good quality information (HCPs) and agreement with SDM (parents/children). Study 2 was a post-test design that evaluated SDM knowledge and acceptability of learners who completed the Ottawa Decision Support Tutorial (ODST). Most learners were HCPs (62%). Overall, ODST learners had a median knowledge test score of 8/10 (IQR = 7-9; n=6604) and 90% reported good or excellent impressions (n=4276) after completing the tutorial. Few learners suggested improvements. Study 3 used mixed methods to evaluate pediatric HCPs’ perceived SDM barriers and facilitators after training (ODST plus workshop). Participants completed a SDM barrier survey (n=60; 88% response rate) and semi-structured interview (n=11). Their intention to use SDM was high (mean score = 5.6/7, SD=0.8). However, 90% of respondents reported minimal SDM use after training. Main barriers were lack of buy-in (adopter level) and time constraints (environmental level). Healthcare providers wanted a team-based approach to SDM training (training level). Adopters face numerous and diverse barriers to SDM use, before and after SDM training. Pediatric HCPs who completed the ODST were knowledgeable about SDM. Despite positive intentions, training alone was insufficient to achieve routine SDM use. These findings can inform intervention development to promote SDM implementation in pediatric clinical practice.

Phenylketonuria (PKU) is a rare inborn error of metabolism that can be managed through lifelong treatment adherence to a restricted diet and supplemental medical formula (Vockley et al., 2014). Untreated PKU can result in severe intellectual disability, anxiety, depression, executive functioning deficits, and seizures (Cappelletti et al., 2013; Moyle et al., 2007). Even individuals who are continuously treated for PKU can experience high rates of anxiety and depression, executive functioning deficits, social difficulties, and lower full-scale IQ scores than their siblings and parents (Bosch et al., 2015; Manti et al., 2016; Waisbren et al., 2007). Additionally, adolescents are at risk for social difficulties due to the restricted diet and treatment of PKU (Bosch et al., 2015). Quality of life is just beginning to be studied in individuals with PKU. Most studies have focused on adults or on parent or clinician ratings of children and adolescents’ quality of life. Results of these studies have been varied with some individuals with PKU and their parents reporting normal quality of life compared to peers (Cazzorla et al., 2014; Thimm, Schmidt, Heldt, & Spiekerkoetter, 2013) and others showing parents rate their children with PKU as being less happy, confident, and joyful than healthy peers (Landolt, Nuoffer, Steinmann, & Superti-Furga, 2002). A qualitative interview study was conducted with five adolescents with PKU between the ages of 14 and 18 years. The purpose of this study was to gain an in-depth awareness of the beliefs and perceptions of these adolescents with PKU on how they understand and conceptualize their condition, the impact it has on their life, factors that influence their quality of life, and perceptions of their peer relationships in regard to their illness. A romantic conceptualization of interviewing was used to build rapport and trust between the interviewer and interviewee in order to access the authentic self of each participant (Roulston, 2010a). Each adolescent participated in a series of four semi-structured individual interviews. Data were analyzed using thematic analysis (Braun & Clarke, 2006). Results indicated adolescents with PKU describe their overall quality of life in positive terms and report similar influences on their life satisfaction and quality of life as other adolescents. Adolescents with PKU identified relationships with family and friends as the most salient influence on their life satisfaction. They largely perceive their social lives to be similar to their peers and believe they are more similar to their peers than different. Adolescents with PKU describe few challenges in social settings and view these challenges as simply inconveniences. However, adolescents with PKU minimize their condition and the impact it has on their life. When talking about PKU, sharing it with others, or when it comes up in social situations they use words that describe it as minor in consequence and significance. The majority of participants had a general understanding and knowledge of how they got PKU, their treatment, and potential consequences. Nevertheless, adolescents also reported a number of incorrect consequences, a lack of awareness of consequences, and misconceptions about PKU and the impact it can have on their life. Implications for medical providers and behavioral health professionals who work with adolescents with PKU include the importance of monitoring and providing extra support during natural transition times, such as moving from elementary school to middle school and then to high school. Current findings also indicate there is room for improvement in health literacy among adolescents with PKU and specific strategies are discussed. Future research should continue to explore the experiences of individuals with PKU during late childhood and early adolescence, the time frame identified as most difficult in the current study. Another direction for future research is further exploration of how PKU influences the idea of self-concept and self-image.

Despite a worsening obesity epidemic and despite the American Medical Association (AMA) declaring Obesity a disease (2013), few assessment tools exist that assist practitioners who are charged with identifying risk for development of OW/OB in children. The Center for Health Statistics (2017) reported a 40% rate in obesity in the adult population and 18.5% in children in the U.S. Successful weight loss maintenance after 1 to 2 years of non-invasive treatment is less than 1%, indicating obesity is nearly incurable, making prevention imperative. Assessing risk for OW/OB in children has proven difficult given the lack of validated tools. The purposes of this study were to evaluate the predictive validity and estimate the reliability of the Electronic Kids Dietary Index (E-KINDEX) to measure risk for development of overweight and obesity OW/OB in children aged 10 to 18. In addition, the relationship between quality of life perceptions and OW/OB in children was assessed. Methods. E-KINDEX, a 30-item questionnaire encompassing three dietary domains of food quality, dietary behaviors (attitudes), and dietary habits (Lazarou et al., 2011), was administered to 50 child participants who, with their parents’ consent, agreed to participate. The children also completed the quality of life questionnaire. The range for E-KINDEX scores was 1 (worst) to 87 (best) for assessment of the obesogenic environment that encompasses the immediate environment of the individual, factors that influence food quality, choices, and behaviors. Predictive validity was evaluated using multiple regression, factor analysis, and receiver operating curve statistics in SPSS; reliability was analyzed using Cronbach’s alpha. Pearson product-moment correlations were used to measure strength of relationships among OW/OB, E-KINDEX scores, and quality of life perceptions in the sample. Results. E-KINDEX overall score was significantly correlated with OW/OB (r = -340, n = 50, p = .008), as was Dietary Behaviors (r = -.593, n = 50, p = Discussion. Predictive validity of E-KINDEX subscales and overall were supported through achievement of aims of the study. Correlations between both E-KINDEX scores and child weights were significant and reliability supported by Cronbach’s alpha. Limitations included small sample size of 50 and accuracy of children self-report data in the presence of parents. Parental weight did not correlate with E-KINDEX, but should be studied further relative to the Obesogenic Environment. Physical activity was high in both OW/OB and lean groups. Validated Physical Activity tools are needed. Implications. Although refinement and further study are needed, E-KINDEX is a useful tool for clinicians to identify children at risk for the chronic disease of OW/OB before it develops, perhaps before risk factors become difficult to modify.

Liya Wang

Abstract not available

Includes bibliographical references. / 1 v. : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / A thesis based on collective clinical, basic research material and publications in endoscopic paediatric surgical procedures. Discusses the application of adult percutaneous renal surgical techniques for managing renal calculi disease in children, and modifications to this technique. Describes the introduction to laparoscopic surgery and the author's contribution to this technique. Also includes publications on paediatric urology. / Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 2000

This study confirmed whether children on the current treatment of choice for HIV infection, Highly Active Antiretroviral Treatment (HAART), exhibit better immune functioning than children on earlier forms of treatment, including sole exposure to Monotherapy/Combination Therapy (Mono-Combo) and "upgrading" from Mono-Combo to HAART (Conversion). It explored whether HAART protects areas of neuropsychological functioning previously found to be compromised in children perinatally infected with HIV more effectively than these earlier treatments. This study includes a unique population (i.e., predominantly minority, low SES status, and largely bilingual), and controls for a number of treatment variables that have not been previously considered. Using the Neurodevelopmental Model and the literature, it was hypothesized that more global functions (i.e., IQ indices besides processing speed) and functions developing earlier in life (i.e., language) would be less affected than more specific functions developing later in life (i.e., visual-motor integration and processing speed). Treatment groups included Mono-Combo, Converters, and HAART. Participants (N=161, 3 to 20 years) were assessed in language, visual-motor integration, processing speed, and IQ using standardized measures and procedures. Three MANCOVAS and an ANCOVA compared groups on immune and neuropsychological measures using age antiretroviral medications were started and years on antiretroviral medications as covariates. Results showed children on HAART have significantly better immune functioning than the Mono-Combo and Converter groups. Consistent with other studies that have controlled for demographic factors, language functioning was not affected by treatment type. Contrary to expectations, visual-motor integration was also not affected by treatment type. Interestingly, Converters were found to perform worse on processing speed than children only exposed to Mono-Combo or HAART. Consistent with expectations, the other IQ indices (i.e., VCI, POI, and FDI) were not affected by treatment type. Findings support the use of HAART globally to improve immune functioning. However, they also provide evidence that HAART does not more effectively protect areas of neuropsychological functioning previously found to be compromised than these former treatments, even when controlling for agents that cross the blood brain barrier, age medications were started, and years on medications. They also bring into question the possible effect of frequency and timing of regimen changes.

Despite the establishment of heart transplantation as a life-saving therapy for children and adolescents, little research has focused on the biopsychosocial impact of the transplant process. Few studies have captured the subjective experiences of young heart transplant recipients. This program of research examined how pediatric heart transplant recipients construct their worlds and the meanings they ascribe to their transplant experience. A grounded theory approach was implemented which guided data collection and analysis. A total of twenty-seven adolescents participated in semi-structured qualitative interviews. Findings illuminate pediatric heart transplantation to be a pervasive experience, with consequent impact on physical, psychological and social well-being. Participants described various biopsychosocial processes and experiences that occurred over the course of their transplant journey. Data analysis yielded themes of quality of life reflecting notions of temporality including: 1) the pre-transplant experience – a struggle to survive, 2) the transplant surgery and hospitalization – a difficult transition and 3) the post-transplant experience – an awakening and transformation. This research identifies that heart transplantation, which may contain elements of suffering and loss, may ultimately enhance young recipients’ overall quality of life. Results reveal the possibility that adolescent heart transplant recipients not only adapt to transplantation, but also potentially experience associated growth-enhancing experiences. An emergent theoretical model is presented, with implications for practice and research.