Objectives: The primary objective was to assess if a correlation exists between CVM and statural height growth velocity. The secondary objective was to assess if a correlation exists between CVM and mandibular growth velocity. Design/Setting: A prospective longitudinal study undertaken at Liverpool University. Subjects: Participants were aged between 8-18 years, of either gender and enrolled from the orthodontic waiting list at Liverpool University Dental Hospital. Methods: Standing height was measured every 6 weeks with subjects barefoot and in natural head position. Lateral cephalograms were taken at the start of treatment, on completing functional appliance therapy and prior to debond. Mandibular growth was assessed using the area of the triangle condylion-gnathion-gonion. Intra- and inter-observer reliability of CVM staging, cephalometric and statural height measurements were assessed using Cohen’s weighted kappa, intra-class correlation coefficient, and Bland and Altman plots respectively. ANOVA was used to test for statistically significant differences between the CVM stages. Results: 108 participants were included for analysis. The peak in statural height growth velocity occurred at CVM stage 3 (P=0.001). The peak in mandibular growth occurred at CVM stage 3, although this was not statistically significant. Conclusions: The findings of this study demonstrate that CVM staging is valid for identifying the pubertal peak in statural height. The peak in mandibular growth as assessed by the triangle Co-Go-Gn occurred at CVM Stage 3, but this was not statistically significant. Ethical approval was granted from Liverpool East Research Ethics Committee on 30th October 2013 with reference number 13/NW/0408 and protocol number UoL000751.

Background: Adolescence is a time of significant psychological readjustment. A number of young people experience the transition to adulthood as challenging, however many are able to adapt without significant difficulties and thus demonstrate resilience. Aim: The aim of this study was to investigate the role of hope and resilience in relation to well-being in late adolescence in a sample of young people aged between 16 and 18 years. Method: A cross-sectional questionnaire design was utilised with a sample of 50 participants aged between 16 and 18 years of age and who were recruited from a college. Participants completed three measures relating to well-being, resilience, and hope. Findings: The results support the hypotheses that hope and resilience are related to well-being. High levels of hope are associated with high levels of well-being and hope is a significant predictor of well-being in young people aged between 16 and 18 years. Implications: Young people may benefit from accessing services that enhance their levels of hope and resilience and emphasise their existing strengths and resources in relation to negotiating the transition to adulthood.

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

This thesis reports a series of laboratory and clinical studies designed to investigate the acute effect of surgical palliation on ventricular function in children with functionally single ventricle anatomy. Ventricular volume and pressure were measured using a combined pressure-conductance catheter. Initial laboratory-based experiments were performed using a physical model of the left ventricle, which allowed examination of the measurement techniques used in the clinical studies but under controlled conditions. These experiments identified a non-linear conductance-absolute volume relationship and demonstrated for the first time that the calibration coefficient, \(\alpha_{SV}\) produced a significant, volume-dependent measurement error. These experiments also demonstrated that conductance volume measurements were adversely influenced by other electrical signals. The ventricular electrogram produced clinically important measurement error that has not previously been described. Two clinical studies were then undertaken to investigate the separate effects of the bidirectional cavo-pulmonary anastomosis (BCPA) and the completion total cavo-pulmonary connection (TCPC). These studies represent the core of the thesis. Both procedures were associated with significant changes in the pressure and volume conditions of the dominant ventricle. In addition, the BCPA was associated with a substantial and immediate improvement in ventricular systolic function but this was accompanied by an increase in diastolic chamber stiffness. By contrast, the TCPC was not associated with a significant change ventricular systolic or diastolic function in spite of the changes in ventricular load. Comparable changes were observed in patients with a dominant ventricle of either left or right ventricular morphology. These studies provide a more detailed understanding about the acute events that accompany surgical palliation in children with functionally single ventricle anatomy. These findings confirm the validity of staged surgical palliation in the management of these children.

Emerging research (Cort and Cline, 2017; Dodd, 2009; Gallagher, 2010) suggests the impact of domestic abuse (DA) on children and young people's lives is a crucial issue for Educational Psychologists (EPs). Whilst there are a number of small scale studies exploring EP practice in this area (Gallagher, 2010; Heath, 2015) researchers are yet to explore EP practice in relation to domestic abuse on a larger scale. This research adopted a mixed method web survey design to explore EP practice at a national level. A pragmatic stance was adopted, and descriptive statistics, thematic analysis and factor analysis were utilised to explore EP practice supporting children, families and schools exposed to DA, factors supporting EP engagement in this area and EPs' views around their unique role in relation to DA. The findings suggest EPs encounter DA within their casework to varying degrees. EPs appear to vary in their consideration of DA within case formulation, and in their exploration of DA with school staff and families. Respondents varied in their approach to exploration of DA and the indicators they utilise to prompt exploration. Factor Analysis identified EPs' confidence in introducing DA to the conversation, whilst also ensuring a co-operative relationship exists with parents, is an important factor for EP practice. EPs reported the use of a range of interventions in response to DA; however interventions specifically focused upon DA were not widely used. EPs identified an interest in further involvement with a range of interventions and 23% of respondents reported involvement in systemic approaches around DA. Further factors perceived to be important by EPs in supporting their work in this area were: supervision and training to support EP knowledge and skills, service level policy, and the establishment of a clear role for EPs around DA. The majority of respondents felt there could be a unique role for the EP around DA, with the EPs' facilitative role and their ability to further the psychological understanding of others identified as key themes.

Background: Insulin pumps have the potential to improve glycaemic control and health in childhood type 1 diabetes (T1D) but they require intensive monitoring and their impact on parental quality of life (QoL) is less well understood. Aims: To explore the views of parents who manage their children’s T1D with insulin pumps, with a particular focus on the impact of this method of insulin delivery on parental QoL. Method: A qualitative, cross-sectional study was conducted. Seven parents with a child aged 12 or younger with T1D, who have used the insulin pump, were recruited using purposive, volunteer sampling. Semi structured interviews were carried out and analysed using interpretative phenomenological analysis (IPA). Results: Four super-ordinate themes describe parents’ experiences adjusting to caring for their child using an insulin pump; ‘life before the pump’, ‘transition to the pump’, ‘life on the pump’, and the ‘perceived impact for their child’. Each super-ordinate theme comprised several sub-themes, and a concept that crossed all themes was ‘fluctuating feelings of control’. Conclusions: Parents were generally positive about using the insulin pump to care for their child with T1D, and most wished to continue with this method of insulin delivery. Parents faced challenges at particular times with the pump, but with support regained control over difficult aspects of pump use. Understanding parents’ experiences will assist diabetes teams to implement care practices centred on the needs of the family.

Background The literature suggests that working and long-term memory are impaired in paediatric brain tumour survivors (Robinson Fraley, Pearson, Kuttesch & Compas, 2013; Robinson et al., 2014). Survivors report difficulties remembering information they learned days before, including for school exams. Sleep and psychological problems can affect memory performance and may exacerbate memory difficulties in this population. Aims Assess learning and long-term memory in paediatric brain tumour survivors relative to healthy controls, and explore associations between memory, sleep and mood. Method A learning paradigm was used to teach verbal and visual material to an 80 percent criterion in ten young brain tumour survivors and ten matched healthy controls (sibling, cousin or best friend) aged between 11 and 24. A between-subjects design compared recall between groups at delays of 30 minutes and one week. Sleep quality (measured by Actigraphy), anxiety and depression were also assessed. Results Verbal learning was significantly impaired in brain tumour survivors relative to controls. There was very tentative evidence of increased visual forgetting in the tumour group, however definitive conclusions could not be drawn from results due to the study lacking power. Some participants had significant impairments in verbal learning or verbal and visual long-term memory, and others did not. Memory was not associated with sleep or psychological variables in the tumour group, although this may be due to the study lacking power. Discussion The variability in memory within the tumour sample emphasises the heterogeneity in the brain tumour population and the need for memory to be monitored in individuals. Education and occupational settings could offer further support to those that require it. Future research should assess memory after delays longer than 30 minutes and further explore how tumour, treatment, sleep and mood variables affect memory.

No description available.

Objective: To retrospectively evaluate antibiotic use in pediatric appendectomy procedures following an educational intervention in December 2001. Methodology: Demographic, clinical, and prescribing data was collected for all the patients <18 years old who have had undergone non-perforated appendectomy procedures at Princess Margaret Hospital for Children, WA. Data collection and analysis were divided into three groups. Group-I involved patients from May 2002 to April 2004 (which followed the post-intervention follow-up conducted from December 2001-April 2002 by Mallik et al.1). In May 2004, the Western Australian Therapeutic Advisory Group (WATAG) sent an advisory note which recommended a change from the use of cefotetan for surgical prophylaxis to cephazolin plus metronidazole. Group-II of the study involved patients between May 2004 (when the WATAG note was released) and June 2004; while Group-III involved patients from July 2004 to April 2005 (when the hospital issued the new guidelines and withdrawn cefotetan).Patient records were randomly selected for Group I & III and all the records were evaluated for Group III. Results: Records for 408 patients were evaluated across the three groups of the study. There no significant difference (p>0.05) between gender and age across the three groups. An appropriate prophylactic drug regimen was prescribed in 68.5%, 66.7% and 39.8% of patients in Groups I, II and III respectively, with a significant difference in appropriate drug choice between Groups I and III (p <0.05). There was no significant difference between the groups with respect to appropriate prophylactic drug dose (p>0.05). Appropriateness rates for antibiotic choices for ward treatment were high at 91.0%, 92.0% and 92.7%, with no significant differences (p>0.05). / There was a significant difference (p<0.05) between the three groups regarding the number of doses for ward treatment, with inappropriateness rates of 29.9%, 40% and 16.4%. The total appropriateness rates (drug choice plus dose in theatre and ward) across the study were 54.7%, 54.2% and 31.5%, with a significant difference (p <0.05) between Groups I and III. Conclusion: This study has identified deficiencies related to the prescribing of antibiotics for prophylaxis. There was a varied level of prescribing appropriateness in terms of antibiotic choice for prophylaxis with an increasing trend for inappropriateness towards the end of the study period. This would indicate that issuing of changed guidelines and withdrawal of the drug being replaced did not positively influence appropriate prescribing. Further interventions are required to improve compliance with hospital prescribing guidelines.

Background: Celiac disease affects 1% of the population and the only treatment for CD is life-long adherence to a gluten-free diet, this affects every aspect of life including emotional, social, physical and psychological which in turn has an effect on patient quality of life. Objective: This pilot study is an effort in understanding the quality of life in the pediatric CD population and is a guide for a future, large sample research study. Design & Methods: Thirteen children diagnosed with CD by intestinal biopsy (mean 6 months) and their parent pair were asked to complete a generic QoL questionnaire (EQ-5D-CY) and a disease-specific questionnaire (TACQoL-CD). Results: The overall QoL was higher on the generic questionnaire, while the effects of CD and the GFD resulted in a lower quality of life as determined by the TACQoL-CD. Future research with a large sample at multiple timepoints is imperative.