Offspring of parents with bipolar disorder (BD) are at high risk for psychiatric disorders, but mechanisms conferring risk are not well understood. Identifying and understanding factors that increase offspring vulnerability may inform intervention efforts. Three studies examined the following risk factors: (1) obstetric complications (OCs); (2) family functioning; and (3) clinical characteristics of parental BD. Investigations included cross-sectional data from two Massachusetts General Hospital studies of 109 BD parents and 206 offspring. Study 1 examined associations between: (1) maternal lifetime comorbid anxiety and OCs in pregnancy/delivery; (2) OCs and development of offspring psychopathology. Associations emerged between maternal anxiety and OCs. OCs, particularly during delivery, also correlated with offspring anxiety disorders. Path analyses revealed that delivery complications mediated the relationship between maternal and offspring anxiety. Study 2 examined associations between family functioning (cohesion, expressiveness, conflict) and offspring psychopathology, and explored moderation by offspring age and sex. Higher conflict and lower cohesion correlated with offspring internalizing and externalizing symptoms. Lower cohesion correlated with offspring mood disorders. Moderation analyses indicated that the link between cohesion and internalizing symptoms was stronger for younger compared to older children. Also, conflict and mood disorder were associated in younger boys, but not in older boys or in girls. Study 3 classified parents according to BD course presentation using latent class analysis, and examined associations between parental class membership and offspring psychopathology. The best-fitting model yielded three parent groups that were based on 8 illness characteristics. Some notable patterns differentiated classes: Class 1 and 2 parents had earlier illness onset, whereas Class 3 parents had later onset; Class 2 consisted of parents with Bipolar-II Disorder, whereas Class 1 parents had Bipolar-I Disorder. Class differences emerged for offspring anxiety disorders, but only among females. Class 3 parents had girls with fewer anxiety disorders compared to the other classes, with girls of Class 2 parents at greatest risk. Altogether, these studies identify several specific environmental mechanisms that increase psychopathology risk in offspring of BD parents. Such findings have important implications for targeted prevention and intervention.

Autism spectrum disorders (ASDs) are a biologically-based and behaviorally-defined spectrum of conditions which impact development. These conditions affect and are diagnosed based on features in three psychological and behavioral domains: social interaction, communication, and repetitive behaviors. Developing better ways to identify early signs of autism, whether through behavioral or other types of measures, is important because it will allow children to gain access to interventions and treatments earlier, which has demonstrated positive outcomes. Over the past 10 years, the prevalence of reported autism cases has increased. As a result, much research has focused on the etiology and phenotype of autism. Investigations seeking early signs of autism have generally studied vulnerable populations, particularly infants with an older sibling diagnosed with autism. Aside from observable behavioral differences, biological abnormalities, often within the gastrointestinal and immune systems as well as endocrine, autonomic and other systems, have been observed in a significant number of children diagnosed with autism. These features raise the possibility that cellular and tissue change in body and brain may be altering brain function such that behaviors emerge later and downstream of these cellular and tissue problems. However, research on the pathophysiology underlying these medical features, and particularly regarding how they develop in infancy, has received almost no attention. Such investigation would require measuring pathophysiological and medical features alongside current standard measures of behavioral and phenotypical presentations of autism. This thesis describes a study, funded by the Department of Defense Autism Research Program and carried out at the Massachusetts General Hospital Lurie Center, that proposed to look for early markers of autism in the pathophysiological domains in high risk infants and place them into developmental context by correlating these observations (some of which might potentially become early markers) with well-established neurocognitive measures. The goal of the study is to find biomarkers of clinical importance that reflect the pathophysiologial development of autism which might substantially precede behavioral changes that are currently used as a standard of diagnosis, but are not developmentally apparent or reliably measurable until well into the second or third year of life. While the overall scope of the study encompassed a range of systemic and nervous system measures as well as neurocognitive assessments, the focus of this thesis is mainly on a subset of the behavioral and neurocognitive measures collected through the study, specifically the Autism Diagnostic Observation Scale (ADOS), Autism Observational Scale for Infants (AOSI), Mullen Scales of Early Learning (MSEL) and Vineland Adaptive Behavior Scales (VABS). Subject development was tracked and assessed through developmental quotients (DQs) and then correlated to measures designed to identify autistic-like features. Results demonstrate that verbal development was the most significant indicator for autism. Additionally, delay in communication preceded problems with socialization. The analysis and information used for this thesis will contribute to the infrastructure utilized by the investigators for assessing further behavioral data. In addition, this behavioral data and the metrics generated in these analyses will be analyzed in relation to physiological data (e.g. brain, autonomic, metabolic, immune, and microbiome data). Tracking early biomedical development, especially alongside the current standard of observing behavioral development, has the potential of offering more comprehensive understanding of the brain-behavior-body relationship in children diagnosed with ASD, which can hopefully contribute to a non-invasive, more accurate, and earlier method of diagnosis and to the development of more treatment options.

This thesis aims to undertake health technology assessments in high risk pregnancies through the following objectives: 1. In women with pre-eclampsia, a) To evaluate the association of maternal genotype and severe pre-eclampsia b) To assess the accuracy of tests in predicting adverse pregnancy outcomes c) To develop composite outcomes for reporting in trials on late onset pre-eclampsia 2. In women with multiple pregnancy, a) To study the association between chorionicity and stillbirth b) To identify the optimal timing of delivery in monochorionic and dichorionic twin pregnancies 3. In the field of prediction research in obstetrics a) To provide an overview of the existing prognostic models and their qualities b) To evaluate the methodological challenges and potential solutions in developing a prognostic model for complications in pre-eclampsia Methods The following research methodologies were used: Delphi survey, systematic reviews and meta-analyses. Results 1. a) Maternal genotype and severe pre-eclampsia: 57 studies evaluated 50 genotypes; increased risk of severe pre-eclampsia with thromobophilic genes. b) Accuracy of tests in predicting pre-eclampsia complications: 37 studies evaluated 13 tests. No single test showed high sensitivity and specificity. c) Delphi survey of 18/20 obstetricians and 18/24 neonatologists identified clinically important maternal and neonatal outcomes and maternal and neonatal composite outcomes were developed. 2. Prospective risk of stillbirth and neonatal deaths in uncomplicated monochorionic and dichorionic twin pregnancies: 32 studies were included. In dichorionic twin pregnancies, the risk of stillbirths was balanced against neonatal death at 37 weeks' gestation. In monochorionic pregnancies, there was a trend towards increase in stillbirths after 36 weeks but this was not significant. 3. a) From 177 studies included, 263 obstetric prediction models were developed for 40 different outcomes, most commonly pre-eclampsia, preterm delivery, mode of delivery and small for gestational age neonates. b) The obstetric prognostic model challenge of dealing with treatment paradox was explored and seven potential solutions proposed by expert consensus. Conclusion I have identified the strength of association for genes associated with complications in pre-eclampsia, components for composite outcomes for reporting in studies on pre-eclampsia, and the optimal timing of delivery for twin pregnancies. My work has highlighted the gaps in prediction research in obstetrics and the limitations of individual tests in pre-eclampsia.

abstract: Despite the societal importance of activism, the understanding of activist intentions remained limited (Liebert, Leve, & Hu, 2011; Klar & Kasser, 2009). The current study used the Theory of Planned Behavior (TPB) to examine two structural models of low-risk activist intentions and high-risk activist intentions (Ajzen, 1991). The traditional TPB model was tested against a hybrid commitment model that also assessed past activist behaviors and activist identity. Participants (N = 383) were recruited through social media, professional list-serves, and word of mouth. Results indicated a good model fit for both the traditional TPB model (CFI = .98; RMSEA = .05; SRMR = .03; χ2(120) = 3760.62, p < .01) and the commitment model (CFI = .97; RMSEA = .05; SRMR = .04; χ2(325) = 7848.07, p < .01). The commitment model accounted for notably more variance in both low-risk activist intentions (78.9% in comparison to 26.5% for the traditional TPB model) and high-risk activist intentions (58.9% in comparison to 11.2% for the traditional TPB model). Despite this, the traditional TPB model was deemed the better model as the higher variance explained in the commitment model was almost entirely due to the inclusion of past low-risk activist behaviors and past high-risk activist behaviors. A post-hoc analysis that incorporated sexual orientation and religious affiliation as covariates into the traditional model also led to a good-fitting model (CFI = .98; RMSEA = .04; SRMR = .04; χ2(127) = 217.18, p < .01) and accounted for increased variance in low-risk activist intentions (29.7%) and high-risk activist intentions (18.7%) compared to the traditional model. The merits of each of the structural models and the practical implications for practice and research were discussed / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2019

No description available.

The transmission and prevalence of Hepatitis C Virus (HCV) among those who use injection drugs is a major public health issue. Injection drug use has been identified as the main cause of transmission for HCV in Canada. Street youth are at risk for acquiring HCV due to injection drug use that is often a consequence of living in a street environment. Presently, research on prevalence trends, characteristics, and associated behaviors for injection drug use and HCV in street youth, is limited. <p>The purposes of this study were to determine prevalence of injection drug use and HCV in Saskatoon street youth, to identify demographic or other factors that may contribute to street youth using injection drugs, and to identify risk factors and other characteristics of street youth associated with HCV. This study utilized data from Phase III of the Enhanced STD Surveillance in Canadian Street Youth Study by Health Canada for those participants recruited from Saskatoon, Canada. Between February and July 2001, 186 Saskatoon street youth participants between the ages 14 and 24 years completed nurse-administered questionnaires and of these, 156 provided blood specimens. Analyses were conducted to compare population characteristics between street youth who have used injection drugs and those who had not. Similarly, population characteristics were analyzed among those street youth who were antibody-HCV positive and those that were antibody HCV negative.<p>In this study 32.3% of 186 participants had used injection drugs. Significant associations with injection drug use were found for older age (p = 0.01), having sexual partners that use injection drugs (p = 0.01), history of incarceration (p = 0.01), and history of living on the street (p = 0.02). Significant interactions were found for sex trade work by gender (p < 0.01) and by age (p = 0.03), and for living on the street by age (p = 0.02). A HCV prevalence rate of 9.3% of 156 participants was determined for Saskatoon street youth. Use of Ritalin by injection (p = 0.04) and history of living on the street (p = 0.05) were found to be significant risk factors associated with HCV. The interaction of living on the street by gender was also significantly associated with HCV (p = 0.05). <p>The relationship identified between HCV and injection drug use in Saskatoon street youth was a history of living on the street. This link between could serve as a valuable marker for use of injection drugs and developing HCV infection in street youth. Nurses are encouraged to seek out street youth social networks to provide health care and messages of health promotion and disease prevention. Strategies that are culturally, socially, and developmentally appropriate are needed to keep these youth off the streets in the first place.

The transmission and prevalence of Hepatitis C Virus (HCV) among those who use injection drugs is a major public health issue. Injection drug use has been identified as the main cause of transmission for HCV in Canada. Street youth are at risk for acquiring HCV due to injection drug use that is often a consequence of living in a street environment. Presently, research on prevalence trends, characteristics, and associated behaviors for injection drug use and HCV in street youth, is limited. <p>The purposes of this study were to determine prevalence of injection drug use and HCV in Saskatoon street youth, to identify demographic or other factors that may contribute to street youth using injection drugs, and to identify risk factors and other characteristics of street youth associated with HCV. This study utilized data from Phase III of the Enhanced STD Surveillance in Canadian Street Youth Study by Health Canada for those participants recruited from Saskatoon, Canada. Between February and July 2001, 186 Saskatoon street youth participants between the ages 14 and 24 years completed nurse-administered questionnaires and of these, 156 provided blood specimens. Analyses were conducted to compare population characteristics between street youth who have used injection drugs and those who had not. Similarly, population characteristics were analyzed among those street youth who were antibody-HCV positive and those that were antibody HCV negative.<p>In this study 32.3% of 186 participants had used injection drugs. Significant associations with injection drug use were found for older age (p = 0.01), having sexual partners that use injection drugs (p = 0.01), history of incarceration (p = 0.01), and history of living on the street (p = 0.02). Significant interactions were found for sex trade work by gender (p < 0.01) and by age (p = 0.03), and for living on the street by age (p = 0.02). A HCV prevalence rate of 9.3% of 156 participants was determined for Saskatoon street youth. Use of Ritalin by injection (p = 0.04) and history of living on the street (p = 0.05) were found to be significant risk factors associated with HCV. The interaction of living on the street by gender was also significantly associated with HCV (p = 0.05). <p>The relationship identified between HCV and injection drug use in Saskatoon street youth was a history of living on the street. This link between could serve as a valuable marker for use of injection drugs and developing HCV infection in street youth. Nurses are encouraged to seek out street youth social networks to provide health care and messages of health promotion and disease prevention. Strategies that are culturally, socially, and developmentally appropriate are needed to keep these youth off the streets in the first place.

INTRODUCTION: HIV disease is thought to be cluster in specific areas rather than be evenly distributed. A study to show a significantly higher HIV risk in certain geographical areas would be beneficial for resource allocation purposes. AIM: The purpose of this study is to describe the demographics of the study population, describe the demographics of those participants that tested HIV-positive, and determine the associations between zip code of residence, HIV infection, and risky behavior. METHODS: Data were collected by Georgia State University’s Center of Excellence for Health Disparities Research for The Geography Project. Univariate and multivariate binary logistic regression analyses were performed on select variables. A p-value of < 0.05 and a 95% confidence interval (CI) were used to determine significance. RESULTS: Participants in high risk groups zip codes were roughly 6.7 times more likely to have been given an HIV-positive result prior to the survey (OR=6.717, CI=1.989-22.683, p=.000), 4.4 times more likely to have been infected with HIV at the time of the survey (OR=4.402, CI=2.109-9.187, p=.000), and 1.4 times more likely to have more than 3 sex contacts in the 6 months prior to the survey (OR=1.425, CI=1.075-1.890, p=.014). The association between HIV and persons that identify as transgender was extremely significant (OR= 28.335, CI=8.305-96.678, p=.000). DISCUSSION: The results indicated that participants in the high risk zip codes group were at a higher risk for HIV infection and having 3 or more sex contacts in the 6 months prior to the interview.

This study is to discuss the business investment strategy risk management model. The enterprise could identify, analysis the investment relative risks and establish the contingency strategy to management the risks in accordance with this model. This study selects the third generation digital mobile communication system to be the research objective. The business investment strategy risk management model could identify the investment strategy position of the industry value process in accordance with the value chain and cash flow. And the model could provide the framework and relationship of the relative risk variables through the risk variable system diagram. This model builds the scenarios of the industry and analyses different situations of the industry for forecasting the contingency strategy of the business. The contingency strategy is established for business implementing risk management of the high technology and high-risk investment. The 3G system is underling the high-level uncertainty status. The risk is increased by high license price, high infrastructure cost, technology development delay and none killer application etc. This study suggests the 3G Mobil communication company should implement the risk management actions for following items: ¡´The user ratio of 2005 ¡´The difference of 3G and 2.5G products¡C ¡´The competitive of system supplier capability. ¡´The supply chain of add-value service. ¡´Competitor status and strategy. ¡´Globe political and economic situation. This study suggests the business should implement the risk management model when it processing the high technology and high-risk investment. This model provides the risk identification, measuring, analysis, evaluation process and follow-up contingency strategy. The business could effectively manage the risk and ensure the competition by the model.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2000. / Bibliography: leaves 109-116.