Objective: To explore interventions that support children and parents making health decisions. Systematic Review: A systematic review was conducted to synthesize evidence on interventions that support children’s health decision making. Five studies of variable quality were included. Interventions that improved decision making were decision coaching with or without an educational resource, or education alone. Pre-/post-test pilot: A pre-/post-test study evaluated the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide for children with type 1 diabetes and their parents. Of 16 families invited, 7 participated. Compared to children/parents who preferred one option at baseline, participants who were unsure of the best option rated decision coaching as more acceptable and had larger decreases in decisional conflict. Conclusions: Few studies have evaluated interventions supporting children’s decision making. The piloted decision support intervention was feasible and acceptable, particularly with children and parents who were unsure of the best option.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background and Significance: The purpose of this study was to evaluate the effectiveness of the Barrow Brainbook (BBB) concussion education program as a tool to increase concussion knowledge among Arizona high school athletes and to modify attitudes and behaviors regarding concussion. Methods: This was a cross sectional study of Arizona high school athletes utilizing a 31 question multiple‐choice de‐identified survey. Attitude, knowledge, and behavior questions, as well as sport and level of participation were analyzed using the Wilcoxon Rank Sum test. Means between groups were analyzed using a two‐way ANOVA. Linear regression was used to determine if there was a relationship between number of years since completing BBB and concussion knowledge. Results: Surveys were distributed to 382 student athletes with 363 of those being completed. 224 students participated in BBB (62%). Knowledge and behaviors regarding concussion were not statistically significant when comparing students who had and had not participated in BBB. Those who participated in BBB scored more poorly on questions regarding attitudes about concussion than those who had not (p=0.033). Subsequent two‐way ANOVA testing showed that students who sustained a concussion scored worse (p<0.01) while completing BBB did not significantly affect attitude (p=0.399) when history of a concussion was brought in to the analysis. 90 students (25%) reported sustaining a concussion. Football and varsity level participation were significant for a higher mean number of concussions (p<0.05, p<0.05). There was no relationship between time since taking BBB and concussion knowledge (R2 was 0.007). Conclusions: In this study, there was no evidence to show that participating in the BBB program improved concussion knowledge, attitudes, or behaviors. Number of years since taking BBB was not a good predictor of concussion knowledge. Students who played football and participated at a varsity level were significantly more likely to sustain a concussion. Sustaining a concussion was associated with a higher attitude risk sum score. This is an evaluation of an educational tool specifically designed for adolescents that demonstrated no statistically significant change in increasing knowledge or modifying attitudes and behaviors in a population of high school athletes in Arizona.

This thesis examines the theory and practice of humanitarian intervention in the modern states system. Humanitarian intervention is defined as the use of military force across state boundaries, against the wishes of the target government, to protect the people from intolerable misrule and grave abuses of human rights. The aim of this thesis is to examine the problem of humanitarian intervention from the perspective of international society. This thesis is divided into two parts. Part One defines the concept, considers the historical and intellectual milieu in which the idea emerged and evolved, and examines the different grounds upon which states have justified a right of intervention. Part Two considers the implications for international society. International society exists when states have shared rules, values, and a mutual concern for order. Three primary arguments are made in Part Two: (1) Humanitarian intervention can co-exist with the rules of state sovereignty, non-intervention, and limitations on the use of force; (2) Humanitarian intervention has performed the historic function of expanding the values of international society; (3) Practised under the right circumstances, it can help promote international order rather than subvert it. As this thesis demonstrates, a more in-depth understanding of how past theorists and practitioners of humanitarian intervention have approached the problem can enrich the current discussion.

INTRODUCTION: Psychiatric disorders are among the most common illnesses in children. Most psychiatric disorders begin in childhood but most children with psychiatric symptoms receive delayed or no treatment. A resilience-based strategy for at-risk children in primary care, such as enhancing childhood sports participation, could be an effective and feasible early intervention. Existing literature demonstrates an association between sports participation and mental health in adolescents and adults, and that exercise can improve depressive symptoms. There are few studies on the link between mental health and sports participation in children under twelve. OBJECTIVE: Since sports participation could be a simple and potentially available intervention for mental health, we investigated the association between sports participation in children ages 6-11 and measures of psychiatric impairment. METHODS: We performed linear regression analyses between measures of psychiatric symptoms (total number of CBCL/6-18 syndrome scale elevations and individual syndrome scale elevations) and sports participation as measured by the number of parent-reported sports, with demographic factors as covariates. RESULTS: The association between sport count and number of CBCL syndrome scale elevations was not significant (p = 0.638). However, we found a significant association between fewer numbers of sports reported and higher T-scores on the Withdrawn/Depressed CBCL syndrome scale (p = 0.019) and was also significant for age (p = 0.003) and ethnicity (p = 0.037). CONCLUSION: Playing one or fewer sports during childhood is associated with higher withdrawn/depressive symptoms in school-age children. This replicates earlier findings which suggest that sports participation may be protective for child mental health.

Cette thèse, par le biais d'une approche scientifique, propose une solution visant à favoriser le développement économique des localités les moins développées de Chine. Les mesures institutionnelles prises sous la Réforme vers l'économie de marché (de 1978 à nos jours), n'ont pas permis de réduire les inégalités économiques entre les différentes localités. L'innovation institutionnelle est nécessaire pour permettre le développement économique et engendrer une société harmonieuse. Bien que davantage d'études théoriques soient encore en cours, mes investigations en Chine en 2004 et 2005 m'ont convaincu que les localités les moins développées de Chine peinent à mettre en place des économies de marché si elles ne bénéficient pas du soutien du gouvernement aussi bien au niveau local que national. Cette découverte contredit le culte actuel du marché et met en évidence la sous-évaluation du rôle à différents niveaux du gouvernement, dans le développement économique local. Grâce aux expériences de développement local en Chine depuis la Réforme, l'intervention de l'Etat a pu adopter une approche 'market-enhancing' et à différents niveaux, le gouvernement a pu coopérer avec des institutions privées pour favoriser le développement économique dans les localités les moins développées. Ainsi, cette thèse tente de redéfinir les relations entre les fonctions économiques du gouvernement, l'économie locale, les agents publics et privés dans le contexte de la Réforme d'économie de marché. Les entreprises d'état sont le point focal de l'innovation institutionnelle. Pendant la période de Pré-Réforme (1949-1978), elles étaient dirigées par le gouvernement central sous le régime du socialisme et ont remarquablement contribué au développement économique local. Mais la Réforme orientée vers une économie de marché lancée en 1978 les a privatisées ou transformées en corporations avec peu d'objectif sociopolitique et ne visant qu'à maximiser les profits, et donc par conséquent la contribution des entreprises d'état à l'économie locale s'est réduite au paiement des impôts et à la création d'emplois. Les répercussions bénéfiques au niveau local s'avèrent très limitées, notamment pour les localités moins développées ne bénéficiant pas des entreprises d'état réformées. Inspirée par des pratiques du partenariat public-privée, cette thèse propose un nouveau modèle d'entreprise d'état multifonctionnelle à double objectif sociopolitique et économique. Les caractéristiques possibles de cette entreprise seraient : 1) sa localisation : dans les localités les moins développées ; 2) la coopération publique-privée pouvant adopter différentes formes d'organisation avec des droits et obligations bien définis dans le contrat des entreprises; 3) elle encourage les initiatives sociopolitiques contribuant au développement de l'économie locale en combinant les dynamiques de marché. / This PhD dissertation offers a scientifically supported solution to economic development in China's less developed localities (LDLs). The market-oriented Reform (from 1978 onwards) has not produced the institutional arrangement necessary to reduce the spatial economic inequality. lnstitutional innovation is necessary to achieve economic development and build a harmonious society. My investigations in China during 2004 to 2005 show that the LDLs hardly build up efficient local market economies without the government support from both central and locallevels. This finding challenges the current market hype in China and shows the undervaluation of multi-levelled governments' roI es in local economic development. Drawing experiences from local economic take-off in China, state intervention can adopt a marketenhancing approach and multi-level governments can cooperate with private forces to develop LDLs. This finding inspires a re-definition of the relationships between the government's economic functions, local economy, public and private forces in the context of the market-oriented Reform. State-owned enterprises (SOE) have proven to be a platform for such cooperation because during the pre-Reform period (1949-1978) they contributed remarkably in their traditional form to local economic development, especially in LDLs. But the SOE reform has gradually privatized traditional SOEs and transformed them into profit-oriented enterprises with hardly any socio-political objectives. The SOEs' contribution to the local economy has been reduced to tax payment and job creation, which both pro duce very limited benefits to localities, because in LDLs few jobs are created and taxes are collected at higher administrative levels. Recalling and updating the 'old' roles of the SOE, this thesis attempts a redefinition of the relationships between the SOE and the local economy in the context of the market-oriented Reform. A new kind ofmulti-functional SOE is proposed by drawing upon the traditional and the reformed models. A set of characteristics identify this SOE: 1) it should be located in LDLs; 2) it may adopt various shareholding forms but shareholders have clear dut Y and right under contract; and 3) it undertakes socio-political objectives, aiming to combine market dynamics with local development potential in order to promote local economic take-off.

The general aim of this thesis was to identify the indicators of reading disability and to analyze the effect of these factors in preschool age children in order to determine which factors play a principal role in the development of dyslexia. Various theories of developmental dyslexia have been investigated and the key components of major theories are presented in this paper. It is a generally held view that dyslexia is caused by a deficit in phonological processing which is an inability to understand the sound structure of language. This thesis aims to unite current research findings in order to better classify dyslexia as well as to determine approaches to intervention which are critical to a preschool child’s development of literacy. Three studies were conducted. The goal of study 1 was to determine the discrepancies in performance between non-dyslexic readers and dyslexic readers. Study 2 investigated phonological awareness abilities in preschool age children and their relationship with intelligence. An intervention study was then carried out on the preschool participants to determine the effects of instruction in the alphabetic principle on elements related to intelligence and phonological awareness. The results of this thesis and the studies conducted herein found a wide range of domains that were causal to reading disability. These include visuo-spatial discrimination skills, phonological knowledge and working memory. These studies also indicate that early identification of weaknesses in these areas can be mediated by well informed instruction in letter-sound correspondence and can be a critical determinant of future reading ability.

The United States is experiencing a significant public health problem in the form of gun violence. Despite being one of the wealthiest countries in the world, the US exhibits significantly higher rates of fatal and non-fatal firearm injuries than other wealthy, industrialized nations. Despite this issue, the debate on gun control is one of the most heated topics discussed across the political spectrum. The constitutional right to own and possess a firearm is defended fiercely by gun advocates that desire fewer restrictions. The content of this thesis provides a detailed overview on the history of gun control through the 20th and 21st century. Current evidence on four major classifications of gun violence: homicide, suicide, non-fatal firearm injuries, and mass shootings are then presented, followed by a brief of discussion of commonly perceived risk factors for gun violence. After the context of gun violence has been defined, the thesis explores several strategies and preventative measures found within the literature. The available data is limited by a lack of research on gun violence. Although inferring true efficacy was limited, based on the established knowledge of prevalence and risk factors for gun violence some conclusions could be made. The expansion of the national background check, along with updated definitions for exclusion criteria could provide the most immediate and far reaching reduction in gun violence. While it was difficult to prove other solutions as effective, good communication and raising awareness could increase implementations of strategies designed to limit gun violence. Well-constructed media campaigns and messages are proposed for raising awareness of the risk factors for gun violence and to promote the public’s interest in research and prevention.

Background: Inability to retain participants in a clinical trial poses a threat to clinical research as it can lead to a number of issues ultimately affecting generalisability, validity and reliability of the study. Patients with schizophrenia have been reported as particularly difficult to engage and retain in research and psychiatric treatment. This thesis aimed to improve the current understanding of the retention of people with schizophrenia in trials evaluating complex interventions. Methods: This thesis adopted a mixed method design. Quantitative methodology was used to identify the scale of attrition and to explore potential predictors of dropout. This included a systematic review and meta-analysis and a separate meta-analysis of individual patient data. Qualitative methodology was used in two studies to explore the perspectives of both trial staff and former trial participants on the factors important for retention and effective practices and strategies. Results: The results of the systematic review and meta-analysis demonstrated the rates of dropout from studies to be higher than from experimental interventions. Dropout from interventions significantly increased as the number of intervention sessions increased. The individual patient data meta-analysis found retention to be higher at the final follow-up assessment than at the penultimate one. The effect of arm allocation almost reached statistical significance pointing to the possibility of participants in the active arm having higher odds of completing the final follow-up than those in the control arm. Two qualitative studies identified barriers and facilitators to retention related to factors related to participant, researcher, study, and wider context. Some of the identified barriers were specific to schizophrenia. Conclusion: Attrition is a phenomenon that should be anticipated by trialists and prevented with the use of multiple strategies. The extent to which dropout can be minimised depends on a number of factors associated with the participant, researcher, study, and context.

Executive Function (EF) comprises general purpose control processes that regulate thoughts and behaviours. Underlying core skills have been identified, including Shift: the ability to move between mental states, operations, or tasks. Research implicates EF (and Shift specifically) in academic achievement and broader life functioning throughout the life span. Most attempts to develop EF skills directly have focused on memory aspects and/or younger children. Reported benefits are controversial and perhaps limited. This research tackles a particular gap: intervention with adolescent core EF skills, with a focus on Shift, in a typical educational setting. All participant sampling was by convenience. Two experts in EF and three local stakeholders guided intervention development. 22 mainstream Year 8 students (one tutor group) trialled the resulting intervention prototype. A teaching assistant facilitated the implementation, with the form tutor present to occasionally assist. Being an exploratory evaluation, this research used mixed methods with an emphasis on qualitative data. Semi-structured group interviews with experts and a stakeholder focus group were used during the development phase. Standardised baseline and retest data were collected up to three weeks before and four weeks after the implementation phase respectively: a half term's trial during morning form-time. This was complemented by semi-structured feedback interviews with the participating adults and eight students. Transcripts were analysed with Thematic Analysis and the researcher's diary with Content Analysis. The quantitative data were summarised with descriptive statistics and additionally analysed with nonparametric inferential statistics. The study extends available data describing the near benefits of EF intervention. It explores the likely utility of EF intervention both theoretically and from an implementation perspective.

Percutaneous Coronary Intervention is a common treatment for obstructive coronary artery disease, in both planned and emergency settings. Its use in the United Kingdom and elsewhere has increased dramatically in recent years due to its efficacy in the management of Acute Coronary Syndromes, increased access to PCI services, and more permissive patient selection practices. Further, a patient undergoing PCI now is likely to be treated quite differently than the same patient ten years ago, with the emergence of new interventional techniques, devices, stent types, and drugs. The widespread adoption of transradial access in favour of transfemoral access in particular has marked a new era in the delivery of PCI in the UK. Due to the rapid changes in patient and treatment characteristics, evidence generated in settings that no longer reflect the radial era is increasingly irrelevant. This thesis addresses this evidence deficit using data from the British Cardiovascular Intervention Society national PCI registry to describe contemporary trends in PCI practice and investigate the potential implications of these trends on the quality of PCI delivery. It focuses on the relationship between procedural volume, arterial access site, and short-term mortality which has not been explored in radial-era UK practice. Broadly, three research questions were posed: (1) What are the qualities and limitations of the British Cardiovascular Intervention Society PCI Registry in answering questions about routine clinical practice in the United Kingdom? (2) What is the impact on PCI outcomes of changes to the underlying patient population, changes to the selection of these patients, and changes to the treatment of these selected patients? (3) What are the consequences of these changes on the relationship of procedural volume and access site on outcomes? This thesis has showed that those centres adopting radial access more readily did not experience a decline in femoral quality, and in the most recent period were associated with better outcomes overall, particularly amongst the highest volume centres. Operator volume itself however was not associated with improved outcomes, suggesting the organisation of PCI services is not leaving operators with too few, or too many, procedures to perform competently. The current trajectory in UK practice of increasing radial adoption should continue unabated, with radial access considered as the primary access route across all clinical settings wherever possible.