Speech perception outcomes for people with a prelingual hearing loss, implanted with a cochlear implant in adolescence or adulthood, are characterized by a large degree of variability. Research findings indicate that some recipients do very well and gain significant open set speech perception skills, whilst a large percentage show little or no change in open set speech results, post implant. In studies to-date, mean speech perception scores were typically substantially poorer than those recorded for implant recipients with a postlingual hearing loss. Despite this, the majority of recipients with a prelingual hearing loss implanted with a cochlear implant in adolescence or adulthood reported satisfaction with their implant and used it regularly. Although there have been a number of studies in the area, none has taken a holistic approach and investigated both objective and subjective outcomes for a large group of participants. In addition, no study has employed a multiple regression analysis to investigate which characteristics were associated with speech perception outcomes in people with a prelingual hearing loss implanted with a cochlear implant in adolescence or adulthood. The objectives of the study were to examine speech perception and other outcomes in people with a bilateral prelingual or perilingual hearing loss, implanted with a cochlear implant as an adolescent or adult, and to investigate prognostic factors associated with positive outcomes. The design consisted of a retrospective review of both speech perception outcomes and other outcomes for 38 recipients, diagnosed with a bilateral hearing loss before age 3, and implanted with a cochlear implant at 14 years or older. There were 24 females and 14 males and the average age at initial stimulation was 33 years. All participants were implanted with a Nucleus device at a private audiology clinic (Attune). Four questionnaires were completed by approximately half of the participants – Glasgow Benefit Inventory (GBI); International Outcome Inventory (IOI-CI); Study Questionnaire; and the Hearing Abilities and Quality of Life Scale. The Study Questionnaire was developed specifically for this project and investigated satisfaction, benefit and advantages/disadvantages of the implant. The Hearing Abilities and Quality of Life Scale was developed by Attune and was completed by recipients pre and post implant. It evaluated the ability to understand conversation in different situations, environmental awareness, safety concerns, involvement in social activities and impact of the hearing loss on relationships. Approximately one third of participants scored between 30 and 90% on the CID/ CUNY test administered via CD post implant and approximately one fifth scored over 90%. The mean score on the CID/CUNY test administered via CD was 8% pre implant and 48% post implant. Over 80% of recipients used their device more than 8 hours a day and all recipients reported being satisfied with it. Three factors accounted for 65% of the variance on the open set sentence test score, post implant. These were stable versus progressive loss, mode of communication in childhood and time without a hearing aid on the implant ear. For the purposes of this research, a ‘stable’ loss was defined as a bilateral severe to profound hearing loss at diagnosis and a ‘progressive’ loss was one that deteriorated to this degree at some point after diagnosis. The findings from this study reveal that a cochlear implant is a viable option for adults and adolescents with a prelingual hearing loss. The majority of participants gained benefit from the device and were satisfied with it. In addition, a substantial number gained good open set speech perception ability, post implant. Consistent with previous studies, there was large intersubject variability in speech scores. The recipients who had a progressive loss, used oral communication in childhood and wore a hearing aid on the implant ear up to the time of surgery were more likely to obtain better speech perception outcomes.

Data from a prospective, longitudinal study of a birth cohort of over 1000 New Zealanders was used to examine the relationships between the level of childhood physical abuse a young person is exposed to during childhood (birth to 16 years), and a range of later parenting outcomes in young adulthood. To address this issue, three questions were considered. First, the study examined risk factors that contribute to an early transition to parenthood. Second, this study investigated the current family circumstances of contemporary young parents and their families. And finally, the association between childhood physical abuse and later parenting outcomes was examined. All members of the Christchurch Health and Development Study (CHDS) who had become parents by age 25 (112 women and 55 men) were included in the study. To be eligible for inclusion cohort members had to be either biological parents or actively involved in the parenting of non-biological children on a regular basis. Exposure to childhood physical abuse (CPA) was measured at ages 18 and 21 based on cohort member's retrospective reports. At age 25, a parenting interview was conducted which included the following measures of parenting: the Conflict-Tactics Scale (CTS-PC; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998), Dunn scales of positivity and negativity (Dunn, Deater-Deckard, Pickering, & Golding, 1999), the Parenting Practices Questionnaire (PPQ; Robinson, Mandleco, Olsen, & Hart, 1995), HOME ratings of responsivity and avoidance of punishment (Caldwell & Bradley, 1979), and interviewer ratings of parental warmth, sensitivity, and child management (Quinton, Rutter, & Liddle, 1984). Findings showed that parents who experienced higher levels of punishment whilst growing up were more negative and less positive towards their own children, were more accepting of the use of physical discipline, and scored lower on warmth, sensitivity and child management compared to those with lower levels of exposure to childhood physical abuse. These findings contribute to our understanding of the effects of childhood physical abuse on later parenting outcomes.

Four studies provide support for the development and validation of a framework for understanding the range of social psychological outcomes valued subjectively as consequences of negotiations. Study 1 inductively elicited and coded elements of subjective value among students, community members, and negotiation practitioners, revealing 20 categories that negotiation theorists in Study 2 sorted to reveal four underlying dimensions: Feelings about Instrumental Outcomes, the Self, Process, and Relationship. Study 3 proposed a new Subjective Value Inventory (SVI) questionnaire and confirmed its 4-factor structure, and Study 4 presents convergent, discriminant, and predictive validity data for this SVI. Results suggest the SVI is a promising tool to systematize and encourage research on the subjective outcomes of negotiation.

This thesis examined neuropsychological and psychological outcomes following paediatric traumatic brain injury (TBI). The introductory chapter provides an overview of the paediatric TBI literature, giving definitions of key terms and concepts and providing a description of the epidemiology of childhood head injury. Key models relevant to paediatric TBI are introduced, including developmental neurological, cognitive and psychological perspectives. This is followed by a discussion of factors pertinent to outcome after TBI, followed by a description of outcomes relating to cognitive, behavioural, psychological, adaptive and family functioning domains. Existing research demonstrates that poor outcomes are frequently observed in paediatric TBI populations across these domains and difficulties are persistent over time, particularly where children have sustained severe head injury. Thus, research has turned its focus to the prediction of outcomes which can assist clinicians in the identification of those individuals who will require rehabilitation in order to promote their long-term recovery. Whilst the literature has identified injury and demographic factors that can assist in this process, little attention has been given to the potential utility of psychological screening assessment. Given the prevalence of neuropsychological and psychosocial problems after paediatric TBI and lack of empirical data considering factors predictive of difficulty at the post-acute phase, this research aimed to consider the clinical utility of completing a pre-discharge screening assessment in children and adolescents with TBI. Specific areas of consideration included the potential impact of injury severity on neuropsychological functioning, psychosocial impairment and return to full-time schooling. The study design comprised a prospective case series of 11 children and adolescents with TBI (aged 7-15 years), who were assessed both pre- and post-discharge (3-6 month follow-up). Domains of intellectual, emotional, behavioural, and adaptive functioning, health-related quality of life and parenting stress were assessed at both time-points. Clinically significant findings were demonstrated in domains of neuropsychological and psychosocial functioning, particularly for those with a severe TBI. Specifically, ratings of self-reported emotional distress, and parental perceptions of child health-related quality of life were found to be within clinical ranges at pre- and post-discharge for more than half of the participants. The majority of participants with severe injury required further neuropsychological assessment and interventions relating to emotional and/or behavioural management. The post-discharge functioning of this cohort provided preliminary evidence for the clinical utility of cognitive and psychosocial screening after paediatric TBI. The observed level of clinical need, particularly in the severely-injured group indicated that screening was a useful tool for early identification of difficulties, and provided an opportunity for timely intervention. Without screening, children and adolescents with TBI may be discharged to the community without appropriate support in place; raising long-term concerns for the child, family, and the wider social and economic systems. Despite this, further research which explicates these findings within larger samples is required. The discussion chapter reviews these findings in relation to the wider literature, followed by consideration of this study's limitations. The thesis concludes with a description of the clinical implications of the findings and suggested future directions.

Chronic Kidney Disease (CKD) is common and is associated with increased risk of progression to end stage renal disease, cardiovascular disease and death. CKD is a heterogeneous condition and accurately predicting an individual’s risk for adverse outcomes remains a challenge. Over the past decade there has been a focus on the identification of novel biomarkers that may help improve risk stratification and the prediction of clinical endpoints in this population. The overall aim of this research project was to investigate a series of novel biomarkers in patients from the Chronic Renal Insufficiency Standards Implementation Study (CRISIS), a prospective observational study of outcome in all cause non-dialysis dependent CKD 3-5. The biomarkers selected for this project were Anti-Apolipoprotein A-1 (Anti-apoA-1 IgG), fetuin-A, fibroblast growth factor-23 (FGF23), high sensitivity cardiac troponin T (HS-cTnT), kidney injury molecule-1 (KIM-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), neutrophil gelatinase associated lipocalin (NGAL) and osteoprotegerin (OPG). These biomarkers were chosen to address the three clinical endpoints of progression, cardiovascular disease and death with biomarkers considered both individually and as groups of related markers. The first aim of this project was to examine associations between the novel biomarkers and the clinical characteristics of the CRISIS population. The second aim was to investigate the associations between novel biomarkers and the study endpoints. In the case of FGF23 longitudinal measurements were analysed and in all other cases associations between baseline levels of the markers and clinical outcomes were considered. The third aim was to consider whether the biomarkers investigated in this project actually improve parameters of risk stratification and model discrimination, thereby demonstrating a potential to improve the prediction of outcome events in the CKD population. Many of the biomarkers were independently associated with one or all of the clinical outcomes considered. Despite these associations, it was more difficult to demonstrate clear improvement in risk classification or the prediction of clinical endpoints. Baseline models of standard biochemical and clinical parameters performed very well so even biomarkers that were strongly associated with clinical outcomes resulted in only small incremental improvements in the prediction of outcome events. It is now important to focus on defining how biomarkers may fit into clinical decision pathways.

Contrary to traditional teaching, patients with Primary Spontaneous Pneumothorax (PSP) do not have normal lungs. Emphysema-like change (ELC) and inflammation are common. However, the natural history of ELC and its significance in terms of future disease is not known. Current management of pneumothorax is generic and not personalised. This thesis updates the UK epidemiology of pneumothorax, describes the use of two novel methods to examine the lungs, a method of predicting early treatment failure, the association of CT findings and recurrence, and a systematic review of chemical pleurodesis to reduce recurrence. Analysis of fifty years' data on ~150,000 admissions demonstrated that the incidence of pneumothorax is increasing, and established a method to identify primary from secondary pneumothoraces and their relative risk of recurrence. Reduced ventilation of hyperpolarised Xenon on enhanced-Magnetic Resonance Imaging (MRI) was seen in those PSP patients with greater low attenuation areas on Computed Tomography (CT) and with reduced pulmonary function. A model of lung inhomogeneity found that metrics of lung ventilation distinguished pneumothorax patients from healthy volunteers and Chronic Obstructive Pulmonary Disease (COPD) patients. This may represent subtle or mild disease, not identified on standard testing, which may be exacerbated by smoking. CT scanning found that mild emphysema and cystic airspaces were common in PSP patients. Ex- or current smokers had more (and larger) cysts. Emphysema was more common in smokers and patients with a history of previous pneumothorax: who were at higher risk of recurrence. However, variation in number and size of cysts were seen in both those patients with and without recurrence. As such, no single algorithm to predict recurrence was identified. Airflow measurement early in the patient pathway has the potential to identify those likely to fail treatment, potentially allowing early triage to surgery. The addition of talc or minocycline as an adjunct to surgery provides the lowest recurrence rates, but physician-led talc poudrage may be similarly effective. Those in whom surgery is not suitable, chemical pleurodesis could be offered via chest drain. Data presented in this thesis thus provides insights into the underlying abnormalities in PSP and lays the groundwork for strategies to fundamentally alter the management paradigm.

The study reported in this dissertation investigated the relationships between thinking style, participation in classroom dialogue and learning outcomes. Classroom dialogue is a commonly used method for teaching and learning, and ways/strategies of taking advantage of classroom dialogue to optimise learning need to be specified. The study addresses this issue. Talking has traditionally been viewed as the main way of participation in classroom dialogue, and there is evidence for its learning benefit. However, silent participants have largely been overlooked and little is known about the function of listening with regard to learning. There is arguably a need to investigate the effects of both talking and listening on learning outcome. At an individual level, talking and listening do not serve all students equally well and individual characteristics should be considered when studying how students benefit from diverse participation behaviours. Thinking style, one aspect of individuality, is rarely related to participation in classroom dialogue nor has the corresponding learning outcomes been investigated previously: this will be addressed in the study. The study focuses particularly on high school students in mainland China, a group of people about whom there is relatively little material. A mixed-method research design was adopted, with the quantitative approach dominating. The Thinking Style Inventory - Revised II (Sternberg, Wagner & Zhang, 2007) was used to measure thinking styles. Talking and listening were considered as two forms of participation in classroom dialogue, with systematic observation being employed to collect data on talk and a newly designed questionnaire used to measure listening. Learning outcomes were illustrated through academic achievement and cognitive ability, with the former being measured by final-examination scores and the latter by the Sternberg Triarchic Ability Test (Sternberg, 1993). A series of statistical analyses were conducted and the results can be summarized as follows. Both talking and listening in classroom dialogue were found to be likely to facilitate academic achievement. Thinking style was significantly associated with participation in classroom dialogue. No relationship was found between thinking style and learning outcomes. Students’ thinking styles affected how they benefited from talking and listening, especially in mathematics. This study provides new perspectives on making use of classroom dialogue at both classroom and individual levels.

Compulsory interventions are widely used in general adult psychiatry for the treatment and care of patients with severe mental illness. While involuntary hospitalisation is established in practice around the world, the use of compulsory interventions outside of hospital – so called community treatment orders (CTOs) – is a more recent development. Three randomised controlled trials of CTO effectiveness have been conducted to date finding no benefits for patients in terms of reduced relapse and readmission to hospital. However, these trials have been relatively short (11-12 months) and focused almost exclusively on CTO effects on clinical functioning and service use. Little attention has been given to patients' social outcomes and broader welfare despite their recognised importance. A sub-sample (n = 121) from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48-months after randomisation to assess whether the duration of the CTO intervention was associated with more or less favourable social outcomes at follow-up. Social outcomes were assessed using three main concepts: social networks (Study 1), social inclusion (Study 2), and capabilities (Study 3). No significant associations between the duration of the CTO intervention and social outcomes at follow-up were found. The association between involuntary hospitalisation and social outcomes was also tested but no significant associations were found. Because the field of social outcome measurement is relatively undeveloped, a further aim was to contribute to the validation and testing of two recently developed instruments: the Social and Community Opportunities Profile (SCOPE) (Study 4) and the Oxford Capability Questionnaire for Mental Health (OxCAP-MH) (Study 5). The SCOPE performed well overall as a measure of social inclusion but questions were raised about its feasibility (length) and the reliability of one of its sub-scales. The OxCAP-MH demonstrated good psychometric properties (reliability and validity) and represents a promising new multi-dimensional patient-reported outcome measure for use in mental health research.

AN ABSTRACT OF THE THESIS OF Katelyn Louise Decker, Master of Science Degree in Behavior Analysis and Therapy, presented on April 30, 2015, at Southern Illinois University TITLE: EFFECTS OF GAMBLING OUTCOMES ON LEVEL OF IMPULSIVITY MAJOR PROFESSOR: Dr. Mark R. Dixon The effects of exposure to winning and losing gambling outcomes on levels of impulsivity among non-gamblers were investigated in a within-subjects experimental design with randomization of treatment phases. Participants included 20 non-gamblers (10 male, 10 female), 18 years or older, selected from a sample of 40 volunteers who completed the South Oaks Gambling Screen (Lesieur & Blume, 1987) and received a score of 0, indicating no predictors of potential pathological gambling. Dependent measures of levels of impulsivity were recorded using an abbreviated version of the delayed discounting questionnaire described by Dixon et al. (2003). Derived k-values were calculated by fitting indifference points at each delay to the hyperbolic equation proposed by Mazur (1987) and average k-value was calculated for each participant across delays. Participants were exposed to both winning and losing outcomes by completing 25 trials within a slot-machine task programmed in Microsoft Visual Basic Express Edition 2008 (Maclin, et al., 2006, p. 127-154). Results were subjected to statistical analysis to determine whether a statistically significant, functional relationship existed between increases and decreases in level of impulsivity (k-value) in comparison to baseline. Across all participants, regardless of order of experimental conditions, results indicated a more than 26% decrease (-82.20-3133.33) in level of impulsivity (0-2.1694) following a losing outcome and a more than 24% decrease (-89.95-3300) in level of impulsivity (0-2.1694) following a winning outcome in comparison to baseline (0-2.3056). Results are consistent with the hypothesis that exposure to winning outcomes decrease impulsivity, but inconsistent with the hypothesis that exposure to losing outcomes increase impulsivity. Historical perspectives of pathological gambling, social impacts of gambling disorder, and trait and state-dependent perspectives of impulsivity are discussed. Potential implications for further research using delayed discounting measures are provided, as well as potential limitations of the present study. Keywords: gambling, impulsivity, delayed discounting, slot-machine, outcomes

Adolescence can be a difficult time for youth, and several additional factors intensify the stress and risk associated with adolescence for refugee youth. Refugee adolescents, for example, often have to learn and speak different languages in different contexts, establish new peer relationships, and adjust to new cultural norms. It is important to understand how such cultural negotiations influence refugee youth's educational experiences because improved educational outcomes for youth are associated with improved health outcomes. The purpose of this study, therefore, was to explore the relationships between peer connectedness, parental monitoring, academic self-efficacy, educational barriers, and school engagement with a sample of refugee adolescents. Research hypotheses were tested using exploratory factor analysis and bivariate correlational, multiple regression, and MANOVA analyses. Data were collected from a sample of 120 refugee adolescent participants who were between 13-18 years old and arrived in the United States from Bhutan, Burma, Somalia, Congo, Ethiopia, Sudan, or Iraq. Refugee adolescent participants and their families were recruited from Ecumenical Refugee and Immigrant Services (ERIS) and the African Community Center (ACC), which are refugee resettlement agencies located in Denver, Colorado. Language interpreters were recruited to assist with communication during data collection. Study findings showed that (a) a significant amount of variance in academic self-efficacy was uniquely accounted for by participants' educational barriers, school engagement, and parental monitoring, (b) a significant amount of variance in educational barriers was uniquely accounted for by ethnically similar peer connectedness, ethnically dissimilar peer connectedness, academic self-efficacy, and school engagement, (c) peer connectedness and educational barriers were positively, rather than inversely, correlated, (d) a significant amount of variance in school engagement was accounted for by educational barriers and academic self-efficacy, and (e) group differences in the level of relationships between variables were found as a function of current geographic location. Research implications include re-evaluating the use of negatively-worded and confusing items within the measures and collaborating with community partners when working with vulnerable populations. Practice implications include involving parents to decrease educational barriers through collaboration and providing educational support to foster success within the school and community.