Background: Changes in clinical management; advances in non-invasive three-dimensional imaging; developments in methods of shape analysis. Aim: To assess three-dimensional dentofacial deformity with a view to early appraisal of primary surgical outcome. Results: Significant differences in upper lip morphology were found between the cleft children and their unaffected peers; nasal asymmetry that became more obvious in function was noted in cleft children; the maxillary dental arches of the children with repaired cleft palate were shallow, short and narrow; and the dental arch, deformity and the facial soft tissue deformity were unrelated. Contributions to the field: It has been shown that deviation from normal could be detected as young as 3 years of age using computerised stereophotogrammetry; preliminary, objective, three-dimensional analysis of facial function has been completed in young children; the accuracy of three-dimensional CT scanning of dentate study models and the time cost of data collection were quantified; and this study has produced a body of three-dimensional data that can test and support analytical advances.

Introduction: Peripherally Inserted Central Catheters (PICCs) are commonly used in medium or long-term infusion therapy. This study aims to assess the costs associated with PICCs and its determinants. Methods: A retrospective cohort of patients with PICCs inserted at the Hospital for Sick Children between Jan.1, 2008 and Dec.31, 2008, were reviewed and followed until their PICCs were removed. Cost analysis, theoretical cost comparison with peripheral intravenous therapy (PIV), and multiple linear regressions were applied from the societal perspective. Findings: The average total cost is $2763.75/catheter/day, including inpatient ward cost. Age, male, ward, home care, catheter dwell days, and complications were found to be significant factors influencing the total cost. PICCs can become a cost saving device, compared to PIV, but is affected by several factors. Conclusion: Information gleaned from this study will inform decision makers maximizing the benefits of better resource allocation.

Introduction: Peripherally Inserted Central Catheters (PICCs) are commonly used in medium or long-term infusion therapy. This study aims to assess the costs associated with PICCs and its determinants. Methods: A retrospective cohort of patients with PICCs inserted at the Hospital for Sick Children between Jan.1, 2008 and Dec.31, 2008, were reviewed and followed until their PICCs were removed. Cost analysis, theoretical cost comparison with peripheral intravenous therapy (PIV), and multiple linear regressions were applied from the societal perspective. Findings: The average total cost is $2763.75/catheter/day, including inpatient ward cost. Age, male, ward, home care, catheter dwell days, and complications were found to be significant factors influencing the total cost. PICCs can become a cost saving device, compared to PIV, but is affected by several factors. Conclusion: Information gleaned from this study will inform decision makers maximizing the benefits of better resource allocation.

Thesis (M.A.). / Written for the Dept. of Philosophy. Title from title page of PDF (viewed 2007/01/14). Includes bibliographical references.

Thesis (Ph. D.)--University of Virginia, 1993. / Includes bibliographical references (leaves 201-216). Also available online through Digital Dissertations.

Thesis (M. Communication Pathology)--University of Pretoria, 2006. / Summary in English and Afrikaans. Includes bibliographical references.

Background: Compared with their term-born peers, school aged children born very preterm (≤32 weeks gestation) are at increased risk of inattention. It remains unclear whether the cognitive and neural mechanisms underlying inattention are the same in both very preterm and term-born children. Aims: The aim of this study was to determine whether the cognitive and neural mechanisms underlying inattention differ between term-born and very preterm children. Chapter 3 explored cognition, while Chapters 4 & 5 explored neural processing in terms of event-related potentials (ERPs) and frequency analysis of functional connectivity respectively, to identify mechanisms underlying inattention. Method: A sample of 65 children born very preterm (≤32 weeks gestation) aged 8-11 years was recruited. A comparison group of 48 term-born peers (≥37 weeks gestation) matched for inattention symptoms using the parent-rated Strengths and Weaknesses of ADHD and Normal behaviour (SWAN) questionnaire was selected for comparison. All children were asked to complete neurocognitive tests to assess basic cognitive processes, executive function and sustained attention. Electroencephalography (EEG) was recorded from a sub-sample of children (very preterm n=43; term-born n=40) while they completed a sustained attention task. The contingent negative variation ERP component and theta and alpha frequency changes following the cue stimulus were derived from the EEG as neural indices of response preparation. Similarly, following the presentation of cued and uncued target stimuli, the P1, P2, and P3 ERP components were derived from the EEG as neural indices of stimulus detection, stimulus categorisation, and evaluation of task-relevance respectively. Results: In both groups, more severe parent-rated inattention on the SWAN was predicted by poorer verbal and visuo-spatial short term memory, visuo-spatial working memory, and greater response time variability, and by smaller amplitude of the P2 ERP to uncued targets at the neural level. In children born very preterm only, slower motor processing speed, and smaller theta increases at the neural level, predicted more severe parent-rated inattention. Similarly, in term-born children only, shorter P2 ERP latencies to all targets predicted more severe parent-rated inattention. Conclusions: In sum, the cognitive and neural mechanisms underlying inattention in term-born and very preterm children were partially overlapping, but some mechanisms were unique to only one group. These results present candidate mechanisms that may be useful for the identification of children at risk for inattention, and as potential targets for intervention.

Thesis (M.S.)-Boston University

Hyper-resistance at the joint is one of the most common symptoms in children with cerebral palsy (CP). There are both neural and non-neural factors contributing to the observed joint hyper-resistance. Non-neural alterations to the musculoskeletal system such as a reduced muscle length, increased tendon length and an increase in joint stiffness are commonly treated by physiotherapy interventions such as stretching exercises. However, the effectiveness of these interventions in terms of improvements in function is of a low magnitude and the response of spastic muscles to stretch is poorly understood. Therefore, the main aim of the programme of work presented in this thesis was to increase the effectiveness of stretching interventions at the ankle joint. To achieve this, it is important to understand the behaviour of the medial gastrocnemius muscle and Achilles tendon in response to a stretch applied at the joint. For this first sub-goal, three experimental studies were performed. First, the relationship between joint rotation and muscle and tendon contribution during a single stretch is described. We show that a smaller Achilles tendon moment arm leads to a decrease in muscle lengthening during joint rotation. Additionally, we show that the relative stiffness of the muscle to the tendon is increased in children with CP, which further limits lengthening of the muscle during joint rotation. Secondly, we document the acute effect of stretching on medial gastrocnemius fascicle lengthening properties. It was found that medial gastrocnemius muscle stiffness cannot explain the increased ankle joint range of motion acutely following passive stretching. These studies all indicate that the lengthening stimulus to the muscle is reduced in children with CP. Therefore, to increase the effectiveness of stretching exercises, an intervention was designed with the aim to increase this stretching stimulus seen by the muscle. By performing progressive resistance training, we showed an increase in the stiffness of the tendon, and thus a reduction in the relative stiffness of the muscle to the tendon. Therefore, the amount of stretch seen by the muscle was increased. We have shown that due to this combined intervention a remodelling of muscle is possible, as we showed muscle fascicle length to increase. Even though functional benefits were limited, the proof of principle was demonstrated and future work should explore this model of intervention further.

This thesis focuses on how it is possible to measure people’s knowledge on a topic where certain statements can effectively discriminate between knowledgeable and non knowledgeable people. It presents an application in measuring healthcare professionals’ knowledge about Sudden Infant Death Syndrome (SIDS) and its risk factors. Identifying the best and worst prepared healthcare professionals allows policymakers to reconsider the structure of their healthcare system and to implement targeted training initiatives about this topic. To do so, this research uses data belonging to the SIDS Project, a project meant to provide the first data about this topic in the United Kingdom and Spain. The mail survey referring to the United Kingdom was carried out in the South Central Strategic Health Authority in 2012, while the Spanish one was carried out in the provinces of Barcelona, Lérida and Tarragona in 2012 and 2013. The target population for the British survey consisted of general practitioners (GPs), while the target population for the Spanish survey consisted of paediatricians. Moreover, data about Italy were also available, which allowed cross country comparisons involving three different realities. This research shows that the Back-To-Sleep (BTS) message seems to have been effectively adopted by the British GPs, but, surprisingly, not as well received by the Spanish and Italian paediatricians. In the first case, in fact, more than 90% of the respondents recommended parents the supine position exclusively. In Spain and Italy, instead, this percentage was of 58% and 69% respectively. By contract, instead, the whole SIDS prevention message seems to have been better received in Spain and Italy than in the United Kingdom. British policymakers should reconsider the role of GPs in terms of delivering parents the BTS message, as they were found to be quite prepared. Spanish and Italian policymakers, instead, should try to increase the degree of adoption of the BTS message among their healthcare professionals. In particular, Spanish policymakers should urgently intervene in order to clarify that the supine position is the only one that can be deemed to be a protective factor against SIDS.