Divorce has long been described as one of the most stressful experiences that any human being can ever experience. The process of divorce implies numerous sudden and highly stressful changes to any individual affected by it, including children. The literature review of the present study revealed valuable insight regarding the effects of divorce, in particular on children. The studies among them which were found to have identified some of the more detrimental implications of divorce for children in particular, included the studies by Jonsson, Njardvik, Olafsdottir and Gretarsson (2000); Eldar-Avidan, Haj-Yahia and Greenbaum (2009); and Yu, Pettit, Lansford, Dodge and Bates (2010). Despite numerous research studies having been done on the phenomena of divorce both in South Africa and globally, it appears that the majority of these studies mostly focused on its detrimental implications for both children and adults. Few of these studies were found to have focused on possible optimal implications or on effective coping with divorce. Some studies that were found to have touched on the potential optimal effects of parental divorce included the studies by Mullis, Mullis, Schwartz, Pease and Shriner (2007); Graff-Reed (N.D.); and Spalding and Pretorius (2001). One particularly influential study that was, however, identified to have been done on the phenomena of coping with parental divorce, was conducted by Roux (2007) who focused specifically on children’s coping with parental divorce. This study focused exclusively on children and involved interviews with children themselves at the time of their parents’ divorce. No research could be identified on how young adults in South Africa had attempted to cope with their parents’ divorce during their childhood and/or adolescent years. This determination led to an attempt to fill this apparent void in the literature and expand on the study that had been conducted by Roux (2007) by completing the present study. The focus of the present study subsequently fell on how young adults had coped with the divorce of their parents during their childhood and/or adolescent years. The aims of the present study were: * To investigate and obtain a clearer understanding of young adults’ coping with divorce during their childhood and/or adolescent years. * To determine if there were factors that played a role in coping with parental divorce. * To determine what recommendations could be made to the parents of children undergoing divorce. * To determine what recommendations could be made to children while undergoing parental divorce. The research questions that were included in the present study for the aforementioned purpose included the following: * How did young adults cope with the divorce of their parents during their childhood and/or adolescent years? * Were there factors that played a role in their coping and if so what were the factors? * What would they recommend to the parents of children during and after divorce? * What would they recommend to children during and after parental divorce? Semi-structured retrospective interviews were conducted with 15 participants in the completion of the present study. Each of these interviews where transcribed and the relevant data were analysed from these transcriptions by firstly reading of the protocols, followed by dividing them into natural meaning units (NMUs), performing linguistic transformation, integrating the NMUs with related themes, synthesising the data and developing a general description before it was finally documented and published. Selection of the participants was made by means of snowball sampling, as young adults nominated acquaintances whom they believed may also be willing to participate in the research (Whitley, 2002). The value of the present study was that it expanded the knowledge base regarding young adults’ coping with parental divorce during their childhood and/or adolescent years. It also culminated in the creation of a set of recommendations for both children and adults that would promote effective coping among them with parental divorce. It is hoped that these insights and recommendations will enable psychologists, social workers, counsellors, health care practitioners and/or any other individual/s involved with assisting families during divorce, to cope more effectively with this event. It is also hoped that further future research and follow-up studies into this particularly relevant and far reaching phenomenon will continue to be conducted by other researchers both in South Africa and abroad. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014

Retrospective revaluation— learning about implied but unpresented cues— poses one of the greatest challenges to classical learning theories. Whereas theorists have revised their models to accommodate revaluation, the empirical reliability of the phenomenon remains contentious. I present two sets of experiments that examine revaluative learning under different but analogous experimental protocols. Results provided mixed empirical evidence that is difficult to interpret in isolation. To address the issue, I apply two computational models to the experiments. An instance-based model of associative learning (Jamieson et al., 2012) predicts retrospective revaluation and anticipates participant behaviour in one set of experiments. An updated classical learning model (Ghirlanda, 2005) fails to predict retrospective revaluation, but anticipates participant behaviour in the other set of experiments. I argue that retrospective revaluation emerges as a corollary of basic memorial processes and discuss the empirical and theoretical implications.

This thesis reports an investigation on the feasibility study of a searching mechanism using an APP suitable for an on-line bibliographic retrieval, operation, especially for retrospective searches. From the study of the searching methods used in the conventional systems it is seen that elaborate file- and data- structures are introduced to improve the response time of the system. These consequently lead to software and hardware redundancies. To mask these complexities of the system an expensive computer with higher capabilities and more powerful instruction set is commonly used. Thus the service of the systen becomes cost-ineffective. On the other hand the primitive operations of a searching mechanism, such as, association, domain selection, intersection and unions, are the intrinsic features of an associative parallel processor. Therefore it is important to establish the feasibility of an APP as a cost-effective searching mechanise. In this thesis a searching mechanism using an 'ON-THE-FLY' searching technique has been proposed. The parallel search unit uses a Byte-oriented VRL-APP for efficient character string processing. At the time of undertaking this work the specification for neither the retrieval systems nor the BO-VRL APP's were well established; hence a two-phase investigation was originated. In the Phase I of the work a bottom up approach was adopted to derive a formal and precise specification for the BO-VRL-APP. During the Phase II of the work a top-down approach was opted for the implementation of the searching mechanism. An experimental research vehicle has been developed to establish the feasibility of an APP as a cost-effective searching mechanism. Although rigorous proof of the feasibility has not been obtained, the thesis establishes that the APP is well suited for on-line bibligraphic information retrieval operations where substring searches including boolean selection and threshold weights are efficiently supported.

Tamoxifen and aromatase inhibitors are treatment options for women with breast cancer and evidence on the risk of stroke is important in choosing between these two options. A systematic review of two randomized controlled trials and their nine related trial reports showed different methods for adverse event reporting and inconsistent estimates of stroke risk. In an observational cohort study of 5443 Ontario women, aged 66 years or older with early stage breast cancer, 86 ischemic stroke events (1.6%) occurred during follow-up of 5 years. There was no statistically significant difference in the risk of stroke between the hormone therapy groups [adjusted HR for tamoxifen compared to AI 1.330 (0.810, 2.179)]. Results were similar across cardiovascular disease risk groups and were robust to different follow up periods and analytic methods. This study suggests that there is no significant difference in stroke between these treatment options.

Single frame ultrasound B-mode image quality is largely governed by the ability to focus the ultrasound beam over a range in depths both in transmission and reception. By developing a comprehensive understanding of acoustic wave propagation two signal processing methods were identified for solving the transmission problem. We made use of both the impulse response using the classical point spread function (PSF) and the spatial sensitivity function (SSF) which describes the spatial distribution at a particular time. Using the angular spectrum method, an accurate analytical model was developed for the field distribution arising from a finite geometry, apodized and focused, plane piston transducer. While there is a thorough understanding of the radiated field arising from uniformly excited plane piston transducers, the focused equivalent (i.e., one that allows a continuous change in phase over the plane piston surface) is incomplete and assumes the Fresnel approximation. Our model addresses the effects of diffraction and evanescent waves without the use of the Fresnel approximation and is applicable at all near- and far-field locations in a lossless medium. The model was analyzed to identify new insights into wave propagation and compared with the Fresnel approximation and the spherically-focused, concave transducer. The piston transducer model was then extended to an attenuating and dispersive medium. After analysing existing models of power-law frequency dependent attenuation, a causal, spherical wave Green’s function was derived from the Navier-Stokes equation for a classical viscous medium. Modifications to the angular spectrum method were presented and used to analyze the radiated field of a focused, planar piston transducer. Finally, after presenting our signal processing strategy for improving imaging spatial resolution through minimization of the SSF, two signal processing methods were derived and analysed in simulation: a deconvolution technique to remove the effects of the ultrasound excitation wave and suppress additive noise from the received ultrasound signal, and a retrospective transmit focusing method that changed the response from a predefined transmit focus to an arbitrary transmit focal depth. Proof-of-concept simulations were presented using a variable number of scatterers and compared with the traditional matched filtering and envelope detection technique.

Objective: To estimate the national prevalence and direct incremental expenditures of musculoskeletal disorders (MSD's) using the 2007 Medical Expenditure Panel Survey data. <br>Methods: A retrospective database analysis was conducted and individuals with MSD's (ICD-9-CM codes 274.00; 710.00-738.00) were identified. Dependent variables were total health care and other service category expenditures. The study utilized descriptive and regression analyses. <br>Results: In 2007, the national prevalence of MSD's was 33 million with incremental costs of $886.49 per person. The inpatient expenditures ($33,461.85) were the highest cost component in MSD's and the predictors of total health care expenditures were age, marital status, and presence of the disease condition. <br>Conclusion: The systematic assessment of MSD's and their associated incremental costs to the society is essential in increasing the awareness of decision makers to implement intervention strategies that are effective in lowering the disease incidence and in reducing the overall cost of disease management. / Mylan School of Pharmacy and the Graduate School of Pharmaceutical Sciences / Pharmacy Administration / MS / Thesis

Thesis (Ph.D.)--University of Alabama at Birmingham, 2009. / Title from PDF title page (viewed on July 16, 2010). Includes bibliographical references (p. 90-105).

There are a considerable number of children who fulfil a young carer role for a parent, sibling or relative. Research into the experiences of young carers is growing, and has explored the areas of supporting parents and siblings with physical and mental health difficulties. Although research into the experience of adult carers of individuals with psychosis-related difficulties is well established, the experience of young carers supporting a parent with a psychosis-related difficulty are yet to be studied. The aim of this study was to gain a richer understanding of the lived experience of young carers supporting a parent with a psychosis-related difficulty from a retrospective position. Semi-structured interviews were conducted with seven adults who were young carers for a parent with a psychosis-related difficulty. The interview transcripts were split into two parts and analysed using Interpretative Phenomenological Analysis. Part one explored the experience of caring at the time, with two themes emerging from participant's accounts: 'Feeling isolated and alone' and 'Caring was taking the parent role'. Part two explored the integration of the experience into the current self, with two themes emerging: 'Understanding the experience is an ongoing struggle' and 'Making sense of the person I have become'. The findings are discussed in light of the current research literature and show both areas of agreement and unique insights into the experiences of this particular group. Clinical implications in light of the findings and future research suggestions are also considered.

OBJECTIVE: The vast majority of physicians frequently faces ethical dilemmas and feels overwhelmed as a result. Those at Boston Medical Center are no exception. Various studies show more adept handling of ethical issues can improve the quality of care and patient safety by reducing moral distress of physicians and fostering better patient-physician relationship. The method of Preventive Ethics, which actively identifies recurrent themes and underlying systematic issues among ethics consultations, is more effective than the traditional, case-by-case approach in reducing the number of ethical conflicts. The purpose of this study is to identify common themes prompting ethics consultations and any hotspots among recurrent ethical dilemmas at Boston Medical Center by using the Armstrong Clinical Ethics Coding System. METHODS: A total of 32 ethics consultations handled by the BMC Ethics Committee between October 2010 and April 2013 were reviewed. Each consultation was coded using the Armstrong Clinical Ethics Coding System. The data was analyzed to identify the types of ethical dilemma that are most prevalent at BMC. The consultations involving the most frequently occurring issues were evaluated further to expose common themes among these cases and potential underlying systematic failures. RESULT: "Clinical Candidacy or Risk / Benefit Analysis" (6.25%), "Concern About Decision Maker Choices" (14.6%) and "Futility / Inappropriate or Nonbeneficial Treatment" (13.5%) were the most prevalent types of ethical issues at BMC. Not only are these three frequently occurring, they also have a very high tendency to occur simultaneously. Further analysis of consultations involving these three issues revealed that at BMC, there are frequent instances of conflict, in which family members serving as healthcare proxies disagreed with physicians in deciding the best interest of patients with severe ailments, ultimately precipitating ethics consultations. DISCUSSION: Comparison with similar retrospective studies previously carried out at other institutions suggests that consultation involving the issue of futility may be more frequently occurring at BMC, which might be coming from unique systematic problems. Several interventions such as improved policies or educational training in physician-family communication should be considered. CONCLUSION: According to the principles of Preventive Ethics, the issue of physician-healthcare proxy conflict regarding patient futility should be issue to be addressed at BMC. The Armstrong Clinical Ethics Coding System can serve as a much needed standard documentation format for ethics consultations, which would open up the possibility of more detailed future studies

INTRODUCTION: Celiac disease is a chronic immune disorder for which the only treatment is strict life-long adherence to a gluten-free diet (GFD). Collaborative management through regular follow-up with a care team that includes physicians and dietitians may improve long-term outcomes. However, many individuals with celiac disease are lost to follow-up. OBJECTIVE: This primary objective of this study was to identify factors associated with pediatric celiac disease patients being lost to follow-up. Secondary aims included identifying adherence to recommended care practices by both patients and providers. METHODS: A chart review of 250 randomly selected children with biopsy-confirmed celiac disease diagnosed between 2010 and 2014 at Boston Children’s Hospital (BCH) was conducted. Follow-up records were reviewed from diagnosis to 2017. Eligible children were diagnosed prior to age 18 and did not attend BCH solely for a second opinion. Demographics, medical history, visit information, and lab results were collected using an online database. RESULTS: Of the 241 eligible subjects (64% female, 1-17 years, median 9.7 years) the median time until lost to follow-up was 2.8 years from diagnosis (IQR, 1.0-4.7 years) with 22 subjects (9%) not attending any follow-up visits with their pediatric gastroenterologist (GI) after diagnosis and an additional 37 subjects (14%) lost within the first year. A majority of subjects (83%) attended a GFD education visit with a registered dietitian, although this was not associated with follow-up adherence (P>0.5). Excluding those who had aged out of the clinical practice, children who were adherent to follow-up had a younger mean age of diagnosis (95% CI 0.5-3.1, P<0.01). Children who were insured under Medicaid/CHIP (N=20) were more likely to be lost within one year compared to those with private health insurance (P<0.01). Celiac serologies taken at time of last clinical visit were abnormal in 25% of the subjects with available results (N=141) and the median time since diagnosis in this positive serology subgroup was 20 months (IQR, 12-29 months). DISCUSSION: The present study illustrates that children with celiac disease are not being followed-up adequately and that identifiable disparities exist in the pediatric celiac disease population. Within three years of diagnosis, 50% of the cohort was lost to follow-up with the majority of subjects lost within the first year of diagnosis. Children diagnosed at a younger age were more adherent to follow-up compared to those diagnosed during adolescence. Factors associated with decreased adherence included reliance on public medical insurance and older age at diagnosis. Improvement in long-term management of celiac disease may be achieved by increased outreach and education.