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Background: To study clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their Child and Adolescent Mental Health Service (CAMHS) and its association with mental health indicators, transition recommendations and mental health service (MHS) use. Methods: 763 CAMHS users from eight European countries were assessed using multi-informant and standardised assessment tools at baseline and nine months follow-up. Separate ANCOVA's and pairwise comparisons were conducted to assess whether clinicians' and parents' awareness of young people's suicidal behaviour were associated with mental health indicators, clinician's recommendations to continue treatment and MHS use at nine months follow-up. Results: 53.5 % of clinicians and 56.9 % of parents were unaware of young people's self-reported suicidal behaviour at baseline. Compared to those whose clinicians/parents were aware, unawareness was associated with a 72–80 % lower proportion of being recommended to continue treatment. Self-reported mental health problems at baseline were comparable for young people whose clinicians and parents were aware and unaware of suicidal behaviour. Clinicians' and parents' unawareness were not associated with MHS use at follow-up. Limitations: Aspects of suicidal behaviour, such as suicide ideation, -plans and -attempts, could not be distinguished. Few young people transitioned to Adult Mental Health Services (AMHS), therefore power to study factors associated with AMHS use was limited. Conclusion: Clinicians and parents are often unaware of suicidal behaviour, which decreases the likelihood of a recommendation to continue treatment, but does not seem to affect young people's MHS use or their mental health problems.

Background: The configuration of having separate mental health services by age, namely child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), might be a barrier to continuity of care that adversely affects young people's mental health. However, no studies have investigated whether discontinuity of care in the transition period affects mental health. We aimed to discern the type of care young people receive after reaching the upper age limit of their CAMHS and examine differences in outcomes at 24-month follow-up between young people receiving different types of care. Methods: To assess mental health in young people from 39 CAMHS in eight European countries (Belgium, Croatia, France, Germany, Italy, Ireland, the Netherlands, and the UK), we did a longitudinal cohort study. Eligible young people were CAMHS users up to 1 year younger than the upper age limit of their CAMHS or up to 3 months older, if they were still in CAMHS. Information on mental health service use, mental health problems (ie, using the Health of the Nation Outcome Scale for Children and Adolescents, Youth Self-Report and Adult Self-Report, DSM-5, and ICD-10), and sociodemographic characteristics were collected using self-reported, parent-reported, and clinician-reported interviews and questionnaires. Mixed models were applied to assess relationships between baseline characteristics, mental health service use, and outcomes. Findings: The MILESTONE cohort included 763 young people. The participants were 60·0% female (n=458) and 40·0% male (n=305), 90·3% White (n=578), and had a mean age of 17·5 years (range 15·2–19·6 years). Over the 24-month follow-up period, 48 young people (6·3%) actively withdrew from the study. For young people, the higher their scores on the Health of the Nation Outcome Scale for Children and Adolescents (p=0·0009) and Youth Self-Report and Adult Self-Report (p=0·046), and who had a clinical classification of severe mental illness (p=0·0033), had suicidal thoughts or behaviours or self-harm (p=0·034), used psychotropic medication (p=0·0014), and had a self-reported or parent-reported need for continued treatment (p

Purpose Young people transitioning from child to adult mental health services are frequently also known to social services, but the role of such services in this study and their interplay with mental healthcare system lacks evidence in the European panorama. This study aims to gather information on the characteristics and the involvement of social services supporting young people approaching transition. Design/methodology/approach A survey of 16 European Union countries was conducted. Country respondents, representing social services’ point of view, completed an ad hoc questionnaire. Information sought included details on social service availability and the characteristics of their interplay with mental health services. Findings Service availability ranges from a low of 3/100,000 social workers working with young people of transition age in Spain to a high 500/100,000 social workers in Poland, with heterogeneous involvement in youth health care. Community-based residential facilities and services for youth under custodial measures were the most commonly type of social service involved. In 80% of the surveyed countries, youth protection from abuse/neglect is overall regulated by national protocols or written agreements between mental health and social services, with the exception of Czech Republic and Greece, where poor or no protocols apply. Lack of connection between child and adult mental health services has been identified as the major obstacles to transition (93.8%), together with insufficient involvement of stakeholders throughout the process. Research limitations/implications Marked heterogeneity across countries may suggest weaknesses in youth mental health policy-making at the European level. Greater inclusion of relevant stakeholders is needed to inform the development and implementation of person-centered health-care models. Disconnection between child and adult mental health services is widely recognized in the social services arena as the major barrier faced by young service users in transition; this “outside” perspective provides further support for an urgent re-configuration of services and the need to address unaligned working practices and service cultures. Originality/value This is the first survey gathering information on social service provision at the time of mental health services transition at a European level; its findings may help to inform services to offer a better coordinated social health care for young people with mental health disorders.

International audience

The transition from child and adolescent to adult mental health services for young people with mental health problems is of international concern. Despite the high prevalence of mental disorders during adolescence and their tendency to continue during adulthood, the majority of young people do not experience continuity of care. The aim of this review paper is to unravel the complexity of transitional mental healthcare to clinicians, policy makers and mental health service managers, and to address challenges to a smooth transition process at all levels. ispartof: BJPSYCH BULLETIN vol:44 issue:4 pages:163-168 ispartof: location:England status: published

ObjectiveYoung people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16–18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person’s readiness for transition, and their outcomes at the transfer boundary.DesignMILESTONE prospective study.SettingEight European Union (EU) countries participating in the EU-funded MILESTONE study.ParticipantsThe first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people.ResultsThe development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported.ConclusionThe TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person.Trial registration numberISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.

International audience; Transition-related discontinuity of care is a major socioeconomic and societal challenge for the EU. The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust. Our aim was to delineate transitional policies and care across Europe and to highlight current gaps in care provision at the service interface. An online mapping survey was conducted across all 28 European Countries using a bespoke instrument: The Standardized Assessment Tool for Mental Health Transition (SATMEHT). The survey was directed at expert(s) in each of the 28 EU countries. The response rate was 100%. Country experts commonly (12/28) reported that between 25 and 49% of CAMHS service users will need transitioning to AMHS. Estimates of the percentage of AMHS users aged under 30~years who had has previous contact with CAMHS were most commonly in the region 20-30% (33% on average).Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available. This is the first survey of CAMHS transitional policies and care carried out at a European level. Policymaking on transitional care clearly needs special attention and further elaboration. The Milestone Study on transition should provide much needed data on transition processes and outcomes that could form the basis for improving policy and practice in transitional care.

Background Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address the significant socioeconomic and societal challenge related to the transition process. This protocol paper describes the development of two MILESTONE transition-related measures: The Transition Readiness and Appropriateness Measure (TRAM), designed to be a decision-making aide for clinicians, and the Transition Related Outcome Measure (TROM), for examining the outcome of transition. Methods The TRAM and TROM have been developed and were validated following the US FDA Guidance for Patient-reported Outcome Measures which follows an incremental stepwise framework. The study gathers information from service users, parents, families and mental health care professionals who have experience working with young people undergoing the transition process from eight European countries. Discussion There is an urgent need for comprehensive measures that can assess transition across the CAMHS/AMHS boundary. This study protocol describes the process of development of two new transition measures: the TRAM and TROM. The TRAM has the potential to nurture better transitions as the findings can be summarised and provided to clinicians as a clinician-decision making support tool for identifying cases who need to transition and the TROM can be used to examine the outcomes of the transition process. Trial registration MILESTONE study registration: ISRCTN83240263 Registered 23-July-2015 - ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

National and international standardised assessments of mathematical competencies challenge students to solve stimulating non-routine problems but, in some sense, they appear to have several limitations exactly in assessing students’ problem solving competencies. In particular, the use of multiple choice or short answer items focuses the assessment on the student’s choice (the product) rather than on how and why the student made that choice (the reasoning, that is, the process). The emersion of the processes appears to be a crucial need for teachers and researchers in order to understand what is involved in students’ answers. In this chapter, we will describe a protocol (developed within an Italian research project) for getting data to understand—at a micro level—the educational macro phenomena illustrated by standardised assessment quantitative results. This approach—that involves educational researchers and mathematics teachers—makes it possible to foster the development of a critical and productive approach to standardised tests, transforming them in an educational opportunity for teachers and researchers.

Objective: To carry out a systematic review and meta-analysis of age of onset (AoO) of bipolar disorder (BD).

Background Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. Methods A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Results Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. Conclusions There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. Electronic supplementary material The online version of this article (10.1186/s12910-018-0276-3) contains supplementary material, which is available to authorized users.

Background: Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014–19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals.Methods: Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians.Discussion: Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers.Trial registration: "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

The original version of this article contained an error in Table 1. The correct table is presented below.

International and national standardized assessments of students’ mathematical competencies have an increasing role in the educational policies. They not only assess if the educational standards have been reached by students, but in a certain sense they determine what is considered particularly relevant as educational outcome, and therefore they can affect teachers’ educational choices. This influence on teachers’ choices depends on teachers’ opinions and feelings about the standardized assessment of their students’ mathematical competencies. Within this frame, we carried out a large narrative research about teachers’ emotions and beliefs towards the Italian standardized assessment of students’ mathematical competencies, comparing the differences between school levels and discussing their educational relevance.

Objective: To evaluate the length of the interval between the onset and the initial management of bipolar disorder (BD). Method: We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches located studies reporting estimates of the age of onset (AOO) and indicators of the age at initial management of BD. We calculated a pooled estimate of the interval between AOO and age at management. Factors influencing between-study heterogeneity were investigated using sensitivity analyses, meta-regression, and multiple meta-regression. Results: Twenty-seven studies, reporting 51 samples and a total of 9415 patients, met the inclusion criteria. The pooled estimate for the interval between the onset of BD and its management was 5.8 years (standardized difference, .53; 95% confidence interval, .45 to .62). There was very high between-sample heterogeneity ( I2 = 92.6; Q = 672). A longer interval was found in studies that defined the onset according to the first episode (compared to onset of symptoms or illness) and defined management as age at diagnosis (rather than first treatment or first hospitalization). A longer interval was reported among more recently published studies, among studies that used a systematic method to establish the chronology of illness, among studies with a smaller proportion of bipolar I patients, and among studies with an earlier mean AOO. Conclusions: There is currently little consistency in the way researchers report the AOO and initial management of BD. However, the large interval between onset and management of BD presents an opportunity for earlier intervention.

Objectives Accurate prognosis is an essential aspect of good clinical practice and efficient health services, particularly for chronic and disabling diseases, as in geriatric populations. This study aims to examine the accuracy of clinical prognostic predictions and to devise prediction models combining clinical variables and clinicians' prognosis for a geriatric patient sample. Study Design and Setting In a sample of 329 consecutive older patients admitted to 10 geriatric units, we evaluated the accuracy of clinicians' prognosis regarding three outcomes at discharge: global functioning, length of stay (LoS) in hospital, and destination at discharge (DD). A comprehensive set of sociodemographic, clinical, and treatment-related information were also collected. Results Moderate predictive performance was found for all three outcomes: area under receiver operating characteristic curve of 0.79 and 0.78 for functioning and LoS, respectively, and moderate concordance, Cohen's K = 0.45, between predicted and observed DD. Predictive models found the Blaylock Risk Assessment Screening Score together with clinicians' judgment relevant to improve predictions for all outcomes (absolute improvement in adjusted and pseudo- R 2 up to 19%). Conclusion Although the clinicians' estimates were important factors in predicting global functioning, LoS, and DD, more research is needed regarding both methodological aspects and clinical measurements, to improve prognostic clinical indices.

This fMRI study investigated neural systems that interpret body language—the meaningful emotive expressions conveyed by body movement. Participants watched videos of performers engaged in modern dance or pantomime that conveyed specific themes such as hope, agony, lust, or exhaustion. We tested whether the meaning of an affectively laden performance was decoded in localized brain substrates as a distinct property of action separable from other superficial features, such as choreography, kinematics, performer, and low-level visual stimuli. A repetition suppression (RS) procedure was used to identify brain regions that decoded the meaningful affective state of a performer, as evidenced by decreased activity when emotive themes were repeated in successive performances. Because the theme was the only feature repeated across video clips that were otherwise entirely different, the occurrence of RS identified brain substrates that differentially coded the specific meaning of expressive performances. RS was observed bilaterally, extending anteriorly along middle and superior temporal gyri into temporal pole, medially into insula, rostrally into inferior orbitofrontal cortex, and caudally into hippocampus and amygdala. Behavioral data on a separate task indicated that interpreting themes from modern dance was more difficult than interpreting pantomime; a result that was also reflected in the fMRI data. There was greater RS in left hemisphere, suggesting that the more abstract metaphors used to express themes in dance compared to pantomime posed a greater challenge to brain substrates directly involved in decoding those themes. We propose that the meaning-sensitive temporal-orbitofrontal regions observed here comprise a superordinate functional module of a known hierarchical action observation network (AON), which is critical to the construction of meaning from expressive movement. The findings are discussed with respect to a predictive coding model of action understanding.

ObjectiveMental illness in parents is a biological and environmental risk factor to which young people are exposed. Living with a parent suffering from a mental disorder may have a variety of detrimental consequences, including: (a) the reversal of caregiving (“parentification”); (b) the exposure to an adverse environment, where developmental needs of the child (emotional and practical) might be repeatedly neglected (lack of communication, high expressed emotion, etc.); (c) stigma and discrimination. We will provide a review of needs of these children and of possible interventions.MethodsSystematic searches located studies reporting and assessing met and unmet needs of these children.ResultsYoung people living in such families often have problems of internalizing and externalizing symptoms, cognitions of shame, guilt, and loneliness, perceptions of lacking social support and social acceptance. Children who have mentally ill parents are up to two and a half times more likely to experience poorer mental health outcomes than their peers. Compared to peers, children of parents with mental disorders are also at risk of poorer intellectual and social outcomes, of affect dysregulation, of behavioral problems, of impaired attention and reduced overall adaptive functioning, of higher rates of substance abuse and multiple diagnosis and finally of low occupational status, health risk behaviour and antisocial behavior.ConclusionsGiven the high toll paid by children having parents suffering from severe mental disorders, it is urgent to develop, test and implement structured programmes to help these children cope with stressful circumstances and improve their resilience.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveTo evaluate the length of the interval between the onset and the initial management of bipolar disorder (BD).MethodWe conducted a meta-analysis using the preferred reporting items for systematic reviews and meta-analyses guidelines. Systematic searches located studies reporting estimates of the age of onset (AOO) and indicators of the age at initial management of BD. We calculated a pooled estimate of the interval between AOO and age at management. Factors influencing between-study heterogeneity were investigated using sensitivity analyses, meta-regression, and multiple meta–regression.ResultsTwenty-seven studies, reporting 51 samples and a total of 9415 patients, met the inclusion criteria. The pooled estimate for the interval between the onset of BD and its management was 5–8 years (standardized difference, .53; 95% confidence interval, .45 to .62). There was very high between-sample heterogeneity (I2 ¼ 92.6; Q ¼ 672). A longer interval was found in studies that defined the onset according to the first episode (compared to onset of symptoms or illness) and defined management as age at diagnosis (rather than first treatment or first hospitalization). A longer interval was reported among more recently published studies, among studies that used a systematic method to establish the chronology of illness, among studies with a smaller proportion of bipolar I patients, and among studies with an earlier mean AOO.ConclusionsThere is currently little consistency in the way researchers report the AOO and initial management of BD. However, the large interval between onset and management of BD presents an opportunity for earlier intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionTransition to adulthood is the period of onset of most serious mental disorders. The current discontinuity of care between Child and Adolescent Mental Health (CAMHS) and Adult Mental Health (AMHS) Services is a major socioeconomic and societal challenge for the EU.Objectives/aimsIn the framework of the MILESTONE project this study aims to map current services and transitional policies across Europe, highlighting current gaps and the need for innovation in care provision.MethodsAn on-line mapping survey has been conducted across all 28 European countries through the administration of two ad-hoc instruments: the Standardized Assessment Tool for Mental Health Transition (SATMEHT) and the European CAMHS Mapping Questionnaire (ECM-Q). The survey systematically collected data about CAMHS organization and characteristics, with a specific focus on actual national transition policies and practice.ResultsResponse rate was 100%. Despite up to 49% of CAMHS service users need to continue with specialist AMHS care, written policies for managing the interface between these two services are available only in 4/28 countries and transition support services are reported as missing by half of the respondents. Lack of connection between CAMHS and AMHS is reported as the major (82%) difficulty experienced by young service users.ConclusionPreliminary results indicate a marked variability in characteristics of services and in data activity among the 28 European countries, with important missing information at national level about CAMHS and their functioning. All these conclusions warrant an improvement in data collection and service planning and delivery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAlthough the onset of bipolar disorder (BD) is usually estimated in early adulthood (Burke et al., 1990; Kessler et al., 1997), it is still not clear which age-specific triggering factors may contribute to the underlying vulnerability.Objectives/aimsThe present meta-analysis attempts to clarify the number of untreated years of BD, from first symptoms appearance, to first actions carried out by health services (first diagnosis, treatment and hospitalization).MethodsA literature search of three databases PubMed, Web of Science and Psychology and Behavioral Sciences Collection was performed, looking for peer-reviewed publications in English, French, German and Italian language that reported the AOO of BD; the search string adopted was “bipolar and onset”. Standardized mean differences were calculated between (i) mean AOO, operationally defined as onset of first symptoms/episodes, and (ii) mean AOO, operationally defined according to four criteria: first contact with services, date of the diagnosis, first pharmacological treatment, or first hospitalization.ResultsThe searches yielded 8710 articles; 2424 of these articles met the inclusion criteria. A final set of 19 studies presenting multiple definitions of AOO has been analyzed, revealing an overall effect size of 6.96 of untreated years (Cohen's d = 0.65)ConclusionTo our knowledge, this is the first meta-analysis that addresses the definition and the modulation of the AOO in bipolar disorder. Identifying the time-frame of untreated illness is very important for the best planning of timely interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The authors gratefully acknowledge the support of the project AMMODIT funded within EU H2020-MSCA-RICE Проблематика. Випадок серця з одним шлуночком є летальним вродженим захворюванням, що вражає близько 2 % новонароджених в західному світі. Через такі патології тільки один шлуночок качає кров у кровоносне русло, артеріальна і венозна кров змішуються, що перешкоджає забезпеченню тканин і органів киснем належним чином. Ці патології сьогодні лікують за допомогою так званої процедури Фонтана (Fontan procedure), що являє собою багатоступеневий і складний хірургічний підхід. Ця процедура спрямована на отримання анатомічного поділу між системним і легеневим колами кровообігу і, отже, між збагаченою та незбагаченою киснем кров’ю. Проте оскільки кров накачується тільки одним шлуночком, кровоток у малому колі кровообігу є пасивним. Крім того, післяопераційна анатомія з’єднання між системними венами і легеневими артеріями при цьому стає явно нефізіологічною. По суті, це пов’язано зі змінами в динаміці крові, небажаними втратами енергії, що, зрештою, веде до значного дискомфорту пацієнта та короткої тривалості його життя. Мета дослідження. З урахуванням причин, викладених вище, лікарі потребують обчислювальних інструментів, реалі­зованих у вигляді комп’ютерного програмного забезпечення, для: I) кількісної оцінки післяопераційних анатомічних і гідро­ди­намічних змін; II) зіставлення різних варіантів анатомії для прогнозу у хворих; III) визначення критеріїв поліпшення хірургії процедури Фонтана. Методика реалізації. Для досягнення зазначених цілей ми розробили обчислювальний інструмент у вигляді комп’ю­терного програмного забезпечення для обробки потокових 4D-даних, тобто фазово-контрастних магнітно-резонансних зображень, що дають інформацію про розподіл швидкостей у тканинах у тривимірній області. Розроблене програмне забезпечення дає змогу реконструювати 3D-геометрію анатомічної області, що підлягає хірургічному лікуванню, і, за допомогою напів­авто­матичного користувацького інтерфейсу, отримувати відповідні геометричні оцінки судин та кількісні оцінки швидкостей потоків у різних судинах, оцінювати втрати енергії, а також зсувні напруження біля стінок. Числовий метод, заснований на підході методу скінченних елементів, був реалізований для оцінки розподілу відносного тиску. Результати досліджень. Розроблені інструменти були попередньо застосовані до аналізу наборів даних шести педіат­ричних хворих. Аналіз даних, отриманих двома незалежними користувачами, показав хорошу відтворюваність геометричних реконструкцій і, отже, отримання кількісних геометричних оцінок. Метод визначення відносних тисків попередньо був протестований на спрощеній моделі грудної аорти, з обнадійливими результатами. Висновки. Розроблений обчислювальний інструмент, який, наскільки нам відомо, є повністю новим, покликаний допомогти лікарям кількісно оцінювати післяопераційні анатомічні та гідродинамічні зміни. Дослідження, що продовжуються по цей день, включають його застосування на реальних наборах даних, а також розширення проведеного аналізу до ширшої групи пацієнтів, щоб перевірити наявність кореляцій між кількісними геометричними і гідродинамічними показниками з прогнозом пацієнтів. Такі можливі кореляції могли б допомогти при визначенні критеріїв для подальшого поліпшення хірургії процедури Фонтана. Background. Univentricular diseases are lethal congenital diseases affecting about 2 % of newborns in the western world. Due to these pathologies, only one ventricle pumps blood into the circulatory bed, and arterial and venous blood are mixed, preventing from properly providing tissues and organs with oxygen. These pathologies are currently treated through the so-called Fontan procedure, which is a multi-step and complex surgical approach. The Fontan procedure aims at obtaining the anatomical separation between the systemic and pulmonary circulations, and hence between oxygenated and non-oxygenated blood. However, the only ventricle present in the heart remains the only pumping organ, and blood flow in the pulmonary circulation is merely passive. Also, and importantly, the post-surgical anatomy of the junction between systemic veins and pulmonary arteries is markedly non-physiological. As such, it is associated with altered blood fluid dynamics, undesired energy losses, and, ultimately, sub-optimal quality of life and short life expectancy. Objective. On this basis, clinicians need tools to 1) quantify the post-surgical anatomical and fluid-dynamic alterations, 2) correlate these anatomies to the patients’ prognosis, and 3) identify criteria to improve Fontan surgery. Methods. In order to support the pursue of these goals, we developed a computational tool for the processing of 4D flow data, i.e., phase contrast magnetic resonance images yielding information on the velocity of tissues within a 3D domain. The tool allows for reconstructing the 3D geometry of the surgically treated anatomical district and, through a semi-automated user-interface, extracting relevant geometrical scores, as well as quantifying flow rates in the different vessels, energy losses, and wall shear stresses. A numerical method based on the finite element approach was implemented to estimate relative pressures. Results. The developed tool was preliminarily applied to the analysis of the datasets of six pediatric patients. The analysis of data obtained by two independent users highlighted a good repeatability of geometrical reconstructions, and hence of the quantification of geometrical scores. The method for the quantification of relative pressures was preliminarily tested in a simplified model of the thoracic aorta, with encouraging results. Conclusions. The developed computational tool, which, to the best of our knowledge, is completely novel, helps clinicians to quantify the post-surgical anatomical and fluid-dynamic alterations. Ongoing activities include its application to the real datasets, and the extension of the analysis to a wider cohort of patients, so to check for correlations between the quantitative geometrical and fluid-dynamic indexes with the patients’ prognosis. Such possible correlations could help identifying criteria to improve Fontan surgery. Проблематика. Случай сердца с одним желудочком является летальным врожденным заболеванием, поражающим около 2 % новорожденных в западном мире. Из-за таких патологий только один желудочек качает кровь в кровеносное русло, артериальная и венозная кровь смешиваются, что препятствует обеспечению тканей и органов кислородом должным образом. Эти патологии в настоящее время лечат с помощью так называемой процедуры Фонтана (Fontanprocedure), которая представляет собой многоступенчатый и сложный хирургический подход. Эта процедура направлена на получение анатомического разделения между системным и легочным кругами кровообращения и, следовательно, между обогащенной и необогащенной кислородом кровью. Тем не менее, поскольку кровь накачивается только одним желудочком, кровоток в малом круге кровообращения является пассивным. Кроме того, послеоперационная анатомия соединения между системными венами и легочными артериями при этом становится явно нефизиологической. По существу, это связано с изменениями в динамике крови, нежелательными потерями энергии, что, в конечном счете, ведет к значительному дискомфорту пациента и короткой продолжительности его жизни. Цели исследования. С учетом причин, изложенных выше, врачи нуждаются в вычислительных инструментах, реализованных в виде компьютерного программного обеспечения, для: I) количественной оценки послеоперационных анатомических и гидродинамических изменений; II) сопоставления различных вариантов анатомии для прогноза у больных; III) определения критериев улучшения хирургии процедуры Фонтана. Методика реализации. Для достижения обозначенных целей мы разработали вычислительный инструмент в виде компьютерного программного обеспечения для обработки потоковых 4D-данных, т.е. фазово-контрастных магнитно-резонансных изображений, дающих информацию о распределении скоростей в тканях в трехмерной области. Разработанное программное обеспечение позволяет реконструировать 3D-геометрию подлежащей хирургическому лечению анатомической области и, с помощью полуавтоматического пользовательского интерфейса, извлекать соответствующие геометрические оценки сосудов и количественные оценки скоростей потоков в различных сосудах, оценивать потери энергии, а также пристеночные сдвиговые напряжения. Численный метод, основанный на подходе метода конечных элементов, был реализован для оценки распределения относительного давления. Результаты исследований. Разработанные инструменты были предварительно применены к анализу наборов данных шести педиатрических больных. Анализ данных, полученных с помощью двух независимых пользователей показал хорошую воспроизводимость геометрических реконструкций, и, следовательно, получения количественных геометрических оценок. Метод определения относительных давлений предварительно был протестирован на упрощенной модели грудной аорты, с обнадеживающими результатами. Выводы. Разработанный вычислительный инструмент, который, насколько нам известно, является полностью новым, помогает врачам количественно оценивать послеоперационные анатомические и гидродинамические изменения. Проводимые в настоящий момент исследования включают его применение на реальных наборах данных, а также расширение проводимого анализа к более широкой группе пациентов, чтобы проверить наличие корреляций между количественными геометрическими и гидродинамическими показателями с прогнозом пациентов. Такие возможные корреляции могли бы помочь при определении критериев для дальнейшего улучшения хирургии процедуры Фонтана.