Obsessive-compulsive disorder (OCD) contributes to significant distress and chronic individual and societal impairment (e.g., DuPont et al., 1995; Ruscio et al., 2010). Despite the effectiveness of existing exposure-based therapies, some clients do not achieve symptom reduction or remission (Öst et al., 2015). Thus, identification of the mechanisms of change in treatment and more focused interventions are warranted to improve intervention effectiveness (e.g., Zvolensky et al., 2006). Distress intolerance may be an important but understudied mechanism of change in treatment for OCD. The current study replicated and extended previous findings that were limited by a small sample size (Macatee & Cougle, 2015), lack of focus on OCD specifically (McHugh et al., 2014; Bornovalova et al., 2012; Williams et al., 2013), and the use of non-clinical participants (Cougle et al., 2011; Macatee & Cougle, 2015) by using a residential and intensive outpatient sample of patients diagnosed with OCD. The current study found that reductions in DI accounted for significant improvement in OCD severity beyond changes in biological sex, anxiety change, depression change. Further, reductions in DI significantly contributed to OCD treatment response. Limitations and future directions were discussed.

Master of Public Health / Department of Kinesiology / Emily Mailey / INTRODUCTION: Research has focused on the relationship between socioeconomic status and physical activity, yet there are limited examinations which directly address social groups dealing with major issues associated with insufficient income. Studies have neglected the role of psychosocial stressors, such as financial stress, food insecurity, availability of government assistance programs, as well as psychological distress relative to the relationship between physical activity and low-income status. The purposes of this study were threefold: 1) to describe the multidimensional characteristics of life among low-income populations; 2) to examine how psychosocial stressors and health conditions vary across subsets of low-income groups; and 3) to examine the relationship among income, psychological distress and physical activity within low-income populations. METHODS: Data from the 2015 National Health Interview Survey (NHIS) were analyzed for the purposes of this investigation. Descriptive statistics were calculated for the low-income status individuals who provide complete data for all variables of interest to this study. A series of chi-square analyses were conducted to determine whether key psychosocial stressors, health behaviors, and health conditions differed by low-income (FIPR) groups. Two stepwise logistic regression analyses were conducted to examine these factors and their relationships with moderate-intensity (MPA) and vigorous (VPA)-intensity physical activity. RESULTS: Overall, women made up 58.5% of the sample size. Blacks/African Americans accounted for 20.6% of the sample, yet 28.0% of FIPR Group 1 identified as Black/African American. FIPR Group 1 was disproportionately unemployed, with 63.5% unemployed compared to 46.9% for the sample. One-quarter (25.9%) of the entire sample reported severe psychological distress, yet 33.9% of FIPR Group 1 and 30.8% of FIPR Group 2 reported severe distress. Nearly three-quarters (70%) of the sample was overweight or obese and 44.2% lived with at least one chronic disease at the time the survey was taken. Overall, 67.9% of the sample reported zero minutes of VPA and 51.3% reported zero minutes of MPA. Both psychological distress and income showed significant relationships with VPA. Psychological distress remained significantly associated with VPA after controlling for all covariates; however, income was no longer related to VPA after demographic and health-related variables were added to the model. Income was not related to MPA. Psychological distress demonstrated a weak relationship with MPA before the other covariates were added to the model, at which point the relationship became non-significant. Only the relationship between psychological distress and VPA was significant in the final models. Although some of the psychosocial stressor, demographic, and health-related variables contributed to the relationships between income, physical activity, and psychological distress, these variables explained only a small portion of the variance in both MPA and VPA. CONCLUSION: Low-income individuals are faced with difficult decisions and are limited in the choices they can make to improve health. It is important to understand the multidimensional characteristics of life under limited income to better serve and improve the health of low-income populations. Further study of the relationships among income, physical activity and psychological distress is needed to further this understanding.

abstract: A growing body of research indicates that people of multiple racial lineages in the US encounter challenges to positive psychological adjustment because of their racial status. In response, they also exhibit unique resilience strategies to combat these challenges. In this study, the moderating roles of previously identified multiracial resilient factors (i.e., shifting expressions, creating third space, and multiracial pride) were examined in the associations between unique multiracial risk factors (i.e., multiracial discrimination, perceived racial ambiguity, and lack of family acceptance) and psychological adjustment (i.e., satisfaction with life, social connectedness, and distress symptoms) of multiracial adults. Drawing on risk and resilience theory, results first indicated that the multiracial risk factors (i.e., multiracial discrimination, perceived racial ambiguity, and lack of family acceptance) relate negatively with social connectedness and distress symptoms, but did not significantly relate with satisfaction with life. Additionally, a differential moderating effect for one multiracial resilient factor was found, such that the protective or exacerbative role of creating third space depends on the psychological outcome. Specifically, results suggest creating third space buffers (e.g., weakens) the association between multiracial discrimination and satisfaction with life as well as lack of family acceptance and satisfaction with life among multiracial adults. Results further suggest creating third space exacerbates (e.g., strengthens) the negative association between perceived racial ambiguity on social connectedness and distress symptoms as well as lack of family acceptance on social connectedness and distress symptoms. Moreover, no two-way interaction effects were found for either of the other multiracial resilient factors (i.e., shifting expressions and multiracial pride). This study highlights the complex nature of racial identity for multiracial people, and the nuanced risk and resilience landscape encountered in the US. / Dissertation/Thesis / Masters Thesis Counseling 2018

Acute respiratory distress syndrome (ARDS) is associated with high mortality rates . The aim of treatment and ventilation is to improve oxygenation. Prone positioning improves oxygenation in patients with ARDS by shifting blood flow to undamaged or better ventilated regions of the lung. Critical care nurses follow the current guidelines with respect to prone positioning, which are mostly based on the medical aspects of the treatment. Prone positioning challenges nursing care of these patients. The research question that emerges is: Which nursing interventions during prone positioning will benefit the patient and reduce or eliminate complications? The purpose of this research is to do a systematic review in order to: Explore the evidence in support of the beneficial nursing interventions during prone positioning of ventilated patients and to develop evidence-based nursing guidelines with regard to the nursing process. The research design can be described as an exploratory, descriptive and retrospective systematic review. The population consisted of experimental study designs, as well as comparative, non-randomised and observational studies on nursing interventions during the prone positioning process. Selected studies included a population of adult or paediatric subjects who were ventilated and turned into the prone position, and the search strategy was restricted to articles published or translated into English. Studies that included animals or neonates were excluded from this review. The data collection process involved the systematic extraction of relevant data onto standardised data abstraction forms and the assessment of the methodological quality of each study. Data were summarised into evidence tables and data from randomised controlled trials were used for meta-analysis. There were thirteen randomised controlled trials, of which only seven could be included for quantitative analysis. Forty five clinical trials involving prone positioning were identified, with a total population of 2 148 patients. Outcomes that were measured, included oxygenation outcomes, responder and non-responder groups, haemodynamic outcomes, complications in the prone position, mortality, the length of sta y in the intensive care units and the total number of ventilated days. Prone positioning showed significant increases in the PaO2 and PaO2 / FiO2 ratio. The effect of the outcomes compared against the different ventilation, sedation, nutrition and positioning protocols had inconclusive results. Haemodynamic variables had insignificant increases in the prone position. Pulmonary artery wedge pressure (PAWP) however, did show a significant increase in the prone position. Complications related to prone positioning were insignificantly less than expected. Patients treated in the prone position were ventilated for an insignificantly shorter period of time, but had a longer ICU stay, although the results were also insignificant. The mortality of patients in the selected trials was 33.5%. Evidence gained from the selected studies could be used to develop nursing guidelines, despite inconclusive results related to some of the measured outcomes. / Dr. Elzabé Nel

Respiratory distress syndrome is the major cause of mortality in premature babies. Increasing numbers of neonates are now surviving the disease due to advances in techniques used in neonatal intensive care units. Mechanical ventilation is an essential part of the treatment for respiratory distress syndrome and is an area in which improvements and modifications are constantly being made. In the early 1980's a new infant ventilator was introduced involving ventilation by a distal jet. As yet, the mechanisms by which the distal jet ventilator enhances gas exchange are unknown. Original experiments are carried out to record the attenuation and speeds of the pressure wave produced by the distal jet ventilator. The observed changes in wave shape and the high wave speed imply that the ventilator produces waves operating within an acoustic regime. An understanding of the gas exchange mechanisms active in shock assisted ventilation is initiated by a comprehensive investigation of the transport properties of acoustic waves. The advection and diffusion that result from a linear concentration gradient in an acoustic flow are analysed, from the Eulerian and Lagrangian viewpoints. The Eulerian investigation shows that the total flux of tracer through a given pipe can be optimized by choosing the frequency appropriately. The Lagrangian transport is increased as both frequency and radius increase. For all values of parameters, Lagrangian streaming is observed, with a steady net flow in the pipe core away from the tube entrance and an opposing net flow near the tube walls.

Background: Obesity has been identified as a global epidemic and is associated with significant morbidity and mortality. Although obesity has been widely recognized for its consequences on physical health, its psychological burden in the adult populations remains unclear. Objectives: Our purpose was to address the relationship between Obesity status and psychological health within the adult young population in the Middle East and particularly in Lebanon (first aim). In addition, we intended to develop and validate a screening tool for the assessment of psychological distress (PD) in the obese young adult populations (second aim). Methods: To achieve the first aim, three studies were conducted. The first study was a systematic review and meta-analysis of observational studies that investigate the association between obesity and depression among adult populations in Middle Eastern countries. The second study was a cross sectional that aimed to explore the relationship between obesity and PD among the Lebanese University Students. The third study was conducted to examine the effects of actual body weight and body image on PD using a convenient sample of obese Lebanese young adults. The second aim was accomplished by conducting a fourth study to develop and validate a measure of PD related to obesity using three different samples of obese young adults. Results: The systematic review identified eight observational studies from six countries of the Middle East. Meta-analysis showed a significant positive association between obesity and depression (OR 1.27; 95% CI 1.11–1.44) particularly in women (Study1). Among the Lebanese university students, no evidence of a positive association was found between obesity and PD for both genders (Study 2). This result was confirmed in our third study in which body image dissatisfaction rather than obesity per se was associated with greater risk for PD. Finally, the “Obesity Specific Distress scale” (OSD) developed to measure distress in the obese young adult population demonstrated good psychometric properties regarding internal consistency, test-retest reliability, and construct validity (Study 4). Conclusions: Our meta-analysis suggests a positive association between obesity and depression among adult population in the Middle East which appeared to be more marked among women. This is of public health significance and provides a framework for establishing policy interventions to diagnose and treat depression in obese adults. In Lebanon, young obese adults who suffer from body image dissatisfaction are at increased risk of PD. Public health interventions targeting PD at the population level may need to promote healthy attitudes towards body weight, body shape and self-acceptance, regardless of weight status. Finally, the developed instrument used to assess young obese persons with high risk of PD can help promote a better understanding of the association between PD and obesity. This might improve the outcome and provide the patients with more efficient treatment. / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

Objectives: The management of depression and anxiety in primary care in the UK is not consistent with clinical guidelines. This has led to training initiatives that aim to change practice by improving the implementation of research evidence, but little is known about what constitutes effective healthcare professional training in this area. This thesis addressed this issue by identifying what determines effective training to improve the management of psychological distress in primary care. Methods: The research was undertaken in three stages. A systematic review and narrative synthesis was conducted to investigate the effects of controlled trials of training interventions delivered to primary care practitioners (PCPs) to improve the management of psychological distress on process outcomes (practitioner behaviour, knowledge, attitudes). Then two qualitative studies using semi structured interviews with PCPs (n=18) and experts in training/behaviour change (n=16) were conducted to explore their perceptions of effective healthcare professional training in this area and in general. The qualitative data were synthesised to produce recommendations for designing effective healthcare professional training to improve the primary care management of psychological distress. The research findings were used to develop a taxonomy of training intervention components for use in the design and reporting of healthcare professional training interventions in this area and more widely. Results: Forty Papers (36 studies) were included in the systematic review. The papers reviewed provide a mixed picture of the effective characteristics of training interventions. Two components: the inclusion of skills practice (role-play) and the use of theory to inform intervention content were associated with positive outcomes. Limitations with outcome measures, absence of theory and poor descriptions of the interventions made it difficult to determine effective intervention components. The analysis of the qualitative studies resulted in the development of the Perceived Effectiveness of Training (PET) framework. It incorporates five themes or core areas that underpin effective training: social interaction, credibility, relevance, information processing, and practicalities. The PET framework was used to identify effective training intervention components. Finally, the qualitative synthesis led to the development of a taxonomy of training intervention components, which was evaluated for comprehensiveness by mapping the training components to the interventions identified in the systematic review. This culminated in a 171 item taxonomy with hierarchical groupings divided into three phases: pre-training, training delivery and post training. Conclusions: Healthcare professional training to improve the management of psychological distress in primary care can be optimised for effectiveness using the PET framework to address core quality training standards. It is recommended that the taxonomy of training intervention components should be used to improve the science of healthcare professional training interventions. Further research to develop the taxonomy and to establish valid training evaluation measures would provide further scope to identify which training components can predict healthcare professional behaviour change and improve the management of psychological distress in primary care.

Business rescue is still in its infancy stage in South Africa, with the introduction of Chapter 6 of the Companies Act 71 in 2008 that took effect in mid-2011. To date the success rate has been dismal and value has been eroded as many companies opt to file for business rescue, but shouldn’t. The objective of this research is to determine glaring attributes that would require extensive consideration before filing for business rescue. These facets should be considered in the pre-assessment stage and should be given the due respect to ensure the organisation has a fighting chance at survival. Business rescue is becoming a tarnished industry within South Africa as a few business rescue practitioners are enriching themselves at the expense of the unexperienced creditors to this new piece of legislation that is designed to help facilitate a turnaround, whilst under the protection of the legal system. This in turn, will help to preserve, not only ailing businesses and their communal value, but the mere jobs of each individual within these distressed ventures. South Africa has struggled from a growth perspective for the past few years and with the help of legislation, and a thorough pre-assessment, ailing and distressed businesses may be saved. / Dissertation (MBA)--University of Pretoria, 2014. / zkgibs2015 / Gordon Institute of Business Science (GIBS) / Unrestricted

This study was undertaken primarily to investigate the plasma protein system in infants with IRDS, as compared with healthy premature infants, as it had previously been reported that the plasma protein concentration in affected infants was abnormally low. It was attempted further to establish biochemical and/or immunological criteria for diagnosis of the disease and to discover reasons for the low IgG concentrations and raised α-fetoprotein concentrations found in the sera of these infants. Maternal serum proteins were also studied during pregnancy and at and after delivery of the infant. Interrelationships between α-fetoprotein, Human Growth Hormone and other proteins, in immunochemical systems were investigated. In summary, the main conclusions reached were as follows: (i) The total serum-protein concentration in affected infants is much reduced, as compared with healthy premature infants of the same gestational age. (ii) In IRDS infants, the relative and absolute concentration, of IgG is extremely low, whereas concentrations of other immune globulins, as far as could be determined, are within normal limits. (iii) Mothers of affected infants have significantly lower concentrations both of serum IgG and of IgM, than mothers of healthy premature infants. These changes in the serum-proteins are present throughout pregnancy. By six weeks post-partum, the IgG level has returned to normal, but the IgM level remains low. Concentrations of IgA and total serum-protein are normal at all times. (iv) Examination of oedema fluid, urine, faeces and amniotic fluid for γ-globulin content, has excluded the possibility that IgG is being lost from the circulation by these routes. (v) IRDS infants have, in their serum, agglutinins of the IgM type directed against the intact maternal IgG molecule. Similar agglutinins are present in a minority of healthy premature infants. Both IRDS and healthy infants have agglutinins against IgG fragments, in approximately 50% of cases. Agglutinin titres against these are similar in the two groups, but the incidence of agglutinins against Bence Jones protein type Lis raised in IRDS. (vi) Affected infants have an elevated serum concentration of α-fetoprotein, which disappears from the serum during the: first week of post-natal life. (vii) The majority of pregnant women examined have been observed to have serum agglutinins directed against α-fetoprotein. These cross-react with albumin prepared from sera of healthy adult males α-fetoprotein has been found in the serum of many pregnant women, especially during the second trimester. (viii) Immunological interrelationships between α-fetoprotein human serum albumin, Human Growth Hormone and human IgG have been demonstrated. (ix) Infants suffering from Rh-isoimmunization exhibit a serum- protein pattern similar to that seen in IRDS. Biochemical and immunological criteria for the diagnosis of IRDS have thus been established. The data to be presented indicate the presence of an immunological factor in the aetiology of the disease.

Magister Psychologiae - MPsych / 30% of the country's population are currently unemployed and this statistic is increasing steadily. Further deterioration of the South African economy and increased unemployment, is likely to increase social instability and continue to marginalise a major proportion of society. Global economic downturn as well as the crash of the Asian economies in the mid-1990's resulted in job losses for both the working class and middle class sectors of society. The literature however suggests that the effects of unemployment are likely to be experienced differently by working and middle class individuals. This reiterates the argument that the unemployed should not be perceived as a homogenous group. The study utilises a broad epistemological framework of social constructionism and employs the theoretical assumptions of Marxism as the theoretical basis for the research.