Class of 2012 Abstract / Specific Aims: The objective of this study is to evaluate and compare clinical outcomes and economic impact involved with the use of beractant (B) compared to poractant (P) for the treatment of respiratory distress syndrome (RDS) in premature neonates admitted to a neonatal intensive care unit. Methods: Patients were included if they were less than 35 weeks gestational age at birth, survived at least 48 hours, and admitted to the neonatal intensive care unit and treated with P or B for RDS. The primary outcome of this study is the change in the fraction of inspired oxygen (FiO2) over the first 48 hours after surfactant administration. Secondary outcomes were the change in oxygen saturation, time spent on mechanical ventilation and continuous positive airway pressure (CPAP), complication occurrence and mortality of the neonates. Main Results: There were a total of 40 neonates whose charts were reviewed (n= 13 and n=27 in the P and B groups respectively). The mean gestational age of the neonates were 29.2+/-2.9 and 28.8+/-2.9 weeks in the P and B groups respectively. The FiO2 was found to not be lower between the P and B groups (35.5+/-22.2 and 42.4+/-24.2, respectively; p=0.379), as well as the O2 saturation (94.6+/-4.6 and 92.3+/-6.1; p=0.194). Significance was also not found for the other clinical or economic outcomes assessed in this study. Conclusions: There was not a significant difference between poractant and beractant in FiO2, O2 saturation, or in the other clinical outcomes evaluated in this study.

Background: Previous research has demonstrated that a history of childhood maltreatment can lead to significant negative consequences across multiple domains of functioning. A significant minority of individuals remain resilience to such negative consequences, necessitating further research into the factors which protect against negative outcomes in young people who have experienced adversity. A systematic review of the literature was carried out in order to assess the evidence base for factors that predict adolescent resilience following childhood maltreatment. Several factors across the individual, family and community level were identified, however, evidence regarding these factors was mixed. Factors that have been shown to predict resilience in other age groups require further validation within adolescent samples. Aim: The first aim of this study was to investigate the role of resilience in the relationship between childhood maltreatment and psychological distress. The second aim was to address a possible role for attachment in mediating the relationship between childhood maltreatment and resilience. Method: Adolescents aged 13 – 17 who were attending Child and Adolescent Mental Health Services were asked to complete measures of childhood maltreatment, individual resilience, attachment and psychological distress. Results: Resilience was shown to mediate the relationship between maltreatment and psychological distress. Attachment avoidance was found to mediate the relationship between maltreatment and resilience but not when emotional reactivity was included in the resilience index. Attachment anxiety did not mediate the relationship between maltreatment and resilience, however, maltreatment history was found to moderate the relationship between attachment anxiety and resilience. Discussion: Generalisability of this study was limited due to possible bias within the recruited sample. Implications of the significant results are discussed along with suggestions for future research.

Abstract Respiratory distress syndrome (RDS) is a disease characterized by neonatal respiratory failure. It is principally caused by a deficiency of pulmonary surfactant, which is a lipoprotein mixture essential for reducing surface tension at the air-liquid interface of the alveolus. Prematurity is the major risk factor predisposing to RDS. Several pieces of evidence suggest the role of genetic factors in the susceptibility to this multifactorial disease. The present study was performed to determine whether polymorphisms of the surfactant protein SP-A1, SP-A2 and SP-B genes associate with RDS and to evaluate the relative contributions of genetic and environmental factors to the disease etiology. Allelic associations between the candidate genes and RDS were investigated using a matched and unmatched case-control and family-based study design. Disease concordance in monozygotic vs. dizygotic twin pairs was determined to measure the impact of heredity in RDS. SP-A and SP-B genes were shown to play a significant role in susceptibility to RDS. In very premature singleton infants born before 32 weeks of gestation, SP-A1 and SP-A2 allelic variations were associated with RDS, whereas the SP-B gene showed no direct association. Instead, the association between the high-risk (6A2, 1A0) or low-risk (6A3, 1A1/1A2) SP-A alleles and RDS was dependent on SP-B Ile131Thr variation, being restricted to a subset of infants carrying the homozygous genotype Thr/Thr. No allelic associations were evident in premature infants born after 32 weeks of gestation. RDS concordance was not significantly higher in monozygotic than in dizygotic twin pairs, implying a non-genetic disease etiology. However, the present study suggests that the concordance difference underestimates the extent of heredity. Twin pregnancies include intrauterine environmental factors that complicate the interpretation of the hereditary impact. SP-B Ile131Thr variation was associated with RDS in the first-born, but not in the second-born twins. The present results indicate that susceptibility to RDS is highly heterogeneous, involving complex environmental and genetic interactions. The degree of prematurity, singleton vs. multiple pregnancy, and birth order in a multiple birth are environmental confounders that determine disease subgroups. Genetic variations in the SP-A and SP-B genes account for part of the genetic component of RDS.

Background: Postoperative delirium (POD) is a common neurocognitive disorder in patients undergoing surgical procedures. Delirium is a disorder that is poorly understood, frequently unrecognized and associated with numerous adverse outcomes including longer hospital stays, significantly higher costs and increased morbidity and mortality. While there has been a great deal of research on proposed etiologies, risk factors and outcomes of delirium, few studies have explored the patient’s subjective experience of the phenomenon. Purpose: The purpose of this qualitative descriptive research was to investigate the patient experience of postoperative delirium and measure the distress associated with the experience. The Delirium Symptoms Experience Model (DSEM) provided the theoretical framework in which to understand the postoperative delirium experience. The three specific aims used to guide the investigation were: 1) Identify patient age, gender, race, type and length of surgery, past medical and surgical history, length of admission, delirium subtype (if known), and medications (including anesthetic agents) used in the perioperative period to better characterize the sample and provide context for the qualitative findings; 2) Describe the postoperative patients’ experience of being and feeling delirious; and, 3) Measure the distress associated with the recall of delirium using the Delirium Experience Questionnaire (DEQ) Methods: Ten participants ranging in age from 33-75 years (mean = 66.2 years of age) who experienced postoperative delirium were interviewed. Patients were screened for persistent delirium or cognitive impairment as assessed with the Confusion Assessment Method and the Mini-Cog™ Instruments. Results: Three organizing themes emerged from the content analysis: 1) Altered Perceptions of Reality; 2) Stuck in the Confusion; and, 3) Seeking Reality. The analysis of the quantitative measures and descriptive data demonstrated a high rate of psychological distress associated with delirium recall with 80% participants reporting it caused severe to very severe distress. The anesthetic drug propofol was the common medication prescribed in the perioperative period and given to all ten participants. Conclusion: Understanding this phenomenon from the patients’ perspective may provide a better understanding of the delirium experience and aid in the development of interventions and treatments to improve care and reduce suffering.

Hematopoietic stem cell transplant (HSCT) is a demanding cancer treatment for HSCT recipients and their caregivers. The thesis objectives were to (a) critically review the literature evaluating the psychosocial impact of being a caregiver to a HSCT patient; (b) evaluate a conceptual framework to examine the individual and dyadic experience of HSCT patients and their caregivers; and (c) gain a better understanding of how couples navigate the HSCT. Study 1 was a comprehensive literature review that demonstrated that caregiver distress is highest pre-HSCT and predictors of caregiver distress include female gender, elevated subjective burden, and higher patient symptom distress. This study also highlighted the need for theoretically driven research that examines reciprocal relationships between HSCT dyads. Study 2 proposed a conceptual model based on equity theory to examine the individual and dyadic experience of HSCT dyads that includes feelings of inequity, patient self-perceived burden (SPB), caregiver burden and distress. A cohort study with 72 HSCT patient-spousal caregiver dyads was conducted pre-HSCT. Questionnaire data was subjected to path analysis. Consistent with the model, pre-HSCT caregiver burden mediated the relationship between caregiver underbenefit and caregiver distress. Patient overbenefit was related to patient SPB, patient distress, and caregiver burden. Overall, the theoretical framework appeared to describe patient and caregivers individual experience of distress pre-HSCT, but did not as clearly encompass the dyadic experience of distress. Study 3 was a qualitative study of patient-caregiver dyads to gain insight on how some successfully navigate, whereas others have difficulties. One year post-HSCT five patient-caregiver dyads were interviewed separately (N =10). Five themes emerged. While all couples adopted patient and caregiver roles, four demonstrated effective adaptation whereas one couple experienced difficulties. Ongoing physical limitations, lack of mutual empathy and relational awareness, limited social support, and poor communication were associated with difficulty adjusting to the HSCT. This thesis provides a greater appreciation of the psychosocial challenges the patients and caregivers are experiencing and highlights that the experience of HSCT recipients and caregivers is unique and intertwined. Importantly, this thesis identifies current knowledge gaps in care of HSCT dyad, discusses its clinical implications and suggests avenues for future research.

Over the last three decades, there has been a growing body of literature that has described moral distress as a prominent issue that negatively affects critical care nurses. However, little focus has been given to how nurses cope and continue on in their practice despite the hardship that moral distress can cause. This study sought to reveal nurses’ strategies of coping with moral distress to allow for a better understanding of this aspect of critical care nurses’ experiences. This study adopted a qualitative design that used Thorne’s (2008) approach to interpretative description. Face-to-face, semi-structured interviews were conducted with seven critical care nurses employed within two ICUs of a tertiary care academic hospital. Interviews were analyzed using Aronson’s (1995) approach to thematic analysis. The experience of coping with moral distress had an overarching theme of being “like grass in the wind.” Four major themes were identified: Going Against What I Think is Best, Moral Distress- It’s Just Inherent in Our Job, It Just Felt Awful, and Dealing with It.

Background: Occupational stress in nursing is common worldwide; with rates of 9.20%-68.0% of nurses suffering from stress being reported in the worldwide literature. This thesis reports an investigation into stress among hospital nurses in Gaza Strip-Palestine. The purpose of this study was to determine the prevalence of occupational stress among hospital nurses in Gaza-Palestine and explore possible causal occupational stressors. Method: A quantitative survey design was employed, with a self-administered questionnaire pack being the data collection technique. Data were collected on psychological distress (GHQ-12), depression (SLC-D), sources of stress (NSS), trauma (IES-R) and demographic variables. Open questions were used to enable participants to describe their experiences of stressful events and enable the researcher to collect more in-depth information regarding some aspects of the stress domains. Data were analysed by SPSS using a variety of descriptive and inferential statistical methods: T-test, one way ANOVA and logistic regression were employed.Sample: The study population is the entire cohort of nurses who were working in the 16 hospitals in Gaza (1801 nurses; 985 males) during the period August 2009 through March 2010. Because of difficulties in access, only 1500 were able to receive questionnaire packs and 1133 were completed and returned (response rate=75.53%). Results: The results of this study revealed a high prevalence of psychological distress (63%, GHQ-12 cut-off=6), depression (59.7%, SCL-D cut-off=1.5) and trauma (69.4%, IES-R cut-off=35). The most severe occupational stressors were: ‘Not enough staff to adequately cover the unit’, ‘Lack of drugs and equipments required for nursing care’ and ‘Unpredictable staffing and scheduling’ respectively. The most frequent occupational stressors were: ‘Not enough staff to adequately cover the unit’, ‘Watching a patient suffer’ and ‘Lack of drugs and equipments required for nursing care’ respectively. As subscales, ‘Workload’ and ‘Death and dying’ were the most frequent and severe occupational stressors.Psychological distress was significantly associated with gender, age, experience, night shifts and extra-work. Depression was significantly associated with gender, hospital type, age, night shifts, experience and marital status. Severity of occupational stressors was significantly associated with age, night shifts, specialisation and qualifications. Frequency of occupational stressors was significantly associated with hospital type, experience specialisation and night shifts. Finally, trauma was significantly associated with hospital type, experience and night shifts. The predictors of psychological distress caseness (GHQ-12) were: depression caseness, uncertainty about treatment (severity), experience and qualifications of nurses. Protective factors were: extra work and experience of more than 15 years. Conclusion: Being a nurse in Gaza hospitals appears to be a stressful experience. More attention should be focused to develop an effective programme to reduce stress levels among Palestinian nurses in Gaza.

Orientation: As required by various sections in The Companies Act 71 of 2008, the appointed practitioner in a rescue must place before the court facts proving reasonable prospect; this is mainly determined through the subjective thought process of the practitioners who rely on his/her experience and knowledge in rescue and/or business management. This appears in direct contrast to the requirements set out by several court cases. There are many questions surrounding the determination of reasonable prospect as there is no benchmark for business rescue practitioners to work towards or a prescribed process to be followed. Research purpose: This article investigates different methods available to business rescue practitioners to factually determine (initial) reasonable prospect and guide the decision making process during the initial stages of the rescue. Motivation for the study: Business rescue is still in its infancy and reasonable prospect is one of the many vague but yet mandatory for initiating business rescue procedures. A better understanding of reasonable prospect and possible ways to factually measure it will contribute greatly to the business rescue regime. Research design and approach: The research studied numerous methods of determining financial distress and decline (literature) as well as relevant cases (law) of rescue accepted or declined in court, on the basis of reasonable prospect. Triangulation of findings assisted to conclude on a series of possible tools to be utilised during the business rescue process. Main findings: Reasonable prospect is mainly based on the practitioner's experience and opinion. Factually proving reasonable prospect remains difficult due to the presence of information asymmetry and the liability of data integrity. Due diligence is important and academic methods of determining financial distress/decline/position mostly serve as a communication tool to creditors. Practical/managerial implications: Business rescue practitioners and other affected parties could benefit from the insights obtained through this study. Confirming possible methods that could assist with the factual determination of (initial) reasonable prospect can contribute to business rescue education/ development as well as avoid the current conflict that surround the subject. Practical benefits for affected parties that must use reasonable prospect are also proposed. Contribution/value add: Identifying relevant methods of determining (initial) reasonable prospect may contribute to the better understanding of business rescue and possibly help future education of BRP's. / Dissertation (MCom)--University of Pretoria, 2016. / tm2016 / Business Management / MCom / Unrestricted

The purpose of the study was to explore the statistical relationships among selected variables related to gay divorced fathers in order to develop a better understanding of their gender role conflict and help-seeking behaviors. Participants (N=105) self-identified as Caucasian (91%), resided in the United States (90%), holding a bachelor's degree or higher (80%), and annual incomes of less than $80,000 (52%). The men ranged in age from 29 to 78 (M= 54), married from 1 to 38 years (M= 18), and divorced from 5 months to just under 37 years (M= 10). Participants completed an on-line questionnaire that included (a) Gender Role Conflict Scale, (b) Attitudes Toward Seeking Professional Psychological Help Scale, (c) Intentions to Seeking Counseling Inventory, (d) Hopkins Symptom Checklist, (e) two open-ended prompts, and (f) demographic questions. Participants who had received mental health services in the past were asked to report on what prompted them to seek services and the helpfulness of those services. Analysis of Pearson r was used to answer each of the research questions related to (a) GRC and psychological distress (positive correlation); (b) GRC and attitudes and intentions towards seeking psychological help (negative correlation); and (c) years married and psychological distress (negative correlation). Significance was not identified between time since divorce and any other variable. Over 80% of the participants had used mental health services with the three main reasons being coming-out, depression, and sexual identity. The most beneficial resources they had available to them and/or they would recommend to others were support groups, counseling/therapy, and general support. Findings are limited by a lack of cultural and ethnic diversity among the sample. Implications include using group counseling methods and/or a coaching model for service delivery. An informed integrated approach that focuses on systems, role development, and strategic thinking is recommended. Interventions should include depression and suicide assessments, brief solution focused methods, narrative work, social networking, and community resource guides. Future research should seek to determine between group differences with regards to the impact GRC has on one's ability to adjust to change, establish and maintain relationships, and willingness to seek help. / Ph. D.

Pediatric food allergies (FA) are increasing in prevalence and have been associated with decreased quality of life (QOL) and impairment in physical, social, academic, and family functioning; however, little is known about the risk factors for psychological distress in this cohort. This was the first large-scale study to examine child, parent, and FA-related factors that may affect functioning in youth with FA. The sample consisted of 533 mothers of children with FA and 241 mothers of children with no chronic medical conditions, recruited through online forums. Mothers completed online questionnaires assessing their child's psychosocial health, physical health, and FA characteristics, as well as their own parenting behaviors and symptoms of psychological distress. It was hypothesized that (1) FA children would exhibit poorer functioning than healthy children; (2) mothers of FA children would exhibit higher levels of psychological distress than mothers of Healthy Control (HC) children; (3) higher FA severity would predict poorer child functioning; and (4) maternal psychological symptoms, overprotection, and gender would moderate the associations between presence of FA and child functioning, and between FA severity and child functioning. Results showed that (1) FA youth exhibited significantly better functioning than healthy children; (2) mothers of FA youth reported significantly less psychological distress than mothers of healthy children; (3) higher FA severity predicted poorer child functioning; and (4) these associations were moderated by maternal depression, anxiety, stress, and overprotection, but not by gender. Specifically, associations between presence of FA and child health-related QOL, child psychosocial health, and physical health were significantly stronger among children whose mothers were more depressed, anxious, and stressed. The associations between presence of FA and child psychosocial health were significantly weaker among highly overprotective mothers, indicating that in line with the anxiety disorder literature, overprotection in mothers of children with FA may serve a maladaptive function. These findings suggest that FA youth and their mothers are a particularly vulnerable population who may benefit from psychosocial interventions to address the psychological distress and interference associated with having FA.