In three separate studies, this thesis examined stress and coping in nurse practitioners during first time exposure to post-mortem care. Using a self report questionnaire and a retrospective design, Study 1 (N=97) examined the nurse's first experience administering post-mortem care to the recently deceased. The results obtained from this exploratory investigation established that many nurses reported significant distress and used emotion-focused coping strategies (avoidance and palliation) to manage the experience. These data are consistent with those reported by others who have researched in the area, and support the hypotheses that first time exposure to post-mortem care can induce significant distress in some nurses, and that the memory is vividly recalled many years after the event. The second study used a prospective design. Base line data were collected prior to the nurse performing post-mortem care (N=59), 24 hours after they participated in their first post-mortem care procedure, and 1 and 5 weeks post-event. The General Health Questionnaire-28, the Revised Ways of Coping Checklist, the Revised Collett-Lester Fear of Death and Dying Scale, and the Impact of Event Scale were used to obtain data which were compared with that of a control group (N=59) of nurses undertaking an academic examination. The results confirmed that beginning nurse practitioners resort to using predominantly emotion-focused coping strategies when faced with stressful life events. Moreover, a direct linear relationship between the participants' fear of death and dying scores and the way they rated the impact of performing post-mortem care was found. Colaizzi's (1978) method of data analysis was used in the third and final study in the series (N=6) that explored the lived experience of nurses performing post-mortem care. The essence of the first experience was embedded in six key themes that structured the lived experience. Psychic disorganisation was experienced by the participants because they were unprepared both psychologically and educationally to deal with the experience and resorted to using emotion-focused coping strategies. It is concluded that nurses' first exposure to post-mortem care procedures is stressful and they use predominately emotion focused coping strategies to deal with the experience.

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

The first codes of the Internet made their tentative steps along the information highway in 1969, connecting two computers at UCLA. Since that time, the Internet has grown beyond institutions of research and scholarship. It is now a venue for commerce, popular culture and political discourse. The last decade, following the development of the World Wide Web, has seen access to the Internet, particularly in wealthy countries such as Australia, spread throughout the majority of the population. While this proliferation of users has created many opportunities, it also profiled questions of disadvantage. The development and continuation of a digital divide between the information ‘haves’ and ‘have nots’ was framed as a problem of ‘access.’ In the context of the increasing population online, debates into social inequity have been directed at technical barriers to access, the physical infrastructure and economic impediments to the adoption of the medium by all members of society. This doctoral research probes questions of access with greater subtlety, arching beyond the spread of broadband or the expansion of computers into schools. Forging dialogues between Internet and Cultural Studies, new theories of the screen – as a barrier and border – emerge. It is an appropriate time for such a study. The (seemingly) ever expanding growth in Internet access is stalling. New approaches are required to not only understand the pattern of events, but the type and mode of intervention that is possible. This doctoral research takes theory, politics and policy to the next stage in the history of digital access. By forging interdisciplinary dialogues, the goal is to develop the concept of ‘cultware’. This term, building on the history of hardware, software and wetware, demonstrates the imperative of understanding context in the framing and forging of exclusion and disempowerment. Mobilising the insights of postcolonial theory, Popular Cultural Studies, literacy theory and socio-legal studies, a new network of exclusions emerge that require a broader palette of interventionary strategies than can be solved through infrastructure or freeing codes. Commencing with the Universal Service Obligation, and probing the meaning of each term in this phrase and policy, there is a discussion of networks and ‘gates’ of the Digital Empire. Discussions then follow of citizenship, sovereignty, nationalism and the subaltern. By applying the insights of intellectual culture from the analogue age, there is not only an emphasis on the continuities between ‘old’ and ‘new’ media, but a confirmation of how a focus on ‘the new’ can mask the profound perpetuation of analogue injustices. Access to the Invisible Empire occurs for each individual in a solitary fashion. Alone at the screen, each person is atomised at the point where they interface with the digital. This thesis dissects that point of access. The three components of access at the screen – hardware, software and wetware – intersect and dialogue. All three components form a matrix of access. However, the ability to attain hardware, software and wetware are distinct. An awareness of how and where to attain these literacies requires the activation of cultware, the context in which the three components manifest. Without such an intersection, access is not possible. The size of the overlap determines the scale of the gateway and the value of access. There is an interaction between each of these components that can alter both the value of the access obtained and the point at which the gateway becomes viable and stable for entry into the digital discourse. A highly proficient user with developed wetware is able to extract more value, capital and currency from hardware and software. They have expert knowledge in the use of this medium in contrast to a novice user. In dissecting the complexity of access, my original contribution to knowledge is developing this concept of cultware and confirming its value in explaining digital inequalities. This thesis diagnoses the nodes and structures of digital and analogue inequality. Critical and interpretative Internet Studies, inflected and informed by Cultural Studies approaches and theories, offers methods for intervention, providing contextual understanding of the manifestations of power and social justice in a digital environment. In enacting this project, familiar tropes and theories from Cultural Studies are deployed. Particular attention is placed on the insights of postcolonial theorists. The Invisible Empire, following the path of the digital intellectual, seeks to act as a translator between the digital subaltern and the digital citizen. Similarly, it seeks to apply pre-existing off screen theory and methodology to the Invisible Empire, illuminating how these theories can be reapplied to the digitised environment. Within this context, my research provides a significant and original contribution to knowledge in this field. The majority of analyses in critical and interpretative Internet Studies have centred on the United States and Europe. While correlations can be drawn from these studies, there are features unique to the Australian environment, both socially and culturally, as well as physical factors such as the geographic separation and sparse distribution of the population, that limit the ability to translate these previous findings into an Australian context. The writer, as a white Australian, is liminally positioned in the colonial equation: being a citizen of a (formerly) colonised nation with the relics of Empire littering the symbolic landscape, while also – through presence and language – perpetuating the colonization of the Indigenous peoples. This ‘in-betweenness’ adds discomfort, texture and movement to the research, which is a fundamentally appropriate state to understand the gentle confluences between the digital and analogue. In this context, the screen is the gateway to the Invisible Empire. However, unlike the analogue gate in the city wall that guards a physical core, these gates guard a non-corporeal Invisible Empire. Whereas barbarians could storm the gates of Rome without the literacy to understand the workings of the Empire within, when an army masses to physically strike at these gates, the only consequences are a broken monitor. Questions cannot be asked at the gate to an Invisible Empire. There is no common space in which the digital subaltern and the digital citizen cohabitate. There is no node at which translation can occur. These gates to the Invisible Empire are numerous. The walls cannot be breached and the gates are only open for the citizenry with the required literacy. This literacy in the codes of access is an absolute requirement to pass the gates of Invisible Empire. The digital citizen transverses these gates alone. It is a point where the off screen self interfaces the digital self. Social interaction occurs on either side of the screen, but not at the gateway itself. Resistance within the borders of Invisible Empire is one of the founding ideologies of the Internet, tracing its origin back to the cyberpunk literature that predicted the rise of the network. However this was a resistance to authority, both on and off screen, by the highly literate on screen: the hacker and the cyber-jockey. This thesis addresses resistance to the Invisible Empire from outside its borders. Such an intervention is activated not through a Luddite rejection of technology, but by examining the conditions at the periphery of Empire, the impacts of digital colonisation, and how this potential exclusion can be overcome. Debates around digital literacy have been deliberately removed or bypassed to narrow the debate about the future of the digital environment to a focus on the material commodities necessary to gain access and the potential for more online consumers. Cultware has been neglected. The Invisible Empire, like its analogue predecessors, reaches across the borders of Nation States, as well as snaking invisibly through and between the analogue population, threatening and breaking down previous understandings of citizenship and sovereignty. It invokes new forms of core-periphery relations, a new type of digital colonialism. As the spread of Internet access tapers, and the borders of Empire close to those caught outside, the condition of the digital subaltern calls for outside intervention, the place of the intellectual to raise consciousness of these new colonial relations, both at the core and periphery. My doctoral thesis commences this project.

The clinical adherence to and combination of methods with EMDR to treat PTSD has not been explored. This is of some concern as 27 000 clinicians are trained in EMDR globally. This exploratory study gained information on Australian trained EMDR clinicians' adherence to EMDR, and the methods they combined with EMDR to treat PTSD. Survey responses from 126 clinicians were analysed using predominantly descriptive statistics. The findings of this study showed that the majority of respondents perceived that they closely adhered to the standard EMDR treatment. However, respondents reported adhering more closely to the phases than the steps of EMDR. Statistically significant findings showed that more experienced EMDR level 1 clinicians were more likely to add steps and phases to EMDR, and to change the standard sequence of steps. Clinicians with greater years of experience were also more likely to change the standard sequence of steps. In addition, more experienced EMDR level 2 clinicians, were less likely to educate their clients about PTSD. Almost all respondents combined EMDR with other methods to treat PTSD. Combined methods included CBT, hypnosis / relaxation, system / solution focused methods and exposure. This research has contributed to theory and practice by uncovering that clinicians appear to use EMDR differently to researchers, by changing EMDR to meet client needs, combining EMDR with other methods and Holly Byron 16/9/99 vi therapies, and introducing EMDR in the mid stage of treatment. These findings are vital to reduce the scientist-practitioner divide by accurately testing EMDR's efficacy and enabling future controlled trials to reflect the clinical use of EMDR.

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Thesis (Ph. D.)--University of Hong Kong, 2007. / Title proper from title frame. Also available in printed format.

This program of research investigated the nature and processes of autobiographical memory deficits in posttraumatic stress disorder (PTSD). Study 1 examined the proposition that difficulties in the retrieval of specific memories present a risk factor for posttraumatic psychopathology. A prospective study of fire-fighters found that a significant predictor of posttraumatic stress was a deficit in retrieving specific memories to positive cues before trauma. Study 2 investigated whether autobiographical retrieval deficits in PTSD can be modified by psychological treatment. Results found that as PTSD symptoms reduced following treatment, individuals with PTSD retrieved more specific memories to positive cues. Together, these results indicated that specific retrieval deficits to positive cues present a vulnerability factor for PTSD. However, this memory style appears to be receptive to modification following therapy. Study 3 investigated the association between autobiographical retrieval deficits and impaired problemsolving in PTSD. Participants with PTSD retrieved more overgeneral categoric memories and took longer to retrieve memories than non-PTSD trauma controls. This deficit was associated with impaired social problem-solving, suggesting that specific retrieval is related to successful problem solving. In an analogue design, Studies 4 and 5 investigated the proposition that resource limitations may underpin autobiographical retrieval deficits. Results generally supported the proposal that reduced cognitive resources may be a mechanism contributing to specific retrieval deficits. Studies 6 and 7 examined rumination as another possible mechanism responsible for these retrieval deficits. Study 6 found high anxious participants retrieved fewer specific memories to positive cues following rumination, compared to distraction. Study 7 found evidence that negative rumination in the high anxious group increased categoric retrieval, whereas positive rumination had no effect. Study 8 found retrieval of trauma-related self-defining memories was strongly associated with personal goals connected to the trauma. Study 9 found that discrepancies in one???s self construct were related to the retrieval of trauma memories to positive cues. This program of research extends current theories of autobiographical memory by identifying risk, maintenance, and recovery factors in the context of PTSD.

This program of research investigated the nature and processes of autobiographical memory deficits in posttraumatic stress disorder (PTSD). Study 1 examined the proposition that difficulties in the retrieval of specific memories present a risk factor for posttraumatic psychopathology. A prospective study of fire-fighters found that a significant predictor of posttraumatic stress was a deficit in retrieving specific memories to positive cues before trauma. Study 2 investigated whether autobiographical retrieval deficits in PTSD can be modified by psychological treatment. Results found that as PTSD symptoms reduced following treatment, individuals with PTSD retrieved more specific memories to positive cues. Together, these results indicated that specific retrieval deficits to positive cues present a vulnerability factor for PTSD. However, this memory style appears to be receptive to modification following therapy. Study 3 investigated the association between autobiographical retrieval deficits and impaired problemsolving in PTSD. Participants with PTSD retrieved more overgeneral categoric memories and took longer to retrieve memories than non-PTSD trauma controls. This deficit was associated with impaired social problem-solving, suggesting that specific retrieval is related to successful problem solving. In an analogue design, Studies 4 and 5 investigated the proposition that resource limitations may underpin autobiographical retrieval deficits. Results generally supported the proposal that reduced cognitive resources may be a mechanism contributing to specific retrieval deficits. Studies 6 and 7 examined rumination as another possible mechanism responsible for these retrieval deficits. Study 6 found high anxious participants retrieved fewer specific memories to positive cues following rumination, compared to distraction. Study 7 found evidence that negative rumination in the high anxious group increased categoric retrieval, whereas positive rumination had no effect. Study 8 found retrieval of trauma-related self-defining memories was strongly associated with personal goals connected to the trauma. Study 9 found that discrepancies in one???s self construct were related to the retrieval of trauma memories to positive cues. This program of research extends current theories of autobiographical memory by identifying risk, maintenance, and recovery factors in the context of PTSD.

Vaccinia virus encodes at least eight proteins that are modified post-translationally by the addition of a 16-carbon saturated fatty acid through thioester linkage to cysteine residues. This is referred to as palmitylation of proteins. The purpose of this work was to gain an understanding of palmitylation, focusing on what defined the substrate for the modification, and the biological relevance of protein palmitylation in the vaccinia virus life cycle. A systematic approach was taken to identify the genes in vaccinia virus that encode these proteins. We found that vaccinia virus palmitylproteins are of the "late" temporal class, associate with intracellular membranes, and are specific for a particular form of the infectious virion. These criteria were used to narrow the number of genes expressed by vaccinia virus that potentially encode palmitylproteins. The "candidate" palmitylprotein genes were cloned and transiently expressed in mammalian tissue culture cells and analyzed for incorporation of palmitic acid. In addition to three previously identified vaccinia virus palmitylproteins, three new palmitylproteins were identified. The six known palmitylprotein genes were mutated to determine the site of modification, leading to the identification of the modification site for four of the six proteins. One of the proteins, p37, was analyzed further for biological significance of the palmitate modification. A recombinant vaccinia virus was constructed that did not express the wild-type palmitylated form of p37, but expressed a nonpalmitylated form of the protein instead. This virus was severely inhibited from proceeding past a particular morphogenetic stage, leading to an attenuated phenotype in tissue culture systems. Although the expression of the nonpalmitylated protein appeared normal compared to the wild-type protein, the lack of the palmityl moiety resulted in the loss of a targeting signal that directed the protein to its normal intracellular location. By this work, significant contributions have been made toward understanding the process of protein palmitylation. We have identified, at least for vaccinia virus, primary structural determinants specifying the modification, leading to the identification of a palmitylation motif. Considering the attenuated phenotype of the mutant virus, our conclusion is that palmitylation is necessary for biological function, at least for p37. / Graduation date: 1999

The attachment of myristic acid to the N-terminal glycine residue of many eukaryotic and viral proteins is often essential for the acquisition of the protein's biological activity. Vaccinia virus (VV), the prototype member of the Poxviridae, expresses several myristylated proteins during the course of infection. Only one of these proteins, L1R, has been identified and characterized. Experiments were performed to identify and analyze four additional VV myristylproteins. These proteins were identified as the A-type inclusion protein (92 kDa), G9R (39 kDa), A16L (36 kDa), and E7R (17 kDa). The latter three proteins were shown to be myristylated on an N-terminal glycine residue. Additional studies demonstrated that both A16L and E7R are soluble proteins, unlike L1R, which is a constituent of the viral envelope. Furthermore, A16L could not be detected in either purified extracellular enveloped virus (EEV) or in intracellular mature virus (IMV). These are the two predominant forms of infectious virions produced during a VV infection. E7R was detected in EEV and, to a lesser extent, in IMV. Unlike the other proteins, the amino terminal sequence of the A-type inclusion protein did not fit the consensus sequence for N-myristylation (M-G-X-X-X-S/T/A/C/N), suggesting that it was internally myristylated. A combination of studies revealed that the protein is both myristylated and palmitylated. Addition of each acyl group could be separated temporally: myristylation occured co-translationally, while palmitylation occurred post-translationally. Genetic analyses of lysine doublets and arginine/lysine doublets within the A-type inclusion protein indicated that these sites are not utilized for myristylation. This is in contrast to the precursors of TNFoc and Ilia which are internally-myristylated on a lysine doublet. It is not clear why this protein would be both myristylated and palmitylated. Only class four palmitylproteins, such as the Src family of proteins, have been shown to be both myristylated and palmitylated. The A-type inclusion protein expressed by cowpox virus forms a large symmetrical matix in the cytoplasm of infected cells and generally contains mature virions. It is possible, therefore, that the function of acylation may be to stabilize the protein matrix or to assist in occlusion of enveloped virus particles. / Graduation date: 1998