The survival rate and life expectancy of infants with complex health needs have increased overthe last decades, and this increases the number of families who have to care for such infants at home. These families seek support in the community setting, and supporting them has a positive impact on the well-being of both the parents and the infant. In South Africa the needs of these parents are not known, and this fact makes it difficult to adequately support them in the community. The aim of this study was to explore and describe the needs of parents of infants with complex health needs in the community setting. Two objectives were set to reach the aim mentioned above: 1) to critically appraise and synthesise the best available evidence on the support needs of parents of infants with complex health needs and 2) to explore and describe parents’ emic perspective on their support needs as parents of infants with complex health needs in a South African context. A sequential mixed method approach was utilised in two phases, here discussed in five chapters. In an attempt to meet objective one, the support needs of parents of infants with complex health needs were determined by means of an integrative literature review from studies obtained through computerised searches of several electronic databases, supplemented by checking reference lists and consultation with experts. This was followed by individual face-to-face interviews with the stated parents in three different settings. The latter addressed the second objective of the study, namely to provide an emic perspective on the support needs of parents of infants with complex health needs in a South African context. The integrative literature review described five main themes on the support needs of parents of infants with complex health needs: need for information, need for parent-to-parent support, need for professional support, need for self-confidence in the care of the infant and need for social support. All of these themes were confirmed in the South African context through the interviews with parents. However, South African parents added an additional theme: the need for normality. The final chapter offers an evaluation of the study and discusses study limitations and recommendations for nursing practice, education and research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

The handling of gradient calculations on non-orthogonal meshes in the Finite Volume Method (FVM) is important in the modelling of complex geometries, since different implementation methods have an influence on the accuracy and the stability of the solution. The application in the current study is the numerical solution of heat conduction in a complex geometry. It finds relevance in many engineering applications such as the Micro-Channel Heat Exchanger (MCHE) that acts as a recuperator in a High Temperature Reactor (HTR) power generation cycle. A program based on the FVM was developed in Excel for the solution of the diffusion equation on a non-orthogonal mesh. A test case of heat conduction in a rectangular block, meshed with a tetrahedral mesh, was solved with the Excel code. The same test case was solved with OpenFOAM. The results of the two codes were compared. Small differences were found and their origins were traced to slightly different implementation methods. Knowledge of the differences in implementation between the two codes resulted in a better understanding of the aspects that influenced accuracy and stability. Computations on meshes with the presence of mesh skewness and non-orthogonal mesh lines at boundaries were performed and an accompanying decrease in accuracy was observed. The results showed that the standard FVM as implemented in the Excel code and in OpenFOAM will need advanced methods to compensate for mesh skewness and non-orthogonality found at boundaries. During the study, a deeper knowledge and understanding was gained of the challenge of obtaining accurate solutions of heat conduction on non-orthogonal meshes. This knowledge may lead to the overall improvement of the simulation of heat transfer models in general and for the MCHE specifically. / Thesis (MIng (Nuclear Engineering))--North-West University, Potchefstroom Campus, 2013.

Studies of MHWs, (social workers, social auxiliary workers, trauma counsellors, and telephone counsellors), who work with trauma and stress, often focus on pathological symptoms and on the need to develop psycho-education programmes (Figley, 2002; Johnson & Hunter, 1997; Mac Ritchie & Leibowitz, 2010; Mikulincer, 1994; Stiles, 2002). A gap was identified how MHWs, who continuously intervene with traumatised children, cope with the stressors associated with their work. The purpose of this research was to explore the coping strategies of Mental Health Workers (MHWs) exposed to Secondary Trauma (ST)as a result of having to deal day to day with children (younger than 18) who have experienced trauma, including sexual, physical and emotional abuse, as well as the witness of violence. The MHWs’ coping responses were investigated using a qualitative case study approach. The investigation showed how MHWs constructed their realities by examining their coping strategies and the individual meanings they assigned to these. A convenience sample, based on the availability of participants, was selected. Nine women and one man, ranging in age from 26 to 57 years, employed at Childline Gauteng, participated in the research. The Mmogo-Method®, a projective visual research technique, explored the MHWs’ coping experiences through qualitative data collection methods. Visual and textual data were gathered and analysed thematically. It was found that the MHWs at Childline Gauteng displayed two main coping styles, namely intrapersonal and relational coping strategies. In the face of their daily stressors, MHWs managed to cope successfully by using strategies that are embedded in their daily activities. Their ability to find alternative ways to cope, despite continuous exposure to children’s trauma, allowed the MHWs to fulfil their work obligations. Their intrapersonal coping strategies reflected an ability to draw on their inner resources. Being aware of their environment and how it affects them, MHWs were able to regulate themselves and their environments by adopting positive attitudes. These attitudes, and the MHWs’ dispositions, positively affected their outlook on life. Moreover, MHWs maintained a healthy distance from their stressful environment by means of meaningful disengagement. Meaningful disengagement was fundamental to creating solitude as a coping strategy. Personal and professional boundaries, self-care and being able to draw on spirituality were further coping resources. MHWs’ discussions about finding meaning in their work revealed that they would not be able to do their work if they did not experience it as spiritually significant. Drawing on external resources, relational coping strategies included supportive relationships with family, friends and colleagues. Reciprocal unconditional acceptance significantly contributed to coping because it was important for MHWs to experience family and friends' attitudes as supportive and non-judgemental. MHWs encountered an organisational culture of care in the form of freedom to interact with colleagues and managers and sharing experiences. This interaction contributed to successful coping because MHWs felt comfort in the knowledge that they were not alone when dealing with children's trauma. This interaction facilitated coping because MHWs were able to interface successfully with their environment, even in difficult circumstances. In conclusion, the MHWs provided nuanced descriptions of the ways in which they experienced coping strategies. They coped with the demands of their profession by using internal and external resources, including intrapersonal and relational coping. / MA (Research Psychology), North-West University, Potchefstroom Campus, 2014

The survival rate and life expectancy of infants with complex health needs have increased overthe last decades, and this increases the number of families who have to care for such infants at home. These families seek support in the community setting, and supporting them has a positive impact on the well-being of both the parents and the infant. In South Africa the needs of these parents are not known, and this fact makes it difficult to adequately support them in the community. The aim of this study was to explore and describe the needs of parents of infants with complex health needs in the community setting. Two objectives were set to reach the aim mentioned above: 1) to critically appraise and synthesise the best available evidence on the support needs of parents of infants with complex health needs and 2) to explore and describe parents’ emic perspective on their support needs as parents of infants with complex health needs in a South African context. A sequential mixed method approach was utilised in two phases, here discussed in five chapters. In an attempt to meet objective one, the support needs of parents of infants with complex health needs were determined by means of an integrative literature review from studies obtained through computerised searches of several electronic databases, supplemented by checking reference lists and consultation with experts. This was followed by individual face-to-face interviews with the stated parents in three different settings. The latter addressed the second objective of the study, namely to provide an emic perspective on the support needs of parents of infants with complex health needs in a South African context. The integrative literature review described five main themes on the support needs of parents of infants with complex health needs: need for information, need for parent-to-parent support, need for professional support, need for self-confidence in the care of the infant and need for social support. All of these themes were confirmed in the South African context through the interviews with parents. However, South African parents added an additional theme: the need for normality. The final chapter offers an evaluation of the study and discusses study limitations and recommendations for nursing practice, education and research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

The handling of gradient calculations on non-orthogonal meshes in the Finite Volume Method (FVM) is important in the modelling of complex geometries, since different implementation methods have an influence on the accuracy and the stability of the solution. The application in the current study is the numerical solution of heat conduction in a complex geometry. It finds relevance in many engineering applications such as the Micro-Channel Heat Exchanger (MCHE) that acts as a recuperator in a High Temperature Reactor (HTR) power generation cycle. A program based on the FVM was developed in Excel for the solution of the diffusion equation on a non-orthogonal mesh. A test case of heat conduction in a rectangular block, meshed with a tetrahedral mesh, was solved with the Excel code. The same test case was solved with OpenFOAM. The results of the two codes were compared. Small differences were found and their origins were traced to slightly different implementation methods. Knowledge of the differences in implementation between the two codes resulted in a better understanding of the aspects that influenced accuracy and stability. Computations on meshes with the presence of mesh skewness and non-orthogonal mesh lines at boundaries were performed and an accompanying decrease in accuracy was observed. The results showed that the standard FVM as implemented in the Excel code and in OpenFOAM will need advanced methods to compensate for mesh skewness and non-orthogonality found at boundaries. During the study, a deeper knowledge and understanding was gained of the challenge of obtaining accurate solutions of heat conduction on non-orthogonal meshes. This knowledge may lead to the overall improvement of the simulation of heat transfer models in general and for the MCHE specifically. / Thesis (MIng (Nuclear Engineering))--North-West University, Potchefstroom Campus, 2013.

Hensikt Studiens hensikt varå kartlegge ulike faktorer som kan bidra til å fortsette med fysisk aktivitet etter en intervensjon i frisklivssentral, sett fra brukernes ståsted. Metode Datainnsamlingen bleforetatt gjennom fem fokusgruppeintervjuer med til sammen 23 deltagere. Personer som hadde deltatti frisklivssentral med frisklivsresept for ett til fire år siden, og hadde fortsatt med regelmessig trening i etterkant, varde som kunne deltai studien. Kvalitativ analyse med en fenomenografisk tilnærmingble benyttet. Resultat Analysen resulterte i tre beskrivelseskategorier: (i) Frisklivsresept er et virksomt helsetilbud, ( ii) Treningsgrupper og treningsmuligheter i nærmiljøet skaper motivasjon, (iii) Trening gir mestring og helsegevnint som fører til varige treningsrutiner Konklusjon Frisklivsresept i regi av frisklivssentral er et helsetilbud som kan bidra til at deltakerne utvikler kunnskap, ferdigheter og kompetanse til å fortsette med fysisk aktivitet etter reseptperioden. Treningsgrupper med egnet trening og aktiviteter, arrangementer og aktivitetsarenaer i nærmiljøet motiverer til fysisk aktivitet. Opplevelse av mestring av fysisk aktivitet, samt å erfare helsegevinst som bedret fysisk form, økt kapasitet og psykisk velvære motiverer til å fortsette med fysisk aktivitet etter en periode i frisklivssentralen / Aim This studyaimed to identify various factors that contribute to continue physical activity following an interventionby Frisklivssentralen (i.e.,physical activity onprescription), as seen from theuser`s perspective. Method We interviewed 23 adults divided into five focus groups. The criteria for selecting people was that they had participated in the programme, exercise on prescription,oneto four years ago, and had continued with regular exercise for at least three hours weekly. We used qualitative analysis anda phenomenographic designto examine all data. Results We identified three categories: (i) physical activity on prescription is a useful intervention (ii) organized groups and training opportunities in the community motiv atestobeing active, (iii)mastering physical exercise providesa sense of accomplishment,and gives health benefits thatinspire ongoing physical activity. Conclusion Physical activity on prescriptionin a Frisklivssentral (public healthcare center) can help participants to acquire knowledge and skills to be able to continue with physical activity after the prescription period. Exercise groups with appropriate training and activities, events and activity settingsin the community encourages physicalactivity. Mastering physical activity and experiencing its health benefits (e.g., improved physical fitness and improved quality of life in general)can motivate people to remainphysically active / <p>ISBN 978-91-86739-75-1</p>

The aim of this study is to investigate the resemblance between the developmental stages and developmental tasks of the seven chakras (Judith, 1996) and Erik Erikson’s developmental theory (Bee, 1996). The researcher aims to describe the similarities between the chakra system and developmental psychology. The discussion of literature was divided into two components. Firstly, Stages 1-8 of Erikson’s developmental theory were discussed. Secondly, the chakra system was discussed. The researcher discussed the following concepts to explain the term chakra system: the human and the body; chakra definitions and associations, chakra names, and the colours associated with the chakras. For the purposes of this study, the functions of the separate chakras and the development of the chakra system were focal points. The study was done at a private yoga organisation in Durbanville, Cape Town, where the participants of the study regularly took part in classes. These participants were chosen because of their reliability (adults and regular participation) and their receptivity for alternative healing. Their age and gender was also relevant to the study, because the researcher used non-probability sampling. The main prerequisites for individuals to participate in the study were regular attendance and the individuals’ status as adults. / Dissertation (MA(Couns Psych))--University of Pretoria, 2005. / Psychology / unrestricted

<p>U okviru ovog rada izvr&scaron;eno je ispitivanje različitih procesa ekstrakcije herbe industrijske konoplje. Za ekstrakciju određenih bioaktivnih jedinjenja primenjene su klasične tehnike ekstrakcije, maceracija i Soxhlet ekstrakcija, dok su od savremenih metoda primenjene ultrazvučna ekstrakcija, mikrotalasna ekstrakcija, ekstrakcija vodom u subkritičnom stanju i ekstrakcija ugljendioksidom u superkritičnom stanju. Praćenjem uticaja ulaznih promenjivih (procesnih parametara) na odabrane izlazne promenjive (sadržaj bioaktivnih jedinjenja ili antioksidativnu aktivnost) za svaku tehniku ekstrakcije pojedinačno utvrđeni su optimalni uslovi ekstrakcije. Nakon izvr&scaron;enog poređenja odabrana je najadekvatnija tehnika ekstrakcije za pripremu tečnog ekstrakta koji će biti transformisan u suvi ekstrakt primenom metode su&scaron;enja raspr&scaron;ivanjem. Prilikom dobijanja suvog ekstrakta ispitan je uticaj različite koncentracije nosača na kvalitet ekstrakata i efikasnost su&scaron;enja. Dobijeni ekstrakti su okarakterisani u pogledu fizičkih i hemijskih osobina. Sadržaj kanabinoida u tečnim ekstraktima suve herbe industrijske konoplje ispitanih u ovoj doktorskoj disertaciji je bio u opsegu od 0,4314 mg/mL CBD-a i 0,0364 mg/mL THC-a (u optimalnom ekstraktu dobijenom maceracijom) do 1,0420 mg/mL CBD-a i 0,0430 mg/mL THC-a (u optimalnom ekstraktu dobijenom mikrotalasnom ekstrakcijom). U ekstraktima koji su nepolarnog karaktera i koji su dobijeni primenom Soxhlet ekstrakcije sadržaj CBD-a i THC-a je bio 64,40 i 2,90 mg/g, dok je primenom superkritične ekstrakcije dobijen sadržaj CBD-a i THC-a u opsegu od 76,1193 do 163,1111 mg/g i od 4,1746 do 6,5803 mg/g. Tečni ekstrakti dobijeni primenom vode i etanola kao ekstragensa bili su bogati flavonoidima i fenolima, a utvrđeno je i da imaju značajnu antioksidativnu aktivnost, dok su ekstrakti dobijeni Soxhlet ekstrakcijom i ekstrakcijom ugljendioksidom u superkritičnom stanju bili bogati lipofilnim jedinjenjima i terpenima. Ovako dobijeni ekstrakti predstavljaju visokovredne proizvode koji imaju veliki potencijal za upotrebu u farmaceutskoj industriji.</p> / <p>Various extraction processes of the aerial parts of industrial hemp were examined. From classic extractions, maceration and Soxhlet extraction were applied, while from novel methods, ultrasound-assisted extraction, microwave-assisted extraction, subcritical water extraction and supercritical carbon dioxide extraction were applied. By monitoring the influence of the input variables on the selected output variables for each extraction, the optimal extraction conditions were determined separately. After a comparison of all the extraction processes tested, microwave-assisted extraction was selected to prepare the liquid extract for spray drying. The effect of different carrier concentrations was examined during the preparation of the dry extract. The extracts obtained were characterized in terms of physical and chemical properties. The content of cannabinoids in liquid extracts of dry Cannabis sativa herba examined ranged from 0.4314 mg/mL for CBD and 0.0364 mg/mL for THC in the optimum extract obtained by maceration to 1.0420 mg/mL for CBD and 0.0430 mg/mL for THC in the optimum extract obtained by microwave-assisted extraction. The CBD and THC content in extract obtained by Soxhlet extraction was 64.4000 mg/mL and 2.9000 mg/mL, respectively, while the highest content of CBD and THC in the supercritical carbon dioxide extract was 163.11 and 6.5803 mg/g. In addition to cannabinoids, the liquid extracts obtained were rich in phenols and flavonoids, and have considerable antioxidant activity, while the extracts obtained by Soxhlet extraction and supercritical carbon dioxide were rich in lipophilic compounds and terpenes. The extracts mentioned above are high value products which have great potential for implementation in the pharmaceutical industry.</p>

<p>UVOD: Drenaža grudnog ko&scaron;a nakon resekcija pluća je osnovni grudno hirur&scaron;ki postupak, koji omogućuje pro&scaron;irenje (reekspanziju) pluća iz kolabiranog stanja, evakuaciju vazduha, krvi i izliva iz pleuralnog prostora i potpomognuta je primenom aspiracije na drenove (sukciona ili aspiraciona drenaža). Iako je drenaža&nbsp; svakodnevna grudno hirur&scaron;ka procedura, postupak sa drenovima je zasnovan prvenstveno na iskustvu, a manje na osnovu naučnih studija. Pri mirnom disanju inspiratorni pritisak u pleuralnom prostoru je prosečno - 8 cm H2O, a ekspiratorni - 4 cm H2O. Pri forsiranom disanju pritisci mogu dostići - 50 cm H2O i +70 cm H2O. Na osnovu tih fiziolo&scaron;kih podataka, većina hirurga primenjuje aspiraciju od - 10 do - 40 cm H2O. Koncepta pleuralnog deficita - disproporcije volumena preostalog plućnog tkiva i zapremine grudnog ko&scaron;a doveo je do razvoja tehničkih postupaka za postizanje nove fiziolo&scaron;ke ravnoteže u pleuralnom prostoru i razmatranja rutinske primene podvodne (pasivne) drenaže nakon resekcija pluća. Pritisak na zdravstvenu službu za smanjenje tro&scaron;kova i skraćenje postoperativne hospitalizacije uz mogućnost rane mobilizacije pacijenta čine podvodnu drenažu zanimljivom alternativom tradicionalno prihvaćenoj aktivnoj aspiraciji na drenove.&nbsp; CILJ: Da se utvrdi da li aplikacija aktivne aspiracije na drenove nakon lobektomije pluća u poređenju da podvodnom drenažom ima povoljno terapijsko dejstvo na postizanje i održavanje reekspanzije pluća; Da se kvantitativno uporede različiti modovi aktivne aspiracije preko drenova; Da se uporedi dužina hospitalizacije i pojava hirur&scaron;kih i nehirur&scaron;kih komplikacija između grupa ispitanika kod kojih se primenjuje podvodna (pasivna) drenaža i aspiracija preko drenova. METODOLOGIJA: Prospektivna studija bez randomizacije obuhvatila je 301 ispitanika kojima je načinjena lobektomija pluća zbog karcinoma pluća na Klinici za grudnu hirurgiju Instituta za plućne bolesti Vojvodine u Sremskoj Kamenici u periodu od 01.01.2008. - 28.02.2010. godine. Beleženi su i analizirani podaci o preoperativnom stanju: plućnoj funkciji, prethodno primljenoj neoadjuvantnoj hemioterapiji i pridruženim bolestima. Analizirani su hirur&scaron;ki operativni podaci o postojanju buloznog emfizema, adhezija u pleuralnom prostoru, anatomskoj vrsti lobektomije, dodatnim hirur&scaron;kim procedurama i postojanju gubitka vazduha na kraju operacije. Analizirani su postoperativni podaci o secernaciji na drenove tokom prva 24 h i ukupno, trajanju gubitka vazduha na drenove u danima, ukupnom trajanju drenaže, ukupnom trajanju hospitalizacije, pojavi produženog gubitka vazduha na dren definisanog kao gubitak duže od 7 dana, potrebi za redrenažom grudnog ko&scaron;a (broj drenova upotrebljenih za redrenažu), kompletnost reekspanzije pluća pre vađenja drenova, pojavi drugih hirur&scaron;kih komplikacija, pojavi op&scaron;tih medicinskih komplikacija i pojavi kasnih komplikacija &ndash; vi&scaron;e od 30 dana nakon operacije ili nakon otpusta. Prvu grupu ispitanika sačinjavaju pacijenti kojima je načinjena lobektomija pluća, nakon čega je aplikovana aspiracija od -20 cm vodenog stuba do klemovanja i vađenja drenova. Drugu grupu ispitanika sačinjavaju pacijenti kojima je aplikovana aspiracija od -20 cm vodenog stuba na dan operacije i zatim -10 cm vodenog stuba do klemovanja i vađenja drenova. Treću grupu ispitanika sačinjavaju pacijenti kojima je načinjena lobektomija pluća, nakon čega je aplikovana aspiracija od -20 cm vodenog stuba na dan operacije i zatim podvodna drenaža do klemovanja i vađenja drenova. Četvrtu grupu ispitanika sačinjavaju pacijenti kojima je načinjena lobektomija pluća, nakon čega je aplikovana aspiracija od -20 cm vodenog stuba na dan operacije i zatim dnevna procena i modifikacija na sledeći način: aspiracija od -20 cm vodenog stuba do postizanja reekspanzije pluća, zatim postepeno smanjenje aspiracije po nahođenju operatera do klemovanja i vađenja drenova. REZULTATI: Između grupa ispitanika ne postoji statistički značajna razlika po starosti (p=0,77),&nbsp; parametrima plućne funkcije: vrednost FEV1 (p=0,6316), vrednost ITGV (p=0,6202), vrednost TLC (p=0,6922) i za vrednost RV ne postoji razlika (p=0,6552). Razlika ne postoji između grupa ni u učestalosti pridruženih bolesti (p=0,4522). Grupe su međusobno homogene po preoperativnim parametrima. Snižen FEV1 u ukupnoj populaciji pacijenata nije uticao na pojavu produženog gubitka vazduha (P=0,571), kao ni povi&scaron;enje ITGV (P=0,22), RV (p=0,912), niti vrednost TLC (0,521). Upoređene su međusobno osnovne vrste lobektomija: desna gornja, leva gornja, desna donja, leva donja, srednja lobektomija, kao i donja i gornja bilobektomija desno. Kako je učestalost svake pojedinačne lobektomije u 4 grupe ispitanika mali da bi se uporedile iste lobektomije između grupa, poređenje je moguće samo između anatomski različitih lobektomija kumulativno u svim grupama. Razlika u pojavi produženog gubitka vazduha između različitih lobektomija postoji, ali nije dostigla statističku značajnost (p=0,061). Međutim, kada se analizira svaka lobektomija pojedinačno, uočava se da desna donja bilobektomija ima značajno veću učestalost produženog gubitka vazduha u odnosu na sve ostale lobektomije zajedno (P=0,009). Razlika u dužini drenaže kod&nbsp; različitih lobektomija je dostigla statistički značaj (p=0,0356), kao i u ukupnoj dužini hospitalizacije (p=0,0007). Dodatak resekcije perikarda, grudnog zida ili dijafragme, klinasta resekcija susednog režnja ili sleeve resekcija bronha kao dodatne procedure nisu uticali na pojavu produženog gubitka vazduha (p=0,58). Podaci o učestalosti adhezija u ispitivanoj populaciji pacijenata i njihovom uticaju na pojavu produženog gubitka vazduha daju granične vrednosti. I ovde je broj pacijenata u svakoj pojedinačnoj kategoriji adhezija (postojanje adhezija na skali od 0-3) mali da bi testiranje povezanosti sa produženim gubitkom vazduha moglo dostići statističku značajnost - razlika postoji, ali nije značajna (p=0,065). Radi povećanja statističke snage je izvedeno testiranje za podelu ima ili nema adhezija. Razlika postoji, ali ni ovim testiranjem nije dostignuta statistički značajna razlika (p=0,057). Postojanje buloznog emfizema takođe dovodi do povećanja učestalosti produženog gubitka vazduha, ali ni ovde razlika nije značajna (p=0,063).&nbsp; Primena hemoterapije pre operacije nije dovela do statistički značajne razlike u pojavi produženog gubitka vazduha (p=0,0623) i ukupnoj stopi komplikacija (p=0,088), kao ni dužine hospitalizacije (p=0,2), iako razlika postoji i paradoksalno rezultat je bolji kod pacijenata koji su primili hemioterapiju, &scaron;to može ukazivati na uticaj selekcije pacijenata za operaciju. Između 4 grupe ispitanika nije uočena razlika u potrebi za redrenažom grudnog ko&scaron;a (p=0,101), potrebi za povećanjem nivoa aktivne aspiracije (p=0,326), ukupnoj pojavi komplikacija (p=0,087) i pojavi produženog gubitka vazduha (P=0,323). Razlika postoji i visoko je značajna u dužini trajanja drenaže (p=0,001) i dužini hospitalizacije (P=0,000). Broj drenova (1 ili 2 drena postavljena intraoperativno) nije uticao na pojavu produženog gubitka vazduha (p=0,279), ali je značajno kraća hospitalizacija kod pacijenata sa jednim drenom (p=0,0001). Logistička regresiona analiza je pokazala da je samo donja bilobektomija značajno uticala na pojavu produženog gubitka vazduha na dren, dok nije nađen uticaj aktivne aspiracije na drenove, prisustva adhezija, buloznog emfizema, sniženih vrednosti FEV1, primene redukcije pleuralnog prostora (space reducing), broja drenova i dodatne operacije (resekcije). ZAKLJUČAK: Sprovedenim istraživanjem utvrđeno je da primena aktivne aspiracije na drenove ne pokazuje razliku u odnosu na podvodnu drenažu u postizanju i održavanju reekspanzije pluća nakon lobektomije. Aktivna aspiracija ne utiče na pojavu produženog gubitka vazduha na drenove definisanog kao gubitak vazduha duže od 7 dana, ali utiče na produženje ukupnog trajanja drenaže i hospitalizacije. Nivo aktivne aspiracije ili primena dnevnih modifikacija nivoa aspiracije ne utiče na rezultate lečenja.&nbsp; U ovom istraživanju preoperativna plućna funkcija, kao ni preoperativna hemoterapija ne utiču na pojavu produženog gubitka vazduha na drenove. Desna donja bilobektomija u odnosu na sve druge lobektomije dovodi do če&scaron;će pojave produženog gubitka vazduha, produžene drenaže i hospitalizacije. Dodatne resekcije okolnih tkiva u sklopu lobektomije ili primena redukcije pleuralnog prostora ne utiču na pojavu produženog gubitka vazduha. Intraoperativni nalaz adhezija u pleuri i buloznog emfizema pluća povećavaju rizik produženog gubitka vazduha, ali je taj uticaj na granici statističke značajnosti. Primena jednog drena nakon lobektomije umesto dva ne utiče na pojavu produženog gubitka vazduha, ali utiče na skraćenje drenaže i hospitalizacije. U multivarijatnoj analizi samo je donja bilobektomija značajno uticala na pojavu produženog gubitka vazduha na dren, dok nije nađen uticaj aktivne aspiracije na drenove, prisustva adhezija, buloznog emfizema, sniženih vrednosti FEV1, primene redukcije pleuralnog, broja drenova i dodatne resekcije okolnih tkiva.</p> / <p>INTRODUCTION: The drainage of the thorax after pulmonary resection is a basic thoracic surgery procedure which enables reexpansion after lung collapse and the evacuation of air, blood and effusion from the pleural cavity. It is supported by the use of drainage aspiration (suction or aspiration drainage). Although drainage is an everyday procedure in thoracic surgery, the use of drains is based mainly on specialist experience and less on scientific research. During calm breathing the inspiratory pressure in the pleural cavity is &ndash; 8cm H2O on average, while the expiratory pressure is &ndash; 4cm H2O. During forced breathing the pressures can reach up to &ndash; 50 cm H2O and + 70 cm H2O. Based on this physiological data, most surgeons apply the aspiration from &ndash; 10 to &ndash; 40 cm H2O. The concept of pleural deficit (the disproportion of the volume of the remaining pulmonary tissue and the volume of the thorax) has attributed to development of new technical procedures in order to achieve a new physiological balance in the pleural cavity. It has also brought upon the consideration of routine underwater seal drainage after pulmonary resection. Underwater seal drainage represents an interesting alternative to the traditional active drainage aspiration, especially considering the need to reduce medical expenses and shorten the postoperative hospitalization period. AIM: To determine whether active drainage aspiration after pulmonary lobectomy has a favorable therapeutic effect on achieving and maintaining pulmonary reexpansion in comparison with underwater seal drainage; to quantitatively compare the different modes of active drainage aspiration; to compare hospitalization duration and surgical and non-surgical complication with groups of patients on whom either underwater seal drainage or aspiration drainage was applied. METHODOLOGY: The prospective study without randomization has covered 301 patients on whom pulmonary lobectomy was performed due to lung carcinoma at the Thoracic Surgery Clinic of the Institute of Pulmonary Diseases of Vojvodina from 1st January 2008 to 28th February 2010. The data collected in the pre-operative state included: pulmonary function, previous neoadjuvant chemotherapy and comorbidities. In the research, surgical operative data and postoperative data were analyzed. Surgical operative data included information about the bullous emphysema, adhesion in the pleural cavity, anatomic type of lobectomy, additional surgical procedures and air leak after surgery. Postoperative data involved information about amount of fluid on drainage during the first 24 hours and in total, air leak duration in days, total drainage period, overall hospitalization period, prolonged air leak defined as leak longer than 7 days, the need for redrainage of thorax (number of tubes used for redrainage), completeness of pulmonary reexpansion before the end of drainage, other surgical complications, comorbidities and late complications (after more than 30 days following the surgery or release). The first group consists of patients on whom pulmonary lobectomy was performed, after which an aspiration of &ndash; 20 cm H2O was applied before clamping and tube extraction. The second group consists of patients on whom pulmonary lobectomy was performed, after which an aspiration of &ndash; 20 cm H2O was applied on surgery day and again &ndash; 10 cm H2O before clamping and tube extraction. The third group consists of patients on whom pulmonary lobectomy was performed, after which an aspiration of &ndash; 20 cm H2O was applied on surgery day and underwater seal drainage was applied before clamping and tube extraction. The fourth group consists of patients on whom pulmonary lobectomy was performed, after which an aspiration of &ndash; 20 cm H2O was applied on surgery day, and then daily monitored and modified in such a way that an aspiration of &ndash; 20 cm H2O was applied until pulmonary reexpansion and then gradually lowered according to individual surgery experience before clamping and tube extraction. RESULTS: There is no significant statistical difference between groups of patients in: age (p=0.77), FEV1 (p=0.6316), ITGV (p=0.6202), TLC (p=0.6922) and RV (p=0.6552) and comorbidities (p=0.4522). The groups are homogenous in pre-operative parameters. Lowered FEV1 among all patients did not affect prolonged air leak (p=0.571), nor the increase in values of ITGV (p=0.22), RV (p=0.912) and TLC (p=0.5211). The lobectomies that were compared were: upper right, upper left, lower right, lower left, middle, as well as upper and lower right bilobectomy. The comparison was implemented only on anatomically different lobectomies cumulatively among groups, due to the low occurrence of each type of lobectomy in groups. The difference in prolonged air leak does exist, but is not statistically significant (p=0.061). Prolonged air leak has a significantly higher occurrence in lower right bilobectomies (p=0.009). Drainage duration and hospitalization period variations in different kinds of lobectomy are statistically significant (p=0.0356 and p=0.0007, respectively). Additional pericardial, thoracic or diaphragm resection, wedge resection of the neighboring lobe, or sleeve bronchial resection did not affect prolonged air leak (p=0.58). The research has established that the occurrence of adhesion (on a scale 0-3) in patients and bulous emphysema attribute to prolonged air leak (p=0.065 and p=0.063, respectively).&nbsp; Comparison between patients with and without adhesions revealed similar result. Difference exists, but it is not statistically significant (p=0,057).&nbsp; Pre-operative chemotherapy had no statistical significance on prolonged air leak (p=0.0623), total rate of complications (p=0.088), nor hospitalization period (p=0.2). Paradoxically, the treatment was in favor of those patients who had taken pre-operative chemotherapy, which could be due to the selection of patients for surgery.&nbsp; Among the four groups, there was no difference in need for thoracic redrainage (p=0.101), need for increase in level of active aspiration (p=0.326), overall complication occurrence (p=0.087) and prolonged air leak occurrence (p=0.323). There is a statistically significant difference in drainage duration (p=0.001) and hospitalization period (p=0.000). The number of tubes (1 or 2 tubes set intraoperatively) did not affect prolonged air leak occurrence (p=0.279). The hospitalization period in patients with one tube set intraoperatively is significantly shorter (p=0.0001). Logistic regression analysis has shown that only lower bilobectomy had a significant impact on prolonged air leak, unlike active drainage aspiration, the presence of adhesions, bullous emphysema or lowered FEV1 values, pleural cavity space reducing, number of tubes and resection. CONCLUSION: The research has shown: Active drainage aspiration has no difference in effect in achieving and maintaining pulmonary reexpansion after lobectomy when compared to underwater seal drainage; Active drainage aspiration does not affect prolonged air leak, defined as air leak longer than 7 days; Active drainage aspiration has an impact on the overall drainage duration and hospitalization period; The level of active drainage aspiration and daily modification of the mentioned do not affect treatment results; Preoperative pulmonary function does not affect prolonged air leak occurrence; Preoperative chemotherapy does not affect prolonged air leak occurrence; Prolonged air leak and drainage and hospitalization period occur most often in lower right bilobectomies; Nor additional resections nor pleural cavity reduction affect prolonged air leak occurrence; The presence of pleural adhesions and bullous emphysema rarely attribute to the increase of prolonged air leak occurrence; The number of tubes implemented intraoperatively does not affect prolonged air leak occurrence, but it shortens drainage and hospitalization periods; By multivariate analysis, that only lower bilobectomy has a significant impact on prolonged air leak, unlike active drainage aspiration, the presence of adhesions, bulous emphysema or lowered FEV1 values, pleural cavity space reducing, number of tubes and resection.</p>

Summaries in Afrikaans and English / Text in Afrikaans / Two opposing approaches to beginning reading are used, namely the phonological and global approach, under which the whole word, whole sentence and whole language methods are classed. The whole crux of the controversy is situated in beginning reading as an explicit, intensive and systematic method of teaching phonics, as opposed to implicit beginning reading through discrimination of global configurations, augmented by psycholinguistic guesses within reading context. Arguments about the advantages and disadvantages of the opposing methods have been hurdled to and fro for decades without any discernible gain. The question emerged whether research on brain physiology with respect to language and reading, a relatively new field of study, could shed light on the foundation of an accountable method for beginning reading. Renewed insights to the controversial differences were gained, and brain physiologically accountable parameters as a base for a beginning reading method were framed from these insights. / Twee opponerende aanvangsleesbenaderings word in die skole gebruik, naamlik die fonologiese benadering en die geheelbenadering, waaronder die geheelwoord-, geheelsinen die geheeltaalmetode ressorteer. Die kern van die verskil tussen die aanvangsleesbenaderings le in aanvangslees as eksplisiete, intensiewe en sistematiese foneemonderrig, teenoor implisiete aanvangslees wat die waarneming van globale konfigurasies, aangevul deur psigolinguistiese raaiskote binne die leeskonteks, aanmoedig. In die polemiek om die beste leesmetode word argumente oor die voor- en nadele ten opsigte van die begronding van hierdie opponerende metodes reeds dekades heen en weer geslinger. Navorsingsresultate word eindeloos, sonder duidelike winste, met mekaar vergelyk. Dit het die vraag laat onstaan of navorsing ten opsigte van die breinfisiologie met betrekking tot taal en lees, 'n relatief nuwe studieveld, moontlik lig sou kon werp op die begronding van 'n verantwoordbare aanvangsleesmetode. Die literatuurstudie ten opsigte van breinfisiologie het vernuwende insigte oor die polemiese begrondingsverskille na vore gebring, en breinfisiologies-verantwoordbare parameters as basis vir 'n aanvangsleesmetode is uit hierdie insigte opgestel. / Psychology of Education / M. Ed. (Psychology of Education)