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abstract: Approximately 2.8 million Americans seek medical care for traumatic brain injury (TBI) each year. Of this population, the majority are sufferers of diffuse TBI, or concussion. It is unknown how many more individuals decline to seek medical care following mild TBI. This likely sizeable population of un- or self-treated individuals combined with a lack of definitive biomarkers or objective post-injury diagnostics creates a unique need for practical therapies among diffuse TBI sufferers. Practical therapies stand to decrease the burden of TBI among those who would otherwise not seek treatment or do not meet clinical diagnostic criteria upon examination. For this unique treatment niche, practical therapies for TBI are defined as having one or more of the following qualities: common availability, easy administration, excellent safety profile, and cost-effectiveness. This dissertation identifies and critically examines the efficacy of four classes of practical treatments in improving rodent outcome from experimental diffuse traumatic brain injury. Over-the-counter (OTC) analgesics, omega-3 fatty acids, specialized pro-resolving mediators (SPMs), and remote ischemic conditioning (RIC) were administered before or following midline fluid percussion injury. Behavioral, histological, and molecular analyses were used to assess treatment effects on functional outcome and secondary injury progression. Acute administration of common OTC analgesics had little effect on post-injury outcome in mice. Dietary supplementation with omega-3 fatty acid docosahexaenoic acid (DHA) prior to or following diffuse TBI significantly reduced injury-induced sensory sensitivity and markers of neuroinflammation with no effect on spatial learning. Intraperitoneal administration of omega-3 fatty acid-derived SPM resolvin E1 significantly increased post-injury sleep and suppressed microglial activation. Aspirin-triggered (AT) resolvin D1 administration improved both motor and cognitive outcome following diffuse TBI. RIC treatment in mice demonstrated little effect on functional outcome from diffuse TBI. Untargeted proteomic analysis of plasma samples from RIC-treated mice was used to identify candidate molecular correlates of RIC. Identification of these candidates represents a vital first step in elucidating the neuroprotective mechanisms underlying RIC. The overall findings suggest that omega-3 fatty acid supplementation, SPM administration, and RIC may serve as effective practical therapies to reduce the somatic, cognitive, and neurological burden of diffuse TBI felt by millions of Americans. / Dissertation/Thesis / Doctoral Dissertation Neuroscience 2017

M.A. (Clinical Psychology) / The post-traumatic stress syndrome has traditionally been defined and treated as pathology residing within the individual. The systemic interactional approach which is favoured in this study, however, holds that all subsystems of the larger system are interconnected and that change within the individual subsystem therefore constitutes change in other subsystems. The question that is posed in this thesis, is whether the theoretical assumptions of the systemic approach may be applied to create a better, fuller understanding of the post-traumatic stress syndrome. Theoretical discussion of both a traditional and a systemic approach to the post-traumatic stress phenomenon, as well as their practical application by means of a case study, indicates that the traditional perspective on the posttraumatic stress syndrome is valuable in terms of diagnosis of the disorder and identification of possible causitive stressful life events. It is, however, very limiting in its specificity and does not allow for a full understanding of the diversity of behaviours presented by a system that has been traumatized, directly or indirectly. In this respect, the systemic interactional approach allows the therapist a wider perspective in which individual behaviour may be systemically contectualized, rendering the behaviour interactionally meaningful. Although the system typically presents with one member who apparently suffers from post-traumatic stress disorder, this study indicates that the whole fa~ily system may in fact come to crisis if the traumatic event cannot be accommodated within the existing interactional patterns. Under such conditions it may be functional to the family system to keep one subsystem overtly symptomatic in order-to focus its attention away from its own pain, thereby trapping theindividual in his symptomatic behaviour. The study thus aims to indicate the value that a systemic interactional approach may have in dealing with the effects of trauma on both the individual and the larger system.

The Operating Room (OR) is a clinical context in which interprofessional teams surgically intervene with the intention of improving the health of the patients they care for. Despite this, surgery is high risk, invasive and often volatile. The reality is that some patients die in the OR, an outcome which violates the care intention of the clinicians who work there. Using the narrative paradigm, this study explores the stories interprofessional team members shared about caring for patients who died intraoperatively. To appreciate the cultural climate in which these stories were rooted, a literature review of OR culture and theoretical analysis of master narratives was conducted. Using individual interviews, six perioperative clinicians were invited to share their stories: two Registered Nurses, one Registered Practical Nurse, two Surgeons and one Anesthetist. Two analytic approaches were used to authentically capture participant narratives: a narrative thematic approach and structural analysis. The structural analysis revealed the types of stories told—tragedies, romances, comedies and satires—while the thematic perspective elucidated participants’ experiences of intraoperative death and their interpretation of the impact of these experiences. These findings illustrated unique perspectives of intraoperative death, illuminating features which enhanced or deteriorated the experiences for clinicians and their teams. Examining results in tandem with master narratives highlighted prevalent cultural discourses which are held in tension by the clinicians who perpetuate them. Exploring these intersecting elements provides insight into implications for nursing practice, research, education and policy, with particular attention to interprofessional dynamics, staff support, and promoting a culture of resilience.

This thesis investigates traumatic affectivity and a complex mesh of artistic strategies in contemporary live art and performance that allow a certain material renegotiation and transformation of social and personal traumatic histories. These strategies are analysed not as means of interpersonal transmission of experience through narrative capture and consolation, but of a transmission of affect, where the sense of affective sharing, of ‘wit(h)nessing’ and ‘transmissibility’ of (traumatic) affect is distinguished from the idea of identification, of mirroring, of emotional identification that in fact subsumes the other to the same, to a life as we can readily articulate and regulate it without needing to acknowledge the violence inherent in such articulations. The thesis also explores how the notion of dramaturgy changes when observed from the perspective of trauma. Dramaturgy is here understood as ‘the text (the weave) of the performance’, where performance is seen to encompass a wide range of artistic practices which involve some element of live or recorded performed action. Such definition of dramaturgy becomes especially significant when this text/weave is marked by a traumatic occurrence, which by definition damages, tears down its integrating fabric. How can we address the difficulty, physically and philosophically, of accessing a destructive event through a creative act? As one possible answer, the thesis proposes the notion of ‘dramaturgies of loss’, of a certain ‘melancholy’ or ‘traumatic’ text as a creative answer to the forces of violence. It argues that an awkward, uncomfortable presence of certain misplaced, ‘emptied’ mimetic forms of contemporary dance and performance can be seen to create a parallel topography that can retroact on accepted notions of culture and render what belongs inside or outside of the cultural sphere indeterminate and thus potentially open to change.

There is increasing evidence that repeat mild traumatic brain injury (rmTBI) may result in cumulative and long-term symptoms, more pronounced behavioural deficits, and neurodegeneration. Children have a greater susceptibility to head injury and represent a significant at risk population for rmTBI, especially those that participate in contact sports. Despite this, there is a paucity of data on rmTBI pathophysiology in the juvenile brain. The current study utilizes a novel awake closed head injury (ACHI) model to deliver repeat injuries to fully conscious juvenile rats. The ACHI model avoids the potential confounds of anaesthesia, and facilitates the assessment of neurological function immediately after each impact. Results indicate that the ACHI model produces acute neurological deficits after each impact, and that repeat injury worsens outcomes. Behavioural testing identified transient anxiety-like behaviour and motor impairment in response to rmTBI. The functional impairments and affective behaviour were in the absence of tau protein pathology. This study represents the first investigation of the consequences of rmTBI on the juvenile brain using an awake model of brain injury. / Graduate

Background Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine.

This research involved the holistic, individualized treatment of patients with post traumatic stress disorder (PTSD), employing homoeopathic medicine. Post traumatic stress disorder can lead to a variety of complications which may diminish or destroy interpersonal relationships, may handicap the patient occupationally or recreationally, or may lead to substance abuse. Research has indicated that patients with PTSD are more likely to have a personality disorder; a previous history of depression, abuse or substance abuse or a family history of psychopathology. Given this, it is presumed that PTSD can occur in anyone who has experienced trauma and sufficient stress. In order to reduce post traumatic stress severity, treatment should emphasise and acknowledge that mental, emotional, behavioural and social factors contribute to trauma. This study involved ten patients (plus two additional) who participated in five homoeopathic consultations, over a period of four months. The appropriate homoeopathic remedy, or similimum, was determined using each patient’s distinguishing mental, emotional and physical symptoms. Each participant completed the Researcher’s Questionnaire at each consultation and recorded their stress episodes on a calendar to be handed in at each follow-up appointment. These results, together with holistic progress as noted by the researcher at every consultation, were used to determine the efficacy of homoeopathy on post traumatic stress disorder. The intent of the research was to prove that treatment should be specific and individualistic, irrespective of the diagnosis. This study aimed to provide a holistic therapy for PTSD and the results indicated that the similimum treatment in sufferers of post traumatic stress disorder was effective in reducing post traumatic stress frequency, severity, and intensity. Moreover, improvement in mental and emotional wellbeing, sleep patterns, appetite, and energy levels were noted in all the patients. / Dr. R. Mistry Dr. A. Fourie

D. Litt. et Phil. / This research focuses on the development of a short term action centered clinical personological treatment programme for adult emergency rescue workers who developed secondary traumatic stress disorder (STSD)/compassion fatigue and co-morbid symptoms of burnout as a result of exposure to critical incidents. A programme, comprising three sessions, was developed incorporating previously tested cognitive behavioural techniques with clinical personological theory as well as newly developed behavioural techniques tailored to the cross cultural South African context. The need for the study arose out of the lack of scientific validated data regarding the treatment of STSD/compassion fatigue among emergency rescue workers as well as the need for a cost-effective treatment programme that would address the serious need of emergency rescue workers in South Africa who for the most part need to make do without any employee wellbeing programmes. The effects of STSD/compassion fatigue are often as debilitating as that of PTSD. It hampers the sufferer unable to operate as well as they previously did. As a result they may present with lower productivity at work as well as various psycho-social problems and be at risk of substance abuse. This ultimately has a negative impact on the victims of trauma they are responsible for rescuing. Various theoretical models are discussed on the etiology of STSD/compassion fatigue, including the constructivist development al theory by McCann and Pearlman (1990) as well as Valent’s (2003) bio-social theory on survival strategies. Treatment approaches are investigated and critiqued, including, the accelerated recovery program (ARP) as developed by Gentry, Baranowsky and Dunning (2003) under the direction of Figley (2003) for the treatment and prevention of compassion fatigue, critical incident stress debriefing as first formally described by Mitchell in 1983 for the treatment of acute traumatic stress reactions, as well as Saakvitne and Pearlman’s (1992) constructivist self-developmental treatment program for vicarious traumatization, based on the constructivist self development al theory developed by McCann and Pearlman (1990). The theories and therapies underlying the intervention programme include various cognitive behavioural and personological principles to offer a person specific practical solutions for their personality type and psychological needs. The hypotheses were formulated with regard to significant improvement of symptoms of STSD/compassion fatigue as result of the intervention programme. The co-morbid symptoms of burnout are also evaluated for a decrease, without significantly reducing their capacity for compassion satisfaction. A test re- test quasi-experimental analysis with two independent groups was required, in order to determine whether there will be a statistically meaning full reduction in the prevalence of symptoms of secondary traumatic stress disorder (STSD)/compassion fatigue and the co-morbid symptoms of burnout amongst emergency rescue staff who had been instructed in an Action Centred Personological Treatment Plan. In an effort to attain spatial and temporal control a sample population was selected with a cluster sampling method from the greater Gauteng emergency rescue staff. They included paramedics, fire fighters and ambulance staff. The specific municipality had been incorporated into a greater Gauteng metropolis in the past two years. Potential subjects for both the experimental and control group were obtained through drawing personnel files, using random sampling. A sample of 17 participants was included in the intervention group and 17 participants were included in a non-intervention group. This was representative of 80% of the total population group of emergency rescue staff in this particular municipality. Existing psychometric assessment instruments were utilised to generate data for the experimental analysis. The measurement instruments included, the Millon inventory of personality styles (MIPS) to customise a cognitive behavioural treatment programme, the Compassion fatigue and satisfaction questionnaire to verify symptoms of STSD/compassion fatigue and burnout, and the British Columbia burnout questionnaire to confirm symptoms of burnout. The quantitative data was supported by information gathered from a clinical social history questionnaire. This information was used as part of the discussion of the results as a means to enhance the former descriptive results. The action centred personological treatment programme proved to be effective in the treatment of symptoms of STSD/compassion fatigue and burnout without significantly reducing the candidates’ potential for compassion satisfaction.

M.A. / One of the most perturbing factors of South Africa's communal existence is the high rates of violent crime and the high incidence of Post-Traumatic Stress Disorder JPTSD) amongst all communities. Crime-related PTSD is a problem of epidemic proportions. Therapeutic and mental health services for trauma related counselling are limited and in some communities non-existent. It is therefor essential to develop preventative programmes aimed at equipping individuals with the skills to avoid possible trauma-inducing situations such as vehicle hijacking. It was decided to utilise a vehicle hijacking management and -prevention programme developed especially for the purposes of a "short course" intervention approach. The experimental intervention was performed to provide skill and increase levels of personal competence in handling, or, ideally, avoiding a hijacking. A sample group of 35 was selected out of a white upper middle-class, middle aged population. The subjects were exposed to the intervention. The results indicated that the intervention produced significant positive change in self-efficacy beliefs in the experimental groups. Possible limitations of the study were sample sizes and the inherent nature of the groups. It was not possible to examine the relationship between sex and efficacy beliefs. No non-whites subjects were utilised and thus the relationship between race and efficacy beliefs was also not examined. It is recommended that the intervention programme be refined further and validated scientifically in order to be utilised in future research.