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Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT:This research assignment is an exploratory qualitative study into mapping unplanned outcomes of executive coaching. The research purpose was twofold: to address the lack of a common and comprehensive framework for the mapping of outcomes of executive coaching, and to add to the body of knowledge regarding unplanned outcomes of executive coaching. In developing the mapping framework, the available literature was reviewed and, through an inductive process, a framework, model, taxonomy and mapping tool were developed. Based on core concepts attributable to Kirkpatrick, Wilber and Jaques, the mapping tool developed was then tested, using data obtained from a purposive sample of seven semi-structured interviews with Gauteng based coachees. The sample excluded any individuals who had been coached by the researcher. During the data analysis, the planned outcomes were mapped using the mapping tool and related processes. Thereafter the actual outcomes were mapped, identifying those outcomes that matched planned outcomes and those that supported the planned outcomes. A technique named ‘outcome chains’ was developed and used for this process. The unplanned outcomes were identified by a process of elimination, being those that remained unallocated in the planned chain process. It was found that outcomes of executive coaching can be mapped using a framework based on the principles of Kirkpatrick, Wilber and Jaques, with all identified outcomes being mapped successfully. Four categories of unplanned outcomes were identified, namely those that hinder the attainment of planned outcomes, insufficient evidence of achieving planned outcomes, actual outcomes related to planned outcomes but with scope different to planned and, fourthly, actual outcomes unrelated to planned outcomes. Additionally, three themes of unplanned outcomes, each with two sub-themes, were identified, namely personal (sub-themes: physical and spiritual), family (sub-themes: immediate and extended) and work (sub-themes: positive and negative). The most surprising finding was that all seven coachees experienced unplanned outcomes, which is markedly different to previous research findings and may be due to the inclusion of non-work related outcomes. The key recommendations arising from this research assignment embrace the research into, and practice of, executive coaching. Regarding the research elements, it is recommended that the mapping framework developed in this research be further refined and tested as a holistic standard for evaluating the outcomes of executive coaching, including those outcomes that impact the coachee as an individual. For the executive coaching fraternity, it is recommended that coaches challenge themselves and their practices regarding the probability, categories and impact of unplanned outcomes, and introduce measures to maximise the upside and minimise the risks of unplanned outcomes. Finally, the regular testing and recording of the coachee’s reaction to executive coaching is recommended as a predictor of coaching efficacy.

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Doctor of Philosophy (PhD) Orthoptics / The aim of this study was to evaluate the safety and efficacy of LASIK as a refractive surgical procedure, using a repeated measures design to assess satisfaction of patients who had LASIK and to correlate clinical outcomes with detailed measures of patient satisfaction to document long-term viability, monitor changes over time and patients’ functional abilities post-operatively. Method In the study 216 post-LASIK subjects were randomly selected from among patients who underwent simultaneous bilateral LASIK using the Chiron Technolas 217C plano-scan excimer laser with the Chiron ACS (Automated Corneal Shaper) and the Hansatome microkeratome. The subjects were recruited from within one centre, and the procedures were performed by any one of three surgeons. The study also included 100 non-LASIK subjects as a control group, to compare and differentiate ocular symptoms and visual difficulties between LASIK and non-LASIK patients. Clinical data documented included visual acuity, subjective refraction, record of glasses and/or contact lenses prescription, corneal topography with EyeSys and Orbscan, slit lamp examination, surgical details, and any pre-existing eye disease/conditions and previous surgery or injury that might prevent the subjects from achieving their desired visual outcome post-operatively. Subjective patient satisfaction evaluation of the treatment group was assessed by subjects completing a survey questionnaire at 3 months, 6 months, 12 months and 24 months post-operatively. The control group subjects completed a comparable questionnaire and were assessed at baseline and 3 months later. Because the control group subjects did not have any surgical alterations, it was unnecessary for them to have more than one follow-up. Results LASIK achieved relatively high patient satisfaction, with only a small number of dissatisfied patients. It was effective in correcting myopia, hyperopia and astigmatism. However, there was some persistent under-correction in myopic spherical and minus cylindrical refractive errors. Hyperopic spherical correction was less effective, as there were more under- as well as over-correction, and the plus cylindrical correction tended to be under-corrected. The LASIK subjects’ post-operative distance uncorrected visual acuity was not as good as their pre-operative best corrected visual acuity, but it did not significantly correlate with patient satisfaction. The findings were consistent with other studies and confirmed the concept that patient satisfaction is not unidimensional and is not related to outcome solely in terms of visual acuity and residual refractive errors. Other contributing factors included problems with glare, rating of unaided distance and near vision, ability to drive at night, change in ability to perform social/recreational, home and work activities, change in overall quality of life, amount of information given prior to surgery, rating of surgery success, and surgery outcome relative to pre-operative expectations. These variables demonstrated distinctive differences between subjects who were satisfied and dissatisfied. Conclusions The findings of this study are consistent with those of earlier studies. However, the repeated measures design and the comparisons between LASIK subjects and the control group revealed some new insights that were previously undocumented. LASIK achieved high patient satisfaction, and factors associated with satisfaction were predictable, but sources of dissatisfaction were more idiosyncratic and contributing factors were identified.

Doctor of Philosophy (PhD) Orthoptics / The aim of this study was to evaluate the safety and efficacy of LASIK as a refractive surgical procedure, using a repeated measures design to assess satisfaction of patients who had LASIK and to correlate clinical outcomes with detailed measures of patient satisfaction to document long-term viability, monitor changes over time and patients’ functional abilities post-operatively. Method In the study 216 post-LASIK subjects were randomly selected from among patients who underwent simultaneous bilateral LASIK using the Chiron Technolas 217C plano-scan excimer laser with the Chiron ACS (Automated Corneal Shaper) and the Hansatome microkeratome. The subjects were recruited from within one centre, and the procedures were performed by any one of three surgeons. The study also included 100 non-LASIK subjects as a control group, to compare and differentiate ocular symptoms and visual difficulties between LASIK and non-LASIK patients. Clinical data documented included visual acuity, subjective refraction, record of glasses and/or contact lenses prescription, corneal topography with EyeSys and Orbscan, slit lamp examination, surgical details, and any pre-existing eye disease/conditions and previous surgery or injury that might prevent the subjects from achieving their desired visual outcome post-operatively. Subjective patient satisfaction evaluation of the treatment group was assessed by subjects completing a survey questionnaire at 3 months, 6 months, 12 months and 24 months post-operatively. The control group subjects completed a comparable questionnaire and were assessed at baseline and 3 months later. Because the control group subjects did not have any surgical alterations, it was unnecessary for them to have more than one follow-up. Results LASIK achieved relatively high patient satisfaction, with only a small number of dissatisfied patients. It was effective in correcting myopia, hyperopia and astigmatism. However, there was some persistent under-correction in myopic spherical and minus cylindrical refractive errors. Hyperopic spherical correction was less effective, as there were more under- as well as over-correction, and the plus cylindrical correction tended to be under-corrected. The LASIK subjects’ post-operative distance uncorrected visual acuity was not as good as their pre-operative best corrected visual acuity, but it did not significantly correlate with patient satisfaction. The findings were consistent with other studies and confirmed the concept that patient satisfaction is not unidimensional and is not related to outcome solely in terms of visual acuity and residual refractive errors. Other contributing factors included problems with glare, rating of unaided distance and near vision, ability to drive at night, change in ability to perform social/recreational, home and work activities, change in overall quality of life, amount of information given prior to surgery, rating of surgery success, and surgery outcome relative to pre-operative expectations. These variables demonstrated distinctive differences between subjects who were satisfied and dissatisfied. Conclusions The findings of this study are consistent with those of earlier studies. However, the repeated measures design and the comparisons between LASIK subjects and the control group revealed some new insights that were previously undocumented. LASIK achieved high patient satisfaction, and factors associated with satisfaction were predictable, but sources of dissatisfaction were more idiosyncratic and contributing factors were identified.

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Aim: Leukocytes are the major source of reactive oxygen species (ROS) in the ejaculate and contribute to up to 30% of male infertility. ROS have been associated with markers of apoptosis such as sperm DNA damage, externalization of phosphatidylserine and caspase-3 activation. Therefore, this study aimed at investigating the impact male genital tract infections/inflammations on the induction of apoptosis in spermatozoa.Materials and Methods: Semen samples were obtained from 60 men consulting for fertility problems at the Reproductive Biology Unit, University of Stellenbosch at Tygerberg Academic Hospital, and Vincent Pallotti Hospital (Cape Town, South Africa). To investigate the relationship between male genital tract infection and sperm apoptosis, the following were measured: semen parameters including sperm count, motility and forward progression; oxidative status in the ejaculate by evaluating the concentration of seminal leukocytes, ROS production in the ejaculate,generation of O2-• and H2O2 by spermatozoa, and the activity of reduced glutathione(GSH) in sperm; sperm apoptotic markers by measuring mitochondrial membrane potential (Δψm), caspase-3/7 activation, and DNA fragmentation (TUNEL).Results: The concentration of seminal leukocytes had a significant positive correlation with ROS production in the ejaculate (ρ=0.378; P=0.0064), sperm O2-• production (ρ=0.336; P=0.0098), and caspase-3/7 activation in sperm (ρ=0.527;P<0.0001). Furthermore, at the cutoff value of ≥0.25×106 leukocytes/mL of semen,the concentration of peroxidase-positive cells correlated significantly with sperm GSH activity (ρ=0.718; P=0.008), the percentage of sperm with disrupted Δψm(ρ=0.465; P=0.043), caspase-3/7 activation in sperm (ρ=0.794; P=0.001), and the percentage of sperm with fragmented DNA (ρ=0.563; P=0.017). ROS production in the ejaculate, besides the association with seminal leukocytes, was also correlated with the sperm count (ρ= -0.296; P=0.033), sperm GSH activity (ρ=0.577; P<0.0001),caspase-3/7 activation in sperm (ρ=0.487; P=0.0005), and sperm DNA fragmentation(ρ=0.331 P=0.0171). Caspase-3/7 activation was strongly correlated with oxidative stress in both, the ejaculate and in spermatozoa; although this parameter was not correlated with sperm Δψm and DNA fragmentation. Sperm O2-•, which had a link with seminal leukocyte concentration, was significantly correlated to sperm Δψm(P=0.0098), as was sperm GSH activity (P=0.0055). Sperm DNA fragmentation was positively correlated with ROS in the ejaculate and sperm H2O2-production(P=0.039). Conclusions: Excessive ROS in the ejaculate, mainly a consequence of seminal leukocytes, is not only linked to internal generation of O2-•, but also to sperm DNA fragmentation and the activation of effector caspases. Moreover, even in nonleukocytospermic patients with ≥0.25×106 leukocytes/mL of semen, oxidative stresscan occur which can trigger apoptosis, caspase-3/7 activation, and induce sperm DNA fragmentation. Therefore, it is possible that male genital tract infection, the major cause of leukocyte infiltration in the male reproductive tract, can induce apoptosis, of which the observed sperm DNA fragmentation is a late feature.

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