More than half of both men and women living in the United States report experiencing at least one traumatic event in their lifetime (Kessler et al., 1995). While not all individuals who experience a traumatic event will develop posttraumatic stress disorder, individuals with traumatic experience exhibit higher levels of functional impairment, suicidality, and are more likely to meet criteria for anxiety, depressive, and alcohol use disorders (Beckham et al., 1998; Marshall et al., 2001). Acceptance and Commitment Therapy (ACT) may aid those who have experienced a traumatic event in reducing avoidance and engaging in valued action in the presence of distressing private experiences (Walser & Hayes, 2006). Those who receive an ACT-oriented treatment may learn behavioral skills consistent with six processes that foster non-judgment, broadened perspective, and acceptance of experiences occurring in the here-and-now (Hayes et al., 2012). Few studies have been conducted to examine the relative effects of component processes within the ACT framework, and among the existing literature little attention has been given to self as context (Carrasquillo & Zettle, 2014; Hayes et al., 2006). All six processes are considered to have some degree of overlap (Hayes et al., 2006). Namely, self as context, a process that involves broadening present moment perspective and objectively relating to self-oriented content, shares similarities with defusion, a process involving objective observation of cognitive phenomenon. Evidenced and conceptual overlap among component processes may lead to measurement concerns, fluid used of interventions, and lack of clinical clarity. The current study examined the relative effects of defusion and self as context in persons who have experienced a traumatic event, using a novel treatment design (counterbalanced alternating treatments SCED) and measurement plan (Ecological Momentary Assessment). Specifically, this study assessed treatment utility of self as context and defusion for individuals who have experienced a traumatic event, evaluated the validity of component interventions, and examined effects of self as context in particular as a core ACT process. This study did not provide evidence that self as context is more or equally as efficacious as defusion as an intervention for persons with past traumatic experience. Several factors may have impacted results of the current study, including individual variability, lack of a clinical sample, and significant time spent explaining intervention rationale and processing intervention experience (all of which was beyond the scope of the current study). Further research is needed to assess unique contributions of component processes of change within the ACT model.

No description available.

No description available.

The purpose of this study was to research the therapeutic outcomes achieved by a five year-old boy with Asperger Syndrome (AS), by means of non-directive processes of child centred play therapy (CCP) and sand tray play therapy (STP). In this investigative-descriptive qualitative research design, a saturated, holistic, intrinsic single case study was used as research method. The therapeutic process, events and outcomes of a unique single case within the context of AS, non-directive play therapy and the interactional-pattern analysis (IPA), are described. This study was motivated by the fact that the researcher disposed of data for a unique single case study that could contribute meaningfully to the need for a research database that describes effective therapeutic interventions and outcomes with children with AS. From the perspective of Rogerian person-centred theory (RPT), the literature study focused on an integrated discussion of AS, CCP and STP by means of 17 interpersonal variables of the interactional-pattern analysis (IPA). The following data sources was investigated: interviews with parents and teachers; CCP-sessions of J recorded on video; photos of some of J’s STP-sessions and the therapists’ process notes. Triangulation was used to evaluate the various categories of therapeutic outcomes from different viewpoints and to give meaning to them. The conclusions indicated that this boy with AS had used the non-directive processes of CCP and STP to achieve various therapeutic outcomes in the areas of: imaginary play; dramatic play; social interaction with the therapist, parents, family, teachers, his peer group and with strangers; traumatic experiences during visits to the doctor and bath times; identification, expressing and regulating emotions; and minimising acting out behaviour. Therapeutic outcomes have been demonstrated in 8 IPA-variables, namely: empathy, defining of relationships, potential to evoke acceptance or rejection, sincere interest and congruent conduct, control, emotional distance, problem solving and aspects relating to the presenting problem. The conclusion was reached that the conduct of the boy with AS as well as his mother and the therapist, played a mutual role in achieving his therapeutic outcomes within the 17 IPA-variables. The unstructured process of the non-directive play (CCP and STP) was utilised by a young child with AS to achieve therapeutic outcomes that relate to his everyday existence. A final conclusion is that involving the boy’s mother in his therapy and utilising an adapted Filial play program, enabled the mother to make emotional contact with her son and to diminish conflict between them. Guidelines for therapists are suggested with regard to non-directive responding in therapeutic contexts as found in this study. Furthermore, the contribution of this research to Psychology as science and discipline, is presented. Limitations of this study are indicated and recommendations for further research are made. / Thesis (Ph.D. (Psigologie))--North-West University, Vaal Triangle Campus, 2013

The purpose of this study was to explore the impact of child-centered play therapy (CCPT) on the social competence, empathy, and self-regulation of children diagnosed with autism spectrum disorder (ASD). The constructs of social competence, empathy, and self-regulation were measured using the Social-Emotional Assets Rating Scale (SEARS). This study utilized a single-case design; the researcher collected data throughout the duration of the study, including baseline, treatment, and follow-up phases. The sample included 5 children ranging from ages 6 to 8 years old: 3 Caucasian males, 1 African-American female, and 1 Latin-American female. Mothers of the participants completed the parent form of the SEARS once per week throughout all phases of the study. During the treatment phase of the study, the children participated in CCPT approximately 2 times per week for 30 minutes each time. Visual analysis of the data indicated play therapy was beneficial for three participants, as they demonstrated improvements in social competence, empathy, and self-regulation. Two participants responded to the intervention with mixed results. Discussion includes implications for clinical practice and future research as well as limitations of the study.

A logística representa uma importante e complexa função de apoio dentro do hospital, assegurando a correta e ótima movimentação dos fluxos de materiais, informações e pessoas, a fim de que os cuidados médicos (competência essencial) sejam prestados com eficácia aos pacientes. Pode-se perceber, no entanto, que embora as atividades logísticas possuam um caráter estratégico, tanto em relação ao custo que representam para as finanças hospitalares, quanto para o nível de serviço prestado e a consequente percepção do paciente, alguns hospitais não a possuem de maneira bem estruturada e desenvolvida, principalmente dentro do setor público. Dessa forma, considerando a relevância da logística hospitalar, afirma-se que a busca de melhorias na execução de suas atividades pode trazer benefícios diretos ao hospital e aos seus clientes internos (colaboradores) e externos (pacientes e familiares). É nesse contexto que se insere o lean healthcare, abordagem advinda do Sistema Toyota de Produção. Baseado em princípios e ferramentas voltados a eliminação de desperdícios, criação de valor para o cliente e melhoria contínua, a produção enxuta já tem sido aplicada com sucesso para otimizar as atividades no ambiente hospitalar. O objetivo desta pesquisa é, portanto, desenvolver uma proposta de aplicação das ferramentas do lean healthcare na gestão da logística hospitalar, em uma unidade laboratorial de um hospital público de ensino. Classificada como uma pesquisa exploratória e qualitativa, foi adotado o método do estudo de caso único e realizado em um hospital público de ensino, localizado no interior do estado de São Paulo. Cinco etapas foram definidas como roteiro de execução: mapeamento da situação atual, seminários de aprovação, projeção de uma situação futura, análise dos resultados esperados e estudo de viabilidade para aplicação. Ao final, a contraposição entre a literatura revisada e as informações do caso estudado permitiu subsidiar a construção da proposta de aplicação das ferramentas do lean healthcare na logística hospitalar. A principal contribuição deste trabalho é, portanto, prática, caracterizada como um roteiro de ações a serem adotadas ao longo do processo de implantação. Espera-se que tal proposta seja uma possível referência aos gestores dos hospitais que desejem implantar as ferramentas do lean healthcare na gestão logística dos fluxos de materiais, pacientes e informações. / Logistics is an important and complex hospital support area that allows the correct and optimal flow of material, information and people. Its activities are part of hospital strategy, because of cost that they represent and the impact on the quality of the service perceived by the patient. Despite of these relevant characteristics, some hospitals do not have a developed and well-structured logistics area, mainly on public sector. Therefore, considering the importance of hospital logistics, looking forward improvements on its activities would benefit internal customers (workers) and external (patients and parents). In this context, lean healthcare, approach emerged from Toyota, could be presented. Based on principles and tools that eliminate waste, create value to customer and continues improvement, lean production has been successfully applied to optimize hospital activities. Thus, the goal of this research is develop an application proposal of lean healthcare tools in hospital logistics, into a laboratory of a public teaching hospital. Classified like an exploratory and qualitative research, the single case method was adopted and executed into a public teaching hospital, located in São Paulo state. Five steps were defined like a sequence of execution: current state mapping, approval seminars, prediction of a future state, analysis of expected results and study of viability to do the application. In the end, the comparison between the reviewed literature and the case informations allowed the construction of an application proposal of lean healthcare tools in hospital logistics. Therefore, the main contribution of this research is practical, described like a sequence of prescribed actions to be adopted during the process of implantation. It is expected that this proposal could be a reference for hospital managers who want to apply lean healthcare tools on logistics\' management of material, patient and information flow.

Ziel: Einzellfallanalyse der Totgeburten hinsichtlich ihrer Vermeidbarkeit und Vermeidungsfaktoren als ein wesentlicher Anteil der internen Qualitätssicherung. Methode: Im Zeitraum von 1996 bis 2000 wurden nach dem Ausschluss der Abbrüche bei Fehlbildungen 100 Totgeburten bei 99 Entbindungen mit einem Geburtsgewicht von mindestens 500 g in die Analyse miteinbezogen. Ergebnisse: Die korrigierte Totgeburtenrate lag bei 5,23 Totgeburten/1000 Geburten. Der Anteil von totgeborenen Mehrlingen (11%) war 4fach so hoch dem Normalkollektiv (2,8%) gegenüber. Die relativ große Zahl der zwischen 20-23 vollendeten SSW (22%) und vor 28 vollendeten SSW (36%) auftretenden intrauterinen Fruchttode in unserer Untersuchung weist auf eine Population mit einem großen Anteil an früher Frühgeburtlichkeit hin. Die meisten Totgeburten (38%) befanden sich in der Gewichtsgruppe 500-999 g. Zwei Drittel (14/21) der Kinder mit SGA wurden ab 32 SSW und knapp die Hälfte (10/21) am Entbindungstermin mit 37 bis 41 SSW geboren. Die Todesursachen waren Plazentainsuffizienz (31%), AIS (21%), vorzeitige Plazentalösung (20%), Nabelschnurkomplikationen (7%), FFTS (2%) und Hydrops fetalis (2%). Das Amnioninfektionssyndrom (AIS) als Todesursache trat häufiger in frühen Schwangerschaftswochen (20-24 SSW: n= 17 von 21 Fällen mit AIS als Todesursache) auf. Nabelschnurkomplikationen fanden sich dagegen in späteren Schwangerschaftswochen (34-40 SSW: n=7). Unabhängig von den Todesursachen waren 51% der Totgeburten nach unserer Analyse nicht vermeidbar, 12% waren intern vermeidbar und 37% möglicherweise vermeidbar durch die Frauenärzte/Innen bzw. die Patientinnen selber. Eine gute Schwangerschaftsvorsorge, eine ausreichende fetale Überwachung und ein gutes Geburtsmanagement hätten viele Totgeburten vermeiden können. Die Beteiligung der Schwangeren ist dabei die Grundvoraussetzung. Schlussfolgerung: Die Betrachtung der Todesursache allein ist zur Beurteilung der Vermeidbarkeit nicht ausreichend. Das Verständnis der Ereignisse, die zu den Totgeburten führten, ist der Ausgangspunkt für eine kritische Auswertung. / Objective: The avoidability and the preventive factors relating to stillbirths were evaluated as an important part of internal quality control. Methods: After exclusion of interruptions because of fetal malformations, the case records of 100 stillbirths with a minimal birth weight of 500 g from 99 deliveries in our clinic in the years 1996 till 2000 were retrospectively as single cases analysed. Results: The corrected rate of stillbirth was 5,23 per 1000 births. The proportion of the stillborn multiplets (11%) was 4 times higher then the proportion in the normal population (2,8%). That the stillbirths occurred preferentially between 20-23 menstrual weeks of pregnancy (22%) and before 28 menstrual weeks in our collection points out a population with a large proportion of earlier prematurity. Most of the stillbirths (38%) were born with a birth weight between 500-999 g. Two third (14/21) of the stillbirths from 32 menstrual weeks and almost the half of the stillbirths (10/21) between 37 till 41 menstrual weeks were born with small for gestational age (SGA). The principal causes of the stillbirths were placental insufficiency (31%), chorioamnionitis (21%), placental abruption (20%), cord complications (7%), twin-to-twin transfusion syndrom (2%) and hydrops (2%). The chorioamnionitis appeared more frequently in the early menstrual weeks (20-24 menstrual weeks: n=17 of 21 cases with chorioamnionitis). The cord complications on the contrary occurred in the late menstrual weeks (34-40 menstrual weeks: n=7). Independent of the causes of deaths, 51% of the stillbirths according to our analysis were not avoidable, 12% were internally preventable and 37% could be prevented by the external gynecologists or the patients themselves. A qualified and compliance to prenatal care, a sufficient fetal surveillance and a good management of delivery could avoid many stillbirths. The corporation of the pregnant patients is nevertheless prerequisite. Conclusion: The only consideration of the cause of death is not sufficient to evaluate the preventability of stilllbirths. The insight of the events that lead to stillbirths is the starting point for a critical interpretation.

High prevalence of individuals with autism spectrum disorder (ASD) and the legislation movement impacted the placement of students with ASD in general education settings. Hence, the increase raised the need to conduct research for ASD populations, and to examine the effectiveness of these interventions. With the increase of single case-design (SCD) studies, there is a demand to include SCD in the evaluation of evidence- based practices (EBPs), to analyze and interpret SCD results in meaningful ways beside visual analysis, and to generate effect size estimates. This dissertation contains four systematic literature reviews which examine single-case intervention research targeting academic, social communication, play, and functional life skills for children with ASD in school settings. 132 studies with 924 AB phase contrasts were analyzed using visual analysis and three non-overlap measures. Sensitivity and specificity of Tau-U, IRD, and Baseline Corrected Tau were tested on detecting intervention effects. Also, the three methods were examined in their agreement with interpretations based on the visual analysis and the effect of confounding factor on their scores. The analysis demonstrated that the three methods performed fairly well in distinguishing effective from non-effective interventions. The three non-overlap methods had a moderate to substantial level of agreement with visual analysis. The author recommended further research on the impact of confounding factors especially baseline trend and autocorrelation as well as the use of effect size methods with high sensitivity and visual aids to improve the reliability and accuracy of visual analysis.

A logística representa uma importante e complexa função de apoio dentro do hospital, assegurando a correta e ótima movimentação dos fluxos de materiais, informações e pessoas, a fim de que os cuidados médicos (competência essencial) sejam prestados com eficácia aos pacientes. Pode-se perceber, no entanto, que embora as atividades logísticas possuam um caráter estratégico, tanto em relação ao custo que representam para as finanças hospitalares, quanto para o nível de serviço prestado e a consequente percepção do paciente, alguns hospitais não a possuem de maneira bem estruturada e desenvolvida, principalmente dentro do setor público. Dessa forma, considerando a relevância da logística hospitalar, afirma-se que a busca de melhorias na execução de suas atividades pode trazer benefícios diretos ao hospital e aos seus clientes internos (colaboradores) e externos (pacientes e familiares). É nesse contexto que se insere o lean healthcare, abordagem advinda do Sistema Toyota de Produção. Baseado em princípios e ferramentas voltados a eliminação de desperdícios, criação de valor para o cliente e melhoria contínua, a produção enxuta já tem sido aplicada com sucesso para otimizar as atividades no ambiente hospitalar. O objetivo desta pesquisa é, portanto, desenvolver uma proposta de aplicação das ferramentas do lean healthcare na gestão da logística hospitalar, em uma unidade laboratorial de um hospital público de ensino. Classificada como uma pesquisa exploratória e qualitativa, foi adotado o método do estudo de caso único e realizado em um hospital público de ensino, localizado no interior do estado de São Paulo. Cinco etapas foram definidas como roteiro de execução: mapeamento da situação atual, seminários de aprovação, projeção de uma situação futura, análise dos resultados esperados e estudo de viabilidade para aplicação. Ao final, a contraposição entre a literatura revisada e as informações do caso estudado permitiu subsidiar a construção da proposta de aplicação das ferramentas do lean healthcare na logística hospitalar. A principal contribuição deste trabalho é, portanto, prática, caracterizada como um roteiro de ações a serem adotadas ao longo do processo de implantação. Espera-se que tal proposta seja uma possível referência aos gestores dos hospitais que desejem implantar as ferramentas do lean healthcare na gestão logística dos fluxos de materiais, pacientes e informações. / Logistics is an important and complex hospital support area that allows the correct and optimal flow of material, information and people. Its activities are part of hospital strategy, because of cost that they represent and the impact on the quality of the service perceived by the patient. Despite of these relevant characteristics, some hospitals do not have a developed and well-structured logistics area, mainly on public sector. Therefore, considering the importance of hospital logistics, looking forward improvements on its activities would benefit internal customers (workers) and external (patients and parents). In this context, lean healthcare, approach emerged from Toyota, could be presented. Based on principles and tools that eliminate waste, create value to customer and continues improvement, lean production has been successfully applied to optimize hospital activities. Thus, the goal of this research is develop an application proposal of lean healthcare tools in hospital logistics, into a laboratory of a public teaching hospital. Classified like an exploratory and qualitative research, the single case method was adopted and executed into a public teaching hospital, located in São Paulo state. Five steps were defined like a sequence of execution: current state mapping, approval seminars, prediction of a future state, analysis of expected results and study of viability to do the application. In the end, the comparison between the reviewed literature and the case informations allowed the construction of an application proposal of lean healthcare tools in hospital logistics. Therefore, the main contribution of this research is practical, described like a sequence of prescribed actions to be adopted during the process of implantation. It is expected that this proposal could be a reference for hospital managers who want to apply lean healthcare tools on logistics\' management of material, patient and information flow.

I den här studien undersöktes fyra elevers kunskapsutveckling och inställning till ämnet matematik under en period av tre veckors intervention. Syftet var att mäta om en enskild intensivundervisning i matematik inom ordinarie undervisningstid kunde vara gynnsam för elever i svårigheter med taluppfattning. Ytterligare syfte var att se på om intensivundervisningen hade någon effekt på elevernas självskattning kring matematik. Studien är en experimentell fallstudie med multipel baslinje singlecase-design. Resultatet visade att interventionen har varit gynnsam för de ingående eleverna både vad gäller kunskapsutvecklingen och deras inställning och självskattning till ämnet. / This study investigates the knowledge progression of four pupils and their attitude to mathematics during a period of three weeks. The aim is to measure whether pupils with number sense problems could benefit from intensive one-to-one teaching of mathematics, within regular teaching hours. The study also aims to find out if intensive teaching affects the pupils´self-assessment regarding mathematics. An experimental case study, with multiple baseline singlecase design, has been used. The results indicate that the intervention has proved beneficial to the pupils in the study, when it comes to their knowledge progression as well as their attitude and self-assessment.