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Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Tuberculosis (TB) is a chronic pulmonary infection characterized by granulomatous inflammation, caseating necrosis and a propensity to develop fibrosis and cavitations. Pulmonary TB (PTB) lesions may develop in a variety of ways and can be grouped into primary, secondary, progressive primary and miliary TB based on their pathogenesis and morphological appearance. The Western Cape Province, South Africa, has a high TB burden with increasing TB notification rates. At Stellenbosch University (SU), approximately 90% of cadavers used for medical dissections come from impoverished communities where TB is a major health problem in terms of morbidity. The aim of the present study was to assess the health status of a cadaver population (n=127) at the Faculty of Medicine and Health Sciences (FMHS), SU, with special reference to TB lesion distribution and prevalence. For this study, full-body digital X-rays of 127 cadavers (87 males; 40 females; average age, 47.1 years) were obtained with the Lodox® Statscan® Imaging System after embalming and prior to dissection. A complete pathology report of six organ systems including the skeletal system was used in combination with histological examination, molecular analysis and radiological findings to investigate the prevalence and association between TB and systemic pathology. Samples for histological purposes were removed from organs with pathology lesions. For molecular studies, five different nucleic acid extraction methods were used to extract DNA from the formalin-fixed paraffin-embedded cadaver samples. Pulmonary samples were subjected to a line probe assay (LPA) and polymerase chain reactions (PCR) to determine mycobacterial genotypic distribution. Two independent radiologists examined the chest X-rays and their findings were compared with the pulmonary findings. PTB was a common finding in the cadaver population (76.4%) with males more commonly affected. A female predilection was observed for extrapulmonary TB. Statistically, TB was associated with pulmonary pathology, including pneumonia and bronchiectasis. Systemic pathology commonly encountered in the present study included neoplasms, coronary artery disease, colonic diverticula, hepatic triaditis, cirrhosis, glomerulosclerosis, pyelonephritis and a variety of healed maxillofacial and appendicular skeletal fractures. Extracted nucleic acid concentrations, as determined with the NanoDrop® spectrophotometer, ranged between 10ng/μl and 1000ng/μl. The standard salting-out method was found to be the most cost-effective and therefore the preferred method for nucleic acid extraction. The HAIN® MTBDRplus® kit was effective in determining the presence of mycobacterial species belonging to the Mycobacterium tuberculosis complex (MTBC). The sensitivity to first-line drugs could not be determined as a result of DNA degradation. Spoligotyping was unsuccessful, as incomplete and unidentifiable hybridization of the 43 spacers occurred. The RD105 and MUB02/RD105 PCR results were non-reproducible and non-specific. Pulmonary cavitation and pleural thickening were the only findings that were positively correlated with the radiological findings (p<0.05). To our knowledge, this is the first study to extensively investigate TB and systemic pathology including histopathology, molecular techniques and postmortem radiology in cadavers from low socio-economic backgrounds from a high TB burden area. This study therefore provides a more complete and thorough understanding of the prevalence, distribution and morphology of TB lesions as well as the association between TB and systemic pathology. / AFRIKAANSE OPSOMMING: Tuberkulose (TB) is a kroniese, pulmonêre infeksie gekenmerk deur granulomateuse ontsteking, verkasende nekrose en ’n neiging om fibrose en kavitasies te ontwikkel. Pulmonêre TB (PTB) letsels kan op verskeie wyses ontwikkel en kan, gebaseer op patogenese en morfologiese voorkoms, geklassifiseer word as primêre, sekondêre, progressiewe primêre of miliêre TB. Die Wes-Kaap provinsie, Suid-Afrika, het ’n hoë TB las met toenemende TB aanmeldingskoerse. Ongeveer 90% van die kadawers wat by die Universiteit Stellenbosch (US) gebruik word vir mediese disseksies kom van verarmde gemeenskappe waar TB ’n groot gesondheidsprobleem is in terme van die siektesyfer. Die doel van hierdie studie was om die gesondheidstoestand te bepaal van ’n kadawerpopulasie (n=127) by die Fakulteit Geneeskunde en Gesondheidswetenskappe (FGG), US, met spesifieke verwysing na die verspreiding en voorkoms van TB letsels. Digitale X-strale van die hele liggaam van 127 kadawers (87 manlik; 40 vroulik; gemiddelde ouderdom, 47.1 jaar) na balseming en voor disseksie is met behulp van die Lodox® Statscan® Imaging System bekom. ’n Volledige patologie-verslag van ses orgaanstelsels, die skeletstelsel ingesluit, is in kombinasie met histologiese ondersoeke, molekulêre ontleding en radiologiese bevindinge gebruik om die voorkoms van en assosiasie tussen TB en sistemiese patologie te ondersoek. Monsters vir histologiese studie is van organe met patologiese letsels geneem. Vir molekulêre studies is vyf verskillende nukleïensuur ekstraksie-metodes gebruik om DNS uit die formalien-gefikseerde paraffien-ingebed kadawermonsters te ekstraheer. Pulmonêre monsters is onderwerp aan ’n lyn-ondersoek-toets (“line probe assay”) en polimerase-kettingreaksies (PKR) om mikobakteriële genotipiese verspreiding te bepaal. Twee onafhanklike radioloë het die bors X-strale ondersoek en hulle bevindinge is vergelyk met die pulmonêre bevindinge. PTB is ’n algemene bevinding in die kadawerpopulasie (76.4%) met mans wat meer dikwels geaffekteer is. ’n Vroulike voorkeur vir ekstrapulmonêre TB is waargeneem. TB is statisties geassosieër met pulmonêre patologie, longontsteking en brongiëktase. Sistemiese patologie wat algemeen gevind is in die huidige studie sluit in neoplasmas, koronêre hartsiekte, kolon divertikula, lewer triaditis, sirrose, glomerulosklerose, piëlonefritis en ’n verskeidenheid geneesde maksillofasiale en appendikulêre skeletale frakture. Geëkstraheerde nukleïensuur-konsentrasies, soos bepaal met die NanoDrop® spektrofotometer, het gewissel tussen10ng/μl en 1000ng/μl. Daar is gevind dat die standaard uitsoutings-metode die mees koste-effektief en dus die voorkeur-metode nukleïensuur ekstraksie-metode was. Die HAIN® MTBDRplus® toets was effektief om die aanwesigheid van mikobakteriële spesies wat aan die Mycobacterium tuberculosis kompleks behoort, te bepaal. Sensitiwiteit vir eerste-linie middels kon nie bepaal word nie as gevolg van DNS degradasie. Spoligotipering was onsuksesvol omdat onvoltooide en onidentifiseerbare hibridisasie van die 43 merkers plaasgevind het. Die RD105 en MUB02/RD105 PCR resultate was nie-herhaalbaar en nie-spesifiek. Pulmonêre kavitasie en pleurale verdikking was die enigste bevindinge wat positief gekorreleer is met die radiologiese bevindinge (p<0.05). Na ons wete is hierdie studie die eerste een wat TB en sistemiese patologie ekstensief ondersoek en gebruik maak van histopatologie, molekulêre tegnieke en nadoodse radiologie in kadawers van lae sosio-ekonomiese agtergronde vanaf ’n area met ’n hoë TB las. Hierdie studie verskaf dus ’n meer volledige en deeglike begrip van die voorkoms, verspreiding en morfologie van TB letsels sowel as die assosiasie tussen TB en sistemiese patologie.

Tratar sobre a temática da morte, o morrer e a finitude da vida faz parte do desenvolvimento humano, apesar de ser considerado um tabu sócio-cultural ocidental ou até mesmo um tema interdito ou silenciado. Abordar esse assunto com os profissionais da saúde, inserido na linha da educação para a saúde é de suma importância, pois possibilita o desenvolvimento humano pessoal e profissional. Pois, enfocar sobre a temática da morte estamos também falando de vida, de seus estilos, e a qualidade da mesma acaba sendo repensada, como também, a questão da morte digna. Objetivamos Identificar e verificar a visão cultural dos Docentes e Discentes em relação à Morte e Morrer e a finitude da vida, e construir um grupo de discussão sobre a temática, para auxiliar na formação dos profissionais de enfermagem, trabalhando coletivamente, ações educativas e planos de aula, para implementar a temática em foco. Trata- se de uma pesquisa qualitativa mediatizada pela metodologia da pesquisa-ação, de cunho humanista. Análise foi realizada por categorização, convergente/divergente, o público-alvo foram docentes que abordam essas temáticas, e discentes do 1º e 5º ano ambos do curso de enfermagem de uma universidade estadual do interior paulista. Após o levantamento dos temas geradores construímos as ações educativas que foram planos de aula abordando a morte e o morrer e a finitude da vida em suas várias faces, além da construção de uma oficina voltada para esse tema que foi realizada num congresso científico. No decorrer de todo esse processo de pesquisa depreendemos que estudar e abordar a temática sobre a morte, o morrer e a finitude da vida pode proporcionar e favorecer uma formação acadêmica diferenciada aos estudantes da área da saúde, preparando-os para lidarem com esse tema no seu cotidiano profissional. Para isso consideramos ser de grande importância a inserção dessa temática nos currículos escolares e nos cursos de atualização profissional e formação docente, com foco na abordagem crítico-social, na ação-reflexão-ação e na humanização do atendimento em saúde / Treating on the subject of death, dying and the finitude of life is part of human development, despite being considered a western socio-cultural taboo, or even an interdict or muted topic. Approach this subject with health professionals, inserted into the line of health education is extremely important, as it allows the personal and professional human development. Therefore, focusing on the theme of death, we are also talking about life, about their styles, and the quality of it turns out to be reconsidered, as well as, the issue of death with dignity. We aim to identify and verify the cultural vision of the teachers and students in relation to the Death and Dying and the finiteness of life, and create a discussion group about this theme, to assist in the formation of nursing professionals, by working collectively, educational activities and lesson plans, to implement the subject that is currently in focus. This is a qualitative research mediated by the methodology of action-research, of humanist nature. Analysis was performed by categorization, convergent/divergent, the target were teachers that approach these issues, and nursing students of the 1st and 5th year, both of the nursing course of a state university in São Paulo. After bringing up the generating themes, we build the educational activities that were lesson plans, addressing the death and the dying and the finitude of life in its many faces, and the construction of a workshop geared towards this theme, which was performed in a scientific congress. During the whole research process, we concluded that study and approach the issue about the death, the dying and the finitude of life can provide and promote a differentiated academic formation for students in the health area, preparing them to deal with this issue in their daily professional activities. For this, we consider to be of great importance the inclusion of this subject in the school curriculum and in the professional updating courses and the teacher formation, focusing on the critical-social approach, in action-reflection-action and the humanization of health care

Tratar sobre a temática da morte, o morrer e a finitude da vida faz parte do desenvolvimento humano, apesar de ser considerado um tabu sócio-cultural ocidental ou até mesmo um tema interdito ou silenciado. Abordar esse assunto com os profissionais da saúde, inserido na linha da educação para a saúde é de suma importância, pois possibilita o desenvolvimento humano pessoal e profissional. Pois, enfocar sobre a temática da morte estamos também falando de vida, de seus estilos, e a qualidade da mesma acaba sendo repensada, como também, a questão da morte digna. Objetivamos Identificar e verificar a visão cultural dos Docentes e Discentes em relação à Morte e Morrer e a finitude da vida, e construir um grupo de discussão sobre a temática, para auxiliar na formação dos profissionais de enfermagem, trabalhando coletivamente, ações educativas e planos de aula, para implementar a temática em foco. Trata- se de uma pesquisa qualitativa mediatizada pela metodologia da pesquisa-ação, de cunho humanista. Análise foi realizada por categorização, convergente/divergente, o público-alvo foram docentes que abordam essas temáticas, e discentes do 1º e 5º ano ambos do curso de enfermagem de uma universidade estadual do interior paulista. Após o levantamento dos temas geradores construímos as ações educativas que foram planos de aula abordando a morte e o morrer e a finitude da vida em suas várias faces, além da construção de uma oficina voltada para esse tema que foi realizada num congresso científico. No decorrer de todo esse processo de pesquisa depreendemos que estudar e abordar a temática sobre a morte, o morrer e a finitude da vida pode proporcionar e favorecer uma formação acadêmica diferenciada aos estudantes da área da saúde, preparando-os para lidarem com esse tema no seu cotidiano profissional. Para isso consideramos ser de grande importância a inserção dessa temática nos currículos escolares e nos cursos de atualização profissional e formação docente, com foco na abordagem crítico-social, na ação-reflexão-ação e na humanização do atendimento em saúde / Treating on the subject of death, dying and the finitude of life is part of human development, despite being considered a western socio-cultural taboo, or even an interdict or muted topic. Approach this subject with health professionals, inserted into the line of health education is extremely important, as it allows the personal and professional human development. Therefore, focusing on the theme of death, we are also talking about life, about their styles, and the quality of it turns out to be reconsidered, as well as, the issue of death with dignity. We aim to identify and verify the cultural vision of the teachers and students in relation to the Death and Dying and the finiteness of life, and create a discussion group about this theme, to assist in the formation of nursing professionals, by working collectively, educational activities and lesson plans, to implement the subject that is currently in focus. This is a qualitative research mediated by the methodology of action-research, of humanist nature. Analysis was performed by categorization, convergent/divergent, the target were teachers that approach these issues, and nursing students of the 1st and 5th year, both of the nursing course of a state university in São Paulo. After bringing up the generating themes, we build the educational activities that were lesson plans, addressing the death and the dying and the finitude of life in its many faces, and the construction of a workshop geared towards this theme, which was performed in a scientific congress. During the whole research process, we concluded that study and approach the issue about the death, the dying and the finitude of life can provide and promote a differentiated academic formation for students in the health area, preparing them to deal with this issue in their daily professional activities. For this, we consider to be of great importance the inclusion of this subject in the school curriculum and in the professional updating courses and the teacher formation, focusing on the critical-social approach, in action-reflection-action and the humanization of health care

No / This book focuses on mortuary practices in the Neolithic Near East to challenge some of the common assumptions about death and the dead body. It explores the way the corpse was treated during the period, in the process raising new questions about identity, personhood, and gender in the past, as well as concepts such as social memory and ‘ancestors’. It also examines the webs of relationships between people, their environments, and their new material world, between humans and animals, and between the living and the dead. Using a case-study approach, the book highlights differences and similarities as well as patterns in archaeological evidence. In addition, it analyses alternative perspectives on gendered identities and family roles, along with human-animal relationships, possible consumption of the human body and animals, and the notion of animals as ancestors. In this chapter, cultural attitudes to death and dying, including practical aspects of dealing with the dead and the emotional reactions of grieving and mourning, are discussed.

Although psychical research identified through structured research the commonality of anomalous experiences for the bereaved from as early as the 1880s, it wasn’t until the 1970s with the publication of a medical doctorate on such phenomena that medical communities and social science began to recognise them too. Beyond this point, research became more popular on the subject. Extensive research conducted on post-death experiences (aka, Post-Death Contacts – ADCs) since the 1970s, has largely focused on what impact they have on the bereaved, rather than the ontology of the phenomena themselves. All such studies have found these experiences to be therapeutic for the bereaved, and a natural aid to recovery. However, no research findings to this point have been presented on what cognitive mechanisms create the therapeutic gains experienced, as a direct result of the spontaneous anomalous experiences. This thesis set out to investigate what makes such experience therapeutic, and aid the process of recovery from grief. From a critical review of the previous literature, it was noted that several of the extensive studies, and related popular literature, identified hope to a consistent reported outcome of such experiences. However, no existing studies appeared to have investigated its presence and process in this context. Therefore, a mixed method study design was developed to investigate the impact of such experiences further and the role of hope within them. A questionnaire approach of validated scales found levels of hope to be significantly higher in groups of the bereaved who do report post-death experience than those who don’t. The bereaved who do not report such experiences appear to encounter a significant drop in hope. Content and thematic analyses were conducted on written feedback of experiences collected from the questionnaires; this highlighted the variety of experiences and their commonality. It also highlighted significant shifts in ‘states of mind’ from negative to positive emotions, from the point of loss, to following the first anomalous encounter. Continued bonds with the deceased were also expressed, as well as previously noted therapeutic gains and themes of hope. In-depth interviews were conducted as the final study of this thesis, with an interpretative phenomenological analysis applied to the data. New findings are presented on the personal changes that take place within post-death events. Experients defined hope and how they saw it acting within their lives and experiences as a support system to feelings of loss, which fell in line with previous positive psychology theories on hope. Several key points are concluded. Firstly, the findings of this thesis have practical applications to clinical practice surrounding palliative care and applied positive psychology, regarding the importance of anomalous experiences encountered by the bereaved. Secondly, the thesis and its findings demonstrate the multi-disciplinary approaches which can be taken to parapsychological issues, in this case combining positive psychology, thanatology and healthcare. And finally, the thesis highlights the usefulness of the mixed method approaches, to provide ‘sweeping maps’ of any given phenomena under investigation, particularly in cases where the previous research findings are limited or are yet to be explored.

The thesis deals with the subject of dying and death and focuses on secondary school students' awareness of this issue. The theoretical part of the thesis describes stages of dying, the needs of a dying person and their emotional state. Furthermore, it distinguishes between dying at home and dying in a health care institution. In the following chapters, the thesis focuses on palliative care, the process of grieving, funeral rites and the issue of euthanasia. The method of the theory was reading of literature that specializes in the issue. The practical part of the thesis compares data from questionnaires given to secondary school students on the topic of death and dying. The research shows that the students' awareness of the issue is considerably low - 84% respondents did not know what the term "palliative care" meant, 88% respondents did not know what the term "hospice" meant and 74% respondents were not familiar with the term "euthanasia". The research has found that there is a need to broaden the secondary school students' knowledge on the topic of dying. KEYWORDS thanatology, dying, death, euthanasia, palliative care

In studies, grief due to the loss of a child is recognized as a complex process, one whose trajectory is influenced by a variety of factors. One factor, the age of the child at the time of death, may be an important influence in the trajectory of grief. The purpose of this interpretive phenomenological study was to explore the experiences of loss for 15 bereaved mothers and fathers whose children suddenly died between the ages of 2 and 12 years. This age range was selected to explore bereavement in parents of young and preteen children because they may feel a greater sense of daily care and responsibility for the safety of their children in comparison to bereaved mothers and fathers of older children or adults. The psychosocial transition theory was used to develop the research questions, which framed the exploration of the experiences and adaptive responses of the parent participants. There were 15 recorded semistructured interviews from which the data were collected. The transcribed data were validated with member checking. Data analysis was completed using open and hierarchical coding to identify meanings and recurrent themes in the participant narratives. Recurrent themes included that grieving was emotional and physical for these parents, and that grief made it difficult for them to do everyday tasks or care for surviving children. Mothers and fathers identified viewing their world as less safe and experienced a reevaluation or complete abandonment of their spiritual beliefs. Implications for positive social change include increasing social awareness in the general public about grief due to child death and challenging unrealistic expectations of grief trajectory. Furthermore, the findings of this study may be used by mental health professionals to create interventions specific to this type of loss.

Increasingly, technology impacts how we communicate and behave following the death of a loved one. However, little is known about technology use by the bereaved. This thesis contributes to understanding this phenomenon through three linked studies. These studies establish an appreciation of how technology engages with human mortality, and proposes "thanatosensitive design" (TSD) as an approach for developing such systems. An exploratory study fi rst examines technology use by the bereaved through a survey with follow-up interviews. Findings show that systems for inheriting data and devices are lacking, despite widespread use of technology for remembrance and communication. Using digital assets in social support is selected as a domain for further inquiry. The second study consists of focus groups with bereaved parents at two community organizations complemented by the perspectives of professional bereavement workers. Based on this fieldwork, 6 considerations concerning interpersonal communication, new ways of being, and materiality are presented. These considerations suggest that systems should permit connections with peers, support storytelling activities, and avoid tendencies to "fix" grief, among others. In the final study, I present Besupp - a website that permits bereaved users to engage in online peer-support groups. Besupp applied these design considerations and was deployed in a 10-week study. Nineteen bereaved individuals met in 3 support groups for bereaved parents, partners/spouses, and young adults. Based on system logs/data, questionnaires, and interviews, the study identified barriers to using digital mementos, preferences for online support systems, and issues concerning timing of use. In the discussion, I reflect on the three studies through four thematic lenses: temporality, materiality, identity, and research ethics/methods. I remark on how systems should consider the varying emotional needs of the bereaved over time. In the conclusion, I summarize and reflect on the status of TSD and identify areas for future work concerning social support for the bereaved, and computing's role at the end of life more broadly.

Increasingly, technology impacts how we communicate and behave following the death of a loved one. However, little is known about technology use by the bereaved. This thesis contributes to understanding this phenomenon through three linked studies. These studies establish an appreciation of how technology engages with human mortality, and proposes "thanatosensitive design" (TSD) as an approach for developing such systems. An exploratory study fi rst examines technology use by the bereaved through a survey with follow-up interviews. Findings show that systems for inheriting data and devices are lacking, despite widespread use of technology for remembrance and communication. Using digital assets in social support is selected as a domain for further inquiry. The second study consists of focus groups with bereaved parents at two community organizations complemented by the perspectives of professional bereavement workers. Based on this fieldwork, 6 considerations concerning interpersonal communication, new ways of being, and materiality are presented. These considerations suggest that systems should permit connections with peers, support storytelling activities, and avoid tendencies to "fix" grief, among others. In the final study, I present Besupp - a website that permits bereaved users to engage in online peer-support groups. Besupp applied these design considerations and was deployed in a 10-week study. Nineteen bereaved individuals met in 3 support groups for bereaved parents, partners/spouses, and young adults. Based on system logs/data, questionnaires, and interviews, the study identified barriers to using digital mementos, preferences for online support systems, and issues concerning timing of use. In the discussion, I reflect on the three studies through four thematic lenses: temporality, materiality, identity, and research ethics/methods. I remark on how systems should consider the varying emotional needs of the bereaved over time. In the conclusion, I summarize and reflect on the status of TSD and identify areas for future work concerning social support for the bereaved, and computing's role at the end of life more broadly.