No description available.

Purpose: To introduce the simplified therapeutic intervention scoring system (TISS-28), the original therapeutic intervention scoring system (TISS-76) and simplified acute physiological score (SAPS) version II in critically ill adult patients, in order to describe the validity and reliability of TISS-28 as a suitable measure of quantifying nursing workload in the adult intensive care units (ICU) of a public sector hospital in Johannesburg. Objectives: To describe the profile of patient admissions to the intensive care units, to investigate the impact of the patients’ profile on the requirements for nursing workload and to validate the use of TISS-28 as a measure of quantifying nursing workload in this setting. Design: A non-experimental, comparative descriptive, correlational and prospective two-staged design was utilized to meet the study objectives. Stage I involved face and content validation of TISS-28 by a panel of ICU nurse experts (n=6). Stage II involved assessment of concurrent and construct validity as well as inter-rater reliability of TISS-28 using participants (n=105) drawn from trauma, cardiothoracic and multidisciplinary ICUs. Data necessary for the calculation of TISS-28, TISS-76 and SAPS II were recorded for each patient in the ICU at 24 and 48 hours after admission and in the wards after discharge within 24-48 hours. Descriptive and inferential statistics were used to analyze data. Results: Content Validity Index (CVI) of 0.93 was found for TISS-28. A significant positive correlation was found between TISS-28 and TISS-76 scores (r = 0.7857, p = 0.0001) as well as TISS-28 and SAPS II scores (r = 0.2098, p = 0.0317). A significant difference was found between TISS-28 scores among patients in the ICU and patients in the ward (t = 25.59, p = 0.0001; t = 21.48, p = 0.0001) respectively. A significant correlation was found between the data collected from a sample of patients by the researcher and the expert assistant researcher with an intra-class correlation coefficient of 0.99 and a p-value of 0.0001. Conclusions: The findings support validity and reliability of TISS-28 hence its feasibility for use in South African ICUs. Recommendations for nursing education, practice, management and research are proposed.

As a consequence of interrogating pupil progress data, the primary school in this study identified apparent inequalities in the rates of progress in Reading and Mathematics made by male and female pupils in Key Stage Two cohorts. To address this school improvement issue, the Key Stage Two pupils and the staff who worked with them, were surveyed in order to establish a starting point for action. The surveys indicated that low-achieving female pupils in the school perceived themselves, and were perceived by staff as having low levels of self-esteem and confidence, which were impacting upon their ability to access the learning and impeding their educational progress. A search of the literature on barriers to learning and the range of approaches and initiatives which have been employed to address these, alongside a consultation process with female pupils though a focus group, resulted in identification of the need for the provision of an intervention which would address the issue. Outcomes from an internally–provided school intervention pilot programme resulted in the adoption of a participatory action-research model which allowed the pupils to contribute to the design, implementation and evaluation of a single-sex therapeutic intervention, facilitated by a drama practitioner. Through the use of drama and mask techniques the practitioner provided a safe, non-judgemental environment which enabled participants to feel accepted, to express their feelings, to lead activities, to take risks and to develop a wider friendship circle. The intervention was widely commended, with staff and parents/carers reporting a perceived increase in levels of confidence, expanded friendship circles and stronger peer relationships and improved active engagement in learning in the mixed-gender classroom environment. Qualitative data, in the form of individual video evaluations of the intervention indicated the learning which had resulted from participation, most strongly evidenced by the positive comments elicited from the participants both in terms of the techniques employed in the intervention and the outcomes achieved: “…At first you’re the one underneath the mask… Then the mask becomes you… The masks helped me feel more confident …When we did the mask it was like a confidence builder – made you speak your mind and gave you the words to express your feelings better – like if your excited or happy you had the words to say that…this project helped all our group…’cos we’ve learned to be more confident in ourselves and I just feel a lot better…”

Magister Psychologiae - MPsych

Attachment theory is a fundamental framework established to understand mental health and emotion regulation in children and adults. Studies have indicated that disruptions to attachment within caregiver-child relationships can result in several psychological and behavioural challenges in children. As a result, various attachment-based interventions have been developed to remediate these relational challenges within caregiver-child dyads. Theraplay® is one such therapeutic modality that is play-based and involves the caregiver and child within the therapeutic process. Despite its popularity among practitioners, Theraplay® has not received much attention in literature with limited consideration given to its implementation in contexts outside of the United States of America (USA). Therefore, the aim of this study is to explore therapists’ perceptions on the implementation of Theraplay® in the South African context. An exploratory qualitative research design situated within an interpretive paradigm was adopted to explore the perceptions of research participants regarding implementing Theraplay® in South Africa. Through purposive sampling, and secondary snowball sampling, six participants—trained in Theraplay®—were selected to take part in the study. Individual semi-structured interviews were conducted with each participant and transcripts were analysed via inductive thematic analysis. The following salient themes emerged across the data set: 1) overall potential of Theraplay® as a therapeutic modality, 2) applicability of Theraplay® in South Africa, 3) impact of resource availability on Theraplay® in South Africa, and 4) role of caregiver accessibility and influence on Theraplay®. Overall, participants valued Theraplay® as an attachment-based modality but considered administrative challenges as requiring further deliberation pertaining to contextual and cultural aspects of this therapeutic intervention for South Africa. This may stimulate further research on possible context-specific adaptations or additions to Theraplay® in order to respond more efficiently through psychological treatment of children’s problems within the South African population. It also indicates the need to continue expanding research regarding caregiving practices within diverse cultural contexts such as South Africa. / Mini Dissertation (MA (Clinical Psychology))--University of Pretoria, 2020. / Psychology / MA (Clinical Psychology) / Unrestricted

Yes / Epidemiological studies have shown that head and neck cancer (HNC) is a complex multistage process that in part involves exposure to a combination of carcinogens and the capacity of certain drug-metabolising enzymes including cytochrome P450 (CYP) to detoxify or activate such carcinogens. In this study, CYP1A1, CYP1B1 and CYP2W1 expression in HNC was correlated with potential as target for duocarmycin prodrug activation and selective therapy. In the HNC cell lines, elevated expression was shown at the gene level for CYP1A1 and CYP1B1 whereas CYP2W1 was hardly detected. However, CYP2W1 was expressed in FaDu and Detroit-562 xenografts and in a cohort of human HNC samples. Functional activity was measured in Fadu and Detroit-562 cells using P450-Glo™ assay. Antiproliferative results of duocarmycin prodrugs ICT2700 and ICT2706 revealed FaDu and Detroit-562 as the most sensitive HNC cell lines. Administration of ICT2700 in vivo using a single dose of ICT2700 (150 mg/kg) showed preferential inhibition of small tumour growth (mean size of 60 mm3) in mice bearing FaDu xenografts. Significantly, our findings suggest a potential targeted therapeutic approach to manage HNCs by exploiting intratumoural CYP expression for metabolic activation of duocarmycin-based prodrugs such as ICT2700. / The authors would like to thank Bradford Institute for Health Research for funding a PhD studentship to DP through a competitive scheme and Yorkshire Cancer Research programme Grant (B381PA) for supporting our cytochrome P450-focused drug discovery research.

Text in Afrikaans / Every person yearns to function as an independent and integrated human being who experiences inner peace and wholeness. The search for a way of life that leads to wisdom and life knowledge has continued through the centuries and according to Hancock (2005:8) it began as early as 40 000 years ago. This research study takes up this search, describing human wholeness from a spiritual, philosophical and psychological perspective, in the context of specific essential characteristics. Together with this, applicable therapeutic approaches were researched to structure an intervention model to achieve wholeness. Wholeness therapy is an eclectic approach based on medical hypnoanalysis with added aspects of the rational-emotive behavioural therapy of Albert Ellis, choice theory of William Glasser and Victor Frankl’s logotherapy. By means of qualitative research a case study from a psychological practice was described, in which a person was enabled to experience wholeness through wholeness therapy which is described in full. / Educational Studies / D.Ed. (Sielkundige Opvoedkunde))

Pancreatic Ductal Adenocarcinoma (PDAC) affects approximately 8000 people every year in the UK and is the fifth leading cause of cancer related death. At a molecular level PDAC is characterized by a significant immune infiltrate. Tumour-associated macrophages (TAMs) infiltrate the tumour and contribute to a worse prognosis by promoting growth, metastasis and resistance to chemotherapy. TAMs are derived from circulating ‘classical’ CD14++ CD16- monocytes in the peripheral blood. Current work in murine models suggests targeting monocyte recruitment in PDAC can reduce TAM infiltration and disease burden therefore improving survival. This project aims to identify markers specific to monocytes from PDAC patients and to investigate their biological relevance and potential for therapeutic intervention. Gene expression and metabolomics analysis was carried out on classical CD14++ CD16- monocytes from locally advanced PDAC patients and age matched healthy donors. Transcriptomic profiling revealed a significantly altered gene expression profile in classical monocytes from patients and genes with the highest fold change difference were chosen for validation using qPCR. Validated gene targets were investigated further in vitro and large-scale gene expression analysis from pancreatic tumours assessed. The results from my work demonstrate that the gene expression profile of classical monocytes from PDAC patients is significantly different compared to healthy volunteers. Identification and validation of up-regulated genes and their biological relevance may represent a relevant novel novel biomarker or therapeutic strategyies to target monocytes and myeloid recruitment in cancer.

The present study investigates the role of attachment in a time-limited marital therapy. The study explores Brief Contextual Modular Psychotherapy (BCMT). This approach to practice provides a model that integrates principles and techniques from the major psychotherapies. BCMT can be distinguished from other brief therapies by its theoretical integration, its six-session time limit, its specific clinical focus, and its techniques for dealing with dissatisfaction and distress. The therapy sets out practice modules—six-session treatment plans—for a diverse range of presenting issues such as the anxiety disorders, depression, trauma, loss and grief, marriage and the phobias. BCMT emphasises the collaboration of the therapist and the client. A community-based psychological counselling centre has practised BCMT for over ten years, applying it in cases of wide diversity and maladjustment. Prior to this research, a comprehensive analysis of the theory underlying the BCMT model or the theory of change it endorses had not been carried out. The study provides a detailed description of the conceptual and treatment elements of the marital module developed in the treatment manual for BCMT. The study explores how the construct of attachment provides an organising framework or metaperspective for theory construction and therapeutic intervention in the clinical application of this time-limited marital therapy. To achieve this objective, one de-facto and four married couples participated in the time-limited therapy. They completed a questionnaire on adult attachment and also a self-report questionnaire to assess the effectiveness of the therapy. Narrative analysis was used to assess the praxis or the experience of participating in the therapy. The results show that the integrated model provided a treatment method for differing expressions of marital disturbance and psychopathology. Three of the five couples and eight of the ten participants reported positive treatment outcomes. The research sample included the paraphilias, a major depressive episode with postpartum psychosis, the narcissistic borderline syndrome and childhood sexual abuse. The study supports the association between the role of adult attachment styles and intrapsychic responses in conflicted intimate relationships. From the point of view of clinical applications of attachment theory, the research highlights how theoretical ideas can be integrated, specific clinical methods can be incorporated and certain treatment perspectives can be derived from one another. Several implications for the treatment process flow from this integration. The integration of attachment theory in BCMT demonstrates how the therapeutic process progressed through three separate yet interrelated stages: past, present and future. In addition, it led to the identification of three stage-related mourning processes associated with the time-limited therapeutic process: protest, despair and detachment. From a clinical perspective, the research finds that the theoretical and treatment model does not need to be restricted to marital therapy. The findings suggest that the integrated model could be applied across a wide range of presenting issues. By defining the theory of personality and psychopathology and the therapeutic change processes associated with it, the integration of attachment theory results in BCMT taking its place in the literature as a theory of psychotherapy.

Humans and animals interaction is showing promise as a way to provide complementary and alternative medicine for humans. Children have an affinity for animals that could be useful therapeutically. Emotional stress and trauma impacts the neurobiology of children, who are vulnerable given the developmental plasticity of the brain. Some research suggests that neuropeptides and neuromodulators in both humans and the animals are mutually altered through human animal interaction, resulting in the attenuation of stressful responses in both (Yorke, in press; McCabe & Albano, 2004; Uvnas-Moberg, 2009). Human or animal touch, proximity and mind body interaction has been found to contribute to trauma recovery (Brooks, 2006; Perry, 2006; Van der Kolk, 2003; Yorke, Adams & Coady, 2008). Trauma results in the release of the peptide glucocortisoid, or cortisol leading to an ongoing over-arousal of the anatomic nervous system (ANS). Kindling (sensitivity) of the brain, a result of stress, ironically makes the brain more receptive to attunement and enriched environments (Francis & Meaney, 1999; Kramer, 1993; Putnam, 2005). Attunement with others as well as enriched environments is prophylactic, contributing to resilience and normal brain development (Caldji, Diorio & Meaney, 2000; Carter, 1998; Lewis & Todd, 2007; Nelson, 2000; Shore, 2003). The empirical evidence indicates that companion animals impact humans in helpful ways (Friedmann, Katcher, Thomas, Lynch & Messent, 1983; Shiloh, S., Sorek, G., & Terkel, J., 2003; Virues-Ortega, & Bruela-Casal, 2006; Wilson, 1991; Uvnas-Moberg, 2009). Equine-human interaction in particular has demonstrated contradictory results (Bass, Duchowny & Llabre, 2009; Davis, 2009; Schultz, Remick-Barlow & Robbins, 2007). Equine-human interaction can be viewed as a kind of ‘mind body experience’ that incorporates the characteristics of affiliation and attunement into a child’s environment (Finger & Arnold, 2002). A pilot study, multiple base line, single case design of four traumatized children, eight to ten years old and four therapeutic riding horses explores the neurobiological interaction between the children and horses. It hypothesizes that there will be physiological resonance and symmetry in the responses. Some trends suggest the need for further research.