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Assessment of Feigning with the Trauma Symptom Inventory: Development and Validation of new Validity Scales with Severely Traumatized PatientsPayne, Joshua W. 05 1900 (has links)
Currently, only the TSI assesses complex traumatic reactions and patient response styles. However, its feigning scale, ATR, uses a flawed detection strategy and is potentially confounded by experiences of complex PTSD. As a consequence, clinicians using the TSI to evaluate severely traumatized patients have no useful method for discriminating genuine and feigned responding. Several detection strategies have demonstrated utility within evaluations of feigned trauma including the assessment of rare symptoms, symptom combinations, symptom selectivity, and symptom severity. The current study created scales on the TSI according to these strategies using a development sample of 107 severely traumatized patients. Validation of all TSI feigning scales was then performed with a second independent sample of 71 severely traumatized patients using a mixed simulation design. Results found support for each scale's convergent validity with SIRS primary scales (M rs = .52) and discriminant validity with measures of defensiveness on the SIRS (M rs = -.07) and TSI (M rs = -.19). Each scale also produced expectedly mild to moderate relationships with SADS-C clinical scales (M rs = .32) and the SCID-IV PTSD module (M rs = -.02). Support for their criterion validity was only moderate (M ds = .69) when comparing the scores of genuine patients to those simulating disability. Potential explanations for this trend were reviewed, including (a) the impact of comorbidity, (b) the restrictions associated with creating embedded feigning scales, and (c) the influence of simulator knowledge in analogue designs. Limitations of the study and future avenues of research were discussed.
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CHILDREN WHO HAVE EXPERIENCED TRAUMA: AN EXAMINATION OF THE ROLE OF RACE, ETHNICITY, AND CULTURAL FACTORS IN PRESENTING SYMPTOMS AND AT THREE MONTH (OR FIRST RECORDED) FOLLOW UPWolf, Stephanie Susanne Genser 16 April 2013 (has links)
Child traumatic stress is a pervasive problem that affects the well-being and healthy development of children from all races, ethnicities, and cultures. Major factors known to affect trauma symptoms include type of trauma, level or severity of trauma exposure, and age and gender of children. Utilizing Bronfenbrenner’s ecological model, this study measured the additional influence of children’s race, ethnicity, and cultural factors on symptoms after trauma. A dataset of children in treatment after experiencing trauma (0-21 years, N = 10,115) from The National Child Traumatic Stress Network (NCTSN), a federally funded initiative that collected longitudinal data across 56 research and treatment centers in the US, was examined, looking at clinical symptoms at baseline and at three month (or first recorded) follow-up. Predictors for symptoms included number of trauma types, age, gender, race, ethnicity (Latino/non-Latino), and three cultural markers, born outside the United States, English as the primary language not spoken at home, and refugee/immigrant status. Results (hierarchical regressions, logistic regressions) confirmed that age, gender, and number of trauma types predict the scores and clinical level of eight validated outcomes (e.g., CBCL externalizing, internalizing; PTSD measures) as well as the total numbers of functional problems and clinical problems. Results also demonstrated that race, ethnicity, and culture affect symptoms but to a very small extent (i.e., these accounted for little variance) and in varying directions. For example, Black/African American children had lower internalizing scores compared to White/Caucasian children, while being Latino was associated with lower externalizing and higher internalizing scores than non-Latinos. Children with differing cultures sometimes scored better, sometimes worse, than their counterparts. For example, children who spoke English at home and were born in the United States had more functional problems, though fewer clinical problems. At three month (or first recorded) follow up, results demonstrated all children’s scores improving. No differences at three month (or first recorded follow up) were found between our predictors in clinical rates except for children with more types of trauma who continued to show a greater likelihood of falling into the clinical range for externalizing and internalizing. Discussion focuses on the possible protective effects of cultural factors and the importance of an ecological model in understanding trauma symptoms in diverse populations.
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Hemorrhage Detection and Analysis in Traumatic Pelvic InjuriesDavuluri, Pavani 31 August 2012 (has links)
Traumatic pelvic injuries associated with high-energy pelvic fractures are life-threatening injuries. Extensive bleeding is relatively common with pelvic fractures. However, bleeding is especially prevalent with high-energy fractures. Hemorrhage remains the major cause of death that occur within the first 24 hours after a traumatic pelvic injury. Emergent-life saving treatment is required for high-energy pelvic fractures associated with hemorrhage. A thorough understanding of potential sources of bleeding within a short period is essential for diagnosis and treatment planning. Computed Tomography (CT) images have been widely in use in identifying the potential sources of bleeding. A pelvic CT scan contains a large number of images. Analyzing each slice in a scan via simple visual inspection is very time consuming. Time is a crucial factor in emergency medicine. Therefore, a computer-assisted pelvic trauma decision-making system is advantageous for assisting physicians in fast and accurate decision making and treatment planning. The proposed project presents an automated system to detect and segment hemorrhage and combines it with the other extracted features from pelvic images and demographic data to provide recommendations to trauma caregivers for diagnosis and treatment. The first part of the project is to develop automated methods to detect arteries by incorporating bone information. This part of the project merges bone edges and segments bone using a seed growing technique. Later the segmented bone information is utilized along with the best template matching to locate arteries and extract gray level information of the located arteries in the pelvic region. The second part of the project focuses on locating the source of hemorrhage and its segmentation. The hemorrhage is segmented using a novel rule based hemorrhage segmentation approach. This approach segments hemorrhage through hemorrhage matching, rule optimization, and region growing. Later the position of hemorrhage in the image and the volume of the hemorrhage are determined to analyze hemorrhage severity. The third part of the project is to automatically classify the outcome using features extracted from the medical images and patient medical records and demographics. A multi-stage feature selection algorithm is used to select the predominant features among all the features. Finally, boosted logistic model tree is used to classify the outcome. The methods are tested on CT images of traumatic pelvic injury patients. The hemorrhage segmentation and classification results seem promising and demonstrate that the proposed method is not only capable of automatically segmenting hemorrhage and classifying outcome, but also has the potential to be used for clinical applications. Finally, the project is extended to abdominal trauma and a novel knowledge based heuristic technique is used to detect and segment spleen from the abdominal CT images. This technique is tested on a limited number of subjects and the results are promising.
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The Effect of Adding Drag-Reducing Polymers to Resuscitation Fluid During Hemorrhagic Shock on Skeletal Muscle MicrocirculationAlexander, Geoffrey C. 01 January 2006 (has links)
Previous studies have shown an increase in survival when a minute amount of drag-reducing polymers were added to a resuscitation fluid. The purpose of this investigation was to examine the effect of adding a minute amount of the drag-reducing polymer polyethylene glycol to a resuscitation fluid, on the microcirculation of skeletal muscle during a volume-controlled hemorrhage model. The spinotrapezius muscle in twelve male Sprague Dawley rats was exteriorized for microvascular measurements of the arterioles. The diameters of the three levels of arterioles, interstitial fluid PO2, and RBC velocity in the feed arteriole were measured. Flow in the feed arteriole was calculated using the diameter and RBC velocity. Heart rate, mean arterial pressure, respiratory rate, arterial blood gases, arterial blood electrolytes, and arterial blood metabolites were measured. No significant physiological differences were observed between the DRP group and the Control group.
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EXAMINATION OF BASAL NEUROENDOCRINE LEVELS IN OIF/OEF/OND VETERANSHawn, Sage E. 01 January 2015 (has links)
Abstract
EXAMINATION OF BASAL NEUROENDOCRINE LEVELS IN OIF/OEF/OND VETERANS
By Sage E. Hawn, B.S.
A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University.
Virginia Commonwealth University, 2015.
Major Director: Ananda B. Amstadter, PhD.
Associate Professor
Departments of Psychiatry, Psychology, & Human and Molecular Genetics
High rates of combat exposure exist among veterans of the recent conflicts, and are associated with debilitating mental health conditions, including posttraumatic stress disorder (PTSD). Numerous psychosocial and biologic factors are associated with PTSD, including the HPA-axis. The present study aimed to compare baseline neuroendocrine levels by trauma group (PTSD, trauma exposed [TE], and non-trauma controls [NTC]) among a sample of young veterans. An exploratory aim was to examine potential moderators of the relation between PTSD and basal cortisol/ACTH. Group differences in cortisol were nominally significant, with the NTC group having significantly higher cortisol than the PTSD group. Sleep disturbance was the only moderator of this relationship in cortisol, although lifetime trauma load significantly predicted basal cortisol across all models. No significant effects were demonstrated for ACTH. Examining effects of trauma on basal physiology provides a critical stepping ground for future investigations that may inform targeted prevention and intervention efforts.
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Traumatic dental emergencies presenting to a children's teaching hospitalRibeiro Pita, Analia M. January 2005 (has links)
Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.
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The value of osteology in an historical context : a comparison of osteological and historical evidence for trauma in the late 18th- to early 19th century British Royal NavyBoston, Ceridwen Victoria January 2014 (has links)
Trauma is arguably the most comparative and least ambiguous of palaeopathological lesions. As such, it is an ideal vehicle for exploring the respective contributions and differences between historical and osteological approaches to health in the past. A direct comparison between historical and osteological assemblages is often impossible due to the lack of comparable data, or complicated by the very different perceptions, motivations and pre-occupations of past writers and present researchers. Nevertheless, where genuine opportunities exist to compare and contrast the alternative strands of evidence, it may lead to a much richer and more nuanced understanding of the past. This study uses trauma in the late 18<sup>th</sup>- to early 19<sup>th</sup> century British Royal Navy (R.N.) to explore the differences between the two disciplines, and through this process to come to a deeper understanding of the physical effects of a maritime lifestyle on the health of late 18th- to early 19th century R.N. seamen and marines. The 18<sup>th</sup>- and early 19<sup>th</sup> century R.N. is one of the best documented institutions of its day, with a large corpus of records accessible in the National Archives in Kew. Recent archaeological excavations in the burial grounds of the three R.N. hospitals of the 18<sup>th</sup> century in Britain- the Royal Hospitals Haslar in Gosport, Stonehouse in Plymouth and Greenwich Hospital in South-East London- have made available over 300 skeletons of seamen and marines, who were treated but died in these institutions. This study explores the osteological evidence for fractures and joint trauma patterning in 300 of these skeletons. Eighteenth century accounts of the privations and dangers of sailing a fighting ship are well supported osteologically by the presence of 926 fractures and 14 joint dislocations. Osteological trauma patterning was compared with historical data collated from the Haslar and Plymouth Hospital musters (1792-1824) and Entry Books of Greenwich Hospital (1749-1765). The most probable aetiology of injuries was explored using insights from modern medical and forensic research, and 18<sup>th</sup> century sea surgeons' journals. Falls accounted for a very high proportion of injuries in both datasets, as did crush injuries, and to a much lesser extent, battle trauma. Extremely high rates of nasal fractures, Bennett's fractures of the first metacarpal, and anterior rib fractures in the skeletal assemblages strongly suggest very high rates of casual interpersonal violence. Interestingly, these injuries were very seldom recorded in either sea surgeon or hospital records, possibly due to seamen's fear of punishment for transgressing official naval regulations against fighting. Several unusual fractures (such as Shepherd's fractures of the talus, and third metacarpal avulsion fractures) and bony modifications (such as shallow and unstable hip and shoulder joints, os acromiale and Eagle's syndrome) appear to be the consequences of engaging in a maritime lifestyle, often beginning in childhood or adolescence. Trauma is arguably the most comparative and least ambiguous of palaeopathological lesions. As such, it is an ideal vehicle for exploring the respective contributions and differences between historical and osteological approaches to health in the past. A direct comparison between historical and osteological assemblages is often impossible due to the lack of comparable data, or complicated by the very different perceptions, motivations and pre-occupations of past writers and present researchers. Nevertheless, where genuine opportunities exist to compare and contrast the alternative strands of evidence, it may lead to a much richer and more nuanced understanding of the past. This study uses trauma in the late 18th- to early 19th century British Royal Navy (R.N.) to explore the differences between the two disciplines, and through this process to come to a deeper understanding of the physical effects of a maritime lifestyle on the health of late 18th- to early 19th century R.N. seamen and marines. The 18th- and early 19th century R.N. is one of the best documented institutions of its day, with a large corpus of records accessible in the National Archives in Kew. Recent archaeological excavations in the burial grounds of the three R.N. hospitals of the 18th century in Britain- the Royal Hospitals Haslar in Gosport, Stonehouse in Plymouth and Greenwich Hospital in South-East London- have made available over 300 skeletons of seamen and marines, who were treated but died in these institutions. This study explores the osteological evidence for fractures and joint trauma patterning in 300 of these skeletons. Eighteenth century accounts of the privations and dangers of sailing a fighting ship are well supported osteologically by the presence of 926 fractures and 14 joint dislocations. Osteological trauma patterning was compared with historical data collated from the Haslar and Plymouth Hospital musters (1792-1824) and Entry Books of Greenwich Hospital (1749-1765). The most probable aetiology of injuries was explored using insights from modern medical and forensic research, and 18th century sea surgeons’ journals. Falls accounted for a very high proportion of injuries in both datasets, as did crush injuries, and to a much lesser extent, battle trauma. Extremely high rates of nasal fractures, Bennett’s fractures of the first metacarpal, and anterior rib fractures in the skeletal assemblages strongly suggest very high rates of casual interpersonal violence. Interestingly, these injuries were very seldom recorded in either sea surgeon or hospital records, possibly due to seamen’s fear of punishment for transgressing official naval regulations against fighting. Several unusual fractures (such as Shepherd’s fractures of the talus, and third metacarpal avulsion fractures) and bony modifications (such as shallow and unstable hip and shoulder joints, os acromiale and Eagle’s syndrome) appear to be the consequences of engaging in a maritime lifestyle, often beginning in childhood or adolescence.
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The process of recovery from childhood sexual abuse for female survivors in TaiwanHung, Su-Chen January 2000 (has links)
The dislocation between the literature on the recovery process from sexual abuse and my clinical experience led me to develop three research questions about the recovery process from childhood sexual abuse: these concern the experience of sexual abuse itself, the process of recovery from the experience of sexual abuse and the difference in recovery process between the participants who received counselling and those participants who did not. I invited ten female survivors of sexual abuse, who received counselling and three female survivors who did not to participant in this study. Each participant had four to eight hours in-depth interview and the data had been analysed according to the principles of grounded theory. I analysed the available literature of recovery process and compared this with the findings in this study. Finally, I developed an account of the process of recovery from sexual abuse according to the findings of this study and comparison with the available literature review. There are three main findings in this study: 1. There were four reasons the participants used to explain why the abuse happened. Firstly, they perceived their family dynamics as a cause of abuse. Secondly, the abusers might use the offensive behaviour to satisfy their emotional needs. Thirdly, the abusers felt curious about sex but the family did not have adequate sex education to satisfy the curiosity. Finally, the abuse was not a physically painful experience for some of the participants so they did not disclose or run away from it. 2. Five systems interact with each other in the process of recovery: (1) The positive and vulnerable parts of the self. (2) Four areas (surviving, issue of self, issue of external world, and integration) of the recovery process. (3) Five outcomes (issue of self, emotions, cognition, sexuality and relations) of the recovery process. (4) Three areas (issues of self, emotions and relations) of unresolved issues. (5) Nine elements (the abuse, family situations, childhood, nature, adulthood, relations, counselling, society's of sexuality, and religions) affecting the above systems. 3. There are different perceptions about the experience of abuse between Group A, who received counselling, and Group B, who did not.
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Chronic psychological trauma predicts mental and physical trauma symptoms differentially based on gender and levels of resilience and forgivenessJeter, Whitney Kristin January 1900 (has links)
Master of Science / Department of Psychology / Brenda L. McDaniel / A large majority of trauma research focuses on relatively acute, physical trauma leading to the development of negative mental and physical trauma symptoms. Sometimes psychological trauma is measured concurrently with these instances of physical trauma. However, less is known about the impact of solely psychological trauma on mental and physical trauma symptom development. Moreover, chronic rather than acute psychological trauma is even more understudied. Therefore, the purpose of the current study was to address the gap of knowledge surrounding the impact of chronic psychological trauma on mental and physical health in young adults. The present inquiry was guided by two theoretical models: the Chronic Relational Trauma (CRT) Model and the Etiology of Psychopathology (EP) Model. The CRT Model posits a cyclical pattern of relational trauma perpetrated by caregivers, peers, and intimate partners. Relatedly, the EP Model focuses on acute physical trauma exposure leading to the development of negative mental and physical trauma symptoms as well as potential biological dysregulation with personality characteristics moderating these relationships. However, it is currently unknown how these moderating personality characteristics impact chronic psychological trauma. Thus, the current study blended these two theoretical models in order to examine the impact of chronic psychological trauma on mental, physical, and biological symptoms. One hundred and eighty young adults (Mean age = 18.53, SD = .70) were recruited for the current study. Participants completed a series of questionnaires and provided five total cortisol samples via oral swabs. Results indicate that after controlling for chronic physical trauma, chronic psychological trauma predicts mental trauma symptoms for females and males, but not physical trauma symptoms or biological dysregulation in cortisol. Further, levels of resilience, namely a sense of mastery and emotional reactivity as well as forgiveness significantly moderate the relationship between chronic psychological trauma and mental and physical trauma symptoms for males and females differentially. Contributions of the current findings in terms of adding unique knowledge to trauma literature and future research projects are discussed.
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Counselor Perceptions of the Efficacy of Training and Implementation of Self-Care Strategies Related to Trauma WorkCulver, Leslie Midtbo 20 May 2011 (has links)
Various forms of trauma are regularly reported across the spectrum of counseling settings and the potential negative psychological effects on counselors who are repeatedly exposed to traumatic material are well documented. However, many researchers suggest that vicarious traumatization can be prevented and mitigated with personal and professional self-care strategies. The American Counseling Association (ACA) Code of Ethics indicates that counselors have a professional responsibility to engage in self-care activities, as efforts to ensure the psychological health of counselors will have a direct effect on their ability to help clients. The purpose of this mixed-method, descriptive, correlational research was to explore what types of educational preparation and training counselors have received regarding self-care and what types of self-care strategies counselors are using. The efficacy of those training methods and self-care strategies when implemented were also measured, from the perspective of the participants. The Self-Care Training and Implementation Questionnaire (STIQ), a 19-item, structured and semi-structured questionnaire developed for this research, was electronically sent to 3000 randomly selected members of ACA, resulting in 310 responses, 286 of which were deemed appropriate for inclusion. Analysis included descriptive analyses (quantitative data) and content and theme analyses (qualitative data). The results of this study indicated that counselors recognized the value of self-care and participated in activities that promoted a healthy lifestyle and mitigated stress, thus working toward a balance that fostered effective work performance. However, the findings demonstrated that most counselors do not receive formal self-care training and self-care has been an endeavor pursued independently, outside of education and work settings. Implications for counselor education, training, policy and research are discussed.
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