Traumatic triggers come in many forms: the smell of a rose, the taste of a warm pie, the sound of music, the gaze of a loved one, and the touch of soft soil. What appears ordinary to one may repel another, but the tension between these two opposing reactions is what entices me as an artist. Every trigger is tied to a specific memory which causes me, as a survivor, to question my reality and what I believe to be true. Is this love or is this abuse? What happens when I succumb to the memory that haunts me? My work addresses themes of domesticity, trauma, and sentimentality through the creation of sculpture and video works. Asunder is a minefield of such works that are my response to personal trauma while offering a space for outside connection.

Research suggests that trauma plays a part in Post Traumatic Stress Disorder (PTSD) and psychosis, but it is unclear what role psychotic symptoms or hospitalisation have. Some research has been carried out on mediators and predictors of PTSD and integrating the evidence has key implications for individual and service outcomes. The two papers presented in this thesis aim to contribute to research in this area, followed by a critical review of the research, its relevance and future implications.Paper One is a systematic review of the literature investigating the prevalence of psychosis-related and hospital-related PTSD and considered what factors moderate or mediates these symptoms. Studies showed high levels of psychosis-related and hospital-related PTSD and seventeen factors that may influence the development of psychosis-related or hospital-related PTSD were explored. However incidence rates in different populations are lacking and there is a need to better explore mediating and moderating factors.Paper Two aimed to investigate the traumatic nature of psychosis and hospitalisation and their relationships with attachment and recovery styles in people with psychosis in a secure setting. The final section, the Critical Review, aimed to place the research in a wider context, considering the findings from the research, limitations of the study, highlighting important issues for services, and implications for interventions and future studies.

The writing of this thesis is to investigate the role that the church plays for the children living with conflicting parents. This investigation takes us both into the role of Gcuwa Circuit and the Presbyterian Church of Africa in the fight against traumatized children because of parent’s conflict. The researcher’s question through this thesis is to find out the role of the church as it seeks to take care for those affected children. This thesis is to enhance the response of the churches and societies to fight against abuse of children. It has attempted to explore new theological perspectives and utilise the available ones, which have already been dealing with issues that address children’s trauma as a result of conflicting parents. The study also seeks to encourage church ministers, pastors and lay leaders to provide the much needed leadership in the fight against children’s trauma and its accompanying social problems of injustices, culture and gender inequality. The church has the pastoral responsibilities for ensuring that all children enjoy their full rights. Nevertheless effective therapy and pastoral care normally transcends all these barriers. / Dissertation (MA(Theol))--University of Pretoria, 2011. / Practical Theology / unrestricted

Background: Up to 40% of trauma patients die during the first 24 hours after injury due to massive hemorrhage. In patients who survive this critical time period, no information is available on rates of delayed major bleeding or factors associated with delayed major bleeding. Methods: A retrospective chart review of 150 critically ill adult trauma patients was used to determine the incidence of delayed major bleeding events. Cox proportional hazards multivariate analysis was performed to assess for risk factors associated with delayed major bleeding events. The anticipated rate of delayed major bleeding events was 10%. Results: The incidence of delayed major bleeding in this cohort of critically ill trauma patients was 44%. Predictors that were statistically significantly associated with delayed major bleeding included: male gender, pre-injury use of the antiplatelet agents aspirin and/or clopidogrel, presence of intracranial bleeding, higher injury severity scores, requirement of massive transfusion, and low pH values. Use of anticoagulant prophylaxis was not associated with delayed major bleeding. Conclusion: The rate of delayed major bleeding was higher than estimated. Larger retrospective and prospective cohorts are needed to confirm these findings.

This project centres on the continuing relevance of the 1947 Partition of India in texts that engage with the national landscape of Pakistan. This approach proposes that Partition cannot be understood outside of a discussion of Pakistan, as Partition emerged through demands for liberty and enfranchisement for India’s Muslims that became articulated through the discourse of the nation-state; my analysis of cultural texts asks what the implications are of this proposal. This study moves beyond looking at Partition as an isolated series of events in 1947 and contextualises its processes, interrogating why Partition and Pakistan became such a persuasive demand, and what the ongoing ramifications are of its happening. This thesis also considers what the 1971 secession of Bangladesh suggests regarding the attempts of the original cartographic articulation of Pakistan to maintain a unified nation. This project seeks to understand Partition in new ways by utilising a framework that takes into account the broader context of Partition both temporally and spatially. It moves beyond work that solely focusses on texts that discuss the moment of Partition directly, by examining texts that approach the time that preceded Partition, and that which succeeded it. In so doing this thesis charts how texts articulate the arguments for Pakistan’s creation against the events and commemoration of its becoming. I aim to be broad temporally, geographically, and in how I engage with the notion of violence, extending this to include the bureaucratic violence of drawing borders and colonial withdrawal. This study maintains a focus on women’s narratives, arguing that due to the gendered experience of violence at the time of Partition, such as rape, abduction, and honour killing, women’s stories have a particular intervention to make. As such this thesis proposes that there is a pattern of specifically gendered trauma that emerges which disrupts dominant nationalist remembering of Partition. This work takes an interdisciplinary focus by analysing fiction, feature film and documentary. Central to the study is the deployment of a number of theoretical methodologies, such as affect, cultural memory and trauma. Engagement with this critical material enables a discussion of the cultural texts that considers the role of affects in generating and maintaining national belonging, the impact of trauma on individuals who lived through Partition and on the nation writ large, and the implications of how trauma and affect are negotiated when texts imagine reparative futures.

This thesis explored attachment in individuals with intellectual disability (ID). It investigated the role that attachment may have in presenting difficulties, including trauma symptoms, which has a growing body of literature, particularly in people without ID. Paper 1 describes a systematic review of the available literature relating to the psychological well-being of young people with ID in the UK who are 'looked after children' (LAC) or who live away from their birth families. Evidence suggests that both LAC and people with ID, may be vulnerable to developing mental health difficulties. However, there is a paucity of research investigating the psychological well-being of young people with ID who are LAC or who live away from birth families. 17 studies were reviewed, which ranged between 21% and 71% in quality as measured by the QATSDD (Sirriyeh, Lawton, Gardner, & Armitage, 2012). . Only one study was found that directly focused on the psychological well-being of LAC with an ID. The available studies offered some insights into the prevalence, characteristics of young people with ID who are LAC or who live away from their birth families and some of the psychological difficulties they encounter. However, given the methodological limitations of the included studies, no firm conclusions could be drawn. Paper 2 describes an empirical study that investigated the relationship between attachment security and trauma symptoms in adults with ID. 27 staff and service users participated in the research. Service user participants completed a self-report questionnaire regarding trauma symptoms with the researcher and staff participants provided demographic information and completed questionnaires that measured attachment security, trauma symptoms, depressive mood and traumatic events in relation to the service user. No relationship was found between attachment security and trauma symptoms. However, it provided tentative evidence with respect to the type of traumatic events experienced by people with ID and of the prevalence of mental health difficulties in people with ID. There were however several methodological limitations, including a small sample size. Implications for future research and clinical practice are outlined. Paper 3 provides a critical and personally reflective account of undertaking the systematic review and empirical study as outlined above. Strengths and limitations of the research are interwoven throughout. Recommendations for future research and implications for practice are also considered.

Introduction: Coagulopathy in trauma increases the likelihood of death. Various approaches to correcting this coagulopathy are being investigated but the decision to use them is often haphazard. The guidelines on their use are limited. This project aims to produce a decision rule to rule in the need for massive transfusion in military trauma, and therefore to rule in the use of methods for treating the coagulopathy of trauma.Methods: A Delphi Study was performed to ascertain which variables a panel of experts felt were most predictive of the need for massive transfusion. This encompassed experts for the fields of emergency medicine, critical care, trauma surgery, pre-hospital care and haematology. Data from the British Defence Joint Theatre Trauma Registry, from January 2007 –July 2010 were obtained and divided into two groups to provide a derivation and validation dataset. Blood timings for people receiving 5 or more units were obtained from clinical records. Regression analysis of potential predictive factors either indicated by the Delphi panel or by literature review were analysed to confirm their value in prediction of Massive Blood Transfusion. A range of clinical prediction rules were produced using parameters deemed appropriate by the Delphi panel and shown to be predictive through regression analysis. Three of these models were then tested in the validation dataset.Results: Ethical approval has been found not to be required following decisions by the relevant military and civilian ethical boards. The Delphi panel was conducted over 3 rounds with a panel of 33 members. Response rates of 94%, 80% and 77% were achieved in rounds 1, 2, and 3 respectively. 195 statements were produced; agreement was achieved at the 80% level in 97 (49.7%) of statements.Regression analysis produced multiple factors that were highly predictive of Massive Blood Transfusion. These were formulated into 22 potential rules combining evidence of injury, clinical observations and pre-hospital care received to produce rules with high sensitivity and specificity. Overall 3 rules were deemed to provide the best balance of sensitivity and specificity, while remaining clinically valid. These were then validated, in a second dataset. The simplest of these rules has a sensitivity of 83.3% and a specificity of 85.5% with an AUROC of 0.907 in the derivation dataset. In the validation dataset sensitivity improved to 87.65% with a specificity of 80.45% with an AUROC curve of 0.91.Discussion: A clinical decision tool which ruled in the use of a massive transfusion protocol allowing early and aggressive resuscitation, and early provision of blood products, would result in better care for severely injured military trauma patients. Although several prediction models are available, they all require either weighted parameters or blood tests so limiting their utility. Further, sensitivity and specificity is poor. This project, through the use of expert opinion, and the production of a validated decision rule, has provided such a tool with improved sensitivity over the currently available prediction models. By using consensus from a Delphi panel, it is hoped that any tool will be acceptable to clinicians therefore improving quality of care. This rule now needs to be assessed prospectively for validity, ease of use and clinical acceptance.

Anestesisjuksköterskans arbete är medicintekniskt avancerat. I sitt arbete utsätts hon ständigt för nya situationer där hon får handskas med svåra etiska problem. Anestesisjuksköterskan ska se till att tillgodose patientens behov i olika tillstånd vilket kräver goda kunskaper inom sitt yrkesområde. Anestesisjuksköterskan träffar patienten under förhållandevis korta stunder. Syftet med studien är att belysa anestesisjuksköterskans upplevelser av att delta vid akut omhändertagande av patienter utanför operationssalens kontext. Tidigare forskning inom detta område är sparsamt. Studien är kvalitativ och datainsamlingen genomfördes med semistrukturerade intervjuer.  Under intervjuprocessen fick anestesisjuksköterskorna som intervjuades svara enskilt på öppna intervjufrågor. Fyra stycken anestesisjuksköterskor deltog i studien. Anestesisjuksköterskorna som deltog i studien är anställda på en operationsavdelning på ett sjukhus i Västsverige. I analysen framkom det en huvudkategori och två kategorier med sex stycken tillhörande subkategorier. Kategorierna är: ”anestesisköterskans upplevda positiva känslor” och ”anestesisjuksköterskans upplevda negativa känslor”. Resultatet visar att anestesisjuksköterskorna upplevde att  det  är tryggare  att  arbeta  på operationsavdelningen i förhållande mot att arbeta i annan kontext så som traumarum förlossningsavdelning eller liknande. Upplevelsen av att arbeta utanför operationssalen varierade. Informanternas erfarenhet av att arbeta under ett akut omhändertagande på olika platser på sjukhuset är att de känner sig trygga i sin arbetsroll förutsatt att det finns en erfaren, trygg och tydlig anestesiolog med som bestämmer om vad som ska göras under ett akut omhändertagande. Det upplevdes tryggare att arbeta på operationsavdelningen än i en annan miljö. På operationsavdelningen finns det gott om folk att ta hjälp av om det skulle behövas och det upplevdes även tryggt att veta vart alla sakerna finns. Utanför operationsavdelningen känner sig informanterna otrygga då det inte vet om akutvagnar är påfyllda eller om de kan få samma service av sina medarbetare på den ”nya” avdelningen.

This mixed-methods study’s purpose was a systematic comparison of contents and aftereffects of near-death experiences (NDEs) occurring in a variety of circumstances with those occurring in combat. They completed an online survey: a demographic questionnaire, the Near-Death Experience Scale, the Life Changes Inventory-Revised (LCI-R), and four narrative response items. Survey completers were 68 participants: 20 combat near-death experiencers (cNDErs) and 48 non-NDErs (nNDErs). The 29% of participants who met NDE Scale criterion for an NDE was comparable to NDE incidence findings from previous retrospective studies. For statistical analyses, significance was set at p < .05, and effect size (Cohen’s d) was calculated. Mean total NDE Scale scores were significantly lower for cNDErs than variety-of-circumstance NDErs from one of two comparable studies (t = 5.083, p < .0001, d = -1.26), possibly suggesting cNDEs may have “less depth” than other-variety NDEs. Regarding cNDE aftereffects, absence of previous LCI-R data made comparison impossible. Cronbach’s alpha analysis yielded acceptable reliability on the total scale and seven of nine subscales, a finding that matched Schneeberger’s (2010); however, factor analytic results did not support the hypothesized subscale structure of the LCI-R. Although cNDErs did not score significantly higher than nNDErs on the total scale or subscales after Bonferroni correction, results indicated a possible trend toward greater absolute changes (p = 0.02, d = 0.74) and spirituality (p = 0.02, d = 0.67) with the latter finding substantiated by narrative responses. Informal analysis of narrative responses yielded several themes.

Psicólogos / La presente Memoria tiene por objeto indagar y problematizar en torno al encuentro originario y la puesta en marcha del psiquismo, esto, en relación con el trauma edificante y necesario. En este sentido, se revisan diversos aportes teóricos de Sigmund Freud y Piera Aulagnier para poder indagar la temática en cuestión. Así, desde Freud se problematizan los constructos de protección antiestímulos y vivencia de satisfacción, para por esta vía darle un lugar a lo originario en su obra, además, del trauma real establecido en 1920. De Piera Aulagnier se utilizarán fundamentalmente los conceptos de proceso originario y violencia primaria para indagar el lugar del trauma edificante y lo traumático en dicha autora. Aquello posibilita dar lugar a un diálogo entre los referentes mencionados que permitirá problematizar el encuentro originario, entre el infans y el otro; el cual conlleva necesariamente un trauma para el psiquismo en constitución, pero sin embargo un trauma de orden diferente al hecho avasallador y destructor de subjetividad, en tanto el trauma establecido en el encuentro originario es edificante y necesario para la emergencia de la subjetividad. Así también, se establecerá que el encuentro con el otro tiene incidencias en la constitución subjetiva, en tanto éste marca los caminos de la pulsión y posibilita cierto modo de actividad psíquica que permite la metabolización representacional para el infans. Consideraciones que nos permitirán explorar la asimetría necesaria del encuentro originario y el carácter político de dicha relación fundante