Over the past three decades, the United States criminal justice system and mental health treatment providers have collaborated in ways to support more than 20.3 million individuals who are struggling with a substance use disorder (SUD), and who may also be facing drug-related offenses due to their ongoing challenges combatting addiction. Through collaborative efforts we have been fortunate to witness the establishment of adult drug treatment courts, as well as other problem-solving court processes. With more than 1,500 active adult drug treatment court programs in this country, there is a critical need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. Adult drug treatment court programs have been shown to have discrepant success outcomes (8% to 80%) in terms of reducing criminal recidivism; moreover, the existing literature examining the lived experiences of participants in these programs is both minimal and disheartening. This lack of empirical data is problematic for the counseling profession given that they serve as key change agents in this process. What we do know is that the process of creating treatment goal and modalities, which should be in the hands of the clients and their counselors, can be complicated by court-mandated requirements. This bi-level structure has the potential to create ruptures in the working alliance between clients and counselors providing SUD treatment to this population. Accordingly, additional research is needed to explore the client experience within the working alliance, and in so doing reveal the influences at play when working with clients who are mandated to receive SUD treatment. This qualitative study was guided by one central research question: How do clients experience the working alliance with counselors during drug court-mandated addictions treatment? Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients. / Doctor of Philosophy / With more than 1,500 active drug court programs throughout the United States, there is a pressing need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. While adult drug treatment court programs have been shown to have positive outcomes in terms of reducing criminal recidivism, the existing literature examining the participants' lived experiences receiving SUD treatment is minimal and disheartening. Due to the nature of the mandated treatment relationship, the confidentiality which has historically bound and secured the therapeutic working alliance is less defined than it is in fully voluntary treatment settings. This shift in understanding what creates a healthy working alliance for mandated clients to work through presenting treatment issues is something that has yet to be explored by current research. The current study sought to explore clients' experiences of the working alliance with counselors during drug court-mandated addictions treatment. Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients.

The purpose of this study was to describe the experiences of elderly people caring for HIV positive orphans on antiretroviral treatment in Swaziland. An exploratory, descriptive and contextual qualitative study based on a phenomenological approach was conducted. Data was collected by means of semi structured interviews with twelve elderly people purposively selected at Mbabane Government Hospital antiretroviral treatment clinic. The findings of the study highlighted that the elderly people were giving care under compulsion with very little support from the government, the community or other organisations. Their care giving capacity was compromised by many challenges which included the heavy burden of caring for a number of dependents; economic constraints; poor infrastructure; food insecurity, and physical, psychological and social constraints. The elderly were employing a number of coping strategies to counteract the challenges that they were facing. The researcher concluded that the elderly people were vital in ensuring the survival of sick orphans under the paediatric antiretroviral treatment programme in Swaziland if afforded sufficient support and empowerment. / Health Studies / M.A. (Public Health)

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2007. / Objectives The objectives were to compare the relative effect of manipulation and core rehabilitation in the treatment of acute mechanical lower back pain in athletes. Project Design: The study design was a randomized controlled parallel group trial. A quantitative study was performed, by making use of a pre à à à ¢ and post experimental investigation (Nansel et al. 1993 and Naidoo, 2002). Setting: Participants presenting with acute low back pain with an onset of 7 days or less, to the Chiropractic Day Clinic at the Durban University of Technology. Subjects: Thirty athletic participants, either male or female, between the ages of 18 and 45 years presented at the initial consultation which included participant screening and establishment of their suitability for the study. These were then divided into either group A (which received a manipulation) or group B (which received core exercises). Outcome measure: A correct contraction of the core stability muscles was maintained, with a decrease in pressure (in mm Hg) on a Pressure Biofeedback Unit, and an increase in length of time (in seconds). Results: It was found that there was no significant difference between the manipulation and the core rehabilitation groups. Although both groups showed v improvement with regards to their acute mechanical low back pain, the core rehabilitation group improved at a significantly faster rate than the manipulation group with regards to endurance on the stabilizer. Conclusions: Both treatments were equally beneficial for most of the quantitative outcomes measured in this study. However, for the outcome of time on the stabilizer, the core rehabilitation group improved at a significantly faster rate than the manipulation group (p=0.006).

This item was digitized as part of the Million Books Project led by Carnegie Mellon University and supported by grants from the National Science Foundation (NSF). Cornell University coordinated the participation of land-grant and agricultural libraries in providing historical agricultural information for the digitization project; the University of Arizona Libraries, the College of Agriculture and Life Sciences, and the Office of Arid Lands Studies collaborated in the selection and provision of material for the digitization project.

The original publication is available at http://www.samj.org.za / Medical practitioners in South Africa are increasingly confronted with requests to treat patients with opioid use disorders. Many do not possess the required knowledge and skills to deal with these patients effectively. This overview of the medical treatment of opioid dependence was compiled by an elected working group of doctors working in the field of substance dependence. Recommendations are based on current best practice derived from scientific evidence and consensus of the working group, but should never replace individual clinical judgement. / Publishers' version

Treatment planning algorithms for use in the radiotherapeutic treatment of cancer have progressively evolved since the earliest attempts to develop automated dose calculation software in the mid-1950s. Modern algorithms use advanced techniques such as convolution superposition or grid-based Boltzmann solvers to perform external beam radiotherapy calculations. A new method of dose calculation was developed at the Georgia Institute of Technology based on transport theory called COMET-PE. The method combines stochastic pre-computation with a deterministic solver to achieve high accuracy and precision. For the COMET-PE method to be implemented clinically it needs a practical source model that closely mimics the physical characteristics of a typical radiation beam from a linear particle accelerator. The COMET-PE method should also be validated against a known benchmark. A novel linear accelerator source model is presented that models the geometry, angular distribution, spectrum, energy, and electron contamination of a 6 MV photon beam from a Varian c-series clinac. Of note is the use of a hemispherical harmonic expansion with the functional expansion tally method to model photonic fluence. The source was implemented in the COMET-PE radiation transport code and calculations performed with various field sizes and phantoms. The results are benchmarked against Monte Carlo reference solutions and compared with calculations performed with two popular commercially available treatment planning algorithms. The results indicate that the proposed source model when coupled with the COMET-PE method is capable of dosimetric calculations that in many cases more closely match Monte Carlo solutions than the commercially available options.

No description available.

Thesis (MSc (Physiological Sciences))--University of Stellenbosch, 2009. / Breast cancer is currently the primary cause of cancer-related death in women worldwide. Conventional treatments such as radiation and chemotherapy have many deleterious and long lasting side-effects, some of which are permanent, such as infertility. As certain tumour cells can also acquire resistance to chemotherapy, the need for the development of a less severe, yet more effective, targeted anti-cancer treatment exists. Curcumin, a plant polyphenol from Curcuma longa, has long been thought to possess antitumour, antioxidant, anti-arthritic, anti-amyloid, anti-ischemic and anti-inflammatory properties. Numerous studies conducted over the past sixty years confirm this. We aimed at examining the effect of curcumin on cell viability and the different modes of cell death, namely apoptosis, necrosis and autophagy, in the MCF-12A (non-tumorigenic mammary epithelial) and MCF-7 (mammary adenocarcinoma) cell lines. Cells were incubated with different doses of curcumin to evaluate the dose response through a MTT assay. Thereafter, cells were incubated with 200 μM curcumin for 48 hrs and stained with markers and DNA stains for apoptosis (Hoechst, Caspase-3, PARP), necrosis (Propidium Iodide) and autophagy (LC3B and Beclin-1). Cells were examined via fluorescence microscopy, Western Blot- and FACS analyses. MTT results showed no significant decrease in viability in the MCF-12A cell line after curcumin treatment. However, a significant decrease in viability was observed in MCF-7 cells after treatment with 200 μM curcumin (p < 0.05). Treated MCF-7 cells also show clear LC3B expression. FACS results show a significant difference in Hoechst mean fluorescence intensity in MCF-7 cells after curcumin treatment (p < 0.05). This study provides evidence that MCF-7 cells respond to a 200 μM dose of curcumin treatment through metabolic change and induction of the autophagic pathway. The model system used in this study provides groundwork for further cell culture based studies regarding breast cancer and curcumin.

Thesis (MSc)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: There is a high prevalence of musculoskeletal problems, including neck and shoulder pain (NSP) among nurses worldwide. Tygerberg hospital (TBH) is the second largest hospital in South Africa with a large complement of nurses. The prevalence of NSP and risks associated therewith have not previously been determined at TBH. It is unknown how the nurses at TBH experience NSP in their workplace. Objective: This study questioned whether the 12 month prevalence of neck pain, shoulder pain and combined NSP is similar to worldwide reports, and questioned the degree of association of NSP with lower back pain and demographic risk factors in the nursing population at TBH. Thereafter the qualitative experiences of nurses with NSP at TBH were elucidated. Methodology: A self-designed Neck and Shoulder Pain Questionnaire for nurses (NSPn) was distributed among seven wards of TBH from March to May 2009. The NSPn was compiled using the pain definition from the Nordic Musculoskeletal Questionnaire and elements of the Dutch Musculoskeletal Questionnaire. The NSPn gathered information regarding the presence of neck and shoulder pain as well as demographic and workplace risk factors. Thereafter semi-structured interviews were conducted with eight nurses working at TBH. Results: The 12 month prevalence of neck pain, shoulder pain and combined NSP was 29%, 34% and 43% respectively among a sample of 143 nurses. A high correlation of neck pain with lower back pain and of neck pain with shoulder pain was observed. No significant associations were found between age, ward module, tenure of work, and the nurses' perception of their general health and fitness with the presence of NSP. The qualitative results describe the conflict between the nurses' beliefs and their symptoms. The nurses named work-related stress as the most prevalent cause or aggravator of NSP. The main underlying cause of their stress was a shortage of nursing staff. Discussion and Conclusions: The prevalence of neck pain (29%) and shoulder pain (34%) among the surveyed TBH nurses was lower than the worldwide prevalence summary statistic of 50% and 52% respectively. However, the NSP prevalence (43%) was within the range of three international studies, suggesting that NSP is a significant concern for TBH nurses. The nurses' desire to hide pain and continue working perpetuates the problem of NSP. The underlying causes of NSP are multifactorial, with physical factors interacting with psychosocial factors. Preventative drives need to consider staffing levels and nurses' methods of coping with stress along with improvements in manual handling practices. / AFRIKAANSE OPSOMMING: Agtergrond: Daar is 'n hoё voorkoms van muskulosketale probleme, insluitend nek en skouer pyn (NSP), by verpleegkundiges wêreldwyd. Tygerberg Hospitaal (TBH) is die tweede grootste hospitaal in Suid-Afrika met 'n groot aantal verpleegkundiges. Die voorkoms van NSP en risiko's verbonde daaraan, is nog nie voorheen by TBH vasgestel nie. Dit is nie bekend hoe die verpleegkundiges by TBH NSP in hulle werksomgewing ervaar nie. Objektief: Hierdie studie ondersoek of die 12 maand teenwoordigheid van nekpyn, skouerpyn en gekombineerde NSP ooreenstem met wêreldwye aanmelding, en ondersoek die assosiasie van NSP met lae rugpyn en demografiese risiko faktore in die verpleegkunde populasie by TBH. Daarna is die kwalitatiewe ondervindings van die verpleegkundiges met NSP by TBH toegelig. Metodologie: Die self-ontwerpde "Nek en Skouer pyn in verpleegsters‟(NSPn) vraelys, is onder sewe sale vanaf Maart tot Mei 2009 versprei. Die NSPn het die die Nordiese muskuloskeletale pyn definisie en elemente vanaf die "Hollandse Bewegingsapparaat Vraelys‟ ingesluit. The NSPn het inligting oor die voorkoms van nek en skouer pyn, sowel as demografiese en werkplek faktore ingesamel. Daarna is semi-gestruktureerde onderhoude gevoer met agt verpleegkundiges wat by TBH werksaam is. Resultate: Die 12 maand voorkoms van nekpyn, skouerpyn en gekombineerde NSP was 29%, 34% en 43% onderskeidelik in die steekproef van 143 verpleegkundiges. 'n Beduidende korrelasie van nekpyn met lae rugpyn en nekpyn met skouerpyn is waargeneem. Geen betekenisvolle ooreenkomste is gevind tussen ouderdom, saal module, termyn van werk en die verpleegkundiges se persepsie van hulle algemene gesondheid en fiksheid, met die teenwoordigheid van NSP nie. Die kwalitatiewe resultate beskryf die konflik tussen die verpleegkundiges se oortuigings en hulle simptome. Die verpleegkundiges noem stres as die mees algemene oorsaak of verergeraar van NSP. Die grootste onderliggende oorsaak van stres was die tekort aan verpleegpersoneel by TBH. Bespreking en Gevolgtrekkings: Die voorkoms van nekpyn (29%) en skouerpyn (34%) was laer as die wereldwye voorkoms opsommings statistiek van 50% en 52% onderskeidelik. Maar die voorkoms van NSP(43%) was binne die grense van drie internasionale studies wat dui daarop dat NSP 'n merkbare kommer vir TBH verpleegkundiges is. Die verpleegkundiges se behoefte om die pyn weg te steek en aan te hou werk, vererger die problem van NSP. Die onderliggende oorsake van NSP is veelvoudig, met fisiese faktore en psigologiese faktore wisselwerkend op mekaar. Voorkomende veldtogte moet verpleegkundiges se stres en personeeltekorte saam met verbetering in manuele hanteringstegnieke in ag neem.

published_or_final_version / Surgery / Doctoral / Doctor of Philosophy