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published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

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Thesis (Ph. D.)--West Virginia University, 2002. / Title from document title page. Document formatted into pages; contains xiii, 166 p. : ill. (some col.), maps (some col.). Includes abstract. Includes bibliographical references (p. 138-158).

Thesis (M.S.N.)--Marshall University, 2003. / Title from document title page. Document formatted into pages; contains iv, 56 p. Includes bibliographical references (p. 43-45).

Thesis (M.A.)--Georgia State University, 2007. / Title from file title page. Cynthia Hoffner, committee chair; Yuki Fujioka, Holley Wilkin, committee members. Electronic text ( 81 p.) : digital, PDF file. Description based on contents viewed Nov. 8, 2007. Includes bibliographical references (p. 57-65).

The one-way mixed lymphocyte culture (MLC) is used to assess histocompatibility between donor and recipient. First introduced in 1966, this method involves the co-culture of lymphocytes from the peripheral blood of the donor and the recipient for a period of 6 to 7 days: antigen disparities, primarily in the HLA-DR region, stimulate proliferation of the responding cells, which is detected by addition of 3H-labelled thymidine and subsequent measurement of radioactivity. The lymphocytes of either the donor, used to predict graft-versus-host disease (GVHD) or recipient, used to predict host-versus-graft disease (HVGD)/graft rejection, are inactivated by exposure to radiation or mitomycin C, so that the observed proliferation is that of the other set of lymphocytes, hence the name “one-way” MLC. The amount of measured radioactivity is directly proportional to the amount of DNA synthesized, which is a reflection of the number of disparities at the major histocompatibility complex (MHC).Previous studies have established that inactivation of the lymphocytes by radiation and mitomycin C, has a negative effect on the structure/expression of HLA-DR molecules on the cell surface, which provides the primary stimulus for the MLC reaction. The laboratory research presented in this dissertation was designed i) to compare the viabilities and HLA-DR levels on stimulator cells exposed to cyclosporin A, mitomycin C and ionizing irradiation , in order to determine whether cyclosporin A can be used as an alternative to mitomycin C or radiation as inactivator of the stimulator cells in the one-way MLC; ii) to improve sensitivity and accelerate the MLC reaction by addition of IL-2; iii) establish a flow cytometric mixed lymphocyte assay using the fluorochrome 5,6 carboxyfluorescein diacetate succinimidyl ester (CFSE). Cyclosporin A showed striking similarities to mitomycin C and ionizing radiation in its effect on viability and reduction/structural changes in HLA-DR molecules of the stimulator cells. Exposure of the stimulator cells to 20ìM cyclosporin A, demonstrated a significant loss of both cell viability and HLA-DR molecule cell surface expression. Thus, in evaluating these three methods of inactivation of the stimulator cells in the one-way MLC, it was concluded that a one-way MLC may not in fact be an accurate and qualitative reflection of the histocompatibility between donor and recipient. Instead the two-way MLC , in which neither the donor’s nor recipient’s cells are inactivated, may be a more reliable alternative. The only limitation associated with a two-way MLC is the inability to distinguish between a host-versus-graft-rejection and a graft-versus-host reaction in the observed allogeneic response Addition of 5 and 10 IU/ml IL-2 to the MLC showed the opposite effect to that intended, inhibiting proliferation in the MLC. Previous studies have shown that an excess of IL-2 results in the production of suppressor T cells. The amount of IL-2 produced during the MLC depends on the number of disparities in the MLC between donor and recipient, which will be different for each MLC reaction. Since the number of allogeneic T cells involved in the MLC reaction is not known, the amount of IL-2 produced during the allogeneic immune response in the MLC can not be predicted and addition of exogenous IL-2 may result in production of suppressor T cells and an inhibition of proliferation. The two-way MLC was modified by staining one of the participating set of lymphocytes (donors or recipients) with CFSE and tracking proliferation in this population, using flow cytometry. The two-way CFSE-based MLC analyzed in this study were counterstained with CD25 (IL-2R). An increase in CD25 expression on the cell surface is an indicator of cell activation and proliferation. Proliferation, as indicated by a progressive loss of CFSE fluorescence correlated well with the corresponding increase in CD25 expression and accumulated daughter cells. In addition, by loading only one of the participating donors in the two-way MLC, the responder/stimulator interaction, observed in the one-way MLC, is re-established. Thus the modified, CFSE-based two-way MLC can be used to predict GVHD. To conclude, the use of CFSE labeling and flow-cytometry to measure proliferation in a two-way MLC, together with CD25 counterstaining provides an alternative, reliable and probably superior method to 3H thymidine uptake. / Dissertation (MSc)--University of Pretoria, 2009. / Immunology / unrestricted

General Abstract Objective: In April 2006, the Scottish Liver Transplant Unit (SLTU) became the first NHS transplant unit in the UK to offer the option of Living Donor Liver Transplantation (LDLT). This represented a unique opportunity to evaluate the functional and psychosocial impact of LDLT upon healthy donors and their recipients. Subsequent aims were to investigate the challenge of introducing LDLT in Scotland and to establish the perceived deterrents and attractions of the procedure. An additional aim was to evaluate the impact of Living Donor Kidney Transplantation (LDKT) upon donors and recipients. Design: A series of cross sectional and longitudinal studies were designed for the purpose of this thesis (3 quantitative, 2 qualitative, and 1 mixed methods). Method: Self report questionnaires were used in each of the quantitative studies, with the addition of neuropsychological computerized tests in two studies. Semi-structured interviews were employed in the qualitative studies. Main Findings: •Prior to its introduction general support for the option of LDLT was found, although it was highlighted that the risk involved was not well understood by the general public. •Since becoming available LDLT has not been a readily acceptable treatment option from the perspective of patients due to the perceived risk for the donor, but it may be considered as a “last option”. Family members were motivated to save their loved one’s life but the personal implications of donating resulted in reconsideration of LDLT. • Staff at the SLTU perceived a lack of family commitment in relation to LDLT, which is explained as a cultural factor contributing to the slow uptake of LDLT. In Scotland, a donation from a younger to an older generation is not easily accepted. This, in addition to patients’ optimism that a deceased donation will arrive, and the poor health of potential donors, is thought to have affected the uptake of LDLT. As has the unit’s conservative approach to the promotion of LDLT. This approach is the result of a perceived reduction in the need for LDLT and a preference to avoid the risk to a healthy donor and conduct transplants with deceased donations. • In over 3 years, only one couple completed LDLT. The recipient showed functional and psychosocial improvement from pre to post procedure, whilst the donor showed slight deterioration in aspects of quality of life 6 weeks post donation, which did not always completely return to a baseline level by 6 months. The donor made sacrifices to provide her husband with a fresh start to life and unmet expectations were found to effect quality of life. •Willingness to become a liver donor is not thought to be influenced by the frame of the information provided. •Like the LDLT donor, LDKT donors experience some functional and psychosocial deterioration at 6 weeks post donation, but donors largely recover by 6 months post donation. However, the anticipated benefit to recipients was not evident and may not be quantifiable until after 6 months post operation. Conclusion: This thesis has added to current knowledge on living organ donation and specifically represents the first psychological evaluation of a UK LDLT programme. The slow uptake of LDLT was unexpected and has resulted in informative, novel research.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Haematopoietic stem cell transplantation has become an increasingly popular treatment option for persons with life-threatening blood related diseases such as leukemia, lymphoma, myeloma and certain forms of anaemia. Due to this new therapy the use of bone marrow from a healthy individual also called a living donor for transplantation is inevitable. These living donors can experience psychological and economic issues and these components needs to be addressed in the transplant protocol. The researcher described the psychosocial factors that influenced sibling donors during allogeneic bone marrow transplantation at a public sector hospital in Cape Town, whether the transplant team members explained the administrative process of the transplant in an understandable manner and language and the effect of the psychosocial factors and administrative process of the allogeneic bone marrow transplantation on the sibling donors. A quantitative research approach with a descriptive design was used in this study. The sample was selected by means of full population sampling. The final sample size of (n=64) stem cell sibling donors over 18 years of age participated in the study. A self-reporting questionnaire was used to gather data, inclusive of four open-ended questions to establish an in depth sense of what the donor experiences during the bone marrow donation process. Descriptive statistics used to describe the variables included frequency distributions in the form of histograms and frequency tables. The Pearson chi-square statistical analysis test was used to test for relationships amongst groups. The study drew on the Roy Adaptation Model (RAM) as the theoretical framework to explain the phenomena surrounding the psychosocial and administrative effect of the transplantation process on the sibling donor. Based on the findings the haematopoietic stem cell donors coped with the psychosocial impact of the donation process by making use of their coping mechanism to adapt to their situation according to the Roy Adaptation Model. This model also offers guidance to the nurses to apply this model to nursing practice. Results revealed that sibling donors developed feelings of anxiety in relation to the invasive procedures that cause them to experience physical pain. Most respondents claimed that they were not psychologically affected by the donation process. The moral obligation the sibling donor has towards his sister or brother outweighed the physical pain or discomfort experienced during the donation process. Results revealed that the responding donors claimed they were well informed regarding the donation process and understood the treatment plan of the recipient. However, results revealed that there was a lack in visual donor information such as books, pamphlets as well as internet information. Results concerning the demographics revealed that (n=29) respondents had no schooling and some respondents had some schooling which can give an indication of how to bridge the knowledge and information gap between them and the donor in terms of language. Statistical significance results regarding the emotional state and economic situation of the donors was found. Some of the respondents were responsible for their own transport and their own accommodation, some of those that are employed were responsible for leave without pay. An organ donation policy needs to be developed to prevent live organ donors from losing valuable working hours that could result in loss of salary and should provide other financial incentives. Furthermore, a lack in a post-donation follow-up medical to alleviate and detect post-donation complications was identified. Further nursing research can help nurses to understand living donation for transplantation, also how the nurses that practice in organ transplant units experience and deal with the psychosocial factors that influence them particularly. / AFRIKAANSE OPSOMMING: Hematopoïetiese stamseloorplanting het ’n toenemend gewilde-behandelingsopsie vir persone met lewensgevaarlike bloedverwante siektes soos leukemie, limfoom, miëloom en sekere soorte anemie geword. Vir hierdie tipe terapie word die beenmurg van ’n gesonde individu, ook bekend as ’n lewende skenker, vir oorplanting gebruik. Lewende skenkers kan sielkundige en ekonomiese probleme ervaar en hierdie kwessies moet in die oorplantingsprotokol hanteer word. In hierdie studie is ondersoek ingestel na die psigososiale faktore wat bloedverwante skenkers tydens allogeneïese beenmurgoorplanting by ’n openbare hospitaal in Kaapstad beïnvloed, of die oorplantingspan die administratiewe proses van die oorplanting op ’n verstaanbare manier en in verstaanbare taal verduidelik het, en wat die uitwerking wat die psigososiale faktore en administratiewe proses is op die bloedverwante skenkers tydens allogeneïese beenmurgoorplanting. ’n Kwantitatiewe benadering met ’n beskrywende navorsingsontwerp is in hierdie studie gebruik. Die steekproef is op grond van volledige populasiesteekproefneming gekies. ’n Finale steekproefgrootte van stamselskenkers (n=64) ouer as 18 jaar het aan die navorsing deelgeneem. ’n Selfverslaggewende vraelys is gebruik om data in te samel, wat vier oop vrae ingesluit het om grondige begrip te verkry van wat die skenker tydens die beenmurgskenkingsproses ervaar. Beskrywende statistiek wat gebruik is om die veranderlikes te beskryf, sluit in frekwensie-verspreidings in die vorm van histogramme en frekwensie-tabelle. Die Pearson chi-kwadraat- statistieseanalise is gebruik om die verwantskappe onder groepe te toets. Die Roy Adaptation Model (RAM) is as die teoretiese raamwerk vir die studie gebruik om die verskynsels betrokke by die psigososiale en administratiewe ervaring van die oorplantingsproses vir die bloedverwante skenker te verklaar. Op grond van die bevindinge het die hematopoïetiese stamselskenkers die psigososiale impak van die skenkingsproses hanteer deur gebruik te maak van hulle hanteringsmeganisme om by hulle situasie aan te pas, wat met die RAM ooreenstem. Hierdie model bied ook leiding aan verpleegkundiges om dit in die verplegingspraktyk toe te pas. Resultate het getoon dat bloedverwante skenkers gevoelens van angs ontwikkel het vanweë die indringende prosedures, wat fisiese pyn veroorsaak het. Die meeste deelnemers het aangedui dat hulle nie sielkundig deur die skenkingsproses geraak is nie. Die morele verpligting wat die bloedverwante skenker het teenoor sy of haar broer of suster het die fisiese pyn of ongemak gedurende die skenkingsproses oortref. Resultate het getoon dat die deelnemende skenkers aangedui het dat hulle goed ingelig was oor die skenkingsproses en die behandelingsplan van die ontvanger verstaan het. Die resultate dui egter daarop dat daar ’n gebrek was aan visuele skenkersinligting soos boeke, pamflette en internet-inligting. Resultate rakende die demografie het bewys dat van die deelnemers (n=29) ongeskoold en sommige deelnemers laag geskoold is, wat ’n aanduiding kan gee van hoe die kennis- en inligtingsgaping tussen hulle en die skenker ten opsigte van taal oorbrug kan word. Statisties beduidende resultate rakende die emosionele toestand en ekonomiese situasie van die skenkers is gevind. Sommige deelnemers was verantwoordelik vir hulle eie vervoer en verblyf. Diegene wat werk, het verlof sonder betaling geneem. ’n Orgaanskenkingsbeleid moet ontwikkel word om te verhoed dat lewende orgaanskenkers kosbare werksure verloor, wat kan lei tot ’n verlies aan salaris. Ander finansiële aansporings behoort ook gegee te word. Voorts is ’n gebrek aan opvolg mediese behandeling vir skenkers om skenkingskomplikasies vas te stel en te verlig, geïdentifiseer. Voortgesette navorsing kan verpleegkundiges help om begrip te verkry van die implikasies van lewende orgaanskenking. Verpleegkundiges wat in hierdie orgaanoorplantings- eenhede werksaam is, kan ‘n beter begrip kry van die psigososiale faktore wat hierdie skenkers spesifiek beïnvloed.

Thesis (M.N.)--Memorial University of Newfoundland, 2004. / Typescript. Bibliography: leaves 92-100.