A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The objective of this project was to review skeletal survey reports and examine the differences in reporting of non-accidental trauma in patients with similar radiological findings. The overall purpose of this project is to develop a standardized reporting system for radiological findings suspicious for non-accidental trauma. Ten years’ worth of skeletal survey reports were obtained on over 1,500 pediatric patients. These reports were individually reviewed and their findings were categorized in a table separating findings suspicious for non-accidental trauma. After data collection, analysis was completed to inspect the consistency of reports amongst studies with similar fractures specifying non-accidental trauma. The comparison was made between reports containing long bone fractures, metaphyseal corner fractures, rib fractures, or any combination of these. It was concluded that there are inconsistencies in reporting of non-accidental trauma in reports with similar patterns of these fractures. We propose a Skeletal Survey – Reporting and Data System (SS-RADS) score which will help radiologist standardize their reporting methods for more consistent interpretations and clinical outcomes.

The study of the mechanism of traumatic brain injury (TBI) processes at the cellular level is vital to obtain characterization of nerve cell damage after mechanical deformation. This understanding is needed to find feasible therapeutic targets for mechanically damaged neurons. To study the cellular level of TBI damage, development of a new in vitro cellular model of TBI might be done to simulate in vivo cellular TBI. In this research, two studies were performed: (1) the design and construction of an in vitro cell stretching device to mechanically injure cells and (2) the characterization of the molecular and cellular level of the TBI mechanism. The cell stretching device design allows for the precise control of cell strain and duration of stretching cells such that TBI can be mimicked. Analysis of the cellular and molecular level mechanisms of TBI in the proposed in vitro model might help in the design of therapeutic strategies for the treatment of TBI. Our proposed mechanism of injury due to TBI is as follows: after the cell is stretched, a cellular signaling molecule is released to activate the cellular signaling pathway. The activated cell signal may activate kinases which phosphorylate proteins and initiate new protein synthesis. Newly phosphorylated and synthesized proteins may activate the apoptotic process. Using a variety of pharmacological agents, one could block steps in the hypothesized mechanism and examine the effect of those agents on downstream cellular processes and cell apoptosis. For example, the inhibitions of calcium transport, protein synthesis, and caspases were performed to examine the initial activation of the signaling pathway and the role of both in the apoptosis process. Proteomics of TBI may help the understanding of the mechanism of TBI related protein expression. This work will contribute to the discovery of new therapeutic targets and better treatments for TBI.

The present research is a field investigation of trauma and its cognitive and emotional consequences. One hundred and nineteen sex trade workers were interviewed about sexually traumatic experiences. The primary focus of this research was an examination of the quantity and quality of memory for sexual trauma. Various predisposing, precipitating, and perpetuating factors were examined regarding their influence on memory and posttraumatic stress. One objective of this study was to test certain assumptions of the biopsychosocial model of eyewitness memory (Hervé, Cooper, & Yuille, 2007), which proposes that individuals differ along a continuum of arousal sensitivity and predicts the quantity and quality of recall. Up to three types of memory narratives were elicited from each participant: (a) one positive event (b) one well-remembered sexual assault, and (c) one sexual assault for which the participant had poor recollection. Each memory was assessed for peritraumatic and posttraumatic factors. The participants also filled out a number of individual differences measures. The results indicated that the participants had extensive histories of trauma, many of which began in their childhood. It was shown that well-remembered sexual assaults contained more narrative details than memories of positive events and less-well-remembered sexual assaults. Such variability of memory for sexual violence is in line with Hervé et al.'s model as well as other field studies of traumatic memory. This was the first study to demonstrate such variability within-subjects. Various moderating factors of memory were examined, for example, dissociation and different symptoms of posttraumatic stress. Some of the findings were at odds with traditional theories, laboratory findings, and certain assumptions held by many eyewitness memory experts regarding the relationship between stress and memory. A second objective of this dissertation was to examine predictors of post traumatic stress disorder. The findings largely confirmed the literature. Men and women did not differ in their levels of posttraumatic stress. Overall, the complexity of clinical symptoms in survivors of repeated sexual violence is highlighted. The results are discussed in terms of their implications for theory development, future research, the criminal justice system, and in terms of their relevance for treatment providers and assessors.

Vyrų po trauminių galūnių amputacijų savęs vaizdą formuojantys veiksniai ir jų ryšys su streso įveika Marija Januškaitienė SANTRAUKA Šiame tęstiniame tyrime buvo mėginta nustatyti vyrų, prieš 30-48 mėn. patyrusių traumines galūnių amputacijas savęs vaizdą formuojančius veiksnius bei jų ryšį su streso įveika. Tyrime dalyvavo 31 tiriamasis. Visi tiriamieji tyrime dalyvavo antrą kartą, pirmą kartą tiriamieji tyrime dalyvavo 2004 metais. Tyrimas buvo atliktas individualiai kiekvieno tiriamojo namuose. Tyrime naudotos kelios metodikos: įveikos strategijų klausimynas, traumos simptomų klausimynas, prielaidų apie pasaulį klausimynas, gynybos mechanizmų klausimynas, H-T-P projekcinė metodika bei pusiau struktūruotas interviu. Gynybos mechanizmų klausimynas buvo naudojamas pirmą kartą, kitos metodikos buvo naudojamos pakartotinai. Atlikta rezultatų kiekybinė bei kokybinė analizė. Tyrimo rezultatų duomenimis, tiriamiesiems praėjus dar dviems metams po patirtos traumos išliko tie patys traumos simptomai, naudojamos tos pačios streso įveikos strategijos bei liko nepakitęs neadekvačiai susiaurėjęs savęs vaizdas. Išaiškėjo tam tikri skirtumai tarp tiriamųjų, kurie per šį laiką gavo psichologinę ar socialinę pagalbą ir kurie nesikreipė jokios pagalbos: pirmieji naudoja adaptyvesnes streso įveikos strategijas, jų traumos simptomai pasireiškia ne taip intensyviai bei paviršiniame lygmenyje jie turi geresnį savęs suvokimą. Tačiau, ši gauta trumpalaikė terapija nepaveikė gelminių tiriamųjų... [toliau žr. visą tekstą] / The formative factors of self- image of men, who suffered traumatic amputations of limbs, and correlation of these factors with stress defeat Marija Januškaitienė SUMMARY This continuous research is constructed for setting of formative factors of self-image of men, who 30-48 years ago suffered traumatic amputations of limbs, and for finding of correlation between these factors and stress defeat. 31 men were involved into this study. All of them took part in this research for the second time, while the first study had been done in 2004. The investigation was performed individually, visiting every man at his home. There were used few methods in this study: stress defence strategies questionnaire, trauma symptoms questionnaire, questionnaire about presumptions of the world, defence mechanisms questionnaire, H-T-P projection method and semi-structuralized interview. The defence mechanisms questionnaire was applied for the first time; other methods were reused. Qualitative and quantitative analyses were applied for results evaluation. According to research findings, after 2 years from the trauma, men suffered the same trauma symptoms, the same stress overcome strategies were used; during mentioned time inadequately insular self-image did not change also. Some differences emerged between the group, which received psychical or social assistance, and the group, which did not received such kinds of support: more adaptive stress defence strategies were applied by the men from the first... [to full text]

My thesis aims to partake in the controversial and theoretical debates surrounding sight which can be traced as far back as Plato. It seeks to provide an overview of the cultural history of the gaze in order to set up a triangulated and in-depth schema or triadic relationship between theatre, text and trauma through the lens of psychoanalytical, phenomenological and socio-theoretical frameworks. More specifically, it attempts to explore the various interactions, along the axis of representation, between theatrical metaphors and those of traumatic vision, as well as traumatic representations on stage of viewing and the multi-layered and socio-political implications of various ways of looking (or non-looking), which often trigger traumatic responses. By examining two canonical plays – Sophocles’ Oedipus Rex and Shakespeare’s Macbeth – as well as the modern performances of artists such as Orlan and Franko B, I hope to show how visual trauma can transcend time and space and how the stage, as well as dramatic performances, can function as a body or body politic upon which various visuo-spatial and traumatic themes can be inscribed and re(enacted). The shift in emphasis, beginning with Freud and onwards, from physical to psychological trauma has often led to a blurring and obfuscation of the question of sight and the various lines of inquiry related to it. It has unfortunately often been overlooked in trauma theory, together with the issue of how certain sights/sites can often lead to broken, baffled and even traumatic responses when there is a failure to adequately interrogate, interpret and subsequently assimilate various events both on and off-stage. This failure is further compounded by various theoretical strands which view trauma as being non-representable. Thus by bringing trauma and vision to the fore, my research aims to inflect the cultural history of the gaze by showing how it contributes invaluably to a greater understanding of identity formation and hermeneutical activity in particular, as well as theatrical practices and even gender discourse analysis in general. By recourse to Sophocles’ Oedipus Rex and Shakespeare’s Macbeth, two canonical plays which draw heavily on notions of sight, blindness and the traumatic implications of viewing certain objects or events, as well as through an interrogation of various responses to the theatrical performances of more modern bodily-based performance artists such as Orlan and Franko B, who cut and refashion their bodies in front of a large audience, this work seeks to bring together various theoretical approaches ranging from psychoanalysis to phenomenology in order to shed light on how sight can lead to trauma both on and off the stage, thus contributing to the ongoing theoretical debates surrounding the body and the theatre.

Döden är oundviklig. Alla kommer vi att dö och alla omkring oss kommer också att dö. Flera gånger varje dag förlorar något barn en förälder. Ett barn som blir kvar att överleva och leva i sorg. Eftersom det händer så plötsligt anser vi att ett “krispaket om arbete med döden” vore en självklarhet på alla förskolor som komplement till krisplanen. Där en kort handledning finns som hjälper arbetslaget med råd och material till att kunna arbeta med ämnet i barngruppen. Ett stöd till att kunna på ett professionellt sätt bemöta föräldrar och barn i denna nya situation, med barn i sorg. Vi bestämde oss för att göra en krisväska (se bilaga 1), innehållandes en bok med tema död, en docka kopplad till boken och ett handledningshäfte. Boken berättar ett barns möte med sorgen. Dockan efterliknar en av bokens karaktärer. Handledningen är riktad till pedagogerna och innehåller information om hur de kan arbeta kring och med detta material, råd om förhållningssätt och en checklista var de kan finna mer vägledning. Stoffet i materialet är baserat på kvalitativa samtalsintervjuer, vetenskap och forskning.

As multiple trauma is ubiquitous, affects predominantly young people and is attended by a high mortality, it seemed a fruitful area for study in an effort to reduce morbidity and mortality. One of the main problems in trauma research has been accurate description of the severity of injury and associating severity with subsequent outcome. While a number of scoring systems have been proposed the Injury Severity Score has been the most widely adopted and validated. The Injury Severity score was adopted with a number of other systems of scoring infection and other complications in a retrospective study of multiple trauma patients admitted to an Intensive Therapy Unit. This study revealed an unexpected increased in mortality in the latter two years of the study period which was not associated with an increase in injury severity as assessed by the ISS nor by any other change in patient characteristics which might explain this finding. Eventually it was noted that the introduction of a hypnotic drug etomidate for use in sedation of ventilated patients seemed to be associated with the increased mortality. Clinical evidence suggested that etomidate might inhibit adrenocortical function and an experimental study indeed confirmed that etomidate had a direct effect on adrenal steroidogenesis such that cortisol and aldosterone production were completely suppressed. Following analysis of the retrospective clinical study etomidate was withdrawn from use in our unit. Analysis of mortality rates both for trauma patients and the general patient population indicated a reversion to the rate which pertained prior to introduction of etomidate. The results of retrospective and prospective clinical studies strongly implied that the administration of etomidate was associated with an increased mortality among trauma patients. The experimental study based on clinical observations clearly demonstrated that etomidate infusion was a potent inhibitor of adrenal steroidogenesis. It seems highly likely that the detrimental effect of etomidate was mediated by its direct inhibitory effect on the production of cortisol and aldosterone by the adrenal gland. Subsequent clinical and experimental studies from other authors tend to confirm these findings.

The purpose of this dissertation was to explore the role of mindfulness as a resilience resource in depressed and trauma exposed college students (Thompson, Arnkoff, & Glass, 2011). Chapter one reviews current literature that is relevant to the role of mindfulness in resilience and focuses on depression as an outcome. Further, chapter two details the research study. The study proposed and tested a model in which resilience and mindfulness predict trauma symptoms and depressive symptoms and mindfulness mediates the relationship between resilience and trauma and depression symptomology. A total of 529 college students were recruited at a large urban university. They were asked to complete a demographics questionnaire followed by an assessment of their trauma exposure using the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013). Participants were then be asked to complete the Five Factor Mindfulness Questionnaire (Baer, 2003), the Connor Davidson Resilience Scale (Connor & Davidson, 2003), the Center for Epidemiological Studies Depression scale (Radloff, 1977), and the Trauma Symptom Checklist (Briere & Runtz, 1989). To assess how well resilience and mindfulness predict depression and trauma symptomology in trauma exposed individuals vs. individuals who did not endorse trauma exposure, separate hierarchical regression analyses were completed based on trauma exposure and outcome variable. The results showed that while mindfulness significantly predicted trauma symptoms and depressive symptoms in trauma exposed college students as well as students with no trauma exposure, resilience did not significantly predict the outcome variables. Further, to test the mediational effects of mindfulness on the relationship between resilience and the outcome variables for the trauma exposed and non-trauma exposed college students, the Preacher and Hayes (2008) bootstrapping approach was utilized by performing the analysis using the macro PROCESS. The results indicated that mindfulness mediated the relationship between resilience and trauma symptoms as well as resilience and depressive symptoms in both trauma-exposed and non-trauma exposed college students. Limitations were discussed and implications for practitioners and future research were provided.

Vis daugiau tyrimų patvirtina, kad sunkius trauminius įvykius išgyvenę asmenys šalia neigiamų trauminės patirties padarinių įžvelgia ir teigiamų aspektų – patiria potrauminį augimą (PTA). Pirmieji potrauminio augimo (PTA) sąvoką pasiūlė Tedeschi ir Calhoun (1996). Potrauminis augimas suprantamas kaip teigiamas pokytis, kurį asmuo patiria po trauminio įvykio sukeltų sunkių išgyvenimų, ir yra siejamas su pastangomis įveikti trauminį įvykį ir jo sukeltą vidinę bei išorinę sumaištį. Potrauminio augimo metu įvyksta teigiami pokyčiai savęs suvokime, gyvenimo filosofijoje bei tarpasmeniniuose santykiuose. Šiame darbe analizuojamas politines represijas išgyvenusių Lietuvos žmonių potrauminio augimo patyrimas, taip pat tai, kaip šis patyrimas susijęs su traumine patirtimi, traumos simptomais bei įveikos veiksniais. Tyrimo dalyviai – 205 politines represijas išgyvenę asmenys: 1) PTA grupė: asmenys, kurie įvardino pozityvius politinių represijų padarinius bei pateikė kokybinius duomenis apie patirtus teigiamus pokyčius (N = 107); 2) ne PTA grupė: asmenys, kurie teigė, kad nepatyrė pozityvių pokyčių, susijusių su politinėmis represijomis (N = 98). Tyrime naudoti šie įvertinimo būdai: Harvardo traumos klausimyno (HTQ) lietuviško varianto pirma dalis (Mollica et al., 1992; liet. k. Gailienė, Kazlauskas, 2005); modifikuoto Traumos simptomų klausimyno (TSK-35) lietuviškas variantas (Gailienė, Kazlauskas, 2005); taip pat buvo pateikti klausimai: 1) apie politinių represijų patyrimą ir... [toliau žr. visą tekstą] / There is a growing amount of studies that prove the fact that negative and positive outcomes of traumatic experience can exist in coherence. Positive outcomes are defined as posttraumatic growth (PTG). Tedeschi and Calhoun (1996) were the first to offer the concept of posttraumatic growth. Posttraumatic growth is defined as positive change that the individual experiences as a result of the struggle with a traumatic event and difficulties following it. Posttraumatic growth is reported in three major domains: change in the sense of self, change in philosophy of life and change in relationships with others. The aim of this study was to evaluate posttraumatic growth experience among political repression survivors in Lithuania and identify the relation between PTG and trauma symptoms, traumatic experience and the factors that helped to overcome traumatic experience. 205 survivors of political repression participated in the survey: 1) PTG group: the ones who reported positive outcomes of political repression and gave qualitative information about this experience (N = 107); 2) non PTG group: the ones who did not report positive changes related to political repression (N = 98). The methods used: The first part of the Harvard Trauma Questionnaire (HTQ-I), Lithuanian version (Mollica et al., 1992; Gailienė, Kazlauskas 2005); Lithuanian version of Trauma Symptom Checklist (TSC-35) (Gailienė, Kazlauskas, 2005); some questions were given: 1) about the traumatic experience of political... [to full text]

Sammanfattning. Föreliggandeexamensarbete studerar terapeuters upplevelser och erfarenheter avpatienters sorgearbete samt i vilken utsträckning sörjandet skiljer sig mellansvenska patienter och patienter med invandrar- och flyktingbakgrund och ärgenomförd med en kvalitativ forskningsmetod medfenomenologisk ansats. Undersökningen bygger på svaren från 14 erfarnapsykoterapeuter med psykodynamisk inriktning.  Resultaten visar att patienters inreupplevelser av sorg är densamma, däremot finns det kulturella skillnader isörjandet. Samtliga affekter som patienter har tillgång till används isorgearbetet. Genom sorgearbetet kommer de gradvis till acceptans avobjektförlusten och anpassar sig till verklighetens krav för att därefter kunnagå vidare i livet. Nya sorger återaktualiserar tidigare obearbetade sorger ochi invandrarens- och flyktingenshistoria finns alltid sorgen över att ha lämnatsitt hemland.