Prediction of multiple infections after severe burn trauma: a prospective cohort study.

OBJECTIVE: To develop predictive models for early triage of burn patients based on hypersusceptibility to repeated infections. BACKGROUND: Infection remains a major cause of mortality and morbidity after severe trauma, demanding new strategies to combat infections. Models for infection prediction are lacking. METHODS: Secondary analysis of 459 burn patients (≥16 years old) with 20% or more total body surface area burns recruited from 6 US burn centers. We compared blood transcriptomes with a 180-hour cutoff on the injury-to-transcriptome interval of 47 patients (≤1 infection episode) to those of 66 hypersusceptible patients [multiple (≥2) infection episodes (MIE)]. We used LASSO regression to select biomarkers and multivariate logistic regression to built models, accuracy of which were assessed by area under receiver operating characteristic curve (AUROC) and cross-validation. RESULTS: Three predictive models were developed using covariates of (1) clinical characteristics; (2) expression profiles of 14 genomic probes; (3) combining (1) and (2). The genomic and clinical models were highly predictive of MIE status [AUROCGenomic = 0.946 (95% CI: 0.906-0.986); AUROCClinical = 0.864 (CI: 0.794-0.933); AUROCGenomic/AUROCClinical P = 0.044]. Combined model has an increased AUROCCombined of 0.967 (CI: 0.940-0.993) compared with the individual models (AUROCCombined/AUROCClinical P = 0.0069). Hypersusceptible patients show early alterations in immune-related signaling pathways, epigenetic modulation, and chromatin remodeling. CONCLUSIONS: Early triage of burn patients more susceptible to infections can be made using clinical characteristics and/or genomic signatures. Genomic signature suggests new insights into the pathophysiology of hypersusceptibility to infection may lead to novel potential therapeutic or prophylactic targets.

An investigation into the physical and psychological stress factors that elementary teachers experience : recommendations to boards and personal calming strategies /

The prlmaiy objective of this study was to Identify and describe the physical and psychological stress factors that elementary school teachers experience and how teachers cope with stress. A secondary objective was to offer boards and teachers potential coping strategies counteracting stress and the effects of stress. The sample consisted of 120 elementaiy teachers from southern Ontario. Ten elementaiy schools were randomly chosen. The Teacher Stress Inventory questionnaire (Flmian, 1989) was used. Data were analyzed using a variety of statistics. Test norms and interpretations were performed based on standard results obtained from the author of the questionnaire (Flmian, 1988). Overall, the results indicated that work-related stressors were the main factor for teacher stress. This Included such factors as caseload/class is too big, too much administrative paperwork, and having little time to prepare lessons. Implications for further research and practical suggestions for further reseairch are discussed. Also a variety of recommendations to boards and for individual use are discussed. Some recommendations are having counselling available for teachers, workshops on how to handle stress, and learning how to breathe and using calm visualization.

Graffiti, memory and contested space : mnemonic initiatives following trauma and/or repression in Buenos Aires, Argentina

Graffiti, Memory and Contested Space: Mnemonic Initiatives Following Periods of Trauma and/or Repression in Buenos Aires, Argentina This thesis concerns the popular articulation ofmemory following periods or incidents of trauma in Argentina. I am interested in how groups lay claim to various public spaces in the city and how they convert these spaces into mnemonic battlegrounds. In considering these spaces of trauma and places of memory, I am primarily interested in how graffiti writing (stencils, spray-paint, signatures, etchings, wall-paintings, murals and installations) is used to make these spaces transmit particular memories that impugn official versions of the past. This thesis draws on literatures focused on popular/public memory. Scholars argue that memory is socially constructed and thus actively contested. Marginal initiatives such as graffiti writing challenge the memory projects of the state as well as state projects that are perceived by citizens to be 'inadequate,' 'inappropriate,' and/or as promoting the erasure of memory. Many of these initiatives are a reaction to the proreconciliation and pro-oblivion strategies of previous governments. I outline that the history of silences and impunity, and a longstanding emphasis on reconciliation at the expense of truth and justice has created an environment of vulnerable memory in Argentina. Popular memory entrepreneurs react by aggressively articulating their memories in time and in space. As a result of this intense memory work, the built landscape in Buenos Aires is dotted with mnemonic initiatives that aim to contradict or subvert officially sanctioned memories. I also suggest that memory workers in Argentina persistently and carefially use the sites of trauma as well as key public spaces to ensure official as well as popular audiences . The data for this project was collected in five spaces in Buenos Aires, the Plaza de Mayo, Plaza Congreso, La Republica Cromanon nightclub, Avellaneda Train Station and El Olimpo, a former detention centre from the military dictatorship.

A qualitative narrative inquiry of the experience of accessing community supports among women who have experienced trauma

Abuse related trauma can have serious consequences on individuals' health and their state of well-being and may result in decreased access to different determinants of health. The purpose of this qualitative narrative inquiry using secondary data was to explore the experience of accessing community supports among eight women who had experienced abuse-related trauma. A conceptual framework drawn from the literature on social inclusion and social exclusion and a narrative inquiry method were used to explore epiphanies, customs, routines, images, and everyday experiences (Clandinin & Connelly, 2000) among the women. A Three-Dimensional Space Narrative Structure was used to explore the participants' personal or internal conditions, feelings, hopes and reaction as well as their social experiences in interaction with others in community. The participants described experiencing the impact of trauma in their past and present circumstances, a lack of accommodation of difference, challenges in maintaining a sense of self in a world of assumption and labels, impact of trauma on the determinants of health, and uncertainty about the future. The findings from the study demonstrate experiences of social exclusion among the participants in the past, further isolation and social exclusion in the present when personal life issues were ignored by community support services, and uncertainty about what the future will bring for them. The findings indicate close relationships between the women's personal lives and their social connections which need to be considered to mitigate social exclusion and enhance social inclusion.

The encounter with the real and post-Soviet trauma : fantasy construction in Russian popular cinema /

This thesis examines the impact of the Soviet Union's collapse on the Russian Symbolic as represented through popular cinema of the post-Soviet period. The disintegration of the USSR in 1991 became one of the most traumatic experiences for many Russian people. The trauma of the collapse of the Soviet Union penetrated the everyday reality of the Russian Symbolic, leaving the traces-symptoms in different cultural fonns like literature, arts, television and cinema. Because popular culture usually reacts very quickly to any social, political and economical shifts in society, it is an excellent barometer for deeper changes in society. Focusing on postSoviet popular cinema, this thesis analyzes the symptoms of cultural and individual trauma occasioned by the momentous changes of the 1990's. This study is grounded in post-analytic theory of Jacques Lacan and its interpretation by Slavoj Zizek, which emphases the traumatic encounter with the Real as a "hard core" of our reality. According to this paradigm, a new chain of signifiers is structured around the traumatic breach in the Symbolic, initiating a process of fantasy construction to deal with consequences of trauma and, thus, to support our Symbolic order. This thesis examines three major fantasy constructions - drinking, traveling to a "happy land" and family reunion and money - in popular films by Alexander Rogozhkin, Yurij Mamin, Georgij Shengelia, Dmitrij Astrakhan, Valerij Todorovskij, Alexej Balabanov, Sergej Bodrov Jr. and Petr Buslov. According to Zizek, enjoyment underlies any fantasy constructions, and that is why after the intrusion of the Real every individual and culture should go through the process of fantasizing about some substitutes which can help to minimize the traumatic effect and which can lead to a partial enjoyment. By analyzing the fantasies about drinking, "happy land", reconstruction of the family bonds and money in Russian popular cinema since 1991, this thesis demonstrates how the traumatic engagement with the Real affected the everyday lives of Russian people, and how individuals tried to fill the gap, the lack, in the post-Soviet Symbolic and "return" the lost feeling of unity and plenitude.

Motivation and psychological need salience in the experiences of initiating and maintaining exercise as an older female adult

Objectives: The primary objective ofthis study was to explore motivation and psychological need salience in the initiatory and maintenance experiences of older female exercIsers. Methods: Female initiates (n = 3) and reflective maintainers (n = 3) 65 years of age or older (M = 76 years; SD = 5.37) participated in semi-structured interviews. Data were analyzed holistically and categorically, following a hermeneutic approach to inquiry. Results: Perceived importance of exercise benefits appeared to be the strongest motive for initiates at this stage of life and connections to others were perceived as valued, but less important in exercise contexts. Also, listening to one's body over instructions from the exercise leader emerged as a key factor to success. Conclusions: Overall, the results ofthis study implicate more self-determined than controlled motives as sources of regulation in older females' exercise initiation experiences. Evidence for psychological needs was more heterogeneous and less conclusive.

Canadian curling coaches' use of psychological skills training

Hom's (2008) model of coaching effectiveness proposes a series of direct relationships between the beliefs and values of coaches, their behaviours, and the perceptions of their athletes. One specific area of coaching behaviour that is in need of more research is their use of psychological skills training (PSn. The purpose of this study was to examine the relationship between the beliefs and behaviours of curling coaches with respect to PST, and the perceptions of their athletes. In collaboration with the Canadian Curling Association, data was collected from a national sample of 115 curling teams with varying levels of competition and experience. One hundred and fifteen coaches completed PST attitude (SPA-RC-revised) and behaviour (MSQ-revised) measures, while 403 athletes completed two perception measures (CCS and S-CI). Interclass correlation coefficients (ICC) were calculated to ensure intra-team consistency. All ICCs were positive, ranging from r =.39 to .56, and significant at the p < .01 level. A series of multiple regressions were performed. Three of the four regression models were significant, with coaches' PST behaviours accounting for 16% of the variance in athletes' evaluation of their coaches' competencies (GeC). The models for athletes' PhysicalSport Confidence (P-SC) and Cognitive-Sport Confidence (C-SC) accounted for 15% and 36% of the variation, with GCC and coaches' PST behaviours both being significant predictors of the models. After statistically controlling the influence of GCC, coaches' PST behaviours accounted for 3% and 26% of the variation in athletes P-SC and C-SC. These results provide partial support for Hom's (2008) model of coaching effectiveness, and offer new insight into the benefits of coaches' use of sport psychology-related training behaviours.

Leisure-time physical activity in individuals with osteoporosis : associations with psychological well-being

With approximately 16% of the Canadian population living with osteoporosis, and rates expected to increase (Osteoporosis Canada, 2009), cost-effective treatment modalities that improve bone health and psychological well-being reflect an important public health agenda. Physical activity has been implicated as one non-pharmaceutical mechanism to help improve psychological well-being in the general population (Fox, Stathi, McKenna, & Davis, 2007) and in people diagnosed with osteoporosis (Osteoporosis Canada, 2007). The purpose of this investigation was to determine the association between leisure-time physical activity (LTP A) and well-being in people diagnosed with osteoporosis. A secondary purpose, using Basic Needs Theory (BNT; Deci & Ryan, 2002) was to determine if the fulfillment of three psychological needs (i.e., competence, autonomy and relatedness) mediated the relationship between LTP A and well-being. People diagnosed with osteoporosis (N= 190; Mage = 68.14; SDage = 11.54) were asked to complete a battery of questionnaires assessing L TP A, hedonic and eudaimonic well-being and perceived psychological need satisfaction in physical activity contexts. Bivariate correlations revealed a pattern of negligible (r's -0.02 to 0.35) to small correlations between LTP A and well-being with contextual positive affect (r = 0.24) and subjective vitality (r = 0.22) demonstrating statistical significance (p < .01). Results of the multiple mediation analysis indicated that perceived satisfaction of the three psychological needs mediated the relationship between LTPA and well-being with perceived competence emerging as a unique mediator. As such, LTP A was positively associated with well-being in people who are diagnosed with osteoporosis, and the fulfillment of the three psychological needs may be the mechanism through which this 111 effect is carried. Health promotion specialists and practitioners should encourage patients with osteoporosis to engage in LTP A, and support their needs for competence, autonomy and relatedness. Practical implications for researchers and health promotion specialists are discussed in terms ofthe results of this investigation.

A phenomenological approach to understanding the psychological response to chronic low back pain

Chronic low back pain (CLBP) is a complex health problem of psychological manifestations not fully understood. Using interpretive phenomenological analysis, 11 semi-structured interviews were conducted to help understand the meaning of the lived experience of CLBP; focusing on the psychological response to pain and the role of depression, catastrophizing, fear-avoidance behavior, anxiety and somatization. Participants characterized CLBP as persistent tolerable low back pain (TLBP) interrupted by periods of intolerable low back pain (ILBP). ILBP contributed to recurring bouts of helplessness, depression, frustration with the medical system and increased fear based on the perceived consequences of anticipated recurrences, all of which were mediated by the uncertainty of such pain. During times of TLBP all participants pursued a permanent pain consciousness as they felt susceptible to experience a recurrence. As CLBP progressed, participants felt they were living with a weakness, became isolated from those without CLBP and integrated pain into their self-concept.

Leisure connections : a case study to understand facilitation techniques with survivors of trauma

Leisure-based therapy is a potentially effective approach to supporting survivors of trauma in their healing. The purpose ofthis qualitative case study was to describe the recreation therapist's facilitation techniques of Leisure Connections, a unique leisurebased psycho-educational group for survivors of trauma, and explore how the facilitation was experienced by participants. Qualitative case study design, following the methods of Yin (1994) was used. One two week, three session Leisure Connections group was observed. Six participants completed the Group· Therapy Alliance Scale (pinsof & Catherall, 1986) and reflection cards. In-depth, semi-structured interviews were conducted with the recreation therapist and four participants. Six themes emerged describing group leader interventions, recreation therapist's actions, recreation therapist's preparation and reflections, group members' experience of a therapeutic alliance, group cohesion, and prior influences and assumptions. Therapeutic alliance and group cohesion were influenced by the recreation therapist's group leader interventions (drawing out, processing, protecting) and actions. The context of the group within a therapeutic community milieu was an important influence.

Health-Enhancing Physical Activity and Well-Being: Is it How Often, How Long, or How Much Effort that Matters? A Test of Basic Psychological Needs Theory

The primary objectives of the present study were 1) to examine the relationship between health-enhancing physical activity (HEPA) and well-being across the previous day and 2) to examine the role of basic psychological need satisfaction as a potential mediator of the HEPA – well-being relationship. Participants (N = 203) were a convenience sample of undergraduate students with data collected cross sectionally. HEPA was generally associated with well-being (r‟s ranged from .18 to .62). Multiple mediation analyses supported psychological need satisfaction as mechanisms underpinning the HEPA – well- being relationship. Subsequent analyses demonstrated that effort put forth in HEPA activities, as opposed to frequency or duration, uniquely predicted well-being. The role of effort was further highlighted in the multiple mediation analyses. As such future research may wish to investigate the utility of a HEPA program that facilitates effortful engagement and fulfillment of basic psychological needs.

Turning points : meaning-making and its association with psychological well-being, academic achievement and parental relationship quality among adolescents

There is substantial research linking meaning-making ability and psychological well-being in the context of turning point events. Still, an important research question remains: whether individuals who report meaning-making and psychological well-being were already better adjusted psychologically, prior to the experience of their turning point. In addition, the role of meaning-making on academic achievement and parental relationship quality has received little empirical attention although both variables have been shown to be positively associated with positive adjustment among adolescents. This longitudinal study examined differences in psychological well-being, academic achievement, and parental relationship quality between adolescents who reported meaning-making (lessons or insights) and those who reported no meaning-making within their turning point narratives. Participants were 803 (52% female) grade 12 adolescents, 26% (N = 209) of whom had reported experiencing a turning point. Participants also completed measures on the outcome variables (psychological well-being, academic achievement, and parental relationship quality) 3 years prior, when they were in grade 9. MANOVA results indicated that, of the participants who experienced a turning point, adolescents who reported meaning-making reported significantly higher psychological wellbeing and more positive parental relationship quality than adolescents who reported no meaningmaking. Importantly, these two groups did not differ on the outcome variables prior to their experience of a turning point event when they were in grade 9. Academic achievement scores did not differ significantly between adolescents who reported meaning-making and those who reported no meaning-making. These findings highlight the importance of meaning-making in relation to positive adjustment subsequent to a turning point among adolescents.

Emergence of conscious awareness of underlying verbal and visual rules over time in moderate closed-head trauma patients

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999.5 E38 L64 2008

Linking Ethical Leadership and Employees’ In-Role Performance: Exploring the Mediating Roles of Psychological Capital and Follower-Leader Relational Capital

This study investigates the mediating impact of psychological capital and follower-leader relational capital on the relationship between ethical leadership and in-role performance through the lenses of social exchange theory, social information processing theory, and psychological resources theory. Analysis of data collected from a sample of 171 employees and 24 supervisors from Pakistan reveals that ethical leadership has a positive effect on followers’ in-role job performance, yet this effect is fully explained through the role of psychological capital and partially through follower-leader relational capital. Significant implications of these findings for further research and practice are discussed.

Basic Psychological Needs as mediators: An examination of the relationship between exercise and well-being

Grounded in Basic Psychological Needs Theory (Deci & Ryan, 2002), the present investigation examined whether psychological need satisfaction mediated the relationship between moderate-to-vigorous physical activity (MVPA) and well-being. Adopting a longitudinal design participants (N= 147) completed questionnaires assessing MVPA, well-being and perceived psychological need satisfaction in exercise contexts on three occasions separated by three weeks. A pattern of small-to-moderate correlations were noted between MVPA and indices of well-being (r12's ranged from .16 to .29). Multiple mediation analysis indicated that perceived psychological need satisfaction mediated the relationship between MVPA and well-being with perceived competence emerging as a unique mediator. Serial mediation analyses indicated the importance of ongoing psychological need satisfaction to well-being. Contexts that afford individuals the opportunity to engage in MVPA, as well as supports their need for competence, would be most advantageous for the promotion of psychological well-being.