Dissertations / Theses on the topic 'Traqua'

This thesis examined the benefits of physiological and performance testing of elite swimmers. The study considered the following research questions: the degree to which physiological and performance measures in training contribute to swimming performance; sources and magnitude of variability in testing, training and competition performance; the magnitudes of changes in test measures during routine training; and the reliability, validity and utility of miniaturised and automated smart sensor technology to monitor the stroke and performance times of swimmers in training. The experimental approach involved the retrospective analysis of five years of physiological and performance testing of elite level swimmers, the development of a new accelerometry-based smart sensor device to monitor swimmers in the pool, a cross-sectional study comparing the physiological and performance responses of swimmers of different levels, and the effects of an intensive 14-day training program on submaximal physiological and performance measures. Collectively, the outcomes of these studies provide a strong justification for the physiological and performance testing of elite swimmers, a quantitative framework for interpreting the magnitude of changes and differences in test scores and sources of variation, and highlight the potential utility of new smart sensor technology to automate the monitoring of a swimmer�s training performance. The first study (Chapter 2) characterises the changes and variability in test performance, physiological and anthropometric measures, and stroke mechanics of swimmers within and between seasons over their elite competitive career. Forty elite swimmers (24 male, 16 female) performed a 7 x 200-m incremental swimming step test several times each 6-month season (10 � 5 tests, spanning 0.5 to 6.0 y). Mixed linear modeling provided estimates of change in the mean and individual responses for measures based on submaximal performance (fixed 4-mM lactate), maximal performance (the seventh step), and lean mass (from skinfolds and body mass). Submaximal and maximal swim speed increased within each season from the pre to taper phase by ~2.2% for females and ~1.5% for males (95% confidence limits �1.0%), with variable contributions from stroke rate and stroke length. Most of the gains in speed were lost in the off-season, leaving a net average annual improvement of ~1.0% for females and ~0.6% for males (�1.0%). For submaximal and maximal speed, individual variation between phases was �2.2% and the typical measurement error was �0.8%. In conclusion, step test and anthropometric measures can be used to confidently monitor progressions in swimmers in an elite training program within and between seasons. The second study (Chapter 3) quantified the relationship between changes in test measures and changes in competition performance for individual elite swimmers. The primary question addressed was whether test measures could predict a swimmers performance at the major end-of-season competition. The same sample group as in Study 1 was examined. A 7 x 200-m incremental swimming step-test and anthropometry were conducted in up to four training phases each season. Correlations of changes in step-test and anthropometric measures between training phases between and within seasons, with changes in competition performance between seasons, were derived by repeated-measures mixed modeling and linear regression. Changes in competition performance were best tracked by changes in test measures between taper phases. The best single predictor of competition performance was skinfolds for females (r = -0.53). The best predictor from the step-test was stroke rate at 4-mM lactate (females, r = 0.46; males, r = 0.41); inclusion of the second-best step-test predictor in a multiple linear regression improved the correlations marginally (females, r =0.52 with speed in the seventh step included; males, r = 0.58 with peak lactate concentration included). Changes in test measures involving phases other than the taper provided weak and inconclusive correlations with changes in performance, possibly because the coaches and swimmers took corrective action when tests produced poor results. In conclusion, a combination of fitness and techniques factors are important for competitive performance. The step test is apparently a useful adjunct in a swimmer�s training preparation for tracking large changes in performance. These initial studies identified stroke mechanics as a major determinant of a swimmer�s performance. Chapter 4 details the development of a small tri-axial accelerometry-based smart sensor device (the Traqua) that enables continual monitoring of various performance/stroke characteristics in swimming. The initial focus was to develop a device that automated the detection of a swimmer�s movements, specifically lap times, stroke rate and stroke count. The Traqua consists of a tri-axial accelerometer packaged with a microprocessor, which attaches to the swimmer at the pelvis to monitor their whole body movements while swimming. This study established the failure/error rate in the first generation algorithms developed to detect the swimming-specific movements of stroke identification, laps (start, turn and finish), and strokes (stroke count and stroke rate) in a cohort of 21 elite and sub-elite swimmers. Movements were analysed across a range of swimming speeds for both freestyle and breaststroke. These initial algorithms were reasonably successful in correctly identifying the markers representing specific segments of a swimming lap in a range of swimmers across a spectrum of swimming speeds. The first iteration of the freestyle algorithm produced error-rates of 13% in detection of lap times, 5% for stroke rate, and 11% for stroke count. Subsequent improvements of the software reduced the error rate in lap and stroke detection. This improved software was used in the following two studies. The next study (Chapter 5) evaluated the reliability and validity of the Traqua against contemporary methods used for timing, stroke rate and stroke count determination. The subjects were 14 elite and 10 sub-elite club-level swimmers. Each swimmer was required to swim seven evenly paced 200-m efforts on a 5-min cycle, graded from easy to maximal. Swimmers completed the test using their main competitive stroke (21 freestyle, 3 breaststroke). Timing was compared for each 50-m lap and total 200-m time by electronic touch pads, video coding, a hand-held manual stopwatch, and the Traqua. Stroke count was compared for video coding, self-reported counting, and the Traqua, while the stroke rate was compared via video coding, hand-held stopwatch, and the Traqua. Retest trials were conducted under the same conditions 7 d following the first test. All data from the Traqua presented in this and the subsequent studies were visually inspected for errors in the automated algorithms, where the algorithms had either failed to correctly identify the start, turn, finish or individual strokes and corrected prior to analysis. The standard error of the estimate for each of the timing methods for total 200 m was compared with the criterion electronic timing. These standard errors were as follows: Traqua (0.64 s; 90% confidence limits 0.60 � 0.69 s), Video (0.52 s; 0.49 � 0.55 s); Manual (0.63 s; 0.59 � 0.67 s). Broken down by 50-m laps, the standard error of the estimate for the Traqua compared with the electronic timing for freestyle only was: 1st 50-m 0.35 s; 2nd and 3rd 50-m 0.13 s; 4th 50-m 0.65 s. When compared with the criterion video-coding determination, the error for the stroke count was substantially lower for the Traqua (0.6 strokes.50 m-1; 0.5 � 0.6 strokes.50 m-1) compared to the self-reported measure (2.3 strokes.50 m-1; 2.5 � 2.9 strokes.50 m-1). However, the error for stroke rate was similar between the Traqua (1.5 strokes.min-1; 1.4 � 1.6 strokes.min-1) and the manual stopwatch (1.8 strokes.min-1; 1.7 � 1.9 strokes.min-1). The typical error of measurement of the Traqua was 1.99 s for 200-m time, 1.1 strokes.min-1 for stroke rate, and 1.1 strokes.50 m-1 for stroke count. In conclusion, the Traqua is comparable in accuracy to current methods for determining time and stroke rate, and better than current methods for stroke count. A substantial source of error in the Traqua timing was additional noise in the detection of the start and finish. The Traqua is probably useful for monitoring of routine training but electronic timing and video are preferred for racing and time trials. Having established the reliability and validity of the Traqua, Chapter 6 addressed the ability to discriminate the pattern of pacing between different levels of swimmers in the 7 x 200-m incremental step test. This study also sought to quantify the differences in pacing between senior and junior swimmers. Eleven senior elite swimmers (5 female, 6 male) and 10 competitive junior swimmers (3 female, 7 male) participated in this study. Each swimmer was required to swim seven evenly paced 200-m freestyle efforts on a 5-min cycle, graded from easy to maximal. The Traqua was used to measure time, stroke rate and stroke count. The senior swimmers were better able to descend in each of the 200-m efforts. Overall the senior swimmers were ~2-3 s per 50 m faster than the junior swimmers. Both groups were fastest in the first 50-m lap with the push start. The senior swimmers then descended the 50- m time for each of the subsequent laps, getting ~0.5 s faster per lap, with the final lap the fastest. In contrast, the junior swimmers swam a similar time for each of the subsequent laps. The junior swimmers were marginally more variable in their times (coefficient of variation: ~2%) compared with the senior swimmers (~1.8%). In comparison to junior swimmers, the senior swimmers in this study were faster, adopted a more uniform negative split strategy to pacing within a 200-m effort, and were more consistent in reproducing submaximal and maximal swimming speeds. The final study (Chapter 7) analysed the effect of 14-d of intensive training on the reproducibility of submaximal swimming performance in elite swimmers. Submaximal physiological and performance testing is widely used in swimming and other individual sports but the variability in test measures, and the effects of fatigue, during intensive training have surprisingly not been quantified systematically. Seven elite swimmers (3 male and 4 female) participated in an intensive 14-d training camp one month prior to the National championships. The aim of the study was to characterise the intra-session, daily and training block variability of submaximal swimming time, physiological and stroke characteristics in elite swimmers. The swimmers performed a specified submaximal 200-m effort in most sessions, after the warm-up and at the end of the session for both morning and afternoon sessions. During the efforts, swimming time and stroke mechanics were measured and physiological measures were recorded immediately on completion. The Traqua was worn by all swimmers in every training session. Mixed linear modeling was used to provide estimates of changes in the mean and individual responses (within-athlete variation as a coefficient of variation) for all measures. The swimmers were moderately slower (1.4%; �1.4%) over the 14-d training camp. The mean submaximal 200-m effort was very likely to be faster (0.7%; confidence limits �0.7%) in the afternoon compared with the morning session. The females were more variable in their submaximal performance times (CV=2.6%) than the male swimmers (1.7%). Blood lactate concentration was almost certainly lower (-23%; �10%) following higher volume in the previous session; however a higher intensity workout the previous session almost certainly leads to higher lactate (21%; �15%) in the current session. Considered together, these results indicate that the 200-m submaximal test is useful in monitoring submaximal physiological and performance measures and the negative effects of cumulative fatigue. In conclusion, changes in the physiological and performance measures derived from the poolbased progressive incremental step test are moderately correlated with changes in end-ofviii. season competition performance. The magnitudes of changes and differences in test measures between phases within a season, from season to season, and between males and females, established in this study can be applied to similar elite level swimmers preparing for major competition. The quantification of typical error of the same measures demonstrates that coaches and scientists can distinguish real and worthwhile improvements using the 7 x 200-m step test. Continual pool-based monitoring with the automated smart sensor Traqua device may provide more accurate and detailed information about a swimmer�s training adaptation than current fitness tests and monitoring methods. Finally, submaximal testing in trained swimmers is useful in monitoring progress in physiological and performance measures, and the impact of cumulative fatigue during an intensive period of training. Collectively, the outcomes of these studies indicate that routine physiological and performance testing can provide measurable benefits for elite swimmers and their coaches.

Magíster en Psicología Clínica Adultos
La Trata de Personas surge en Chile como un ilícito nuevo, visualizándose en gran parte, a través de las denuncias y procesos judiciales, a partir de la Ley 20.507, promulgada en Abril del 2011. Si bien la Trata es un ilícito que afecta a hombres, mujeres y niños, chilenos o extranjeros, los afectados en su mayoría han sido migrantes (mujeres y hombres). A pesar de los esfuerzos de instituciones no gubernamentales y gobierno para llevar a efecto la prevención del delito y protección a las víctimas, esta temática permanece invisibilizada ante la sociedad y las personas que han sido vulneradas. A partir de este contexto se desarrolla esta investigación, a través de un enfoque etnográfico reflexivo, el cual tiene por objetivo indagar el impacto de la Trata de Personas en la sociedad chilena, así como también en los profesionales expertos, que han trabajado con víctimas de Trata, y en especial migrantes. Las respuestas e indagaciones de esta investigación ayudarán a comprender las diferentes voces o polifonías en tensión, como un entramado social, que impiden una mejor visualización del ilícito. Esto, ayudaría además, a otorgar luces y directrices para una atención clínica a las víctimas, sustentadas desde una posición ética, política y develadora

ABSTRACT Despite a plethora of research documenting the effectiveness of various therapeutic interventions on the symptoms of Post Traumatic Stress Disorder (PTSD), there continues to be ambiguity insofar as which approaches or combination thereof are most effective at improving adverse manifestations of this disorder. This lack of clarity is further confounded when other variables and nuances pertaining to variations of PTSD (i.e. military, sexual trauma, childhood abuse, etc.) are factored into these comparisons. Therefore, the purpose of this study was to explore the impact of various interventions on improving the symptoms of PTSD. This study also examined the variances which stand in need of recognition when determining which interventions are most appropriate and meaningful in improving the quality of life and functionality of individuals with this disorder. This has significance in both macro and micro social work practices due to the potential for improvements in policies, allocation of resources, and enhancements in micro-level interventions. The research design involved qualitative interviews with clinicians devised to identify gaps, areas of agreement, and dissent among the research. Data analysis will be qualitatiive and will be guided by assessing the impact of interventions on the 17 symptoms which, according to the DSM-5 are associated with PTSD.

A grounded theory study was conducted to identify, describe and provide a theoretical analysis of the conditions and events surrounding the occurrence of physical trauma. Research questions addressed were: What pattern of behavior is present in individuals prior to experiencing a motor vehicle collision (MVC)?; To what degree do trauma patients view themselves as active participants in a MVC that results in physical injury? Twenty one informants participated in the study. Theoretical sampling involved the use of a variety of sources of data. Vignettes, interviews, songs, commercials and automobile advertisements were triangulated with existing literature. Constant comparative analysis revealed a grounded theory of self protection. Self protection consists of three phases; perceptions of actual control over the environment, experiencing a traumatic event that signifies loss of control over their environment, and self protection to enhance perceptions of actual control over the environment post event. Controlling perceptions influenced use of protection devices and post trauma driving behavior. Self protection involved emotional focused and problem focused strategies similar to that described in the literature. Perceptions of actual control over the environment was not a static trait but appeared to be situationally dependent. The theory explained the behavior of the majority of the informants regardless of their mechanisms of injury; although patients with injuries resulting from violence were omitted from the study. Informants who viewed driving as a pleasurable action with unpredictable outcomes, as a form of risk taking behavior, did not identify self protection strategies post event. The other informants viewed driving as an unconscious, automatized behavior and denied engaging in risk taking prior to the MVC. Findings indicate the need to explore the social context of the American lifestyle and the image of the automobile when explaining self protective strategies. Automobile manufacturers provide the illusion of control over the environment in their advertisements perhaps negating the need for self protection. Rationale for not supporting mandatory protection for the use of seat belts and helmets was provided by the informants. Further testing with contrasting groups is indicated to determine the usefulness of the theory outside the trauma patient population.

In writing/trauma, I address the association of trauma with knowledge, language, and writing. My discussion first works to establish the relationship between trauma and knowledge. I argue that trauma does not fit into the traditional Enlightenment model of scientific knowledge or the ontological model of what Michele Foucault calls the ‘truth-event.’ Rather, I contend that trauma is unique embodied knowledge, different from that of praxis and normal memory. In general, embodied knowledge is a matter of prenoetic and intentional operations. The body schema and body image maintain a power of plasticity and adjust to new motilities in order to re-establish an equilibrium when disrupted or threatened. In line with this, embodiment involves a sense of temporality, agency, and subjectivity. But in the case of extreme disruption, such as trauma, these fundamental aspects of embodiment are compromised to the point that there is a corruption of the “embodied feeling of being alive.” Physical pain, to some extent, produces this phenomenon. However, the distinctive function of the repetition compulsion within trauma distinguishes it as an exceptional embodied experience unlike physical pain or analogous phenomena. In the case of trauma, an equilibrium is not maintained, similar to the ontology of the accident. Instead, at best, we can say that what takes place is a destructive plasticity, in which the individual is transformed to the point of being a whole new ontological subject. This phenomenon of destructive plasticity is significant in establishing the relationship of language to trauma-knowledge as trauma is the precise point at which language is ruptured. That is to say, purported within psychanalytic discourse, traumatic experience is observed in a break within the symbolic order. As opposed to physical pain, then, trauma is more akin to the abject, sharing the same resistance to narrative language. Traumatic experience is expressed through semiotic compulsions in the body as a revolt of being. In light of this, I argue that trauma, rather than being treated as a pathology, is a specific embodied knowledge which can be captured in semiotic, poetic language. Moreover, fragmentary writing, the interface of fragmented knowledge and language, captures the disruptive force of traumatic experience. In conclusion, I assert that writing-trauma is valuable, not because it allows for a ‘working through’ of the traumatic experience, but because it is an expression of a distinctly human experience. My work canvases nineteenth century to contemporary literature on trauma such as Bessel van der Kolk in the neurobiological discipline, literary critics including Cathy Caruth, Dori Laub, Dominick LaCapra, et al, and the psychoanalytic theorists Sigmund Freud and Jacques Lacan. I draw from such literature to analyze the ambiguous impossible-possibility of witnessing and giving testimony of traumatic experience in history and writing, as well as the concern with trauma and language specific to the repetition compulsion and the unconscious. Yet, my primary focus is on the contribution of philosophy to the ongoing discourse of trauma. I look to philosophical thinkers such as Michele Foucault and Friedrich Nietzsche to depict the types of epistemological models traditionally addressed within the history of philosophy. My analysis of phenomenology and embodiment is mainly informed by the works of Maurice Merleau-Ponty and Shaun Gallagher. Additionally, Catharine Malabou’s work on destructive plasticity provides an understanding of the ontology of the accident, one of the most critical pieces to my work. Additionally, the works of Elaine Scarry and Julia Kristeva help to disclose the intimate relationship between language and trauma. I also incorporate the work of Gloria Anzalúa along with Julia Kristeva to describe the multi-dimensionality of poetic language and how this is what allows for an articulation of embodied trauma-knowledge. Finally, Maurice Blanchot’s depiction of the disaster and fragmentary writing best captures writing-trauma as it is, like trauma, a process of fragmenting language and meaning. My purpose is to make clear the value of poetic language and fragmentary writing in regard to knowing and writing trauma. The significance to philosophy is that my discussion bridges the phenomenological and epistemological perspectives with that of the literary in order to engage in philosophical discussion on the implications and value of traumatic experience for understanding the human condition. It is my observation that the more we experience trauma, the more valuable artistic expression becomes, and the more we are pressed within the philosophical tradition to account for an experience so many individuals suffer.

Embora a órtese de Palmaz tenha sido utilizada para tratamento de graves obstruções da via aérea, em pacientes com traqueomalacia ou estenose após traqueoplastia, não existe nenhum estudo experimental sobre o uso desta órtese. Este trabalho foi então realizado com o objetivo de determinar o efeito do uso experimental da órtese de Palmaz emtraquéias normais e previamente submetidas a cirurgia. A órtese de Palmaz foi colocada, através de broncoscopia e sob controle fluoroscópico, na traquéia intratorácica de quatro grupos de gatos anestesiados. Nos animais dos grupos I (adultos, n=10) e fi (filhotes, n=10), a órtese foi colocada na traquéia normal. Animais do grupo m (adultos, n=15) submeteram-se a toracotomia, incisão e sutura traqueal, e aqueles do grupo IV (adultos, n=15) à toracotomia e traqueoplastia com pericárdio. Nos grupos m e IV, a órtese foi inserida em dez animais, tendo cinco sido utilizados como controle. Balonete de 15 mm de diâmetro foi usado para expandir a órtese nos animais do grupo I; balonete de 8mmfoi usado nos demais grupos. Os animais foram avaliados diariamente. Broncoscopia e radiografia de tórax foram feitas em 2, 5, 8 e 10 semanas. Metade dos animais com órtese foram sacrificados em 5 semanas; todos os demais em 10 semanas. Após sacrificio foram realizados histologia e medida dos diâmetros traqueais. Testes t de student e exato de Fisher foram utilizados, considerando-se 0,05 como o nível mínimo de significância. Um animal do grupo I foi sacrificado após perfuração traqueal provocada pela órtese. A não ser episódios intermitentes de tosse observados em 19 gatos, e recusa alimentar com perda de peso em três do grupo IV, nenhum outro problema clínico foi notado. Em todos os grupos, a média de peso na inserção da órtese foi igualou menor do que aquela observada no momento do sacrificio dos animais. Traqueoscopia revelou tecido de granulação não obstrutivo, caracteristicamente localizado nas extremidades da órtese, em 15 animais dos grupos I e fi, e em 17 dos grupos fi e IV. Tecido de granulação também foi observado na região da cirurgia traqueal prévia, nos animais com órtese dos grupos m, e em todos do grupo IV. Esofagoscopia realizada nos animais com recusa alimentar e perda de peso excluiu esofagite ou obstrução esofágica. No grupo I, a área seccional da traquéia com órtese foi significativamente maior do que aquela da traquéia normal (pPalmaz stents have been used to relieve severe airway obstructions in patients with tracheobronchomalacia and post tracheoplasty stenosis. Experimental data to support their use are lack:ing. This study was undertaken to determine their effect on the normal and fresh1y operated trachea. Palmaz stents were placed bronchoscopically with f1uoroscopic control in thoracic tracheas of 4 groups of anesthetized cats. Gp I (adults, n=10) and Gp fi (kittens; n=lO): normal tracheas; Gp m(adults, n=15): thoracotomy, traeheal incision and closure; Gp IV (adults, n=15): thoracotomy, traeheoplasty with pericardial pateh. In Gp mand IV, stents were inserted in 10 and 5 served as controls. The balloon stents were inflated to 15 mmin Gp I and to 8 mmin the others. Cats were assessed daily, and by bronchoscopy and x-ray at 2, 5, 8 and 10 weeks. Halfthe stented animaIs were sacrificed at 5 weeks; all others at 10. At autopsy, tracheas were evaluated by size, contoU! and histology. Fiseher's and Student's "t" tests were utilized, and 0.05 was the significance leveI. One Gp I animaIs was sacrificed because of tracheal perforation. Except for mild cough in 19 eats, and difficulty of eating with loss ofweight in three, no clinicaI problems were noted. A non obstructing rim of granulation tissue at the upper or lower end of the stent in 15/20 Gp I and fi cats, and in 17/20 Gp m and IV animaIs, and also at the tracheal repair site in stented Gp m and all Gp IV. Endoscopy excluded esophagus inflammation and obstruction in animaIs with difficulty of eating and loss of weight. The difference in cross-sectional area ofthe stented versus the normal trachea in Gp I cats was significant (p<0.02); in Gp IV, the control (unstented) tracheoplasty site was narrower than the normal trachea (p<0.02). Mild epithelial damaged and inflammatory reaction with granulation tissue was observed in all stented animaIs, but Gp I (over distention) the reaction was more severe with epithelial ulceration and fibrosis. Stented tracheas in Gp m had significantly more inflammatory reaction, granulation tissue and epithelial damaged than eontrols. We ean conelude this study that: 1) Adequate expanded Palmaz stents provoke an inflammatory reaetion in the normal and fresh1y operated upon cat trachea; 2) Overexpanded (Gp I) Palmaz stents provoke traeheal perforation and severe histologic damage; 3) Palmaz stents insertion afier tracheal suture in cats provoke more granulation tissue and histologic damage; 4) Palmaz stents maintain the normal lumen size afier pericardial tracheoplasty in eats.

The topic of this dissertation is the aspects of trauma and reaction to the traumatic experience that can be found in 9/11 literature. The research engages in a comparative analysis of five books that can be categorised as 9/11 literature, which means that the events of 9/11 are central in the novels and are a recurrent theme. The books have been written by authors of different nationalities: "Extremely Loud & Incredibily Close" by J. S. Foer, "Falling Man" by D. DeLillo, "Windows on the World" by F. Beigbeder, "Saturday" by I. McEwan and "The Reluctant Fundamentalist" by M. Hamid. The characters have either experienced the attacks personally or their lives have been largely influenced by the event. In either case, the protagonist has been traumatised by the tragedy. Therefore, in this study two different fields are fused together – the field of comparative literature and that of trauma studies.

Therapists who specialize in trauma therapy are indirectly exposed traumatic events presented by clients within the therapeutic relationship. The potential consequences for trauma therapists may be the risk of vicarious trauma. Effective coping and self-care are essential in the practice of trauma work. The research question for this study is: Do coping skills and self-care practices in trauma therapists moderate the disruptive effect of vicarious trauma on the fulfillment of their psychological needs (trust/dependence and control)? The purpose of this research study was to examine quantitatively, the role of trauma therapists' beliefs in the effectiveness of coping skills and time spent devoted to self-care practices as moderators of the disruptive effect of vicarious trauma on their fulfillment of psychological needs of trust/dependence and control. Based on the constructive self-development theory, this study explored 2 psychological needs areas including trust/dependence and control. A sample of therapists with 10 years or more experience in the field and who primarily treated traumatized populations were recruited. A survey design methodology via a customized internet-based system was used to administer the trauma and attachment belief scale and the coping inventory scale. A hierarchical multiple regression analysis was completed to address the research question and hypotheses. The results of regression analysis supported the research question. Contributions to positive social change include increased awareness of the risk of vicarious trauma and potential coping strategies necessary to address this phenomenon. Therapists may then enhance their therapeutic effectiveness and organizational service delivery to traumatized client populations.

Referring to the academic phenomenon of 'Trauma Studies', this thesis argues that if it is possible to 'speak about and speak through' trauma (Caruth, 1996), such a double operation can only occur through a writing which, paradoxically, touches on what exceeds it. To structure this argument, the thesis proposes a distinction between 'Trauma Studies' – as a discipline or field of academic study – and a trauma study; the latter being a writing (on) trauma which suffers and survives as an inscription of the traumatic event, an event which nevertheless remains irreducible to the text 'as such'. Moreover, by referring to Jacques Derrida's consideration of the term 'survivre', a quasi-originary textual dimension which 'survives' or 'lives on' the border between life and death, I suggest that if a trauma study is to 'take place', it must affirm this essentially 'spectral' dimension as its very condition. Following Derrida's suggestion that all events are in a sense traumatic, I further argue that a trauma study must write (on) the traumatic event in terms of the force and potentiality of the future – what I refer to as the 'might' of what remains to come. This thesis, therefore, considers a trauma study in terms of 'living on', a textual dimension which suffers and survives the 'might' of what remains to come. Chapter One reads Chris Marker's film La Jetée, Chapter Two Roland Barthes's reading of Stendhal, and Chapter Three considers Hélène Cixous's Le jour où je n‟étais pas là. These chapters read how a trauma study remains a possibility of the im-possible, an experimental writing which survives or lives on the precarious border between experience and study. The thesis concludes by suggesting that, in order to write (on) what remains traumatic, the (im)possibility of a trauma study is determined by a certain feminine 'might'.

This thesis proposed an Adlerian therapy group with a focus on integrating art, play, trauma-, and attachment-informed practices to treat children who are experiencing the effects of intergenerational trauma. Summaries of the research documented various mechanisms of trauma transmission from parents to children, as well as the consequences for the children, including a decrease in executive and behavioral functioning and less academic success. The review of the literature supported multilevel, school-wide, trauma-informed interventions that provide information and support to administrators, teachers, staff, and parents, and direct services to the children. These services include the proposed Adlerian therapy group designed to support school-aged children suffering from the effects of trauma. The purpose of the group is to foster self-worth, to improve mental health, and to enhance better academic and social functioning. This paper also recommended future research to assess the effectiveness of the approach and of school-based trauma-informed programs, in general.

Människor med allvarligare missbruksproblem lider ofta av samsjuklighet. Syftet med studien var att undersöka kvantitativ förekomst av PTSD bland klienter med diagnosen missbruk/beroende på ett behandlingshem i Sverige samt skillnader i förekomst av PTSD mellan män och kvinnor. Även ett kvalitativt syfte fanns avseende missbrukande människors livsvärld och deras syn på sambandet mellan trauma och missbruk samt behandling. Urvalet bestod av 41 individer med diagnosen missbruk/beroende som testats med mätinstrumentet PCL-C vilket mäter problem och besvär som människor kan få som en reaktion på stressande upplevelser. Två av individerna från urvalet valdes för djupintervjuer. Studiens kvantitativa resultat visade att urvalsgruppen i förhållande till en normalpopulation, har betydande större del individer med indikationer på PTSD (65% mot 5,6%). Mer än dubbelt så många kvinnor som män indikerade förekomst av PTSD vilket överensstämmer med normalpopulationen. 90% av kvinnorna hade värden över det kritiska värdet på PCL-C. Studiens kvalitativa resultat visade på ett möjligt samband mellan tidigare svåra upplevelser i livet och situationen idag. Båda de intervjuade individerna hade erfarenhet av svåra händelser i barndomen, tonåren och i vuxenlivet. Båda såg de svåra händelsernas påverkan på psykisk- och fysisk hälsa och relationer samt en koppling mellan svåra händelser och missbruk. Båda hade också tankar om att fokus på/behandling av svåra händelser kan påverka missbruket. Slutsatser av studien kan sammanfattas i att många människor med missbruksproblem också har en traumabakgrund, att kvinnor har det i större utsträckning än män och att detta bör beaktas vid mötet med, och i behandlingen av missbrukare.

There is an extensive literature exploring the effects of trauma, and the variables which moderate reactions following a stressful experience. Emotional responses can vary in response to numerous factors, and one area receiving increasing attention is that of coping. It has been acknowledged that there is an important relationship between how individuals cope and their psychological wellbeing following a trauma. Highly stressful experiences can impact on coping styles, and at times this can lead to maladaptive coping, exacerbating the original symptoms and potentially invoking additional difficulties. Existing coping styles also appear to impact on how individuals cope with events, possibly predicting future symptomatology. It is known that some populations, for example combat veterans, the homeless and refugees, experience a higher than average exposure to trauma, but less is known about they cope with these experiences. On the basis of this, this study aimed to investigate trauma and coping styles in street and hostel homeless adults, and additionally explore the relationship between coping and trauma symptomatology on the basis of existing research findings. It found that the street homeless reported more approach coping skills than those living in hostels, and this group also displayed higher levels of trauma symptomatology. Furthermore, it was shown that there is an association between avoidant coping and trauma, complex trauma and PTSD, supporting existing literature. Due to the cross-sectional design, causal associations could not be drawn, but the research gives suggestions for future research and potentially beneficial psychotherapeutic interventions for those who have experienced trauma, including homeless populations. 3.

Trauma-provoked tinnitus challenges patients and clinicians. Effects of trauma may exacerbate tinnitus, and patients with both tinnitus and posttraumatic stress disorder rate distress levels as higher than patients who experience only one or the other. This presentation will highlight links between tinnitus and trauma histories relevant to clinical audiologists.

This thesis recalls and surveys the work of major theorists in the field of Trauma theory, including Freud, Charcot, Prince, Caruth and Leys. It will consider if literature can provide a positive response to the attestation and representation of trauma. For Derrida, testimony must always remain irreducible to evidence or proof. This secret at the heart of every telling is what is at stake for survivors of trauma. Further, pain (either physical or mental) is that which precisely can't be shared between subjects it cannot be denied neither can it be confirmed. On the one hand it induces certainty (I feel pain) and on the other, doubt (I can't see or feel your pain). One's pain is entirely aversive, a secret that evades language. How does this affect the textual production of trauma narratives? And how are those narratives received? The definition of testimony, that it alone can't constitute a 'proof whilst possibly recuperating one's right to 'tell' insomuch as one can construct an apparatus to evade censorship by government or other authorities, reduces that telling to a fiction, a story; which could be described as akin to the violence of blocking one's ears, refusing to partake in witnessing, a dismissal of subjectivity/sovereignty. Can literature and the art of testimony confront the impossibility of a proper response to trauma, a trauma that evades language and majority discursive practices?.

Magíster en Psicología Clínica de Adultos
Autor no autoriza la publicación de su tesis a texto completo en el Portal de Tesis Electrónicas.
Autor: Luis Cruz Villalobos (cires.chile@gmail.com). Profesor Guía: Juan Yáñez M. Título: Hermenéuticas del Trauma. Aproximación al Trauma y su Afrontamiento Positivo como Fenómenos Hermenéuticos. Grado: Magíster en Psicología Clínica de Adultos. El presente trabajo es una investigación de carácter teórico sobre el trauma y su afrontamiento positivo, que tiene como tesis central la comprensión de estos como fenómenos fundamentalmente hermenéuticos. El documento desarrolla un abordaje inicial del estrés, los procesos de afrontamiento, el trauma y los fenómenos psicopatológicos que se le vinculan. Luego revisa los últimos planteamientos investigativos referidos al estudio del afrontamiento positivo del trauma, particularmente en torno a los constructos de resistencia (hardiness), resiliencia y crecimiento postraumático. Como abordaje central para el desarrollo de la tesis se presentan algunas perspectivas que se consideran muy relevantes para una comprensión del trauma como fenómeno interpretativo, tales como una revisión al día sobre neurofisiología de los procesos de memoria, una reseña al constructivismo y la hermenéutica y un recorrido por los principales aportes de la fenomenología hermenéutica desarrollada por Heidegger. Se realiza una integración de las perspectivas, aplicando la comprensión heideggeriana del hombre como Dasein y ser-en-el-mundo, abordando sus consecuencias para el estudio del trauma y su afrontamiento, integrándolas con los referidos descubrimientos de la neurociencia respecto a la memoria humana como fenómeno dinámico y en permanente reconsolidación. Finalmente entregamos una perspectiva que integra los desarrollos conceptuales ya articulados a los modelos que abordan el afrontamiento positivo del trauma, incorporando como constructo articulador el sentido de coherencia, que logra conjugar la comprensión del trauma y su afrontamiento positivo como fenómeno hermenéutico. Se entregan algunas implicancias clínicas y posibles líneas de investigación futuras

Dissertação (mestrado profissional) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Cuidados Intensivos e Paliativos, Florianópolis, 2015.
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Objetivo. Analisar o perfil epidemiológico e o manejo de crianças vítimas de trauma abdominal fechado na Unidade de Terapia Intensiva em um hospital pediátrico terciário. Metodologia. Trata-se de um estudo observacional, de coorte histórico, descritivo, por meio de análise de prontuários. Resultados. Foram analisados 58 prontuários. Trinta e cinco crianças (60% do total) foram do sexo masculino. A idade média foi de 8,6 anos e a mediana de 9 anos. O tipo de lesão mais comum foi a esplênica com 35% dos casos, seguida da hepática, com 26%. A associação de lesões foi encontrada em 26% dos casos, sendo que o baço foi o principal órgão acometido dentre as associações. Os acidentes com veículos automotores foram os principais mecanismos de lesão, sendo responsáveis por 57% do total. Queda foi a segunda causa de lesão, em 31% dos casos. O tempo de permanência hospitalar médio foi de 12,8 dias, enquanto que o tempo médio aproximado de permanência na unidade de terapia intensiva foi de 37 horas. Treze crianças (22% do total) chegaram hemodinamicamente instáveis ao hospital. A chance de uma criança que chegou hemodinamicamente instável ao hospital ser submetida à cirurgia foi 7 vezes maior do que uma criança que chegou estável. Oito crianças mantiveram a instabilidade hemodinâmica mesmo após a ressuscitação volêmica. A chance de um paciente que manteve instabilidade hemodinâmica ser submetido à cirurgia foi 18 vezes maior do que uma criança que se tornou estável hemodinamicamente.

Abstract : Objective. To analyze the epidemiology and management of patients with blunt abdominal trauma in the intensive care unit in a tertiary care pediatric hospital. Methodology. This is an observational, cross-sectional, descriptive, through analysis of medical records. Results. Fifty-eigth records were analyzed. Thirty-five children (60% of total) were male. The mean age was 8.6 years old and the median was 9 years old. The splenic injury was the most common type of injury, with 35% of cases, followed by the liver injury, with 26%. The injury association was found in 26% of cases, and the spleen was the main organ affected among the associations. The motor vehicle accidents were the main mechanisms of injury, accounting for 57% of the total. Fall was the second cause of injury (31% of cases). The mean length of stay in the hospital was 12.8 days, while in the intensive care unit was approximately 37 hours. Thirteen children (22% of the total) came with hemodynamic instability to the hospital. The chance of a child who came with hemodynamic instability to the hospital undergoing surgery was 7 times greater than a child who came with hemodynamic stability. Eight children maintained hemodynamic instability even after resuscitation. The chance of a patient that remained hemodynamically unstable to undergo surgery was 18 times greater than of a child who became hemodynamically stable.

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Programa de Pós-Graduação em Psicologia, Florianópolis, 2013.
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O presente estudo tem como ponto de partida a interrogação sobre o trauma, considerando que no centro da experiência traumática existe um excesso que comporta a ideia de um "corpo estranho", de impossível assimilação e representação. A partir das investigações freudianas sobre o trauma e do registro do real, em relação ao traumático, na obra lacaniana, pretende-se traçar um diálogo com a poética de Paul Celan. A questão inicialmente formulada neste estudo parte do fato de que a escrita celaniana busca atravessar - por meio da linguagem e na própria linguagem - o horror da catástrofe vivida no território europeu nos anos 1933-1945, sendo esta uma forma de buscar orientar-se frente a esta violência. Interessa analisar de que maneira a escrita enfrenta a experiência traumática, considerada de impossível representação. No diálogo traçado com a psicanálise, os conceitos que balizam este percurso, em razão da sua aproximação com a lírica celaniana, são, além do trauma e do registro do real, os conceitos de compulsão à repetição (Wiederholungszwang), de letra e de significante, de Das Unheimliche, bem como a noção de temporalidade no psiquismo, passando, ainda, pela questão do endereçamento. A obra de Paul Celan caracteriza-se pela busca do Outro, mantendo-se aberta, comporta em si mesma o estranho, o estrangeiro.

Abstract : The present study has the interrogation about the trauma as a starting point, considering the existence of some excess that holds the ideia of a "strange body" in the core of the traumatic experience, which is of impossible representation and assimilation. From the Freudian investigations about the trauma and the category of the real, in relation to the traumatic, in Lacan's works, we aim at establishing a dialogue with Paul Celan's poetics. The initially formulated question in this study starts off from the fact that Celan's writing seeks for crossing - through language and in language itself - the horror of the catastrophe experienced in the European territory between 1933-1945, being this a way of searching for orienting himself towards that violence. It is of our interest to investigate in which way writing faces the traumatic experience, considered of impossible representation. In the dialogue with psychoanalysis, the concepts that ground this path, due to their proximity to Celan's lyric, are, beyond the trauma and the order of the real, the concepts of compulsion to repetition (Wiederholungszwang), of letter and significant, and of Das Unheimliche, as well as the notion of temporality in the psyche, passing by the matter of addressing. Paul Celan's work is characterized by the search for the Other, and by keeping itself open, bears the strange, the stranger in itself.

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O objetivo deste trabalho é investigar o processo de aquisição da glossolalia através da observação dos papéis que esta exerce dentro de grupos pentecostais. Inicialmente buscamos compreender se sua aquisição relacionava-se com aprendizagem pura e simples de padrão lingüístico levando os simpatizantes a adquiri-la mais ou menos rapidamente (Goodman, 1974). Como segunda etapa compreendemos que não era simples o padrão comportamental que deveria ser adquirido pelos membros e passamos a investigar como se processava a aquisição deste complexo padrão comportamental que inclui o fenômeno de glossolalia (Hine, 1969 e 1974). A pesquisa de campo foi realizada em dois grupos pentecostais de origem religiosa diferente: um protestante, outro católico Trabalhamos com os grupos comparando-os quanto aos seguintes aspectos: formação e condição histórica, organização e relação de todos os aspectos institucionais com o fenômeno em estudo. Durante alguns meses assistimos como observador participante as mais variadas atividades dos grupos visando observar sistematicamente as diversas formas de manifestação do fenômeno. Foram entrevistados "falantes" (g1ossolálicos de ambos os grupos) Quanto ao primeiro objetivo da pesquisa, as observações indicaram, embora não tenhamos procedido a análises linguísticas profundas, a inexistência de padrões lingüísticos que justificassem a rápida aquisição do fenômeno. Em relação ao segundo, nossas conclusões apontam para: representar a glossolalia um traço de comportamento cultural apreendido por processo de aprendizagem; está incluída dentro de um padrão comportamental complexo que, por sua vez, desenvolveu-se de modo diferente em cada um dos grupos e de acordo com o contexto institucional; e, Por fim, que é adquirida pelo indivíduo como forma de assemelhar-se (identificar-se), com o padrão grupal. Concluímos ainda que o indivíduo passa por uma reestruturação cognitiva no processo, que altera sua auto-imagem modelando a identidade como pentecostal.

A review ofthe literature revealed that norsearch to date has focused on women's recovery from post-natal trauma. The aim ofthe current study was to explore the 'lived experience ofrecovery' (Deegan, 1988) using a qualitative approach. A purposive sample ofeleven participants who felt that they had made a partial or fuII recovery after being traumatised by childbirth completed written accounts oftheir recovery. Retrospective assessment ofwomen's PTSD symptoms when they were at their worst indicated that fIve women had met fuII criteria for PTSD according to a checklist based on the Post-traumatic Distress Scale (Foa, 1995), and all nine participants who returned the checklist could be considered as 'partial PTSD'. Analysis ofrecovery stories produced four main themes. Women's recovery was aided by the provision ofvalidation and support and a healing birth experience. Recovery was hindered by items that kept them living the trauma and feelings ofloss. Despite making a partial recovery, some women could not progress further as they continued to feel an intense sense ofloss at not having had their desired 'good' birth experience. This had implications for their mood, behaviour and perception ofthemselves as mothers.

Determina la relación entre ATI y complicaciones postoperatorias en pacientes quirúrgicos. El trabajo es analítico y retrospectivo. La población de estudio corresponde a pacientes operados por trauma abdominal penetrante en el Hospital Daniel Alcides Carrión durante enero 2007 a febrero 2008. Se realizaron tabulaciones descriptivas de las características demográficas, órganos afectados, puntaje de ATI, tiempo operatorio, mecanismo de trauma, desarrollo de complicaciones y reintervenciones. Se determinó la asociación entre el puntaje de ATI y las complicaciones o la reintervención utilizando el test de suma de rangos Wilcoxon, se realizó un modelo de regresión logística para determinar la asociación entre el puntaje ATI y las complicaciones. Se determinó la asociación entre complicaciones y el puntaje de ATI con puntos de corte menor o igual a 15 y menor o igual a 25, utilizando el test exacto de Fischer. Toda evaluación estadística se determinó a un nivel de significancia de 95%. La población total de estudio fue de 53 pacientes, 51 hombres y 2 mujeres, edad promedio 26.67 años (15-57 años). El tiempo operatorio promedio fue de 141.98 minutos (30-290 minutos). El mecanismo de lesión en 37 pacientes fue arma de fuego y en 16 arma blanca. Se presentaron complicaciones postoperatorias en 20 pacientes, de ellos 10 presentaron dos o más. 10 pacientes tuvieron un solo órgano afectado por el trauma, 40 tuvieron dos o más. Los órganos más afectados fueron: asa delgada (50%), epiplón (46%), colon (36%) e hígado (26%). Se excluyeron del análisis referente al ATI a 3 pacientes (laparotomía en blanco). El puntaje de índice de trauma abdominal promedio fue de 15.36 (rango de 2-52). En pacientes no reoperados (n=44) el ATI promedio fue 13.63 y para reoperados (n=6) fue de 28 (p=0.012). En pacientes que no presentaron complicaciones (n=29) el ATI promedio fue 10.13, mientas que los que las presentaron (n=21) fue de 22.57. Después de una regresión logística ajustada para edad, sexo, mecanismo de trauma y tiempo de cirugía el puntaje de ATI persiste asociado a las complicaciones (OR 1.14 (IC95%: 1.01-1.29), p=0.035). El grupo con ATI mayor de 25 tuvo mayor riesgo de reintervenciones que el grupo con ATI menor (33.33% vs 7.32%; OR 6.33 [IC 95% 1.029-38.98]) y mayor riesgo de desarrollar complicaciones (88.88% vs 28.27%; OR 17.231 [IC 95%; 1.9-152.]). El grupo con ATI mayor de 15 tuvo mayor riesgo de reintervenciones que el grupo con ATI menor (26.32% vs 3.23%; OR 10.7 [IC 95% 1.14-100.52]) y mayor riesgo de desarrollar complicaciones (73.68% vs 19.35%; OR 9.6 [IC 95%; 2.55-36.06.]). Se concluye que el índice de trauma abdominal es un factor predictivo de complicaciones postoperatorias, tanto con el puntaje de corte de 25, como con el puntaje de 15; es un significativo predictor de reoperaciones, recomendamos su utilización en pacientes con trauma abdominal penetrante.
Trabajo académico

The aim of this thesis is to explore the currently dominant discourse on child abuse and trauma as it has come to be understood in the last 30 years in British psychoanalysis. This research mainly draws on a psychoanalytic framework, to show how a specific way of conceptualising trauma and child abuse has led to a shift from a non-trauma based psychoanalysis in the UK to a trauma-based one. In order to present the core elements of this discourse, I closely read psychoanalytic (British and French) and second-wave feminist texts that are relevant to this topic, against the background of the wider trauma paradigm and memory studies, which are also presented in the thesis. In the British psychoanalytic tradition in particular in attachment theory and contemporary Kleinianism this shift towards trauma has not yet been studied in the context of wider discussions that are occurring in cultural and social studies. Hence, the shift towards trauma-based psychoanalysis is routinely seen as a positive step forward, without examining it in the context of wider discussions about trauma and its meaning. The shift from a non-trauma based to a trauma-based psychoanalysis signifies a parallel shift towards the desexualisation of psychoanalysis, which I also examine. The introduction of trauma as a central concept in psychoanalysis has meant a shift from a discourse of desire to a discourse of needs, and this is one of this thesis' central findings.

Flood literature presents an inconsistent account of post-disaster distress; debating whether distress is pathological or normal and attempting to understand distress in terms of disaster variables. The literature therefore provides little guidance as to how to formulate difficulties in a clinically meaningful way reflective of individual’s experiences. The SPAARS model is presented as a model by which to reconcile these differences and quantitative support for its concepts were studied within two flooded samples. Participants who were flooded in Carlisle in 2005 (n=32) and participants flooded in Morpeth in 2008 (n=29) provided two samples at different stages in flood recovery and facilitated a quasi-longitudinal sample for comparison of flood-related distress over time. Participants were asked to complete a survey pertaining to: basic emotions experienced during the flood event, basic emotions experienced after the flood, Impact of Events Scale-Revised (IES-R), Regulation of Emotions Questionnaire (REQ) and the Trauma Symptom Inventory (TSI). Findings suggest that a third of participants who were flooded experienced clinically significant levels of distress, even after four years. Both samples showed higher levels of impact symptoms on the IES compared to symptoms on the TSI. Anxiety and anger were significant in reported flood experiences both during and after the flooding. Flood-related variables and previous experiences had no effect on increased distress but greater use of internal-dysfunctional emotion regulation strategies was related to increased impact and distress symptoms. Study findings and the SPAARS model are discussed in relation to previous flooding and PTSD literature, as well as clinical implications for the treatment of post-disaster distress and for the future management of flood-affected populations.

Le traumatisme est historiquement une notion centrale dans le champ de la médecine chirurgicale. Avec les revendications des associations de victimes, il est devenu un syndrome psychiatrique. La psychanalyse va s'efforcer tout au long du siècle dernier d'en décrire son fonctionnement. Elle met à l'ordre du jour la responsabilité de chaque sujet traumatisé dans ce qui lui arrive. L'événement vient réactiver un processus psychopathologique dont l'existence serait antérieure à l'accident traumatique. Mais le problème général du traumatisme psychique et de son interprétation reste encore une réalité de nos jours.Cette recherche clinique, effectuée auprès d'enfants et adolescents malades (services pédiatriques) ou blessés (services de chirurgie pédiatrique), généralise la psychopathologie du traumatisme dans le domaine des affections somatiques pédiatriques. Elle établit une différence entre une clinique de l'effroi et une clinique de l'angoisse. L'effroi associé à un mécanisme de sidération se rencontre plutôt dans le domaine des blessures corporelles, l'angoisse articulée au refoulement est plutôt mise en jeu après l'annonce d'une maladie grave, type cancer.

Le traumatisme est historiquement une notion centrale dans le champ de la médecine chirurgicale. Avec les revendications des associations de victimes, il est devenu un syndrome psychiatrique. La psychanalyse va s’efforcer tout au long du siècle dernier d’en décrire son fonctionnement. Elle met à l’ordre du jour la responsabilité de chaque sujet traumatisé dans ce qui lui arrive. L’événement vient réactiver un processus psychopathologique dont l’existence serait antérieure à l’accident traumatique. Mais le problème général du traumatisme psychique et de son interprétation reste encore une réalité de nos jours.Cette recherche clinique, effectuée auprès d’enfants et adolescents malades (services pédiatriques) ou blessés (services de chirurgie pédiatrique), généralise la psychopathologie du traumatisme dans le domaine des affections somatiques pédiatriques. Elle établit une différence entre une clinique de l’effroi et une clinique de l’angoisse. L’effroi associé à un mécanisme de sidération se rencontre plutôt dans le domaine des blessures corporelles, l’angoisse articulée au refoulement est plutôt mise en jeu après l’annonce d’une maladie grave, type cancer
The traumatism is historically a central notion in the field of the surgical medicine. With the claimss of victims' associations, it becomes a psychiatric syndrome. The psychoanalysis will endeavour throughout the last century to describe its functioning. It puts at the day order the responsibility of each traumatized subject in what happens to him. The event comes to reactivate a psychopathological process whose existence would be previous to the traumatic accident. But the general problem of the psychic traumatisme and of its interpretation (performance) still remains a reality nowadays. This clinical research, conducted among children and adolescents sick ( pediatric services) or wounded (pediatric surgery services), generalizes the psychopathology of the traumatism in the domain of pediatric somatic affections. It establishes a difference between a clinic of the dread and a clinic of anguish. The dread (or terror) associated with a mechanisme of sideration, rather occurs in the domain of corporal wounds, the anguish articulated with the repression is rather concerned after the annoncment of a serious disease, such as cancer

This study considers the history of trauma, both as a psychiatric concept and as a diagnosis, and its social and cultural representation from a transnational perspective after WWII. The intellectual evolution of trauma was determined by various medical, social and cultural variables, institutions, and people who wielded influence in the postwar world order as well as diverse local contexts. This thesis focuses on the globalisation and localisation of such concept and diagnosis shaped by international and local mental health experts at the World Health Organization and the National Taiwan University Hospital. Through the efforts of these experts, trauma not only became one of the most globally diffused psychiatric diagnoses, but also a hyperbole appropriated by Taiwanese psychiatrists to account for extreme forms of social suffering. Studies have criticised the universality and the Anglo-American-centred approach to the history of traumatic psychiatry. Scholars have also begun to explore transnational histories of psychiatry by systematically comparing or tracing the diffusion routes of psychiatric topics. Their methods of enquiry and problems solved, however, differ. My research analyses a disparate collection of evidence at the level of international organisations and from local aspects, allowing not only a critical reconsideration of trauma in the trend of global medicine, but also its reception, contestation and appropriation in the non-Western contexts. Guided by the works of medical historians, literary critics and cultural anthropologists, this project combines archival research with oral history interviews to challenge the existing historical accounts of trauma, and provide evidence of the limited capacity of globalised psychiatric norms and their reception and appropriation beyond the imagination of world citizenship. It argues that such scientific artefacts were not only produced through mutual reference between Eastern and Western experiences, but also measures of instrumental rationality employed by postwar internationalists to engineer their modernity in the Global South.

Professionals who work with victims of sexual trauma frequently experience emotional and psychological stressors that affect their everyday life. Vicarious traumatization is an occupational risk among helping professionals, but it is not known how this phenomenon can be identified and minimized among professionals who work with victims of sexual trauma. The purpose of this qualitative narrative study was to explore the personal experiences of licensed and nonlicensed professionals who work with female victims of sexual trauma. Constructivist self-development theory and the traumagenic dynamics model provided the framework for the study. The research questions focused on the evidence of vicarious trauma among participants, the skills and techniques used to minimize the risk of vicarious trauma, and the influence of vicarious traumatization on helping professionals. Data were collected through semistructured interviews with 8 helping professionals in the Southern United States. Findings from data coding and theme analysis indicated that (a) professionals experience psychological and emotional risks in trauma work, (b) establishing boundaries and implementing self-care techniques can minimize vicarious trauma, and (c) consistent training and ongoing discussions about vicarious trauma are essential to professionals who commit their lives to helping sexual trauma victims. Findings may be used to increase awareness and education about vicarious trauma among professionals who work with victims of sexual trauma, and to develop techniques to minimize the risk of vicarious trauma.

Background: Penetrating abdominal trauma (PAT) in South Africa represents a significant burden of disease. The current global trend has seen management shift towards selective conservatism. The purpose of this study is to describe the presentation, management and outcomes of PAT in a level I trauma unit, which routinely practices selective non-operative management (SNOM). Methods: This was a retrospective descriptive audit of prospectively collected data. The Setting was Groote Schuur Hospital Trauma Centre, Cape Town, South Africa over 24 months (1 May 2015 to 30 April 2017). All patients presenting to the centre with PAT during the study period were included. The data captured and analysed included: basic demographics; admission vital signs; blood investigations; number of traumatic insults; penetrating wound positions; radiological investigations and interventions; indication for laparotomy; operative or nonoperative management; laparotomy findings: negative, therapeutic or non-therapeutic; abdominal visceral injuries and associated injuries. The Revised Trauma Score (RTS); Injury Severity Score (ISS); Penetrating Abdominal Trauma Index (PATI); and Kampala Trauma Score (KTS) were then calculated. The descriptive end points included the following: Length of hospital stay (LOS); ICU admission time; relaparotomy; readmission; mortality; and in-hospital complications. Results: During the study period, 805 patients with penetrating abdominal trauma were managed. There were 502 (62.4%) and 303 (37.6%) patients with gunshot and stab wounds, respectively. The majority were young men (762 – 94.7%) with a mean age of 28.3 (95%CI: 27.7-28.9) years. The median trauma scores were as follows: RTS – 7.84 (IQR: 7.00-7.84); ISS: 13 (IQR: 9-22), PATI: 6 (IQR: 1-14); and KTS: 14 (IQR: 14-15). Abdominal penetration was thoracoabdominal in 332 (41.2%), abdominal in 694 (86.5%), and pelvic in 192 (23.9%) patients. Immediate laparotomy was performed in 446 (55.4%) patients for: haemodynamic instability – 42 (5.2%); peritonism – 296 (36.8%); evisceration - 27 (3.4%); unreliable clinical evaluation – 24 (3.0%); and positive radiological findings – 57 (7.1%). There were 406 (50.4%) therapeutic laparotomies; 18 (2.3%) negative laparotomies; and 22 (2.7%) nontherapeutic laparotomies in the immediately operated group. Initial SNOM was performed in 359 (44.5%) patients, of which 208 (68.7%) sustained stab wounds and 151 (30.1%) gunshot wounds. Thirty-five (4.3%) patients failed SNOM and underwent delayed laparotomy. Should a policy of mandatory laparotomy have been implemented in this series, 206 (68.0%) SW and 163 (32.5%) GSW patients would have underwent unnecessary exploration. Overall non-fatal complications were 179 (22.2%) which were then further classified according to the Clavien-Dindo grading system. The median hospital stay was 4.5 (IQR: 3-7) and 7 (IQR: 5-12) days for SW and GSW, respectively. Overall 114 (14.2%) patients required admission to critical care unit for a median stay of 3 (IQR: 2-5) days. Total mortality was 7.2% (n=58). Conclusion: Clinical evaluation (haemodynamic instability, peritonism and evisceration) was remarkably accurate in determining the need for early laparotomy. The unnecessary laparotomy rate of this group was 5.0% (negative: 2.3% and nontherapeutic: 2.7%) overall. Selective nonoperative management was performed in 44.5% of patients with a successful SNOM rate of 90.3%. The overall mortality was 7.2 %.

O interesse da comunidade científica pelos aspectos psicológicos do câncer de mama aumentou consideravelmente nas duas últimas décadas. Diversas pesquisas com esse enfoque sugerem que a personalidade das pacientes pode influenciar o curso da doença, mas poucas contemplam especificamente essa questão. O presente estudo teve como objetivo comparar aspectos dinâmicos e elementos estruturais de personalidade em dois grupos distintos, em termos do curso da doença, de mulheres acometidas por câncer de mama. A amostra foi constituída por um grupo de mulheres em remissão (n=8), denominado Grupo 1, e um grupo de mulheres em recidiva (n=8), denominado Grupo 2. Todas as participantes eram vinculadas a uma entidade assistencial, cumpriram o tratamento médico preconizado e não apresentavam antecedentes psiquiátricos. A coleta de dados foi conduzida mediante o emprego de entrevista psicológica e do Teste de Apercepção Temática (TAT). Os dados obtidos foram inicialmente submetidos a análises qualitativas, descritivas e exploratórias e, posteriormente, organizados em estudos de caso. Além disso, foram interpretados sob a ótica da sicossomática psicanalítica a partir de uma articulação entre as proposições teóricas de Marty e McDougall. Considerando-se o estado da arte na atualidade, trata-se de um desenho metodológico inovador. Os resultados revelam que, na maioria das articipantes do Grupo 1, a integração lógica, a capacidade adaptativa e o funcionamento defensivo são apropriados, mas o controle dos impulsos é restritivo. As imagos parentais têm valência essencialmente positiva e a dinâmica das relações interpessoais varia da dominância à submissão. Conflitos associados à oscilação entre desejos de passividade e rigidez ou à insustentabilidade de ideais narcísicos se mostraram típicos e o contato com a própria subjetividade pareceu penoso, mas viável. O Grupo 2 diferenciou-se porque, na maioria das participantes, a capacidade adaptativa é comprometida por uma veemente dificuldade na utilização da realidade interna como referência para a organização da realidade externa. O funcionamento defensivo se sustenta à custa do apelo descontextualizado a operações psíquicas que sugerem uma estruturação egóica pouco consistente. O controle dos impulsos é restritivo e as imagos parentais têm valência predominantemente negativa. Além disso, um apego excessivo ao factual decorrente do apagamento da dinâmica mental conduz à conformidade social dos afetos, à contenção da atividade imaginativa ou até mesmo à estase libidinal. É possível afirmar, portanto, que o pensamento operatório e a desafetação são as principais características da personalidade das mulheres em situação de recidiva avaliadas. Conseqüentemente, pode-se situar o retorno do câncer na trama do trauma ensejado pelos desdobramentos do diagnóstico e do tratamento do tumor primário, uma vez que tais características promovem a substituição da simbolização pela reação biológica quando da ocorrência de eventos potencialmente desestruturantes. O presente estudo, assim, favorece uma compreensão inicial dos mecanismos psicodinâmicos por meio dos quais a personalidade das pacientes é capaz de influenciar o curso do câncer de mama.
The scientific community has become increasingly interested in the psychological aspects of breast cancer over the last two decades. Several studies on this issue suggest that patients personality can affect the course of the disease, but only a few address this issue specifically. The purpose of the present study was to compare dynamic aspects and structural elements of personality in two distinct groups of women with breast cancer, in terms of the course of the disease. The sample consisted of a group of women in remission (n=8), Group 1, and another of women with recurrence (n=8), Group 2. Every participant was registered in a communitarian entity, followed the recommended medical treatment, and presented no psychiatric history. Data collection was performed through psychological interviews and administrating the Thematic Apperception Test (TAT). The obtained data were initially submitted to qualitative, descriptive, and exploratory analyses, and, later, organized in case studies. In addition, the data were interpreted under a psychoanalytic psychosomatic view based on the articulation between the theoretical propositions of Marty and McDougall. Considering the current state-of-the-art, this study has an innovative methodological design. The results show that most participants in Group 1 have an appropriate logical integration, adjustment capacity, and defensive functioning, but their impulse control is restrictive. The parental imago have essentially positive associations and the dynamics of the interpersonal relationships ranges from dominance to submission. The conflicts were associated with the oscillation between desires of passivity and rigidity or to the insustainability of narcissistic ideals were typical and the contact with ones own subjectivity seemed pitiful, but feasible. Group 2 was different because most participants adjustment capacity was compromised by a great difficulty to use their internal reality as a reference to organize their external reality. Their defensive function is sustained by the decontextualized appeal to psychological operations that suggest a poorly consistent ego structure. Impulse control is restrictive and the parental imago had a predominantly negative association. In addition, an excessive attachment to the reality due to erasing the mental dynamics led to social conformity of affect, to the contention of the imaginative activity or even to libidinal stasis. Therefore, it can be stated that operational thinking and disaffectation are the main personality characteristics of women in recurrence, evaluated in this study. Consequently, cancer recurrence can be inserted in the plot of trauma caused by the outcomes of diagnosis and treatment of the primary tumor, since these characteristics promote the replacement of symbolization by the biological reaction when potentially destructuring events occur. The present study, thus, favors the initial comprehension of the psychodynamic mechanisms through which the patients personality is capable of influence the course of breast cancer.

Considerable variation exists in the type and quality of interventions carried out on victims of major trauma in the pre-hospital phase of care. One model of care consists of high level interventions delivered by a doctor-led team. Examining two controversial areas of treatment (traumatic cardiac arrest and advanced airway management), this thesis set out to determine the quality and potential shortfalls of current practice and how they might be improved. A systematic review of traumatic cardiac arrest survival confirmed that outcome was historically very poor. A study of the largest series of traumatic cardiac arrest reported to date then suggested that a doctor –led system was associated with survival rates which were greater, and which were compatible with those after medical cardiac arrest. A significant proportion of survivors were victims of penetrating trauma who had been treated with on-scene thoracotomy. I thus examined the use, success rate and place of this intervention through analysis of the only reported case series. Finally, I considered how new or established interventions might be best applied in the early phase of trauma care to improve outcome, proposing a treatment algorithm to guide current management. Advanced airway management is presented as a controversial subject with uncertainty about who should deliver it and how it should be performed. The data presented demonstrates that, in a UK system ambulance service, interventions fail to deliver adequate airway care to trauma victims. In terms of doctor-delivered care, a meta-analysis is presented which demonstrates that doctors have better intubation success rates than paramedics, even when drug assistance and high levels of training are provided. The largest series of physician-delivered intubation then confirms this position. Lastly, a pre-hospital airway consensus process is described which attempts to improve the quality of data to guide future service development and research.

The aim of this study was to assess risk factors to PTSD following childbirth incorporating a longitudinal design. Since the introduction of DSM-IV (APA, 1994) there has been an awareness in the literature that women can develop PTSD following childbirth. The first study in this thesis provides a comprehensive review of the literature in this area and the clinical implications of the disorder. The aim of the second study was to investigate the factor structure of a questionnaire measure (PLDQ) that has been used in past studies to assess women's perceptions of labour and delivery. The findings from this study indicate that the PLDQ consists of three internally reliable factors that can assess a woman's perception of pain, staff support/care and fear during labour and delivery. The scale can differentiate among women on these factors according to type of delivery. The aim of the third paper was to assess risk. factors to PTSD across time in the antenatal period, appraisal factors during delivery with the PLDQ, and maintenance factors in the postnatal period. There is an absence of studies in the literature that assess risk factors to PTSD over time. The results of this study indicate that postnatal depression (PND) and a negative appraisal of staff support and care during labour and delivery can predispose women to PTSD at 5-8 weeks following delivery. At 10 -14 weeks the relationship between PTSD and PND was still consistent. The clinical implications of the research are discussed for screening women at risk of PTSD following childbirth, assessment of a woman's appraisal of a difficult labour and delivery and the provision of support in the postnatal period.

The qualitative research on this intervention involves therapists and their work with patients within the field of mental health, working with inner city and under-served teens from 12 to 18 years’ old in Middle and High School settings. While providing care to patients, one of the key elements used in therapeutic interventions is that of mindfulness. Thus, while using mindfulness-based techniques, such as Mindfulness-based Stress Reduction (MBSR) or Dialectical Behavioral Therapy (DBT) or Cognitive Behavior Therapy (CBT), therapists worked to treat patients’ symptoms. Often however, many of the therapists using these interventions faced situations where patients began exhibiting maladaptive behaviors with their original symptoms being left intact or severely intensified. Furthermore, in using mindfulness techniques many of the patients working through severe anxiety found themselves dissociating from their bodies in an attempt to avoid re-experiencing powerful traumatic emotions. Thus, two main issues resulted, a) symptoms got worse, and b) dissociation from the body took place.

As a response, I devised an intervention that incorporated principles of Buddhist meditative practice such as virtue, mental cultivation through awareness, and subsequently wisdom, i.e. the three trainings (sīa, samāhi, paññā). The goal of this intervention is to alter patients’ automatic reactions of being drawn into overwhelming feelings and the dysregulation of bodily sensations, and instead to simply ground the patient by intentionally directing their thoughts and attention to the here and now, while using the body and its parts as anchors of awareness. Thus, the intervention was coined the “Mindful Grounding” (MG).

In using the MG, patients were able to meet their treatment goals much sooner than originally anticipated in their initial assessment during intake. In some cases, therapists observed reduction of anxiety, depression, anger, and post-traumatic stress disorder (PTSD) symptoms within one or two sessions from first introducing patients to the MG intervention. The process of experiencing the body thus in a new way as prescribed by the MG, involves helping patients become calmly reacquainted with their own bodies. It is through this connection of body and mind that they develop a deeper and more existential connection with their world, as they heal with the insight gained through acceptance and understanding of their trauma and thereby rebuild their lives.