Dissertations / Theses on the topic 'The Caretaker'

Ataxia telangiectasia: Identifizierung und Charakterisierung nicht-konservativer Spleißmutationen und deren Auswirkungen im ATM-Gen. Ein hoher Anteil der bisher im ATM-Gen identifizierten Mutationen (>350, www.vmresearch.org/atm.htm) stellt Deletionen oder Insertionen direkt an den Exongrenzen dar; viele dieser Aberrationen wurden allerdings nur auf cDNA-Ebene detektiert. Sollte es sich hierbei in den meisten Fällen um Mutationen an den Spleiß-Konsensussequenzen handeln, läge der Anteil der Spleißmutationen im ATM-Gen beträchtlich höher (~35 Prozent) als in anderen betroffenen Genen (~15 Prozent). Um der Frage nachzugehen, ob im ATM-Primärtranskript aufgrund einer erhöhten Labilität gegenüber Spleißmutationen auch Veränderungen weniger konservierter Positionen innerhalb der Donor- oder Akzeptor-Spleißstellen zu aberrantem Spleißen führen, wurden 20 AT-Zellinien mittels „Protein Truncation Test“ nach Deletionen oder Insertionen an den Exongrenzen durchsucht. Die 7 neu identifizierten Spleißmutationen wurden anschließend unter Verwendung eines „Splice Scoring“- Systems näher charakterisiert, die Penetranz der jeweiligen Mutation durch semiquantitative PCR evaluiert und die Auswirkungen auf Proteinebene durch Western Blotting überprüft. Obwohl nur eine der 7 neu identifizierten Spleißmutationen eine schwächer konservierte Position der Spleißsequenzen betraf, konnten im Rahmen einer Kooperation mit der Medizinischen Hochschule Hannover (Arbeitsgruppe Dr. T. Dörk) weitere Spleißmutationen an den Intronpositionen +3, +5 und -6 identifiziert werden, die ebenfalls in völlig aberrantem Spleißen resultieren. Daten weiterer Arbeitsgruppen lassen vermuten, daß tatsächlich ~ 50 Prozent aller Spleißaberrationen im ATM-Gen auf Mutationen außerhalb der konservierten Dinukleotidbereiche (gt und ag) zurückführen sind. Nijmegen Breakage Syndrom (NBS): Suche nach Genen, die einen NBS-ähnlichen Phänotyp auslösen. Über 90 Prozent aller NBS-Patienten tragen Mutationen im NBS1-Gen, dessen Translationsprodukt im Komplex mit MRE11 und RAD50 eine zentrale Rolle in DNA-DSB-Reparatur und Zellzykluskontrolle spielt. Weitere Mutationen bei Patienten mit NBS-ähnlichem Phänotyp wurden im Gen der DNA-Ligase IV identifiziert, die zusammen mit weiteren Angehörigen des NHEJ-Reparaturweges (XRCC4, DNA-PKcs, Ku70, Ku80) ebenfalls in DNA-DSB-Reparatur involviert ist. Zellen von Patienten mit NBS-ähnlichem Phänotyp wurden daher durch direkte Sequenzierung und/oder Western Blotting auf Defekte in den oben genannten Genen/Proteinen untersucht. In einem parallel durchgeführten unabhängigen Mutationsscreening (Medizinische Hochschule Hannover, Arbeitsgruppe Dr. T. Dörk) wurden in Fibroblasten einer Patientin mit NBS-ähnlichem Phänotyp Mutationen im RAD50-Gen identifiziert. Die Auswirkungen der RAD50-Defizienz auf die zelluläre Lokalisation der beiden Komplexpartner NBS1 und MRE11 sowie deren Fähigkeit zur Focibildung nach DNA-Schädigung wurde im Rahmen dieser Arbeit durch Immunfluoreszenzstudien untersucht: während NBS1 vorwiegend nukleäre Lokalisation aufwies, war MRE11 zu etwa gleichen Anteilen zwischen Nukleus und Zytoplasma verteilt; beide Proteine waren nach Bestrahlung der Zellen nicht mehr zur Focibildung fähig. Da in MRE11-defizienten Zellen keine nukleäre NBS1-Lokalisation beobachtet wird, scheint der Kerntransport des NBS1 von funktionellem MRE11, nicht aber von RAD50 abhängig zu sein. Fanconi Anämie (FA): Untersuchung einer möglichen Verbindung zwischen den FA-Proteinen und der RAD51-Familie. FA-Zellen aller bisher bekannter Komplementationsgruppen zeichnen sich durch Hypersensitivität gegenüber DNA-„interstrand crosslinks“ (ICLs) aus, zu deren Behebung u.a. die homologe Rekombinationsreparatur (HRR) eingesetzt wird, bei der das RAD51(A)-Protein eine zentrale Rolle spielt. Aufgrund schwacher Homologien werden 5 weitere Proteine (RAD51B, C, D, XRCC2 und 3) der RAD51-Familie zugeordnet. Da Knockout-Zellinien aller RAD51-Familienmitglieder ebenfalls hohe Sensitivität gegenüber ICLs aufweisen, wurde eine mögliche Verbindung zwischen den FA-Proteinen FANCA, C, G und der RAD51-Familie getestet. Unter Verwendung des "Yeast Two Hybrid" (Y2H)-Systems konnten zunächst mehrere Interaktionen zwischen FA- und RAD51-Proteinen detektiert werden. Zur Bestätigung einer funktionellen Verbindung wurden die FA- und RAD51-Proteine in humanen 293-Zellen überexprimiert. Aufgrund der focibildenden Eigenschaften des RAD51-Proteins wurden die FA-Proteine und die RAD51-Familie auf Focibildung nach DNA-Schädigung sowie etwaige Kolokalisationen getestet; mögliche physikalische Interaktionen wurden durch Koimmunpräzipitationsstudien überprüft. Die RAD51-Familie zeigten keinerlei Focibildung nach DNA-Schädigung während die FA-Proteine in einigen Experimenten eine Lokalisation in nukleäre Foci zeigten, die sich jedoch in Größe und Homogenität deutlich von denen klassischer DNA-Reparaturfoci unterschieden und nicht mit RAD51 kolokalisierten. Die häufige Beschränkung der FA-Foci auf Bereiche besonders dicht gepackten Chromatins kann möglicherweise als weiterer Hinweis auf die postulierte Rolle der FA-Proteine bei Chromatin Remodelling Mechanismen interpretiert werden. Bei Überexpression in HEK293-Zellen konnte keine der im Y2H-System identifizierten Interaktionen zwischen FA- und RAD51-Proteinen durch Koimmunpräzipitationen detektiert werden. Dennoch erscheinen seit der Identifizierung des FANCD2, das durch den FA-Komplex aktiviert wird und mit dem RAD51-Interaktor BRCA1 in nukleäre Foci kolokalisiert, weitere Untersuchungen einer Verknüpfung der FA-Proteine mit den Angehörigen des HRR-Weges durchaus sinnvoll
Ataxia telangiectasia: Identification and characterization of mutations at non-conserved splice positions within the ATM gene. Since the identification of ATM, more than 350 different mutations have been identified (www.vmresearch.org/atm.htm) with an unusual frequency of exon skipping or deletions/insertions at the exon boundaries. Although in many studies only the observed aberrations in cDNA were reported, they presumably represent splice mutations. These findings suggest that the rate of splicing defects in the ATM gene may be substantially higher than that reported for other human genetic disorders. In order to investigate this phenomenon, we have asked the question whether the high frequency of splice mutations in the ATM gene might be caused by an increased liability of the ATM transcript towards mutations at less conserved positions within the splice site consensus sequences. Mutation screening of 20 AT cell lines using the protein truncation test revealed 10 different splice mutations, seven of which had not been reported previously. A splice scoring system was used to estimate the penetrance of each mutation. Potentially leaky splicing was evaluated by semiquantitative PCR. The implications of each mutation on the protein level were investigated by western blotting. One out of seven new splice mutations was positioned at a less conserved consensus site. Furthermore, in cooperation with the Medizinische Hochschule Hannover (group of Dr. T. Doerk), point mutations at intron positions +3, +5 and –6 were identified, each resulting in completely aberrant splicing. In addition, there is accumulating evidence from other studies that indeed ~50 per cent of splice mutations in the ATM gene are positioned outside the highly conserved donor or acceptor dinucleotides, gt or ag, respectively. Nijmegen breakage syndrome (NBS): Search for genetic defects resulting in an NBS- or NBS-like phenotype. More than 90 per cent of NBS patients carry mutations in the NBS1 gene. The NBS1 protein, in a complex with MRE11 and RAD50, is known to be involved in DNA DSB repair via NHEJ and cell cycle control. In cells from patients with an NBS-like phenotype, defects in another component of the NHEJ pathway, DNA ligase IV, have been identified very recently. Therefore, mutation screening in genes known to be involved in NHEJ (NBS1, MRE11, RAD50, DNA ligase IV, XRCC4, DNA-PKcs, Ku70, Ku80) was carried out in cell lines from NBS-like patients using direct sequencing and/or western blotting. In one of these cell lines, an independently performed screening at the Medizinische Hochschule Hannover (group of Dr. T. Doerk) revealed two mutant alleles of the RAD50 gene. In the present work, the cellular RAD50-deficient phenotype was characterized in response to induced DNA damage. In contrast to normal controls, the RAD50-deficient fibroblasts were not able to form IR-induced foci. Localization of NBS1 was still predominantly nuclear, whereas MRE11 was distributed equally between nucleus and cytoplasm. In contrast, MRE11-deficient cells do not show much nuclear localization for NBS1, suggesting that the nuclear localization of NBS1 depends on functional MRE11, but not on the presence of RAD50. Fanconi anemia (FA): Are the FA proteins linked to DNA DSB repair via the RAD51 family? FA cells of all complementation groups are hypersensitive towards DNA interstrand crosslinks (ICLs). Removal of ICLs includes the generation of a DNA DSB. Their repair is then presumably carried out by the homologous recombination (HRR) pathway, an essential component of which is the RAD51 protein. Due to weak homologies five other proteins have been assigned to the RAD51 family (RAD51B, C, D, XRCC2 and 3). Strikingly, knockout mutants of all RAD51 paralogs also show high sensitivity to ICL-inducing agents. In order to investigate a possible connection between the FA pathway and the RAD51 family, the yeast two-hybrid system was used to test for any interactions between the FA proteins FANCA, C, G and the RAD51 family members. Several interactions were detected. Further characterization was done by study of nuclear foci and immunoprecipitation. FA and RAD51 proteins were overexpressed in human 293 cells. Since RAD51 localizes into nuclear foci after DNA damage, FA proteins and RAD51 paralogs were tested for their ability to (co-) localize into nuclear foci after MMC-treatment. Whereas none of the RAD51 paralogs showed nuclear foci formation, in some experiments FA proteins moved into nuclear speckles following DNA damage. However, size and homogeneity of DNA damage-induced FA speckles was quite different from those formed by „classical“ DNA repair proteins; in addition, no colocalization was seen with foci containing RAD51. Notably, FA speckles were often restricted to sites of very tightly packed chromatin, again suggesting a role of the FA-proteins in chromatin remodelling mechanisms. To identify any physical interaction between FA proteins and the RAD51 family, coimmunoprecipitation studies (Co-IPs) were carried out, after overexpression in HEK293 cells. Whereas the reported interaction between FANCA and FANCG could repeatedly be shown, no Co-IP was detected for any combination of an FA protein with a member of the RAD51 family. However, since the identification of FANCD2, a connection between the FA pathway and RAD51 seems all the more plausible: following DNA damage FANCD2 colocalizes with BRCA1, which itself is closely associated with RAD51. Further studies will be necessary in order to unravel the way by which the FA proteins might interact with conserved DNA repair mechanisms like the HRR pathway

Thesis (Ph. D.)--Florida State University, 2009.
Advisors: Gary Peterson and James P. Sampson, Florida State University, College of Education, Dept. of Educational Psychology and Learning Systems. Title and description from dissertation home page (viewed on May 7, 2010). Document formatted into pages; contains xii, 103 pages. Includes bibliographical references.

The purpose of this investigation was to (a) use the positive routines procedure to decrease child noncompliance and the time it takes the child to comply (latency) at bedtime, (b) to assess treatment fidelity, and (c) to record objectively parent behavior. Research was conducted with four children and five parents in their homes. The treatment was explained to each parent and introduced to each child after the baseline phase. Positive routines requires the parent to implement a low-stimulation “routine” at the time the child naturally gets sleepy. The routine gradually begins earlier so that by the end of treatment, it is completed at the time the parent originally attempted to establish bedtime. The data reveal that with high treatment fidelity, the treatment was effective in reducing bedtime noncompliance, latency, and parental reinforcing behaviors. The data also supported the notion that parent behavior can be controlled by child behavior.

Magister Psychologiae - MPsych
Previous studies on motivation of higher education students have predominantly focused on the role of motivation in academic achievement. The aim of this study was to identify what motivates students to attend university and to establish the connection of this motivational orientation to demographic correlates. A correlational research design was employed and data was analysed by means of the Statistical Package for Social Sciences (SPSS). Correlational analysis (Pearson’s correlation coefficient (r)) was used to determine the strength of the association between demographic factors and student motivations for attending university.

O ato de cuidar tem sido atribuído ao gênero feminino. Na sociedade ocidental, a mãe é a principal cuidadora dos filhos no que se refere ao cuidado em geral, na alimentação, na vestimenta, na educação e na saúde. Na promoção da saúde bucal infantil, o cuidado materno, bem como uma boa relação dentista-mãe são essenciais. Objetivou-se compreender os significados atribuídos pelas as mães de crianças de 0 a 6 anos em tratamento odontológico acerca de seu papel como cuidadora da saúde bucal do filho. Constitui-se de uma pesquisa qualitativa com desenho metodológico de uma pesquisa estratégica. Participaram como sujeitos, dez mães com filhos em atendimento odontológico pelo Curso de Graduação em Odontologia, de Especialização em Odontopediatria e da Clínica de bebês da Universidade de Ribeirão Preto – UNAERP na cidade de Ribeirão Preto, estado de São Paulo/Brasil. Realizou-se entrevistas semi-estruturadas e observação durante o atendimento odontológico. Os dados foram analisados segundo a técnica de análise de conteúdo proposta por Bardin (1979). Considerando o perfil do grupo de mães a idade variou de 26 a 39 anos, todas eram casadas ou viviam em união consensual, nenhuma estava inserida no mercado de trabalho formal. Depreendeu-se dos dados seis categorias temáticas: a) Saúde: “quando não tem nada” ... “saúde é a base de tudo”; b) Saúde? É saúde da boca também!”; c) Saúde bucal é ter bons hábitos; d) O Processo saúde – doença e a relação com os cuidados maternos na saúde bucal; e) Cuidado à saúde bucal do filho: o sentido desse fazer; f) Profissional odontólogo: referência para o cuidado em saúde bucal. Percebeu-se que a saúde para essas mães reveste-se de um significado mais amplo, não restrito ao biológico, entretanto, ainda mostram-se ancoradas na idéia de saúde como ausência de doença e de corpo funcional. A saúde bucal apresenta-se dissociada da saúde geral e as práticas de manutenção da saúde bucal são voltadas para evitar uma única doença: a cárie, relacionando sua ocorrência na dependência dos cuidados prestados por elas como formadoras de hábitos. Em meio a essas práticas de cuidados reconhecem o profissional especializado como fonte do saber, estando prontas a auxiliá-los no tratamento independentemente de suas emoções mergulhadas no ideário do amor incondicional da mãe para com o filho e do dever materno, sentindo satisfação e realização em atender as necessidades do filho. Concluí- se que a mãe pode ser considerada como um agente multiplicador de ações educativas relacionadas a saúde bucal, uma vez que a atuação materna não fica circunscrita a ajudas momentâneas durante o atendimento clínico, perpassando as barreiras físicas, chegando aos cuidados diários na manutenção da saúde bucal do filho. Dentro dessa lógica há que se investir na capacitação dos profissionais que lidam diariamente com tais mães e todos os indivíduos da família, para que estes sintam-se responsáveis pela saúde das crianças menores.
Caring is an act attributed to feminine gender. Mothers are the main general caretaker of children. They care about food, clothing, education and health. Focusing the children’s oral health promotion the mothering care and a good relation between dentist and mothers are required. This survey aimed at understands mothering meanings about being a caretaker of small children (age from 0 to 6 years) oral health. It’s a qualitative research founded on strategic survey. The subjects were ten mothers from Dentistry Graduate Course, Pediatric Dentistry Specialization and Baby Clinic from Ribeirão Preto University – UNAERP in Ribeirão Preto City, São Paulo State/Brazil. Semi-structured interview and observation during the treatment were made. Data was analyzed by Content’s Analysis proposed by Bardin (1979). Considering the mother’s profile: age range from 26 to 39 years, all of them were married or lived with someone, none of them had an official job. Six thematic categories were identified: a) Health: “when you’re ok” … “health as a foundation”; b) Health? Oral health too! d) For a good oral health you must have good habits; d) Health – Illness process and its relation with maternal care on oral health; e) Caring about children oral health: what does it mean? And f) Dentist: a reference for oral health care. Mothers perceived health throw biological meanings, but they still emphasize the idea of health as illness absence based on the functional body construction. Oral health seems to be dissociated from general health. Practices toward a good oral health are directed to avoid just one disease – the Carie. Mothers also correlate caries’ occurrence with fails on habit formation. Among all these situations, mothers recognize the dentist as a knowledge resource. They are always ready to do anything to help the professional during the treatment. In this situation, they forget their emotions and fears based on ideas like unconditional mother’s love and mother’s duty. After all they experienced satisfaction and realization because they solved the child’s needs. We conclude that mothers can be multiplicative agents considering educational actions direct to oral health. Mother’s actions are not just circumscribed to short proceedings during the treatment, because they delivery daily oral health care at their homes. So we believe that improving the professional abilities, they’ll work better with mothers and family individuals. In this way all these people will be responsible for oral health of small children.

Made available in DSpace on 2015-03-05T19:37:25Z (GMT). No. of bitstreams: 0 Previous issue date: 19
Nenhuma
O presente estudo buscou compreender e analisar as demandas psicológicas de três meninos, com idade entre um e dois anos e de seus cuidadores, a partir da sua interação em uma instituição abrigo. Trata-se de uma pesquisa qualitativa, por meio de estudos de casos múltiplos. Para tanto, utilizou-se como técnica de coleta de dados, uma inspiração no Método Bick de Observação. Além disso, foi realizada a entrevista Entrevista de Transtorno de Apego com o cuidador principal de cada criança observada. Também consideramos os dados referentes à história de vida dos meninos observados, adquiridos por meio de relatos informais da equipe e de documentos obtidos pela direção da instituição. Somada a isso, foi realizada uma entrevista não estruturada com os cuidadores principais dessas crianças, com o objetivo de acessar as suas demandas psicológicas. Com base na observação dos três casos, concluiu-se que, apesar das diferentes características, as crianças observadas evidenciaram uma busca ativa pelos cuidadores, expressa
The present study aimed to realize and analyze the psychological demands and the characteristics of three boys between one and two years old and their caretakers through their interaction in a shelter institution. It is a qualifying research which studies several cases. For this reason it was used an adaptation of Bick’s Method of Observation to collect data. Besides, it was made an Interview on the Perturbation of Strong Attachment with the main caretaker of each observed child. We also considered the data of the boys’ story of life gathering informal reports from the group and documents given by the direction of the institution. Furthermore, it was made a non-structured interview with the main children’s caretakers, aiming to access their characteristics and psychological demands. Basing on the observation of these three cases, it was concluded, besides the different characteristics, that the observed children sought actively for their caretakers, showing their psychological demand through their annoyance a

Made available in DSpace on 2016-03-15T19:48:46Z (GMT). No. of bitstreams: 1 Rosemeire Santiago.pdf: 513164 bytes, checksum: a2835495cdaf9bd34f48fb0918de3411 (MD5) Previous issue date: 2008-01-22
Fundo Mackenzie de Pesquisa
Through history, many occurrences that have made dehumanization a regular part of life, invading families and individuals indiscriminately, destroying souls, and decimating relationships. This created a necessity for a different way of seeing/perceiving these people, which would bring them hope and courage. With this, there began to arise the first organizations called philanthropic , today known as Non-Governmental Organizations, or Third-Sector Organizations. As these structures grew, the number also of volunteers who had the vision of helping these forgotten people grew. However, in the majority of cases, these caretakers were not cared for themselves. They carried pain, lack of love, destroyed dreams and broken lives working with people who had long ago lost the meaning of the word hope. An analysis of these caretakers will be done, who for innumerable reasons begin to lose their own identity, demonstrating, often in the way they treat the people they are serving, that they themselves need to be remembered and cared for. We intend to prepare a basis to raise consciousness of the need for training and recognition of the other and the I, creating a proposal for working in a group. The caretaker helps other people many times to bring order of the chaos into their emotional and social lives, but it is necessary also that the caretaker be heard and embraced. Having his/her own sense of dignity and worth recognized, will reflect in the heart of the other the ones cared for.
No decorrer da história, muitos acontecimentos levaram a desumanização a fazer parte do cotidiano, contagiando, envolvendo famílias e pessoas indiscriminadamente, destruindo egos, dizimando relacionamentos. Criou-se a necessidade de olhares diferentes, olhares que trouxessem alento e esperança. Com isso, começaram a surgir as primeiras organizações chamadas filantrópicas, hoje conhecidas como Organizações Não Governamentais ou Organizações do Terceiro Setor. Quanto mais essa área crescia, tanto maior era o número de voluntários que se abdicavam em prol de seu próximo. Entretanto, esses voluntários, em seu papel de cuidadores, não eram cuidados. Armazenavam dores e desamores, sonhos destruídos e vidas repartidas, pois trabalham com gente, que há muito esqueceu o significado da palavra esperança. Portanto, a dissertação analisa esses cuidadores que começaram a ter a sua identidade perdida, demonstrando - nos atendimentos - a impressão de que precisavam ser lembrados e cuidados. A pesquisa busca criar um embasamento para uma profunda reflexão sobre a necessidade da conscientização, de treinamento e de reconhecimento do outro e do eu , bem como da importância do trabalho de grupo. O cuidador ajuda às pessoas a colocarem em ordem seu caos emocional e vivencial, mas é preciso que seja também ouvido e abraçado. É necessário um resgate de sua dignidade e identidade para promover eco no coração do outro.

SAMMANFATTNING Bakgrund En del av företagssköterskans arbetsuppgifter är att arbeta förebyggande och se olika typer av problematik som finns hos arbetstagare och arbetsgivare. Omvårdnad av människan ska stå i fokus och rikta sig mot arbetslivet där en säker och god omvårdnad ges (SOU 2011:63). Vibrationsexponering av händer och åtföljande effekter utgör ett betydande arbetsmedicinskt problem där kyrkvaktmästare utgör en exponerad yrkesgrupp. Syfte Syftet med studien var att kartlägga besvär i händer och armar hos kyrkvaktmästare och deras kunskaper kring riskerna med vibrationsexponering. Metod 50 kyrkvaktmästare besvarande två enkäter, en om symtom och en om arbetsmiljö vid vibrationsexponering av handhållna verktyg och dess risker och skador. Resultatet presenterades som deskriptiva data. Resultat Köldkänsla 40 %, vita fingrar 38 % och kramp 38 % var de vanligaste symtomen. Symtom var vanligare bland dem som arbetat minst 10 år i vibrations exponerade arbete. De hade lite kunskap om riskerna med arbetet. Ingen av kyrkvaktmästarna hade blivit erbjuden medicinsk kontoroll enligt Arbetsmiljöverkets föreskrifter. Slutsats Symtom var vanligt förekommande, om medicinska kontroller hade utförts skulle symtomen förmodligen ha upptäcks i ett tidigare skede och inneburit att deras lidande kunde ha minskat. Den medicinska kontrollen hade även inneburit att arbetsgivaren tagit sitt arbetsmiljöansvar för att minimera vibrationsexponeringen (AFS 2005:15). En viktig del i företagssköterskans preventiva arbete är att informera arbetsgivaren om dennes ansvar vid vibrations exponerade arbete och arbetstagarna om riskerna. Nyckelord: hand- arm vibration, riskfaktorer, yrkessjukdomar, yrkesmässig exponering, kyrkvaktmästare
ABSTRACT Background Part of the company nurse's work is to work proactively and identify different types of problems among workers and employers. Nursing of man should be the focus and target the workplace where a safe and good nursing care is provided (SOU 2011:63). Vibration exposure of hands and concomitant effects represent a significant work related problem with care takers from an exposed profession. Aim The aim of the study was to identify hand and arm symptoms in vibration exposure with care takers and their knowledge of the risks associated with vibration exposure. Method Fifty care takers answered two questionnaires, one about symptoms and one about the work environment and vibration exposure of the hand-held tools and its risks and injuries. The results were presented as descriptive data. Results Sensation of cold (40%), white fingers (38%) and cramp (38%) were the most common symptoms. Symptoms were more common among those who had worked at least ten (10) years in vibration exposed work. They had little knowledge of the risks associated with vibration exposure. None of the care takers had been offered medical examination according to the regulation. Conclusion Symptoms were common among care takers; if medical examinations had been carried out the symptoms would probably have been detected at an earlier stage and meant that their suffering could have been reduced. The medical examinations had also meant that the employer would have taken the safety responsibilities to minimize vibration exposure (AFS 2005:15). An important part of the job of the company nurse is to inform the employer of his responsibility for vibration exposure and the workers about the risks. Keywords: hand-arm vibration, risk factors, occupational diseases, occupational exposure, care takers.

The purpose of this study is to find out if dolls are used as an artifact in preschools for communication, language and identity development - based on previous research. It also examines the teachers' opinions about what a doll or puppet is. To be able to look in to this I sent out a survey with questions and got responses from 176 informants within the preschool. The result shows that dolls are frequently used by many preschool teachers, but around 40-50% had not taken part in any research or education on the subject. The result also shows that the teachers usually associates the word ‘doll’ with baby dolls”. Some conclusions I can see after this study is that the dolls place in the preschool is determined based on adults' opinions about it. The doll is often used as a communicative tool but not always consciously or with a basis in research.
Syftet med denna studie är att undersöka om dockor används inom förskolan som en artefakt för kommunikation, språk och identitetsskapande utifrån tidigare forskning. Den undersöker även pedagogers svar om vad en docka respektive puppet är. Detta behandlas genom svar på enkäter från 176 informanter inom förskolan varav 138 är utbildade förskollärare och 38 är utbildade barnskötare.    Resultatet visar att dockor används frekvent av många förskollärare och barnskötare men runt 40–50% har inte tagit del av forskning eller utbildning inom ämnet. Resultatet visar också att pedagogerna oftast tänker på dockan i form av bebisdockor vid ordet ’docka’. Några slutsatser jag kan se efter denna studie är att dockans plats på förskolan avgörs utifrån vuxnas åsikter om den. Dockan används ofta som ett kommunikativt redskap men inte alltid medvetet eller med grund inom forskning.

The particular characteristics of Pinter’s theatre such as the theme of violence, the competitive interpersonal relationships, the implied unwillingness in communication between the characters and the distinctive use of silences and pauses, distinguish his work from the writers of the absurd. Pinter makes particular use of “Silences” and “Pauses” as theatrical techniques that present a non-verbal way of communication in his plays. The frequent use of these particular techniques in Pinter’s dialogue has urged some critics to coin new expressions such as “Pinteresque” or “Pinter Pause” in the vocabulary of drama to specify Pinter’s technique. One of the important objectives in this essay is to point out the fundamental significance and function of the “Silences” and “Pauses” in Pinter’s work and point out their distinction. I will discuss how the silences and pauses function in Pinter’s theatre as a non-verbal way of communication by creating fragments in the dialogue.   The plays which will be analyzed in this essay are: The Room, The Dumb Waiter, The Birthday Party and The Caretaker. My objective in this essay is to explore the context of these plays with regards to the theme of menace. In the first chapter, I mainly aim to explore the menacing context of these plays regarding the structure of menace and the ways it takes place in each play separately. This analysis will be presented in relation to the spatial territory in which the characters are confined. My aim is also to describe why menace is presented in a theatrical sense. I have chosen to quote some significant passages of each play in each section to illustrate my purposes in the first chapter. The aim of the second chapter is to define the character types involved in the presentation of menace, “The Intruders” and “The Victims”, and to analyze the strategies their use in encounters with each other. After describing the character types I will explore in detail how “The Intruders” use linguistic strategies to confuse and subdue their victims and finally victimize them and how “The Victims” use strategies to cope with menace in order to survive. There are some passages quoted from the plays to facilitate the purpose of the second chapter. The objective in the third chapter is to define “Silences” and “Pauses” as theatrical techniques used in form of non-verbal communication between the characters. I will discuss, based on Peter Hall’s definition, how these techniques are significant in understanding a Pinter play for the readers and the actors who perform them on stage, and will further explore the function of “Silences” and “Pauses” and their distinction in the context of the plays in question in this essay.

Made available in DSpace on 2016-04-27T18:47:07Z (GMT). No. of bitstreams: 1 Marta Lucia Souto da Silva.pdf: 2127286 bytes, checksum: 6fa08a32591ad629b61443672e61d33a (MD5) Previous issue date: 2011-05-31
This research on dependent elderly arises from a visible observation of the increasing number of elderly under chronic diseases and functional dependence, what results in the need of a caretaker assistance which, most of the times, a family member undertakes. This research aims at analyzing the representation of the family caretaker on the dependent elderly caring, using a qualitative approach methodology. The field research developed in a Basic Health Unit with the Family Health Strategy belonging to the Santa Marcelina Health Social Organization of the Eastern Small Region Guaianases. The study population consisted of 10 dependent elderly and their respective family caretakers. Through a questionnaire named "Knowing the dependent elderly and his/her caretaker", data of identification was collected and complemented with semi- structured interviews and the use of guided questions on caretaker representations. The analysis showed that 50% of the elderly had Cerebral Vascular Accident as the trigger for the need of a caretaker. It was evident that 90% were female caretakers, frequently his/her own daughters, and that difficulties are present concerning residence infrastructure to provide such assistance, what most of the times can even interfere negatively in the daily routine of the elderly and his/her caretaker. The conflicts among relatives regarding the caring attribution to the family members, could be also observed in the results reached, demonstrating the need for more and more qualified interventions from the Family Health Strategy
Esta pesquisa sobre o idoso dependente decorre da visível constatação do aumento do número de idosos portadores de doenças crônicas que encontramse em situação de dependência funcional, o que resulta na necessidade da assistência de um cuidador, muitas vezes assumida por um membro da família. O objetivo dessa pesquisa foi analisar as representações do cuidador familiar sobre o cuidar do idoso dependente, utilizando-se uma metodologia de abordagem qualitativa. A pesquisa de campo foi desenvolvida em uma Unidade Básica de Saúde com a Estratégia Saúde da Família, pertencente à Organização Social de Saúde Santa Marcelina da Micro Região Leste Guaianases. A população do estudo foi composta por 10 idosos dependentes e seus respectivos cuidadores familiares. Por meio da aplicação de questionário intitulado Conhecendo o idoso dependente e seu cuidador foram coletados dados de identificação complementados com a realização de entrevistas semiestruturadas e o uso de roteiro com questões sobre as representações dos cuidadores. As análises revelaram que 50% dos idosos tiveram o Acidente Vascular Encefálico como desencadeador da necessidade do cuidador. Ficou evidente que 90% eram cuidadoras, sendo a prevalência de filhas e que há dificuldades quanto à infra-estrutura do domicílio para atendimento, o que, muitas vezes, chega a prejudicar o dia a dia do idoso e do cuidador. Os conflitos entre os parentes referentes à atribuição do cuidar para os membros da família, também ficou exposto nos resultados alcançados, o que demonstra a necessidade de intervenções cada vez mais qualificadas da Estratégia Saúde da Família

Made available in DSpace on 2016-07-27T14:20:29Z (GMT). No. of bitstreams: 1 Savanah Borges Araujo Fleury.pdf: 1029037 bytes, checksum: 1b40e7cbbc77de5f46012aa65c865b35 (MD5) Previous issue date: 2014-08-19
This dissertation has as the objective of study, the caretaker (mother or father) of children with the Down´s Syndrome. The main objective of this work is to understand the subjective sense which this caretaker (father or mother) develops concerning the buccal health of their child with the Down´s Syndrome and general health. The child Down´s Syndrome is seen within their biological, odontological and psychological limits. To understand the human development of such a person with the Down´s Syndrome, the dissertation applies to Vygotsky s Human Development Theory. For this author, the human development of a handicap child follows the same principles of a normal child, the only thing about the indirect ways. On the other hand, the caretaker will be analyzed while the senses of buccal health are developed with their interaction with the handicap child, together with a professional team, their family and society in general. The author who will be employed to accomplish such analysis will be Gonzalez Rey, who, for twenty years, has been constructing the subjective theory within the parameters of the Vygotskian historic cultural school, and which has one of its main pillar the subjective sense. The qualitative methodology has been used for such study, while a whole set of epistemological rules defend the constructive interpretative knowledge character. The instrument which was used to collect the data was the conversational system, of which,the thematic dialog is accomplished as a complement. The main conclusion of the work is that the caretaker of a child with the Down Syndrome, living with their child s syndrome, transformed or is transforming, their subjective feelings as to the buccal health to the child s general health.
Esta dissertação tem como objeto de estudo o cuidador (pai ou mãe) de crianças com Síndrome de Down. O objetivo principal do trabalho é compreender os sentidos subjetivos que este cuidador (pai ou mãe) gera em relação à saúde bucal de seu filho com Síndrome de Down e à saúde em geral. A criança com Síndrome de Down é vista em seus limites biológicos, odontológicos e psicológicos. Para compreender o desenvolvimento humano de tal sujeito com Síndrome de Down, a dissertação recorre à Teoria do Desenvolvimento Humano de Vygotski. Para este autor o desenvolvimento humano de uma criança especial segue os mesmos princípios que o de uma criança comum, só que a criança especial atinge seu desenvolvimento por caminhos indiretos. Por outro lado, o cuidador será analisado enquanto gera sentidos da saúde bucal em sua interação com a criança especial, com a equipe profissional, com sua família e sociedade em geral. O autor usado para se concretizar tal análise será González Rey, que há vinte anos, esta construindo a teoria da subjetividade dentro dos parâmetros da escola históricocultural vygotskiana, e que tem como um de seus pilares o sentido subjetivo. A metodologia usada para tal tipo de estudo é a qualitativa, enquanto um conjunto de regras epistemológicas que defende o caráter construtivo interpretativo do conhecimento. O instrumento utilizado para coleta de dados foi o dos sistemas conversacionais, nos quais o diálogo temático é realizado como complemento. A principal conclusão do trabalho é que a cuidadora da criança com Síndrome de Down, na vivência com a síndrome de seu filho, transformou e está transformando, seus sentidos subjetivos tanto da saúde bucal, quanto da saúde geral de sua criança.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Enfermagem
Nos tempos modernos assiste-se a um aumento da esperança média de vida, e com isso um aumento do número de idosos com dependência. Assim a necessidade de prestação de cuidados por parte de terceiros nomeadamente cuidadores é francamente maior. Com o avançar da idade surge o aumento da dependência no idoso e com isso todas as limitações que o envelhecimento acarreta. Assim surgem os cuidadores informais, que segundo Neri e Carvalho (2002) citado por Oliveira (2009) cit in Sousa, partilham da opinião que o cuidador informal é habitualmente um familiar ou alguém muito próximo do idoso. Oliveira (2009) cit in Sousa (2011), salienta que as necessidades da família de cuidar da pessoa idosa dependente pode causar situações de stress e problemas de saúde físicos e mentais. Ainda assim esta função pode gerar sentimentos de frustração, ansiedade, inquietação e uma preocupação constante na pessoa que cuida, sendo que esta pode levar á sobrecarga do cuidador informal. Face ao exposto surgiu o interesse por parte da investigadora de aprofundar os conhecimentos sobre esta temática e entender qual a intervenção da enfermagem. Assim, o objetivo geral delineado para o presente Projeto de Graduação foi: Avaliar a sobrecarga dos cuidadores informais de Ponte de Lima. A população escolhida foram cuidadores informais do concelho de Ponte de Lima e dentro dos mesmos selecionou-se uma amostra de 30 elementos com pelo menos 6 meses a exercer a atividade de cuidador informal e que pertencem ao concelho de Ponte de Lima. Como instrumento de recolha de dados recorreu-se ao Questionário de Avaliação da Sobrecarga do Cuidador Informal da autoria da Professora Doutora Teresa Martins. A Sobrecarga do Cuidador Informal em Ponte de Lima Em termos de tipo de estudo, optou-se por um estudo quantitativo, descritivo simples e transversal de acordo com a metodologia de Fortin (2009). Após análise e discussão dos dados conclui-se que dos 30 elementos que constituem a amostra, maioritariamente são do género feminino, possuem idades compreendidas entre os 21 e os 77 anos, tendo assim uma média de idades de 45 anos. Relativamente aos dados obtidos com a aplicação do QASCI conclui-se que os fatores com mais influência na caracterização da sobrecarga do cuidador informal foram o IVP, SE, SF e RE, tendo-se obtido um nível de sobrecarga moderada com um total de 35,30%. Isto vai de encontro ao exposto por Martins (2003) em que sugere como níveis de sobrecarga: o valor 0 indica ausência de sobrecarga, de 1 a 25 considera-se sobrecarga ligeira, 25 a 50 corresponde a uma sobrecarga moderada, de 50 a 75 indica sobrecarga grave e por fim um valor maior a 75 é indicador de sobrecarga extremamente grave.
In this modern times, it is attended an increase of the hope of life, and with that an increase of the number of seniors with dependence. Like this, the need of care giving on the part of third namely caretakers are frankly larger. With the elderness, the increase of the dependence it appears in the senior and with that all of the limitations that the aging carts. Like this the informal caretakers appear, that according to Neri e Carvalho (2002) mentioned by Oliveira (2009) cit in Sousa, share of the opinion that the informal caretaker is habitually a relative or somebody very close of the senior. Oliveira (2009) cit in Sousa (2011), points out that the needs of the family to take care of the dependent senior person can cause stress situations and physical and mental problems. Nevertheless this function can generate frustration feelings, anxiety, inquietude and a constant concern in the person that takes care, and this can take the informal caretaker's á overload. Face to the exposed the interest appeared on the part of the investigator of to deep the knowledge on this theme and to understand which the intervention of the nursing. Like this, the general objective delineated for the present Graduation Projert was: To evaluate the informal caretakers from Ponte Lima overload. The chosen population was informal caretakers of the county of Ponte Lima and inside of the same ones a sample of 30 elements was selected with at least 6 months to exercise informal caretaker's activity. As instrument of colleting data was the Questionnaire of Evaluation of the Overload of the Informal Caretaker of the Teacher's authorship Teresa Martins. In terms of study type, was a simple and traverse study quantitative, descriptive in agreement with the methodology of Fortin (2009). A Sobrecarga do Cuidador Informal em Ponte de Lima After analysis and discussion of the data the 30 elements that constitute the sample, most part are of the feminine gender, they possess ages understood between the 21 and the 77 years, tends like this an average of 45 year-old. In concern to the data obtained with the application of QASCI is ended that the factors with more influence in the characterization of the informal caretaker's overload were IVP, IF, SF and RE, having obtained a level of moderate overload with a total of 35,30%. This goes to same information into the exposed by Martins (2003) in that suggests as overload levels: the value 0 indicates overload absence, from 1 to 25 is considered quick overload, 25 to 50 correspond to a moderate overload, from 50 to 75 indicates serious overload and finally a larger value to 75 is indicative of extremely serious overload.
N/A

Syftet med uppsatsen har varit att undersöka hur anställda inom rättspsykiatrin ser på relationen mellan sig själva och vårdtagarna, samt att studera de olika aspekter som berör relationen i vårdandet, bland annat maktrelationen och vänskapsrelationen. Uppsatsen baseras på en kvalitativ studiemetod med semistrukturerade intervjuer. Nio stycken anställda vårdare (undersköterskor och skötare) från en avdelning inom rättspsykiatrin i Växjö deltar i studien. Resultatet visar att relationen mellan vårdare och vårdtagare är en viktig aspekt inom vården, och att relationen är basen inom vården för att kunna erbjuda bra vård till patienten. Intervjupersonerna menar att: En bra relation mellan vårdare och vårdtagare kännetecknas av att vårdaren ska kunna skapa förtroende, tillit i relationen, samt stödja och tillfredsställa patientens behov med hjälp av relationen. Studien belyser svårigheterna inom relationen mellan vårdare och vårdtagare samt de risker som kan förekomma. Resultatet visar även att en viss synlig och osynlig makt utövas; den makten är svår att definiera, personalen är delvis omedvetna om att de själva utövar makt dagligen.
The purposes of this essay are to examine how employees in a psychiatric ward experience the relationships between them and the caretakers, and to study the different aspects of relationships between them. For instance the power relation and the friend relation. The essay is based on a qualitative method with semi structured interviews from 9 employees, whom are nurses and caregivers at a ward in Växjö psychiatric institution.  The results from this study illuminate that the relationship between caregivers and caretakers is a vital aspect of the care itself. And that this relationship is the foundation for caregiver to be able to offer necessary care. A good relationship between caregiver and caretaker is characterized by the abilities of the caregiver to create trust and confidence in their relationship to the caretaker, as well as supporting and satisfying the caretakers’ needs by help of their relationship.  This study highlights the issues in the relationship between caregivers and caretakers as well as the risk that pertain to this relationship. The results indicate that certain power exertions overt and covert are factors in some relationships. These power exertion are, however, hard to define, the caregivers also seem partly unaware of them.

The purpose of this thesis is to examine the relationship between the elderly at a retirement home and their professional caretakers with focus on the perspective of the elderly. Chosen method, a qualitative interview analysis has been conducted to describe how the relationship affects the elderly in their everyday lives. The total amount of interviews were four. The relationship between the elderly and their professional caretakers has rarely been examined in previous research from an elder’s perspective. The results indicate that the elderly often are satisfied with the way the professional caretakers treat them. Factors that the elderly mentioned as problematic were that professional caretakers often acted stressed, and rushed through things which the elderly considered as problematic for their own well- being. Another feature was the asymmetric relationship with the professional caretakers which affected the elderly ́s belief in their own capability in managing their everyday lives. In cases where the elderly felt that the relationship was equal their capacity and their beliefs to their own capacity increased significantly which was an effect that was positive for the elderly ́s physical and mental health.

O propósito deste trabalho é investigar a pessoa e o papel do cuidador familiar de pessoa idosa como ser humano sujeito à necessidade de cuidado. Além disso, propõe-se ações de cuidado integral para o cuidador, tendo em vista mais qualidade de vida para si e para a pessoa por ele cuidada. Portanto, o primeiro capítulo apresenta, com o auxílio de teóricos da área geronto-geriátrica e com os resultados de uma pesquisa de campo, quem são os cuidadores familiares, quais são seus sentimentos e suas necessidades, bem como quais são os impactos da atividade de cuidar. O segundo capítulo desenvolve a compreensão dos conceitos cuidado e cuidar de si a partir da Teologia e da Filosofia. Também verifica o que a Bíblia diz sobre o cuidado, passando pela interpretação de alguns textos, em especial, o de Lc 10.25-37. Este exercício fornece elementos para uma prática em relação a pessoas que exercem e que carecem de cuidados. Assim, o terceiro capítulo, apresenta indicações de cuidado integral para o cuidador familiar, para que ele desenvolva a prática do cuidado de si, como também indica elementos de como a comunidade cristã pode cuidar do cuidador, buscando exercitar a proposta da Igreja do Cuidado.
The purpose of this paper is to investigate the role that caretakers of elderly people as a human being subject to the need of care. Also actions of care are suggested to the caretaker regarding more quality of life to himself/herself and to the person being taken care of. Therefore, the first chapter presents, with the help of theorists from the geriatric area and with the results of a Field research who the Family caretakers are what are their feelings and needs, as well as the impacts of the activity of caretaking. The second chapter develops the comprehension of concepts as care and self caring from Theology and Philosophy. Also examines what the Bible says about care going through the interpretation of some texts, especially of Lc 10.25-37. This activity offers elements to a practice in relation to people who give and need care. The third chapter presents indications of care to the Family caretaker, so that she/he develops the care towards herself/himself as well as it indicates elements of how a Christian community can take care of the caretaker by exercising the proposal of the Church of Care

Les gènes de la famille ING : « INhibitor of Growth » (ING1-5) jouent un rôle crucial dans l'inhibition de la prolifération cellulaire, en régulant notamment le cycle cellulaire, l'apoptose et la sénescence. De plus, plusieurs études (portant majoritairement sur ING1) montrent que ces gènes sont fréquemment perdus dans de nombreux cancers. Ils pourraient donc être impliqués dans l'émergence et le développement de tumeurs. Ainsi, l'objectif de mon projet de thèse était d'étudier le gène ING2, afin d'évaluer son intérêt en cancérogénèse. Nous avons tout d'abord montré que l'expression d'ING2 (ARN et protéique) est perdue dans plus de la moitié des cancers bronchiques non à petites cellules, confortant ainsi un rôle d'ING2 comme gène suppresseur de tumeurs. Par ailleurs, nous avons montré que l'inhibition de l'expression d'ING2 conduit à des défauts de réplication et à une forte augmentation de l'instabilité génomique, mettant ainsi en évidence pour la première fois qu'ING2 est un gène suppresseur de tumeurs de type « caretaker ». Ceci permet aussi pour la première fois d'expliquer comment l'inactivation des ING, observée dans les tumeurs, pourrait contribuer à la cancérogénèse. Enfin, nous avons mis en évidence le premier mécanisme de régulation post-traductionnelle d'ING2. En effet, ING2 peut être sumoylée, et cette sumoylation est nécessaire pour son association avec le complexe de régulation Sin3A/HDAC afin de cibler ce dernier au niveau des promoteurs de gènes pour réguler leur expression. Ces travaux ont donc contribué à démontrer l'intérêt d'ING2 en cancérogénèse et à mieux comprendre ses fonctions suppressives de tumeurs. De plus, ils ont permis d'ouvrir plusieurs voies d'investigation sur les fonctions et les mécanismes de régulation des protéines ING.

A formação de cuidadores de idosos da saúde pública deve ser considerada, atualmente, questão de grande relevância, num pais em que expressiva parcela da população não conta com recursos para enfrentar despesas que surgem a partir do envelhecimento. Esta capacitação deve incluir não apenas conhecimentos específicos em relação a cuidados corporais, mas também preparo de caráter psicológico, que permita a instauração de vinculação suficientemente saudável entre cuidador e idoso. Neste contexto, a presente investigação visa estudar empiricamente o imaginário coletivo de cuidadores de idosos profissionais da saúde pública a respeito da pessoa idosa. Concebida e realizada a partir do uso do método psicanalítico, em todas as suas etapas, esta pesquisa articulou-se ao redor de uma entrevista com cuidadores, durante a qual o Procedimento de Desenhos-Estórias com Tema foi usado como recurso facilitador da comunicação emocional, bem como da consideração de experiências vivenciadas, no cotidiano institucional, em situações formais e informais, junto a idosos, cuidadores e da equipe, constituída por profissionais de várias formações. O conjunto do material emergente permitiu a elaboração de duas narrativas transferenciais, a partir das quais seis campos de sentido afetivo-emocional, ou inconscientes relativos, puderam ser criados/encontrados: cuidar enobrece a alma, cuidado com esse velho!, mas eu sou de confiança!, perdendo a autonomia, empobrecendo a convivência e vontade de viver(?). A condição de idoso frágil gera impactos emocionais e os cuidadores são sensíveis aos delicados aspectos que ligam a dimensão relacional inerente ao cuidado do idoso. Os seis campos criados/ encontrados indicam, de modo suficientemente preciso, quais são as principais questões psicológicas em processos de capacitação de cuidadores de idosos: apresentar-lhes a dramática de vida do idoso frágil e prepará-los para lidar com as delicadas interações que este tipo singular de intimidade certamente vai gerar
The training of caretakers for the elderly in public health must be considered, nowadays, a matter of great importance, in a country in which a considerable part of the population does not have the means to handle expenses that come with aging. This training must include not only specific knowledge on physical care, but also psychological preparation which allows for the creating of a bond strong and healthy enough between caretaker and elderly citizen. In such context, this investigation aims to study empirically the collective imaginary of professional public health caretakers of the elderly regarding older citizens. Conceived and executed using the psychoanalytic method, in all its steps, this research was organized based on an interview with the caretakers, during which the Drawing-Stories with Theme Procedure was used a facilitating resource for emotional communication, in discussing experiences lived, in the institutional daily happenings, in formal and informal situations, together with the elderly, caretakers and the staff, which is constituted by professionals from several backgrounds. The resulting material allowed for the creation of two transferential narratives, from which six affective-emotional or relative unconscious, fields could be created/derived: care-taking ennobles the soul, take care around that old man/woman!, but I\'m trustworthy!, losing autonomy, crippling relationships and will to live(?). The condition of frail elderly citizen impacts emotionally and caretakers are sensitive to the delicate aspects that connect the relationship dimension inherent to taking care of an older person. The six fields created/found indicate, in a sufficiently precise manner, which are the main psychological issues in the training process of caretakers for the elderly: presenting them the dramatic life of a frail elderly citizen and preparing them to deal with the delicate interactions this singular kind of intimacy will certainly bring

It is assumed that a parenting role by a grandparent or grandparents has been tied to life events, Such as divorce or the death of their own children. The parent was no longer in the picture and the grandparent stepped in to care for the children. Although this pattern has by no means disappeared, society is now seeing more and more cases of dysfunctional parents who are unable or unwilling to raise their own children who are therefore being raised by the grandparent. relative caregivers such as grandparents.

Sibling caretaking, although common across time and cultures, has not been well researched from the carer’s point of view. In Nicaragua, ranked as one of the poorest countries in the Americas, sibling caretaking is common. The country’s historical background and its state of chronic poverty, widespread unemployment, loose family structures, and migration and mobility makes of the old practise of shared management child care a necessity. Households headed by sing¬le mothers constitute a particular Nica¬raguan charact¬eristic. Many children are expected to help in their own families and care for their siblings and other children living in their households. In its broadest sense sibling caretaking is a public health concern, and we conducted this study to widen the understanding of the phenomenon as it is represented in a setting undergoing a rapid social transition. The main objectives were to identify, describe and analyse the life situation of sibling caretakers in poor areas in León, Nicaragua, with focus on how they perceived it themselves. A combined qualitative and quantitative methodological design was used, mainly applying an ethnographic approach. A further ambition was to explore involvement of children in a participatory research process in accordance with the ‘Convention on the Rights of the Child’. The overall emotion expressed among the caretakers was pride, even if their situation often was characterized by stress and coping problems. They perceived their work as important for their families and they appreciated to fend for their siblings. Household work and nurturing of siblings were shaping the future lives of the caretakers and constituted part of their socialization. Even if many of these children achieve essential life skills as caretakers, they are at risk of falling behind as they grow older. Their long-term personal development is likely to be hampered by the obligations they have as caretakers. The carers' awareness of missing out on education was the most problematic issue for them. From a societal point of view, caretaking has negative consequences. The individual child is marginalised with limited access to basic education, contributing to overall low educational levels in Nicaragua. While the structuring conditions leading to sibling caretaking may be difficult to change, awareness of how these can affect children might make way for improvements in terms of access to school education and support from the society. The knowledge gained from this study should be further utilised to plan for interventions that take children’s perspectives into consideration.

Made available in DSpace on 2016-04-27T18:47:17Z (GMT). No. of bitstreams: 1 Francimar Felipa da Silva Costa.pdf: 1224855 bytes, checksum: 4a0ebf0e6de35ed4986b77f20331f4de (MD5) Previous issue date: 2015-05-26
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
The caretaking responsibility of elderly people in need of palliative treatment at home has been increasingly assigned to their families, in which considering this scenario can experience moments of fragility; physical, social and financial problems with serious consequences to the caregiver health. The adopted methodology for this research is an exploratory-descriptive study, utilising an interdisciplinary qualitative perspective, which is based in the literacy and interpretation of an empiric dissertation of 10 voluntary caretakers, using semi-structured interview processes. The objective is to contribute with theories, based in Social Gerontology, in order to provide a better comprehension about the caretaker of the elderly in palliative care, the practical implications and effects that can affect the caretaker. The socio-demographic profile of the palliative caretakers was identified, as were the groupings, based specifically in the answers provided, such as; how to proceed in palliative care , performance limits and possibilities of performance improvement . These answers indicate us there can be no connection between everyday life events and public and social policies, being both necessarily in complementation of each other. The recommendation is to give the proper importance to the situation, implementing the use of specific public policies to help the caretaker, as it was specifically noted in some of the reports, allowing the improvement of their well being, the prevention of conflicts, stress, depression and furthermore the security necessary in some palliative care procedures. Moreover, it is also indispensable the total support of the family and the articulation in a social network, either formal or informal, contributing to a less arduous day-to-day life of the caretaker, as well as a more comfortable end of life for the elderly, alleviating pain and suffering
O ato de cuidar de idosos em cuidados paliativos, em domicílio, atualmente, é responsabilidade cada vez mais atribuída às famílias que, nesse cenário, podem vivenciar contextos de fragilidades, subjetiva, física, social e financeira, com implicações sérias, senão amargas, para a saúde do seu cuidador. A metodologia adotada nesta pesquisa é a de estudo exploratório-descritivo, em perspectiva qualitativa e abordagem interdisciplinar que, pautada na literatura e na interpretação de um empírico trazido pelos discursos de 10 cuidadores voluntários em entrevistas semiestruturadas, objetiva contribuir, sob o enfoque da Gerontologia Social, com subsídios teóricos para uma melhor compreensão sobre como procede o cuidador familiar de idoso em cuidado paliativo, e quais as implicações das práticas e efeitos que o impactam. Foi identificado o perfil sociodemográfico do cuidador familiar em situação paliativa, assim como categorias temáticas advindas de suas respostas especialmente a como procede nos cuidados paliativos , seus limites de atuação e possibilidades de melhoria em sua performance . Essas respostas nos fazem ver que não pode haver cisão entre acontecimentos da vida cotidiana e políticas público-sociais, sendo ambos necessariamente complementares; insiste-se, pois, sobre a importância de serem postas em ação as políticas públicas de cuidados específicos ao cuidador familiar em situação paliativa, a partir de suas demandas em vários registros, a fim de permitir-lhe a melhoria de seu bem-estar, a prevenção de conflitos, do estresse e depressão, além da segurança necessária para os procedimentos de cuidados paliativos. Ratifica-se ainda o imprescindível apoio da família e da articulação a uma rede social, formal ou informal, contribuindo para tornar menos árduo o dia a dia do cuidador, assim como mais confortável o do idoso em final de vida, escapando da dor e do sofrimento

This dissertation is based on the study of the spirituality of caretakers, mainly physicians and nurses, with regard to its effect on the care of terminally ill patients. Terminally ill patients, in addition to physical symptoms, have many spiritual issues in their final days of life. While historically spiritual care has been available for many centuries it is becoming more and more neglected with the advancement of science and technology. These advances, however, do not significantly alleviate patient suffering related to psychological, spiritual, and social aspects. Now there is a renewed interest in the area of spirituality and people have again become aware of the importance of caring for the dying patients and their families. Numerous studies over the last two decades support the therapeutic effect of spiritual care, but these studies concentrate more on the perspective of the patient and the family members.

The literature search is based on the historical development of spirituality in various parts of the world. This approach gives a broader perspective on spirituality that goes beyond the limitations of religion and culture. Spirituality is further explored in terms of psychological, philosophical, and sociological contexts. The psychological areas focus on existential themes. The review also incorporates other psychological aspects such as psychodynamic, humanistic, imaginal, and transpersonal principles. Additional areas of the review emphasize and examine the importance of spiritual care relating to elderly patients.

The current dissertation is based on patients in a cancer hospital who were admitted to the intensive care unit (ICU). The spirituality of caretakers was evaluated by interviews, surveys, and case studies. The evaluation was mainly carried out on experienced physicians in an academic setting and on those involved in the care of the patients in the ICU. The results show that spirituality of caretakers has a beneficial effect on the spiritual care provided to the patients.

The study examines interactions between children with cancer, their parents and hospital staff. Participant observation and interviewing techniques were used to gain insight into the perspectives of the three groups of persons involved. Various hospital staff members were followed through their daily routines and parents were extensively observed and interviewed. Children were observed during their first phase of the treatment in hospital using a case study approach. Extensive examples of interactions and scenes from the hospital setting are presented and analyzed. The changing role of participant observation is discussed and examined from the personal perspective of the observer. The understanding of the communication of each group which was generated showed many failures in mutual understanding during interactions. Well-meaning staff were often caught in organizational and hierarchical issues of the hospital setting and interpreted parent's and children's behaviour according to its usefulness for the application of treatment procedures. Parents tried to comply with hospital requirements, which seemed to represent their only hope for the well-being of their child, while at the same time they had to cope with their feelings in face of the suffering of their child. Children seemed to suffer from the direct consequences of the treatment as well as from the lack of meaningful explanations of the events, which led them to distrust communications. It is concluded that caring persons frequently fail to relate to the world of children with cancer, impeding a cooperative effort in the fight against the illness.
Graduate and Postdoctoral Studies
Graduate

This investigation grew out of my experiences while working as a mental nurse with people deemed to be insane. The behaviours which they presented and the medical and legal control exercised over them became of concern to me because I felt their rights were not being respected. A primary issue is the extent to which adherence to the medical-somatic view of insanity held by psychiatrists, lawyers and politicians has led to the exclusion of viable custody and treatment alternatives. The purpose of this research is to question the role and functions of mental nurses. It suggests that 'caretakers' might be a more suitable title for such workers with the insane. The hypothesis underlying the research links the work of 'caretakers' of the insane to changes in government policies and legislation; the thesis examines this hypothesis in the light of changes in the roles and functions of 'caretakers' over the period from 1890 to 1990. Research activities included the examination of primary sources, Hansard, newspapers, and professional journals. Interviews were also carried out with nine contemporary caretakers who have worked with the 1959 and the 1983 Mental Health Acts. These research methods provided an historical background to the debates in the Houses of Parliament when mental health legislation was discussed; information from the writings of the professionals who worked with the insane at the times of new mental health legislation; data on the public and media debate of these issues; and information on the perceptions and duties of caretakers working with the insane at the times of new mental health legislation. The research findings show that both those who cared for the insane and the insane themselves have been subjected to changes brought about by mental health legislation since 1890. These changes affected the working conditions of the caretakers and the social control and rights of the insane. The changes in the work of caretakers led to new directions in their education. Workers with the insane became a part of nursing by adopting the somatic approach to care. When this occurred, many of the care activities of keepers, attendants and mental nurses became redundant. Over time, there has been a move to, and then away from, the clinical-somatic model of nursing towards caretaking skills such as group work, therapeutic community skills, counselling skills and psychotherapy skills. These caretaking skills are seen by contemporary caretakers as going beyond their custodial and social control functions, towards providing a space in which people can be respected, encouraged, supported and be open to new insights.

The bulk of museum studies research focuses on professionalized museums. Little research has been conducted on the challenges of small museums. This study looks at volunteers in small North Dakota museums. Sparsely populated North Dakota lacks the funds and manpower to professionally staff their rural museums. While it is especially difficult for museums to recruit younger volunteers because they tend to be more mobile and have constricted schedules, North Dakota?s small museums have adapted by staffing with older volunteers. Museums in Southwest North Dakota such as the Hettinger County Historical Society, Dakota Buttes Museum, and Mott Gallery of History and Art survive because older volunteers sustain their museums. These older volunteers do not always follow strict professional guidelines, but they do contribute life skills, knowledge of the community, and historical understanding to their work at the museums in North Dakota. Their contributions are vital to the survival of these museums.

A mixed method study pretest and posttest research design was used in this study similar to those used by the Expanded Food and Nutrition Education Program (EFNEP) and Women, Infants and Children (WIC). An individual interview method was used to gather the qualitative data. The study was conducted using 26 caretakers and 31 children. No significant change in knowledge in the caretakers was observed across all lessons. A significant gain in knowledge was observed only in the nutrition lesson â Fruits and Vegetablesâ . A significant change in household dietary habits was seen when comparing dietary pretest and posttest score in the caretakers. A correlation of 0.33 was observed between dietary posttest scores between caretakers and children. A significant correlation (r2 0.50) was observed between the posttest (1) in caretakers from the nutrition lessons and dietary posttest taken by the caretakers. The need for a social worker, further education and more financial resources were some of the major themes identified by the qualitative component. Self sufficiency, increased evangelism and more trade classes were identified as the future goals of the nutrition program. This study showed that providing nutrition education in the caretakers can have a positive impact on the dietary choices within the household and can be a vital tool to targeting the issues of malnutrition in Tegucigalpa, Honduras.
Ph. D.

O trabalho com familiares que cuidam de portadores de síndrome demencial levou a autora a refletir sobre a emergência do cuidador principal no âmbito da família, sobre a complexidade do seu relacionamento tanto com a pessoa alvo de cuidados, como com os demais familiares, e ainda sobre a importância dos grupos de suporte para os familiares que cuidam. A pessoa enferma reage de forma diferenciada ao membro da família que arca com a maior parte das tarefas inerentes ao ato de cuidar, dando a impressão de que é ela quem escolhe esse parente, entre outros. Partindo desta questão elaborou-se uma pesquisa de campo com o objetivo de verificar como surge na família o cuidador principal, ou seja, aquele parente responsável por quase todas as atividades referentes aos cuidados com o paciente. A pesquisa está fundamentada em estudos relativos ao envelhecimento e na terapia familiar sistêmica. Entrevistou-se 24 cuidadores familiares principais (sete homens e 17 mulheres), participantes do Grupo de Suporte aos Familiares Cuidadores de Pacientes com Alto Nível de Dependência de um dos ambulatórios da Universidade Aberta da Terceira Idade da Universidade do Estado do Rio de Janeiro. Além das entrevistas individuais 14 sessões do mesmo grupo foram gravadas. A análise categorial do material obtido e a interpretação das entrevistas e das sessões de grupo, à luz da bibliografia consultada, mostram como resultados relevantes a importância da distribuição dos papéis, dos legados e dos mitos familiares; da dívida de reciprocidade e das transmissões geracionais no surgimento do cuidador principal. Mostra ainda a participação da pessoa cuidada na decisão de quem vai cuidar dela. Por fim, deixa evidente a importância do Grupo de Suporte para os familiares cuidadores. Os resultados constituem uma contribuição significativa para os profissionais que trabalham com idosos fragilizados e seus familiares.
The work with relatives who take care of people who suffer from demential syndromes led the author to reflect upon the emergence of the main caretaker in the family, the complexity of his relationship with the person who is the target of the care as well as with the other relatives, and also about the importance of the supporting groups for the relatives who take care. The sick person reacts in a different way with the family member who is the responsible of the most part of the duties which are inherent to the caretaking action, giving the impression the it is the person herself who chooses this relative among others. Starting from this question, a field research was elaborated with the objective of checking how this main caretaker appear in the family, that is to say, the relative who is responsible of almost all the activities related to the cares with the patient. The research is based upon studies related to the aging process and on the sistemic family therapy. Twenty-four main family caretakers were interviewed (7 men and 17 women), participants of the Supporting Groups for Relatives Caretakers of Patients with a High Degree of Dependence of one of the ambulatories of the Open University for the Third Age of the University of the State of Rio de Janeiro. Beyond the individual interviews, 14 sessions of the same group were recorded. The categorial analysis of the given material and the interpretations of the interviews and of the group sessions, based on the refered bibliography, show as relevant results the importance of the distribution of roles, the legates and the family myths, the debt of reciprocity and the generational transmissions in the emergence of the main caretaker. It also shows the participation of the person who is taken care in the decision of who is going to take care of her. Finally, it makes clear the importance of the supporting groups for the relatives who are caretakers. The results constitute a significant contribution for the professionals who work with fragile old people and their relatives.

Cerebral Vascular Accident is one of the leading causes of disability worldwide. Most people who have suffered from a CVA are cared for at home by a caregiver who is usually a close relative or friend. The aim of this study was to explore the role that music therapy sessions could play in enhancing the relationship between individuals who have experienced a CVA and their primary caretakers in the home context. The study made use of a sample of three such dyads. The sessions took place in their home settings. Sessions included listening to and singing familiar songs, drumming, vocal and instrumental improvisation and movement. A total of 16 sessions were conducted. Videotaped recordings were made of each session and the last session from each dyad’s therapy process was transcribed verbatim. Three themes emerged from the thematic analysis. The therapy process allowed them to explore difficulties and challenges in their relationships, there was enhanced communicating and relating, and there was an expressed desire for a return to the self that once was as well as a hope for the future.
Mini Dissertation (MMus)--University of Pretoria, 2016.
Music
MMus
Unrestricted

According to the World Health Organization(WHO) the most efficient and cost-effective strategies in the global fight of malaria are the Indoor Residual Spraying (IRS) and the Insecticide Treated Nets ITNs). However, since the strategies include the use of synthetic insecticides, WHO reports that they sometimes meet opposition in the society. In a Global Malaria Programme report from 20061, WHO describes that concerns in the community regarding the safety of the IRS hinder its effective implementation. WHO states that the social acceptability of ITNs2 has to increase. This study aims at investigating if and where in the Ugandan society the antimalarial strategies meet opposition. The study analyzes whether authorities, non-governmental organizations and caretakers in one region in Uganda reject the antimalarial strategies recommended by WHO. The aim is further to investigate where focus should be put in order to meet the

opposition (if any) to current strategies and thus facilitate the implementation of the strategies. The methodology used is an empirical approach based on interviews with officials at authorities, representatives of non-governmental organizations (NGOs) and caretakers in the slum areas in Kawempe Division, which is an area highly exposed to malaria, in Uganda. The results show that the authorities and the NGOs in this study accept the current strategies but believe that they are not fully accepted by caretakers. Further, the authorities and the NGOs point out that current strategies, mainly IRS, meet great resistance among politicians and within the agricultural and environmental sector. Nevertheless, the majority of the caretakers in the interviews does accept the strategies and give other reasons for not having them implemented in their houses. Many of the households do not have the money neither to buy the ITNs nor to have the IRS implemented in their houses. Thus, this study implies that the opposition to the current strategies is not among authorities, NGOs or caretakers but in the political, environmental and agricultural

sphere. In order to fight malaria in the study area, WHO and stakeholders have to work with the change of attitudes among politicians and stakeholders within the environmental and agricultural sector in Uganda. They also have to provide poor households with ITNs or IRS for free, since lack of money is the reason for the studied group of caretakers not having the recommended strategies implemented in their houses.

The aim of this research was to determine the way in which informal caregivers of HIV/AIDS patients experience their task as caregivers as well as to identify factors, or general resistance resources, which exercise an influence on their psychological well-being, and more specifically on their sense of coherence. The stressors encountered by informal caregivers of HIVIAIDS patients have previously been investigated thoroughly in a number of studies. The tasks of informal caregivers very often encompass much more than what would be, for example, included in the nursing context and therefore exceed the limits applying to the formal sector. Stressors to which caregivers are exposed include physical, financial and emotional aspects. It has been proved that this state of affairs has a negative impact on their physical health conditions as well as their psychological well-being. Caregivers do, however, at times report a certain extent of growth experienced by them which can be related to the care giving situation. The salutogenic perspective allows for a study of the origin of health and has, for the purposes of this study, been applied to obtain an alternative description of the caregivers' experiences. According to this perspective health does not merely mean the absence of disease, but also refers to health being influenced by an individual's management of stressful events. When an individual, even if confronted with stressful circumstances, has adequate general resistance resources at his/her disposal, a strong sense of coherence can develop and this will have a positive influence on his/her psychological well-being. In the South African context little if any literature can be found on the salutogenic factors that may affect informal caregivers of HIV/AIDS patients. The investigation of this study was based on an availability sample consisting of 8 informal caregivers of HIVIAIDS patients. A one shot cross sectional design with triangulation of data assessment techniques was used. The researcher obtained data with regard to the caregivers' sense of coherence by means of the Sense of Coherence Scale (SOC) (Antonovsky, 1987). Semistructured interviews were conducted with all the caregivers involved and a qualitative analysis followed. The results revealed that informal caregivers' sense of coherence was much lower than- that of a group of nurses (formal caregivers) as described by Cilliers (2003). One of the reasons for this significant difference could be the lack of a structured setting or environment in which caregivers still have to perform their duties and responsibilities. According to the results a variety of factors exercising a negative impact on informal caregivers' sense of coherence could be identified. These included (a) stress, (b) exposure to unfamiliar situations, and (c) a lack of counselling skills. Within the framework of the salutogenic perspective there were, however, different factors also known as general resistance resources, that exercised a positive impact on the caregivers' sense of coherence. Among these the following could be counted: (a) spirituality, (b) insight into interpersonal situations, (c) utilisation of social support systems, and (d) multi-disciplinary cooperation. It would therefore seem that informal caregivers do possess general resistance resources which enable them to persevere with their tasks as caregivers in spite of the stressors they encounter on a daily basis. One of the recommendations that can be posed after having carried out this study and after having analysed the results, is the compilation as well as the evaluation and implementation, of a psycho-education training programme for informal caregivers, with special emphasis on such general resistance resources.
Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2006.

Purpose of this study was to determine feasibility of an information system that enables remote assistance between caretakers and elderly people suffering from dementia in a smart kitchen environment. Such system could alleviate stress experienced by caretakers by enabling provisioning of care giving between any combination of informal and formal caretakers, and by increasing mobility of caretakers. Second research problem was to evaluate benefits and drawbacks of using workflow technology to model cooking activities as workflow process models in smart kitchen environment. The research was conducted following the design science research framework. Scenario-based method and literature review were used to determine functional and technical requirements for the designed system. Quality function deployment method was used to choose technical solutions to be implemented. The designed system was evaluated by conducting a pilot test that is comparable to alpha test in software industry. Two external test participants evaluated the design following formative usability study guidelines. The pilot test confirmed that designed information system is feasible to be built from technical perspective. The most significant benefit of using workflow technology is ability to model and customize important daily activities such as preparing own meals to match individual needs of users and changing nature dementia. The most significant drawback of using workflow technology is demandingness of creating the models. The results of this study provide technical confirmation on ability to construct a supporting system for remote guidance of cooking activities. Also the study confirms that workflow technology is an viable candidate for powering such system.

Our genome is constantly challenged by sources that cause DNA damage. To repair DNA damage and maintain genomic stability eukaryotes have evolved a complex network of pathways termed the DNA damage response (DDR). The DDR consists of signal transduction pathways that sense DNA damage and mediate tightly coordinated reactions to halt the cell cycle and repair DNA with a collection of different enzymes. In this manner, the DDR protects the genome by preventing the accumulation of mutations and DNA aberrations that promote cellular transformation and cancer development. Loss of function mutations in DDR genes and genomic instability occur frequently in many tumor types and underlie numerous cancer-prone hereditary syndromes such as Fanconi Anemia (FA). My thesis research applies candidate-based and unbiased experimental approaches to investigate the role of several tumor suppressor genes (TSGs) in the DDR. My dissertation will first describe a novel function for the breast and ovarian cancer tumor suppressor and FA-associated gene FANCJ in the DDR to ultraviolet (UV) irradiation. In response to UV irradiation FANCJ supports checkpoint induction, the arrest of DNA synthesis, and suppresses UV induced point mutations. Suggesting that FANCJ could suppress UV induced cancers, in sequenced melanomas from multiple databases I found somatic mutations in FANCJ previously associated with breast/ovarian cancer and FA syndrome. The second part of my dissertation will describe an RNA interference screen to identify genes modulating cellular sensitivity to the chemotherapeutic drug cisplatin. The hereditary breast/ovarian cancer tumor suppressor BRCA2 is essential for DNA repair, thus BRCA2 mutant ovarian cancer cells are initially sensitive to cisplatin chemotherapy that induces DNA damage. However, drug resistance develops and remains a major problem in the clinic. My screen identified the chromatin remodeling factor CHD4 as a potent modulator of cisplatin sensitivity and predictor of response to chemotherapy in BRCA2 mutant cancers. Taken together, my investigations highlight the important contribution of the DDR and the role they play in tumorigenesis and predicting therapeutic response.

Our genome is constantly challenged by sources that cause DNA damage. To repair DNA damage and maintain genomic stability eukaryotes have evolved a complex network of pathways termed the DNA damage response (DDR). The DDR consists of signal transduction pathways that sense DNA damage and mediate tightly coordinated reactions to halt the cell cycle and repair DNA with a collection of different enzymes. In this manner, the DDR protects the genome by preventing the accumulation of mutations and DNA aberrations that promote cellular transformation and cancer development. Loss of function mutations in DDR genes and genomic instability occur frequently in many tumor types and underlie numerous cancer-prone hereditary syndromes such as Fanconi Anemia (FA). My thesis research applies candidate-based and unbiased experimental approaches to investigate the role of several tumor suppressor genes (TSGs) in the DDR. My dissertation will first describe a novel function for the breast and ovarian cancer tumor suppressor and FA-associated gene FANCJ in the DDR to ultraviolet (UV) irradiation. In response to UV irradiation FANCJ supports checkpoint induction, the arrest of DNA synthesis, and suppresses UV induced point mutations. Suggesting that FANCJ could suppress UV induced cancers, in sequenced melanomas from multiple databases I found somatic mutations in FANCJ previously associated with breast/ovarian cancer and FA syndrome. The second part of my dissertation will describe an RNA interference screen to identify genes modulating cellular sensitivity to the chemotherapeutic drug cisplatin. The hereditary breast/ovarian cancer tumor suppressor BRCA2 is essential for DNA repair, thus BRCA2 mutant ovarian cancer cells are initially sensitive to cisplatin chemotherapy that induces DNA damage. However, drug resistance develops and remains a major problem in the clinic. My screen identified the chromatin remodeling factor CHD4 as a potent modulator of cisplatin sensitivity and predictor of response to chemotherapy in BRCA2 mutant cancers. Taken together, my investigations highlight the important contribution of the DDR and the role they play in tumorigenesis and predicting therapeutic response.