Dissertations / Theses on the topic 'Reproductive medicine not elsewhere classified'

Malignant gliomas are the commonest primary malignant tumours of the brain and carry a poor prognosis with current treatment modalities. Chemotherapy is an increasingly important treatment option for these turnouts; however response is limited by the development of drug resistance. A study was undertaken to investigate the feasibility of providing information about tumour chemosensitivity in vitro by culturing glioma tumour cells in a hospital setting and performing chemnosensitivity assays on them using five common chemotherapeutic agents i.e. Cisplatin, Carmustine, Paclitaxel, Temozolomide and Etoposide. It was found that a successful culture was obtained in roughly half the patients (21/47) where culture was attempted, and in those successful cultures information about drug sensitivity could be provided within 3 weeks. The colorimnetric MTS assay and the luminescent ATP assay were compared for chemosensitivity results and it was found that the ATP assay was more sensitive in that it could detect cell death at lower cell numbers. A wide variation was found in the range of chemosensitivities between known glial cell lines and primary cultures and also between the various primary cultures. De Novo drug resistance was also shown to develop in subsequent subcultures derived from the primary culture. Every tumour is unique phenotypically and genotypically and several factors induding clinical characteristics, radiological features and conventional histology might act as pointers to this uniqueness. Proteins ktown to be associated with drug resistance in other tumours might be contributory to the development of drug resistance in gliomas. Profiles of successfully assayed tumours (nr19) were prepared induding clinical and radiological data, histology, culture characteristics, chemosensitivity data and immunohistochemistry for pglycoprotein (PGP), multiple drug resistance associated protein 1(MRP1), p53, Ki-67 and MGMT proteins. These profiles did not show any correlation between the factors analyzed and chemosensitivity to the five chemotherapeutic agents used. Functional studies of drug efflux pumps PGP and MRPI, performed on 5 cultures using drug efflux assays and confocal microscopy demonstrated no correlation between presence of the proteins on immunostaining and their functional activity.

In the United Kingdom (UK), men face a significantly higher risk of contracting and dying from cancer. Prostate, lung and colorectal cancer are the most common cancers diagnosed in men; with prostate cancer disproportionately affecting black men. Little is known about black African (BA) and black African-Caribbean (BAC) men’s view towards cancer; yet culture and acculturation determine the way in which people understand, explain and develop their attitudes towards cancer. Hence, cancer prevention and early detection strategies may not be sensitive to UK-based black men views, affecting their awareness of risk factors and early detection services. An evidence based understanding about black men’s views towards cancer is needed to effectively target cancer prevention strategies. This qualitative study explored the influence of culture on the views of UK based BA and BAC men towards cancer. In collaboration with black community organisations based in Leeds, Manchester, Birmingham, and London, 27 participants were recruited. Convenience and theoretical sampling methods were used. Data were collected from June 2013-February 2014 using semi-structured one-to-one interviews. Data were analysed using the grounded theory analytical method. BA and BAC men have their own distinct beliefs concerning the causes of cancer, which influence how they view cancer as a whole. Seven categories: ‘Cultural views’; ‘Religious beliefs’; ‘Avoiding Babylon’; ‘Alienation’; ‘Suspicious mind’; ‘Advertisements and information influence very little’, and ‘Gap in service provision (Bridging the gap)’ were identified as sub-categories revolving around the core category: ‘Cancer through black eyes’. Cancer was not viewed as a purely medical condition through black eyes. Black men’s views towards cancer were closely linked to socially constructed perspectives of themselves, linked with their cultural and religious beliefs; what being black male means in society, the meanings of historical phenomena like slavery, and the meanings they ascribed to social systems and establishments, such as healthcare systems. Clinical risk factors such as smoking and obesity had different meanings and symbolisation through black eyes. There were macro- and micro-level similarities and differences between BA and BAC men. Cancer-related services, such as public-health campaigns, aimed at black men need to be sensitive enough to understand cancer through black eyes. Public health campaigns based on only the clinical meaning of cancer mismatch with black men’s understandings of cancer. Accordingly, the effort made to increase public awareness of cancer and to reduce health inequality in this regard may continue to be ineffective. Findings from this study can be used to inform public health policy makers, and healthcare professionals more broadly, including professionals involved in health promotion, as well as charitable organisations aiming to provide services that will be utilised by BA and BAC men.

A polyphasic study of the population diversity in a collection of Campylobacter jejuni isolates involved in human disease and from animal and environmental sources was undertaken. Isolates were characterised by phenotype, using heat stable antigen serotype, bacteriophage type and biotyping methods. Isolates were also genotyped by restriction fragment length polymorphism analysis of genomic DNA, using a 16S rRNA gene probe, a random-cloned DNA sequence probe, and of the flagellin A gene following amplification by the potymerase chain reaction. A diverse range of polyphasic strain profiles was seen amongst a population of C. jejuni isolates examined from sporadic human infections in the UK over a seven-month period. Associations between gene polymorphisms identified a number of prevalent genotypes and a cluster analysis of RFLP profiles identified a strong relationship between three of these prevalent genotypes. The association of these three genotypes with serogroup and phage-group markers was highly suggestive of clonality within this C. jejuni population. Three hunian pathogenic C. jejuni strains identified by this analysis could be recognised by association with specific Preston phage-groups. A retrospective survey indicated that these phage-groups were responsible for approximately 27% of sporadic cases of C. jejuni infection in the UK. The population diversity amongst sporadic human C. jejuni isolates remained consistent over a seven year period and these three phagegroups were a consistent feature of sporadic C. jejuni infections during this period. Each phage-group demonstrated a distinctly different seasonal distñbution suggesting that the epidemiology of these strains could be different. C. jejuni isolates from poultry samples were also diverse and a significant proportion of these isolates were indistinguishable from human C. jejuni isolates using the same polyphasic strain characteristics. Pathogenic human strains were found in contaminated environments but environmental populations largely contained stains which had not been seen amongst human isolates in this study. One of the strains identified in this study (R4:C8:11S4:flaA-26:PG55: BT6000) was demonstrated to have a global distribution and appears to have a host preference for cattle. In addition this strain was responsible for at least four milkborne outbreaks of (Ljejuni enteritis. Data from this study indicates that this strain may be responsible for up to 5 % of sporadic cases of human enteritis in the United Kingdom each year and that milking cows may be a reservoir for the organism.

Background: Diabetes mellitus (DM) is a major metabolic disorder leading to severe long term complications including cardiomyopathy, nephropathy, retinopathy and neuropathy that are common in type 1 DM (T1DM) and type 2 DM (T2DM). Epidemiological studies have demonstrated a role of hyperglycaemia (HG) in eliciting adverse cardiac and renal outcomes including heart failure (HF), diastolic and renal dysfunction. This study investigated the effect of HG on left ventricle (LV) and kidney structural remodelling, function and underlying molecular events associated with the two organs over a period of 2 and 4 months compared to age-matched control. Methods: Molecular mechanisms underlying HG-induced remodelling changes including extracellular matrix (ECM) and myocyte apoptosis deposition, underlying cytokine induction, recapitulation of foetal genes, and transcriptional alterations that may influence the ECM and intracellular calcium [Ca2+]i handling in the LV and kidney of T1DM as well as T2DM were examined in this study. LV and kidney isolations following 2 and 4 months of the development of T1DM were used to assess the remodelling changes and underlying transforming growth factor β1 (TGFβ1) activity, gene expression profile of the ECM and calcium mediators using histological, immunohistochemical and quantitative gene expression analyses compared to age-matched Wistar control rats. Results: The results show that T1DM over 4 months can elicit severe structural and molecular changes in the LV and the kidney compared to 2 months of DM. The severity of these changes was significantly less in respective healthy age-matched control animals. The isolated ventricular cardiomyocytes from T1DM rats displayed altered cellular calcium (Ca2+) homeostasis and [Ca2+]i translating to alterations in mRNA abundance of key Ca2+ handling proteins, cardiac sarcoplasmic reticulum Ca2+ATPase 2a (SERCA2a), ryanodine receptor (RyR2), Na2+/Ca2+ exchanger, phospholamban (Plb), L-type Ca2+ channel proteins (Cav1.2 and Cav1.3), calmodulin2 (Calm2) and Ca2+/calmodulin-dependant protein kinase II delta (CaMK2d) were significantly (p < 0.05) altered in DM compared to age-matched control animals. The results showed LV and kidney remodelling in the T1DM rats with increased ECM deposition that translated into increased gene expressions of key components (collagen 1α, collagen 3α, fibronectin and elastin) and modulators i.e. MMP2 and MMP9 and their tissue inhibitor (TIMP4), connective tissue growth factor (CTGF), integrin 5α and connexin 43 (Cx43) of the ECM. Molecular derangements underlying this phenotype included increased TGFβ1 transcription and activity, recapitulation of foetal gene phenotype atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) with marked hypertrophy, underscored by caspase-3 mediated cell apoptosis. Electron microscopic analysis revealed ultrastructural alterations in LV highlighted by increased mitochondrial number and altered mitochondrial population, whereas the kidney presented with increase glomerular basement membrane thickness in T1DM compared to controls. These data clearly show that adult vs young adult, in combination with STZ-induced T1DM, can elicit severe changes to both the heart and the kidney, respectively in structural, functional and biochemical alterations. The final part of the study revealed exercise training after 2-3 months may have beneficial effects in T2DM animals compared to sedentary control rats. Ventricular myocyte and shortening were generally well preserved despite alterations in mRNA gene expression encoding a variety of cardiac muscle proteins in the exercised trained adult GK diabetic rat. LV remodelling in GK rat presented with marked hypertrophy of cardiomyocytes and increased ECM deposition that altogether translated into increased ECM components and regulators which were reversed by exercise training. Conclusions: The present results have demonstrated that T1DM, if left untreated, can lead to severe changes to both the heart and the kidney. These changes seem to occur at structural and molecular levels leading to dysfunction of the heart and kidney and the severity of the damage is enhanced over time. Data suggests that diabetic cardiomyopathy (DCM) may have possible origins in pro-fibrotic and pro-hypertrophic mechanisms. Moreover, this study demonstrates that physical exercise training continues to be one of the most valuable forms of non-pharmacological therapy in DM. Data concerning molecular signalling cascades and ECM phenotype is particularly significant as targeting features of structural remodelling may delay onset and severity of myocardial and renal complications.

The combination of physical and psychosocial factors observed in cystic fibrosis (CF), has the potential to severely impact on the health related quality of life (HRQoL) experienced by adults with CF. To date, FIRQoL has not been systematically assessed in adults with the disease. This is primarily for two reasons; (a) complete testing and validation of an appropriate generic measure for this population has not been conducted and (b) as yet, no disease specific HRQoL for adults with CF has been developed, tested, validated or published. The present work has addressed both of these deficits by testing and validating a generic measure of HRQoL, the short form 36 (SF-36) item questionnaire, and secondly, by addressing the primary aim of developing, testing and validating a disease specific measure of HRQoL for adults with CF. The research achieved a partial validation of the SF-36 although frill validation proved to be equivocal. Structural validation of the measure using principal components analysis, Cronbach alpha coefficients and correlational techniques indicated that the measure was robust. However, discriminatory sensitivity proved problematic, indicating that across some domains, the SF-36 may not be sensitive to differences based on disease severity. The most original and significant achievement of the work has been the development and validation of a disease specific measure for adults with CF, the cystic fibrosis quality of life (CFQoL) questionnaire. Testing has shown the CFQoL to be structurally robust, reliable, discriminatory and also sensitive to transient changes in health status. Furthermore, using correlational techniques, the work has also highlighted the weak relationships between aspects of HRQoL and clinical indicators. In addition, the information gleaned from the CFQoL during the validation process, identified specific problem areas amongst adults with CF that may be amenable to psychosocial interventions, and which have not previously been targeted in the population. This information would fUrther enhance the multidisciplinary approach to treatment of adults with CF, making interventions truly holistic.

Early intervention to promptly identify and treat psychosis limits the duration of untreated psychosis and improves patient outcome. Despite evidence to support efficacy, approximately 50% of young people do not take antipsychotic medication as prescribed. This research was designed to explore factors which may promote and deter teenage adherence with antipsychotic medication. Initially intended as a quantitative study, the research pragmatically shifted to a qualitative design following recruitment difficulties. Narrative inquiry and auto-photography were used to obtain stories from ten young people prescribed antipsychotic medication as a teenager. Participants collected images illustrative of their medication journey, discussing these images and their medication stories at interview. Analysis of data uncovered a metastory of a journey from darkness to brightness. In darkness, symptoms predominated bringing fear, isolation and unpredictability. As medication took effect, stories became brighter evidencing hope, happiness and productivity. Four stories linked to medication adherence emerged; namely endurance, motivation, control and resentment. Underpinning sub-stories included the endurance of resisting symptoms, taking medication long term and dealing with medication side effects. Sub-stories of motivations related to being well, being a ‘normal’ teenager and having a brighter future. Control was evident in the positive choices.

Background There will be approximately four million people living with cancer in the United Kingdom (UK) by 2030. The National Health Service faces a major challenge meeting the support needs of this growing population, who commonly report feeling isolated and lacking social support. Approximately 45 million adults in the UK use the internet, and online communities might be a culturally relevant way to connect people affected by cancer, allowing them to support one another. However, internet communication is fraught with challenges such as misleading or untrustworthy information. We have a limited understanding of how people experience these communities and whether they can provide meaningful support for people affected by cancer. Aims To explore and understand the experiences and interactions of people affected by cancer who visit online cancer communities. Methods This was a qualitative study involving 23 people who had visited online cancer communities. Participants were affected by a range of cancers and were a combination of cancer survivors and families members. Semi-structured interviews elicited participants’ experiences, preferences and perceived consequences of using online communities. Data analysis was guided by principles of Constructivist Grounded Theory. Findings Participants used communities to ‘navigate’ the challenges they faced with cancer. This navigation produced three categories of experience in online communities. Firstly, advice from fellow community members set participants on a ‘journey to become informed’. Secondly, participants were cast into a ‘journey to recreate identity’ as they connected and formed friendships online. Thirdly, participants discovered a ‘journey through different online worlds’ to the most relevant and often hidden social communities. Conclusions This was the first qualitative in-depth study exploring how contemporary online cancer communities are used by people affected by cancer. Online communities offered multifaceted opportunities to support the cancer experience, and they may promote self-management in cancer care. These findings can inform and improve the delivery of existing online communities.

The provision of enteral feeding continues to increase with approximately 20,000 people in the United Kingdom feeding at home. Health care professionals have an ethical duty to recognise and treat malnutrition, though in clinical practice they are often faced with difficult decisions to ensure that the benefits of tube feeding are greater than the burdens; that the provision of a tube feed is in the patient's best interests. The aim of this study was to evaluate how the provision of enteral nutrition via a Percutaneous Endoscopic Gastrostomy (PEG) impacts on the Quality of Life (QoL) of patients from the patients' and carers' perspectives. Initially, QoL was measured using the SF36 Health questionnaire. A longitudinal, prospective pilot study was undertaken including clinical and QoL assessments prior to PEG placement, and at one week, one month, three months and six months following PEG insertion. The results of the pilot study of 22 patients clearly demonstrated that the SF-36 was not an appropriate tool for measuring QoL in this patient group. A semi-structured interview approach was developed to determine the concerns relating to PEG feeding and how feeding impacted on QoL. Health care professionals' views were also sought using a postal questionnaire and the results compared to those of patients and carers. These data informed the development of a preliminary QoL assessment tool which involved item generation, item reduction, response scale generation and pre-testing for acceptability and feasibility. Sixteen adult patients, 27 carers of adults and 24 carers of children were interviewed. In general, patients living in their own home viewed their QoL as acceptable. However, the carers of adult patients were less positive about the patients QoL. In contrast, the carers of children frequently reported their child's QoL to be acceptable. The reported impact of feeding on daily and social lives ranged from the PEG feeding being totally disruptive to the PEG having no impact at all. Delayed and disturbed sleep, restricted ability to go out, difficulties finding a place outside the home to feed, childcare problems, the negative attitudes of others towards feeding and family divisions emerged as key issues and concerns. A wide range of feelings towards the PEG feeding including feelings of anger, gratitude, relief and fear were expressed. Healthcare professionals, carers and patients disagreed on key issues of patient and carer involvement in the decision making process, the quantity of information provided prior to PEG placement, appropriateness of patient selection for the procedure and acceptability of QoL. The delivery of patient centred care must be based on appropriate patient selection, decisionmaking, setting of treatment goals for PEG feeding and the evaluation of the impact of treatment. Current generic QoL measures are highly likely to be inappropriate to measure the impact of feeding upon QoL and a validated PEG specific QoL tool is required to measure the impact of PEG feeding upon QoL. A research proposal has been developed to fully validate the tool for use in clinical practice. The impact of PEG feeding on QoL was variable. Although it is recognised that the results are not generalisable to wider populations, the results support increased patient and carer involvement in the decision-making process, more appropriate information, timely explanations of the procedure and flexible care in the community to meet patients' needs.

There is an on-going debate among health professionals, policy-makers and politicians, as to the optimal way of delivering sexual health services to young people. There is as yet, no consensus on their best patterns of organisation or configuration. This study uses qualitative and quantitative research methods, to explore both the views of young people accessing sexual health services, expressed through in-depth interview, and variations in client satisfaction with different characteristics of service delivery, expressed through completion of a questionnaire. The key research questions are:  How does young people’s satisfaction with sexual health services vary with the age-dedication of the service; that is, whether it serves young people only, or all ages?  How does young people’s satisfaction with sexual health services vary with the integration of the service; that is, whether family planning and genito-urinary services are offered separately, or together?  How does young people’s satisfaction with sexual health services vary with the location of the service; that is, in community or hospital based services? In the qualitative component, in-depth interviews were conducted with 25 young people recruited from a purposively selected sample of young people’s services. In the survey, a total sample of 1166 was achieved. Of these, 36% were attending an integrated contraceptive and STI service and 64% were attending a more traditional ‘separate’ service. 48% attended a service dedicated to young people and 52% an all-age service. 50% attended a hospital-based service and 50% a service located in the community. Of the total sample, 22% were male and 78% female. The analysis has been done not on a comparison of services in their entirety, but on a comparison of key features of their organisation, that is, whether they are provided separately as contraceptive and STI sessions or services, or whether these aspects of sexual health provision are integrated in sessions or services (integration); on whether they are run exclusively for young people or for all ages (dedication); and on whether they are located in the community or in a hospital setting (location). Recommendations are made for future service development and delivery and implications for policy are discussed.

This PhD provides the first organized view of art therapy education in Australia. It focuses on the theories that are used in this specialized teaching and learning process. It evolved from the authors’ immersion in the field as a migrant art therapy educator to Australia from the UK and a desire to be reflexive on this experience. The research questions aimed to discover the field of art therapy education in Australia: to find out what theories and practices were taught; and where the theoretical influences were coming from, in order to develop understanding of this emerging field. Positioned as a piece of qualitative research a bricolage of methods were used to gather and analyse information from several sources (literature, institutional sources, and key participants, including the author) on the theories and practices of art therapy training programs in Australia. This also included investigating other places in the world shown to be influential (USA and UK). The bricolage approach (McLeod, 2006) included: phenomenology; hermeneutics; semi-structured interviews; practical evaluation (Patton, 1982, 1990/2002); autoethnography (Ellis & Bochner, 2000); heuristic (Moustakas, 1990); and visual methodologies (Kapitan, 2010). These were used to develop a body of knowledge in the form of institution/program profiles, educator profiles, country profiles and an autoethnographic contribution using visual processes. Epistemologically, the project is located in a paradigm of personal knowledge and subjectivity which emphasizes the importance of personal experience and interpretation. The findings contribute knowledge to support the development of art therapy education and the profession in Australia, towards the benefit, health and wellbeing of people in society. The findings show a diverse and multi-layered field of hybrid views and innovative approaches held within seven programs in the public university and private sectors. It was found that theories and practices are closely linked and that theoretical views have evolved from the people who teach the programs, location, professional contexts (health, arts, education, social, community) and the prevailing views within these contexts, which are driven by greater economic, socio-political forces and neo-liberal agendas. The university programs generally teach a range of the major theories of psychotherapy underpinned with a psychodynamic or humanistic perspective. Movement towards a more integrative and eclectic approach was found. This was linked to being part of more general masters programs and economic forces. The private sector programs are more distinctly grounded in a particular theoretical perspective or philosophical view. Key words distilled from the profiles included: conflict, transpersonal, survival through art, pedagogy, epistemology, theory driven by context and mental health. Important issues for art therapy education were identified as: the position and emphasis on art; working with the therapy/education tension; the gender imbalance in the profession; Indigenous perspectives; intercultural issues and difference. The horizons of the field revealed the importance of developing the profile of the profession, reconciling differences towards a more inclusive view and the growth of research. A trend towards opportunities in the social, education and community areas was found, driven by the increasing presence of discourses on arts and wellness.

This research aimed to investigate the socio-demographic characteristics alongside the psycho-social factors that impact on the uptake of telephone based healthcare using a socio-cognitive approach. The first study analysed four ‘one month’ periods of national NHS Direct call data (July 2010, October 2010, January 2011 and April 2011) for all 0845 4647 calls in England. Expected and actual usage of NHS Direct was determined for each ethnic group of the population and compared using Chi-square analysis. Results confirmed that White British used NHS Direct more than expected, alongside Mixed (Caribbean/African) and Asian Pakistani groups, with lower representation found for Asian Indian\Bangladeshi, Black African\Caribbean, alongside Chinese ethnic groups. No gender differences were noted. Calls were then analysed for age, gender and deprivation (IMD health, income, employment & education) using negative binominal regression. Results suggest that deprivation increases call rates for adult calls but reduced in calls about children (<15 years). This study also highlights that NHS Direct call rates (all ages combined) are highest in areas with deprivation levels at, or just above, the national average, which remains consistent when accounting for employment, income and education deprivation. The second study, adopted a qualitative approach to explore the psycho-social factors that impact on the uptake of telephone based healthcare. Focus groups were conducted with low user groups (Manchester (N=3) and Mendip (N=4)), alongside high service users (N=2) and service providers (N=2). Five themes emerged: attitudes, structural and perceived barriers, knowledge and awareness of NHS Direct alongside improving access. Findings highlight a preference for instant face-to-face reassurance in low user groups, whereby low users appear to have lower perceived confidence in self-management of symptoms and engaging with telephone based health services. In conclusion the findings suggest there is variation in usage of NHS Direct, influenced by ethnicity, gender, age and deprivation. This research has explored some of the barriers, and has provided a theoretical framework that can be applied to understand uptake of telephone based healthcare. This research can help enable the development of future promotional campaigns that can target particular sections of the population to encourage use of telephone based healthcare services.

This action research project examines the researcher’s journey of establishing a therapeutic relationship with a child with autism spectrum disorder during her practicum. Children with ASD present difficulty in communication and social relationship skills. As a student in training with a limited experience, the researcher had uncertainty and low confidence with regard to her clinical and professional skills which affected her work. In this project, the researcher has examined her own process of music therapy with a child with ASD and shows how she was able to improve her practice and therefore establish meaningful and effective therapeutic relationships with this client population and obtain valuable learning through the training. The study was conducted at a dedicated therapy centre in New Zealand where the researcher was in placement. A total of seven, thirty-minute weekly individual music therapy sessions and four supervision sessions were employed. This process was adapted into the design of action cycles which involved the repeated process of planning, action and evaluation. In-depth analysis of the researcher’s work was carried out throughout the cycles, using clinical notes, journal excerpts, supervision notes and video recordings of the sessions. The findings suggest that the researcher was able to improve her practice while attempting to build a therapeutic relationship with the client. Various clinical and personal issues arose such as uncertainty about improvisation, and lack of confidence in professional skills including communicating with parents, which led to disjunction and burnout symptoms. Discussions in supervision aided in in-depth reflection of the researcher’s work as well as emotional support. The researcher could ultimately develop ‘internal supervisor’ and was able to use independent strategies to help develop her work. Implications for training include making personal therapy a compulsory course requirement, providing training on professional skills, and student support groups. Future research may investigate the effectiveness of verbal input in music therapy and the emotional stages of parents.

Preterm birth is the leading cause of newborn mortality, with 15 million babies born premature worldwide every year. Children that do survive early delivery are more likely to develop cognitive abnormalities, motor deficits, heart disease, cerebral palsy, and more. While little is known about the pathophysiology of preterm birth, several pregnancy-related complications are related to preterm birth, namely cervical insufficiency and preeclampsia. In the former, premature cervical remodeling and softening can result in the shortening of the cervix, increasing a woman’s risk of preterm birth; this condition is called cervical insufficiency (CI), which is the inability of the cervix to remain closed as a result of weakened tissues. CI is currently measured by a one-dimensional sonographic cervical length, where < 25 mm indicates shortening. Preeclampsia is a disorder that can be explained through the Page kidney phenomenon: compression of the left renal vein (LRV) causes renal venous outflow obstruction, leading to elevated intrarenal pressure and hypertension. The supine pressor test (SPT) is a diagnostic tool for preeclampsia where a positive test is defined by an increase of 20 mmHg in diastolic blood pressure (BP) when shifting from the left lateral recumbent to the supine position. Due to the intense risk of morbidity and mortality for both the mother and the fetus, the need to monitor BP changes is critical. Currently, there is an unmet clinical need to characterize the hemodynamic and geometric properties of the female reproductive organs throughout gestation. Utilizing ultrasound imaging can increase our knowledge about the 3D anatomy and systemic changes during pregnancy, unravel risk factors, establish preventative methods, and standardize treatment plans. In this thesis research, we developed a murine model to 1) examine the pathophysiology of renal vein stenosis, and 2) investigate the effects of stenosis on various cervical dimensions. Renal vein stenosis was found to greatly impact blood flow velocities, as well as cervical width (p<0.05). LRV and cervical area and height also trend towards significance, and there is negative damage to the left kidney and placentae within the stenosed cohort. We also conducted a human study that showed reduced change in postural BP in patients with higher body mass index (BMI). Systolic and diastolic BP in the supine position was significantly greater than in the lateral position for all BMIs with a baseline increase in BP of approximately 9-14 mmHg. These findings suggest that therapeutic positioning and close monitoring of BP could mitigate the risk of developing related disorders in pregnancy.

Laryngeal cancer affects tens of thousands worldwide every year. The standard of care of surgical resection, chemotherapy, and/or radiation therapy results in significant quality of life deficits including reliance on tracheostomy tubes, loss of voice, and inability to swallow. There are no therapeutic options that restore a functional larynx so that patients can live a more normal life. Laryngeal reconstruction using tissue engineering strategies offers the potential to solve this problem. Laryngeal anatomy is complex with multiple tissue types and therefore engineering approaches require consideration of a multi-layer, interfacial tissue design. Our strategy to overcome these challenges involves the use of advanced bio fabrication techniques where type I oligomeric collagen alone or in the presence of autologous stem cells is used to custom-make the cartilage, skeletal muscle, and mucosal layer of the larynx. This doctoral research project begins by describing the development of the tissue engineered skeletal muscle with aligned collagen matrix and autologous muscle progenitor cells induced to express motor endplates. Next, using this engineered muscle plus the cartilage layer developed by a colleague; we implanted the myochondral engineered construct in a rat hemilaryngectomy model. In this study we saw host-implant integration with no inflammatory foreign body response, neo cartilage and muscle formation, and some return of laryngeal function on the reconstructed side. Next, we worked to scale-up these technologies for use in a porcine model. The pig larynx is more similar in size and function to the human larynx and allows for a full thickness defect to be created. Using confined compression, we created 4-mm thick acellular and cellular cartilage constructs, as well as a 0.5-mm thick acellular mucosal layer. A 1-cm diameter muscle layer containing autologous muscle progenitor cells was created using flow alignment and cultured to induce expression of motor endplates before implantation. Tissue constructs were subjected to mechanical property analyses as well as PCR analysis to describe the differential gene expression by component cells within muscle and cartilage constructs. Each layer was individually sutured into a pig hemilaryngectomy model. The pigs recovered well from the surgery, were eating, had no difficulty breathing, and no aspiration events. At 2 months, respiratory epithelium had completely healed over the implant and was vascularized and had areas of submucosal gland growth. The motor endplate expressing muscle implants showed new, organized muscle ingrowth while the acellular implants showed a relative paucity of new, disorganized muscle. This work represents a significant advancement in the field of laryngeal reconstruction and is a first of its kind to use scalable tissue engineering technologies designed to specifically meet each layer’s functional criteria.

This thesis describes a series of studies in which ultrasound was used to measure muscle activity around the shoulder. The preliminary studies used professional musicians as subjects because the chronic nature of their problems with shoulder muscles offered an opportunity to test the usefulness of ultrasound in a changing physical environment. Once protocols, reliability, validity and sensitivity to change were established, the main study focused on ?normal? subjects in order to explore ?normal? variability.

An increasing number of individuals with physical disabilities or mental disorders are incorporating specially trained service dogs as an assistance aid to improve functionality. In addition to the tasks that service dogs are rained for, studies also suggest that service dogs may benefit psychosocial health and wellbeing. However, current knowledge on these potential benefits is limited by methodological weaknesses without multi-method assessment. There remains a need for empirical and replicable quantification the psychosocial outcomes of service dog assistance and companionship.

The objective of Chapters 1-3 was to summarize, evaluate, and quantify the effects of service dogs on psychosocial health among individuals with physical disabilities. Chapter 1 conducted a systematic literature review of N=24 articles describing the effects of guide, hearing, mobility, and medical service dogs on standardized measures of psychosocial functioning. Chapters 2 and 3 conducted an empirical investigation using quantitative and qualitative methods to quantify the psychosocial effects of mobility and medical service dogs among N=154 individuals with physical disabilities. Results identified specific psychological, social, and emotional benefits that are associated with having an assistance dog or service dog among diverse populations with physical disabilities or chronic conditions.

The objective of Chapters 4-6 was to quantify the role of psychiatric service dogs for post-9/11 military veterans with PTSD. Chapter 4 quantified the perceived importance, frequency of use, and therapeutic value of service dog behaviors for N=216 military veterans with PTSD. Chapters 5 and 6 then quantified the effects that PTSD service dogs on psychosocial outcomes and physiological indicators of functioning, respectively, among a sample of N=141 military veterans with PTSD. Results identified therapeutic components, tangible psychosocial benefits, and potential physiological mechanisms of psychiatric service dogs for military veterans with PTSD.

Overall, this research combined quantitative, qualitative, and physiological measurement to describe outcomes of service dog pairings in two different at-risk populations. Results provide non-causational evidence of psychosocial benefits from service dogs for individuals with physical disabilities or mental disorders. Findings provide a basis for further large-scale research to disentangle active components of the assistance dog-human partnership and identify potential mediating variables of effects.

This dissertation examines the relationship between legislation and advocacy as forms of professional communication and interrogates their influence on mental health in the United States. Through a case study of one mental health nonprofit’s advocacy materials and interactions with the legislative process, this dissertation demonstrates the entanglements between legislation and advocacy materials and how their circulation impacts mental health outcomes at the national, state, and local levels. I use two major research strategies to conduct my case study: 1) structured interviews with staff members from the nonprofit’s national, Indiana state, and local offices and 2) a qualitative analysis of mental health legislation at the federal, state, and local levels, as well as the nonprofit’s advocacy materials using Rhetorical Ecologies and Assemblage Theory as the primary theoretical frameworks. My findings suggest that, although both the organization and legislative bodies in the United States have some hierarchal tendencies, they function more like a rhizomatic, multilevel assemblage that is constantly evolving and growing as a result of the communicative interactions among its various components. This is due largely in part to the organization’s grassroots structure, which enables staff and supporters from the state and local levels to affect change within and beyond the organization. Although components at the federal/national level have the most significant affects across the assemblage, my findings demonstrate how state and local components can disrupt or deterritorialise the assemblage to create new “lines of flight” or “flows” that expand the assemblage (DeLanda, 2006, 2016; Deleuze & Guattari, 1987; Fox & Alldred, 2015).

The findings and conclusions generated from this dissertation have several implications for mental health advocacy organizations, Technical and Professional Communication (TPC) pedagogy, and the Rhetoric of Health and Medicine (RHM) and the broader field of Rhetoric and Composition. For advocacy organizations, it provides a framework for tracking the potential material impacts of advocacy initiatives and legislation. For TPC pedagogy, it enables instructors to frame professional genres as components of a larger assemblage or organizational/institutional system, rather than as static artifacts. Finally, for RHM and Rhetoric and Composition, it provides a methodology for engaging in institutional and systems research that can be adapted to other rhetorical contexts.

The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.

Heat stress (HS) induced changes in energy metabolism, proteolysis, lipogenesis, and oxidative balance have meat quality ramifications for livestock. However, several knowledge gaps exist in understanding heat stressed finishing pig physiology and pork quality characteristics and how dietary zinc may ameliorate undesirable outcomes. Research was completed to determine zinc supplementation effects on carcass composition, meat quality, and oxidative stability of fresh and processed pork from pigs subjected to a chronic, cyclic heat stress using a 2×2×2 factorial arrangement of treatments with main effects of environment (HS vs. thermoneutral; TN), added zinc level (50 vs. 130 mg kg^-1 available zinc), and zinc source (inorganic vs. organic). Commercial crossbred mixed-sex pigs (initially 72.0 kg) were group-housed under either TN (18.9-16.7°C) or cycling HS conditions with chronic diurnal heat (30-29°C/26-27°C for 12h:12h) on days 24-71 with acute heat waves (32-33°C/29-30°C for 12h:12h) on days 21-24, 42-45, and 63-65. One representative pig (n=80) per pen was slaughtered on day 64. The HS pigs were lighter bodyweight (P=0.039), yielded lighter carcasses (P=0.011), less last rib backfat (P=0.032), tended to have smaller loin eye area (P=0.062) but similar percent lean in belly center slices (P>0.10). Compared to TN, HS carcasses had higher 24-h pH (P=0.001) and decreased drip loss (P=0.034). Shifts in individual fatty acid profile of sausage product derived from HS carcasses were observed but were of insufficient magnitude to affect iodine value. Initially, sausage from HS carcasses tended (day 0, P=0.071) to have less thiobarbituric acid reactive substances than TN but over a 10-day simulated retail display, no treatment induced lipid oxidation differences (P>0.05) were observed in either sausage or displayed loin chops. Consistent treatment differences in CIE L*a*b* of products throughout the 10-day display were not observed. The relationships between physiological changes in pigs receiving supplemental zinc and their body and ambient temperatures were also investigated. A representative gilt (n=96) was selected for thermal monitoring from each pen of the 2×2×2 treatments plus 4 additional treatments representing 2 intermediate levels of Zn in both environments. Core body temperatures (T_core) during the day 42-45 acute heat wave were continuously recorded via indwelling vaginal thermometers and infrared thermal imaging was used to measure skin temperatures at 12-hour intervals. From a 64-gilt subset of the 2×2×2 treatments, jejunum and ileum samples were collected on day 64 for analysis of villus height, crypt depth, and jejunal gene expression of heat shock proteins (27, 70, 90), occludin, and mucin (MUC2). The HS model induced thermoregulatory changes and increases in T_core (P<0.05). Day 42-45 ambient temperature was negatively correlated with expression of HSP-27 (r=-0.42, P=0.047), HSP-90 (r=-0.49, P=0.014), and occludin (r=-0.69, P<0.001) in HS pigs. For the organic Zn supplemented pigs, ambient temperature was positively correlated with expression of HSP-27 (r=0.42, P=0.034) and MUC2 (r=0.45, P=0.017) and negatively correlated with villus height in jejunum (r=-0.42, P=0.027) and ileum (r=-0.38, P=0.048). Thermal Circulation Index (measure of heat dissipation) of HS pigs was negatively correlated with their ileum villus height (r=-0.51, P=0.015) and positively correlated with HSP-70 expression (r=0.46, P=0.041). The T_core lacked correlation with most variables. This research demonstrates cyclic HS affects carcass composition and quality but does not appear to reduce display shelf-life of pork as indicated by lack of differences in lipid oxidation and color stability. In this HS model, zinc level or source imparted negligible benefits and thermal correlations with gut integrity characteristics existed for organic zinc supplemented and HS pigs. The degree of heat dissipation by heat stressed pigs appeared to be associated with classic HS damage and intestinal responses which may be useful indicators of HS in the grow-finish pig. Another agricultural challenge is maintaining higher education programming which establishes a successful career trajectory for agricultural students amid generational shifts in attitudes and background experiences. Undergraduates studying Animal Science and/or Agricultural Economics were surveyed to understand their perception of how collegiate curricular, co-curricular, and extracurricular experiences (coursework, club participation, relevant work experience, international experience, advising/mentoring, college life, and professional networking) contribute to their anticipated career success. A best-worst scaling experiment was used to force respondents (n=487) to make unbiased tradeoffs between the collegiate experience attributes. Responses were then related back to additional demographical and experience/perception characteristics of respondents. Students indicated relevant work experience was overwhelmingly the most critical of the 7 factors (57% preference share), followed by professional networking (19%), and coursework (14%). Students solely in a pre-veterinary Animal Science curriculum represented a distinct category of students regarding their beliefs and experiences. Further research is needed to investigate possible disconnects between student perceptions and reality in higher education and agricultural careers.