Bakgrund: Sexualiteten följer en person genom hela livet. Andelen äldre personer ökar i befolkningen då medellivslängden ökar. Allt fler äldre personer är sexuellt aktiva och många önskar att de kunde vara mer sexuellt aktiva. Att undersöka äldre personers sexuella aktivitet och tillfredsställelse med sexuallivet i samband med livstillfredställelse skulle kunna generera kunskap för sjuksköterskan i arbetet att bedriva en god omvårdnad. En ökad kunskap om äldre personers sexualitet skulle kunna användas i utvecklingsarbetet till att förbättra omvårdnaden för äldre personer i relation till deras sexualitet. Syfte: Syftet med studien var att beskriva sexuell aktivitet och tillfredsställelse med sexualliv relaterat till kön, ålder och partnerskap samt undersöka sambandet mellan sexuell aktivitet, tillfredställelse med sexualliv och livstillfredställelse hos äldre personer. Metod: En kvantitativ tvärsnittsstudie. Baserad på inhämtad data från Swedish National Study on Aging and Care – Blekinge (SNAC-B). Deskriptiv och analyserande statistik har använts för att kunna se samband och förekomster. 1119 personer är med i studien i åldrarna 60 år till 90 år och uppåt. 43,8 % är män och 56,2 % är kvinnor av de som deltog. Resultat: Sexuell aktivitet (p=<0,001) och tillfredsställelse med sexuallivet (p=<0,01) påverkar livstillfredsställelsen. Fler män är sexuellt aktiva (57,8%) medan fler kvinnor är tillfredsställda med sitt sexualliv (85,0%) (p=<0,001). De som har en partner är mer sexuellt aktiva (63,8%) (p=<0,001). Den sexuella aktiviteten minskar succesivt med åren (p=0,001).   Slutsats: Studien visar att det finns ett samband mellan sexuell aktivitet, tillfredsställelse med sexuallivet och livstillfredsställelsen. Detta visar att sexualiteten är viktigt del av livet även för äldre personer. Denna kunskap kan ha en betydelse för att sjuksköterskan ska kunna förbättra omvårdnaden till äldre personer i förhållande till deras sexualitet. Det är viktigt att inom sjukvården bejaka äldre personers sexualitet och inte förkasta den.

This thesis consists of three parts. The first part is an introduction and referencessome recent work on 2D electromagnetic scattering problems at high frequencies. It alsopresents the basic integral equation types for impenetrable objects. A brief discussionof the standard elements of the method of moments is followed by summaries of thepapers.Paper I presents an accurate implementation of the method of moments for a perfectlyconducting cylinder. A scaling for the rapid variation of the solution improves accuracy.At high frequencies, the method of moments leads to a large dense system of equations.Sparsity in this system is obtained by modifying the integration path in the integralequation. The modified path reduces the accuracy in the deep shadow.In paper II, a hybrid method is used to handle the standing waves that are prominentin the shadow for the TE case. The shadow region is treated separately, in a hybridscheme based on a priori knowledge about the solution. An accurate method to combinesolutions in this hybrid scheme is presented.

Single enzymes of E. coli sourced B-galactosidase were analysed in effort to expand the wealth of knowledge in the area of heterogeneity. Static and dynamic heterogeneity was studied with respect to catalytic rate, electrophoretic mobility, and heat shock protein chaperone systems. Temperature was found to be a contributing factor to the observed range of dynamic heterogeneity, with the range increasing with temperature. The inhibitor dissociation constant was determined to be a heterogeneous property of B-galactosidase. A novel assay was developed in which a single enzyme molecule was subjected to three separate solutions while the enzyme itself remained free in solution. / October 2016

Chronic lymphocytic leukemia (CLL) is a cancer of B cells and is the most common leukemia in North America. Current therapies are fraught with challenges, and drug resistance and disease relapse remain common occurrences. Therefore, novel therapies and novel therapeutic strategies are needed to improve CLL therapy. Better yet, therapies targeted at specific weaknesses of CLL cells will ensure maximum efficacy and minimum adverse toxicity. To this end, this thesis focuses on targeting the susceptible BCR pathway and lysosome-mediated cell death pathway using gefitinib and lysosomotropic agents, respectively. Firstly, the novel use of the tyrosine kinase inhibitor gefitinib was explored. This drug was most effective in aggressive ZAP-70+ CLL cells and cell lines. A similar inhibitor, erlotinib, had no effect in CLL. Gefitinib inhibited phosphorylation of Syk and ZAP-70, prevented downstream kinase activation, and supressed the pro-survival BCR response. ZAP-70 is implicated in the mechanism of action of gefitinib as introduction of ZAP-70 into a B cell line increased their sensitivity to gefitinib. Secondly, the novel strategy of targeting lysosomes was explored. The lysosomotropic drugs siramesine, nortriptyline, desipramine, mefloquine, and tafenoquine were all found to induce cytotoxicity and lysosome permeabilization. Lysosome permeabilization was accompanied with lipid peroxidation and followed by loss of mitochondrial membrane potential. Compared with healthy B cells, CLL cells were more sensitive to this cell death pathway. This was potentially due to the overexpression of SPP1 and overproduction of sphingosine, which destabilized lysosomes. Lastly, this thesis explored the clinical utility of these targeted therapies. Both gefitinib and siramesine were more effective in CLL cells than patient T cells. Furthermore, they retained efficacy amid protective stromal cells. Clinical correlations revealed that gefitinib and siramesine were effective in CLL cells with poor prognostic features. Siramesine was more effective in male cells and in previously-treated cells. Gefitinib was most effective in young patients. Overall, work presented herein demonstrates the efficacy of the tyrosine kinase inhibitor gefitinib and lysosomotropic agents in primary CLL cells. This work investigates the altered biology of the BCR pathway and lysosomes in CLL cells, and takes advantage of these weaknesses using targeted therapies. / October 2016

This study is an effort to add to the body of evidence for or against the validity of the concept of Interchange Compatibility as a factor in the goal achievement and cohesion of a group.

The investigation examined the effects of formal and semantic intralist stimulus similarity (ISS) on transfer of stimulus differentiations in the A-B, A-C paradigm.

Objetivo: Comparar los perfiles de seguridad de la Anfotericina B complejo lipídico y Anfotericina B convencional. Metodología: Se analizaron todas las historias clínicas de pacientes del Hospital Nacional “Edgardo Rebagliati Martins”que recibieron anfotericina B, tanto en terapia confirmada de infecciones fúngicas como en terapia empírica en sospecha de infección fúngica o como medicamento antileishmaniásico durante el periodo comprendido desde el 01 de Agosto del 2011 hasta el 31 de Julio del año 2012. 76 pacientes cumplieron con criterios de inclusión y exclusión. Se evaluó las dosis administradas, las pruebas de laboratorio de cada paciente antes, durante y después del tratamiento, junto con las observaciones registradas por el médico tratante y las notas de enfermería. Resultados: No se encontraron diferencias estadísticas significativas en la efectividad clínica de anfotericina B deoxicolato (48,5%) –AmB– y anfotericina B complejo lipídico (60%) –ABCL– (p-valor 0.421); tampoco se encontraron diferencias en la eficacia clínica (50,0% para AmB vs 66,7% para ABCL, p-valor 0.348). De las reacciones intrínsecas al medicamento, se encontró diferencias estadísticas significativas a nivel de perfil renal en el incremento de creatinina sérica tanto en presencia (79,7% para AmB vs 50% para ABCL, OR 0.25 IC 95% [0.087 – 0.74], p-valor 0.009) como en probabilidad de incremento mayor igual al 20% (p-valor 0.03); sin embargo, no se encontraron diferencias significativas en la presencia de lesión renal aguda (40,6% para AmB y 30% para ABCL, p-valor 0.393). 9,6% de pacientes que utilizaron AmB presentó falla renal (Lesión renal estadío 3/ RIFLE-F). No se encontraron diferencias significativas a nivel de perfil hematológico y hepático. Según los criterios CIOMS modificados, la presencia de hepatotoxicidad fue de 21,7% para AmB y 37,5% para ABCL (p-valor 0.60). Respecto a las reacciones debidas a infusión, se encontraron diferencias significativas en la presencia de náuseas (25,0% para AmB vs 56,5% para ABCL, p-valor 0.006), fiebre (28,1% para AmB vs 52,2% para ABCL, p-valor 0.037), y escalofríos (3,1% para AmB vs 30,4% para ABCL, p-valor 0.001), sin embargo no se encontraron diferencias significativas en la presencia de vómitos, malestar general, hipertensión y flebitis. Conclusiones: Anfotericina B complejo lipídico muestra una eficacia y efectividad comparable al de anfotericina B deoxicolato. Se encontraron diferencias estadísticas significativas en el incremento de creatinina a favor de anfotericina B complejo lipídico. Palabras clave: Anfotericina B deoxicolato, Anfotericina B complejo lipídico, lesión renal aguda, hepatotoxicidad, reacciones adversas. / Objective: To compare the safety profiles of amphotericin B lipid complex and conventional amphotericin B. Methods: It was analyzed the medical records of all patients of "Edgardo Rebagliati Martins" National Hospital who received amphotericin B, both confirmed fungal infections and empirical therapy of suspected fungal infection or as antileishmanial drug during the period from 1 August 2011 until 31 July 2012. 76 patients met inclusion and exclusion criteria. It was evaluated the administered dose, laboratory tests of each patient before, during and after treatment with those recorded observations by the attending physician and nursing notes. Results: No statistically significant differences were found in the clinical effectiveness of amphotericin B deoxycholate (48.5%) - AmB - and amphotericin B lipid complex (60 %) - ABCL -(p - value 0.421), no differences were found in the clinical efficacy (50.0 % vs 66.7 % for AmB for ABCL, p- value 0.348). Of intrinsic drug reactions, statistically significant differences at the level of renal profile was found in the serum creatinine increase both in the presence (79.7% vs 50 % for AmB for ABCL, OR 0.25 95% CI [0.087 to 0.74] , p- value 0.009) and more likely to increase at least 20% (p- value 0.03 ), but no significant differences were found in the presence of acute renal injury (40.6 % for AmB and 30% for ABCL, p- value 0.393). 9.6% of patients using AmB had renal failure (kidney injury stage 3 / RIFLE -F). No significant differences at the level of haematological and liver function were found. According to CIOMS modified criteria, the presence of hepatotoxicity was 21.7% and 37.5% for AmB for ABCL (p- value 0.60). Concerning infusion reactions, there was significant differences in the presence of nausea (25.0% vs 56.5 % for AmB for ABCL, p- value 0.006), fever (28.1% were found for AmB vs 52.2 % for ABCL, p- value 0.037), and chills (3.1% for AmB vs. 30.4 % ABCL, p- value 0.001), however no significant differences were found in the presence of vomiting, malaise, hypertension and phlebitis. Conclusions: Amphotericin B lipid complex shows efficacy and effectiveness comparable to that of amphotericin B deoxycholate. Statistically significant differences in the increase of creatinine in favor of amphotericin B lipid complex were found. Keywords: Amphotericin B deoxycholate, amphotericin B lipid complex, acute renal injury, hepatotoxicity, adverse reactions.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

The chromosome passenger complex (CPC) is an essential mitotic regulator with key roles in mitotic processes such as chromosome condensation, spindle dynamics, chromosome bi-orientation, the spindle checkpoint and cytokinesis. The Aurora B kinase is the CPC’s catalytic subunit. Its targeting and activation are dependent on interactions with the other components of the complex: inner centromere protein (INCENP), survivin and borealin/Dasra B. INCENP serves both as a scaffolding subunit for the CPC as a whole and as an activator of Aurora B via its highly conserved INbox domain. Aurora B is a putative anti‐cancer target; several inhibitors of the kinase are currently in clinical trials. All these are ATP-analogues targeting the kinase active site. The protein-­protein interaction between Aurora B and the INCENP INbox is also essential for CPC function. Earlier studies have demonstrated that INCENP INbox mutants unable to bind and/or activate Aurora B cannot rescue lethality in the absence of endogenous INCENP. The first goal of this study was to test the in vivo effects of disrupting the interaction between endogenous wild type INCENP and Aurora B. For this, a cell-based CPC function assay was developed in HeLa cells. Using this assay, I show that expression of soluble INbox in HeLa cells produces a significant increase in multinucleated and micronucleated cells: both effects consistent with Aurora B loss of function. Expression of soluble INbox bearing the mutations W845G and/or F881A does not elicit this effect suggesting that those mutants cannot bind to Aurora B and occlude INCENP binding. The result concerning the F881A mutant contrasts with earlier reports that equivalent mutants could bind, but not activate, Aurora B. Expression of an INbox mutant lacking the C-­terminal TSS motif reported to be involved in Aurora B activation but not binding has effects similar to those of the wild type INbox. Using the INbox/Aurora B interaction as a model, a secondary goal of this study was to develop and evaluate a novel approach to identify small peptides capable of dissociating intracellular protein‐protein interactions. For this, a library of small (5-­9 residues long) circular peptides (CPs) mimicking the INbox was generated using the split intein circular ligation of proteins and peptides (SICLOPPS) methodology and assayed using the cell-­based CPC function assay. Over two successive rounds of screening, a small number of CPs were identified that caused a significant increase in rates of multinucleated and micronucleated cells. Although statistically significant, these increases were very modest. Furthermore, due to high heterogeneity in SICLOPPS processing efficiencies, it was not practicable to compare the effects of different peptides side-­by-side by transfection. The level of variation in processing efficiency – thus, CP production – was unexpectedly high and puts into question the functional complexity of more commonly used combinatorial cyclic peptide libraries derived using current SICLOPPS methodology. The results of this study are divided into three sections. The first is a methods section concerning the testing of SICLOPPS in HeLa cells and the development of a cell­‐based CPC function assay. In the second, the effects of expressing soluble INbox and mutants thereof in HeLa cells are presented. The final results section presents the results of the feasibility study of the rationally-­designed genetically encoded library approach.

Proteolytic processing of transmembrane receptors and ligands can have dramatic effects on cell signaling and subsequent cellular responses. Previous studies demonstrated that a disintegrin and metalloproteinase 10 (ADAM10) may cleave numerous B cell-expressed receptors, including the low affinity IgE receptor (CD23). However, lethality of ADAM10-deficient embryos has limited examination of these cleavage events in lymphocytes. To investigate their role in B cell development and function, we generated B cell-specific ADAM10 knockout mice. Intriguingly, deletion prevented development of the entire marginal zone B cell (MZB) lineage. Further analysis revealed that ADAM10 is required for S2 cleavage of the Notch2 receptor and initiation of Notch2 signaling, which is required for MZB development. Additionally, cleavage of CD23 was dramatically impaired in ADAM10-deficient B cells. This finding and results of ex vivo cleavage assays demonstrated that ADAM10 is the principal in vivo sheddase of CD23. Previous studies have demonstrated that Notch signaling and CD23 cleavage regulate antibody production. Accordingly, deletion of ADAM10 profoundly inhibited germinal center formation, and T-dependent and T-independent antibody responses to immunization, implicating ADAM10 as a novel regulator of adaptive immunity. Additionally, to determine the role of ADAM10 activity in hematopoiesis, we generated transgenic mice (A10Tg) that overexpress the protease on lymphoid and myeloid progenitors. Surprisingly, this markedly suppressed B2 cell development and promoted dramatic expansion of myeloid-derived suppressor cells (MDSCs) via a cell intrinsic mechanism. A10Tg MDSCs inhibited T cell proliferation and adoptive immunotherapy of B16 melanoma, resulting in exacerbated metastatic progression that was prevented by MDSC depletion. Thus, A10Tg mice represent a novel model for the examination of MDSC development and MDSC-mediated immune suppression in a tumor-free environment. Finally, hematopoietic stem cell cultures revealed that ADAM10 overexpression directs myeloid development by dysregulating Notch signaling via uncoupling the highly regulated proteolysis of Notch receptors. Collectively, these findings demonstrate that ADAM10 is a critical regulator of Notch signaling, B cell development, and MDSC expansion. Moreover, they have important implications for the treatment of numerous CD23 and Notch mediated pathologies, ranging from allergy to cancer.