This insider research journey explores the meaning-making processes of female spousal caregivers in anticipatory mourning and the knowledges which they have gained in retrospect. The research traces the social constructions of meaning and how they influence the process of meaning-making. A phenomenological study was undertaken in which unstructured interviews were conducted with five bereaved participants, highlighting the unique way in which each woman made meaning of loss in anticipatory mourning. The main phenomenological themes to emerge from their meaning-making were: a) the significance of time; b) challenges and gifts; c) witnessing the decline; d) paradoxes; e) the significance of the spousal relationship; and f) spirituality. The therapeutic effect of telling the life story is explored in this study and the need for contextual pastoral care that is specific to the state of anticipatory mourning is highlighted. Finally, possibilities for co-constructive pastoral care are raised in the light of the research findings. / Philosophy, Practical and Systematic Theology / M. Th. ( Practical Theology, with Specialisation in Pastoral Therapy)

The purpose of this research is to explore how narrative practices can be meaningful in pastoral conversations with women living with breast cancer. A theoretical collaboration between narrative therapy, feminism and pastoral theology has been used in order to facilitate meaning-making, to give ‘voice’ to local knowledge, and to co-create a more holistic understanding of the experiences of illness narratives and breast cancer. The methodology of this research is ‘interdisciplinary’ and uses qualitative, co-participatory action research and reflexivity as its research design. Conversations with the co-researchers explore illness narratives, breast cancer, spirituality and faith, life-giving relationships, femininity and body image, socially constructed discourses and pivotal moments that enable alternative stories. Values of respect, curiosity and listening have been upheld in order to provide a safe place for the co-researchers to give voice to their stories and experiences of breast cancer in a way that supports the researcher position of ‘witness’. / Philosophy, Practical and Systematic Theology / M. Th. (Practical Theology, with specialisation in Pastoral Therapy)

O propósito desta dissertação é examinar como mulheres percebem e vivenciam a experiência de serem diagnosticadas com câncer de mama. A pesquisa social de campo envolve um universo de oito mulheres que passaram por esta trajetória sendo uma delas a própria autora, que traça uma auto-análise de sua experiência com este diagnóstico. Um aspecto específico com o qual a pesquisa busca se ocupar é identificar o lugar que a espiritualidade ocupa na história das mulheres entrevistadas. O câncer de mama apresenta um alto índice da doença no Rio Grande do Sul. Conforme a Revista Gaúcha de Enfermagem, o câncer de mama é a maior causa de morte de mulheres entre 30 a 50 anos de idade. De acordo com as estatísticas do Instituto Nacional do Câncer, o câncer de mama é o segundo tipo mais freqüente de câncer do mundo. Assim sendo, o câncer de mama ainda é uma doença que leva à morte, mesmo com o enorme avanço da medicina. Mas, há quem sobreviva o temido e assustador processo da descoberta e tratamento do câncer. Com a doença do câncer vem também a angústia da finitude. O presente trabalho baseia suas reflexões teóricas em Eugen Drewermann e Paul Tillich e como os mesmos descrevem a angústia existencial do ser humano, diferenciando-a do medo real, que tem o seu objeto definido, enquanto que a angústia existencial tem como fonte de sua permanente ameaça o nada. A angústia e a culpa estão relacionadas, estando a culpa ligada ao afastamento de Deus. A aceitação do ser finito, através da coragem do ser, ato de fé por graça divina, substitui, em última análise, a angústia por confiança no Deus da Vida. Os autores, ambos os teólogos, apontam para a interdisciplinaridade. A proposta dessa pesquisa é de atuar em colaboração com outras ciências, de maneira especial com a Psicologia Analítica. Uma pessoa em crise, que trabalha seus processos interiores, poderá ter facilitado sua entrega confiante a Deus. É ainda sucintamente apresentado, conforme Drewermann, como o patológico se manifesta na vida de pessoas que, assim como todas as demais pessoas, carecem da experiência da graça de Deus para sua libertação. A pesquisa finaliza trazendo a abordagem de Erika Schuchardt, formulada no modelo de uma espiral de oito fases, pelas quais passam as pessoas em crise. / The purpose of this dissertation is to examine how women perceive and live the experience of receiving a diagnostic of breast cancer. Field research involves a total of eight women who have experienced this situation, one of them being the authors self-reflection on a cancer diagnostic. A specific aspect of the present research is to identify the place that spirituality takes in the life history of the interviewed women. The State of Rio Grande do Sul presents a high rate of breast cancer. According to the agency Revistal Gaúcha de Enfermagem, breast cancer is the death main cause among women between thirty and fifty years old. Statistics of the National Cancer Institute indicates that breast cancer occupies the second place among the different sorts of cancer. Even though medicine has shown great advance in the last decades, breast cancer still continues to be a deadly disease. However, there are people who survive the fearsome and frightening fatal process caused by this disease. With cancer comes along the human finitude anxiety. The present work bases its reflection on how Eugen Drewermann and Paul Tillich describe the human existential anxiety distinguishing it from real fear. According to the authors real fear has its object defined, while existential anguish has as source of its permanent threat, the nothingness. Anguish and guilt are connected, but guilt is associated to the alienation from God. Acceptance of the existence as finite, through the courage of Being, which is an act of faith by divine grace, replaces anguish by trust in the God of Life. The authors above, both theologians, aim at interdisciplinarity. The purpose of this research is to act in collaboration with other sciences, specially with Analytical Psychology. A person in crisis working her/his interior processes might have facilitated the confident surrender to God. It is also briefly presented, according to Drewermann, how pathology evidences itself in the life of a person who, as all other persons, lacks the experience of the grace of God to his/her liberation. Concluding, the research approaches Erika Schuchartds theory formulated in the model for working through crisis in eight spiral phases.

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

La voie de signalisation mTOR (mammalian Target Of Rapamycin) joue un rôle central dans la croissance cellulaire, le métabolisme, et l'homéostasie des lymphocytes T (LT). Lors de la transplantation d'organes, l'administration de rapamycine, un inhibiteur de mTOR (mTORi), bloque l'activation des LT et promeut la polarisation des lymphocytes T CD4 régulateur (Treg). En cancérologie, des mTORi sont utilisés pour leur action inhibitrice sur la prolifération et l'angiogenèse tumorales. Cependant l'immunosuppression via l'induction de Treg nécessaire à la prévention du rejet de greffe pourrait être délétère pour la réponse anti-tumorale. Notre hypothèse est que l'efficacité clinique des mTORi serait également dépendante de la modulation de l'immunité adaptative T induite par ces traitements chez les patients atteints de cancer.Au cours de cette thèse, nous avons abordé cette question immunologique dans une cohorte prospective de patients atteints de cancer rénal métastatique (mRCC) traités par évérolimus. L'analyse du taux de Treg et de la réponse spontanée T CD4 Thl anti-tumorale (anti-télomérase TERT) par Elispot-IFN-y a été effectuée au moment de l'inclusion des patients et tous les deux mois après le début du traitement. Nous avons observé chez la majorité des patients une augmentation du taux de Treg après traitement par évérolimus. Ces Treg expriment Hélios, suggérant un phénotype Treg naturel. La fréquence et la qualité de la réponse Thl anti-TERT sont également augmentées suite au traitement. Nous avons montré que conjointement ces deux paramètres immunologiques corrèlent avec l'efficacité clinique du traitement. Les patients présentant précocement une diminution des Treg associée à une augmentation des Thl anti-TERT ont une meilleure survie par rapport aux patients dont les paramètres immunitaires ne variaient pas, ou variaient dans une même direction (13,2 mois vs 8 et 4 mois). De plus, au moment de la progression la plupart des patients perdaient leur réponse Thl anti-TERT, et cet effet était associé à une augmentation des Treg. Les Treg traités par mTORi in vitro inhibent plus fortement la prolifération de LT allogéniques, par un mécanisme contact dépendant. Par l'utilisation d'anticorps monoclonaux déplétant les LT chez la souris et par l'utilisation de souris DEREG, nous avons montré que la présence de Treg in vivo altère l'efficacité anti-tumorale des mTORi, par un mécanisme impliquant l'inhibition des réponses T CD8 anti-tumorales. En conséquence, l'efficacité des mTORi a pu être augmentée par sa combinaison avec des agents bloquant les Treg. En addition, l'administration de temsirolimus améliore l'efficacité anti-tumorale d'un vaccin thérapeutique, en favorisant la différenciation des LT CD8 anti-tumoraux centraux mémoires (CD62L+CD127+) et précurseurs mémoires (CD127+KLRGl'°) induits par la vaccination.En conclusion, ces études ont montré pour la première fois le rôle de l'immunité T anti-tumorale sur l'efficacité clinique des mTORi et soulignent ainsi l'intérêt potentiel de combiner les mTORi avec des immunothérapies anti-tumorales / The mammalian Target of Rapamycin (mTOR) pathway plays a central role in the regulation of cell growth andmetabolism, and is involved in oncogenesis. Everolimus and temsirolimus are two mTOR inhibitors (mTORi) approvedfor renal and breast carcinoma treatments. However, accumulating evidence highlights a central role for mTOR pathwayin T cell immunity. We showed that 21 out of 23 metastatic renal cell carcinoma patients under everolimus treatmenthad an increase of Tregs atter everolimus treatment. Paradoxically, strong antitumor Th 1 responses were detected andthen greatly decreased at the time of disease progression when high expansion of Tregs occurred. Furthermore, weidentified three immune groups based on the early modulation of both Treg and anti-tumor Thl cells and found thatpatients with {low Tregs plus high anti-tumor Thl cells} showed the best survival. In vitro, mTORi-exposed Tregs highlysuppressed T cell proliferation and Thl-associated cytokines production. We showed in vivo that T cells depletiondifferentially modulated the antitumor efficacy of mTORi. Although anti-mTOR effect was loss in B16-OVA-bearingmice lacking CD8 T cells, CD4 T depletion increased mTORi efficacy. The studies conducted in mice demonstratedthat the presence of Tregs in vivo altered the responses to mTORi via a mechanism involving the inhibition of antitumorCD8 T cell responses. Finally the efficacy of mTORi was improved by combination with Tregs depleting agents andvaccines. Altogether, our results describe for the first time a dual impact of host adaptive antitumor T cell immunity onthe clinical effectiveness of mTQRi and prompt their association with immunotherapies.

This PhD thesis explored the experiences of dependent children and children care-givers facing challenges with their parent s cancer. The aim was to understand children s information experience including their perception of cancer and information culture; information needs, information seeking behaviour, barriers and enablers. The research used a six-stage process. This was informed by an extensive literature review and discussions with cancer specialists, psychologists and researchers from United Kingdom, United States, Australia and Malaysia. This study used a three-cycle, eight-step process of Participative Action Research (PAR) with participation from ten Malay breast cancer patients and their dependent children. Three bilingual (English and Bahasa Malaysia) instruments were developed; 1) An Inquiry to Participate Form to select participants who had dependent children, 2) Three opened-ended questions to obtain children s cancer experience and information needs where drawing was used to encourage children s responses and, 3) A 15-question questionnaire to understand children s experience and information preference. Cancer affected parenting abilities and challenging experiences identified the lack of culturally relevant information and the shift in caregiving responsibilities to dependent children. Children s understanding of cancer was influenced by their experiences and observations, many of which resulted in misconceptions about cancer, its causes, treatment and preventative measures. Children participant s reaction to a health situation triggered their information behaviour. The burden of caregiving and the consequences of a lack of information were greater than anticipated; children had many dimensions of concern and experienced many challenges. This advocated for a more assessable, attractive and sensitive information system. Data synthesis contributed to the development of a Children s Reactive Information Seeking Behaviour An Integrated Model that seeks to explain the relationship between children participants reaction to a health situation and the subsequent processes they undergo to resolve their state of information need.

The thesis discusses the methods of determination of tumor markers and their clinical importance in medical diagnostics. The theoretical part describes clinically important tumor markers and also the chemiluminescent immunoassay methods used for their determination. The practical part of the thesis describes the introduction of new chemiluminescent methods for the determination of tumor markers in routine operation, evaluates its basic analytical parameters and compares it with the existing immunoturbidimetric method. The practical part also presents results of monitoring of cancer patients with various tumors, which is performed by evaluation of the values of tumor markers. Comparison of our method with other methods within the context of System of external quality control is also documented.

MCur / Department of Advanced Nursing Science / See the attached abstract below

In der vorliegenden Arbeit wurde der zelluläre Immunstatus von 17 Patienten mit Erstdiagnose eines soliden gastrointestinalen Tumors vor und nach intravenöser Applikation von drei Zyklen einer konventionellen Polychemotherapie untersucht. Verglichen wurde zu Beginn der Therapie mit einer Kontrollgruppe, bestehend aus 21 nicht onkologisch vorerkrankten Probanden. Zur Messung der individuellen T-Zellvermittelten Immunantwort auf Einzelzellebene wird auf die Methode des IFN-γ-ELISPOT-Assays zurückgegriffen. Die zentrale Frage war, ob die Applikation einer Polychemotherapie einen messbaren Effekt auf die Immunantwort des einzelnen Individuums hat. Zudem sollte untersucht werden, ob generelle Unterschiede zwischen Patienten mit einer unbehandelten Tumorerkrankung und gesunden Probanden bzw. allgemein internistisch erkrankten Patienten zu erkennen sind. In Zusammenschau der Ergebnisse sind trotz überwiegend unveränderter T-Zell-Antwort auf die meisten der eingesetzten Antigene einige statistisch signifikante Unterschiede festzuhalten. So zeigte die Gruppe der Tumorpatienten vor Applikation der Chemotherapie im Vergleich zur Kontrollgruppe eine signifikant erhöhte Spotintensität und einen höheren Stimulationsindex [A] in Bezug auf das Tuberkulose-Antigen CFP-10. Diese Veränderungen waren nach Applikation der Chemotherapie nicht mehr nachzuweisen. Des Weiteren ergaben sich bei den Tumorpatienten vor und nach Chemotherapie signifikante Veränderungen der T-Zell-Antwort bezüglich des Antigens Tetanus-Toxoid. Nach Applikation von 3 Zyklen Chemotherapie kam es zu einer Verminderung des Stimulationsindex [A]. Es wird daher die Vermutung nahe gelegt, dass sich gerade in Bezug auf bakterielle Infektionen die T-Zell-Antwort der Tumorpatienten signifikant ändert. Die klinische Relevanz müsste jedoch anhand gezielter Messung auf spezifische bakterielle Antigene in größer angelegten Studien überprüft werden.

Indiana University-Purdue University Indianapolis (IUPUI) / Greater levels of loneliness have shown consistent associations with poorer mental and physical health; however, the reason for these relationships is unknown. Engagement in poorer health behaviors among individuals with higher levels of loneliness is one potential explanation for this relationship. Self-regulation theory suggests that coping with feelings of loneliness may impair attempts to control health behaviors. Caregivers of cancer patients have been found to have poor health behaviors (e.g., inadequate exercise) and high levels of loneliness. Thus, the aim of the study is to examine whether health behaviors mediate the relationships between loneliness and mental and physical health outcomes among caregivers of cancer patients. Methods: A secondary data analysis was conducted using data from a longitudinal study of cancer patients and their family caregivers who were staying at the American Cancer Society’s Hope Lodge. Participants completed self-report questionnaires measuring levels of loneliness, engagement in health behaviors (i.e., exercise and fruit and vegetable consumption), mental and physical health, and demographic and medical characteristics at three time points over a 4-month period. A bootstrapping macro was used to examine the indirect effect of loneliness on mental and physical health via health behaviors. Results: Contrary to hypotheses, exercise and fruit and vegetable consumption did not mediate the relationships between loneliness and physical and mental health among cancer patients’ caregivers. Additional research is needed to determine whether health behaviors partially account for the relationships between loneliness and health outcomes or whether alternate explanations for these relationships should be considered.