The increasing popularity of integrative medicine requires that we understand the meaning that patients attribute to their treatment experience. This project was a phenomenological study that sought to understand how nine chronically ill patients perceived their experience of living with illnesses and the treatment process at the integrative clinic. My findings reveal that their illnesses disrupted their life and were a threat to their self. An impetus combined with the influence of the social sphere led patients to join the clinic. The relationship with caregivers at the clinic was an important component of the treatment process and provided participants with the knowledge necessary to manage their illnesses. The positive interaction with caregivers enhanced patient empowerment and improved patient participation. Following treatments at the clinic, the majority of participants felt that their health had improved and that they had returned to their old self. Many had set future goals.

The field study took place in Dzodze, Ghana, over a period of 4 months in 2009. The data was collected through semi directed interviews and ethnography. The aim of this study was to investigate how localized practices provide a lens to gain larger insights into national and transnational politics of healing and knowledge. Precisely, how are current relationships between informal healers and biomedical practitioners performed in the everyday life of Dzodze, Ghana? The results of the study indicate no direct or institutionalized collaboration between biomedical practitioners and healers, however there is some form of relationships between informal birth attendants and public midwives. It is also apparent that the power relations linked with formal practices decrease possibilities for collaboration with informal medicine and also have a negative influence on any possible medium of innovation. The study also shows that people continue to use informal medicine because it works for them yet government reaction towards integration of informal medicine into national health system remains slow. Keywords: informal medicine, biomedicine, relationships

Integrative healthcare (IHC), the combination of biomedical disciplines and expertise in various forms of complementary and alternative medicine (CAM), is an example of interdisciplinary collaboration that has emerged over the last two decades. Little has been written so far to gain an understanding of how the healthcare practitioners in such setting collaborate. The main goal of this doctoral dissertation was to better understand what is inside the "black box" of interdisciplinary collaboration within IHC clinics so that appropriate links related to clinic effectiveness and cost-effectiveness as well as patient outcomes could be tested in future research. This thesis explored the concept of interprofessional collaboration in IHC using three theoretical and conceptual models: Input Process Output, Relationship-Centered Care, and Models of Team Healthcare Practice. Inductive and deductive inquiries were conducted through sequential mixed methods and methodological triangulation techniques. Four objectives were proposed to better understand how collaboration was experienced and conceptualized within these clinics and how the related factors interacted with each others. Finally, assumptions of a conceptual model of classification of IHC clinics were tested. Constructs contributing to collaboration included practitioners' attitudes and educational background, as well as external factors such as the healthcare system and financial pressures. Major processes affecting collaboration consisted in communication, patient referral and power relationships. These determinants of collaboration resulted in learning opportunities for practitioners, modified burden of work and ultimately, higher affective commitment toward the clinic. The quantitative inquiry revealed that interpersonal relationships were shown to be central to the collaborative practice of IHC delivery. Additionally, beliefs in the benefits of collaboration were found to play an important role in an IHC collaborative enterprise. Finally, clinic model comparisons confirmed that interprofessional collaboration is modulated by the practice model. Suggestions to improve the conceptual model of classification were made. This multi-method study was the first to summarize systematically the factors that impact and ensue from interprofessional collaboration in the context of Canadian IHC. The framework lay down by this dissertation represents an important step to investigate further the impact of IHC on patients and the Canadian healthcare system and to guide the development of more effective IHC clinics.

This thesis investigated the phytochemistry and pharmacology of boreal plant species used traditionally as treatments for symptoms and complications of diabetes and was completed in collaboration with the Team in Aboriginal Anti-Diabetic Medicine and the Cree of Eeyou Istchee in northern Quebec. Using a novel metabolomic-based approach, we first developed methods of phytochemical analysis to characterize Vaccinium angustifolium extracts and then other medicinal Ericaceae, identifying and quantifying an abundance of phenolic compounds. These methods were then employed to profile the phenolics in anti-diabetic species identified by Cree Elders. Pharmacological assays of extracts focused primarily on in vitro inhibition of mechanisms involved in the pathophysiology of diabetic neuropathy, associated diabetic complications and neurodegenerative conditions. Upon testing for cytoprotective effects in two models of diabetic neuropathy, few extracts prevented cell loss mediated by serum/glucose deprivation but 10 of 18 significantly reduced glucotoxic cell death. The activities of Picea glauca needles, which was cytoprotective in both models, and Sarracenia purpurea leaves were of particular interest as observed organ-specific effects correlated with medicinal uses identified by Cree Elders. Cytoprotection, however, did not correlate with extract phenolic content or anti-oxidant activity. Active principles were therefore sought through assay-guided fractionation of S. purpurea extract, identifying quercetin-3- O-galactoside, which inhibited glucotoxicity at low micromolar concentrations. Extracts were then tested for effects on formation of advanced glycation endproducts. Most displayed concentration-dependent inhibition with IC50 values ranging from 0.4-38.6 mug/ml. Anti-glycation activity was significantly correlated with extract phenolic content and anti-oxidant capacity. The bioactivities of individual phenolic metabolites were then evaluated at physiologically relevant concentrations using molecular tools to determine cell proliferation, survival and death. A wealth of anti-apoptotic and mitogenic effects were observed and structure-activity relationships were separately identified among benzoic acid derivatives and flavonoids. To explore the neuroprotective potential of these two phenolic classes, collections of each were tested for the ability to inhibit platelet-activating factor (PAF) neurotoxicity. Three novel PAF inhibitors were identified, orsellinic acid, hesperetin and quercetin, and all prevented PAF-mediated executioner caspase activation. Together, these results validate the traditional knowledge shared by our Cree collaborators and highlight the multidimensional therapeutic potential of boreal plants as culturally appropriate complementary anti-diabetic therapies.

Cyclotides, circular peptides isolated from plants of the Violaceae and Rubiaceae families, have a unique cyclic cystine knot topology and may play a role in plant defense. In addition to being antibacterial and insecticidal, cyclotides also display antitumor and anti-HIV activities. Their mechanism of bioactivity is not fully understood, but they disrupt cellular function by forming pores on lipid membranes. Reports on the distribution of cyclotides in Rubiaceae are limited; this dissertation focuses on the discovery, characterization and bioactivity of cyclotides in Psychotria (Rubiaceae). Eleven species of Psychotria were screened for cyclotides; six novel cyclotides (named psyle A - psyle F) were purified and sequenced from extracts of Psychotria leptothyrsa var. longicarpa using a combination of liquid chromatography-mass spectrometry and tandem nanospray MS-MS sequencing. The bioactivity of the psyle cyclotides, as well as the cyclotide cycloviolacin O2 (CyO2) from Viola odorata was examined using bioassays (fluorometric microculture, cell proliferation, SYTOX Green nucleic acid stain, trypan blue and saquinavir uptake) and fluorescence microscopy. Cytotoxic, chemosensitizing and pore-forming abilities of cyclotides were monitored in the human adenocarcinoma breast cancer cell line (MCF-7), its drug resistant sub-line (MCF-7/ADR), an uninfected T-lymphocytic cell line (HuT78) and its HIV-infected sub-line (HTLVIIIB), and the human lymphoma cell line (U-937GTB). Cyclotides displayed potent, dose-dependent cytotoxicities (IC50 = 0.72--26 muM), and co-exposure to cyclotides significantly enhanced doxorubicin-induced toxicity (IC50 = 0.39--0.76 muM). Cyclotides formed pores on membranes of breast cancer cells, and this pore-formation correlated with their chemosensitizing abilities. Psyle E and CyO2 were the most potent of the cyclotides tested, but a linear rubiaceous cyclotide (psyle C) also maintained cytotoxicity (IC50 = 0.47--8.70 muM). CyO2 formed rapid (< 10 minutes) and stable (24 hours) pores on cellular membranes, enhanced the uptake of saquinavir in T-lymphocytes (HuT78) by more than three-fold, and was five times more potent in HIV-infected T-lymphocytes (HTLVIIIB) as compared to HuT78s. Cyclotides did not produce significant pore-formation in brain endothelial or kidney epithelial cell lines, which suggests specificity toward inducing pore-formation in highly proliferating breast tumor and HIV-infected cells. In conclusion, cyclotides may be promising candidates in targeted membrane disruption approaches to the treatment of drug resistant breast cancer and HIV / acase@tulane.edu

This dissertation evaluates preksha dhyana, a form of modern yoga introduced by the Jain Shvetambara Terapanth in 1975. Modern yoga emerged as a consequence of a complex encounter of Indian yogic gurus, American and British metaphysical thinkers, and modern ideas about science and health. I provide a brief history of the Terapanth from its eighteenth-century founder, Bikshu, to its current monastic guru, Mahaprajna, who constructed preksha dhyana. I evaluate the historical trajectory that led from the Terapanth's beginnings as a sect that maintained a world-rejecting ascetic ideal to its late twentieth-century introduction of preksha dhyana, which is popularly disseminated as a practice aimed at health and well-being. The practice and ideology of preksha dhyana is, however, context specific. In the Terapanthi monastic context, it functions as a metaphysical, mystical, and ascetic practice. In this way, it intersects with classical schools of yoga, which aim at ascetic purification and release from the world. In its popular dissemination by the samanis, female members of an intermediary Terapanthi monastic order, it functions as a physiotherapeutic practice. The samanis teach yoga to students in India, the United States, and Britain whose interests are primarily in yoga's physical and psychological benefits. In this way, it is a case study of modern yoga, which aims at the enhancement of the body and life in the world. I demonstrate how the samanis are mediators of their guru, Mahaprajna, and thus resolve ancient and contemporary tensions between ascetic and worldly values. I also demonstrate how Mahaprajna and the samanis construct preksha dhyana as a form of modern yoga by appropriating scientific discourse and attributing physiological function to the yogic subtle body. I argue that preksha dhyana can be located at an intersection with late capitalist cultural processes as well as New Age spirituality insofar as its proponents participate in the transnational yoga market. Finally, I conclude with some thoughts on the successes and failures of the Terapanth in its attempt to globally disseminate preksha dhyana.

<p>Yttrium-90 (⁹⁰Y) is one of the most commonly used radionuclides in targeted radionuclide therapy (TRT). In treatment planning, reliable prediction of the 90Y distribution <i>in vivo</i> is essential to performing both safe and effective therapy. However, the distribution of surrogate agents used in treatment planning may not exactly predict the distribution of ⁹⁰Y. Thus it would be useful to image the ⁹⁰Y distribution after therapeutic administration to provide the ground truth for the ⁹⁰Y distribution. This would facilitate evaluating and potentially improving pre-therapy methods for individualizing and optimizing the therapy. Single photon emission computed tomography (SPECT) is a powerful imaging technique for estimating 3D distribution of radionuclides <i> in vivo.</i> However, as an essentially pure &beta;-particle emitter, ⁹⁰Y does not emit gamma photons considered appropriate for SPECT imaging. One possible solution is to image bremsstrahlung photons generated by the interaction of the 13-particles with atomic nuclei in the body. The continuous and broad energy distribution of bremsstrahlung photons, however, imposes substantial challenges on quantitative SPECT imaging. The overall goal of this work was to develop and evaluate new quantitative bremsstrahlung SPECT methods for improving the reliability (accuracy and precision) of the ⁹⁰Y activity estimates for the dosimetry application. </p><p> Reconstruction method, acquisition energy window, and collimator are three crucial factors that determine the reliability of quantitative SPECT imaging. </p><p> In this work, we first developed an improved quantitative reconstruction method. The improvement resulted from more accurate modeling of the image formation process in a statistical iterative reconstruction method. Improvements in the model included enhancements to the Monte Carlo (MC) bremsstrahlung simulation used to generate various components of the model and better modeling of the energy dependence of various image degrading effects through the use of multiple energy ranges. The evaluation, using both a physical phantom experiment and an XCAT phantom simulation, demonstrated more accurate modeling of the image formation process and more accurate organ activity estimates than previous methods. </p><p> We then developed new methods for optimizing the acquisition energy window and parallel-hole collimator, respectively, for quantitative imaging. These methods account for the effects of energy window or collimator on both the bias and the variance of the activity estimates, and are applicable to radionuclides with any type of emission energy spectra. We applied these methods to optimizing the energy window and collimator for quantitative ⁹⁰Y bremsstrahlung SPECT in microsphere brachytherapy. </p><p> In addition to improving the reliability of quantitative imaging, we also did some work on improving the visual image quality for ⁹⁰Y bremsstrahlung SPECT imaging. We optimized the energy window for a detection task based on the performance of an observer that accounts for the degradation of the image quality due to model-mismatch. This is important as detection of post-administration extra-hepatic 90Y could be useful in predicting and preparing for complications such as radiation-induced gastro-intestinal ulcerations. </p>

<p> The purpose of this study was to determine the demographic profiles, the major reported health problems, and the complementary, alternative (CAM), and conventional treatments used for these health problems and for wellness by a sample of rural Appalachian chiropractic patients. Differences in patient profiles among patients with acute and chronic problems and between chiropractic and non-chiropractic problems were also analyzed.</p><p> A non-experimental descriptive cross-sectional design was employed. Descriptive analyses revealed that participants (N = 130) were 37 men and 93 women who were predominately white, married, middle-aged, well-educated and lived in Lee, Wise, Floyd or a surrounding county in Southwest Virginia. The majority of respondents were employed, insured, had an income greater than $35,000 per year, and reported their health as either "very good" or "good." They reported a low rate of alcohol and tobacco use. They tended to use either a Doctor of Chiropractic (DC) or a medical provider or both as a regular source of health care. A DC was used as a health care provider six percent more than a medical provider for regular health care visits.</p><p> Respondents reported forty separate health conditions as the main two health problems they experienced, the majority being chronic versus acute problems. Back, neck, and joint problems were the most frequently reported followed by headaches, diabetes, hypertension, thyroid, gastrointestinal, sinus and lung problems. The majority of the sample used chiropractic manipulation/adjustment with a substantial percentage of respondents using massage therapy or the two treatments concurrently. Chiropractic manipulation was used by one-quarter to one-third of those with diabetes and hypertension to treat these conditions and was employed by respondents with thyroid, gastrointestinal, sinus and lung problems as well. About one-quarter to one-half of respondents with these conditions used chiropractic manipulation, massage therapy, or both therapies together for treatment. The use of energy work, counseling, physical therapy, and reflexology were reported by only a small number of respondents.</p><p> Differences in patient profiles among patients with acute and chronic health problems were evaluated with health status found to be significantly better in those with acute as compared with chronic health conditions. Those respondents who were not working were found to have non-chiropractic or medical problems more often.</p>

<p> The need for an adjunctive and alternative program at Alternative, Community, and Correctional Schools and Services (ACCESS) schools is critical to better serve the youth of Orange County. The purpose of this project was to write a grant proposal seeking funds to develop a program that will explore the use of active treatment approaches: healthy diet and exercise as an alternative or adjunct to the use of psychotropic medications among adolescents identified at risk for mental health problems. The proposed program if funded will introduce active approaches to improve the student's self-regulation and level of mental health functioning. The program will involve a nutritional, well balanced diet integrated into their daily life along with daily exercise and a weekly outdoor engagement outing. If funded, this program would result in the adolescent's ability to overcome their mental health challenges holistically, attaining self-sufficiency without pharmacotherapeutic treatment. Submission of this grant is not required for this thesis project.</p>

<p> This study examined the effects of a mindfulness-based coaching intervention on perception and emotional regulation shifts related to workplace stressors (internal and external), quality of worklife, interpersonal relationships, and general sense of well-being of high-level executives (HLE) who indicated a desire to improve these areas of their worklife. </p><p> Participants in this study were six HLEs, responsible for managing the direction and change strategies of the organization or department under their charge, who supervise, manage others, and work in dynamic environments. Participants identified negative stress response and emotional regulation as well as being focused on the past and the future to be a challenge in their daily work lives. </p><p> Kabat-Zinn (2012) posited that mindfulness practice can provide the practitioner with a true embracing of a deeper sense of self and others, which can permeate life and transform the relationship to how one thinks, feels and works. Marlatt and Kristeller (1999) described mindfulness as "bringing one's complete attention to the present experience on a moment to moment basis" (p. 9). </p><p> The study included an 8-week mindfulness coaching intervention, pre and post questionnaires, semi-structured interviews. Mindfulness Based Stress Reduction (MBSR), HeartMath Mindful-Hearth Intelligence workbook, tools, exercises and practice were used within a coaching frame work. </p><p> A multiple case study design was used and a thematic analysis of the coaching intervention was conducted. The analysis detailed themes and patterns in shifts and changes in perception, emotional regulation around stress response, relationships, and general sense of well-being. </p><p> The study elucidated the impact of these interventions on HLEs. Several themes emerged as assets for participants during the intervention, specifically, work stress management, heightened awareness, and acceptance. Suggestion for further research would be to explore the hardiness of the process of acceptance in deepening the impact of the other central themes. An unanticipated result which was explored was the extent to which participants came to understand with kindness and curiosity the negative aspects of nondisclosure within their work culture. </p>