A silent pandemic, chronic, non-healing wounds are a major cause of morbidity, with treatment and management representing significant health burdens. The opportunistic pathogens Staphylococcus aureus and Pseudomonas aeruginosa are the most common species isolated from chronic wounds. Polydimethylsiloxane (PDMS), a biocompatible and, inexpensive to fabricate polymer, can undergo various modifications. The ability of the produced polymers to attract S. aureus and P. aeruginosa, either from the planktonic state, or while sessile in biofilms on ex vivo skin, was investigated using flat (FL) or patterned (PT) PDMS with or without 1% or 10% triclosan Patterned PDMS + 10% triclosan (PT 10%) attracted significantly more live S. aureus and P. aeruginosa, as determined using Colony Forming Unit (CFU) analysis (*p<0.01), Scanning Electron Microscopy (SEM) (*p<0.01) and Confocal Scanning Laser Microscopy (CSLM) (*p<0.01). The released triclosan was not cytotoxic against either bacteria or primary cultures of human dermal fibroblasts using Water Soluble Tetrazolium Salts (WST-1) assay. High performance liquid chromatography analysis highlights low level of triclosan release from the PDMS. Bacterial infection in co-culture using the Boyden chamber assay increased fibroblast viability in the presence of PDMS (*p<0.05). PT 10% demonstrated superior biofilm transfer from epidermis (*p<0.05), in comparison to all other analysed polymers. In summary, the unique topography of PDMS combined with triclosan attracted bacteria most efficiently. This promising data suggests potential for engineering a patterned polymer to physically transfer biofilms from wounds, and importantly lacks bactericidal properties which is vital in the quest to combat antimicrobial resistance.

Concussion is the most common form of brain injury, comprising over 80% of traumatic brain injuries (TBIs) occurring in the United States and around the world. While many individuals are able to fully recover in the weeks following a concussion, an estimated 50% of patients go on to suffer from persistent symptoms that may range from months to years in duration. Among the most common complaints of those with persistent symptoms is sadness or depression, and significantly elevated rates of suicide have been reported in this population. Females are more likely to develop persistent symptoms and have reported higher rates of neuropsychiatric symptoms than males following injury. Altered glutamatergic neurotransmission has been implicated as a possible cause of depression following concussion due to similarities in glutamatergic changes that occur following concussion and during depression, independently of brain injury. Excitotoxicity is known to occur following TBI, resulting in neuronal death, and dysfunction in the cells that survive. Glutamatergic dysfunction occurring in regions such as the hippocampus, prefrontal cortex or amygdala, may be a driver of depressed mood or major depressive disorder (MDD) in concussed individuals as these regions, among others, have previously been linked to MDD. There are currently no approved pharmacological treatments for TBI symptoms. Therefore, gaining insight into chronic pathophysiology underlying TBI symptoms, including depression, is essential to support the development of therapeutic approaches for patients. The glutamate system represents a promising avenue of investigation in the context of chronic TBI pathophysiology. Using a clinically-relevant rodent model of concussion, this work sought to elucidate chronic glutamatergic changes occurring in the brain in association with the development of depression-like behavior following injury. Delayed-onset deficits in social and self-care behaviors were observed in association with region-specific changes in N-methyl-D-aspartate (NMDA) receptor and glutamate transporter expression in injured male animals. Females responded differently to injury, showing disinhibition and compulsive behaviors in conjunction with upregulation of glutamatergic signaling proteins. Further, this work aimed to investigate chronic sex-specific responses to TBI. Direct comparisons of behavioral changes in injured males and females demonstrated differences in both the emergence and nature of behavioral deficits. Examinations of hippocampal subregions showed deeper specificity in expressional changes in glutamatergic markers with both region- and sex-specific alterations observed at a chronic time point. Additionally, proteomic analysis was employed to evaluate widespread protein-level changes in the injured frontal cortex, and results revealed significant dysregulation in pathways involved in excitatory neurotransmission and calcium signaling. However, the dysregulated proteins within these pathways differed in a sex-dependent manner, indicating a sexual dimorphism in chronic TBI pathophysiology. Potential drug targets were also identified for investigation in future studies. The fundamental work presented in these studies provides strong evidence of dynamic, sex-specific modifications in the glutamate system in association with chronic TBI deficits in a translational model, ultimately providing a foundation for future development of therapeutic options to improve the lives of patients suffering with persistent symptoms. / Doctor of Philosophy / Concussion is the most common form of brain injury, comprising over 80% of traumatic brain injuries (TBIs) occurring in the United States and around the world. While many individuals are able to fully recover in the weeks following a concussion, an estimated 50% of patients go on to suffer from persistent symptoms that may range from months to years in duration. Among the most common complaints of those with persistent symptoms is sadness or depression, and significantly elevated rates of suicide have been reported in this population. Females are also more likely to develop persistent concussion symptoms and tend to experience more severe symptoms than males, but the reasons for this are not known. Changes in important signaling proteins, which allow neurons to properly communicate with one another, have been observed in the brains of concussed patients. Changes in the same proteins have been reported in depressed patients, leading to the belief that these signaling proteins may be involved in the development of depression after a brain injury. These proteins are involved in glutamate signaling, and glutamate is the main excitatory neurotransmitter in the brain. Excitatory neurotransmission is responsible for activating receptors which can lead to the firing of neurons, hence its importance in neuron communication. There are currently no approved treatments for TBI symptoms. Therefore, gaining insight into the chronic biological changes underlying TBI symptoms, including depression, is essential to support the development of therapies for patients. Using a rodent model of concussion, this work identified long-term changes in important glutamate signaling proteins in injured animals which were observed alongside depression-like behaviors. Injured male rodents were less social and were less motivated to take care of themselves, similar to humans with major depressive disorder (MDD). Female rodents showed different changes in depression-like behaviors and also developed behaviors similar to humans with obsessive compulsive disorder (OCD). This work demonstrated the development of sex-specific symptoms in injured animals, and these were accompanied by different changes in key glutamate signaling proteins, which suggests problems in neuron communication due to injury. These protein changes were detected in regions of the brain linked to MDD. The fundamental work presented in these studies provides strong evidence of dynamic, sex-specific modifications in the glutamate system in association with chronic TBI symptoms, ultimately providing a foundation for future development of therapeutic options to improve the lives of patients suffering with persistent symptoms.

This dissertation begins with a critical preface that examines the haunted present and its impact on writing for third and fourth generation Holocaust survivors. Then follows a collection of poetry and prose that examine themes of intergenerational trauma, experiences of the Shoah, grief, and chronic illness.

This study sought to better understand the experiences of individuals with a chronic health condition utilizing telemedicine during the first twelve months of the COVID-19 pandemic. To do this, an online survey was advertised in two private Facebook support groups for individuals with adrenal insufficiency; a chronic health condition that requires frequent communication with healthcare providers. The survey consisted primarily of closed-response questions which examined the demographic data of respondents, their access to healthcare providers, their comfort levels accessing healthcare providers, and the number of times individuals sought healthcare during the first twelve months of the COVID-19 pandemic to try and predict their preference for telemedicine and in-person healthcare visits going forward. Additionally, the survey included open-response questions which allowed for respondents to describe their experience utilizing telemedicine during the first twelve months of the COVID-19 pandemic. Most respondents described their use of telemedicine as being positive but have indicated there are some health circumstances in which telemedicine may not be the best option for them. Additionally, findings indicate that individual's comfort level in visiting their healthcare providers in-person during that first year of the COVID-19 pandemic is a significant predictor of an individual's preference for telehealth. This gives future studies a starting point to investigate the driving social and health factors that shape an individual's perception of risk influencing their level of comfort and predicting their preference of telemedicine or in-person visits for their non-emergency healthcare needs.

Chronic pain sufferers are frequently misunderstood and stigmatised. The aim of this investigation was to provide a description of the lifewor1d of people with chronic low back pain, using the phenomenological method. Themes which emerged were that the persistent nature of chronic pain makes it particularly difficult to endure, arousing a profound fear of the future. It causes a disruption in the relationship between the person and the body, in which the person is forced to function within the constraints of pain. Sufferers are unable to fulfil social roles as expected and are forced to revise their goals and activities. The distress of their experience is mediated by the ability to make sense of their condition, finding meaning in the pain itself. The study highlights the value of the phenomenological method in health psychology. Recommendations are made which may be of benefit to people with chronic pain and their families. / Psychology / M. Sc. (Psychology)

Die gesin is die sentrum waarbinne die kind se vorming tot volwaardige volwassenheid plaasvind. Indien een van die ouers met 'n chroniese fisieke siektetoestand gediagnoseer word, mag dit moontlike implikasies inhou vir die ouer, die kind, maar ook ander gesinslede. Die chroniese siektetoestand en die implikasies wat dit vir die siek persoon inhou is bestudeer. Daarbenewens is die dinamiek van die gesin, waarbinne die ouer en die kind met mekaar in interaksie is, ontleed. Om te bepaal wat die effek van die chroniese fisieke siektetoestand van die ouer op die kind is, is 'n literatuurstudie onderneem. Dit is daarna geverifieer met gevallestudies wat ondemeem is. Die gevallestudies het die bevindinge van die literatuurstudie bevestig. Dit blyk dat die chroniese siektetoestand van die ouer 'n invloed op die wording van die kind het. Die siektetoestand is 'n voortdurende stressor binne die gesin, wat veroorsaak dat kind(ers) affektiewe-, kognitiewe-, gedrags- en sosiale probleme manifesteer. Daar moet aanpassings gemaak word om die stres binne die gesin te minimaliseer. Riglyne is saamgestel om die terapeut, wat hierdie kind(ers) en gesinne begelei, te help. / The family is the system within which the child develops and eventually attains maturity. When a patient is diagnosed with chronic disease, it has certain implications not only for the parent, but also for children and other members of that family. A liteature study was undertaken to determine the impact of the chronically ill parent on the child. This study was then verified with specific case studies done by the author. These case studies confinned the findings of the literature study. It would seem that the chronic illness of a parent has a definite impact on the development of a child. The parent's illness is a constant stressor within the family, causing children to manifest affective, cognitive, behavioral as well as social problems. Certain adjustments have to be made to minimize stress within such a family. Guidelines are provided to assist the therapist in dealing with these children and families. / Psychology of Education / M. Ed. (Voorligting)

Bakgrund: Smärta är en multidimensionell och subjektiv upplevelse som kan drabba alla människor. Smärta är den vanligaste orsaken till uppsökande av sjukvård samt orsakande av funktionsnedsättningar och oförmåga att arbeta. Personer med långvarig smärta måste självständigt utföra en stor del av sin behandling och omvårdnad i form av egenvård. Det ingår i sjuksköterskans uppdrag att uppmuntra och stödja patienter till att utföra egenvård, dock finns ingen entydig definition av begreppet egenvård. Syfte: Att redogöra för hur personer med långvarig smärtproblematik beskriver egenvård. Metod: En litteraturöversikt baserad på tio vetenskapliga artiklar med kvalitativa och kvantitativa ansatser. Artiklarna togs fram via sökningar i databaserna CINAHL Complete och MEDLINE, och var publicerade mellan åren 2005-2015. Artiklarna har analyserats enligt Fribergs analysmetod. Resultat: Resultatet i litteraturöversikten presenterade att personer med långvarig smärta beskrev egenvård som multidimensionell. Egenvård ansågs bestå av personliga förmågor samt mentala och praktiska strategier. Personer med långvarig smärta ansåg även att utbildning och stöd ifrån hälso- och sjukvården var viktigt för utförandet av egenvård. Diskussion: Resultatet har diskuterats utifrån Dorothea Orems omvårdnadsteori om egenvårdsbalans samt vetenskapliga publiceringar. Egenvårdens innebörd för personer med långvarig smärta har jämförts med de olika definitioner av egenvård som tillämpas inom hälso- och sjukvården. Vidare har egenvårdsdefinitionernas betydelse för hälso- och sjukvårdens egenvårdsstödjande insatser diskuterats. / Background: Pain is a multidimensional and subjective experience that can affect anyone. Pain is the most common reason to seek medical care and is the main cause to disability and inability to work. People with chronic pain need to independently manage a large part of their treatment and care in the form of self-management. One part of the nursing role is to encourage and support patients to perform self-management, however there is no clear definition of the term self-management. Aim: To illustrate how people with chronic pain describes self-management. Method: The literature review was based on ten scientific articles, with qualitative and quantitative approaches. The articles were found through searches in the databases CINAHL Complete and MEDLINE, with publication between the years 2005-2015. The articles were analyzed using Fribergs method of analysis. Results: The literature review showed that people with chronic pain described that self-management was multidimensional. Self-management was considered to involve both personal abilities, mental and practical strategies. People with chronic pain also believed that education and support from healthcare was essential for self-management. Discussion: The result has been discussed against Dorothea Orems nursing theory about self-care and relevant scientific publications. The ​​meaning of self-management for people with chronic pain has been compared with various definitions of self-management that are applied in healthcare. Furthermore the definitions of self-management were put in relation to how the healthcare provide supporting self-management interventions.

The primary purpose of the present study was to examine the potential relationships that exist between anger expression, as measured by several MMPI-2 scales, and chronic pain.

Chronic obstructive pulmonary disease (COPD) including emphysema is a devastating condition, increasing in prevalence in the US and worldwide. There remains no cure for COPD, rather only symptomatic treatments. Due to unique challenges of the lung, translation of therapies for acute lung injury to target chronic lung diseases like COPD has not been successful. We have been investigating lung derived extracellular matrix (ECM) hydrogels as a novel approach for delivery of cellular therapies to the pulmonary system. During the course of this work we have developed and characterized a lug derived ECM hydrogel that exhibits “injectability,” allowing cells or dugs to be delivered in a liquid and encapsulated at body temperature. The hydrogel self assembles in <5 minutes and achieves mechanical stiffness similar to other soft tissue ECM hydrogels. The hydrogel can support 3D cell growth and encapsulated cell viability. Encapsulated hMSCs can also still be activated by simulated inflammatory environments. Naïve mouse macrophages exposed to the fully formed gel were not significantly induced to express markers for pro or anti-inflammatory polarized phenotypes, but increased expression for several secreted inflammatory mediators was observed. We also investigated a novel approach for preparing and solubilizing the isolated ECM proteins, using digestion time as a variable for controlling hydrogel density (interconnectivity), mechanical stiffness, component protein size distribution, and cell behavior on fully formed gels. The potential future impact for the presented research includes optimization for future animal studies, expansion to additional applications, and the development of new derivative materials.

Law Man Yee. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 123-132). / Abstracts in English and Chinese; appendix in Chinese. / Precis --- p.vi / 摘要 --- p.viii / Captions for Tables --- p.x / Caption for Figure --- p.xii / Abbreviations --- p.xiii / Chapter Part 1 --- Literature Review --- p.0 / Chapter Chapter 1 --- Aims and Hypothesis --- p.1 / Chapter 1.1 --- Aims --- p.3 / Chapter 1.2 --- Hypothesis --- p.4 / Chapter Chapter 2 --- Epidemiology of HBV Infection --- p.5 / Chapter 2.1 --- Global and Local Epidemiology --- p.6 / Chapter 2.2 --- Modes of Transmission --- p.8 / Chapter 2.2.1 --- Perinatal Tansmission --- p.8 / Chapter 2.2.2 --- Percutaneous Transmission --- p.8 / Chapter 2.2.3 --- Sexual Transmission --- p.8 / Chapter 2.2.4 --- Healthcare Setting and Transplantation --- p.8 / Chapter 2.2.5 --- Transfusion --- p.9 / Chapter 2.2.6 --- Other --- p.9 / Chapter Chapter 3 --- Popularity of TCM --- p.10 / Chapter 3.1 --- Traditional Chinese Medicine Use --- p.11 / Chapter 2.2 --- Regulation on TCM Practice --- p.12 / Chapter Chapter 4 --- Philosophy of TCM on HBV Infection --- p.13 / Chapter 4.1 --- Basic Principles --- p.14 / Chapter 4.1.1 --- Yin-Yang Theory --- p.14 / Chapter 4.1.2 --- Five Elements Theory --- p.14 / Chapter 4.1.3 --- Zang Fu Theory --- p.14 / Chapter 4.2 --- Pathogenesis --- p.16 / Chapter 4.3 --- Diagnosis --- p.17 / Chapter 4.4 --- Treatment --- p.20 / Chapter Chapter 5 --- Western Medicine --- p.23 / Chapter 5.1 --- Natural History of HBV Infection --- p.24 / Chapter 5.1.1 --- Replicative Phase: Immune Tolerance --- p.24 / Chapter 5.1.2 --- Replicative Phase: Immune Clearance --- p.24 / Chapter 5.1.3 --- Noreplicating (Low-Replication) Phase --- p.25 / Chapter 5.2 --- Diagnostic Tests for HBV Infection --- p.26 / Chapter 5.2.1 --- Serologic Assays --- p.26 / Chapter 5.2.2 --- Serum Enzymes --- p.26 / Chapter 5.2.3 --- HBV DNA Assays --- p.27 / Chapter Chapter 6 --- Health-related Quality of Life --- p.29 / Chapter 6.1 --- Principle and Definition --- p.30 / Chapter 6.2 --- Assessment --- p.31 / Chapter 6.2.1 --- Generic Instrument --- p.31 / Chapter 6.2.2 --- Disease-Specific Instrument --- p.32 / Chapter Part 2 --- Studies & Results --- p.33 / Chapter Chapter 7 --- Research Methodology --- p.34 / Chapter 7.1 --- Study 1: Hospital-Based Surveys on Chronic Hepatitis B Patients: TCM Use --- p.35 / Chapter 7.1.1 --- Patients --- p.35 / Chapter 7.1.2 --- Survey Instrument & Logistic --- p.35 / Chapter 7.1.4 --- Statistical Analysis --- p.36 / Chapter 7.1.4 --- Sample Size Justification --- p.36 / Chapter 7.2 --- Study 2: Hospital-Based Survey on Chronic Hepatitis B Patients: HRQoL & Psychiatric Involvement --- p.38 / Chapter 7.2.1 --- Patients --- p.38 / Chapter 7.2.2 --- Survey Instrument and Logistic --- p.38 / Chapter 7.2.3 --- Statistical Analysis --- p.39 / Chapter 7.3 --- Study 3: Population-Based Survey on Chinese Medicine Practitioners (CMPs): Practice Behavior & Knowledge Assessment --- p.41 / Chapter 7.3.1 --- Study Population --- p.41 / Chapter 7.3.2 --- Survey Instrument --- p.41 / Chapter 7.3.3 --- Statistical Analysis & Knowledge Assessment --- p.42 / Chapter 7.4 --- Study 4: TCM Consultation Agreement --- p.44 / Chapter 7.4.1 --- Patients --- p.44 / Chapter 7.4.2 --- Chinese Medicine Practitioners --- p.44 / Chapter 7.4.3 --- Questionnaire --- p.44 / Chapter 7.4.4 --- Study Design --- p.45 / Chapter 7.4.5 --- Sample Size Estimation --- p.45 / Chapter 7.4.6 --- Data Analysis --- p.45 / Chapter 7.5 --- "Study 5: TCM Interpretation of Laboratory, Imaging & HRQoL Assessment" --- p.47 / Chapter 7.5.1 --- Patients --- p.47 / Chapter 7.5.2 --- HRQoL Assessment --- p.47 / Chapter 7.5.3 --- Statistical Analysis --- p.47 / Chapter Chapter 8 --- TCM Use on Chronic Hepatitis B Patients --- p.48 / Chapter 8.1 --- Patient Characteristics --- p.49 / Chapter 8.2 --- Health-Seeking Behavior of TCM Users --- p.51 / Chapter 8.3 --- Determinants of TCM Use --- p.53 / Chapter 8.4 --- Common Herbal Ingredients Used --- p.56 / Chapter Chapter 9 --- Impacts of HBV Infection on Patients --- p.58 / Chapter 9.1 --- Patient Socio-Demographic and Clinical Characteristics --- p.59 / Chapter 9.2 --- Patient Symptoms and Anxiety /Depression --- p.61 / Chapter 9.3 --- HRQoL & its Determinants --- p.63 / Chapter 9.3.1 --- Physical Aspect of HRQoL --- p.63 / Chapter 9.3.2 --- Mental Aspect of HRQoL --- p.67 / Chapter Chapter 10 --- Chinese Medicine Practitioners' (CMP) Practice --- p.71 / Chapter 10.1 --- CMPs Demographics and Training --- p.72 / Chapter 10.2 --- Practice Behavior --- p.75 / Chapter 10.3 --- Diagnostic and Therapeutic Approach --- p.76 / Chapter 10.4 --- Professional Knowledge Assessment --- p.79 / Chapter 10.5 --- Determinants of Diagnostic Approach --- p.82 / Chapter Chapter 11 --- Agreement of TCM Diagnosis among Different CMPs --- p.85 / Chapter 11.1 --- Patients Characteristics & Disease Severity --- p.86 / Chapter 11.2 --- Agreement of TCM Diagnosis & Treatment --- p.88 / Chapter Chapter 12 --- Interpretation of TCM diagnosis --- p.93 / Chapter 12.1 --- Patients --- p.94 / Chapter 12.2 --- Clinical Characteristics --- p.96 / Chapter 12.3 --- HRQoL Assessment --- p.98 / Chapter Part 3 --- Discussion & Conclusions --- p.100 / Chapter Chapter 13 --- Discussion --- p.101 / Chapter 13.1 --- TCM Popularity and its Practice --- p.102 / Chapter 13.2 --- Impact of TCM Symptomatology & Anxiety /Depression on HRQoL --- p.107 / Chapter 13.3 --- TCM Diagnosis Consistency --- p.111 / Chapter 13.4 --- Association of TCM Diagnosis with Western Medicine --- p.114 / Chapter 13.5 --- Limitations of the Study --- p.117 / Chapter Chapter 14 --- Conclusions --- p.120 / Reference --- p.122 / List of Publications of My Work Used in This Thesis --- p.133 / Acknowledgement --- p.136 / Appendix --- p.138