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This dissertation is informed by lived experience of disability, artistic practice, and medical practice. My dissertation is also intended to be a model of how to bring to bear professional expertise, personal history, and personal obligations on scholarship. An inter-field survey of critical lenses within the humanities is developed, making for a heterogeneous model of engagement for scholars interested in studying medicine and medical representations in literature and other artistic genres and forms. A fusion of fields is created, demonstrating that many different approaches can be brought to bear – a deliberate choice because medicine is in need of critique from the humanities. Settler/bioscientific epistemologies are unpacked alongside Indigenous epistemologies. Metaphor, intersubjectivity, Indigenous place-thought, and disability studies are also deployed. I develop a way to link all of these pieces when they use the representation of pain as a common cause. I respectfully consider Indigenous knowledge without defining same or clinicalizing their knowledges. Ultimately, I develop a pain poetics. / Thesis / Doctor of Philosophy (PhD)

Yes / Studies have shown that a significant proportion of people with epilepsy use complementary and alternative medicine (CAM). CAM use is known to vary between different ethnic groups and cultural contexts; however, little attention has been devoted to inter-ethnic differences within the UK population. We studied the use of biomedicine, complementary and alternative medicine, and ethnomedicine in a sample of people with epilepsy of South Asian origin living in the north of England. Interviews were conducted with 30 people of South Asian origin and 16 carers drawn from a sampling frame of patients over 18 years old with epilepsy, compiled from epilepsy registers and hospital databases. All interviews were tape-recorded, translated if required and transcribed. A framework approach was adopted to analyse the data. All those interviewed were taking conventional anti-epileptic drugs. Most had also sought help from traditional South Asian practitioners, but only two people had tried conventional CAM. Decisions to consult a traditional healer were taken by families rather than by individuals with epilepsy. Those who made the decision to consult a traditional healer were usually older family members and their motivations and perceptions of safety and efficacy often differed from those of the recipients of the treatment. No-one had discussed the use of traditional therapies with their doctor. The patterns observed in the UK mirrored those reported among people with epilepsy in India and Pakistan. The health care-seeking behaviour of study participants, although mainly confined within the ethnomedicine sector, shared much in common with that of people who use global CAM. The appeal of traditional therapies lay in their religious and moral legitimacy within the South Asian community, especially to the older generation who were disproportionately influential in the determination of treatment choices. As a second generation made up of people of Pakistani origin born in the UK reach the age when they are the influential decision makers in their families, resort to traditional therapies may decline. People had long experience of navigating plural systems of health care and avoided potential conflict by maintaining strict separation between different sectors. Health care practitioners need to approach these issues with sensitivity and to regard traditional healers as potential allies, rather than competitors or quacks.

Inhibitors belonging to the serpin (serine protease inhibitor) family control proteases involved in various physiological processes. All serpins have a common tertiary structure based on the dominant b-sheet A, but they have different inhibitory specificity. The specificity of a serpin is determined by the Pl-Pl’ peptide bond acting as a bait for the target protease which is made up of an exposed reactive centre loop (RCL). The serpin plasminogen activator inhibitor type-1 (PAI-1) is the main physiological inhibitor of urokinase-type and tissue-type plasminogen activators (uPA and tPA, respectively). Elevated plasma levels of PAI-l have been correlated with a higher risk of deep venous thrombosis, and PAI-1 is a risk factor for recurrent myocardial infarction. Furthermore, PAI-1 has a role in cell migration and has been suggested to regulate tumor growth and angiogenesis. PAI-1 is unique among the serpins in that it can spontaneously and rapidly convert into its latent form. This involves full insertion of the RCL into b-sheet A. There were two partially overlapping goals for this thesis. The first was to use latent PAI-1 as model for development of a fluorescence-based method, Donor-Donor Energy Migration for intramolecular distance measurements. The second goal was to use DDEM, together with other biochemical methods, to reveal the structure of the PAI-1/uPA complex, the conformation of the RCL in active PAI-1, and molecular determinants responsible for the conversion of PAI-1 from the active to the latent form. The use of molecular genetics for introduction of fluorescent molecules enables the use of DDEM to determine intramolecular distances in a variety of proteins. This approach can be applied to examin the overall molecular dimensions of proteins and to investigate structural changes upon interactions with specific target molecules. In this work, the accuracy of the DDEM method has been evaluated by experiments with the latent PAI-1 for which X-ray structure is known. Our data show that distances approximating the Förster radius (57±1 Å) obtained by DDEM are in good agreement (within 5.5 Å) with the distances obtained by X-ray crystallography. The molecular details of the inhibitory mechanism of serpins and the structure of the serpin/protease complex have remained unclear. To obtain the structural insights required to discriminate between different models of serpin inhibition, we used fluorescence spectroscopy and cross-linking techniques to map sites of PAI-1/uPA interaction, and distance measurement by DDEM to triangulate the position of the uPA in the complex. The data have demonstrated clearly that in the covalent PAI-1/uPA complex, the uPA is located at the distal end of the PAI-1 molecule relative to the initial docking site. This indicates that serpin inhibition involves reactive center cleavage followed by full loop insertion, whereby the covalently linked protease is translocated from one pole of the inhibitor to the opposite one. To search for molecular determinants that could be responsible for conversion of PAI-1 to the latent form, we studied the conformation of the RCL in active PAI-1 in solution. Intramolecular distance measurements by DDEM, the newly a developed method based on probe quenching and biochemical methods revealed that the RCL in PAI-1 is located much closer to the core of PAI-1 than has been suggested by the recently resolved X-ray structures of stable PAI-1 mutants, and it can be partially inserted. This possibly explains for the ability of PAI-1 to convert spontaneously to its latent form.

Endometrial adenocarcinoma (EAC) is the most frequently diagnosed gynecological cancer of the female genital tract in the Western world. Research studies in EC is difficult to conduct on human tumor samples due to the complex nature of tumor arousal and genetic heterogeneousness in the human population. Therefore, inbred animal models can be promising tools to use in EC research due to similar histopathology and pathogenesis as humans. Studies performed on MAP2K1 and CCND1 has shown that their altered expression play a crucial role in carcinogenesis. CCND1 has been demonstrated to have oncogenic properties when overexpressed in human neoplasias. The aim of this study is to investigate gene expression levels of MAP2K1 and CCND1 in BDII rat model of endometrial adenocarcinoma cells. Quantitative real-time PCR was used to analyze expression levels of MAP2K1 and CCND1 genes in BDII/Han rat model of endometrial cancer cells using TaqMan approach. The differences in gene expression levels of MAP2K1 and CCND1 between pathologically EAC malignant and nonmalignant cells showed an upregulation of MAP2K1 and CCND1 in EAC malignant cells. The analyzed data presented observable mean differences between MAP2K1 and CCND1 in several endometrial cell lines that were examined. Although no statistical significance was reached, an alteration in gene expression levels in malignant and nonmalignant endometrial cells could be observed. Furthermore, this present study shows observable upregulation of MAP2K1 and CCND1 in endometrial carcinoma cells vs. nonmalignant endometrium cells and encourages further investigation of the role of CCND1 and MAP2K genes in endometrial carcinogenesis.

A utilização de nanopartículas magnéticas em biomedicina e biotecnologia vem recebendo elevado destaque nos últimos anos, graças à versatilidade de aplicações como reparo de tecidos, diagnósticos, ressonância magnética por imagem, tratamento contra o câncer, separação celular, transporte controlado de drogas, entre outras. Atualmente, as nanopartículas com potencialidade de aplicação em biomedicina se restringem aos óxidos magnéticos de ferro, os quais apresentam comportamento superparamagnético a temperatura ambiente e magnetização da ordem de 300 emu/cm3. Entretanto, há necessidade inerente da funcionalização da superfície para possibilitar aplicações biomédicas tornando as nanopartículas biocompatíveis e/ou biosseletivas. Essa funcionalização adicional é obtida geralmente introduzindo camadas de materiais diamagnético e/ou paramagnéticos na superfície das NP, as quais baixam a eficiência das propriedades magnéticas exigindo o desenvolvimento de núcleos com elevado valor de magnetização de saturação. Desta forma, nesse trabalho foram sintetizadas nanopartículas magnéticas metálicas de FePt recobertas com óxido de ferro obtidas via processo poliol modificado combinado com a metodologia de crescimento mediado por sementes. Os núcleos magnéticos como-sintetizados foram recobertos com uma camada de sílica, seguido pelo recozimento em atmosfera redutora para elevar o valor da magnetização de saturação. Em seguida, sobre a superfície de sílica foram ancoradas moléculas luminescentes de rodamina B com o auxílio de moléculas de APTES atuando como grupo sililante e as NP resultantes foram novamente recobertas com uma fina camada de sílica. Os resultados permitem concluir que foi obtido um sistema bifuncional combinando em uma única nanopartícula a possibilidade de sensoriamento óptico e magnético, além de possuir sua magnetização de saturação intensificada cerca de 10 vezes em relação aos óxidos metálicos (64 emu/g), manter o caráter superparamagnético e possuir superfície biocompatível com possibilidades de funcionalizações adicionais, com grande potencial para aplicações em biomedicina. / In recent years, the magnetic nanoparticles uses in many biomedical and biotechnological areas have received great attention due to their several applications possibilities such as: tissue repair, diagnostics, magnetic resonance imaging, cancer treatment, cell separation, and controlled drug delivery, among others. Today, the potential magnetic nanoparticles applications are limited to magnetic iron oxides uses, which exhibit superparamagnetic behavior at room temperature and low saturation magnetization around 300 emu/cm3. However, for biomedical applications, the nanoparticle surface must be properly functionalized in order to confer biocompatibility and biosselectivity. These additional functionalizations are generally obtained by paramagnetic and/or diamagnetic materials incorporations onto the nanoparticle surface leading a dramatic decreasing in the already low saturation magnetization. In this context, the development of new magnetic nuclei with high magnetizations values is required. Thus, in this work iron oxide-coated metallic FePt magnetic nanoparticles were synthesized by using the modified polyol process combined with the seed mediated growth method. The magnetic as-synthesized nuclei were coated with a thin silica shell followed by thermal annealing under reducing atmosphere in order to increase the saturations magnetization of this material. After that, onto the silica-coated magnetic nanoparticles surface luminescent dye Rhodamine B molecules were supported using the APTES as intermediate sililant molecules. Then, the functionalized nanoparticles were coated again with an outer layer. In conclusion, according to the obtained results, a bifunctional system combining the optical and magnetic sensing in the same nanoparticle was reported. The obtained nanoparticles present superparamagnetic behavior and high saturation magnetization around 10 times higher (~64 emu/g) compared with the iron oxide nanoparticles synthesized at the same conditions. In addition, the luminomagnetic nanoparticle surface is biocompatible allowing additional future functionalizations with high potential to biomedical applications.

Este trabalho apresenta novos métodos para análise de formas tridimensionais dentro do contexto de visão computacional, destacando-se o uso das transformadas wavelets 1D, 2D e 3D, as quais proporcionam uma análise multi-escala das formas estudadas. As formas analisadas se dividem em três tipos diferentes, dependendo da sua representação matemática: f(t)=(x(t),y(t),z(t)), f(x,y)=z e f(x,y,z)=w. Cada tipo de forma é analisado por um método melhor adaptado. Primeiramente, tais formas passam por uma rotina de pré-processamento e, em seguida, pela caracterização por meio da aplicação das transformadas wavelet 1D, 2D e 3D para as respectivas formas. Esta aplicação nos permite extrair características que sejam invariantes à rotação e translação, levando em consideração alguns conceitos matemáticos da geometria diferencial. Destaca-se também neste trabalho a não obrigatoriedade de parametrização das formas. Os resultados obtidos a partir de formas extraídas de imagens médicas e dados biológicos, que justificam este trabalho, são apresentados. / This work presents new methods for three-dimensional shape analysis in the context of computational vision, being emphasized the use of 1D, 2D and 3D wavelet transforms, which provide a multiscale analysis of the studied shapes. The analyzed shapes are divided in three different types depending on their representation: f(t)=(x(t),y(t),z(t)), f(x,y)=z and f(x,y,z)=w. Each type of shape is analyzed by a more suitable method. Firstly, such shapes undergo a pre-processing procedure followed by the characterization using the 1D, 2D or 3D wavelet transform, depending on its representation. This application allows to extract features that are rotation- and translation-invariant, based on some mathematical concepts of differential geometry. In this work, we emphasize that it is not necessary to use the parameterized version of the 2D and 3D shapes. The experimental results obtained from shapes extracted from medical and biological images, that corroborate the introduced methods, are presented.

<p>Alongside the complementary and alternative medicine movements, a new concept is emerging: integrative medicine. Though more and more authors have begun to use this term, they use it to refer to widely varying concepts of health care. This study begins with a theoretical look at integration and continues with an examination of current integrative efforts. These general discussions are followed by the presentation of the situation in Sweden, and at the Vidarklinik in particular. Finally the study turns to an empirical study investigating the communication between the Vidarklinik and the outside biomedical system. The research suggests a much more comprehensive picture of integrative medicine than those put forward by most authors and finds that to create and maintain an integrative system, all the levels of health care must be actively engaged in the system and the entire spectrum of care must be coordinated for the patient. Attempts at integration are found in diverse local efforts, which are all limited by lack of cooperation between different levels of health care. The study of communication at the Vidarklinik in Sweden illustrates that communication is crucial between all levels of health care in order for even relatively localised efforts in integration, and further that various factors limit whom various individuals and groups can communicate with, while in-person dialogue mitigates some of these factors.</p>

<p>Multiple myeloma (MM) is a virtually incurable B cell malignancy of the bone marrow. One important part of tumor progression and an obstacle for successful therapy is resistance to apoptosis. To combat this resistance, the mechanisms of apoptosis and survival in MM must be better defined. </p><p>In this thesis, we identified Fas up-regulation as a mechanism underlying interferon (IFN)-mediated sensitization to Fas-induced apoptosis in the MM cell line U-266-1970. IFN treatment induced activation of signal transducer and activator of transcription (Stat)1 but, intriguingly, also attenuated activation of MM survival factor Stat3. </p><p>Exploring the role of Stat1 further, we established sub-lines of U-266-1970 with a stable over-expression of Stat1 and of its active mutant Stat1C. These sub-lines displayed a decreased expression and activation of Stat3, and an altered expression of apoptosis-related genes Harakiri, Bcl-2 and Mcl-1. In a drug library screening, Stat1 over-expression was associated with an increased sensitivity to Fas-induced apoptosis and, conversely, an increased resistance to several drugs, including the cyclin dependent kinase (cdk)1 inhibitor CGP74514A. We conclude that Stat1 over-expression does not confer a general resistance or sensitivity to apoptosis in MM, but may strongly affect the response to some specific drugs.</p><p>We also explored the effects of picropodophyllin (PPP), an inhibitor of the insulin-like growth factor I (IGF-I) receptor tyrosine kinase (RTK), in MM. PPP selectively inhibited the IGF-I RTK activity without inhibiting the insulin RTK activity. Furthermore, PPP potently induced cell cycle arrest and apoptosis in all MM cell lines and patient samples tested, also in the presence of survival factors IGF-I and IL-6. We conclude that PPP has great therapeutic potential in MM </p><p>Finally, we examined the expression and regulation of the inhibitors of apoptosis proteins (IAPs) in a panel of MM cell lines and patient samples. The glucocorticoid dexamethasone, which is used in MM therapy, induced a transient up-regulation and a subsequent down-regulation of c-IAP2, as well as a down-regulation of XIAP, possibly influencing the sensitivity to apoptosis induced by this drug. Supporting this notion, abrogation of IGF-IR signaling by PPP, which sensitizes MM cells to dexamethasone-induced apoptosis, enhanced the down-regulation of c-IAP2 and XIAP.</p>