This thesis explores the experience of living with cancer-related cachexia (CRC) from the patient perspective. Critique of the literature indicates few examples where patients have had the opportunity to speak. Following a challenging recruitment process, six people living with the syndrome were interviewed to elicit their narrative. Their stories were examined and themes identified relating to their personal feelings and how these affected social interactions. Thematic analysis was applied to produce what is a rich qualitative description of the experience from this small sample. Living with CRC requires development of strategies to survive. Emergent themes included the loss of sense of self and a changing relationship to the social world, social isolation and dissatisfaction with truth-telling by health professionals. Recommendations are made to mitigate the suffering of patients by empowering them through better information and acknowledgement of their condition. The balance between nutrition and wellbeing is re-examined, calling for a reorientation of perspective from a focus on intake towards a focus on quality of life. This clearly falls within the nurse-as patient-advocate paradigm and the relevance and meaning of this research to the nursing profession is explored. Potential areas for further research in regards to both patient experience and nursing practice are extrapolated.

No description available.

Aim To determine that carbon dioxide (CO2), instead of air, insufflated during colonoscopy reduces pain experienced by patients post colonoscopy. Method A randomised, double blinded, controlled trial with 205 consecutive consented patients referred for elective colonoscopy was undertaken at MidCentral Health Gastroenterology Department between July 2008 and January 2009. Patients were randomised to colonic insufflation with either air or CO2. A comparison of reported pain was undertaken using a 0 -10 point numeric rating scale at several time periods; intra procedure, 10, 30, and 60 minutes post procedure. Results The results were analysed using the SPSS programme. CO2 insufflation was used in 108 patients and air in 97 patients. Pain scores 10 minutes after were 0.43 ± 1.20 for CO2 and 1.61 ± 2.40 for air (P < .0001). 30 minutes after the procedure 90% of patients in the CO2 group reported no pain, compared to 61% of the air group. CO2 significantly reduced the amount of discomfort post colonoscopy at 10, 30 and 60 minutes. Conclusion Those receiving CO2 during colonoscopy experienced less post colonoscopy pain than those who received air insufflation. Carbon dioxide should be considered as the insufflating gas during colonoscopy.

<p>In our first study, we explored the barriers to complying with iron supplement recommendations using focus groups. We recruited adults, ages 18-75 years, who have had bariatric surgery at least two months previously to participate in one of four 90-minute focus groups. Participants filled out a survey asking for information on demographics and supplement use, and a facilitator asked a set of pre-determined questions to each group. Responses were written, recorded, transcribed using TranscribeMe (San Francisco CA), and analyzed using NVivo (QSR International Pty Ltd, Doncaster, Victoria). The focus groups contained nineteen participants, five of which had sleeve gastrectomy (SG) and fourteen had Roux-en-Y gastric bypass (RYGB). The average age of the participants was 49.3 ± 9.4 years, and they had undergone surgery 3.9 ± 3.6 years previously. The key factors that influenced participants’ adherence to supplement guidelines were cost, tolerability, and palatability of the supplement, level of knowledge and support from healthcare providers, and convenience of the supplementation regime.</p> <p>The second study was a prospective observational study to determine the bioavailability of ASP compared to FS. Iron deficient RYGB patients ages 18-65 years, who had surgery at least 6 months previously, participated in 8-hour iron absorption tests. Participants received a low-iron breakfast with 65 mg ASP (N=7) or FS (N=3). We assessed serum iron every 30 minutes for 8 hours following the supplementation using a colorimetric assay (South Bend Medical Foundation, South Bend, IN). In participants administered FS, serum iron increased 96.0 ± 27.2 µg/dL compared to baseline, whereas with ASP, serum iron increased 5.8 ± 4.7 µg/dL compared to baseline (<i>P</i> = 0.02). These data indicate that ASP is not as bioavailable as FS in RYGB patients.</p>

<p>Determining the macroscopic properties such as diffusivity, concentration, and viscosity is of paramount importance to many engineering applications. The determination of macroscopic properties from experimental or numerical data is a challenging task due to the inverse nature of these problems. Data analytic techniques with recent advances in machine learning as well as optimization techniques have enabled tackling problems that were once considered impossible to solve. In the current proposal, we focus on using Bayesian and the state of the art machine learning techniques to solve three problems that involve calculations of the macroscopic transport properties. </p> <p><br></p> <p>i) We developed a Bayesian approach to estimate the diffusion coefficient of rhodamine 6G in breast cancer spheroids. Determination of the diffusivity values of drugs in tumors is crucial to understanding drug resistivity, particularly in breast cancer tumors. To this end, we invoked Bayesian inference to solve the problem of determining the light attenuation coefficient and diffusion coefficient in breast cancer spheroids for Rhodamine 6G (R6G) as a mock drug for the tyrosine kinase inhibitor, Neratinib. We noticed that the diffusion coefficient values do not noticeably vary across a HER2+ breast cancer cell line as a function of transglutaminase 2 levels, even in the presence of fibroblast cells. </p> <p><br></p> <p>ii) We developed a multi-fidelity model to predict the rheological properties of a suspension of fibers using neural networks and Gaussian processes. Determining the rheological properties of fiber suspensions is of indispensable to many industrial applications. To this end,  multi-fidelity Gaussian processes and neural networks were utilized to predict the apparent viscosity. Results indicated that with tuned hyperparameters, both the multi-fidelity Gaussian processes and neural networks lead to predictions with a high level of accuracy, where neural networks demonstrate marginally better performance.</p> <p><br></p> <p><br></p> <p>iii) We developed machine learning models to analyze measles,</p> <p>mumps, rubella, and varicella (MMRV) vaccines using Raman and absorption spectra. Monitoring the concentration of viral particles is indispensable to producing vaccines or anti-viral medications. To this end, we designed and optimized a convolutional neural network and random forest models to map spectroscopic signals to concentration values. Results indicated that when the joint Raman-absorption signals are used for training, prediction accuracies are higher, with the random forest model demonstrating marginally better performance.  </p> <p><br></p> <p>iv) We developed four machine learning models, including random forest, support vector machine, artificial neural networks, and convolutional neural networks to classify diseases using gut microbiota data. We distinguished between Parkinson’s disease, Crohn’s disease (CD), ulcerative colitis (UC), human immune deficiency virus (HIV), and healthy control (HC) subjects in the</p> <p>presence and absence of fiber treatments. Our analysis demonstrated that it would be possible to use machine learning to distinguish between healthy and non-healthy cases in addition to predicting four different types of diseases with very high accuracy. </p> <p>v</p>

<p>   </p> <p>Subcutaneous injection is a biotherapeutic drug delivery method that is currently growing due to low cost, better patient compliance, minimally invasive, and the convenience that it can be done at home. Common injection sites for subcutaneous injection include the upper outer arms, abdomen, buttocks, and upper outer thigh. Heterogeneity of the tissue exists between and within each of these locations. The subcutaneous tissue space is made up of adipose tissue, proteins, collagen, and blood vessels and each of these components has an impact on the mass transport of the injected biotherapeutics and how they are absorbed into the vascular system and then distributed to the body. The current methods used to model the subcutaneous tissue space are either very expensive and not feasible for multiple repetitions, cannot incorporate fibrillar proteins or cellular components, or model a more homogeneous tissue space. These limitations do not allow for these models to accurately represent the subcutaneous tissue space. The engineering objective for this project was to develop a platform with tunable matrix architecture and biochemical composition for evaluating mass transport. This project utilizes collagen and the primary matrix due to the large abundance of collagen in the body.  We explored the effects that a change in polymerization temperature of the collagen and collagen concentration had on the fiber architecture and pore diameter. The results showed that higher polymerization temperatures of the collagen gels resulted in smaller fiber and pore diameters and an increase in concentration resulted in an increase in fiber volume fraction and a decrease in pore diameter. Fibronectin (FN) and hyaluronic acid (HA) were added to the collagen gels to analyze the impact on the structure of collagen gels with a change in polymerization temperature and collagen concentration. The addition of FN did not strongly alter the collagen fiber architecture between polymerization temperatures and collagen concentrations. Through staining and imaging, we saw an aggregation of FN around the collagen fibrils due to their opposing charges causing them to bind. The addition of HA had moderate impact on collagen fiber architecture across all polymerization temperatures and between collagen concentrations. The collagen + FN gels were used for the mass transport study. The results showed that there was little to no difference between the recovery rates of macromolecules of different charges and size between the collagen and collagen + FN gels, indicating that the transport of molecules through both of the collagen gels was impacted by a steric effect rather than an effect in charge.</p> <p>  </p>

<p dir="ltr">The recent COVID-19 pandemic has emphasized the risk of respiratory infections leading to acute respiratory distress syndrome (ARDS). A significant factor contributing to poor ARDS outcomes is the impairment of lung surfactant due to infiltrating surface-active proteins and phospholipases during lung inflammation. Lung surfactant's vital role in stabilizing alveoli by reducing air-water interfacial tension becomes evident as its dysfunction severely compromises respiratory function. Although lung surfactant (LS) replacement therapy effectively addresses neonatal LS deficiencies, its efficacy in ARDS treatment for adults remains limited. The challenge lies in the chemical similarity between current animal-extracted surfactants and human lung surfactant which are both phospholipid-based. To address this issue, this dissertation outlines a transformative "polymer lung surfactant (PLS)" designed to overcome the limitations of conventional exogenous surfactants in treating ARDS.</p><p dir="ltr">Firstly, a formulation method, referred to as equilibration-nanoprecipitation (ENP), is established which achieves reproducibility, controls sizing, and limits dispersity of the PLS formulation consisting of block copolymer (BCP) kinetically "frozen" micelles/nanoparticles suspended in water. The method uses a two-step approach of 1) equilibrating the BCP nanoparticles in a water/co-solvent mixture and 2) removing co-solvent using dialysis against a large water reservoir. Comparison of ENP with a conventional solvent-exchange technique through experimental and computational analysis yields further insights into ENP's advantages.</p><p dir="ltr">Next, various studies are highlighted which provide fundamental characterizations of the air-water surface behavior and physical properties of BCP nanoparticles in water. The air-water surface properties of block copolymers have been studied extensively when spread as free chains in organic solvent; however, little was previously known about air-water interfacial behavior of water-spread polymer nanoparticles. The studies address such topics as the effect of nanoparticle size, effect of nanoparticle core chemistry, and the effect of temperature on surface-mechanical behavior. Insights into nanoparticle molecular structure at the interface are provided through X-ray reflectivity and grazing incidence X-ray diffraction. The effect of temperature is further characterized by developing novel NMR and Langmuir trough methods to determine the physical state (glassy vs rubbery) of the core domain in the nanoconfined state at temperatures above and below physiologic temperature.</p><p dir="ltr">Lastly, <i>in vivo </i>studies are presented which demonstrate the detailed and promising proof-of-concept results on the efficacy of the PLS technology in mouse models of lung injury. The PLS therapy not only improves biomechanical function of the lung, but it also significantly lowers the extent of lung injury as shown by histological analysis and inflammatory marker measurements. An additional <i>in vivo </i>study is presented which highlights challenges in the delivery of the liquid PLS suspension to the lungs. The <i>in vivo </i>studies ultimately provide solid motivation for continued research into the development of the PLS therapy.</p><p dir="ltr">Given the promising potential of the PLS technology shown in the <i>in vivo</i> studies, the materials characterizations shared in this presentation offer valuable insights into the design of a novel PLS therapy. From these insights, key design parameters such as nanoparticle size characteristics, core chemistry, and core molecular weight can be chosen to produce the most desirable material properties. Overall, this dissertation furthers the progress of PLS therapeutic development and will hopefully ultimately contribute to improved health outcomes in patients suffering from ARDS.</p>

<p dir="ltr">Hematopoietic stem cells (HSCs) originating from aorta-gonad-mesonephros (AGM) could self-renew and develop into various immune cells, such as T cells, neutrophil and natural killer (NK) cells, rendering them as a promising cell source for immunotherapy. NK cells belong to the family of the innate lymphoid cells, and are employed as one of immunotherapy to cure solid and hematological malignancies including leukemia. Neutrophils are one of the granulocytes, and they are emerging as a new therapeutic target in various cancers. Due to the lack of reliable sources for the amounts of HSCs and immune cells required for clinical infusions (~10⁹ cells/patient), it remains as a major challenge to realize their full potential in targeted cell and immunotherapy. While substantial efforts have been made to generate native cell-like HSPCs and immune cells from human pluripotent stem cells (hPSCs), intricate molecular process governing the differentiation of HSCs and immune cells remain elusive, preventing the development of robust strategies for HSC and immune cell productions.</p><p dir="ltr">In this study, we first demonstrated that critical role of temporally regulating Wnt signaling in initiating AGM-like hematopoiesis across 11 hPSC lines. By inhibiting TGFβ at the stage of aorta-like CD34+SOX17⁺ hemogenic endothelium, which led to the downregulation of Wnt signaling, we established a chemically defined, feeder-free culture system that efficiently produced robust AGM-like hematopoietic cells. Furthermore, we investigated how hypoxia affects the <i>in vitro</i> hPSC differentiation into HSPCs, which resulted in a hypoxia-enhanced HSPC differentiation platform.</p><p dir="ltr">Next, the temporal roles of transcription factors (TFs), including <i>NFIL3</i>, <i>ID2</i>,<i> </i>and <i>SPI1</i>, in regulating and promoting NK cell differentiation from hPSCs are determined. <i>NFIL3</i> and <i>SPI1</i> have been reported to influence the early stages of NK cell development, while <i>ID2</i> has an impact on the generation of NK cells throughout the early and intermediate stage. We genetically modified hPSCs with doxycycline-inducible expression of <i>NFIL3</i>, <i>ID2</i>,<i> </i>and <i>SPI1</i>, and investigated their roles in NK cell induction from hPSCs. Among these three TFs, forced expression of <i>ID2</i> yielded the highest percentage of NK cells under a chemically defined, feeder-free monolayer culture condition, demonstrating that forced expression of NK-specific TFs improves the efficiency of NK cell differentiation from hPSCs.</p><p dir="ltr">Chimeric antigen receptor (CAR) is an artificial cell receptor expressed on immune T or NK cells that has been engineered to allow T or NK cells to re-target cancer cells by exclusively binding to a cancer-specific protein. CAR engineering has significantly improved the anti-tumor efficacy of NK cell therapy, resulting in 6 FDA-approved CAR-T therapies and many other ongoing clinical trials. Recently, a chlorotoxin (CLTX)-based CAR was developed and shown to specifically bind to a variety of heterogenous glioblastoma (GBM) cell lines. To test whether CLTX-CAR could improve the anti-tumor cytotoxicity of hPSC-derived NK cells, hPSCs were engineered with CLTX-CAR for stable and homogenous CAR expression via Cas9-mediated homologous recombination. The expression of CLTX-CAR did not affect the pluripotency and NK cell differentiation potential of hPSCs, and CLTX-CAR significantly improved the cytotoxicity of hPSC-derived NK cells against GBM cells.</p><p dir="ltr">Finally, we implemented a GBM-on-a-chip microfluidic model to interrogate the tumor microenvironment (TME). Microfluidics are an emerging device for investigating cancer biology with spatiotemporal control over signaling modulators by using a small volume. The interaction between hPSC-drived neutrophils and GBM was explored in this microfluidic device. GBM TME is very complex and involves many cell types, including neurons, microglia, immune T and NK cells. In the future, microfluidic models with isogenic cell components will be designed and implemented to better model GBM TME.</p><p dir="ltr">In summary, these discoveries confirm the pivotal role of Wnt signaling in guiding hPSCs towards hematopoietic lineages, while also highlighting <i>ID2</i> as a potent enhancer of NK cell differentiation from hPSC-derived hematopoietic progenitor cells. Additionally, CAR engineering enhances the anti-tumor capabilities of hPSC-derived NK cells. Furthermore, microfluidic models are employed to interrogate GBM TME.</p>

<p>Human disease and the corresponding immune response occur in three-dimensional space and time. Many diseases are difficult to study, either <em>in vivo</em> or <em>in vitro</em>, due to the complexity of the system. Despite computational models that can address complexity, many do not capture the spatial  aspects  of  disease.  Agent-based  models  are  mechanistic,  spatiotemporal  computational models that can be integrated with other mathematical models to create multiscale models. Here I detail two models to examine spatiotemporal progression and possible treatment strategies for two diseases  with  low  treatment  success: <em>Mycobacterium  avium complex</em>  (MAC)  and  Alzheimer’s Disease.</p> <p>MAC  are  biofilm-forming  environmental  microbes  capable  of  residing  in  human  lung nodules,  causing  MAC  pulmonary  disease  (MAC-PD).  Clinical  drug  susceptibility  tests  and treatment  outcomes  are  poorly  correlated,  and  nodules  are  complex  and  difficult  to  monitor, leading to low MAC cure rates (45-65%)². I have developed an informative model of the initial infection  events  in  MAC-PD. This  model  has  been  used  to  probe  many  different  scenarios  of infection and to predict the effect of potential interventions.</p> <p>Alzheimer’s  Disease  (AD)  is  the  leading  cause  of  dementia,  with  no  disease-altering pharmacological  intervention.  Microglia  are  phagocytotic  neuroimmune  cells,  known  to  form barriers around plaques. There has been increased interest in leveraging microglia to slow the progression of neurodegeneration by manipulating these barriers. I present an agent-based model of microglia barriers at the single plaque level and use knock-out experiments to probe possible targets for immunotherapy and quantify their effects on plaque progression.</p>

<p dir="ltr">Skeletal fragility can be caused by a wide array of diseases and disorders, but the most difficult etiologies to clinically circumvent are those in which the body loses not just bone mass but the ability to create healthy bone tissue. While in conditions such as osteoporosis (the most prevalent cause of age-related skeletal fragility in which elevated resorption without compensatory elevated formation leads to bone loss), interventions can target bone remodeling pathways to protect and increase bone mass, many other diseases are characterized by genetic and metabolic crippling of the remodeling process, rendering those same mass-based interventions less effective at reducing fracture risk. Osteogenesis imperfecta (OI) is a class of genetic disorders in which gene mutations affect the formation of collagen, a crucial building block of bone tissue that makes up 90% of its organic matrix, leading to lost bone mass and quality. As the main genetic causes of OI cannot currently be directly treated, therapeutic OI treatments are needed that improve tissue-level material properties. Similarly, metabolic conditions such as diabetes, a disorder in which the body cannot properly regulate blood sugar due to loss of insulin production and/or efficacy, can have multi-organ impacts including increased risk of developing chronic kidney disease and skeletal fragility. Type 2 diabetes is especially notorious for increasing fracture risk despite maintained or even increased apparent bone mass, which is strong evidence that intrinsic bone material properties are impaired by the disease state. A possible solution to the bone quality problem may be treatments that increase bone water content, as amplifying the water content of bone can improve multi-scale material properties such as collagen fibril elasticity and whole-bone toughness. Therefore, increasing bone hydration could be a way of improving tissue-level material properties, despite being unable to eradicate the genetic or metabolic disorders that alter how collagen is produced and incorporated into the bone matrix. To that end, this dissertation presents several studies that characterize models of osteogenesis imperfecta and diabetic kidney disease in mice and investigate methods of rescuing skeletal fragility in these animals through treatments that target both bone mass and bone quality with ties to tissue hydration.</p>