Coming theses from other universities
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Daily Experiences and Perceived Quality of Care for Patients with Liver Cirrhosis
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-517092
Aim and methods: This thesis aimed to study patients’ experiences with illness in their day-to-day lives and their perceived quality of care before and after implementing a 24-month adjunctive registered nurse-based outpatient intervention in liver cirrhosis. Qualitative data was used to explore patient perspectives on day-to-day life and healthcare experiences related to liver cirrhosis. The patient-perceived quality of care following the adjunctive registered nurse-based outpatient care was studied in a pragmatic, randomised controlled multicentre study, preceded by a study protocol.
Results: Liver cirrhosis led to physical symptoms sometimes appearing rapidly. Fatigue, fear and social stigma affected daily life, resulting in cancelled activities and creating an unpredictable daily life situation. Patients with liver cirrhosis lacked adequate support to learn about the disease and manage it. They sought a trustworthy relationship with healthcare providers. When this was lacking, they felt neglected. After 12 months, the adjunctive registered nurse-based outpatient care revealed an improvement in patient-perceived quality of care. Enhancements were observed in 7 out of 22 questionnaire items regarding: patient participation, access to outpatient care, and feeling understood. However, these improvements were not sustained after 24 months.
Conclusions: Fluctuating liver cirrhosis symptoms and constant worry significantly impact patients’ daily lives. Patients expressed a wish to be more involved in their healthcare and support in understanding and managing their illness. Structured registered nurse-based outpatient care for liver cirrhosis could complement physician-based care to meet patient desires for a more person-centred approach, continuity and care coordination.
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Stimuli-Responsive Materials Derived from Cellulose Nanofibrils : Synthesis, characterization, and performance evaluation
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-224538
This thesis presents a comprehensive study on stimuli-responsive materials derived from cellulose nanofibrils (CNFs), focusing on their synthesis, characterization, and performance evaluation in various applications. Renowned for their biodegradability, renewability, and robust mechanical properties, CNFs are explored in three primary contexts: moisture-responsive actuators, voltage-responsive actuators, and CO2-responsive sensors.
The unique properties of CNFs, such as high tensile strength and surface area, are leveraged to achieve effective motion in response to moisture exposure. Specifically, CNFs are utilized to create bilayer, torsional, and tensile actuators. These actuators exhibit controllable and dynamic responses, making them suitable for applications in soft robotics and wearable technology.
In the realm of voltage-responsive actuators, this study investigates the impact of various electrolytes and counteranions on positively charged CNFs. It uncovers the critical role of electrolyte choice, ion migration and the plasticization effect within the CNFs matrix, resulting in volumetric expansion, which is pivotal to the actuation mechanism. These insights pave the way for CNFs applications requiring precise control of motion and flexibility in shape, such as in soft robotics.
The third area of application involves the development of a capacitive CO2 sensor using CNFs-based foams functionalized with primary amines to enhance CO2 capture through chemisorption. This functionalization turns the CNFs-based foam into an efficient dielectric layer (DE) for sensor applications. The addition of 1,8-diazabicyclo[5.4.0]undec-7-ene (DBU) to the DE further expands the scope of sensor's capacitance change in response to CO2 exposure, underscoring its potential in environmental monitoring and CO2 detection.
Overall, this thesis emphasizes the versatility and adaptability of CNFs as a sustainable biomaterial for developing stimuli-responsive devices. The insights gained from studying CNFs in these varied applications contribute significantly to materials science and open new avenues for research in sustainable, bio-based materials.
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HER2-receptor quantification in breast cancer patients by imaging with ABY-025 Affibody and PET
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-517674
Breast cancer is the most common malignancy in women worldwide. Human epidermal growth factor receptor type 2 (HER2) is overexpressed in up to 20% of breast cancer cases and is considered an important prognostic factor and a therapeutic target. With the introduction of HER2-targeted therapy, it was important to recognize patients who will likely benefit from such treatment. Immunohistochemistry staining performed on a tumor biopsy, with in situ hybridization to detect gene amplification if needed, is the current gold standard method for HER2 receptor quantification. However, in cases with multiple metastases, it is both unfeasible and impractical to perform multiple biopsies without risking higher morbidity. Molecular imaging with tracers specifically targeting HER2 receptors provides a non-invasive approach, which allows full body quantification without the serious side effects associated with invasive biopsies. The molecule of focus in this thesis work is Affibody ZHER2:2891 (ABY-025) molecule that has a high affinity and selectivity towards HER2 receptors.
This thesis is based on four original articles. The first part focused on the aspect of breast cancer imaging using HER2-targeting gallium-labeled tracer 68Ga-ABY-025 in positron emission tomography (PET) and its role in predicting breast cancer outcome. The second part was to investigate the effect of different risk factors on developing brain metastasis, the overall survival and the effect of HER2-targeted treatment on breast cancer brain metastasis based on Uppsala County cancer registry.
We demonstrated that HER2-binding Affibody PET kinetics can be explained using a two-tissue compartment model and SUV values correlated well with the influx rates calculated using kinetic modeling, supporting its use to measure actual HER2 receptor binding. Phase II study demonstrated the potential of 68Ga-ABY-025 PET to predict the treatment outcome more accurately compared to biopsy HER2-status that uses the traditional immunohistochemistry staining and in situ hybridization techniques. 68Ga-ABY-025 PET provided accurate staging and reduced false positive 18F-FDG PET results in HER2-positive cases. HER2-positive molecular subtypes were associated with an increased risk of developing brain metastasis. Yet, longer survival times were observed in HER2-positive subtypes receiving HER2-targeted therapy.