Bridging the Distance: Communicating to Distance Family Members during Palliative Care

Communication within families can be a critical concern for a person diagnosed with a life-limiting illness. As the patient is faced with decisions about their care, family members are also faced with decisions about their supporting role during this emotional time. Access to information—or lack of access to information—can be a key factor in the ability to feel connected to a loved one, as they experience decline at end-of-life. Added to the complexity of connection and decision- making at end-of-life is an increasingly aging demographic; a changing family structure, no longer defined by traditional roles and geographic proximity; and a Canadian society that is unable, or unwilling, to discuss death and dying. A design research approach, supported by systems thinking and future shifts, is used to better understand the communication needs of family members at a distance during palliative care. The project also explores a complex problem, rooted in what it means to be human: to live life, and to accept the death of our loved ones and ourselves

Ecological and Epidemiological Analyses of Multiple Sclerosis Relapse Rate

The underlying cause of many human autoimmune diseases is unknown, but several environmental factors are implicated in triggering the self-destructive immune reactions. Multiple Sclerosis (MS) is a chronic autoimmune disease of the central nervous system, potentially leading to persistent neurological deterioration. The cause of MS is not known, and apart from immunomodulatory treatments there is no cure. In the early phase of the disease, relapsing-remitting MS (RR-MS) is characterized by unpredictable exacerbations of the neurological symptoms called relapses, which can occur at different intervals ranging from 4 weeks to several years. Microbial infections are known to be able to trigger MS relapses, and the patients are instructed to avoid all factors that might increase the risk of infections and to properly use antibiotics as well as to take care of dental hygiene. Among those environmental factors which are known to increase susceptibility to infections, high ambient air inhalable particulate matter levels affect all people within a geographical region. During the period of interest in this thesis, the occurrence of MS relapses could be effectively reduced by injections of interferon, which has immunomodulatory and antiviral properties. In this thesis, ecological and epidemiological analyses were used to study the possible connection between MS relapse occurrence, population level viral infections and air quality factors, as well as the effects of interferon medication. Hospital archive data were collected retrospectively from 1986-2001, a period in time ranging from when interferon medication first became available until just before other disease-modifying MS therapies arrived on the market. The grouped data were studied with logistic regression and intervention analysis, and individual patient data with survival analysis. Interferons proved to be effective in the treatment of MS in this observational study, as the amount of MS exacerbations was lower during interferon use as compared to the time before interferon treatment. A statistically significant temporal relationship between MS relapses and inhalable particular matter (PM10) concentrations was found in this study, which implies that MS patients are affected by the exposure to PM10. Interferon probably protected against the effect of PM10, because a significant increase in the risk of exacerbations was only observed in MS patients without interferon medication following environmental exposure to population level specific viral infections and PM10. Apart from being antiviral, interferon could thus also attenuate the enhancement of immune reactions caused by ambient air PM10. The retrospective approach utilizing carefully constructed hospital records proved to be an economical and reliable source of MS disease information for statistical analyses.Siirretty Doriast

The reflection room: Shifting from death-avoiding to death-discussing

Thinking about dying and death is something we tend not to do, and those who promote Advance Care Planning for the health care in ourlast days, hours and minutes would like us to do more. However, planning requires us to think about how we want to live our final days and then share those wishes with others. This research proposes the question: How might we use human-centred design and qualitative research to go from being a death-avoiding society to a death- discussing society? Human beings are storytellers. Understanding complex challenges through narrative builds empathy. Stories also trigger the imagination for future possibility. We propose that providing places for storytelling — and places for reading the stories of others — might trigger more thinking and break through the social complexity that can be a barrier to discussing dying and death. As part of a year-long research project, we are creating “Reflection Rooms” – both short-term physical spaces across Canada and an online website – where people are invited to write their stories about dying and death and read the stories of others. We will share emerging themes from the research and pose the questions: How might we engage patients and families in shared storytelling as they navigate decision-making at end-of- life? How might collective storytelling about dying and death support the design of human-centred Advance Care Planning experiences? At the RSD5 Conference we also propose to set-up a Reflection Room pop-up for the duration of the conference and invite people to take a few moments to reflect on their own experiences with dying and death and add them to the reflection wall to continue building the collective story

Dying. Using a public event series as a research tool to open communication on death and dying

This paper will explore the use of public engagement as a strategy for encouraging and enhancing conversations about end of life through the variety of events that were part of the Dying., a public event series that ran in the 2019 DesignTO festival. Dying. invited practitioners, researchers, artists, and designers to collaborate with the wider community to explore the topic of death and dying. The Dying. series attracted over 4,000 attendees in 2019, 14 speakers, and 12 exhibiting artists. These events included public engagement through interactive exhibit, a public art/design show, public lectures, participatory art installations, participatory design workshops, and evidence-based game playing. Dying. encouraged dialogue among community members and practitioners, initiating non-medical portrayals and expression of experiences associated with dying and death. Part, research tool for knowledge mobilisation, the interactive exhibits served to engage the public in sharing experiences of end of life in light weight and playful interactions, as well as more heavy weight interactions. Data gathering for research on health topics using participatory public exhibit was part of the research intention behind the design of the exhibits. Dying. opened an interdisciplinary dialogue between designers, medical practitioners, and the public, addressing a need among practitioners for more opportunities to share their work and learn from colleagues, and a need among the public for opportunities to hear and experience a more varied discourse about death (knowledge mobilization). Dying. creatively offered the public multiple ways to engage with the topic of end of life also supplying supporting resources on advanced care planning and other aspects of end of life decision making

Kinetic Modelling of [⁶⁸Ga]Ga-DOTA-Siglec-9 in Porcine Osteomyelitis and Soft Tissue Infections

Background: [68Ga]Ga-DOTA-Siglec-9 is a positron emission tomography (PET) radioligand for vascular adhesion protein 1 (VAP-1), a protein involved in leukocyte trafficking. The tracer facilitates the imaging of inflammation and infection. Here, we studied the pharmacokinetic modelling of [68Ga]Ga-DOTA-Siglec-9 in osteomyelitis and soft tissue infections in pigs. Methods: Eight pigs with osteomyelitis and soft tissue infections in the right hind limb were dynamically PET scanned for 60 min along with arterial blood sampling. The fraction of radioactivity in the blood accounted for by the parent tracer was evaluated with radio-high-performance liquid chromatography. One- and two-tissue compartment models were used for pharmacokinetic evaluation. Post-mortem soft tissue samples from one pig were analysed with anti-VAP-1 immunofluorescence. In each analysis, the animal’s non-infected left hind limb was used as a control. Results: Tracer uptake was elevated in soft tissue infections but remained low in osteomyelitis. The kinetics of [68Ga]Ga-DOTA-Siglec-9 followed a reversible 2-tissue compartment model. The tracer metabolized quickly; however, taking this into account, produced more ambiguous results. Infected soft tissue samples showed endothelial cell surface expression of the Siglec-9 receptor VAP-1. Conclusion: The kinetics of [68Ga]Ga-DOTA-Siglec-9 uptake in porcine soft tissue infections are best described by the 2-tissue compartment model

Pancreatic metabolism, blood flow, and β-cell function in obese humans.

Context: Glucolipotoxicity is believed to induce pancreatic &beta;-cell dysfunction in obesity. Previously, it has not been possible to study pancreatic metabolism and blood flow in humans. Objective: The objective of the study was to investigate whether pancreatic metabolism and blood flow are altered in obesity using positron emission tomography (PET). In the preclinical part, the method was validated in animals. Design: This was a cross-sectional study. Setting: The study was conducted in a clinical research center. Participants: Human studies consisted of 52 morbidly obese and 25 healthy age-matched control subjects. Validation experiments were done with rodents and pigs. Interventions: PET and magnetic resonance imaging studies using a glucose analog ([18F]fluoro-2-deoxy-d-glucose), a palmitate analog [14(R,S)-[18F]fluoro-6-thia-heptadecanoic acid], and radiowater ([15O]H2O) were performed. In animals, a comparison between ex vivo and in vivo data was performed. Main Outcome Measures: Pancreatic glucose/fatty acid (FA) uptake, fat accumulation, and blood flow parameters of &beta;-cell function were measured. Results: PET proved to be a feasible method to measure pancreatic metabolism. Compared with healthy participants, obese participants had elevated pancreatic FA uptake (P &lt; .0001), more fat accumulation (P = .0001), lowered glucose uptake both during fasting and euglycemic hyperinsulinemia, and blunted blood flow (P &lt; .01) in the pancreas. Blood flow, FA uptake, and fat accumulation were negatively associated with multiple markers of &beta;-cell function. Conclusions: Obesity leads to changes in pancreatic energy metabolism with a substrate shift from glucose to FAs. In morbidly obese humans, impaired pancreatic blood flow may contribute to &beta;-cell dysfunction and in the pathogenesis of type 2 diabetes. &nbsp;</div

Renal hemodynamics and fatty acid uptake: effects of obesity and weight loss

Human studies of renal hemodynamics and metabolism in obesity are insufficient. We hypothesized that renal perfusion and renal free fatty acid (FFA) uptake are higher in subjects with morbid obesity compared with lean subjects and that they both decrease after bariatric surgery. Cortical and medullary hemodynamics and metabolism were measured in 23 morbidly obese women and 15 age- and sex-matched nonobese controls by PET scanning of [O-15]-H2O (perfusion) and 14(R,S)-[F-18]fluoro-6-thia-heptadecanoate (FFA uptake). Kidney volume and radiodensity were measured by computed tomography, cardiac output by MRI. Obese subjects were re-studied 6 mo after bariatric surgery. Obese subjects had higher renal volume but lower radiodensity, suggesting accumulation of water and/or lipid. Both cardiac output and estimated glomerular filtration rate (eGFR) were increased by similar to 25% in the obese. Total renal blood flow was higher in the obese [885 (317) (expressed as median and interquartile range) vs. 749 (300) (expressed as means and SD) ml/min of controls, P = 0.049]. In both groups, regional blood perfusion was higher in the cortex than medulla; in either region, FFA uptake was similar to 50% higher in the obese as a consequence of higher circulating FFA levels. Following weight loss (26 +/- 8 kg), total renal blood flow was reduced (P = 0.006). Renal volume, eGFR, cortical and medullary FFA uptake were decreased but not fully normalized. Obesity is associated with renal structural, hemodynamic, and metabolic changes. Six months after bariatric surgery, the hemodynamic changes are reversed and the structural changes are improved. On the contrary, renal FFA uptake remains increased, driven by high substrate availability