Saudi Cultural Missions Theses & Dissertations
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Item Restricted Fatigue Self-Management in Rheumatoid Arthritis: Uncovering Needs, Opportunities and Design Implications(Queen Mary University of London, 2024-07) Albarrak, Maha; Curzon, PaulFatigue poses a significant challenge for many individuals living with Rheumatoid Arthritis (RA). Yet, despite its impact on quality of life, fatigue remains an often overlooked and underdiscussed symptom. This indicates a clear need for more targeted and effective support for fatigue self-management. The use of computer technology for this purpose is little explored. However, it holds promise to enhance the lives of those with RA. This thesis addresses this gap by exploring the lived experiences of fatigue among individuals with RA and providing insights into the potential role of technology in supporting fatigue self-management. I used a mixture of qualitative methods: online ethnography, interviews and co-design workshops. This allowed to triangulate results. In the online ethnography study, I drew on the rich context of online discussion forums to gain deep insights into their perspectives and coping stages necessary for living with fatigue. Following this, I interviewed people with RA to further identify the factors and strategies in coping with fatigue. This also highlighted areas where technology could play a role in enhancing fatigue self-management and potential barriers to its adoption. I synthesised these findings into a set of low-fidelity design concepts exploring a range of identified fatigue-related needs and design considerations. I used co-design workshops, to refine the existing insights and identify further ones. Some design considerations were reaffirmed, others challenged and I identified more perspectives on some design elements related to tracking or measuring fatigue. Overall, the contribution is to provide a deep understanding of the fatigue-related needs of those with RA. I translate this into design implications and demonstrate the potential for how technology might support fatigue self-management.8 0Item Restricted Experiences and beliefs about fatigue, physical activity, physical fitness, and information needs in childhood cancer: Children and their parents’ perspectives(The University of Sydney, 2023) Alqahtani, Qamra Muaikel; Dylke, ElizabethThis thesis aimed to explore the experiences of beliefs about, and information needs related to fatigue, particularly in relation to physical activity and physical fitness, in childhood cancer from children’s and parents’ perspectives. The experience of fatigue, the information needed by children treated for cancer and their families and the use of physical activity as a possible coping strategy were examined in this thesis through a multitude of methods, including a systematic review, as well as quantitative and qualitative research methods. Clearly, fatigue is a complex and variable experience, which places a burden both on children and their parents (Chapter 3,4,5). Fatigue has adverse consequences on all aspects of the child’s life (Chapter 3,4), including hindering their physical activity (Chapter 3,5), emotionally affecting parents (Chapter 3,4), and restricting social and family activities (Chapter 3). Children have different perspective on their information needs on cancer-related symptoms, including fatigue (Chapter 2,3) and their beliefs about fatigue (Chapter 4) than their parents. Children and their parents reported their needs for individualised informational support from healthcare providers about all aspects of the child’s fatigue (Chapter 2,3). Addressing questions and providing information about the child’s fatigue in verbal and written formats would better support both parents (Chapter 2,3) and children (Chapter 3). Physical activity appeared to be underappreciated strategy for the management of fatigue in children (Chapter 3,4,5). Children’s dichotomy perceptions on how physical activity helps with fatigue (Chapter 5), diversity of the beliefs around fatigue between children and their parents and between parents and each other (Chapter 4), and the complexity of fatigue experience (Chapter 3), indicate that fatigue is an issue that requires further discussion and multiple encounters with healthcare providers across and beyond the cancer treatment phases.29 0Item Restricted Diffusion Tensor Tractography Evaluation for White Matter Damage in MS Patients(Saudi Digital Library, 2023-11-09) Alshehri, Abdulaziz; Ramadan, Saadallah; Lechner-Scott, Jeannette; Al-Idani, Oun; Lea, RodneyMultiple sclerosis (MS) is an idiopathic, acquired neurological disorder described by complex patterns of demyelination and axonal loss in the central nervous system (CNS). Symptoms include among others chronic fatigue, loss of motor control, and cognitive deficits. Clinical imaging outcomes such as lesion load and atrophy have limitations in diagnosing and tracking treatment response in MS, often have varying correlations with the symptoms of MS, and lack insight into pathological processes. Diffusion-weighted imaging (DWI) is a promising neuroimaging technique that can provide insights into the microstructural changes in MS. This thesis investigates the utility of DWI techniques, specifically the use of diffusion tensor imaging (DTI), fibre orientation distributions (FODs), and tractography, by exploring their relationships with clinical parameters and the effects of disease-modifying therapies (DMTs) in patients with a relapsing-remitting disease course. This thesis contains chapters of published, presented, and submitted works that contribute to understanding WM microstructure and its relationship with MS pathology and clinical outcomes. DTI is a method of measuring water flow in the brain, fitting a tensor model described by the nature of a molecule’s polarization and relaxation in a pulsed magnetic field. Because water mobility is highly sensitive to the surrounding cellular environment, it is thought that DTI can provide a more sensitive measure of pathology and better identify WM microstructure than traditional MRI, such as structural T1-weighted imaging. FODs are a recent extension of understanding multiple spherical harmonics of water flow in the brain. These FODs allow higher resolution of diffusivity in areas of crossing WM and are thought to better circumscribe pathological tissue than DTI. In combination with tractography, a method of reconstructing WM fibres, FODs can allow insight into the underlying cellular pathologies of MS. This thesis compared DTI metrics between individuals with relapsing-remitting MS (pw-RRMS) and healthy controls (HCs) and examined their correlations with clinical parameters and volumetric measures. Significant alterations in diffusivity and fractional anisotropy (FA) in total brain white matter (TBWM) were found in pw-RRMS when compared to HCs, and moderate correlations were found between these DTI measures and disability status and cognitive domains. It investigated the sensitivity of DTI to microstructural changes in pw-RRMS and the effects of different DMTs on DTI parameters in normal-appearing white matter (NAWM) and white matter lesions (WML) over time. It showed correlations between diffusion metrics and cognitive domains, suggesting the potential of DTI in evaluating treatment efficacy and disease progression. By examining the microstructural integrity of cortico-thalamic-striatal (CTS) tracts, the thesis found significant differences between pw-RRMS with HCs, and significant correlations of these changes with fatigue and disability over time. Utilizing FODs and tractography, it focused on assessing white matter microstructure at a network level in pw-RRMS over two years and their correlation with clinical parameters. It revealed widespread reductions in fibre density in specific brain regions of pw-RRMS compared to HCs and highlighted potential remyelination in a thalamocortical network during disease-modifying treatments. The findings from this thesis contribute to a deeper understanding of the microstructural changes in MS and their clinical implications. Both DTI and FODs combined with tractography have demonstrated correlations with clinical symptoms, cognitive function, and treatment response, suggesting their potential as valuable markers for assessing disease severity and treatment outcomes in MS. The utilization of advanced imaging techniques and analysis tools in this thesis provides insights into the underlying pathophysiology and supports the development of long-term treatment strategies for MS. This thesis consists of many chapters for some published/submitted or under review papers that include: Chapter 2 aims to contrast DTI metrics in people with relapsing-remitting MS (pw-RRMS) and healthy controls (HCs) and study the links between these metrics, clinical parameters, and volumetric measures. This study showed that diffusivity increased, and FA decreased for total brain white matter (TBWM) in pw-RRMS. Mean and radial diffusivity in TBWM and axial diffusivity in WML moderately correlated with disability status. Volumetric segmentation indicated a decrease in total brain volume, grey and white matter, accompanied by an increase in cerebrospinal fluid in pw-RRMS. DTI parameters in this study showed moderate correlation with cognitive domains, contrasting with white matter-related volumetric measurements in pw-RRMS, demonstrating the usefulness of DTI for assessing clinical features of MS. Chapter 3 evaluates the sensitivity of DTI in detecting microstructural changes in the white matter of pw-RRMS that result in progressive disability, since the role of diffusion in assessing the effectiveness of various therapies requires further research. This pioneering study compares the longitudinal effects of different DMTs on DTI metrics in pw-RRMS in NAWM and WML with HCs. Findings showed dissimilarities in most clinical parameters between pw-RRMS and HCs in both instances of observation. However, no significant differences in average changes over time were observed in any diffusion metrics between treatment groups in either tissue type. Diffusion metrics in NAWM and WML negatively correlated with most cognitive domains, whereas FA positively correlated at the initial measurement but only for NAWM at follow-up and negatively with disability over time. Chapter 4 delves into the microstructural integrity of cortico-thalamic-striatal (CTS) tracts and their correlation with fatigue and disability over time, using DTI measures in NAWM and WML selected nine tracts-of-interest (TOIs). The key finding is the significant difference in most diffusion metrics in TOIs in pw-RRMS versus HCs at baseline and 2-year follow-up (2-YFU). Notably, there was a significant decrease in WML diffusivities and an increase in FA over the follow-up period in most TOIs. Nonetheless, in this clinically stable cohort, DTI parameters remained unchanged in NAWM tracts over time, indicating potential repair of damaged MS tracts. This may serve as an outcome measure in future remyelination clinical trials. Chapter 5 studies white matter (WM) microstructure at a network level in a group of clinically stable, treated RRMS patients over two years and contrasts this network with matched HCs. Also, it explores the connection between changes in WM microstructure during treatment and clinical parameters in pw-RRMS. This study seeks to connect multiple sclerosis research with network neuroscience by quantifying network-level differences. This research points out extensive network reductions in fibre density in pw-RRMS at baseline compared to HCs, occurring in the frontal, parietal, and temporal regions. This network increased in size and connectivity at the 2-YFU, comprising similar regions as the baseline differences. Pw-RRMS exhibited lower fibre density at baseline in a thalamocortical network than 2-YFU, suggesting that remyelination may have occurred in this network over time. Chapter 6 concludes the main findings of this research and provides recommendations for future work.7 0