El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Revisión por pares / INTRODUCCIÓN: Los pacientes con diabetes mellitus tipo 2 son más propensos a una baja calidad de vida, discapacidad e incluso muerte. También, tienen una mayor predisposición a la depresión en comparación con los pacientes no diabéticos; así como una evolución favorable producto de la evaluación e intervención de su salud mental. OBJETIVOS: El objetivo de este estudio fue explorar la presencia de síntomas depresivos en una población ambulatoria con diagnóstico de diabetes mellitus tipo 2 y filiación militar. También examinar los factores asociados a la presencia de síntomas depresivos. MÉTODOS: Realizamos un estudio transversal en 108 personas con diabetes mellitus tipo 2, durante enero de 2012 en una muestra ambulatoria de un hospital de las fuerzas armadas. Los síntomas depresivos se evaluaron con el test autoaplicado de Zung. Usamos la prueba de Chi-cuadrado para examinar las asociaciones entre síntomas depresivos y los factores asociados de interés. Usamos modelos lineales generalizados crudos y ajustados para estimar las Razones de Prevalencia (RP) de la asociación entre las características clínicas y sociodemográficas con la presencia de síntomas depresivos. RESULTADOS: La prevalencia de sintomatología depresiva fue de 56,5% (intervalo de confianza 95%: 46,6-66,0%). El análisis bivariado mostró como significativa la asociación entre la presencia de síntomas depresivos con las variables: sexo, edad y complicaciones clínicas de la diabetes. En los análisis ajustados, la retinopatía diabética [RP: 1,3; intervalo de confianza 95%: 1,1-1,7], y la neuropatía diabética [RP: 1,4; intervalo de confianza 95%: 1,1-1,7] se asociaron a una mayor presencia de síntomas depresivos luego de considerar el sexo de los participantes. CONCLUSIONES: Observamos una elevada presencia de síntomas depresivos en la población de estudio, especialmente en los pacientes geriátricos o del sexo femenino. También en aquellos con complicaciones tardías de la diabetes mellitus tipo 2, y que probablemente representen la repercusión de la enfermedad en la calidad de vida del paciente. Un abordaje multidisciplinario, con enfoque físico y mental, debe ser considerado ya que podría beneficiar a la evolución de los pacientes con esta concomitancia en Perú.

Diabetes is a chronic, complex illness with a risk for acute and long-term complications. The aim of this quality improvement project on prevention of type 2 diabetes was to increase self-management behaviors in patients at high risk of type 2 diabetes, decrease the financial burden of type 2 diabetes, and decrease the incidence of complications that can occur from type 2 diabetes. The primary outcome of this project was each participant reporting at least one lifestyle modification that would be helpful in preventing type 2 diabetes after attending two group education sessions. A pretest posttest design was used for this project. Three completed the initial questionnaires, and two attended the educational sessions and completed the posttest questionnaires. Of the total number of participants, one reported a decrease in hot/cold cereal, regular soda, sugar or honey in coffee/tea, other potatoes, tomato sauces, chocolate, doughnuts, and cookies, cake, pies, brownies. Two participants reported a decrease in fruit juice, fried potatoes, and pizza. One participant had an increase in physical activity while the other participant had no change in physical activity. The landmark Diabetes Prevention Program (DPP) Trial demonstrated that counseling on a healthy diet and moderate physical activity reduced the incidence of type 2 diabetes. The two participants in this project reported they made some helpful changes in diet after two education sessions. It is vital to the success of a prevention program to convey the significance of preventing a chronic disease such as type 2 diabetes

Abstract Background: Individuals with type 2 diabetes mellitus (T2D) face many challenges in self-management of their current disease state. Nutrition education has been identified as a key component in managing metabolic control in individuals diagnosed with T2D. The purpose of this study is to investigate the effect of a 4-week nutrition intervention on glycated hemoglobin (HbA1c) and nutrition knowledge by food security status in individuals with T2D who attend the Family Health Centers of Georgia (FHCGA) located in West Atlanta. Methods: Subjects enrolled in the study (n=6) completed a nutrition knowledge survey at the beginning of the intervention and had their HbA1c values extracted from the FHCGA medical record. Subjects then entered a 4-week group nutrition intervention program. The program consisted of four lessons that focused on the basic diet for diabetes, food label reading, grocery store shopping and eating out with diabetes. Subjects took a nutrition knowledge survey after the intervention and were asked to return to have a follow-up blood draw for HbA1c levels. Results: Two out of six subjects completed the entire protocol. The HbA1c for this subject was higher after the nutrition intervention. An additional two subjects completed all of the lessons and the post survey, but did not have a follow-up HbA1c drawn. The mean nutrition knowledge score pre-intervention (72.33 + 5.13) was lower than the mean post-intervention score (78.67 + 4.04) but was not significantly different. When subdivided by food security status, subjects with a higher food security status had a lower baseline HbA1c. Conclusion: Nutrition knowledge scores increased after nutrition education but not significantly. The effect of nutrition education on HbA1c by food security status could not be determined due to low participation. Future studies with a larger sample size and incentives for compliance are needed to investigate how group nutrition education influences metabolic control in food insecure and secure people with T2D.

Polarization behaviours of copper diffused p-type GaAs was studied in 1. 0M NaCl and 1. 0M NaNO₃ by means of pitting scan and linear sweep potentiodynamic polarization techniques. The thermodynamic potential-pH diagram of the GaAs-H₂O system was constructed. The observed electrode behaviours of GaAs were compared and correlated to the potential-pH diagram. Freely corroding potential, passivation behaviour and pitting potential were examined as a function of a number of factors. These included the effects of different annealing and polishing pretreatments, the bulk solution pH and polarization methods. The corrosion potential (Ecorr) , pitting potential (Epit) and passivation behaviour were affected by the different pretreatments which changed the surface condition of GaAs. For mechanically polished samples, pitting corrosion was found in pH 7.0 solution only. The Ecorr and Eplt were independent of NO₃⁻ and Cl⁻ at pH 7.0. Initial polarization behaviour of p-GaAs at pH 2.0 and 12.0 followed the Tafel Law for semiconductors quite well. There was a reasonable correlation between the experimental observations and the potential-pH diagram of GaAs-H₂O system. SEM images of polarized samples showed that pits formed in NaCl and NaNO₃ had a different shape, being more elongated in NaCl. However, the walls of all pits appeared to be composed of {111} planes. In general, the pit distribution appeared to be similar to the dislocation distribution. A model of pitting corrosion of GaAs was proposed based on strain induced breakdown of the oxide film, localized changes in solution chemistry and the structure of the compound semiconductor. / Applied Science, Faculty of / Materials Engineering, Department of / Graduate

Class of 2017 Abstract / Objectives: The purpose of the study was to identify the types of motivation that promote sustained physical activity among adolescents between the ages of 11-17 who are diagnosed with type 1 diabetes (T1D) to prevent diabetes related complications. Methods: Questionnaires were distributed and collected among the Juvenile Diabetes Research Foundation’s (JDRF) listserv, Facebook page, and events in Phoenix and Tucson, Arizona on motivations for managing diabetes and exercise and confidence in diabetes management and performing physical activity. Demographic data was collected on age, gender, and race/ethnicity. Physical activity, levels of activity intensity, weight, height, health- related risk behaviors, chronic health conditions, and use of preventative services were also included in this study. Results: 11 adolescents completed questionnaires, categorized by participants who exercise less than 60 minutes daily (Group below recommended exercise level, GBRE) and participants who exercise more or equal to 60 minutes daily (Group meeting recommended exercise level, GMRE). GBRE’s average mean age was 15.75 and GMRE’s average mean age was 13.92. GMRE was associated with higher intensity physical activity (42.85% versus 0%). GBRE had a relative autonomy index (RAI) of 1.67 on the Treatment Self-regulation Questionnaire (TSRQ) compared to GMRE with a RAI of 3.81 (Mann-Whitney U 19, p-value 0.412). GBRE scored 73.75 on the Diabetes Self-efficacy Scale (DSES) and GMRE scored 78.71 (Mann-Whitney U 7, p-value 0.23). Conclusions: Adolescents who exercised ≥ 60 minutes daily were observed to be self-motivated in managing their diabetes, especially maintaining exercise recommendations to decrease diabetes related complications.

Dans cette thèse nous obtenons des approximations et les erreurs associées pour la distribution de la statistique de scan discrète multi-dimensionnelle. La statistique de scan est vue comme le maximum d'une suite de variables aléatoires stationnaires 1-dépendante. Dans ce cadre, nous présentons un nouveau résultat pour l'approximation de la distribution de l'extremum d'une suite de variables aléatoire stationnaire 1-dépendante, avec des conditions d'application plus larges et des erreurs d'approximations plus petites par rapport aux résultats existants en littérature. Ce résultat est utilisé ensuite pour l'approximation de la distribution de la statistique de scan. L'intérêt de cette approche par rapport aux techniques existantes en littérature est du à la précision d'une erreur d'approximation, d'une part, et de son applicabilité qui ne dépend pas de la distribution du champ aléatoire sous-adjacent aux données, d'autre part.Les modèles considérés dans ce travail sont le modèle i.i.d et le modèle de dépendance de type block-factor. Pour la modélisation i.i.d. les résultats sont détaillés pour la statistique de scan uni, bi et tri-dimensionnelle. Un algorithme de simulation de type "importance sampling" a été introduit pour le calcul effectif des approximations et des erreurs associées. Des études de simulations démontrent l'efficacité des résultats obtenus. La comparaison avec d'autres méthodes existantes est réalisée. La dépendance de type block-factor est introduite comme une alternative à la dépendance de type Markov. La méthodologie développée traditionnellement dans le cas i.i.d. est étendue à ce type de dépendance. / In this thesis, we derive accurate approximations and error bounds for the probability distribution of the multidimensional discrete scan statistics. We start by improving some existing results concerning the estimation of the distribution of extremes of 1-dependent stationary sequences of random variables, both in terms of range of applicability and sharpness of the error bound. These estimates play the key role in the approximation process of the multidimensional discrete scan statistics distribution. The presented methodology has two main advantages over the existing ones found in the literature: first, beside the approximation formula, an error bound is also established and second, the approximation does not depend on the common distribution of the observations. For the underlying random field under which the scan process is evaluated, we consider two models: the classical model, of independent and identically distributed observations and a dependent framework, where the observations are generated by a block-factor. In the i.i.d. case, in order to illustrate the accuracy of our results, we consider the particular settings of one, two and three dimensions. A simulation study is conducted where we compare our estimate with other approximations and inequalities derived in the literature. The numerical values are efficiently obtained via an importance sampling algorithm discussed in detail in the text. Finally, we consider a block-factor model for the underlying random field, which consists of dependent data and we show how to extend the approximation methodology to this case. Several examples in one and two dimensions are investigated.

Background: A marked increase of type 2 diabetes and associated morbidity and mortality rate over the last 10 years has been recorded in Malaysia. Ineffective diabetes management and a lack of self-care practice among type 2 diabetic patients have been identified as the major reasons for this problem. Research in other countries has highlighted a range of factors influencing effective self-care of type 2 diabetes including patients' perspectives of diabetes, sociocultural issues, religious beliefs and support from healthcare. Nevertheless, there is paucity of research conducted in Malaysia. Therefore, the exploration of self-care practice and self-care support provision in patients with type 2 diabetes in Malaysia is needed to understand the problem. Aims: To understand the self-care practice of patients with type 2 diabetes in Malaysia and the factors that influence the patients' self-care practice. To understand the type 2 diabetes’ self-care support provision in Malaysia from the perspective of patients, healthcare professionals, and healthcare system. Methods: A qualitative, single embedded case study design was utilised. Eighteen patients with type 2 diabetes and 19 healthcare professionals (physicians, diabetes educators, nurse, pharmacist and dietician), involved in self-care support provision primary- and secondary-care settings in Kuala Lumpur and Putrajaya, Malaysia, participated in in-depth semi-structured interviews between November 2012 and June 2013. In addition, data were collected through participant-observation of clinic consultations, and analysis of relevant documents used in the provision of diabetes management in the respective clinics. The framework technique supported analysis of data. Data were stored and managed using Nvivo 9 software. Findings: The findings indicate that patients with type 2 diabetes had a good understanding of diabetes and self-care, but a lack of self-care support meant that effective self-care was difficult to sustain. Healthcare professionals’ (HCPs’) provision of self-care support was restricted due to several factors, including lack of opportunity to provide self-care support, unsuitable clinic environment and a fragmented management within primary and secondary care. Additionally, barriers in patient–HCP communication, a combination of the personal, interpersonal and inter-professional HCP factors, and a traditional medical model adopted by Malaysian healthcare system, seem to have influenced the practice and quality of the service delivered. Conclusion: It is clear that the increased incidence of uncontrolled type 2 diabetes is not merely due to poor self-care practice by patients, but also due to constraints in service delivery and underdevelopment of self-care support provision. The evidence generated can assist in the development of strategies to improve the quality of care and facilitate changes in the self-care support provision in Malaysia.

Type IV pili, or fimbriae, are long, thin proteinaceous appendages found on the surface of many well-known pathogens. They mediate a variety of important virulence functions for the organism, such as twitching motility, biofilm formation, uptake of genetic material and host cell recognition and adhesion. Pili are formed by the rapid polymerization and de-polymerization of the pilin subunit, and this is orchestrated by a complex macromolecular machine which spans the bacterial cell envelope, requiring a variety of gene products. The type IV pilus biogenesis system is closely related to the bacterial type II secretion system, one of six designated multi-protein cell envelope complexes which are dedicated to the specific secretion of exotoxins and virulence factors. Many of these secretion systems also produce fimbrial structures to facilitate the extrusion of their substrates or to communicate with the host. As they form crucial virulence factors, the secretion systems and the type IV pilus biogenesis system have become attractive potential antimicrobial targets and obtaining structural and functional information for the components of these systems is an important first step towards achieving this.Type IV pili appear on the surface of bacteria through an outer membrane pore, PilQ, which is a member of the secretin family. Secretins are also found in the type II and III secretion systems, but the way in which they are regulated remains unclear. PilQ forms a dodecameric chamber in the outer membrane with a large vestibule which reaches into the periplasm, composed of its N-terminal domains. In this project, N-terminal domains from PilQ were produced in recombinant form and their structures determined by NMR. One of these domains revealed an eight-stranded beta-sandwich structure which appears to be unique to type IV pilus secretins and has not been structurally characterized before. Another revealed an alpha/beta type fold which is common to secretins of other systems. In the second part of this project, the interaction formed between the N-terminal alpha/beta domains of PilQ and an essential inner membrane-anchored lipoprotein, PilP, was probed by NMR chemical shift perturbation. Based on changes to the 15N-HSQC spectra the binding site was mapped onto each protein to produce a computational model for the complex formed between the two. Using a recent cryo-EM structure for the Neisseria PilQ dodecamer determined by colleagues, it was possible to model the PilQ N-terminal domains in complex with PilP into the electron density map. This produced a model for the trans-periplasmic assembly formed by PilQ and PilP in the type IV pilus biogenesis system, and led to the conclusion that the PilQ dodecamer needs to disassemble considerably at the base to accommodate a pilus fibre. The novel beta-domains might therefore function to gate or open the secretin, and PilP may play a role in stabilizing the secretin during this and serve to connect the outer and inner membrane system components.

This study sought to examine the relationship between the procrastination involved in thesis writing and Jungian personality type. A sample of 50 graduate students enrolled in the Department of Counselling Psychology at the University of British Columbia participated in the study. These individuals were classified into one of two groups: those who procrastinated while writing their thesis and those who did not. Procrastination was measured using length of time taken to complete the thesis coupled with self-report. The 50 subjects were then administered the Myers-Briggs Type Indicator which measures Jungian personality type. These two groups were then compared to determine if significant differences in personality type existed between the procrastinating and nan-procrastinating groups. Five hypotheses were tested. A t-test (two tailed) was performed using the continuous scores of the four scales of the MBTI to test the first four hypotheses to determine if a statistical difference could be found between these two groups on these dimensions. No differences were found on the first three scales (extraversion-introversion; sensation-intuition; thinking-feeling), but a significant difference was found on the judging-perceiving index (p=.008). Procrastinators tended to score toward the perceiving end of the scale while non-procrastinators scored toward the judging end of the continuum. A chi-square analysis using tire dichotomous scores of the MBTI was performed to test the fifth hypothesis which predicted that a significantly higher number of NFP types would be procrastinators than nan-procrastinators. This hypothesis was accepted (p=.0017) indicating that specific personality variables do tend to correlate with procrastination. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Although cardiovascular disease (CVD) does not occur until mid to late life for most adults, the presence of risk factors for CVD, such as high blood pressure (BP) and high cholesterol, has increased dramatically in young adults. Type D personality consists of two personality traits, negative affectivity (NA) and social inhibition (SI), and has repeatedly been shown to be an independent predictor of hard medical outcomes (e.g. morbidity and mortality) in cardiac patients. The present study examined the relationships between Type D personality (high NA and high SI), coping strategies, and physiological markers of cardiovascular health in a sample of non-medical, university students. Measures of cardiovascular risk included high frequency heart rate variability (HF HRV), calculated LDL cholesterol, and systolic blood pressure (SBP). Regression analyses revealed that higher use of social supportive coping was a significant predictor of calculated LDL cholesterol. Social supportive coping was also shown to moderate the relationship between Type D personality and HF HRV. Interventions that target psychological and physiological mechanisms associated with CVD are well developed. Clear identification of young adults who are at risk of developing CVD is necessary to intervene in a manner that could potentially save lives. Additional systematic research, especially if it is longitudinal, will help to clarify the ability of Type D personality and coping to predict CVD.