Background: Diabetic foot neuropathy (DFN) is one of the most important complications of diabetes mellitus; its early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is concerning. Delivering messages to remind patients to perform thermometry and foot care might be helpful to guarantee regular foot monitoring. This trial was designed to compare the incidence of diabetic foot ulcers (DFUs) between participants who receive thermometry alone and those who receive thermometry as well as mHealth (SMS and voice messaging) over a year-long study period. Methods/design: This is an evaluator-blinded, randomized, 12-month trial. Individuals with a diagnosis of type 2 diabetes mellitus, aged between 18-80 years, having a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Foot), have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent will be eligible to participate in the study. Recruitment will be performed in diabetes outpatient clinics at two Ministry of Health tertiary hospitals in Lima, Peru. Interventions: participants in both groups will receive education about foot care at the beginning of the study and they will be provided with a thermometry device (TempStat (TM)). TempStat (TM) is a tool that captures a thermal image of the feet, which, depending on the temperature of the feet, shows different colors. In this study, if a participant notes a single yellow image or variance between one foot and the contralateral foot, they will be prompted to notify a nurse to evaluate their activity within the previous 2 weeks and make appropriate recommendations. In addition to thermometry, participants in the intervention arm will receive an mHealth component in the form of SMS and voice messages as reminders to use the thermometry device, and instructions to promote foot care. Outcomes: the primary outcome is foot ulceration, evaluated by a trained nurse, occurring at any point during the study. Discussion: This study has two principal contributions towards the prevention of DFU. First, the introduction of messages to promote self-management of diabetes foot care as well as using reminders as a strategy to improve adherence to daily home-based measurements. Secondly, the implementation of a thermometry-based strategy complemented by SMS and voice messages in an LMIC setting, with wider implications for scalability.

Background Type 2 diabetes mellitus (T2DM) and serious mental illness involves major public health problems in the world. People with severe mental illness have an increased risk of metabolic abnormalities and obesity, leading to an increased incidence for T2DM. District nurses with advanced training in diabetes care will in their profession give support to lifestyle changes and healthy living habits. Aim The purpose of this study was to illuminate district nurses´ experience of how they can support people with T2DM and serious mental illness.Method A qualitative methodology based on individual interviews analyzed with qualitative content analysis was used. Twelve informants were part of the study. Results The individual meeting with mutual relations and respect for individuals was important. During periods of worsening mental health of the patient, the district nurses provide support and monitoring, adjusted to the patients' ability. The district nurses felt inadequacy and frustration when the patients' physical and mental health were deteriorating. The strategy was to acknowledge progress when small improvements were made and extended contacts with nurses in out-patient psychiatry were requested. Conclusion Support was designed as respectful treatments and individual meetings were prioritized. District nurses' strategies were to guide the patient by positive attitudes according to the individual, and by giving support adapted to the needs of the patient. Despite feelings of insufficiency the district nurses never gave up and conveyed the message to never let go. Cooperation and extended contact with open psychiatry were desirable to exchange knowledge, giving accordance in decisions and messages.

Bakgrund: Diabetes mellitus typ 1 är en autoimmun sjukdom och antalet som insjuknar ökar varje år. Under ungdomstiden sker mycket i människans kropp och det kan vara en utmaning att balansera blodsockernivåer när hormonerna i kroppen svajar. Ungdomar med diabetes mellitus typ 1 står därför inför stora utmaningar för att lyckas med sin behandling. Syfte: Syftet är att belysa ungdomars upplevelser av att leva med diabetes mellitus typ 1. Metod: Metoden är en litteraturstudie baserad på både kvalitiva och kvantitativa studier. Analysen är genomförd utifrån en modell av Axelsson (2012). Resultat: I resultatet framkom att ungdomarna med diabetes mellitus typ 1 växte in i rollen i att bli mer självständiga i sin behandling. Detta var inte alltid lätt. Ungdomarna påverkades av hur deras vänner bemötte diagnosen, hur de blev bemötta av vården samt hur villiga deras föräldrar var att lämna över ansvaret. Resultatet presenteras utifrån fyra huvudteman samt nio subteman. Diskussion:I diskussionen tar vi upp vikten av att jobba med målet att patienten ska få kunskap så att denne kan sköta sin behandling självständigt. Vikten av stöd för att motverka känslor av skam för sjukdomen och dess behandling belyses också.

Type 2 Diabetes Mellitus (T2DM) was once a disease process found only in the adult population. However, incidence rates of T2DM in children and adolescents are increasing at alarming rates and becoming a grave public health concern. As many as 5,089 individuals under the age of 20 are newly diagnosed with T2DM each year. The military community is not immune to these national trends and T2DM among military dependents is growing at similar rates to that of the civilian population. The primary aim of this DNP project was to investigate if barriers exist with regard to pediatric military dependents, ages 10-17 years, receiving appropriate diagnosis, and treatment of T2DM. Previously published literature has identified health disparities exist within the Military Health System (MHS), despite beneficiaries having equal access to care. This project also sought to assess providers' use of Evidence Based Practice (EBP) and Clinical Practice Guidelines (CPGs) in the treatment of pediatric patients' ages 10-17 with T2DM, as it has been indicated that use of evidence based guidelines for management of T2DM vary among military treatment facilities. Results of the DNP Project reflected information found in previous evidence based literature. Fifty percent of providers felt there is "probably" a health disparity among Type 2 Diabetic youth who seek care at a Military Treatment Facility (MTF). Diverse responses were received regarding applicable health disparity indicators among MHS beneficiaries, indicating these disparities may be multifactorial. Routine incorporation of EBP and CPGs into clinical practice also appeared to vary among participants. It is evident that further research may positively contribute to current understanding of health disparities among MHS beneficiaries.

No description available.

This thesis explores the impact of type 2 diabetes among Indian and Pakistani migrants. Indians and Pakistanis living in the UK have a high incidence of type 2 diabetes and associated complications. Research is needed in order to understand factors that make it difficult to adhere to lifestyle advice about diet, exercise and medication. Drawing on data collected during a sixteen-month ethnographic investigation, this thesis explores Indians’ and Pakistanis’ perceptions of diabetes. The research revealed that Indians and Pakistanis related the onset of diabetes to processes of migration and settling in the UK as well as to stress and depression. In particular, holding on to negative thoughts and worries, were perceived by respondents as directly affecting the body by causing stress, depression and eventually illness. Struggles over diabetes control were also perceived as to cause distress. Specifically, respondents struggled to adhere to a healthy diet regime, since food, especially taste, played a crucial role in forming, reinforcing and demarcating social relations and in ensuring cultural continuity. In addition, respondents struggled to ‘adhere’ to their prescriptions of diabetes medications due to the uncomfortable side effects that they experienced, particularly in the stomach. Respondents, however, counteracted side effects by turning to alternative medications which were perceived to facilitate flow within the circulatory and digestive system. Thus, in spite of the difficulties that Indians and Pakistanis experienced in following biomedical recommendations for diabetes control, they still actively engaged in searching and using different treatments available to them in order to control the disease.

Type 1A diabetes mellitus or T1D is a chronic disease characterized by T cell mediated destruction of the insulin producing β cells in the islets of Langerhans. The classical symptoms include high glucose levels in urine and blood, polyuria, and polydipsia. Complications associated with T1D include blindness, amputations, and end-stage renal disease, and premature death. The non-obese diabetic (NOD) mouse, first described in 1980, is widely used as a model organism for T1D. T1D disease in the NOD mouse shares a number of similarities to human T1D including dependence on genetic and environmental factors. More than 30 disease associated gene regions or loci (termed insulin dependent diabetes, or Idd, loci) have been associated with T1D development in NOD. For some of these Idds, the corresponding region in human has been linked to the development of T1D in human. T1D, both in humans and mice, is recognized as a T cell mediated disease. However, many studies have shown the importance of both the metabolome and the immune system in the pathogenesis of the disease. Appearance of autoantibodies in the serum of patients is the first sign of pathogenesis. However, molecular and cellular events precede the immune attack on the β-cell immunity. It has been shown that patients who developed T1D have an altered metabolome prior to the appearance of autoantibodies. Although much is known about the pathogenesis of T1D, the contribution of the environment/immune factors triggering the disease is still to be revealed.  In the present study both metabolic and immune deviations observed in the NOD mouse was analyzed. Serum metabolome analysis of the NOD mouse revealed striking resemblance to the human metabolic profile, with many metabolites in the TCA cycle significantly different from the non-diabetic control B6 mice. In addition, an increased level of glutamic acid was of the most distinguishing metabolite. A detailed bioinformatics analysis revealed various genes/enzymes to be present in the Idd regions. Compared to B6 mice, many of the genes correlated to the metabolic pathways, showed single nucleotide polymorphism (SNP), which can eventually affect the functionality of the protein. A genetic analysis of the increased glutamic acid revealed several Idd regions to be involved in this phenotype. The regions mapped in the genetic analysis harbor important enzymes and transporters related to glutamic acid. In-vitro islet culture with glutamic acid led to increased beta cell death indicating a toxic role of glutamic acid specifically towards insulin producing beta cells. In the analysis of the immune system, B cells from NOD mice, which are known to express high levels of TACI, were stimulated with APRIL, a TACI ligand. This resulted in enhanced plasma cell differentiation accompanied with increased class switching and IgG production. NOD mice have previously been shown to react vigorously to T-dependent antigens upon immunization. In this study we confirmed this as NOD mice showed an enhanced and prolonged immune response to hen egg lysozyme. Thus, serum IgG levels were significantly increased in the NOD mice and were predominantly of the IgG1 subtype. Immunofluorescence analysis revealed increased number of germinal centers in the NOD mice. Transfer of purified B and T cells from NOD to an immune deficient mouse could reproduce the original phenotype as seen in the NOD mice.     Collectively, this thesis has analyzed the metabolomics and immune deviations observed in the NOD mice.

Thesis (MEd)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: In South Africa effective leadership is an important priority in all walks of life. With the implementation of Curriculum 2005, greater emphasis is placed on the development of leadership skills to prepare learners for leadership demands in adult life. In order to do this one must firstly create leadership opportunities. Secondly it is important to convey the knowledge and skills necessary for the optimum fulfillment of their roles as leaders. Personality types and preferences as well as the strengths and weaknesses of the leader and other group members can be utilized to enhance teamwork and improve leadership. The empirical investigation comprised the determination of the personality types of the research group as well as leadership positions held by them during their school careers, and the leadership skills perceived as important by them. Fifty youth leaders, representative of head boys and head girls in former model C schools, who attended the conference for youth leaders annually hosted by Die Burger, were used as the investigation group. For the purpose of this research the Myers-Briggs Type Indicator (MBTI®), Form G, was used. The MBTI® is based on Carl Jung's theory of personality types. The most important findings of the study are that trends exist in the personality types that were reported by the youth leaders. The dominant personality type preference of the youth leaders was ESTJ. This shows a preference for extroversion (E), sensing (S), thinking (T) and judging (J). Good interpersonal relationships, listening skills and high moral values were identified as the most important characteristics for effective leadership. The implications for leadership development, emanating from the knowledge of the personality types and preferences of the youth leaders, are discussed. / AFRIKAANSE OPSOMMING: In Suid-Afrika is effektiewe leierskap op alle vlakke van die samelewing 'n belangrike prioriteit. Ook in die opvoedingsituasie word daar met die implementering van Kurrikulum 2005 groter klem geplaas op die ontwikkeling van leierskapsvaardighede om leerders voor te berei vir leierskapseise wat in hulle volwasse leeftyd gestel gaan word. Om dit te kan doen moet daar in die eerste plek geleenthede geskep word waartydens die leerders leierskap kan beoefen en tweedens is dit belangrik dat kennis en vaardighede wat die leerder kan help om sy rol as leier so suksesvol moontlik te vervul, aan hom oorgedra word. Kennis oor die leier en ander groeplede se persoonlikheidstipes en voorkeure asook elkeen se sterkpunte en leemtes kan suksesvol benut word om groepsamewerking te verbeter en sodoende suksesvolle leierskap te bevorder. Die empiriese gedeelte van die ondersoek het die vasstelling van die ondersoekgroep se persoonlikheidstipes, die leierskapsposisies wat deur hulle beklee is gedurende hulle skoolloopbaan asook die leierskapseienskappe wat deur die betrokke leerders as belangrik geag is, behels. 'n Ondersoekgroep van 50 jeugleiers, bestaande uit 'n seleksie van hoofseuns en -meisies in die vorige Model C skole wat Die Burger se jaarlikse jeugleierskonferensie bygewoon het, word by hierdie navorsing betrek. Vir die doel van hierdie ondersoek word gebruik gemaak van die Myers-Briggs Type Indicator (MBTI®), vorm G. Die MBTI® is gebaseer op Carl Jung se persoonlikheidsteorie. Die belangrikste bevindinge van die ondersoek is dat daar tendense bestaan in die persoonlikheidstipes wat meer algemeen by jeugleiers voorkom. Die oorwegende persoonlikheidstipevoorkeur wat by die jeugleiers voorgekom het, was ESTJ. Dit dui 'n voorkeur vir ekstroversie(E); sintuiglike waarneming (S); denke (T) en beoordeling (J) aan. Goeie luistervaardighede en hoë morele waardes is as die belangrikste eienskappe vir effektiewe leierskap geïdentifiseer. Die implikasies vir die leierskapsontwikkeling van leerders wat voortspruit uit die kennis van leiers se persoonlikheidstipe en -voorkeure, word bespreek.

The neurotransmitter dopamine (DA) represents a neural substrate for positive motivation as its spatiotemporal distribution across the brain is responsible for goaldirected behavior and learning reward associations. The critical determinant of DA release throughout the brain is the firing pattern of DA-producing neurons. Synchronized bursts of spikes can be triggered by sensory stimuli in these neurons, evoking phasic release of DA in target brain areas to drive reward-based reinforcement learning and behavior. These bursts are generated by NMDA-type glutamate receptors (NMDARs). This dissertation reports a novel form of long-term potentiation (LTP) of NMDARmediated excitatory transmission at DA neurons as a putative cellular substrate for changes in DA neuron firing during reward learning. Patch-clamp electrophysiological recording from DA neurons in acute brain slices from young adult rats demonstrated that synaptic NMDARs exhibit LTP in an associative manner, requiring coordinated pre- and postsynaptic burst firing. Ca2+ signals produced by postsynaptic burst firing needed to be amplified by preceding metabotropic neurotransmitter inputs to effectively drive plasticity. Activation of NMDARs themselves was also necessary. These two coincidence detectors governed the timingdependence of NMDAR plasticity in a manner analogous to the timing rule for cuereward learning paradigms in behaving animals. Further mechanistic study revealed that PKA, but not PKC, activity gated LTP induction by regulating the magnitude of Ca2+ signal amplification via the inositol 1,4,5-triphospate (IP3) receptor and release of Ca2+ from intracellular stores. Plasticity of NMDARs was input specific and appeared to be expressed postsynaptically, but was not associated with a change in NMDAR subunit stoichiometry. LTP of NDMARs was DA-independent, and was specific for NMDARs: the same induction protocol produced long-term depression of AMPA receptors. NMDARs that had undergone LTP could be depotentiated in a spike-conditional manner, consistent with active unlearning. Finally, repeated, in vivo amphetamine experience dramatically increased facilitation of spike-evoked Ca2+ signals, which in turn drove enhanced plasticity. NMDAR plasticity thus represents a potential neural substrate for conditioned DA neuron burst responses to environmental stimuli acquired during reward-based learning as well a novel therapeutic target for intervention-based therapy of addictive disorders. / text

Utilizing the information garnered from research on information processing in the two elaboration types (i.e., item-specific and relational processing) this research examines the influence of gender and advertising narrative effectiveness. Advertising effectiveness is determined by recall and perception from exposure to relational and item-specific developed narratives. Included are literature reviews, supporting data and analysis, results, discussion, and speculations of differing outcomes based on the study conducted. / text