In our current environment virtually any information, including health-related data, can be readily accessible due to the ubiquity of smart devices and health monitoring smart device accessories, such as activity, sleep, heart rate, pulse, and blood pressure tracking devices. However, currently available self-monitoring devices are restricted to extra-corporeal data, leaving many important physiological parameters such as glucose, hormone, and electrolyte level changes uncharted. Of notable interest in the area of self-monitoring is that of blood glucose levels in the pre-diabetic population. Continuous glucose monitoring (CGM) devices utilised by diabetics are invasive and cost prohibitive for general consumers and therefore uncommonly used pre-diagnosis. These devices are thus unlikely to enable the lifestyle changes and administration of the appropriate adjustments in a timely manner to pre-diabetics, which may prevent the progression to diabetes. This dissertation discusses and demonstrates the development of a minimally invasive wearable device for the continuous sensing of glucose, with Bluetooth wireless connectivity to enable data transfer to a smart device. Three major components of this device are: 1) microneedles, which serve to penetrate the skin to access the underlying dermal interstitial fluid, and to immobilise the glucose sensor; 2) fluorescent glucose sensor, which senses glucose in the dermal interstitial fluid whilst being immobilised to the microneedles; and 3) wearable fluorescence detection system, which interrogates and evaluates the light signal generated by the microneedle sensing platform. The microneedles are unique compared to the previous microneedle sensing devices, in that the sensing moiety can be chemically integrated into the microneedles to allow for continuous fluid sampling and analyte monitoring to take place simultaneously in situ. Glucose sensing is enabled by modular fluorescent sensors, consisting of glucose receptors, a reporting fluorophore, and an immobilisation site. The wearable fluorometer is 5.1 x 3.2 x 1.9 cm in dimension, is battery-powered, has an adjustable dynamic range, and exhibits fluorescence detection capability comparable to that of the gold standard microplate reader device. In vitro and in vivo assessments demonstrate that the microneedle sensing platform and the detector are able to perform their intended functions, and more importantly, can be integrated compatibly into the final envisioned system. Beyond the intended overall application of continuous glucose monitoring, each component and their fabrication methods have the potential to be utilised for the continuous monitoring of other health metrics. When these components are assembled, the end product is a wearable continuous sensing system that is easy to use, almost painless, minimally invasive, and overall, accessible in terms of convenience and cost to the general consumer.

Maintaining appropriate glucose levels is important to patients with diabetes because it helps to improve patients' quality of life and prevents medical complications. This study was designed to determine if there was a statistically significant difference in blood glucose levels between a treatment group that completed a certified diabetes education program with telephonic follow-up by a diabetes educator and a comparison group that also received the certified diabetes education program but without telephonic follow-up. A pretest/posttest control group design was used which randomly assigned subjects to groups by clusters. From the analysis of data it was determined that there was no statistical difference in blood glucose levels between the treatment and the comparison groups. Therefore, weekly telephonic follow-up did not statistically impact blood glucose levels in the treatment group. However, the results did indicate that the telephonic follow-up may have impacted the proportion of patients who returned for post blood glucose testing and sought treatment for other related health concerns. / Department of Physiology and Health Science

In an attempt to investigate the role of the endogenous opioid peptides in substrate utilization and hormonal responses to exercise, eight trained cyclists completed two exercise trials at each of two distinct intensity/duration combinations. Briefly, cyclists completed two trials at 70% VO2max for 90 minutes and two trials at 90% VO2max until exhaustion. Trials were conducted following the administration of the opiate antagonist naloxone (NAL) (0.1 mg-kg-1 bolus + 0.1 mg-kg-1-·hr-1) or volume matched saline (SAL). Serum glucose was maintained at significantly higher levels at 60 and 90 minutes of exercise in 70% NAL vs 70% SAL. Serum glucose was significantly higher at all points during exercise and at 30 and 60 minutes of recovery in 90% NAL vs 90% SAL. Serum insulin was not altered by naloxone administration at either 70% or 90% trials. Serum Cpeptide was significantly higher at 60 and 90 minutes in 70%-NAL vs 70% SAL, and was significantly lower during exercise in 90%-NAL vs 90% SAL. Plasma glucagon was not different during exercise in the 70% trials, but was significantly higher during exercise in 90%-NAL vs 90%-SAL. The glucagon:insulin molar ration was not significantly altered by naloxone administration in any trial. Rating of peceived exertion was significantly higher during exercise in 70%-NAL, but was not different during exercise in the 90% trials. However, time to exhaustion was significantly (18%) reduced in 90%-NAL vs 90%-SAL. No systematic differences were observed in the cardiorespiratory responses to exercise at either intensity, although pulmonary ventilation was modestly (7%) elevated in 90%-NAL. Thus, opiate antagonism prevents the decline in serum glucose seen in prolonged exercise without altering substrate oxidation, and with minimal influence on the pancreatic hormone response. In contrast, opiate antagonism potentiates the hyperglycemic response to high intensity exercise at least in part by altering pancreatic hormone responses which may contribute to the hyperglycemia. / School of Physical Education

Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 115-120)

Thesis (M.S.)--University of Akron, School of Family and Consumer Science-Nutrition and Dietetics , 2007. / "May, 2007." Title from electronic thesis title page (viewed 4/26/2009) Advisor, Deborah Marino; Faculty readers, Richard Steiner, Evelyn Taylor, Cinda Chima; School Director, Richard Glotzer; Interim Dean of the College, James Lynn; Dean of the Graduate School, George R. Newkome. Includes bibliographical references.

Dissertation (Ph.D.)--University of Toledo, 2010. / Typescript. "Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Doctor of Philosophy Degree in Engineering." "A dissertation entitled"--at head of title. Title from title page of PDF document. Bibliography: p. 191-212.

M.Cur. / Please refer to full text to view abstract

Diabetes mellitus is a metabolic disease with abnormally high concentration of glucose in blood in patients. Continuous glucose monitoring, which involves measuring glucose concentration in the patient throughout the day and night, can significantly reduce the risk of diabetes-related complications. Commercially available CGM sensors are not yet suited for long-term applications due to reliability and accuracy issues associated with the irreversible, consumptive nature of the underlying electrochemical reactions. Affinity sensing methods, which are based on reversible affinity binding between glucose and a recognition molecule, hold the potential to address these challenges in CGM applications. These methods do not involve the consumption of glucose and can offer improved stability and accuracy for CGM. When combined with impedance-based transduction methods, affinity sensors can also offer a high level of miniaturization, allow low-cost instrumentation, and are amenable to physical and functional integration. The affinity sensors investigated in this thesis include hydrogel-based affinity microsensors and graphene-based affinity nanosensors. We first present a dielectric affinity microsensor that consists of a pair of coplanar electrodes functionalized in situ with a glucose-responsive hydrogel for dielectrically based affinity measurement of glucose in subcutaneous tissue. We present a study of the effects of the choice of hydrogel compositional parameters on the characteristics of the hydrogel-based microsensor, allowing the identification of the optimal hydrogel composition for the microsensor to sensitively and rapidly respond to changes in glucose concentration. A differential design is then demonstrated, both in vitro and in vivo, to effectively minimize the influence of fluctuations in the environmental conditions, thereby allowing the hydrogel-based microsensor to function appropriately as a subcutaneously implanted device. In addition, we present a preliminary study on affinity nanosensors for non-invasive monitoring of glucose concentrations in physiological media such as tears. The affinity nanosensor is based on a chemically modified graphene field-effect transistor for the electrical measurement of glucose concentrations. The study explores the sensing mechanism of the nanosensors and demonstrates a device with high sensitivity and low limit of detection, which satisfies the requirement for monitoring glucose concentrations in tears. Experimental results demonstrate that these affinity micros and nanosensors are capable of measuring glucose concentrations with a suitable sensitivity and dynamic range for the intended physiological media, with potential applications to minimally invasive or non-invasive continuous glucose monitoring in diabetes care.

Periodontal inflammation is a hallmark of periodontitis and a primary driver of progressive periodontal tissue destruction. In addition, inflammation is hypothesized as a critical mechanistic intermediate linking periodontal disease to systemic inflammation and extra-oral disease outcomes. However, most of the commonly used measures of periodontitis, for research and/or surveillance purposes, focus on quantifying the periodontal tissue loss (i.e., gingival recession (GR) and clinical attachment loss (CAL)). There are few indices that focus on quantifying periodontal inflammation in the periodontal literature, and there are inherent limitations in the way they are calculated. The Periodontal Inflamed Surface Area (PISA) is a composite measure that incorporates bleeding on probing (BOP) and other measures of periodontal disease to quantify the amount of periodontal inflamed surfaces. This dissertation examined PISA as a useful measure that attempted to quantify periodontal inflammation, and it is divided into three parts. The first paper is a scoping review focused on reviewing the relevant literature around PISA since its introduction to the literature in 2008. The second paper is an empirical paper that examined the psychometric properties of PISA compared to other measures of periodontitis. The third paper is another empirical study that explored how PISA correlated with some biological features of periodontitis, including the subgingival microbial profile, systemic immune response, and selected dysbiosis indices. The empirical papers utilized data from two population-based cohorts: the Oral Infections, Glucose Intolerance, and Insulin Resistance Study (ORIGINS) and the Washington Heights Inwood Community Aging Project's Ancillary Study of Oral Health (WHICAP-OH). The review found that PISA was primarily utilized in studies that looked at oral-systemic health connections, with results that mostly confirmed the associations between periodontal disease and systemic health. However, most evidence suffered from methodological concerns that could limit the validity and generalizability of results. The psychometrics analyses showed that PISA had good sensitivity, specificity, and accuracy in identifying patients with periodontitis. The latent factor analyses suggested a multi-level three-factor model showing PISA to cluster with bleeding on probing in the same factor that indicates an inflammation component of the unobserved periodontal disease status. The third paper showed that PISA was significantly associated with alpha diversity indices (Shannon's, Simpson's, and Faith's phylogenetic diversity) and two of the dysbiosis indices in both cohorts. The strength of associations and amount of variance explained in some of the biological features were higher for PISA than other measures of periodontitis. The evidence from this dissertation suggests that PISA is a valuable index that describes periodontal inflammation and has good psychometric properties. Future research can explore the replication of our methods in other cohorts to expand the validity and utility of PISA in periodontal literature.

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