Background: Type 2 diabetes has been found to be associated with cognitive impairments in planning, problem solving, organization, and working memory and also with an increased risk of dementia. Neurocognitive impairment may impact self-care and other health behaviours increasing the risk of poor health outcomes in this patient population. Detection of neurocognitive impairment in low and middle-income settings is challenging; there is a lack of validated screening tools suitable for local use in primary care and outpatient settings and access to formal neuropsychological testing services is limited. The inability to easily identify people with type 2 diabetes with neurocognitive impairments is constraining the development of context appropriate interventions to improve the care and outcomes in this sub-group of patients. Aim: The aim of the current analysis is to explore associations between neurocognitive function and measures of diabetes control (HbA1c, disease duration, type of blood glucose lowering treatment) at baseline in a population of people with type 2 diabetes participating in a clinical trial of treatment adherence support using SMS-text messages. Materials and Methods: Sms text Adherence suppoRt for type 2 Diabetes (StAR2D) is a randomised clinical trial testing if a system of SMS-text messages to support treatment adherence is more effective than usual care for controlling blood sugar among people with type 2 diabetes in sub-Sahara Africa (ISRCTN70768808). We have embedded neurocognitive assessment sub-studies into the Cape Town trial site. At baseline participants in the StAR2D trial complete a novel mobile-device based cognitive assessment, NeuroScreen, assisted by a field research assistant. The assessment contains 9 variants of tests found in the gold-standard neuropsychological test battery that have been adapted and normed for use in South Africa. It is available in English or isiXhosa. The assessment takes between 20 to 40 minutes depending on participant error rate. This cross-sectional analysis of baseline data uses linear and logistic regression models to explore associations between neurocognitive function and measures of diabetes control. Results: Six hundred participants eligible for enrolment in the StAR2D trial were recruited from the Cape Town trial site; 499 participants completed the baseline neurocognitive screening assessment (20 to 40 minutes to complete); 101 participants did not complete the assessment (commonly due to eyesight, hearing or motor difficulties e.g. hemiplegia due to previous stroke or technical difficulties.) We found differences in the scores in some but not all the neuropsychological tests. Using cut points suggested by an earlier validation study of NeuroScreen tool more than half of study participants would be scored as having at least mild neurocognitive impairment. HbA1c, duration of disease, type of blood glucose lowering treatment were not significantly associated with individual or overall neuropsychological test scores or odds of neurocognitive impairment. Conclusions: The prevalence of neurocognitive impairment may be substantial in this patient population. A novel tablet based neurocognitive screening tool was broadly feasible and acceptable to lay researchers and trial participants. There was no evidence that HbA1c, duration of disease, or type of blood glucose lowering treatment (oral agents alone or insulin containing regimens) was significantly associated with individual or overall neuropsychological test scores or odds of neurocognitive impairment. Validating this tool for this patient population and optimising its role in routine clinical care need further study.

Diabetes and depression are both highly prevalent within the U.S. and it is worrisome that these two conditions are related. Several meta-analyses and studies using qualitative, clinical, and nationally representative cross-sectional quantitative data have shown that depression is associated with an increased risk of developing diabetes (Ducat et al. 2014; Lloyd, Hermanns, Nouwen, Pouwer, Underwood, and Winkley 2010; Katon et al. 2010; Mezuk et al. 2008) and/or those who are diabetic have a moderately increased risk of developing depression (Katon at al. 2010; Moulton, Pickup, and Ismail 2015). Controversy exists as to which way the association may be stronger and whether these conditions are causally related. Additionally, although research into the biological links between these diseases exists, little work has been done that examines the social conditions that link diabetes and poor mental health throughout the life course. Using the National Social Life, Health, and Aging Project (NSHAP), this dissertation examines the biopsychosocial connection between marital biography, mental health, and diabetes with an emphasis on gender differences. I examine 1) how mental health and diabetes are associated cross-sectionally and longitudinally; 2) how marital biography impacts the relationships between mental health and diabetes; and 3) how social mechanisms influence the previously established relationships between marital biography, mental health, and diabetes. Each relationship is examined for the women and men separately and compared to the overall sample. Results add to existing literature by demonstrating that diabetes and depressive symptomology are associated cross-sectionally when each health condition is examined as the dependent variable. Longitudinally, those who are diabetic report higher depressive symptoms over time than non-diabetics. Results vary in magnitude and significance based on gender. For women, those who were diabetic at baseline report higher depressive symptoms over time than non-diabetic women. Results also contribute to the field by showing that marital biography impacts the cross-sectional relationships between diabetes and depressive symptomology. Finally, results also demonstrate that social disconnectedness, social isolation, and perceived social stress mediate the association between diabetes and depressive symptoms. The findings highlight the complexity within diabetes-mental health relationship and demonstrate the importance of understanding the biopsychosocial connection throughout the life course between marital biography, mental health, and diabetes. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester 2016. / May 16, 2016. / Aging, Diabetes, Gender, Marriage, Mental Health / Includes bibliographical references. / Isaac Eberstein, Professor Directing Dissertation; Heather Flynn, University Representative; Amy Burdette, Committee Member; Michael McFarland, Committee Member.

Pancreatic islet beta-cells play a vital role in regulating blood glucose levels by releasing insulin into the bloodstream. Insulin is released in pulses that parallel interacting beta-cell rhythms, including oscillatory glucose metabolism and periodic calcium influx. We present concurrent time series records of metabolic variables and intracellular calcium levels in glucose-stimulated beta-cells that support regulation of mitochondrial dehydrogenases is the dominant calcium feedback effect onto metabolism in the insulin secretory pathway. We include this effect into the beta-cell Dual Oscillator Model to reconcile model simulations with experimental data, then we determine the oscillation mechanism in the modified model. Islets lose the rhythms that govern insulin pulses when glucose is elevated to hyperglycemic levels. We demonstrate with modeling and experiments that oscillations lost to elevated glucose can be recovered by converting the elevated glucose stimulus to a sinusoidal wave. We predict with modeling which periodic glucose stimuli can recover islet oscillations. / A Dissertation submitted to the Department of Mathematics in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester 2017. / April 14, 2017. / beta-cell, bifurcation, bursting, insulin, islet, oscillation / Includes bibliographical references. / Richard Bertram, Professor Directing Dissertation; Michael G. Roper, Committee Member; Ziad H. Muslimani, Committee Member; M. Nicholas J. Moore, Committee Member; Brian G. Miller, University Representative.

<p>2022-03-21</p>

No description available.

<p>2022-03-22</p>

<p>2022-03-23</p>

Thyroid cancer is the most prevalent endocrine cancer (1). The prevalence of palpable thyroid nodules in the general adult population is 4% to 7% (2). Ultrasound imaging detects thyroid nodules in 19%-68% of randomly selected individuals (3). The rate of thyroid cancer in nodules found on US is 4% to 15% (4). In order to evaluate thyroid nodules patients undergo thyroid ultrasonography and, if needed, a fine-needle aspiration biopsy. Of all fine-needle aspiration biopsies, 15-30% are indeterminate on cytology (5). While only 3% of these nodules are malignant on average, a much higher percentage of nodules are surgically removed in order to rule out malignancy after indeterminate FNA results. Our goal is to identify clinical and ultrasound predictors of benign results in indeterminate nodules, to assist physicians in selecting nodules for surgical removal versus monitoring with ultrasound imaging. Between October 2010 and November 2017 there were 129 patients with 134 thyroid nodules from Temple University Hospital, Jeanes Hospital, and Fox Chase Cancer Center who had a total or partial thyroidectomy after a cytology report of at least one AUS or FLUS thyroid nodule. These patients were evaluated for age, sex, BMI, TSH, fT4, tT3, nodule size, and ultrasonography features to determine if any features were predictive of a benign or malignant thyroid nodule. Additionally, we looked at whether any of these features were more likely to occur in an AUS nodule or a FLUS nodule. We found that none of the demographic factors, thyroid function tests, or ultrasound features were good predictors of malignancy in AUS or FLUS thyroid nodules. We found that AUS nodules are more likely to be malignant than FLUS nodules, and this held true when we accounted for age, sex, smoking history, and BMI. We concluded that demographic factors and thyroid function tests are unable to predict increased risk of malignancy in Bethesda category III nodules, AUS nodules are more likely to be malignant that FLUS nodules, and nodules with at least one suspicious ultrasound feature are more likely to be AUS nodules than FLUS nodules due to AUS nodules having nuclear atypia and FLUS nodules having architectural atypia.

No description available.

No description available.