The risk of developing Type 2 diabetes is increasing at epidemic proportions, and is 12-17% higher in Marion County Florida than it is across the state, based on Florida Department of Health statistics. The purpose of this DNP project was to determine if awareness of individual risk of developing Type 2 diabetes through a questionnaire would result in high-risk participants agreeing to attend a diabetes prevention program (DPP) at a local medical clinic. The health belief model and Rosswurm and Larrabee's model for change were used as frameworks. The review of the literature showed that prevention programs were highly effective in reducing the risk of developing diabetes. A validated diabetes risk questionnaire was placed at reception desks at 3 clinic sites. Forty-four anonymous participants completed the questionnaire. The convenience sample obtained from the questionnaire provided a score that categorized individuals into a high-risk and a low-risk group. Quantitative data from the participants were analyzed using descriptive statistics. Twenty-one of the participants indicated they were at high risk of developing diabetes. Ninety-five percent of those who received a high-score on the diabetes risk questionnaire responded that they would be interested in participating in a DPP at a local medical clinic. As a result of the DNP project completion, a DPP with the goal of reducing the risk of developing Type 2 diabetes will be implemented in the Marion County medical clinic. Future collaboration with health care and community organizations will assist to expand DPP's, bring awareness of diabetes risk, and promote social change.

Free-living vertebrates likely encounter many stressors throughout their lifetime, from fighting off a predator to coping with unpredictable weather. As a result, vertebrates will mount an acute response to the stressors. Here, we outline previous research conducted in behavioral endocrinology and stress physiology as it relates to our research. We then discuss our study with white-crowned sparrows (Zonotrichia leucophrys) in Tioga Pass Meadow, in which we examined how the acute stress response affects foraging behavior 24 hours after a stressor. In birds that underwent a stress series, we found there to be a significant 57% decrease in foraging behavior 24 hours following the stressor. Additionally, we found no significant difference in foraging of unstressed birds during this same time frame. Our findings suggest that the acute stress response in this species causes a reduction in foraging activity 24 hours following a stressful event.

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Over the past few decades, there has been an increase in prevalence of diabetes in the United States. Prevention of diabetes and improving patients' knowledge and awareness of diabetes are crucial for healthcare providers. Using the Health Belief Model (HBM) as a theoretical foundation, the student used the National Diabetes Prevention Program (NDPP) from the Centers for Disease Control and Prevention (CDC), to improve awareness and knowledge of diabetes among obese individuals with prediabetes. The key research question of this project was to determine whether the patients' diabetes knowledge and awareness improved after the NDPP program. A convenience sample of 30 participants was recruited from patients seeking care at a family practice clinic. Data collection was conducted using the Michigan Diabetes Research and Training Center's Diabetes Knowledge Test (DKT). Pretest and posttests were used to evaluate improvement in the participants' knowledge and awareness after administration of education sessions. The t-tests indicated a significant improvement in the patients' knowledge (p < 0.000) and awareness (p < 0.000) of diabetes after the NDPP program. Thus, the NDPP program was effective in improving the patients' diabetes knowledge and awareness. The nationwide adoption of the NDPP program was recommended to reduce the rate of diabetes among high risk individuals. The implication of this Doctor of Nursing Practice (DNP) project to social change was that improving knowledge and awareness of diabetes among obese patients with prediabetes would increase their participation in lifestyle and behavioral modification programs, thus, improving the control of blood sugar levels.

付記する学位プログラム名: 霊長類学・ワイルドライフサイエンス・リーディング大学院 / 京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第20964号 / 理博第4416号 / 新制||理||1634(附属図書館) / 京都大学大学院理学研究科生物科学専攻 / (主査)准教授 Michael Alan Huffman, 准教授 足立 幾磨, 教授 友永 雅己 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DGAM

Introduction: Diabetes management in very young children remains challenging. Glycaemic targets are achieved at the expense of high parental diabetes management burden and frequent hypoglycaemia, impacting quality of life for the whole family. Our objective is to assess whether automated insulin delivery can improve glycaemic control and alleviate the burden of diabetes management in this particular age group. Methods and analysis: The study adopts an open-label, multinational, multicentre, randomised, crossover design and aims to randomise 72 children aged 1-7 years with type 1 diabetes on insulin pump therapy. Following screening, participants will receive training on study insulin pump and study continuous glucose monitoring devices. Participants will be randomised to 16-week use of the hybrid closed-loop system (intervention period) or to 16-week use of sensor-augmented pump therapy (control period) with 1-4 weeks washout period before crossing over to the other arm. The order of the two study periods will be random. The primary endpoint is the between-group difference in time spent in the target glucose range from 3.9 to 10.0 mmol/L based on sensor glucose readings during the 16-week study periods. Analyses will be conducted on an intention-to-treat basis. Key secondary endpoints are between group differences in time spent above and below target glucose range, glycated haemoglobin and average sensor glucose. Participants' and caregivers' experiences will be evaluated using questionnaires and qualitative interviews, and sleep quality will be assessed. A health economic analysis will be performed. Ethics and dissemination: Ethics approval has been obtained from Cambridge East Research Ethics Committee (UK), Ethics Committees of the University of Innsbruck, the University of Vienna and the University of Graz (Austria), Ethics Committee of the Medical Faculty of the University of Leipzig (Germany) and Comité National d'Ethique de Recherche (Luxembourg). The results will be disseminated by peer-reviewed publications and conference presentations.

<p>Females experience reproductive plasticity in several situations. Under stress, females can experience implantation failure. In the presence of unfamiliar males, females can also experience implantation failure (Bruce effect), or hastened sexual maturation (Vandenbergh effect). Sexual maturation and implantation failure are also induced by 17β-estradiol (E₂). Male mice excrete E₂ in their urine; furthermore, stress can increase endogenous E₂ in females. Accordingly, I explored the role of male urinary E₂ in the Bruce and Vandenbergh effects, and examined E₂ and progesterone (P₄) during stress-induced implantation failure in mice. I showed that a male mouse’s ability to induce the Bruce and Vandenbergh effects depends on his urinary E₂, as castration removed this ability,and injections of E₂ restored it and urinary E₂ levels. I also developed urinary measurements of the stress hormone, corticosterone, for use in subsequent stress studies. I showed that serum and urinary corticosterone follow a similar circadian rhythm, and that urinary corticosterone responds appropriately to acute stress in male mice. Also, urinary and serum corticosterone, P₄, and E₂ in female mice show similar responses to stress, with slightly different time courses. Lastly, I showed that rat-exposure is stressful and causes implantation failure in female mice. Furthermore, P₄ suppressed and E₂ is elevated in stressed females losing their pregnancies. Exogenous P₄ did not mitigate stress-induced pregnancy failure, unless it was combined with a low dose of E₂. Taken together, I suggest that exogenous and endogenous E₂ contribute to reproductive plasticity in female mice, particularly their ability to abandon early pregnancy.</p> / Doctor of Philosophy (PhD)

Thesis (MSc (Biochemistry))--Stellenbosch University, 2008. / This study describes: 1. The preparation of chloroform, methanol and aqueous extracts of unfermented and fermented rooibos (Aspalathus linearis). 2. The chromatographic fractionation of aqueous rooibos extracts and an investigation into the polyphenol content and antioxidant activity of the fractions. 3. The preparation of ovine adrenal microsomes containing active steroidogenic P450 enzymes, including cytochrome P450 17a-hydroxylase, CYP17, and cytochrome P450 steroid 21-hydroxylase, CYP21. 4. An investigation into the influence of chloroform and methanol extracts of rooibos on the binding of steroid substrates, progesterone and 17-hydroxyprogesterone, to CYP17 and CYP21.

<p> Repeated exposure to stress has been associated with negative health outcomes. The present study investigated how different emotion regulation strategies&mdash;cognitive reappraisal and suppression&mdash;are associated with stress and how executive function may influence these relationships. Thirty two women, all mothers with young children, were assessed using the emotion regulation questionnaire, the affective go/no go task, and salivary cortisol collection. Cognitive reappraisal was not significantly related to stress. Greater endorsement of suppression was significantly associated with two measures of stress&mdash;increased output of daily cortisol and increased cortisol awakening response. Executive function was not a significant moderator. This is the first study to date to examine these questions and to assess them in a naturalistic setting with a sample of mothers with young children. Given that mothers regularly experience emotion-eliciting situations, these results have several implications for how emotion regulation strategies may impact stress (cortisol levels) in this population.</p>

Introduction: The risk factors involved in treating transgender individuals with hormone therapy have been documented, but a full understanding of them remains elusive. Much of the research performed in transgender medicine is old or being completed overseas. It is thus the responsibility of current providers and investigators to expand our current knowledge, so this often marginalized population can receive the best quality care. Methods: A group of 28 transgender men and women who received care from the Endocrinology Clinic at Boston Medical Center were randomly selected as part of a quality control project to evaluate the risk factors involved in hormone therapy. Analysis was two-fold. First, change in lab values associated with known risk factors over a two-year period were assessed in individual patients. Second, group analysis sought to correlate changing hormone levels with lab values associated with known risk factors. Results: The result of the analysis was the majority of the patients who were observed did not suffer from any of the risk factors commonly associated with hormone therapy, and if anything benefited from the consistent clinical care. Several correlations were calculated between hormone levels and the lab values associated with the risk factors, however further analysis must be completed to confirm any connection. Discussion: The goal of this project was to not only evaluate care at Boston Medical Center, but also to draw attention to transgender health. In doing so, we have given an example of safe and effective hormone therapy and shown additional avenues for future research.