Thesis (M.D.)--University of Pennsylvania, 1801. / Microform version available in the Readex Early American Imprints series.

Two thousand years elapsed before man could unravel several of the problems and implications of disturbed glucose tolerance. As far back as 30 years B.C. gross manifestations of the disease now known as Diabetes Mellitus were recognized. Despite great advances, however, there is much that is still unknown. The history of many a malady begins with the observation of the illness in its most grotesque form. As medical science gathers more and more knowledge the less severe symptoms and signs come to be recognized. Gradually special tests are evolved, by means of which the disorder can be diagnosed inits earliest stages. And thereafter, the tendency to develop the condition is seen before it becomes manifest. The long history of disturbed glucose tolerance follows this pattern. Many centuries have passed in the gradual evolvement of the various stages. With the passing of the years improved diagnostic methods were discovered, so that mild rooms of the disorder could be detected. In the past few decades the concept of mildly impaired glucose and "pre-diabetes" has been formulated. One of the most interesting of recent developments, for example, has been the conclusion that the birth of overlarge babies may be a sign of predisposition to this metabolic disturbance.

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Introduction: Although cervical cancer can be prevented through known interventions it still remains a major cause of mortality in developing countries. Currently in South Africa there is little literature on cervical cancer radiotherapy treatment and its prognostic factors. Knowledge of prognostic factors helps in understanding the determinants of a disease better and optimize treatment strategies. The aim of this study was to determine overall survival rate and to investigate potential prognostic factors for cervical cancer in patients who underwent radiotherapy during the period of 1 January 2004 to 31 December 2006 at the Division of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital. Methods: This was a retrospective cohort study of 900 patients who were treated with radiotherapy between 1 January 2004 and 31 December 2006. Patient and treatment related data was obtained from the hospital treatment records. Follow-up was then censored as of 31st of December 2008. Subjects of this study had either mono-therapy or a combination of therapies: external beam radiotherapy, brachytherapy and chemotherapy. A Cox regression model was fitted to determine the prognostic and predictive factors of cervical cancer. Kaplan Meier methods were used to establish the effect of different socio-demographic and clinic-pathological factors on overall survival. The overall two year survival was also determined. Results: At 2 years post-treatment for each individual patient, 26 out of 900 patients had died, 281 were still alive and 593 lost to follow up leaving 307 patients available for analysis. The overall 2 year mortality rate was 45 per 1000 person years and highest in the period of 0-6 months. In the final model, completion of brachytherapy remained a significant predictor of survival (HR=0.04, 95% CI: 0.01-0.11, p<0.001) after adjusting for all other factors. Furthermore, HIV status was the only significant prognostic factor (HR=3.23, 95% CI: 1.04- 10, p=0.042). Patients who had brachytherapy treatment prescribed and completed the prescription were 96% less likely to die compared to those who didn’t complete it at any point in time, after adjusting for age and HIV status. Patients who were HIV positive were approximately three times more likely to die as compared to HIV negative patients at any point in time after adjusting for age and completed brachytherapy. The overall 2-year survival rate was 92% for this group of patients. Conclusion: Completion of the brachytherapy prescription was a significant predictor of treatment outcome, while the patient’s HIV status was also a significant prognostic factor for treatment. Patients who were HIV positive were three-times more likely to die compared to HIV negative patients. The overall 2-year survival rate was 92%, however, these results need to be interpreted with caution due to the large loss to follow-up in this patient population. Prospective clinical trials are recommended in the future to confirm the validity of the findings of this work in a representative patient population. In addition this work puts forward some suggestions to optimize treatment of cervical cancer patients in typical university teaching public health centres in South Africa.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in the field of Epidemiology and Biostatistics. Johannesburg, June 2017 / Cervical cancer (CC) is the leading cause of female cancer morbidity and mortality in South Africa, despite the introduction of preventive programs. However, there is a paucity of information on current CC rates and trends in South Africa. This study aimed to evaluate the national trends and determinants of CC over a 19 year period (1994-2012). We conducted temporal analyses of age-standardised incidence rates (ASIR) from 1994 to 2009 and age-standardised mortality rates (ASMR) from 2004 to 2012 using data from the National Cancer Registry and Statistics South Africa, respectively. We also evaluated a novel surrogate measure (complement of MR: IR ratio) to calculate five-year relative survival rates of CC (2004-2009). Temporal analyses were stratified by the province of residence, histological type, population- and age-groups, while linear regression models were fitted to determine the average annual percent change (AAPC) of the time trends. Spatial distribution was conducted by utilising the GIS coordinates of SA to map the provincial ASMR. Unconditional logistic regression analyses were carried out for three casecontrol studies using data from the hospital-based Johannesburg Cancer Case-Control Study (JCCCS) (1995-2010), to evaluate the effect of HIV infection; tobacco smoking and alcohol abuse and sexual and reproductive behaviours on the risk CC in Black South Africans. The cases were participants with CC while controls were other female cancer participants that had no known association with CC and its risk factors. There were 75,099 incident cases and 25,101 mortalities from CC in the periods studied with women below 50 years accounting for 43.1% of the cases and 35.7% deaths. The ASIR was 22.1/100,000 in 1994 and 23.3/100,000 in 2009 and there was an average annual decrease in incidence of 0.9% (AAPC=-0.9%, P-value<0.001). The ASMR decreased slightly from 13.9/100,000 in 2004 to 13.1/100,000 in 2012 (AAPC = -0.6%, P-value < 0.001). Based on current trends, the ASIR and ASMR were predicted to increase to 26.3/100,000 and 14.6/100,000 in 2030, respectively. From 2004 to 2012, five provinces had increased mortality rates (AAPC: 1.2 – 8.3, P-value<0.001) while four provinces had decreased mortality rates (AAPC: -16.6 - -1.0, P-value<0.001). In 2012, the ASMR in Black population group was 5.7-fold higher than in the White population group. The highest mortality was recorded in Mpumalanga Province (19.8/100,000) and the least in the Eastern Cape Province (8.9/100,000). From 2000 to 2009, the ASIR of adenocarcinoma of the cervix was relatively low (2.00 to 2.6 per 100,000 women) and stable, while the incidence of squamous cell carcinoma was high (17.0 to19.0 per 100,000 women) and the rate increased by 1.4% annually. The relative survival rates were higher in White and Indians/Asian women (60-80%) than in Blacks and Coloureds (40- 50%). The results of the JCCCS studies showed that the association between CC and HIV infection increased from two-fold (adjusted odds ratio, (adjOR) =1.98; 95% CI: 1.34-2.92) during the pre-anti-retroviral therapy (ART) era (1995-2003) to three-fold (adjOR=2.94 95%CI: 2.26- 3.83) in the ART era (2004-2010). Current tobacco smoking (adjOR=2.1, 95%CI: 1.10-4.01) and snuff use (adjOR=1.3, CI: 1.08-1.61) increased the likelihood of CC among Black women in South Africa. The risk of CC increased with prolonged use of hormonal contraceptives (P-value for trend = 0.003) and high parity (>6) (adjOR=4.5, 95%CI: 2.85- 7.25). The incidence and mortality of CC are probably underestimated due to underreporting of cancer in the country. South Africa had minimal changes in overall CC rates between 1994 and 2012, despite the initiation of a population-based CC screening program in 2000 and the nationwide roll out of ART in 2004. There was a marked disparity in CC rates by population group, age and province. HIV-infected women and those who use tobacco are more likely to develop CC, therefore targeted programs should be introduced to inform women about risk factors for CC. Maternal and child health initiatives should also involve CC control activities since a considerable number of women of the reproductive age (15 – 49 years) were affected. / MT2017

The objective of this study is to remove or, at least, reduce the noise in uterine EMG recordings, which at their present noise level render the data unusable. Predicting when true labor will start and recognizing when labor actually starts are important for both normal and complex pregnancies. For normal pregnancy, the prognosis of labor is important for reducing unnecessary hospital costs. About 10% of the four million babies born each year in the United States are born prematurely. At $1,500 a day for neonatal intensive care, this comprises national health care expenses of well over $5 billion. Spectral analysis, filter design, and 1/3 octave analysis were applied to analyze the uterine EMG recordings. Signal-to-noise ratio was increased with IIR Butterworth bandstop filter. The spectral band between 0.25 and 0.4 Hz shows matching of the Toco belt via spectral analysis. Nevertheless, 1/3 octave analysis gives the highest correct detection percentage compare with frequency analysis and filter design.

The objective of this study was to determine whether exercise-induced hyperthermia results in an increase in uterine temperature, as measured by an iButton temperature-measurement device inserted into the uterus, comparable to temperatures measured by a rectal thermometer or microchip with temperature-recording capability implanted in the neck. The 3 methods of measurement were examined under 4 different management conditions. The Control-pasture (Cont P) group was maintained in a pasture without man-made shelter, with the intent to measure effects of ambient temperature. The Control- No device (Cont N) group was under the same management conditions, but did not have intrauterine temperature measurement devices implanted. The Control-stall (Cont S) group was housed in individual stalls with fans in an effort to minimize the effect of environmental temperature. The Exercise (EXE) group was also housed in stalls with fans, similar to Cont S but was also subjected to 45 min of exercise each day. The results of this study indicate that the 3 methods of temperature measurement are equally repeatable when evaluating temperatures during exercise (P<0.001). Among the treatment groups, rectal temperatures were lowest in the Cont N and Cont P groups (P<0.05). In contrast, for both the microchip and iButton data, the mares in Cont S and EXE had the lowest core temperatures (P<0.001), indicating that horses under this management type underwent the least amount of heat stress as indicated by core temperature. While rectal temperatures did not show a diurnal effect, both core temperatures (microchip and iButton) showed significant differences between times (P<0.05 and P<0.005, respectively), demonstrating a diurnal temperature effect.

The objective of this study is to remove or, at least, reduce the noise in uterine EMG recordings, which at their present noise level render the data unusable. Predicting when true labor will start and recognizing when labor actually starts are important for both normal and complex pregnancies. For normal pregnancy, the prognosis of labor is important for reducing unnecessary hospital costs. About 10% of the four million babies born each year in the United States are born prematurely. At $1,500 a day for neonatal intensive care, this comprises national health care expenses of well over $5 billion. Spectral analysis, filter design, and 1/3 octave analysis were applied to analyze the uterine EMG recordings. Signal-to-noise ratio was increased with IIR Butterworth bandstop filter. The spectral band between 0.25 and 0.4 Hz shows matching of the Toco belt via spectral analysis. Nevertheless, 1/3 octave analysis gives the highest correct detection percentage compare with frequency analysis and filter design.