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The Molecular Basis Of Diabetic Cardiomyopath, Ahmed Salaheldin Mustafa Ali Sultan

Dissertations

Diabetes mellitus (DM) is a major and worsening global health problem. Type 2 diabetes mellitus (T2DM) accounts for more than 90% of DM and the global epidemic of obesity largely explains the dramatic increase in the incidence and prevalence of T2DM over the past 20 years. Cardiovascular complications are the major cause of morbidity and mortality in diabetic patients. The electrocardiogram (ECG) of diabetic and obese patients is frequently disturbed. The aim of this project was to characterize and clarify the molecular basis of electro-mechanical dysfunction in the hearts of type 2 diabetic and type 2 diabetic/obese rats. Experiments were …

An Evaluation Of A Multidisciplinary Implementation Of Evidence Based Practice In Prediabetes, Emily Sisco

Dissertations

Abstract

Problem Over 70% of prediabetic patients progress to full diabetes. There are over 80 million American adults who are diabetic. Diabetes is the costliest chronic disease that often leads to many other health issues.

Methods This QI project utilized a descriptive observational design. Quantitative data was collected via retrospective chart review. Primary data collected was documentation of a patient visit to the registered dietician and the hemoglobin A1c (HbA1c) of patients who followed up in the office after the referral.

Results Eight patients followed up to the office for a second visit (n=8). Four patients did see the registered …

Lxr Acts As A Differentiator In The Regulation Of Fas And G6pdh Gene Expression Under Insulin Resistant Conditions, Jaafar Hachem

Dissertations

Diabetes is a chronic disease that effects 10 percent of the world’s population and causes more than 1.5 million deaths a year and billions of dollars in associated health care cost. It can lead to very serious complications such as renal failure, liver cirrhosis, heart attack, and vision loss. The most common type of diabetes is type 2 diabetes. Type 2 diabetes arises when blood glucose levels remain chronically high due to insulin resistance. The reason for this elevation is due to the failure of insulin to allow tissues to uptake glucose causing problems in subsequent metabolic pathways. Over the …

Implementing A Three-Minute Foot Exam For Diabetic Patients In Primary Care, Emilee Laster

Dissertations

Problem- One in four U.S. Veterans have Diabetes Mellitus, and one in four U.S. Veterans with diabetes will develop a diabetic foot complication. There is currently no protocol for healthcare providers to perform foot screenings on diabetic patients at each visit. Utilizing a foot screening at each visit for high risk diabetic patients may help to recognize problems sooner, making treatment easier and less aggressive.

Methods- This quality improvement initiative was a retrospective and prospective record review before and after evidence based three-minute foot exams were implemented. A convenience sample of 50 patient medical records were reviewed to collect demographical, …

Evaluation Of A Type 2 Diabetes Mellitus Care Coordination Program, Carrie Smith

Dissertations

Abstract

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing Diabetes Care Coordination (DCC) program at an urban clinic for clients with no health insurance in the Midwest. Diabetes related indicators of those enrolled in the DCC program and client reported barriers were documented over a 19 month period.

Sample: Clients included were 18 years and older, with no insurance, having the diagnosis of Type 2 diabetes mellitus, and were enrolled in the DCC program within the first six months of the program's initiation.

Methods: A retrospective chart review of 24 clients recording diabetes related outcome indicators …

The Influence Of Stressful Life Events On The Development Of Type 2 Diabetes, Joshua Minks

Dissertations

This study examined the relationship between distress and the development of Type 2 diabetes mellitus (T2DM) in the presence of established risk factors. Distress secondary to mental health disparities, stressful life events, and work conditions has been shown to promote insulin resistance and the development of T2DM.

Subjects (N=79) diagnosed with T2DM within the previous six months were recruited from SSM Health Centers and VA Medical Centers in the greater St. Louis area. They completed the Recent Life Changes Questionnaire, ENRICHD Social Support Instrument, and a demographic survey and analyses were conducted to determine differences between the veteran …

Yczr, A New Case Of Plp-Dependent Mocr/Gabr Type Transcription Regulator In Klebsiella Pneumonia, Yuanzhang Zheng

Dissertations

Increasing number of genes encoding PLP-dependent transcription regulators, MocR/GabR type regulators, have been identified in various bacterial genomes. However, only a handful of them, including MocR, PdxR and GabR have been studied experimentally. They control different aspects of the bacterial metabolism. Only GabR has reported crystallographic structures. MocR/GabR regulators possess a chimeric structure consisted of a WHTH DNA binding domain and an Aminotransferase-like regulation domain, which can bind PLP as an effector in transcription regulation. Such a chimeric construct presents an interesting case in molecular evolution. The regulation domains of All MocR/GabR type regulators loss their catalytic capacity during evolution …

Eye Examination:Satisfying A Quality Care Measure In Diabetes, Meera Shekar

Dissertations

Abstract

Purpose: Diabetic retinopathy (DR), a microvascular complication occurs in patients with poorly controlled diabetes mellitus (DM). A known risk of increased visual impairment associated with DM occurs in patients when the glycosylated hemoglobin level (HbA1c) increases over 7.0%. Therefore, an annual retinal assessment as a quality care measure in diabetes management is necessary. The conducted study aimed to evaluate the documentation of an annual eye exam in all patients with DM in a private family practice clinic and to investigate any possible association between HbA1c level.

Method: This quality improvement study included a retrospective medical record review in …

Health Literacy As A Moderator In The Relationship Between Diabetes Knowledge And Diabetes Outcomes, Jameshyia Ballard Thompson

Dissertations

The purpose of this research was to determine if health literacy was a moderator in the relationship between diabetes knowledge and diabetes outcomes, and explore the relationship between diabetes knowledge and health literacy. The target population included adults living in Mississippi with a diagnosis of diabetes at any point in life. A pilot study was performed to determine if the Functional Communicative Critical Health Literacy scales (FCCHL) and the Spoken Knowledge in Low Literacy in Diabetes scale (SKILLD) were appropriate for use in a population of adults in Mississippi with a diagnosis of diabetes. Participants for the pilot study were …

Binding Properties Of Large Antiviral Polyamides (Pa1 And Pa25) And Natural Product Derivatives As Inhibitors Of Serine Hydrolases, Elena Vasilieva

Dissertations

Polyamides are a class of DNA minor groove binders that were developed from the natural product Distamycin A. PA25 (20-ring PA) showed better activity (3-fold) in the elimination of HPV16 episomes than PA1 (14-ring PA). Binding studies of PA1 and PA25 were performed in the long control region of HPV16 (7348-122 bp). PA1 showed similar binding affinity to perfect match and single mismatch binding sites. PA1 bound to double, triple, and quadruple mismatch sites with lower affinity. PA25 bound with similar binding affinity to perfect through triple mismatch binding sites. PA25 bound quadruple mismatch sites and nonspecifically. Therefore, it was …

Access And Barriers To Care During Transition From Active Duty To Veteran Status In Veterans With Diabetes: A Look At Health Literacy, Change, And Ongoing Diabetes Self-Management Education, Mark R. Malebranche

Dissertations

Background and Rationale: Transition from active duty to veteran status may be a challenging time, especially for veterans with diabetes. These veterans face multiple changes that can cause distress. Most veterans with diabetes have type 2 diabetes, however a diagnosis of type 1 diabetes on active duty is cause for discharge for active duty.

Purposes and Aims: The purpose of this study was to describe the transition experience of veterans diagnosed with diabetes while on active duty from active duty to veteran status. The study describes barriers and facilitators to healthcare and diabetes self-care management. The four aims of the …

Efficacy Of Behavioral Interventions In African-Americans With Type Ii Diabetes: A Comparative Effectiveness Analysis, Tangela Nicole Hales

Dissertations

Context: The efficiency and effectiveness of the healthcare system are prime foci for nursing research.

Objective:The purpose of this study was to review and critically appraise the current state of the evidence in the treatment of African American adults with type II diabetes. To address this objective, a systematic review was undertaken that investigated the comparative effectiveness of behavioral interventions in improving glycemic control.

Methods: Robust methodological approaches to comparative effectiveness research (CER) serve to improve the transparency, consistency, and scientific rigor of the research. The methods for this systematic review of literature followed those recommended in the Agency …

Experimental Investigation On The Relationship Between Lead Exposure And Thyroids In Diabetes, Salah Sumar Ali Al-Zadjali

Dissertations

Lead exposure can cause multiple systemic toxicities, particularly affecting the hematopoietic, nervous and renal systems. However, its effects on the thyroid functions are not well elucidated and the published studies are controversial. In addition, although there are several experimental thyroid models, each one of them has its own limitations. Accordingly, in this dissertation, we investigated the possible relationship between lead exposure, thyroid functions and short-term systemic toxicity in two animal models, namely normal (non-diabetic) and diabetic animals. We also investigated the possibility of developing a hormonal thyroid model. In the non-diabetic model, Wistar rats were divided into five groups and …

Experimental Investigation On The Relationship Between Lead Exposure And Thyroids In Diabetes., Salah Sumar Ali Al-Zadjali

Dissertations

Lead exposure can cause multiple systemic toxicities, particularly affecting the hematopoietic, nervous and renal systems. However, its effects on the thyroid functions are not well elucidated and the published studies are controversial. In addition, although there are several experimental thyroid models, each one of them has its own limitations. According, in this dissertation, we investigated the possible relationship between lead exposure, thyroid functions and short-term systemic toxicity in two animal models, namely normal (non-diabetic) and diabetic animals. We also investigated the possibility of developing a hormonal thyroid model.

In the non-diabetic model, Wistar rats were divided into five groups and …

Negotiating Diabetes: Professional Diabetes Care Work In The U.S., Melissa Marie Gesbeck

Dissertations

The rising incidence of diabetes mellitus (types 1 and 2) transcends national borders, creating a global pandemic. The U.S. leads the world in diabetes prevalence, despite its wealth and access to sophisticated medical technologies. Within health care, there is an increasing focus on lifestyle and behavioral interventions that research suggests may be the key to reversing this trend, but thus far their effectiveness in practice is uneven at best. In order to gain a better understanding of the other factors involved in professional diabetes care work that might support or inhibit effective diabetes management, this research treats diabetes as a …

The Role Of Glutamate Signalling In Diabetic Neuropathy, Nadia Hussain

Dissertations

The majority of diabetics develop neuropathy, which can be debilitating, but the underlying pathophysiological mechanisms are poorly understood. Diabetic neuropathy progresses in a distal to proximal manner. Previous studies have shown that glutamate, the most common excitatory neurotransmitter, plays a role in the pathogenesis of neuropathy. The reason why the role of glutamate in nociception becomes a problem in diabetes and the mechanisms that are involved are unknown. Based on the preliminary data, the hypothesis was that glutamate pathways are likely to be involved in diabetic neuropathy particularly neuropathic pain. Pathways were investigated to look for changes that might reflect …

The Impact Of Insulin Management On Quality Of Life In Type 2 Diabetes, Sandra Ellen Mccormick

Dissertations

Complications of type 2 diabetes (T2DM) are severe but can be minimized through excellent glycemic control, optimally achieved by using intensive, or basal-bolus, insulin management. The quality of life (QOL) effects of basal-bolus insulin management are not fully known. This cross-sectional, observational study was based on the Revised Wilson and Cleary Model for Health Related Quality of Life, which measures five QOL domains (biological function, symptoms, functional status, general health perceptions, and overall QOL). The study aims were to describe, compare, and predict QOL in persons with T2DM based on type of insulin management (oral meds only, basal insulin only, …

Examination Of The Pediatric Diabetes Routines Questionnaire In Adolescents: Development Of An Adolescent Self-Report Version And Confirmatory Factor Analysis, Jessica Sima Pierce

Dissertations

Previous literature suggests a positive relationship between general child routines and diabetes treatment adherence. However, research examining routines specific to the diabetes regimen is lacking. Recently, the Pediatric Diabetes Routines Questionnaire (PDRQ) was developed as a parent-report measure of diabetes-specific routines for children and adolescents with type 1 diabetes. Though the PDRQ has provided a means to measure routines specific to the diabetes regimen, limitations exist in regard to its use with adolescents. Thus, the goals of this study were to develop and evaluate a parallel adolescent self-report version (PDRQ: Adolescent; PDRQ:A) of the PDRQ and to examine the psychometric …

A Descriptive Study Of The Leadership Role Of Community Health Ambassadors On Diabetes-Related Health Behaviors, Barbara Pullen-Smith

Dissertations

Diabetes is a chronic disease that bears a disproportionate burden among African American populations. The lack of access to affordable, culturally appropriate health care is a key barrier to effective diabetes prevention or disease management for racial/ethnic minority populations. Living in public housing communities, with concentrated poverty, exacerbates the burden of diabetes and reduces access to screening and early detection services to prevent the onset of diabetes. The purpose of the study was to describe the leadership role of lay health advisors, known as Community Health Ambassadors (CHAs), on diabetes-related health behaviors of African Americans living in a public housing …

Inpatient Glycemic Management: Glucose Control Relationship With Hospital Variables, Discharge Planning And Education, Crisamar Javellana-Anunciado Phd, Fnp-Bc, Rn

Dissertations

This dissertation study examined the relationship of glucose control with clinical outcomes, costs, discharge planning and education. Extant studies showed that hyperglycemia, in the presence or absence of a diabetes diagnosis, is prevalent in hospitalized patients. Hyperglycemia is found in one-third of all hospital admissions and is linked to poor clinical outcomes and increased healthcare costs. Furthermore, clinical evidence suggests that lack of discharge coordination associated with medical errors and readmission. This entire body of work contains three distinct sections: Two manuscripts and a grant proposal. The two manuscripts in this study were based on more current retrospective data at …

Improving Diabetic Outcomes With Caring Communication: Identifying Communication Patterning For The Human Diabetic, James R. Kennett Phd

Dissertations

Introduction. The purpose of this study was to identify the influence of caring communication for people living with diabetes (PLD) and the relationship to diabetic outcomes. Caring communication has not been studied for improving diabetic outcomes. Randomized control trials (RCTs) direct care, however people do not do what they told, they need to be included in their care. PLD need a voice to establish what is important to them. Incorporating medical, communication, and nursing science as multidisciplinary approach within a theoretical framework can be predictive diabetic outcomes. Methods. A correlational cross sectional survey design study was done. A sample of …

Expression And Regulation Of Osteopontin In The Diabetic Heart, Abigail Goodman

Dissertations

Diabetes leads to several alterations in cardiac structure, one of which is fibrosis of the ventricular myocardium. Myocardial fibrosis is a common underlying factor in most cardiac pathologies. Osteopontin (OPN) is a small phospho-protein that has been implicated in fibrotic tissue remodeling. In the heart, the expression of OPN protein is increased after acute and chronic pathologies. Upregulation of OPN coincides with a transition to heart failure and a direct role for OPN in the progression of diabetic cardiomyopathy to heart failure has been reported.

The overall objective of this project is to determine if OPN is upregulated in the …

Forced-Exercise Alleviates Neuropathic Pain In Experimental Diabetes: Effects On Voltage-Gated Calcium Channels, Sahadev A. Shankarappa

Dissertations

Exercise is now established as an integral adjunct to the management of diabetes. Diabetic polyneuropathy, a painful complication of diabetes, remains untreatable, emphasizing a critical need for improved therapeutic strategies. Recent evidence suggests that exercise may facilitate recovery of peripheral nerve function in diabetes. However, the mechanism by which exercise protects against diabetes-induced nerve dysfunction is unknown. In this dissertation we hypothesized that forced-exercise protects against experimental DPN by preventing glucose-associated alterations of voltage-gated calcium currents (VGCC) in small diameter dorsal root ganglion (DRG) neurons. Using behavioral, nerve-electrophysiology and patch-clamp methodology we examined the functional consequences of forced-exercise (treadmill, 5.4 …