MEDICATION ADHERENCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS - A CROSS-SECTIONAL STUDY

Objective: This study was conducted to determine the adherence of medications among type 2 diabetes mellitus (DM) patients. To evaluate adherence to therapy and study factors associated with non-adherence and adherence in patients with type II DM. Methods: A cross-sectional, observational study was conducted for 6 months in three hospitals. A total of 200 type II diabetic patients, who were on anti-diabetic drug therapy for at least 6 months, were enrolled. Blood glucose was measured and details of drug therapy were noted. Medication adherence was assessed using the Morisky Medication Adherence Scale and adherence scores were calculated. Results: Only 15% had high medication adherence, while 24% had moderate and 61% had low medication adherence. Only 30% were having optimally controlled glycemic levels, whereas 70% were having uncontrolled glycemic levels. Medication adherence scores were lower (reflecting lower adherence) in type II patients with uncontrolled glycemic levels than those having optimally controlled glycemic levels, but this difference was not statistically significant. Conclusion: Overall, medication adherence was low in type II diabetic patients. The study shows that to improve medication adherence, better counseling and health education of patients are required. Although several patients were adherent to therapy, adherent patients are more preferably to achieve glycemic control than nonadherent patients. Greater efforts are needed to facilitate diabetes self-management behaviors to improve patient outcomes

Multicentre randomised controlled trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin (ROSHNI-2): study protocol

Background: In the UK, postnatal depression is more common in British SouthAsian women than White Caucasion women. Cognitive–behavioural therapy (CBT) is recommended as a first-line treatment, but there is little evidence for the adaptation of CBT for postnatal depression to ensure its applicability to different ethnic groups.Aims: To evaluate the clinical and cost-effectiveness of a CBT-based positive health programme group intervention in British South Asian women with postnatal depression.Method: We have designed a multicentre, two-arm, partially nested, randomised controlled trial with 4- and 12-month follow-up, comparing a 12-session group CBT-based intervention (positive health programme) plus treatment as usual with treatment as usual alone, for British South Asian women with postnatal depression. Participants will be recruited from primary care and appropriate community venues in areas of high South Asian density across the UK. It has been estimated that randomising 720 participants (360 into each group) will be sufficient to detect a clinically important difference between a 55% recovery rate in the intervention group and a 40% recovery rate in the treatmentas-usual group. An economic analysis will estimate the costeffectiveness of the positive health programme. A qualitative process evaluation will explore barriers and enablers to study participation and examine the acceptability and impact of the programme from the perspective of British South Asian women and other key stakeholders

Mobilization and electoral success: Ideological parties in Jordan, 1989-1993.

In states undergoing a transition to democracy, the success of ideological political parties can vary significantly from one election to the next. Examining Jordan, this dissertation offers a partial explanation---institutionally defined mobilization---for differences in electoral success achieved by ideological parties in successive elections by examining the strategies these parties use to solicit popular support. I argue that changes in the opportunities available to ideological parties to pursue party-based mobilization result in the differences in electoral outcomes. The degree to which parties have the ability to mobilize, however, is influenced by political institutions, particularly electoral rules. In response to changes in political institutions, parties alter their strategy for soliciting electoral support by either expanding their mobilization efforts or using the less successful strategy of social networking more frequently. Among the most important ideological parties in the Middle East ate Islamist parties whose success is said to depend on social networking rather than on mobilization. In Jordan, the main Islamist party was the Muslim Brotherhood, (which later evolved into the Islamic Action Front). The significant differences in the electoral results experienced by the Islamists from 1989 to 1993 allowed me to test whether changes in institutional rules effected the opportunities for party-based mobilization. Additionally, I tested whether the changes in opportunities for mobilization motivated ideological parties to use the less successful strategy of social networking that subsequently led to the electoral decline of the Islamists in the second elections. I also tested whether the degree of repression and the changes in economic conditions could account for the differences in electoral outcomes. The analyses revealed that even after accounting for repression, the effects of political institutions on the opportunities for mobilization are significant. Additionally, in Jordan, economic conditions had actually worsened rather than improved. Worsening economic conditions ought to have favored the Islamists in the second elections but did not. The dissertation concludes by briefly examining whether institutional rules have had a similar effect on the opportunities for mobilization in Turkey in the post-1983 period. Preliminary results indicate that similar institutions have been used in Turkey to shape the scope of mobilization in order to influence electoral outcomes. The importance of examining the linkages between mobilization and electoral outcomes and between institutional rules and mobilization is particularly crucial in democratizing countries where the trends in the first few elections foreshadow the future of competitive party systems.Ph.D.Middle Eastern historyPolitical scienceSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131597/2/9929779.pd

1254-1262 interact with particulate PSPases

Abstract We have examined the regulation of GLUT4 phosphorylation in adipocytes isolated from diabetic rats. Despite progressive (40-70%) reductions in GLUT4 protein contents on the 2nd, 7th, and 14th day of diabetes, the phosphorylation of GLUT4 was increased two-to fourfold. These alterations were accompanied by concomitant reductions (40-66%) in the insulin-stimulated 2-deoxyglucose transport. Insulin treatment of diabetic animals for 5 d restored glucose transport activity, GLUT4 protein, and GLUT4 phosphorylation to control levels whereas vanadate and phlorizin were ineffective. In control adipocytes, insulin promoted GLUT4 translocation from the low density microsomal (LDM) pool to the plasma membranes (PM) and decreased the state of GLUT4 phosphorylation. In adipocytes isolated from the diabetic rats, insulin failed to stimulate GLUT4 translocation and to decrease GLUT4 phosphorylation. To explore the mechanism of the diabetes-induced increases in the GLUT4 phosphorylation, we investigated phosphoserine phosphatase (PSPase) activities using 32P-labeled GLUT4 and phosphorylase "a" as substrates. Diabetes resulted in 50-60% increase in the particulate PSPase activity and concomitant reductions in cytosolic PSPase activities. Although reduced cytosolic PSPase activity correlated with an inadequate dephosphorylation of LDM GLUT4, the existence of highly phosphorylated PM GLUT4 in the presence of increased particulate PSPase activity required additional explanation. To address this problem, we used PM GLUT4 from diabetic rats as a substrate of particulate PSPase. Highly active diabetic particulate PSPase, which dephosphorylated control GLUT4 and phosphorylase a, failed to dephosphorylate PM GLUT4 from diabetic rats. These data suggest that PM GLUT4 from diabetic rats is unable to interact with PSPase or that its phosphorylation sites are not accessible to PSPase action. In summary, an induction of diabetes with streptozotocin resulted in significant increases in GLUT4 phosphorylation. In contrast to normal cells, insulin failed to promote GLUT4 recruitment to the plasma membranes and its dephosphorylation in diabetic adipocytes. At the same time, diabetes appears to induce redistribution of PSPases, resulting in lower cytosolic activity and higher particulate activity. It also appears that the existence of highly phosphorylated GLUT4 in the plasma membranes of diabetic adipocytes resulted from its inability t

Afghan Refugee Teacher Education (From 1980 To 2015): A Qualitative Case Study of BEFARe, Peshawar, Pakistan

Refugee teacher education has remained an area of research and practice that has received little attention of academics and researchers alike. In first providing a brief description of the Soviet model of education after their arrival in Afghanistan, the purpose of this paper is to describe the process of rehabilitation of Afghan refugees and provision of emergency education to them. Grounding this empirical research into Lev Vygotsky’s and Yrjo Engeström’s First Generation Activity Theory (FGAT), and Second Generation Activity Theory (SGAT, henceforth),this research paper aims to decipher the socio-economic and cultural context of Afghan refugees before applying SGAT on Afghan Refugees Teachers’ Education (ARTE, henceforth). Qualitative research design was used to conduct this research, whereas, data was collected from primary sources through conducting semi-structured interviews and Focused Group Discussions (FGDs) to gain deep insight into the subject matter. However, secondary sources, such as reports of UNHCR, BEFARe/GTZ were also used to substantiate the central argument. Purposive sampling strategy was used to get sample for the study. Major findings of the study show that the influence of the curriculum taught to student teachers brought certain changes in Afghan refugee teachers’ pedagogical skills, and resolved the problems of some classroom teaching practices. The findings also showed that BEFARe remained successful in changing Afghan refugee student teachers’ teaching methods from traditional teaching to activity based teaching. The study contributes to the current knowledge in the field of teacher education and training, the Afghan Ministry of Education, and other NGOs’ working in Afghanistan for education, emergency teachers’ training in general, and specifically refugees’ education across the world

Block-Chain Based Unified Identity Authentication System in Medical Report for Health-Cares

Organisations and individuals can efficiently manage their identity management operations with the help of identity management software. 'Identity Management' (IdM) software assists the administrators of an organisation in clearly defining and modifying a person's role in the organisation and authorising the relevant access to them. An identity management process is designed to identify, authenticate, and authorise individuals to access organisational software resources. Using this programme, administrators are also able to monitor user login and activity on the corporate computer network. Thus, operational security is improved. The healthcare industry has grown at the quickest rate in terms of revenue and data. Security is now more crucial than ever because electronic medical records are so common. The security of each patient's medical records is a top priority in current medical systems. Furthermore, there are efforts to increase safety of this confidential data by encrypting it. Therefore, we advocated for implementation of block chain systems as decentralized approach to protecting patients' health information. It has three parts: data retrieval, encryption, and authentication using block chain technology. While assuring patient protection, the suggested framework might also keep the healthcare system's security and legitimacy

Stimulation of glycogen synthesis by heat shock in L6 skeletal-muscle cells: regulatory role of site-specific phosphorylation of glycogen-associated protein phosphatase 1.

Recent evidence suggests that glycogen-associated protein phosphatase 1 (PP-1(G)) is essential for basal and exercise-induced glycogen synthesis, which is mediated in part by dephosphorylation and activation of glycogen synthase (GS). In the present study, we examined the potential role of site-specific phosphorylation of PP-1(G) in heat-shock-induced glycogen synthesis. L6 rat skeletal-muscle cells were stably transfected with wild-type PP-1(G) or with PP-1(G) mutants in which site-1 (S1) Ser(48) and site-2 (S2) Ser(67) residues were substituted with Ala. Cells expressing wild-type and PP-1(G) mutants, S1, S2 and S1/S2, were examined for potential alterations in glycogen synthesis after a 60 min heat shock at 45 degrees C, followed by analysis of [(14)C]glucose incorporation into glycogen at 37 degrees C. PP-1(G) S1 mutation caused a 90% increase in glycogen synthesis on heat-shock treatment, whereas the PP-1(G) S2 mutant was not sensitive to heat stress. The S1/S2 double mutant was comparable with wild-type, which showed a 30% increase over basal. Heat-shock-induced glycogen synthesis was accompanied by increased PP-1 and GS activities. The highest activation was observed in S1 mutant. Heat shock also resulted in a rapid and sustained Akt/ glycogen synthase kinase 3 beta (GSK-3 beta) phosphorylation. Wortmannin blocked heat-shock-induced Akt/GSK-3 beta phosphorylation, prevented 2-deoxyglucose uptake and abolished the heat-shock-induced glycogen synthesis. Muscle glycogen levels regulate GS activity and glycogen synthesis and were found to be markedly depleted in S1 mutant on heat-shock treatment, suggesting that PP-1(G) S1 Ser phosphorylation may inhibit glycogen degradation during thermal stimulation, as S1 mutation resulted in excessive glycogen synthesis on heat-shock treatment. In contrast, PP-1(G) S2 Ser phosphorylation may promote glycogen breakdown under stressful conditions. Heat-shock-induced glycogenesis appears to be mediated via phosphoinositide 3-kinase/Akt-dependent GSK-3 beta inactivation as well as phosphoinositide 3-kinase-independent PP-1 activation

Machine learning prediction of nutritional status among pregnant women in Bangladesh: Evidence from Bangladesh demographic and health survey 2017-18.

AimMalnutrition in pregnant women significantly affects both mother and child health. This research aims to identify the best machine learning (ML) techniques for predicting the nutritional status of pregnant women in Bangladesh and detect the most essential features based on the best-performed algorithm.MethodsThis study used retrospective cross-sectional data from the Bangladeshi Demographic and Health Survey 2017-18. Different feature transformations and machine learning classifiers were applied to find the best transformation and classification model.ResultsThis investigation found that robust scaling outperformed all feature transformation methods. The result shows that the Random Forest algorithm with robust scaling outperforms all other machine learning algorithms with 74.75% accuracy, 57.91% kappa statistics, 73.36% precision, 73.08% recall, and 73.09% f1 score. In addition, the Random Forest algorithm had the highest precision (76.76%) and f1 score (71.71%) for predicting the underweight class, as well as an expected precision of 82.01% and f1 score of 83.78% for the overweight/obese class when compared to other algorithms with a robust scaling method. The respondent's age, wealth index, region, husband's education level, husband's age, and occupation were crucial features for predicting the nutritional status of pregnant women in Bangladesh.ConclusionThe proposed classifier could help predict the expected outcome and reduce the burden of malnutrition among pregnant women in Bangladesh