Exploring Self-Efficacy in the Current Era of Type 1 Diabetes Management in Youth

Type 1 diabetes is a chronic incurable autoimmune disease characterized by dysregulated carbohydrate metabolism. Nearly 3 million individuals in the United States with type 1 diabetes are challenged to meticulous self-management to avoid diabetes-related complications. Self-efficacy is an important construct associated with health behavior change that may be relevant for adherence to diabetes self-management tasks involving diabetes technologies, such as continuous glucose monitoring (CGM). Yet, there is a fundamental gap in understanding how self-efficacy relates to CGM use in youth with type 1 diabetes. This dissertation focuses on the behavior of CGM use in youth with type 1 diabetes as well as the relationship of self-efficacy and self-management adherence in the contemporary era of diabetes technologies. Specifically, the following research questions are addressed: (a) how do masked CGM and treatment recommendations following sensor wear affect glycemic control in a contemporary cohort of youth with type 1 diabetes, (b) what instruments are available to measure self-efficacy related to contemporary diabetes management in youth with type 1 diabetes and their caregivers, (c) how does self-efficacy, measured by a novel CGM Self-Efficacy instrument (CGM-SE), relate to CGM use and glycemic control in a cohort of youth with type 1 diabetes initiating CGM therapy. The conclusions from this research are that: (a) masked CGM offers opportunities to guide advanced insulin management and requires orchestration of the multidisciplinary diabetes team, particularly nurse educators, (b) an integrative review identified 10 different instruments to measure self-efficacy related to diabetes management with varying levels of reliability and validity, yet there is a deficit in available instruments to measure self-efficacy related to diabetes technologies such as CGM, (c) a novel CGM-SE instrument used in a contemporary cohort of youth with type 1 diabetes appears to have strong psychometric properties and demonstrated predictive validity as youth that reported higher baseline self-efficacy had significantly greater CGM wear and lower hemoglobin A1c (HbA1c) at 3 and 6 months compared to youth reporting lower self-efficacy. This body of work provides a greater understanding of the use of masked CGM technology, the concept of self-efficacy as it relates to youth with type 1 diabetes and their caregivers, and how to measure self-efficacy related to CGM use in a contemporary cohort of youth with type 1 diabetes. Importantly, this dissertation refines the relationship between self-efficacy and CGM use by establishing the utility of the CGM-SE instrument. Identifying elements, such as self-efficacy, that may promote and improve self-management behaviors is an important step towards improving diabetes outcomes and consistent use of CGM technology. This is especially relevant to diabetes nurse educators who play a critical role in supporting the self-management of youth with type 1 diabetes and their families

Trees: song (medium high)

https://digitalcommons.ithaca.edu/sheetmusic/1166/thumbnail.jp

Trees : song

https://digitalcommons.library.umaine.edu/mmb-vp/2943/thumbnail.jp

Trees: song (low voice)

https://digitalcommons.ithaca.edu/sheetmusic/1165/thumbnail.jp

Trees: song (medium low)

https://digitalcommons.ithaca.edu/sheetmusic/1167/thumbnail.jp

Measles virus glycoprotein-based lentiviral targeting vectors that avoid neutralizing antibodies

Lentiviral vectors (LVs) are potent gene transfer vehicles frequently applied in research and recently also in clinical trials. Retargeting LV entry to cell types of interest is a key issue to improve gene transfer safety and efficacy. Recently, we have developed a targeting method for LVs by incorporating engineered measles virus (MV) glycoproteins, the hemagglutinin (H), responsible for receptor recognition, and the fusion protein into their envelope. The H protein displays a single-chain antibody (scFv) specific for the target receptor and is ablated for recognition of the MV receptors CD46 and SLAM by point mutations in its ectodomain. A potential hindrance to systemic administration in humans is pre-existing MV-specific immunity due to vaccination or natural infection. We compared transduction of targeting vectors and non-targeting vectors pseudotyped with MV glycoproteins unmodified in their ectodomains (MV-LV) in presence of α-MV antibody-positive human plasma. At plasma dilution 1:160 MV-LV was almost completely neutralized, whereas targeting vectors showed relative transduction efficiencies from 60% to 90%. Furthermore, at plasma dilution 1:80 an at least 4-times higher multiplicity of infection (MOI) of MV-LV had to be applied to obtain similar transduction efficiencies as with targeting vectors. Also when the vectors were normalized to their p24 values, targeting vectors showed partial protection against α-MV antibodies in human plasma. Furthermore, the monoclonal neutralizing antibody K71 with a putative epitope close to the receptor binding sites of H, did not neutralize the targeting vectors, but did neutralize MV-LV. The observed escape from neutralization may be due to the point mutations in the H ectodomain that might have destroyed antibody binding sites. Furthermore, scFv mediated cell entry via the target receptor may proceed in presence of α-MV antibodies interfering with entry via the natural MV receptors. These results are promising for in vivo applications of targeting vectors in humans

Monte Iato, Italien: Die hellenistisch-römischen Metallfunde

The Monte Iato was settled since the 6th century BC till the 13th century AD. It is a long-term project of the University Zürich and the University Innsbruck which deals with metal finds of Hellenistic and Roman times. Sensational are the number of brooches. Most of the fibulae are of Jezerine, Alesia and Aucissa types from late 2nd and 1st century BC. Especially the Jezerine type was – at the current state of research – mainly distributed in the Italia Padana and in the north-eastern Alps. These finds might reflect auxiliar troops of the civil war

Trees

Illustration of trees in a open fieldhttps://scholarsjunction.msstate.edu/cht-sheet-music/5450/thumbnail.jp