Assessing prevalence and predictors of depression in Type 2 Diabetes Mellitus (DM) patients - The DEPDIAB study.

OBJECTIVES: Depression is common in diabetes and has significant impact on health outcomes. Suicidal ideation also forms a part of the spectrum of diabetes and coexistent depression. To assess the predictors of depression as well as its prevalence in Type 2 Diabetes Mellitus (T2DM) patients, we conducted a cross sectional study entitled "DEPression in DIABetes" (DEPDIAB). MATERIAL AND METHODS: A cohort of consecutive 1371 T2DM patients from Eastern India suffering from diabetes greater than 1 year was assessed in a cross- sectional survey in 9 different hospitals and medical polyclinics in Kolkata, India for depression by administering the 9-item PHQ - 9 and Beck depression scales. Socioeconomic status was assessed by the "Revised Kuppuswamy and B G Prasad socio-economic scales for 2016", a validated scoring system for assessing the socioeconomic status of Indian patients. RESULTS: In our study 836 patients (60.9%) were male and 535 (39.02%) were female. 56 patients (4.1%) met the criteria for major depression and 494 patients (36.16%) for minor depression. No sign of depression was found in 816 patients (59.74%). Depression was strongly associated with younger age (18-40 years vs. >60 years) [OR-2.09; 95% CI 1.11-3.96], female sex [OR-1.31; 95% CI 1.11-2.01], low socioeconomic status [OR-2.69; 95% CI 1.34-3.79], poor compliance [OR- 5.05; 95% CI 2.79-8.13], hypoglycemia [OR 1.466; 95% CI 1.076-1.999] and difficulty in managing day-to-day activities [OR- 4.648; 95% CI 3.450-6.262] Suicidal ideation was detected in 201 patients (14.8%). Among patients who had repeated attacks of hypoglycemia (>1 episode per month), 22% experienced suicidal ideation. This was significantly higher than in patients who had not suffered from hypoglycemia (12%) (p < 0.0001). Patients with HbA1C of 7% or lower experienced statistically significantly lesser suicidal ideation than patients with a higher HbA1C (12% vs. 16.8% {p = 0.016}). Suicidal ideation did not correlate withbody mass index (BMI), fasting plasma glucose (FPG) or insulin usage. CONCLUSIONS: We found a high prevalence of depression in T2DM patients in Eastern India. Younger age, female sex, lower socio-economic status, poor compliance, hypoglycemia, and difficulty in managing day to day activities emerged as significant predictors of depression in this study. Recurrent episodes of hypoglycemia were an independent risk factor for suicidal ideation in patients with depression. Depression was not significantly associated with co morbidities associated with T2D and surprisingly insulin usage was not associated with increased depression.

Enhancing Physical Human Evasion of Moving Threats Using Tactile Cues.

New human-centric approaches to safety can combine over-head camera views with situational awareness tools to enable humans to avoid rapidly evolving threats such as moving machines or falling debris. This article explores how 360° information can be used to inform humans of potential collisions. Specifically, we quantify how different individual (tactile, audio, and visual) and combined cue modalities affect failure rates and reaction times. Human-subject experiments were conducted in a custom virtual reality environment that simulates objects rapidly moving toward the subject. In order to successfully perform their task, the human subject must physically move their body out of the path of the moving threat before a collision occurs. This exploration of full body physical response differentiates this article from previous related studies. The results of the 18-subject study provide quantified data on a range of cues and cue combinations. The study quantified failure rates and reaction times as a function of index of difficulty (Fitt's Law) and threat directionality. The results confirm the hypothesis that the addition of tactile cues statistically improve performance compared to non-tactile cues with regards to failure rate and reaction time. This demonstrates how sensory cues can improve human physical response to rapid threats.

A pressure and shear sensing liner for prosthetic sockets.

Interface pressures are closely related to the comfort and fit of a lower-limb prosthetic socket and clinicians and researchers are interested in monitoring these loads. In particular, shear stresses at the socket/liner interface are indicative of important fit characteristics but are difficult to measure in situ. We have developed an elastomeric liner with sixteen integrated pressure and shear sensors, along with necessary wiring and data acquisition electronics. The sensors measure three-axis pressures using optical emitter/detector pairs coupled with transparent and opaque elastomeric layers. The liner has similar properties to those typically used in clinical practice. The system was tested on a single amputee subject during several sit/stand/walk cycles.

A portable air jet actuator device for mechanical system identification.

System identification of limb mechanics can help diagnose ailments and can aid in the optimization of robotic limb control parameters and designs. An interesting fluid phenomenon--the Coanda effect--is utilized in a portable actuator to provide a stochastic binary force disturbance to a limb system. The design of the actuator is approached with the goal of creating a portable device which could be deployed on human or robotic limbs for in situ mechanical system identification. The viability of the device is demonstrated by identifying the parameters of an underdamped elastic beam system with fixed inertia and stiffness and variable damping. The nonparametric compliance impulse response yielded from the system identification is modeled as a second-order system and the resultant parameters are found to be in excellent agreement with those found using more traditional system identification techniques. The current design could be further miniaturized and developed as a portable, wireless, unrestrained mechanical system identification instrument for less intrusive and more widespread use.

Design of a Catheter-Based Device for Performing Percutaneous Chordal-Cutting Procedures.

This paper focuses on the design and implementation of a percutaneous catheter-based device to provide physicians with an externally controlled tool capable of manipulating and cutting specific chordae tendinae within the hear to alleviate problems associated with some forms of mitral valve regurgitationt. In the United States alone, approximately 500,000 people develop ischemic or functional MR per year, and the chordae tendinae cutting procedure and device are needed because many patients do not have the required level of health necessary to survive open-heart surgery. A deterministic design process was used to generate several design concepts and then evaluate and compare each concept based on a set of functional requirements. A final concept to be alpha prototyped was then chosen, further developed, and fabricated. Experiments showed that the design was capable of locating and grabbing a chord and that ultrasound imaging is a viable method for navigating the device inside of the human body. Once contact between the chord and an RF ablator tip was confirmed, the chord was successfully ablated.