Validity of the Supramaximal Test to Verify Maximal Oxygen Uptake in Children and Adolescents

This is the author accepted manuscript. The final version is available from Human Kinetics via the DOI in this record.Purpose: This study had 2 objectives: (1) to examine whether the validity of the supramaximal verification test for maximal oxygen uptake ( formula presented ) differs in children and adolescents when stratified for sex, body mass, and cardiorespiratory fitness and (2) to assess sensitivity and specificity of primary and secondary objective criteria from the incremental test to verify formula presented . Methods: In total, 128 children and adolescents (76 male and 52 females; age: 9.3-17.4 y) performed a ramp-incremental test to exhaustion on a cycle ergometer followed by a supramaximal test to verify formula presented . Results: Supramaximal tests verified formula presented in 88% of participants. Group incremental test peak formula presented was greater than the supramaximal test (2.27 [0.65] L·min-1 and 2.17 [0.63] L·min-1; P  .18). Supramaximal test time to exhaustion predicted supramaximal test formula presented verification (P = .04). Primary and secondary objective criteria had insufficient sensitivity (7.1%-24.1%) and specificity (50%-100%) to verify formula presented . Conclusion: The utility of supramaximal testing to verify formula presented is not affected by sex, body mass, or cardiorespiratory fitness status. Supramaximal testing should replace secondary objective criteria to verify formula presented

The acute and postprandial effects of sugar moiety on vascular and metabolic health outcomes in adolescents

This is the author accepted manuscript. The final version is available from Canadian Science Publishing via the DOI in this recordThis study explored the cardiometabolic responses to sugar moieties acutely, and following a subsequent mixed meal tolerance test (MMTT). Twenty-one healthy adolescents (N=10 female, 14.3±0.4 years) completed three experimental and one control condition, in a counterbalanced order. These consisted of different drinks to compare the effect of 300 mL of water (control), or 300 mL of water mixed with 60 g of glucose, fructose or sucrose, on vascular function (flow-mediated dilation; FMD, microvascular reactivity (total hyperaemic response; TRH); and cerebrovascular reactivity; CVR), and blood samples for [uric acid], [glucose], [triglycerides] and [lactate]. FMD increased 1 hour after glucose and sucrose (P<0.001, ES≥0.92) but was unchanged following fructose and water (P>0.19, ES>0.09). CVR and TRH were unchanged 1 hour following all conditions (P>0.57, ES>0.02). Following the MMTT, FMD was impaired in all conditions (P0.40) with no differences between conditions (P>0.13, ES<0.39). Microvascular TRH was increased in all conditions (P=0.001, ES=0.88), and CVR was preserved in all conditions post MMTT (P=0.87, ES=0.02). Blood [uric acid] was elevated following fructose consumption and the MMTT (P0.40). Consumption of a sugar sweetened beverage did not result in vascular dysfunction in healthy adolescents, however the vascular and metabolic responses were dependent on sugar moiety

CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial: A multi-center, multi-national, randomized controlled trial - Study protocol.

BACKGROUND: Women with type 1 diabetes strive for optimal glycemic control before and during pregnancy to avoid adverse obstetric and perinatal outcomes. For most women, optimal glycemic control is challenging to achieve and maintain. The aim of this study is to determine whether the use of real-time continuous glucose monitoring (RT-CGM) will improve glycemic control in women with type 1 diabetes who are pregnant or planning pregnancy. METHODS/DESIGN: A multi-center, open label, randomized, controlled trial of women with type 1 diabetes who are either planning pregnancy with an HbA1c of 7.0 % to ≤10.0 % (53 to ≤ 86 mmol/mol) or are in early pregnancy (<13 weeks 6 days) with an HbA1c of 6.5 % to ≤10.0 % (48 to ≤ 86 mmol/mol). Participants will be randomized to either RT-CGM alongside conventional intermittent home glucose monitoring (HGM), or HGM alone. Eligible women will wear a CGM which does not display the glucose result for 6 days during the run-in phase. To be eligible for randomization, a minimum of 4 HGM measurements per day and a minimum of 96 hours total with 24 hours overnight (11 pm-7 am) of CGM glucose values are required. Those meeting these criteria are randomized to RT- CGM or HGM. A total of 324 women will be recruited (110 planning pregnancy, 214 pregnant). This takes into account 15 and 20 % attrition rates for the planning pregnancy and pregnant cohorts and will detect a clinically relevant 0.5 % difference between groups at 90 % power with 5 % significance. Randomization will stratify for type of insulin treatment (pump or multiple daily injections) and baseline HbA1c. Analyses will be performed according to intention to treat. The primary outcome is the change in glycemic control as measured by HbA1c from baseline to 24 weeks or conception in women planning pregnancy, and from baseline to 34 weeks gestation during pregnancy. Secondary outcomes include maternal hypoglycemia, CGM time in, above and below target (3.5-7.8 mmol/l), glucose variability measures, maternal and neonatal outcomes. DISCUSSION: This will be the first international multicenter randomized controlled trial to evaluate the impact of RT- CGM before and during pregnancy in women with type 1 diabetes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01788527 Registration Date: December 19, 2012

Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection

IRIS – providing a nationally accessible infrastructure for UK science

In many countries around the world, the development of national infrastructures for science either has been implemented or are under serious consideration by governments and funding bodies. Current examples include ARDC in Australia, CANARIE in Canada and MTA Cloud in Hungary. These infrastructures provide access to compute and storage to a wide swathe of user communities and represent a collaboration between users, providers and, in some cases, industry to maximise the impact of the investments made. The UK has embarked on a project called IRIS to develop a sustainable e-infrastructure based on the needs of a diverse set of communities. Building on the success of the UK component of the WLCG and the innovations made, a number of research institutes and universities are working with several research groups to co-design an infrastructure, including support services, which take this to a level applicable to a wider use base. We present the preparatory work leading to the definition of this infrastructure, showing the wide variety of use cases which require to be supported. This leads us to a definition of the hardware and interface requirements needed to meet this diverse set of criteria, and the support posts identified in order to make best use of this facility and sustain it into the future