The ADIPS pilot national diabetes in pregnancy benchmarking programme

Background: To test the feasibility of benchmarking the care of women with pregnancies complicated by hyperglycaemia. Methods: A retrospective audit of volunteer diabetes services in Australia and New Zealand involving singleton pregnancies resulting in live births between 2014 and 2020. Ranges are shown and compared across services. Results: The audit included 10,144 pregnancies (gestational diabetes mellitus (GDM) = 8696; type 1 diabetes (T1D) = 435; type 2 diabetes (T2D) = 1013) from 11 diabetes services. Among women with GDM, diet alone was used in 39.4% (ranging among centres from 28.8-57.3%), metformin alone in 18.8% (0.4-43.7%), and metformin and insulin in 10.1% (1.5-23.4%); when compared between sites, all p 6.5% (48 mmol/mol)), 78.4% and 54.6%, respectively (p < 0.001). Conclusion: Management of maternal hyperglycaemia and pregnancy outcomes varied significantly. The maintenance and extension of this benchmarking service provides opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy

Pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy in an urban New Zealand population and their association with postnatal HbA1c uptake

Background: Adverse pregnancy outcomes are more common in women with hyperglycaemia. Many women have suboptimal uptake of HbA1c testing postdelivery. Aims: To compare pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy, and their association with postnatal HbA1c uptake after the introduction of email reminders. Materials and Methods: A retrospective and prospective single-centre study was conducted in South Auckland in 2639 women with early gestational diabetes mellitus (GDM) (diagnosed < 20 weeks), late GDM (diagnosed ≥ 20 weeks), overt diabetes in pregnancy, or known type 2 diabetes (T2DM) during pregnancy. Automated email reminders were sent to general practitioners to increase postnatal HbA1c screening. Results: HbA1c during pregnancy increased across the late GDM (n = 1425), early GDM (n = 148), overt diabetes (n = 573) and T2DM (n = 493) groups (P < 0.001). Stillbirth was least common in the late GDM group (0, 0.7, 0.5, and 1.9%, respectively, P < 0.001), as were caesarean delivery (32.7, 45.1, 39.4, and 53.5%, respectively P < 0.001), large for gestational age (LGA) (14.7, 18.2, 22.3, and 30.5%, respectively, P < 0.001), small for gestational age (8.8, 16.7, 11.0, and 11.1%, respectively, P = 0.02), and preeclampsia/eclampsia (7.7, 9.2, 13.0, and 14.8%, respectively, P < 0.001). LGA and preeclampsia/eclampsia were more common among Pacific and Māori women than European women (LGA, 30.1, 22.7, 10.3%, respectively, P < 0.001; preeclampsia/eclampsia, 13.5, 14.0, and 8.1%, respectively, P < 0.001). Postpartum HbA1c screening increased among women with GDM/overt diabetes after the introduction of the reminder emails (39.6% vs 34.0%, P = 0.03). Conclusions: Women with late GDM are least likely to experience adverse outcomes. Email reminders to improve postpartum HbA1c screening warrant further investigation

Thinking like a ruin

Through the methodology of conversation, Lavery and Murray explore approaches to ruin and ruination, asking what job of work the ruin might perform in the twenty-first century. Using the provocation of “thinking like a ruin,” the authors propose different perspectives to help understand the materiality and theoretical context(s) of ruin and ruination. Drawing upon four case studies—Andy Goldsworthy’s Stonehouse Bonnington, St. Peter’s Seminary near Glasgow, Kris Verdonck’s Conversations at the End of the World, and the Sicilian town of (New) Gibellina—Lavery and Murray debate the ethical and political potential ruins have for imagining new forms of resistance, thus reconfiguring or re-purposing how decay and dereliction might provide a different lens for approaching issues of environment and ecology

I Can't Believe It's Not Bakhtin!: Literary Theory, Postmodern Advertising and the Gender Agenda

Taking the literary theories of Mikhail Bakhtin as a starting point, the authors offer three gendered readings of a postmodern advertisement for Moët & Chandon champagne. They commence with a discussion of the influence of gender on textual interpretation; continue with an outline of Bakhtin's key concepts, with particular reference to gender; present three contrasting readings of Moët's postmodern advertisement; and conclude with a discussion of their interpretations together with some reflexive reflections on the gender agenda. Though not claiming to offer a comprehensive introduction to Bakhtin, they do try to exemplify, in a quasi-carnivalesque mode of exposition, something of the character of that supremely gifted thinker and to demonstrate the insights his concepts provide in relation to gendered readings of advertising texts