HbA1c, weight, quality of life and hypoglycaemia awareness after a structured education programme teaching carbohydrate counting and insulin dose adjustment

Objective - The primary aim was to assess the effects of Aintree Hospital’s ‘4-Step’ programme which teaches carbohydrate counting and insulin dose adjustment to patients with Type 1 diabetes, on HbA1c, Weight, Quality of life and Hypoglycaemia awareness. A secondary aim was to compare the effects of group education and one to one clinics in HbA1c, Weight, Quality of life and Hypoglycaemia awareness. Methods -All parameters were measured at baseline and four months later. HbA1c is measured by blood test, Quality of Life using the Problem Areas in Diabetes questionnaire and Hypoglycaemia Awareness using the ‘Symptom Awareness of Hypoglycaemia’ questionnaire. A convenience sampling technique was used whereby patient data was collected over a 6 month period from all patients who fit the criteria. Those excluded were patients with patients receiving nutritional support and those undertaking weight management programmes, those undergoing chemo/radiotherapy and those on renal dialysis. Fifty two sets of patient data were collected in total. All patients underwent either group or one-to-one clinic sessions. The programme was of four weeks duration and patients were followed up for repeat measurements three months after the programme. Where populations fit a normal ’Gaussian’ distribution parametric paired t-tests were chosen for statistical analysis. Where the population was found to be skewed, non- parametric Wilcoxon tests were used. Results - Following the programme overall HbA1c levels improved by 0.29% (p=0.008) with greater improvements occurring in those undertaking joint clinics (p=0.037) than groups (p=0.111). There was an overall weight loss of 0.5kg which did not reach statistical significance (p=0.100). However weight loss was greater in those attending group education (p=0.04) compared to those attending clinics (p=0.438). Quality of life scores improved by 11% overall (p=0.000) with group education being slightly more effective in achieving improvements (p=0.000) than group education (p=0.001). There was no change in symptoms of Hypoglycaemia awareness in the population as a whole (p=0.052) although as with HbA1c, those undergoing individual education had great improvements (p=0.046) compared to those in groups (p=0.409). Conclusions - The study has served to demonstrate the effectiveness of Aintree’s ‘4-Step’ programme in achieving key improvements in clinical and non-clinical aspects of patients’ diabetes care. While the improvement in HbA1c is beneficial, it is unclear whether this is sustained over time. Longer term follow-up and refresher education at intervals may increase the likelihood of sustained clinical benefits. Whilst weight loss was shown to be minimal, the study importantly demonstrates that the ‘4-Step’ programme does not lead to weight gain, an important finding when offering a programme enabling greater food freedom. Quality of Life improvements were highly significant with impressive improvements. However, future studies would benefit from including a more detailed analysis of the Quality of Life questionnaire. Whilst highlighting aspects which are most favourably influenced by the programme, this would also enable targeting of those aspects which demonstrate lower levels of satisfaction for future service provision. Hypoglycaemia Awareness did not improve, possibly due to the short study duration. Future evaluations may be better placed to measure frequency of hypoglycaemia for a more accurate assessment of the impact of the ‘4-Step’ programme on hypoglycaemic events

Constitutional Law - Fifth Amendment - Fourteenth Amendment - Equal Protection - Standard of Review - Racial Classifications

The United States Supreme Court held that racial classifications imposed by either federal, state or local governments must be analyzed by a reviewing court using a strict scrutiny standard. Adarand Constructors, Inc. v. Pena, 115 S. Ct. 2097 (1995)

Research urodynamics: Developing a greater understanding of lower urinary tract dysfunction and interrelated role of the nurse researcher

DPhil Submissio

A Search For a Cure: One Step Closer to Eliminating Breast Cancer

In 2009, there were more than 194,000 new cases of breast cancer, and more than 40,000 deaths caused by this most common form of cancer among women in the United States. Human epidermal growth factor receptor-2 (HER2) positive breast cancer is one of the more aggressive forms of breast cancer and is prevalent in about one of every three cases of breast cancer. This protein is made in low levels by normal breast cells, but is produced in excessively high levels in HER2-positive breast cancer. In addition, HER2- positive tumors grow faster, recur more often than other breast tumors and are less responsive to hormone treatments. Wayne State University in conjunction with the Barbara Ann Karmanos Cancer Institute is on the cusp of a new discovery that may someday save many lives. Wei-Zen Wei, professor of immunology and microbiology in the School of Medicine and at Karmanos, is leading a research team that has developed a cancer vaccine that recognizes HER-2 positive cancer cells, and helps to prevent their spread and destroy them

A genetic basis for a postmeiotic X versus Y chromosome intragenomic conflict in the mouse.

Intragenomic conflicts arise when a genetic element favours its own transmission to the detriment of others. Conflicts over sex chromosome transmission are expected to have influenced genome structure, gene regulation, and speciation. In the mouse, the existence of an intragenomic conflict between X- and Y-linked multicopy genes has long been suggested but never demonstrated. The Y-encoded multicopy gene Sly has been shown to have a predominant role in the epigenetic repression of post meiotic sex chromatin (PMSC) and, as such, represses X and Y genes, among which are its X-linked homologs Slx and Slxl1. Here, we produced mice that are deficient for both Sly and Slx/Slxl1 and observed that Slx/Slxl1 has an opposite role to that of Sly, in that it stimulates XY gene expression in spermatids. Slx/Slxl1 deficiency rescues the sperm differentiation defects and near sterility caused by Sly deficiency and vice versa. Slx/Slxl1 deficiency also causes a sex ratio distortion towards the production of male offspring that is corrected by Sly deficiency. All in all, our data show that Slx/Slxl1 and Sly have antagonistic effects during sperm differentiation and are involved in a postmeiotic intragenomic conflict that causes segregation distortion and male sterility. This is undoubtedly what drove the massive gene amplification on the mouse X and Y chromosomes. It may also be at the basis of cases of F1 male hybrid sterility where the balance between Slx/Slxl1 and Sly copy number, and therefore expression, is disrupted. To the best of our knowledge, our work is the first demonstration of a competition occurring between X and Y related genes in mammals. It also provides a biological basis for the concept that intragenomic conflict is an important evolutionary force which impacts on gene expression, genome structure, and speciation