SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe

Aims: To develop and validate a recalibrated prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in individuals with type 2 diabetes in Europe. Methods and results: SCORE2-Diabetes was developed by extending SCORE2 algorithms using individual-participant data from four large-scale datasets comprising 229 460 participants (43 706 CVD events) with type 2 diabetes and without previous CVD. Sex-specific competing risk-adjusted models were used including conventional risk factors (i.e. age, smoking, systolic blood pressure, total, and HDL-cholesterol), as well as diabetes-related variables (i.e. age at diabetes diagnosis, glycated haemoglobin [HbA1c] and creatinine-based estimated glomerular filtration rate [eGFR]). Models were recalibrated to CVD incidence in four European risk regions. External validation included 217 036 further individuals (38 602 CVD events), and showed good discrimination, and improvement over SCORE2 (C-index change from 0.009 to 0.031). Regional calibration was satisfactory. SCORE2-Diabetes risk predictions varied several-fold, depending on individuals' levels of diabetes-related factors. For example, in the moderate-risk region, the estimated 10-year CVD risk was 11% for a 60-year-old man, non-smoker, with type 2 diabetes, average conventional risk factors, HbA1c of 50 mmol/mol, eGFR of 90 mL/min/1.73 m2, and age at diabetes diagnosis of 60 years. By contrast, the estimated risk was 17% in a similar man, with HbA1c of 70 mmol/mol, eGFR of 60 mL/min/1.73 m2, and age at diabetes diagnosis of 50 years. For a woman with the same characteristics, the risk was 8% and 13%, respectively. Conclusion: SCORE2-Diabetes, a new algorithm developed, calibrated, and validated to predict 10-year risk of CVD in individuals with type 2 diabetes, enhances identification of individuals at higher risk of developing CVD across Europe

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

‘By God’s Arse’ Genre, Humour and Religion in William Wager’s Moral Interludes

This chapter reflects on the theoretical problem raised by the depiction of reprobate protagonists and their demise in two plays that present themselves emphatically as comedies and humorous drama. Rather than taken seriously as fully fledged Christian comedies, William Wager’s Reformation interludes The Longer Thou Livest the More Fool Thou Art and Enough Is as Good as a Feast have been interpreted as early tragedies or dismissed as flawed comedies because of what critics have regarded as their tragic endings and coarse humour. I argue that while the plays’ theology was informed by the new Protestant doctrine of double predestination, its humour was still firmly rooted in a late medieval appreciation of comedy as a weapon against evil and instrument of Christian hope. From this perspective, even the portrayals of the deaths of the protagonists can be perceived as comforting and fitting as genuinely comedic endings. The plays help us gain a more complex understanding of the historical correlation between humour and religion

Leadership transfer in rural communities: A mixed methods investigation

The United States is poised to experience one of the largest transfers of leadership in its history, markedly impacting rural community sustainability efforts. The purpose of this exploratory sequential mixed methods study was to identify themes related to rural leadership transfer using grounded theory and to test the facilitation of effective leadership transfer using structural equation modeling. Adult and youth leaders (N = 19) from three nominated rural communities comprised the qualitative phase and secondary data from a 2015 rural survey (N = 1991) comprised the quantitative phase. Mixed methods results indicated the environment conducive for effective leadership transfer (via broadened civic engagement) was facilitated when community hope became contagious based upon community development efforts achieved by hopeful, persistent community leaders. The presented findings offer greater precision to leadership research in community contexts and enable increased effectiveness in facilitating community leadership transitions, thus enhancing their generative capabilities

‘By God’s Arse’ Genre, Humour and Religion in William Wager’s Moral Interludes

This chapter reflects on the theoretical problem raised by the depiction of reprobate protagonists and their demise in two plays that present themselves emphatically as comedies and humorous drama. Rather than taken seriously as fully fledged Christian comedies, William Wager’s Reformation interludes The Longer Thou Livest the More Fool Thou Art and Enough Is as Good as a Feast have been interpreted as early tragedies or dismissed as flawed comedies because of what critics have regarded as their tragic endings and coarse humour. I argue that while the plays’ theology was informed by the new Protestant doctrine of double predestination, its humour was still firmly rooted in a late medieval appreciation of comedy as a weapon against evil and instrument of Christian hope. From this perspective, even the portrayals of the deaths of the protagonists can be perceived as comforting and fitting as genuinely comedic endings. The plays help us gain a more complex understanding of the historical correlation between humour and religion

‘By God’s Arse’ Genre, Humour and Religion in William Wager’s Moral Interludes

This chapter reflects on the theoretical problem raised by the depiction of reprobate protagonists and their demise in two plays that present themselves emphatically as comedies and humorous drama. Rather than taken seriously as fully fledged Christian comedies, William Wager’s Reformation interludes The Longer Thou Livest the More Fool Thou Art and Enough Is as Good as a Feast have been interpreted as early tragedies or dismissed as flawed comedies because of what critics have regarded as their tragic endings and coarse humour. I argue that while the plays’ theology was informed by the new Protestant doctrine of double predestination, its humour was still firmly rooted in a late medieval appreciation of comedy as a weapon against evil and instrument of Christian hope. From this perspective, even the portrayals of the deaths of the protagonists can be perceived as comforting and fitting as genuinely comedic endings. The plays help us gain a more complex understanding of the historical correlation between humour and religion

Data from: RAD sequencing resolves fine-scale population structure in a benthic invertebrate: implications for understanding phenotypic plasticity

The field of molecular ecology is transitioning from the use of small panels of classical genetic markers such as microsatellites to much larger panels of single nucleotide polymorphisms (SNPs) generated by approaches like RAD sequencing. However, few empirical studies have directly compared the ability of these methods to resolve population structure. This could have implications for understanding phenotypic plasticity, as many previous studies of natural populations may have lacked the power to detect genetic differences, especially over micro-geographic scales. We therefore compared the ability of microsatellites and RAD sequencing to resolve fine-scale population structure in a commercially important benthic invertebrate by genotyping great scallops (Pecten maximus) from nine populations around Northern Ireland at 13 microsatellites and 10 539 SNPs. The shells were then subjected to morphometric and colour analysis in order to compare patterns of phenotypic and genetic variation. We found that RAD sequencing was superior at resolving population structure, yielding higher Fst values and support for two distinct genetic clusters, whereas only one cluster could be detected in a Bayesian analysis of the microsatellite dataset. Furthermore, appreciable phenotypic variation was observed in size-independent shell shape and coloration, including among localities that could not be distinguished from one another genetically, providing support for the notion that these traits are phenotypically plastic. Taken together, our results suggest that RAD sequencing is a powerful approach for studying population structure and phenotypic plasticity in natural populations