Random plasma glucose in early pregnancy is a better predictor of gestational diabetes diagnosis than maternal obesity.

AIMS/HYPOTHESIS: Asymptomatic pregnant women are screened for gestational diabetes (GDM) at 24-28 weeks' gestation. Recent guidelines also recommend screening early in gestation to identify undiagnosed pre-existing overt diabetes. We assessed the performance of random plasma glucose (RPG) testing at antenatal booking in predicting GDM diagnosis later in pregnancy. METHODS: Data from 25,543 consecutive singleton pregnancies at the Rosie Hospital in Cambridge (UK) were obtained from hospital electronic records as a service evaluation. All women were invited for an antenatal RPG (12-16 weeks) and a 50 g glucose challenge test (GCT; 24-28 weeks) with a 75 g OGTT if GCT >7.7 mmol/l (139 mg/dl). RESULTS: At booking, 17,736 women had an RPG that was able to predict GDM (receiver operating characteristic AUC 0.8) according to various diagnostic criteria in common use. A cut-off point of ≥7.5 mmol/l (135 mg/dl) gave a sensitivity of 0.70 and a specificity of 0.90 for GDM diagnosis. Theoretically, using this screening policy, 13.2% of women would have been categorised at high risk (26.3% had GDM) and 86.8% of women at low risk (1.7% had GDM). RPG performed better than maternal age (AUC 0.60) or BMI (AUC 0.65) at predicting GDM diagnosis. CONCLUSIONS/INTERPRETATION: RPG at booking has reasonable performance as a screening test and is better than maternal age or BMI for identifying women at high risk of GDM. RPG cannot replace OGTT for diagnosis but it may be useful to exclude women who do not need further investigation for GDM and to identify women who could be prioritised for early diagnosis or lifestyle interventions.This project was not supported by any specific funding. Claire Meek receives salary funding from the European Union Seventh Framework Programme (FP7/2007-2013; grant agreement n° 266408) and from the Wellcome Trust Translational Medicine and Therapeutics Programme which is funded by the Wellcome Trust in association with Glaxo SmithKline.This is the final version of the article. It was first available from Springer via http://dx.doi.org/10.1007/s00125-015-3811-

Teaching in groups in grade III.

Thesis (Ed.M.)--Boston University N.B.:Pages 28, 144 and 145 are missing from original thesis

Likelihood of 'falling through the net' relates to contemporary prevalence of gestational diabetes. Reply to Ikomi A, Mannan S, Anthony R, Kiss S [letter].

This project was not supported by any specific funding. Claire Meek receives salary funding from the European Union Seventh Framework Programme (FP7/2007-2013; grant agreement n° 266408) and from the Wellcome Trust Translational Medicine and Therapeutics Programme which is funded by the Wellcome Trust in association with Glaxo SmithKline.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s00125-015-3737-

Development and Evaluation of an Undergraduate Science Communication Module

This paper describes the design and evaluation of an undergraduate final year science communication module for the Science Faculty at the University of East Anglia. The module focuses specifically on science communication and aims to bring an understanding of how science is disseminated to the public. Students on the module are made aware of the models surrounding science communication and investigate how the science culture interfaces with the public. During the module they learn how to adapt science concepts for different audiences and how to talk confidently about science to a lay-audience. Student motivation for module choice centres on the acquisition of transferable skills and students develop these skills through designing, running and evaluating a public outreach event at a school or in a public area. These transferable skills acquired include communication, interaction with different organisations such as museums and science centres, developing understanding of both the needs of different audiences and the importance of time management. They also develop skills relating to self-reflection and how to use this as a tool for future self development. The majority of students completing the module go on to further study, either a PhD, MSc or teacher training. The module can be sustained in its present formed if capped at 40 students, however it is recognised that to increase cohort size, further investment of faculty time and resources would be required

Structure and phase transition in BaThO3: A combined neutron and synchrotron X-ray diffraction study

The structure of BaThO3, obtained by solid state synthesis, was refined for the first time by the Rietveld method using a combination of synchrotron X-ray and neutron powder diffraction data. BaThO3 has an orthorhombic structure at room temperature, in space group Pbnm with a = 6.3491(5), b = 6.3796(4) and c = 8.9907(7) Å. Heating BaThO3 to above 700 °C results in a continuous transition to a second orthorhombic structure, in space group Ibmm, demonstrated by both in situ neutron and synchrotron X-ray powder diffraction measurements. The coefficient of volumetric thermal expansion for BaThO3 is determined to be 1.04 x 10-5 oC-1 from 50 to 625 oC (Pbnm phase), and 9.43 x 10-6 oC-1 from 800 to 1000 oC (Ibmm phase). BaThO3 was found to decompose upon exposure to atmospheric moisture resulting in the formation of ThO2. The thermal expansion of ThO2, which invariably co-exists with BaThO3, is also described.Australian Synchrotron Australian Research Council2019-12-1

Structure and phase transition in BaThO3: A combined neutron and synchrotron X-ray diffraction study

The structure of BaThO3, obtained by solid state synthesis, was refined for the first time by the Rietveld method using a combination of synchrotron X-ray and neutron powder diffraction data. BaThO3 has an orthorhombic structure at room temperature, in space group Pbnm with a = 6.3491(5), b = 6.3796(4) and c = 8.9907(7) Å. Heating BaThO3 to above 700 °C results in a continuous transition to a second orthorhombic structure, in space group Ibmm, demonstrated by both in situ neutron and synchrotron X-ray powder diffraction measurements. The coefficient of volumetric thermal expansion for BaThO3 is determined to be 1.04 x 10-5 oC-1 from 50 to 625 oC (Pbnm phase), and 9.43 x 10-6 oC-1 from 800 to 1000 oC (Ibmm phase). BaThO3 was found to decompose upon exposure to atmospheric moisture resulting in the formation of ThO2. The thermal expansion of ThO2, which invariably co-exists with BaThO3, is also described.Australian Synchrotron Australian Research Counci

MHC class II-restricted antigen presentation by plasmacytoid dendritic cells drives proatherogenic T cell immunity

Background—Plasmacytoid dendritic cells (pDCs) bridge innate and adaptive immune responses and are important regulators of immuno-inflammatory diseases. However, their role in atherosclerosis remains elusive. Methods and Results—Here, we used genetic approaches to investigate the role of pDCs in atherosclerosis. Selective pDC deficiency in vivo was achieved using CD11c-Cre × Tcf4–/flox bone marrow transplanted into Ldlr–/– mice. Compared with control Ldlr–/– chimeric mice, CD11c-Cre × Tcf4–/flox mice had reduced atherosclerosis levels. To begin to understand the mechanisms by which pDCs regulate atherosclerosis, we studied chimeric Ldlr–/– mice with selective MHCII deficiency on pDCs. Significantly, these mice also developed reduced atherosclerosis compared with controls without reductions in pDC numbers or changes in conventional DCs. MHCII-deficient pDCs showed defective stimulation of apolipoprotein B100–specific CD4+ T cells in response to native low-density lipoprotein, whereas production of interferon-α was not affected. Finally, the atheroprotective effect of selective MHCII deficiency in pDCs was associated with significant reductions of proatherogenic T cell–derived interferon-γ and lesional T cell infiltration, and was abrogated in CD4+ T cell–depleted animals. Conclusions—This study supports a proatherogenic role for pDCs in murine atherosclerosis and identifies a critical role for MHCII-restricted antigen presentation by pDCs in driving proatherogenic T cell immunity

A new integrated care pathway for ambulance attended severe hypoglycaemia in the East of England: The Eastern Academic Health Science Network (EAHSN) model

Aims: We developed a new clinical integrated pathway linking a regional Ambulance Trust with a severe hypoglycaemia (SH) prevention team. We present clinical data from the first 2,000 emergency calls taken through this new clinical pathway in the East of England. Methods: SH patients attended by Ambulance crew receive written information on SH avoidance, and are contacted for further education through a new regional SH prevention team. All patients are contacted unless they actively decline. Results: Median age (IQR) was 67 (50 - 80) years, 23.6% of calls were for patients over 80 years old, and patients more than 90 years old were more common than 20 - 25 year olds in this population. Most calls were for patients (84.9%) who were insulin treated, even those over 80 years (75%). One - third of patients attended after a call were unconscious on attendance. 5.6% of patients in this call population had 3 or more ambulance call outs, and they generated 17.6% of all calls. In total, 728 episodes (36.4%) were repeat calls. Insulin related events were clinically more severe than oral hypoglycaemic related events. Patients conveyed to hospitals (13.8%) were significantly older, with poorer recovery in biochemical hypoglycaemia after ambulance crew attendance. Only 19 (1%) opted out of further contact. Patients were contacted by the SH prevention team after a median 3 (0 - 6) days. The most common patient self - reported cause for their SH episode was related to percieved errors in insulin management (31.4%). Conclusions: This new clinical service is simple, acceptable to patients, and a translatable model for prevention of recurrent SH in this largely elderly insulin treated SH population

Erratum: Dietary Intervention in Pregnant Women with Gestational Diabetes; Protocol for the DiGest Randomised Controlled Trial; Nutrients 2020, 12, 1165.

The authors would like to correct an error in a recent published paper [...]

Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial.

BACKGROUND: Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT). METHODS: This was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres ( ClinicalTrials.gov NCT01788527; registered 11/2/2013). Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. RESULTS: Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62, 67 and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2, 1.3 and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born > 97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes. CONCLUSIONS: GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes. TRIAL REGISTRATION: This trial is registered with ClinicalTrials.gov . number NCT01788527 . Trial registered 11/2/2013