Continuous glucose monitoring in pregnant women with Type 1 diabetes: benefits for mothers, using pumps or pens, and their babies

Aims: To review the current literature on the use of continuous glucose monitoring during pregnancy in women with Type 1 diabetes. Methods: We searched the literature for randomized controlled trials using continuous glucose monitoring during pregnancy in women with Type 1 diabetes. Results: Three randomized trials were found and discussed in this review. One UK study found a reduction in large-for-gestational-age infants; however, only masked continuous glucose monitoring was used in that study. A Danish study used intermittent real-time continuous glucose monitoring and found no differences. The present authors conducted the CONCEPTT trial, in which pregnant women and women planning pregnancy were randomized to receive continuous glucose monitoring or standard care. We found a greater drop in HbA1c, more time spent in the target range, and a reduction in some adverse neonatal outcomes in women using continuous glucose monitoring. Numbers-needed-to-treat to prevent a large-for-gestational-age infant, a neonatal intensive care unit admission for >24 h, and a neonatal hypoglycaemia event were low. These findings were seen in both injection and pump users and across all countries. Possible reasons for differences in study findings are discussed. In addition, several issues need further study. Glycaemic variability and differences in dietary intake may also have played a role. Despite excellent glycaemic control, babies continue to be large. More research is needed to understand the role of glucose targets and the dynamic placental processes involved in fetal growth. Conclusions: The use of continuous glucose monitoring in women with Type 1 diabetes in pregnancy is associated with improved glycaemic control and neonatal outcomes. Further research examining the glycaemic and non-glycaemic variables involved in fetal growth and the cost–benefit of using continuous glucose monitoring in pregnancy is warranted

Paper Session II-B - The Electric Insertion Transfer Experiment (ELITE): An Air Force Critical Experiment to Revolutionize Space Transportation

As the Air Force mission in space continues to expand, the cost of delivering the necessary resources to assure mission accomplishment has become a critical issue. With the amount of payload delivered to high earth orbit driven by the characteristics of the upper stage, significant benefits can be achieved by reducing its weight and/or increasing its performance. Highly efficient electric propulsion stages can provide advantages in both areas. Ongoing studies at Air Force Space Command and Space Systems Division have identified some payoffs of using this revolutionary propulsion method to power future orbit transfer vehicles. Preliminary results indicate that an Electric Orbital Transfer Vehicle (EOTV) may allow us to efficiently launch some of our largest payloads, currently planned for Titan IV, on Atlas or Delta class vehicles. This capability offers the potential to significantly reduce launch costs by tens of millions of dollars per mission. The ELectric Insertion Transfer Experiment (ELITE) is proposed as a critical experiment to demonstrate the capability of solar electric propulsion in an orbit raising mode. ELITE integrates several ongoing technology programs within the Department of Defense (DoD) and NASA in a space demonstration. The experiment will address issues associated with low thrust, solar powered orbit transfers and methods for autonomous control of EOTVs. ELITE will also address issues peculiar to electric thrusters such as contamination of spacecraft components, plume-plume interaction of multiple thrusters, charging of spacecraft surfaces and potential interference with radio frequency transmissions and other electronics. Other potential applications for electric propulsion are also discussed in the context of future DoD and NASA missions

Geometric-Phase-Effect Tunnel-Splitting Oscillations in Single-Molecule Magnets with Fourth-Order Anisotropy Induced by Orthorhombic Distortion

We analyze the interference between tunneling paths that occurs for a spin system with both fourth-order and second-order transverse anisotropy. Using an instanton approach, we find that as the strength of the second-order transverse anisotropy is increased, the tunnel splitting is modulated, with zeros occurring periodically. This effect results from the interference of four tunneling paths connecting easy-axis spin orientations and occurs in the absence of any magnetic field.Comment: 6 pages, 5 eps figures. Version published in EPL. Expanded from v1: Appendix added, references added, 1 figure added, others modified cosmeticall

Dietary intakes of women with Type 1 diabetes before and during pregnancy: A pre‐specified secondary subgroup analysis among CONCEPTT participants

Aim To describe the dietary intakes of women with Type 1 diabetes before and during pregnancy. Methods This was a pre‐specified subgroup analysis of CONCEPTT involving 63 women planning pregnancy and 93 pregnant women from 14 sites in England, Scotland and Ireland. Two hundred and forty‐six 3‐day food diaries (104 planning pregnancy, 142 pregnant) were matched to data source and food reference codes, and analysed using dietary software. Participants were informed that food diaries would be de‐identified and used only for research purposes. Results Mean (sd) daily energy intake was 1588 (346) kcal and 1673 (384) kcal in women planning pregnancy and pregnant women respectively. Total carbohydrate intake was consistent with dietary guideline recommendations [180 (52) g planning pregnancy, 198 (54) g pregnant], but non‐recommended sources (e.g. sugars, preserves, confectionery, biscuits, cakes) contributed to 46% of total daily carbohydrate intake. Fat consumption exceeded guideline recommendations [70 (21) g planning pregnancy, 72 (21) g pregnant]. Fibre [15.5 (5.3) g planning pregnancy, 15.4 (5.1) g pregnant], fruit and vegetable intakes [3.5 (2.2) and 3.1 (1.8) serves/day] were inadequate. Twelve women planning pregnancy (19%) and 24 pregnant women (26%) did not meet micronutrient requirements. Conclusions The diets of pregnant women from England, Scotland and Ireland are characterized by high fat, low fibre and poor‐quality carbohydrate intakes. Fruit and vegetable consumption is inadequate, with one in four women at risk of micronutrient deficiencies. Further research is needed to optimize maternal nutrition for glycaemic control and for maternal and offspring health

Entanglement area laws for long-range interacting systems

We prove that the entanglement entropy of any state evolved under an arbitrary 1/r^α long-range-interacting D-dimensional lattice spin Hamiltonian cannot change faster than a rate proportional to the boundary area for any α>D+1. We also prove that for any α>2D+2, the ground state of such a Hamiltonian satisfies the entanglement area law if it can be transformed along a gapped adiabatic path into a ground state known to satisfy the area law. These results significantly generalize their existing counterparts for short-range interacting systems, and are useful for identifying dynamical phase transitions and quantum phase transitions in the presence of long-range interactions

Assessment of ambient air pollution in the Waterberg Priority Area 2012-2015

The Waterberg Priority Area ambient air quality monitoring network was established in 2012 to monitor the ambient air quality in the Waterberg Air Quality Priority Area. Three monitoring stations were established in Lephalale, Thabazimbi and Mokopane. The monitoring stations measure the concentrations of PM10, PM2.5, SO2, NOx, CO, O3, BTEX and meteorological parameters. Hourly data for a 31 month period (October 2012-April 2015) was obtained from the South African Air Quality Information System (SAAQIS) and analysed to assess patterns in atmospheric concentrations, including seasonal and diurnal patterns of the ambient concentrations and to assess the impacts that such reported pollution concentration may have. Local source regions for SO2, PM10, PM2.5 and O3 were identified and trends in the recorded concentrations are discussed

Sodium and Fluid Excretion With Torsemide in Healthy Subjects is Limited by the Short Duration of Diuretic Action

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142477/1/jah32580_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142477/2/jah32580.pd

Circulating extracellular vesicles during pregnancy in women with type 1 diabetes: a secondary analysis of the CONCEPTT trial.

BACKGROUND: Extracellular vesicles are membrane vesicles that are released into the extracellular environment and accumulate in the circulation in vascular disease. We aimed to quantify circulating extracellular vesicles in pregnant women with type 1 diabetes and to examine associations between extracellular vesicle levels, continuous glucose measures, and pregnancy outcomes. METHODS: We used plasma samples from the Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial study and quantified circulating extracellular vesicles by flow cytometry (n = 163). Relationships with clinical variables were assessed by repeated measures correlation. Logistic regression was used to assess associations between elevated extracellular vesicle levels and pregnancy outcomes. RESULTS: Platelet extracellular vesicle levels were inversely associated with glucose time above range and glycaemic variability measures (P < 0.05). A weak positive association was observed between endothelial extracellular vesicles and mean amplitude of glycemic excursion (P < 0.05). In a univariate logistic regression model, high baseline endothelial extracellular vesicles was associated with increased risk of neonatal intensive care unit (NICU) admission (OR: 2.06, 1.03-4.10), and respiratory distress requiring ventilation (OR: 4.98, 1.04-23.92). After adjusting for HbA1c and blood pressure the relationship for NICU admission persisted and an association with hyperbilirubinemia was seen (OR: 2.56, 1.10-5.94). Elevated platelet extracellular vesicles were associated with an increased risk of NICU admission (OR: 2.18, 1.04-4.57), and hyperbilirubinemia (OR: 2.61, 1.11-6.12) after adjusting for HbA1c and blood pressure. CONCLUSIONS: High levels of extracellular vesicles in early pregnancy were associated with adverse neonatal outcomes. Assessment of extracellular vesicles may represent a novel approach to personalized care in type 1 diabetes pregnancy