Type 1 diabetes

Type 1 diabetes is a chronic disease caused by autoimmune destruction of pancreatic β cells. Individuals with type 1 diabetes are reliant on insulin for survival. Despite enhanced knowledge related to the pathophysiology of the disease, including interactions between genetic, immune, and environmental contributions, and major strides in treatment and management, disease burden remains high. Studies aimed at blocking the immune attack on β cells in people at risk or individuals with very early onset type 1 diabetes show promise in preserving endogenous insulin production. This Seminar will review the field of type 1 diabetes, highlighting recent progress within the past 5 years, challenges to clinical care, and future directions in research, including strategies to prevent, manage, and cure the disease

Gestational diabetes and progression to type two diabetes mellitus: missed opportunities of follow up and prevention?

Abstract Background: The incidence of type 2 diabetes (T2DM) is increasing. Having a pregnancy complicated by gestational diabetes mellitus (GDM) is a potent risk factor for the later development of T2DM. Aims: To explore the characteristics of women diagnosed with GDM in a single centre and their follow up for progression to T2DM. Methods: A retrospective cohort study using anonymised data of one hundred and fifty four (154) women with GDM receiving maternity care at the Oxford University Hospitals NHS Foundation Trust (OUHFT) in 2010 and their follow up until 2018. Results: The prevalence of GDM in women delivering in Oxfordshire in 2010 was 3.4%. 70% of pregnant women were overweight or obese (with 51% being obese) at booking. Gestational weight gain (GWG) was excessive in 29% of women, when compared to Institute of Medicine (IOM) guidelines. Almost a quarter of women (23.4%) had no follow up after delivery. Over a median follow up of 3.5 years (range 0-8 years) nearly one in six (16.9%) of the total cohort (22% of those tested) went on to develop T2DM. 74% of women with GDM were multiparous, and 65% of nulliparous women were tested compared to 81% of multiparous women. There was a significant difference between multiparous women (53.8%) compared to nulliparous women (46.2%) developing T2DM (p=0.01). There was no significant difference in BMI (p=0.866) or GWG (p=0.83) in women who progressed to T2DM versus those who did not. Conclusion: The risk of T2DM after GDM is substantial however, follow up rates of this population is poor. Subsequent screening of women with GDM and their management crosses secondary and primary care with scope for improvement in counselling of women of the importance of annual reviews, in data collection and follow up in both obstetrics and general practice. The implementation of a recall system, an education programme for general practitioners and/or a registry of women diagnosed with GDM could be useful to identify those at high risk of developing T2DM as well as providing a platform for the potential development of interventions to prevent progression to T2DM after GDM

Abdominal massage for the relief of constipation in people with Parkinson’s: a qualitative study

Objectives. To explore the experiences of people with Parkinson’s (PwP) who suffer from constipation, the impact this has on their lives, and the effect of using lifestyle changes and abdominal massage as a form of constipation management. Method. Fourteen semistructured interviews were completed (8 males and 6 females; mean age 72.2 years) at the end of a care programme, which consisted of either lifestyle advice and abdominal massage (intervention group;) or lifestyle advice only (control group;). Data were analysed using constant-comparison techniques and Framework methods. Themes and key quotes were identified to depict major findings. Findings. Four key themes were identified: (i) the adverse impact of bowel problems on quality of life; (ii) positive experience of behaviour adjustments: experimentation; (iii) abdominal massage as a dynamic and relaxing tool: experiential learning (intervention group only); (iv) abdominal massage as a contingency plan: hesitation (control group only). Constipation was reported as having a significant impact on quality of life. Participants in both groups perceived lifestyle advice to relieve symptoms. Specific improvements were described in those who also received the abdominal massage. Conclusions. Both lifestyle advice and abdominal massage were perceived to be beneficial in relieving symptoms of constipation for PwP

Using age-progression facial morphing technology to encourage smoking cessation in women and the role of the stress response

Background: Women are at increased risk from smoking and experience specific barriers to smoking cessation. Age-progression interventions that demonstrate the ageing effect of smoking to the face, appear to be effective in changing smoking intentions and behaviour in women. One underlying theme of age-progression research is a shock reaction that is thought to create stress reactivity. The impact of this shock response on efficacy of the intervention has yet to be understood. Aim: The research within this thesis aimed to investigate the effectiveness of an ageprogression intervention for smoking cessation in women aged 18-55 years, and the role of the stress response elicited by the intervention on smoking outcomes. Methods: A systematic review updated and synthesised information regarding the effectiveness of appearance based interventions. A mixed methods approach was used in a pilot study, to develop aspects of research design, including the use of physiological stress measurement and intervention instruction types (Neutral and Reassuring) to influence levels of stress. A qualitative investigation also explored the experiences of women who received the intervention. Findings from the pilot were implemented in a randomised controlled trial that assessed the impact of psychological and physiological stress induced by the intervention and its impact on the long-term smoking outcomes. Results: Qualitative study indicated the age-progression technique continues to create shock, with more instances of accounts of shock reported by women that received the Reassuring instructions. The quantitative study showed this response was accompanied by an increase in subjective and physiological stress. Lastly, findings from the randomised controlled trial indicated the age-progression intervention delivered using Reassuring instructions produced changes in smoking intentions and abstinence. Importantly, stress elicited by the intervention, positively moderated intentions to quit. Conclusions: The synthesised findings from this thesis conclude that age-progression interventions for smoking cessation can reduce smoking behaviour in women. Additionally, when administered via Reassuring instructions, high levels of shortterm stress can increase the effectiveness of the intervention. Future research should ii focus on identifying the optimal stress levels induced by smoking cessation interventions that increase successful smoking cessation

Does Alcohol Drinking Behaviour in First Year Students Relate to Executive Function Performance Under Stress?

Executive Function (EF) is a mental process which involves the ability to plan and control behaviour; an important function for university students as it is linked to academic outcomes. Stress and alcohol drinking behaviour have previously been found to impact negatively upon executive function yet the combined effects of both of these factors has not been widely investigated. The present study aimed to investigate the relationship between alcohol drinking behaviour in first year undergraduate students and scores on a test of EF measuring aspects of working memory and cognitive fluidity after acute psychological stress was induced. Through experimental design 30 participants were recruited using opportunity sampling and asked to provide information about an average month of alcohol drinking. Stress was then induced through a task with time and performance elements provoking a stress response. EF was then assessed using the trail making task - a neuropsychological test of EF. Stress was measured subjectively and through the physiological measures of electro-dermal activity and heart rate in rest and throughout the stress procedure. Inconsistent with previous research the present study indicated no relationship in the whole sample, yet a positive correlation emerged in the male participants suggesting the more alcohol they consumed in an average month the worse they performed on a test of EF in stress. Future research needs to consider how results might vary dependant on year of study and type of stres

The singer-actor as creator and collaborator: a model for performer-led new music theatre works

This study sets out to consider alternative creative, collaborative and career possibilities for the classically trained singer in current industry practice. By means of three music theatre works written, or co-written, co-produced and performed by the author/ researcher, the thesis maps and interrogates the process of creating and producing the projects under industry conditions, from inception through to performance and final evaluation. The dissemination of these dual creative and professional processes is tracked via the methodological framework of the Pro-Create cycle, a model conceived by the researcher and presented as a new contribution to integrated practice-led performance research. Current models, for example Robin Nelson’s and Melissa Trimingham’s, map and analyse the creative process on its own terms; the researcher’s model, by contrast, tracks and reviews not only the cyclical developmental progress of the creator and the creative work itself, but the dialogic dynamic of how that work’s production is affected by the external factors of industry acceptance and promotion. Through the trajectory of the three self-created performance projects, the Pro-Create model concurrently examines the singer-actor’s collaborative and agential journey, the interaction between the singer-actor’s autobiography with the authorial process, and links between creative responsibility and enhanced performer agency. Finally, the thesis explores the inherent tension between creative autonomy and professional agency for the singer-actor as independent producer, in current industry conditions

100 years post-insulin: immunotherapy as the next frontier in type 1 diabetes.

Type 1 diabetes (T1D) is an autoimmune disease characterised by T cell-mediated destruction of the insulin-producing β cells in the pancreas. Similar to other autoimmune diseases, the incidence of T1D is increasing globally. The discovery of insulin 100 years ago dramatically changed the outlook for people with T1D, preventing this from being a fatal condition. As we celebrate the centenary of this milestone, therapeutic options for T1D are once more at a turning point. Years of effort directed at developing immunotherapies are finally starting to pay off, with signs of progress in new onset and even preventative settings. Here, we review a selection of immunotherapies that have shown promise in preserving β cell function and highlight future considerations for immunotherapy in the T1D setting

100 years post-insulin: immunotherapy as the next frontier in type 1 diabetes.

Type 1 diabetes (T1D) is an autoimmune disease characterised by T cell-mediated destruction of the insulin-producing β cells in the pancreas. Similar to other autoimmune diseases, the incidence of T1D is increasing globally. The discovery of insulin 100 years ago dramatically changed the outlook for people with T1D, preventing this from being a fatal condition. As we celebrate the centenary of this milestone, therapeutic options for T1D are once more at a turning point. Years of effort directed at developing immunotherapies are finally starting to pay off, with signs of progress in new onset and even preventative settings. Here, we review a selection of immunotherapies that have shown promise in preserving β cell function and highlight future considerations for immunotherapy in the T1D setting