The impact of birthweight on subsequent phenotype of type 2 diabetes in later life

AIMS: It is well established that low birthweight is associated with subsequent risk of type 2 diabetes (T2DM). The aim of our study was to use a large birth cohort linked to a national diabetes registry to investigate how birthweight impacts the phenotype at diagnosis of T2DM and the subsequent rate of glycaemic deterioration. METHODS: We linked the Walker Birth Cohort (48,000 births, 1952–1966, Tayside, Scotland) to the national diabetes registry in Scotland (SCI‐Diabetes). Birthweight was adjusted for gestational age. Simple linear regression was performed to assess the impact of the adjusted birthweight on the diabetes phenotype at diagnosis. This was then built up into a multiple regression model to allow for the adjustment of confounding variables. A cox proportional hazards model was then used to evaluate the impact of birthweight on diabetes progression. RESULTS: Lower birthweights were associated with a 293 day younger age of diagnosis of T2DM per 1 kg reduction in birthweight, p = 0.005; and a 1.29 kg/m(2) lower BMI at diagnosis per 1 kg reduction in birthweight, p < 0.001. There was no significant association of birthweight on diabetes progression. CONCLUSION: For the first time, we have shown that a lower birthweight is associated with younger onset of T2DM, with those with lower birthweight also being slimmer at diagnosis. These results suggest that lower birthweight impacts on T2DM phenotype via reduced beta‐cell function rather than insulin resistance

Dating the Life of St Chad: Reviewing the Evidence and Approaches

The Life of St Chad is an anonymous Old English saint’s life and is extant only in Oxford, Bodleian, MS Hatton 116. Saint Chad (c. 634–672) was a Northumbrian monk, missionary, and bishop of Mercia. The Life is probably an Old English translation of a lost, original Latin vita, adapted from Bede’s Historia Ecclesiastica gentis Anglorum with an introduction and conclusion based on Sulpicius Severus’s Vita Sancti Martini. This thesis includes an originally edited edition of the text, alongside a translation and critical apparatus. This thesis enters the debate about when the Old English Life was composed, with the central question of establishing the extent to which linguistic—and specifically vocabulary—evidence can be used to establish parameters for the date of the text and re-evaluating the evidence to date. More broadly, this thesis considers the dating methodologies employed in relation to early medieval English texts, and my approach offers new insights into these. I argue that a reasonable conclusion on the more likely date for a text is possible through employing probabilistic reasoning to analyse certain types of linguistic data, particularly the frequency and distribution patterns of pertinent vocabulary, when supported by the other literary, historical, and contextual evidence. I conclude that it is most likely that the Life was composed by the first half of the tenth century, and probably prior to c. 930. Almost certainly, based on vocabulary evidence, it was composed much earlier than it was copied in the extant twelfth-century manuscript. The findings of this thesis offer a range of insights into the importance of the Life of St Chad in understanding the development of early English prose and continuing literary activity in Mercia after the advent of a West Saxon literary tradition at the end of the ninth century

Visit-to-visit HbA_1c variability is associated with cardiovascular disease and microvascular complications in patients with newly diagnosed type 2 diabetes

OBJECTIVE To investigate the association between visit-to-visit HbA1c variability and cardiovascular events and microvascular complications in patients with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS This retrospective cohort study analyzed patients from Tayside and Fife in the Scottish Care Information–Diabetes Collaboration (SCI-DC) who were observable from the diagnosis of diabetes and had at least five HbA1c measurements before the outcomes were evaluated. We used the previously reported HbA1c variability score (HVS), calculated as the percentage of the number of changes in HbA1c >0.5% (5.5 mmol/mol) among all HbA1c measurements within an individual. The association between HVS and 10 outcomes was assessed using Cox proportional hazards models. RESULTS We included 13,111–19,883 patients in the analyses of each outcome. The patients with HVS >60% were associated with elevated risks of all outcomes compared with the lowest quintile (for example, hazard ratios and 95% CIs [HVS >80 to ≤100 vs. HVS ≥0 to ≤20]: 2.38 [1.61–3.53] for major adverse cardiovascular events, 2.4 [1.72–3.33] for all-cause mortality, 2.4 [1.13–5.11] for atherosclerotic cardiovascular death, 2.63 [1.81–3.84] for coronary artery disease, 2.04 [1.12–3.73] for ischemic stroke, 3.23 [1.76–5.93] for heart failure, 7.4 [3.84–14.27] for diabetic retinopathy, 3.07 [2.23–4.22] for diabetic peripheral neuropathy, 5.24 [2.61–10.49] for diabetic foot ulcer, and 3.49 [2.47–4.95] for new-onset chronic kidney disease). Four sensitivity analyses, including adjustment for time-weighted average HbA1c, confirmed the robustness of the results. CONCLUSIONS Our study shows that higher HbA1c variability is associated with increased risks of all-cause mortality, cardiovascular events, and microvascular complications of diabetes independently of high HbA1c

Mining usage data for adaptive personalisation of smartphone based help-on-demand services

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Mobile computing devices and their applications that encompass context aware components are becoming increasingly more prevalent. The context-awareness of these types of applications typically focuses on the services offered. In this paper we describe a framework that supports the monitoring and analysis of mobile application usage patterns with the goal of updating user models for adaptive services and user interface personalisation. This paper focuses on two aspects of the framework. The first is the modelling and storage of the usage data. The second focuses on the data mining component of the framework, outlining the five different capabilities of the adaptation in addition to the algorithms used. The proposed framework has been evaluated through specific case studies, with the results attained demonstrating the effectiveness of the data mining capabilities and in particular the adaptation of the User Interface. The accuracy and efficiency of the algorithms used are also evaluated with three users. The results of the evaluation show that the aims of the data mining component were achieved with the personalisation and adaptation of content and user interface, respectively

The Complete Ethical Framework for End-of-Life Care

The Ethical Framework for End-of-life Care is part of a national programme, the Hospice Friendly Hospitals Programme (HfH) of the Irish Hospice Foundation, which is intended to improve the culture of care and organization regarding dying, death and bereavement in Irish hospitals. The Framework is an educational resource that consists of eight Modules of Learning for health professionals, patients, families and the general public. The Framework is the outcome of a unique collaboration between University College Cork, the Royal College of Surgeons in Ireland and the Irish Hospice Foundation, with contributions from ethicists, legal experts, theologians, sociologists and clinicians. It draws on a range of values and principles that have been identified as important considerations in end-oflife decision making by international experts in bioethics and by professional codes of conduct, policy documents and laws. It is also informed by extensive international research on patients’ and families’ experiences of death and dying and the contribution of health professionals and organizations to quality end-of-life care. In order to ensure that the Framework addresses the concerns of the Irish public and that it is relevant and useful to the work of health professionals involved in end-of-life care in Irish hospitals, the Framework is informed by reviews and studies involving hospice, palliative and acute care services especially commissioned by the Irish Hospice Foundation in the last decade. It also draws on a significant body of research, undertaken in 2007/2008, which specifically addresses ethical issues in relation to end-of-life care in Irish hospitals