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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.

BACKGROUND: Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. METHODS: In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. FINDINGS: Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference -0·19%; 95% CI -0·34 to -0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). INTERPRETATION: Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. FUNDING: Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.

‘Lovely Leitrim, where the Shannon waters flow’ is renowned for its scenic combination of waterways and uplands, for its rural borderland location, and for its small population. While it shares many challenges and opportunities with neighbouring western counties, some of its recent experiences are unique to the county and reflect its geographical location and its population decline, as well as efforts to address both issues. Attempts to drive economic growth in Leitrim have had a number of unintended outcomes for the county, as the following discussion will demonstrate. As the least populous county in Ireland, there are few Leitrim-dwellers who are not acutely aware of the vulnerable position in which this places them. While Leitrim might be a ‘hidden gem’, it could also be characterised as a forgotten county, which can struggle to have its voice heard on a national stage. This chapter explores some of the recent pressures facing Leitrim’s landscape and society, including housing oversupply, fracking and afforestation.

This chapter presents a concise overview of the evolution and development of Irish suburbia from the nineteenth century to the present. As well as charting the changing nature, form, function and meaning of the Irish suburb, the chapter also recognises key phases in its development that reflect social, political and economic change. It reveals that while the growth and development of Irish suburbia largely mirrors the American and British experience, Irish suburbia has its own particular character and unique cultures.

Lodging and boarding were well established housing options which played an important economic and social role in early twentieth century cities, yet there has been little academic study of the phenomenon in an Irish context. For many people arriving to Dublin in search of work, as well as for adults who were not in a position to establish a separate household, lodging was an important accommodation choice. Offering lodgings was also economically beneficial to householders. Drawing on a range of sources, including census returns, city electoral rolls, newspaper and other archival sources, the demographic and socio-economic profile of lodgers and the households in which they resided is examined. A wide variety of arrangements and durations of lodging is revealed for the period centred on the 1911 census, suggesting that this form of accommodation appealed to a diverse range of individuals due to their economic or family circumstances, or need for mobility.

Background: \ud Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes.\ud \ud Methods: \ud In this multicentre, open-label, randomised controlled trial, we recruited women aged 18–40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527.\ud \ud Findings: \ud Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference −0·19%; 95% CI −0·34 to −0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy).\ud \ud Interpretation: \ud Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use.\ud \ud Funding: \ud Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.

Background Women with type 1 diabetes strive for optimal glycemic control before and during pregnancy to avoid adverse obstetric and perinatal outcomes. For most women, optimal glycemic control is challenging to achieve and maintain. The aim of this study is to determine whether the use of real-time continuous glucose monitoring (RT-CGM) will improve glycemic control in women with type 1 diabetes who are pregnant or planning pregnancy. Methods/design A multi-center, open label, randomized, controlled trial of women with type 1 diabetes who are either planning pregnancy with an HbA1c of 7.0 % to ≤10.0 % (53 to ≤ 86 mmol/mol) or are in early pregnancy (

The study of population is at the forefront of many different aspects of geography. Following an overview of the key demographic variables and their significance, this paper examines the role which an understanding of population plays in relation to the outcomes of humanitarian crises, particularly natural disasters. The concept of vulnerable populations is considered, with specific reference to gender differences and to the likely future impact of climate change.

Laurence O’Neill, described on the occasion of his election to a fifth successive term of office as a ‘popular, useful, independent and energetic Lord Mayor’, was the last person to hold the office under the British regime and the first to hold it under the Free State administration. His term, then, straddled a very turbulent period in Ireland’s political and social history. It began in the midst of the First World War and continued through the ‘troubles’ of the early 1920s, coming to an end – perhaps- with the abolition of Dublin Corporation in 1924. The word ‘perhaps’ is apposite, because O’Neill did not vacate the Mansion House until 1925 and as late as 1926 a court case failed to conclude that he was no longer lord mayor, with the judge suggesting that ‘probably’ he remained lord mayor. In any case, it was O’Neill who was the proposer, in 1930, of the next elected lord mayor of the city, that well-known and charismatic leader Alfie Byrne, discussed in the following chapter.

Cet article explore comment la collaboration entre les départements de géographie des universités peut renforcer les compétences pratiques, les compétences de reflection et les approches innovantes des futurs enseignants dans les domaines de l'interculturalisme, la mondialisation et le civisme, et également faciliter la déconstruction des stéréotypes négatifs à l'égard des personnes, des lieux, des paysages et des enjeux. Ceci a été facilité par un module de géographie américano-européen commun qui a eu lieu en 2012-13 entre la University of Northern Colorado (UNCO), et SPD-Dublin City University. Ils ont collaboré sur de cours basé sur Moodle pour les étudiants facilitées par le AAG (Association des géographes américains) - Centre for Global Geography Education. Le module d'identité nationale CGGE examine les caractéristiques géographiques de l'identité nationale et de l'interaction de la culture, la politique, et le lieu. Étudiants UNC et SPD-DCU ont été rejoints dans la dernière partie de ce projet pilote par les étudiants grecs de l'Université de la mer Egée. La méthodologie utilisée dans ce cours pilote est facilement transférable. Dans ce document, les points de vue des étudiants irlandais au module sont analysés. This paper explores how collaboration between Geography Departments in universities can enhance the practical competencies, skills and innovative approaches of future teachers in the areas of inter-culturalism, globalization, and good citizenship, and also facilitate the deconstruction of negative stereotyping in relation to people, places, landscapes and issues. This was facilitated by a shared US-European Geography module that took place in 2012-13 between the University of Northern Colorado, and SPD-Dublin City University. They collaborated on a Moodle-based course for students facilitated by the AAG’s (Association of American Geographers) Centre for Global Geography Education. The CGGE National Identity module examines geographic characteristics of national identity and interplay of culture, politics, and place. UNCO and SPD-DCU students were joined in the latter part of this pilot project by Greek students from the University of the Aegean. The methodology used in this pilot course is easily transferable. In this paper the viewpoints of the Irish students to the module are analysed.

This article outlines the approaches to internationalization undertaken by the Geography Department at St. Patrick’s College, Drumcondra in Dublin. It begins with an overview of the potential of the discipline of geography for internationalization, before explaining some existing practices within the Department which are intended to foster both mobility and internationalization at home. The core of the paper is a discussion of an approach to internationalization through fieldwork which has been developed and refined in the Department over the past eight years. The module is described in detail, together with an examination of learning outcomes and an evaluation of the various IT, linguistic, disciplinary and interpersonal skills fostered by this approach.

While tourism in Ireland is of significant economic importance, there is major geographical variation in its impacts. A case study of County Cavan, located in one of the less successful tourism regions, is used to examine some characteristics of tourism promotion and the various factors which may influence the generation of tourist numbers, revenue and jobs at a local and regional level. The range of research methodologies utilised for the study is also outlined

Concerns about increasing costs of pensions and competitiveness of the European economy are frequently discussed in the media. Much of this worry is related to an ageing population structure, with fewer children being born, higher numbers of people in older age groups, and an expected overall decline in the European population. This paper explores current population trends across Europe, drawing on some of the most recent research area to consider likely implications for the future. Leaving Cert relevance: Core Unit 2 Regional Geography, Elective Unit 5 Patterns and Processes in the Human Environment.

This study investigates the criteria necessary for the development of sustainable communities in Irish urban areas from the perspectives of local residents, key actors and planning policies. The understanding of a sustainable community that underpins this study engages with the complexities of sustainability and sustainable community development (SCD), in which there are often contested views. The literature suggests that differing, and at times conflicting, views of SCD, are held by international and national bodies. This research provides a working definition of sustainable community development and outlines the criteria which a community must reach in order to be deemed successfully sustainable. It is unique in identifying a 'true' definition of SCD based on bottom-up dialogue with community members in two case study areas, located in urban Ireland, using anonymous surveys. This qualitative bounded case study which investigates the ‘true’ definition of SCD in Irish urban areas is scaffolded by three key pillars: the voice of current academic literature; the voice of international and Government policies; and the voice of the local residents. Firstly, the study provides an insight into how current literature has shaped the understanding of SCD, with particular attention paid to the criteria identified within such policies in order for sustainable development to occur. Secondly, an in-depth analysis of the current policies pertaining to sustainable development and sustainable community development across different spatial scales, i.e.: international, national and regional, is undertaken to provide a contextualisation of this research within policy circles. Finally, the perspective of the local resident on the criteria which make their community sustainable is investigated, with attention paid to their lived experience.