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Understanding habitat requirements for species at risk is crucial for effective conservation management, even though the location and extent of vital habitats may be unknown for rare or elusive species.In the case of marine species, determining important habitat often relies on limited occurrence data or extrapolation from species distribution models (SDMs). SDMs predict habitat by associating species records with environmental variables, assuming a functional ecological relationship.This study focuses on northern bottlenose whales (NBW; Hyperoodon ampullatus) and Sowerby's beaked whales (SBW; Mesoplodon bidens) in the western North Atlantic. As both NBW and SBW are at risk in Canada, the objective was to identify the extent and function of important habitats to guide conservation efforts.The analysis mapped all available geographic occurrence data and used passive acoustic monitoring (PAM) data to inform the development of ensemble SDMs to predict potential habitat and assess the persistence of realized habitat use.Important habitats for NBW and SBW were found primarily concentrated along the continental shelf edges, at an average depth of 1200 m ± 460 SD. All habitat areas support foraging and movement and critical life history functions for both species.The Gully and other submarine canyons off eastern Nova Scotia emerged as important areas for both species, validating the existing Critical Habitat for NBW. However, spatial–temporal patterns diverged on either side of this region. North‐eastern Newfoundland was identified as the next closest area of near‐year‐round presence for NBW, whereas the south‐western Scotian Shelf region, Georges Bank and the Fundian Channel supported persistent foraging by SBW.By integrating multiple data sources (sightings, acoustic detections and SDMs) and demonstrating the temporal persistence of habitat use by NBW and SBW, this study provides valuable insights for identifying, protecting and managing important habitat for beaked whales. [ABSTRACT FROM AUTHOR]

The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these technologies. The COVID‐19 pandemic has created an opportunity for diabetes healthcare professionals to use continuous glucose monitoring technology to remotely deliver diabetes services to support people with diabetes. This opportunity can be maximized with improved application and interpretation of continuous glucose monitoring‐generated data. Amongst the diverse measures of glycaemic control, time in range is considered to be of high value in routine clinical care because it is actionable and is visibly responsive to changes in diabetes management. Importantly, it is also been linked to the risk of developing complications associated with diabetes and can be understood by people with diabetes and healthcare professionals alike. The 2019 International Consensus on Time in Range has established a series of target glucose ranges and recommendations for time spent within these ranges that is consistent with optimal glycaemic control. The recommendations cover people with type 1 or type 2 diabetes, with separate targets indicated for elderly people or those at higher risk from hypoglycaemia, as well as for women with type 1 diabetes during pregnancy. The aim of this best practice guide was to clarify the intent and purpose of these international consensus recommendations and to provide practical insights into their implementation in UK diabetes care. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA1c, during the COVID‐19 pandemic. Methods: Retrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004–2008; 826 consecutive gestational diabetes pregnancies, 2014–2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large‐for‐gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver‐operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA1c performance. Results: Gestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver‐operating characteristic curve for both criteria 0.81 (95% CI 0.79–0.83)], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver‐operating characteristic curve 0.75 (95% CI 0.65–0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver‐operating characteristic curve 0.92 (95% CI 0.85–0.98)] and HbA1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75–0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77–0.91)]. Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2–5.4 mmol/l (sensitivity 18–41%; specificity 97–98%). Conclusions: Random plasma glucose at 12 weeks, and fasting plasma glucose or HbA1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available. [ABSTRACT FROM AUTHOR]

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. What's new?: Maternal glycaemic control is the main modifiable determinant of pregnancy outcomes in Type 1 diabetes. Maternal diet influences insulin dosing and glycaemia; and contributes to the overall health of the mother, yet this has not been described previously.This study demonstrates that pregnant women with Type 1 diabetes have higher than recommended intakes of fat and inadequate intakes of fibre, fruit and vegetables.One in four women are at risk of micronutrient deficiencies suggesting substantial scope for improvement.Further research is required to understand how to optimize maternal nutrition both for achieving glucose control targets and for improving overall maternal and infant health. [ABSTRACT FROM AUTHOR]

Aim: Clinicians mediate access to new technologies. Consequently, their views on specific devices may influence user access to diabetes technology in mainstream care. As yet, little is known about clinicians' views about closed‐loop systems. This qualitative study explored clinicians' views on the likely impacts of future closed‐loop systems in mainstream diabetes care in England. Methods: We conducted interviews with 36 clinicians from a range of professional backgrounds in five hospital outpatient clinics (two adult, two pregnancy, one paediatric) in England to explore possible consequences of closed‐loop systems for users and clinicians. Data analysis utilized a framework approach. Results: Clinicians reported a range of expected benefits for future users, including improved glucose control and quality of life. Expected burdens included continued need for manual input and the risk of losing basic self‐care skills. In terms of future clinical workloads, three clinicians emphasized only positive impacts, seven emphasized both positive and negative impacts, and 17 mentioned only negative impacts. Our most prominent finding, expressed by 24 clinicians, was that closed‐loop systems would generate initial challenges due to the need for staff training, user education and support, and new analytical capacities, alongside existing intra‐clinic variations in technological experience. Conclusions: Clinicians recognize the value of closed‐loop systems in terms of health benefits, but also identify a range of concerns for both users and healthcare staff, which could impact negatively on user access. Future implementation efforts should address these concerns by providing training and support for healthcare teams, taking varied technological expertise into account. What's new?: Clinician attitudes towards new technologies influence outcomes in mainstream care. Little is known about clinician views about the likely impacts of future closed‐loop systems in diabetes care.Alongside benefits and burdens for users, clinicians expect closed‐loop systems to generate health service challenges due to heightened needs for training, user support and analytical capacities.Clinicians identify a range of concerns for both users and staff, which could impact negatively on user access. Future implementation efforts should address these concerns by providing training and support for healthcare teams. [ABSTRACT FROM AUTHOR]

Aims: To determine whether the neonatal and delivery outcomes of gestational diabetes vary seasonally in the context of a relatively cool temperate climate. Methods: A retrospect cohort of 23 735 women consecutively delivering singleton, live‐born term infants in a single tertiary obstetrics centre in the UK (2004–2008) was identified. A total of 985 (4.1%) met the diagnostic criteria for gestational diabetes. Additive dynamic regression models, adjusted for maternal age, BMI, parity and ethnicity, were used to compare gestational diabetes incidence and outcomes over annual cycles. Outcomes included: random plasma glucose at booking; gestational diabetes diagnosis; birth weight centile; and delivery mode. Results: The incidence of gestational diabetes varied by 30% from peak incidence (October births) to lowest incidence (March births; P=0.031). Ambient temperature at time of testing (28 weeks) was strongly positively associated with diagnosis (P<0.001). Significant seasonal variation was evident in birth weight in gestational diabetes‐affected pregnancies (average 54th centile June to September; average 60th centile December to March; P=0.027). Emergency Caesarean rates also showed significant seasonal variation of up to 50% (P=0.038), which was closely temporally correlated with increased birth weights. Conclusions: There is substantial seasonal variation in gestational diabetes incidence and maternal–fetal outcomes, even in a relatively cool temperate climate. The highest average birth weight and greatest risk of emergency Caesarean delivery occurs in women delivering during the spring months. Recognizing seasonal variation in neonatal and delivery outcomes provides new opportunity for individualizing approaches to managing gestational diabetes. What's new?: Gestational diabetes (GDM) shows seasonal variation in hot climates, but there is no consensus on whether this impacts on neonatal or delivery outcomes.Birth weights and emergency Caesarean section rates vary seasonally in GDM‐affected pregnancies. The highest average birth weight and greatest risk of emergency Caesarean delivery occur when fewest births are complicated by GDM (March births).There are seasonal differences in GDM outcomes, and consideration should be given to the differing environmental, dietary and lifestyle factors faced by women with GDM throughout the year. [ABSTRACT FROM AUTHOR]

Aim: To investigate potential cost savings associated with the use of real‐time continuous glucose monitoring (RT‐CGM) throughout pregnancy in women with Type 1 diabetes. Methods: A budget impact model was developed to estimate, from the perspective of National Health Service England, the total costs of managing pregnancy and delivery in women with Type 1 diabetes using self‐monitoring of blood glucose (SMBG) with and without RT‐CGM. It was assumed that the entire modelled cohort (n = 1441) would use RT‐CGM from 10 to 38 weeks' gestation (7 months). Data on pregnancy and neonatal complication rates and related costs were derived from published literature, national tariffs, and device manufacturers. Results: The cost of glucose monitoring was £588 with SMBG alone and £1820 with RT‐CGM. The total annual costs of managing pregnancy and delivery in women with Type 1 diabetes were £23 725 648 with SMBG alone, and £14 165 187 with SMBG and RT‐CGM; indicating potential cost savings of approximately £9 560 461 from using RT‐CGM. The principal drivers of cost savings were the daily cost of neonatal intensive care unit (NICU) admissions (£3743) and the shorter duration of NICU stay (mean 6.6 vs. 9.1 days respectively). Sensitivity analyses showed that RT‐CGM remained cost saving, albeit to lesser extents, across a range of NICU costs and durations of hospital stay, and with varying numbers of daily SMBG measurements. Conclusions: Routine use of RT‐CGM by pregnant women with Type 1 diabetes, would result in substantial cost savings, mainly through reductions in NICU admissions and shorter duration of NICU care. What's new?: Real‐time continuous glucose monitoring (RT‐CGM) improves neonatal health outcomes, with fewer large for gestational age infants, fewer neonatal intensive care unit (NICU) admissions and a shorter neonatal length of hospital stay.It is not known whether the costs of implementing RT‐CGM into National Health Service England antenatal care, would be offset by the reduction in neonatal complications.The approximately threefold higher costs of RT‐CGM use, compared with self‐monitoring of blood glucose (£1820 vs. £588), are offset by substantial cost savings, mainly through reductions in NICU admissions and a shorter duration of NICU stay. [ABSTRACT FROM AUTHOR]

Aim: To assess the health‐related outcomes of hypoglycaemia for people with diabetes admitted to hospital; specifically, hospital length of stay and mortality. Methods: We conducted a systematic review and meta‐analysis of studies relating to hypoglycaemia (< 4 mmol/l) for hospitalized adults (≥ 16 years) with diabetes reporting the primary outcomes of interest, hospital length of stay or mortality. Final papers for inclusion were reviewed in duplicate and the adjusted results of each were pooled, using a random effects model then undergoing further prespecified subgroup analysis. Results: In total, 15 studies were included in the meta‐analysis. The pooled mean difference in length of stay for ward‐based inpatients exposed to hypoglycaemia was 4.1 days longer [95% confidence interval (CI) 2.36 to 5.79; I² = 99%] compared with those without hypoglycaemia. This association remained robust across the pre‐specified subgroup analyses. The pooled relative risk (RR) of in‐hospital mortality was greater for those exposed to hypoglycaemia (RR 2.09, 95% CI 1.64 to 2.67; I² = 94%, n = 7 studies) but not in intensive care unit mortality (RR 0.75, 95% CI 0.49 to 1.16; I² =0%, n = 2 studies). Conclusion: There is an association between inpatient hypoglycaemia and longer length of stay and greater in‐hospital mortality. Studies examining this association were heterogenous in terms of both clinical populations and effect size, but the overall direction of the association was consistent. Therefore, glucose concentration should be considered a potential tool to aid the identification of inpatients at risk of poor health‐related outcomes. What's new?: Heterogeneity of inpatient populations and definitions of hypoglycaemia are a significant challenge in synthesizing evidence from previously published studies.Hypoglycaemia events, including those considered non‐serious, are associated with an increased length of hospital stay and increased risk of inpatient mortality.Inpatient hypoglycaemia is a marker for clinical deterioration and potential increased risk for adverse outcomes.Glucose measurements could aid the identification of those at risk of poor health‐related outcomes. [ABSTRACT FROM AUTHOR]

Aims: To examine the relationship between maternal glycaemic control and risk of neonatal hypoglycaemia using conventional and continuous glucose monitoring metrics in the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT) participants. Methods: A secondary analysis of CONCEPTT involving 225 pregnant women and their liveborn infants. Antenatal glycaemia was assessed at 12, 24 and 34 weeks gestation. Intrapartum glycaemia was assessed by continuous glucose monitoring measures 24 hours prior to delivery. The primary outcome was neonatal hypoglycaemia defined as glucose concentration < 2.6 mmol/l and requiring intravenous dextrose. Results: Neonatal hypoglycaemia occurred in 57/225 (25.3%) infants, 21 (15%) term and 36 (40%) preterm neonates. During the second and third trimesters, mothers of infants with neonatal hypoglycaemia had higher HbA1c [48 ± 7 (6.6 ± 0.6) vs. 45 ± 7 (6.2 ± 0.6); P = 0.0009 and 50 ± 7 (6.7 ± 0.6) vs. 46 ± 7 (6.3 ± 0.6); P = 0.0001] and lower continuous glucose monitoring time‐in‐range (46% vs. 53%; P = 0.004 and 60% vs. 66%; P = 0.03). Neonates with hypoglycaemia had higher cord blood C‐peptide concentrations [1416 (834, 2757) vs. 662 (417, 1086) pmol/l; P < 0.00001], birthweight > 97.7th centile (63% vs. 34%; P < 0.0001) and skinfold thickness (P ≤ 0.02). Intrapartum continuous glucose monitoring was available for 33 participants, with no differences between mothers of neonates with and without hypoglycaemia. Conclusions: Modest increments in continuous glucose monitoring time‐in‐target (5–7% increase) during the second and third trimesters are associated with reduced risk for neonatal hypoglycaemia. While more intrapartum continuous glucose monitoring data are needed, the higher birthweight and skinfold measures associated with neonatal hypoglycaemia suggest that risk is related to fetal hyperinsulinemia preceding the immediate intrapartum period. What's new?: Neonatal hypoglycaemia is a common complication of Type 1 diabetes pregnancy.This study found that 15% of term and 40% of preterm infants had neonatal hypoglycaemia requiring treatment with intravenous dextrose.Modest differences in continuous glucose monitoring time‐in‐target (5–7% increase) and HbA1c [4 mmol/mol (0.4%) decrease] during the second and third trimesters are associated with lower risk of neonatal hypoglycaemia.Clinicians should focus on improving maternal glucose control thereby reducing fetal hyperinsulinemia during the second and third trimesters to reduce the risk of neonatal hypoglycaemia. [ABSTRACT FROM AUTHOR]

Aim: Excessive gestational weight gain increases risk of gestational diabetes mellitus (GDM) but it remains unclear whether weight control after GDM diagnosis improves outcomes. We assessed whether: (1) total gestational weight gain during pregnancy (0–36 weeks); (2) early gestational weight gain (0–28 weeks, before GDM diagnosis); or (3) late gestational weight gain (28–36 weeks, after diagnosis) are associated with maternal–fetal outcomes. Methods: Some 546 women with GDM who delivered viable singleton infants at a single UK obstetric centre (October 2014 to March 2017) were included in this retrospective observational study. Results: Higher total gestational weight gain was associated with Caesarean section [n = 376; odds ratio (OR) 1.05; confidence intervals (CI) 1.02–1.08, P < 0.001] and large for gestational age (OR 1.08; CI 1.03–1.12, P < 0.001). Higher late gestational weight gain (28–36 weeks; n = 144) was associated with large for gestational age (OR 1.17; CI 1.01–1.37, P < 0.05), instrumental deliveries (OR 1.26; CI 1.03–1.55, P < 0.01), higher total daily insulin doses (36 weeks; beta coefficient 4.37; CI 1.92–6.82, P < 0.001), and higher post‐partum 2‐h oral glucose tolerance test concentrations (beta coefficient 0.12; CI 0.01–0.22, P < 0.05). Women who avoided substantial weight gain after GDM diagnosis had 0.7 mmol/l lower postnatal 2‐h glucose and needed half the amount of insulin/day at 36 weeks compared with women with substantial weight gain after diagnosis. There were no significant associations between early gestational weight gain (0–28 weeks) and pregnancy outcomes. Conclusions: These findings suggest that controlling gestational weight gain should be a priority following GDM diagnosis to optimize pregnancy outcomes and improve maternal postnatal glucose homeostasis. The period after diagnosis of GDM (often 28 weeks gestation) is not too late to offer lifestyle advice or intervention to improve weight management and pregnancy outcomes. What's new?: Gestational diabetes is associated with pre‐pregnancy obesity and excessive gestational weight gain.However, there is no clear evidence to guide weight management after diagnosis of gestational diabetes (at 28 weeks).In this study, excessive gestational weight gain was strongly associated with fetal growth and difficult deliveries in women with gestational diabetes.Women who gained weight after diagnosis needed higher insulin doses and had higher postnatal glucose concentrations.Keeping weight stable after diagnosis of gestational diabetes should be a priority to improve outcomes for both mother and child; 28 weeks is not too late to offer advice or intervention.A clinical trial to guide weight management in women with gestational diabetes would be extremely useful to confirm these findings and provide clear targets for weight gain after diagnosis. [ABSTRACT FROM AUTHOR]

Optimal glycaemic control before and during pregnancy improves both maternal and fetal outcomes. This article summarizes the recently published guidelines on the management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units produced by the Joint British Diabetes Societies for Inpatient Care and available in full at www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpa tient-care-group. Hyperglycaemia following steroid administration can be managed by variable rate intravenous insulin infusion (VRIII) or continuous subcutaneous insulin infusion (CSII) in women who are willing and able to safely selfmanage insulin dose adjustment. All women with diabetes should have capillary blood glucose (CBG) measured hourly once they are in established labour. Those who are found to be higher than 7 mmol/l on two consecutive occasions should be started on VRIII. If general anaesthesia is used, CBG should be monitored every 30 min in the theatre. Both the VRIII and CSII rate should be reduced by at least 50% once the placenta is delivered. The insulin dose needed after delivery in insulin-treated Type 2 and Type 1 diabetes is usually 25% less than the doses needed at the end of first trimester. Additional snacks may be needed after delivery especially if breastfeeding. Stop all anti-diabetes medications after delivery in gestational diabetes. Continue to monitor CBG before and 1 h after meals for up to 24 h after delivery to pick up any pre-existing diabetes or new-onset diabetes in pregnancy. Women with Type 2 diabetes on oral treatment can continue to take metformin after birth. [ABSTRACT FROM AUTHOR]

Aim Little is known about the challenges of transitioning from school to university for young people with Type 1 diabetes. In a national survey, we investigated the impact of entering and attending university on diabetes self-care in students with Type 1 diabetes in all UK universities. Methods Some 1865 current UK university students aged 18-24 years with Type 1 diabetes, were invited to complete a structured questionnaire. The association between demographic variables and diabetes variables was assessed using logistic regression models. Results In total, 584 (31%) students from 64 hospitals and 37 university medical practices completed the questionnaire. Some 62% had maintained routine diabetes care with their home team, whereas 32% moved to the university provider. Since starting university, 63% reported harder diabetes management and 44% reported higher HbA1c levels than before university. At university, 52% had frequent hypoglycaemia, 9.6% reported one or more episodes of severe hypoglycaemia and 26% experienced diabetes-related hospital admissions. Female students and those who changed healthcare provider were approximately twice as likely to report poor glycaemic control, emergency hospital admissions and frequent hypoglycaemia. Females were more likely than males to report stress [odds ratio (OR) 4.78, 95% confidence interval (CI) 3.19-7.16], illness (OR 3.48, 95% CI 2.06-5.87) and weight management issues (OR 3.19, 95% CI 1.99-5.11) as barriers to self-care. Despite these difficulties, 91% of respondents never or rarely contacted university support services about their diabetes. Conclusion The study quantifies the high level of risk experienced by students with Type 1 diabetes during the transition to university, in particular, female students and those moving to a new university healthcare provider. [ABSTRACT FROM AUTHOR]

Abstract: Bed sediment resuspension is a potential source of faecal microorganisms in the water column of estuaries. As such, it is important to identify the survival of faecal microorganisms in these bed sediments and understand how bed sediment resuspension impacts the quality of estuarine waters. This study explores the effect of bed sediment resuspension on Escherichia coli concentrations in the water column and the persistence of E. coli in the water column and bed sediments of the Yarra River estuary in South‐Eastern Australia. Using sediment cores, we identified that the resuspension of both surficial sediments (e.g., by tidal movements) and deeper bed sediments (e.g., by large storm events) can increase E. coli concentrations in the water column by up to 20 times in estuaries in oceanic climates. Bed sediment resuspension can result in increased E. coli concentrations in the water column even up to 24 days after E. coli first enters the estuarine water. This study demonstrates that faecal microorganisms, such as E. coli, can persist for extended periods in estuarine bed sediments, which may then be re‐entrained into the water column via recreational activities, high flow events, or tidal fluctuations. If the survival and resuspension processes observed here hold true for pathogenic microorganisms, the resuspension of bed sediments may indeed represent an increased public health risk. [ABSTRACT FROM AUTHOR]

Abstract: 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. [ABSTRACT FROM AUTHOR]

Our aim was to review the data from the National Pregnancy in Diabetes (NPID) audit, and to identify the challenges and opportunities for improving pregnancy outcomes in women with diabetes. We reviewed three years of NPID data and relevant diabetes and obstetric literature, and found that there has been little change in pregnancy preparation or outcomes over the past 3 years, with substantial clinic-to clinic variations in care. Women with Type 2 diabetes remain less likely to take 5 mg preconception folic acid (22.8% vs. 41.8%; P < 0.05), and more likely to take potentially harmful medications (statin and/or ACE inhibitor 13.0% vs. 1.8%; P < 0.05) than women with Type 1 diabetes. However, women with Type 1 diabetes are less likely to achieve the recommended glucose control target of HbA1c < 48 mmol/mol (6.5%) (14.9% vs. 38.1%; P < 0.05). The following opportunities for improvement were identified. First, the need to integrate reproductive health into the diabetes care plans of all women with diabetes aged 15–50 years. Second, to develop more innovative approaches to improve uptake of pre-pregnancy care in women with Type 2 diabetes in primary care settings. Third, to integrate insulin pump, continuous glucose monitoring and automated insulin delivery technologies into the pre-pregnancy and antenatal care of women with Type 1 diabetes. Fourth, to improve postnatal care with personalized approaches targeting women with previous pregnancy loss, congenital anomaly and perinatal mortality. A nationwide commitment to delivering integrated reproductive and diabetes healthcare interventions is needed to improve the health outcomes of women with diabetes. [ABSTRACT FROM AUTHOR]

Aims To explore the experiences of pregnant women with Type 1 diabetes, and the relationships between perceptions of glucose control, attitudes to technology and glycaemic responses with regard to closed-loop insulin delivery. Methods We recruited 16 pregnant women with Type 1 diabetes [mean ± sd age 34.1 ± 4.6 years, duration of diabetes 23.6 ± 7.2 years, baseline HbA1c 51±5 mmol/mol (6.8 ± 0.6%)] to a randomized crossover trial of sensor-augmented pump therapy vs automated closed-loop therapy. Questionnaires (Diabetes Technology Questionnaire, Hypoglycaemia Fear Survey) were completed before and after each intervention, with qualitative interviews at baseline and follow-up. Results Women described the benefits and burdens of closed-loop systems during pregnancy. Feelings of improved glucose control, excitement and empowerment were counterbalanced by concerns about device visibility, obsessive data checking and diminished attentiveness to hyper- and hypoglycaemia symptoms. Responding to questionnaires, eight participants felt less worry about overnight hypoglycaemia and that diabetes 'did not run their lives'; however, five reported that closed-loop increased time thinking about diabetes, and three felt it made sleep and preventing hyperglycaemia more problematic. Women slightly overestimated their glycaemic response to closed-loop therapy. Most became more positive in their technology attitudes throughout pregnancy. Women with more positive technology attitudes had higher degrees of overestimation, and poorer levels of glycaemic control. Conclusions Women displayed complex psychosocial responses to closed-loop therapy in pregnancy. Perceptions of glycaemic response may diverge from biomedical data. [ABSTRACT FROM AUTHOR]

In an apparent paradox, bioenergy crops offer potential benefits to a world adjusting to the challenges of climate change and declining fossil fuel stocks, as well as potential ecological and economic threats resulting from biological invasions. In considering this paradox it is important to understand that benefits and threats may not always be apparent in equal measure throughout the potential range of each candidate biofuel species. In some environments, a species could potentially produce valuable biological materials without posing a significant invasion threat. In this study, we develop a bioclimatic niche model for a candidate biofuel crop, Millettia pinnata, and apply the model to different climatic and irrigation scenarios to estimate the current and future patterns of climate suitability for its growth and naturalization. We use Australia as a case study for interpreting the niche model in terms that may be informative for both biofuels proponents and biosecurity regulators to plan management programmes that reflect the invasive potential in different areas. The model suggests that suitable growing conditions for M. pinnata in Australia are naturally restricted to the moist and semimoist tropics. Irrigation can extend the suitable growing conditions more widely throughout the tropics, and into more arid regions. Under future climate scenarios, suitable growing conditions for M. pinnata under natural rainfall contract towards the east coast, and extend southward into the subtropics. With irrigation, M. pinnata appears to have the potential in the future to naturalize across much of Australia. The bioclimatic modelling method demonstrated here is comparatively quick and easy, and can produce a rich array of data products to inform the interests of both bioenergy proponents and biosecurity regulators. We show how this modelling can support the development of spatially explicit biosecurity policies designed to manage invasion risks in a manner that balances bioenergy and biosecurity concerns. [ABSTRACT FROM AUTHOR]

Aim To explore the additional risk of stillbirths and to quantify that risk according to gestational age among women with diabetes. Methods Data on pregnancies ending in 2007 and 2008 in women with pre-gestational diabetes in three English regional audits were identified. A prospective audit collected data on all pregnancies delivering between June 2010 and May 2011 in one region and in 13 other units across England. The data on all singleton pregnancies from these two cohorts were combined. Comparisons were made to all births in England and Wales for the same time period using data from the Office for National Statistics. Results In the cohort of women with pre-gestational diabetes there were a total of 2085 singleton pregnancies, of which 29 resulted in a stillbirth (overall stillbirth rate 13.9 per 1000, 95% CI 9.7-19.9, relative risk compared with all pregnancies in England and Wales 2.73, 95% CI 2.61-2.84). The relative risk of stillbirth between 32 and 34 weeks' gestation was 4.95 (95% CI 4.24-5.78), 3.77 (95% CI 3.42-4.16) at 35 to 36 weeks, 5.75 (95% CI 5.43-6.09) for deliveries at 37 or 38 weeks and 7.34 (95% CI 6.52-8.25) for those born at 39 weeks or more. Conclusion Women with diabetes have a significantly higher risk of stillbirth at all gestations after 32 weeks and this additional risk is not just confined to pregnancies at 37 weeks or more. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, e249-e254 (2012) Abstract Aims To evaluate the effectiveness of a family-centred group education programme, in adolescents with Type 1 diabetes. Methods Three hundred and five adolescents with Type 1 diabetes; age 13.1 ± 1.9 years, diabetes duration 5.6 ± 3.3 years, BMI 20.9 ± 3.7 kg/m2, HbA1c 78 ± 6 mmol/mol (9.3 ± 1.9%) were randomly allocated to the Families and Adolescents Communication and Teamwork Study (FACTS) diabetes education programme; (six 90-min monthly sessions attended by parents and adolescents incorporating skills training and family teamwork) or conventional clinical care. Primary outcome was HbA1c at 18 months (12 months post-intervention). Secondary outcomes were HbA1c at 9 months, psychosocial outcomes, adolescent quality of life, well-being, family responsibility and insulin dose adjustment behaviours at 12 months (6 months post-intervention) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12 months post-intervention. All analyses are intention to treat. Results Session attendance was poor with 48/158 families (30.4%) not attending any sessions and only 75/158 (47.5%) families attending ≥ 4 group education sessions. All biomedical and psychosocial outcomes were comparable between groups. At 18 months there was no significant difference in HbA1c in either group and no between-group differences over time: intervention group 75 mmol/mol (9.0%) to 78 mmol/mol (9.3%), control group 77 mmol/mol (9.2%) to 80 mmol/mol (9.5%). Adolescents perceived no changes in parental input at 12 months. Conclusion Poor attendance of group education sessions delivered in routine clinics was a major challenge. More personalized educational approaches may be required to support and motivate families who are struggling to integrate the demands of intensive insulin regimens into their daily lives. [ABSTRACT FROM AUTHOR]

Diabet. Med. 28, 1060-1067 (2011) Abstract Aims To compare obstetric and perinatal outcomes in women with Type 1 and Type 2 diabetes and relate these to maternal risk factors. Methods Prospective cohort study of 682 consecutive diabetic pregnancies in East Anglia during 2006-2009. Relationships between congenital malformation, perinatal mortality and perinatal morbidity (large for gestational age, preterm delivery, neonatal care) with maternal age, parity, ethnicity, glycaemic control, obesity and social disadvantage were examined using bivariable and multivariate models. Results There were 408 (59.8%) Type 1 and 274 (40.2%) Type 2 diabetes pregnancies. Women with Type 2 diabetes were older ( P < 0.001), heavier ( P < 0.0001), more frequently multiparous ( P < 0.001), more ethnically diverse ( p < 0.0001) and more socially disadvantaged ( P = 0.0004). Although women with Type 2 diabetes had shorter duration of diabetes ( P < 0.0001) and better pre-conception glycaemic control [HbA1c 52 mmol/mol (6.9%) Type 2 diabetes vs. 63 mmol/l (7.9%) Type 1 diabetes; p < 0.0001), rates of congenital malformation and perinatal mortality were comparable. Women with Type 2 diabetes had fewer large-for-gestational-age infants (37.6 vs. 52.9%, P < 0.0008), fewer preterm deliveries (17.5 vs. 37.1%, P < 0.0001) and their offspring had fewer neonatal care admissions (29.8 vs. 43.2%, P = 0.001). Third trimester HbA1c (OR 1.35, 95% CI 1.09-1.67, P = 0.006) and social disadvantage (OR 0.80, 95% CI 0.67-0.98; P = 0.03) were risk factors for large for gestational age. Conclusions Despite increased age, parity, obesity and social disadvantage, women with Type 2 diabetes had better glycaemic control, fewer large-for-gestational-age infants, fewer preterm deliveries and fewer neonatal care admissions. Better tools are needed to improve glycaemic control and reduce the rates of large for gestational age, particularly in Type 1 diabetes. [ABSTRACT FROM AUTHOR]

Objectives To develop and evaluate a standardized data set for measuring pregnancy outcomes in women with Type 1 and Type 2 diabetes and to compare recent outcomes with those of the 2002-2003 Confidential Enquiry into Maternal and Child Health. Methods Existing regional, national and international data sets were compared for content, consistency and validity to develop a standardized data set for diabetes in pregnancy of 46 key clinical items. The data set was tested retrospectively using data from 2007-2008 pregnancies included in three regional audits (Northern, North West and East Anglia). Obstetric and neonatal outcomes of pregnancies resulting in a stillbirth or live birth were compared with those from the same regions during 2002-2003. Results Details of 1381 pregnancies, 812 (58.9%) in women with Type 1 diabetes and 556 (40.3%) in women with Type 2 diabetes, were available to test the proposed standardized data set. Of the 46 data items proposed, only 16 (34.8%), predominantly the delivery and neonatal items, achieved ≥ 85% completeness. Ethnic group data were available for 746 (54.0%) pregnancies and BMI for 627 (46.5%) pregnancies. Glycaemic control data were most complete-available for 1217 pregnancies (88.1%), during the first trimester. Only 239women (19.9%) had adequate pregnancy preparation, defined as preconception folic acid and first trimester HbA1c ≤ 7% (≤ 53 mmol/mol). Serious adverse outcome rates (major malformation and perinatal mortality) were 55/1000 and had not improved since 2002-2003. Conclusions Astandardized data set for diabetes in pregnancymay improve consistency of data collection and allow formore meaningful evaluation of pregnancy outcomes in women with pregestational diabetes. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 1264-1270 (2010) Aims We tested the hypothesis that diabetes during pregnancy leads to chromosomal DNA damage and telomere attrition in the feto placental unit and cord blood, and provides evidence for intrauterine programming towards a senescent phenotype in the offspring. Methods We obtained cord blood from pregnant women with pregestational Type 1 diabetes ( n = 26), Type 2 diabetes ( n = 20) or gestational diabetes ( n = 71), and control subjects without diabetes ( n = 45, n = 76 and n = 81, respectively) matched for maternal and gestational age. We measured cord blood mononuclear cell telomere length, telomerase activity (a reverse transcriptase that limits telomere attrition), and concentrations of insulin, high-sensitivity C-reactive protein (hs-CRP) and soluble intercellular adhesion molecule-1 (sICAM-1). Results We found no significant differences between groups in cord blood telomere length in any nucleated cell type, or in hs-CRP or sICAM-1 concentrations, but telomerase activity was higher in cord blood from Type 1 ( P < 0.05) and gestational diabetes pregnancies ( P < 0.05), but not in Type 2 diabetes pregnancies. There were no significant relationships between glycaemic control, cord blood telomere length, telomerase activity or inflammatory markers in any group. Conclusions We found no difference in cord blood telomere length in pregnancies of women with diabetes compared with control subjects, but higher cord blood telomerase activity in Type 1 and gestational diabetes. This may reflect upregulated telomere reverse transcriptase in response to in utero oxidative DNA and telomere damage. These observations are relevant to the hypothesis that diabetes during pregnancy leads to in utero preprogramming towards senescence in the offspring. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 92–100 (2010) Aims To explore the views of women who did not attend pre-pregnancy care (PPC), in particular their accounts of contraception, previous pregnancies and the influence of healthcare advice. Methods We conducted semi-structured interviews with 29 pregnant women (21 with Type 1 diabetes, eight with Type 2 diabetes) at three UK specialist diabetes antenatal clinics. Interviews explored women’s journeys to becoming pregnant, including use of contraception, their views regarding diabetes and pregnancy and the factors which encouraged and discouraged them from attending PPC. Results All women had some understanding of the issues concerning diabetes during pregnancy, predominantly regarding the benefits of PPC (90%) and optimal glycaemic control (80%) and risks of malformation (48%) and macrosomia (35%). Most were not regularly using contraception (70%), having stopped deliberately (45%), become unintentionally less rigorous (28%) or experienced side effects/contraindications (14%). Knowledge concerning the risks of pregnancy (90%) and past pre-conception counselling (38%) did not encourage women to attend PPC, and neither did personal experience of miscarriage, malformation or stillbirth in women with previous poor pregnancy outcome (41%). Barriers included conceiving faster than anticipated (45%), fertility concerns (31%), negative experiences with health professionals (21%), desire for a ‘normal’ pregnancy (17%) and the logistics of attending (10%). Conclusions More integrated diabetes and reproductive health/contraceptive advice, increased awareness of the potentially short time between stopping contraception and conception and more intensive support between pregnancies are required, particularly for women with previously poor outcomes. Research is also needed into how communication between health professionals and women with diabetes can be improved. [ABSTRACT FROM AUTHOR]

In tropical forests, natural disturbance creates opportunities for species to claim previously utilized space and resources and is considered an important mechanism in the maintenance of species diversity. However, ecologists have long recognized that disturbance also promotes exotic plant invasions. Cyclones cause extensive defoliation, loss of major branches and multiple tree falls, resulting in a significantly more open canopy and increased light and heat levels in the understorey. The widespread and massive disturbance caused by cyclones provides ideal conditions for rapid recruitment and spread of invasive species. The ecological roles of invasive species in rainforest habitats following such a severe disturbance are poorly understood. Severe category 4 Cyclone Larry crossed the North Queensland coast in March 2006 causing massive disturbance to rainforest habitats from Tully to Cairns and west to the Atherton Tablelands. We established 10 plots in an area extensively damaged by this cyclone near El Arish in North Queensland. On each plot nine 2 × 2 m quadrats were established with three quadrats per plot in each of the following treatments: (i) complete debris removal down to the soil layer, (ii) removal of coarse woody debris only, and (iii) uncleared. We monitored recruitment, growth and mortality of all native and invasive species in the 90 quadrats every 3 months since the cyclone. Here we present the recruitment dynamics of invasive species across the study area in relation to the level of disturbance, the type of quadrat treatment, and the diversity and abundance of the native recruiting flora over the first 12 months post-cyclone. Our results suggest that invasive species will mostly comprise a transient component of the flora in the early stages of the successional response. However, some species may have longer-term effects on the successional trajectory of the rainforest and future forest composition and structure. [ABSTRACT FROM AUTHOR]

Aims The Families, Adolescents and Children's Teamwork Study (FACTS) is a family-centred structured education programme for children and adolescents with Type 1 diabetes. It aims to integrate group-based diabetes education into routine care, enhance parental responsibility for self management and improve glycaemic control. Methods A randomized wait-list control group study allocated participants to either the immediate (four educational sessions during year 1) or delayed intervention (four educational sessions during year 2). In both groups, glycated haemoglobin (HbA1c) was measured 3-monthly and participants completed the Paediatric Quality of Life Inventory (PedsQL), Problem Areas in Diabetes Scale (PAID) and Diabetes Family Responsibility Questionnaire (DFRQ) before and after the intervention. Results Intention-to-treat analysis showed no significant difference in HbA1c or parental responsibility between participants randomized to the immediate or delayed programme. However, during 12 months’ follow-up, families who attended ≥ 2 sessions reported increased parental involvement ( P = 0.01), and in children/adolescents who attended ≥ 2 sessions HbA1c fell by 0.29% compared with an increase of 0.11% in non-attenders ( P = 0.04). Conclusion This family-centred education programme has been integrated into paediatric diabetes care with potential benefits on parental involvement and glycaemic control, but further study is warranted before routine application into clinical care. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the influence of pre-pregnancy care and its effect on early glycaemic control and also the effect of glycaemic control in later pregnancy on risk of pre-eclampsia in women with type I diabetes. A prospective cohort study of 290 consecutive nonselected pregnancies in women with type I diabetes was performed from 1991 to 2002. We examined the relationship of monthly glycosylated haemoglobin (HbA1c) level, pre-pregnancy care, parity, diabetes duration, microvascular complications, maternal age, weight and smoking with risk of pre-eclampsia. Pre-eclampsia developed in 31/243 singleton births (12.8%). HbA1c level at 24 weeks was significantly increased in women with pre-eclampsia compared with women without pre-eclampsia (6.0 versus 5.6%, P= 0.017) and was, after nulliparity, the strongest independent predictor of increased risk (OR 1.65 for each 1% increase in HbA1c; P= 0.01). In contrast, there was no relationship between pre-pregnancy care or HbA1c level at booking and risk of pre-eclampsia. [ABSTRACT FROM AUTHOR]

Background A systematic review of the literature in 2000 revealed numerous methodological shortcomings in education research, but in recent years progress has been made in the quantity and quality of psycho-educational intervention studies. Summary of contents This review focuses on diabetes education programmes developed for children, young people and their families in the past 5 years. A comprehensive review of the literature identified 27 articles describing the evaluation of 24 psycho-educational interventions. Data summary tables compare the key features of these, and comparisons are made between individual, group and family-based interventions. Effect sizes are calculated for nine of the randomized studies. Three research questions are posed: firstly has the recent literature addressed the problems highlighted in the previous review; secondly is there sufficient evidence to recommend adaptation of a particular programme; and, finally, what do we still need to do? Conclusions Progress in the quality and quantity of educational research has not resulted in improved effectiveness of interventions. There is still insufficient evidence to recommend adaptation of a particular educational programme and no programme that has been proven effective in randomized studies for those with poor glycaemic control. To develop a range of effective educational interventions, further research involving larger sample sizes with multicentre collaboration is required. [ABSTRACT FROM AUTHOR]

Aim To compare the outcomes of Type 1 and Type 2 diabetic pregnancies and identify risk factors for poor outcome of Type 2 pregnancies Methods The data from all (389 Type 1 and 146 Type 2) pre-gestational diabetic pregnancies from 10 UK hospitals were collected prospectively. Results The Type 2 mothers were less likely to have documented pre-pregnancy counselling (28.7 vs. 40.5%; P < 0.05) or be taking folic acid at conception (21.9 vs. 36.4%; P < 0.001) than Type 1 mothers. The percentage of pregnancies having a serious adverse outcome was higher in Type 2 patients (16.4 vs. 6.4%; P = 0.002). Congenital abnormalities (12.3% in Type 2 vs. 4.4% in Type 1; P = 0.002) accounted for most of this difference. The HbA1c of the Type 2 patients was similar to that of the Type 1 with mean first trimester HbA1c of 7.22 and 7.35%, respectively ( P = 0.5). Treatment with oral hypoglycaemic agents [odds ratio (OR), 1.8; 95% confidence interval (CI), 1.0–3.3; P = 0.04], body mass index (OR, 1.09; 95% CI, 1.01–1.18; P = 0.02) and folic acid supplementation (OR, 0.3; 95% CI, 0.09–1.0; P = 0.04) were all independently associated with congenital malformation. Conclusion Type 2 diabetic pregnancies are characterized by poor pre-pregnancy planning, inadequate folic acid supplementation and treatment with oral hypoglycaemic agents, all of which may contribute to the serious adverse outcomes affecting one in six Type 2 diabetic pregnancies. These remediable aspects of the pre-pregnancy care of women with Type 2 diabetes provide opportunities for improving the outcome towards that of women with Type 1 diabetes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the concurrent validity of the National Dental Examining Board of Canada (NDEB) Written Examination and Objective Structured Clinical Examination (OSCE) by correlating students' scores with their performance in the final year of the D.D.S./D.M.D. program. The subjects of this study were the 2,317 students at nine Canadian dental schools who completed both NDEB examinations between 1995 and 2000. The findings indicate positive correlations (r = 0.43 and r = 0.46, p < .001, for the written and OSCE examinations respectively) between students' examination scores and final year results. Year-to-year and school-to-school variations were minimal. These findings supported the concurrent validity of both NDEB examinations. [ABSTRACT FROM AUTHOR]

Graduates of dental programs constitute a stakeholder group that is able to provide unique information concerning the effectiveness of the dental curriculum in preparing them for dental careers. Following the implementation of planned curricular changes, graduates of the former and the new curricula were surveyed. Results indicate that, while both groups perceive themselves to have been adequately prepared by their D.D.S. program for practice, graduates of the new curriculum indicated a higher level of preparedness in several areas, especially regarding selecting, prescribing and administering pharmacotherapeutic agents. In addition, the results suggest that the change in the first two years from an emphasis on basic sciences and preclinical laboratory work to an early introduction to live dental patients and the integration of foundation sciences and clinical courses were endorsed. The evidence gathered from this alumni survey indicates that the reforms implemented in the dental curriculum were appropriate. Areas requiring further investigation are also discussed. [ABSTRACT FROM AUTHOR]

A modified open annular ligament desmotomy followed by passive open drainage was used to treat 12 horses with chronic digital septic tenosynovitis due to trauma in the form of open wounds or self-sealing punctures. The surgical approach included complete transection of the palmar/plantar annular ligament of the fetlock and proximal digital annular ligament, which facilitated the removal of fibrin, selective debridement and synovectomy, followed by lavage of the digital sheath. The incision was partially closed leaving a 2 cm gap open distally to allow for passive open drainage. Gentamicin was administered intrathecally during surgery. Postoperatively the horses received ceftiofur and non-steroidal antiinflammatory drugs. A sterile bandage was used to protect the wound until the gap had healed completely by second intention. Infection was controlled in 11 of the horses which all returned to their previous levels of work, but one horse was euthanased as a result of the persistence of the infection and financial considerations. [ABSTRACT FROM PUBLISHER]

The article presents a study which investigates the ability of the educational game, "The Prosthodontic Olympics," to improve the quality and proficiency of dental students on selected laboratory procedure. The study reveals that the gaming activity increased the efficiency of students in clinics and the spirit of dental schools, too. Moreover, it notes the ability of the competition to provide an opportunity of students and faculty to have fun while learning.

The development of evaluation of a comprehensive oral examination system are described. These examinations are designed to measure, in an authentic manner, graduating students' understanding and use of the clinical reasoning and professional communication skills employed in the diagnosis, treatment and management of realistic clinical situations. The examination cases were developed from actual clinic cases, enhanced to fit the requirements of the examination. Faculty members were provided with training sessions designed to promote consistency of administration and scoring. A mock oral examination was held to acquaint students with the process and to help reduce their anxiety. The results suggest that the oral examination is a reasonably valid and reliable approach to assessing clinical reasoning skills and that graduating students demonstrated competency in the areas tested. [ABSTRACT FROM AUTHOR]

The integrity of formalin-fixed periodontally diseased root surfaces was assessed following root planing to dentin and citric acid application. Extracted human teeth (fixed in 10% formalin), with crowns removed, were vertically sectioned in half. A horizontal groove on each proximal surface marked the extent of attachment loss. The diseased root surface was vigorously root planed to expose dentin. Cotton pellets, soaked in a saturated solution of citric acid, were either "placed" (control) or "burnished" (vigorously rubbed using root planing pressure) (experimental) on the prepared root surface for 5 min. Pellets were changed 2 times/min. The teeth were fixed and prepared for scanning electron microscope viewing and photography. A representative print was selected for each specimen. To confirm differences between test and control groups, untrained raters were asked to perform 2 sorting exercises. First, they were asked to sort the representative photographs of each specimen into 2 piles based on surface characteristics. Second, they were asked to choose from pairs of photographs, representing matched specimens, the one photograph which appeared to have the greatest collagen surface area. The surfaces of experimental specimens revealed patent dentinal tubules and an intertubular area with a very distinct "shag carpet" appearance of deeply tufted collagen fibrils. Control samples also exhibited open dentinal tubules, yet the intertubular surface displayed a "matted collagen" surface. Results of the 2 sorting exercises confirm that burnishing of formalin-fixed dentin root surfaces for 5 min with cotton pellets soaked in a saturated solution of citric acid consistently produces a distinct tufted collagen fibril surface. In addition, this surface consistently appears to have exposed more collagen surface area than matched controls. It is proposed that the citric acid "burnishing" technique described removes more inorganic material through a combined mechanical/chemical process while fluffing and separating the entangled fixed dentin collagen. The effect citric acid has on the organic component of native dentin is raised. The clinical significance of these results is discussed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Periodontology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Clinical Periodontology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A review of the article "National guidance contributes to the high incidence of inpatient hypoglycaemia" by N. Levi is presented.

The article reports on the relevance of the National Pregnancy in Diabetes Audit (NPID), which measures the quality of diabetes pregnancy care in Great Britain. The role of clinical audit was highlighted by the British paediatric cardiac surgery scandal in the 1990s. Among the major clinical issues addressed by the NPID was minimization of adverse outcomes during pregnancy.

An introduction for the periodical "Diabetic Medicine" is presented in which editor discusses articles within this issue including blood glucose monitoring, digital health, and dual hormone systems.

The article determines whether 16PF scale scores could contribute significantly to the prediction of a measure of fitness. Sixty-three firemen from a large metropolitan area in the Southeast were subjects. Factor M contributed significantly to the prediction of one measure of fitness. The assumption cited in the literature that Factor M reflects "imagination" in individuals who score high on fitness measures was questioned. The article concluded that Sixteen Personality Factor Questionnaire relating high Factor M to high energy and endurance suggests a more logical interpretation of Factor M vis a vis measures of fitness.

The article comments on the effects of maternal hyperglycaemia on pregnant women with diabetes, based on the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study. The study was participated by 25,505 women from 15 hospitals in 9 nations. The study revealed that women with glucose values that were less than the odds ratio criteria had fewer risks of pre-eclampsia and neonatal hypoglycaemia. HAPO proved that hyperglycaemia is an essential risk factor on the health of pregnant women.