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Introduction Many people with type 1 diabetes (T1DM) continue to run high HbA1c levels with an associated elevated risk of cardiovascular events and increased mortality. We describe here how adjunctive prescription of an SGLT2 inhibitor has improved the glycaemic control of several people with T1DM, where the new technology has been intensively deployed. Methods We report outcomes of six adults with T1DM who have been given dapagliflozin in East Cheshire, UK. Initiation was with education/support from the diabetes specialist nurses. All had an HbA1c of 70 mmol/mol (8.6%) or more before this was initiated. All had been monitoring glycemia with a FreeStyle Libre monitor for at least 6 months prior to this. Results The age range was 30-68 years. The mean duration of T1DM was 23.3 ± 5.5 years. All were on a basal-bolus regime. Over a 6 month period, HbA1c fell from 78.5 mmol/mol (9.3%) to 55 mmol/mol (7.2%). The greatest reduction in HbA1c was 57 mmol/mol (7.4%). Analysis of the FreeStyle Libre blood glucose records showed that the proportion of blood glucose readings on target (4-10 mmol/L) increased from 33.1 to 65.2% with the addition of dapagliflozin(P = 0.007). The proportion of blood glucose readings above target (>10 mmol/L) decreased from 68.0 to 26.4%, 6 months after initiation of dapagliflozin (P = 0.005). There was no increase in symptomatic hypoglycemia. Conclusion Dapagliflozin as adjunctive therapy to basal-bolus regime insulin in individuals with T1DM was well tolerated and improved glycemic control with no increase in hypoglycemia. We provide further evidence of the value of this intervention.

A partial answer is provided to the question “what are the most research productive business school Operations Management departments?” Among the many research rankings published, this research question appears to be unique. Other efforts in Operations Management rank either business schools or entire universities. Our criterion for ordering departments is also unique: publications only by faculty currently employed by the department. Other rankings do not consider the number or title of faculty, thereby providing an advantage to larger and more experienced faculty. This ranking is adjusted for both number of faculty and years of experience.

Male circumcision is one of the most commonly performed surgical procedures worldwide. To help inform men about the procedure, there are various sources of information that explain both the perceived benefits and risks involved. Although some sources such as the National Health Service (NHS) website discuss the physical risks of the procedure, these same information sources do not discuss any potential psychological risks. With some men claiming to have been adversely affected by their circumcision, it questions whether becoming circumcised could have any potential negative psychological consequences. More specifically, whether it could be viewed as a traumatic experience for the male. If a psychologically traumatic reaction to the experience is present, it would necessitate updated health information, improved recognition for those affected, and a review into the ethics and prescription of using circumcision as a prophylactic or remedy for conditions affecting the penis. This paper conducted a literature review to investigate various areas that may contribute to circumcision-based trauma. Based on the research explored, this paper concludes that not only can male circumcision be a traumatic event, but male circumcision-based trauma should be shown greater recognition. Further research should be conducted into this field to discover the extent of this trauma.

In 1825, amidst the industrial revolution taking place in the United States of America, the Erie Canal was constructed bringing industry and wealth to the communities along with it. Almost 200 years later, the governor of New York announced a 300-million-dollar plan to Reimagine the Canals and bring new economic and social development to those communities along the canal.Of the 57 locks and 19 guard gates along the Erie Canal, lock E11, and guard gate 12 are examples that offer the ability to use their heritage value to bring economic value to the areas around them by pairing them with a footbridge, due to their location. These pieces of infrastructure, still performing critical functions to prevent flooding, often fall forgotten and sit in the backdrop. As part of the Reimagine the Canals initiative these historic structures will become a centrepiece, showcasing their heritage value.Along the canal network also sit many derelict old road bridges. One in the community of Waterloo on Locust Street has been closed for several years, having been through cycles of rebirth before- we looked at how this bridge could again become the centre of the local community.

Larvae of the greater wax moth (Galleria mellonella) are susceptible to infection with C. burnetii, an obligate intracellular bacterial pathogen. We show that bacteria are found in hemocytes after infection, and occupy vacuoles which are morphologically similar to Coxiella-containing vacuoles seen in infected mammalian phagocytes. We characterized the infection by transcriptome profiling of bacteria isolated from the hemocytes of infected larvae and identified 46 highly upregulated genes. The encoded proteins are predicted to be involved in translation, LPS biosynthesis, biotin synthesis, scavenging of reactive oxygen species, and included a T4SS effector and 30 hypothetical proteins. Some of these genes had previously been shown to be upregulated in buffalo green monkey (BGM) cells or in mice, whilst others appear to be regulated in a host-specific manner. Altogether, our results demonstrate the value of the G. mellonella model to study intracellular growth and identify potential virulence factors of C. burnetii.

Alongside recent renewed interest in urban agriculture, there has been an increased focus on school farming. The School Farms Network has a large membership base and interest from other green space organisations across the UK. Using contributions from grass roots practitioners and network co-ordinators, we present case studies to illustrate the breadth of the school farms concept, as well as the value which practitioners find in being part of such a network We examine the future role of school farming and how the practice can be sustained or expanded.

Bridge H16 is foot and cycle bridge located within the Queen Elizbeth’s Olympic Park, London. It aims to provide the user with an engaging experience as they cross between the Park to Hackney Wick and Fish Island. This has been achieved through close collaboration between the designer and architects during the early design development. This paper explores the history of the site, the key drivers that defined the bridge, the consideration for the user experience as they cross the bridge, material choices and detailing to successfully deliver the new pedestrian and cycle bridge. It is recognised that the value of the bridge is best expressed through the positive social and economic impact to the developing area. The footbridge was opened to the public during the Summer of 2019. The second bridge; a road bridge, is constructed and due to open fully in the latter of 2021/early 2020.

INTRODUCTION: The COVID-19 vaccination programme is under way worldwide. Anecdotal evidence is increasing that some people with Type 1 Diabetes Mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before/after vaccination. METHODS: We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle® Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage (%) BG readings in the designated target range 3.9-10mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1). RESULTS: There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ±se 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ±se 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1-13.9%/ ≥14%. There was no significant change in BG variability in the 7days post COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age

Introduction The COVID-19 vaccination programme is under way. Anecdotal evidence is increasing that some people with Type 1 Diabetes Mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before and after vaccination. Methods We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle® Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage(%) BG readings in the designated target range 3.9-10mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1). Results There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ±se 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ±se 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1-13.9%/ ≥14%. There was no significant change in BG variability in the 7days post COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age