A randomised controlled trial investigating the effect of an intensive lifestyle intervention v. standard care in adults with type 2 diabetes immediately after initiating insulin therapy

Obesity and type 2 diabetes are inextricably linked. It is therefore unfortunate that insulin, the ultimate treatment to improve glycaemic control in type 2 diabetes, is associated with significant weight gain. The aim of the present investigation was to ascertain whether a dietitian-led intensive lifestyle intervention could attenuate weight gain associated with commencing insulin therapy. Subjects (n 50) with type 2 diabetes, within 4 weeks of starting insulin therapy, were randomly allocated to a control or intervention group. The control group continued with standard care whilst the intervention group followed a dietitian-led intensive lifestyle intervention. Over 6 months the control group gained 4.9 (sd 3.6) kg (P < 0.001), whilst the intervention group maintained their weight (-0.6 (sd 5.1) kg (NS). The difference in weight change between the groups was 5.5 kg (P < 0.001). The control group had significant increases whilst the intervention group had slight decreases in: BMI (+1.7 (sd 1.3) kg/m (P < 0.001) v. -0.3 (sd 2.0) kg/m (NS)), waist circumference (+5.3 (sd 5.0) cm (P < 0.001) v. -0.4 (sd 5.2) cm (NS)) and percentage body fat (+1.5 (sd 2.0) % (P < 0.001) v. -0.4 (sd 2.8) % (NS)). Differences between the groups for these parameters were significant (P < 0.01). Throughout the study, both groups experienced significant reductions in HbA1c, but only minor changes in blood lipids. The present study demonstrates that weight gain is not an inevitable consequence of starting insulin therapy, but attenuation of the weight gain requires a high level of intervention. The first 6 months to 1 year after initiating insulin therapy provides the ideal 'window of opportunity'

A phase II trial of paclitaxel and epirubicin in advanced breast cancer

Initial trials of paclitaxel and doxorubicin in advanced breast cancer yielded high response rates but significant cardiac toxicity was observed. In this phase II trial we investigated the efficacy and safety of paclitaxel combined with epirubicin. Patients with advanced breast cancer, performance status 0–2, measurable disease, and a normal left ventricular ejection fraction, who may have received adjuvant chemotherapy were treated with epirubicin 75 mg m–2followed by a 3-h infusion of paclitaxel 175 mg m–2repeated every 3 weeks. Forty-three eligible patients were treated at six centres. 67% patients received the maximum of six cycles. The response rate was 54% (95% CI 38–69%), 12% CR and 42% PR. Estimated median progression-free survival was 6.9 months (95% CI 5.4–10.0) and estimated median overall survival was 17.9 months (95% CI 14.2–25.7). Four patients had a decrease in the left ventricular ejection fraction (LVEF) of ≥20% of baseline value, and in two patients the LVEF decreased to below the lower limit of normal, but no patient developed clinical evidence of cardiac failure. Grade 4 neutropenia occurred in 56% cycles, but only 4% of cycles were complicated by febrile neutropenia. Grade 3 or 4 non-haematologic toxicity was uncommon. In conclusion, paclitaxel 175 mg m–2and epirubicin 75 mg m–2is a well tolerated, promising regimen for the treatment of advanced breast cancer. © 2000 Cancer Research Campaig

On the shopfloor: exploring the impact of teacher trade unions on school-based industrial relations

Teachers are highly unionised workers and their trade unions exert an important influence on the shaping and implementation of educational policy. Despite this importance there is relatively little analysis of the impact of teacher trade unions in educational management literature. Very little empirical research has sought to establish the impact of teacher unions at school level. In an era of devolved management and quasi-markets this omission is significant. New personnel issues continue to emerge at school level and this may well generate increased trade union activity at the workplace. This article explores the extent to which devolved management is drawing school-based union representation into a more prominent role. It argues that whilst there can be significant differences between individual schools, increased school autonomy is raising the profile of trade union activity in the workplace, and this needs to be better reflected in educational management research

Understanding the impact of diet and nutrition on symptoms of Tourette Syndrome: A Scoping Review

This document is the accepted manuscript version. The final, definitive version of this paper has been published in Journal of Child Health Care, December 2017, published by SAGE Publishing, doi:https://doi.org/10.1177/1367493517748373.Anecdotal reports frequently suggest some dietary involvement in the maintenance of tics in children with Tourette syndrome (TS). This scoping review aimed to (1) understand the possible influence of diet as a trigger of tics and (2) map out the existing studies documenting dietary interventions in children with TS. Current evidence suggests no single diet to benefit individuals with TS. However, reports from parents of children with TS suggest that certain allergens in food may exacerbate tic-related symptoms. For example, an increase in tics has been related to the consumption of caffeine and refined sugar. Moreover, oligoantigenic diets and sugar-free diets have been identified as significantly reducing tics. More research is urgently needed to develop more accurate guidance for parents and children with TS, as many have reported using dietary and nutritional supplements, despite the lack of evidence detailing any benefits, side effects and recommended doses.Peer reviewedFinal Accepted Versio

From Predicting Solar Activity to Forecasting Space Weather: Practical Examples of Research-to-Operations and Operations-to-Research

The successful transition of research to operations (R2O) and operations to research (O2R) requires, above all, interaction between the two communities. We explore the role that close interaction and ongoing communication played in the successful fielding of three separate developments: an observation platform, a numerical model, and a visualization and specification tool. Additionally, we will examine how these three pieces came together to revolutionize interplanetary coronal mass ejection (ICME) arrival forecasts. A discussion of the importance of education and training in ensuring a positive outcome from R2O activity follows. We describe efforts by the meteorological community to make research results more accessible to forecasters and the applicability of these efforts to the transfer of space-weather research.We end with a forecaster "wish list" for R2O transitions. Ongoing, two-way communication between the research and operations communities is the thread connecting it all.Comment: 18 pages, 3 figures, Solar Physics in pres

Matrix analysis of identifiability of some finite markov models

Methods developed by Bernbach [1966] and Millward [1969] permit increased generality in analyses of identifiability. Matrix equations are presented that solve part of the identifiability problem for a class of Markov models. Results of several earlier analyses are shown to involve special cases of the equations developed here. And it is shown that a general four-state chain has the same parameter space as an all-or-none model if and only if its representation with an observable absorbing state is lumpable into a Markov chain with three states.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45730/1/11336_2005_Article_BF02291365.pd

Transgressing the moral economy: Wheelerism and management of the nationalised coal industry in Scotland

This article illuminates the links between managerial style and political economy in post-1945 Britain, and explores the origins of the 1984–1985 miners' strike, by examining in longer historical context the abrasive attitudes and policies of Albert Wheeler, Scottish Area Director of the National Coal Board (NCB). Wheeler built on an earlier emphasis on production and economic criteria, and his micro-management reflected pre-existing centralising tendencies in the industries. But he was innovative in one crucial aspect, transgressing the moral economy of the Scottish coalfield, which emphasised the value of economic security and changes by joint industrial agreement