Dietary approaches to the management of type 2 diabetes (DIAMOND) in primary care: a protocol for a cluster randomised trial

Introduction There is strong evidence that type 2 diabetes (T2D) remission can be achieved by adopting a low-energy diet achieved through total dietary replacement products. There is promising evidence that low-carbohydrate diets can achieve remission of T2D. The Dietary Approaches to the Management of type 2 Diabetes (DIAMOND) programme combines both approaches in a behaviourally informed low-energy, low-carbohydrate diet for people with T2D, delivered by nurses in primary care. This trial compares the effectiveness of the DIAMOND programme to usual care in inducing remission of T2D and in reducing risk of cardiovascular disease. Methods and analysis We aim to recruit 508 people in 56 practices with T2D diagnosed within 6 years, who are demographically representative of the UK population. We will allocate general practices, based on ethnicity and socioeconomic status, to provide usual care for diabetes or offer the DIAMOND programme. Participants in practices offering DIAMOND will see the nurse seven times over 6 months. At baseline, 6 months, and 1 year we will measure weight, blood pressure, HbA1c, lipid profile and risk of fatty liver disease. The primary outcome is diabetes remission at 1 year, defined as HbA1c < 48 mmol/mol and off glucose-lowering medication for at least 6 months. Thereafter, we will assess whether people resume treatment for diabetes and the incidence of microvascular and macrovascular disease through the National Diabetes Audit. Data will be analysed using mixed-effects generalised linear models. This study has been approved by the National Health Service Health Research Authority Research Ethics Committee (Ref: 22/EM/0074). Trial Registration number: ISRCTN46961767

A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology

BACKGROUND: Understanding variations in the incidence of schizophrenia is a crucial step in unravelling the aetiology of this group of disorders. The aims of this review are to systematically identify studies related to the incidence of schizophrenia, to describe the key features of these studies, and to explore the distribution of rates derived from these studies. METHODS: Studies with original data related to the incidence of schizophrenia (published 1965–2001) were identified via searching electronic databases, reviewing citations and writing to authors. These studies were divided into core studies, migrant studies, cohort studies and studies based on Other Special Groups. Between- and within-study filters were applied in order to identify discrete rates. Cumulative plots of these rates were made and these distributions were compared when the underlying rates were sorted according to sex, urbanicity, migrant status and various methodological features. RESULTS: We identified 100 core studies, 24 migrant studies, 23 cohort studies and 14 studies based on Other Special Groups. These studies, which were drawn from 33 countries, generated a total of 1,458 rates. Based on discrete core data for persons (55 studies and 170 rates), the distribution of rates was asymmetric and had a median value (10%–90% quantile) of 15.2 (7.7–43.0) per 100,000. The distribution of rates was significantly higher in males compared to females; the male/female rate ratio median (10%–90% quantile) was 1.40 (0.9–2.4). Those studies conducted in urban versus mixed urban-rural catchment areas generated significantly higher rate distributions. The distribution of rates in migrants was significantly higher compared to native-born; the migrant/native-born rate ratio median (10%–90% quantile) was 4.6 (1.0–12.8). Apart from the finding that older studies reported higher rates, other study features were not associated with significantly different rate distributions (e.g. overall quality, methods related to case finding, diagnostic confirmation and criteria, the use of age-standardization and age range). CONCLUSIONS: There is a wealth of data available on the incidence of schizophrenia. The width and skew of the rate distribution, and the significant impact of sex, urbanicity and migrant status on these distributions, indicate substantial variations in the incidence of schizophrenia

A study of establishing infrastructure : a law- and case study on establishing infrastructure including road building, water and sewer

Masteroppgaven tar sikte på å belyse de problemer som oppstår i forbindelse med etablering av noen utvalgte typer infrastruktur. Begrepet infrastruktur er et vidt begrep og jeg har derfor valgt å avgrense oppgaven til å gjelde vei, vann og avløp. Det har gitt meg mulighet til å undersøke noen saker der flere har gått sammen om å etablert infrastruktur. Jeg har sammenholdt mine undersøkelser med gjeldende rett på området. En viktig del av oppgaven har vært å se på de alternative løsningene som er hjemlet i oreigningslova, matrikkelloven og plan- og bygningsloven. I tillegg har jeg sett og vurdert kommuneplaner og reguleringsplaner,som er viktige premissgivere for hvordan tiltak, blir utformet og tilpasset de eksisterende forhold på stedet hvor tiltakene planlegges gjennomført. Jeg har valgt å benytte meg av casestudie, og har derfor en praktisk tilnærming til problemstillingen. Ved å undersøk flere case og sammenholde funnene med gjeldende lov på området, har jeg sett hvordan tiltak etableres og gjennomføres på ulik måte. Jeg har undersøkt to saker som begge er avsluttet som jordskiftesaker. Mine undersøkelser viser hvilken kompetanse og hvilke muligheter som ligger i jordskifteretten for nettopp denne type saker. Videre har jeg sett hvordan jordskifterettens avgjørelse kan innvirke på forhold som transaksjonskostnader, gjennomføringstid og fornøydhet hos partene. Jordskifteretten som særdomstol åpner for å etablere, og gjennomføre infrastrukturtiltak på en rekke områder. Om partene velger å bruke jordskiftelovens bestemmelser ved etablering og gjennomføring av infrastrukturtiltak vil det bety store besparelser for partene både økonomisk og tidsmessig.M-EI

[Rezension zu:] Jörg Schuster: »Kunstleben«. Zur Poetik des Briefs um 1900 – Korrespondenzen Hugo von Hofmannsthals und Rainer Maria Rilkes. Paderborn: Wilhelm Fink 2014 (429 Seiten, ISBN 978-3-7705-5602-1)

Rezension zu Jörg Schuster: "Kunstleben". Zur Poetik des Briefs um 1900 – Korrespondenzen Hugo von Hofmannsthals und Rainer Maria Rilkes. Paderborn: Wilhelm Fink 2014 (429 Seiten, ISBN 978-3-7705-5602-1

Tilbakefall til seksualforbrytelser

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Rettspsykiatrisk undersøkte menn - hvordan går det med dem?

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CReDDI - A proof of concept trial investigating tracking the respiratory exchange ratio (RER) during dietary intervention

In this study we examine how ambulatory RER measurements, using a handheld device, change in response to changes in fat and carbohydrate intake and changes in energy balance. Participant experience and engagement will be examined to provide input into the potential use of this device as a motivational tool for health behaviour change

Brannstiftere

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