The effectiveness of adding cognitive behavioural therapy aimed at changing lifestyle to managed diabetes care for patients with type 2 diabetes: design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>In patients with type 2 diabetes, the risk for cardiovascular disease is substantial. To achieve a more favourable risk profile, lifestyle changes on diet, physical activity and smoking status are needed. This will involve changes in behaviour, which is difficult to achieve. Cognitive behavioural therapies focussing on self-management have been shown to be effective. We have developed an intervention combining techniques of Motivational Interviewing (MI) and Problem Solving Treatment (PST). The aim of our study is to investigate if adding a combined behavioural intervention to managed care, is effective in achieving changes in lifestyle and cardiovascular risk profile.</p> <p>Methods</p> <p>Patients with type 2 diabetes will be selected from general practices (n = 13), who are participating in a managed diabetes care system. Patients will be randomised into an intervention group receiving cognitive behaviour therapy (CBT) in addition to managed care, and a control group that will receive managed care only. The CBT consists of three to six individual sessions of 30 minutes to increase the patient's motivation, by using principles of MI, and ability to change their lifestyle, by using PST. The first session will start with a risk assessment of diabetes complications that will be used to focus the intervention.</p> <p>The primary outcome measure is the difference between intervention and control group in change in cardiovascular risk score. For this purpose blood pressure, HbA_1c, total and HDL-cholesterol and smoking status will be assessed. Secondary outcome measures are quality of life, patient satisfaction, physical activity, eating behaviour, smoking status, depression and determinants of behaviour change. Differences between changes in the two groups will be analysed according to the intention-to-treat principle, with 95% confidence intervals. The power calculation is based on the risk for cardiovascular disease and we calculated that 97 patients should be included in every group.</p> <p>Discussion</p> <p>Cognitive behavioural therapy may improve self-management and thus strengthen managed diabetes care. This should result in changes in lifestyle and cardiovascular risk profile. In addition, we also expect an improvement of quality of life and patient satisfaction.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN12666286</p

The heterodimeric ecdysteroid receptor complex in the brown shrimp Crangon crangon: EcR and RXR isoform characteristics and sensitivity towards the marine pollutant tributyltin

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Sustainable bisphenols from renewable softwood lignin feedstock for polycarbonates and cyanate ester resins

© The Royal Society of Chemistry 2017. The selective reductive catalytic depolymerisation of softwood lignin (e.g. pine, spruce) yields predominantly 4-n-propylguaiacol (4PG; 15-20 wt% on lignin basis), an interesting platform chemical for bio-based chemistry. This contribution specifically shows promising technical, sustainable and environmental advantages of such a bio-phenol for various polymer applications. The bisphenolic polymer precursor, 5,5′-methylenebis(4-n-propylguaiacol) (m,m′-BGF-4P), was therefore first synthesized by acid-catalysed condensation, and its synthesis and isolation are compared with shorter chain analogs, viz. 4-methyl- and 4-ethylguaiacol. A thorough GC-GPC/SEC analysis of the crude condensation mixture was developed to assess the purity of the isolated dimers. Isolation is done by a single-step crystallization, yielding 57 wt% of m,m′-BGF-4P in >99% purity. This pure m,m′-BGF-4P bisphenol displays a notably reduced potency to activate human estrogen receptor alpha (hERα; EC50 at 10-5 M) in comparison with commercial bisphenols, and is therefore useful for future polymer applications. As a proof of concept, polycarbonates and cyanate ester resins were prepared from m,m′-BGF-4P and compared to other bisphenols. The polycarbonate had Mn = 5182 g mol-1, Tg = 99 °C, Tm = 213 °C, Td,5% = 360 °C, and displayed improved processability in common solvents, as opposed to the methylated and ethylated bisguaiacols. A fully cured resin disk exhibited a Tg = 193 °C, Td,5% = 389 °C and a water uptake of only 1.18% after being immersed in 85 °C water for four days. These results underscore the potential of the intrinsic functionality of lignin-derived building blocks to transcend the scope of renewability.status: publishe

Reductive lignocellulose fractionation into soluble lignin-derived phenolic monomers and dimers and processable carbohydrate pulps

© The Royal Society of Chemistry 2015. A catalytic lignocellulose biorefinery process is presented, valorizing both polysaccharide and lignin components into a handful of chemicals. To that end, birch sawdust is efficiently delignified through simultaneous solvolysis and catalytic hydrogenolysis in the presence of a Ru on carbon catalyst (Ru/C) in methanol under a H2 atmosphere at elevated temperature, resulting in a carbohydrate pulp and a lignin oil. The lignin oil yields above 50% of phenolic monomers (mainly 4-n-propylguaiacol and 4-n-propylsyringol) and about 20% of a set of phenolic dimers, relative to the original lignin content, next to phenolic oligomers. The structural features of the lignin monomers, dimers and oligomers were identified by a combination of GC/MS, GPC and 2D HSQC NMR techniques, showing interesting functionalities for forthcoming polymer applications. The effect of several key parameters like temperature, reaction time, wood particle size, reactor loading, catalyst reusability and the influence of solvent and gas were examined in view of the phenolic product yield, the degree of delignification and the sugar retention as a first assessment of the techno-economic feasibility of this biorefinery process. The separated carbohydrate pulp contains up to 92% of the initial polysaccharides, with a nearly quantitative retention of cellulose. Pulp valorization was demonstrated by its chemocatalytic conversion to sugar polyols, showing the multiple use of Ru/C, initially applied in the hydrogenolysis process. Various lignocellulosic substrates, including genetically modified lines of Arabidopsis thaliana, were finally processed in the hydrogenolytic biorefinery, indicating lignocellulose rich in syringyl-type lignin, as found in hardwoods, as the ideal feedstock for the production of chemicals.crosscheck: This document is CrossCheck deposited related_data: Supplementary Information identifier: W. J. J. Huijgen (ResearcherID) copyright_licence: The Royal Society of Chemistry has an exclusive publication licence for this journal copyright_licence: This article is freely available. This article is licensed under a Creative Commons Attribution 3.0 Unported Licence (CC BY 3.0) history: Received 20 January 2015; Accepted 20 April 2015; Accepted Manuscript published 20 April 2015; Advance Article published 30 April 2015; Version of Record published 3 June 2015status: publishe

Follow-up of 686 patients with acute Q fever and detection of chronic infection

Recent outbreaks in the Netherlands allowed for laboratory follow-up of a large series of patients with acute Q fever and for evaluation of test algorithms to detect chronic Q fever, a condition with considerable morbidity and mortality. For 686 patients with acute Q fever, IgG antibodies to Coxiella burnetii were determined using an immunofluorescence assay at 3, 6, and 12 months of follow-up. Polymerase chain reaction (PCR) was performed after 12 months and on earlier serum samples with an IgG phase I antibody titer ≥ 1:1024. In 43% of patients, the IgG phase II antibody titers remained high (≥ 1:1024) at 3, 6, and 12 months of follow-up. Three months after acute Q fever, 14% of the patients had an IgG phase I titer ≥ 1:1024, which became negative later in 81%. IgG phase I antibody titers were rarely higher than phase II titers. Eleven cases of chronic Q fever were identified on the basis of serological profile, PCR results, and clinical presentation. Six of these patients were known to have clinical risk factors at the time of acute Q fever. In a comparison of various serological algorithms, IgG phase I titer ≥ 1:1024 at 6 months had the most favorable sensitivity and positive predictive value for the detection of chronic Q fever. The wide variation of serological and PCR results during the follow-up of acute Q fever implies that the diagnosis of chronic Q fever, necessitating long-term antibiotic treatment, must be based primarily on clinical grounds. Different serological follow-up strategies are needed for patients with and without known risk factors for chronic Q feve

Recommendations for serological and clinical follow-up in acute Q-fever patients regardless of compatible clinical presentation.

<p>^a Heart valve/vascular disease or prosthesis. ^b See [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131848#pone.0131848.ref021" target="_blank">21</a>].</p