Safety of two-year caloric restriction in non-obese healthy individuals

BACKGROUND: The extent to which sustained caloric restriction (CR) in healthy non-obese adults is safe has not been previously investigated. OBJECTIVE: Assess the safety and tolerability of sustained two-year CR intervention in healthy, non-obese adults. DESIGN: A multi-center, randomized controlled trial. Participants were randomized using a 2:1 allocation in favor of 25% CR vs. Ad-Libitum intake (AL). Adverse and serious adverse events (AE, SAE), safety laboratory tests, and other safety parameters were closely monitored. RESULTS: Three participants were withdrawn from the CR intervention because of the safety concerns. No deaths and one SAE was reported by participants in the CR group. Although the difference in AE between AL and CR groups was not significant, within the CR group, the incidence of nervous system (p = 0.02), musculoskeletal (p = 0.02) and reproductive system (p = 0.002) disorders was significantly higher in the normal-weight than in the overweight participants. At months 12 and 24, bone mineral densities at the lumbar spine, total hip, and femoral neck of participants in the CR group were significantly lower than in those in the AL group. CONCLUSIONS: Two-years of CR at levels achieved in CALERIE was safe and well tolerated. Close monitoring for excessive bone loss and anemia is important

From welfare to warfare: class struggle on the margins

Since the mid-1980s, UK welfare reform has seen policymakers incrementally re-design the framing, structure and delivery of the UK’s social security system. Britain’s network of benefit administration and employment service offices have experienced a range of expenditure cuts and are increasingly governed by a new ‘workfarist’ mesh of behavioural conditionality and labour market activation policy. The overarching purpose of this, or at least according to a number of key politicians, has been to ensure labour market discipline among the UK’s out-of-work claiming population by transforming the social security system into a device for altering behaviour. In recent decades, a number of critical interpretations of welfare reform have emerged; two of which have been dominant above all others. One interpretation—heavily influenced by Marxist regulation theory—suggests that welfare reform has emerged as a logical social policy compliment to wider processes of labour market restructuring and a rise in low-paying, contingent ‘jobs that nobody wants’. This interpretation suggests that the services tasked with delivering welfare reform are experienced as sites of discipline and deterrence; ensuring that out-of-work claimants engage with unattractive jobs. A second interpretation—evolving partially out of regulation theory but significantly developed and heavily influenced by Wacquant—suggests that welfare reform has emerged as one part of a dual regulatory response to manage a surge in social unrest and urban marginality. This interpretation suggests that the services tasked with delivering welfare reform are experienced as sites of criminalisation and suffering in order to correct behavioural dysfunction and bend out-of-work claimants towards dependency on low-wage, precarious work. The present thesis offers an alternative interpretation. It is suggested here that UK welfare reform has emerged in response to an accumulation of working class struggles. Drawing on longitudinal interviews with 15 young male claimants and 11 interviews with frontline benefit administration/employment service workers, it is also suggested here that the services tasked with delivering welfare reform are experienced as sites of class struggle. On one side of the desk, frontline workers operate in pressured conditions to probe for claimant resistance, ensure work-related compliance and, in some instances, antagonise claimants in efforts to secure their resignation from benefit receipt. Whilst, on the other side of the desk, claimants use a range of methods to struggle against and subvert frontline service delivery in favour of prioritising their own individual needs and interests.</jats:p

The correlation between the suspected clinical diagnoses and the radiographic diagnoses for patients with shoulder pain

Background The association between the radiographic and clinical findings of shoulder pain is unclear and it is not fully understood how plain film radiographs of the shoulder influence the suspected clinical diagnosis and conservative management of shoulder pain at the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT). Previous research at the CDC reported that plain film radiographs did not significantly influence the suspected clinical diagnosis and conservation management of the lumbar spine and knee conditions. This study was conducted in order to determine if a similar trend was observed for plain film radiographs of the shoulder and the suspected clinical diagnosis and conservative management of shoulder pain. Objectives Objective 1: To determine the association between the suspected clinical diagnosis and radiographic diagnosis of shoulder pain. Objective 2: To describe the type of incidental radiographic findings in the selected plain film radiographs of the shoulder. Objective 3: To determine the proportion of change in the suspected clinical diagnosis and the conservative management of shoulder after obtaining the radiographic report. Method The archives of the CDC at the Durban University of Technology were searched for plain film radiographs of the shoulder and corresponding patients’ records from 4 April 1992 to 19 September 2011. These were collected, examined and evaluated, and the relevant data was extracted. Statistical analysis included the use of percentages, mean, standard deviation, range and frequency counts for the descriptive objectives. The suspected clinical diagnoses were categorized into groups (trauma, mechanical conditions, muscular or tendon dysfunction, capsular syndromes, neurological conditions, arthritides and other). These were then constructed using two-by-two tables for the absence or presence of radiographic diagnoses versus the suspected clinical diagnosis. The McNemars chi square test was used to determine any association between the radiographic and suspected clinical diagnosis. Results The mean age of the patients whose clinical and plain film radiographic records were examined was 43.5 years, with 53.7% male and 46.3% female patients. It was not possible to find an association between the suspected clinical and radiographic diagnoses as the categories were too different for statistical testing to be done. Thirty one (57.4%) plain film radiographs were requested at the first consultation. In 53.7% (29/54 radiographs) of cases, no specific suspected clinical diagnosis was given and “suspected pathology” was the reason given for referral. Of the 54 patients, 21 had a change in the suspected clinical diagnosis; however, in many of these cases (13/21) it was not a direct result of the radiographic findings. A wide range of treatments were used both before and after plain film radiographs, including soft tissue therapy, manipulation and electrotherapy. There was no significant change in the frequency of use of any of the modalities post-radiographs. Conclusion The reasons provided for ordering plain film radiographs were sometimes vague or even invalid. Although there was a change in 21 of the 54 suspected clinical diagnoses it was not conclusively as a result of the radiographic findings. The management of shoulder complaints did not change appreciatively following plain film radiographs. These findings suggest that the current use of plain film radiographs in the clinical and management context at the CDC needs to be reviewed.</jats:p