Educational weight loss interventions in obese and overweight adults with type 2 diabetes : a systematic review and meta‐analysis of randomized controlled trials

Aim The worldwide prevalence of type 2 diabetes mellitus is increasing, with most individuals with the disease being overweight or obese. Weight loss can reduce disease‐related morbidity and mortality and weight losses of 10–15 kg have been shown to reverse type 2 diabetes. This review aimed to determine the effectiveness of community‐based educational interventions for weight loss in type 2 diabetes. Methods This is a systematic review and meta‐analysis of randomized controlled trials (RCT) in obese or overweight adults, aged 18–75 years, with a diagnosis of type 2 diabetes. Primary outcomes were weight and/or BMI. CINAHL, MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardized mean difference (SMD) (from baseline to follow‐up) and 95% confidence intervals (95% CI) between trial groups (difference‐in‐difference) were estimated through random‐effects meta‐analyses using the inverse variance method. Heterogeneity was quantified using I2 and publication bias was explored visually using funnel plots. Results Some 7383 records were screened; 228 full‐text articles were assessed and 49 RCTs (n = 12 461 participants) were included in this review, with 44 being suitable for inclusion into the meta‐analysis. Pooled estimates of education combined with low‐calorie, low‐carbohydrate meal replacements (SMD = –2.48, 95% CI –3.59, –1.49, I2 = 98%) or diets (SMD = –1.25, 95% CI –2.11, –0.39, I2 = 95%) or low‐fat meal replacements (SMD = –1.15, 95%CI –2.05, –1.09, I2 = 85%) appeared most effective. Conclusion Low‐calorie, low‐carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with type 2 diabetes

Evaluating the accuracy of diffusion MRI models in white matter

Models of diffusion MRI within a voxel are useful for making inferences about the properties of the tissue and inferring fiber orientation distribution used by tractography algorithms. A useful model must fit the data accurately. However, evaluations of model-accuracy of some of the models that are commonly used in analyzing human white matter have not been published before. Here, we evaluate model-accuracy of the two main classes of diffusion MRI models. The diffusion tensor model (DTM) summarizes diffusion as a 3-dimensional Gaussian distribution. Sparse fascicle models (SFM) summarize the signal as a linear sum of signals originating from a collection of fascicles oriented in different directions. We use cross-validation to assess model-accuracy at different gradient amplitudes (b-values) throughout the white matter. Specifically, we fit each model to all the white matter voxels in one data set and then use the model to predict a second, independent data set. This is the first evaluation of model-accuracy of these models. In most of the white matter the DTM predicts the data more accurately than test-retest reliability; SFM model-accuracy is higher than test-retest reliability and also higher than the DTM, particularly for measurements with (a) a b-value above 1000 in locations containing fiber crossings, and (b) in the regions of the brain surrounding the optic radiations. The SFM also has better parameter-validity: it more accurately estimates the fiber orientation distribution function (fODF) in each voxel, which is useful for fiber tracking

Prevention of childhood poisoning in the home: overview of systematic reviews and a systematic review of primary studies

Unintentional poisoning is a significant child public health problem. This systematic overview of reviews, supplemented with a systematic review of recently published primary studies synthesizes evidence on non-legislative interventions to reduce childhood poisonings in the home with particular reference to interventions that could be implemented by Children's Centres in England or community health or social care services in other high income countries. Thirteen systematic reviews, two meta-analyses and 47 primary studies were identified. The interventions most commonly comprised education, provision of cupboard/drawer locks, and poison control centre (PCC) number stickers. Meta-analyses and primary studies provided evidence that interventions improved poison prevention practices. Twenty eight per cent of studies reporting safe medicine storage (OR from meta-analysis 1.57, 95% CI 1.22–2.02), 23% reporting safe storage of other products (OR from meta-analysis 1.63, 95% CI 1.22–2.17) and 46% reporting availability of PCC numbers (OR from meta-analysis 3.67, 95% CI 1.84–7.33) demonstrated significant effects favouring the intervention group. There was a lack of evidence that interventions reduced poisoning rates. Parents should be provided with poison prevention education, cupboard/drawer locks and emergency contact numbers to use in the event of a poisoning. Further research is required to determine whether improving poison prevention practices reduces poisoning rates

X-ray photoemission spectroscopy determination of the InN/yttria stabilized cubic-zirconia valence band offset

The valence band offset of wurtzite InN(0001)/yttria stabilized cubic-zirconia (YSZ)(111) heterojunctions is determined by x-ray photoemission spectroscopy to be 1.19±0.17 eV giving a conduction band offset of 3.06±0.20 eV. Consequently, a type-I heterojunction forms between InN and YSZ in the straddling arrangement. The low lattice mismatch and high band offsets suggest potential for use of YSZ as a gate dielectric in high-frequency InN-based electronic devices

Spatial effects should be allowed for in primary care and other community-based cluster RCTS

<p>Abstract</p> <p>Background</p> <p>Typical advice on the design and analysis of cluster randomized trials (C-RCTs) focuses on allowance for the clustering at the level of the unit of allocation. However often C-RCTs are also organised spatially as may occur in the fields of Public Health and Primary Care where populations may even overlap.</p> <p>Methods</p> <p>We allowed for spatial effects on the error variance by a multiple membership model. These are a form of hierarchical model in which each lower level unit is a member of more than one higher level unit. Membership may be determined through adjacency or through Euclidean distance of centroids or in other ways such as the proportion of overlapping population. Such models may be estimated for Normal, binary and Poisson responses in Stata (v10 or above) as well as in WinBUGS or MLWin. We used this to analyse a dummy trial and two real, previously published cluster-allocated studies (one allocating general practices within one City and the other allocating general practices within one County) to investigate the extent to which ignoring spatial effects affected the estimate of treatment effect, using different methods for defining membership with Akaike's Information Criterion to determine the "best" model.</p> <p>Results</p> <p>The best fitting model included both a fixed North-South gradient and a random cluster effect for the dummy RCT. For one of the real RCTs the best fitting model included both a random practice effect plus a multiple membership spatial term, while for the other RCT the best fitting model ignored the clustering but included a fixed North-South gradient. Alternative models which fitted only slightly less well all included spatial effects in one form or another, with some variation in parameter estimates (greater when less well fitting models were included).</p> <p>Conclusions</p> <p>These particular results are only illustrative. However, we believe when designing C-RCTs in a primary care setting the possibility of spatial effects should be considered in relation to the intervention and response, as well as any explanatory effect of fixed covariates, together with any implications for sample size and methods for planned analyses.</p

Repetitive fracturing during spine extrusion at Unzen volcano, Japan

Rhythmic seismicity associated with spine extrusion is a well-documented phenomenon at a number of dome-forming volcanic systems. At Unzen volcano, Japan, a 4-year dome-forming eruption concluded with the emplacement of a spine from October 1994 to February 1995, offering a valuable opportunity to further investigate seismogenic processes at dome-forming volcanoes. Using continuous data recorded at a seismic station located close to the dome, this study explores trends in the seismic activity during the extrusion of the spine. We identify a total of 12 208 volcano-seismic events in the period between October 1994 and February 1995. Hourly event counts indicate cyclic activity with periods of ∼ 40 to ∼ 100 h, attributed to pulsatory ascent defined by strain localisation and faulting at the conduit margins. Waveform correlation revealed two strong clusters (a.k.a. multiplets, families) which are attributed to fracturing along the margins of the shallow, ascending spine. Further analysis indicates variable seismic velocities during the spine extrusion as well as migration of the cluster sources along the spine margins. Our interpretation of the results from seismic data analyses is supported by previously published field and experimental observations, suggesting that the spine was extruded along an inclined conduit with brittle and ductile deformation occurring along the margins. We infer that changes in stress conditions acting on the upper and lower spine margins led to deepening and shallowing of the faulting sources, respectively. We demonstrate that the combination of geophysical, field and experimental evidence can help improve physical models of shallow conduit processes

The Autophagy Receptor TAX1BP1 and the Molecular Motor Myosin VI Are Required for Clearance of Salmonella Typhimurium by Autophagy.

Autophagy plays a key role during Salmonella infection, by eliminating these pathogens following escape into the cytosol. In this process, selective autophagy receptors, including the myosin VI adaptor proteins optineurin and NDP52, have been shown to recognize cytosolic pathogens. Here, we demonstrate that myosin VI and TAX1BP1 are recruited to ubiquitylated Salmonella and play a key role in xenophagy. The absence of TAX1BP1 causes an accumulation of ubiquitin-positive Salmonella, whereas loss of myosin VI leads to an increase in ubiquitylated and LC3-positive bacteria. Our structural studies demonstrate that the ubiquitin-binding site of TAX1BP1 overlaps with the myosin VI binding site and point mutations in the TAX1BP1 zinc finger domains that affect ubiquitin binding also ablate binding to myosin VI. This mutually exclusive binding and the association of TAX1BP1 with LC3 on the outer limiting membrane of autophagosomes may suggest a molecular mechanism for recruitment of this motor to autophagosomes. The predominant role of TAX1BP1, a paralogue of NDP52, in xenophagy is supported by our evolutionary analysis, which demonstrates that functionally intact NDP52 is missing in Xenopus and mice, whereas TAX1BP1 is expressed in all vertebrates analysed. In summary, this work highlights the importance of TAX1BP1 as a novel autophagy receptor in myosin VI-mediated xenophagy. Our study identifies essential new machinery for the autophagy-dependent clearance of Salmonella typhimurium and suggests modulation of myosin VI motor activity as a potential therapeutic target in cellular immunity.FB and DAT thank the Wellcome Trust (www.wellcome.ac.uk) for funding of a University Award to FB (086743), the CIMR Strategic Award (100140) and an equipment grant [093026]. FB also thanks the Medical Research Council UK (www.mrc.ac.uk) for funding of a project grant (MR/K000888/1). JKJ, MA and MB were supported by the Medical Research Council UK (www.mrc.ac.uk) (U105184325).This is the final published version. It first appeared at http://dx.doi.org/10.1371/journal.ppat.100517