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Efficacy, acceptability and experiences of very low energy diets in adults with type 2 diabetes
Get PDFPhD ThesisAims: Type 2 diabetes (T2DM) has traditionally been regarded as an irreversible and progressive chronic condition. Recent evidence suggests that T2DM can be reversed by dietary restriction of energy intake through very low energy diets (VLEDs), indicating its potential for the treatment of one of the most prevalent chronic conditions associated with overweight and obesity around the world. VLEDs represent the most rapid, non-surgical method of weight loss (WL), but evidence showing acceptability of VLEDs and their short- and long-term efficacy in people with T2DM is limited. This PhD project aims to: 1) determine efficacy of VLEDs for weight loss and diabetes remission; 2) explore peoples` experiences with adherence to VLEDs; and 3) evaluate acceptability of VLEDs. In order to determine long-term sustainability of weight loss through VLEDs, this project further aimed to 4) explore peoples` experience with weight maintenance following weight loss through VLEDs; 5) evaluate acceptability of different plans for weight loss maintenance (WLM); and 6) explore changes in peoples` experiences from the beginning of weight loss through to weight loss maintenance. Methods: A mixed-methods approach was used to achieve the above aims. Chapter 1 provides a review of literature relating to T2DM and its treatments. Chapter 2 gives an overview of the relevant theoretical perspectives and provides a theoretical background to this PhD project. To determine efficacy and acceptability of VLEDs from the existing literature, Chapter 3 presents a systematic review of controlled trials and qualitative studies of individuals with T2DM that compared the efficacy of VLEDs with standard care, minimal interventions and other WL interventions. Chapter 4 briefly describes the Counterbalance Study, which investigated the principle determinants of long term reversal of T2DM, consisting of a 2-month WL period with VLEDs, followed by a 6-month WLM phase. The Counterbalance Study was independent of this project, but provided a platform for all qualitative work I have conducted within this PhD. In Chapters 5 and 6, I employed qualitative methods to explore experiences with a VLED amongst people with T2DM, who were engaged on the Counterbalance Study, and to determine acceptability of the VLED as an intervention for weight loss and diabetes remission. For this study, I interviewed 15 of 30 participants in the Counterbalance Study at the start and the end of the VLED. I conducted thematic analyses to find out about peoples` motivation to take part in the Counterbalance study, their experiences, their perceived barriers and facilitators to adherence with the VLED, about behavioural strategies they used
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to overcome the barriers, and about their views on acceptability of the VLED. In Chapters 7 and 8, I employed the same qualitative methods and interviewed 16 and 15 participants of the Counterbalance Study after the WL and the WLM phases respectively. The interviews aimed to explore peoples` experiences with the WLM phase including their motivation, experience, barriers and facilitators to adherence, behavioural strategies they employed, and support needs at this stage. In the last empirical chapter (Chapter 9), I analysed the narratives of 11 participants who were interviewed at all three stages (baseline, end of WL and end of WLM) to identify themes of change, and to find out how peoples` experience of WL relates to experience of WLM.
Results: Chapter 1 described T2DM and its complications, comorbidities and the impact of T2DM on peoples` health and the economy. It provided an overview of the current invasive and non-invasive treatments of T2DM, introduced VLEDs and the existing evidence of their efficacy and acceptability.
Chapter 2 provided an overview of the psychological literature relevant to WL, WLM and eating behaviours. It introduced the behaviour change theories relevant to this thesis, discussed their strengths and weaknesses, and discussed their utility in health psychology research. This chapter also provided a springboard for hypotheses that I further explored in the qualitative studies in Chapters 5-9. The systematic review in Chapter 3 identified 9 controlled trials that were included in meta-analyses and narrative syntheses. These analyses showed that VLEDs induced greater WL than minimal interventions, standard care or low energy diets, and equal WL compared to bariatric surgery, at 3 and 6 months. It also showed that a larger difference in energy prescription between the intervention and the comparator arms is associated with larger differences in WL and fasting blood glucose levels at 3 months. No qualitative studies were suitable for inclusion in the systematic review, however acceptability of VLEDs was suggested by attrition rates, which did not differ between the VLED and the comparator groups at any measurement point. The qualitative study of peoples` experiences with and acceptability of VLED in Chapters 5 and 6 found that the VLED was perceived as generally highly acceptable among motivated individuals involved in a clinical study. The following themes reflected the experience of people with a WL through VLEDs: 1) improving health-related quality of life and 2) enhancing appearance, which were the main motives for the participants to take part in the study; 3) exceeded expectations, and 4) positive feedback loop, which stimulated the continuous motivation to adhere with the diet, and 5) facilitation of adherence,
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including behaviour-regulation strategies that the people used to overcome barriers to adherence.
In Chapter 7 and 8, I extended the qualitative enquiry to the WLM phase of the Counterbalance Study: The following themes reflected the participants` experience with and acceptability of the WLM phase: 1) shifting of goals, 2) from uncertainty to regaining control, transcending which was the notion of a 3) shifting identity. Uncertainty about transition to regular food and weight maintenance and a progress towards building healthier habits and growing control of behaviour was a common denominator of the themes. To facilitate successful WLM, people used behaviour-regulation strategies of monitoring and compensation by physical activity and calorie restriction. Acceptability of the WLM phase and WLM success were related with: 1) preference for a WLM plan; and 2) satisfaction with WL and WLM outcomes. The participants also evaluated which intervention features were useful and offered suggestions for improvement of the intervention.
Lastly, in Chapter 9 I identified changes in the peoples` experiences with weight management over time. The results show that success during WL and WLM is facilitated by the experience of transition from behavioural inter-dependency (with other people) to behavioural independence, and by adaptation of their mindset from a regimented one during WL to more flexible one during WLM. The interviews also showed that behaviour change can be “contagious” and other people may benefit from one`s behaviour change. The longitudinal narratives also highlighted the shift in identity people experience during the process of behaviour change.
Conclusions: The empirical studies in this PhD project found that VLEDs are effective and acceptable for WL and remission of T2DM among highly motivated individuals within a clinical setting. People who struggle adhering to a VLED or WLM following a VLED may use behaviour regulation strategies identified in this PhD to facilitate adherence. Social support was an important facilitator both, WL and WLM. The WL and WLM interventions can be improved by enabling the participants to meet each other to exchange experience, tips and to support each other. Monitoring and providing feedback on performance during the WL and WLM phases stimulates continuous effort and clinical support beyond WLM might facilitate long-term sustainability of the achieved outcomes. Future studies should explore efficacy and acceptability of VLEDs in a primary care setting, with more limited resources
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
Author Under Sail The Imagination of Jack London, 1893-1902
No full textIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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