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Aims/hypothesisDietary recommendations for treating type 2 diabetes are unclear but a trend towards recommending a diet reduced in carbohydrate content is acknowledged. We compared a carbohydrate-reduced high-protein (CRHP) diet with an iso-energetic conventional diabetes (CD) diet to elucidate the effects on glycaemic control and selected cardiovascular risk markers during 6 weeks of full food provision of each diet.MethodsThe primary outcome of the study was change in HbA1c. Secondary outcomes reported in the present paper include glycaemic variables, ectopic fat content and 24 h blood pressure. Eligibility criteria were: men and women with type 2 diabetes, HbA1c 48–97 mmol/mol (6.5–11%), age >18 years, haemoglobin >6/>7 mmol/l (women/men) and eGFR >30 ml min−1 (1.73 m)−2. Participants were randomised by drawing blinded ballots to 6 + 6 weeks of an iso-energetic CRHP vs CD diet in an open label, crossover design aiming at body weight stability. The CRHP/CD diets contained carbohydrate 30/50 energy per cent (E%), protein 30/17E% and fat 40/33E%, respectively. Participants underwent a meal test at the end of each diet period and glycaemic variables, lipid profiles, 24 h blood pressure and ectopic fat including liver and pancreatic fat content were assessed at baseline and at the end of each diet period. Data were collected at Copenhagen University Hospital, Bispebjerg and Copenhagen University Hospital, Herlev.ResultsTwenty-eight participants completed the study. Fourteen participants carried out 6 weeks of the CRHP intervention followed by 6 weeks of the CD intervention, and 14 participants received the dietary interventions in the reverse order. Compared with a CD diet, a CRHP diet reduced the primary outcome of HbA1c (mean ± SEM: −6.2 ± 0.8 mmol/mol (−0.6 ± 0.1%) vs −0.75 ± 1.0 mmol/mol (−0.1 ± 0.1%); p < 0.001). Nine (out of 37) pre-specified secondary outcomes are reported in the present paper, of which five were significantly different between the diets, (p < 0.05); compared with a CD diet, a CRHP diet reduced the secondary outcomes (mean ± SEM or medians [interquartile range]) of fasting plasma glucose (−0.71 ± 0.20 mmol/l vs 0.03 ± 0.23 mmol/l; p < 0.05), postprandial plasma glucose AUC (9.58 ± 0.29 mmol/l × 240 min vs 11.89 ± 0.43 mmol/l × 240 min; p < 0.001) and net AUC (1.25 ± 0.20 mmol/l × 240 min vs 3.10 ± 0.25 mmol/l × 240 min; p < 0.001), hepatic fat content (−2.4% [−7.8% to −1.0%] vs 0.2% [−2.3% to 0.9%]; p < 0.01) and pancreatic fat content (−1.7% [−3.5% to 0.6%] vs 0.5% [−1.0% to 2.0%]; p < 0.05). Changes in other secondary outcomes, i.e. 24 h blood pressure and muscle-, visceral- or subcutaneous adipose tissue, did not differ between diets.Conclusions/interpretationA moderate macronutrient shift by substituting carbohydrates with protein and fat for 6 weeks reduced HbA1c and hepatic fat content in weight stable individuals with type 2 diabetes.Trial registrationClinicalTrials.gov NCT02764021.FundingThe study was funded by grants from Arla Food for Health; the Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen; the Department of Clinical Medicine, Aarhus University; the Department of Nutrition, Exercise and Sports, University of Copenhagen; and Copenhagen University Hospital, Bispebjerg.

In this essay, Christopher Kliewer, Douglas Biklen, and Amy J. Petersen unravel the construct of intellectual disability that has dominated both policy and practice in schools and communities. The authors synthesize data from first-person narratives, family accounts, and participatory inquiry to propose a theory of human connectedness in which intellectual competence is constructed through social action and interaction. The authors trace the isolating, brutalizing, and dehumanizing consequences of the presumed \"nothingness\" associated with those labeled as having an intellectual disability and, by way of contrast, integrate written and video data that offer counterpoints to the notion of intellect as immutable and individual. The authors discuss the development of supports in valued arenas where the right to belong and to participate is realized without question; the provision of resources and materials based on affirmation, actualization, and empowerment; and the fostering of surrounding communities comprised of committed individuals who have stepped apart from deficit ideology and who are open to self-critique, surprise, and learning. The authors propose that in these contexts is found the end of intellectual disability.

Introduction The global medical technology industry brings thousands of devices to market every year. However, significant gaps persist in the scientific literature, in the medical device approval process, and in the realm of postmarketing surveillance. Although thousands of drugs obtain approval only after review in randomized controlled trials, relatively few new medical devices are subject to comparable scrutiny. Objective To improve health outcomes, we must enhance our scrutiny of medical devices, and, without simply deferring to the Food and Drug Administration, we must ask ourselves: Who is responsible for evaluating the safety and effectiveness of medical devices? Conclusions Technology assessments by independent organizations are a part of the solution to this challenge and may motivate further research focused on patient outcomes.

The spread of electronic health records systems (EHRs) poses challenges for both patient and provider care experience. Limited research suggests that scribes offer potential benefits to productivity and clinician satisfaction in emergency health and specialty settings. We conducted this evaluation of trained volunteer scribes for primary care clinics serving a diverse, low-income population in a US safety net system, which implemented a new EHR 2011–2014. The scribe programme trained and managed scribes for 51 providers (25% participation) from 5 of 12 San Francisco Health Network primary care clinics. We evaluated the programme using four measures. Providers reported spending less time out of clinic completing notes after sessions with scribes versus sessions without scribes (14.0 min vs 30.2 min, p<0.01). The rate of incomplete EHR notes at 72 hours was not significantly different for clinics using and not using scribes (16.9% vs 16.7%, p=0.4). Mean visit length using EHR-recorded provider cycle time was shorter for sessions with scribes (24.0 min), compared with sessions without scribes (26.4 min, p<0.01). Patients at clinics using scribes were as likely to recommend their provider (74.5%), compared with patients at clinics not using scribes (74.3%). Limitations of our evaluation include selection bias and possible confounding by clinic- and provider-level factors. In a safety net primary care system, trained volunteer scribes were associated with improved clinician efficiency and experience and no difference in patient satisfaction.

In this article, the author explores the possibilities of teaching and learning through multiple-literacies in an arts environment. Acknowledging that technologies have a profound effect on our society, and often outpace our ability to properly assess or understand their implications, the author asserts that young people can become critical and active agents in their interactions with new media. Arts education, specifically theater education, is uniquely positioned to substantially contribute to these interactions between teachers and students that acknowledge and explore the new forms of literacy that are essential to navigating our contemporary culture. To this end, the author calls on arts educators to effectively engage with their students' multimodal concerns through interactions that value new multimodal literacies.

The effects of selective-harvest on forest composition and structure in the southern range of the coast redwood (Sequoia sempervirens) forest have not been well documented. This case study was focused on the Byrne-Milliron Forest located in Santa Cruz County, where selective-harvest is currently the primary method of timber extraction. The purpose of this research was to determine how forest structure and composition changed in relation to time since the last harvest re-entry, the percentage cut per hectare and number of harvest re-entries. The study design consisted of 100 plots located within the Byrne-Milliron Forest, spanning over five harvest sites. Data were analyzed using one-way analysis of variance (ANOVA) and correlations were determined with Pearson product-moment correlation coefficient. Results indicated that the percentage cut per hectare was the strongest independent variable, with significant differences found among sites in relation to canopy cover, stand density, large woody debris (LWD) density, coast redwood sprouts, coast redwood associated herbaceous species and exotic species richness. These findings suggest that a lower percentage cut is more effective in maintaining healthy structure and composition in actively managed stands.

In this article, the authors describe an integrated science and literacy instructional model in which students build background knowledge by engaging in free-choice learning options during an investigation of school yard habitats. Students interact with their peers while inquiring, discussing findings, and using print resources to enhance learning.

A book edited by Jessica Hoffman Davis is reviewed.