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The effect of a multidisciplinary lifestyle program for patients with rheumatoid arthritis, an increased risk for rheumatoid arthritis or with metabolic syndrome-associated osteoarthritis

Low-grade inflammation and metabolic syndrome are seen in many chronic diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). Lifestyle interventions which combine different non-pharmacological therapies have shown synergizing effects in improving outcomes in patients with other chronic diseases or increased risk thereof, especially cardiovascular disease. For RA and metabolic syndrome-associated OA (MSOA), whole food plant-based diets (WFPDs) have shown promising results. A WFPD, however, had not yet been combined with other lifestyle interventions for RA and OA patients. In this protocol paper, we therefore present Plants for Joints, a multidisciplinary lifestyle program, based on a WFPD, exercise, and stress management. The objective is to study the effect of this program on disease activity in patients with RA (randomized controlled trial [RCT] 1), on a risk score for developing RA in patients with anti-citrullinated protein antibody (ACPA) positive arthralgia (RCT 2) and on pain, stiffness, and function in patients with MSOA (RCT 3), all in comparison with usual care.We designed three 16-week observer-blind RCTs with a waiting-list control group for patients with RA with low to moderate disease activity (2.6 ≤ Disease Activity Score [DAS28] ≤ 5.1, RCT 1, n = 80), for patients at risk for RA, defined by ACPA-positive arthralgia (RCT 2, n = 16) and for patients with metabolic syndrome and OA in the knee and/or hip (RCT 3, n = 80). After personal counseling on diet and exercise, participants join 10 group meetings with 6-12 other patients to receive theoretical and practical training on a WFPD, exercise, and stress management, while medication remains unchanged. The waiting-list control group receives usual care, while entering the program after the RCT. Primary outcomes are: difference in mean change between intervention and control groups within 16 weeks for the DAS28 in RA patients (RCT 1), the RA-risk score for ACPA positive arthralgia patients (RCT 2), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for MSOA patients (RCT 3). Continued adherence to the lifestyle program is measured in a two-year observational extension study.

Reducing meat consumption: The influence of life course transitions, barriers and enablers, and effective strategies according to young Dutch adults

High consumption of animal-source foods, specifically meat, adversely affects human health and the environment. Dietary habits are shaped at younger ages and a reduction in meat consumption may be facilitated by the life course transitions in early adulthood, but studies are limited. This study among young Dutch adults aimed to describe their perceptions on the influence of life course transitions on meat consumption, barriers and enablers to reduce meat consumption, and strategies for reducing meat consumption. Barriers and enablers were grouped applying the COM-B model that includes capability, opportunity, and motivation. This quantitative cross-sectional study included a representative sample of 1806 young adults from two Dutch consumer panels who completed an online survey. Young adults frequently reported life course transitions, especially those related to moving house, to have decreased their meat consumption. Barriers and enablers to reduce meat consumption were identified for all three factors of the COM-B model. Important barriers included taste, perceived high prices of meat alternatives, and habits. In contrast, important enablers included care for the environment and animal welfare, enjoyment of smaller portions of meat and saving money. However, barriers and enablers largely differed by groups of meat consumption frequency. Self-perceived effective strategies for reducing meat consumption were price reduction of meat alternatives, recipes for vegetarian meals, and more attractive meat alternatives. The findings of this study are relevant for the development of targeted behaviour-change programmes including interventions in the physical and the social environment (like lowering prices and improving the offer of meat alternatives).

MultipleXLab: A high-throughput portable live-imaging root phenotyping platform using deep learning and computer vision.

Changes in stool frequency following chicory inulin consumption, and effects on stool consistency, quality of life and composition of gut microbiota

Inulin is a soluble dietary fibre, also classified as a prebiotic, extracted from chicory roots. The present study aimed to determine the effect of consumption of native chicory inulin on the stool frequency of middle-aged to older adults (40–75 years old) with uncomfortably but not clinically relevant low stool frequency, specified as two to four days without bowel movements per week. Two randomised, double blind, placebo-controlled crossover trials were conducted using similar protocols in differing populations. Trial A was conducted in Amsterdam, The Netherlands and subsequently Trial B was conducted in Newcastle, United Kingdom. Both trials involved supplementation for 5 weeks with 10 g per day of inulin or placebo, a washout period of 2 weeks, and then crossed over to receive the other treatment. In Trial B, faecal gut microbiota composition was assessed using 16S rRNA gene sequencing. In Trial A, which 10 volunteers completed, the stool frequency was significantly increased to an average 4.9 ± 0.23 (SEM) times per week during inulin periods versus 3.6 ± 0.25 in the periods with placebo (p = 0.01). In contrast, in Trial B which 20 volunteers completed, there was no significant effect of the inulin on stool frequency (7.5 ± 2.1 times per week with inulin, 8.1 ± 3.0 with placebo, p = 0.35). However, many subjects in Trial B had a stool frequency >5 per week also for the placebo period, in breach of the inclusion criteria. Combining the data of 16 low stool frequency subjects from Trials A and B showed a significant effect of inulin to increase stool frequency from 4.1 to 5.0 per week (p = 0.032). Regarding secondary outcomes, stool consistency was significantly softer with inulin treatment compared to placebo periods, it increased 0.29 on the Bristol stool scale (p = 0.008) when data from all subjects of Trials A and B were combined. No other differences in bowel habit parameters due to inulin consumption were significant. None of the differences in specific bacterial abundance, alpha or beta diversity were significant, however the trends were in directions consistent with published studies on other types of inulin. We conclude that 10 g per day of native chicory inulin can increase stool frequency in subjects with low stool frequency.

De moderne sociotechniek als theoretische onderbouwing van Lean

Lean is een ontwerptheorie op zoek naar een theoretische onderbouwing. In deze bijdrage laat de auteur zien dat de Moderne Sociotechniek (MST), zoals ontwikkeld door Ulbo de Sitter, kan dienen als een dergelijke theoretische onderbouwing. De overeenkomsten zijn dus groter dan menigeen, inclusief De Sitter zelf, denkt. Daarnaast wijst hij ook op verschillen. Zo is het de verdienste van De Sitter, dat hij het vraagstuk van de lerende organisatie als een structuurvraagstuk geherformuleerd heeft. En het is de verdienste van Lean dat ze de rol van standaarden en routines in dit leerproces geherwaardeerd heeft.

Evaluating advancements in accident investigations using a novel framework

Safety is monitored by various proactive and reactive methods, including the investigation of adverse accidents and incidents, which are collectively known as safety investigations. In this study we demonstrate how accident and incident investigation reports can be useful to identify implicit safety views and accident investigation approaches. An analysis framework was developed based on contemporary safety literature. The framework incorporates aspects such as hindsight bias, judgemental approach, proximal or distal focus, and the application of systemic versus sequential accident causation models. The framework was piloted through the analysis of sixteen (16) accident investigation reports published by a Nuclear Power Plant (NPP). The comments of independent researchers lead to framework refinements that increased the inter-rater reliability substantially. The initial results were validated through interviews with the staff of the NPP. Afterwards, the framework was applied to 52 air accident reports published by the Dutch Safety Board (DSB) from 1999 to 2013. Frequency calculations revealed the extent of new safety thinking embracement from the DSB, and Fisher’s Exact Test showed that none of the modern safety aspects has changed over time. The framework can be used to analyse accident investigation reports published by various organisations as means to identify implicit safety views and evolution of accident investigation practices over time. Further research will explore the reasons for potential gaps between theory and practice and contribute to minimizing such distance. Safety is monitored by various proactive and reactive methods, including the investigation of adverse accidents and incidents, which are collectively known as safety investigations. In this study we demonstrate how accident and incident investigation reports can be useful to identify implicit safety views and accident investigation approaches. An analysis framework was developed based on contemporary safety literature. The framework incorporates aspects such as hindsight bias, judgemental approach, proximal or distal focus, and the application of systemic versus sequential accident causation models. The framework was piloted through the analysis of sixteen (16) accident investigation reports published by a Nuclear Power Plant (NPP). The comments of independent researchers lead to framework refinements that increased the inter-rater reliability substantially. The initial results were validated through interviews with the staff of the NPP. Afterwards, the framework was applied to 52 air accident reports published by the Dutch Safety Board (DSB) from 1999 to 2013. Frequency calculations revealed the extent of new safety thinking embracement from the DSB, and Fisher’s Exact Test showed that none of the modern safety aspects has changed over time. The framework can be used to analyse accident investigation reports published by various organisations as means to identify implicit safety views and evolution of accident investigation practices over time. Further research will explore the reasons for potential gaps between theory and practice and contribute to minimizing such distance.