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Summary Overweight and obesity are increasing worldwide. In general practice, different approaches exist to treat people with weight problems. To provide the foundation for the development of a structured clinical pathway for overweight and obesity management in primary care, we performed a systematic overview of international evidence‐based guidelines. We searched in PubMed and major guideline databases for all guidelines published in World Health Organization (WHO) “Stratum A” nations that dealt with adults with overweight or obesity. Nineteen guidelines including 711 relevant recommendations were identified. Most of them concluded that a multidisciplinary team should treat overweight and obesity as a chronic disease. Body mass index (BMI) should be used as a routine measure for diagnosis, and weight‐related complications should be taken into account. A multifactorial, comprehensive lifestyle programme that includes reduced calorie intake, increased physical activity, and measures to support behavioural change for at least 6 to 12 months is recommended. After weight reduction, long‐term measures for weight maintenance are necessary. Bariatric surgery can be offered to people with a BMI greater than or equal to 35 kg/m2 when all non‐surgical interventions have failed. In conclusion, there was considerable agreement in international, evidence‐based guidelines on how multidisciplinary management of overweight and obesity in primary care should be performed.

Background Evidence that antihyperglycaemic therapy is beneficial for people with type 2 diabetes mellitus is conflicting. While the United Kingdom Prospective Diabetes Study (UKPDS) found tighter glycaemic control to be positive, other studies, such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, found the effects of an intensive therapy to lower blood glucose to near normal levels to be more harmful than beneficial. Study results also showed different effects for different antihyperglycaemic drugs, regardless of the achieved blood glucose levels. In consequence, firm conclusions on the effect of interventions on patient-relevant outcomes cannot be drawn from the effect of these interventions on blood glucose concentration alone. In theory, the use of newer insulin analogues may result in fewer macrovascular and microvascular events. Objectives To compare the effects of long-term treatment with (ultra-)long-acting insulin analogues (insulin glargine U100 and U300, insulin detemir and insulin degludec) with NPH (neutral protamine Hagedorn) insulin (human isophane insulin) in adults with type 2 diabetes mellitus. Search methods For this Cochrane Review update, we searched CENTRAL, MEDLINE, Embase, ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was 5 November 2019, except Embase which was last searched 26 January 2017. We applied no language restrictions. Selection criteria We included randomised controlled trials (RCTs) comparing the effects of treatment with (ultra-)long-acting insulin analogues to NPH in adults with type 2 diabetes mellitus. Data collection and analysis Two review authors independently selected trials, assessed risk of bias, extracted data and evaluated the overall certainty of the evidence using GRADE. Trials were pooled using random-effects meta-analyses. Main results We identified 24 RCTs. Of these, 16 trials compared insulin glargine to NPH insulin and eight trials compared insulin detemir to NPH insulin. In these trials, 3419 people with type 2 diabetes mellitus were randomised to insulin glargine and 1321 people to insulin detemir. The duration of the included trials ranged from 24 weeks to five years. For studies, comparing insulin glargine to NPH insulin, target values ranged from 4.0 mmol/L to 7.8 mmol/L (72 mg/dL to 140 mg/dL) for fasting blood glucose (FBG), from 4.4 mmol/L to 6.6 mmol/L (80 mg/dL to 120 mg/dL) for nocturnal blood glucose and less than 10 mmol/L (180 mg/dL) for postprandial blood glucose, when applicable. Blood glucose and glycosylated haemoglobin A1c (HbA1c) target values for studies comparing insulin detemir to NPH insulin ranged from 4.0 mmol/L to 7.0 mmol/L (72 mg/dL to 126 mg/dL) for FBG, less than 6.7 mmol/L (120 mg/dL) to less than 10 mmol/L (180 mg/dL) for postprandial blood glucose, 4.0 mmol/L to 7.0 mmol/L (72 mg/dL to 126 mg/dL) for nocturnal blood glucose and 5.8% to less than 6.4% HbA1c, when applicable. All trials had an unclear or high risk of bias for several risk of bias domains. Overall, insulin glargine and insulin detemir resulted in fewer participants experiencing hypoglycaemia when compared with NPH insulin. Changes in HbA1c were comparable for long-acting insulin analogues and NPH insulin. Insulin glargine compared to NPH insulin had a risk ratio (RR) for severe hypoglycaemia of 0.68 (95% confidence interval (CI) 0.46 to 1.01; P = 0.06; absolute risk reduction (ARR) -1.2%, 95% CI -2.0 to 0; 14 trials, 6164 participants; very low-certainty evidence). The RR for serious hypoglycaemia was 0.75 (95% CI 0.52 to 1.09; P = 0.13; ARR -0.7%, 95% CI -1.3 to 0.2; 10 trials, 4685 participants; low-certainty evidence). Treatment with insulin glargine reduced the incidence of confirmed hypoglycaemia and confirmed nocturnal hypoglycaemia. Treatment with insulin detemir compared to NPH insulin found an RR for severe hypoglycaemia of 0.45 (95% CI 0.17 to 1.20; P = 0.11; ARR -0.9%, 95% CI -1.4 to 0.4; 5 trials, 1804 participants; very low-certainty evidence). The Peto odds ratio for serious hypoglycaemia was 0.16, 95% CI 0.04 to 0.61; P = 0.007; ARR -0.9%, 95% CI -1.1 to -0.4; 5 trials, 1777 participants; low-certainty evidence). Treatment with detemir also reduced the incidence of confirmed hypoglycaemia and confirmed nocturnal hypoglycaemia. Information on patient-relevant outcomes such as death from any cause, diabetes-related complications, health-related quality of life and socioeconomic effects was insufficient or lacking in almost all included trials. For those outcomes for which some data were available, there were no meaningful differences between treatment with glargine or detemir and treatment with NPH. There was no clear difference between insulin-analogues and NPH insulin in terms of weight gain. The incidence of adverse events was comparable for people treated with glargine or detemir, and people treated with NPH. We found no trials comparing ultra-long-acting insulin glargine U300 or insulin degludec with NPH insulin. Authors' conclusions While the effects on HbA1c were comparable, treatment with insulin glargine and insulin detemir resulted in fewer participants experiencing hypoglycaemia when compared with NPH insulin. Treatment with insulin detemir also reduced the incidence of serious hypoglycaemia. However, serious hypoglycaemic events were rare and the absolute risk reducing effect was low. Approximately one in 100 people treated with insulin detemir instead of NPH insulin benefited. In the studies, low blood glucose and HbA1c targets, corresponding to near normal or even non-diabetic blood glucose levels, were set. Therefore, results from the studies are only applicable to people in whom such low blood glucose concentrations are targeted. However, current guidelines recommend less-intensive blood glucose lowering for most people with type 2 diabetes in daily practice (e.g. people with cardiovascular diseases, a long history of type 2 diabetes, who are susceptible to hypoglycaemia or older people). Additionally, low-certainty evidence and trial designs that did not conform with current clinical practice meant it remains unclear if the same effects will be observed in daily clinical practice. Most trials did not report patient-relevant outcomes.

The urge to achieve climate protection goals and a more prevalent interest in finding alternatives to fossil fuel based products focus attention increasingly on cascade raw material utilization respectively to intensify commercial production processes. The present project provides a study on the combination of liquid/liquid extraction and esterification using the system acetic acid/octanol and 4-dodecylbenzenesulfonic acid as catalyst. The surfactant 4-dodecylbenzenesulfonic acid causes emulsification during extraction, but emulsification was successfully avoided by using supported liquid membrane permeation equipment.

The majority of commodity plastics is made from petroleum-based chemicals. Lactic acid serves as a monomer for the production of the biodegradable polymer polylactic acid (PLA). This paper provides a review on the state of the art production and isolation process for lactic acid. Problems in production and isolation have been identified, the relevant results in optimized production are presented in the first part of the paper. In the second part, a decision matrix is used as a guideline for the discussion on the state of research in the isolation and purification of lactic acid. Mechanical unit operations, mass transfer unit operations, reactive separation techniques, and process combinations are reported in the literature. At the end, an economic evaluation of isolation processes such as conventional precipitation, reactive membrane separation, and reactive distillation are presented. © 2017 Society of Chemical Industry

Isolation of low concentrated constituents from side streams of biobased processes has recently received increased technical and economical attention. For energy efficient acid isolation reactive extraction is proposed in literature. The crucial step for efficient process application is the solvent regeneration. Alternatively to conventional reactive extraction, physical extraction with chemical conversion simplifies the technical demand. For continuous operation of heterogeneous catalyzed esterification with physical extraction the Taylor-Couette disc contactor has proven to be applicable.

The calcination of magnesite and dolomite is a state of the art technology step in minerals processing. The concomitantly produced carbon dioxide (CO2) is released into the flue gas, with all its negative effects on the global carbon balance. Reductive calcination of magnesite and dolomite to carbon monoxide (CO) and methane would open a window to reuse CO2 and produce value-added carbonaceous products. The conversion of more than 70 % of the CO2 emitted during reductive calcination of the magnesite content of a mixed magnesite/dolomite (1:1 mol/mol) to CO at moderate temperature is feasible without admixture of catalyst.

The Taylor-Couette disc contactor is a hydrodynamic hybrid of a rotating disc contactor and a Taylor-Couette contactor. For application in reactive bioseparations, this type of liquid-liquid contactor may offer advantageous operation features. This paper summarizes the design characteristics of the Taylor-Couette disc contactor. For hydrodynamic characterization, experimental data of the mean Sauter diameter and dispersed-phase hold-up were compared with results predicted by empirical correlations, which were originally developed for rotating disc contactors. Several correlations were modified for the application on Taylor-Couette disc contactors. Operation characteristics have been deduced from mass-transfer experiments on the pilot-plant scale.

The conversion of mineral magnesite to magnesium oxide, methane, carbon dioxide, and carbon monoxide in a hydrogen atmosphere at ambient pressure and overpressure without catalysts is discussed. Low temperature and elevated pressure facilitate CH4 formation whereas moderate to high temperature and low pressure facilitate CO formation. Methane is formed directly without any additional catalyst. CO2 emissions are decreased substantially in reductive calcination. Additional experiments revealed that reductively calcined magnesium oxide is a highly active reverse water-gas shift catalyst. CO formation from gaseous CO2 and H2 at catalytically active magnesium oxide was reproducibly confirmed. Further reduction of carbon monoxide to methane is not catalyzed by reductively calcined magnesium oxide.