Look AHEAD was a randomized clinical trial designed to examine the long-term health effects of weight loss in overweight and obese individuals with type 2 diabetes. The primary result was that the incidence of cardiovascular events over a median follow up of 9.6 years was not reduced in the intensive lifestyle group relative to the control group. This finding is discussed, with emphasis on its implications for design of clinical trials and clinical treatment of obese people with type 2 diabetes.

We report a paediatric case of suspected shoulder injury related to vaccine administration (SIRVA). A 15-month-old child presented to a paediatric acute care facilty with a 10-day history of localised tenderness and limitation of movement of his right shoulder and arm. Twelve month immunisations had been administered 4 days prior to the onset of initial symptoms. Abnormalities within the shoulder joint were detected on ultrasound and magnetic resonance imaging (MRI). Symptoms resolved with conservative management including non-steroidal anti-inflammatory medication. SIRVA is a rare adverse event following immunisation. SIRVA is thought to occur when a vaccine has been given incorrectly either too high in the deltoid or too deep into the joint space damaging surrounding structures including bursa/tendons and potentially inducing an immune-mediated response locally resulting in pain and restricted movement. 1-4 Following an extensive literature search, SIRVA has not been identified or reported in any other paediatric cases. The risk of SIRVA would be reduced if immunisation