Classic Anglo-European definitions of tourism as recreational travel have hindered more nuanced locally-grounded understandings of travel phenomena elsewhere in the world. Moreover, contemporary ...global labor and educational mobility have produced novel travel forms and behaviors that straddle the Western categories of "tourist" and "migrant." The purpose of this analysis is to examine Toraja (Indonesia) perspectives on travel which can be instructive for correcting the binary divides between tourism and migration that have long plagued dominant Western models of travel. Drawing from data culled from long-term qualitative fieldwork and online research, I convey three ethnographically-grounded stories of Toraja migrants on return visits to their homeland in order to destabilize Western-centrism in tourism studies. Research findings underscore contemporary travel understandings and practices that do not fit neatly with Western mutually exclusive categories of "tourism" and "migration." These Toraja practices encompass local historical patterns of travel for experiential/financial enrichment (merantau), migration and tourism. This study also advances tourism scholarship by highlighting the importance of local knowledge and demonstrating the value of ethnographic storytelling as a scholarly strategy for destabilizing orthodox Western-centric theoretical understands of tourism. The global significance of this place-based research is that tourism studies can be enriched by widening our lenses to also consider emigrants on return visits to their homelands.
Objective
The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American ...Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists.
Methods
Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.
Results
New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).
Conclusions
Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
Art as Politics Adams, Kathleen M
2006, 2006., 20060831, 20060101, Letnik:
2
eBook
Art as Politics explores the intersection of art, identity politics, and tourism in Sulawesi, Indonesia. Based on long-term ethnographic research from the 1980s to the present, the book offers a ...nuanced portrayal of the Sa’dan Toraja, a predominantly Christian minority group in the world’s most populous Muslim country. Celebrated in anthropological and tourism literatures for their spectacular traditional houses, sculpted effigies of the dead, and pageantry-filled funeral rituals, the Toraja have entered an era of accelerated engagement with the global economy marked by on-going struggles over identity, religion, and social relations. In her engaging account, Kathleen Adams chronicles how various Toraja individuals and groups have drawn upon artistically-embellished "traditional" objects—as well as monumental displays, museums, UNESCO ideas about "word heritage," and the World Wide Web—to shore up or realign aspects of a cultural heritage perceived to be under threat. She also considers how outsiders—be they tourists, art collectors, members of rival ethnic groups, or government officials—have appropriated and reframed Toraja art objects for their own purposes. Her account illustrates how art can serve as a catalyst in identity politics, especially in the context of tourism and social upheaval. Ultimately, this insightful work prompts readers to rethink persistent and pernicious popular assumptions—that tourism invariably brings a loss of agency to local communities or that tourist art is a compromised form of expression. Art as Politics promises to be a favorite with students and scholars of anthropology, sociology, cultural studies, ethnic relations, art, and Asian studies.
The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of ...Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists.
Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.
New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).
Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
= hemoglobin A1c;
= American Association of Clinical Endocrinologists;
= adiposity-based chronic disease;
= American College of Endocrinology;
= American Diabetes Association;
= Apnea-Hypopnea Index;
= American Society of Anesthesiologists;
= American Society of Metabolic and Bariatric Surgery;
= body mass index;
= biliopancreatic diversion;
= biliopancreatic diversion with duodenal switch;
= confidence interval;
= continuous positive airway pressure;
= clinical practice guideline;
= C-reactive protein;
= computed tomography;
= cardiovascular disease;
= dysglycemia-based chronic disease;
= duodenal switch;
= deep venous thrombosis;
= dual-energy X-ray absorptiometry;
= essential fatty acid;
= evidence level;
= enteral nutrition;
= enhanced recovery after bariatric surgery;
= U.S. Food and Drug Administration;
= Guidelines for Guidelines;
= gastroesophageal reflux disease;
= gastrointestinal;
= health-care professional(s);
= hypertension;
= intensive care unit;
= intragastric balloon(s);
= intravenous;
= laparoscopic adjustable gastric band;
= laparoscopic adjustable gastric banded plication;
= laparoscopic greater curvature (gastric) plication;
= laparoscopic Roux-en-Y gastric bypass;
= laparoscopic sleeve gastrectomy;
= metabolic syndrome;
= nonalcoholic fatty liver disease;
= nonalcoholic steatohepatitis;
= nonsteroidal anti-inflammatory drug;
= osteoarthritis;
= one-anastomosis gastric bypass;
= Obesity Medicine Association;
= odds ratio;
= obesity-related complication(s);
= obstructive sleep apnea;
= pulmonary embolism;
= parenteral nutrition;
= pulmonary recruitment maneuver;
= randomized controlled trial;
= registered dietician;
= recommended daily allowance;
= Roux-en-Y gastric bypass;
= sleeve gastrectomy;
= small intestinal bacterial overgrowth;
= The Obesity Society;
= thyroid-stimulating hormone;
= type 1 diabetes;
= type 2 diabetes;
= venous thromboembolism;
= Wernicke encephalopathy;
= World Health Organization.
Objective: The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American ...Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results: New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic ...and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists.
Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.
New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).
Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
Drug resistance and relapse remain key challenges in pancreatic cancer. Here, we have used RNA sequencing (RNA-seq), chromatin immunoprecipitation (ChIP)-seq, and genome-wide CRISPR analysis to map ...the molecular dependencies of pancreatic cancer stem cells, highly therapy-resistant cells that preferentially drive tumorigenesis and progression. This integrated genomic approach revealed an unexpected utilization of immuno-regulatory signals by pancreatic cancer epithelial cells. In particular, the nuclear hormone receptor retinoic-acid-receptor-related orphan receptor gamma (RORγ), known to drive inflammation and T cell differentiation, was upregulated during pancreatic cancer progression, and its genetic or pharmacologic inhibition led to a striking defect in pancreatic cancer growth and a marked improvement in survival. Further, a large-scale retrospective analysis in patients revealed that RORγ expression may predict pancreatic cancer aggressiveness, as it positively correlated with advanced disease and metastasis. Collectively, these data identify an orthogonal co-option of immuno-regulatory signals by pancreatic cancer stem cells, suggesting that autoimmune drugs should be evaluated as novel treatment strategies for pancreatic cancer patients.
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•Map of PDAC dependencies using RNA-seq, ChIP-seq, and genome-wide CRISPR screening•Expression and direct utilization of cytokine and immune signals in PDAC stem cells•Nuclear hormone receptor RORγ regulates mouse and human pancreatic cancer•Pharmacologic blockade of RORγ reduces tumor burden and improves survival
Pancreatic cancer stem cells co-opt immuno-regulatory pathways, a vulnerability that could be exploited therapeutically by agents currently in trials for autoimmune diseases.
The small GTPase RAP1 is critical for platelet activation and thrombus formation. RAP1 activity in platelets is controlled by the GEF CalDAG-GEFI and an unknown regulator that operates downstream of ...the adenosine diphosphate (ADP) receptor, P2Y12, a target of antithrombotic therapy. Here, we provide evidence that the GAP, RASA3, inhibits platelet activation and provides a link between P2Y12 and activation of the RAP1 signaling pathway. In mice, reduced expression of RASA3 led to premature platelet activation and markedly reduced the life span of circulating platelets. The increased platelet turnover and the resulting thrombocytopenia were reversed by concomitant deletion of the gene encoding CalDAG-GEFI. Rasa3 mutant platelets were hyperresponsive to agonist stimulation, both in vitro and in vivo. Moreover, activation of Rasa3 mutant platelets occurred independently of ADP feedback signaling and was insensitive to inhibitors of P2Y12 or PI3 kinase. Together, our results indicate that RASA3 ensures that circulating platelets remain quiescent by restraining CalDAG-GEFI/RAP1 signaling and suggest that P2Y12 signaling is required to inhibit RASA3 and enable sustained RAP1-dependent platelet activation and thrombus formation at sites of vascular injury. These findings provide insight into the antithrombotic effect of P2Y12 inhibitors and may lead to improved diagnosis and treatment of platelet-related disorders.
While tourism scholars have sought to problematize the unevenly distributed impacts of the COVID-19 pandemic, we know much less about how resilience is cultivated among tourism practitioners and ...communities whose lives and livelihoods are have been placed in limbo. Drawing on literature at the intersection of critical tourism studies and resilience theory as well as interviews with local tourism practitioners and academics, four historically situated and place-based trends in Southeast Asia that are reshaping tourism in the region are outlined: livelihood diversification, ecosystem regeneration, cultural revitalization, and domestic tourism development. These trends highlight how the political economy of tourism in the region has both challenged and facilitated opportunities for reshaping the industry in (post-) pandemic times. These interconnected trends should not be understood in silo but rather as historically rooted and place-based experiences. The examples of resilience among Southeast Asian residents presented in the article demonstrate that local individuals and communities are active agents in resilience. While the concept of resilience has been applied widely by scholars from multiple disciplines during the COVID-19 pandemic, a critical tourism studies approach to resilience theory accounts for the historically situated nuances of local scale dynamics and their relationship to macro-level processes. Rather than simply focusing on the pandemic's sudden transformative effects, practices of resilience in Southeast Asia reflect ongoing political-economic and cultural shifts that have often been underway in the region for several decades. The conclusion identifies several policy implications and future directions for tourism research in (post-) pandemic times.
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