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 (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.
Inledning I denna studie undersöker vi hur förskollärare använder barnlitteraturen med fokus på genus. Böcker är ett material som speglar samhället, därför är det intressant att se hur förskollärare ...reflekterar kring böckers innehåll. Vår studie kommer dels beröra hur förskollärarna förhåller sig till de stereotypa respektive normkritiska böckerna, och dels hur de anser att barnen påverkas av litteraturen. Syfte Denna forskningsstudie gör vi med syfte att undersöka hur förskollärare använder barnlitteratur som redskap, i arbetet med genuspedagogik. Metod Studien grundar sig på en kvalitativ undersökning med intervju som insamlingsmetod. Urvalsgruppen består av sex deltagare fördelat på tre förskolor. Dessa förskolor är litteratur profilerade vilket innebär att ett aktivt arbete med barnlitteraturen sker. En litteratur certifierad förskola är diplomerad för sitt arbete att väva in litteraturen i den dagliga verksamheten. Resultat I resultatet framgick det att förskollärarna gärna ville arbeta med genuspedagogik i koppling till böcker, men att det bara utförs under spontana sammanhang på grund av brist på resurser. Några förskollärare var fullt medvetna vid de genuspedagogiska tankesätten medan andra inte var riktigt lika medvetna och medgav att de oftare bör reflektera över sitt handlande. Vi kunde också se skillnader mellan stora- och småbarnsavdelningarna, där tankesätten kring genuspedagogik frångick varandra.
The Cold Pool is a subsurface layer with water temperatures below 2 °C that is formed in the eastern Bering Sea. This oceanographic feature of relatively cooler bottom temperature impacts zooplankton ...and forage fish dynamics, driving different energetic pathways dependent upon Bering Sea climatic regime. Odontocetes echolocate to find prey, so tracking foraging vocalizations acoustically provides information to understand the implications of climate change on Cold Pool variability influencing regional food web processes. Vocal foraging dynamics of ice-associated and seasonally migrant marine mammal species suggest that sperm whales spend more time searching for prey in warm years when the Cold Pool is reduced but are more successful at capturing prey during cold years when the Cold Pool is stronger. Beluga whale foraging vocal activity was relatively consistent across climate regimes but peaked during the warm regime. Killer whale foraging vocal activity peaked in both warm and cold regimes with indicators of different ecotypes exploiting changing prey conditions across climate regimes. Foraging activity of odontocete apex predators may serve as a sentinel indicator of future ecosystem change related to prey availability that is linked to a diminishing Cold Pool as water temperatures rise and seasonal sea ice decreases due to climate change.
Decades of work in rodents suggest that movement is a powerful driver of hippocampal low-frequency “theta” oscillations. Puzzlingly, such movement-related theta increases in primates are less ...sustained and of lower frequency, leading to questions about their functional relevance. Verbal memory encoding and retrieval lead to robust increases in low-frequency oscillations in humans, and one possibility is that memory might be a stronger driver of hippocampal theta oscillations in humans than navigation. Here, neurosurgical patients navigated routes and then immediately mentally simulated the same routes while undergoing intracranial recordings. We found that mentally simulating the same route that was just navigated elicited oscillations that were of greater power, higher frequency, and longer duration than those involving navigation. Our findings suggest that memory is a more potent driver of human hippocampal theta oscillations than navigation, supporting models of internally generated theta oscillations in the human hippocampus.
•The 3–12 Hz hippocampal “theta” oscillation in rodents is related to movement and linked to navigation•Yet, theta oscillations are also observed in humans during verbal memory processing•Here, we tested whether navigation or memory was the primary driver of human theta•Results showed greater prevalence of human hippocampal theta during memory
Low-frequency “theta” oscillations are strongly linked to movement in the rodent hippocampus but are more transient in humans. By directly comparing the prevalence of human hippocampal theta oscillations during navigation and episodic simulation, Seger et al. show that memory is the primary driver of human hippocampal theta oscillations.
Primary immunodeficiency diseases (PIDs) are a genetically heterogeneous group of disorders that affect distinct components of the innate and adaptive immune system, such as neutrophils, macrophages, ...dendritic cells, complement proteins, natural killer cells, and T and B lymphocytes. The study of these diseases has provided essential insights into the functioning of the immune system. More than 120 distinct genes have been identified, whose abnormalities account for more than 150 different forms of PID. The complexity of the genetic, immunologic, and clinical features of PID has prompted the need for their classification, with the ultimate goal of facilitating diagnosis and treatment. To serve this goal, an international committee of experts has met every 2 years since 1970. In its last meeting in Jackson Hole, Wyo, after 3 days of intense scientific presentations and discussions, the committee has updated the classification of PID, as reported in this article.