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OBJECTIVE: The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS: The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS: This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS: This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.

Spinal cord injuries lead to impairment of the central regulation of respiratory muscle activity. This impairs the cough response, which can increase the risk of complications if infected with coronavirus disease 2019. This case describes a 32-yr-old man with an acute traumatic motor incomplete spinal cord injury, C4 American Spinal cord Injury Association Impairment Scale D D, in an inpatient rehabilitation facility who presented with only a fever. Initial infectious workup was negative, and he continued to have elevated temperatures with no other symptoms. He was then tested for coronavirus disease 2019 and found to be positive. This is the first documented case that identifies this potentially lethal disease in an acute motor incomplete spinal cord injury in an inpatient rehabilitation setting. We further discuss how physiatrists need to be aware of milder presentation of coronavirus disease 2019 in patients with spinal cord injuries. Inability to recognize this disease can lead to delayed diagnosis and asymptomatic spread in an inpatient rehabilitation setting.

The theory of finite-rank perturbations allows for the determination of spectral information for broad classes of operators using the tools of analytic function theory. In this work, finite-rank perturbations are applied to powers of the derivative operator, providing a full account from self-adjoint boundary conditions to computing aspects of the operators' matrix-valued spectral measures. In particular, the support and weights of the Clark (spectral) measures are computed via the connection between matrix-valued contractive analytic functions and matrix-valued nonnegative measures through the Herglotz Representation Theorem. For operators associated with several powers of the derivative, explicit formulae for these measures are included. While eigenfunctions and eigenvalues for these operators with fixed boundary conditions can often be computed using direct methods from ordinary differential equations, this approach provides a more complete picture of the spectral information.

We show that all self-adjoint extensions of semi-bounded Sturm--Liouville operators with general limit-circle endpoint(s) can be obtained via an additive singular form bounded self-adjoint perturbation of rank equal to the deficiency indices, say $d\in\{1,2\}$. This characterization generalizes the well-known analog for semi-bounded Sturm--Liouville operators with regular endpoints. Explicitly, every self-adjoint extension of the minimal operator can be written as \begin{align*} \boldsymbol{A}_\Theta=\boldsymbol{A}_0+{\bf B}\Theta{\bf B}^*, \end{align*} where $\boldsymbol{A}_0$ is a distinguished self-adjoint extension and $\Theta$ is a self-adjoint linear relation in $\mathbb{C}^d$. The perturbation is singular in the sense that it does not belong to the underlying Hilbert space but is form bounded with respect to $\boldsymbol{A}_0$, i.e. it belongs to $\mathcal{H}_{-1}(\boldsymbol{A}_0)$. The construction of a boundary triple and compatible boundary pair for the symmetric operator ensure that the perturbation is well-defined and self-adjoint extensions are in a one-to-one correspondence with self-adjoint relations $\Theta$. As an example, self-adjoint extensions of the classical symmetric Jacobi differential equation (which has two limit-circle endpoints) are obtained and their spectra are analyzed with tools both from the theory of boundary triples and perturbation theory., Comment: 29 pages, 1 figure

This study investigated the evolution of physical and technical performances in the English Premier League (EPL), with special reference to league ranking. Match performance observations (n = 14,700) were collected using a multiple-camera computerised tracking system across seven consecutive EPL seasons (2006–07 to 2012–13). Final league rankings were classified into Tiers: (A) 1st–4th ranking (n = 2519), (B) 5th–8th ranking (n = 2965), (C) 9th–14th ranking (n = 4448) and (D) 15th–20th ranking (n = 4768). Teams in Tier B demonstrated moderate increases in high-intensity running distance while in ball possession from the 2006–07 to 2012–13 season (P < 0.001; effect size [ES]: 0.68), with Tiers A, C and D producing less pronounced increases across the same period (P < 0.005; ES: 0.26, 0.41 and 0.33, respectively). Large increases in sprint distance were observed from the 2006–07 to 2012–13 season for Tier B (P < 0.001; ES: 1.21), while only moderate increases were evident for Tiers A, C and D (P < 0.001; ES: 0.75, 0.97 and 0.84, respectively). Tier B demonstrated large increases in the number of passes performed and received in 2012–13 compared to 2006–07 (P < 0.001; ES: 1.32–1.53) with small-to-moderate increases in Tier A (P < 0.001; ES: 0.30–0.38), Tier C (P < 0.001; ES: 0.46–0.54) and Tier D (P < 0.001; ES: 0.69–0.87). The demarcation line between 4th (bottom of Tier A) and 5th ranking (top of Tier B) in the 2006–07 season was 8 points, but this decreased to just a single point in the 2012–13 season. The data demonstrate that physical and technical performances have evolved more in Tier B than any other Tier in the EPL and could indicate a narrowing of the performance gap between the top two Tiers.

The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs).Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols.The Executive Summary of this document contains 87 recommendations of which 45 are Grade A (51.7%), 18 are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D. These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world medical care. The evidence base presented in the subsequent Appendix provides relevant supporting information for Executive Summary Recommendations. This update contains 695 citations of which 203 (29.2 %) are EL 1 (strong), 137 (19.7%) are EL 2 (intermediate), 119 (17.1%) are EL 3 (weak), and 236 (34.0%) are EL 4 (no clinical evidence).This CPG is a practical tool that endocrinologists, other health care professionals, health-related organizations, and regulatory bodies can use to reduce the risks and consequences of dyslipidemia. It provides guidance on screening, risk assessment, and treatment recommendations for a range of individuals with various lipid disorders. The recommendations emphasize the importance of treating low-density lipoprotein cholesterol (LDL-C) in some individuals to lower goals than previously endorsed and support the measurement of coronary artery calcium scores and inflammatory markers to help stratify risk. Special consideration is given to individuals with diabetes, familial hypercholesterolemia, women, and youth with dyslipidemia. Both clinical and cost-effectiveness data are provided to support treatment decisions.4S = Scandinavian Simvastatin Survival Study A1C = glycated hemoglobin AACE = American Association of Clinical Endocrinologists AAP = American Academy of Pediatrics ACC = American College of Cardiology ACE = American College of Endocrinology ACS = acute coronary syndrome ADMIT = Arterial Disease Multiple Intervention Trial ADVENT = Assessment of Diabetes Control and Evaluation of the Efficacy of Niaspan Trial AFCAPS/TexCAPS = Air Force/Texas Coronary Atherosclerosis Prevention Study AHA = American Heart Association AHRQ = Agency for Healthcare Research and Quality AIM-HIGH = Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides trial ASCVD = atherosclerotic cardiovascular disease ATP = Adult Treatment Panel apo = apolipoprotein BEL = best evidence level BIP = Bezafibrate Infarction Prevention trial BMI = body mass index CABG = coronary artery bypass graft CAC = coronary artery calcification CARDS = Collaborative Atorvastatin Diabetes Study CDP = Coronary Drug Project trial CI = confidence interval CIMT = carotid intimal media thickness CKD = chronic kidney disease CPG(s) = clinical practice guideline(s) CRP = C-reactive protein CTT = Cholesterol Treatment Trialists CV = cerebrovascular CVA = cerebrovascular accident EL = evidence level FH = familial hypercholesterolemia FIELD = Secondary Endpoints from the Fenofibrate Intervention and Event Lowering in Diabetes trial FOURIER = Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects With Elevated Risk trial HATS = HDL-Atherosclerosis Treatment Study HDL-C = high-density lipoprotein cholesterol HeFH = heterozygous familial hypercholesterolemia HHS = Helsinki Heart Study HIV = human immunodeficiency virus HoFH = homozygous familial hypercholesterolemia HPS = Heart Protection Study HPS2-THRIVE = Treatment of HDL to Reduce the Incidence of Vascular Events trial HR = hazard ratio HRT = hormone replacement therapy hsCRP = high-sensitivity CRP IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial IRAS = Insulin Resistance Atherosclerosis Study JUPITER = Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin LDL-C = low-density lipoprotein cholesterol Lp-PLA2 = lipoprotein-associated phospholipase A2 MACE = major cardiovascular events MESA = Multi-Ethnic Study of Atherosclerosis MetS = metabolic syndrome MI = myocardial infarction MRFIT = Multiple Risk Factor Intervention Trial NCEP = National Cholesterol Education Program NHLBI = National Heart, Lung, and Blood Institute PCOS = polycystic ovary syndrome PCSK9 = proprotein convertase subtilisin/kexin type 9 Post CABG = Post Coronary Artery Bypass Graft trial PROSPER = Prospective Study of Pravastatin in the Elderly at Risk trial QALY = quality-adjusted life-year ROC = receiver-operator characteristic SOC = standard of care SHARP = Study of Heart and Renal Protection T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus TG = triglycerides TNT = Treating to New Targets trial VA-HIT = Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial VLDL-C = very low-density lipoprotein cholesterol WHI = Women's Health Initiative.

Objectives: The aim of this study was to examine the evolution of physical and technical performances in elite soccer. Design: Retrospective study. Methods: Soccer match performance observations (n=14700) collected using a multiple-camera computerized tracking system over seven seasons and controlled for season, phase of season, position and standard were analysed for emergent trends. Results: Total distance covered during a match was ~2% lower in 2006-07 compared to 2012-13. Across seven seasons, high-intensity running distance increased by ~30% (890±299 vs 1151 ± 337 m, p0.6), whereas the number of long passes varied little between seasons (p

Purpose: To investigate match-to-match variability of physical and technical performances in English Premier League players and quantify the influence of positional and contextual factors. Methods: Match data (N = 451) were collected using a multicamera computerized tracking system across multiple seasons (2005–06 to 2012–13). The coefficient of variation (CV) was calculated from match to match for physical and technical performances in selected positions across different match contexts (location, standard, and result). Results: Wide midfielders demonstrated the greatest CVs for total distance (4.9% ± 5.9%) and central midfielders the smallest (3.6% ± 2.0%); nevertheless, all positions exhibited CVs P > .05, effect size [ES] 0.1–0.3). Central defenders demonstrated the greatest CVs and wide midfielders the lowest for both high-intensity running (20.2% ± 8.8% and 13.7% ± 7.7%, P < .05, ES 0.4–0.8) and sprint distance (32.3% ± 13.8% and 22.6% ± 11.2%, P < .05, ES 0.5–0.8). Technical indicators such as tackles (83.7% ± 42.3%), possessions won (47.2% ± 27.9%), and interceptions (59.1% ± 37.3%) illustrated substantial variability for attackers compared with all other positions (P < .05, ES 0.4–1.1). Central defenders demonstrated large variability for the number of times tackled per match (144.9% ± 58.3%) and passes attempted and received compared with other positions (39.2% ± 17.5% and 46.9% ± 20.2%, P < .001, ES 0.6–1.8). Contextual factors had limited impact on the variability of physical and technical parameters. Conclusions: The data demonstrate that technical parameters varied more from match to match than physical parameters. Defensive players (fullbacks and central defenders) displayed higher CVs for offensive technical variables, while attacking players (attackers and wide midfielders) exhibited higher CVs for defensive technical variables. Physical and technical performances are variable per se regardless of context.

In ITER, each heating neutral beam injector (HNB) will deliver about 16.5 MW heating power by accelerating a 40 A deuterium negative ion beam up to the energy of 1 MeV. The ions are generated inside a caesiated negative ion source, where the injected H2/D2 is ionized by a radio frequency electromagnetic field. The SPIDER test bed, currently being manufactured, is going to be the ion source test facility for the full size ion source of the HNBs and of the diagnostic neutral beam injector of ITER. The SPIDER beam source comprises an ion source with 8 radio-frequency drivers and a three-grid system, providing an overall acceleration up to energies of about 100 keV [1]. SPIDER represents a substantial step forward between the half ITER size ion source, which is currently being tested at the ELISE test bed in IPP-Garching, and the negative ion sources to be used on ITER, in terms of layout, dimensions and operating parameters. The SPIDER beam source will be housed inside a vacuum vessel which will be equipped with a beam dump and a graphite diagnostic calorimeter. The manufacturing design of the main parts of the SPIDER beam source has been completed and many of the tests on the prototypes have been successfully passed. The most complex parts, from the manufacturing point of view, of the ion source and the accelerator, developed by galvanic deposition of copper are being manufactured. The manufacturing phase will be completed within 2015, when the assembly of the device will start at the PRIMA site, in Padova (I). The paper describes the status of the procurement, the adaptations operated on the design of the beam source for the fabrication, with particular emphasis to the engineering development to enable the fulfillment of the tight requirements set in the technical specifications. Moreover the tests performed on the prototypes are reported.

The relative contribution of serologic screening and nucleic acid testing (NAT) to prevent hepatitis C virus (HCV) transmission has not been rigorously addressed.Twenty-one blood organizations in seven geographical regions performing individual-donation (ID)-NAT in parallel with anti-HCV screening provided data from 10,897,105 donations to establish HCV infection rates in first-time, lapsed, and repeat donations. Screening efficacy was modeled for: anti-HCV alone, HCV antigen/antibody (combo), minipool (MP)-NAT in pools of 8 and 16 with anti-HCV, ID-NAT and anti-HCV, and ID-NAT alone. Probabilities of infectivity for red blood cell transfusions were estimated as 100% from window period (WP) and concordant HCV RNA/antibody-positive (concordantly positive [CP]) donations and 0.028% from anti-HCV-positive and RNA-negative probable resolved (PR) donations.There were 5146 confirmed infections (30 WP, 3827 CP, and 1289 PR). Infection rates and transmission risks varied substantially across regions and by donation status. Residual risk with ID-NAT and serology screening was estimated at one in 250,000 in Egypt and at one in 10,000,000 in other regions combined; risk would increase to one in 7300 and one in 312,000, respectively, if NAT had not been performed. ID-NAT with or without anti-HCV testing showed higher efficacy than either MP-NAT or combo assays, particularly in lapsed or repeat donors in whom 99.2, 98.5, and 93.2% of infectious donations were estimated to be interdicted by these respective testing strategies.The incremental efficacy of anti-HCV testing when ID- NAT screening is performed was minimal, particularly for screening lapsed and repeat donations.

This study aimed to investigate position-specific evolution of physical and technical performance parameters in the English Premier League (EPL). Match performance observations (n = 14700) were collected using a multiple-camera computerized tracking system across seven seasons (2006–07 to 2012–13). Data were analyzed relative to five playing positions: central defenders (n = 3792), full backs (n = 3420), central midfielders (n = 3200), wide midfielders (n = 2136) and attackers (n = 2152). High-intensity running distance increased in the final season versus the first season in all playing positions (p < .05, ES: 0.9–1.3) with full backs displaying the greatest increase (∼36% higher in 2012–13). Similar trends were observed for sprint distance with full backs demonstrating the most pronounced increase across the seven seasons (36–63%, p < .001, ES: 0.8–1.3). Central players (central defenders and midfielders) illustrated the most pronounced increases in total passes and pass success rate (p < .05, ES: 0.7–0.9) whilst wide players (full backs and wide midfielders) demonstrated only small-moderate increases in total passes and pass success rate (p < .05, ES: 0.6–0.8). The data demonstrates that evolving tactics in the EPL have impacted on the physical demands of wide players and the technical requirements of central players. These findings could be used for talent identification or position-specific physical and technical training.

While urinary tract infections (UTIs) are often suspected on the basis of clinical symptoms and the finding of pyuria on urinalysis, the documentation of a bacterial UTI is based on the significant growth ofa uropathogen on an agar medium incubated at 35-37 degrees C. The recommended length of time for incubation has ranged from 24 to 48 hours. We present a case of a UTI associated with the slow-growing, gram-negative organism, Oligella ureolytica which was finally documented after incubation of an agar medium for more than 48 hours.

It is well established nowadays the benefits that physical activity can have on the health of individuals. Walking is considered a fundamental method of movement and using a backpack is a common and economical manner of carrying load weight. Nevertheless, the shock wave produced by the impact forces when carrying a backpack can have detrimental effects on health status. Therefore, the aim of this study was to investigate differences in the accelerations placed on males and females whilst carrying different loads when walking. Twenty nine sports science students (16 males and 13 females) participated in the study under 3 different conditions: no weight, 10% and 20% body weight (BW) added in a backpack. Accelerometers were attached to the right shank and the centre of the forehead. Results showed that males have lower accelerations than females both in the head (2.62 ± 0.43G compared to 2.83 + 0.47G) and shank (1.37 ± 0.14G compared to 1.52 ± 0.15G; p0.05). The body acts as a natural shock absorber, reducing the amount of force that transmits through the body between the foot (impact point) and head. Anthropometric and body mass distribution differences between males and females may result in women receiving greater impact acceleration compared to men when the same load is carried.

This paper aims to provide a composite sketch of the executive utilization of information technologies and its relation to agencies' use of such technologies in state and local government organizations in Arizona. The data were collected through mail surveys by a group of faculty members and graduate students at the School of Public Affairs, Arizona State University. The findings show that (1) regardless of their functional managerial responsibilities, executives surveyed in the study all reported involvement in decision making concerning information technology acquisition and management; (2) organizations that enjoy a higher level of information technology use tend to have managers who have positive attitudes toward information technology (IT); (3) executives' personal familiarity (personal use of) with information technology has only limited correlation with the organizations' technology adoption and use; (4) executives' attitudes toward, and personal involvement in, information technology, are directly related to their educational background and age. The paper concludes that positively shaped attitudes toward information technology on the part of public organization managers are essential in determining public organizations' technological innovation and service provision. Such attitudes do not grow with age, but are obtainable by way of education.

Explores the issues of health gain and the importance of rigorous assessment of existing services in terms of true health gain before instituting change. Notes that much health gain has already been achieved and that this must be recognized before overzealous and enthusiastic action is instituted to create untested change. Health gain has not arison de novo from the latest reforms but may be being used as a means of justifying rationing. The key problem is that what is technically possible exceeds what is economically affordable. The only way of tackling the enormity of the existing problem is to address the agenda in a co‐ordinated fashion and to avoid prejudicing positive change through a process of rigorous assessment.

The Pilgrimage of Grace broke out in October 1536, affecting most of the north and raising nine armies manned by 50,000 men. Its threat to march on London extracted from the government a pardon for every rebel and the promise of a parliament at York to consider its grievances. It saw itself as a rising of the commons. Each army was the commons militant; its leaders were called captains of the commons; its manifestos were issued with ‘the consent of the commons’; its oath was ‘to be true to God, the king and the commons’; its cause was seen as ‘the business of the commons’; its complaints were described as ‘the griefs of the commons’; the 24 articles it submitted to the government were referred to as ‘the commons’ petition’; and those resisting the uprising were regarded as ‘traitors to the commons’. ‘Commons’ was the cry to raise revolt: not ‘Dacre, a Dacre’, not comrades, goodfellows, neighbours, brothers, liegemen. The term meant commonalty, not community, and designated that level of society below the gentlemen and the clergy.2.

This paper describes the results of the first implementation of multidisciplinary design optimisation (MDO) techniques by undergraduates ina design course. The objective of the work was to design a civilian transport aircraft of the Boeing 777 class. The first half of the two semester design course consisted of application of traditional sizing methods and techniques to form a baseline aircraft. MDO techniques were then applied to this baseline design. This paper describes the evolution of the design with special emphasis on the application of MDO techniques, and presents the results of four iterations through the design space. Minimization of take-off gross weight was the goal of the optimization process. The resultant aircraft derived from the MDO procedure weighed approximately 13,382 lbs (2.57 percent) less than the baseline aircraft.

This study investigated the longitudinal match performance characteristics in the English Premier League\ud (EPL), with special reference to player nationality (UK vs. non-UK). Match observations (n = 14700) were\ud 10 collected using a multi-camera computerised tracking system across 7 consecutive EPL seasons (2006–2007 to\ud 2012–2013). Player nationality referred to their birthplace, with players born in England, Scotland, Wales or\ud Northern Ireland classified as the UK players and other nationalities considered non-UK. The non-UK players\ud demonstrated the most pronounced increases in high-intensity running distance across the 7 seasons\ud compared with UK players (P < 0.001, ES: 0.91 vs. 0.73). The UK players covered more high-intensity running\ud 15 distance in 2006–2007 (P < 0.001, ES: 0.24 [CI 0.17–0.31]), however by 2012–2013 both populations covered\ud similar distances (P > 0.05, ES: 0.08 [CI 0.01–0.15]). In contrast, the non-UK players performed more passes in\ud 2006–2007 compared with the UK players (P < 0.001, ES: 0.23 [CI 0.16–0.3]), however by 2012–2013, passing\ud performance between the UK and non-UK players was equal (P > 0.05, ES: 0.05 [CI −0.01–0.13]). The data\ud demonstrates that the longitudinal match performance characteristics in the EPL are similar between the UK\ud 20 and non-UK populations.