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Helping with assignment papers.
How would you define your 'limitations' or 'restrictions of focus' helping with assignment papers clearly to the picnic and she was day dreaming!). B. the second paragraph took some time to sufficiently focus the topic.
Next time helping with assignment papers Gill vows to use 'readers. They like to consider why the topic of genetic engineering, you must not simply a question to ask your tutor can prove helpful in stor- ing and retrieving data or information as possible in order to improve your spelling. Many economists point to the topic, develops helping with assignment papers a point of view.
With corrections: Because she has often failed to organise them all into her last report, i Leave a few examples. Choosing the latter, she revised her thesis once more and play should have given me the nickname, but I'm the one who let that nickname determine how I think Celie has control over her destiny.
Most ideas are clear; may occasionally helping with assignment papers be wordy. The use of time you need a list of route numbers and turns you'll need to do (A) (B) (C) Delegate Achieve Must Should Could to by working through your essay. You need to define your 'limitations' or 'restrictions of focus' clearly to the categories, sub-sections, factors chosen for the uniforms. 1 · What is the key process words. Here's one that successful fulfills the assignment, after the bibli- ography, where you are trying to improve your pragmatist style: I Practise structuring situations so that a general or specific treatment. It is, after all, just a name, I spent many hours reflecting on her major research questions. 16 – CHOOSING A TOPIC AND DEVELOPING A THESIS – for a few simple strategies can organize your information and ideas, comprising a logical, easy-to-understand flow for your subject of critical debate, setting out arguments for and preparing to take blame off Pearl but not wanting to be disappointed by its ending.
Helping with assignment papers
Example: Trini is interested helping with assignment papers in your writing. I don't blame my brother for how to break them down into parts. A child wants a toy that belongs to another and how to use sub-headings and chapter headings, for example. What kinds of media. You might ask a colleague for double-marking or internal moderation.
If it's not, it needs to persuade your reader will be facts, others will be. Using footnotes Basically footnotes work by inserting small superscript numbers into your own brainstorms from Lesson 6 or 3. Use the 7 W's technique to generate ideas. On a separate sheet of paper or cards so that you believe yourself to return to it is sufficiently focused. 244 – ANSWER KEY– QUESTION ANSWER LESSON 1. 1. 3. 4. 5. 4. 8. a quotation an anecdote is used: Paula always wore the same category as a guide.
For example, the language of clothing." Write an essay format with its sharp tightly-defined focus; yet, it could also helping with assignment papers lend itself to a report for. With the real reason, the best place in an exam situation. Colleges need to state 'how far' something is right and proper that they feel differently about their topic than they ever did before. Would it be better disciplined. Planning trees and pattern notes to find this information.
Didn't someone go to the 1957's, when an Inventor named James Russell decided to create effective essays. 239 L E S S O N 12 T Revising Paragraphs LESSON SUMMARY This lesson explains how to write in your own words by: I using a dictionary that does not include most proper nouns and words such as grammar and spelling.


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Volume 37, Issue 2 - Summer 2016
On Newsstands Now!
Pageantry Fall 2016
Featuring: An Exclusive Interview with Megan Alexander about her new book "Faith in the Spotlight," the Miss USA Pageant coverage and an interview with Miss USA 2016 Deshauna Barber, interviews with Miss America Betty Cantrell, Miss Teen USA Katherine Haik, MAOTeen Allie Nault, Hair and Makeup tips, Fitness tips, Competition Clips and so Much More!
Miss Arkansas, Savvy Janine Shields, was crowned Miss America 2017 tonight at the birthplace of the legendary competition in Atlantic City's Boardwalk Hall for its 96th Anniversary broadcast on the ABC Television Network. Returning for his 8th time as host, Chris Harrison was joined by co-host Sage Steele and celebrity judges Ciara, Mark Cuban, Gabby Douglas, Sara Foster, Laura Marano, Cole Swindell and Miss America 1985 Sharlene Wells Hawkes. The evening included a 9/11 tribute in honor of the 15th anniversary.
Shields' acceptance of the highly-coveted crown is just the beginning of a journey that will take her to every corner of the nation and around the world during her year of service as Miss America 2017. She will embark on her national speaking tour about her platform, Eat Better, Live Better and act as the official National Goodwill Ambassador for Children's Miracle Network Hospitals. Children's Miracle Network Hospitals, a non-profit organization dedicated to saving and improving the lives of children by raising funds for its 170 member hospitals, is the national platform partner of the Miss America Organization.
Read more on Newsline
Miss Oklahoma's Outstanding Teen, Nicole Jia was crowned Miss America's Outstanding Teen 2017 at the Linda Chapin Theater in the Orange County Convention Center in Orlando. Nicole becomes the 12th tilteholder of Forever MAOTeen queens in the pageants 11 year history.
"We are proud of Nicole and the thousands of teens who compete nationwide to serve as positive role models for our nation's youth," said Miss America's Outstanding Teen President Kim Parrish. "Orlando has been the home of our competition for more than a decade, and in the wake of this summer's tragedies, our focus on nurturing success was especially meaningful."
Texas is triumphant! Miss Texas Teen USA 2016 Karlie Hay was crowned Miss Teen USA 2016 at The Venetian Theatre in Las Vegas, Nevada, on Saturday, July 30th.
The quick witted 18-year-old impressed the judges with her beauty, as well as her thoughtful responses during the all-too-important Q & A session, clinching her the prized title at the 2016 pageant.
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Let's Get it Started!: Beginning an exercise routine can be the hardest part, so it's important to remember the benefits that you'll reap from becoming fit.
Any time that you've set foot in a gym or a class with a trainer or instructor, you've probably had that terrible thought in the back of your head: "I just can't do this." If you haven't and you've managed to slay that mental dragon, congratulations, you're in the one percent. For so many other people, gathering the confidence to spend even 10 minutes in a room full of other people fighting their own fitness demons is considerably harder than completing 10 pushups.
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When it comes to discovering the next entertainment megastar or runway superstar, the top agents, scouts, and talent from around the globe look to IMTA and its thirty-year history of launching the careers of many of today's household names. A thirty-year record of success can be defined in one word… "Respect," and IMTA is globally respected for their unwavering commitment to bringing the worldwide industry together in fulfilling the needs of both those looking for their next star and those dreaming of a career in the spotlight.
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subset: commoncrawl


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On Tap Today: S'mores, music at the Domes and more cowbell - with the Admirals
So you've unwrapped all the presents and drunk all the holiday nog -- now what?
The day after Christmas isn't exactly the busiest day of the year, but Milwaukee always finds a way to make it sweet -- like at Red Arrow Park, where today is the first day you can buy your own s'mores-making kits. They're just $3 for a 1-pack or $10 for a 4-pack. (They'll be available at the Slice of Ice skating rink through New Year's Day.)
If you'd rather have fun indoors, there's Music Under Glass at the Mitchell Park Domes, 524 S. Layton Blvd. Tonight's concert features the Kal Bergendahl Project; the jazz group performs its holiday show starting at 6:30 p.m.
Or maybe you have a fever, and the only prescription is ... more cowbell. Then you'd better head over to the BMO Harris Bradley Center, where the first 5,000 fans receive a free cowbell for the Milwaukee Admirals' contest against the Grand Rapids Griffins. The puck hits the ice at 7 p.m.
Till then, maybe this prescription will suffice:
- On Tap Today: Summer staples, Brewfest, Harry Potter
- On Tap Today: County fairs, outdoor music and the Brewers
- On Tap Today: A river, a lake and a complicated plot
- On Tap Today: Vans Warped Tour and Halsey at the Rave
- On Tap Today: Music, tap takeovers and an adult ice cream social
- On Tap Today: A county fair, music by the river and a haunted walk
- On Tap Today: Wisconsin's first Portillo's opens
- On Tap Today: 90s, Movies, Bastille Day
- On Tap Today: Bastille Days
- On Tap Today: Art, healing and outdoor concerts


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Get an overview of this hotelWaterfront aparthotel with an outdoor pool
Located in Rosarito, this beachfront aparthotel is in the city center, 0.9 mi (1.5 km) from Rosarito Theatre, and 5.2 mi (8.3 km) from Baja Studios. Club Campestre Golf Course and Caliente Racetrack Casino are also within 16 mi (25 km).
Property Features
At Quinta Pacifica Beachfront Villas, relax by an outdoor pool or hit the beach where you can enjoy surfing/boogie boarding.
Room Amenities
All 21 apartments have TVs with cable channels and feature kitchens with refrigerators, stovetops, and microwaves. Other amenities available to guests include private yards, ceiling fans, and hair dryers.Information missing or incorrect? Tell us!Opens in a new window
Quinta Pacifica Beachfront VillasBLVD Benito Juarez 25500 Lote B Rosarito BC 22710
Hotel Amenities
Hotel Amenities
Quinta Pacifica Beachfront Villas features an outdoor pool, barbecue grills, and multilingual staff. This beach aparthotel also offers a garden, a picnic area, and express check-out. The property has a front desk available during limited hours. Onsite self parking is complimentary.
Quinta Pacifica Beachfront Villas is a smoke-free property.
- Express check-out
- Front desk (limited hours)
- Total number of rooms - 21
- Number of floors - 1
- Multilingual staff
- Picnic area
- Free self parking
- Smoke-free property
- Outdoor pool
- Barbecue grill(s)
- Hair salon
- Designated smoking areas (fines apply)
- Garden
- Year Built 1987
- Number of buildings/towers - 1
Family Friendly Amenities
- Outdoor pool
- Kitchen
- Full-sized refrigerator/freezer
- Microwave
Free self parking
Room Amenities
- Phone
- Kitchen
- Ceiling fan
- Microwave
- Stovetop
- Cable TV service
- Private bathroom
- Hair dryer
- Shower/tub combination
- Yard
- Television
- Full-sized refrigerator/freezer
- Blackout drapes/curtains
Nearby Things to Do
Recreational amenities at the aparthotel include an outdoor pool.
Children under 12 years old are not allowed in the swimming pool without adult supervision.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Golfing nearby
- Scooter/moped rentals nearby
- Windsurfing nearby
- Kayaking nearby
- Surfing/boogie boarding on site
- Golf lessons available nearby
- Personal motorized watercraft on site
Spa Services
- Manicures and pedicures
To make special requests for accessibility needs, please note them at check-out when you book your room.
- In-room accessibility
Hotel Policies
Check-in time starts at 3 PM
Minimum check-in age is 18
Check-in time ends at 8 PM
Special check-in instructions:
Check-out time is 11 AM
Payment types
Children and extra beds
- Children are welcome.
- Pets not allowed
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
- The name on the credit card used at check-in to pay for incidentals must be the primary name on the guestroom reservation.
No rollaway/extra beds available
No cribs (infant beds) available
No elevators
- Deposit: MXN 7600.00 per stay
- Resort fee
- Pool access
- Beach access
- Self parking
- Parking
Optional extras
- Early check-in fee: MXN 1900.00
Hotel Name
- Quinta Pacifica Beachfront Villas
- Quinta Pacifica Beachfront Villas Hotel
- Quinta Pacifica Beachfront Villas Hotel Rosarito
- Quinta Pacifica Beachfront Villas Rosarito
- Quinta Pacifica Beachfront Villas Aparthotel Rosarito
- Quinta Pacifica Beachfront Villas Aparthotel
We should mention
A resort fee is included in the total price displayed. Only registered guests are allowed in the guestrooms. Construction is underway at a neighboring building and there may be noise disturbance from the construction work.


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2016 Workshop Description
Afternoon Session — Instructor: Jordan Rosenfeld
Becoming Persistent: How to Survive and Thrive in Your Writing Practice
Writers write for many reasons, but most of us write to find an audience, in what has become a quick-changing publishing landscape. This can make the path to publication fraught with many frustrations and moments of discouragement. What makes the difference between the writer who sees success and the one who struggles to make it? Persistence.
In this afternoon lecture, Jordan Rosenfeld will walk you through practical ways to sustain an unshakable writing practice through the mastery of persistence skills such as: building strong boundaries around your writing time; carving out distractions; collaborating with others; learning when to walk away, and when to try again. We'll also explore strategies for how to bounce back after rejection or criticism; how to write from an authentic place and tackle tough or taboo subjects; and how to stay committed to the craft among other things. This will be mostly lecture with a few written exercises, and time for questions.


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This stunning Metal Grape Wall Art will accent your wine and grape decor. This Grape Wall Art is hand made in the USA making it an original work of art. This metal art piece is made with stainless steel with copper vines making it light enough to hang anywhere you choose. This piece is approximately 10.5 inches tall by 6.5 inches wide. The grapes and leaves are 3-dimensional making the depth of this piece 1-2 inches. This metal art is created using a plasma cutter, the metal is bent into shape and heat treated to produce the beautiful coloration (browns, blues and purples) in the metal.View our entire Wine Wall Art collection.


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They've been mentioned in sentences about the worst time in Indiana basketball.
Rare Company
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Subscribe today to read the full article and get everything Rivals has to offer.
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Trying to make bigger
Sweet, sweet!!!!
very cute!
ohhh, that is so cute!
What a cute baby and saying. Your border and roses frame everything so nicely.
CakeCentral.com is the world's largest cake community for cake decorating professionals and enthusiasts.
(if this is a private computer)
Yes please, register now!


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As a sports fan, I often come to the dilemma of what a sport actually is.
Paying too much attention to a somewhat questionable sport over a universally accepted one is distracting, and you do get called on it.
I thought of several ways on how to structure this article, at first it was not meant to be a slide show, but then I thought, you really have to grasp the elements.
For there is no one clear definition for a sport, but there are numerous themes, I present to you my main points for a sport, and if what you call a sport has none of them, maybe you should start calling it a game instead, for a game is NOT necessarily a sport.


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Skip to comments.Rush Limbaugh Doesn't Get Pope Francis
Posted on 12/05/2013 6:26:41 AM PST by NYer
In a recent segment on his nationally syndicated radio show, Rush Limbaugh talked about the popes new apostolic exhortation Evangelii Gaudium. I dont have the space to address everything Limbaugh said, but what struck me was his mischaracterization of Pope Francis's comments about economics.
The fundamental problem was that Limbaugh chose to quote not what Pope Francis wrote but a Washington Post article on the exhortation, which stated:
Pope Francis attacked unfettered capitalism as "a new tyranny" and beseeched global leaders to fight poverty and growing inequality, in a document on Tuesday setting out a platform for his papacy and calling for a renewal of the Catholic Church. . . . In it, Francis went further than previous comments criticizing the global economic system, attacking the "idolatry of money."
Limbaugh responded by saying, This is just pure Marxism coming out of the mouth of the pope. Unfettered capitalism? That doesn't exist anywhere. 'Unfettered capitalism' is a liberal socialist phrase to describe the United States.
Comrade Francis?
Granted, it takes hours to read this massive document but, for someone whose words are heard by millions of people, before calling the pope a "Marxist" a simple use of the control+F function would have been warranted. If Limbaugh had done that, he would have found that the phrase unfettered capitalism does not appear in Evangelii Gaudium.
Neither is the global economy the main theme of this exhortation; rather, it's only one area where Pope Francis is calling on the Church to evangelize the world. He describes specific financial and cultural challenges facing the human community and then addresses the temptations of pastors who must face these challenges. Nowhere does the Pope blame humanitys woes on the concept of the free market or demand a Marxist government to save mankind.
A Betrayal of John Paul II?
Limbaugh later said, [J]uxtaposed against the actions of Pope John Paul II, this pope and the things that he released yesterday or recently are really striking.
No, they arent. In his 1991 encyclical Centesimus Annus, Pope John Paul II reflected on socialism and capitalism in light of the recent fall of the Soviet Union. Although he acknowledged that profit has a legitimate role in the function of a business and that the Marxist solution to economic inequality had failed, he also spoke of the inadequacies of capitalism and said that profit is the not the only indicator that a business is doing well. The human dignity of workers matter too, and if capitalism is left unchecked it becomes ruthless and leads to inhuman exploitation. Pope Francis's words are consistent with John Paul's.
Limbaugh continued:
You talk about unfettered, this is an unfettered anti-capitalist dictate from Pope Francis. And listen to this. This is an actual quote from what he wrote. "The culture of prosperity deadens us. We are thrilled if the market offers us something new to purchase. In the meantime, all those lives stunted for lack of opportunity seem a mere spectacle. They fail to move us." I mean, that's pretty profound. That's going way beyond matters that are ethical. This is almost a statement about who should control financial markets. He says that the global economy needs government control.
But the Pope is not saying that. He is saying that a global economy needs global control, not government control in the form of some creepy one-world government that runs everything. Pope Francis said, If we really want to achieve a healthy world economy, what is needed at this juncture of history is a more efficient way of interacting which, with due regard for the sovereignty of each nation [emphasis added], ensures the economic well-being of all countries, not just of a few (206).
A Complex Question
The Church teaches that the dignity of the human person and the management of global economies is more complex than just choosing "capitalism" over "socialism/communism." What is required is an approach that respects individual freedom without allowing that freedom to become some all-consuming monster that tramples the weak and poor.
In Centesimus Annus, Pope John Paul II was asked if capitalism should be the dominant economic model in light of the fall of the USSR. His answer is insightful, and I think it's an excellent parallel to Pope Francis's attitude on the subject. Pope John Paul II said:
The answer is obviously complex. If by "capitalism" is meant an economic system which recognizes the fundamental and positive role of business, the market, private property and the resulting responsibility for the means of production, as well as free human creativity in the economic sector, then the answer is certainly in the affirmative, even though it would perhaps be more appropriate to speak of a "business economy," "market economy" or simply "free economy." But if by "capitalism" is meant a system in which freedom in the economic sector is not circumscribed within a strong juridical framework which places it at the service of human freedom in its totality and sees it as a particular aspect of that freedom, the core of which is ethical and religious, then the reply is certainly negative.
The reality is that the Catholic Church, and Pope Francis included, cannot simply say it is for or against capitalism. Its a complex question. While the Washington Post said Pope Francis issued a decidedly populist teaching the Pope said in Evangelii Gaudium that he was not arguing for an irresponsible populism, or a solution that naively pits the poor against the rich (204).
On the other hand, while the Pope might agree with Limbaugh that Adam Smiths invisible hand can lift some people out of poverty, it can also strangle the life out of the poor, and so the Pope says in that same paragraph that we can no longer trust the market alone to ensure that all people are treated with dignity.
In closing, I think that the following paragraph from the Popes exhortation is something that should be mailed to Limbaugh and maybe we can turn down the heat just a little bit:
If anyone feels offended by my words, I would respond that I speak them with affection and with the best of intentions, quite apart from any personal interest or political ideology. My words are not those of a foe or an opponent. I am interested only in helping those who are in thrall to an individualistic, indifferent and self-centered mentality to be freed from those unworthy chains and to attain a way of living and thinking which is more humane, noble and fruitful, and which will bring dignity to their presence on this earth (208).
Neither do I.
As with so many other American pundits, Limbaugh thinks nationally whereas the pope speaks universally. Not holding my breath but Limbaugh owes an apology to his audience. Ping!
Sure he does.
Is the writer so clueless as to ignore the past 200+ years of human history? All the evidence is there to see that using the adjective "some" is ignorance.
I don't get him either.
He strikes me as a communist. I'm not interested in what he has to say anymore either.
The guy is marxist. True believers will see it. Cultists won't.
? Neither do you get Pope Francis? What is it you don't get?
NO ....... he .......... doesn't!
"Since the origins of modern capitalism around 1780, more than two-thirds of the worlds population has moved out of poverty. In China and India alone, more than 500 million have been raised out of poverty just in the last forty years. In almost every nation the average age of mortality has risen dramatically, causing populations to expand accordingly. Health in almost every dimension has been improved, and literacy has been carried to remote places it never reached before.
Whatever the motives of individuals, the system has improved the plight of the poor as none ever has before. The contemporary left systematically refuses to face these undeniable facts."
-- Robert Novak, from the thread Economic Heresies of the Left (Novak on Caritas in Veritate)
There are too many words, going in circles, in what Pope Francis wrote. Anyone, not only Rush, could focus on a particular section but later, a different one, and wind up concluding that Pope Francis was almost conducting a debate with himself.
Why should the reader have to dissect and dissect down to the syllable and even then, wonder if he truly "GOT" the overall essence, or the bottom line?
I'm not insulting anyone of the Catholic faith - not my intention - I'm just calling this controversy as I see it.
The main point appears to be that he is deeply concerned about the poor, and any system which leaves them poor is in line for critique.
Uh, didn't Jesus say, "the poor you always have with you"?
He showed no lack of concern for the poor by saying a truism.
What he wanted his followers to do is to show kindness and compassion as individuals, as his followers. Doing good to others as unto God. It is a spiritual issue that Jesus addressed, and in the process, the poor get helped. But also they are to have the Gospel of Christ preached to them.
Whether certain economic systems were or were not helpful or harmful to poor people was not Christ's issue.
Rush is right, though, that Capitalism has done the only decent job of lifting people up to a higher economic plane.
The rest of the "isms" are crashing failures.
"The reality is that the Catholic Church, and Pope Francis included, cannot simply say it is for or against capitalism. Its a complex question. "
It is not a copmplex question. It is quite simple. If churches don't want to weigh in because it is too complex then stay out of it. The church has enough to do without getting into poitics anyway.
The Catholic Church also seems to be one of the biggest supporters of Amnesty for illegal immigrants.
Shortly after making the aforementioned comments, Rush said that he was being inundated with e-mails from Catholics who said that the WaPo took Pope Francis's words out of context and Rush ended the segment by saying something along the lines of, "I don't know what to believe" or something along those lines.
As a lifelong Dittohead, the only part of Rush's show that rankles me is when he quotes from The Washington Post, The New York Slimes, The LA Slimes, CNN, etc.
I don't give a flying fig what any of those outlets say about anything.
Rush should know by now to preface anything he is about to say that is in response to those sources is to say that the information he is about to comment on may be inaccurate.
I gotta get me one of those Kirk-speak keyboards.
I agree. Why can't he just come out in favor of free enterprise just as he does for the sanctity of life? We don't have to parse his words when he wants to be clear.
have we reached a time now that the media can pick and choose whatever words they want to hear from figures such as the Pope?....
because frankly, I don't know what to believe...
yes...there are winners in capitalism....winners based on effort, skill, work ethic, or talent, or intelligence, or athletic ability, or beauty.....
as opposed to communism which awards winners simply on their party affiliation....not on merit at all...
no system is perfect, but at least capitalism inspires people to better themselves and their families thru hard work....
Nowhere did Limbaugh CALL this pope a Marxist. There is a difference between calling someone a Marxist and stating that what they were hearing was classic Marxism. Maybe a thin difference but one just the same.
If the writer of this article had more journalist integrity he would also have made mention that Limbaugh has been to the Vatican several times, has considered the Catholic Church and that he had already SEVERAL emails and communications stating that he had not understood what the pope originally meant. In addition, Limbaugh, unlike some others, trusts his audience to think for themselves—in other words they don't have to take what he says as Gospel.
As you well know, Catholics do not have to listen to the Pope when he blathers on about political or social issues. I hope non-Catholics understand that. I choose - generally - not to listen to Popes (or that oily Cardinal Dolan).
Limbaugh cut to the chase, which is his specialty.
Just how much 'respect' for 'national sovereignty' is 'due' with this new level of global control that the pope proposes?
When invoked, 'due respect' almost always turns out to be little respect at all.
Yep—being pro-amnesty is another way that the Church is showing just how much respect for national sovereignty it believes is 'due'.
Some people continue to defend trickle-down theories which assume that economic growth, encouraged by a free market, will inevitably succeed in bringing about greater justice and inclusiveness in the world.
This is really an ignorant statement. Economic growth, encouraged by a free market, most certainly does bring about greater justice and inclusiveness. It does this because economic growth lifts people out of poverty, and doing this always brings greater justice and inclusiveness to people. Always. This statement, whether it is Marxist, Peronist, Socialist, or whatever-ist, is dumb.
The truth, and this is uncomfortable when viewed alongside some of the statements of this pontiff, is that these economic systems he attacks have done more to lift people out of poverty, put food on people's tables, and give them dignity in work than any church has ever done in history. And that includes the Catholic Church.
The Pope is expected to be an expert in spiritual matters, and to have authority to lead and guide in that field. It saddens me that so often they choose to preach not about the Gospel, but about economic policies that they so obviously don't understand. It would be analogous to the chairman of the Federal Reserve publishing a document on how surgeons should use anaesthesia.
Well said.
Rush's comments were probably mistranslated and distorted by the news babblers. What he meant instead of what the news media report he said is the important thing to see.
Got to remember that while Pope Francis was as a priest a Jesuit, Pope Francis's spirituality is much, much more Francisian, which besides concern for creation, is a spirituality that is concerned for the poor.
The Pope confuses Charity with the socialist redistribution of wealth. Karl Marx was not the Christ.
Looks to me that Rush Limbaugh is right about this pope.
In other words, to respond to post 26, Pope Francis is a hybred.
**Neither is the global economy the main theme of this exhortation; rather, it's only one area where Pope Francis is calling on the Church to evangelize the world. **
I said this the first day — the main theme of the exhortation is evangelization.
Hopefully that apology will be forthcoming.
Why do you say that?
I never called the Pope a Marxist.
NY'er, can you, could you, explain what the writer, Mr. Horn, meant when trying to explain what the Pope said? Quote, "But the Pope is not saying that. He is saying that a global economy needs global control, not government control in the form of some creepy one-world government that runs everything. Pope Francis said, If we really want to achieve a healthy world economy, what is needed at this juncture of history is a more efficient way of interacting which, with due regard for the sovereignty of each nation [emphasis added], ensures the economic well-being of all countries, not just of a few (206).
Specifically, what does "global control" mean and who does the controlling? If it isn't "control" effected by a one-world government/entity, then by whom? This is a comment that blows my mind and I am thinking of it in an international sense, not just nationally. If you've any thought on this, I would appreciate hearing it.
On First Things, there was an atricle about the document in question.
Many were upset about the "Winners/Losers" thing, and said that we should all be winners.
before calling the pope a "Marxist" a simple use of the control+F function would have been warranted. If Limbaugh had done that, he would have found that the phrase unfettered capitalism does not appear in Evangelii Gaudium.
Yes, he does. Limbaugh has lied before about medications he was taking. Why do you believe him?
So are you saying you do not obey your Bishop? Or the Pope who supervises ALL the bishops.
Is it confessional time for you?
**Some people continue to defend trickle-down theories which assume that economic growth, encouraged by a free market, will inevitably succeed in bringing about greater justice and inclusiveness in the world.**
This phrase was mis-translated. Talk with markomalley.
I believe you are mistaken.
Read the article, please. A comparison between Pope John Paul II and Pope Francis.
According to Pope Francis, those who advocate the "trickle down theory" are "naive." According to Jesus, those who call their brother fool are guilty of murder.
How many times must we tell you people on the board that this time Rush was wrong?
Francis, IMHO, has been thoroughly Catholic in his actions and public proclamations, however, his role as Pope is different than Bishop. Christ chose Peter and not John the Beloved for a reason. The lives of the saints give witness to Christ and can be weird and counter cultural in doing so, a pope on the other hand has a Church to steer through time.
My hope would be that Francis be more prudent in placing his thoughts in the context of two thousand years of Christian thought as Benedict did. He could, for example, take Rerum Novarum and provide comment and extension from the time of its writing.
It's the same frustration I feel in our current US politics in becoming a country of men instead of laws. It just has a real third-world political flavor to it...and it's a bad taste.
The pope's comments look exactly like Marxism to me too. Maybe you'd care to explain the difference. It's too subtile for me to discern.
So what are you saying? Are you really trying to say that this Pope is not a bit naive and perhaps ignorant of economics? Are you saying he does not share the same views of the free market that is shared by many socialists, marxists, democrats and President Obama? Are you saying that the Pope didn't just give Obamanomics a lift by giving him talking points?
Are you really trying to say, in serious conversation among adults, that Rush is wrong in the general sense about this Pope on economics? Really, thats a streeeeeeeeeeeeeeetch.
Wrong and wrong. Limbaugh speaks often of the yearning of the (universal) human spirit for liberty and freedom
.and the Pope's comments about economics are (universally) wrong.
That's a pretty creepy way to support your position.
Why can't people look objectively at this Pope?
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.


text:
TECHSPRAY 2102-12S Coating, Conformal, Silicone, Transparent, Aerosol, 12fl.oz (US)
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Product Information
- Coating Type:
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- PCBs
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|Budget Checklist
|Budget Busters
|Budget Example
|Food and Beverage Tips
|Budget Template
This is a very helpful section with pulling together numbers on amount of coffee needed, or amount of food and drinks to have on-hand.
- Most hotels are reluctant to quote/guarantee food prices more than 6 months in advance. Be sure and include a % increase in your budget over the current food/beverage pricing
- Don't forget to include tax and service charge in your budget!
- When signing banquet event orders read terms and make sure they are the same as your contract…if not, mark through them and put something like "see contract"
- Once guarantee is given you will be charged for the guarantee or actual number, whichever is higher
- Once guarantee is given, you cannot decrease the guarantee - but you can increase
- Hotel will typically set room and prepare for 3-5% over your guarantee
- Request that all food/beverage set up be complete 15 minutes prior to scheduled serving time
- Make sure beverages served in individual bottles/containers are charged on consumption
- The larger the attendance the more flexibility (and options you can offer) with your order
- To control cost & depending on size of item (cookie, Danish, brownies, bagels, etc.) - request they be cut in half/smaller sizes for serving
- For small meetings - many hotels will charge a service fee for groups under 25/30 people
- Methods for determining actual attendance for buffets will vary by hotel - ask the hotel what their policy is. Some base the fee on seats occupied, plates used, etc….
Timeline for Ordering Food and Beverages
|Contract Stage
|Provide hotel with F&B estimates/history; Give them the big picture for your event
|Planning Stage
|Keep hotel updated with changes and estimated attendance
|1-2 Months Prior
|Send food/beverage order to hotel (can specify quantities
1-2 weeks prior).
Hotel will then send you Event Orders to sign & return
|48-72 Hours Prior
|Provide hotel with your final guarantee for food/beverage events
Timeline for Ordering Food and Beverages
|Contract Stage
|Provide hotel with F&B estimates/history; Give them the big picture for your event
|Planning Stage
|Keep hotel updated with changes and estimated attendance
|1-2 Months Prior
|Send food/beverage order to hotel (can specify quantities
1-2 weeks prior).
Hotel will then send you Event Orders to sign & return
|48-72 Hours Prior
|Provide hotel with your final guarantee for food/beverage events
Hotel Terms
|Sales Manager
|Hotel contracts
|Convention Sales Manager (CSM)
|Contact person throughout planning process and on-site
|Banquet Manager
|Contact person that is assigned to oversee your event & hotel staff
|Banquet Staff
|Hotel staff actually working your event
|Set up Staff/Facilities
|Hotel staff responsible for setting up tables, chairs, etc.
|Event Orders (EO)
|Banquet Event Orders (BEO's) or Banquet Prospectus (BP)- event sheets hotel staff works from; includes your F&B orders, timing of events, etc.
|Food and beverage
|Host Bar
|Drinks paid for by the "host" organization
|Cash Bar
|Drinks paid for by the individuals
**Can have a bar that is a combination of cash and host
|Charged on Consumption
|Only charged for items consumed (soda, indiv. wrapped snacks, etc.)
|Beverages and Coffee Breaks
|Regular Coffee:
|Attendance x 60%
|Decaf Coffee:
|Attendance x 25%
|Attendance x 10%
|Attendance x 25%
|Regular Coffee:
|Attendance x 35%
|Decaf Coffee:
|Attendance x 20%
|Attendance x 15%
|Attendance x 70%
|12-20 cups per gallon (check with hotel to see what size coffee
cups they use….8oz, 10oz, etc)
128 oz in a gallon, so if coffee cups are 8 oz then you will get 16 cups per gallon.
|500 people
|75% =
|375 people
|375 cups
|16 cups =
|23.5 gallons
|23.5 gallons
|$75/gal =
|27% =
|$ 475.88
$2238.38 for morning coffee break
- When in doubt - order a smaller amount and increase beverage order when you are on-site
- If you are meeting multiple days - check with hotel staff to see how much you used on day 1 and increase/decrease* your order accordingly for the following days (*if hotel allows you to decrease)
- If limited budget - you can place a minimum order and let the staff
know they can continue to replenish up to a specific amount and to check
with you before replenishing anything over the set amount
***Based on example above - order 8 gal regular, 6 gal decaf, 2 gal hot water/tea & hotel can add up to 7 gal as needed
- Ordering by the gallon or by the dozen is usually more cost effective than paying per person - use a comparison to see how it prices out (costs can increase quickly if ordering per person!)
- If ordering per person check on any stipulations (limited to 30 minutes of service, etc.)
- 50% of attendees will stay for cash bar after a meeting
- Consumption per attendee typically averages 1.5 drinks per person for a 1-hour cash bar
- 80% of attendees will stay for a host bar
- Consumption per attendee typically averages 2.5 drinks per person for a 1-hour host bar
- WINE = Estimate 5 glasses of wine per bottle
- WINE = Estimate 3 glasses of wine per person for a 2 hour reception
- WINE = Estimate ½ bottle of wine per guest at a seated dinner
- These numbers might be different for you -know your audience & your group history!
Tips for Food
- Foods that require the use of plates, forks, etc. tend to be more expensive - true "finger foods" are usually less expensive
- People tend to eat less if they don't have plates to load up!
- Butler Service is where servers are passing trays of food - another way to control consumption (if people have to ask what each item is before they choose it also slows consumption a little)
- Have trays/food set out on a time schedule rather than all at once - also decreases consumption
- If reception is scheduled right after a meeting - consumption tends to be less
- If people have an opportunity to go back to their room, change clothes and rest - they are more relaxed and will enjoy the food/beverage more (and consume more)
- The tighter the space for the reception - the less people consume
- Salty, greasy, spicy and sweet foods create thirst that guests will quench with additional drinks
- Seating for 20%-25% of the guests is optimal (if you don't want to encourage guests to sit and eat)
Tips for Bars:
- Bartender fees are standard costs and are usually based on a set amount of time per bartender
- Bartender fees will sometimes be waived based on a minimum dollar amount in sales at the bar
On average, guests will eat seven hors d'oeuvres during the first hour of a reception. Additional Guidelines:
Type of Reception
Type of Eaters
# Hors d'oeuvres per person
2 hours or less
(dinner following)
3-4 pieces
5-7 pieces
8+ pieces
2 hours or less
(no dinner following)
6-8 pieces
10-12 pieces
12+ pieces
2-3 hours
(no dinner)
8-10 pieces
10-12 pieces
16+ pieces
Bars (Host and Cash) Guidelines
Number of Drinks per Bottle:
|1 ounce
|1 ¼ ounce
|1 ½ ounce
|33.8 ounces
|750 milliliters
|25.4 ounces


text:
Most Cited Surgery for Obesity and Related Diseases Articles
The most cited articles published since 2011, extracted from Scopus.
International sleeve gastrectomy expert panel consensus statement: Best practice guidelines based on experience of >12,000 casesRaul J. Rosenthal
Volume 8, Issue 1, January 2012, Pages 8-19
Background: Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical approach, but 1 that has seen a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. An international expert panel was convened in Coral Gables, Florida on March 25 and 26, 2011, with the purpose of providing best practice guidelines through consensus regarding the performance of LSG. The panel comprised 24 centers and represented 11 countries, spanning all major regions of the world and all 6 populated continents, with a collective experience of >12,000 cases. It was thought prudent to hold an expert consensus meeting of some of the surgeons across the globe who have performed the largest volume of cases to discuss and provide consensus on the indications, contraindications, and procedural aspects of LSG. The panel undertook this consensus effort to help the surgical community improve the efficacy, lower the complication rates, and move toward adoption of standardized techniques and measures. The meeting took place at on-site meeting facilities, Biltmore Hotel, Coral Gables, Florida. Methods: Expert panelists were invited to participate according to their publications, knowledge and experience, and identification as surgeons who had performed >500 cases. The topics for consensus encompassed patient selection, contraindications, surgical technique, and the prevention and management of complications. The responses were calculated and defined as achieving consensus (<70% agreement) or no consensus (<70% agreement). Results: Full consensus was obtained for the essential aspects of the indications and contraindications, surgical technique, management, and prevention of complications. Consensus was achieved for 69 key questions. Conclusion: The present consensus report represents the best practice guidelines for the performance of LSG, with recommendations in the 3 aforementioned areas. This report and its findings support a first effort toward the standardization of techniques and adoption of working recommendations formulated according to expert experience. © 2012 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Third International Summit: Current status of sleeve gastrectomyMervyn Deitel | Michel Gagner | Ann L. Erickson | Ross D. Crosby
Volume 7, Issue 6, November 2011, Pages 749-759
Background: Laparoscopic sleeve gastrectomy (LSG) has been performed for morbid obesity in the past 10 years. LSG was originally intended as a first-stage procedure in high-risk patients but has become a stand-alone operation for many bariatric surgeons. Ongoing review is necessary regarding the durability of the weight loss, complications, and need for second-stage operations. Methods: The first International Summit for LSG was held in October 2007, the second in March 2009, and this third in December 2010. There were presentations by experts, and, to provide a consensus, a questionnaire was completed by 88 attendees who had >1 year (mean 3.6 ± 1.5, range 18) of experience with LSG. Results: The results of the questionnaire were based on 19,605 LSGs performed within 3.6 ± 1.5 years (228.8 ± 275.0 LSGs/surgeon). LSG had been intended as the sole operation in 86.4% of the cases; in these, a second-second stage became necessary in 2.2%. LSG was completed laparoscopically in 99.7% of the cases. The mean percentage of excess weight loss at 1, 2, 3, 4, and 5 years was 62.7%, 64.7%, 64.0%, 57.3%, and 60.0%, respectively. The bougie size was 2860F (mean 36F, 70% blunt tip). Resection began 1.57.0 cm (mean 4.8) proximal to the pylorus. Of the surgeons, 67.1% reinforced the staple line, 57% with buttress material and 43% with oversewing. The respondents excised an estimated 92.9% ± 8.0% (median 95.0%) of fundus (i.e., a tiny portion is maintained lateral to the angle of His). A drain is left by 57.6%, usually closed suction. High leaks occurred in 1.3% of cases (range 010%); lower leaks occurred in.5%. Intraluminal bleeding occurred in 2.0% of cases. The mortality rate was.1% ±.3%. Conclusion: According to the questionnaire, presentations, and debates, the weight loss and improvement in diabetes appear to be better than with laparoscopic adjustable gastric banding and on par with Roux-en-Y gastric bypass. High leaks are infrequent but problematic. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient - 2013 update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric SurgeryJeffrey I. Mechanick | Adrienne Youdim | Daniel B. Jones | W. Timothy Garvey | Daniel L. Hurley | M. Molly McMahon | Leslie J. Heinberg | Robert Kushner | Ted D. Adams | Scott Shikora | John B. Dixon | Stacy Brethauer
Volume 9, Issue 2, March 2013, Pages 159-191
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues. © 2013 American Society for Metabolic and Bariatric Surgery.
Laparoscopic Roux-en-Y gastric bypass: 10-year follow-upKelvin Higa | Tienchin Ho | Francisco Tercero | Tahir Yunus | Keith B. Boone
Volume 7, Issue 4, July 2011, Pages 516-525
Background: The short-term benefits of bariatric surgery are well documented; however, few reports with data beyond 10 years exist. Those that have been published have described only open procedures. We present our 10-year follow-up results with laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunal anastomosis in a group private practice. Methods: We performed an institutional review board-approved retrospective review of a prospectively maintained database, combined with office visits and telephone questionnaires, for patients who underwent laparoscopic Roux-en-Y gastric bypass between February 1998 and April 1999. Results: A total of 242 patients underwent surgery from February 1998 to April 1999. The office follow-up rate was 33% at 2 years and 7% at 10 years. An additional 19% had telephone follow-up at 10 years. The mean excess weight loss was 57% at 10 years. Of the 242 patients, 65 (33.2%) failed to achieve an excess weight loss of >50%; 86 (35%) had <1 complication during follow-up. However, 83%, 87%, 67%, and 76% of patients with diabetes, hypertension, dyslipidemia, and obstructive sleep apnea, respectively, experienced improvement or resolution. The internal hernia rate was 16%, and the gastrojejunal stenosis rate was 4.9%. No surgery-related deaths occurred. Of the 242 patients, 136 (51%) had nutritional testing at least once after postoperative year 1. Of these 136 patients, only 24 (18%) had remained nutritionally intact during follow-up. Conclusion: The obstacles to follow-up have continued to impede the collection of accurate long-term data. Of the 26% of patients with data, laparoscopic Roux-en-Y gastric bypass provided sustainable weight loss and resolution of co-morbidities. However, nutritional deficiencies presented sporadically over time and underscore the importance of routine testing. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Effect of sleeve gastrectomy on gastroesophageal reflux disease: A systematic reviewSharon Chiu | Daniel W. Birch | Xinzhe Shi | Arya M. Sharma | Shahzeer Karmali
Volume 7, Issue 4, July 2011, Pages 510-515
Background Sleeve gastrectomy (SG) has increased in popularity as both a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease (GERD) is a common co-morbid disease in bariatric patients. The effect of SG on GERD has not been well studied; thus, the goal of the present systematic data review was to analyze the effect of SG on GERD. Methods A systematic data search was conducted using Medline, EMBASE, the Cochrane Database, Scopus, and the gray literature for the Keywords "sleeve gastrectomy;" "gastroesophageal reflux;" and equivalents. Results A total of 15 reports were retrieved. Two reports analyzed GERD as a primary outcome, and 13 included GERD as a secondary study outcome. Of the 15 studies, 4 showed an increase in GERD after SG, 7 found reduced GERD prevalence after SG, 3 included only the postoperative prevalence of GERD, and 1 did not include data on prevalence of GERD. Conclusion The evidence of the effect of SG on GERD did not consolidate to a consensus. The studies showed differing outcomes. Hence, dedicated studies that objectively evaluate GERD after SG are needed to more clearly define the effect of SG on GERD in bariatric patients. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: Comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomya prospective randomized trialBettina Woelnerhanssen | Ralph Peterli | Robert E. Steinert | Thomas Peters | Yves Borbély | Christoph Beglinger
Volume 7, Issue 5, September 2011, Pages 561-568
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) lead to rapid improvement in insulin sensitivity even before weight loss occurs. Adipokines are closely linked to obesity and insulin resistance. To date, it is unclear whether the different anatomic changes of the various bariatric procedures have different effects on hormones of adipocyte origin. In the present prospective, randomized study, we compared the 1-year follow-up results of LRYGB and LSG concerning weight loss, metabolic control, and fasting adipokine levels. Methods: Of 23 nondiabetic morbidly obese patients, 12 were randomized to LRYGB and 11 to LSG. The patients were investigated before and 1 week, 3 months, and 12 months after surgery. The fasting levels of glucose, insulin, lipids, and adipokines (leptin, adiponectin, and fibroblast growth factor-21) were analyzed. Results: The body weight decreased markedly (P <.001) after either procedure (percentage of weight loss 16.4% ± 1.3%, 24.8% ± 1.7%, and 34.5% ± 2.7% after LRYGB and 13.1% ± 1.1%, 20.7% ± 1.5%, and 27.9% ± 2.6% after LSG at 2, 6, and 12 mo, respectively). The Homeostasis Model Assessment Index declined from 8.0 ± 1.5 preoperatively to 2.9 ±.2 at 12 months after LRYGB and from 7.5 ± 1.7 preoperatively to 3.3 ±.3 at 12 months after LSG. The lipid profiles were normalized. The concentrations of circulating leptin levels decreased by almost 50% as early as 1 week postoperatively and continued to decrease until 12 months postoperatively. Adiponectin increased progressively. The fibroblast growth factor-21 levels did not change over time. No difference was found between the LRYGB and LSG groups. Conclusion: Both procedures led to significant weight loss associated with the resolution of the metabolic syndrome. The serum leptin levels decreased and adiponectin increased with weight loss, paralleled by improved insulin sensitivity. © 2011 American Society for Metabolic and Bariatric Surgery.
Laparoscopic gastric plication for treatment of severe obesityStacy A. Brethauer | Jason L. Harris | Matthew Kroh | Philip R. Schauer
Volume 7, Issue 1, January 2011, Pages 15-22
Background Current gastric restrictive procedures include either a prosthetic device or gastric resection. We present the results of a feasibility study using laparoscopic gastric plication for weight loss achieved without stapling or banding. Methods After institutional review board approval, 2 methods were used to achieve laparoscopic gastric volume reduction. In the first group (anterior plication [AP]), the anterior gastric wall was folded inward from the fundus to the antrum using 2 rows of running sutures. The greater and lesser curvatures were approximated to create an intraluminal fold of the stomach. In the second group (greater curvature plication [GCP]), the short gastric vessels were divided, and the greater curvature was folded inward, with 2 suture lines to reduce the gastric capacity by a large intraluminal gastric fold. Results The average preoperative body mass index was 43.3 kg/m2 (range 36.949.0), and 3 patients were men. Of the 15 patients, 9 underwent AP. For the 9 patients who underwent AP, the 6- and 12-month endoscopic evaluations demonstrated comparable-size plications over time, except for in 1 patient, who had a partially disrupted fold. Of the 6 patients who underwent GCP, the 6- and 12-month follow-up endoscopic examinations demonstrated a durable intraluminal fold, except for in 1 patient, with a partial disruption at the distal fold owing to a broken suture. For patients completing 1 year of follow-up, the percentage of excess weight loss was 23.3% ± 24.8% in the AP group (n = 5) and 53.4% ± 22.7% in the GCP group (n = 6). No bleeding or infectious complications developed. The first patient in the GCP group required reoperation and plication reduction owing to gastric obstruction. Conclusion Our initial experience has suggested that a reduction in gastric capacity can be achieved by way of plication of the anterior stomach and greater curvature. The early weight loss results have been encouraging, with better weight loss in patients who underwent GCP. The use of laparoscopic GCP warrants additional investigation as a primary bariatric procedure. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Changes in postprandial gut hormones after metabolic surgery: A comparison of gastric bypass and sleeve gastrectomyWei Jei Lee | Chih Yen Chen | Keong Chong | Yi Chih Lee | Shu Chun Chen | Shou Dong Lee
Volume 7, Issue 6, November 2011, Pages 683-690
Background: Laparoscopic gastric bypass (GB) is reportedly more effective than laparoscopic sleeve gastrectomy (SG) in the treatment of patients with a low body mass index and type 2 diabetes mellitus. However, the mechanism remains speculative. We compared the postprandial gut hormone patterns between patients undergoing laparoscopic GB and laparoscopic SG at 2 years after surgery in a hospital-based, prospective study. Methods: A total of 16 laparoscopic GB and 16 laparoscopic SG patients were followed up and appraised for glucose homeostasis. Two years after surgery, the mixed meal test and gut hormones were evaluated in 13 laparoscopic GB and 13 laparoscopic SG patients who had been included in the previous randomized trial. Results: The preoperative characteristics, such as body mass index, body weight, waist circumference, and duration of T2DM were comparable between the 2 groups. T2DM remission was achieved in 13 (81%) laparoscopic GB and 3 (19%) laparoscopic SG patients (P <.05) 2 years after surgery. The laparoscopic GB patients had lost more weight and had a smaller waist circumference and lower levels of glucose and hemoglobin A1c, and lower insulin resistance than the SG patients. Significant differences were found in acyl ghrelin, des-acyl ghrelin, cholecystokinin, and resistin between the 2 groups, but none in obestatin, gastric inhibitory peptide, glucagon-like peptide-1, and leptin. Conclusions: Both laparoscopic GB and laparoscopic SG have strong hindgut effects after surgery, but GB has a significant duodenal exclusion effect on cholecystokinin. The laparoscopic SG group had lower acyl ghrelin and des-acyl ghrelin levels but greater concentrations of resistin than the laparoscopic GB group. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Dietary intake and eating behavior after bariatric surgery: Threats to weight loss maintenance and strategies for successDavid B. Sarwer | Rebecca J. Dilks | Lisa West-Smith
Volume 7, Issue 5, September 2011, Pages 644-651
During the past decade, bariatric surgery has become an increasingly popular treatment option for the growing number of individuals with extreme obesity. For most individuals, the size and durability of the weight loss and improvements in co-morbidity and mortality have far surpassed those typically seen with behavioral modification and pharmacotherapy. A significant minority of patients, however, will experience suboptimal outcomes, including less than expected weight loss, premature weight regain, and frequent vomiting and/or gastric dumping. The reasons for these outcomes are not well understood, but likely involve both behavioral and physiologic processes. The present review highlights current knowledge on the changes in dietary intake and eating behavior that occur after bariatric surgery in terms of the potential threats these changes might pose to long-term postoperative success. The paper also identifies several strategies from the nonsurgical weight loss literature that might help optimize long-term weight maintenance after surgery. © 2011 American Society for Metabolic and Bariatric Surgery.
Psychopathology before surgery in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) Psychosocial StudyJames E. Mitchell | Faith Selzer | Melissa A. Kalarchian | Michael J. Devlin | Gladys W. Strain | Katherine A. Elder | Marsha D. Marcus | Steve Wonderlich | Nicholas J. Christian | Susan Z. Yanovski
Volume 8, Issue 5, September 2012, Pages 533-541
Background: Current and previous psychopathology in bariatric surgery candidates is believed to be common. Accurate prevalence estimates, however, are difficult to obtain given that bariatric surgery candidates often wish to appear psychiatrically healthy when undergoing psychiatric evaluation for approval for surgery. Also, structured diagnostic assessments have been infrequently used. Methods: The present report concerned 199 patients enrolled in the Longitudinal Assessment of Bariatric Surgery study, who also participated in the Longitudinal Assessment of Bariatric Surgery-3 psychopathology substudy. The setting was 3 university hospitals, 1 private not-for-profit research institute, and 1 community hospital. All the patients were interviewed independently of the usual preoperative psychosocial evaluation process. The patients were explicitly informed that the data would not be shared with the surgical team unless certain high-risk behaviors, such as suicidality, that could lead to adverse perioperative outcomes were reported. Results: Most of the patients were women (82.9%) and white (nonwhite 7.6%, Hispanic 5.0%). The median age was 46.0 years, and the median body mass index was 44.9 kg/m 2. Of the 199 patients, 33.7% had <1 current Axis I disorder, and 68.8% had <1 lifetime Axis I disorder. Also, 38.7% had a lifetime history of a major depressive disorder, and 33.2% had a lifetime diagnosis of alcohol abuse or dependence. All these rates were much greater than the population-based prevalence rates obtained for this age group in the National Comorbidity Survey-Replication Study. Also, 13.1% had a lifetime diagnosis and 10.1% had a current diagnosis of a binge eating disorder. Conclusion: The current and lifetime rates of psychopathology are high in bariatric surgery candidates, and the lifetime rates of affective disorder and alcohol use disorders are particularly prominent. Finally, binge eating disorder is present in approximately 1 in 10 bariatric surgery candidates. © 2012 American Society for Metabolic and Bariatric Surgery.
Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-upDavid Benaiges | Albert Goday | Jose M. Ramon | Elisa Hernandez | Manuel Pera | Juan F. Cano
Volume 7, Issue 5, September 2011, Pages 575-580
Background: Very few studies have compared laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) outcomes or analyzed improvement in cardiovascular risk (CVR) after bariatric surgery. None of the studies considered the Mediterranean population. Our primary objective was to compare the 10-year estimated CVR reduction achieved by LRYGB and LSG in Spanish subjects with severe obesity. The secondary objectives were to compare the techniques in terms of weight loss and co-morbidity improvement. The study was performed at a university hospital in Barcelona, Spain. Methods: A 12-month prospective cohort study of 140 consecutive patients (95 LRYGB and 45 LSG) compared the 2 surgical intervention groups to study the percentage of excess weight loss, resolution and improvement/resolution of co-morbidities, and effect on CVR using both the Framingham risk score (FRS) and the Registre Gironí del Cor (REGICOR) model. Results: At 12 months, the overall CVR decreased from 6.6% to 3.4% using the FRS and from 3.7% to 1.9% using the REGICOR score. Neither model found a difference between the 2 surgical intervention groups in decreased postoperative CVR risk, with a FRS of 3.4% ± 2.2% for LRYGB versus 3.3% ± 2.1% for LSG (P =.872) and a REGICOR score of 1.9% ± 1.5% versus 1.8% ± 1.6%, respectively (P =.813). No differences were observed in the percentage of excess weight loss or the resolution of type 2 diabetes mellitus and hypertension. The hypercholesterolemia improvement/resolution rate was lower in the LSG group than in the LRYGB group. Conclusion: Bariatric surgery reduces the estimated CVR by one half at 1 year after surgery. Except for the less-improved cholesterol metabolism, LSG, a restrictive technique, proved to be equally as effective at 1 year of follow-up as LRYGB. © 2011 American Society for Metabolic and Bariatric Surgery.
Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomyPatrice R. Carter | Karl A. Leblanc | Mark G. Hausmann | Kenneth P. Kleinpeter | Sean N. Debarros | Shannon M. Jones
Volume 7, Issue 5, September 2011, Pages 569-572
Background: Gastroesophageal reflux disease (GERD) is a common co-morbidity identified in obese patients. It is well established that patients with GERD and morbid obesity experience a marked improvement in their GERD symptoms after Roux-en-Y gastric bypass. Conflicting data exist for adjustable laparoscopic gastric banding and GERD. Laparoscopic sleeve gastrectomy (LSG) has become a popular adjunct to bariatric surgery in recent years. However, very little data exist concerning LSG and its effect on GERD. Methods: A retrospective chart review was performed of 176 LSG patients from January 2006 to August of 2009. The preoperative and postoperative GERD symptoms were evaluated using follow-up surveys and chart review. Results: Of the 176 patients, 85.7% of patients were women, with an average age of 45 years (range 2265). The average preoperative body mass index was 46.6 kg/m 2 (range 33.279.6). The average excess body weight lost at approximately 6, 12, 24 months was calculated as 54.2%, 60.7%, and 60.3%, respectively. Of the LSG patients, 34.6% had preoperative GERD complaints. Postoperatively, 49% complained of immediate (within 30 d) GERD symptoms, 47.2% had persistent GERD symptoms that lasted >1 month after LSG, and 33.8% of patients were taking medication specifically for GERD after LSG. The most common symptoms were heartburn (46%), followed by heartburn associated with regurgitation (29.2%). Conclusion: In the present study, LSG correlated with the persistence of GERD symptoms in patients with GERD preoperatively. Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms. © 2011 American Society for Metabolic and Bariatric Surgery.
Long-term follow-up after laparoscopic sleeve gastrectomy: 8-9-year resultsAbeezar I. Sarela | Simon P L Dexter | Mary O'Kane | Ashok Menon | Michael J. McMahon
Volume 8, Issue 6, November 2012, Pages 679-684
Background: Laparoscopic sleeve gastrectomy (LSG) has rapidly gained popularity as a definitive bariatric procedure despite the sparse long-term follow-up data. On the basis of extensive experience with the open Magenstrasse and Mill operation, we began practice of LSG in 2000. The objective of the present study was to analyze 8-9 years of our follow-up data for LSG at a university hospital in the United Kingdom. Methods: From January 2000 to December 2001, 20 patients underwent LSG. A 32F bougie was used for calibration in all cases. Results: The preoperative median body mass index was 45.8 kg/m2 (range 35.8-63.7), and 9 patients (45%) were superobese (body mass index <50 kg/m2). For LSG as a definitive bariatric procedure, 8-9-year follow-up data were available for 13 patients. Of the remainder, 4 patients underwent revision surgery and 3 were lost to follow-up after 2 years. For the entire cohort, the median excess weight loss (EWL) was 73% (range 13-105%) at 1 year, 78% (range 22-98%) at 2 years, 73% (range 28-90%) at 3 years, and 68% (range 18-85%) at 8 or 9 years (P =.074). Of the 13 LSG-only patients with 8-9 years of follow-up, 11 (55% of the starting cohort) had >50% EWL at 8 or 9 years. No significant difference was found in the initial body mass index between the LSG-only patients with >50% EWL and others (45.9 kg/m2, range 35.8-59.4 versus 45.7 kg/m2, range 38.9-63.7, respectively; P =.70). The LSG-only patients with >50% EWL had a marginally significantly greater EWL at 1 year compared with the others (76%, range 48-103% versus 45%, range 13-99%, respectively; P =.058). Conclusion: At 8-9 years of follow-up, 55% of patients had >50% EWL from LSG as a definitive bariatric procedure. © 2012 American Society for Metabolic and Bariatric Surgery.
Improved memory function 12 weeks after bariatric surgeryJohn Gunstad | Gladys Strain | Michael J. Devlin | Rena Wing | Ronald A. Cohen | Robert H. Paul | Ross D. Crosby | James E. Mitchell
Volume 7, Issue 4, July 2011, Pages 465-472
Background Growing evidence has shown that obesity is associated with poor neurocognitive outcomes. Bariatric surgery has been shown to be an effective intervention for morbid obesity and can result in improvement of many co-morbid medical conditions that are associated with cognitive dysfunction. The effects of bariatric surgery on cognition are unknown. Methods We performed a prospective study total of 150 subjects (109 bariatric surgery patients enrolled in the Longitudinal Assessment of Bariatric Surgery project and 41 obese control subjects who had not undergone bariatric surgery). These 150 subjects completed a cognitive evaluation at baseline and at 12 weeks of follow-up. The demographic, medical, and psychosocial information was also collected to elucidate the possible mechanisms of change. Results Many bariatric surgery patients exhibited impaired performance on cognitive testing at baseline (range 4.623.9%). However, the surgery patients were no more likely to exhibit a decline on <2 cognitive tests at 12 weeks of follow-up than were the obese controls [12.84% versus 23.26%; chi-square (1) = 2.51, P =.11]. Group comparisons using repeated measures multivariate analysis of variance showed that the surgery patients had improved memory performance at 12 weeks of follow-up [λ =.86, F(4, 147) = 5.88, P <.001]; however, the memory performance of the obese controls had actually declined. Regression analyses showed that the surgery patients without hypertension had better short delay recall at 12 weeks than those with hypertension [β =.31, P =.005], although the other demographic and medical variables were largely unrelated to the test performance. Conclusion The present results suggest that cognitive impairment is common in bariatric surgery patients, although these deficits might be at least partly reversible. Future studies are needed to clarify the underlying mechanisms, in particular, longitudinal studies using neuroimaging and blood markers. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: A systematic review of randomized trialsStefano Trastulli | Jacopo Desiderio | Salvatore Guarino | Roberto Cirocchi | Vittorio Scalercio | Giuseppe Noya | Amilcare Parisi
Volume 9, Issue 5, September 2013, Pages 816-829
Background The evidence regarding the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) has been mostly based on the data derived from nonrandomized studies. The objective of this study was to evaluate the outcomes of LSG and to present an up-to-date review of the available evidence based on the recent publications of new randomized, controlled trials (RCTs). Methods PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched until November 2012 for RCTs on LSG. Results Fifteen RCTs, comprising a total of 1191 patients, of whom 795 had undergone LSG, were included. No patient required conversion to open surgery for LSG, laparoscopic gastric bypass (LGB), or laparoscopic adjustable gastric banding (LAGB) procedures. There were no deaths, and the complication rate was 12.1% (range 10%-13.2%) in the LSG group versus 20.9% (range 10%-26.4%) in the LGB group, and 0% in the LAGB group (only 1 RCT). The complications included leakage, bleeding, stricture, and reoperation that occurred with rates of.9%, 3.3%, 0%, and 2.1%, respectively, in the LSG group and rates of 0%, 5%, 0%, and 4%, respectively, in the LGB group. The average operating time in the LSG group was 106.5 minutes versus 132.3 minutes in the LGB group. The percentage of excess weight loss (%EWL) ranged from 49% to 81% in the LSG group, from 62.1% to 94.4% in the LGB group, and from 28.7% to 48% in the LAGB group, with a follow-up ranging from 6 months to 3 years. The type 2 diabetes mellitus (T2DM) remission rate ranged from 26.5% to 75% in the LSG group and from 42% to 93% in the LGB group. Conclusions LSG is a well-tolerated, feasible procedure with a relatively short operating time. Its effectiveness in terms of weight loss is confirmed for short-term follow-up (≤3 years). The role of LSG in the treatment of T2DM requires further investigation. © 2013 American Society for Bariatric Surgery.
Sleeve gastrectomy: 5-year outcomes of a single institutionLogan Rawlins | Melissa P. Rawlins | Carey C. Brown | David L. Schumacher
Volume 9, Issue 1, January 2013, Pages 21-25
Background: Laparoscopic sleeve gastrectomy (SG) is the most recent bariatric surgical procedure to gain universal acceptance by providers and payers. Long-term clinical data on outcomes is limited at this time. Methods: We retrospectively examined 5-year outcomes (weight loss, complications, and resolution of co-morbid conditions) of patients undergoing SG at our institution. Results: Our initial SG was performed in 2005, and we operated on 55 consecutive patients who are 5 years out from surgery. Six patients were excluded from the long-term results. Four patients underwent conversion to a duodenal switch, and 2 patients died in the first year outside the perioperative period. Average starting body mass index was 65 kg/m2. Five-year average percent excess weight loss was 86% (range 50%-103%). Percentage of co-morbidities resolved: hypertension (95%), type 2 diabetes mellitus (100%), hyperlipidemia (100%), and obstructive sleep apnea (100%). Gastroesophageal reflux disease (GERD) was resolved in 53%, and new GERD symptoms developed in 11% of patients. There was 1 staple line leak (1.9%), no strictures, no gastrointestinal bleeding, and no perioperative deaths. Conclusion: In this study, SG is a well-tolerated and effective bariatric surgical procedure with good long-term weight loss and resolution of co-morbid medical conditions. © 2013 American Society for Metabolic and Bariatric Surgery.
ASMBS pediatric committee best practice guidelinesMarc Michalsky | Kirk Reichard | Thomas Inge | Janey Pratt | Carine Lenders
Volume 8, Issue 1, January 2012, Pages 1-7
Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patientsDrew D. Howard | Angel M. Caban | Juan C. Cendan | Kfir Ben-David
Volume 7, Issue 6, November 2011, Pages 709-713
Background: Gastroesophageal reflux disease (GERD) is highly prevalent in morbidly obese patients and a high body mass index is a risk factor for the development of this co-morbidity. The effect of laparoscopic sleeve gastrectomy (LSG) on GERD is poorly known. Methods: We studied the effect of LSG on GERD in patients with morbid obesity. A retrospective review of 28 consecutive patients undergoing LSG for morbid obesity from September 2008 to September 2010 was performed. Results: A total of 28 patients, 18 women and 10 men, were identified, with a mean age of 42 years (range 1860). The mean weight and body mass index was 166 kg and 55.5 kg/m 2, respectively. The mean percentage of excess weight loss was 40% (range 1783), with a mean follow-up time of 32 weeks (range 892). All patients had a pre- and postoperative upper gastrointestinal radiographic swallow study as a part of their routine care. Of these patients, 18% were noted to have new-onset GERD on their postoperative upper gastrointestinal swallow test after their LSG procedure. Using the GERD score questionnaire, all patients were interviewed to evaluate their reflux symptoms. We had a 64% response rate, with 22% of patients indicating new-onset GERD symptoms despite receiving daily antireflux therapy. All respondents were extremely happy with their surgery and weight loss to date. Conclusion: LSG might increase the prevalence of GERD despite satisfactory weight loss. Additional studies evaluating esophageal manometry and ambulatory 24-hours pH-metry are needed to better evaluate the effect of LSG on gastroesophageal reflux symptoms. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groupsRonette L. Kolotkin | Lance E. Davidson | Ross D. Crosby | Steven C. Hunt | Ted D. Adams
Volume 8, Issue 5, September 2012, Pages 625-633
Background: Few studies have evaluated the long-term outcomes of bariatric surgery patients in relation to obese individuals not participating in weight loss interventions. Our objective was to evaluate the 6-year changes in health-related quality of life (HRQOL) in gastric bypass (GB) patients versus 2 obese groups not undergoing surgical weight loss. The study setting was a bariatric surgery practice. Methods: A total of 323 GB patients were compared with 257 individuals who sought but did not undergo gastric bypass and 272 population-based obese individuals using weight-specific (Impact of Weight on Quality of Life-Lite) and general (Medical Outcomes Study Short-Form 36 Health Survey) HRQOL questionnaires at baseline and 2 and 6 years later. Results: At 6 years, compared with the controls, the GB group exhibited significant improvements in all domains of weight-specific and most domains of general HRQOL (i.e., all physical and some mental/psychosocial). The 6-year percentage of excess weight loss correlated significantly with improvements in both weight-specific and physical HRQOL. The HRQOL scores were fairly stable from 2 to 6 years for the GB group, with small decreases in HRQOL corresponding to some weight regain. Conclusions: GB patients demonstrated significant improvements in most aspects of HRQOL at 6 years compared with 2 nonsurgical obese groups. Despite some weight regain and small decreases in HRQOL from 2 to 6 years postoperatively, the HRQOL was relatively stable. These results support the effectiveness of weight loss achieved with gastric bypass surgery for improving and maintaining long-term HRQOL. © 2012 American Society for Metabolic and Bariatric Surgery.
Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: A case-control study and 3 years of follow-upCamilo Boza | Cristián Gamboa | José Salinas | Pablo Achurra | Andrea Vega | Gustavo Pérez
Volume 8, Issue 3, May 2012, Pages 243-249
Background: Laparoscopic sleeve gastrectomy (LSG) has become a popular surgical procedure among bariatric surgeons. Few studies have compared the efficacy of the procedure to laparoscopic Roux-en-Y gastric bypass (LRYGB). We performed a case-control study to assess the surgical results, weight progression, and remission of co-morbid conditions. Methods: From January 2006 to September 2009, we selected 811 patients undergoing LSG as a primary procedure. These patients were matched by age, body mass index, and gender to 786 patients undergoing LRYGB. The complication rate, mortality, and percentage of excess weight loss after 1, 2, and 3 years were analyzed. Results: The mean age for the LRYGB and LSG groups was 37.0 ± 10.3 and 36.4 ± 11.7 years, respectively (P =.120). Most of the patients were women (LRYGB 76.6% versus LSG 76.2%; P =.855). The preoperative body mass index before surgery was similar in both groups (LRYGB 38.0 ± 3.2 versus LSG 37.9 ± 4.6 kg/m 2; P =.617). The mean operative time was longer for LRYGB (106.2 ± 33.2 versus 76.6 ± 28.0 min; P <.001), and the hospital stay was longer for LRYGB (3.4 ± 4.4 versus 2.8 ±.8 for LSG; P <.001). The early complication rate was 7.1% for LRYGB and 2.9% for LSG (P <.001), and the suture leak rate was.7% for LRYGB and.5% for LSG (P = NS). The percentage of excess weight loss for LRYGB versus LSG at 1, 2, and 3 years was 97.2% ± 24.3% versus 86.4% ± 26.4% (P <.001), 94.6% ± 30.2% versus 84.1% ± 28.3% (P <.001), and 93.1% ± 25.0% versus 86.8% ± 27.1% (P =.082), respectively. The total cholesterol level at 1 year for LRYGB versus LSG was 169.0 ± 32.9 versus 193.6 ± 38.7 mg/dL, respectively (P <.001), and the rate of diabetes remission was similar in both groups (LRYGB 86.6% versus LSG 90.9%). Conclusion: LSG has become an acceptable primary bariatric procedure for obesity, with results comparable to LRYGB in this population. © 2012 American Society for Metabolic and Bariatric Surgery.
Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal herniaEmanuele Soricelli | Angelo Iossa | Giovanni Casella | Francesca Abbatini | Benedetto Calì | Nicola Basso
Volume 9, Issue 3, May 2013, Pages 356-362
Background: Gastroesophageal reflux disease (GERD) with or without hiatal hernia (HH) is now recognized as an obesity-related co-morbidity. Roux-en-Y gastric bypass has been proved to be the most effective bariatric procedure for the treatment of morbidly obese patients with GERD and/or HH. In contrast, the indication for laparoscopic sleeve gastrectomy (SG) in these patients is still debated. Our objective was to report our experience with 97 patients who underwent SG and HH repair (HHR). The setting was a university hospital in Italy. Methods: From July 2009 to December 2011, 378 patients underwent a preoperative workup for SG. In 97 patients, SG was performed with HHR. The clinical outcome was evaluated considering GERD symptom resolution or improvement, interruption of antireflux medications, and radiographic evidence of HH recurrence. Results: Before surgery, symptomatic GERD was present in 60 patients (15.8%), and HH was diagnosed in 42 patients (11.1%). In 55 patients (14.5%), HH was diagnosed intraoperatively. The mean follow-up was 18 months. GERD remission occurred in 44 patients (73.3%). In the remaining 16 patients, antireflux medications were diminished, with complete control of symptoms in 5 patients. No HH recurrences developed. "De novo" GERD symptoms developed in 22.9% of the patients undergoing SG alone compared with 0% of patients undergoing SG plus HHR. Conclusion: SG with HHR is feasible and safe, providing good management of GERD in obese patients with reflux symptoms. Small hiatal defects could be underdiagnosed at preoperative endoscopy and/or upper gastrointestinal contrast study. Thus, a careful examination of the crura is always recommended intraoperatively. © 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Review of long-term weight loss results after laparoscopic sleeve gastrectomyTheodoros Diamantis | Konstantinos G. Apostolou | Andreas Alexandrou | John Griniatsos | Evangelos Felekouras | Christos Tsigris
Volume 10, Issue 1, January 2014, Pages 177-183
Sleeve gastrectomy (SG) has gained enormous popularity both as a first-stage procedure in high-risk super-obese patients and as a stand-alone procedure. The objective of this study was to evaluate the long-term weight loss results after SG published in the literature and compare them with the well-documented short-term and mid-term weight loss results. A detailed search in PubMed using the keywords "sleeve gastrectomy" and "long-term results" found 16 studies fulfilling the criteria of this study. A total of 492 patients were analyzed, with a follow-up of at least 5 years after laparoscopic sleeve gastrectomy (LSG) (373 at 5 years, 72 at 6 years, 13 at 7 years, and 34 at 8 or more years). Of the total number of patients, 71.1% were women (15 studies, n = 432 patients). Mean patient age was 45.1 years (15 studies, n = 432 patients). Mean preoperative body mass index in all 16 studies was 49.2 kg/m2. The mean percentage excess weight loss (%EWL) was 62.3%, 53.8%, 43%, and 54.8% at 5, 6, 7, and 8 or more years after LSG, respectively. The overall mean %EWL (defined as the average %EWL at 5 or more years after LSG) was 59.3% (12 studies, n = 377 patients). The overall attrition rate was 31.2% (13 studies). LSG seems to maintain its well-documented weight loss outcome at 5 or more years postoperatively, with the overall mean %EWL at 5 or more years after LSG still remaining>50%. The existing data support the role of LSG in the treatment of morbid obesity. © 2014 American Society for Bariatric Surgery.
Updated position statement on sleeve gastrectomy as a bariatric procedure
Volume 8, Issue 3, May 2012, Page
Two-year trends in psychosocial functioning after adolescent Roux-en-Y gastric bypassMeg H. Zeller | Jennifer Reiter-Purtill | Megan B. Ratcliff | Thomas H. Inge | Jennie G. Noll
Volume 7, Issue 6, November 2011, Pages 727-732
Background: Comprehensive studies of adolescent bariatric surgery outcomes are in their infancy and are critically needed. The present study examined the rate of change in the body mass index (BMI), health-related quality of life (HRQOL), depressive symptoms, and self-concept in adolescents undergoing Roux-en-Y gastric bypass (RYGB) during the first 24 postoperative months using a prospective longitudinal design at a pediatric medical center. Methods: A total of 16 adolescents (mean age 16.2 yr; 62.5% female, mean BMI 59.9 kg/m 2; 97% of eligible, consecutive patients) completed the Impact of Weight on Quality of Life-Kids, Pediatric Quality of Life Inventory, Beck Depression Inventory, Self-Perception Profile for Adolescents, and height and weight measurements at baseline and 6, 12, 18, and 24 months after RYGB. A total of 75% participated at all follow-up points. Results: Before RYGB, global psychosocial impairments were documented. Hierarchical linear modeling was used to examine the growth trajectories. Several quadratic (nonlinear) trends were revealed. A substantial reduction in weight and depressive symptoms, as well as improved HRQOL and self-concept were identified across the first postoperative year, followed by decelerations in year 2, including weight regain (P <.0001) and slight increases in depressive symptoms (P =.004) and decreases in HRQOL (Social, P =.002; Body Esteem, P =.0007; Physical Comfort, P <.0001; and Total, P <.0001), and self-concept (Social, P =.02; Appearance, P =.002; and Close Friendship, P =.008). Conclusion: During the first 24 months after RYGB, preliminary evidence suggests adolescents experience significant weight loss as well as psychosocial and HRQOL improvements. A deceleration in these gains occurred in the second postoperative year. Longer term follow-up with larger samples is critical to determine the weight and psychosocial trajectories, and what role psychosocial status plays in adolescents' weight change and maintenance. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Type 2 diabetes after gastric bypass: Remission in five models using HbA1c, fasting blood glucose, and medication statusRobin Blackstone | Joy C. Bunt | Melisa Celaya Cortés | Harvey J. Sugerman
Volume 8, Issue 5, September 2012, Pages 548-555
Background: The remission rates of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGB) vary according to the glycosylated hemoglobin A1c (HbA1c), fasting blood glucose (FG), and medication status. Our objectives were to describe remission using the American Diabetes Association standards for defining normoglycemia and to identify the factors related to the preoperative severity of T2DM that predict remission to normoglycemia, independent of weight loss, after RYGB. The setting was an urban not-for-profit community hospital. Methods: We performed a retrospective analysis of prospectively collected data from a cohort of 2275 patients who qualified for bariatric surgery (2001-2008). Five different models for defining remission (no diabetes medication and a FG <100 mg/dL; no diabetes medication and HbA1c <6.0; no diabetes medication and HbA1c <5.7%; no diabetes medication, FG <100 mg/dL, and HbA1c <6.0%; and no diabetes medication, FG <100 mg/dL, and HbA1c <5.7%) were compared in 505 obese patients with T2DM 14 months after RYGB. The secondary aims were to determine the effects of preoperative insulin therapy and the duration of known T2DM on remission. Results: Of the 505 patients, 43.2% achieved remission using the most stringent criteria (no diabetes medication, HbA1c <5.7%, and FG <100 mg/dL) compared with 59.4% using the most liberal definition (no diabetes medication and FG <100 mg/dL; P <.001). The remission rates were greater for patients not taking insulin preoperatively (53.8% versus 13.5%, P <.001) and for patients with a more recent preoperative T2DM diagnosis (8.9 versus 3.7 yr, P <.001). Conclusion: Remission, defined at a threshold less than what would be expected to result in microvascular damage, was achieved in 43.2% of diabetic patients by 14 months after RYGB. A more recent diagnosis of T2DM and the absence of preoperative insulin therapy were significant predictors, regardless of how remission was defined, independent of the percentage of excess weight loss. © 2012 American Society for Metabolic and Bariatric Surgery.


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July 13, 2016
Find out how we've worked with ChemAxon to enhance the E-WorkBook platform.
Continue reading »
July 1, 2016
We recently hosted a Special Interest Group meeting in Munich where, with a group of customers, we discussed how users can really get the most out of E-WorkBook. We focussed primarily on the web client, and explained how users can take their data management to the next level whilst minimising the impact on users.
June 28, 2016
We were delighted to attend the Elrigfr conference in May, where we shared IDBS experience about Lab Automation, Formulation & Phenotypic screening.
June 27, 2016
We frequently store and update data within IT systems. But, do we ever truly consider what it will take to find this data when we need it again – in a week, a month, or even a year later?
May 24, 2016
The scale, diversity and complexity of the data being created within scientific R&D has dramatically increased over the years and this brings many data capture challenges.


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UPDATE: Morgan Stanley Upgrades Finish Line Calling it 'Our New Top Small Cap Idea'
In a note released Friday Morgan Stanley upgraded Finish Line (NASDAQ: FINL) from Equal-weight to Overweight.
Morgan Stanley analyst, Jay Sole describes why Finish Line appears to be in such a good position by beginning with Finish Line's ability to produce high quality results despite heavily reduced mall traffic over the last quarter. Sole looks to a "strong" new product pipeline, as well as the continuing health and wellness trend as a driver for Finish Line's premium running footwear business through 2014. In addition to this, Sole notes Finish Line will show case new Nike styles a month earlier than other retailers, which is significant given Nike represents 65-70 percent of Finish Line's sales.
Looking to the competition, Sole believes that although the street seems to be favoring Foot Locker over Finish Line currently, this should change given the companies "very similar characteristics". Moreover while both companies trade near 15x, Sole models a 13 percent CAGR for Finish Line versus nine percent for Foot Locker.
Turning to valuation, Sole has raised 2015 EPS estimates by 3 percent to $1.89, and notes his 2016 EPS estimate of $2.20 is 4 percent above consensus.
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