Role of the exercise professional in metabolic and bariatric surgery.

BACKGROUND: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. OBJECTIVES: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? SETTING: Clinical and academic exercise settings worldwide. METHODS: This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. RESULTS: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and postoperative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". CONCLUSIONS: The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.

How does humidity data impact land surface modeling of hydrothermal regimes at a permafrost site in Utqiagvik, Alaska?

Humidity is a basic and crucial meteorological indicator commonly measured in several forms, including specific humidity, relative humidity, and absolute humidity. These different forms can be inter-derived based on the saturation vapor pressure (SVP). In past decades, dozens of formulae have been developed to calculate the SVP with respect to, and in equilibrium with, liquid water and solid ice surfaces, but many prior studies use a single function for all temperature ranges, without considering the distinction between over the liquid water and ice surfaces. These different approaches can result in humidity estimates that may impact our understanding of surface-subsurface thermal-hydrological dynamics in cold regions. In this study, we compared the relative humidity (RH) downloaded and calculated from four data sources in Alaska based on five commonly used SVP formulas. These RHs, along with other meteorological indicators, were then used to drive physics-rich land surface models at a permafrost-affected site. We found that higher values of RH (up to 40 %) were obtained if the SVP was calculated with the over-ice formulation when air temperatures were below freezing, which could lead to a 30 % maximum difference in snow depths. The choice of whether to separately calculate the SVP over an ice surface in winter also produced a significant range (up to 0.2 m) in simulated annual maximum thaw depths. The sensitivity of seasonal thaw depth to the formulation of SVP increases with the rainfall rate and the height of above-ground ponded water, while it diminishes with warmer air temperatures. These results show that RH variations based on the calculation of SVP with or without over-ice calculation meaningfully impact physically-based predictions of snow depth, sublimation, soil temperature, and active layer thickness. Under particular conditions, when severe flooding (inundation) and cool air temperatures are present, care should be taken to evaluate how humidity data is estimated for land surface and earth system modeling.

Role of the exercise professional in metabolic and bariatric surgery.

Background: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. Objectives: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? Setting: Clinical and academic exercise settings worldwide. Methods: This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. Results: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being: supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and post-operative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". Conclusions: The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.

High-resolution mapping of spatial heterogeneity in ice wedge polygon geomorphology near Prudhoe Bay, Alaska.

It is well known that microtopography associated with ice wedge polygons drives pronounced, meter-scale spatial gradients in hydrologic and ecological processes on the tundra. However, high-resolution maps of polygonal geomorphology are rarely available, due to the complexity and subtlety of ice wedge polygon relief at landscape scales. Here we present a sub-meter resolution map of >106 discrete ice wedge polygons across a ~1200 km2 landscape, delineated within a lidar-derived digital elevation model. The delineation procedure relies on a convolutional neural network paired with a set of common image processing operations and permits explicit measurement of relative elevation at the center of each ice wedge polygon. The resulting map visualizes meter- to kilometer-scale spatial gradients in polygonal geomorphology across an extensive landscape with unprecedented detail. This high-resolution inventory of polygonal geomorphology provides rich spatial context for extrapolating observations of environmental processes across the landscape. The map also represents an extensive baseline dataset for quantifying contemporary land surface deformation (i.e., thermokarst) at the survey area, through future topographic surveys.

Impacts from above-ground activities in the eagle ford shale play on landscapes and hydrologic flows, La Salle County, Texas.

We assess the spatial and geomorphic fragmentation from the recent Eagle Ford Shale play in La Salle County, Texas, USA. Wells and pipelines were overlaid onto base maps of land cover, soil properties, vegetation assemblages, and hydrologic units. Changes to continuity of different ecoregions and supporting landscapes were assessed using the Landscape Fragmentation Tool (a third-party ArcGIS extension) as quantified by land area and continuity of core landscape areas (i.e., those degraded by "edge effects"). Results show decreases in core areas (8.7%; ~33,290 ha) and increases in landscape patches (0.2%; ~640 ha), edges (1.8%; ~6940 ha), and perforated areas (4.2%; ~16230 ha). Pipeline construction dominates landscape disturbance, followed by drilling and injection pads (85, 15, and 0.03% of disturbed area, respectively). An increased potential for soil loss is indicated, with 51% (~5790 ha) of all disturbance regimes occurring on soils with low water-transmission rates (depth to impermeable layer less than 50 cm) and a high surface runoff potential (hydrologic soil group D). Additionally, 88% (~10,020 ha) of all disturbances occurred on soils with a wind erodibility index of approximately 19 kt/km(2)/year (0.19 kt/ha/year) or higher, resulting in an estimated potential of 2 million tons of soil loss per year. Results demonstrate that infrastructure placement is occurring on soils susceptible to erosion while reducing and splitting core areas potentially vital to ecosystem services.