American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis — 2016--Executive Summary

Abbreviations:AACE = American Association of Clinical EndocrinologistsAFF = atypical femur fractureASBMR = American Society for Bone and Mineral ResearchBEL = best evidence levelBMD = bone mineral densityBTM = bone turnover markerCBC = complete blood countCI = confidence intervalDXA = dual-energy X-ray absorptiometryEL = evidence levelFDA = U.S. Food and Drug AdministrationFLEX = Fracture Intervention Trial (FIT) Long-term ExtensionFRAX® = Fracture Risk Assessment ToolGFR = glomerular filtration rateGI = gastrointestinalHORIZON = Health Outcomes and Reduced Incidence with Zoledronic Acid Once YearlyIOF = International Osteoporosis FoundationISCD = International Society for Clinical DensitometryIU = international unitsIV = intravenousLSC = least significant changeNBHA = National Bone Health AllianceNOF = National Osteoporosis Foundation25(OH)D = 25-hydroxy vitamin DONJ = osteonecrosis of the jawPINP = serum carboxy-terminal propeptide of type I collagenPTH = parathyroid hormoneR = recommendationRANK = receptor activator of nuclear factor kappa-BRANKL = receptor activator of nuclear factor kappa-B ligandRCT = randomized controlled trialRR = relative riskS-CTX = serum C-terminal telopeptideSQ = subcutaneousVFA = vertebral fracture assessmentWHO = World Health Organization     

Yerba de la fleche—Arrow and fish poison of the American southwest

Analysis and toxicity tests of the latex obtainable from this shrub, previously not reported, are presented here.     

Mustela or Vison? Evidence for the taxonomic status of the American mink and a distinct biogeographic radiation of American weasels

The American mink’s relationship to the weasels in Mustela has been uncertain. Karyological, morphological, and phylogenetic comparisons to Eurasian Mustela support placing the mink outside the genus as Neovison vison. However, genetic comparisons that incorporate other endemic American Mustela suggest the interpretation of N. vison’s position to Mustela has been handicapped by biased geographic sampling. Here, we analyzed mitochondrial cytochrome-b from all weasels endemic to the Americas, including two poorly known South American species (M. felipei, M. africana), weasels native to North America (M. vison, M. frenata, M. nigripes), Mustela migrant to North America (M. erminea, M. nivalis), palearctic Mustela, and other American members of Mustelidae. Bayesian and likelihood inference methods were used to construct a phylogeny of Mustela, and relaxed Bayesian phylogenetic techniques estimated ages of divergence within the genus using priors calibrated by fossil ages. Our analyses show that the American mink and the smaller Mustela endemic to the Americas represent a distinct phylogenetic heritage apart from their Eurasian cousins, and biogeographic barriers like the Bering and Panamanian land bridges have influenced the evolutionary history of Mustela in the Americas.     

Un-Separate and Still Unequal? Three Books about American Education and Race at the End of the Liberal Century

Multicultural Education, Transformative Knowledge, and Action: Historical and Contemporary Perspectives. James Banks, ed. New York: Teachers College Press, 1996. 352 pp.
Other People's Children: Cultural Conflict in the Classroom. Lisa Delpit. New York: The New Press, 1995. 206 pp.
Beyond Desegregation: The Politics of Quality in African American Schooling. Mwalimu J. Shujaa, ed. Thousand Oaks, CA: Corwin Press, 1996. 268 pp.     

Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2020 Executive Summary

Abbreviations: A1C = hemoglobin A1C; AACE = American Association of Clinical Endocrinologists; ABCD = adiposity-based chronic disease; ACCORD = Action to Control Cardiovascular Risk in Diabetes; ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure; ACE = American College of Endocrinology; ACEI = angiotensin-converting enzyme inhibitor; AGI = alpha-glucosidase inhibitor; apo B = apolipoprotein B; ARB = angiotensin II receptor blocker; ASCVD = atherosclerotic cardiovascular disease; BAS = bile acid sequestrant; BMI = body mass index; BP = blood pressure; CCB = calcium channel blocker; CGM = continuous glucose monitoring; CHD = coronary heart disease; CKD = chronic kidney disease; DKA = diabetic ketoacidosis; DPP4 = dipeptidyl peptidase 4; eGFR = estimated glomerular filtration rate; EPA = eicosapentaenoic acid; ER = extended release; FDA = Food and Drug Administration; GLP1 = glucagon-like peptide 1; HDL-C = high-density-lipoprotein cholesterol; HeFH = heterozygous familial hypercholesterolemia; LDL-C = low-density-lipoprotein cholesterol; LDL-P = low-density-lipoprotein particle; Look AHEAD = Look Action for Health in Diabetes; NPH = neutral protamine Hagedorn; OSA = obstructive sleep apnea; PCSK9 = proprotein convertase subtilisin-kexin type 9 serine protease; RCT = randomized controlled trial; SU = sulfonylurea; SGLT2 = sodium-glucose cotransporter 2; SMBG = self-monitoring of blood glucose; T2D = type 2 diabetes; TZD = thiazolidinedione     

Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2018 Executive Summary

Abbreviations: A1C = hemoglobin A1C; AACE = American Association of Clinical Endocrinologists; ACCORD = Action to Control Cardiovascular Risk in Diabetes; ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure; ACEI = angiotensin-converting enzyme inhibitor; ADVANCE = Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation; AGI = alpha-glucosidase inhibitor; apo B = apolipoprotein B; ASCVD = atherosclerotic cardiovascular disease; BAS = bile acid sequestrant; BCR-QR = bromocriptine quick release; BMI = body mass index; BP = blood pressure; CCB = calcium channel blocker; CHD = coronary heart disease; CKD = chronic kidney disease; CVD = cardiovascular disease; DASH = Dietary Approaches to Stop Hypertension; DPP4 = dipeptidyl peptidase 4; eGFR = estimated glomerular filtration rate; ER = extended release; FDA = Food and Drug Administration; GLP1 = glucagon-like peptide 1; HDL-C = high-density lipoprotein cholesterol; IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial; LDL-C = low-density lipoprotein cholesterol; LDL-P = low-density lipoprotein particle; Look AHEAD = Look Action for Health in Diabetes; NPH = neutral protamine Hagedorn; OSA = obstructive sleep apnea; RCT = randomized controlled trial; SU = sulfonylurea; SGLT2 = sodium glucose cotransporter-2; SMBG = self-monitoring of blood glucose; T2D = type 2 diabetes; TZD = thiazolidinedione; VADT = Veterans Affairs Diabetes Trial     

Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2019 Executive Summary

Abbreviations: A1C = hemoglobin A1C; AACE = American Association of Clinical Endocrinologists; ACCORD = Action to Control Cardiovascular Risk in Diabetes; ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure; ACE = American College of Endocrinology; ACEI = angiotensin-converting enzyme inhibitor; AGI = alpha-glucosidase inhibitor; apo B = apolipoprotein B; ARB = angiotensin II receptor blocker; ASCVD = atherosclerotic cardiovascular disease; BAS = bile acid sequestrant; BMI = body mass index; BP = blood pressure; CCB = calcium channel blocker; CGM = continuous glucose monitoring; CHD = coronary heart disease; CKD = chronic kidney disease; DKA = diabetic ketoacidosis; DPP4 = dipeptidyl peptidase 4; eGFR = estimated glomerular filtration rate; EPA = eicosapentaenoic acid; ER = extended release; FDA = Food and Drug Administration; GLP1 = glucagon-like peptide 1; HDL-C = high-density-lipoprotein cholesterol; HeFH = heterozygous familial hypercholesterolemia; LDL-C = low-density-lipoprotein cholesterol; LDL-P = low-density-lipoprotein particle; Look AHEAD = Look Action for Health in Diabetes; NPH = neutral protamine Hagedorn; OSA = obstructive sleep apnea; PCSK9 = proprotein convertase subtilisin-kexin type 9 serine protease; RCT = randomized controlled trial; SU = sulfonylurea; SGLT2 = sodium-glucose cotransporter 2; SMBG = self-monitoring of blood glucose; T2D = type 2 diabetes; TZD = thiazolidinedione     

The North American «Hipparion Datum and implications for the Neogene of the Old World

A large sample of skulls and associated dentitions of Cormohipparion sphenodus (Cope, 1889). new combination, is described from Miocene deposits of Nebraska, Colorado, New Mexico, and California. This species is morphologically more advanced than the most primitive species of the genus, C. goorisiMacFadden & Skinner, 1981, and more primitive than a third and more advanced species of this genus. C. occidentale (Leidy, 1856). In several characters such as configuration of the preobrital fossa, size, hypsodonty, shape of protocone, and complexity of enamel plication, C. sphenodus is morphologically similar, and potentially related to, some Old World Vallesian «Hipparion. In addition, based on radiometric calibration of stratigraphic sequences in Nebraska and California, C. sphenodus spans an interval of time from about 13.6 to 11 Ma. Inasmuch as the Old World «Hipparion Datum is calibrated at about 12 Ma, we conclude that C. sphenodus exhibits the morphological and chronological prerequisites to have been directly ancestral to some of these Old World forms.The hipparion horses apparently were a polyphyletic assemblage of several genera, and their biogeographic and biochronologic history is more complex than classically thought. Several dispersal events involving these horses may have occurred between the New and Old Worlds during the late Miocene.     

Effect of changing mortality on the working life of American men and women, 1970–1990

Abstract

The mortality patterns of men and women of working age, in terms of the major causes of death, have changed over the past three decades. This study assesses the extent to which mortality among persons of working age represents an economic loss to society. This economic loss is measured by the per capita loss of productive working life, defined as the number of years, on the average, a person can expect to be an active member of the labor force. Causes of death affecting primarily older Americans (heart disease, cancer, stroke) had a relatively small and declining impact on the working lives of men and women. Major causes of death affecting the young (motor vehicle accidents, homicide, AIDS), although accounting for fewer deaths, were responsible for many more years of lost productivity. Gender and socioeconomic differentials in mortality suggest that different strategies are necessary for future reductions in lost work‐years.     

American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis— 2020 Update Executive Summary

Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs).Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols.Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) evidence level (EL) 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very-high-risk features, a new dual-action therapy option, and transitions from therapeutic options.Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of post-menopausal osteoporosis.     

The challenge of understanding the Asian‐American experience

Roger Daniels, ASIAN AMERICA: CHINESE AND JAPANESE IN THE UNITED STATES SINCE 1850, Seattle: University of Washington Press, 1988, 344 pp., $24.95 (hardback).

Harriet Duleep, THE ECONOMIC STATUS OF AMERICANS OF ASIAN DESCENT: AN EXPLORATORY INVESTIGATION, Washington DC: US Commission on Civil Rights Clearinghouse Publication 95, October 1988.

James A. Freeman, HEARTS OF SORROW: VIETNAMESE‐AMERICAN LIVES, Stanford, CA: Stanford University Press, 1989, 427 pp., $29.50 (hard cover)     

Testing Bergmann’s rule and the Rosenzweig hypothesis with craniometric studies of the South American sea lion

We tested the validity of Bergmann’s rule and Rosenzweig’s hypothesis through an analysis of the geographical variation of the skull size of Otaria flavescens along the entire distribution range of the species (except Brazil). We quantified the sizes of 606 adult South American sea lion skulls measured in seven localities of Peru, Chile, Uruguay, Argentina, and the Falkland/Malvinas Islands. Geographical and environmental variables included latitude, longitude, and monthly minimum, maximum, and mean air and ocean temperatures. We also included information on fish landings as a proxy for productivity. Males showed a positive relationship between condylobasal length (CBL) and latitude, and between CBL and the six temperature variables. By contrast, females showed a negative relationship between CBL and the same variables. Finally, female skull size showed a significant and positive correlation with fish landings, while males did not show any relationship with this variable. The body size of males conformed to Bergmann’s rule, with larger individuals found in southern localities of South America. Females followed the converse of Bergmann’s rule at the intraspecific level, but showed a positive relationship with the proxy for productivity, thus supporting Rosenzweig’s hypothesis. Differences in the factors that drive body size in females and males may be explained by their different life-history strategies. Our analyses demonstrate that latitude and temperature are not the only factors that explain spatial variation in body size: others such as food availability are also important for explaining the ecogeographical patterns found in O. flavescens.     

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Management of Acromegaly Patients: What is the Role of Pre-Operative Medical Therapy?

Objective: Acromegaly is a complex disease characterized by growth hormone (GH) excess originating in most cases from a pituitary tumor. The goals of treatment include removing the tumor or reducing tumor burden, normalizing GH secretion and insulin-like growth factor 1 levels, and preserving normal pituitary function if possible. Surgery by an experienced neurosurgeon is still considered first-line therapy, especially in cases with small tumors. In the last few decades, significant progress in the development of selective pharmacologic agents has greatly facilitated the management of active acromegaly, with agents such as somatostatin-receptor ligands (SRLs), GH-receptor antagonists, and dopamine agonists. In addition to adjuvant treatment, pre-operative medical therapy and primary therapy in de novo patients are increasingly employed.Methods: A United States National Library of Medicine PubMed search (through July 2014) was conducted for the following terms: acromegaly, pre-operative medical therapy, somatostatin-receptor ligands, and somatostatin analogs. Articles not in English and those not in peer-reviewed journals were excluded. In reviewing pertinent articles, focus was placed on biochemical and other postoperative outcomes of medical therapy.Results: An analysis of the full effect of pre-operative use of SRLs on surgical outcomes (remission rates and peri-operative complications) is limited by heterogeneity of methodology, low overall surgical cure rates, and different study designs. The assumption that SRL use prior to surgery reduces peri-operative surgical risk has yet to be proven. A variable degree of tumor shrinkage with preoperative SRLs is observed. Likewise, SRL treatment 3 months before surgery may improve surgical remission rates in the short term; however, positive results do not persist in the long term.Conclusion: We consider that medical therapy before surgery could play a role in carefully selected patients, but treatment should be individualized. Primary medical therapy with a SRL may be considered in patients with macroadenomas without local mass effects on the optic chiasm, as SRLs have been shown to reduce tumor size and control GH hypersecretion. However, the data are insufficient to support general use of a SRL prior to surgery in order to improve post-surgery biochemical outcomes. Theoretically, patients with severe cardiac and respiratory complications due to acromegaly could potentially benefit from pre-operative SRLs in order to reduce peri-operative morbidity. Further investigation and investment in large randomized long-term clinical trials are needed to define the precise role and duration of pre-surgical medical treatment in acromegaly patients.Abbreviations: GH = growth hormone IGF-1 = insulin-like growth factor 1 MRI = magnetic resonance imaging SRL = somatostatin-receptor ligand     

American geneticists and the eugenics movement: 1905–1935

Conclusion I have attempted to show that between 1905 and 1935, both internal and external factors were important in producing and influencing geneticists' attitudes toward the eugenics movement. Internal factors operated in several ways during this period. In the first decade of the century, discoveries within genetics supplied geneticists a mode of expression to evoke their already existing social concern by providing a new vocabulary with which to present eugenic proposals. In addition, because these findings were relatively easy to explain to the layman, it became an easy matter for geneticists to popularize eugenics. After 1915, by suggesting the complexity of inheritance, other developments within genetics helped dim their initial enthusiasm for the movement. During this period, factors external to the science of genetics also were important. By producing a general interest in social affairs among many geneticists, the intellectual and social milieu of the late 1800's lay the foundations for their early participation in the eugenics movement. In the 1920's and 1930's the subjection of genetic theory to support preconceived social and political doctrines prompted them to renounce the movement publicly.While both internal and external factors operated on geneticists, the lesson of this study is that external factors were more important in influencing their attitudes toward the movement than internal factors. At the turn of the century, geneticists inherited from Social Darwinism a general interest in applying biological principles to the analysis of social problems; discoveries within genetics mainly provided a convenient and persuasive terminology with which to express their interest. Later, both internal and external factors caused their enthusiasm for the movement to wane, but their public renunciation of it was caused primarily by external factors alone.The importance of external factors is seen to be even greater by considering the model I suggested to explain the development of social responsibility in modern form among scientists. According to this model, social responsibility results after a crisis in the social uses of a given science—as a response to external factors. This model appears to account satisfactorily for the emergence of geneticists' sense of social responsibility: alarmed by eugenicists' frequent endorsement of Nazi eugenic programs, many geneticists claimed it was their duty to explain the facts of their science to the public so that the layman could see for himself the scientific errors of racism. Geneticists were now presenting the layman the facts, though not necessarily interpreting the facts for him. This same pattern—the emergence of modern social responsibility after an externally induced crisis-appears to be present in the other examples that I gave.The ironies revealed by this study are many. First, it is ironic that principles of genetics created feelings of both pessimism and optimism among many geneticists. Early developments in genetics-Mendel's laws, the concept of unit inheritance, and Weismann's theory-supplemented Social Darwinism in creating an atmosphere of pessimism among many geneticists by posing the grim assumption that human defects are hereditarily determined and incapable of medical cure. In recognizing the importance of heredity in development, many geneticists for a while were overly pessimistic in their forecasts of the evolutionary future of the human race. These same three genetic developments, however, by suggesting the feasibility of a eugenics program, of controlling reproduction to eliminate defective genes from the population, provided a remedy to the problem they had helped create.It is also ironic that even though the classical eugenics movement has been discredited in America for over thirty years, many individuals today are speaking of certain dangers to society in terms remarkably similar to those used by the classical eugenicists. The explosion of the atomic bomb created a sudden awareness among the public of the dangers of gene mutation from radiation and other sources⁴¹. Today, as topics such as the genetic load are increasingly discussed, many individuals are experiencing a growing alarm over the future genetic condition of the American people, a marked concern over the rising genetic and financial costs to society of modern medicine for preserving defectives and allowing them to reproduce.Although geneticists in the 1930's generally abandoned the ideal of using science to prescribe policy, to construct ends for social action, it was this ideal which initially attracted many of them to the eugenics movement in the first place. In the early years of the century, geneticists viewed science in a new light: as a restraint upon conduct. Hitherto, science had been valued for its products, for releasing man from old burdens, for supplying him new opportunities to enjoy and to explore life. In supporting the eugenics movement, geneticists departed from this mode. They now appealed to science, not for a particular product, but to determine who should and who should not reproduce. They let science act as a constraint upon their actions; they let science tell them that individual desires are less important than the biological and moral imperative of improving the human race⁴². Thus, it becomes understandable why many geneticists for a time regarded eugenics as a religion, for they had permitted biology to assume religion's traditional function of defining permissible conduct. The history of geneticists' involvement with the eugenics movement reminds us that science can play many roles and be put to many purposes.     

A South American snake lineage from the Eocene Greenhouse of North America and a reappraisal of the fossil record of “anilioid” snakes

“Anilioidea” is a likely paraphyletic assemblage of pipe snakes that includes extant Aniliidae from equatorial South America, Uropeltoidea from South and Southeast Asia, and a fossil record that consists primarily of isolated precloacal vertebrae ranging from the earliest Late Cretaceous and includes geographic distributions in North America, South America, Europe, and Africa. Articulated precloacal vertebrae from the middle Eocene Bridger Formation of Wyoming, attributed to Borealilysia nov. gen., represent an unambiguous North American aniliid record and prompts a reconsideration of described pipe snakes and their resultant biogeographic histories. On the basis of vertebral apomorphies, the vast majority of reported fossils cannot be assigned to “Anilioidea”. Instead, most records represent stem taxa and macrostomatans erroneously assigned to anilioids on the basis of generalized features associated with fossoriality. A revised fossil record demonstrates that the only extralimital distributions of fossil “anilioids” consist of the North American aniliid record, and there is no unambiguous fossil record of Old World taxa. The occurrence of aniliids in the mid-high latitudes of the late early Eocene of North America is consistent with histories of northward shifts in equatorial ecosystems during the early Paleogene Greenhouse.