A Functional Algorithm for Weight Loss and Obesity Practice: Guide for Clinical Decision-Making for Treating Women

ABSTRACT Background Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time. Objectives To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated. Methods After an extensive literature review to identify best-practice guidelines for weight loss a retrospective chart review was performed at two women’s health clinics located in St. Louis County over a five-month period. For three consecutive appointments 50 patient charts were audited and compared to current evidence-based practice guidelines. Any gaps between the office practice and the guidelines were identified. A weight loss algorithm was then developed incorporating clinical assessment methods, lab work, anthropometric measurements and appropriate referrals. Results Fifty patient’s charts spanning from 10/2014-01/2017 were examined and compared to evidence-based clinical guidelines for weight loss. The comparison revealed gaps between evidence based research and practice related to lack of time, not wanting to add additional work for the staff/ healthcare providers, and forgetting to include various assessments and referrals. To improve the assessment practice while saving valuable clinical time, an algorithm was recommended as a template to use in the electronic health records (EHR) along with a hard-copy paper form. Additional measurements were added to the women’s health clinic computer system for neck and waist circumference by their IT staff, and a packet was developed containing assessment questionnaires for patients to either complete prior to coming to the initial appointment or fill out while in the waiting room. This weight loss algorithm was then presented to the participating clinician for implementation for a future pilot study

Morphological adaptations of 3.22 Ga-old tufted microbial mats to Archean coastal habitats (Moodies Group, Barberton Greenstone Belt, South Africa)

Microbial life was well established and widespread by the Paleoarchean; however, the degree of evolutionary advancement such as microbial motility, intra- and inter-species interactions, phototropism, or oxygenic photosynthesis by that time remains highly debated. The 3.22 Ga Moodies Group in the Barberton Greenstone Belt (BGB, South Africa) are Earth's oldest well-preserved siliciclastic tidal deposits. They exhibit a unique assemblage of microbial mats, providing an excellent opportunity to decipher the morphological adaptations of microbial communities to different paleoenvironmental settings. The fossil mats are preserved as kerogenous laminations (0.5–1 mm thick) that can be traced laterally for ∼15 km in a ∼1000 m-thick succession of fine- to coarse-grained tidal sandstones and conglomerates. We here present a detailed stratigraphic and depositional facies analysis, documenting the association of the three principal mat morphotypes with specific environmental settings: (1) planar-type in coastal floodplain, (2) wavy-type in intertidal, and (3) tufted-type in upper inter- to supratidal facies. All mat types indicate a flourishing phototrophic biota; moreover, the tufted morphology suggests an intricate level of coordinated growth commonly known from cyanobacterial mats in modern environments