Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines

BackgroundERAS® Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS® Society guideline and the methodology that should be followed in its development.MethodsThe ERAS® Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence.ResultsClear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus‐based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up‐to‐date evidence is used consistently to support surgical patients.ConclusionThere is a need for a standardized, evidence‐informed approach to both the development of new ERAS® Society guidelines, and the adaptation and revision of existing guidelines

The Performance of Private Equity Funds: Does Diversification Matter?

This paper is the first systematic analysis of the impact of diversification on the performance of private equity funds. A unique data set allows the exact evaluation of diversification across the dimensions financing stages, industries, and countries. Very different levels of diversification can be observed across sample funds. While some funds are highly specialized others are highly diversified. The empirical results show that the rate of return of private equity funds declines with diversification across financing stages, but increases with diversification across industries. Accordingly, the fraction of portfolio companies which have a negative return or return nothing at all, increase with diversification across financing stages. Diversification across countries has no systematic effect on the performance of private equity funds

Temperature Covariance in Tree Ring Reconstructions and Model Simulations Over the Past Millennium

Spatial covariance in the simulated temperature evolution over the past millennium has been reported to exceed that of multiproxy-based reconstructions. Here we use tree ring-based temperature reconstructions and state-of-the-art climate model simulations to assess temporal changes in Northern Hemisphere intercontinental temperature covariance during the last 1000 years. Tree ring-only approaches reveal stronger agreement with model simulations compared to multiproxy networks. Although simulated temperatures exhibit a substantial spread among individual models, intercontinental temperature coherency is mainly driven by the cooling of large volcanic eruptions in 1257, 1452, 1600, and 1815 Common Era. The coherence of these synchronizing events appears to be elevated in several climate simulations relative to their own unforced covariance baselines and in comparison to the proxy reconstructions. This suggests that some models likely overestimate the amplitude of abrupt summer cooling in response to volcanic eruptions, particularly at larger spatial scales.Supported by the German Science Foundation, grant 161/9-1 and the U.S. National Science Foundation grant AGS-1602920. U. Büntgen received funding from the Ministry of Education, Youth and Sports of Czech Republic within the National Sustainability Program I (NPU I; GN LO1415)

European summer temperatures since Roman times

The spatial context is critical when assessing present-day climate anomalies, attributing them to potential forcings and making statements regarding frequency and severity in the long-term perspective. Recent initiatives have expanded the number of high-quality proxy-records and developed new reconstruction methods. These advances allow more rigorous regional past temperature reconstructions and the possibility of evaluating climate models on policy-relevant, spatio-temporal scales. We provide a new proxy-based, annually-resolved, spatial reconstruction of the European summer temperature fields back to 755 CE based on a Bayesian hierarchical modelling (BHM), together with estimates of the European mean temperature variation since 138 BCE based on Composite-plus-Scaling. Our reconstructions compare well with independent instrumental and proxy-based temperature estimates, but suggest a larger amplitude in summer temperature variability than previously reported. Temperature differences between the medieval period, the recent period and Little Ice Age are larger in reconstructions than simulations. This may indicate either inflated variability of the reconstructions, a lack of sensitivity to external forcing on sub-hemispheric scales in the climate models and/or an underestimation of internal variability on centennial and longer time scales including the representation of internal feedback mechanisms

Neue linguistische Methoden und arbeitstechnische Verfahren in der Erschliessung der ägyptischen Grammatik

15 páginas, 1 tabla, 6 figuras.Does diversity beget diversity? Diversity includes a diversity of concepts because it is linked to variability in and of life and can be applied to multiple levels. The connections between multiple levels of diversity are poorly understood. Here, we investigated the relationships between genetic, bacterial, and chemical diversity of the endangered Atlanto-Mediterranean sponge Spongia lamella. These levels of diversity are intrinsically related to sponge evolution and could have strong conservation implications. We used microsatellite markers, denaturing gel gradient electrophoresis and quantitative polymerase chain reaction, and high performance liquid chromatography to quantify genetic, bacterial, and chemical diversity of nine sponge populations. We then used correlations to test whether these diversity levels covaried. We found that sponge populations differed significantly in genetic, bacterial, and chemical diversity. We also found a strong geographic pattern of increasing genetic, bacterial, and chemical dissimilarity with increasing geographic distance between populations. However, we failed to detect significant correlations between the three levels of diversity investigated in our study. Our results suggest that diversity fails to beget diversity within a single species and indicates that a diversity of factors regulates a diversity of diversities, which highlights the complex nature of the mechanisms behind diversityResearch funded by grants from the Agence Nationale de la Recherche (ECIMAR), from the Spanish Ministry of Science and Technology SOLID (CTM2010-17755) and Benthomics (CTM2010-22218-C02-01) and the BIOCAPITAL project (MRTN-CT-2004-512301) of the European Union. This is a contribution of the Consolidated Research Group ‘‘Grupo de Ecologı´a Bento´nica,’’ SGR2009-655.Peer reviewe

Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations.

Background and purpose - There is a large volume of heterogeneous studies across all Enhanced Recovery After Surgery (ERAS®) components within total hip and total knee replacement surgery. This multidisciplinary consensus review summarizes the literature, and proposes recommendations for the perioperative care of patients undergoing total hip replacement and total knee replacement with an ERAS program.Methods - Studies were selected with particular attention being paid to meta-analyses, randomized controlled trials, and large prospective cohort studies that evaluated the efficacy of individual items of the perioperative treatment pathway to expedite the achievement of discharge criteria. A consensus recommendation was reached by the group after critical appraisal of the literature.Results - This consensus statement includes 17 topic areas. Best practice includes optimizing preoperative patient education, anesthetic technique, and transfusion strategy, in combination with an opioid-sparing multimodal analgesic approach and early mobilization. There is insufficient evidence to recommend that one surgical technique (type of approach, use of a minimally invasive technique, prosthesis choice, or use of computer-assisted surgery) over another will independently effect achievement of discharge criteria.Interpretation - Based on the evidence available for each element of perioperative care pathways, the ERAS® Society presents a comprehensive consensus review, for the perioperative care of patients undergoing total hip replacement and total knee replacement surgery within an ERAS® program. This unified protocol should now be further evaluated in order to refine the protocol and verify the strength of these recommendations