Bücher zum Thema „Type-2 development“

Owing to the epidemiologic dimensions of type 2 diabetes, obesity, and depression, the development of novel and effective treatment options for these conditions is of great importance. One of the major challenges in this field is that many antidiabetic and antidepressive drugs may have disadvantageous metabolic effects by increasing weight and worsening insulin resistance. Novel technologies more effectively considering the pathophysiological changes related to this entity are needed. The DIAMOND electrical stimulation device improves glycaemic control, causes weight loss and decreases systolic blood pressure in overweight and obese patients with type 2 diabetes. The DIAMOND device detects food ingestion and automatically activates its postprandial metabolic effects. It does so with minimal side effects, no hypoglycaemia, modest weight loss, minimal requirement for self-blood glucose monitoring, and improvement in eating behaviour. The properties of DIAMOND treatment suggest that it may have merit for treating patients with comorbid diabetes and depression.

Metabolic syndrome is defined as the co-occurrence of metabolic risk factors for both type 2 diabetes and cardiovascular disease (i.e. abdominal obesity, hyperglycemia, dyslipidemia, and hypertension). Indeed, metabolic syndrome is an important risk factor for subsequent development of type 2 diabetes and/or CVD. Thus, the key clinical implication of a diagnosis of metabolic syndrome is the identification of a patient who needs aggressive lifestyle modification focused on weight reduction and increased physical activity. Multiple different phenotypes and ethnic-specific values for waist circumference are included within metabolic syndrome, with indications for differing treatment strategies. This book covers several aspects of metabolic syndrome, including its definition, diagnostic criteria, preventive measures, and treatment, as well as the possible association between ethnicity and the occurrence of metabolic syndrome.

Diabetic nephropathy is kidney damage occurring as a result of diabetes mellitus. Overt diabetic nephropathy is defined as proteinuria greater than 0.5 g/day. Diabetic nephropathy has a complicated pathogenesis including glomerular hypertension with hyperfiltration and advanced glycation end products. Poor glycaemic control is associated with progression to microalbuminuria and overt diabetic nephropathy. The lifetime risk is fairly equivalent for type 1 and type 2 diabetes mellitus. Early disease is usually asymptomatic. Hyperglycaemia causes an osmotic diuresis and, thus, diabetes can present with polyuria. Hypertension develops with microalbuminuria; oedema indicates abnormal sodium and water retention and, occasionally, the development of nephrotic syndrome. Patients with diabetes, perhaps due to accompanying cardiac disease, are particularly susceptible to fluid overload and uraemic symptoms. End-stage renal disease can occur as early as when the estimated glomerular filtration rate is 15 ml/min 1.73 m−2.

A major event in liver cirrhosis is the development of a progressive deterioration of circulatory function due to splanchnic arterial vasodilation and impairment in cardiac function. This feature determines a homeostatic activation of the renin–angiotensin–aldosterone system, sympathetic nervous system, and antidiuretic hormone. The splanchnic microcirculation is resistant to the vasoconstrictor effect of these systems. Therefore, the homeostasis of arterial pressure in cirrhosis occurs in the extrasplanchnic, mainly renal circulation. The activation of these systems produces renal fluid retention, which accumulates as ascites, and water retention and dilutional hyponatraemia. In the latest phase of cirrhosis, when circulatory dysfunction is severe, renal vasoconstriction is intense and patients develop type 2 hepatorenal syndrome (HRS) and refractory ascites.Type 1 HRS is an acute and rapidly progressive renal failure that occurs in the setting of a precipitating event, commonly an infection. Patients with type 1 HRS also present with rapid deterioration of liver function (encephalopathy, jaundice) and relative adrenal insufficiency. The mechanism of this multiorgan failure is an acute deterioration in circulatory function due to both an accentuation of arterial vasodilation and of cardiac dysfunction.There is no specific test for the diagnosis of HRS. The most accepted diagnostic criteria are those proposed by the International Ascites Club which are based on the exclusion of other types of renal failure. The course of renal failure following treatment of the precipitating event of HRS is another important diagnostic feature.The treatment of choice of tense ascites in cirrhosis is paracentesis associated with intravenous albumin infusion. Moderate sodium restriction and diuretics (spironolactone alone or associated with furosemide) are subsequently given to prevent re-accumulation of ascites. Diuretics are the treatment of choice in patients with moderate ascites. Patients with type 2 HRS and refractory ascites (not responding to diuretics) could be treated by frequent paracentesis or by the insertion of a transjugular intrahepatic portosystemic shunt (TIPS).Terlipressin plus albumin is the treatment of choice in type 1 HRS

Circadian (approximately 24-hour) rhythms are generated by a hierarchical system responsible for coordinating behaviour and physiology throughout the 24-hour day. Increasing evidence supports roles for disruption of the circadian system in the development of type 2 diabetes (T2DM) and depression. We outline the key aspects of circadian system regulation, discuss the findings indicating that biological disruption of the circadian system produces various behavioural and metabolic abnormalities, and review human studies which show that environmental disruption of the circadian system contributes to T2DM and depression. Finally, we will summarize the therapeutic potential of restoring circadian system organization to manage these diseases.

This chapter explores the historical development of understanding about the structure, function, and disorders of the cerebellum. The chosen papers represent the following development: the discovery that the cerebellum is concerned with movement control rather than movement generation; the first recognition of a distinct spinocerebellar disorder; recognition of the existence of dominantly-inherited ataxias; the delineation of the classic motor features of ataxia; the formal recognition of paraneoplastic cerebellar degenerations; the description of truncal ataxia due to anterior vermal damage in chronic alcoholics; the demonstration of long-term depression at the parallel fibre; the discovery of the first gene (ATXN 1) for a dominantly-inherited spinocerebellar ataxia; the revelation that episodic ataxia type 2 is an ion channel disorder; and the recognition of a cerebellar role in cognition and emotional regulation.

The landmark paper discussed in this chapter, published by Calignano et al. in 1998, focuses on the control of pain initiation by endogenous cannabinoids. In the paper, analgesic lipid mediators are shown to be present in peripheral paw tissue where they control the ability of pain signals to ascend to the central nervous system (CNS). Anandamide acts through a peripheral mechanism to suppress inflammatory pain via cannabinoid type 1 receptors. Palmitoylethanolamine, subsequently identified as an endogenous ligand for peroxisome proliferator-activated receptor-α‎, produces peripheral antinociceptive effects via a mechanism similar to that for the cannabinoid type 2 receptor. These lipids do not serve redundant functions and, in combination, produce synergistic antinociceptive effects. These observations suggested that drug-development efforts targeting peripheral control of pain may elucidate improved pharmacotherapies that lack the unwanted CNS side effects of current treatments.

This chapter on CFRD reviews the ever-evolving topic and provides up-to-date information on how to diagnose and manage cystic fibrosis-related diabetes CFRD in the acute and chronic setting. The treatments necessary to treat and prolong life in CF, including their unique dietary requirements, must always be followed as a first priority, with diabetes care adjusted accordingly. Early intervention with insulin has been shown to reverse clinical deterioration, even in those with mild diabetes. Newly emerging treatments for CF which have the potential to restore defective chloride channels may have implications for the development and treatment of CFRD. Whilst CFRD shares features of both type 1 and type 2 diabetes, there are important differences which necessitate a unique approach to diagnosis and management. Factors specific to CF that variably affect glucose metabolism include chronic respiratory infection and inflammation, increased energy expenditure, malnutrition, glucagon deficiency, and gastrointestinal abnormalities.

This chapter presents a reflection on different policy initiatives targeting multimorbidity. Owing to its global impact on public health, type 2 diabetes is used as an example in this context. Challenges on different levels are illustrated, and the implementation and limitations of scaling-up processes in integrated care initiatives as well as national policies on the prevention of chronic diseases are discussed. Questions on the responsibilities of society, government, and insurance companies to jointly tackle the epidemiologic challenges are addressed and general conclusions on the different approaches are drawn. One important issue significantly hampering the development, implementation, and scaling up of effective policies is the lack of sufficient long-term evaluations. To accomplish sustained improvements of the current public health situation, a strategic shift from individual to shared responsibilities of the different parties is needed. The chapter concludes with proposals for prevention policies and general recommendations for policy development.

Leveraging Equity and Excellence for English Learners: An Annotated Bibliography is comprised of 320 annotations from both recent and seminal literature (released between 1992–2021) that have significant implications for research, policy, and practice for English learner (EL) linguistic, social, and academic achievement. This annotated bibliography serves as a resource for researchers, policymakers, educators, and advocates who are working for equity and excellence for ELs. The authors provide a comprehensive selection of works focused on theory, research, and practice. The annotations are a result of purposeful searches of 23 topics in empirical and theoretical articles from peer-reviewed journals, books, book chapters, and reports from leading scholars in the field. Among the topics addressed relevant to EL education are broad areas such as: bilingual teacher preparation, teaching and professional development, university partnerships, digital learning, social emotional development, culturally sustaining pedagogy, and English Language Development (ELD) for elementary and secondary level students. The Integrated ELD (content instruction) topic is subcategorized according to specific disciplines including: English language arts, history, mathematics, science, visual & performing arts, and STEM. In order to provide additional information for readers, each annotation includes: (1) the source description (e.g., book, journal article, report), (2) type of source (e.g., empirical, guidance, theoretical), and (3) keywords.

Spontaneous thoughts occur by default in the interstices between directed, task-oriented thoughts or moments of perceptual scrutiny. Their contents are overwhelmingly related to thinkers’ current goals, either directly or indirectly via associative networks, including past and future goals. Their evocation is accompanied by emotional responses that vary widely in type, valence, and intensity. Given these properties of thought flow, spontaneous thoughts are highly adaptive as (1) reminders of the individual’s larger agenda of goals while occupied with pursuing any one of them, (2) promotion of planning for future goal pursuits, (3) deeper understanding of past goal-related experiences, and (4) development of creative solutions to problems in goal pursuit. The same mechanisms may occasion repetitive but unproductive thoughts about the pursuit, the consequences of the failure, or the self, and strong negative emotions steering the train of thought may lead to narrowing of its focus, thus producing rumination.

Persistent pain after childbirth has recently received a lot of attention as potentially many women could be affected. Several pain syndromes including pelvic girdle pain, low back pain, and headaches occur during the pregnancy and can persist after delivery. The prevalence of chronic pain directly related to the delivery, at 6 months and later after childbirth, is however very low (< 2%) compared to chronic pain which occurs after other types of tissue trauma as in common surgical procedures. Acute pain is a major risk factor in the development of persistent pain after surgery and trauma. After childbirth, the severity of acute pain, independent of the mode of delivery (i.e. the degree of tissue damage) only predicts an increased risk of persistent pain (a 2.5-fold increase) at 2 months but not later. An individual’s pain response seems to be the most relevant factor in the development of persistent pain. In retrospective studies, patient-specific risk factors, such as a pre-existing chronic pain condition or pain elsewhere, were predictive factors. In prospective studies, the low incidence of persistent pain at 6 and 12 months make the analysis of risk factors unreliable.

Gout is a common and treatable disorder of purine metabolism. Gout typically presents as recurrent self-limiting episodes of severe inflammatory arthritis affecting the foot. In the presence of persistent hyperuricaemia, tophi, chronic synovitis, and joint damage may develop. Diagnosis of gout is confirmed by identification of monosodium urate (MSU) crystals using polarizing light microscopy. Hyperuricaemia is the central biochemical cause of gout. Genetic variants in certain renal tubular urate transporters including SLC2A9 and ABCG2, and dietary factors including intake of high-purine meats and seafood, beer, and fructose, contribute to development of hyperuricaemia and gout. Gout treatment includes: (1) management of the acute attack using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or low-dose colchicine; (2) prophylaxis against gout attacks when commencing urate-lowering therapy (ULT), with NSAIDs or colchicine; and (3) long-term ULT to achieve a target serum urate of less than 0.36 mmol/litre. Interleukin (IL)-1β‎ is a central mediator of acute gouty inflammation and anti-IL-1β‎ therapies show promise for treatment of acute attacks and prophylaxis. The mainstay of ULT remains allopurinol. However, old ULT agents such as probenecid and benzbromarone and newer agents such as febuxostat and pegloticase are also effective, and should be considered in patients in whom allopurinol is ineffective or poorly tolerated. Management of gout should be considered in the context of medical conditions that frequently coexist with gout, including type 2 diabetes, hypertension, dyslipidaemia, and chronic kidney disease. Patient education is essential to ensure that acute gout attacks are promptly and safely managed, and long-term ULT is maintained.

Gout is a common and treatable disorder of purine metabolism. Gout typically presents as recurrent self-limiting episodes of severe inflammatory arthritis affecting the foot. In the presence of persistent hyperuricaemia, tophi, chronic synovitis, and joint damage may develop. Diagnosis of gout is confirmed by identification of monosodium urate (MSU) crystals using polarizing light microscopy. Hyperuricaemia is the central biochemical cause of gout. Genetic variants in certain renal tubular urate transporters including SLC2A9 and ABCG2, and dietary factors including intake of high-purine meats and seafood, beer, and fructose, contribute to development of hyperuricaemia and gout. Gout treatment includes: (1) management of the acute attack using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or low-dose colchicine; (2) prophylaxis against gout attacks when commencing urate-lowering therapy (ULT), with NSAIDs or colchicine; and (3) long-term ULT to achieve a target serum urate of less than 0.36 mmol/litre. Interleukin (IL)-1β‎ is a central mediator of acute gouty inflammation and anti-IL-1β‎ therapies show promise for treatment of acute attacks and prophylaxis. The mainstay of ULT remains allopurinol. However, old ULT agents such as probenecid and benzbromarone and newer agents such as febuxostat and pegloticase are also effective, and should be considered in patients in whom allopurinol is ineffective or poorly tolerated. Management of gout should be considered in the context of medical conditions that frequently coexist with gout, including type 2 diabetes, hypertension, dyslipidaemia, and chronic kidney disease. Patient education is essential to ensure that acute gout attacks are promptly and safely managed, and long-term ULT is maintained.

Coronary heart disease (CHD) and stroke, collectively cardiovascular disease (CVD), are caused by narrowing and blockage of the arteries supplying the heart and brain, respectively. In type 2 diabetes (DM₂) insulin is insufficient to maintain normal blood glucose. South Asians have high susceptibility to these diseases. Drawing upon the scientific literature and discussions with 22 internationally recognized scholars, this book focuses on causal explanations and their implications for prevention and research. Genetically based hypotheses are considered together with the developmental origins of health and disease (DOHAD) family of hypotheses. The book then considers how CHD, stroke, and DM₂ are closely linked to rising affluence and the accompanying changes in life-expectancy and lifestyles. The established causal factors are shown to be insufficient, though necessary, parts of a convincing explanation for the excess of DM₂ and CVD in South Asians. In identifying new explanations, this book emphasizes glycation of tissues, possibly leading to arterial stiffness and microcirculatory damage. In addition to endothelial pathways to atherosclerosis an external (adventitial) one is proposed, i.e. microcirculatory damage to the network of arterioles that nourish the coronary arteries. In addition to the ectopic fat in their liver and pancreas as the cause of beta cell dysfunction leading to DM₂, additional ideas are proposed, i.e. microcirculatory damage. The high risk of CVD and DM₂ in urbanizing South Asians is not inevitable, innate or genetic, or acquired in early life and programmed in a fixed way. Rather, exposure to risk factors in childhood, adolescence, and most particularly in adulthood is the key. The challenge to produce focused, low cost, effective actions, underpinned by clear, simple, and accurate explanations of the causes of the phenomenon is addressed.

This introductory chapter to Part III examines whether there are generalizable lessons concerning law and its regulation of technology that we can learn from past experience with the law reacting to technological evolution. I suggest three insights from historical interactions between law and technological change: (1) pre-existing legal categories may no longer apply to new law and technology disputes; (2) legal decision makers should be mindful to avoid letting the marvels of a new technology distort their legal analysis; and (3) the types of legal disputes that will arise from new technology are often unforeseeable. These lessons are applicable across a wide range of technologies, legal fields, and contexts to aid in determining current and future legal responses to technological development.

At STIAS, the ‘Health in Transition’ theme includes a programme to address the epidemic rise in the incidence of non-communicable diseases (NCDs) such as Type 2 diabetes, hypertension, obesity, coronary heart disease and stroke in Africa. The aim is to advance awareness, research capacity and knowledge translation of science related to the Developmental Origins of Health and Disease (DOHaD) as a means of preventing NCDs in future generations. Application of DOHaD science is a promising avenue for prevention, as this field is identifying how health and nutrition from conception through the first 1 000 days of life can dramatically impact a developing individual’s future life course, and specifically predicate whether or not they are programmed in infancy to develop NCDs in later life. Prevention of NCDs is an essential strategy as, if unchecked, the burden of caring for a growing and ageing population with these diseases threatens to consume entire health budgets, as well as negatively impact the quality of life of millions. Africa in particular needs specific, focussed endeavors to realize the maximal preventive potential of DOHaD science, and a means of generating governmental and public awareness about the links between health in infancy and disease in adult life. This volume summarizes the expertise and experience of a leading group of international scientists led by Abdallah Daar brought together at STIAS as part of the ‘Health in Transition’ programme.

Longhorn Beetles — Cerambycidae are one of the most easily recognised groups of beetles, a family that worldwide encompasses over 33 000 species in 5200 genera. With over 1400 species classified in 300 genera, this is the sixth largest among 117 beetle families in Australia. These beetles often attack and kill living forest or orchard trees and develop in construction timber (like the European House borer, introduced to WA), causing serious damage. Virtually all Cerambycidae feed on living or dead plant tissues and play a significant role in all terrestrial environments where plants are found. Larvae often utilise damaged or dead trees for their development, and through feeding on rotten wood form an important element of the saproxylic fauna, speeding energy circulation in these habitats. Many species are listed as quarantine pests because of their destructive role to the timber industry. This second of three volumes on Australian Longhorn Beetles covers the taxonomy of genera of the Cerambycinae, with comments on natural history and morphology. One hundred and forty-two Cerambycinae genera are diagnosed and described, an illustrated key to their identification is provided, and images illustrate representatives of genera and of actual type specimens. A full listing of all Australian species with synonymies and bibliographic citations is also included. Recipient of a 2017 Whitley Awards Certificate of Commendation for Taxonomic Zoology

This chapter studies the professional, political, and academic ‘human capital endowment’ of the central bank governors in office between 1950 and 2000 in twelve OECD countries. Although many national differences are observed, four more general shifts in central bank governor ‘types’ have been identified: (1) the civil servant central banker of the economic ‘golden age’ of the 1950s and 1960s; (2), the central bank politicians of the 1970s; (3) the market-oriented governors of the 1980s; and (4), the academic central banker from the 1990s onward. During the period studied, it is also possible to track the development of an international elite of central bankers, sharing similar backgrounds (academically and professionally) and views on monetary policy. A key observation is that ‘what makes for a credible central banker’ has changed over time, and especially following events such as economic recessions or financial crises.

The wind power development policy community faces a conundrum. On the one hand, as the most commercially viable form of utility-scale renewable energy, the wind power industry has experienced in excess of ten-fold growth in total installed capacity over the past decade. On the other hand, installed wind power capacity still accounts for less than 2% of global electricity-generation capacity, despite the prevalence of studies indicating that, in certain situations, wind power can be a cheaper form of electricity than most fossil fuel alternatives. Accordingly, the most puzzling aspect of wind power development policy can be summed up in the following manner: given the global imperative to facilitate an expedient transition away from CO2-intensive energy technologies and the commercial viability of wind power, what is stopping the wind power industry from capturing higher market shares around the world? In Wind Power Politics and Policy, Scott Valentine examines this question from two angles. First, it presents an analysis of social, technical, economic and political (STEP) barriers which research shows tends to stymie wind power development. Case studies which examine phlegmatic wind power development in Japan, Taiwan, Australia and Canada are presented in order to demonstrate to the reader how these barriers manifest themselves in practice. Second, the book presents an analysis of STEP catalysts which have been linked to successful growth of wind power capacity in select nations. Four more case studies that examine the successful development of wind power in Denmark, Germany, the USA and China are put forth as practical examples of how supportive factors conflate to produce conditions that are conducive to growth of wind power markets. By examining its impediments and catalysts, the book will provide policymakers with insight into the types of factors that must be effectively managed in order to maximize wind power development.

Herpes simplex virus (HSV) types 1 and 2 cause several important syndromes, including congenital and perinatal infections that can cause devastating consequences in newborns (i.e., neonatal HSV). Most neonatal HSV infections are acquired intrapartum in the infected maternal birth canal. Since genital HSV infections are common, neonatal HSV is an important complication in infected women, even if maternal symptoms are absent. As a result of the developmental status of the fetal and newborn immune system, neonatal HSV infection is associated with life-threatening disease. This chapter reviews the clinical presentations of neonatal HSV infection, as well as advances in diagnosis and therapy. Skin vesicles and fever are often absent, which contributes to a delay in initiating effective therapy. Early recognition is key. Despite significant advances in diagnostic testing and antiviral treatment for neonatal HSV, morbidity and mortality remain high and no vaccine is currently available for clinical use.

Coronary artery anomalies occur either in isolation or in the context of congenital heart defects (CHD). Isolated coronary artery anomalies include anomalies of connection to the pulmonary artery or to the aorta, anomalies of the intrinsic coronary arterial anatomy including anomalous orifices, and anomalies of myocardial/coronary arterial interaction including myocardial bridges and fistulae. Such defects are of major significance in clinical cardiology and cardiac surgery because of their association with myocardial ischaemia and sudden death. Coronary anomalies associated with CHD can result from three types of developmental perturbation: (1) anomalous epicardial course (in congenitally corrected transposition of the great arteries and L-looped ventricles), (2) anomalous communication with a high-pressure ventricular cavity (pulmonary atresia with intact ventricular septum and hypoplastic left heart syndrome), or (3) anomalous connection to the aorta. Outflow tract defects represents 30–40% of CHD, and their main characteristic is great artery defects influencing coronary arterial anatomy.

This book answers the question of the usefulness of criminological fiction. Criminological fiction is fiction that can provide an explanation of the causes of crime or social harm and could, in consequence, contribute to the development of crime or social harm reduction policies. The book argues that criminological fiction can provide at least the following three types of criminological knowledge: (1) phenomenological, i.e. representing what certain experiences are like; (2) counterfactual, i.e. representing possible but non-existent situations; and (3) mimetic, i.e. representing everyday reality in detail and with accuracy. The book employs the phenomenological, counterfactual, and mimetic values of fiction to establish a theory of the criminological value of narrative fiction. It begins with a critical analysis of current work in narrative criminology and current criminological work on fiction. It then demonstrates the phenomenological, counterfactual, and mimetic values of narrative fiction using case studies from fictional novels, graphic novels, television series, and feature films. The argument concludes with an explanation of the relationship between the aetiological and pedagogic values of narrative fiction, focusing on cinematic fictions in virtue of the vast audiences they reach courtesy of their place in global popular culture.

Sugar-sweetened beverage excise taxes are an effective evidence-based noncommunicable diseases (NCD) prevention policy. Along with tobacco and alcohol excise taxes, they are a tool to attain the Sustainable Development Goals, and are recommended by the World Health Organization to modify behavioral risk factors associated with obesity and NCDs, as featured in the WHO Global Action Plan. Taxes on sugar-sweetened beverages have been described as a triple win for governments, because they 1) improve population health, 2) generate revenue, and 3) have the potential to reduce long-term associated healthcare costs and productivity losses. Taxation of sugar-sweetened beverages has been implemented in more than 73 countries worldwide. In the Region of the Americas, 21 PAHO/WHO Member States apply national-level excise taxes on sugar-sweetened beverages and seven jurisdictions apply local sugar-sweetened beverage taxes in the United States of America. While the number of countries applying national excise taxes on sugar-sweetened beverages in the Region is promising, most of these taxes could be further leveraged to improve their impact on sugar-sweetened beverages consumption and health. This publication provides economic concepts related to the economic rationale for using sugar-sweetened beverage taxes and the costs associated with obesity; key considerations on tax design including tax types, bases, and rates; an overview of potential tax revenue and earmarking; evidence on the extent to which these taxes are expected to impact prices of taxed beverages, the demand for taxed beverages, and substitution to untaxed beverages; and responses to frequent questions about the economic impacts of sugar-sweetened beverage taxation.

These Guidelines are one of the results of the four-year research project “Open Online Learning for Digital and Networked Society” (2017-2021). The project objective was to enable university teachers to design open and online learning through open and online learning curriculum and environment applying learning analytics as a metacognitive tool and creating open and online learning assessment and recognition practices, responding to the needs of digital and networked society. The research of the project resulted in 10 scientific publications and 2 studies prepared by Vytautas Magnus university Institute of Innovative Studies research team in collaboration with their international research partners from Germany, Spain and Portugal. The final stage of the research attempted creating open and online learning assessment and recognition practices, responding to the learner needs in contemporary digital and networked society. The need for open learning recognition has been increasing during the recent decade while the developments of open learning related to the Covid 19 pandemics have dramatically increased the need for systematic and high-quality assessment and recognition of learning acquired online. The given time also relates to the increased need to offer micro-credentials to learners, as well as a rising need for universities to prepare for micro-credentialization and issue new digital credentials to learners who are regular students, as well as adult learners joining for single courses. The increased need of all labour - market participants for frequent and fast renewal of competences requires a well working and easy to use system of open learning assessment and recognition. For learners, it is critical that the micro-credentials are well linked to national and European qualification frameworks, as well as European digital credential infrastructures (e.g., Europass and similar). For employers, it is important to receive requested quality information that is encrypted in the metadata of the credential. While for universities, there is the need to properly prepare institutional digital infrastructure, organizational procedures, descriptions of open learning opportunities and virtual learning environments to share, import and export the meta-data easily and seamlessly through European Digital Hub service infrastructures, as well as ensure that academic and administrative staff has digital competencies to design, issue and recognise open learning through digital and micro-credentials. The first chapter of the Guidelines provides a background view of the European Qualification Framework and National Qualification frameworks for the further system of gaining, stacking and modelling further qualifications through open online learning. The second chapter suggests the review of current European policy papers and consultations on the establishment of micro-credentials in European higher education. The findings of the report of micro-credentials higher education consultation group “European Approach to Micro-credentials” is shortly introduced, as well as important policy discussions taking place. Responding to the Rome Bologna Comunique 2020, where the ministers responsible for higher education agreed to support lifelong learning through issuing micro-credentials, a joint endeavour of DG Employment, Social Affairs and Inclusion and DG Research and Innovation resulted in one of the most important political documents highlighting the potential of micro-credentials towards economic, social and education innovations. The consultation group of experts from the Member States defined the approach to micro-credentials to facilitate their validation, recognition and portability, as well as to foster a larger uptake to support individual learning in any subject area and at any stage of life or career. The Consultation Group also suggested further urgent topics to be discussed, including the storage, data exchange, portability, and data standards of micro-credentials and proposed EU Standard of constitutive elements of micro-credentials. The third chapter is devoted to the institutional readiness to issue and to recognize digital and micro-credentials. Universities need strategic decisions and procedures ready to be enacted for assessment of open learning and issuing micro-credentials. The administrative and academic staff needs to be aware and confident to follow these procedures while keeping the quality assurance procedures in place, as well. The process needs to include increasing teacher awareness in the processes of open learning assessment and the role of micro-credentials for the competitiveness of lifelong learners in general. When the strategic documents and procedures to assess open learning are in place and the staff is ready and well aware of the processes, the description of the courses and the virtual learning environment needs to be prepared to provide the necessary metadata for the assessment of open learning and issuing of micro-credentials. Different innovation-driven projects offer solutions: OEPass developed a pilot Learning Passport, based on European Diploma Supplement, MicroHE developed a portal Credentify for displaying, verifying and sharing micro-credential data. Credentify platform is using Blockchain technology and is developed to comply with European Qualifications Framework. Institutions, willing to join Credentify platform, should make strategic discussions to apply micro-credential metadata standards. The ECCOE project building on outcomes of OEPass and MicroHE offers an all-encompassing set of quality descriptors for credentials and the descriptions of learning opportunities in higher education. The third chapter also describes the requirements for university structures to interact with the Europass digital credentials infrastructure. In 2020, European Commission launched a new Europass platform with Digital Credential Infrastructure in place. Higher education institutions issuing micro-credentials linked to Europass digital credentials infrastructure may offer added value for the learners and can increase reliability and fraud-resistant information for the employers. However, before using Europass Digital Credentials, universities should fulfil the necessary preconditions that include obtaining a qualified electronic seal, installing additional software and preparing the necessary data templates. Moreover, the virtual learning environment needs to be prepared to export learning outcomes to a digital credential, maintaining and securing learner authentication. Open learning opportunity descriptions also need to be adjusted to transfer and match information for the credential meta-data. The Fourth chapter illustrates how digital badges as a type of micro-credentials in open online learning assessment may be used in higher education to create added value for the learners and employers. An adequately provided metadata allows using digital badges as a valuable tool for recognition in all learning settings, including formal, non-formal and informal.