bluuebunny/crossref_metadata_2025 huggingface dataset:
The experience of a tertiary referral centre in Romania on basal cell carcinomas in outdoor workers: why to assess?
Authors: Salavastru C.M. , Ulrich C. , Cretu S. , Moldovan H.R. , Tiplica G.S.
Published: March 2016

Background

Published epidemiological literature indicates that outdoor workers are at significantly increased risk for developing basal cell carcinomas.

Objectives

The main objective is to identify basal cell carcinoma features in patients with prolonged occupational exposure to UV radiation and compare them to basal cell carcinoma in patients with no occupational exposure to UV radiation.

Methods

Data regarding age, gender, living area, occupation, number of lesions, involved anatomic site and histologic subtype of tumor were collected from the charts of 321 patients diagnosed with basal cell carcinoma in our department between 01.01.2013‐31.12.2014. We divided the patient population in which the occupation was accurately identified in two study groups: occupations with UV exposure (OW), and non‐UV exposed occupations (IW) and we compared the clinical and histologic features of the lesions in the two groups.

Results

The most affected area in both groups was the facial “mask area”. The cheek was second most affected area in exposed group whereas the scalp area was the second most affected in the non‐exposed group. The nodular pattern is the most numerous in both groups (30 lesions in OW group and 15 lesions in the IW group with a mean number of lesions of 1.57±0.90 and 1.27±0.46, respectively) with the mixed type being the second most frequent type for both groups. However, for the OW group the mixed type with an aggressive component was the second most frequent one, while in the non‐exposed group, the mixed type with non‐aggressive components was the second most frequent, the difference being statistically significant. A multinomial logistic regression analysis was conducted to predict the presence of histopathologically aggressive lesions using gender, age, exposure and anatomical site out of which UV exposure and 3 main anatomical sites (mask zone, cheek and torso) were selected in the final analysis. The probability of the model chi‐square (9.430), p = .05, supports a relationship between the dependent variable and the independent variables.

Conclusion

Our data suggest that in Romania patients diagnosed with basal cell carcinoma, occupationally exposed to UV radiation, develop more frequently lesions on the “mask area” of the face; furthermore, prediction of the histo‐pathologically aggressive lesions may be supported by the presence of occupational UV exposure and anatomical site (mask zone, cheek and torso) involved.Also, these patients may be at a higher risk to develop more aggressive histologic subtype BCCs. Although limited by a number of factors, especially the small number of subjects, these data suggest the necessity of conducting both retrospective and prospective studies on clinical and histological types of BCCs evolving in patients working outdoor along with identifying additional risk factors.
Knowledge of outdoor workers on the effects of natural UV radiation and methods of protection against exposure
Authors: Hault K. , Rönsch H. , Beissert S. , Knuschke P. , Bauer A.
Published: March 2016

The most important but influenceable risk factor in the development of skin cancer is the unprotected exposure to solar ultraviolet (UV) radiation. In order to assure adequate and effective protection against UV exposure, a level of knowledge about solar radiation and its effects is required. The objective of this study was to assess the knowledge of workers in outdoor professions on the effects of natural UV radiation and methods of protection against exposure. Forty outdoor workers were given a standardized questionnaire designed to ascertain their level of knowledge. The majority of participants knew exposure to solar radiation can be detrimental depending on exposure time. Eighty‐three percentage recognized that people working regularly in an outdoor environment may be at risk due to high exposure. Long‐sleeved clothing plus headgear and sunscreen containing sun‐protecting substances were deemed adequate methods of protection by 83% and 85% respectively. Seventy percentage of the outdoor workers were familiar with the definition of the sun protection factor (SPF), yet only 25% correctly identified the amount of sunscreen needed to achieve the SPF as indicated on the product. A mere 8% of participants knew that symptoms of a sunburn first became apparent 3 h after sun exposure and only 18% were able to accurately gauge the amount of time they could spend in the sun before developing one. Although 30% had heard of the ultraviolet index (UVI), only 13% understood that protecting your skin using additional measures is recommended as of UVI 3. Overall, 30% of the outdoor workers thought themselves sufficiently protected against the harmful effects of the sun. While the participants of this study had a basic fundamental understanding of the effects of solar radiation and methods of protection against exposure, there remains an urgent need for further clarification across all demographic groups.
Influence of oxidative homeostasis on bacterial density and cost of infection in Drosophila–Wolbachia symbioses
Authors: Monnin D. , Kremer N. , Berny C. , Henri H. , Dumet A. , Voituron Y. , Desouhant E. , Vavre F.
Published: March 2016

The evolution of symbioses along the continuum between parasitism and mutualism can be influenced by the oxidative homeostasis, that is the balance between reactive oxygen species (ROS) and antioxidant molecules. Indeed, ROS can contribute to the host immune defence to regulate symbiont populations, but are also toxic. This interplay between ROS and symbiosis is notably exemplified by recent results in arthropod–Wolbachia interactions. Wolbachia are symbiotic bacteria involved in a wide range of interactions with their arthropods hosts, from facultative, parasitic associations to obligatory, mutualistic ones. In this study, we used Drosophila–Wolbachia associations to determine whether the oxidative homeostasis plays a role in explaining the differences between phenotypically distinct arthropod–Wolbachia symbioses. We used Drosophila lines with different Wolbachia infections and measured the effects of pro‐oxidant (paraquat) and antioxidant (glutathione) treatments on the Wolbachia density and the host survival. We show that experimental manipulations of the oxidative homeostasis can reduce the cost of the infection through its effect on Wolbachia density. We discuss the implication of this result from an evolutionary perspective and argue that the oxidative homeostasis could underlie the evolution of tolerance and dependence on Wolbachia.
Saving and Portfolio Allocation Before and After Job Loss
Authors: BASTEN CHRISTOPH , FAGERENG ANDREAS , TELLE KJETIL
Published: March 2016

We investigate the development of household labor income, financial wealth, and asset holdings over a 9‐year period around job loss, using unique administrative panel data from Norway. Consistent with predictions from theory, the data show additional saving and a shift toward safer assets in the years leading up to unemployment, and depletion of savings after job loss. In the years after job loss, the households' after‐tax labor income is reduced by about USD 12,500. Over the same time period, households deplete USD 3,000 of their financial assets, of which one third is accumulated prior to the job loss. This suggests that at least some households can foresee and prepare for the upcoming unemployment, which indicates that private savings can, to some extent, serve as a substitute for publicly provided unemployment insurance.
Automated background subtraction technique for electron energy‐loss spectroscopy and application to semiconductor heterostructures
Authors: ANGADI VEERENDRA C , ABHAYARATNE CHARITH , WALTHER THOMAS
Published: March 2016

Electron energy‐loss spectroscopy (EELS) has become a standard tool for identification and sometimes also quantification of elements in materials science. This is important for understanding the chemical and/or structural composition of processed materials. In EELS, the background is often modelled using an inverse power‐law function. Core‐loss ionization edges are superimposed on top of the dominating background, making it difficult to quantify their intensities. The inverse power‐law has to be modelled for each pre‐edge region of the ionization edges in the spectrum individually rather than for the entire spectrum. To achieve this, the prerequisite is that one knows all core losses possibly present. The aim of this study is to automatically detect core‐loss edges, model the background and extract quantitative elemental maps and profiles of EELS, based on several EELS spectrum images (EELS SI) without any prior knowledge of the material. The algorithm provides elemental maps and concentration profiles by making smart decisions in selecting pre‐edge regions and integration ranges. The results of the quantification for a semiconductor thin film heterostructure show high chemical sensitivity, reasonable group III/V intensity ratios but also quantification issues when narrow integration windows are used without deconvolution.
Lived experience of vulnerability from a Gypsy Roma Traveller perspective
Authors: Heaslip Vanessa , Hean Sarah , Parker Jonathan
Published: March 2016

Aims and objectives

To describe the lived experience of vulnerability of individuals within a Gypsy Roma Travelling community.

Background

People experience vulnerability whenever their health or usual functioning is compromised. This may increase when they enter unfamiliar surroundings, situations or relationships. One's experience of vulnerability can also be heightened through interactions between the individual and the society within which they live. Gypsy Roma Travellers are often identified as vulnerable owing to increased morbidity and mortality as well as their marginalised status within society. Yet little is known of the experiences of vulnerability by the individuals themselves. Without their stories and experiences, health professionals cannot effectively develop services that meet their needs.

Design

This descriptive phenomenological study sought to explore the lived experience of vulnerability in a Gypsy Roma Travelling community.

Methods

Seventeen Gypsy Roma Travellers were interviewed in 2013–2014 about their experiences of feeling vulnerable. This paper reports on the findings from the depth phase in which 13 individuals were interviewed. The interviews were conducted and analysed using Giorgi's descriptive phenomenological approach.

Findings

Six constituents of the phenomenon of vulnerability were identified as feeling: defined and homogenised as a group; pressurised to conform to live in a particular way; split in one's identity; a loss of one's heritage; discriminated, persecuted and threatened; and powerlessness.

Relevance to clinical practice

There is a wealth of evidence that Gypsy Roma Travellers experience high levels of morbidity and mortality, which has led to them being identified by health professionals and policy makers as a vulnerable community. Exploring their lived experience of vulnerability presents a different perspective regarding this concept and can help explain why they may experience poorer levels of physical and mental health.
Historicizing diaglossia
Authors: Rutten Gijsbert
Published: March 2016

Auer (2005, 2011) presents a typology of present‐day dialect/standard constellations in Europe, thereby reintroducing the concept of diaglossia, which refers to a situation with intermediate variants between dialect and standard. Characterizing the sociolinguistic landscape in many languages in Europe today, diaglossia is assumed to be a relatively recent phenomenon dating back to the late nineteenth or early twentieth century, following a previous stage of diglossia. Drawing on a range of case studies of post‐Medieval English, German and Dutch, this article argues that the sociolinguistic situation in the Early and Late Modern period cannot be described in terms of diglossia, and is characterized by a ubiquity of intermediate variants instead, that is, by diaglossia. This means that diaglossia should be extended much farther back in time and is not a recent development following a state of diglossia.
What's a stigmatized variant doing in the word list? Authenticity in reading styles and Hebrew pharyngeals
Authors: Gafter Roey J.
Published: March 2016

The pharyngeal segments in Hebrew, [ʕ] and [ħ], are historically conservative and considered prescriptively correct, but are also socially stigmatized as a feature associated with Mizrahi (Middle Eastern) descent. I present data from sociolinguistic interviews in two Israel field sites and demonstrate a robust pattern in both communities: speakers who produce pharyngeals in the interview use more [ʕ] in reading a word list than in free‐form conversation, but show no such effect for [ħ]. The results are difficult to reconcile with a single axis of standardness or formality and highlight the need for a more multidimensional approach to interpreting reading styles. Taking into account both the community's language ideologies that link reading styles to their ethnic identity and the fact that [ʕ] has been shown to be more useful as a stylistic resource for performing Mizrahi personae, I argue for an interpretation that considers word list reading as a site for performing a Mizrahi ethnic identity.
USprivate oil and natural gas royalties: estimates and policy relevance
Authors: Fitzgerald Timothy , Rucker Randal R
Published: March 2016

Widespread ownership of oil and natural gas resources by private individuals is unique to theUnitedStates. The owner's share is typically specified as a gross revenue royalty. We develop estimates of income from production of privately owned minerals. Focusing on onshore resources in the continentalUnitedStates, we determine that the share of total oil and natural gas production attributable to privately owned minerals has been approximately 75 per cent in recent years. We find that average private royalty rates in recent years were 13.5 per cent for oil and 11.8 per cent for natural gas, and that private royalty income from oil and gas production was $21–22 billion in 2011 and 2012. We then briefly discuss four current policy issues upon which our estimates have bearing: exports of liquefied natural gas and crude oil, effects of refinery and pipeline constraints, state and federal tax policy, and regulation of technology.
Determinants of stock prices during dividend announcements: an evaluation of firms' variable effects in Nigeria's oil and gas sector
Authors: Chiek Aik Nai , Akpan Mfon NU
Published: March 2016

The aim of this research was to analyse, statistically significant, quantitative variables that determine the share price of oil and gas sector companies listed on the Nigerian Stock exchange, during the economic slowdown period of 2009–2013, after the world financial crisis of 2008, and investigate whether the signalling hypothesis holds or not. In terms of analytical tools, multiple regression analysis is used. During dividend increase announcements, the regression coefficient determinant (R2) indicates that over 90 per cent of variations in stock prices is explained by variations in dividend announcements. This study supports the dividend signalling hypothesis (DSH) but discredits the efficient market hypothesis. During a dividend decrease, the R2 for both equations indicates that over 64 per cent of variations in stock prices is explained by variations in dividend announcements. This result also supports the DSH. The implication of this is that racketeers can capitalise on this and make unjustified returns. By so doing, both sector investors and the stock market will be short changed. As this research considers only the oil and gas sector, further studies need to be conducted that consider possibly all listed firms in the Nigerian stock market, within the same interval to further investigate if the signalling hypothesis will hold or not. But most appropriately, applicable, as a comparative study of the same sector before and after the world financial crisis of 2008 the paper seeks to find out if this phenomenon is also applicable to OPEC member states. This research is in progress.
An empirical study on the valuation of oil companies
Authors: Kumar Bhaskaran Rajesh , K Sukumaran Sujit
Published: March 2016

This study examines the determinants of value creation for the world's largest oil and gas companies. The study was based on 82 oil companies. The financial performance analysis for the period 2009–2013 reveals that the average total revenues increased from $39.82 billion in year 2009 to $68.87 billion in year 2013. The largest oil firms in terms of average revenues were Exxon Mobil, Royal Dutch Shell and Sinopec during the period 2009–2013. Three major market value variables were regressed on various independent variables representing performance, the financing, investment and dividend policy variables of oil firms. The empirical analysis finds that dividend policy and cost efficiency are important determinants of valuation of oil companies. The higher the liquidity position of the energy firms, the higher is the value creation in the market. The study establishes negative relationship between capital intensity and value creation. It can be viewed that market is sceptical about high capital expenditures by oil and gas firms. Higher cash flows result in increase in value for oil firms in stock market. Higher working capital efficiency leads to higher value creation. Undervalued stocks in the oil sector tends to have higher potential for value appreciation. Focus on effective asset utilisation is a value increasing activity for oil and gas sector firms.
Drug Reaction with Eosinophilia and Systemic Symptoms in Children: A Prospective Study
Authors: Sasidharanpillai Sarita , Sabitha Sasidharanpillai , Riyaz Najeeba , Binitha Manikoth P. , Muhammed Kunnummal , Riyaz Arakkal , Jayakrishnan Machinary P. , Reyila Vengarakath P.
Published: March 2016

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction that can affect any age group. We carried out a prospective study of the clinicoepidemiologic aspects of DRESS in children. We prospectively studied all patients ages 12 years and younger admitted to the departments of pediatrics and dermatology at a tertiary care hospital over a 3‐year period with probable or definite DRESS, defined based on the RegiSCAR scoring system. A total of 11 patients were studied. Lamotrigine (four patients) and pencillins (three patients) were the most common offending drugs. Not adhering to the standard guidelines of introduction and gradual titration of lamotrigine to therapeutic dose may have increased the chance of lamotrigine‐induced DRESS. A short latent period between the onset of drug intake and drug reaction was noted in DRESS induced by antibiotics.
Hale on the Architecture of Modal Knowledge
Authors: Fischer Bob
Published: March 2016

There are many modal epistemologies available to us. Which should we endorse? According to Bob Hale, we can start to answer this question by examining the architecture of modal knowledge. That is, we can try to decide between the following claims: (1) knowing that p is possible is essentially a matter of having a well‐founded belief that there are no conflicting necessities—a necessity‐based approach—and (2) knowing that p is necessary is essentially a matter of having a well‐founded belief that there are no conflicting possibilities—a possibility‐based approach. Hale argues for the first of these claims, but I contend that his arguments fail. However, it doesn't follow that we should endorse a possibility‐based approach. I repurpose Hale's arguments to show those who would endorse possibility‐based approaches need to say more about our modal knowledge concerning logic and mathematics; if they can't, then they ought to endorse a hybrid modal epistemology that doesn't give priority to one modality across the board. Additionally, those who endorse possibility‐based views may be committed to Peter van Inwagen's modal skepticism.
Automatic Keyline Recognition and 3D Reconstruction For Quasi‐Planar Façades in Close‐range Images
Authors: Li Chang , Zhang Yongjun , Zhang Zuxun
Published: March 2016

Critical keylines, such as concave and convex edges of a building façade, can be lost in photogrammetric recognition procedures. To solve this problem and to reconstruct quasi‐planar 3D façades automatically and precisely, a set of algorithms and techniques for the automatic recognition of lines and 3D reconstruction is proposed. This includes: (1) a procedure for line‐segment matching that satisfies the spatial requirements of a 3D scene based on “global independence” and “local dependence”; (2) a technique of generalised point bundle block adjustment combined with spatial line constraints (in the form of virtual observations) to control the propagation of error; and (3) the methods of perceptual organisation, plane fitting and plane–plane intersection are suggested to acquire the critical keylines corresponding to concave and convex building edges. Experimental results show that these new algorithms are feasible and applicable to recognition and 3D reconstruction. Recommendations for recognition methods are provided depending on whether or not a priori topological relationships are available between the planes under consideration.
Is Morality Policy Different? Testing Sectoral and Institutional Explanations of Policy Change
Authors: Hurka Steffen , Adam Christian , Knill Christoph
Published: March 2016

We analyze morality policy change from the perspective of punctuated equilibrium theory (PET) to test whether reform dynamics in this policy sector follow a distinct pattern. First, we propose a new measurement scheme capturing changes in the intensity of morality policy output. Second, we demonstrate that morality policy change is strongly punctuated. Finally, and most importantly, we show that the degree of policy punctuations varies between different domains of morality policy, but not according to institutional features operating on the country level, supporting existing PET research, which has discovered similar domain‐specific dynamics in changes of public spending. Specifically, punctuations are particularly pronounced in areas of manifest morality policy, that is, policies characterized by strong value conflicts, whereas punctuations are less pronounced for latent morality policies, that is, policies in which other dimensions of conflict are present next to the value dimension. Significant differences in reform dynamics are neither discerned for countries belonging to the religious or the secular world, nor for countries with majoritarian or consensual democracies. The analysis relies on an original dataset capturing legislative changes in five manifest (abortion, euthanasia, prostitution, pornography, and homosexuality), and three latent morality policies (drugs, gambling, and handguns) in 19 European countries (1960–2010).
Prosecutorial regulation in the Global South: Environmental civil litigation by prosecutors in China compared to Brazil
Authors: Shi Yifan , van Rooij Benjamin
Published: March 2016

Brazil's successful prosecutorial civil action against polluters could be a regulatory example for the Global South. This paper analyses whether such regulation could also develop without the major political, institutional, and legal reforms that spurred it in Brazil. To do so, it analyzes China, where similar reforms have so far not occurred, but where prosecutors have recently started to initiate civil litigation against polluters. It finds that prosecutorial civil litigation in China has only a limited regulatory effect or potential. Prosecutors in China are influenced by conflicting incentive structures that reward one‐off lower level test cases with an innovation bonus, while structurally stimulating a focus on general crime fighting. Ironically, as a result of such incentives, the recent legal reform, toward providing standing for prosecutors in public interest litigation, will, in contrast to Brazil, decrease rather than increase the regulatory effect of these cases. These findings have implications for understanding how the interaction between regulatory independence, legal reform, and regime type shapes possibilities for regulatory innovation in the Global South.
Improving Perceptions of the Insurance Industry: The Influence of Insurance Professionals
Authors: Karl J. Bradley , Wells Brenda
Published: March 2016

The “talent crisis” in the insurance industry is well documented. Solutions to this crisis, however, are not plentiful. One of the major challenges faced by the industry is its reputation. We hypothesize that opinions of the industry can be changed through brief but specific education efforts. We test our hypothesis at a major university and find very strong support for our hypothesis.
Imagining ‘Europe’: Constituting Turkey's Identity on the Path to Eu Membership
Authors: Arkan Zeynep
Published: March 2016

In the aftermath of the Cold War, Turkey, once the ‘southern bastion of NATO’, had to redefine its identity and geopolitical location in relation to not only the West and Europe, but also its neighbours to the East. In this period, the country's aspiration to join the European Union and its position vis‐à‐vis Europe proved to be determining factors in its identity transformation process, taking into consideration its traditional Western orientation. By specifically focusing on the last decade, this study analyses how Turkey's decision‐makers constituted the identity of the state in relation to a specific conception of Europe. It argues that these decision‐makers, through references to the distinctive history and geography of Turkey, reconceptualised the identity of the state in order to transform Turkey into an effective actor in the world and, in doing so, challenged the dominant inclusive, multi‐cultural and normative characterisations of the European Union's identity.
Divided we rise: politics, architecture and vertical cityscapes at opposite ends of Jerusalem
Authors: Rosen Gillad , Charney Igal
Published: March 2016

This paper explores how planning, politics and architecture work together to socially produce new vertical cityscapes. Our contention is that the inception and development of high‐rises are interlocked into the narrations of cities, reflecting cultural values and social cleavages, political interests and planning agendas, symbolic connotations and everyday life experiences. By using a mixed‐method approach, which includes the analysis of official documents and interviews with decisionmakers, planners and observers, we examine two trajectories of tall‐building development at opposite ends of Jerusalem. In Israeli West Jerusalem, the development of high‐rises is part of a neo‐liberal growth package that seeks to stimulate economic activity, rebrand the city and increase the city's competiveness at national and global scales while evading highly contentious religious‐cultural cleavages. At the other end of the city, the construction of tall buildings in grey spaces symbolically represents a Palestinian revolt against Israeli restrictive planning and development policies, but also addresses day‐to‐day needs and changing preferences of the Palestinian population. Our analysis uses verticality as a representation of social relations demonstrating manipulations of power and legitimacy. In Jerusalem, planning and development of ordinary high‐rises next to recently completed icons, the Bridge of Strings and the Separation Wall, epitomises a dialogue that unmistakably promotes political agendas and produces symbolic meanings. This dialogue can either support the original values and aims of urban icons or challenge them.
‘A band of public‐spirited women’: middle‐class female philanthropy and citizenship in Bolton, Lancashire before 1918
Authors: Moore Francesca
Published: March 2016

In the 19th and early 20th centuries, despite the cultural ideal of private and public as separate spheres and a lack of formal voting rights, many middle‐class women engaged in philanthropic and social work outside the home. Taking as its focus a group of middle‐class women in Bolton, Lancashire, this paper conducts a prosopography, or group biography, in order to shed light on female citizenship and make a historical contribution to literature on citizenship beyond voting rights. The paper uses archive traces to reconstruct the experience of the female philanthropist and understand her motivations. The focus of the paper is a new theoretical approach to women's citizenship in the early 20th century. Using Michel Foucault's concept of biopolitics, or life politics, the paper reconceptualises women's social work as a form of biopolitical patriotism that was the basis of a scalar claim to citizenship. This historical evidence from Bolton reveals that biopolitical action was not solely the preserve of the state. Women claimed fitness for citizenship and the vote by nation‐building, carrying out work that shaped children into the citizens of the future and safeguarded the moral and physical health of the nation.
Best practice recommendations for prehospital veterinary care of dogs and cats
Authors: Hanel Rita M. , Palmer Lee , Baker Janice , Brenner Jo‐Anne , Crowe Dennis T. (Tim) , Dorman David , Gicking John C. , Gilger Brian , Otto Cynthia M. , Robertson Sheilah A. , Rozanski Elizabeth , Trumpatori Brian
Published: March 2016

Objective

To examine available evidence on prehospital care in human and veterinary trauma and emergency medicine and develop best practice guidelines for use by both paramedical and nonparamedical personnel in the approach to the prehospital care of dogs and cats.

Design

Systematic evaluation of the literature gathered via medical databases searches of Medline, CAB abstracts, and Google Scholar.

Synthesis

From a review and systematic evaluation of the available evidence, consensus guidelines on the approach to prehospital care of dogs and cats in 18 scenarios were developed.

Conclusions

Due to the lack of current evidence in the veterinary prehospital arena, best practice guidelines were developed as an initial platform. Recommendations were based on a review of pertinent human and available veterinary literature as well as a consensus of the authors’ professional opinions. It is anticipated that evidence‐based additions will be made in the future.
Natural History of C282Y Homozygotes for Hemochromatosis
Authors: Wojcik John P , Speechley Mark R , Kertesz Ann E , Chakrabarti Subrata , Adams Paul C
Published: March 2016

PURPOSE: To study the clinical outcomes of subjects who are homozygous for the C282Y mutation of the hemochromatosis gene.

SUBJECTS AND METHODS: All patients referred to a tertiary referral centre for hemochromatosis were included. The study also included 16 C282Y homozygotes detected in a population screening study.

RESULTS: The study comprised 277 C282Y homozygotes, including 16 nonexpressing C282Y homozygotes. The mean follow-up period was 7.3 years (range zero to 44 years). The actuarial survival rates of C282Y homozygotes at five, 10 and 20 years were 95%, 93% and 66%, respectively. Life-threatening diseases (cirrhosis, hepatocellular carcinoma, diabetes, heart disease) were present in 36% of male C282Y homozygotes and 19% of female C282Y homozygotes. Cirrhosis of the liver and diabetes were the major clinical symptoms affecting long term survival. Only one nonexpressing homozygote required venesection therapy during the follow-up period.

CONCLUSIONS: Long term survival is excellent in C282Y homozygotes diagnosed and treated before the development of cirrhosis and diabetes.
Motion – Laparoscopic Nissen Fundoplication Is More Cost-Effective than Oral PPI Administration: Arguments against the Motion
Authors: Sonnenberg Amnon
Published: March 2016

Discussion of the cost effectiveness of medical and surgical treatments of gastroesophageal reflux disease (GERD) is plagued by a number of logical fallacies. Several of these defects in reasoning are reviewed. For example, it is inappropriate to compare the costs of therapies unless they are equally effective. The relative cost effectiveness of various treatment options is difficult to determine because monetary expenditures and gains in health status cannot easily be measured in commensurate units. Not everything can be translated into incremental cost effectiveness ratios. Two decision analyses from European investigators seemed to show that Nissen fundoplication was more cost effective than long term acid-suppression therapy, but they failed to consider the costs of surgical complications and failures. The most comprehensive decision analysis, employing a Markov chain model, found that the two treatment options were roughly equivalent, at least during the first seven years of follow-up. Decision analyses often do not reflect actual practice patterns and cannot provide solutions to problems that cannot be solved by appropriate medical reasoning. Moreover, results that are reported by specialized surgical centres probably cannot be duplicated by less experienced surgeons. The increasing incidence of esophageal adenocarcinoma has been erroneously attributed to the use of potent acid-suppressant medications, but the actual cause has been shown to be the decreased prevalence ofHelicobacter pylori. There are no significant differences in the incidence of this tumour after medical or surgical therapy of GERD. It is unlikely, however, that arguments will convince proponents of one treatment or another to change their opinions.
Motion – The Available Treatments for Hepatits C Are Cost Effective: Arguments for the Motion
Authors: Terrault Norah
Published: March 2016

The treatment of hepatitis C has evolved over the past decade, and a combination of interferon (IFN), pegylated or standard type, and ribavirin is now acknowledged as the therapy of choice. Questions remain, however, about the duration of treatment and which patients are the most likely to benefit from therapy. Cost effectiveness analyses (CEAs) have been employed to answer these questions. Before the results can be interpreted appropriately, however, clinicians must make themselves aware of the underlying assumptions and the nature of the ‘reference’ case. Moreover, certain parameters, including quality-of-life evaluations, may not be easily translated from one jurisdiction to another. The costs and benefits of treatment are often very sensitive to such factors as patient age, viral load, histological severity and the viral genotype. Randomized controlled clinical trials, and the CEAs on which they are based, have shown that combination therapy is more cost effective than IFN monotherapy, and that both are cost effective compared with no treatment. Ongoing research on the use of pegylated IFN, weight-adjusted dosing of ribavirin, and the treatment of relapsers and nonresponders will provide valuable data that could be incorporated into future CEAs. Health care resources are vast, but not limitless. Therefore, health care providers need to become aware of how best to allocate resources to the general population. CEAs can facilitate this process by determining which treatment strategies are likely to yield the greatest clinical benefits without excessive expenditures.
Two for One: Coexisting Ulcerative Colitis and Crohn’s Disease
Authors: Chen Grant I , Saibil Fred , Morava-Protzner Izabella
Published: March 2016

Three cases of coexisting ulcerative colitis and Crohn’s disease are presented. In the first case, the patient had a long-standing history of ulcerative proctitis before developing Crohn’s colitis. In the two remaining cases, the patients presented initially with Crohn’s disease of the ileum and, subsequent to resection, developed ulcerative colitis. Well-documented cases of patients diagnosed with both ulcerative colitis and Crohn’s disease are rare. The literature on such cases is reviewed, and the controversy over whether ulcerative colitis and Crohn’s disease are two distinct diseases is explored.
Motion – Laparoscopic Nissen Fundoplication Is More Cost Effective Than Oral PPI Administration: Arguments for the Motion
Authors: Swanström Lee L
Published: March 2016

Gastroesophageal reflux disease is a mechanical disorder of the foregut. While medications can only provide symptom relief, surgery can correct the pathophysiological abnormality of the lower esophageal sphincter. The costs of medical and surgical therapy are much greater than the costs of medication or hospitalization alone. In the case of medical therapy, one must consider the costs of serial monitoring and of failed treatment. The effectiveness of treatment also depends on patient-related factors, including weight, socioeconomic factors, smoking, alcohol use, dietary habits and the use of nonsteroidal anti-inflammatory drugs. Surgical results depend on the experience and skill of the surgeon, as well as the attributes of the institution in which the procedure is undertaken. Therefore, studies that come from specialized centres may not be applicable to the community. Data from the author’s facility indicate that laparoscopic Nissen fundoplication is the most cost effective option when it is undertaken by experienced surgeons on otherwise healthy patients who have documented gastroesophageal reflux disease.
Distal Ulcerative Colitis Refractory to Rectal Mesalamine: Role of Transdermal Nicotine versus Oral Mesalamine
Authors: Guslandi Mario , Frego Roberto , Viale Edi , Testoni Pier Alberto
Published: March 2016

BACKGROUND: Distal ulcerative colitis usually responds to treatment with rectal mesalamine, but the management of refractory cases is poorly defined.

AIM: To evaluate the possible therapeutic benefit of transdermal nicotine versus oral mesalamine.

PATIENTS AND METHODS: Thirty patients with left-sided ulcerative colitis unresponsive to treatment with a mesalamine 4 g enema at bedtime were randomly allocated to additional therapy with either transdermal nicotine 15 mg daily or oral mesalamine 800 mg tid for four weeks. Clinical remission was evaluated by Rachmilewitz’s activity index and confirmed by sigmoidoscopy.

RESULTS: Remission was observed in 12 of 15 patients receiving additional treatment with nicotine and in five of 15 patients receiving additional treatment with oral mesalamine (P=0.027).

CONCLUSIONS: The addition of transdermal nicotine to treatment with mesalamine enemas is significantly superior to combined therapy with oral and rectal mesalamine in patients with distal ulcerative colitis refractory to rectal mesalamine alone.
Identifying Contraindication to Resection in Patients with Pancreatic Carcinoma: The Role of Endoscopic Ultrasound
Authors: Wiersema Maurits J
Published: March 2016

OBJECTIVE: To present recently published material comparing the performance of endosonography relative to other imaging modalities when evaluating the patient with a suspected or known pancreas carcinoma.

METHODS: Medline was searched using the terms ‘endosonography’ and ‘pancreas neoplasms’. References from retrieved papers were reviewed to identify other reports. Emphasis was placed on peer-reviewed material published within the past three years that included comparison with other imaging modalities.

RESULTS: Despite advances in cross-sectional imaging modalities, endosonography remains the most sensitive and specific method for identifying pancreatic mass lesions. The resectability of pancreatic carcinoma is best determined with dual-phase helical computed tomography, although endosonography may be slightly more accurate for lymph node assessment. Endoscopic ultrasound-guided fine needle aspiration biopsy has a high sensitivity (93%) and specificity (100%) when used in patients with masses in whom pancreatic cancer is suspected but prior biopsies have been negative.

CONCLUSIONS: Endosonography helps in the diagnosis of pancreatic neoplasms through definitive inclusion or exclusion of a mass lesion as well as biopsy confirmation of malignancy. The role of endosonography in the determination of resectability has been eclipsed by dual-phase helical computed tomography. However, endoscopic ultrasound with fine needle aspiration of nonperitumoral lymph nodes may identify advanced disease with sufficient frequency to justify its routine use in patients with lesions that are thought to be resectable based on helical computed tomography.
Motion – Screening and Surveillance of Barrett’s Epithelium Is Practical and Cost Effective: Arguments against the Motion
Authors: Chiba Naoki
Published: March 2016

The issue of whether to screen individuals for Barrett’s esophagus (BE) to prevent esophageal adenocarcinoma (EAC) is highly controversial. Important considerations are that BE is not highly prevalent in the general population and that not many patients with BE develop or die from EAC. Studies that suggest an improved prognosis from surveillance programs are susceptible to lead-time bias. Most of the principles for effective screening, as outlined by the World Health Organization, are not met by endoscopic screening and surveillance protocols. The diagnosis of BE (and dysplasia) is often unclear. Most patients with BE are not identified by screening, and few deaths would be prevented by surveillance. A decision analysis found that the most cost effective screening protocol would be every five years, but the costs associated with prolongation of life are very high, even if a group at high risk for EAC could be identified.
The Physiology, Pharmacology and Therapeutic Manipulation of the Internal Anal Sphincter
Authors: Jones Oliver M , Brading Alison F , Mortensen Neil J McC
Published: March 2016

Recent research into the physiology and pharmacology of the internal anal sphincter has elucidated the importance of this structure in health and disease. Its pharmacological manipulation for therapeutic gain has focused mainly on agents to reduce internal anal sphincter tone, a ‘chemical sphincterotomy’ that might heal chronic anal fissure. However, drugs to increase sphincter tone, and augment intermittent and appropriate relaxation are also being evaluated. The initial results with this medical approach to anorectal disease have often been disappointing, failing to match the results achievable with surgery, and many of these drugs have a high rate of side effects in the short term. However, clinical trials have yet to establish the optimum doses, dose intervals and routes of administration for many of these therapies. Furthermore, it is uncertain whether this medical approach should be applied to all patients or just to an as yet undefined subgroup. Certainly, even in the current environment of uncertainty, there is little reason not to try medical manipulation of the internal sphincter as first-line treatment. Surgery remains an option for treatment failures; patients responding to pharmacological manipulation of the internal anal sphincter are spared the long term risks of continence that are inherent in many surgical procedures on the anorectum.
Iron Deficiency Anaemia Caused by Nonspecific (Idiopathic) Small Bowel Ulceration: An Uncommon Presentation of an Uncommon Disease
Authors: Capurso Gabriele , Lahner Edith , Pallotta Nadia , Panzuto Francesco , Delle Fave Gianfranco , Annibale Bruno
Published: March 2016

Ulcers of the small bowel are rare, and in most cases are due to infections, inflammatory bowel diseases, malignancies or drugs. When none of these causes is recognized, they are classified as ‘nonspecific’ or idiopathic. Such lesions are uncommon, and in most cases present with occlusion. A case of a middle-aged woman with iron deficiency anemia due to occult bleeding, with negative gastroscopy and colonoscopy is presented. The diagnosis of a small bowel pathology resembling Crohn’s disease was made by small bowel follow through and small intestine contrast ultrasonography. An ileal ulcer was identified at surgery, and after resection the patient experienced a stable recovery from the anemia without ulcer recurrence. Neither histology nor clinical or biochemical features suggested the diagnosis of an inflammatory bowel disease. Other possible causes were unlikely and the lesion was therefore diagnosed as idiopathic. This report also focuses on the need and the modality to investigate the small bowel in iron deficiency anemia patients.
Two Decades ofHelicobacter pylori: A Review of the Fourth Western PacificHelicobacterCongress
Authors: Fallone Carlo A , Chiba Naoki , Buchan Alison , Su Bin , Taylor Diane
Published: March 2016

From March 3 to 6, 2002,Helicobacterenthusiasts gathered in Perth, Australia for the Fourth Western PacificHelicobacterCongress to celebrate the 20th anniversary of the modern discovery of this organism by Barry Marshall and Robin Warren. The meeting included state-of-the-art lectures highlighting the breakthroughs that have occurred since the discovery of this bacterium. As well, advances from the forefront of currentHelicobacter pyloriresearch were presented, particularly in the realm of genomics and molecular biology. A symposium about vaccines and trends for futureH pyloriresearch completed this congress. The purpose of the present review is to summarize the highlights from this conference, emphasizing new advances.
Recommendations for the Appropriate Use of Anti-Inflammatory Drugs in the Era of the Coxibs: Defining the Role of Gastroprotective Agents
Authors: Hunt Richard H , Barkun Alan N , Baron David , Bombardier Claire , Bursey Ford R , Marshall John R , Morgan David G , Paré Pierre , Thomson Alan BR , Whittaker J Scott
Published: March 2016

Treatment with anti-inflammatory drugs and the analgesic efficacy of conventional nonsteroidal anti-inflammatory drugs (NSAIDs) are compromised by a two- to fourfold increased risk of gastrointestinal complications. This increased risk has resulted in an increasing use of the new selective cyclooxygenase-2 inhibitors or coxibs, which, in clinical trials and outcomes studies, reduced gastrointestinal adverse events by 50% to 65% compared with conventional NSAIDs. However, the coxibs are not available to all patients who need them, and NSAIDs are still widely used. Moreover, treatment with a coxib cannot heal pre-existing gastrointestinal lesions, and cotherapy with an anti-secretory drug or mucosal protective agent may be required.

This paper addresses the management of patients with risk factors for gastrointestinal complications who are taking NSAIDs and makes recommendations for the appropriate use of ‘gastroprotective’ agents (GPAs) in patients who need to take an NSAID or a coxib. When economically possible, a coxib alone is preferable to a conventional NSAID plus a GPA to minimize exposure to potential gastrointestinal damage and avoid unnecessary dual therapy. Patients at high risk require a GPA in addition to a coxib.