High concordance between trained nurses and gastroenterologists in evaluating recordings of small bowel video capsule endoscopy (VCE)

Background & Aims: The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the entire small bowel mucosa, but VCE recordings interpretation by the gastroenterologist is time-consuming. A pre-reading of VCE recordings by an expert nurse could be accurate and cost saving. We assessed the concordance between nurses and gastroenterologists in detecting lesions on VCE examinations. Methods: This was a prospective study enrolling consecutive patients who had undergone VCE in clinical practice. Two trained nurses and two expert gastroenterologists participated in the study. At VCE pre-reading the nurses selected any abnormalities, saved them as “thumbnails” and classified the detected lesions as a vascular abnormality, ulcerative lesion, polyp, tumor mass, and unclassified lesion. Then, the gastroenterologist evaluated and interpreted the selected lesions and, successively, reviewed the entire video for potential missed lesions. The time for VCE evaluation was recorded. Results: A total of 95 VCE procedures performed on consecutive patients (M/F: 47/48; mean age: 63 ± 12 years, range: 27−86 years) were evaluated. Overall, the nurses detected at least one lesion in 54 (56.8%) patients. There was total agreement between nurses and gastroenterologists, no missing lesions being discovered at a second look of the entire VCE recording by the physician. The pre-reading procedure by nurse allowed a time reduction of medical evaluation from 49 (33-69) to 10 (8-16) minutes (difference:-79.6%). Conclusions: Our data suggest that trained nurses can accurately identify and select relevant lesions in thumbnails that subsequently were faster reviewed by the gastroenterologist for a final diagnosis. This could significantly reduce the cost of VCE procedure

THE INCIDENCE OF THE INFRAPATELLAR PLICAE IN THE ELDERLY WELSH POPULATION

There are several studies reporting the incidence of suprapatellar, medial and lateral plicae, but there is very limited information regarding the incidence of the infrapatellar plica. The purpose of our study was to record the incidence of the infrapatelar plicae in the elderly Welsh population suffering of knee osteoarthritis. A prospective study was performed and 90 knees with severe osteoarthritis of the knee joint (Kellgren-Lawrence type III and IV) were investigated during total knee arthroplasty surgery.  Documentation was performed at every total knee replacement surgery for the length of the study. Knee replacement was performed by one senior surgeon. Infrapatellar plica was investigated by a medial parapatellar approach and was classified into five types according to Kim’s classification. The overall incidence of the infrapatellar plicae was 37.7%. The most common type of plicae was the separate type (23.3 %). There was no significant difference found between male and female patients. The fenestra type was the least common (2.22%). The incidence of infrapatellar plicae in the elderly Welsh population suffering of knee osteoarthritis was significantly lower when compared to a study that recorded the incidence of infrapatellar plica in young patients. Possibly, the degenerative changes of the knee joint can cause the reabsorption of the infrapatellar plica decreasing by this way its incidence in the elderly population.Key words: infrapatellar plicae, incidence, knee osteoarthritis, elderl

Showcasing green: how culture influences sustainable behavior in food eco-labeling

Purpose: The aim of this study is to verify, through Hofstede's 6-D model, the impact of national culture on the implementation of eco-labeling activities on the supplier side, in order to provide consumers information about the sustainable behavior adopted by firms. Design/methodology/approach: The authors tested the impact of culture dimensions through an econometric model, on a sample composed by several countries of the world, in which at least a food certification is in force. Findings: Interesting results have been obtained and discussed, proving the existence of a relationship between culture and corporate sustainability showcasing. Cultural heritage has a deep influence on sustainable consumption demand. Firms need to put more effort to showcase their green behavior. Economic indicators have a role in fostering sustainable behavior. Originality/value: Food labeling is little explored, despite its growing importance for consumers. This research is a window in green marketing issues, specifically in global branding strategies

Problematising separated children:a policy analysis of the UK ‘Safeguarding Strategy: Unaccompanied asylum seeking and refugee children’

While international and national policies, strategies and legislation have been designed to address the problems of forced displacement, they also form a vital role in the discursive construction, governance and regulation of those who have been displaced. This paper critically interrogates the ‘UK Safeguarding Strategy: Unaccompanied Asylum Seeking and Refugee Children’ to highlight the ways in which unaccompanied asylum seeking children (UASC) are implicitly constructed as a policy problem. Drawing on Foucault, and using a novel analytic method (WPR) for studying problematisation within policy, this paper moves beyond the policy definition of an unaccompanied asylum seeking child to unearth characterisations that the policy ascribes to this group of children, and in particular the conceptual boundaries established for the way society thinks about UASC. These conceptual boundaries are divisive in nature, including suspicion around routes of arrival to the UK; constructions of risk; and questions about the responsibility of providing care and of being in need of care. The significance of the paper lies in its aim to use the examination of the discursive practices of the UK’s Safeguarding Strategy as a starting point to open a broader discussion around how UASC are constructed and governed, nationally and internationally.</p

Could Religiosity and Religion Influence the Tax Morale of Individuals? An Empirical Analysis Based on Variable Selection Methods

When people who adhere to tax morality act in a situation where there is no sense of risk, no acceptance of the government, or no environment conducive to tax compliance, it is easier to see how they are motivated to do so. Tax morality is also known as the ethics of compliance. It is the independent cause that motivates a positive tax behaviour. Employees' religious beliefs may impact their ideas and actions in organizational life, just as individuals' attitudes, values, emotions, abilities, and behaviours influence their thoughts and actions at work. Religion can positively influence a worker's loyalty, morale, and communication. In this context, the research seeks to determine whether religiosity and religion may have an effect on tax morale, examining whether an individual’s religiosity reduces tax evasion and increases the degree of tax morale. Using machine learning variable selection techniques appropriate for categorical variables, we have used the dataset of the Joint EVS/WVS 2017-2020 (European Value Survey/World Value Survey), allowing for comparisons of tax morality in more than 79 nations globally (chi-squared and mutual information). The empirical findings showed that the most important aspects of religiosity, such as religious denomination, belief in God, and the significance of God, along with the degree of trust placed in other religions and churches, have a considerable positive impact on the level of tax morale. Another significant conclusion relates to how much people feel the government is responsible, how much they care about their nation, and how satisfied they are with the political system - findings that have been shown to boost employee morale. The following are a person's primary traits that indicate their financial morale: an adult above the age of 25, a full-time worker or retired person, married, and living alone. Therefore, employees that are morally upright, trustworthy, diligent, and committed to the workplace values of justice and decency raise morale generally and improve an organisation's success. A business may enhance its reputation and help to secure its long-term success by establishing behavioural policies

Mercury in fishes from Augusta Bay (southern Italy): Risk assessment and health implication

Our study reports on the total mercury (HgT) concentrations measured in the muscles and livers of several benthic, demersal and pelagic fish species caught inside and outside of Augusta Bay (southern Italy), a semi-enclosed marine area, highly contaminated by the uncontrolled (since the 1950s to 1978s) discharge of the largest European petrochemical plant. Mercury levels in fish tissues are discussed with regard to specific habitat, size and/or age of the specimens and HgT distribution in the bottom sediments. Results suggest a still active Hg release mechanism from the polluted sediments to the marine environment. Also, the high HgT concentrations measured in fishes caught in the external area of the bay imply a potential role of Augusta Bay as a pollutant source for the Mediterranean ecosystem. Finally, values of hazard target quotient (THQ) and estimated weekly intake (EWI) demonstrate that consumption of fishes caught inside the bay represents a serious risk for human health. Also, data indicate that intake of fishes caught from the external area of the bay, especially for that concern demersal and benthic species, could be represent a significant component of risk for the local population

A 10-3 drift velocity monitoring chamber

The MEG-II experiment searches for the lepton flavor violating decay: mu in electron and gamma. The reconstruction of the positron trajectory uses a cylindrical drift chamber operated with a mixture of He and iC4H10 gas. It is important to provide a stable performance of the detector in terms of its electron transport parameters, avalanche multiplication, composition and purity of the gas mixture. In order to have a continuous monitoring of the quality of gas, we plan to install a small drift chamber, with a simple geometry that allows to measure very precisely the electron drift velocity in a prompt way. This monitoring chamber will be supplied with gas coming from the inlet and the outlet of the detector to determine if gas contaminations originate inside the main chamber or in the gas supply system. The chamber is a small box with cathode walls, that define a highly uniform electric field inside two adjacent drift cells. Along the axis separating the two drift cells, four staggered sense wires alternated with five guard wires collect the drifting electrons. The trigger is provided by two 90Sr weak calibration radioactive sources placed on top of a two thin scintillator tiles telescope. The whole system is designed to give a prompt response (within a minute) about drift velocity variations at the 0.001 level

Culture-based antibiotic susceptibility testing for Helicobacter pylori infection: a systematic review

Background Primary antibiotic resistance in Helicobacter pylori (H. pylori) strains is increasing worldwide, affecting therapy success. The use of therapies tailored on susceptibility pre-testing at culture has been proposed, but data are still conflicting. Method We performed a systematic review to evaluate the role of a culture-based therapeutic approach for H. pylori treatment, taking into account the sensitivity of culture and the success rates achieved with tailored therapies in different therapeutic steps. Results We analyzed data from 51 studies. Overall, H. pylori strains were isolated in 80.7% of 7889 patients, the success rates being 78.1%, 77.5%, 86.3% and 86.6%, before first-, second-, third-line or more therapies, respectively. In comparative studies, the infection was cured in 89.9% of 2052 patients treated with tailored therapies, and in 77.6% of 2516 patients receiving empiric therapy (P&lt;0.001). However, in the subanalysis, the tailored approach achieved optimal eradication rates (&gt;90%) only when it was applied before first-and second-line therapies, but not before third-line or more attempts (&lt;80%). Moreover, no significant difference emerged between the 2 approaches when data from only the most recent (last 5 years) studies were considered, as well as in those performed in Western populations. Conclusions The attempt to achieve antibiotic susceptibility testing before treatment failed in 20% of infected patients managed in dedicated laboratories. Culture-tailored therapies administered after 2 or more therapies achieved suboptimal eradication rates. The role of bacterial culture in patients whose therapeutic management failed to eradicate H. pylori probably needs to be corroborated by further data

Hexafurcated coeliac trunks, trifurcated common hepatic artery, and a new variant of the arc of Bühler

Background: The coeliac trunk (CT) is well-known as trifurcated into the left gastric (LGA), common hepatic (CHA) and splenic (SA) arteries.Materials and methods: Scarce reports indicate that the CT could appear quadri-, penta-, hexa-, or even heptafurcated. Reports of CTs with six branches (hexafurcated CT) are few, less than ten. The hexafurcated CT variant was documented by a retrospective study of 93 computed tomography angiograms.Results: Two hexafurcated CTs were found. In one case an arc of Bühler was added to the inferior phrenic arteries, LGA, CHA and SA. In the second case the dorsal pancreatic artery was added to the other five branches. That arc of Bühler descended in front of the aorta to connect with the origin of the third jejunal artery. The CHA in that second case was trifurcated into the left and right hepatic arteries, and the gastroduodenal artery; the proper hepatic artery was absent.Conclusions: Although the hexafurcated CT, as well as the trifurcated CHA, are rarely occurring and reported anatomic variants, this doesn’t mean they could not be encountered during surgical or interventional procedures, which they would complicate if not recognised. Moreover, the arc of Bühler, the embryonic remnant, was not reported previously to insert into the CT as an additional branch of it