The management of patients with primary chronic anal fissure: a position paper

Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several different therapeutic options have been proposed. In the last decades, the understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal sphincter muscle relaxation. Despite some systematic reviews and an American position statement, there is ongoing debate about the best treatment for anal fissure. This review is aimed at identifying the best treatment option drawing on evidence-based medicine and on the expert advice of 6 colorectal surgeons with extensive experience in this field in order to produce an Italian position statement for anal fissures. While there is little chance of a cure with conservative behavioral therapy, medical treatment with calcium channel blockers, diltiazem and nifepidine or glyceryl trinitrate, had a considerable success rate ranging from 50 to 90%. Use of 0.4% glyceryl trinitrate in standardized fashion seems to have the best results despite a higher percentage of headache, while the use of botulinum toxin had inconsistent results. Nonresponding patients should undergo lateral internal sphincterotomy. The risk of incontinence after this procedure seems to have been overemphasized in the past. Only a carefully selected group of patients, without anal hypertonia, could benefit from anoplasty

How Smart Cities Transform Operations Models: A New Research Agenda for Operations Management in the Digital Economy

The notion of smart cities is growing in prominence in the digital economy. The integration of urban infrastructures with information and communication technologies (ICT) enables the development of new operations models. Digitised infrastructures offer opportunities for public and private organisations to design and deliver more customer-centric products or services, particularly for those that require geographical proximity with consumers in the O2O (online to offline) context. A framework is developed and used to analyse three case examples. These cases illustrate the emergence of new operations models and, demonstrate how smart cities are re-defining the characteristics of operations models around their scalability, analytical output and, connectivity. We also explore the feasibility, vulnerability and acceptability of each new operation. This paper contributes to our understanding of how smart cities can potentially transform operational models, and sets out a research agenda for operations management in smart cities in the digital economy

1968 and The Paradox of Freedom

Commentary on Clive Hamilton\u27s book The Freedom Paradox: Towards a post-secular ethics and the 1960s and 1970s