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

Computed and chemically determined nutrient content of foods in Greece

Energy-generating nutrients and total energy were computed and analytically determined for four widely used foods in Greece (mousaka, bean soup, infant food, and feta cheese), as well. as for the individual food items necessary for their preparation. Standard procedures were used for chemical analyses, whereas computed values were generated through the Unilever Dietary Analysis Program UNIDAP (Barrow et al., 1988) on the basis of the British food composition tables. Pesticides and pesticide residues were also determined in the studied samples. A very good agreement was noted with respect to the nutrient composition of the four prepared foods, whereas the agreement was somewhat weaker for the individual food items used for the preparation of the composite foods. It is concluded that the UNIDAP program generates reliable nutrient composition data for composite foods and for time integrated dietary intakes in Greece. The concentrations of several of the determined pesticides were towards the higher end of the spectrum of levels reported in the literature. This project has demonstrated the value of collaboration between academic institutions, industry, and state laboratories towards the development and validation of food composition databases

Black Swan : a history of continental philosophy in Australia and New Zealand

Like the fabled black swan of early epistemological inquiry, ‘Australasian Continental philosophy’ seems a kind of chimera apt to raise doubts rather than certainty. Is there such a mythical creature? Is it nothing more than a pale reflection of more paradigmatic instances found ‘overseas’, as we say in Australia, an Antipodean counterpart to the ‘major’ developments occurring in the United Kingdom or the United States? Or are there distinctive features of this phenomenon that, like the black swan, represent an unexpected variation unique to the Australasian environment? For a movement that one can date as first appearing in the early part of the twentieth century—the publication of John McKellar Stewart’s 1913 critical study of Henri Bergson’s philosophy may serve as a convenient starting point—it is surprising that Continental philosophy in Australia has only recently become a topic of historical interest. Part of the problem is the contested nature of the phenomenon in question. ‘Continental philosophy’ is a term that goes back to the nineteenth-century historical contrast between ‘British empiricism’ and ‘Continental rationalism’ (Bertrand Russell dates the term ‘from the time of Locke’ (1945, pp. 631, 640)). It emerges more explicitly, however, with J.S. Mill’s essays (from 1832 to 1840) on the contrast between Benthamite philosophy and the ‘Germano-Coleridgean doctrine’, the latter being identified with the ‘Continental philosophers’, and ‘the Continental philosophy’ as well as ‘French philosophy’ (Critchley 2000, p. 42). It takes on its more contemporary meaning, however, only after WWII, especially during the 1950s (see Glendinning 2006, pp. 69–90). The term gives way to the political urgency of Marxism and feminism during the 1970s, gains a new sense of institutional valency during the 1980s and 90s (with the rise of poststructuralism), and has more recently become the subject of meta-philosophical reflection (see Critchley 2000; Glendinning 2006; Levy 2003; Reynolds and Chase 2010).42 page(s