Editorial: Women in surgical oncology: 2021

Currently, female researchers represent merely a minority, accounting for an estimated 29.3% who end up covering this position worldwide, with a great variability according to each country (1). Specifically, Central Asia exhibits the greatest proportion of female researchers with an estimated 48.2% as opposed to South and West Asia with the lowest count globally (i.e. 18.5%) (1). In response to such a large gender gap in the scientific research community, the UNESCO Institute for Statistics (UIS) is in the midst of developing new indicators in order to better comprehend the reasons behind women’s decisions to pursue one career over another. Several could be the reasons implicated in limiting and discouraging women’s access to the scientific community, including ancient biases and gender stereotypes. By further understanding such issues, the UIS project concurrently aims at reducing the gender inequality in science, technology, engineering and mathematics (STEM) fields, by possibly promoting reforms in policies and implementing changes in favor of gender equality in all countries with the ultimate goal of empowering women (2

Regulatory Challenges to Energy Storage Deployment An Overview of the UK Market

This working paper investigates how the UK is currently integrating energy storage technologies into its electricity markets, the regulatory barriers it is facing, and how it is responding to these challenges. It was prepared by the ‘Realising Energy Storage Technologies in Low-carbon Energy Systems’ (RESTLESS) project, which is funded by the UK Engineering and Physical Sciences Research Council. The project is part of the EPSRC Energy Superstore Hub and is associated with the UK Energy Research Centre (UKERC). The authors are solely responsible for all of the analysis in this paper. Any views expressed in this paper are the authors’ and have not been endorsed by any of the organisations associated with the RESTLESS project

Cost Pass-through in the British Wholesale Electricity Market: Implications of Brexit and the ETS reform

This Cost pass-through rates give a useful perspective of market competition. This paper studies how generation costs are passed through to electricity wholesale prices in Great Britain, both theoretically and empirically, between 2015 and 2018. Our empirical results fail to reject the null of 100% pass-through rates for gas prices, carbon prices, and exchange rates, indicating a competitive GB wholesale electricity market. We observe higher pass-through rates in peak compared to off-peak periods, and argue this results from generators bidding at a lower rate during off-peak periods and supplying at minimum load to avoid the cost of shutting down and starting up. We extend the analysis by assessing generators’ bidding behaviour. The study also considers how two key events occurred during the examined period – the 2016 Brexit referendum, and major reformation of the EU Emission Trading System – have affected electricity costs to a typical domestic household, showing they have increased average annual bills by £41 p.a., constituting a 7% rise

Response to Sleeve gastrectomy may double the risk of esophageal adenocarcinoma in morbidly obese patients

We would like to thank Papadia et al. for their interest in our article, “Esophageal Adenocarcinoma After Sleeve Gastrectomy: Actual or Potential Threat? Italian Series and Literature Review” [1]. We also greatly appreciated their attempt at evaluating the relative risk (RR) of developing esophageal adenocarcinoma (EAC) in patients who undergo sleeve gastrectomy (SG). To do so, they extrapolated the reported number of SGs performed in Italy over the 3-year period (2012–2015) in which the EAC cases belonging to our series occurred. Papadia et al. [1] show how SG may raise the risk of developing EAC by an estimated 11-fold compared with the general population. Furthermore, they highlight how the RR of EAC in the SG subpopulation appears to be substantially greater compared with patients affected by morbid obesity (RR of 11.9 versus 4.8, respectively). The authors also share our concern regarding the young age (40.3 ± 16.7 yr) and early presentation (27.3 ± 7.6 mo) of EAC after surgery, pointing out how the progression from a normal esophageal mucosa to Barrett’s esophagus (BE) generally befalls over a considerably longer timeframe in patients with GERD that did not have SG. This observation is supported by several studies published by our group demonstrating how the incidence of BE, 58 months after SG, is as high as 17.2%—consistent with other reported rates (i.e., 15%–18.8%) [2,3]—and is correlated to the increased presence of a biliary-type refluxate [[4], [5], [6]], likely to be responsible for the accelerated mucosal injury of the distal esophagus [7]. Emblematic is the case reported in literature of the patient who had a preoperatively diagnosed short-segment BE and who inevitably developed an EAC 36 months later [8]. Although a sporadically reported case, this further emphasizes not only the importance of performing a preoperative esophagogastroduodenoscopy (EGD) to detect any mucosal lesion, but also how BE should constitute an absolute contraindication to SG due to its innate risk of malignant evolution. Finally, loss to follow-up still represents a major, long-standing issue after bariatric surgery, which contributes to precluding the chance of performing protocols of secondary prevention for the identification of any esophageal malignancy at its earliest stages. To this regard, close endoscopic surveillance is of paramount importance for a prompt detection. We also would like to reiterate the necessity of having international online registries, which could allow physicians to determine the actual incidence of EAC after SG and to comprehend its pathogenesis, management, and outcomes possibly better. Despite this potential downside, SG persists as a safe and effective procedure for the cure of obesity and its co-morbid conditions, concurrently carrying low rates of long-term complications and nutritional deficiencies. Additionally, due to its greater technical simplicity and shorter operative time compared with other common bariatric procedures, SG is also the treatment of choice in the super-obese group, easily granting the option for revisional surgery (i.e., RYGB, one anastomosis gastric bypass [OAGB], duodenal switch [DS], single anastomosis duodeno-ileal sleeve [SADI-S]) in case of weight regain or insufficient weight loss. Hence, SG should yet be regarded as a fundamental and valuable bariatric operation to be performed after a thorough preoperative workup and a close endoscopic follow up

Evaluating consumer investments in distributed energy technologies

The adoption of solar photovoltaic and electrical energy storage by end users depends on their economic attractiveness, which is typically assessed with metrics of future cash flow such as Net Present Value (NPV). Yet analyses using NPV typically do not account for the evolution towards low-carbon electricity systems in the short and long term. We show this to be of critical importance for accurately calculating the profitability of these technologies. By linking an energy system model with a power system model, we observe substantial differences between NPV estimates calculated with and without representing potential evolutions of the electricity system. Our results suggest that not accounting for short- and long-run changes in the electricity system could underestimate the NPV of an investment in photovoltaic and storage by around 20%, especially in scenarios with high levels of renewables, moderate flexibility, and high electrification in the energy system. Using system-dependent cash flow metrics can have a major impact on end-users' energy technology profitability

No contagion from Russia toward global equity markets after the 2014 international sanctions

We examine the possibility of financial contagion from the Russian stock market toward 18 global markets as a result of the international sanctions arising from Russia's actions in Crimea. We develop a dynamic heteroskedastic procedure and use z-transform analysis to determine the potential degrees of contagion and explore possible volatility spillovers. Among our main results, the Russian market substantially decoupled from the vast majority of world markets, irrespectively of the strength of economic ties between Russia and the corresponding countries. Nonetheless, the crisis was characterized by large transmissions of volatility associated with the Russian stock market, particularly in emerging and frontier economies

Evaluating consumer investments in distributed energy technologies

The adoption of solar photovoltaic and electrical energy storage by end users depends on their economic attractiveness, which is typically assessed with metrics of future cash flow such as Net Present Value (NPV). Yet analyses using NPV typically do not account for the evolution towards low-carbon electricity systems in the short and long term. We show this to be of critical importance for accurately calculating the profitability of these technologies. By linking an energy system model with a power system model, we observe substantial differences between NPV estimates calculated with and without representing potential evolutions of the electricity system. Our results suggest that not accounting for short- and long-run changes in the electricity system could underestimate the NPV of an investment in photovoltaic and storage by around 20%, especially in scenarios with high levels of renewables, moderate flexibility, and high electrification in the energy system. Using system-dependent cash flow metrics can have a major impact on end-users' energy technology profitability

Obesity surgery and cancer. What are the unanswered questions?

Obesity has become a global epidemic with a soaring economic encumbrance due to its related morbidity and mortality. Amongst obesity-related conditions, cancer is indeed the most redoubtable. Bariatric surgery has been proven to be the most effective treatment for obesity and its associatedmetabolic and cardiovascular disorders. However, the understanding of whether and how bariatric surgery determines a reduction in cancer risk is limited. Obesity-related malignancies primarily include colorectal and hormone-sensitive (endometrium, breast, prostate) cancers. Additionally, esophago-gastric tumors are growing to be recognized as a new category mainly associated with post-bariatric surgery outcomes. In fact, certain types of surgical procedures have been described to induce the development and subsequent progression of pre-cancerous esophageal and gastric lesions. This emerging category is of great concern and further research is required to possibly prevent such risks. Published data has generated conflicting results. In fact, while overall cancer risk reduction was reported particularly in women, some authors showed no improvement or even increased cancer incidence. Although various studies have reported beneficial effects of surgery on risk of specific cancer development, fundamental insights into the pathogenesis of obesity-related cancer are indispensable to fully elucidate its mechanisms