Surveillance of FAP: a prospective blinded comparison of capsule endoscopy and other GI imaging to detect small bowel polyps

Background: Familial adenomatous polyposis (FAP) is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Ca

Enabling political legitimacy and conceptual integration for climate change adaptation research within an agricultural bureaucracy: a systemic inquiry

The value of using systems approaches, for situations framed as ‘super wicked’, is examined from the perspective of research managers and stakeholders in a state-based climate change adaptation (CCA) program (CliChAP). Polycentric drivers influencing the development of CCA research pre-2010 in Victoria, Australia are reflected on, using Soft Systems Methodology (SSM) to generate a boundary critique of CCA research as a human activity system. We experienced the complexity of purpose with research practices pulling in different directions, reflected on the appropriateness of agricultural bureaucracies’ historical new public management (NPM) practices, and focused on realigning management theory with emerging demands for adaptation research skills and capability. Our analysis conceptualised CliChAP as a subsystem, generating novelty in a wider system, concerned with socio-ecological co-evolution. Constraining/enabling conditions at the time dealing with political legitimacy and conceptual integration were observed as potential catalysts for innovation in research management towards better handling of uncertainty as a social process using systemic thinking in practice (StiP)

Familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is characterized by the development of many tens to thousands of adenomas in the rectum and colon during the second decade of life. FAP has an incidence at birth of about 1/8,300, it manifests equally in both sexes, and accounts for less than 1% of colorectal cancer (CRC) cases. In the European Union, prevalence has been estimated at 1/11,300-37,600. Most patients are asymptomatic for years until the adenomas are large and numerous, and cause rectal bleeding or even anemia, or cancer develops. Generally, cancers start to develop a decade after the appearance of the polyps. Nonspecific symptoms may include constipation or diarrhea, abdominal pain, palpable abdominal masses and weight loss. FAP may present with some extraintestinal manifestations such as osteomas, dental abnormalities (unerupted teeth, congenital absence of one or more teeth, supernumerary teeth, dentigerous cysts and odontomas), congenital hypertrophy of the retinal pigment epithelium (CHRPE), desmoid tumors, and extracolonic cancers (thyroid, liver, bile ducts and central nervous system). A less aggressive variant of FAP, attenuated FAP (AFAP), is characterized by fewer colorectal adenomatous polyps (usually 10 to 100), later age of adenoma appearance and a lower cancer risk. Some lesions (skull and mandible osteomas, dental abnormalities, and fibromas on the scalp, shoulders, arms and back) are indicative of the Gardner variant of FAP. Classic FAP is inherited in an autosomal dominant manner and results from a germline mutation in the adenomatous polyposis (APC) gene. Most patients (~70%) have a family history of colorectal polyps and cancer. In a subset of individuals, a MUTYH mutation causes a recessively inherited polyposis condition, MUTYH-associated polyposis (MAP), which is characterized by a slightly increased risk of developing CRC and polyps/adenomas in both the upper and lower gastrointestinal tract. Diagnosis is based on a suggestive family history, clinical findings, and large bowel endoscopy or full colonoscopy. Whenever possible, the clinical diagnosis should be confirmed by genetic testing. When the APC mutation in the family has been identified, genetic testing of all first-degree relatives should be performed. Presymptomatic and prenatal (amniocentesis and chorionic villous sampling), and even preimplantation genetic testing is possible. Referral to a geneticist or genetic counselor is mandatory. Differential diagnoses include other disorders causing multiple polyps (such as Peutz-Jeghers syndrome, familial juvenile polyps or hyperplastic polyposis, hereditary mixed polyposis syndromes, and Lynch syndrome). Cancer prevention and maintaining a good quality of life are the main goals of management and regular and systematic follow-up and supportive care should be offered to all patients. By the late teens or early twenties, colorectal cancer prophylactic surgery is advocated. The recommended alternatives are total proctocolectomy and ileoanal pouch or ileorectal anastomosis for AFAP. Duodenal cancer and desmoids are the two main causes of mortality after total colectomy, they need to be identified early and treated. Upper endoscopy is necessary for surveillance to reduce the risk of ampullary and duodenal cancer. Patients with progressive tumors and unresectable disease may respond or stabilize with a combination of cytotoxic chemotherapy and surgery (when possible to perform). Adjunctive therapy with celecoxib has been approved by the US Food and Drug Administration and the European Medicines Agency in patients with FAP. Individuals with FAP carry a 100% risk of CRC; however, this risk is reduced significantly when patients enter a screening-treatment program

Filosofia del Futuro : Un'Introduzione

Il volume offre un’introduzione al contempo accessibile e rigorosa ai più recenti sviluppi di una fondamentale branca della filosofia del tempo: la filosofia del futuro. Al centro dell’attenzione sono le domande chiave del dibattito contemporaneo. Il futuro è già scritto o esistono cammini alternativi che il tempo è in grado di imboccare? Esistere significa semplicemente essere presenti o ci sono veri e propri oggetti futuri? Siamo davvero liberi di scegliere quali azioni compiere e di modificare il corso degli eventi? Il dibattito intorno alle risposte di volta in volta offerte dalla filosofia esplora un’intrigante zona d’intersezione tra metafisica, logica ed etica, e interessa discipline diverse come la fisica, la psicologia e l’economia. Gli autori offrono gli strumenti necessari per inquadrare concettualmente le domande sul futuro, introducendo tutte le nozioni tecniche in un linguaggio chiaro e intuitivo

Flow Fragmentalism

In this article, we articulate a version of non-standard A-theory–which we call Flow Fragmentalism–in relation to its take on the issue of supervenience of truth on being. According to the Truth Supervenes on Being (TSB) Principle, the truth of past- and future-tensed propositions supervenes, respectively, on past and future facts. Since the standard presentist denies the existence of past and future entities and facts concerning them that do not obtain in the present, she seems to lack the resources to accept both past and future-tensed truths and the TSB Principle. Contrariwise, positions in the philosophy of time that accept an eternalist ontology (e.g., B-theory, moving spotlight, and Fine’s and Lipman’s versions of fragmentalism) allow for a“direct”supervenience base for past- and future-tensed truths. We argue that Flow Fragmentalism constitutes a middle ground, which retains most of the advantages of both views, and allows us to articulate a novel account of the passage of time

A Philosophically Neutral Semantics for Perception Sentences

Jaakko Hintikka proposed treating objectual perception sentences, such as "Alice sees Bob," as de re propositional perception sentences. Esa Saarinen extended Hintikka's idea to eventive perception sentences, such as "Alice sees Bob smile." These approaches, elegant as they may be, are not philosophically neutral, for they presuppose, controversially, that the content of all perceptual experiences is propositional in nature. The aim of this paper is to propose a formal treatment of objectual and eventive perception sentences that builds on Hintikka's modal approach to propositional attitude ascriptions while avoiding controversial assumptions on the nature of perceptual experiences. Despite being simple and theoretically frugal, our approach is powerful enough to express a variety of interesting philosophical views about propositional, objectual, and eventive perception sentences, thus enabling the study of their inferential relationships

Materiality, parthood, and possibility

This paper offers an argument in favour of a Lewisian version of concretism that maintains both the principle of material inheritance (according to which, if all the parts of an object x are material, then x is material) and the materiality-modality link (that is, the principle that, for every x, if x is material, then x is possible)