Risk Factors for Bleeding After Endoscopic Submucosal Dissection for Gastric Cancer in Elderly Patients Older Than 80 Years in Japan.

Introduction:As the aging of people in a society advances, the number of elderly patients older than 80 years in Japan with gastric cancer continues to increase. Although delayed ulcer bleeding is a major adverse event after endoscopic submucosal dissection (ESD), little is known about characteristic risk factors for bleeding in elderly patients undergoing ESD. This study aimed to evaluate risk factors for delayed bleeding after ESD for gastric cancer in elderly patients older than 80 years.Methods:We retrospectively evaluated the incidence of delayed bleeding after ESD in 10,320 patients with early-stage gastric cancer resected by ESD between November 2013 and January 2016 at 33 Japanese institutions and investigated risk factors for delayed bleeding in elderly patients older than 80 years.Results:The incidence of delayed bleeding in elderly patients older than 80 years was 5.7% (95% confidence interval [CI]: 4.6%-6.9%, 95/1,675), which was significantly higher than that in nonelderly (older than 20 years and younger than 80 years) patients (4.5%, 4.1%-5.0%, 393/8,645). Predictive factors for ESD-associated bleeding differed between nonelderly and elderly patients. On multivariate analysis of predictive factors at the time of treatment, risk factors in elderly patients were hemodialysis (odds ratio: 4.591, 95% CI: 2.056-10.248, P < 0.001) and warfarin use (odds ratio: 4.783, 95% CI: 1.689-13.540, P = 0.003).Discussion:This multicenter study found that the incidence of delayed bleeding after ESD in Japanese patients older than 80 years was high, especially in patients receiving hemodialysis and taking warfarin. Management of ESD to prevent delayed bleeding requires particular care in patients older than 80 years

Linking Informal and Formal Electronics Recycling via an Interface Organization

Informal recycling of electronics in the developing world has emerged as a new global environmental concern. The primary approach to address this problem has been command-and-control policies that ban informal recycling and international trade in electronic scrap. These bans are difficult to enforce and also have negative effects by reducing reuse of electronics, and employment for people in poverty. An alternate approach is to link informal and formal sectors so as to maintain economic activity while mitigating environmental damages. This article explores the idea of an interface organization that purchases components and waste from informal dismantlers and passes them on to formal processors. Environmental, economic and social implications of interface organizations are discussed. The main environmental questions to resolve are what e-scrap components should be targeted by the interface organization, i.e., circuit boards, wires, and/or plastic parts. Economically, when formal recycling is more profitable (e.g., for circuit boards), the interface organization is revenue positive. However, price subsidies are needed for copper wires and residual waste to incentivize informal dismantlers to turn in for formal processing. Socially, the potential for corruption and gaming of the system is critical and needs to be addressed