Environmental factors associated with biological use and surgery in inflammatory bowel disease

Background and Aim: While major efforts were made studying the complex etiology of inflammatory bowel disease (IBD) including environmental factors, less is known about underlying causes leading to the heterogeneous and highly variable course of disease. As cigarette smoking cessation is the best-known environmental factor with beneficial effect in Crohn's disease (CD), more exposome factors are likely involved. Further insights into the role of the exposome in heterogeneity of disease might not only further knowledge of underlying pathways, but also allow for better risk stratification. Methods: Seven hundred twenty-eight IBD patients completed the validated Groningen IBD Environmental Questionnaire, collecting exposome data for 93 exposome factors. Associations with disease course, that is, for need for surgery or biological therapy, were evaluated using univariate and multivariate-adjusted logistic regression modeling. Results: No significant associations were seen after Bonferroni correction. However, 11 novel exposome factors were identified with P < 0.05. Two factors were associated with course of CD and ulcerative colitis (UC): beer (CD OR0.3/UC OR0.3) and cannabis (0.5/2.2). While in CD, carpet flooring (0.5) was associated with biological use, and four factors were associated with surgery: working shifts (1.8), appendectomy (2.4), frequent tooth brushing (2.8), and large household size (0.1). For UC, migrants more often required biologicals (10.2). Childhood underweight (3.4), amphetamine use (6.2), and cocaine use (4.8) were associated with surgery. Five factors were replicated. Conclusions: We identified 16 environmental factors nominally associated with biological use and surgery in established IBD. These new insights form an important stepping stone to guide research on biological pathways involved, risk stratification, tailor-made interventions, and preventive strategies in IBD

Not interesting enough to be followed by the NSA: An analysis of Dutch privacy attitudes

Open curtains and a careless attitude. The Dutch are described as holding an indifferent stance towards privacy in the aftermath of Snowden’s revelations of far-reaching government surveillance. But are Dutch reactions as aloof as often claimed? This study provides an in-depth overview of privacy attitudes in the Dutch debate about the National Security Agency (NSA) leaks, showing a greater variety of sentiments than anticipated. A qualitative frame analysis and a quantitative descriptive analysis resulted in six frames, which convey distinct privacy attitudes. Online and offline as well as professional and non-journalistic content in the debate displays a different distribution of frames. The frames, ranging from an “End justifies the means” attitude to an anxious fear of an “Orwellian dystopia”, are placed in a larger framework as the research demonstrates the connection to existing theories about privacy and surveillance. Dutch discussions about the NSA revelations often display a trade-off narrative balancing safety against privacy, and include (de)legitimisation strategies. These outcomes are in line with previous studies about mediated surveillance debates, which indicates that privacy attitudes transcend national boundaries. However, the inclusion of user-generated content adds an individual dimension to the existing body of research and reveals a personal perspective on surveillance issues

The role of diet in the aetiopathogenesis of inflammatory bowel disease

Crohn’s disease and ulcerative colitis, collectively known as IBD, are chronic inflammatory disorders of the gastrointestinal tract. Although the aetiopathogenesis of IBD is largely unknown, it is widely thought that diet has a crucial role in the development and progression of IBD. Indeed, epidemiological and genetic association studies have identified a number of promising dietary and genetic risk factors for IBD. These preliminary studies have led to major interest in investigating the complex interaction between diet, host genetics, the gut microbiota and immune function in the pathogenesis of IBD. In this Review, we discuss the recent epidemiological, gene–environment interaction, microbiome and animal studies that have explored the relationship between diet and the risk of IBD. In addition, we highlight the limitations of these prior studies, in part by explaining their contradictory findings, and review future directions

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease

The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011

Predictive profiling and its legal limits: Effectiveness gone forever

We examine predictive group profiling in the Big Data context as an instrument of governmental control and regulation. We first define profiling by drawing some useful distinctions (section 6.1). We then discuss examples of predictive group profiling from policing (such as parole prediction methods taken from the us) and combatting fraud (the icov and syri systems in the Netherlands) (section 6.2). Three potential risks of profiling – the negative impact on privacy; social sorting and discrimination; and opaque decision-making – are discussed in section 6.3. We then turn to the legal framework. Is profiling by governmental agencies adequately framed? Are existing legal checks and balances sufficient to safeguard civil liberties? We discuss the relationship between profiling and the right to privacy (section 6.4) and between profiling and the prohibition on discrimination (section 6.5). The jurisprudence on the right to privacy clearly sets limits to the use of automated and predictive profiling. Profiling and data screening which interfere without distinction with the privacy of large parts of the population are disproportional. Applications need to have some link to concrete fact to be legitimate. An additional role is played by the prohibition of discrimination, which requires strengthening through the development of audit tools and discrimination-aware algorithms. We then discuss current safeguards in Dutch administrative, criminal procedure and data protection law (section 6.6), and witness a trend of weakening safeguards at the very moment when they should be applied with even more rigor. In our conclusion, we point to the tension between profiling and legal safeguards. These safeguards remain important and need to be overhauled to make them effective again

Genetic classes and genetic categories: Protecting genetic groups through data protection law

Each person shares genetic code with others. Thus, one individual’s genome can reveal information about other individuals. When multiple individuals share aspects of genetic architecture, they form a ‘genetic group’. From a social and legal perspective, two types of genetic group exist: Those which map to social groups – ‘genetic classes’ – and those which are perceived through interrogation of shared genetic code – ‘genetic categories’. Both of these groups may be seen to have legitimate interests affected when data about them are processed. This contribution considers if these interests can be effectively protected by the Data Protection Regulation. The contribution finds that the Regulation explicitly excludes genetic groups only in a relation to a limited number of provisions. Yet, the contribution also finds that the use of the Regulation to protect genetic groups would raise significant technical and substantial problems. In light of these problems, the contribution suggests a way forward based around guidance and ex ante oversight