Abstract Obesity is usually associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the ...direct cause e.g. non-alcoholic fatty liver diseases (NAFLD) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease (GERD), erosive esophagitis, Barrett’s esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including NAFLD, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions.
•Government success in reducing stunting resulted from greater policy coordination.•Pooled nutrition funding enhanced incentives for institutional coordination.•Longer term commitment to nutrition ...was reinforced through electoral campaigning.•Civil society pushed nutrition advocacy and monitoring efforts through a coordination platform.•Nutrition targets became binding when linked to poverty reduction strategies.
The dramatic reduction in children’s chronic malnutrition in Peru observed in recent years has defied the patterns of stunting reduction worldwide. After nearly a decade of stalled progress, the government reported a reduction in stunting rates of nearly 10 points, from 29.8% in 2005 to 18.1% in 2011. The specialized literature has acknowledged the critical role that immediate (e.g. increasing breastfeeding promotion) and underlying (e.g. investments to improve household food security) interventions have played in reducing stunting (Black et al., 2013), as well as the contributing role of enabling factors related to economic performance. This paper offers an alternative explanation to success by looking at the shift in the government’s nutrition strategy after 2006 with the formation of the Child Malnutrition Initiative (CMI), a civil society working platform, and the adoption of a national poverty reduction strategy prioritizing nutrition interventions (known as CRECER) and conditional cash transfers (JUNTOS). The paper uses veto players theory to explain how these changes effectively contributed to policy change by reducing the effective number of nutrition stakeholders involved and facilitating policy agreements around a common policy platform and established goals. The Peruvian case also highlights the importance of the government’s public commitment to reduce chronic malnutrition in children under five by 5 percent in 5years (“5 by 5 by 5”) and the accompanying role, advocacy and monitoring from civil society organizations.
The paper looks at the success of implementing the nutrition strategy in three dimensions. Horizontally, it looks at the coordination between government and non-government agencies to converge around a common policy discourse;vertically, it looks at the implementation of the nutrition strategy across national, regional and municipal governments;and financially, it looks at the coordinated and conditional allocation of nutrition funding and how this created greater incentives for horizontal and vertical coordination. The paper draws some theoretical and policy implications for improving the effective and accountable delivery of nutrition interventions in Peru and other countries outside Latin America.
The rapid growth in the past decade in transparency and accountability initiatives (TAIs) in the extractive industries sector reflects attempts to devise institutional mechanisms to make governments ...accountable for the extraction, allocation and use of revenues that, if well invested, could alleviate socio‐economic inequalities among citizens. Understanding and measuring the impact and effectiveness of these initiatives is a matter of proposing and empirically validating a causal link between interventions and governance improvements. To do this requires improved data collection, reporting and analysis; a stronger focus on the allocation and use of government expenditures that come from natural‐resource wealth; and a better understanding of importance of incentives and sanctions for ensuring effective impact.
Testicular cancer is rare overall but comprises the most common solid malignancy diagnosed in young men aged ∼20–40 years. Most testicular neoplasms generally fall into 2 broad categories: germ cell ...tumors (GCTs; ∼95%) and sex cord-stromal tumors (SCSTs ∼5%). Given the relative rarity of these tumors, diagnostic biomarkers are highly relevant for their diagnosis. Over the past several decades, diagnostic biomarkers have improved dramatically through targeted immunohistochemical and molecular characterization. Despite these recent advances, most markers are not perfectly sensitive or entirely specific. Therefore, they need to be used in combination and interpreted in context. In this review, we summarize tissue-based biomarkers relevant to the pathologist, with a focus on practical diagnostic issues that relate to testicular GCT and SCST.
•Testicular germ cell tumors (GCTs) and sex cord stromal tumors (SCSTs) are infrequent and often require the use of biomarkers for diagnosis.•New tissue-based immunohistochemical and molecular biomarkers have demonstrated potential value for the diagnosis and prognostication of testicular GCTs and SCSTs.•The development of additional biomarkers that identify the small but clinically relevant subset of testicular GCT and SCST that behaves aggressively is needed.
Mixed adenoneuroendocrine carcinomas (MANECs) are composite neoplasms with areas of adenocarcinoma or squamous cell carcinoma intermingled with neuroendocrine carcinoma or neuroendocrine tumor, each ...composing at least 30% of the neoplasm. MANECs are very infrequent overall, and they are more commonly diagnosed in the appendix, colon, and stomach. Biliary MANECs are particularly rare, and their histogenesis is debated because neuroendocrine cells are seldom identified in the normal biliary tract. They can show one of the 3 different architectural patterns described in Lewin's original classification: collision tumors, combined lesions, or amphicrine neoplasms. The neuroendocrine component is usually of a high grade, with small or large cell cytomorphology, whereas the adenocarcinoma component is either an intestinal or biliary type. Clinical presentation is characterized by locally advanced disease at the time of initial diagnosis. Recent studies suggest that treatment should be guided by the most aggressive histologic component.
This book explains how presidents achieve market-oriented reforms in a contentious political environment. Using an impressive amount of quantitative and qualitative empirical evidence, most of which ...is reported for the first time, Mejía Acosta argues that presidents in Ecuador adopted significant reforms by crafting informal yet functional coalitions with opposition parties in congress. This pattern of success is particularly relevant in a country known for its chronic political fragmentation and deep regional and ethnic divisions. Paradoxically, the adoption of constitutional reforms to promote governance undermined the success of informal coalitions and directly contributed to greater regime instability after 1996. Mejía Acosta's work offers a compelling analysis of how formal and informal political institutions contribute to policy change. His far-reaching conclusions will capture the attention of political scientists and scholars of Latin America.
1. Pushing Reforms through the Eye of a Needle 2. A Proposed Model for Legislative Cooperation 3. Presidential Success in a Fragmented Legislature 4. Party Brokers and Voting Unity in the Ecuadorian Congress 5. Voting at the Margins: Pivotal Players and Coalition Making 6. Ghost Coalitions in the Making of Economic Reforms 7. Ghost Coalitions, Institutional Change and Democratic Accountability
Andrés Mejía Acosta is a Research Fellow at the Institute of Development Studies at the University of Sussex.
Testicular germ cell tumors (TGCTs) and sex cord-stromal tumors (SCSTs) are the most common testicular neoplasms. The morphologic spectrum of such tumors is wide, with several histologic subtypes ...within each group. Testicular tumors often represent a diagnostic challenge, requiring proper identification of their biologic potential for accurate risk stratification and selection of therapy. In the era of precision medicine, molecular biomarkers are increasingly assuming a critical role in the management of patients with cancer. Given the overall rarity of certain types of testicular neoplasms, progress in biomarker research has been relatively slow. However, in recent years, we have witnessed a multitude of important contributions, including both tissue-based and liquid biopsy biomarkers, stemming from important discoveries of tumor pathobiology, accurate histopathological analysis, multi-institutional studies, and genome-wide molecular analyses of specific tumor subtypes. In this review, we provide an overview of the progress in molecular biomarkers of TGCTs and SCSTs, focusing on those with greatest potential for clinical application. In TGCTs, developmental biology has been the key to understanding these tumors and identifying clinically useful biomarkers (from classical serum tumor markers to pluripotency factors and circulating microRNAs of the 371-373 cluster). For SCSTs, studies have focused on tissue biomarkers only, and genome-wide investigations have recently contributed to a better understanding of rare phenotypes and the aggressive biological behavior of some tumors within this nosologic category. Several new biomarkers are moving toward clinical implementation in this field. Therefore, the practicing pathologist should be aware of their strengths and limitations in order to utilize them properly and maximize their clinical benefits.
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