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Background/Aims: Barrett’s esophagus (BE), defined by the presence of intestinal metaplasia (IM) on histology, is thought to be the only identifiable precursor lesion for esophageal adenocarcinoma (EAC). Recent studies have suggested the possibility of an alternate, non-IM associated EAC that is a more aggressive form of EAC with worse survival. Among EAC patients, we aimed to compare survival of patients with and without IM at the time of diagnosis. Methods: This was a retrospective cohort study of all patients with histologic confirmed EAC evaluated at a tertiary care center from 2013 to 2019. Cases were categorized according to the presence or absence of IM on histologic specimens (Group I—IM-EAC and Group II—non-IM-EAC). We compared demographic characteristics, clinical stage, therapy, and survival between the 2 groups using the Chi-square and ANOVA tests (for categorical and continuous variables, respectively). We used Cox proportional hazards regression to determine the association of IM with overall survival, adjusting for sex, age at diagnosis, tumor location, histologic grade, and clinical stage. Results: A total of 475 patients were included in this analysis (mean age 64.8 years [SD 10.8], 89% white) and 109 (23.0%) had no evidence of IM. Compared with IM-EAC (Group I), individuals in the non-IM-EAC group were younger ( P = .01) and had a greater proportion of patients diagnosed with advanced disease (49.5 vs 20.2% for stage 4, P Conclusions: EAC without the presence of IM on histology was associated with worse survival compared to those with IM. Future prospective studies with detailed molecular sequencing are required to clarify if 2 separate phenotypes of EAC exist (IM-EAC and non-IM-EAC). If confirmed, this may have significant implications for screening and management strategies.

Background & Aims The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19. Methods Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. Results A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76–1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80–2.12) were not associated independently with mechanical ventilation or death. Conclusions Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.

BackgroundThe prevalence and significance of digestive manifestations in COVID-19 remain uncertain.MethodsConsecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were manually abstracted from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19.ResultsA total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least one gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were elevated to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio 0.93, 95% confidence interval 0.76-1.15) or liver test abnormalities on admission (odds ratio 1.31, 95% confidence interval 0.80-2.12) were not independently associated with mechanical ventilation or death.ConclusionsAmong patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common but the majority were mild and their presence was not associated with a more severe clinical course

The 1967 federal referendum, which gave the Commonwealth government power to legislate for Aboriginal people and count them in the national census, is celebrated as a turning point in the Aboriginal history of Australia. Given the disinclination of Australians to change the Constitution, it is rare to find such apparent unity in Australian politics, with over 90 per cent of the voting population answering 'yes' to the two referendum questions. Although the passage of time and a history of both advances and retreats in Aboriginal policy have led to a more measured assessment of its impact, many people still regard the referendum as a high point in Aboriginal people's struggle for human rights. They see it as a moment of great symbolic and political importance, a significant step in the transition from the politics of citizenship to the politics of Aboriginal self-determination and as the realisation of a long-held dream for a truly national Aboriginal policy, a dream that began as early as Federation itself. However, 1967 was not the first time the Australian people had been asked to pass control of Aboriginal affairs to the Commonwealth by referendum. Clause N of Section 2 of the so-called 'fourteen powers' referendum held in August 1944 - the Curtin Labor Government's attempt to clothe itself with extra powers in order to fully administer its plans for postwar reconstruction - asked the Australian people, as part of that process, to agree to the transfer of power over Aboriginal people to the Commonwealth. The referendum failed and so did the Aboriginal clause. It was a casualty of the government's insistence that all fourteen powers be voted on as one and this meant that power over Aboriginal people remained with the states for a further 23 years. This article sets out the history and explores the debates surrounding the inclusion of the Aboriginal clause in the 1944 referendum and tries to estimate its importance in the heated arguments about the referendum, post-war reconstruction and the extent of Commonwealth powers. It supports existing arguments that the government added the clause to an already existing list only after representations from the Association for the Protection of Native Races (APNR) and similar bodies. The paper argues that the Aboriginal clause was placed last on the list of powers to be transferred in the referendum - underlining its status as an afterthought - and, in the national and state debates about Commonwealth powers in the wider referendum campaign, it was generally marginalised, overshadowed by seemingly weightier issues such as repatriation and employment. Finally it argues that there was a substantial degree of support for the clause among all political parties and, curiously, it was this almost universal support that caused it to be so little discussed.

through Unit 31, a locked ward in the men's section of Kew Residential Services, Melbourne. Known popularly as Kew Cottages, and built in the grounds of Kew Hospital for the Insane in the 1880s, this was Victoria's largest institution accommodating people with intellectual disability. The men died where they had lived out most of their lives, in an institution established 110 years before, and still used to house more than 600 people. Kew Cottages was an anachronism, a relic of long-forgotten policies, retained by successive governments as a place of last resort for intellectually disabled men and women, as other institutions were closed and their residents moved out mostly into homes in the suburbs. As seems to have happened frequently in the history of Kew Cottages, the fire caused but a brief frenzy of interest and was soon forgotten. The fire raised four immediate issues. What caused the fire? An