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Education holds promise as a vehicle for sustainable global development and human capacity development, as reflected in the Sustainable Development Goals set by the United Nations. International education has become a prominent feature in contemporary times on the educational landscape as students become increasingly mobile in pursuit of their right to education. This study investigates the key factors that motivate international students to undertake better quality education at higher education (university) level, particularly in Europe, and the underlying gender preferences for study destinations within the framework of push-pull factors. The study collected responses of 288 individuals from 84 countries who had undertaken some form of education in Europe through the European Commission-funded Erasmus Mundus (EM) Scholarship. Responses were collected through an online platform, Survey Monkey. Outcomes of the study revealed that Germany, United Kingdom, Sweden, Netherlands, and Spain are the most popular destinations for pursuing higher education in Europe. The United Kingdom is the most preferred destination for female students while Germany is the most preferred destination for male students, with slight changes for other countries. Key motivating factors for international education were found to be scholarship opportunity, better quality of education, and availability of the relevant study program. The least influencing factors were found to be the commonality of language, suitable environment (eg climate, temperature), geographical proximity, the scope of migration, and social cost.

Background: Information about obesity among people with intellectual disability comes mostly from small-scale, national samples in high-income countries. There are limited data from transnational studies. Method: BMI scores had been obtained for over 25,000 youth and adults with intellectual disabilities drawn from 60 European and Eurasian countries. Their height and weight had been measured using standardized procedures when they attended Special Olympics Healthy Athletes events. Results: Binary logistic regression identified higher levels of obesity for athletes living in high-income countries, and for adult females, for those aged 30 years and over, and also for youth aged 8-13 years. Conclusions: Participation in sports does not appear to have protected these athletes from obesity. Arguably, this remains the most pressing health issue for people with intellectual disability, particularly in Western Europe.

Scholarly studies of international student mobility programs have increased during the last two decades, particularly following the Bologna Declaration. Nevertheless, a systematic review of international student mobility programs and the outcomes and benefits derived from participation in such programs has not been undertaken. This paper provides a comprehensive review of studies examining the various outcomes of student participation in short-term international mobility programs and identifies under-researched areas such as employment and career outcomes. A future research agenda based on the review is outlined, along with recommendations for improving research designs in order to increase our understanding of the short- and long-term outcomes of international student mobility programs.

Background: Increased levels of obesity have been reported for people with intellectual disability based on data mostly gathered in high income countries. Likewise few studies internationally have focussed on underweight in this population. Method: Data on obesity and underweight were analysed from nearly 86,500 youth and adults with intellectual disabilities drawn from 178 countries attending Special Olympic events. Results: Binary logistic regressions identified higher levels of obesity for athletes in high income countries -- especially in North America -- and for females and for adults aged 40 years and over; and for youth aged 8 to 10 years. Rates of underweight were higher for younger adults in low income countries of Asia-Pacific, and highest for males aged 11-13 from lower-middle income countries of Africa. Conclusions: Contrasting intervention strategies are needed globally to enable people with intellectual disabilities to achieve healthy weight.

Respiratory syncytial virus (RSV) is a major cause of hospitalisation in infants. The burden of RSV infection in healthy term infants has not yet been established. Accurate health-care burden data in healthy infants are necessary to determine RSV immunisation policy when RSV immunisation becomes available. We performed a multicentre, prospective, observational birth cohort study in healthy term-born infants (≥37 weeks of gestation) in five sites located in different European countries to determine the health-care burden of RSV. The incidence of RSV-associated hospitalisations in the first year of life was determined by parental questionnaires and hospital chart reviews. We performed active RSV surveillance in a nested cohort to determine the incidence of medically attended RSV infections. The study is registered with ClinicalTrials.gov , NCT03627572. In total, 9154 infants born between July 1, 2017, and April 1, 2020, were followed up during the first year of life and 993 participated in the nested active surveillance cohort. The incidence of RSV-associated hospitalisations in the total cohort was 1·8% (95% CI 1·6–2·1). There were eight paediatric intensive care unit admissions, corresponding to 5·5% of 145 RSV-associated hospitalisations and 0·09% of the total cohort. Incidence of RSV infection in the active surveillance cohort confirmed by any diagnostic assay was 26·2% (24·0–28·6) and that of medically attended RSV infection was 14·1% (12·3–16·0). RSV-associated acute respiratory infection causes substantial morbidity, leading to the hospitalisation of one in every 56 healthy term-born infants in high-income settings. Immunisation of pregnant women or healthy term-born infants during their first winter season could have a major effect on the health-care burden caused by RSV infections. Innovative Medicines Initiative 2 Joint Undertaking, with support from the EU's Horizon 2020 research and innovation programme and European Federation of Pharmaceutical Industries and Associations. [ABSTRACT FROM AUTHOR]

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Background: Respiratory syncytial virus (RSV) causes significant morbidity and mortality in infants worldwide. Although prematurity and cardiopulmonary disease are risk factors for severe disease, the majority of infants hospitalized with RSV are previously healthy. Various vaccines and therapeutics are under development and expected to be available in the near future. To inform the use of these new vaccines and therapeutics, it is necessary to determine the burden of RSV disease in Europe. We will prospectively follow-up a birth cohort to obtain incidence data on RSV acute respiratory tract infection (ARTI).Methods: Multicenter prospective study of a birth cohort consisting of 10 000 healthy infants, recruited during 3 consecutive years. RSV associated hospitalization in the first year of life will be determined by questionnaires and hospital chart reviews. A nested cohort of 1000 infants will be actively followed. In case of ARTI, a respiratory sample will be collected for RSV molecular diagnosis.Results: The primary outcome is the incidence rate of RSV-associated hospitalization in the first year of life. In the active cohort the primary outcome is RSV associated ARTI and MA-ARTI.Conclusions: We will provide key information to fill the gaps in knowledge about the burden of RSV disease in healthy infants.Clinical Trials Registration: NCT03627572. [ABSTRACT FROM AUTHOR]

This study fills an important gap in policymaker understanding of the effectiveness and implementation costs of marine plastic cleanup technologies. Previous studies have mainly listed inventories of different plastic litter cleanup technologies, not systematically examined their cost-effectiveness. Through a survey in Europe and North America that asked for cost and cleanup capacity data, per kilogram cost figures were calculated for several categories of cleanup technologies, ranging from fixed-in-place filters in stormwater drainage systems to mobile skimmers on water. Mobile skimmers and dredgers appear to be most cost-effective. Adding performance criteria related to operational conditions and ease of use, such as energy use and economies of scale, dredgers and stormwater filters rank higher. Litter traps in drainage systems are most preferred when furthermore considering weather sensitivity and whether technologies operate standalone, making them an interesting complementary technology to skimmers and dredgers to prevent plastic litter from entering water courses. These results show how sensitive the outcome of the ranking is to the inclusion of additional operational criteria, how different categories of technologies can effectively be combined in the plastic waste supply chain, and what the cost implications are for the future upscaling of plastic litter cleanup technologies. • The cost-effectiveness of plastic cleanup technologies is not well understood. • Technologies range from fixed-in-place filters in stormwater drainage to mobile water skimmers. • In this study, water-based technologies appear to be most cost-effective. • A combination of land-based and water-based technologies is preferred when adding performance criteria. [ABSTRACT FROM AUTHOR]

This article critically, and comparatively, evaluates the legal basis and key shortcomings of the blocking injunction, which has gained popularity in the EU, Singapore and lately Australia, as an alternative to the extrajudicial "notice and takedown" approach to enforcing intellectual properly rights. The article concludes that there are problems not only with the remedy itself, but also in the manner in which the blocking injunction is implemented. The fact that multiple proceedings have to be filed in order to obtain a global level of enforcement and the possibility of blocking measures being circumvented are problems with the remedy itself. In the EU context, at least, not only does the implementation of the blocking injunction fall short of due process requirements, but also the legal basis for the remedy in the context of enforcing trade mark rights is questionable. [ABSTRACT FROM AUTHOR]

The author presents an personal memoir of working in fashion designing, art museums and Costume Society, a social organization for conserving costume history. He states that he worked as Chairman of Costume Society from 1968 to 1974 and served as Director of the National Portrait Gallery and the Victoria and Albert Museum. He discusses various topics related to costume history including trends in fashion industry, working in art museums of clothing and dress and information on his colleagues.

Copyright of Proceedings of the Prehistoric Society is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The author discusses demographic and subsistence crises in connection with precautionary issues from the 14th century to 2012. Consequences regarding such crises such as decreases in marriage, child birth, the intervention of public authority, and resorting to prayers are noted. Topics include the great famine of 1315 and its impact on the European population, the famine of 1481 during the reign of French King Louis XI, and agricultural and commerce development during the 20th century, which greatly reduced famines.

The article discusses issues centered around the contemporary layout and mission of populist movements in Europe and Islamic immigration into the continent. The author discusses over arching similarities between groups from various ends of the political spectrum, before stressing the relative heterogeneity of contemporary populist groups in the European continent. Themes discussed include Islamic immigration, the construction of an anti-Muslim representation, and national identity.

Recent comprehensive data provided through the DAISIE project (www.europe-aliens.org) have facilitated the development of the first pan-European assessment of the impacts of alien plants, vertebrates, and invertebrates - in terrestrial, freshwater, and marine environments - on ecosystem services. There are 1094 species with documented ecological impacts and 1347 with economic impacts. The two taxonomic groups with the most species causing impacts are terrestrial invertebrates and terrestrial plants. The North Sea is the maritime region that suffers the most impacts. Across taxa and regions, ecological and economic impacts are highly correlated. Terrestrial invertebrates create greater economic impacts than ecological impacts, while the reverse is true for terrestrial plants. Alien species from all taxonomic groups affect "supporting", "provisioning", "regulating", and "cultural" services and interfere with human well-being. Terrestrial vertebrates are responsible for the greatest range of impacts, and these are widely distributed across Europe. Here, we present a review of the financial costs, as the first step toward calculating an estimate of the economic consequences of alien species in Europe. [ABSTRACT FROM AUTHOR]

The article discusses various classical methods of data collection, presentation, analysis, and interpretation of problems related to cost-estimating under applied economic theory. It cites the significance of combining economic, mathematical, and statistical techniques to measure and interpret uncertain parametric values in cost estimating relationship (CER). It explains basic economic principles and its mathematical properties. It outlines strategies on how to develop CER through linear cost function, sample size determination, data collection, linear specifications. An example of the establishment of CER in the procurement of land is also provided.

This essay reports on the presence of Muslims and the religion Islam in Europe and its effects on religion and culture. Two models have shaped Western European countries' immigration policies when the bulk of incoming immigrants stay in Europe, the multiculturalism and assimilationism. Multiculturalism fails because of culturalism, while assimilationism fails because it initially ignored the religious dimension of immigrants' identities. Islam is the mirror for Europe in looking at its own identity, but it doe not offer new culture or new values.

General circulation models constrained by past meteorological records have been run as part of a major community effort, using datasets from 1958 to the present date, to produce consistent gridded atmospheric databases known as reanalysis data. We derive linear regression models to transfer reanalysis gridded data to high elevation weather stations in Europe using daily observations from 1994 to 2001. The models are then used to reconstruct daily mean, minimum and maximum air temperatures since 1958 at the weather stations. The regression models use principal components of reanalysis temperature and pressure variables in addition to local (nearest grid point) temperature and pressure variables. An all-subsets regression technique in conjunction with cross validation is used to find the best model. The accuracy of the approach is verified using observed monthly data from 1980 to 1990 at 29 stations, and monthly data since 1958 at 8 stations. The verification results indicate that retrodiction to 1980 is good at all stations. However, validation at 3 alpine stations shows large differences between observed and reconstructed temperatures prior to 1970. Nevertheless, the basic spatio-temporal warming pattern we reconstruct for the European mountains has many similarities to that for the European ‘lowlands’. We find regional climatic trends for the period 1958 to 2001 of typically 0.7°C per 100 yr for minimum temperatures and twice that for maximum temperatures. These trends are probably underestimated. Our reconstructions suggest that there has been an increase in the diurnal temperature range in European mountains in addition to the overall warming. [ABSTRACT FROM AUTHOR]

A growing number of citizens are concerned about the environmental impact of air transport, and aviation has become synonymous with high carbon emissions and global warming, which has led to the development of flygskam (or flight shame) in Europe. While its impact on air traffic remains unclear, flight shame has forced the airline industry to react and better understand its origin. In this research, building on the growing literature on industry and organizational stigma, we assume that flight shame can be partly explained by a distorted public perception of the environmental impact of air transport. Accordingly, we investigate the level of knowledge of the environmental footprint of air transport. Based on a sample of 1018 French respondents, we reveal that more than 90% of respondents overestimate the share of air transport in global carbon emissions. We also show that 98% of the respondents underestimate the reduction in carbon emissions per passenger. Finally, we investigate the awareness of the measures taken by the industry to curb its carbon emissions and highlight, for instance, that 70% of respondents overestimate the fuel consumption of the newest generations of aircraft. Based on these results, we draw lessons for airlines and for the air transport industry to help cope with flight shame in Europe. • Flight shame forces airlines to react to the growing concerns regarding the environmental impact of aviation. • The literature on industry and organizational stigma can shed light on the emergence of flight shame. • Flight shame can be partly explained by a distorted public perception of the environmental impact of air transport. • We show that respondents to our survey tend to strongly overestimate the environmental impact of air transport. • We reveal that respondents underestimate the efforts of the air transport industry to reduce its environmental footprint. • We highlight a lack of knowledge of the measures taken by airlines and airports to reduce their carbon emissions. [ABSTRACT FROM AUTHOR]

FaMRIsc trial shows: MRI breast screening for women with >=20% lifetime risk is also cost-effective in Europe B Background: b The randomized trial FaMRIsc showed the huge stage shift caused by screening women with >=20% lifetime breast cancer risk with MRI compared to mammography at every breast density SP 1 sp . B Conclusions: b Interpretation: Screening women with >=20% lifetime breast cancer risk with MRI may considerably reduce mortality and should also in Europe be advised. [Extracted from the article]

Conventional approaches to the fabrication of fine features in the printed circuit board and metal finishing industries typically employ a multistage photolithography stage to process each individual substrate, which is both inefficient and wasteful of valuable materials. By developing and implementing a maskless electrochemical process that decreases the use of lithography, the Mesmoproc project aims to assist European industry in these sectors. [ABSTRACT FROM AUTHOR]

In January of this year (2020), a major scientific study ('the Minshull report') announced that gas hydrate reservoirs were found in many offshore areas across Europe. The European Commission is now considering a policy view to commercialize the development and extraction of methane gas from European offshore areas. Affirmation from the European Commission that offshore methane hydrates are too useful and too valuable to forego development could initiate a global response to adopt offshore methane hydrates as a new source of natural gas for heating, for electrical power supplies, and for potential new revenues. The upside? The potential rewards from offshore methane hydrates are multi-fold. Coastal states are surrounded in methane hydrate resources that if responsibly developed could enable vast amounts of methane (natural gas) to be produced for decades or centuries beyond the timelines of conventional natural gas assets. There are also massive volumes of fresh water trapped in hydrates that could aid in fighting droughts and desertification. The downside? There are novel foreseeable risks that might result from those commercial methane hydrate activities. The climate change risks and geo-physical hazards from offshore methane hydrates are quite distinct from both conventional and unconventional hydrocarbons. There are new challenges to achieving safety and sustainability. In review, this paper both welcomes the discovery and confirmation of offshore methane hydrates in European waters and also raises concerns that more research is required on the optimal policy strategies for the known and foreseeable risks to best enable safe and sustainable policy choices. [ABSTRACT FROM AUTHOR]

Abstract: There have been multiple separate outbreaks of Bluetongue (BT) disease of ruminants in Europe since 1998, often entering via the Mediterranean countries of Italy, Spain and Greece. BT is caused by an orbivirus, Bluetongue virus (BTV), a member of the family Reoviridae. BTV is a non-enveloped double-capsid virus, which encodes 7 structural proteins (VP1-VP7) and several non-structural proteins (NS1, NS2, NS3/3a and NS4) from ten double-stranded RNA segments of the genome. In this report, we have prepared BTV virus-like particles (VLPs, composed of VP2, VP3, VP5 and VP7) and sub-viral, inner core-like particles (CLPs, VP3 and VP7) using a recombinant baculovirus expression system. We compared the protective efficacy of VLPs and CLPs in sheep and investigated the importance of geographical lineages of BTV in the development of vaccines. The Greek crossbred Karagouniko sheep, which display mild to sub-clinical BT, were vaccinated with VLPs or CLPs of BTV-1, derived from western lineage and were challenged with virulent BTV-1 from an eastern lineage. All VLP-vaccinated animals developed a neutralising antibody response to BTV-1 from both lineages prior to challenge. Moreover, post-challenged animals had no clinical manifestation or viraemia and the challenged virus replication was completely inhibited. In contrast, CLP-vaccinated animals did not induce any neutralising antibody response but developed the group specific VP7 antibodies. CLPs also failed to prevent the clinical manifestation and virus replication, but in comparison to controls, the severity of disease manifestation and viraemia was mitigated. The data demonstrated that the outer capsid was essential for complete protection, while the geographical origin of the BTV was not critical for development of a serotype specific vaccine. [Copyright &y& Elsevier]

Abstract: Bluetongue virus causes an emerging disease of ruminants, principally affecting sheep and cattle. Since 1998, there have been multiple separate outbreaks of bluetongue disease in Europe that have highlighted the need for a safe, efficacious, DIVA compliant vaccine. We report here a new baculovirus expression strategy which allowed pre-integration of the genes encoding the BTV inner capsid proteins at one baculovirus locus and those encoding the outer capsid proteins at a different locus. A modified baculovirus with two marker proteins to facilitate the phenotypic selection of recombinant viruses was developed. The utility of this approach is demonstrated by the production of BTV VLPs to a number of serotypes. For a proof of concept, VLPs of one serotype was then tested for protective immune response. VLPs were demonstrated to be safe, highly effective, immunogens in sheep, reducing post-challenge viraemia to levels below the threshold detection limit of quantitative RT-PCR when vaccinated animals were challenged with virulent virus. [Copyright &y& Elsevier]

Background: Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder associated with abnormal angiogenesis and disabling epistaxis. Tranexamic acid (TA) has been widely used in the treatment of these severe bleeds but with no properly designed trial., Objectives: To demonstrate the efficacy of TA in epistaxis in HHT patients and to explore its safety of use., Patients/methods: A randomized, placebo-controlled, double-blind, cross-over trial was conducted. Participants were randomized to receive TA (3 g a day) then placebo or the opposite sequence. The main analysis compared intra-individual mean duration of epistaxis under TA vs. placebo on a log scale. The primary outcome was the mean duration of epistaxis per month, assessed with specific grids to be completed by participants. The number of epistaxis episodes was recorded as a secondary outcome., Results: A total of 118 randomized patients contributed to the statistical analysis. The mean duration of epistaxis per month was significantly shorter with TA than placebo (0.19 on the log scale; SD = 0.07; P = 0.005), corresponding to a decrease of 17.3% (15.7 min) in the duration of epistaxis per month (CI 95%, 5.5-27.6). The median number of epistaxis episodes per month was 22.1 episodes in the placebo arm vs. 23.3 episodes in the TA arm. No thrombophlebitis was observed., Conclusions: In the ATERO study, we demonstrated a significant decrease in the duration of epistaxis in HHT patients taking TA. No safety issues were recorded in our cohort of patients., (© 2014 International Society on Thrombosis and Haemostasis.)

Since 1998, 9 of the 26 serotypes of bluetongue virus (BTV) have spread throughout Europe, and serotype 8 has suddenly emerged in northern Europe, causing considerable economic losses, direct (mortality and morbidity) but also indirect, due to restriction in animal movements. Therefore, many new types of vaccines, particularly subunit vaccines, with improved safety and efficacy for a broad range of BTV serotypes are currently being developed by different laboratories. Here we exploited a reverse genetics-based replication-deficient BTV serotype 1 (BTV-1) (disabled infectious single cycle [DISC]) strain to generate a series of DISC vaccine strains. Cattle and sheep were vaccinated with these viruses either singly or in cocktail form as a multivalent vaccine candidate. All vaccinated animals were seroconverted and developed neutralizing antibody responses to their respective serotypes. After challenge with the virulent strains at 21 days postvaccination, vaccinated animals showed neither any clinical reaction nor viremia. Further, there was no interference with protection with a multivalent preparation of six distinct DISC viruses. These data indicate that a very-rapid-response vaccine could be developed based on which serotypes are circulating in the population at the time of an outbreak.

Background: If the prevalence of pulmonary embolism (PE) differs significantly between the US and Europe, this observation could reduce the generalizability of diagnostic protocols for PE derived in either location., Objective: To determine possible causes and potential clinical consequences of these PE prevalence differences., Methods: Secondary analysis of three prospectively collected multicenter samples (two French and one from the US) including 3174 European and 7940 American PE-suspected patients in Emergency departments (ED) (117 for Europe and 12 for US). Comparison of clinical features, resource use and outcomes of European- and US-suspected PE populations in ED., Results: European patients evaluated for PE were significantly older and had a higher clinical pretest probability (CPP) for PE. The final PE prevalence was significantly higher in Europe, in the overall sample (26.5% vs. 7.6%) and in each level of CPP. Suspected European patients categorized as low CPP had a higher posttest probability than US low CPP patients. Suspected US patients categorized as high CPP had a much lower posttest probability of PE than in Europe. The mean number of tests performed for one PE diagnosis was lower in Europe (7.4 vs. 21.6). Among patients diagnosed with PE, European patients had a higher mean severity of illness score and a higher PE-mortality rate (3.4% vs. 0.7%)., Conclusions: Among patients suspected of a PE and those ultimately diagnosed with a PE, European patients had higher acuity, a higher pretest probability and worse outcome than US patients. The present study underscores the importance of disease prevalence for pretest probability scoring approaches and for significance interpretation of imaging tests., (© 2012 International Society on Thrombosis and Haemostasis.)

Bluetongue has been recognized as a viral disease of livestock for more than 100 years. Repeated incursions of Bluetongue into Europe since 1998 have been particularly devastating for highly sensitive European fine-wool sheep breeds, and have resulted in a resurgence of interest in vaccine manufacture. Fortunately, the virus and its serology are well understood and vaccination prevents the disease. However, current vaccines are not without their problems, and many new approaches are being tested to improve the safety and breadth of protection afforded. This review describes the leading technologies for improved bluetongue vaccines and looks ahead to how advances in other viral vaccines might be applied to this disease.

Proliferative abnormalities of the normal colorectal mucosa have been proposed as a possible marker of enhanced susceptibility to colorectal cancer. A case-control study was conducted to compare the cell kinetics of normal colon mucosa through the different steps of the adenoma-carcinoma sequence. The number and position of labelled epithelial nuclei after in vitro incubation of tritiated thymidine were compared in patients with large bowel cancer (n = 39), large adenoma >1 cm (n = 47), small adenoma (n = 30) and in controls (n = 135). The distribution of tertiles between cases and controls was analysed using odds ratio (OR), comparing the second tertile (OR2) and the third tertile (OR3) to the first one. There was no significant difference in the overall cell proliferation rate when comparing cancer, large adenoma and small adenoma groups to the control group. The ratio number of labelled cells in the upper 40% of the crypt/total number of labelled cells (4h index) was found to be significantly higher only when the cancer group was compared to the control group: OR2 = 5.87 (1.33-25.90), OR3 = 9.48 (2.07-43.38), P for trend = 0.002. The upward shift of the proliferative compartment in the normal mucosa of patients with large bowel cancer suggests that this abnormality is related to cancer risk.

It is unclear whether neutral steroids and bile acids are involved in large bowel carcinogenesis. This study was conducted to compare the concentration of these faecal constituents at the different stages of the adenoma-carcinoma sequence. Neutral sterols and free bile acid concentrations were determined from stool samples collected form patients with large bowel cancer (n = 47), large adenoma > or = 1 cm (n = 42), small adenoma (n = 24), and controls (n = 104). The distribution of tertiles between cases and controls was analysed using odds ratio (OR), with 95% confidence interval (CI), comparing (two-sided tests) the second tertile (OR2) and the third tertile (OR3) to the first one. Persistence of primary bile acids appeared as a protective factor against cancer: (OR = 0.09, 95% CI 0.02-0.54). High values of cholesterol were associated with cancer risk (OR2 = 5.8, 95% CI 1.3-26.6; OR3 6.4, 95% CI 1.3-31.4). High values of cholesterol were more frequently observed in patients with large adenomas than in controls (OR2 = 8.5, 95% CI 1.9-37.5; OR3 = 4.3, 95% CI 0.9-20.9). Neutral sterols, cholesterol especially, may play a role in adenoma growth and adenoma transformation into carcinoma. Persistence of primary bile acids may afford protection.