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Background: In clinical trials, hepatitis C virus (HCV) salvage treatment with sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) achieved an SVR12 rate of >95% in NS5A-experienced participants. Lower SVR12 rates have been reported in real-world studies, particularly for genotype (GT)3 infection and cirrhosis. We determined the efficacy and safety of SOF/VEL/VOX in a large real-world cohort. Method(s): We assessed the efficacy of salvage SOF/VEL/VOX for HCV infection in NS5A-inhibitor experienced participants with cirrhosis and portal hypertension, prior liver transplantation (LT) or severe extra-hepatic manifestations. SOF/VEL/VOX was available via an early access program. The primary outcome was SVR12. Secondary outcome was frequency of adverse events (AE). Finding(s): Ninety-seven participants were included. Median age was 58, 82% were male, 78% had cirrhosis, most with portal hypertension (61%, n=46/76), and 18% had prior-LT. Of the cirrhotic participants, 96% were Child-Turcotte-Pugh class A, and 4% were class B. Of the 72% with GT3, 76% were also cirrhotic. By intention-to-treat analysis, SVR12 rate was 85% (n=82/97). Per protocol, the SVR12 rate was 90%, including 91% in GT1 (GT1a n=18/18, GT1b n=2/4), 89% in GT3 (n=59/66) and 100% in GT6 (n=3/3). SVR12 in participants with GT3 and cirrhosis was 90%. No predictors of non-SVR12 were identified. There were 4 serious AEs including 1 death and 3 hepatic decompensation events. NS5A resistance-associated substitutions detected at baseline did not affect SVR12. Conclusion(s): This real-world study confirms high efficacy of SOF/VEL/VOX for the treatment of difficult-to-cure NS5A-inhibitor experienced patients, including those with GT3 and cirrhosis. Treatment was well tolerated in most; however, serious AEs can occur in those with advanced liver disease.Copyright © 2020 The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail

Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM), but the efficacy of intervention components across different ethnic groups is less clear. This systematic review examined the effects of intervention characteristics of lifestyle interventions on diabetes incidence and weight loss by ethnicity using the Template for Intervention Description and Replication (TIDieR) framework. MEDLINE, EMBASE and other databases were searched for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American and African groups. Forty-five studies (18,789 participants) were included in the systematic review and 41 studies in meta-analysis. Meta-analysis showed a high number of intervention sessions was significantly associated with a greater reduction in diabetes incidence (P = 0.043) and weight (P = 0.015), while other intervention characteristics including intervention provider and delivery format did not alter the outcomes (all P > 0.05). Additionally, narrative synthesis showed long-term interventions (>=12 months) were associated with significant diabetes risk reduction for all ethnic groups, while short-term interventions (<12 months) were more effective in weight loss in most ethnic groups. There may be ethnic preferences for the optimal number of intervention sessions.Copyright © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Background and Aim: Transient elastography with liver stiffness measurement (LSM) is known to correlate with liver fibrosis and liver-related outcomes. 4AGP is a new algorithm that uses indirect biomarkers to determine those who are at risk of elevated LSM (> 12.5 kPa). It is calculated using alpha-fetoprotein, albumin, aspartate aminotransferase, age, sex (gender), and platelet count. Although 4AGP correlates with elevated LSM in patients with chronic hepatitis C (CHC) virus infection, it is unknown whether it also predicts liver-related outcomes. We aimed to determine whether LSM or 4AGP, or other indirect biomarkers such as aspartate aminotransferase to platelet ratio index (APRI), Fibrosis-4 (FIB-4), or Forns index, can best predict liver-related outcomes in a cohort of patients with CHC. Method(s): The Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma (CATCH) study is a prospective study that recruited patient with CHC. Baseline LSM and indirect biomarkers were assessed (all were before treatment), along with outcomes (hepatocellular carcinoma [HCC], decompensation, or liver-related death). Survival curves were analyzed using a log-rank test, along with receiver operator characteristic (ROC) curves and Cox proportional hazard ratios. Optimal cut-off points were calculated, accounting for sensitivity, specificity, false positives and negatives, as well as the area under the ROC curve (AUROC). Result(s): A total of 1049 patients with CHC were recruited between October 2014 and June 2018. Mean follow-up was 3.4 +/- 0.7 years, indicating 3631 patient-years. Patients' mean age was 45.1 years (19-82), and 31.3% were female. Seven patients developed HCC; the best predictors of HCC development were, in order, 4AGP, Forns index, FIB-4, LSM, and APRI (Fig. 1a). An LSM of 21.3 kPa was the optimal cut-off point for predicting HCC, with a sensitivity of 85.7%, specificity of 92.2%, and a hazard ratio (HR) of 30 (95% CI, 5.7-150). A 4AGP value of -2.81 had

Background and Aims: In clinical trials, salvage therapy including Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX) achieved an SVR12 rate of 96% in NS5A-experienced participants. An extended access program (EAP) for SOF/VEL/VOX was sponsored by Gilead Pharmaceuticals for Australian patients with advanced liver disease or prior liver transplantation (LT), who had relapsed. We determined the real-world efficacy and safety of this regimen in this cohort with advanced liver disease. Method(s): In this Australian multicentre EAP study, adult patients with chronic HCV infection genotype(GT)1-6 with prior failure on a DAA NS5A inhibitor containing regimen were eligible to access 12 weeks of SOF/VEL/VOX 400 mg/100 mg/100 mg. Other eligibility criteria included compensated liver disease with at least one of the following i) Child Pugh (CP)A cirrhosis with clinically significant portal hypertension or platelets <100 x 109/L, ii) prior LT, or iii) severe extra hepatic manifestations. Hospitals with >1 EAP recipient were invited to participate. Clinical characteristics and treatment outcomes were recorded at baseline, end-of-treatment (EOT) and SVR12. HCV NS5A RAS testing was performed prior to retreatment, where serum was available. The primary outcomes was SVR12 rate. Result(s): To date, baseline data is available for 89 patients from 24 participating hospitals. 85 have reached end-of-treatment (EOT), and 80 have SVR12 data available for analysis. Four patients have incomplete data due to early discontinuation of therapy (n = 2), loss to follow up (n = 1) and death (n = 1). 74 (83%) were male and the median age was 53. GT3 was the most common (n = 64), then GT1a (n = 18), GT1b (n = 4), GT6 (n = 2) and GT4 (n = 1). The median platelet count was 127. 68 (75%) had cirrhosis and of these, 35 (51%) had portal hypertension. 14 (16%) had prior hepatoma and 15 (17%) prior LT. All participants were NS5A-experienced and 8 (9%) had received?>1 DAA course (1-4). Three participants were

Abstract Background In clinical trials, hepatitis C virus (HCV) salvage treatment with sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) achieved an SVR12 rate of >95% in NS5A-experienced participants. Lower SVR12 rates have been reported in real-world studies, particularly for genotype (GT)3 infection and cirrhosis. We determined the efficacy and safety of SOF/VEL/VOX in a large real-world cohort. Methods We assessed the efficacy of salvage SOF/VEL/VOX for HCV infection in NS5A-inhibitor experienced participants with cirrhosis and portal hypertension, prior liver transplantation (LT) or severe extra-hepatic manifestations. SOF/VEL/VOX was available via an early access program. The primary outcome was SVR12. Secondary outcome was frequency of adverse events (AE). Findings Ninety-seven participants were included. Median age was 58, 82% were male, 78% had cirrhosis, most with portal hypertension (61%, n = 46/76), and 18% had prior-LT. Of the cirrhotic participants, 96% were Child-Turcotte-Pugh class A, and 4% were class B. Of the 72% with GT3, 76% were also cirrhotic. By intention-to-treat analysis, SVR12 rate was 85% (n = 82/97). Per protocol, the SVR12 rate was 90%, including 91% in GT1 (GT1a n = 18/18, GT1b n = 2/4), 89% in GT3 (n = 59/66) and 100% in GT6 (n = 3/3). SVR12 in participants with GT3 and cirrhosis was 90%. No predictors of non-SVR12 were identified. There were 4 serious AEs including 1 death and 3 hepatic decompensation events. NS5A resistance-associated substitutions detected at baseline did not affect SVR12. Conclusions This real-world study confirms high efficacy of SOF/VEL/VOX for the treatment of difficult-to-cure NS5A-inhibitor experienced patients, including those with GT3 and ci

BACKGROUND AND AIMS: IgG4 sclerosing cholangitis (IgG4-SC) is the biliary component of the multisystem IgG4-related disease. We aimed to investigate the clinical features, demographics, treatment response and outcomes of IgG4-SC in a large Australian cohort. METHODS: We conducted nationwide retrospective cohort via the Australian Liver Association Clinical Trials Network (ALA-CRN). 39 sites were invited to participate. IgG4-SC was defined by the clinical diagnostic criteria established by the Japanese Biliary Association in 2012. Data were collected on patient demographic, clinical and laboratory information, presenting features, response to therapy and clinical outcomes. RESULTS: 67 patients meet inclusion criteria from 22 sites. 76% were male with mean age of 63.3 ± 14.5 years and a median IgG4 level of 3.6 g/L [0.09-67.1]. The most frequent presenting symptom was jaundice (62%) and abdominal pain (42%) and Type 1 biliary stricturing (52%) at the distal common bile duct was the most frequent biliary tract finding. Prednisolone was used as a primary treatment in 61 (91%) and partial or complete response occurred in 95% of subjects. Relapse was common (42%) in those who ceased medical therapy. After a median follow up of 3.9 years there was one hepatocellular carcinoma and no cholangiocarcinomas. CONCLUSIONS: Our study confirms the preponderance of IgG4-SC in males and highlights the steroid response nature of this condition although relapse is common after steroid cessation. Progression to malignancy was uncommon.

BACKGROUND: Management of single small hepatocellular carcinoma (HCC) is straightforward with curative outcomes achieved by locoregional therapy or resection. Liver transplantation is often considered for multiple small or single large HCC. Management of two small HCC whether presenting synchronously or sequentially is less clear. AIM: To define the outcomes of patients presenting with two small HCC. METHODS: Retrospective review of HCC databases from multiple institutions of patients with either two synchronous or sequential HCC ≤ 3 cm between January 2000 and March 2018. Primary outcomes were overall survival (OS) and transplant-free survival (TFS). RESULTS: 104 patients were identified (male n = 89). Median age was 63 years (interquartile range 58-67.75) and the most common aetiology of liver disease was hepatitis C (40.4%). 59 (56.7%) had synchronous HCC and 45 (43.3%) had sequential. 36 patients died (34.6%) and 25 were transplanted (24.0%). 1, 3 and 5-year OS was 93.0%, 66.1% and 62.3% and 5-year post-transplant survival was 95.8%. 1, 3 and 5-year TFS was 82.1%, 45.85% and 37.8%. When synchronous and sequential groups were compared, OS (1,3 and 5 year synchronous 91.3%, 63.8%, 61.1%, sequential 95.3%, 69.5%, 64.6%, P = 0.41) was similar but TFS was higher in the sequential group (1,3 and 5 year synchronous 68.5%, 37.3% and 29.7%, sequential 93.2%, 56.6%, 48.5%, P = 0.02) though this difference did not remain during multivariate analysis. CONCLUSION: TFS in patients presenting with two HCC ≤ 3 cm is poor regardless of the timing of the second tumor. All patients presenting with two small HCC should be considered for transplantation.

Open innovation internet of things (OI-IoT) is in a nascent stage of development. IoT vignettes enable an understanding of the entrepreneurial orientation and open innovation in nurturing IoT and achieving enormous future growth and pervasiveness in everyday life. The interplay of open innovation in IoT (OI-IoT) suggests a two-step long run arrival of the IoT revolution during 2012–2030 with OI-IoT becoming a fabric of successful IoT implementations emerging in 2020 and beyond. Several propositions provide guidance for entrepreneurs developing IoT products as a service with new revenue streams and business models and builds on the early stage of IoT and entrepreneurial moves away from a closed technology assemblage towards embracing service dominant reasoning with an OI-IoT.

© 2017 The Royal Society for Public Health Objective Many blind children in the developing world are unable to obtain timely treatment due to lack of financial and medical resources. Can public health programs that identify and treat such children several years after the onset of blindness enhance their quality of life? The notion that visual development is subject to an early ‘critical period’ argues against this possibility. However, there are inadequate empirical data from humans on this issue. To address this need, we examined the quality of life of children living in India and who were treated for early-onset blindness (before one year of age), due to cataracts or corneal opacities. Study design Survey study. Methods As part of an ongoing scientific effort named Project Prakash, we screened over 40,000 children in rural northern India to identify those suffering from early-onset blindness. They were provided eye surgeries in a tertiary care ophthalmic center in New Delhi. We subsequently surveyed 64 Prakash children, ranging in age from 5 to 22 years and obtained their responses on a multi-dimensional quality of life questionnaire. Results Nearly all of the subjects indicated that their quality of life had improved after treatment. Children reported marked enhancement in their mobility, independence, and safety, and also in social integration. Surprisingly, we found no significant correlations between quality of life metrics and factors such as age at treatment, gender, time since treatment, and pre-surgery and post-surgery acuity. Conclusions A key question for public health policy makers is whether a program of surgical intervention for older blind children is likely to be beneficial, or if the resources are better spent on rehabilitation via vocational training and assistive devices. The marked improvements in quality of life we find in our data strongly argue for the provision of surgical care regardless of a child's age.

BACKGROUND: In clinical trials, HCV salvage treatment with Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX) achieved an SVR12 rate of >95% in NS5A-experienced participants. Lower SVR12 rates have been reported in real-world studies, particularly for genotype (GT)3 infection and cirrhosis. We determined the efficacy and safety of SOF/VEL/VOX in a large real-world cohort. METHOD(S): We assessed the efficacy of salvage SOF/VEL/VOX for HCV infection in NS5A-inhibitor experienced participants with cirrhosis and portal hypertension, prior liver transplantation (LT) or severe extra-hepatic manifestations. SOF/VEL/VOX was available via an early access program. The primary outcome was SVR12. Secondary outcome was frequency of adverse events (AE). FINDINGS: Ninety-seven participants were included. Median age was 58, 82% were male, 78% had cirrhosis, most with portal hypertension (61%, n=46/76), and 18% had prior-LT. Of the cirrhotic participants, 96% were Child-Turcotte-Pugh class A and 4% were class B. Of the 72% with GT3, 76% were also cirrhotic. By intention-to-treat analysis, SVR12 rate was 85% (n=82/97). Per protocol, the SVR12 rate was 90%, including 91% in GT1 (GT1a n=18/18, GT1b n=2/4), 89% in GT3 (n=59/66) and 100% in GT6 (n=3/3). SVR12 in participants with GT3 and cirrhosis was 90%. No predictors of non-SVR12 were identified. There were four serious AEs including one death and three hepatic decompensation events. NS5A resistance-associated substitutions detected at baseline did not affect SVR12. CONCLUSION(S): This real-world study confirms high efficacy of SOF/VEL/VOX for the treatment of difficult-to-cure NS5A-inhibitor experienced patients, including those with GT3 and cirrhosis. Treatment was well tolerated in most however serious AEs can occur in those with advanced liver disease.Copyright © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions

Background: IgG4-Sclerosing Cholangitis (IgG4-SC) is an uncommon clinical entity that has an uncertain prognosis and incompletely defined clinical management pathway. Existing data are predominantly from Japanese populations with limited data from Western countries. We sought to describe the presentation, management and outcomes of an Australian IgG4-SC population Methods: Retrospective data collection from major liver centres affiliated with the ALA Clinical Research Network with site selection based on an affirmative response to an expression of interest Patients were included as IgG4-SC if they fulfilled the criteria for definite or probable IgG4-SC according to the IgG4-SC 2012 clinical diagnostic criteria Baseline demographic and biochemical data were obtained in addition to treatment response Follow-up data included disease progression, relapse, development of malignancy and survival Results: 53 patients from 18 institutions met the inclusion criteria (M/F 40/13; Age 64 2+/-1 9 year [range 14.5 - 84.1 years]). Caucasian (68%) and Asian (28%) A previous diagnosis of PSC had been made in 3 (6%) subjects and a suspected biliary tract malignancy or pancreatic tumour in 5 (9%) Three subjects had evidence of cirrhosis The most frequent presenting symptom was jaundice (62%) and abdominal pain (32%) and 34% had co-existing diabetes mellitus Bilirubin (80+/-13mumol/L), ALT (267+/-43 U/L) and IgG4 (6.2+/-0.8 g/L) were significantly elevated at diagnosis and 38% had Ca19-9 > 37 kU/L (range 1-2248 kU/L). The bile duct lesion was: Type 1 (distal bile duct stricture only; 57%), Type 2A (13%), Type 2B (2%), Type 3 (13%) and Type 4 (9%) IgG4-SC was associated with other IgG4-related diseases, most commonly: autoimmune pancreatitis (AIP) (55%), dacryoadenitis/sialadenitis (15%) 87% received prednisolone as initial treatment and 60% achieved remission while a further 19% experienced a partial response with a median time to best response of 3 4 months Endoscopic dilatation was p

Background and Aim: The prevalence of primary biliary cholangitis (PBC) reported in different countries varies significantly and in some parts of the world appears to be increasing. The aim of this study was to determine the 2013 prevalence of PBC in Victoria, Australia, and to determine the time trend by comparing it with previous studies undertaken in 1991 and 2002. Method(s): Four case-finding methods were used to identify cases of PBC in Victoria: (1) physicians' survey; (2) tertiary hospital search; (3) liver transplant database search; and (4) private pathology antimitochondrial antibody search. Result(s): The prevalence of PBC in Victoria, Australia, is 189.0 per million using all four methods. The average annual increase in prevalence from 1991 to 2013 was 7.7 per million per year. Using the same case-finding methods as the 1991 Victorian prevalence study (methods 1 and 2), the prevalence of PBC increased from 19.1 per million in 1991 to 49.4 per million in 2002 (P < 0.001) and to 80.7 per million in 2013 (P < 0.001). Conclusion(s): The current prevalence of PBC in Victoria is significantly higher than previously reported. The use of private pathology-based case-finding methods is important in identifying the maximum number of PBC cases.Copyright © 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd

Background: Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion. Method(s): Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included. Variables encompassing clinical, tumour, treatment type and response factors were analysed against the primary outcome of overall survival. Univariate analysis and multivariate Cox regression modelling were used to identify factors pre- and post-TACE therapy significantly associated with survival. Result(s): Total of 292 consecutive patients underwent rTACE with mainly Child Pugh A cirrhosis (61%) and BCLC stage A (57%) disease. Median overall survival (OS) was 30 months (IQR 15.2-50.2) from initial TACE. On multivariate analysis greater tumour number (p = 0.02), higher serum bilirubin (p = 0.007) post initial TACE, and hepatic decompensation (p = 0.001) post second TACE were associated with reduced survival. Patients with serum AFP >= 200 ng/ml following initial TACE had lower survival (p = 0.001), compared to patients with serum AFP level that remained < 200 ng/ml post-initial TACE, with an overall survival of 19.4 months versus 34.7 months (p = 0.0001) respectively. Conclusion(s): Serum AFP level following initial treatment in patients undergoing repeat TACE for HCC is a simple and useful clinical prognostic marker. Moreover, it has the potential to facilitate appropriate patient selection for rTACE particularly when used in conjunction with baseline tumour burden and severity of hepatic dysfunction post-initial TACE.Copyright © 2020 The Author(s).

Background: Hepatocellular carcinoma (HCC) is responsible for 1% of deaths worldwide, and the incidence continues to increase. Despite surveillance programs, 70% of HCC patients are not suitable for curative options at diagnosis, and therefore, non-curative treatments are essential to modern clinical practice. There are many novel treatments, though their roles are not well defined. This study aimed to contrast Selective Internal Radiation Therapy (SIRT) and Drug Eluting Bead Transarterial Chemoembolisation (DEB-TACE) to further define their roles. Method(s): This was a retrospective multicentre cohort study. Factors included for analysis were type of HCC treatment, number of lesions, lesion size, multiple disease severity scores, cirrhosis and vascular invasion. The primary endpoint was transplant-free survival. Result(s): Transplant-free survival was similar between the two cohorts (p = 0.654), despite a variation in median lesion size, SIRT: 54.5 mm, DEB-TACE: 34 mm (p <= 0.001). A univariate Cox proportional hazard model utilising treatment modality as the covariate showed no significant difference in survival (DEB-TACE HR 1.4 (95%CI 0.85-2.15 p = 0.207). The size of the largest lesion was the best predictor of 3-year survival (p = 0.035). Lesion size was inversely associated with survival (HR 1.01 (95%CI 1-1.02, p = 0.025)) on multivariate analysis. Conclusion(s): This study is the first to catalogue the experience of using SIRT in HCC in a real-world Australian population. It has demonstrated no difference in survival outcomes between DEB-TACE and SIRT. Further, it has shown SIRT to be a reasonable alternative to DEB-TACE especially in larger lesions and has demonstrated that DEB-TACE has a role in select patients with advanced disease.Copyright © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival. KEYPOINTS.

BACKGROUND: Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion. METHOD: Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included. Variables encompassing clinical, tumour, treatment type and response factors were analysed against the primary outcome of overall survival. Univariate analysis and multivariate Cox regression modelling were used to identify factors pre- and post-TACE therapy significantly associated with survival. RESULTS: Total of 292 consecutive patients underwent rTACE with mainly Child Pugh A cirrhosis (61%) and BCLC stage A (57%) disease. Median overall survival (OS) was 30 months (IQR 15.2-50.2) from initial TACE. On multivariate analysis greater tumour number (p = 0.02), higher serum bilirubin (p = 0.007) post initial TACE, and hepatic decompensation (p = 0.001) post second TACE were associated with reduced survival. Patients with serum AFP ≥ 200 ng/ml following initial TACE had lower survival (p = 0.001), compared to patients with serum AFP level that remained < 200 ng/ml post-initial TACE, with an overall survival of 19.4 months versus 34.7 months (p = 0.0001) respectively. CONCLUSION: Serum AFP level following initial treatment in patients undergoing repeat TACE for HCC is a simple and useful clinical prognostic marker. Moreover, it has the potential to facilitate appropriate patient selection for rTACE particularly when used in conjunction with baseline tumour burden and severity of hepatic dysfunction post-initial TACE.

AIM OF THE STUDY: Analgesic use in patients with liver cirrhosis can be associated with increased morbidity and mortality and presents clinicians with a significant and challenging management issue. We evaluated the efficacy of opiate analgesia in patients with cirrhosis, while closely monitoring the side effect profile. MATERIAL AND METHODS: This prospective cohort pilot study compared inpatients with cirrhosis who required regular opiate analgesia to non-cirrhotic patients requiring opiates and patients with cirrhosis who did not require opiates. Participants completed daily surveys to assess for analgesic efficacy and encephalopathy. RESULTS: Fifty-two patients were initially recruited, of whom 50 patients were analysed in three groups (40 male, 10 female, median age 52 years). These included 13 cirrhotic patients (69% Child-Pugh B or C) requiring regular opiate analgesia, 18 cirrhotic patients (67% Child-Pugh B or C) not receiving regular opiate analgesia, and 19 non-cirrhotic controls. Two patients were excluded due to past stroke and acquired brain injury. All cirrhotic patients received regular lactulose. There was no statistical difference in the adequacy of analgesia between the three groups. The modified orientation log score for encephalopathy remained in the normal range in all but two cirrhotic patients receiving regular opiate analgesia. CONCLUSIONS: Effective pain control is achievable with opiate analgesia in most patients with advanced liver disease without precipitating hepatic encephalopathy.

This paper introduces a new approach, Globotics (Baldwin 2019), with the main focus directed towards the lack of skills in digital marketing and e-commerce. Globotics is assumed to provide insights for the adoption of a pedagogy of experiential learning. Furthermore, the adoption of globotics (ibid) may potentially lead towards a brighter future for tertiary marketing education, as well as fulfil the diverse needs of Asia and Oceania regarding the acquisition of digital marketing talent. The author conducted in-depth interviews with academics and practitioners in order to gain insight into the overall context of marketing practice. Upon reviewing the data, informats have, recognizing its value, highlighted the differences between digital and its counter point – traditional marketing. We assumed that tracking the online search trends can help solidify and feedback some information where past search demands for digital marketing, social media marketing e-commerce marketing and social commerce. An online service using “globotics” (Baldwin 2019) provides a promising approach towards solving the problems of both digital marketing curriculum and scarce talent linking marketing educators and students with practitioners. Importantly, with globotics marketing students as interns have an opportunity to take on tasks well beyond previous undergrad and postgrad entry- level roles of the last century.

The purpose of this paper is to generate a framework for investigating direct face-to-face interactions during corporate results presentations from senior executives. This is important because face-to-face communications represent opportunities for impression management owing to cognitive biases and constraints arising from the interplay of non-verbal and verbal cues. Our Behavioural Impression Management Framework combines eight ways of non-verbal communication augmenting verbal cues. This framework paves the way for helping professional analysts and executives pay attention to critical moments during financial presentations expressed through verbal and non-verbal communication. Further, our framework lends itself to the design of authentic yet artificial intelligence to human interactions.

The use of photographs has become a key feature of corporate reporting in the last decades. As a form of impression management, photographs may be designed to influence investors’ judgments. Where a paucity of research on the use of photographs in corporate reports exists, this short communication discusses two important photographic features that can frame judgments — its ability to attract attention and convey emotions with simplicity. Usually, the non-creative content of photographs, such as size, is responsible for capturing our attention, while its creative content influences cognition and judgments through the elicitation of specific emotional responses. The use of photographs is now a norm and this letter will help open new avenues of behavioral research and methodologies.

Background: The novel severe acute respiratory syndrome coronavirus 2 virus that emerged in December 2019 causing coronavirus disease 2019 (COVID-19) has led to the sudden national reorganization of health care systems and changes in the delivery of health care globally. The purpose of our study was to use a survey to assess the global effects of COVID-19 on colorectal practice and surgery. Materials and Methods: A panel of International Society of University Colon and Rectal Surgeons (ISUCRS) selected 22 questions, which were included in the questionnaire. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in the ISUCRS database and was advertised on social media sites. The questionnaire remained open from April 16 to 28, 2020. Results: A total of 287 surgeons completed the survey. Of the 287 respondents, 90% were colorectal specialists or general surgeons with an interest in colorectal disease. COVID-19 had affected the practice of 96% of the surgeons, and 52% were now using telemedicine. Also, 66% reported that elective colorectal cancer surgery could proceed but with perioperative precautions. Of the 287 respondents, 19.5% reported that the use of personal protective equipment was the most important perioperative precaution. However, personal protective equipment was only provided by 9.1% of hospitals. In addition, 64% of surgeons were offering minimally invasive surgery. However, 44% reported that enough information was not available regarding the safety of the loss of intra-abdominal carbon dioxide gas during the COVID-19 pandemic. Finally, 61% of the surgeons were prepared to defer elective colorectal cancer surgery, with 29% willing to defer for ≤ 8 weeks. Conclusion: The results from our survey have demonstrated that, globally, COVID-19 has affected the ability of colorectal surgeons to offer care to their patients. We have also discussed suggestions for various practical adaptation strategies for use during the r