SAGES guidelines for the use of peroral endoscopic myotomy (POEM) for the treatment of achalasia.

BACKGROUND: Peroral endoscopic myotomy (POEM) is increasingly used as primary treatment for esophageal achalasia, in place of the options such as Heller myotomy (HM) and pneumatic dilatation (PD) OBJECTIVE: These evidence-based guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) intend to support clinicians, patients and others in decisions about the use of POEM for treatment of achalasia. RESULTS: The panel agreed on 4 recommendations for adults and children with achalasia. CONCLUSIONS: Strong recommendation for the use of POEM over PD was issued unless the concern of continued postoperative PPI use remains a key decision-making concern to the patient. Conditional recommendations included the option of using either POEM or HM with fundoplication to treat achalasia, and favored POEM over HM for achalasia subtype III.

The role of race and respectability in attributions of responsibility for acquaintance rape.

Previous researchers have explored the role of race and respectability, independently, on attributions of responsibility; however, the interaction between race and respectability has not been analyzed in situations of acquaintance rape. Participants (N = 241) read a vignette detailing a case of acquaintance rape that manipulated the race of both the victim and the perpetrator and the respectability of the victim. Regression and ANOVA analyses indicated that victim race and respectability interacted in such a way that when Black victims were respectable, they were held less responsible than respectable White victims; however, less respected Black victims were held more responsible than less respected White victims. Manipulating perpetrator race revealed surprising results; the White perpetrator was found guilty more often than the Black perpetrator (although this appeared to be related to victim race).

Issues in Australian contaminated land risk assessment toxicology.

Since implementation of the National Environmental Protection (Assessment of Site Contamination) Measure (NEPM) guidelines in 1999, a number of improvements are needed to enhance the contaminated land risk assessment process. In particular, due to advances in toxicological research there is a need to update the Australian adopted health investigation levels (HILs), presented in the NEPM guidelines, and to significantly expand the number of HILs to generate a comprehensive list of soil screening criteria. Furthermore, there is a need to develop Australian benchmark doses for carcinogens and to incorporate benchmark doses more widely in Australian risk assessment practice. The NEPM is currently under revision and consequently there is an excellent opportunity to undertake such development; however, this will require appreciation of the need for improvement and significant financial investment.

The applicability of traditional health risk analysis and ill-health models in the investigation of medically unexplained physical symptoms.

Many cases of medically unexplained physical symptoms (MUPS) have been recorded. The sufferers of a large proportion of the more recent cases believe their illness to have been caused by exposure to chemicals in the environment. The evacuation of Melbourne airport in February 2005 exemplifies a recent health "scare" where people thought they were ill but no tangible evidence of illness was recorded and no chemical or biological agents detected. It was suggested that the "illnesses" in this instance were psychogenic. In such cases, where psychogenic illnesses are a potential diagnosis, risk managers need to think carefully about how the message is communicated, as contested causation often arises. While environmental investigations and health testing are important steps in the diagnostic process, they are used more to exclude possibilities, that is, to prove a negative, rather than to discover the "smoking gun." An example of a case of MUPS that lasted several years in a primary school is provided to illustrate that different forms of investigation are needed and that there is a need to consider a potential diagnosis of MUPS relatively early in the investigation. It is important to recognise the potential for MUPS so that the psychogenic elements of the illness can be investigated and treated.