A novel serogenetic approach determines the community prevalence of celiac disease and informs improved diagnostic pathways

Background
Changing perspectives on the natural history of celiac disease (CD), new serology and genetic tests, and amended histological criteria for diagnosis cast doubt on past prevalence estimates for CD. We set out to establish a more accurate prevalence estimate for CD using a novel serogenetic approach.

Methods
The human leukocyte antigen (HLA)-DQ genotype was determined in 356 patients with ‘biopsy-confirmed’ CD, and in two age-stratified, randomly selected community cohorts of 1,390 women and 1,158 men. Sera were screened for CD-specific serology.

Results
Only five ‘biopsy-confirmed’ patients with CD did not possess the susceptibility alleles HLA-DQ2.5, DQ8, or DQ2.2, and four of these were misdiagnoses. HLA-DQ2.5, DQ8, or DQ2.2 was present in 56% of all women and men in the community cohorts. Transglutaminase (TG)-2 IgA and composite TG2/deamidated gliadin peptide (DGP) IgA/IgG were abnormal in 4.6% and 5.6%, respectively, of the community women and 6.9% and 6.9%, respectively, of the community men, but in the screen-positive group, only 71% and 75%, respectively, of women and 65% and 63%, respectively, of men possessed HLA-DQ2.5, DQ8, or DQ2.2. Medical review was possible for 41% of seropositive women and 50% of seropositive men, and led to biopsy-confirmed CD in 10 women (0.7%) and 6 men (0.5%), but based on relative risk for HLA-DQ2.5, DQ8, or DQ2.2 in all TG2 IgA or TG2/DGP IgA/IgG screen-positive subjects, CD affected 1.3% or 1.9%, respectively, of females and 1.3% or 1.2%, respectively, of men. Serogenetic data from these community cohorts indicated that testing screen positives for HLA-DQ, or carrying out HLA-DQ and further serology, could have reduced unnecessary gastroscopies due to false-positive serology by at least 40% and by over 70%, respectively.

Conclusions
Screening with TG2 IgA serology and requiring biopsy confirmation caused the community prevalence of CD to be substantially underestimated. Testing for HLA-DQ genes and confirmatory serology could reduce the numbers of unnecessary gastroscopies.

The impact of divergent historical and cultural factors on convergence in global communication practice

Communication practice is increasingly converging around globally consistent approaches and techniques shaped by both globalisation and globalising communications technologies. However, this paper argues, national and regional practice histories and cultural characteristics have shaped, and continue to shape, practice in individual markets. The paper analyses the extent of that these divergent histories and cultures have shaped the structure and practices of the public relations industry in Australia and other countries. The paper challenges the common assumptions about public relations development and industry practice having developed from a predominantly US-based model progressively disseminated globally. It traces the history of public relations in Australia, counterpointing its distinctive origins, to the US-origin thesis. It also examines the impact of demography and diverse national culture on industry shape and practice, comparing the Australian industry to that of other industries around the world. It uses mini-case studies of campaigns in specific countries to assess the extent to which they are culturally bound by historical and cultural differences and the extent to which they are capable of being transferred or adapted to individual markets. For instance, assumptions about globally consistent brand identities are contradicted by McDonald’s’ branding practices in markets such as Canada and Japan. The paper also discusses how emerging market PR industries are being shaped by distinctive and divergent cultures and development paths and may create new structural and practice models as the emerging economies becoming dominant internationally. The authors suggest that history and cultural diversity continue, and will continue to, shape national and regional practices.

Incorporating indigenous Australian knowledge and perspectives into planning practice : past, present and future

The history and contemporary practice of land-use planning and place-making by Indigenous Australians is poorly understood by academics, students and practitioners in the field of urban and regional planning in Australia. This is despite recent high-profile events which have increased the profile of Indigenous peoples’ rights, such as the recognition of native title by the High Court in Mabo v the State of Queensland [No. 2] (1992) 175 CLR 1 and The United Nations Declaration on the Rights of Indigenous Peoples (2007), and Commonwealth policy and reconciliation discourses. Further, little impact has been discernible arising from the adoption of reconciliation policies by government bodies, planning authorities and the Planning Institute of Australia (PIA). This paper reviews this lack of progress and discusses why this is a problem for Australian planners which needs to be addressed. The paper reviews the present Australian historical and socio-cultural context in terms of collaboration with traditional land owners as it relates to contemporary planning practice. It considers ontological, epistemological and axiological differences between the dominant western model of planning and Indigenous models, and the challenges this presents. A case-study documenting past, present and future planning practices at Lake Condah in South West Victoria which is the Country of the Gunditjmara and Budj Bim will bring to life these topics through the documentation of Indigenous planning practices prior to and post European arrival. It offers a vision for the future of planning with Indigenous communities. The paper envisages a future which values and incorporates Indigenous place-making and planning, which goes far beyond the tacit acknowledgement of traditional owners commonly observed around Australia today.

Certificate-based signatures: New definitions and a generic construction from certificateless signatures

Certificate-based encryption was introduced in Eurocrypt’03 to solve the certificate management problem in public key encryption. Recently, this idea has been extended to certificate-based signatures. To date, several new schemes and security models of certificate-based signatures have been proposed. In this paper, we first introduce a new security model of certificate-based signatures. Our model is not only more elaborated when compared with the existing ones, but also defines several new types of adversaries in certificate-based signatures. We then investigate the relationship between certificate-based signatures and certificateless signatures, by proposing a generic construction of certificate-based signatures from certificateless signatures. Our generic construction is secure (in the random oracle model) under the security model defined in this paper, assuming the underlying certificateless signatures satisfying certain security notions.

Sex as a determinant of relapse incidence and progressive course of multiple sclerosis

The aim of this work was to evaluate sex differences in the incidence of multiple sclerosis relapses; assess the relationship between sex and primary progressive disease course; and compare effects of age and disease duration on relapse incidence. Annualized relapse rates were calculated using the MSBase registry. Patients with incomplete data or <1 year of follow-up were excluded. Patients with primary progressive multiple sclerosis were only included in the sex ratio analysis. Relapse incidences over 40 years of multiple sclerosis or 70 years of age were compared between females and males with Andersen-Gill and Tweedie models. Female-to-male ratios stratified by annual relapse count were evaluated across disease duration and patient age and compared between relapse-onset and primary progressive multiple sclerosis. The study cohort consisted of 11 570 eligible patients with relapse-onset and 881 patients with primary progressive multiple sclerosis. Among the relapse-onset patients (82 552 patient-years), 48 362 relapses were recorded. Relapse frequency was 17.7% higher in females compared with males. Within the initial 5 years, the female-to-male ratio increased from 2.3:1 to 3.3:1 in patients with 0 versus ≥4 relapses per year, respectively. The magnitude of this sex effect increased at longer disease duration and older age (P < 10−12). However, the female-to-male ratio in patients with relapse-onset multiple sclerosis and zero relapses in any given year was double that of the patients with primary progressive multiple sclerosis. Patient age was a more important determinant of decline in relapse incidence than disease duration (P < 10−12). Females are predisposed to higher relapse activity than males. However, this difference does not explain the markedly lower female-to-male sex ratio in primary progressive multiple sclerosis. Decline in relapse activity over time is more closely related to patient age than disease duration.