On the liberties of the ancients: licentiousness, equal rights, and the rule of law

In this article, we discuss Greek and Roman conceptions of liberty. The supposedly ‘neo-Roman’ view of liberty as non-domination is really derived from negative Greek models, we argue, while Roman authors devised an alternative understanding of liberty that rested on the equality of legal rights. In this ‘paleo-Roman’ model, as long as the law was the same for all, you were free; whether or not you participated in making the law was not a constitutive feature of liberty. In essence, this Roman theory was a theory of freedom as the rule of law and the guarantee of equal rights, especially due process rights. For this Roman concept of ‘legal liberty,’ as we call it,political participation was neither necessary nor sufficient. Theorized by Cicero and historicized by Livy, the Roman understanding of freedom flourished in early-modern times, proving important to paradigmatic republican authors such as Machiavelli and Rousseau as well as to Hobbes, whose work we discuss as a helpful point of comparison

Food‐induced immediate response of the esophagus—A newly identified syndrome in patients with eosinophilic esophagitis

Background Dysphagia is the main symptom of adult eosinophilic esophagitis (EoE). We describe a novel syndrome, referred to as “food-induced immediate response of the esophagus” (FIRE), observed in EoE patients. Methods Food-induced immediate response of the esophagus is an unpleasant/painful sensation, unrelated to dysphagia, occurring immediately after esophageal contact with specific foods. Eosinophilic esophagitis experts were surveyed to estimate the prevalence of FIRE, characterize symptoms, and identify food triggers. We also surveyed a large group of EoE patients enrolled in the Swiss EoE Cohort Study for FIRE. Results Response rates were 82% (47/57) for the expert and 65% (239/368) for the patient survey, respectively. Almost, 90% of EoE experts had observed the FIRE symptom complex in their patients. Forty percent of EoE patients reported experiencing FIRE, more commonly in patients who developed EoE symptoms at a younger age (mean age of 46.4 years vs 54.1 years without FIRE; P < .01) and in those with high allergic comorbidity. Food-induced immediate response of the esophagus symptoms included narrowing, burning, choking, and pressure in the esophagus appearing within 5 minutes of ingesting a provoking food that lasted less than 2 hours. Symptom severity rated a median 7 points on a visual analogue scale from 1 to 10. Fresh fruits/vegetables and wine were the most frequent triggers. Endoscopic food removal was significantly more commonly reported in male patients with vs without FIRE (44.3% vs 27.6%; P = .03). Conclusions Food-induced immediate response of the esophagus is a novel syndrome frequently reported in EoE patients, characterized by an intense, unpleasant/painful sensation occurring rapidly and reproducibly in 40% of surveyed EoE patients after esophageal contact with specific foods

Development of a core outcome set for therapeutic studies in eosinophilic esophagitis (COREOS)

BACKGROUND End points used to determine treatment efficacy in eosinophilic esophagitis (EoE) have evolved over time. With multiple novel therapies in development for EoE, harmonization of outcomes measures will facilitate evidence synthesis and appraisal when comparing different treatments. OBJECTIVE We sought to develop a core outcome set (COS) for controlled and observational studies of pharmacologic and diet interventions in adult and pediatric patients with EoE. METHODS Candidate outcomes were generated from systematic literature reviews and patient engagement interviews and surveys. Consensus was established using an iterative Delphi process, with items voted on using a 9-point Likert scale and with feedback from other participants to allow score refinement. Consensus meetings were held to ratify the outcome domains of importance and the core outcome measures. Stakeholders were recruited internationally and included adult and pediatric gastroenterologists, allergists, dieticians, pathologists, psychologists, researchers, and methodologists. RESULTS The COS consists of 4 outcome domains for controlled and observational studies: histopathology, endoscopy, patient-reported symptoms, and EoE-specific quality of life. A total of 69 stakeholders (response rate 95.8%) prioritized 42 outcomes in a 2-round Delphi process, and the final ratification meeting generated consensus on 33 outcome measures. These included measurement of the peak eosinophil count, Eosinophilic Esophagitis Histology Scoring System, Eosinophilic Esophagitis Endoscopic Reference Score, and patient-reported measures of dysphagia and quality of life. CONCLUSIONS This interdisciplinary collaboration involving global stakeholders has produced a COS that can be applied to adult and pediatric studies of pharmacologic and diet therapies for EoE and will facilitate meaningful treatment comparisons and improve the quality of data synthesis

UK guidelines on oesophageal dilatation in clinical practice

These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques-including stents-will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Develop-ment and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made.</p

Roman rights talk: subjective rights in Cicero and Livy

While most scholars today recognize that Roman writers occasionally used ius to denote a subjective right, the extent and reasons for this usage have not been well studied. In this article, we offer an analysis, based on a statistical survey, of how Cicero and Livy used ius to designate a range of subjective rights. We also trace this usage back to the basic Ciceronian metaphor of the populus as a kind of societas . Rights, in the Roman context, emerged out of this legal-commercial comparison, in which citizens (or even members of different nations) are entitled to equal rights in their common venture

Food-induced Immediate Response of the Esophagus - a newly identified Syndrome in Patients with Eosinophilic Esophagitis.

BACKGROUND Dysphagia is the main symptom of adult EoE. We describe a novel syndrome, referred to as "Food-induced Immediate Response of the Esophagus" (FIRE), observed in EoE patients. METHODS FIRE is an unpleasant/painful sensation, unrelated to dysphagia, occurring immediately after esophageal contact with specific foods. EoE experts were surveyed to estimate the prevalence of FIRE, characterize symptoms and identify food triggers. We also surveyed a large group of EoE patients enrolled in the Swiss EoE Cohort Study (SEECS) for FIRE RESULTS: Response rates were 82% (47/57) for the expert- and 65% (239/368) for the patient-survey, respectively. Almost 90% of EoE experts had observed the FIRE symptom-complex in their patients. Forty percent of EoE patients reported experiencing FIRE, more commonly in patients who developed EoE symptoms at a younger age (mean age of 46.4 vs. 54.1 years without FIRE; p<0.01) and in those with high allergic comorbidity. FIRE symptoms included narrowing, burning, choking and pressure in the esophagus appearing within 5 minutes of ingesting a provoking food that lasted less than 2 hours. Symptom severity rated a median 7 points on a visual analogue scale from 1-10. Fresh fruits/vegetables and wine were the most frequent triggers. Endoscopic food removal was significantly more commonly reported in male patients with vs. without FIRE (44.3% vs. 27.6%; p = 0.03). CONCLUSIONS FIRE is a novel syndrome frequently reported in EoE patients, characterized by an intense, unpleasant/painful sensation occurring rapidly and reproducibly in 40% of surveyed EoE patients after esophageal contact with specific foods

Food‐induced immediate response of the esophagus—A newly identified syndrome in patients with eosinophilic esophagitis

BACKGROUND Dysphagia is the main symptom of adult EoE. We describe a novel syndrome, referred to as "Food-induced Immediate Response of the Esophagus" (FIRE), observed in EoE patients. METHODS FIRE is an unpleasant/painful sensation, unrelated to dysphagia, occurring immediately after esophageal contact with specific foods. EoE experts were surveyed to estimate the prevalence of FIRE, characterize symptoms and identify food triggers. We also surveyed a large group of EoE patients enrolled in the Swiss EoE Cohort Study (SEECS) for FIRE RESULTS: Response rates were 82% (47/57) for the expert- and 65% (239/368) for the patient-survey, respectively. Almost 90% of EoE experts had observed the FIRE symptom-complex in their patients. Forty percent of EoE patients reported experiencing FIRE, more commonly in patients who developed EoE symptoms at a younger age (mean age of 46.4 vs. 54.1 years without FIRE; p<0.01) and in those with high allergic comorbidity. FIRE symptoms included narrowing, burning, choking and pressure in the esophagus appearing within 5 minutes of ingesting a provoking food that lasted less than 2 hours. Symptom severity rated a median 7 points on a visual analogue scale from 1-10. Fresh fruits/vegetables and wine were the most frequent triggers. Endoscopic food removal was significantly more commonly reported in male patients with vs. without FIRE (44.3% vs. 27.6%; p = 0.03). CONCLUSIONS FIRE is a novel syndrome frequently reported in EoE patients, characterized by an intense, unpleasant/painful sensation occurring rapidly and reproducibly in 40% of surveyed EoE patients after esophageal contact with specific foods