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Home › IMRG Blog › Why Omnichannel Retailers Adopt AI-Powered Search
Why Omnichannel Retailers Adopt AI-Powered Search
By Marie Griffin
Against the headwinds of Brexit uncertainty, a soft economy, margin deflation and shifting consumer shopping habits, UK retailers must continue their omnichannel evolution in order to satisfy customers and stay competitive.
Internet sales represented 18% of UK retail revenues last year, with ecommerce sales up 14% over the prior year, according to a House of Commons briefing. In a study of UK shoppers from Periscope By McKinsey, 60% of respondents said that they shop in stores and online to a similar extent, while 21% shop mostly online and 4% shop online exclusively. Just 15% shop mostly or only in stores.
Omnichannel capabilities are essential as customers move effortlessly from one channel to another, expecting retailers to accommodate shopping preferences that fluctuate moment by moment. And retailers must respond to consumers who have become much more demanding.
Researchers from Salesforce and Publicis Sapient surveyed 6,000 adults in six countries, including the UK, and 67% of respondents said that their standards for good retail experiences are higher than ever. Consumers also want retailers to delight them continually with exciting new products. Whether they are visiting a website or store, 69% of shoppers surveyed said they expect to see new merchandise whenever they visit.
Meanwhile, the UK's top online retailer, Amazon, is increasing its share of retail sales. According to GlobalData, 5% of all retail revenue in the country goes to Amazon, and half of British consumers purchase on Amazon every month. Having locked in the loyalty of 26% of the population with its Prime program, Amazon is set to expand its brick-and-mortar footprint in the UK. Already operating seven Whole Foods units, the company is reported to have secured space for its first Amazon Go shops in London.
The acceleration of AI development
Given the challenging business environment and shifting consumer habits, retailers are looking toward technology fortified with artificial intelligence (AI) and machine learning to boost supply chain efficiency, personalise customer relationships and fuel growth.
"Retailers, seeking any advantage they can in an increasingly competitive marketplace, are turning to AI technologies," writes Matthew Bennett, partner, technology and media at CMS UK, in a report titled Disruption 2.0—here we go again.
As AI becomes a popular buzzword for technology vendors, retailers may find themselves confused by conflicting claims. There's a reason for that. "There's no single accepted definition of 'artificial intelligence,'" according to ExplAIned, a Guide for Executives, from Accenture Applied Intelligence. "And that's because AI as we know it isn't really a technology in its own right at all. In reality, it's a collection of different technologies that can be brought together to enable machines to act with what appears to be human-like levels of intelligence."
The idea that computers would eventually be able to "think" dates back decades, most famously to British mathematician Alan Turing, who developed the Turing Test whereby a computer would demonstrate its "sentience" by being indistinguishable from a human being when answering certain questions.
Within this decade, though, the development of AI has been accelerated by more powerful computing hardware, the availability of cheap storage in the cloud, improvements in mathematical formulas called algorithms and vast amounts of data for training those algorithms. As Ray Kurzweil, best-selling author, inventor, futurist and AI guru, put it: "There's a motto in the field that says life begins at a billion examples."
Using AI to power search
Retailers must prioritise their investments as they implement AI projects, and search has become one of the most popular use cases. In a global survey of retailers and consumer goods companies, 40% of respondents that had adopted AI for at least one application were using it to provide relevant search results, according to Consumer Experience in the Retail Renaissance, a report by Deloitte Digital and Salesforce.
Capgemini Research Institute's global survey of retailers implementing AI found a similar pattern. "Among the various categories of AI use cases for customer-facing functions, we found that personalised search, targeted recommendations and chat bots for answering customer queries were the most common implementations."
AI and machine learning produce search results and recommendations in an entirely new way.
With a traditional rules-based search system, explicit programming directs the search. Think of it like a spreadsheet, where product categories have subcategories and descriptions that are linked together in a linear way. When a search does not follow the logic that has been programmed into the search engine, the results will be poor.
For example, when a shopper types "leopard print" into the search box, she might only see wall art with animals instead of apparel with a pattern similar to leopard fur. This is because the logic of the search separated the words leopard and print, and the word print was associated with the wall art and leopard was associated with animals.
Ultimately, the problem with rules-based systems is that it is impossible to anticipate all the different words and combinations of words a searcher might use, not to mention misspellings and other ordinary human mistakes that could cause a rules-based search to break down.
AI returns search results based on signals, which is data collected from every user interaction on the website. This includes queries, clicks, previous similar searches, product popularity, page views, add-to-carts and purchases. All of this data teaches the AI how to anticipate a user's intention based on actual behaviour. AI is not limited by the ways humans understand language or concepts; it follows the data wherever it leads.
One example of the difference between rules-based and signals-based search comes from Peter Curran, president-cofounder of Cirrus10 and a consultant on the business and technology of ecommerce: "People will type the word 'dysentery' into the search box for a home goods website, even though it makes no sense for an intestinal infection to be associated with any of this retailer's products," he said. "But by going through enough sessions, the machine learning discovers that people who search for dysentery buy Dyson vacuum cleaners, and it starts automatically returning that result. A human merchandiser would never think to create a rule like 'dysentery=Dyson,' but the pairing occurs in actual searches for an 'illogical' reason. It's because of the iPhone's autocorrect feature."
Users of the search box are more likely to buy
Retailers have traditionally viewed search as a tool that improves the customer experience — making it easier for the customer to find an item when they come to the site with a product in mind — but the real value of better search is that it produces better bottom-line results.
When a visitor uses the search box rather than browsing the site, that person is much more likely to become a buyer. Conversion rates are on average 139% higher when search is used, as compared to the overall retail conversion rate, according to IMRG.
"Retailers invest millions in content management systems (CMS), ecommerce platforms and analytics solutions, but for some reason they underfund or don't consider search," observes Grant Ingersoll, chief technology officer for Lucidworks. "But search gets the user from a query in the CMS to conversion or purchase in the ecommerce platform. This is where the money is made."
Visitors who use the search box might be planning to buy a product online, but they also might be doing research in advance of a visit to a brick-and-mortar store. In any event, they will go to a competitor if they do not find the product when they use a retail brand's website search — even when the product they want is available.
"Even if a purchase ultimately occurs offline, the role of online interactions remains critical," according to The Era of Ecommerce: Capitalizing on the New Customer Journey from ClickZ and Catalyst, based on a survey of 750 consumers in North America. "We found that 74% of consumers research online and then purchase in-store either 'always' or 'sometimes.'"
Consumers are more likely to start their shopping journey at a retail site when they know what they are looking for, according to the study. Half of those searches start on a retail site and half with a general search engine such as Google. In comparison, when shoppers are unsure of what they want, only 38% of journeys start on a retailer site and 62% start with a general search site.
Delaying AI adoption may be risky
There is risk involved in implementing any new technology, but retailers waiting to deploy AI are postponing exponential benefits. "Well-planned AI-driven solutions get more effective over time in a non-linear fashion," according to the FitForCommerce Annual Report 2018. "They are self-leveraging. So, the ROI you realize two years from today will be vastly greater if you start tomorrow than if you start six months from now."
Although AI is considered a buzzword in many circles, it's still possible that organisations are undervaluing the potential impact of AI, asserts Andrew McAfee, principal research scientist at the Massachusetts Institute of Technology, in an interview with McKinsey Publishing. "Even though they see a lot of disruption coming, I still think that many really smart, well-managed companies are underestimating the scale, scope and speed of disruption this time around," he said.
Marie Griffin, Lucidworks
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Morning Edition takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts David Greene, Steve Inskeep, Noel King and Rachel Martin bring you the latest breaking news and features to prepare you for the day.
6488 episodes available. A new episode about every hour averaging 7 mins duration .
Attorney General William Barr says Russia interfered in the 2016 election and they did it without the help of any one on the Trump Campaign or any American.
David Greene talks to Kimberly Wehle, who served as associate independent counsel during the Whitewater probe, and former federal prosecutor Shan Wu on what to expect from the redacted Mueller report.
Attorney General William Barr is expected to hold a press conference at the Department of Justice just ahead of the release of a redacted version of Special Counsel Robert Mueller's report.
The Justice Department is expected to release a redacted version of the Mueller report on Thursday. And Attorney General William Barr is expected to hold a news conference ahead of its release.
The Justice Department will release a redacted version of special counsel Robert Mueller's report Thursday. While it's likely to shed light on some big open questions, it could also raise others.
David Greene talks to Kimberly Wehle, who served as independent counsel during the Whitewater probe, and former federal prosecutor Shan Wu, on what to expect from the redacted Mueller report.
The Mueller probe found that Russia tried to interfere in the U.S. presidential election. David Greene talks to Laura Rosenberger of the Alliance for Securing Democracy at the German Marshall Fund.
Democratic presidential contenders have discussed reparations for slavery during this campaign season. David Greene talks to commentator Cokie Roberts, who answers listeners' reparation questions.
Steve Inskeep talks to conservative commentator Jonah Goldberg and Democratic pollster Margie Omero about what Republicans and Democrats have to gain from the release of the redacted Mueller report.
Christelle Doyhambehere ran the race on a challenge from her partner, who dared her to run in her stylish footwear. She ran in just over six hours, beating that record by about an hour and half.
Researchers wanted to know whether they could use the same MRI scanners for dogs and people. They swabbed the machines used by 18 bearded men and 30 dogs. The beards had higher microbial levels.
Hugo's novel tops Amazon's best-seller list in France, following Monday's fire that ravaged the cathedral. The 19th century story was a campaign to get the cathedral restored.
After recusing herself, text messages show, Cook County state's attorney was concern with heavy-handed charging of Empire star Jussie Smollett, compared to defendants accused of more serious crimes.
Voters are deciding on more than 20,000 legislative seats and selecting a president. The incumbent president is pitted against a former military general accused of human rights abuses.
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CHESTO MEANS BUSINESS
The race is on for PPE in the Mass. business community
The Black Economic Council of Mass. launches an online portal to link buyers and sellers.
By Jon Chesto Globe Staff,Updated May 11, 2020, 7:59 p.m.
Boston, MA - 2/26/2018 - Black Economic Council of Massachusetts board member Richard Taylor(L) leads a panel to discuss racial and economic inequality in Massachusetts at the U.S. Treasury in Boston, MA, Feb. 26, 2018. (Keith Bedford/Globe Staff)Keith Bedford
Governor Charlie Baker unveiled new rules on Monday that will require masks and more sanitation in offices and on factory floors, to guard against the spread of COVID-19.
But finding all that personal protective equipment to meet the demand is easier said than done.
The state's PPE shortage doesn't seem to be anywhere near as bad as it was in March, when Baker ordered all nonessential workplaces to close, and hospitals scrambled to get gear for health care workers.
However, many companies are still coming up short as they plan to reopen as soon as next week.
Greater Boston Chamber of Commerce chief executive Jim Rooney said he heard from a major financial company in Boston whose bulk order for masks was canceled. Chris Geehern at Associated Industries of Massachusetts said he received an e-mail Monday from a 25-person manufacturer that was having a hard time finding gloves, masks, and face shields. And JD Chesloff, head of the Massachusetts Business Roundtable, said most employees at his organization's member companies are working from home now, but availability of PPE and cleaning supplies remains a big concern as they look forward to bringing some workers back to the office.
A state Senate working group led by Senator Bruce Tarr raised this concern in a letter sent last week to leaders in the Baker administration, suggesting that the state government consider making bulk PPE purchases to ensure small and midsized businesses can obtain what they need to reopen.
A new online portal that the Black Economic Council of Massachusetts launched on Monday, at www.protectma.com, shows one way that the private sector can play a role. The council is using the site to match businesses looking for protective equipment with black- and Latino-owned manufacturers and distributors who are looking to sell it.
Segun Idowu, the council's executive director, said he is starting with minority-owned businesses on the supply side first, but would expand it to include others if the demand is strong enough. For now, the council is soliciting information about buyers and sellers via its site, but Idowu hopes to have a viable online marketplace for PPE and cleaning supplies and services running by the end of next week. Eventually, he wants to loop in delivery businesses, too, and arrange for bulk buying to help needy families.
The idea sprang out of concerns raised by many of his members in early April: They were struggling to find adequate masks and sanitizer, despite being deemed essential businesses by the state. At the time, the PPE was getting bought up for or donated to front-line workers, Idowu said. He said he asked if the state managed a reserve for essential businesses. No luck.
City Fresh Foods in Roxbury was among those essential businesses that initially found it challenging to get the PPE they needed. Chief executive Sheldon Lloyd said the company had to improvise, in part by making its own wipes and sanitizers. His order of face shields finally came in on Monday. (He already had a steady supplier for gloves because he's in the food business.) He has enough PPE now, but he expects smaller businesses, with smaller networks, could end up scrambling without assistance.
Companies are already stepping up to meet the need. Newton-Needham Regional Chamber president Greg Reibman said the problem seemed more acute two weeks ago: The most popular items in his newsletter to members then were his lists of local companies selling PPE. But the local supply and demand seem now to be more evenly matched, he said, as some members pivoted their business to make or sell PPE. (One example: Adam and Marissa Goldstein launched Rafi Nova in Needham this year to sell travel bags made in Vietnam, but are now selling tens of thousands of masks instead.)
The demand will pick up again as countless offices, factories, restaurants, and stores reopen after Baker's shutdown ends on May 18. The members of a task force advising Baker on his reopening strategy know this, as do Baker and his top lieutenants.
The administration recently launched a nearly $11 million program to help manufacturers that want to get into the PPE market. That's a good start. However, until a viable COVID-19 vaccine is widely available, businesses of all sizes need dependable sources for their PPE supplies.
What was once primarily an issue for hospital workers and first responders could become an issue for nearly every workplace soon enough.
Jon Chesto can be reached at jon.chesto@globe.com. Follow him on Twitter @jonchesto.


Microsoft released its pre-announcement for the upcoming patch Tuesday. The summary indicates 14 bulletins total, 4 are critical all with remote code execution and 10 Important with a mix of remote code execution, Denial of Service and elevation of privileges. The announcement is available here.


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Laser, the Future of Flight.
EDWARDS AIR FORCE BASE, Calif., Oct. 10 — NASA has built and flown a remote-controlled plane powered from the ground by the invisible beam of a laser. In indoor flights conducted last month at a NASA center in Alabama, the plane flew lap after lap, gliding to a landing once the laser beam was turned off, the agency says.
WHILE IN FLIGHT, the laser tracked the 11-ounce (300-gram), 5-foot wingspan (1.5-meter wingspan) plane, striking the photovoltaic cells that powered the tiny motor that turned its lone propeller.
"The craft could keep flying as long as the energy source, in this case the laser beam, is uninterrupted," said Robert Burdine, laser project manager for the tests, conducted at the Marshall Space Flight Center in Huntsville, Ala.
In earlier flights completed last year, engineers manually traced the path flown by the plane with a theatrical spotlight that provided the power needed to turn its propeller.
The remote-controlled planes don't have to carry their own fuel or batteries, providing more room for scientific instruments or communications equipment.
Scientists envision flying the planes on long-duration flights to monitor the environment, including erupting volcanos. The planes also could be used for…
Does Lindberg Live..
Total Lunar Eclipse..


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Home » Measure bank » The Brief Resilience Scale
The Brief Resilience Scale
The Brief Resilience Scale was created to assess the perceived ability to bounce back or recover from stress. The scale was developed to assess a unitary construct of resilience, including both positively and negatively worded items.
The possible score range on the BRS is from 1 (low resilience) to 5 (high resilience).
Instructions (depending on how the questions are set out):
How strongly to you agree or disagree with the following statements
or Respond to each statement below by circling one answer per row
1. I tend to bounce back quickly after hard times.
2. I have a hard time making it through stressful events.
3. It does not take me long to recover from a stressful event.
4. It is hard for me to snap back when something bad happens.
5. I usually come through difficult times with little trouble.
6. I tend to take a long time to get over setbacks in my life.
Strongly Disagree,
Disagree,
Agree,
Questionnaire here
Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: assessing the ability to bounce back. International journal of behavioral medicine, 15(3), 194-200.
Validation details
Fung SF. Validity of the Brief Resilience Scale and Brief Resilient Coping Scale in a Chinese Sample. Int J Environ Res Public Health. 2020;17(4):1265. Published 2020 Feb 16. doi:10.3390/ijerph17041265
Cronbach's α = 0.71
Cost / Terms of Use
Free (No permission required)
Instructions and Scoring
Note that items 1, 3, and 5 are positively worded, and items 2, 4, and 6 are negatively worded. The BRS is scored by reverse coding items 2, 4, and 6 and finding the mean of the six items.
For questions 1, 3, and 5:
1. Strongly Disagree, 2. Disagree, 3. Neutral, 4. Agree, 5. Strongly Agree
Add the responses varying from 1-5 for all six items giving a range from 6-30. Divide the total sum by the total number of questions answered.
BRS score
Low resilience
Normal resilience
High resilience
Smith, B.W., Epstein, E.E., Oritz, J.A., Christopher, P.K., & Tooley, E.M. (2013). The Foundations of Resilience: What are the critical resources for bouncing back from stress? In Prince-Embury, S. & Saklofske, D.H. (Eds.), Resilience in children, adolescents, and adults: Translating research into practice, The Springer series on human exceptionality (pp. 167-187). New York, NY: Springer.
In a study with 844 participants, a mix of healthy people and people suffering from diseases (cardiac patients and women with fibromyalgia), Smith and colleagues found an average score of 3.70 (Smith et al., 2013, p.177).
If you have access to useful benchmarking data please get in touch.
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There are a number of other resilience scales in use, and a good review of them is:
Windle, G., Bennett, K.M. & Noyes, J. A methodological review of resilience measurement scales. Health Qual Life Outcomes 9, 8 (2011). https://doi.org/10.1186/1477-7525-9-8
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A temporary family friendly room has been set up in the Merrill Library at USU.
USU raising funds for projects accommodating students who are parents
By Irma Mora staff writer
Irma Mora
In an effort to make Utah State University a more family-friendly campus, the Aggie Childcare Committee is raising funds to help the construction of an infant care/lactation space in the Merrill-Cazier Library.
"We have a lot of students who are also parents," said USU Inclusion Center Director Michelle Bogdan-Holt. "We are always wanting to be the most inclusive campus we can be, and part of that means making sure that our students who are parents, faculty who are parents and staff who are parents have enough spaces where they can provide infant care."
The committee, created to help address the needs of student parents, is working on two projects to help parents feel comfortable studying while still caring for their children.
"Over and over again, what we heard from them was that we need, or they needed, more space on campus where they feel comfortable to bring their kids," Committee member Kristin Hall said. "The lactation space was one of those things that came up a lot."
The first project is the remodel of an underused area in the library into a family study space where students who are parents could meet with study groups in a quiet room where they can watch their children as they play in the playroom.
This new family study space, funded through grants, would replace the temporary space that was established in the library last year.
The second project is remodeling a space donated by the library into an infant care/lactation space. Since this project is not covered by the grants, the committee is asking for donations to finish remodeling and furnishing the space.
"We are so thrilled that the Merril-Cazier Library, the dean and associate dean have been so generous to donate this space to be able to provide this infant care/lactation space," Bogdan-Holt said. "But we really need help in doing the remodel."
With a rendering created by interior design student Kelcie Buchanan, the committee plans for the space to have a sink with running water, a changing station, electrical outlets and comfortable furnishings to help create a space where parents can relax and care for their children.
"Just a place that feels nice, feels clean, feels welcoming for parents to come in," Hall said. "It's not going to be super huge or anything like that, but we don't want parents to have to go into a bathroom stall to feed their kids."
Merrill-Cazier Library Associate Dean for Instruction Jeanne Davidson said the infant care/lactation space is needed on campus.
"We know it's needed," Davidson said. "There's a lot of moms in particular who really want to just have a place to be able to do what they need to do."
Bogdan-Holt said the committee sees the projects as part of a larger effort to offer more parent-friendly spaces on campus as well as part of a statewide initiative that encourages women to return to school or complete their education.
"Sometimes what we'll see is women may drop out when they start their families," Bogdan-Holt said. "Another purpose to all of this is to encourage women, in particular, to continue their studies."
Davidson said the school wants to be open and available to as many people that need their services.
"We know that student parents have a challenging job being a parent and a student at the same time, and we want to do whatever we can to support them," Davidson said.
Both projects are scheduled to be completed by the fall semester.
The committee hopes to raise $10,000 for the remodel of the space. For more information and to donate for the infant care/lactation space, visit usu.edu/aggiefunded/infantroom.
Jeanne Davidson
Michelle Bogdan-holt
Kelcie Buchanan
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Statewide MS Poll Shows Voters Equally Divided Over Retiring State Flag
On June 10, 2020, Chism Strategies conducted a statewide survey to measure voter opinion on the current state flag. We found likely voters are statistically tied on whether to keep or replace the state's flag that contains the Confederate battle emblem.
61% of white respondents want to keep the state flag, with the greatest measure of support among seniors, who favor keeping the flag 71%-17%.
84% of African Americans want to replace the state flag and are 8% more likely than whites who agree with them to say this issue is "very important."
Support for the flag splits along party lines with strong Republicans supporting it 81%-11% and strong Democrats opposing it 74%-17%. However, self-styled independents favor replacing the flag 54% to 32%, and a third of voters who say they only lean Republican support replacing the flag.
A majority of voters under age 65 support removing the current state flag (52 to 41%), but voters age 65 and older support keeping the current flag 62%-25%.
Enthusiasm is high on both sides of the argument—four in five supporters AND opponents of the current flag say the matter is "very important" to them.
For voters who wish to replace the state flag, there is strong support for both the Unity argument (the current flag is a racist symbol that divides us) and the National Image argument (it keeps people and businesses from moving here and hurts our economy). For Republican voters who want to replace the state flag, the argument about its effect on our national image holds more weight, while for Democrats, the notion that the flag is a racist symbol is closer to their opinion.
For those who want to keep the state flag, the overwhelming response is that the flag is part of our heritage and to replace it means turning our backs on history.
To fully understand the significance of these survey results one must consider that 19 years ago, nearly two thirds of voters (64.6%) rejected the idea of a new state flag.
About five years ago, a Chism Strategies statewide poll found that 1 only 39% of voters agreed that the current state flag limited outside investment and hurt tourism. 48% disagreed. Moreover, 55% of voters felt the 2011 referendum had settled the issue while only 27% wanted a new vote.
In the fall of 2017, a Chism Strategies statewide poll 2 found that for the first time ever supporters of the state flag were less than a majority (49.1%) but they still out polled those who wanted a new flag (40.7%). We saw for the first time that a majority of whites under age 55 supported changing the state flag.
About the Survey: This survey was conducted June 10, 2020. The sample size was 540 with a margin of error of 4.38% with 50.4% from landlines and 49.6% from mobile phones. We weighted results to reflect the likely partisan, age, race and gender composition of the general election turnout. Whites comprise 65% and African Americans make up 33% of the sample. The partisan mix is 48% Republican, /38% Dem. And 14% Ind. Chism Strategies undertook this survey with no input nor funding from any outside individual or organization.
You can find toplines and cross tabs here.
1 April 2014. N = 602. 3.98% MOE. IVR survey. Partisan breakdown of 46% R, 36% D, 17% Ind.
2 Sept 2017. N = 500. 4.38% MOE. IVR survey. Partisan breakdown of 44% R, 32% D, 24% Ind. 29% AA; 67% white
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Chism Strategies helps elect Democrats and advance progressive causes, serving clients across the nation from offices in Atlanta, Jackson, Memphis, and San Antonio.
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Geological Survey of Northern Ireland / made and printed by the Ordnance Survey for the Geological Survey of Northern Ireland
Great Britain. Ordnance Survey
MAP G5791.C5 s63
Southampton : The Survey, 1961-1968
maps : col. ; 50 x 34cm, on sheets 59 x 76 or smaller.
Great Britain. Ordnance Survey & Geological Survey of Great Britain. (1961). Geological Survey of Northern Ireland Retrieved January 28, 2023, from http://nla.gov.au/nla.obj-2911164808
Great Britain. Ordnance Survey and Geological Survey of Great Britain. Geological Survey of Northern Ireland Southampton: The Survey, 1961. Web. 28 January 2023 <http://nla.gov.au/nla.obj-2911164808>
Great Britain. Ordnance Survey & Geological Survey of Great Britain. 1961, Geological Survey of Northern Ireland The Survey, Southampton viewed 28 January 2023 http://nla.gov.au/nla.obj-2911164808
| author1=Great Britain. Ordnance Survey.
| author2=Geological Survey of Great Britain.
| title=Geological Survey of Northern Ireland
| scale=Scale 1:63,360. One inch to one statute mile = 1:63360, one centimetre to .6336 of a kilometre
| section=maps : col. ; 50 x 34cm, on sheets 59 x 76 or smaller.
| location=Southampton
| publisher=The Survey
Until 2038 [Created/Published Date + 70 Years]


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AllPlacesToVisit.comCHURCH OF ST. JACOB info
Church of St. Jacob
This building, outwardly practically unchanged since its construction (end of the 16th century), is the most valuable landmark of the late Gothic in Bohemia.
Jakubské nám. 11, 602 00 Brno-střed, Czechia
brno-jakub@dieceze.cz
https://www.svatyjakub.cz/
Monday - Saturday: 8:00 and 19:00.
Sunday: 8:00, 9:30, 11:00, 19:00.
#Churches
An essential element of the St. Yakuba is a 92-meter tower. It was she who marked the completion of all construction. And on the south window of the building, there is a small figurine of a peasant showing his naked back in the direction of the Old Town Hall. They say that this is how one of the builders, A. Pilgram, showed his attitude towards the city authorities, who did not pay him extra for his work. But it turned out that the peasant was not alone there! In the 19th, they carried out restoration work, and when they looked at the scandalous decor from above, they realized: these are figurines of a man and a woman. Looking at the blissful face of the female figure, it becomes immediately clear what they are doing.
And inside the church, St. Jakuba atmosphere of awe and grandeur:
Tall Gothic columns
Elongated stained glass windows around the entire perimeter of the building
Pulpit with images of scenes from the Bible
Catholic church of St. Jacob is active. It is open daily.
Admission is free. Everyone can go to see the interior decoration. But during the memorial prayer, wedding and baptism, outsiders are not allowed.
Ossuary
In 2001, under the Church of St. Jacob, across the entire width of the nave (25 m), a large-scale ossuary was discovered - the second largest in Europe (after the Parisian one). The number of those buried exceeds 50,000!
For almost 500 years, on today's Jacob's Square, there was the largest cemetery in Brno, practically surrounding the church. But there were still not enough places for burials in the city, so the graves were located in layers one above the other: after 10-12 years, the remains from the old burial were raised, making room for a new one. A raised bones piled in the ossuary.
Groups of up to 20 people are allowed to an excursion to the ossuary every day, except Monday. Opening hours - from 9:30 to 18:00. The ticket costs 140 CZK.
The Church of St. Jacob and the ossuary located in the city centre are Jakubske Namesti 2, Brno 602 00, Czech Republic.


Northyorkshire.police.uk reported on 3rd March, 2015 stating that NCA (National Crime Agency) has developed customized intelligence for companies hosting Internet service providers acting on data which was provided by CERT-UK (Computer Emergency Response Team of UK) and the voluntary Shadowserver Foundation in trying to fight cybercrime.
The analysis revealed that there are more than 5,500 compromises on servers within UK and each of these can be employed for distributing spam email, for launching web attacks against servers or websites or for installing phishing sites to gain entry for classified information. With phishing representing one of the commonest threats to the businesses and public, NCA assesses that organisations following this advice, remove half of phishing attacks which normally originate from the UK every month.
As more number of sophisticated malware threats is happening in UK, the NCA is conducting this activity to proactively help network administrators who manage main components of the UK Internet infrastructure.
The NCA will release intelligence reports through ten police Regional Organized Crime Units (ROCUs) consisting of over 40 individual police forces along with Police Scotland and Police Service of Northern Ireland.
The ROCUs will inform businesses on their systems about the cybercrime threats and will include details on how they can subscribe to customized live threat data feeds.
Scmagazineuk.com published news on 4th March, 2015 quoting Andy Archibald, Deputy Director of National Cyber Crime Unit of NCA as saying: "It is vital to be aware of such type of cybercrimes which are existing because whoever you be, it is the teamwork between organisations of different sectors, countries and regions which is the most effective way of fighting those threats."
Computerweekly.com published news on 2nd March, 2015 quoting Peter Goodman, Deputy Chief Constable of National Policing Lead for Cybercrime, as saying "The Internet is a great source for everyone and we want the community to have faith in the digital space. We can inspire that confidence in public by ruthlessly targeting those who exploit the Internet for crime."
However, Goodman said that only officers of law enforcement cannot prevent people from being victimized by cybercriminals and therefore it is a must that they all do what they can to avoid being victimized by cybercriminals.


Individual Artists from the five counties of Region 2 are invited to join Region 2 Arts Council for a FREE arts grant writing workshop in Bemidji, MN from 5:30-7:30 in the Region 2 Arts Council office in the lower level of the Historic Carnegie Library Building at 426 Bemidji Avenue on Wednesday August 7, 2013.
Artists residing in Mahnomen, Beltrami, Lake of the Woods, Hubbard, and Clearwater counties are eligible to apply for Region 2 Arts Council grants. Individual artists applying to the Individual Artist and Anishinaabe Arts Initiative Grants must be 18 or older. Native Artists residing in Itasca, Becker, Roseau, and Cass counties are also eligible to apply for the AAI grant. Artists applying for the Fellowship must be 21 or older.
The most updated versions of these R2AC grant applications will be presented at this workshop. For download copies of these and other grants, go to r2arts.org/grants/. For questions regarding R2AC grants and REGISTRATION for this workshop, please contact us at staff@r2arts.org / 218 751-5447 or 1800 275-5447.


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Celiac / Gluten Intolerance
#13957 - 07/14/03 01:59 PM
All articles related to Celiac or gluten intolerance should be posted here.
High prevalence of small intestinal bacterial overgrowth in celiac patients
American Journal of Gastroenterology Volume 98 , Issue 4 , Pages 839-843
High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal
Antonio Tursi M.D. * a , Giovanni Brandimarte M.D. b and GianMarco Giorgetti M.D. c
Received: 12/21/2001. Accepted: 4/12/2002.
Abstract Objective
Celiac disease is a gluten-sensitive enteropathy with a broad spectrum of clinical manifestation, and most celiac patients respond to a gluten-free diet (GFD). However, in some rare cases celiacs continue to experience GI symptoms after GFD, despite optimal adherence to diet. The aim of our study was to evaluate the causes of persistence of GI symptoms in a series of consecutive celiac patients fully compliant to GFD.
We studied 15 celiac patients (five men, 10 women, mean age 36.5 yr, range 24�59 yr) who continued to experience GI symptoms after at least 6�8 months of GFD (even if of less severity). Antigliadin antibody (AGA) test, antiendomysial antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as well as esophagogastroduodenoscopy (EGD) with histological evaluation, were performed before starting GFD. Bioptic samples were obtained from the second duodenal portion during EGD, and histopathology was expressed according to the Marsh classification. To investigate the causes of persistence of GI symptoms in these patients, we performed AGA and EMA tests, stool examination, EGD with histological examination of small bowel mucosa, and sorbitol-, lactose-, and lactulose H2-breath tests.
Histology improved in all patients after 6�8 months of GFD; therefore, refractory celiac disease could be excluded. One patient with Marsh II lesions was fully compliant to his diet but had mistakenly taken an antibiotic containing gluten. Two patients showed lactose malabsorption, one patient showed Giardia lamblia and one patient Ascaris lumbricoides infestation, and 10 patients showed small intestinal bacterial overgrowth (SIBO) by lactulose H2-BT. We prescribed a diet without milk or fresh milk�derived foods to the patient with lactose malabsorption; we treated the patients with parasite infestation with mebendazole 500 mg/day for 3 days for 2 consecutive wk; and we treated the patients with SIBO with rifaximin 800 mg/day for 1 wk. The patients were re-evaluated 1 month after the end of drug treatment (or after starting lactose-free diet); at this visit all patients were symptom-free.
This study showed that SIBO affects most celiacs with persistence of GI symptoms after gluten withdrawal.
a Department of Emergency, "L. Bonomo" Hospital, Andria (BA), Italy. b Department of Internal Medicine, Digestive Endoscopy Unit, "Cristo Re" Hospital, Rome, Italy. c Department of Internal Medicine, Artificial Nutrition Unit, "S. Eugenio" Hospital, Rome, Italy.
� 2003 Am. Coll. of Gastroenterology
Celiac Disease: More Common Than You Think
American Family Physician - December 15, 2002
Gluten-Sensitive Enteropathy (Celiac Disease): More Common Than You Think
DAVID A. NELSEN, JR., M.D., M.S., University of Arkansas for Medical Sciences, Little Rock, Arkansas
Gluten-sensitive enteropathy or, as it is more commonly called, celiac disease, is an autoimmune inflammatory disease of the small intestine that is precipitated by the ingestion of gluten, a component of wheat protein, in genetically susceptible persons. Exclusion of dietary gluten results in healing of the mucosa, resolution of the malabsorptive state, and reversal of most, if not all, effects of celiac disease. Recent studies in the United States suggest that the prevalence of celiac disease is approximately one case per 250 persons. Gluten-sensitive enteropathy commonly manifests as "silent" celiac disease (i.e., minimal or no symptoms). Serologic tests for antibodies against endomysium, transglutaminase, and gliadin identify most patients with the disease. Serologic testing should be considered in patients who are at increased genetic risk for gluten-sensitive enteropathy (i.e., family history of celiac disease or personal history of type I diabetes) and in patients who have chronic diarrhea, unexplained anemia, chronic fatigue, or unexplained weight loss. Early diagnosis and management are important to forestall serious consequences of malabsorption, such as osteoporosis and anemia. (Am Fam Physician 2002;66:2259-66,2269-70. Copyright� 2002 American Academy of Family Physicians.)
Although celiac disease was formally described late in the 19th century, treatment remained empiric until the middle of the 20th century when patients were noted to improve dramatically after wheat was removed from their diet. With the development of small-bowel biopsy techniques, the small intestine was identified as the target organ. Disease causality was established when the characteristic features of villous flat tening, crypt hyperplasia, and increased intraepithelial lymphocytes (Figure 1) were shown to normalize after the institution of a gluten-free diet.1
In the mid-1960s, an enteropathy strikingly similar to celiac disease was identified in patients with dermatitis herpetiformis. Subsequently, this skin disorder was shown to be a manifestation of gluten-sensitive enteropathy. In the mid-1960s, adult celiac disease was also noted to be associated with numerous neuro logic disorders, including epilepsy, cerebral calcifications, and peripheral neuropathy.1
Recent population studies indicate that celiac disease is more common than was previously thought. Some patients with gluten-sensitive enteropathy have minimal or no symptoms and are unlikely to be referred to a gastroenterologist unless the disease is considered. Hence, family physicians need to be familiar with the diagnosis and management of gluten-sensitive enteropathy.
Ingested protein does not normally provoke an immune response. This phenomenon is termed "oral tolerance." Patients who exhibit true allergy to an ingested protein (e.g., milk or soy protein) have a typical IgE-mediated response consisting of urticaria, angioedema, and bronchoreactivity.
The autoimmunity in gluten-sensitive enteropathy involves plasma cells that produce IgA and IgG; there is little or no IgE involvement. Current theory suggests that ingested alpha-gliadin (a component of the gluten protein) and related peptides bind with tissue transglutaminase (a ubiquitous intracellular enzyme) in enterocytes. The alpha-gliadin is rich in glutamine; transglutaminase deamidates glutamine residues, forming glutamic acid. Deamidation enhances the immunogenicity of alpha-gliadin by creating epitopes that are recognized as foreign by host cell�mediated immunity.2
Plasma cells produce IgA and IgG that are directed against a variety of antigens, including transglutaminase, endomysium, gliadin, and reticulin. Locally elaborated lymphokines attract inflammatory cells.3 This intense local inflammatory reaction produces the villous flattening characteristic of gluten-sensitive enteropathy. Malabsorption of micronutrients (e.g., vitamins and minerals) and macronutrients (e.g., protein, carbohydrate, fat) follows. Small-bowel involvement is most prominent proximally and may be "patchy," especially in patients with "silent" celiac disease (i.e., minimal or no symptoms) and those with dermatitis herpetiformis.
Approximately 95 percent of patients with celiac disease exhibit specific Human Leukocyte Antigen (HLA) class II alleles DQA1*0501 and DQB1*0201.4 Patients with type 1 diabetes, autoimmune thyroid disease,5 Sj�gren's syndrome, primary biliary cirrhosis, Addison's disease, systemic lupus erythematosus, selective IgA deficiency, and alopecia areata may also exhibit similar genotypes and are at risk for gluten-sensitive enteropathy (Table 1). Because many persons have these genotypes and only a few develop gluten-sensitive enteropathy, investigators have hypothesized that other genes or cofactors may be involved.1
Until recently, celiac disease was considered to be relatively uncommon. Previous U.S. figures suggested that it affected one in 6,000 persons.6 However, population studies published in the past four years suggest a much higher prevalence, particularly in persons of European ancestry.7 Studies conducted in Europe estimate the seroprevalence of celiac disease to be one case per 130 to 300 persons.8-10
FIGURE 2. Dermatitis herpetiformis, sometimes termed "celiac disease of the skin." Vesicular, crusted, intensely pruritic lesions develop on the back (top left and right), buttocks (lower left), and elbows (lower right). Secondary infection of the lesions is common.
In a recent U.S. study,11 investigators tested sera from 2,000 healthy Red Cross blood donors and found eight samples that were positive for antibodies associated with gluten-sensitive enteropathy (seven samples from white persons, one sample from a black person). The seroprevalence rate in this study (one case per 250 persons tested) is consistent with the rates in European studies.
The likelihood of having gluten-sensitive enteropathy increases to 10 to 20 percent in persons who have a first-degree relative with celiac disease.1 In addition, celiac disease is associated with other autoimmune syndromes. For example, as many as 7 percent of patients with type I diabetes also have gluten-sensitive enteropathy.12
Untreated gluten-sensitive enteropathy is associated with a range of symptoms13,14 (Table 2). The "classic" form typically presents in infancy and manifests as failure to thrive, diarrhea, abdominal distention, developmental delay, and, occasionally, severe malnutrition. Failure to diagnose the disorder may lead to a true medical emergency.
Beyond infancy, the symptoms of celiac disease tend to be less dramatic. Older children may present with constitutional short stature or dental enamel defects.
Women comprise approximately 75 percent of newly diagnosed adult celiac disease cases. Women also tend to have more clinically conspicuous disease.15 In adults of both sexes, gastrointestinal tract involvement may manifest as diarrhea, constipation, or other symptoms of malabsorption, such as bloating, flatus, or belching. Fatigue, depression, fibromyalgia-like symptoms, aphthous stomatitis, bone pain, dyspepsia, gastroesophageal reflux, and other nonspecific symptoms may be present and can make the diagnosis quite challenging.14 A number of other autoimmune syndromes have been associated with celiac disease (Table 1).
DERMATITIS HERPETIFORMIS
Fewer than 10 percent of adults with gluten-sensitive enteropathy present with dermatitis herpetiformis.16 This skin condition may be misdiagnosed as atypical psoriasis or nonspecific dermatitis.
The rash of dermatitis herpetiformis is intensely pruritic and typically occurs on the back, buttocks, knees, and elbows (Figure 2). Unexcoriated lesions (Figure 3) are remarkably like those of herpes simplex (thus, the term "herpetiformis"). Granular IgA deposition on immunofluorescence of a skin biopsy specimen is diagnostic (Figure 4).
Anemia is the most common laboratory manifestation of celiac disease13,14 (Table 3). One half of patients with newly diagnosed gluten-sensitive enteropathy are anemic. Iron is absorbed in the proximal small intestine, where celiac manifestations are most prominent; hence, iron malabsorption is common. In addition, occult blood loss related to intense small-bowel inflammation may occur in 50 percent of patients with gluten-sensitive enteropathy.17 Less commonly, vitamin B12 deficiency, folate deficiency, or both may be present.
SILENT CELIAC DISEASE
A number of investigators believe that clinically apparent gluten-sensitive enteropathy represents the "tip of the iceberg" of the overall disease burden.7 Patients who were detected in the seroprevalence studies8-11 were asymptomatic or oligosymptomatic (so-called "silent" celiac disease).
Family physicians should consider serologic testing in patients with the following: family history of celiac disease, personal history of thyroid disease or type I diabetes, irritable bowel syndrome, anemia (especially iron deficiency), chronic diarrhea, chronic fatigue, unexplained weight loss, short stature, epilepsy, infertility,18 or unexplained elevation of transaminase levels. Asymptomatic or oligosymptomatic patients are still at risk for complications of celiac disease.
SEROLOGIC TESTS
When the diagnosis of gluten-sensitive enteropathy is suspected, serologic tests can identify many affected patients.19 (Figure 5). IgA antiendomysial antibody has been shown to be 85 to 100 percent sensitive and 96 to 100 percent specific for celiac disease. IgA antiendomysial antibody is measured using direct immunofluorescence of monkey esophagus or umbilical cord tissue processed with suspect serum.
IgG and IgA antigliadin antibodies are also useful in diagnosing celiac disease. The antibody directed against endomysium has recently been identified as identical to the antibody directed against (tissue) transglutaminase. An enzyme-linked immunosorbent assay has been developed to measure IgA antitransglutaminase; this test will generally replace the more tedious direct fluorescent antibody test for IgA antiendomysial antibody.20-22 In diagnosing celiac disease, antitransglutaminase antibody is considered to be approximately as sensitive and specific as antiendomysial antibody (Table 4).21,23-25
The presence of IgA antiendomysial and antitransglutaminase antibodies correlates with intestinal damage. Tests for these antibodies are highly sensitive in patients with total and subtotal villous atrophy. IgA antiendomysial antibody testing has been reported to be 100 percent sensitive in patients with total villous atrophy. The combination of IgA antiendomysial antibody and IgG and IgA antigliadin antibodies detects 76 percent of patients with mucosal damage.
It is important to note that 2 to 3 percent of patients with gluten-sensitive enteropathy also have selective IgA deficiency. Because these patients may not produce the diagnostic IgA antibodies, a positive IgG antigliadin antibody test may be the only serologic evidence of the disease. If clinical suspicion is high, quantitative IgA measurements should be obtained in these patients.26 Endoscopy and biopsy should be strongly considered in patients with selective IgA deficiency.
Declining autoantibody titers correlate with resolution of the gastrointestinal lesion and may be used to document clinical improvement. In equivocal cases or when a patient has been on a gluten-free diet, a gluten challenge test may be used to provoke the gastrointestinal lesion and serologic response.
DISTAL DUODENAL BIOPSY
Distal duodenal biopsy is the gold standard for the diagnosis of celiac disease. Biopsy should be performed in most patients with suspected gluten-sensitive enteropathy. In determining the need for biopsy, family physicians should consult a gastroenterologist who is experienced in the diagnosis and management of celiac disease.1
Calcium and vitamin D malabsorption dramatically increases the risk of osteoporosis and osteomalacia in patients with gluten-sensitive enteropathy. Most patients with celiac disease have some degree of osteopenia or osteoporosis. Fortunately, calcium and vitamin D supplementation, coupled with a strict gluten-free diet, usually results in remineralization of the skeleton.27,28
Bone density should be assessed in all patients with newly diagnosed celiac disease. Postmenopausal women should be advised about the benefits of estrogen replacement. The use of antiresorptive agents (e.g., alendronate [Fosamax]) has not been extensively studied, but these drugs may be of benefit.
NEUROLOGIC MANIFESTATION
Cerebral calcifications and epilepsy have been associated with celiac disease29,30 and do not always resolve with the institution of a gluten-free diet. Peripheral neuropathy, postural instability, "gluten ataxia," and other vague neurologic complaints may be the sole manifestation of gluten-sensitive enteropathy.31 Autoantibodies associated with celiac disease have demonstrated a strong affinity for brain vasculature.32
REFRACTORY SPRUE
In patients with refractory sprue, gastrointestinal tract inflammation continues despite maintenance of a gluten-free diet. Dietary noncompliance is the most common reason for persistent inflammation; however, coexistent conditions such as hyperthyroidism and collagenous colitis should also be considered.
Patients who are truly refractory to dietary measures may have cryptic lymphoma of (bowel) intraepithelial lymphocytes. All diet-refractory patients should be evaluated by a gastroenterologist with expertise in the management of celiac disease. Corticosteroids and immunosuppressant drugs have been used to treat refractory sprue, but data on their effectiveness are sparse.
IgA antiendomysial antibody has been shown to be 85 to 100 percent sensitive and 96 to 100 specific for celiac disease.
Intestinal strictures and bowel obstruction may develop in patients with refractory sprue or celiac disease that has been untreated over a long period.
LYMPHOMA AND BOWEL ADENOCARCINOMA
Enteropathy-associated T-cell lymphoma has been associated with untreated gluten-sensitive enteropathy and refractory sprue.33 Lymphoma may develop in patients with celiac disease who also have dermatitis herpetiformis.
Studies34,35 have shown that maintenance of a long-term gluten-free state reduces the risk of lymphoma to the level in the general population. Thus, it is imperative that patients with celiac disease (and dermatitis herpetiformis) maintain a gluten-free diet for the rest of their lives.
Patients with celiac disease are also at risk for the development of bowel adenocarcinoma in all sites. The risk is especially high in patients with a long period of disease preceding institution of a gluten-free diet.
Once the diagnosis of celiac disease has been made, patients should be evaluated for known manifestations and complications (Table 5). Iron deficiency should be treated with supplemental iron. Osteoporosis should be treated with calcium and vitamin D replacement. Depending on individual factors, patients with gluten-sensitive enteropathy may need to take a multivitamin, iron, calcium, magnesium, zinc, selenium, vitamin D, or other nutrients.
The primary treatment for celiac disease is the removal of gluten and related proteins from the diet. Complete exclusion of dietary gluten generally results in rapid and complete healing of small-bowel inflammation. Advice from a registered dietitian is essential to outline an appropriate diet.
Gluten, a prolamine, is the primary protein in wheat. Hence, wheat and products containing wheat must be avoided. Barley and rye contain similar proteins and must also be avoided. Oats are a subject of controversy.36,37 Although oats themselves may be nontoxic in limited quantities, commercial oat products are measurably contaminated with wheat. Rice, corn, maize, flax, quinoa, tapioca, potato, amaranth, and other grain substitutes, such as nuts and beans, are safe.
There are many commercial gluten-free products, including breads, cookies, chips, and cereals, that can be used to fashion a rich and interesting diet. Meats, vegetables, fruit, and most dairy products are free of gluten, as long as they have not been contaminated during production.
A number of food manufacturers maintain lists of gluten-free products. These lists can be obtained from the manufacturers' Web sites or by telephone request. Information on gluten-free foods is also available from local or national support groups such as the Celiac Sprue Association. Selected resources are provided in Table 6.
The author indicates that he does not have any conflicts of interest. Sources of funding: none reported.
Figure 1 provided by Laura Lamps, M.D., assistant professor of pathology, University of Arkansas for Medical Sciences (UAMS), Little Rock. Figure 4 provided by Bruce Smoller, M.D., professor of pathology and dermatology, UAMS.
DAVID A. NELSEN, JR., M.D., M.S., is associate professor in the Department of Family and Community Medicine at the University of Arkansas for Medical Sciences, Little Rock, where he earned his medical degree and completed a family medicine residency. He completed a faculty development and clinical investigation fellowship at the University of Minnesota Medical School, Minneapolis, where he also earned a master's degree in family and community medicine. Dr. Nelsen has published and presented in the area of medical informatics and speech recognition. He serves on the technical panel of the American Academy of Family Physicians.
Address correspondence to David A. Nelsen Jr., M.D., M.S., University of Arkansas for Medical Sciences, Department of Family and Community Medicine, Mail Slot #530, 4301 W. Markham, Little Rock, AR 72205 (e-mail: nelsendavida@uams.edu). Reprints are not available from the author.
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Marsh MN. The natural history of gluten sensitivity: defining, refining and re-defining. QJM 1995;88:9-13.
Sollid LM, Markussen G, Ek J, Gjerde H, Vartdal F, Thorsby E. Evidence for a primary association of celiac disease to a particular HLA-DQ alpha/beta heterodimer. J Exp Med 1989;169:345-50
Collin P, Salmi J, Hallstrom O, Reunala T, Pasternack A. Autoimmune thyroid disorders and coeliac disease. Eur J Endocrinol 1994; 130:137-40.
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Branski D, Troncone R. Celiac disease: a reappraisal. J Pediatr 1998;133:181-7.
Not T, Horvath K, Hill ID, Partanen J, Hammed A, Magazzu G, et al. Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol 1998;33:494-8.
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Cataldo F, Marino V, Bottaro G, Greco P, Ventura A. Celiac disease and selective immunoglobulin A deficiency. J Pediatr 1997;131: 306-8.
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Sategna-Guidetti C, Grosso SB, Grosso S, Mengozzi G, Aimo G, Zaccaria T, et al. The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly-diagnosed adult coeliac disease patients. Aliment Pharmacol Ther 2000; 14:35-43.
Dickey W. Epilepsy, cerebral calcifications, and coeliac disease. Lancet 1994;344:1585-6.
Hadjivassiliou M, Chattopadhyay AK, Davies-Jones GA, Gibson A, Grunewald RA, Lobo AJ. Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry 1997;63: 770-5.
Hadjivassiliou M, Grunewald RA, Chattopadhyay AK, Davies-Jones GA, Gibson A, Jarratt JA, et al. Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet 1998;352:1582-5.
Pratesi R, Gandolfi L, Friedman H, Farage L, de Castro CA, Catassi C. Serum IgA antibodies from patients with coeliac disease react strongly with human brain blood-vessel structures. Scand J Gastroenterol 1998;33:817-21.
Pricolo VE, Mangi AA, Aswad B, Bland KI. Gastrointestinal malignancies in patients with celiac sprue. Am J Surg 1998;176:344-7.
Lewis HM, Renaula TL, Garioch JJ, Leonard JN, Fry JS, Collin P, et al. Protective effect of gluten-free diet against development of lymphoma in dermatitis herpetiformis. Br J Dermatol 1996; 135:363-7.
Holmes GK, Prior P, Lane MR, Pope D, Allan RN. Malignancy in coeliac disease--effect of a gluten free diet. Gut 1989;30:333-8.
Hoffenberg EJ, Haas J, Drescher A, Barnhurst R, Osberg I, Bao F, et al. A trial of oats in children with newly diagnosed celiac disease. J Pediatr 2000;137:361-6.
Janatuinen EK, Pikkarainen PH, Kemppainen TA, Kosma VM, Jarvinen RM, Uusitupa MI, et al. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995;333: 1033-7.
Copyright � 2002 by the American Academy of Family Physicians.
Is it necessary to screen for celiac disease in postmenopausal osteoporotic women?
Calcif Tissue Int. 2002 Aug;71(2):141-4. Epub 2002 Jul 24.
Gonzalez D, Sugai E, Gomez JC, Oliveri MB, Gomez Acotto C, Vega E, Bagur A, Mazure R, Maurino E, Bai JC, Mautalen C.
Seccion Osteopatias, Hospital de Clinicas, University of Buenos Aires, (1114) Buenos Aires, Argentina. diana@bertini.com
Decreased bone mass is a frequent finding in celiac patients, and subclinical celiac disease (CD) appears to be unusually overrepresented among patients with idiopathic osteoporosis. Since silent CD may be more common than previously believed, it has been suggested that all osteoporotic patients should be checked for occult CD. The aim of this study was to explore the prevalence of CD in a well-defined population of postmenopausal osteoporotic women. We evaluated 127 consecutive postmenopausal patients (mean age: 68 years; range: 50-82 years) with verified osteoporosis. The observed prevalence of CD in this group was compared to that observed in a group of 747 women recruited for a population-based study. The screening algorithm used to diagnose CD was based on a 3-level screening using type IgA and IgG antigliadin antibodies (AGA) in all the patients (1st level) followed by antiendomysial antibodies (EmA) and total IgA (2nd level) of samples testing positive, and intestinal biopsy of positive cases (3rd level). At the end of the serological screening, only 1 of 127 osteoporotic women was eligible for jejunal biopsy showing a characteristic celiac flat mucosa (prevalence 7.9 x 1,000; 95% CI 0.2-43.1). In addition, CD was diagnosed in 6 of 747 women of the population-based study (prevalence: 8.0 x 1,000; 95% CI 3.3-18.3). There was no significant difference between the two groups. Therefore, our study showed that the prevalence of CD in postmenopausal osteoporotic women was lower than that reported in previous studies and similar to that of the general population. In conclusion, although the relatively small size of the group tested does not allow us to be conclusive, the results suggest that a case finding policy in postmenopausal osteoporosis would have a high cost/benefit ratio except for patients not responding to conventional therapies, or presenting borderline laboratory results.
PMID: 12200648 [PubMed - indexed for MEDLINE]
Celiac disease and spontaneous abortion
Minerva Ginecol. 2002 Apr;54(2):151-9.
[Full Article in Italian]
Foschi F, Diani F, Zardini E, Zanoni G, Caramaschi P.
Istituto di Clinica Ginecologica e Ostetrica A, Universita degli Studi, Verona, Italy.
BACKGROUND: Over the last ten years it has become clear that the clinical expression of celiac disease is more heterogeneous than was thought in the past. Although celiac disease is a relatively frequent disease (1/170-200), it is only diagnosed in a small percentage of adult cases compared to the real situation because it is manifested with few symptoms or in an atypical form, or occasionally is completely silent. Gynecological problems have been reported in women with celiac disease, in particular delayed menarche, early menopause, sterility, recurrent abortion and fetal intrauterine growth retardation. The main aim of this study was to investigate the association between celiac disease and abortion, and in particular to evaluate whether patients suffering from recurrent spontaneous abortion might present an atypical or subclinical form of the disease. METHODS: During the period 1997-1998 a series of laboratory tests were carried out at the Department of Obstetrics and Gynecology and at the Institute of Medicine B of Verona University, in a sample of 184 women (149 from the Obstetrics Clinic and 35 from Internal Medicine B ). These tests included circulating anti-gliadin (AGA) and anti-endomysium (EMA) antibodies and total serum immunoglobulins. In positive cases, further diagnostic tests were performed using small bowel biopsy specimens. RESULTS: In our selected sample of cases, 5 women (2.7%) were positive for immunological screening against IgA-EMA and for bowel biopsy (confirmed diagnosis of celiac disease). Four of these women (2.1%) formed part of a group of patients with a positive history of spontaneous abortion and one (0.5%) was from the control group. CONCLUSIONS: An analysis of the cases that emerged from this study and those reported in the literature shows that tests to identify the celiac disease should be extended to the population with a risk of developing this disease. These subjects should include those with a family history or clinical symptoms, in particular women with a history of multiple abortions. In these cases, there are grounds for suspecting an atypical form of celiac disease.
Celiac disease: fertility and pregnancy.
Gynecol Obstet Invest. 2001;51(1):3-7.
Eliakim R, Sherer DM.
Division of Gastroenterology, Rambam Medical Center, Technion School of Medicine, Haifa, Israel.
Celiac disease (gluten-sensitive enteropathy) may manifest clinically with an array of nongastrointestinal symptoms among which are: dermatitis herpetiformis; dementia; depression; various neurological symptoms; osteoporosis; osteomalacia; dental enamel defects, and anemia of various types. Important data have accumulated in recent years regarding the association between celiac disease, fertility and pregnancy. Many primary care obstetricians and gynecologists and perinatologists are not aware of these important relationships. The aim of this review, utilizing a MEDLINE search from 1966 through March 2000 of the English language, is to describe the possible effects of celiac disease and its treatment upon the reproductive cycle, fertility, pregnancy, and menopause. Review of the literature reveals that patients with untreated celiac disease sustain a significantly delayed menarche, earlier menopause, and an increased prevalence of secondary amenorrhea. Patients with untreated celiac disease incur higher miscarriage rates, increased fetal growth restriction, and lower birth weights. It appears that improvement of celiac disease, as reflected by restoration of small bowel mucosa associated with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall perinatal outcome. Copyright 2001 S. Karger AG, Basel.
Publication Types:
Review, Tutorial
Against the grain: The growing awareness of celiac sprue
The wide-ranging symptoms of the disease can disguise the intestinal disorder, but new tests are helping to make diagnosis easier.
By Susan J. Landers, AMNews staff. Aug. 18, 2003.
True or false: Celiac disease is rarely seen in the United States. When Alessio Fasano, MD, born, raised and medically trained in Italy, first arrived on American shores, he would have said "true" without hesitation.
The intestinal disorder was common in his native country. One of his medical school mentors was an expert in the condition. And he already had treated celiac patients of all ages with a wide variety of symptoms ranging from diarrhea and abdominal pain to constipation, osteoporosis, anemia and even behavior changes.
But it also was widely accepted that Americans almost never harbor this illness, which is triggered in genetically susceptible people by gluten-containing foods. Dr. Fasano looked forward to the different experiences he thought would accompany his new position as professor of medicine, pediatrics and physiology at the University of Maryland School of Medicine in Baltimore.
Instead, he almost immediately began seeing patients who had the very familiar range of complaints.
Now, Dr. Fasano co-directs the University of Maryland's Center for Celiac Research and focuses on spreading a different truth among primary care physicians. Celiac disease actually is one of the most common lifelong disorders in the United States -- American doctors just had not been trained to look for it.
This task -- making physicians more aware about celiac disease -- runs counter to much of American conventional wisdom about the disorder's incidence. Thus, Dr. Fasano and colleagues decided that mounting a large-scale study was necessary to gather the evidence that celiac disease affected many patients.
One in 133 Americans is at risk for celiac disease.
They hypothesized that because the necessary components for the disease almost certainly were present in the United States -- both the genetic background and the gluten trigger -- there either was a third element at work that prevented the interplay of the components or the disorder was being overlooked.
After screening more than 13,000 people in 32 states, they found that the latter assertion proved true. One in 133 Americans is at risk for celiac disease.
Those figures, published in the Feb. 10 Archives of Internal Medicine, demonstrated a tremendous increase from the one in 4,700 Americans who had been diagnosed up until that point. Estimates of the prevalence of celiac disease, also called celiac sprue, now range from one in 100 to one in 300.
"Whichever way you look at it, it's a very large number of people," said Chaitan Khosla, PhD, a professor of chemistry at Stanford (Calif.) University, who started the Celiac Sprue Research Foundation after his son and wife were diagnosed with the disease.
The disorder also can be found in many of the world's populations, he said, "pretty much all the way from the Indian subcontinent to Eastern and Western Europe as well as Northern Africa."
The fact that it is not always recognized in the United States doesn't surprise Joseph Murray, MD, professor of medicine at the Mayo Clinic in Rochester, Minn. Originally from Ireland, where celiac disorder is considered a very common ailment, and trained in medicine at the University of Galway, he never expected to confront the disease again once he arrived in the New World. "I came to study another part of the digestive system, and celiac disease kind of came along and bit me on the leg."
Celiac disease is often overlooked in the U.S.
He attributes celiac's lack of American celebrity to the fact that there are a lot of diseases, and places in the medical school curriculum are reserved for those that are either very big, such as cancer or heart disease, or very noticeable.
"It has to be a classic something," he said. Celiac disease doesn't fit this description -- it often presents atypically, "so it's not what you're expecting."
Others would agree. "It falls into that category of squirrelly disorders that show themselves in many different ways," Dr. Khosla said. Dr. Fasano described it in the June 19 New England Journal of Medicine as a "clinical chameleon."
Despite this shifty nature, celiac disease can be suspected if a patient complains of chronic diarrhea that's been going on for several weeks; has other autoimmune diseases such as type 1 diabetes, thyroid disorders, some types of arthritis or lupus, or if they have a family history of those disorders; or is anemic and the condition cannot be easily explained, Dr. Murray said.
Dr. Fasano defined the disease even more broadly. "You can have vomiting, bloating or constipation, or you can have symptoms that have nothing to do with the gastrointestinal system, such as chronic fatigue syndrome, joint pain, osteoporosis, depression or miscarriage."
Many people with the disorder go undiagnosed for years. The typical time between the onset and diagnosis in the United States is 11 to 13 years. Sometimes the disease is triggered by severe emotional stress, surgery, pregnancy or viral infections.
The disease is split about 50/50 between being a disease of children and a disease of adults, Dr. Fasano said. In textbooks, it is likely to be described as a pediatric condition with the typical symptoms of diarrhea and big belly developing a few weeks after grains are introduced into a child's diet. If there is anything like a classic form of this condition, it is the one diagnosed in very young children.
"During the past two decades, however, the clinical picture of the disease has changed to include milder forms, thus resulting in an upward shift of the age at diagnosis," writes Maki Markku, MD, PhD, of the Pediatric Research Center in Tampere, Finland, also in the June 19 NEJM.
Testing one, two, three
The disease can be detected in patients via blood tests. And these readily available screens put the power to consider the disorder in the hands of the primary care physician.
That's a good thing, according to the experts. After all, it's the primary care physicians who are seeing most of the patients with celiac disorder, although they might not know it. "If a primary care doctor has 2,000 to 3,000 patients, then he or she is likely to have 10 or 15 patients with celiac disease. That's not a small number for a chronic disease," Dr. Murray said.
Celiac's only treatment is to avoid foods with gluten.
Negative blood test results can rule out the disease, while a positive finding indicates there's a good chance a patient has it.
But these outcomes are not entirely clear cut.
One problem with the blood test is that it will result in a negative finding if patients already have eliminated gluten from their diets.
A way to circumvent this problem is to order a DNA test, which doesn't require the presence of antibodies to gluten to confirm the presence of the disease. The diagnostic gold standard, however, is a biopsy of the intestine performed when a patient has eaten gluten-containing food and the resulting damage to the villi lining the intestine can be verified.
Dr. Khosla urges primary care physicians to consider sending patients for a blood test the day they present with symptoms and before they make dietary changes.
He would also like to see an even simpler pin-prick blood test developed as a diagnostic tool that could be on hand in every primary care physician's office. "But it is just not on the radar screen, because primary care physicians aren't saying they have a need for it."
Changes for life
Once diagnosed, the effective, albeit difficult, treatment is to avoid eating anything containing gluten. Foods that contain wheat, rye, oats and barley must be eliminated from the diet. There are also hidden sources of gluten in many foods and even in prescription medications. Labels sometimes identify them as "vegetable" or "plant" protein.
The good news is that avoiding gluten allows damaged intestinal villi to heal and an individual to fully recover. Advocates are lobbying Congress for passage of food labeling legislation that clearly indicates which foods are off limits. Europe has adopted a universal sign of wheat with a line through it to indicate safe products.
Dr. Khosla is very familiar with the implications of diet and the changes celiac disease has made necessary in his life. "We've learned to keep a gluten-free kitchen. I would say on average, if someone asked me the difference between my kitchen now and my kitchen seven years ago [before his son was born], the primary difference is higher grocery bills."
But these costs are nothing compared with the high price patients can pay if the disorder is not adequately diagnosed and treated. Quality of life is one thing. Stomachaches and gas make it hard for individuals to socialize. Additional consequences include short-term memory loss and depression.
Miscarriages and osteoporosis also are among the complications. Dr. Fasano recently spoke with a woman who was diagnosed with celiac disease at age 46. She had experienced nine miscarriages, and her diagnosis came too late to allow her to have children.
"I can't do anything for her now because she is in menopause and has lost the opportunity to have a baby," he said.
Lymphoma is the scariest complication of undiagnosed celiac disease, although it is extremely rare, Dr. Fasano said. "But the chances of developing other autoimmune diseases as a consequence of celiac disease, like type 1 diabetes, are well described," he said. "And that is a travesty."
There are efforts under way to find a cure other than dietary restrictions, and Dr. Khosla hopes to hasten its discovery through the work of his foundation. "If this was like GERD [gastroesophageal reflux disease] or any other gastrointestinal disorder for which there are good treatments, there wouldn't be any room for a nonprofit organization to do what is typically done by the pharmaceutical industry."
Others agree that an alternate treatment or even a cure is not impossible in the next five or 10 years. After all, celiac disorder is unique in that it is the only autoimmune disease for which all elements are known, Dr. Fasano said. The trigger, gluten, is well understood. And the genes involved, though there may be more, also are known, as is the part of the body that is attacked.
"For scientists, that is the blessing. I believe we will come up with a cure," he said.
That's what Dr. Khosla hopes is in store for his young son.
"I have a dream that when he goes to college in the fall of 2014, he takes with him a refillable prescription for a pill he can take whenever he finds himself in a situation where he cannot avoid, or does not wish to avoid, a gluten-containing meal."
Pale sores inside mouth
Recurring abdominal bloating and pain
Source: National Institute of Diabetes & Digestive & Kidney Diseases
Blood tests are available to measure levels of antibodies to gluten, which is found in wheat, rye and barley, as well as other foods and some pharmaceutical products.
If the blood tests suggest celiac disease, a biopsy of the intestine would confirm the disease.
Blood tests and biopsy should be completed before an individual begins a gluten-free diet.
Celiac Disease Foundation (www.celiac.org)
Celiac Sprue Assn. (www.csaceliacs.org)
University of Maryland Center for Celiac Research (www.celiaccenter.org)
Celiac Sprue Research Foundation (www.celiacsprue.org)
Copyright 2003 American Medical Association. All rights reserved.
Celiac disease is a risk factor for schizophrenia
Public release date: 19-Feb-2004
Contact: Tim Parsons
paffairs@jhsph.edu
Johns Hopkins University Bloomberg School of Public Health
People with a history of the digestive disorder celiac disease are three times more likely to develop schizophrenia than those without the disease, according to a report by Danish researchers and a researcher at the Johns Hopkins Bloomberg School of Public Health. The report is published in the February 21, 2004, edition of the British Medical Journal.
Celiac disease is an autoimmune disorder that impairs the body's ability to digest the protein gluten, which is found in grains and many other foods. The condition can lead to diarrhea, weight loss and malnutrition. William W. Eaton, PhD, lead author of the report and interim chair of the Department of Mental Health at the School of Public Health, said, "For years, scientists have suspected a link between celiac disease and schizophrenia. Our research shows that the link is moderately strong."
Dr. Eaton and his colleagues examined the records of 7,997 schizophrenic patients admitted to a Danish psychiatric facility for the first time between 1981 and 1998. Those records were compared to Denmark's national patient register to determine if the schizophrenic patients or their parents were previously treated for celiac disease. The researchers also looked for diagnosis of similar digestive disorders not previously associated with schizophrenia, which included dermatitis herpetiformis, Crohn's disease and ulcerative colitis. The researchers found a small number of schizophrenic patients were previously treated for celiac disease or had a parent treated for celiac disease. Both conditions are rare. The prevalence of celiac disease among schizophrenics was 1.5 cases per 1,000 compared to 0.5 cases per 1,000 in the larger control group.
After adjusting for other factors associated with schizophrenia, the researchers determined that the risk of schizophrenia was three times greater with a history of celiac disease. Crohn's disease and ulcerative colitis were not associated with an increased risk of schizophrenia.
"More research is needed to understand the link between celiac disease and schizophrenia. The most important question is whether treatment for celiac disease, in the form of a gluten-free diet, would benefit the small proportion of individuals with schizophrenia who are genetically prone to celiac disease but have not been diagnosed with it," said Dr. Eaton.
"Coeliac disease and schizophrenia: population based case control study with linkage of Danish national registers" was written by William W. Eaton, Preben Bo Mortensen, Esben Agerbo, Majella Byrne, Ole Mors and Henrik Ewald. Mortensen, Agerbo and Byrne are with the National Centre for Register-Based Research, Aarhus University, Denmark. Mors and Ewald are with the Institute of Basic Psychiatric Research, Aarhus, Denmark.
The research was funded by the Danish National Research Foundation, Stanley Medical Research Institute and the National Institute for Mental Health.
http://www.eurekalert.org/pub_releases/2004-02/jhub-cdi021804.php
Oats Safe for Celiac in Children
Oats to children with newly diagnosed coeliac disease: a randomised double blind study
L H�gberg1, P Laurin2, K F�lth-Magnusson2, C Grant3, E Grodzinsky4, G Jansson5, H Ascher6, L Browaldh7, J-� Hammersj�8, E Lindberg9, U Myrdal10 and L Stenhammar1
1 Department of Paediatrics, Norrk�ping Hospital, Sweden, and Department of Paediatrics, Link�ping University Hospital, Sweden
2 Department of Paediatrics, Link�ping University Hospital, Sweden
3 Laboratory Medicine �sterg�tland, Pathology, Norrk�ping Hospital, Sweden
4 Development Unit for Primary Care and Psychiatry, County Council in �sterg�tland, Sweden
5 Department of Paediatrics, Motala Hospital, Sweden
6 Department of Paediatrics, The Sahlgrenska Academy, G�teborg University, G�teborg, Sweden
7 Department of Paediatrics, Sachsska Hospital, Stockholm, Sweden
8 Department of Paediatrics, V�stervik Hospital, Sweden
9 Department of Paediatrics, �rebro University Hospital, Sweden
10 Department of Paediatrics, V�ster�s Hospital, Sweden
Dr L H�gberg
Department of Paediatrics, Link�ping University, Norrk�ping Hospital, SE-601 82 Norrk�ping, Sweden; lotta.hogberg@lio.se
Background: Treatment of coeliac disease (CD) requires lifelong adherence to a strict gluten free diet (GFD) which hitherto has consisted of a diet free of wheat, rye, barley, and oats. Recent studies, mainly in adults, have shown that oats are non-toxic to CD patients. In children, only open studies comprising a small number of patients have been performed.
Aim: To determine if children with CD tolerate oats in their GFD.
Patients and methods: In this double blind multicentre study involving eight paediatric clinics, 116 children with newly diagnosed CD were randomised to one of two groups: one group was given a standard GFD (GFD-std) and one group was given a GFD with additional wheat free oat products (GFD-oats). The study period was one year. Small bowel biopsy was performed at the beginning and end of the study. Serum IgA antigliadin, antiendomysium, and antitissue transglutaminase antibodies were monitored at 0, 3, 6, and 12 months.
Results: Ninety three patients completed the study. Median (range) daily oat intake in the GFD-oats group (n = 42) was 15 (5�40) g at the six month control and 15 (0�43) g at the end of the study. All patients were in clinical remission after the study period. The GFD-oats and GFD-std groups did not differ significantly at the end of the study regarding coeliac serology markers or small bowel mucosal architecture, including numbers of intraepithelial lymphocytes. Significantly more children in the youngest age group withdrew.
Conclusions: This is the first randomised double blind study showing that the addition of moderate amounts of oats to a GFD does not prevent clinical or small bowel mucosal healing, or humoral immunological downregulation in coeliac children. This is in accordance with the findings of studies in adult coeliacs and indicates that oats, added to the otherwise GFD, can be accepted and tolerated by the majority of children with CD.
http://gut.bmjjournals.com/cgi/content/abstract/53/5/649
No Link Apparent Between IBS and Celiac Disease
NEW YORK (Reuters Health) Apr 13 - The results of a study of local residents by researchers at the Mayo Clinic College of Medicine, Rochester, Minnesota, show no association between irritable bowel syndrome (IBS) and celiac disease.
There have been reports of a particularly high prevalence of celiac disease in patients with IBS, Dr. G. Richard Locke III and colleagues note in the April issue of the Mayo Clinical Proceedings. They also point out that serological testing offers a sensitive and specific means of identifying celiac disease.
Ten percent of the population has symptoms consistent with IBS, Dr. Locke told Reuters Health. Since the symptoms of celiac disease and IBS are similar, it has been suggested that these patients may have undiagnosed celiac disease.
To investigate, the researchers conducted a case-control study, based on the results of a bowel disease questionnaire sent to a random sample of Olmsted County residents between the ages of 20 and 50 years.
One hundred fifty subjects were evaluated. These included 72 respondents who reported symptoms of IBS and dyspepsia and 78 controls who reported no notable gastrointestinal symptoms. Overall, 50 had IBS, 24 had dyspepsia and 15 had both conditions.
However, serological testing showed no significant difference in celiac disease distribution among groups. In all, two controls tested positive for celiac disease (2.6%), as did two subjects with IBS (4.0%) and two with dyspepsia (5.9%). Celiac disease, the team concludes, "did not explain the presence of either IBS or dyspepsia in these subjects."
"Our study," Dr. Locke added, "shows that celiac disease is an uncommon cause of IBS symptoms in the community."
He and his colleagues suggest that "selection bias possibly explains in part the increased prevalence of celiac disease reported in outpatients with IBS and dyspepsia."
Mayo Clin Proc 2004;79:476-482.
http://www.medscape.com/viewarticle/473449?src=mp


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Energy in Italy
Italy consumed about 185 Mtoe of primary energy in 2010. This came mostly from fossil fuels. Among the most used resources are petroleum (mostly used for the transport sector), natural gas (used for electric energy production and heating), coal and renewables.
An important share of electricity comes from import, mainly from Switzerland and France. The share of primary energy dedicated to electricity production is above 35%, and grew steadily since the 1970s.
Electricity is produced mainly from natural gas, which accounts for the source of more than half of the total final electric energy produced. Another important source is hydroelectric power, which was practically the only source of electricity until 1960. Wind and solar power grew rapidly between 2010 and 2013 thanks to high incentives.
Italy has few energy resources, and most of supplies are imported.
In 2014 Italy consumed 291.083 TWh (4790 kWh/person) in electricity, consumption in household were 1057 kWh/person. Italy is a net importer of electricity: the country imported 46,747.5 GWh and exported 3,031.1 GWh in 2014. Gross production in 2014 was 279.8 TWh. The main power sources are natural gas and hydroelectricity.
Italy has no nuclear power since it was banished in 1987 by referendum. In Tuscany was built the first geothermal power station. In 2014 the geothermal production was 5.92 TWh. All active Italian geothermal power stations are now in Tuscany.
According to Energy Information Administration, the 2009 Italian CO2 emissions from energy consumption were 408 Mt, slightly below Indonesia 413 mt. worldwide, Italy was ranked 17th in 2009 according to this list. The Italian emissions decline of 9% in 2008–2009 was rather influenced by the European economic recession 2008–2009 than large sustainable changes in energy consumption. From 2008 to 2009 change was at a 6.9% decline in Europe and at a 7.5 increase in Asia & Oceania.
Emissions of consumption could be a more significant indicator rather than national greenhouse production: many European companies have moved production from Europe to Asia the last ten years, which does not necessarily change the overall emissions of the world or the company. According to the Guardian, the most widely cited international dataset for consumption emissions is from year 2001 including the consumption emissions per capita of all greenhouse gases. Italy's footprint in 2001 was 12 ton CO2 per person (rank no 21) Italy's domestic share of greenhouse gas emissions was 62%.
Energy in Italy Wikipedia
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