Application programming interface.

Header files.

The application programming interface (API) of the C standard library is declared in a number of header files. Each header file contains one or more function declarations, data type definitions, and macros.  After a long period of stability, three new header files (codice_1, codice_2, and codice_3) were added with "Normative Addendum 1" (NA1), an addition to the C Standard ratified in 1995. Six more header files (codice_4, codice_5, codice_6, codice_7, codice_8, and codice_9) were added with C99, a revision to the C Standard published in 1999, and five more files (codice_10, codice_11, codice_12, codice_13, and codice_14) with C11 in 2011. In total, there are now 29 header files:  Three of the header files (codice_4, codice_11, and codice_13) are conditional features that implementations are not required to support.  The POSIX standard added several nonstandard C headers for Unix-specific functionality. Many have found their way to other architectures. Examples include codice_18 and codice_19. A number of other groups are using other nonstandard headers – the GNU C Library has codice_20, and HP OpenVMS has the codice_21 function.

Documentation.

On Unix-like systems, the authoritative documentation of the actually implemented API is provided in the form of man pages. On most systems, man pages on standard library functions are in section 3; section 7 may contain some more generic pages on underlying concepts (e.g. codice_22 in Linux).

Implementations.

Unix-like systems typically have a C library in shared library form, but the header files (and compiler toolchain) may be absent from an installation so C development may not be possible. The C library is considered part of the operating system on Unix-like systems. The C functions, including the ISO C standard ones, are widely used by programs, and are regarded as if they were not only an implementation of something in the C language, but also de facto part of the operating system interface. Unix-like operating systems generally cannot function if the C library is erased. This is true for applications which are dynamically as opposed to statically linked. Further, the kernel itself (at least in the case of Linux) operates independently of any libraries.  On Microsoft Windows, the core system dynamic libraries (DLLs) provide an implementation of the C standard library for the Microsoft Visual C++ compiler v6.0; the C standard library for newer versions of the Microsoft Visual C++ compiler is provided by each compiler individually, as well as "redistributable" packages. Compiled applications written in C are either statically linked with a C library, or linked to a dynamic version of the library that is shipped with these applications, rather than relied upon to be present on the targeted systems. Functions in a compiler's C library are not regarded as interfaces to Microsoft Windows.  Many other implementations exist, provided with both various operating systems and C compilers. Some of the popular implementations are the following:

Compiler built-in functions.

Some compilers (for example, GCC) provide built-in versions of many of the functions in the C standard library; that is, the implementations of the functions are written into the compiled object file, and the program calls the built-in versions instead of the functions in the C library shared object file. This reduces function-call overhead, especially if function calls are replaced with inline variants, and allows other forms of optimization (as the compiler knows the control-flow characteristics of the built-in variants), but may cause confusion when debugging (for example, the built-in versions cannot be replaced with instrumented variants).  However, the built-in functions must behave like ordinary functions in accordance with ISO C. The main implication is that the program must be able to create a pointer to these functions by taking their address, and invoke the function by means of that pointer. If two pointers to the same function are derived in two different translation units in the program, these two pointers must compare equal; that is, the address comes by resolving the name of the function, which has external (program-wide) linkage.

Linking, libm.

Under FreeBSD and Linux, the mathematical functions (as declared in codice_23) are bundled separately in the mathematical library libm. If any of them are used, the linker must be given the directive codice_24.

Detection.

According to the C standard the macro codice_25 shall be defined to 1 if the implementation is hosted. A hosted implementation has all the headers specified by the C standard. An implementation can also be "freestanding" which means that these headers will not be present. If an implementation is "freestanding", it shall define codice_25 to 0.

Concepts, problems and workarounds.

Buffer overflow vulnerabilities.

Some functions in the C standard library have been notorious for having buffer overflow vulnerabilities and generally encouraging buggy programming ever since their adoption. The most criticized items are:  Except the extreme case with codice_30, all the security vulnerabilities can be avoided by introducing auxiliary code to perform memory management, bounds checking, input checking, etc. This is often done in the form of wrappers that make standard library functions safer and easier to use. This dates back to as early as "The Practice of Programming" book by B. Kernighan and R. Pike where the authors commonly use wrappers that print error messages and quit the program if an error occurs.  The ISO C committee published Technical reports TR 24731-1 and is working on TR 24731-2 to propose adoption of some functions with bounds checking and automatic buffer allocation, correspondingly. The former has met severe criticism with some praise, the latter received mixed responses. Despite this, TR 24731-1 has been implemented into Microsoft's C standard library and its compiler issues warnings when using old "insecure" functions.

Threading problems, vulnerability to race conditions.

The codice_33 routine is criticized for being thread unsafe and otherwise vulnerable to race conditions.

Error handling.

The error handling of the functions in the C standard library is not consistent and sometimes confusing. According to the Linux manual page codice_34, "The current (version 2.8) situation under glibc is messy. Most (but not all) functions raise exceptions on errors. Some also set "errno". A few functions set "errno", but don't raise an exception. A very few functions do neither."

Standardization.

The original C language provided no built-in functions such as I/O operations, unlike traditional languages such as COBOL and Fortran. Over time, user communities of C shared ideas and implementations of what is now called C standard libraries. Many of these ideas were incorporated eventually into the definition of the standardized C language.  Both Unix and C were created at AT&T's Bell Laboratories in the late 1960s and early 1970s. During the 1970s the C language became increasingly popular. Many universities and organizations began creating their own variants of the language for their own projects. By the beginning of the 1980s compatibility problems between the various C implementations became apparent. In 1983 the American National Standards Institute (ANSI) formed a committee to establish a standard specification of C known as "ANSI C". This work culminated in the creation of the so-called C89 standard in 1989. Part of the resulting standard was a set of software libraries called the ANSI C standard library.

POSIX standard library.

POSIX, as well as SUS, specify a number of routines that should be available over and above those in the basic C standard library. The POSIX specification includes header files for, among other uses, multi-threading, networking, and regular expressions. These are often implemented alongside the C standard library functionality, with varying degrees of closeness. For example, glibc implements functions such as codice_35 within codice_36, but before NPTL was merged into glibc it constituted a separate library with its own linker flag argument. Often, this POSIX-specified functionality will be regarded as part of the library; the basic C library may be identified as the ANSI or ISO C library.

BSD libc.

BSD libc is a superset of the POSIX standard library supported by the C libraries included with BSD operating systems such as FreeBSD, NetBSD, OpenBSD and macOS. BSD libc has some extensions that are not defined in the original standard, many of which first appeared in 1994's 4.4BSD release (the first to be largely developed after the first standard was issued in 1989). Some of the extensions of BSD libc are:

The C standard library in other languages.

Some languages include the functionality of the standard C library in their own libraries. The library may be adapted to better suit the language's structure, but the operational semantics are kept similar. The C++ language, for example, includes the functionality of the C standard library in the namespace codice_50 (e.g., codice_51, codice_52, codice_53), in header files with similar names to the C ones (codice_54, codice_55, codice_56, etc.). Other languages that take similar approaches are D, Perl, Ruby and the main implementation of Python known as CPython. In Python 2, for example, the built-in file objects are defined as "implemented using C's codice_57 package", so that the available operations (open, read, write, etc.) are expected to have the same behavior as the corresponding C functions. Rust has a crate called which allows several C functions, structs, and other type definitions to be used.

Comparison to standard libraries of other languages.

The C standard library is small compared to the standard libraries of some other languages. The C library provides a basic set of mathematical functions, string manipulation, type conversions, and file and console-based I/O. It does not include a standard set of "container types" like the C++ Standard Template Library, let alone the complete graphical user interface (GUI) toolkits, networking tools, and profusion of other functionality that Java and the.NET Framework provide as standard. The main advantage of the small standard library is that providing a working ISO C environment is much easier than it is with other languages, and consequently porting C to a new platform is comparatively easy.

The C standard library or libc is the standard library for the C programming language, as specified in the ANSI C standard. It was developed at the same time as the C library POSIX specification, which is a superset of it. Since ANSI C was adopted by the International Organization for Standardization, the C standard library is also called the ISO C library.

Die C-Standard-Bibliothek (, auch bekannt als "libc") ist die Standardbibliothek der Programmiersprache C. In jeder standardkonformen betriebssystemgestützten Implementierung "(hosted environment)" von C muss die C-Standard-Bibliothek in vollem Umfang vorhanden sein. Hingegen müssen freistehende Umgebungen "(freestanding environment)", wie man sie beispielsweise im Embedded-Bereich häufig antrifft, nur eine festgelegte Untermenge der Standardbibliothek anbieten, um standardkonform zu sein.


Signs and symptoms.

Gastrointestinal.

People with ulcerative colitis usually present with diarrhea mixed with blood and mucus, of gradual onset that persists for an extended period of time (weeks). People with UC may experience rectal tenesmus, which is the urgent desire to evacuate the bowels but with the passage of little stool. Tenesmus may be misinterpreted as constipation, due to the urge to defecate despite small volume of stool passage. Lower abdominal pain often occurs in UC, and the severity varies from mild discomfort to very painful bowel movements and abdominal cramping. High frequency of bowel movements, weight loss, nausea, fatigue, and fever are also common during disease flares. The inflammation caused by the disease along with the chronic bleeding from the GI tract often leads to anemia, which may contribute to fatigue.  The clinical presentation of ulcerative colitis depends on the extent of the disease process. Ulcerative colitis is associated with a general inflammatory process that can affect many parts of the body. Sometimes, these associated extra-intestinal symptoms are the initial signs of the disease, such as painful arthritic knees in teenagers, which also may be seen in adults. A substantial proportion (up to 45%) of people with a history of UC without any symptoms (clinical remission) have objective evidence of ongoing inflammation.

Extent of involvement.

In contrast to Crohn's disease, which can affect areas of the gastrointestinal tract outside of the colon, ulcerative colitis is usually confined to the colon. Inflammation in ulcerative colitis is usually continuous, extending from the rectum proximally up the colon, whereas inflammation with Crohn's disease is often patchy with so-called "skip lesions." The rectum is typically involved in UC.  The disease is classified by the extent of involvement, depending on how far the disease extends: proctitis (rectal inflammation), proctosigmoiditis (rectal and sigmoid colon inflammation), left sided colitis (inflammation extending to descending colon), and extensive colitis (inflammation proximal to the descending colon). Pancolitis describes involvement of the entire colon, extending from the rectum to the cecum.  While usually associated with Crohn's disease, ileitis (inflammation of the ileum) also occurs in UC. About 17% of individuals with UC have ileitis. Ileitis more commonly occurs in the setting of pancolitis, and tends to correlate with the activity of colitis. This so-called "backwash ileitis" can occur in 10–20% of people with pancolitis and is believed to be of little clinical significance.

Severity of disease.

In addition to the extent of involvement, people may also be characterized by the severity of their disease. Mild disease correlates with fewer than four stools daily, with or without blood, no systemic signs of toxicity, and a normal levels of serum inflammatory markers (erythrocyte sedimentation rate and C-reactive protein). Mild abdominal pain or cramping may occur.  Moderate disease correlates with more than four stools daily, but with minimal signs of toxicity. Moderate abdominal pain, low-grade fever,, and anemia may develop (not requiring transfusion). Severe disease correlates with more than six bloody stools a day or observable massive and significant bloody bowel movements. Toxicity is present, as demonstrated by fever, tachycardia, anemia or an elevated ESR or CRP.  Fulminant disease correlates with more than 10 bowel movements daily, continuous bleeding, toxicity, abdominal tenderness and distension, blood transfusion requirement, and colonic dilation (expansion). People in this category may have inflammation extending beyond just the mucosal layer, causing impaired colonic motility and leading to toxic megacolon. If the serous membrane is involved, a colonic perforation may ensue. Untreated, fulminant disease may be life threatening.

Extraintestinal features.

As UC is believed to have a systemic (i.e., autoimmune) origin, people with UC may present with comorbidities leading to symptoms and complications outside the colon. The frequency of such extraintestinal manifestations has been reported as between 6 and 47%, and include:

Primary sclerosing cholangitis.

Ulcerative colitis has a significant association with primary sclerosing cholangitis (PSC), a progressive inflammatory disorder of small and large bile ducts. As many as 5% of people with ulcerative colitis may progress to develop primary sclerosing cholangitis.

Causes.

No direct causes for UC are known, but many possible factors such as genetics and environment play a role.

Genetic factors.

A genetic component to the cause of UC can be hypothesized based on:  Twelve regions of the genome may be linked to UC, including, in the order of their discovery, chromosomes 16, 12, 6, 14, 5, 19, 1, and 3, but none of these loci has been consistently shown to be at fault, suggesting that the disorder is influenced by multiple genes. For example, chromosome band 1p36 is one such region thought to be linked to inflammatory bowel disease.  Some of the putative regions encode transporter proteins such as OCTN1 and OCTN2. Other potential regions involve cell scaffolding proteins such as the MAGUK family. Human leukocyte antigen associations may even be at work. In fact, this linkage on chromosome 6 may be the most convincing and consistent of the genetic candidates.  Multiple autoimmune disorders have been recorded with the neurovisceral and cutaneous genetic porphyrias including UC, Crohn's disease, celiac disease, dermatitis herpetiformis, diabetes, systemic and discoid lupus, rheumatoid arthritis, ankylosing spondylitis, scleroderma, Sjögren syndrome and scleritis. Physicians should be on high alert for porphyrias in families with autoimmune disorders and care must be taken with the use of potential porphyrinogenic drugs, including sulfasalazine.

Environmental factors.

Many hypotheses have been raised for environmental factors contributing to the pathogenesis of ulcerative colitis. They include:

Autoimmune disease.

Ulcerative colitis is an autoimmune disease characterized by T-cells infiltrating the colon. Ulcerative colitis can also be associated with comorbidities that produce symptoms in many areas of the body outside the digestive system. Surgical removal of the large intestine often cures the disease.

Alternative theories.

Levels of sulfate-reducing bacteria tend to be higher in persons with ulcerative colitis, which could indicate higher levels of hydrogen sulfide in the intestine. An alternative theory suggests that the symptoms of the disease may be caused by toxic effects of the hydrogen sulfide on the cells lining the intestine.  Infection by mycobacterium avium, subspecies paratuberculosis, has been proposed as the ultimate cause of both ulcerative colitis and Crohn's disease.

Pathophysiology.

An increased amount of colonic sulfate-reducing bacteria has been observed in some people with ulcerative colitis, resulting in higher concentrations of the toxic gas hydrogen sulfide. Human colonic mucosa is maintained by the colonic epithelial barrier and immune cells in the lamina propria (see intestinal mucosal barrier). N-butyrate, a short-chain fatty acid, gets oxidized through the beta oxidation pathway into carbon dioxide and ketone bodies. It has been shown that N-butyrate helps supply nutrients to this epithelial barrier. Studies have proposed that hydrogen sulfide plays a role in impairing this beta-oxidation pathway by interrupting the short chain acetyl-CoA dehydrogenase, an enzyme within the pathway. Furthermore, it has been suggested that the protective benefit of smoking in ulcerative colitis is due to the hydrogen cyanide from cigarette smoke reacting with hydrogen sulfide to produce the non-toxic isothiocyanate, thereby inhibiting sulfides from interrupting the pathway. An unrelated study suggested that the sulfur contained in red meats and alcohol may lead to an increased risk of relapse for people in remission.

Diagnosis.

The initial diagnostic workup for ulcerative colitis includes the following:  Although ulcerative colitis is a disease of unknown causation, inquiry should be made as to unusual factors believed to trigger the disease.  The simple clinical colitis activity index was created in 1998 and is used to assess the severity of symptoms.

Endoscopic.

The best test for diagnosis of ulcerative colitis remains endoscopy. Full colonoscopy to the cecum and entry into the terminal ileum is attempted only if the diagnosis of UC is unclear. Otherwise, a flexible sigmoidoscopy is sufficient to support the diagnosis. The physician may elect to limit the extent of the exam if severe colitis is encountered to minimize the risk of perforation of the colon. Endoscopic findings in ulcerative colitis include the following:  Ulcerative colitis is usually continuous from the rectum, with the rectum almost universally being involved. Perianal disease is rare. The degree of involvement endoscopically ranges from proctitis or inflammation of the rectum, to left sided colitis, to pancolitis, which is inflammation involving the ascending colon.

Histologic.

Biopsies of the mucosa are taken to definitively diagnose UC and differentiate it from Crohn's disease, which is managed differently clinically. Microbiological samples are typically taken at the time of endoscopy. The pathology in ulcerative colitis typically involves distortion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscesses, and hemorrhage or inflammatory cells in the lamina propria. In cases where the clinical picture is unclear, the histomorphologic analysis often plays a pivotal role in determining the diagnosis and thus the management. By contrast, a biopsy analysis may be indeterminate, and thus the clinical progression of the disease must inform its treatment.

Laboratory tests.

Blood and stool tests serve primarily to assess disease severity, level of inflammation and rule out causes of infectious colitis. A complete blood count may demonstrate anemia, which may be caused by inflammation or bleeding. Chronic blood loss may lead to iron deficiency as a cause for anemia, particularly microcytic anemia (small red blood cells), which can be evaluated with a serum ferritin, iron, total iron-binding capacity and transferrin saturation. Anemia may be due to a complication of treatment from azathioprine, which can cause low blood counts, or sulfasalazine, which can result in folate deficiency. Thiopurine metabolites (from azathioprine) and a folate level can help.  UC may cause high levels of inflammation throughout the body, which may be quantified with serum inflammatory markers, such as CRP and ESR. However, elevated inflammatory markers are not specific for UC and elevations are commonly seen in other conditions, including infection. In addition, inflammatory markers are not uniformly elevated in people with ulcerative colitis. Twenty five percent of individuals with confirmed inflammation on endoscopic evaluation have a normal CRP level. Serum albumin may also be low related to inflammation, in addition to loss of protein in the GI tract associated with bleeding and colitis. Low serum levels of vitamin D are associated with UC, although the significance of this finding is unclear.  Specific antibody markers may be elevated in ulcerative colitis. Specifically, perinuclear antineutrophil cytoplasmic antibodies (pANCA) are found in 70 percent of cases of UC. Antibodies against Saccharomyces cerevisiae may be present, but are more often positive in Crohn's disease compared with ulcerative colitis. However, due to poor accuracy of these serolologic tests, they are not helpful in the diagnostic evaluation of possible inflammatory bowel disease.  Several stool tests may help quantify the extent of inflammation present in the colon and rectum. Fecal calprotectin is elevated in inflammatory conditions affecting the colon, and is useful in distinguishing irritable bowel syndrome (noninflammatory) from a flare in inflammatory bowel disease. Fecal calprotectin is 88% sensitive and 79% specific for the diagnosis of ulcerative colitis. Fecal leukocytes and lactoferrin are additional nonspecific markers of intestinal inflammation.

Differential diagnosis.

The following conditions may present in a similar manner as ulcerative colitis, and should be excluded:  The most common disease that mimics the symptoms of ulcerative colitis is Crohn's disease, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases since their courses and treatments may differ. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.

Management.

Standard treatment for ulcerative colitis depends on the extent of involvement and disease severity. The goal is to induce remission initially with medications, followed by the administration of maintenance medications to prevent a relapse. The concept of induction of remission and maintenance of remission is very important. The medications used to induce and maintain a remission somewhat overlap, but the treatments are different. Physicians first direct treatment to inducing remission, which involves relief of symptoms and mucosal healing of the colon's lining, and then longer-term treatment to maintain remission and prevent complications. Acute severe ulcerative colitis requires hospitalisation, exclusion of infections, and corticosteroids.  For acute stages of the disease, a low fiber diet may be recommended.

Medication.

Ulcerative colitis can be treated with a number of medications, including 5-ASA drugs such as sulfasalazine and mesalazine. Corticosteroids such as prednisone can also be used due to their immunosuppressive and short-term healing properties, but because their risks outweigh their benefits, they are not used long-term in treatment. Immunosuppressive medications such as azathioprine and biological agents such as infliximab and adalimumab are given only if people cannot achieve remission with 5-ASA and corticosteroids. Infliximab or vedolizumab are recommended in those with moderate or severe disease. Such treatments are used less commonly due to their possible risk factors, including but not limited to increased risk of cancers in teenagers and adults, tuberculosis, and new or worsening heart failure (these side effects are rare).  A formulation of budesonide was approved by the U.S. Food and Drug Administration (FDA) for treatment of active ulcerative colitis in January 2013. In 2018, tofacitinib was approved for treatment of moderately to severely active ulcerative colitis in the United States, the first oral medication indicated for long term use in this condition. The evidence on methotrexate does not show a benefit in producing remission in people with ulcerative colitis. Off-label use of drugs such as ciclosporin and tacrolimus has shown some benefits. Fexofenadine, an antihistamine drug used in treatment of allergies, has shown promise in a combination therapy in some studies. Opportunely, low gastrointestinal absorption (or high absorbed drug gastrointestinal secretion) of fexofenadine results in higher concentration at the site of inflammation. Thus, the drug may locally decrease histamine secretion by involved gastrointestinal mast cells and alleviate the inflammation.

Aminosalicylates.

Sulfasalazine has been a major agent in the therapy of mild to moderate ulcerative colitis for over 50 years. In 1977, it was shown that 5-aminosalicylic acid (5-ASA, mesalazine/mesalamine) was the therapeutically active component in sulfasalazine. Many 5-ASA drugs have been developed with the aim of delivering the active compound to the large intestine to maintain therapeutic efficacy but with reduction of the side effects associated with the sulfapyridine moiety in sulfasalazine. Oral 5-ASA drugs are particularly effective in inducing and in maintaining remission in mild to moderate ulcerative colitis. Rectal suppository, foam or liquid enema formulations of 5-ASA are used for colitis affecting the rectum, sigmoid or descending colon, and have been shown to be effective especially when combined with oral treatment.

Biologics.

Biologic treatments such as the TNF inhibitors infliximab, adalimumab, and golimumab are commonly used to treat people with UC who are no longer responding to corticosteroids. Tofacitinib, vedolizumab, and etrolizumab can also produce good clinical remission and response rates in UC. Usually, these medications are only used if other options have been exhausted (i.e., the person has received and not responded favorably to high-dose corticosteroids and immunomodulators such as azathioprine and mesalazine).  Unlike aminosalicylates, biologics can cause serious side effects such as an increased risk of developing extra-intestinal cancers, heart failure; and weakening of the immune system, resulting in a decreased ability of the immune system to clear infections and reactivation of latent infections such as tuberculosis. For this reason, people on these treatments are closely monitored and are often given tests for hepatitis and tuberculosis at least once a year.

Nicotine.

Unlike Crohn's disease, ulcerative colitis has a lesser chance in affecting smokers than non-smokers. Studies using a transdermal nicotine patch have shown clinical and histological improvement.  In one double-blind, placebo-controlled study conducted in the United Kingdom, 48.6% of people with UC who used the nicotine patch, in conjunction with their standard treatment, showed complete resolution of symptoms. Another randomized, double-blind, placebo-controlled, single-center clinical trial conducted in the United States showed that 39% of people who used the patch showed significant improvement, versus 9% of those given a placebo. Use of a transdermal nicotine patch without the addition of other standard treatments such as mesalazine has relapse occurrence rates similar to standard treatment without the use of nicotine.

Iron supplementation.

The gradual loss of blood from the gastrointestinal tract, as well as chronic inflammation, often leads to anemia, and professional guidelines suggest routinely monitoring for anemia with blood tests repeated every three months in active disease and annually in quiescent disease. Adequate disease control usually improves anemia of chronic disease, but iron deficiency anemia should be treated with iron supplements. The form in which treatment is administered depends both on the severity of the anemia and on the guidelines that are followed. Some advise that parenteral iron be used first because people respond to it more quickly, it is associated with fewer gastrointestinal side effects, and it is not associated with compliance issues. Others require oral iron to be used first, as people eventually respond and many will tolerate the side effects. All guidelines advise that parenteral iron should be administered in cases of severe anemia (a hemoglobin level less than 100 g/L).

Surgery.

Unlike in Crohn's disease, the gastrointestinal aspects of ulcerative colitis can generally be cured by surgical removal of the large intestine, though extraintestinal symptoms may persist. This procedure is necessary in the event of: exsanguinating hemorrhage, frank perforation, or documented or strongly suspected carcinoma. Surgery is also indicated for people with severe colitis or toxic megacolon. People with symptoms that are disabling and do not respond to drugs may wish to consider whether surgery would improve the quality of life.  Ulcerative colitis affects many parts of the body outside the intestinal tract. In rare cases, the extra-intestinal manifestations of the disease may require removal of the colon – although this does not necessarily resolve these symptoms.  The removal of the entire large intestine, known as a proctocolectomy, results in a permanent ileostomy – where a stoma is created by pulling the terminal ileum through the abdomen. Intestinal contents are emptied into a removable ostomy bag which is secured around the stoma using adhesive.  Another surgical option for ulcerative colitis that is affecting most of the large bowel is called the ileal pouch-anal anastomosis (IPAA). This is a two- or three-step procedure. In a three-step procedure, the first surgery is a sub-total colectomy, in which the large bowel is removed, but the rectum remains in situ, and a temporary ileostomy is made. The second step is a proctecomy and formation of the ileal pouch (commonly known as a "j-pouch"). This involves removing the large majority of the remaining rectal stump and creating a new "rectum" by fashioning the end of the small intestine into a pouch and attaching it to the anus. After this procedure, a new type of ileostomy is created (known as a loop ileostomy) to allow the anastomoses to heal. The final surgery is a take-down procedure where the ileostomy is reversed and there is no longer the need for an ostomy bag. When done in two steps, a proctocolectomy – removing both the colon and rectum – is performed alongside the pouch formation and loop ileostomy. The final step is the same take-down surgery as in the three-step procedure. Time taken between each step can vary, but typically a six- to twelve-month interval is recommended between the first two steps, and a minimum of two to three months is required between the formation of the pouch and the ileostomy take-down.  While the ileal pouch procedure removes the need for an ostomy bag, it does not restore normal bowel function. In the months following the final operation, patients typically experience 8–15 bowel movements a day. Over time this number decreases, with many patients reporting four-six bowel movements after one year post-op. While many patients have success with this procedure, there are a number of known complications. Pouchitis, inflammation of the ileal pouch resulting in symptoms similar to ulcerative colitis, is relatively common. Pouchitis can be acute, remitting, or chronic however treatment using antibiotics, steroids, or biologics can be highly effective. Other complications include fistulas, abbesses, and pouch failure. Depending on the severity of the condition, pouch revision surgery may need to be performed. In some cased the pouch may need to be de-functioned or removed and an ileostomy recreated.

Leukocyte apheresis.

A type of leukocyte apheresis, known as granulocyte and monocyte adsorptive apheresis, still requires large-scale trials to determine whether or not it is effective. Results from small trials have been tentatively positive.

Alternative medicine.

About 21% of people with inflammatory bowel disease use alternative treatments. A variety of dietary treatments show promise, but they require further research before they can be recommended.

Prognosis.

Progression or remission.

People with ulcerative colitis usually have an intermittent course, with periods of disease inactivity alternating with "flares" of disease. People with proctitis or left-sided colitis usually have a more benign course: only 15% progress proximally with their disease, and up to 20% can have sustained remission in the absence of any therapy. A subset of people experience a course of disease progress rapidly. In these cases, there is usually a failure to respond to medication and surgery often is performed within the first few years of disease onset. People with more extensive disease are less likely to sustain remission, but the rate of remission is independent of the severity of the disease. Several risk factors are associated with eventual need for colectomy, including: prior hospitalization for UC, extensive colitis, need for systemic steroids, young age at diagnosis, low serum albumin, elevated inflammatory markers (CRP & ESR), and severe inflammation seen during colonoscopy.

Colorectal cancer.

The risk of colorectal cancer is significantly increased in people with ulcerative colitis after ten years if involvement is beyond the splenic flexure. People with backwash ileitis might have an increased risk for colorectal carcinoma. Those people with only proctitis or rectosigmoiditis usually have no increased risk. It is recommended that people have screening colonoscopies with random biopsies to look for dysplasia after eight years of disease activity, at one to two year intervals.

Mortality.

Research has not revealed any difference in overall risk of dying in people with ulcerative colitis from that of the background population. The cause-of-death distribution may be different from that of the background population. It is thought that the disease primarily affects quality of life, and not lifespan. Specific risk factors may predict worse outcomes and a higher risk of mortality in people with ulcerative colitis, including: C. difficile infection and cytomegalovirus infection (due to reactivation).

Other long-term features.

Changes that can be seen in chronic ulcerative colitis include granularity, loss of the vascular pattern of the mucosa, loss of haustra, effacement of the ileocecal valve, mucosal bridging, strictures and pseudopolyps.

Epidemiology.

The geographic distribution of UC and Crohn's disease is similar worldwide, with the highest number of new cases a year of UC found in Canada, New Zealand and the United Kingdom. It begins most commonly between the ages of 15 and 25. A second peak of onset is the 6th decade of life. In general, higher rates are seen in northern locations compared to southern locations in Europe and the United States.  As with Crohn's disease, the rates of UC are greater among Ashkenazi Jews and decreases progressively in other persons of Jewish descent, non-Jewish Caucasians, Africans, Hispanics, and Asians. Appendectomy prior to age 20 for appendicitis and current tobacco use are protective against development of UC (although former tobacco use is associated with a higher risk of developing the disease.)

United States.

, the number of new cases of UC in the United States was between 2.2 and 14.3 per 100,000 per year. The number of people affected in the United States is between 37 and 246 per 100,000.

Canada.

In Canada, between 1998 and 2000, the number of new cases per year was 12.9 per 100,000 population or 4,500 new cases. The number of people affected was estimated to be 211 per 100,000 or 104,000.

United Kingdom.

In the United Kingdom 10 per 100,000 people newly develop the condition a year while the number of people affected is 243 per 100,000. Approximately 146,000 people in the United Kingdom have been diagnosed with UC.

Research.

Helminthic therapy using the whipworm "Trichuris suis" has been shown in a randomized control trial from Iowa to show benefit in people with ulcerative colitis. The therapy tests the hygiene hypothesis which argues that the absence of helminths in the colons of people in the developed world may lead to inflammation. Both helminthic therapy and fecal microbiota transplant induce a characteristic Th2 white cell response in the diseased areas, which was unexpected given that ulcerative colitis was thought to involve Th2 overproduction.  Alicaforsen is a first generation antisense oligodeoxynucleotide designed to bind specifically to the human ICAM-1 messenger RNA through Watson-Crick base pair interactions in order to subdue expression of ICAM-1. ICAM-1 propagates an inflammatory response promoting the extravasation and activation of leukocytes (white blood cells) into inflamed tissue. Increased expression of ICAM-1 has been observed within the inflamed intestinal mucosa of ulcerative colitis sufferers, where ICAM-1 over production correlated with disease activity. This suggests that ICAM-1 is a potential therapeutic target in the treatment of ulcerative colitis.  Gram positive bacteria present in the lumen could be associated with extending the time of relapse for ulcerative colitis.  A series of drugs in development looks to disrupt the inflammation process by selectively targeting an ion channel in the inflammation signaling cascade known as KCa3.1. In a preclinical study in rats and mice, inhibition of KCa3.1 disrupted the production of Th1 cytokines IL-2 and TNF-∝ and decreased colon inflammation as effectively as sulfasalazine.  Neutrophil extracellular traps and the resulting degradation of the extracellular matrix have been reported in the colon mucosa in ulcerative colitis patients in clinical remission, indicating the involvement of the innate immune system in the etiology.

Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood. Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include megacolon, inflammation of the eye, joints, or liver, and colon cancer. The cause of UC is unknown. Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors. Rates tend to be higher in the developed world with some proposing this to be the result of less exposure to intestinal infections, or to a Western diet and lifestyle. The removal of the appendix at an early age may be protective. Diagnosis is typically by colonoscopy with tissue biopsies. It is a kind of inflammatory bowel disease (IBD) along with Crohn's disease and microscopic colitis. Dietary changes, such as maintaining a high-calorie diet or lactose-free diet, may improve symptoms. Several medications are used to treat symptoms and bring about and maintain remission, including aminosalicylates such as mesalazine or sulfasalazine, steroids, immunosuppressants such as azathioprine, and biologic therapy. Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop. Removal of the colon and rectum generally cures the condition. Together with Crohn's disease, about 11.2 million people were affected. Each year it newly occurs in 1 to 20 per 100,000 people, and 5 to 500 per 100,000 individuals are affected. The disease is more common in North America and Europe than other regions. Often it begins in people aged 15 to 30 years, or among those over 60. Males and females appear to be affected in equal proportions. It has also become more common since the 1950s. Together, ulcerative colitis and Crohn's disease affect about a million people in the United States. With appropriate treatment the risk of death appears the same as that of the general population. The first description of ulcerative colitis occurred around the 1850s.

Die Colitis ulcerosa (CU, ) gehört zur Gruppe der chronisch-entzündlichen Darmerkrankungen. Sie ist durch einen entzündlichen Befall des Dickdarms bzw. des Colons gekennzeichnet. Im Gegensatz zum Morbus Crohn ist von der Entzündung nur der Dickdarm kontinuierlich betroffen und diese ist auf die Darmschleimhaut (Mukosa und Submukosa) beschränkt.


Playing career.

Breitner's football career lasted from 1970 until 1983, mainly playing for Bayern Munich (1970–74 and 1978–83) and Real Madrid (1974–77), with one season playing for Eintracht Braunschweig. His early success was as a free roaming left back, as likely to score from the right midfield as to stop an attacker in his own penalty area. Later in his career he moved to midfield and became one of the top midfielders through the early 1980s.  The early peak of Breitner's long and successful career was at age 21 in 1972 as part of the winning German European Championship team. Two years later he won the 1974 FIFA World Cup. The final was played in Munich against the Netherlands, and Breitner scored the first German goal on a penalty kick. In the final, he, Franz Beckenbauer and Berti Vogts formed a formidable unit at the back, their resolute defense preventing the Dutch from getting many scoring chances. He moved to Real Madrid following the World Cup and withdrew from the West German squad, remaining off the side until enticed to return by Jupp Derwall in 1981. Breitner is one of only four footballers to have achieved the feat of scoring in two different World Cup final matches, sharing that honour with Pelé, Vavá, and Zinedine Zidane. He achieved this in 1974 against the Netherlands and in 1982 against Italy. During his club career, Breitner won seven National Championships with Bayern Munich (1972, 1973, 1974, 1980, 1981) and Real Madrid (1975, 1976), the Champions' Cup (1974) as well as the German (1971, 1982) and Spanish Cups (1975). During his spell with Bayern Munich, Karl-Heinz Rummenigge and he formed such a formidable one-two-punch that they were often called "Breitnigge".  Outside the pitch, Breitner was often decried by more traditional fans in Germany for his "revolutionary" attitude and his tendency for voicing strong opinions on political and social issues, especially during a time when Germany was still divided by the Berlin Wall. He was infamously seen bringing Mao Zedong's "little red book" to training. Before the 1982 World Cup in Spain he caused a major uproar in Germany when he accepted an offer by a German cosmetics company to pay him the – what many Germans regarded at that time as a "scandalously high" – sum of 150,000 Deutsche Mark if he shaved off his fluffy full beard, used their fragrance and advertised for the company. In the previous years his long hair had been perceived as a show of rebellion. Breitner further infuriated many fans with his subsequent move to Spanish club giants Real Madrid. He returned to Germany after the successful spell in Madrid and retired as a player in 1983.

Honours.

Club.

Bayern Munich  Real Madrid

International.

West Germany

Post-retirement.

In 1998, Breitner was announced as the new national coach by DFB president Egidius Braun. However, after some steam from fellow association officials, Braun reconsidered 17 hours later, making Breitner the infamous "17 Hours Bundestrainer".  Today, Breitner mainly works as a TV pundit and newspaper columnist. In March 2007 he entered into a contract with FC Bayern Munich and acts as an advisor on various issues. He occasionally still plays for the "Bayern All-stars" in charity games, captaining the team on several occasions.

Paul Breitner (born 5 September 1951 in Kolbermoor, Bavaria) is a former German footballer, who played as a midfielder or as a defender. One of Germany's most controversial players, he earned 48 caps for West Germany. He was known for his partnerships with Franz Beckenbauer and Berti Vogts in defence for the German national team, and his midfield combination with Karl-Heinz Rummenigge for Bayern.

Paul Breitner (* 5. September 1951 in Kolbermoor) ist ein ehemaliger deutscher Fußballnationalspieler. Breitner, der anfänglich auf einer offensiv interpretierten Position des linken Außenverteidigers spielte, später aber zum Spielmacher im Mittelfeld mutierte, gewann mit dem FC Bayern München den Europapokal der Landesmeister 1973/74, fünf deutsche Meisterschaften und zweimal den DFB-Pokal. Mit Real Madrid gewann er zwei spanische Meisterschaften und einmal den Pokal. Zudem spielte er eine Saison für Eintracht Braunschweig. Mit der Nationalmannschaft wurde er 1972 Europa- und 1974 Weltmeister sowie 1982 Vizeweltmeister.


Nature of a cheque.

A cheque is a negotiable instrument instructing a financial institution to pay a specific amount of a specific currency from a specified transactional account held in the drawer's name with that institution. Both the drawer and payee may be natural persons or legal entities. Cheques are "order instruments", and are not in general payable simply to the bearer as bearer instruments are, but

Spelling and etymology.

The spellings "check", "checque", and "cheque" were used interchangeably from the 17th century until the 20th century. However, since the 19th century, the spelling "cheque" (from the French word "chèque") has become standard for the financial instrument in the Commonwealth and Ireland, while "check" is used only for other meanings, thus distinguishing the two definitions in writing.  "Check" is

History.

The cheque had its origins in the ancient banking system, in which bankers would issue orders at the request of their customers, to pay money to identified payees. Such an order was referred to as a "bill of exchange". The use of bills of exchange facilitated trade by eliminating the need for merchants to carry large quantities of currency (for example, gold) to purchase goods and services.

Early years.

There is early evidence of using cheques. In India, during the Maurya Empire (from 321 to 185 BC), a commercial instrument called the adesha was in use, which was an order on a banker desiring him to pay the money of the note to a third person.  The ancient Romans are believed to have used an early form of cheque known as "praescriptiones" in the 1st century BCE.  Beginning in the third century CE, banks in Persian territory began to issue letters of credit. These letters were termed "čak", meaning "document" or "contract". The "čak" became the "sakk" later

Modern era.

By the 17th century, bills of exchange were being used for domestic payments in England. Cheques, a type of bill of exchange, then began to evolve. Initially they were called "drawn notes", because they enabled a customer to draw on the funds that he or she had in the account with a bank and required immediate payment. These were handwritten, and one of the earliest known still to be in existence was drawn on Messrs Morris and Clayton, scriveners and bankers based in the City of London, and dated 16 February 1659.  In 1717, the Bank of England pioneered the first use of a pre-printed form. These forms were printed on "cheque paper" to prevent fraud, and customers had to attend in person and obtain a numbered form from the cashier.

Parts of a cheque.

The four main items on a cheque are:  As cheque usage increased during the 19th and 20th centuries, additional items were added to increase security or to make processing easier for the financial institution. A signature of the drawer was required to authorize the cheque, and this is the main way to authenticate the cheque. Second, it became customary to write the amount in words as well as in numbers to avoid mistakes and make it harder to fraudulently alter the amount after the cheque had been written. It is not a legal requirement to write the amount in words, although some banks will refuse to accept cheques that do not have the amount in both numbers and words.  An issue date was added, and cheques may become invalid a certain amount of time after issue. In the US and Canada a cheque is typically valid for six months after the date of issue, after which it is a "stale-dated cheque," but this depends on where the cheque is drawn. In Australia a cheque is typically valid for fifteen months of the cheque date. A cheque that has an issue date in the future, a post-dated cheque, may not be able to be presented until that date has passed. In some countries writing a post dated cheque may simply be ignored or is illegal. Conversely, an antedated cheque has an issue date in the past.  A cheque number was added and cheque books were issued so that cheque numbers were sequential. This allowed for some basic fraud detection by banks and made sure one cheque was not presented twice.  In some countries, such as the US, cheques may contain a memo line where the purpose of the cheque can be indicated as a convenience without affecting the official parts of the cheque. In the United Kingdom a memo line is not available and such notes may be written on the reverse side of the cheque.  In the US, at the top (when cheque oriented vertically) of the reverse side of the cheque, there are usually one or more blank lines labelled something like "Endorse here".  Starting in the 1960s, machine readable routing and account information was added to the bottom of cheques in MICR format, which allowed automated sorting and routing of cheques between banks and led to automated central clearing facilities. The information provided at the bottom of the cheque is country-specific and standards are set by each country's cheque clearing system. This means that the payee no longer has to go to the bank that issued the cheque, instead they can deposit it at their own bank or any other bank and the cheque would be routed back to the originating bank, and funds transferred to their own bank account.  In the US, the bottom 5/8 inch of the cheque is reserved for MICR characters only. Intrusion into the MICR area can cause problems when the cheque runs through the clearinghouse, requiring someone to print an MICR cheque correction strip and glue it to the cheque. Many new ATMs do not use deposit envelopes and actually scan the cheque at the time it is deposited and will reject cheques due to handwriting incursion which interferes with reading the MICR. This can cause considerable inconvenience as the depositor may have to wait days for the bank to be open and may have difficulty getting to the bank even when they are open; this can delay the availability of the portion of a deposit which their bank makes available immediately as well as the balance of the deposit. Terms of service for many mobile (cell phone camera) deposits also require the MICR section to be readable. Not all of the MICR characters have been printed at the time you manually fill in the cheque as additional characters will be printed later to encode the amount; thus your sloppy signature could obscure characters that you didn't realize would later be printed there. Since MICR characters are no longer necessarily printed in magnetic ink and will be scanned by optical rather than magnetic means, the readers will be unable to distinguish pen ink from pre-printed magnetic ink; these changes allow cheques to be printed on ordinary home and office printers without requiring pre-printed cheque forms, allow ATM deposit capture, allow mobile deposits, and facilitate electronic copies of cheques.  For additional protection, a cheque can be crossed, which restricts the use of the cheque so that the funds must be paid into a bank account. The format and wording varies from country to country, but generally two parallel lines may be placed either vertically across the cheque or in the top left hand corner. In addition the words 'or bearer' must not be used, or if pre-printed on the cheque must be crossed out on the payee line. If the cheque is crossed with the words 'Account Payee' or similar then the cheque can only be paid into the bank account of the person initially named as the payee, thus it cannot be endorsed to a different payee.

Usage.

Parties to regular cheques generally include a "drawer", the depositor writing a cheque; a "drawee," the financial institution where the cheque can be presented for payment; and a "payee," the entity to whom the drawer issues the cheque. The drawer "drafts" or "draws" a cheque, which is also called "cutting a cheque", especially in the US. There may also be a "beneficiary"—for example, in depositing a cheque with a custodian of a brokerage account, the payee will be the custodian, but the cheque may be marked "F/B/O" ("for the benefit of") the beneficiary.  Ultimately, there is also at least one "endorsee" which would typically be the financial institution servicing the payee's account, or in some circumstances may be a third party to whom the payee owes or wishes to give money.  A payee that accepts a cheque will typically deposit it in an account at the payee's bank, and have the bank process the cheque. In some cases, the payee will take the cheque to a branch of the drawee bank, and cash the cheque there. If a cheque is refused at the drawee bank (or the drawee bank returns the cheque to the bank that it was deposited at) because there are insufficient funds for the cheque

Declining use.

Cheque usage has been declining for some years, both for point of sale transactions (for which credit cards and debit cards are increasingly preferred) and for third party payments (for example, bill payments), where the decline has been accelerated by the emergence of telephone banking and online banking. Being paper-based, cheques are costly for banks to process in comparison to electronic payments, so banks in many countries now discourage the use of cheques, either by charging for cheques or by making the alternatives more attractive to customers. In particular the handling of money transfer requires more effort and is time-consuming. The cheque has to be handed over in person or sent through mail. The rise of automated teller machines (ATMs) means that small amounts of cash are often easily accessible, so that it is sometimes unnecessary to write a cheque for such amounts instead.

Alternatives to cheques.

Alternative payment

Europe.

In most European countries, cheques are now rarely used, even for third party payments. In these countries, it is standard practice for businesses to publish their bank details on invoices, to facilitate the receipt of payments by giro. Even before the introduction of online banking, it has been possible in some countries to make payments to third parties using ATMs, which may accurately and rapidly capture invoice amounts, due dates, and payee bank details via a bar code reader to reduce keying. In some countries, entering the bank account number results in the bank revealing the name of the payee as an added safeguard against fraud. In using a cheque, the onus is on the payee to initiate the payment, whereas with a giro transfer, the onus is on the payer to effect the payment (The writer of a paper cheque is pushing on a rope: he cannot force money out of his own account and into the destination's account. By writing the paper cheque, he is handing the far end of the rope to the payee, who will pull in his own good time. In contrast,

North America (Canada and the United States).

In 2002 the US still relied heavily on cheques, due to the convenience it affords payers, and due to the absence of a high volume system for low value electronic payments. Since then the decline in cheque usage seen around the world has also started in the US. The cheque, although not as common as it used to be, is still a long way from disappearing completely in the US.  In the US, an estimated 18.3 billion cheques were paid in 2012, with a value of $25.9 trillion.  About 70 billion cheques were written annually in the US by 2001, though around 17 million adult Americans do not have bank accounts at all. Certain companies whom a person pays with a cheque will turn it into an Automated Clearing House (ACH) or electronic transaction. Banks try to save time processing cheques by sending them electronically between banks. Cheque clearing is usually done through an electronic cheque broker, such as The Clearing House, Viewpointe LLC or the Federal Reserve Banks. Copies of the cheques are stored at a bank or the broker, for

Asia.

In many Asian countries cheques were never widely used and generally only used by the wealthy, with cash being used for the majority of payments. Where cheques were used they have been declining rapidly, by 2009 there was negligible consumer cheque usage in Japan, South Korea and Taiwan. This declining trend was accelerated by these developed markets advanced financial services infrastructure. Many of the developing countries in Asia have seen an increasing use of electronic payment systems, 'leap-frogging' the less efficient chequeing system altogether.  India is one of the few countries

Oceania.

In Australia, following global trends, the use of cheques continues to decline. In 1994 the value of daily cheque transactions was A$25 billion; by 2004 this had dropped to only A$5 billion, and by 2018 this had dropped to only A$1 billion, with almost half of this for B2B transactions. Personal cheque use is practically non-existent thanks to the longstanding use of the EFTPOS system, BPAY, electronic transfers, and debit cards.  In New Zealand, payments by cheque

Variations on regular cheques.

In addition to regular cheques, a number of variations were developed to address specific needs or address issues when using a regular cheque.

Cashier's cheques and bank drafts.

Cashier's cheques and banker's drafts, also known as bank cheques, banker's cheques or treasurer's cheques, are cheques issued against the funds of a financial institution rather than an individual account holder. Typically, the term "cashier's check" is used in the US and "banker's draft" is used in the UK and most of the Commonwealth. The mechanism

Certified cheque.

When a certified cheque is drawn, the bank operating the account verifies there are currently sufficient funds in the drawer's account to honour the cheque. Those funds are then set aside in the

Payroll cheque.

A cheque used to pay wages may be referred to as a payroll cheque. Even when the use of cheques for paying wages and salaries became rare,

Warrants.

Warrants look like cheques and clear through the banking system like cheques, but are not drawn against cleared funds in a deposit account. A cheque differs from a warrant in that the warrant is

Traveller's cheque.

A traveller's cheque is designed to allow the person signing it to make an unconditional payment to someone else as a result of paying the issuer for that privilege. Traveller's cheques can usually be replaced if lost or stolen, and

Money or postal order.

A cheque sold by a post office, bank, or merchant such as a grocery store for payment in favour of a third party is referred to as a money order or postal order. These are paid for

Oversized cheques.

Oversized cheques are often used in public events such as donating money to charity or giving out prizes such as Publishers Clearing House. The cheques are commonly in size; however, according to the Guinness Book of World Records, the largest ever is. Until recently, regardless of the size, such

Payment vouchers.

In the US some public assistance programmes such as the Special Supplemental Nutrition Program for Women, Infants and Children, or Aid to Families with Dependent Children make "vouchers"

Cheques around the world.

Australia.

The Cheques Act 1986 is the body of law governing the issuance of cheques and payment orders in Australia. Procedural and practical issues governing the clearance of cheques and payment orders are handled by Australian Payments Clearing Association (APCA).  In 1999, banks adopted a system to allow faster clearance of cheques by electronically

Canada.

In Canada, cheque sizes and types,

India.

The Cheque was introduced in India by the Bank of Hindustan, the first joint stock bank established in 1770. In 1881, the Negotiable Instruments Act (NI Act) was enacted in India, formalising the usage and characteristics of instruments like the cheque, the bill of exchange, and promissory note. The

Japan.

In Japan, cheques are called, and are governed by.  Bounced cheques are called. If an account owner bounces two cheques

New Zealand.

Instrument-specific legislation includes the Cheques Act 1960, part of the Bills of Exchange Act 1908, which codifies aspects related to the cheque payment instrument, notably the procedures for the endorsement, presentment and payment of cheques. A 1995 amendment provided for the electronic presentment of cheques and removed the previous requirement to deliver cheques physically to the paying bank, opening the way for

United Kingdom.

In the UK all cheques must now conform to an industry standard detailing layout and font ("Cheque and Credit Clearing Company (C&CCC) Standard 3"), be printed on a specific weight of paper (CBS1), and contain explicitly defined security features.  Since 1995, all cheque printers must be members of the Cheque Printer Accreditation Scheme (CPAS). The scheme is managed by the Cheque and Credit Clearing Company and requires that all cheques for use in the British clearing process are produced by accredited printers who have adopted stringent security standards.  The rules concerning crossed cheques are set out in Section 1 of the Cheques Act 1992 and prevent cheques being

United States.

In the United States, cheques are referred to as "checks" and are governed by Article 3 of the Uniform Commercial Code, under the rubric of negotiable instruments.  In the US, the terminology for a cheque historically varied with the type of financial institution on which it is drawn. In the case of a savings and loan association it was a "negotiable order of withdrawal" (compare Negotiable Order of Withdrawal account); if a credit union it was a "share draft." "Checks" were associated with chartered commercial banks. However, common usage has increasingly conformed to more recent versions of Article 3, where "check" means any or all of these negotiable instruments. Certain types of cheques drawn on a government agency, especially payroll cheques, may

Turkey.

In Turkey, cheques are usually used for

Cheque fraud.

Cheques have been a tempting target for criminals to steal money or goods from the drawer, payee or the banks. A number of measures have been introduced to combat fraud over the years. These range from things like writing a cheque so it is difficult to alter after it is drawn, to mechanisms like crossing a cheque so that it can only be paid into another bank's account providing some traceability. However, the inherent security weaknesses of cheques as a payment method, such as having only the signature as the main authentication method and not knowing if funds will be received until the clearing cycle to complete, have made them vulnerable to a number of different types of fraud.

Embezzlement.

Taking advantage of the float period (cheque kiting) to delay the notice of non-existent funds. This often involves

Forgery.

Sometimes, forgery is the method of choice in defrauding a bank. One form of forgery involves the use of a victim's

Identity theft.

Since cheques include significant personal information (name, account number, signature and in some countries driver's license number,

Dishonoured cheques.

A dishonoured cheque cannot be redeemed for its value and is worthless; they are also known as an "RDI" (returned deposit item), or "NSF" (non-sufficient funds) cheque. Cheques are usually dishonoured because the drawer's account has been frozen or limited, or because there are insufficient funds in the drawer's account when the cheque was redeemed. A cheque drawn on an account with insufficient funds is said to have "bounced" and may be called a "rubber cheque". Banks will typically charge customers for issuing a dishonoured cheque, and in some jurisdictions such an act is a criminal action. A drawer may also issue a "stop" on a cheque, instructing the financial institution not to honour a particular cheque.  In England and Wales, they are typically returned marked "Refer to Drawer"—an instruction to contact the person issuing the cheque for an explanation as to why the cheque was not honoured. This wording was brought in after a bank was successfully sued for libel after returning a cheque with the phrase "Insufficient Funds" after making an error—the court ruled that as there were sufficient funds the statement was demonstrably false and damaging to the reputation of the person issuing the cheque. Despite the use of this revised phrase, successful libel lawsuits brought against banks by individuals remained for similar errors.  In Scotland, a cheque acts as an assignment of the amount of money to the payee. As such, if a cheque is dishonoured in Scotland, what funds are present in the bank account are "attached" and frozen, until either sufficient funds are credited to the account to pay the cheque, the drawer recovers the cheque and hands it into the bank, or the drawer obtains a letter from the payee stating that they have no further interest in the cheque.  A cheque may also be dishonoured because it is stale or not cashed within a "void after date". Many cheques have an explicit notice printed on the cheque that it is void after some period of days. In the US, banks are not required by the Uniform Commercial Code to honour a, which is a cheque presented six months after it is dated.

Consumer reporting.

In the United States some consumer reporting agencies such as ChexSystems, Early Warning Services, and TeleCheck have been providing cheque verification services that track how people manage their checking accounts. Banks use the agencies to screen checking account applicants. Those with low debit scores are denied checking

Lock box.

Typically when customers pay bills with cheques (like gas or water bills), the mail will go to a "lock box" at the post office. There a bank will pick up all the mail, sort it, open it, take the cheques and remittance advice out, process it all through electronic machinery, and post the funds to the proper accounts. In modern systems, taking advantage of the Check 21 Act, as in the US, many cheques are transformed into electronic objects and the paper is destroyed.

A cheque, or check (American English; see spelling differences), is a document that orders a bank to pay a specific amount of money from a person's account to the person in whose name the cheque has been issued. The person writing the cheque, known as the "drawer", has a transaction banking account (often called a current, cheque, chequing or checking account) where their money is held. The drawer writes the various details including the monetary amount, date, and a payee on the cheque, and signs it, ordering their bank, known as the "drawee", to pay that person or company the amount of money stated.

Der Scheck (schweiz. zumeist "Cheque" oder "Check") ist ein Zahlungsmittel, bei dem der zahlungspflichtige Aussteller ein Kreditinstitut anweist, einem Zahlungsempfänger zu Lasten des Girokontos des Ausstellers einen bestimmten Geldbetrag zu zahlen.


History.

The forensic expert practice is an ancient profession. For example, in ancient Babylonia, midwives were used as experts in determining pregnancy, virginity and female fertility. Similarly, the Roman Empire recognized midwives, handwriting experts and land surveyors as legal experts. The codified use of expert witnesses and the admissibility of their testimony and scientific evidence has developed significantly in the Western court system over the last 250 years. The concept of allowing an expert witness to testify in a court setting and provide opinionated evidence on the facts of other witnesses was first introduced by Lord Mansfield in the case of "Folkes v. Chadd" in 1782. In this particular case, the court was hearing litigation regarding the silting of Wells Harbor in Norfolk and allowed leading civil engineer, John Smeaton, to provide scientific rationale behind the proposed legislation. The decision by the English Court to allow for an expert to provide contextual background and detail on a case is often cited as the root of modern rules on expert testimony.

Role of expert witnesses.

Expert witnesses are called upon in the court system to serve as an objective party to the lawsuit and never function as an advocate for one side or the other. Expert witnesses are present in litigation to explain complicated scientific issues, not to influence the jury or judge with fervor. The main responsibilities of expert witnesses are to evaluate potential problems, defects, deficiencies, or errors only when able to fully appreciate a process or system. Expert witnesses are obligated to study the processes prior to making a survey or postpone the assignment prior to potentially missing the target due to lack of specific condition understanding. They are called to testify under the assumption with all the preparation required for a competent evaluation of the process.  Typically, experts are relied on for opinions on severity of injury, degree of sanity, cause of failure in a machine or other device, loss of earnings and associated benefits, care costs, and the like. In an intellectual property case an expert may be shown two music scores, book texts, or circuit boards and asked to ascertain their degree of similarity. In the majority of cases, the expert's personal relation to the defendant is considered and irrelevant.  The tribunal itself, or the judge, can in some systems call upon experts to technically evaluate a certain fact or action, in order to provide the court with a complete knowledge on the fact/action it is judging. The expertise has the legal value of an acquisition of data. The results of these experts are then compared to those by the experts of the parties.  The expert has a great responsibility, and especially in penal trials, and perjury by an expert is a severely punished crime in most countries. The use of expert witnesses is sometimes criticized in the United States because in civil trials, they are often used by both sides to advocate differing positions, and it is left up to a jury to decide which expert witness to believe. Although experts are legally prohibited from expressing their opinion of submitted evidence until after they are hired, sometimes a party can surmise beforehand, because of reputation or prior cases, that the testimony will be favorable regardless of any basis in the submitted data; such experts are commonly disparaged as "hired guns."

Qualifications of expert witnesses.

An expert witness at the time of trial is qualified by the court and must be re-qualified each time that person comes to trial for the offering of opinions. The qualification is given by each trial judge and takes place regardless of prior appearances by a particular expert witness. Expert witnesses are those who the court has deemed qualified to speak on a topic to provide background to anyone on a lay jury.

Duties of experts in United States Courts.

In high stakes cases multiple experts, in multiple topics, are often retained by each party. Although it is still relatively rare, the court itself may also retain its own independent expert. In all cases, fees paid to an expert may not be contingent on the outcome of the case.  Expert evidence is often the most important component of many civil and criminal cases today. Fingerprint examination, blood analysis, DNA fingerprinting, and forensic firearm examination are common kinds of expert evidence heard in serious criminal cases. In civil cases, the work of accident analysis, forensic engineers, and forensic accountants is usually important, the latter to assess damages and costs in long and complex cases. Intellectual property and medical negligence cases are typical examples.  Electronic evidence has also entered the courtroom as critical forensic evidence. Audio and video evidence must be authenticated by both parties in any litigation by a forensic expert who is also an expert witness who assists the court in understanding details about that electronic evidence.  Voice-mail recordings and closed-circuit television systems produce electronic evidence often used in litigation, more so today than in the past. Video recordings of bank robberies and audio recordings of life threats are presented in court rooms by electronic expert witnesses.

Rules of evidence and code of procedure.

Hearsay rule.

One important rule that applies to the expert witness but not the percipient witness is the exception to the hearsay rule. A percipient witness tells only what he/she actually knows about a case and nothing more. Percipient witnesses cannot give opinions nor conjecture regarding a hypothetical set of conditions. Conversely, the court does allow an expert to testify about issues that may not be personally known by them. This allows the expert to rely upon scientific articles, discussions with colleagues on the subject, testimony read in preparation for testimony in the case and similar pieces of information not personally known to the expert.

Chain of custody.

It is important that expert witnesses who handle evidence maintain a proper chain of custody such that they are able to authenticate the evidence, prove that it is what they represent it to be, when testifying at trial. Most notably in the context of a criminal prosecution, an expert witnesses who evaluates or examines an item pertinent to an investigation or case evaluation may add an entry to a “chain of custody” document, a form that contains the item's description, the time and date of release for all prior custodians of the item, and the time and date of release to the witness.

Weight of testimony.

In the case of an expert witness, the weight of his/her evidence depends heavily on the foundation support established prior to an opinion being given. Examples include educational background, review of scholarly works, field studies and trainings which all lead up to developing a foundation of knowledge for credibility of a testimony. Before trial, all experts must prepare a report summarizing their analysis and conclusions and share the report with all other parties. This allows other parties to effectively cross-examine the expert.

Types of expert witness.

Testifying experts.

If the witness needs to testify in court, the privilege is no longer protected. The expert witness's identity and nearly all documents used to prepare the testimony will become discoverable. Usually an experienced lawyer will advise the expert not to take notes on documents because all of the notes will be available to the other party.  An expert testifying in a United States federal court must satisfy the requirements of Fed. R. Evid. 702. Generally, under Rule 702, an expert is a person with "scientific, technical, or other specialized knowledge" who can "assist the trier of fact," which is typically a jury. A witness who is being offered as an expert must first establish his or her competency in the relevant field through an examination of his or her credentials. The opposing attorney is permitted to conduct a voir dire of the witness in order to challenge that witness’ qualifications. If qualified by the court, then the expert may testify "in the form of an opinion or otherwise" so long as: "(1) the testimony is based upon sufficient facts or data, (2) the testimony is the product of reliable principles and methods, and (3) the witness has applied the principles and methods reliably to the facts of the case."  Although experts can testify in any case in which their expertise is relevant, criminal cases are more likely to use forensic scientists or forensic psychologists, whereas civil cases, such as personal injury, may use forensic engineers, forensic accountants, employment consultants or care experts. Senior physicians – UK, Ireland, and Commonwealth consultants, U.S. attending physicians – are frequently used in both the civil and criminal courts.  The Federal Court of Australia has issued guidelines for experts appearing in Australian courts. This covers the format of the expert's written testimony as well as their behaviour in court. Similar procedures apply in non-court forums, such as the Australian Human Rights and Equal Opportunity Commission.

Educating witness.

The educating witness teaches the fact-finder (jury or, in a bench trial, judge) about the underlying scientific theory and instrument implementing theory. This witness is an expert witness, called to elicit opinions that a theory is valid and the instruments involved are reliable. The witness must be qualified as an expert witness, which may require academic qualifications or specific training.

Reporting witness.

Called after teaching witness leaves stand. Usually the laboratory technician who personally conducted the test. Witness will describe both the test and the results. When describing test, will venture opinions that proper test procedures were used and that equipment was in good working order.

Non-testifying experts.

In the U.S., a party may hire experts to help them evaluate a given case. For example, a car maker may hire an experienced mechanic to decide if its cars were built to specification. This kind of expert opinion will be protected from discovery by the opposing party. In other words, if the expert finds evidence against their client, the opposite party will not automatically gain access to it. This privilege is similar to the work-product doctrine (not to be confused with attorney–client privilege).  The non-testifying expert can be present at the trial or hearing to aid the attorney in asking questions of other expert witnesses. Unlike a testifying expert, a non-testifying expert can be easily withdrawn from a case. It is also possible to change a non-testifying expert to a testifying expert before the expert disclosure date.

United States.

In the United States, under the Federal Rule of Evidence 702 (FRE), an expert witness must be qualified on the topic of testimony. In determining the qualifications of the expert, the FRE requires the expert have had specialized education, training, or practical experience in the subject matter relating to the case. The expert's testimony must be based on facts in evidence, and should offer opinion about the causation or correlation to the evidence in drawing a conclusion.  Experts in the U.S. typically are paid on an hourly basis for their services in investigating the facts, preparing a report, and if necessary, testifying during pre-trial discovery, or at trial. Hourly fees range from approximately $200 to $750 or more per hour, varying primarily by the expert's field of expertise, and the individual expert's qualifications and reputation. In several fields, such as handwriting analysis, where the expert compares signatures to determine the likelihood of a forgery, and medical case reviews by a physician or nurse, in which the expert goes over hospital and medical records to assess the possibility of malpractice, experts often initially charge a flat fixed fee for their initial report. As with the hourly fees discussed previously, the amount of that flat fee varies considerably based on the reviewing expert's field, experience and reputation.  The expert's professional fee, plus his or her related expenses, is generally paid by the party retaining the expert. In some circumstance the party who prevails in the litigation may be entitled to recover the amounts paid to its expert from the losing party.

Scientific evidence.

In law, scientific evidence is evidence derived from scientific knowledge or techniques. Most forensic evidence, including genetic evidence, is scientific evidence.

"Frye" test.

The "Frye" test, coming from the case "Frye v. United States" (1923), said that admissible scientific evidence must be a result of a theory that had "general acceptance" in the scientific community. This test results in uniform decisions regarding admissibility. In particular, the judges in "Frye" ruled that:  In 1923, the case of Frye v. United States instituted significant change to both criminal and civil law by addressing the use of expert witness testimony in conjunction with scientific testimony. In Frye v. United States, the defense team attempted to introduce both the results of a polygraph test administered to Frye to determine Frye's innocence as well as the testimony of an expert witness to verify and explain the results.  However, the court rejected the expert's testimony, ruling that: “While courts will go a long way in admitting expert testimony deduced from a well-recognized scientific principle or discovery, the thing from which the deduction is made must be sufficiently established to have gained general acceptance in the particular field in which it belongs.”  Through this ruling, the judge's opinion on Frye v. United States set precedent and the standard by which expert witnesses would be utilized in the court system for years to come. In the federal courts, between 1948 and 1975, Frye was cited 55 times; however, the use and application was not consistent. One of the major struggles that came out of this precedent was the application to both civil and criminal cases. Many of the courts and judges had trouble interpreting the "general acceptance" notion of a particular field in a concise and non-arbitrary manner.

Daubert standard.

The Daubert standard arose out of the Supreme Court of the United States case "Daubert v. Merrell Dow Pharmaceuticals, Inc.". It requires four things to be shown:  The Federal Rules of Evidence use the Daubert Test. See FRE 702.  The Federal Rules of Evidence  In 1975, the United States Congress issued the Federal Rules of Evidence (FRE). FRE 702 was issued to provide a standard for expert witness testimony to be upheld by the United States court system. The rule specified that the application of expert witnesses had to be attributed to a person with “scientific or technical knowledge,” in conjunction with a list of qualifications that would quality one to be an expert in terms of “knowledge, skill, experience, training or education”. This rule thus clarified the acceptable use of expert witnesses in both criminal and civil cases.  However, FRE 702 still left some courts in confusion. The courts and subsequently the judges who would use this new rule were confused as to whether FRE 702 served to bolster the "general acceptance" ruling in Frye or if FRE 702 was the replacement of this rule. For instance, in U.S. v. Williams, the Second Circuit responded that “the applicable considerations [for expert witness testimony] are ‘probativeness, materiality, and reliability of the evidence on the one side, and any tendency to mislead, prejudice or confuse the jury on the other.’” The court rejected the evidence brought by the defense as “junk science,” and therefore, appeared to reject the previous precedent set by Frye on “general acceptance”. This ruling and rational in the Williams case was later adopted by other federal courts, including the Third Circuit. Consequently, in 1984, the Third Circuit cited Williams in U.S. v. Downing, which adopted the “reliability” test in lieu of Frye's “generally accepted” test. Meanwhile, other federal courts stuck to the Frye precedent, causing a stark rift in the Circuit Court system.

United Kingdom.

England and Wales.

In England and Wales, under the Civil Procedure Rules (CPR), an expert witness is required to be independent and address his or her expert report to the court. A witness may be jointly instructed by both sides if the parties agree to this, especially in cases where the liability is relatively small.  Under the CPR, expert witnesses may be instructed to produce a joint statement detailing points of agreement and disagreement to assist the court or tribunal. The meeting is held quite independently of instructing lawyers, and often assists in resolution of a case, especially if the experts review and modify their opinions. When this happens, substantial trial costs can be saved when the parties to a dispute agree to a settlement. In most systems, the trial (or the procedure) can be suspended in order to allow the experts to study the case and produce their results. More frequently, meetings of experts occur before trial. Experts charge a professional fee which is paid by the party commissioning the report (both parties for joint instructions) although the report is addressed to the court. The fee must not be contingent on the outcome of the case. Expert witnesses may be subpoenaed (issued with a witness summons), although this is normally a formality to avoid court date clashes.

Scotland.

In Scots Law, "Davie v Magistrates of Edinburgh" (1953) provides authority that where a witness has particular knowledge or skills in an area being examined by the court, and has been called to court in order to elaborate on that area for the benefit of the court, that witness may give evidence of his/her opinion on that area.

An expert witness, particularly in common law countries such as the United Kingdom, Australia, and the United States, is a person whose opinion by virtue of education, training, certification, skills or experience, is accepted by the judge as an expert. The judge may consider the witness's specialized (scientific, technical or other) opinion about evidence or about facts before the court within the expert's area of expertise, referred to as an "expert opinion". Expert witnesses may also deliver "expert evidence" within the area of their expertise. Their testimony may be rebutted by testimony from other experts or by other evidence or facts.

Ein Sachverständiger () oder Gutachter ist eine natürliche Person oder eine Behörde mit einer besonderen Sachkunde und einer Expertise auf einem bestimmten Fachgebiet.