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Introduction Joint Advisory Group (JAG) certification in endoscopy is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update standards for training and certification in flexible sigmoidoscopy (FS).Methods A modified Delphi process was conducted between 2019 and 2020 with multisociety representation from experts and trainees. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on FS training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer-reviewed by national stakeholders for incorporation into the JAG FS certification pathway.Results In total, 41 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (17), assessment of competence (7) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (A) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, rectal retroversion >90%, polyp retrieval rate >90%, patient comfort Conclusion The UK standards for training and certification in FS have been updated to support training, uphold standards in FS and polypectomy, and provide support to the newly independent practitioner.

Introduction In the UK, endoscopy certification is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for colonoscopy training and certification.Methods Under the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted between 2019 and 2020 with multisociety expert representation. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on colonoscopy training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer reviewed by JAG and relevant stakeholders for incorporation into the updated colonoscopy certification pathway.Results In total, 45 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (20), assessment of competence (8) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (1) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, unassisted caecal intubation rate >90%, rectal retroversion >90%, polyp detection rate >15%+, polyp retrieval rate >90%, patient comfort Conclusion The UK standards for training and certification in colonoscopy have been updated, culminating in a single-stage certification process with emphasis on polypectomy competency (SMSA Level 2+). These standards are intended to support training, improve standards of colonoscopy and polypectomy, and provide support to the newly independent practitioner.

BackgroundRestorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the gold standard procedure for ulcerative colitis refractory to medical treatment, as an alternative to permanent end ileostomy. Gaining experience in pouch surgery is difficult as the procedure is performed infrequently. This study presents an institutional initiative to promote standardisation of multidisciplinary care in IPAA surgery.MethodsA dedicated pathway for patients who had an IPAA or are considering IPAA surgery was developed among colorectal surgeons, gastroenterologists, paediatric colorectal surgeons, inflammatory bowel disease (IBD) nurses, dietitians, stoma nurses, trainees in colorectal surgery. Pathway items were discussed and finalised via emails and videoconferences.The pathway included triaging of patients referred for IPAA surgery, preoperative IBD multidisciplinary team discussion and management plan for surgery, surgical review prior to surgery, peer to peer counselling, surgical technique, postoperative short-term and long-term follow-up, audit, research and training in IPAA surgery.ResultsA multidisciplinary preoperative pathway was developed and a stepwise approach to minimally invasive ileoanal pouch surgery was formalised. A dedicated one-stop ileoanal pouch clinic was established integrating endoscopy and imaging on the same day of the consultation with the surgical and gastroenterology team. The clinic reviewed 72 patients over 24 months, and during the same time 36 patients underwent IPAA surgery at our institution.ConclusionsWe have described our initial experience in establishing a specialist IPAA surgery pathway and have proposed outcome measures that we hope will support a subspecialty IPAA service.

This paper develops a multi-scalar geography of youth volunteering in Uganda. A growing body of research has explored the geographies of volunteering in the global North and international volunteering and development. However, despite the mainstreaming of volunteers as development actors, less attention has been paid to the unique local and national geographies of volunteering in global South settings. This paper explores how and why different ideas and practices of volunteering take shape and prominence in Uganda and how this impacts patterns of youth inclusion, inequality and opportunity. Analysing data on volunteering by young refugees in Uganda, we develop a multi-scalar geography to situate volunteering at the interface of ‘global’ volunteering policy and knowledges, aid and development architectures, youth unemployment, community institutions and local socio-economic inequalities. Through this, we reveal how programmed and audited forms of youth volunteering oriented to youth skills and employability are privileged. We show how this articulates with local inequalities to create uneven access to volunteering opportunities and practices. Through our approach, we show how a multi-scalar geography of volunteering enables us to build richer, more nuanced conceptualisations of volunteering in the global South that address the different ways global discourses, local histories, community organisations and social inequalities come together across space and time to produce uneven geographies of volunteering in particular places.

While there is a widely shared sense that policy action is required for the electricity system in the United States to decarbonize, most climate policy courses focus only on a handful of federal and state policies. In reality, however, there is a web of state- and local-government-level policy choices that can serve to facilitate or hinder an energy transition, which is less discussed and researched in higher education. A new graduate course, first taught in Winter 2019 at the University of Michigan in the Ford School of Public Policy, employs a range of unique course design elements to introduce the idea of a complex web of policies and actors in the energy transition, and to provide students with practical skills to prepare them to be leaders in the transition. By interviewing students 18 months after finishing the Winter 2019 iteration of the course, in addition to surveying students enrolled in the second interaction of the course in the Fall 2020 semester, this study finds that student experiential learning and applied projects, in tandem with the instructor’s focus on local, real-world implications, was found to be effective in preparing students to be climate leaders.

Central nervous system tumours are the leading oncology cause of paediatric mortality. The aim of this research was to identify stages within the diagnostic process of a primary paediatric brain tumour that could be improved resulting in better outcomes.The electronic medical records of Queensland Children's Hospital patients with central nervous system tumours between the 17/12/2014 till 11/12/2019 were retrospectively accessed. Time intervals of symptom onset to first medical review,location, time till medical imaging,subspecialty or neurosurgical review, timing of surgery, diagnosis and mortality status were recorded then analysed.A total of 168 patients were included. Mean age to 7.5, 65% male, with pilocytic astrocytoma representing 31%. 71.4% of the population were from a major city as determined by Remoteness Area classification, ABS, with 19% inner regional and 9.5% being outer regional and remote. The average time from first medical review to diagnostic imaging was significantly different when comparing remoteness classification (p = 0.044). There was also a statistically significant difference in the duration of time from medical imaging to specialist review comparing major city and outer regional/remote (p = 0.016) and inner regional versus outer regional/remote areas (p = 0.026).Delays in imaging in outer regional and remote Queensland are contributing to a delay in diagnosis and intervention in paediatric brain tumours. Service provision for neurosurgery in outer regional and remote Queensland is currently on par with inner regional and city areas. Suspicion of paediatric brain tumours is needed with clear referral pathways for general practitioners to access diagnostic imaging.

This paper examines work in cultural and human geography that theorises temporality in terms of events. Moving from humanist phenomenology, to non-representational and assemblage theories and current geographies of encounter, it suggests these accounts of events tend to analyse the past and future through the lens of the present. Building upon these literatures and the work of Tristan Garcia, the paper argues for an expanded notion of the event, where past and future events can be considered as both distinct from, and linked to, the present moment. Here, time comes to be defined as the ordering and stacking of events, where events are understood as sites of comprehension, in which entities are differentiated. The paper suggests this position is useful in order to trace temporal causality across and between entities and events. Tracing the causality of entities and their ordering and stacking across events enables a closer analysis of what the paper terms the temporal power of non-human things. To illustrate this argument, examples from an ESRC project on digital gaming and in-game purchasing are analysed.

Precision immuno-oncology approaches are needed to improve cancer care. We recently demonstrated that in patients with metastatic melanoma, an increase of clonality or diversity of the T cell receptor (TCR) repertoire of peripheral T cells following one cycle of immunotherapy is coincident with response to immune-checkpoint blockade (ICB). We also identified a subset of peripheral CD8Fifty patients with metastatic melanoma treated with first-line anti-PD-1 ICB were included. We analysed TCR repertoire and peripheral TWe observed a correlation between TWe demonstrate that immunotherapy-induced immune-awakening patterns in patients with melanoma are age-related and may impact patient response to ICB, and thus have implications for biomarker development and planning of personalised therapeutic strategies.

In developed countries the incidence of anal squamous cell carcinoma (SCC) has been rising; especially in women over the age of 60 years who present with more advanced disease stage than men. Historically, anal SCC screening has focused on people living with Human Immunodeficiency Virus (HIV) (PLWH) who are considered to be at the highest risk of anal SCC, and its precancerous lesion, anal squamous intraepithelial lesion (SIL). Despite this, women with vulval high-grade squamous epithelial lesions (HSIL) and SCCs have been shown to be as affected by anal HSIL and SCC as some PLWH. Nevertheless, there are no guidelines for the management of anal HSIL in this patient group. The ANCHOR trial demonstrated that treating anal HSIL significantly reduces the risk of anal SCC in PLWH, there is therefore an unmet requirement to clarify whether the screening and treatment of HSIL in women with a prior genital HSIL is also beneficial. This review presents the current evidence supporting the screening, treatment, and surveillance of anal HSIL in high-risk women with a previous history of genital HSIL and/or SCC.

Identification of mismatch repair (MMR)-deficient colorectal cancers (CRCs) is recommended for Lynch syndrome (LS) screening, and supports targeting of immune checkpoint inhibitors. Microsatellite instability (MSI) analysis is commonly used to test for MMR deficiency. Testing biopsies prior to tumour resection can inform surgical and therapeutic decisions, but can be limited by DNA quantity. MSI analysis of voided urine could also provide much needed surveillance for genitourinary tract cancers in LS. Here, we reconfigure an existing molecular inversion probe-based MSI and BRAF c.1799T > A assay to a multiplex PCR (mPCR) format, and demonstrate that it can sample >140 unique molecules per marker from

BACKGROUND There is little consensus regarding effective interventions for diverse populations. This is due to the difficulty of quantifying digital health interventions that use various media and content, and the lack of consensus on how to evaluate and report dose and outcomes. One of the most rapidly changing areas is digital smoking behavior change intervention and reviewing the contents and outcomes of digital interventions and consistency of reporting leads to informing future research. OBJECTIVE This paper aims to 1) systematically review the current practice of digital smoking behavior change interventions, and 2) evaluate the consistency in measuring and reporting intervention contents, channels, and dose and response outcomes in this field. METHODS PubMed, Embase, Scopus, Psych INFO, and PAIS were used to search literature. General search and journal-based search were combined to find literature that was directly related to the scope of the study. All records were imported to COVIDENCE, a screening tool designed for systematic reviews, and duplicates were removed. Titles and abstracts were screened by four trained reviewers to determine eligible full-text literature. The data synthesis scheme was designed under the concept that exposure to digital interventions can be divided into 1) intended doses that were planned by the intervention, and 2) enacted doses that were completed by participants. The intended dose consisted of frequency and lengths of interventions, and the enacted dose was assessed as engagement. Response measures were assessed for behaviors, intentions, and psychosocial outcomes. Measurement of dose-response relationship was reviewed for all literature. RESULTS A total of 2,916 articles were identified through a database search. Title and abstract review yielded 324 articles for possible eligibility, and 19 articles on digital smoking behavior change interventions were ultimately included for data extraction and synthesis. The analysis revealed the lack of prevention studies (0%, 0/19) and dose-response studies (16%, 3/19) in this field. 6 studies (32%, 6/19) reported multiple behavioral measures and 5 studies (23%, 5/19) reported multiple psychosocial measures as outcomes. As dose measures, 7 studies (37%, 7/19) used frequency of exposure, and 4 studies (21%, 4/19) mentioned the length of exposure to the intervention. The assessment of clarity of reporting revealed that duration of intervention and data collection tend to be reported vaguely in literature. CONCLUSIONS This review revealed the lack of studies that assess targeted behavioral outcomes. Data synthesis showed that both measurement and reporting were not consistent across studies, illustrating current challenges in this field. Although most studies paid attention to reporting outcomes, measurement of exposure including intended and enacted doses was unclear in a large proportion of studies. Clear and consistent reporting of both outcomes and exposures is needed to develop further evidence in digital smoking behavior change intervention research. CLINICALTRIAL N/A

BACKGROUND: The present case report describes a complication after a percutaneous spine surgery technique that is highly uncommon in clinical practice: a bone cement cardiac embolism. This rare complication emphasizes the importance of this case, which is also interesting considering the midterm follow-up. Documented cardiac embolisms published in the literature (which are scarce) describe the acute phase of these cases but lack follow-up. There are no systematic reviews on this topic, only case-by-case presentations, and surgeons are not aware of its real implications. CASE: We report a case of an 84-year-old man who developed sudden thoracic and spinal pain associated with 82% saturation and dyspnea a few hours after 4-level thoracic spine vertebroplasty and kyphoplasty. Imaging revealed multiple bone cement embolisms in his lung and heart. Because the patient was hemodynamically stable, cardiologists recommended conservative treatment with low molecular weight heparin, without embolus removal. At 4-year follow-up, the patient remained asymptomatic. CONCLUSION: Cardiac cement embolization following percutaneous techniques represents a life-threatening situation that should be ruled out if the patient presents symptoms during the early postoperative period. Treatment may vary from conservative to emergency open-heart surgery.

In this paper we examine the latest chapter in the relationship between the state and the voluntary sector in the UK. We present an analysis of the UK Government’s ‘National Citizen Service’ scheme and map the landscape of youth services over the past decade. Drawing on interview data with delivery providers of the programme, and key government and policy actors, we explore the new geographies NCS has created and reflect on the wider implications of this programme in austerity Britain.

Chronic psychosocial stress has been indicated as a potentially important driver of U.S. health disparities. Allostatic load (AL) is an indicator of cumulative biological risk or “wear and tear” on the body resulting from repeated adaptations to life stressors. A population-level examination of AL may be particularly useful in understanding the intermediate physiological dysregulation that underlies social inequalities in health. No study has yet documented changes in allostatic load over a wide range of ages and intersecting sociodemographic groups. To address this gap, we pooled biomarker data from three U.S. longitudinal cohort studies (National Longitudinal Study of Adolescent to Adult Health, Midlife Development in the U.S., and the Health and Retirement Survey) to create an integrated dataset covering individuals ages 24 to over 95 from several birth cohorts. We conducted growth curve models to examine associations of AL trajectories with cohort and multiple dimensions of social identity. We found more recently born cohorts were associated with higher mean levels in AL as compared to earlier-born cohorts. Net of cohort, education, and other covariates, Black men and women and Hispanic men had significantly higher AL than their White counterparts. These differences were present in early adulthood and persisted at all ages. Hispanic women experienced the largest increases in AL with age, surpassing nearly all other groups at older ages. These findings contribute new knowledge about the temporal dynamics and social patterning of AL as individuals age, particularly intersecting stress exposures as an underlying and enduring source of health inequity.