The B-ADENOMA study: Bowelscope – Accuracy of detection using endocuff optimisation of mucosal abnormalities: Study protocol for randomised controlled trial

Background and study aims UK Bowel Cancer Screening flexible sigmoidoscopy (BowelScope) currently offers patients aged 55 a one-off flexible sigmoidoscopy for adenoma clearance to decrease colorectal cancer incidence by interrupting the adenoma-carcinoma sequence. Recent evidence has shown maximum benefit in increasing adenoma detection rate (ADR) using the Endocuff Vision device in the left side of the colon and in screening patients. Currently, ADR is low and shows unacceptable variation in BowelScope. ADR is a quality indicator in screening sigmoidoscopy and higher rates have been shown to reduce colorectal cancer incidence. Patients and methods This will be a prospective, multicenter, UK-based randomized controlled trial (RCT) comparing ADR in Endocuff-assisted versus standard bowel cancer screening flexible sigmoidoscopy (BowelScope). All patients aged 55 to 61 years invited to BowelScope screening and able to give informed consent will be eligible for recruitment. Exclusion criteria include absolute contraindications to flexible sigmoidoscopy, known or suspected large bowel obstruction or pseudo-obstruction, colonic strictures or polyposis syndromes, known severe diverticular segment, active colitis, inability to give informed consent, anticoagulation precluding polypectomy and pregnancy. Patients will be randomized on the day of procedure to Endocuff-assisted flexible sigmoidoscopy or standard flexible sigmoidoscopy, stratified by age group and sex. Baseline, endoscopy and polyp data were collected as well as nurse and patient assessment of comfort. Polyp histology was collected when available. Patients will be asked to return a comfort questionnaire the following day and were followed up for 14 days for complications. The study will take place across 12 to 20 hospital trusts across the UK and recruited 3222 patients. Results The ADENOMA trial will be designed to demonstrate a significant improvement in ADR with maximal effect in the left colon and in fecal occult blood test-positive screening patients. This trial will be the first RCT to look at Endocuff Vision in bowel cancer screening flexible sigmoidoscopy. We will aim to establish whether Endocuff vision improves ADR in this population. Clinicaltrials.gov Identifier: NCT0307247

Taking Tiger Worm Toilets to scale: opportunities and challenges

Tiger Worm Toilets (TWTs) are a relatively recent innovation in sanitation technology, with the potential to offer affordable and safely managed on-site sanitation for underserved communities in line with Sustainable Development Goal 6. This article, authored by members of the International Worm-Based Sanitation Association (IWBSA), presents the state-of-the-art in TWT construction and operation based on frontier global experiences to-date, stemming from both knowledge from literature and the practical knowledge imparted by the authors, who were involved in the birth of this technology and are still active in the research and deployment of it today. The focus of this paper is on the implementation of TWTs to solve sanitation challenges in least-developed and lower-middle income countries specifically. The design of TWTs can be adapted to a wide range of environmental conditions including high water tables and rocky ground conditions, and in both rural and urban contexts. The challenge for TWTs therefore lies primarily in creating opportunities for scaling the uptake of this promising technology. Our article discusses the key barriers to this, identified to be broadly categorised as user preference, capacity and capability building, and governmental support–and proposes how to overcome these

Gaps in Humanitarian WASH Response: Perspectives from people affected by crises, WASH practitioners, global responders, and the literature

Water, sanitation, and hygiene (WASH) interventions prevent and control disease in humanitarian response. To inform future funding and policy priorities, WASH ‘gaps’ were gathered from 220 focus group discussions with people affected by crisis and WASH practitioners, 246 global survey respondents, and 614 documents. After extraction, 2,888 (48%) gaps from direct feedback and 3,151 (52%) from literature were categorized. People affected by crises primarily listed “services gaps”, including need for water, sanitation, solid waste disposal, and hygiene items. Global survey respondents primarily listed “mechanism gaps” to provide services, including collaboration, WASH staffing expertise, and community engagement. Literature highlighted gaps in health (but not other) WASH intervention impacts. Overall, people affected by crises wanted the what (services), responders wanted the how (to provide), and researchers wanted the why (health impacts). Our research suggests need for renewed focus on basic WASH services, collaboration across stakeholders, and research on WASH impacts beyond health