An interpretative phenomenological analysis exploring the lived experience of trainee endoscopists

With service demand outweighing service provision training, more endoscopists are vital in the future planning of the endoscopy workforce. A review of the contemporary literature highlights a gap in qualitative research relating to the lived experience of trainee endoscopists. The aim of this research is to examine the experience of trainee endoscopists and to explore specific themes that the trainee considers important to the training experience. The intention of the research is to investigate the lived experience of the trainee undergoing skills-based endoscopy training as a window onto the experience of being a trainee endoscopist. The chosen methodology for this research is Interpretative Phenomenological Analysis (IPA), with data collected from ten purposively-selected participants using the methods of observations to give contexts to semi-structured interviews. The data is qualitative and adheres to IPA methodology protocols resulting in the development of three super-ordinate themes and ten sub-ordinate themes which emerged from the data. The findings demonstrate that the trainee endoscopists identify themes such as organisational barriers, hierarchy and emotional factors which have been highlighted by the detailed analysis of the data. This provides an in-depth understanding of aspects of current training which can have an impact on the training experience and the quality of the training delivered. These findings will help provide a basis in the development of quality endoscopy training programmes which consider the themes highlighted in this research. However, it is essential that we acknowledge that learning endoscopy is an emotional journey and this needs to be managed by the endoscopy curriculum

Exploring the lived experience of endoscopy trainees and their perceptions of nurse endoscopists as trainers

Background UK endoscopy services face considerable workforce pressures from an increasing demand for procedures. To meet this need, health services have introduced the role of nurse endoscopist (also known as clinical, non-medical or non-physician endoscopist). These roles have grown and developed to include performing many complex diagnostic and therapeutic procedures, as well as the provision of endoscopy training. Aims This study examines the lived experiences of (nurse and medical) endoscopy trainees, especially regarding being trained by nurse endoscopists. Methods The study employed interpretive phenomenological analysis (IPA). Data were collected through semi-structured in-depth interviews of 10 participants, who were selected from a sample of trainees attending a basic colonoscopy skills course. Interviews were preceded by observations to gain contextual insights into the training experience. The data were analysed in stages through a process of reading and re-reading the transcripts, making initial descriptive observations and then annotating with discursive, linguistic and conceptual comments. Findings Four emerging themes were identified. A lack self-confidence was a barrier to progression, compounded by the emotional impact of making mistakes without comprehensible constructive feedback. Attitudes of trainers and other endoscopy staff, as well as their relationships with trainees, had an impact on self-confidence and educational experience. Pressure on endoscopy units to perform procedures led to a tendency to treat training like a burden, although training was seen as an important investment. Trainees sought to differentiate nurse endoscopist and medical endoscopist roles and justify their skills and value, with comparisons between different nurse and medical trainers. Conclusion The emerging themes illustrate the requirement for a collegiate approach to endoscopy training

Service Group Management facilitated by DSL driven Policies in embedded Middleware

Middleware by its very nature is fundamental to the functioning of systems as it provides the communication between software components. It is very much an underlying technology and is rarely visible to end users. As systems develop, certain domain semantics, provided by the domain experts, need to be injected into the behaviour of the underlying middleware, but in a controlled manner. The methods used to achieve this are often static in nature, wholly dependent on how they are implemented, deployed and managed. An increasingly popular way to manage this behaviour injection is through the use of policies, a technique used to govern defined rules, triggered by associated events, resulting in specific actions when certain conditions are encountered. Strong efforts have been made throughout the evolution of software development methods and programming languages to solve the lack of dynamicity which can arise through poor practices. Successive language based attempts to attain a higher level of abstraction in the notations used and techniques deployed have resulted in the re-discovery of Domain Specific Languages (DSL). This paper looks at injecting the dynamicity required in the management of service groups through a policy based DSL

Unexpected Long-Term Variability in Jupiter's Tropospheric Temperatures

An essential component of planetary climatology is knowledge of the tropospheric temperature field and its variability. Previous studies of Jupiter hinted at periodic behavior that was non-seasonal, as well as dynamical relationships between tropospheric and stratospheric temperatures. However, these observations were made over time frames shorter than Jupiter's orbit or they used sparse sampling. We derived upper-tropospheric (300-mbar) temperatures over 40 years, extending those studies to cover several orbits of Jupiter, revealing unexpected results. Periodicities of 4, 7 8-9 and 10-14 years were discovered that involved different latitude bands and seem disconnected from seasonal changes in solar heating. Anti-correlations of variability in opposite hemispheres were particularly striking at 16, 22 and 30 degrees from the equator. Equatorial temperature variations are also anticorrelated with those 60-70 km above. Such behavior suggests a top-down control of equatorial tropospheric temperatures from stratospheric dynamics. Realistic future global climate models must address the origins of these variations in preparation for their extension to a wider array of gas-giant exoplanets.Comment: Primary file: 16 pages, 5 figures. Supplemental File (attached): 12 pages, 3 figures, 1 tabl

Management of obstetric anal sphincter injury: a systematic review & national practice survey

BACKGROUND: We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK obstetricians and coloproctologists. METHODS: A systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out. RESULTS: We found a wide variation in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians (46.5% undertaking ≥ 5 repairs/year), whilst only 10% of responding colorectal surgeons had similar levels of experience (p < 0.001). There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification (p < 0.01). Observational studies suggest that a new 'overlap' repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial (RCT) on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 337(50%) consultants, 82 (55%) trainees and 80 (89%) coloproctologists already using the 'overlap' method for repair of a torn EAS (p < 0.001). Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians (p < 0.001). Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees (p < 0.001). CONCLUSION: An agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended

Clinical, genetic, epidemiologic, evolutionary, and functional delineation of TSPEAR-related autosomal recessive ectodermal dysplasia 14

TSPEAR variants cause autosomal recessive ectodermal dysplasia (ARED) 14. The function of TSPEAR is unknown. The clinical features, the mutation spectrum, and the underlying mechanisms of ARED14 are poorly understood. Combining data from new and previously published individuals established that ARED14 is primarily characterized by dental anomalies such as conical tooth cusps and hypodontia, like those seen in individuals with WNT10A-related odontoonychodermal dysplasia. AlphaFold-predicted structure-based analysis showed that most of the pathogenic TSPEAR missense variants likely destabilize the β-propeller of the protein. Analysis of 100000 Genomes Project (100KGP) data revealed multiple founder TSPEAR variants across different populations. Mutational and recombination clock analyses demonstrated that non-Finnish European founder variants likely originated around the end of the last ice age, a period of major climatic transition. Analysis of gnomAD data showed that the non-Finnish European population TSPEAR gene-carrier rate is ∼1/140, making it one of the commonest AREDs. Phylogenetic and AlphaFold structural analyses showed that TSPEAR is an ortholog of drosophila Closca, an extracellular matrix-dependent signaling regulator. We, therefore, hypothesized that TSPEAR could have a role in enamel knot, a structure that coordinates patterning of developing tooth cusps. Analysis of mouse single-cell RNA sequencing (scRNA-seq) data revealed highly restricted expression of Tspear in clusters representing enamel knots. A tspeara−/−;tspearb−/− double-knockout zebrafish model recapitulated the clinical features of ARED14 and fin regeneration abnormalities of wnt10a knockout fish, thus suggesting interaction between tspear and wnt10a. In summary, we provide insights into the role of TSPEAR in ectodermal development and the evolutionary history, epidemiology, mechanisms, and consequences of its loss of function variants

Evaluating protein cross-linking as a therapeutic strategy to stabilize SOD1 variants in a mouse model of familial ALS

Mutations in the gene encoding Cu-Zn superoxide dismutase 1 (SOD1) cause a subset of familial amyotrophic lateral sclerosis (fALS) cases. A shared effect of these mutations is that SOD1, which is normally a stable dimer, dissociates into toxic monomers that seed toxic aggregates. Considerable research effort has been devoted to developing compounds that stabilize the dimer of fALS SOD1 variants, but unfortunately, this has not yet resulted in a treatment. We hypothesized that cyclic thiosulfinate cross-linkers, which selectively target a rare, 2 cysteine-containing motif, can stabilize fALS-causing SOD1 variants in vivo. We created a library of chemically diverse cyclic thiosulfinates and determined structure-cross-linking-activity relationships. A pre-lead compound, “S-XL6,” was selected based upon its cross-linking rate and drug-like properties. Co-crystallographic structure clearly establishes the binding of S-XL6 at Cys 111 bridging the monomers and stabilizing the SOD1 dimer. Biophysical studies reveal that the degree of stabilization afforded by S-XL6 (up to 24°C) is unprecedented for fALS, and to our knowledge, for any protein target of any kinetic stabilizer. Gene silencing and protein degrading therapeutic approaches require careful dose titration to balance the benefit of diminished fALS SOD1 expression with the toxic loss-of-enzymatic function. We show that S-XL6 does not share this liability because it rescues the activity of fALS SOD1 variants. No pharmacological agent has been proven to bind to SOD1 in vivo. Here, using a fALS mouse model, we demonstrate oral bioavailability; rapid engagement of SOD1G93A by S-XL6 that increases SOD1G93A’s in vivo half-life; and that S-XL6 crosses the blood–brain barrier. S-XL6 demonstrated a degree of selectivity by avoiding off-target binding to plasma proteins. Taken together, our results indicate that cyclic thiosulfinate-mediated SOD1 stabilization should receive further attention as a potential therapeutic approach for fALS