Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gatric cardia cancer.

<b>INTRODUCTION</b> Atrophic gastritis is a risk factor for non-cardia gastric cancer, and gastro-oesophageal reflux disease (GORD) for oesophageal adenocarcinoma. The role of atrophic gastritis and GORD in the aetiology of adenocarcinoma of the cardia remains unclear. We have investigated the association between adenocarcinoma of the different regions of the upper gastrointestinal tract and atrophic gastritis and GORD symptoms. <b>METHODS</b> 138 patients with upper GI adenocarcinoma and age and sex matched controls were studied. Serum pepsinogen I/II was used as a marker of atrophic gastritis and categorised to five quintiles. History of GORD symptoms, smoking and H.pylori infection was incorporated in logistic regression analysis. Lauren classification of gastric cancer was used to subtype gastric and oesophageal adenocarcinoma. <b>RESULTS</b> Non-cardia cancer was associated with atrophic gastritis but not with GORD symptoms; 55% of these cancers were intestinal subtype. Oesophageal adenocarcinoma was associated with GORD symptoms, but not with atrophic gastritis; 84% were intestinal subtype. Cardia cancer was positively associated with both severe gastric atrophy [OR, 95% CI: 3.92 (1.77 – 8.67)] and with frequent GORD symptoms [OR, 95% CI: 10.08 (2.29 – 44.36)] though the latter was only apparent in the nonatrophic subgroup and in the intestinal subtype. The association of cardia cancer with atrophy was stronger for the diffuse versus intestinal subtype and this was the converse of the association observed with non-cardia cancer. <b>CONCLUSION</b> These findings indicate two distinct aetiologies of cardia cancer, one arising from severe atrophic gastritis and being of intestinal or diffuse subtype similar to non-cardia cancer, and one related to GORD and intestinal in subtype, similar to oesophageal adenocarcinoma. Gastric atrophy, GORD symptoms and histological subtype may distinguish between gastric versus oesophageal origin of cardia cancer

Immediate reward reinforcement learning for clustering and topology preserving mappings

We extend a reinforcement learning algorithm which has previously been shown to cluster data. Our extension involves creating an underlying latent space with some pre-defined structure which enables us to create a topology preserving mapping. We investigate different forms of the reward function, all of which are created with the intent of merging local and global information, thus avoiding one of the major difficulties with e.g. K-means which is its convergence to local optima depending on the initial values of its parameters. We also show that the method is quite general and can be used with the recently developed method of stochastic weight reinforcement learning [14]

Community action projects: community-engaged quality improvement for medical students.

BACKGROUND: Healthcare Quality Improvement (QI) is an essential skill for medical students to acquire, although there is insufficient empirical research which suggests the best educational methods to do this. This study explored the experiences of medical students participating in two versions of a Community Action Project (CAP) which gave medical students the opportunity to learn QI skills in a community setting. The first version (GPCAP) was pre-pandemic where students identified and delivered QI projects on placement in general practice to improve local population health. The second version (Digi-CAP) ran remotely where students worked on QI projects identified by local voluntary sector organisations focused on local community priorities during COVID-19. METHODS: Semi-structured interviews were conducted with volunteers from the two cohorts of students who had taken part in quality improvement initiatives. Transcriptions were independently coded by two researchers and analysed through thematic analysis. RESULTS: Sixteen students were interviewed. Whilst students had mixed experiences of completing their CAP, engagement and successful learning was associated with the following themes from the two versions of QI CAP projects: finding a sense of purpose and meaning in QI projects; preparedness for responsibility and service-driven learning; the importance of having supportive partnerships throughout the project duration and making a sustainable difference. CONCLUSIONS AND IMPLICATIONS: The study provides valuable insights into the design and implementation of these community-based QI projects, which enabled students to learn new and often hard to teach skills, whilst working on projects which have a sustainable impact on local community outcomes

Effects of cooperation on information disclosure in mock‐witness interviews

Purpose: Forensic interviewers often face witnesses who are unwilling to cooperate with the investigation. In this experimental study, we examined the extent to which cooperativeness instructions affect information disclosure in a witness investigative interview. Methods: One hundred and thirty-six participants watched a recorded mock-crime and were interviewed twice as mock-witnesses. They were randomly assigned to one of four conditions instructing different levels of cooperativeness: Control (no instructions), Cooperation, No Cooperation, and No Cooperation plus Cooperation. The cooperativeness instructions aimed to influence how participants’ perceived the costs and benefits of cooperation. We predicted that Cooperation and No Cooperation instructions would increase and decrease information disclosure and accuracy, respectively. Results: We found decreased information disclosure and, to a lesser extent, accuracy in the No Cooperation and No Cooperation plus Cooperation conditions. In a second interview, the shift of instructions from No Cooperation to Cooperation led to a limited increase of information disclosure at no cost of accuracy. Cooperativeness instructions partially influenced the communication strategies participants used to disclose or withhold information. Conclusions: Our results demonstrate the detrimental effects of uncooperativeness on information disclosure and, to a lesser extent, the accuracy of witness statements. We discuss the implications of a lack of witness cooperation and the importance of gaining witness cooperation to facilitate information disclosure in investigative interviews

Timing of daily calorie loading affects appetite and hunger responses without changes in energy metabolism in healthy subjects with obesity

Acknowledgments The authors gratefully acknowledge Sylvia Stephen, Jean Bryce, Nina Lamza, Karen Taylor, Melanie Hudson, Kat Niblock, Ewa Wojtaczka, Aimee Sutherland, David Bremner, Claire Kidd, and Alicia Bryce at the Human Nutrition Unit of the Rowett Institute for their support in meal preparation and participant assessment. The authors acknowledge the contribution of NIHR Core Biochemistry Assay Laboratory, Cambridge Biomedical Research Centre (gut hormone analysis), and Loek Wouters at Maastricht University, Netherlands (DLW analysis). The authors also gratefully acknowledge Claus-Dieter Mayer for statistical analysis and modeling of the gastric emptying data. The authors gratefully acknowledge funding from the Medical Research Council (grant MR/P012205/1, The Big Breakfast study). A.M.J., P.J.M., G.W.H., and J.A.N.F. also acknowledge funding support from the Scottish Government, Rural and Environment Science and Analytical Services Division. Author contributions Conceptualization, design, and funding acquisition, A.M.J., P.J.M., and J.D.J.; investigation, L.C.R.-C. and C.L.F.; DLW analysis and modeling, K.R.W.; statistical analysis, G.W.H. and J.A.N.F.; writing – original draft, L.C.R.-C. and A.M.J.; writing – review & editing, all authors.Peer reviewedPublisher PD

Timing of daily calorie loading affects appetite and hunger responses without changes in energy metabolism in healthy subjects with obesity

Acknowledgments The authors gratefully acknowledge Sylvia Stephen, Jean Bryce, Nina Lamza, Karen Taylor, Melanie Hudson, Kat Niblock, Ewa Wojtaczka, Aimee Sutherland, David Bremner, Claire Kidd, and Alicia Bryce at the Human Nutrition Unit of the Rowett Institute for their support in meal preparation and participant assessment. The authors acknowledge the contribution of NIHR Core Biochemistry Assay Laboratory, Cambridge Biomedical Research Centre (gut hormone analysis), and Loek Wouters at Maastricht University, Netherlands (DLW analysis). The authors also gratefully acknowledge Claus-Dieter Mayer for statistical analysis and modeling of the gastric emptying data. The authors gratefully acknowledge funding from the Medical Research Council (grant MR/P012205/1, The Big Breakfast study). A.M.J., P.J.M., G.W.H., and J.A.N.F. also acknowledge funding support from the Scottish Government, Rural and Environment Science and Analytical Services Division.Peer reviewedPublisher PD

Revisiting Southern Hemisphere polar stratospheric temperature trends in WACCM: The role of dynamical forcing

The latest version of the Whole Atmosphere Community Climate Model (WACCM), which includes a new chemistry scheme and an updated parameterization of orographic gravity waves, produces temperature trends in the Antarctic lower stratosphere in excellent agreement with radiosonde observations for 1969-1998 as regards magnitude, location, timing, and persistence. The maximum trend, reached in November at 100hPa, is -4.42.8Kdecade(-1), which is a third smaller than the largest trend in the previous version of WACCM. Comparison with a simulation without the updated orographic gravity wave parameterization, together with analysis of the model's thermodynamic budget, reveals that the reduced trend is due to the effects of a stronger Brewer-Dobson circulation in the new simulations, which warms the polar cap. The effects are both direct (a trend in adiabatic warming in late spring) and indirect (a smaller trend in ozone, hence a smaller reduction in shortwave heating, due to the warmer environment)

Risk of Buruli Ulcer and Detection of Mycobacterium ulcerans in Mosquitoes in Southeastern Australia

Buruli ulcer (BU) is a destructive skin condition caused by infection with the environmental bacterium, Mycobacterium ulcerans. BU has been reported in more than 30 countries in Africa, the Americas, Asia and the Western Pacific. How people become infected with M. ulcerans is not completely understood, but numerous studies have explored the role of biting insects. In 2007, it was discovered that M. ulcerans could be detected in association with mosquitoes trapped in one town in southeastern Australia during a large outbreak of BU. In the present study we investigated whether there was a relationship between the incidence of BU in humans in several towns and the likelihood of detecting M. ulcerans in mosquitoes trapped in those locations. We found a strong association between the proportion of M. ulcerans-positive mosquitoes and the incidence of human disease. The results of this study strengthen the hypothesis that mosquitoes are involved in the transmission of M. ulcerans in southeastern Australia. This has implications for the development of strategies to control and prevent BU

Does police size matter?:A review of the evidence regarding restructuring police organisations

Restructuring and merging public sector organisations is often seen as a way to enhance efficiency and efficacy. There is ongoing debate about the impact of police force sizes, structures and mergers as police organisations attempt to adapt to reductions in their budgets and changes in patterns of criminality. The article reviews the evidence regarding key aspects of police reform: finding mixed evidence regarding the links between size and performance, while noting risks that mergers may impair local policing. The article discusses the impact of mergers on protective services, governance and accountability, while also discussing potential risks and opportunities associated with the merger process itself. The review finds significant gaps in the available evidence, and significant opportunities to expand the evidence base on this topic. Given current gaps in the evidence regarding size, efficacy and efficiency, it is important to give due consideration to symbolic and rhetorical aspects of mergers