Endoscopic control of polyp burden and expansion of surveillance intervals in serrated polyposis syndrome

Introduction Serrated polyposis syndrome (SPS) increases colorectal cancer (CRC) risk. We describe the numbers of colonoscopies and polypectomies performed to achieve and maintain low polyp burdens, and the feasibility of expanding surveillance intervals in patients who achieve endoscopic control. Methods We retrospectively evaluated a prospectively collected database on 115 SPS patients undergoing surveillance at Indiana University Hospital between June 2005 and May 2018. The endoscopist provided surveillance interval recommendations based on polyp burden. Endoscopic control was considered successful if surveillance examinations exhibited fewer polyps and if no or only an occasional polyp ≥1 cm in size was present at follow-up. Initial control was designated the clearing phase and the maintenance phase was surveillance after control was established. Results In total, 87 patients (75.7%) achieved endoscopic control, with some others in the clearing phase at this writing. Achieving control required a mean of 2.84 colonoscopies (including the baseline) over 20.4 months and a mean total 27.9 polyp resections. After establishing control, 71 patients were recommended to receive ≥24-month follow-up. Of those, 60 patients (69.0% of patients with initial control) continued surveillance at our center. The mean interval between colonoscopies during maintenance was 19.3 months with 6.74 mean polypectomies per procedure on polyps primarily <1 cm. There were no incident cancers or colon surgeries during maintenance. Conclusion Most patients achieved control of polyp burden with 2 to 3 colonoscopies over 1 to 2 years. After reaching control, 60 patients returned at intervals up to 24 months with no incident cancers and no surgeries required. Expansion of surveillance intervals to 24 months is effective and safe for many SPS patients who reach control of polyp burden

White and non-White Australian mental health care practitioners’ desirable responding, cultural competence, and racial/ethnic attitudes

Background: Racial, ethnic, religious, and cultural diversity in Australia is rapidly increasing. Although Indigenous Australians account for only approximately 3.5% of the country’s population, over 50% of Australians were born overseas or have at least one migrant parent. Migration accounts for over 60% of Australia’s population growth, with migration from Asia, Sub-Saharan African and the Americas increasing by 500% in the last decade. Little is known about Australian mental health care practitioners’ attitudes toward this diversity and their level of cultural competence. Aim: Given the relationship between practitioner cultural competence and the mental health outcomes of non-White clients, this study aimed to identify factors that influence non-White and White practitioners’ cultural competence. Methods: An online questionnaire was completed by 139 Australian mental health practitioners. The measures included: the Balanced Inventory of Desirable Responding (BIDR); the Multicultural Counselling Inventory (MCI); and the Color-blind Racial Attitudes Scale (CoBRAS). Descriptive statistics were used to summarise participants’ demographic characteristics. One-way ANOVA and Kruskal–Wallis tests were conducted to identify between-group differences (non-White compared to White practitioners) in cultural competence and racial and ethnic blindness. Correlation analyses were conducted to determine the association between participants’ gender or age and cultural competence. Hierarchical multiple regression analysis was conducted to predict cultural competence. Results: The study demonstrates that non-White mental health practitioners are more culturally aware and have better multicultural counselling relationships with non-White people than their White counterparts. Higher MCI total scores (measuring cultural competence) were associated with older age, greater attendance of cultural competence-related trainings and increased awareness of general and pervasive racial and/or ethnic discrimination. Practitioners with higher MCI total scores were also likely to think more highly of themselves (e.g., have higher self-deceptive positive enhancement scores on the BIDR) than those with lower MCI total scores. Conclusion: The findings highlight that the current one-size-fits-all and skills-development approach to cultural competence training ignores the significant role that practitioner diversity and differences play. The recommendations from this study can inform clinical educators and supervisors about the importance of continuing professional development relevant to practitioners’ age, racial/ethnic background and practitioner engagement with prior cultural competence training

Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoring.

In high-income countries, viral load is routinely measured to detect failure of antiretroviral therapy (ART) and guide switching to second-line ART. Viral load monitoring is not generally available in resource-limited settings. We examined switching from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line regimens to protease inhibitor-based regimens in Africa, South America and Asia

Evaluating the Impact of an Interprofessional Practice Experience Involving Pharmacy and Dental Students on Medication Histories within an Urban Academic Dental Admissions Clinic

Primary Objective: To compare interprofessional (IP) care versus standard care on medication history clarifications in dental patients. Secondary Objectives: To assess the clinical significance of these clarifications with regards to the potential impact on dental treatment plans. To describe the interventions provided by IP care to clarify discrepancies and/or resolve medication-related problems

Prisoner's Dilemma cellular automata revisited: evolution of cooperation under environmental pressure

We propose an extension of the evolutionary Prisoner's Dilemma cellular automata, introduced by Nowak and May \cite{nm92}, in which the pressure of the environment is taken into account. This is implemented by requiring that individuals need to collect a minimum score $U_{min}$, representing indispensable resources (nutrients, energy, money, etc.) to prosper in this environment. So the agents, instead of evolving just by adopting the behaviour of the most successful neighbour (who got $U^{msn}$), also take into account if $U^{msn}$ is above or below the threshold $U_{min}$. If $U^{msn}<U_{min}$ an individual has a probability of adopting the opposite behaviour from the one used by its most successful neighbour. This modification allows the evolution of cooperation for payoffs for which defection was the rule (as it happens, for example, when the sucker's payoff is much worse than the punishment for mutual defection). We also analyse a more sophisticated version of this model in which the selective rule is supplemented with a "win-stay, lose-shift" criterion. The cluster structure is analyzed and, for this more complex version we found power-law scaling for a restricted region in the parameter space.Comment: 15 pages, 8 figures; added figures and revised tex

The Marco Gonzalez Maya site, Ambergris Caye, Belize: assessing the impact of human activities by examining diachronic processes at the local scale

Research at the Maya archaeological site of Marco Gonzalez on Ambergris Caye in Belize is socio-ecological because human activities have been a factor in the formation and fluctuation of the local marine and terrestrial environments over time. The site is one of many on Belize's coast and cayes that exhibit anomalous vegetation and dark-coloured soils. These soils, although sought for cultivation, are not typical 'Amazonian Dark Earths' but instead are distinctive to the weathering of carbonate-rich anthropogenic deposits. We tentatively term these location-specific soils as Maya Dark Earths. Our research seeks to quantify the role of human activities in long-term environmental change and to develop strategies, specifically Life Cycle Assessment (LCA), that can be applied to environmental impact modelling today

'It's the other assessment that is the key': three Norwegian physical education teachers' engagement (or not) with assessment for learning

peer-reviewedThe international agenda for assessment continues to convey a growing interest in assessment for learning (AfL) as a tool to support learning and enhance teaching. Complementing this, the recent literature on assessment in physical education acknowledges the need for physical educators to integrate AfL into their teaching and assessment practice as an important part of the future development of the subject. Appreciating that physical education must be recognized as part of the larger movement culture in society and is a place to learn about movement culture, this study explores how AfL is understood and enacted by physical education teachers and the extent to which such enactment complements or challenges learning movement cultures within physical education. This study shares how three Norwegian physical education teachers used AfL to term what they were practicing with respect to assessment in physical education. We follow the interactions of the selected teachers throughout focus groups, using the empirical data as our 'dialogue partner' in reconstructing and discussing their assessment stories. We conclude that the need of embedding AfL in learning theory may well be one of the strongest challenges to enacting AfL in physical education. We acknowledge that not only are most existing theories of learning defined cognitively, but also that learning connected to physical education and activity is, to a large extent, practical and embodied, and also linked to the powerful discourses of sport and related areas such as health.PUBLISHEDpeer-reviewe

Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

Objectives To determine the safety and effectiveness of the middle cranial fossa (MCF) approach in repairing spontaneous cerebrospinal fluid (sCSF) leaks. Study Design Retrospective cohort study. Methods Patient with sCSF leaks repaired by MCF approach between January 1, 2014 and August 31, 2019 were included. Demographic information, clinical and surgical findings, and postoperative outcomes were recorded. Results The cohort (n = 45) included 24 tegmen repairs by multilayer reconstruction using hydroxyapatite cement and 21 cases of multilayer repair without hydroxyapatite cement. Ten MCF repairs were performed on patients ≥65 years old. Twenty (53%) ears had multiple tegmen defects (range, 1–9 tegmen defects) and 78% of patients had ≥1 encephaloceles. All sCSF leaks were resolved with one surgical intervention. There were no major intracranial complications. Transient expressive aphasia occurred in 2 patients. Medical complications occurred in four patients. There were no short-term postoperative CSF leaks with bone cement reconstruction and two postoperative leaks without bone cement. One resolved with lumbar drain (LD) and the other resolved without treatment. The average (SD) length of stay (LOS) with bone cement was shorter than in patients without bone cement (2.54 [0.83] days vs. 3.52 [1.99] days, P < .05). There have been no long-term CSF leak recurrences with an average (SD) follow-up of 13.5 (12.9) months (range 0.25–46 months). Conclusions MCF approach for sCSF repairs demonstrate efficacious outcomes, particularly with tegmen reconstruction using hydroxyapatite cement. The approach exhibited no serious adverse events and few complications requiring intervention. Therefore, MCF is a safe and effective approach to resolve sCSF leaks

Sexual Power and HIV Risk, South Africa1

Among a sample of young women, limited sexual power was associated with inconsistent condom use but not directly with HIV