Background
The aim of this study was to evaluate the efficacy of a novel bowel preparation and booster regimen for colon capsule endoscopy (CCE) using macrogol, phospho-soda and gastrografin, ...compared with a control regimen consisting of polyethylene glycol and sodium picosulfate.
Methods
This was a prospective cohort study using historical controls. Symptomatic patients undergoing CCE between 11/07/2021 and 21/12/2021 using the novel regimen were included. Symptomatic patients who underwent CCE in the ScotCap evaluation using the control regimen were used as historical controls. We measured the rate of complete test (visualisation of the whole colon and rectum), adequate bowel preparation, successful test (complete and adequate bowel preparation) and need for further test following CCE. The rate of adverse events was also collected.
Results
Patients undergoing CCE using the new and control regimen were 200 and 316, respectively. The median age, age range and proportion of female patients in the new and control regimen cohorts was 61 vs 60 years, 16–86 vs 20–83 years, and 60.5% vs 56.6%. The rate of complete test, adequate bowel reparation and successful test for the new and control regimen was 69% vs 72.2%, 86.6% vs 80.7% and 60.5% vs 65.8%. Comparing the new and control regimen, 39.5% vs 37.3% of patients required no test following CCE, 26% vs 32.6% required a colonoscopy, 31.5% vs 21.5% required a flexible sigmoidoscopy and 3% vs 2.9% required a computed tomography colonogram. No adverse events were reported using the new regimen compared to 2 (0.6%) in the control group.
Conclusions
The rate of adequate bowel preparation has improved following the introduction of a new regimen. However, further work is needed to increase the complete test rate. A significant proportion of patients continue to avoid colonoscopy following CCE.
Aim
The coronavirus pandemic has led to significant challenges for healthcare delivery across the globe. Non‐emergency endoscopic activity in the UK has been postponed, raising concerns of increased ...delays in the diagnosis of colorectal cancer and a surge in demand once services resume. Measures to mitigate this risk must be considered.
Method
This paper reviews various investigative modalities for colorectal disease which could be deployed during cessation of colonoscopy services. We focus on colon capsule endoscopy (CCE) due to its relevance during the COVID‐19 pandemic and its ability to triage patients effectively to further endoscopic investigations.
Results
CT of the abdomen and pelvis has been suggested as a triage tool while access to colonoscopy is limited. However, CT may lead to the spread of COVID‐19 as patients attend the hospital, and it exposes them to the risks of radiation. Faecal immunochemistry tests have been demonstrated as a good predictor of colonic pathology and could be safely used to risk stratify patients when prioritizing colonoscopy. CCE is a safe and innovative technology for investigating the colon. Procedures can be carried out in the community and can be conducted safely during the coronavirus pandemic. It has been shown to be an accurate detector of colonic neoplasia and can reduce demand for colonoscopy.
Conclusion
As colonoscopy services resume, they will probably experience high demand leading to further delays for patients. CCE could be used to reduce the number of patients requiring colonoscopy and triage those requiring further endoscopic investigations appropriately.
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The identification and SAR development of a series of negative allosteric modulators of the GABAA α5 receptor is described. This novel series of compounds was optimised to provide ...analogues with high GABAA α5 binding affinity, high α5 negative allosteric modulatory activity, good functional subtype selectivity and low microsomal turnover, culminating in identification of ONO-8590580.
Background. A systematic review of randomized controlled trials (RCTs) comparing continuous ambulatory peritoneal dialysis (CAPD) with all forms of automated peritoneal dialysis (APD) was performed ...to assess their comparative clinical effectiveness. Methods. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL, were searched for relevant RCTs. Analysis was by a random effects model and results expressed as relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI). Results. Three trials (139 patients) were identified. APD when compared to CAPD was found to have significantly lower peritonitis rates (two trials, 107 patients, rate ratio 0.54, 95% CI 0.35–0.83) and hospitalization rates (one trial, 82 patients, rate ratio 0.60, 95% CI 0.39–0.93) but not exit-site infection rates (two trials, 107 patients, rate ratio 1.00, 95% CI 0.56–1.76). However no differences were detected between APD and CAPD in respect to risk of mortality (RR 1.49, 95% CI 0.51–4.37), peritonitis (RR 0.75, 95% CI 0.50–1.11), switching from the original peritoneal dialysis (PD) modality to a different dialysis modality including an alternative form of PD (RR 0.50, 95% CI 0.25–1.02), PD catheter removal (RR 0.64, 95% CI 0.27–1.48) and hospital admissions (RR 0.96, 95% CI 0.43–2.17). Patients on APD were found to have significantly more time for work, family and social activities. Conclusions. APD appears to be more beneficial than CAPD, in terms of reducing peritonitis rates and with respect to certain social issues that impact on patients’ quality of life. Further, adequately powered trials are required to confirm the benefits for APD found in this review and detect differences with respect to other clinically important outcomes that may have been missed by the trials included in this review due to their small size and short follow-up periods.
ABSTRACT BACKGROUND Indigenous youth have higher rates of chronic health conditions interfering with healthy development, including high rates of ear, dental, chest and musculoskeletal pain, as well ...as headache, arthritis and mental health issues. This study explores differences in pain-related diagnoses in First Nations and non–First Nations children. METHODS Data from a study population of age- and sex-matched First Nations and non–First Nations children and youth were accessed from a specific region of Atlantic Canada. The primary objective of the study was to compare diagnosis rates of painful conditions and specialist visits between cohorts. The secondary objective was to determine whether there were correlations between early physical pain exposure and pain in adolescence (physical and mental health). RESULTS Although ear- and throat-related diagnoses were more likely in the First Nations group than in the non–First Nations group (ear 67.3% v. 56.8%, p < 0.001; throat 89.3% v. 78.8%, p < 0.001, respectively), children in the First Nations group were less likely to see a relevant specialist (ear 11.8% v. 15.5%, p < 0.001; throat 12.7% v. 16.1%, p < 0.001, respectively). First Nations newborns were more likely to experience an admission to the neonatal intensive care unit (NICU) than non–First Nations newborns (24.4% v. 18.4%, p < 0.001, respectively). Non–First Nations newborns experiencing an NICU admission were more likely to receive a mental health diagnosis in adolescence, but the same was not found with the First Nations group (3.4% v. 5.7%, p < 0.03, respectively). First Nations children with a diagnosis of an ear or urinary tract infection in early childhood were almost twice as likely to have a diagnosis of headache or abdominal pain as adolescents (odds ratio OR 1.9, 95% confidence interval CI 1.1–3.0, and OR 1.7, 95% CI 1.2–2.3, respectively). INTERPRETATION First Nations children were diagnosed with more pain than non–First Nations children, but did not access specific specialists or mental health services, and were not diagnosed with mental health conditions, at the same rate as their non–First Nations counterparts. Discrepancies in pain-related diagnoses and treatment are evident in these specific comparative cohorts. Community-based health care access and treatment inquiries are required to determine ways to improve care delivery for common childhood conditions that affect health and development.
The Long-Rains wet season of March–May (MAM) over Kenya in 2018 was one of the wettest on record. This paper examines the nature, causes, impacts, and predictability of the rainfall events, and ...considers the implications for flood risk management. The exceptionally high monthly rainfall totals in March and April resulted from several multi-day heavy rainfall episodes, rather than from distinct extreme daily events. Three intra-seasonal rainfall events in particular resulted in extensive flooding with the loss of lives and livelihoods, a significant displacement of people, major disruption to essential services, and damage to infrastructure. The rainfall events appear to be associated with the combined effects of active Madden–Julian Oscillation (MJO) events in MJO phases 2–4, and at shorter timescales, tropical cyclone events over the southwest Indian Ocean. These combine to drive an anomalous westerly low-level circulation over Kenya and the surrounding region, which likely leads to moisture convergence and enhanced convection. We assessed how predictable such events over a range of forecast lead times. Long-lead seasonal forecast products for MAM 2018 showed little indication of an enhanced likelihood of heavy rain over most of Kenya, which is consistent with the low predictability of MAM Long-Rains at seasonal lead times. At shorter lead times of a few weeks, the seasonal and extended-range forecasts provided a clear signal of extreme rainfall, which is likely associated with skill in MJO prediction. Short lead weather forecasts from multiple models also highlighted enhanced risk. The flood response actions during the MAM 2018 events are reviewed. Implications of our results for forecasting and flood preparedness systems include: (i) Potential exists for the integration of sub-seasonal and short-term weather prediction to support flood risk management and preparedness action in Kenya, notwithstanding the particular challenge of forecasting at small scales. (ii) We suggest that forecasting agencies provide greater clarity on the difference in potentially useful forecast lead times between the two wet seasons in Kenya and East Africa. For the MAM Long-Rains, the utility of sub-seasonal to short-term forecasts should be emphasized; while at seasonal timescales, skill is currently low, and there is the challenge of exploiting new research identifying the primary drivers of variability. In contrast, greater seasonal predictability of the Short-Rains in the October–December season means that greater potential exists for early warning and preparedness over longer lead times. (iii) There is a need for well-developed and functional forecast-based action systems for heavy rain and flood risk management in Kenya, especially with the relatively short windows for anticipatory action during MAM.
Sustainability indicators are well recognized for their potential to assess and monitor sustainable development of agricultural systems. A large number of indicators are proposed in various ...sustainability assessment frameworks, which raises concerns regarding the validity of approaches, usefulness and trust in such frameworks. Selecting indicators requires transparent and well-defined procedures to ensure the relevance and validity of sustainability assessments. The objective of this study, therefore, was to determine whether experts agree on which criteria are most important in the selection of indicators and indicator sets for robust sustainability assessments. Two groups of experts (Temperate Agriculture Research Network and New Zealand Sustainability Dashboard) were asked to rank the relative importance of eleven criteria for selecting individual indicators and of nine criteria for balancing a collective set of indicators. Both ranking surveys reveal a startling lack of consensus amongst experts about how best to measure agricultural sustainability and call for a radical rethink about how complementary approaches to sustainability assessments are used alongside each other to ensure a plurality of views and maximum collaboration and trust amongst stakeholders. To improve the transparency, relevance and robustness of sustainable assessments, the context of the sustainability assessment, including prioritizations of selection criteria for indicator selection, must be accounted for. A collaborative design process will enhance the acceptance of diverse values and prioritizations embedded in sustainability assessments. The process by which indicators and sustainability frameworks are established may be a much more important determinant of their success than the final shape of the assessment tools. Such an emphasis on process would make assessments more transparent, transformative and enduring.
Ecological engineering principles are increasingly being applied to develop multifunctional artificial structures or rehabilitated habitats in coastal areas. Ecological engineering initiatives are ...primarily driven by marine scientists and coastal managers, but often the views of key user groups, which can strongly influence the success of projects, are not considered. We used an online survey and participatory mapping exercise to investigate differences in priority goals, sites and attitudes towards ecological engineering between marine scientists and coastal managers as compared to other stakeholders. The surveys were conducted across three Australian cities that varied in their level of urbanisation and environmental pressures. We tested the hypotheses that, relative to other stakeholders, marine scientists and coastal managers will: 1) be more supportive of ecological engineering; 2) be more likely to agree that enhancement of biodiversity and remediation of pollution are key priorities for ecological engineering; and 3) identify different priority areas and infrastructure or degraded habitats for ecological engineering. We also tested the hypothesis that 4) perceptions of ecological engineering would vary among locations, due to environmental and socio-economic differences. In all three harbours, marine scientists and coastal managers were more supportive of ecological engineering than other users. There was also greater support for ecological engineering in Sydney and Melbourne than Hobart. Most people identified transport infrastructure, in busy transport hubs (i.e. Circular Quay in Sydney, the Port in Melbourne and the Waterfront in Hobart) as priorities for ecological engineering, irrespective of their stakeholder group or location. There were, however, significant differences among locations in what people perceive as the key priorities for ecological engineering (i.e. biodiversity in Sydney and Melbourne vs. pollution in Hobart). Greater consideration of these location-specific differences is essential for effective management of artificial structures and rehabilitated habitats in urban embayments.
•Marine ecological engineering projects require greater consideration of social values.•Most users (>70%) are supportive of ecological engineering.•Boating infrastructure in busy transport hubs are key priorities for ecological engineering.•Residents in Sydney and Melbourne focused on improving biodiversity.•Residents in Hobart were more concerned about remediating pollution.
Routine HIV-1 antiretroviral drug resistance testing for patients failing NNRTI-based regimens is not recommended in resource-limited settings. Therefore, surveys are required to monitor resistance ...profiles in patients failing ART.
A cross-sectional survey was conducted amongst patients failing NNRTI-based regimens in the public sector throughout South Africa. Virological failure was defined as two consecutive HIV-1 viral load results >1000 RNA copies/mL. Pol sequences were obtained using RT-PCR and Sanger sequencing and submitted to Stanford HIVdb v7.0.1.
A total of 788 sequences were available for analysis. Most patients failed a tenofovir-based NRTI backbone (74.4%) in combination with efavirenz (82.1%) after median treatment duration of 36 months. K103N (48.9%) and V106M (34.9%) were the most common NNRTI mutations. Only one-third of patients retained full susceptibility to second-generation NNRTIs such as etravirine (36.5%) and rilpivirine (27.3%). After M184V/I (82.7%), K65R was the most common NRTI mutation (45.8%). The prevalence of K65R increased to 57.5% in patients failing a tenofovir regimen without prior stavudine exposure. Cross-resistance to NRTIs was often observed, but did not seem to affect the predicted activity of zidovudine as 82.9% of patients remained fully susceptible to this drug.
The introduction of tenofovir-based first-line regimens has dramatically increased the prevalence of K65R mutations in the HIV-1-infected South African population. However, most patients failing tenofovir-based regimens remained fully susceptible to zidovudine. Based on these data, there is currently no need to change either the recommended first- or second-line ART regimens in South Africa.
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