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Background/Aims This study aims to compare polyp detection performance of “Deep-GI,” a newly developed artificial intelligence (AI) model, to a previously validated AI model computer-aided polyp detection (CADe) using various false positive (FP) thresholds and determining the best threshold for each model. Methods Colonoscopy videos were collected prospectively and reviewed by three expert endoscopists (gold standard), trainees, CADe (CAD EYE; Fujifilm Corp.), and Deep-GI. Polyp detection sensitivity (PDS), polyp miss rates (PMR), and false-positive alarm rates (FPR) were compared among the three groups using different FP thresholds for the duration of bounding boxes appearing on the screen. Results In total, 170 colonoscopy videos were used in this study. Deep-GI showed the highest PDS (99.4% vs. 85.4% vs. 66.7%, p

Abstract Introduction Our simulation‐based mastery learning (SBML) curriculum, delivered in person, has been shown to successfully train novices in structured esophagogastroduodenoscopy (EGD). SBML with virtual coaching (VC) has the potential to improve the effectiveness and efficiency of endoscopy training and expand access to trainees from around the world. We share our observations conducting an EGD training course using SBML with VC. Methods We conducted a 1‐week virtual SBML course for novice trainees across seven academic centers in the USA and Asia. The cognitive component was delivered using an online learning platform. For technical skills, a virtual coach supervised hands‐on training and local coaches provided assistance when needed. At the end of training, an independent rater assessed simulation‐based performance using a validated assessment tool. We assessed the clinical performance of 30 EGDs using the ASGE Assessment of Competency in Endoscopy tool. We compared the trainees’ scores to our cohort trained using in‐person SBML training using non‐inferiority t‐tests. Results We enrolled 21 novice trainees (mean age: 30.8 ± 3.6 years; female: 52%). For tip deflection, the trainees reached the minimum passing standard after 31 ± 29 runs and mastery after 52 ± 37 runs. For structured EGD, the average score for the overall exam was 4.6 ± 0.6, similar to the in‐person cohort (4.7 ± 0.5, p = 0.49). The knowledge‐based assessment was also comparable (virtual coaching: 81.9 ± 0.1; direct coaching: 78.3 ± 0.1; p = 0.385). Over time, our novice trainees reached clinical competence at a similar rate to our historical in‐person control. Conclusions VC appears feasible and effective for training novice gastroenterology trainees. VC allowed us to scale our SBML course, expand access to experts, and administer SBML simultaneously across different sites at the highest standards.

Gastroparesis, once regarded as a rare disease, is difficult to diagnose and challenging to treat; there were many breakthrough advances in the 2010s, shifting the paradigm of the understanding of this complex entity and its management. Similar to diabetes, its increasing prevalence reflects increased accessibility to diagnostic modalities and suggests that gastroparesis was underacknowledged in the past. Major developments in the three main aspects of the disease include the discovery of smooth muscle cells, interstitial cells of Cajal, PDGFRα+ cells syncytium, rather than interstitial cells of Cajal alone, as the main gastric pacemaker unit; the development of validated point-of-care diagnostic modalities such as a wireless motility capsule, the carbon 13-labeled breath test, and impedance planimetry; and the introduction of novel minimally invasive therapeutic options such as newer pharmacologic agents and gastric peroral endoscopic pyloromyotomy. All aspects of these advances will be discussed further in this review.

Background/Aims The Thai Association for Gastrointestinal Endoscopy published recommendations on safe endoscopy during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the practicality and applicability of the recommendations and the perceptions of endoscopy personnel on them. Methods A validated questionnaire was sent to 1290 endoscopy personnel globally. Of these, the data of all 330 responders (25.6%) from 15 countries, related to the current recommendations on proper personal protective equipment (PPE), case selection, scope cleaning, and safety perception, were analyzed. Ordinal logistic regression was used to determine the relationships between the variables. Results Despite an overwhelming agreement with the recommendations on PPE (94.5%) and case selection (95.5%), their practicality and applicability on PPE recommendations and case selection were significantly lower (p=0.001, p=0.047, p

The effect of isospin-dependent nuclear forces on the inner crust of neutron stars is modeled within the framework of Quantum Molecular Dynamics (QMD). To successfully control the density dependence of the symmetry energy of neutron-star matter below nuclear saturation density, a mixed vector-isovector potential is introduced. This approach is inspired by the baryon density and isospin density-dependent repulsive Skyrme force of asymmetric nuclear matter. In isospin-asymmetric nuclear matter, the system shows nucleation, as nucleons are arranged into shapes resembling nuclear pasta. The dependence of clusterization in the system on the isospin properties is also explored by calculating two-point correlation functions. We show that, as compared to previous results that did not involve such mixed interaction terms, the energy symmetry slope L is successfully controlled by varying the corresponding coupling strength. Nevertheless, the effect of changing the slope of the nuclear symmetry energy L on the crust-core transition density does not seem significant. To the knowledge of the authors, this is the first implementation of such a coupling in a QMD model for isospin asymmetric matter, which is relevant to the inner crust of neutron and proto-neutron stars.

The landfilling of paper mill sludge (PMS) has been restricted or even banned in many countries due to the raised concern about greenhouse gas (GHG) emissions and contamination of the soil and water, calling for a sustainable PMS management approach. The potential valorization of PMS to nanomaterials combined with traditional biorefinery was examined in this work. Three types of PMS-derived cellulose nanofibrils (CNFs) were prepared and evaluated: enzymatically assisted CNF (AU: with in-house produced enzyme and CT: with commercial enzyme), mechanically pretreated CNF (BT), and chemically pretreated CNF by TEMPO oxidation (TEMPO). It was found that enzyme-assisted mechanical fibrillation-derived CNFs had a comparable average diameter (27.9 nm for AU and 22.7 nm for CT) with that produced from mechanical pretreatment (26.5 nm for BT) and TEMPO oxidation pretreatment (20.0 nm for TEMPO), and they showed the best drainage properties among the three types of CNF. The CNFs resulting from enzymatic pretreatment reduced 15% of energy consumption compared to the mechanical method and had better thermostability than TEMPO oxidation method. In addition, the on-site produced enzyme showed similar performance to the commercial enzymes towards the CNF properties. These findings provide new insights into a promising integrated strategy in engineering CNF from PMS with on-site enzyme production as a novel and sustainable approach for PMS management and valorization., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)