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The recent experiences and impact of the COVID-19 pandemic provide a valuable lens for understanding the vulnerabilities of informal settlements and how they are positioned to respond to other large-scale hazards. This article explores the body of knowledge on the pandemic in the context of informal settlements, guided by the scoping review strategy. Our findings reveal that COVID-19 has impacted informal settlements in several ways, including increasing loss of income, food insecurity, increased gender inequality, gender-based violence and forced evictions. While there have been numerous responses to the crisis, several pre-existing factors in informal settlements impeded their implementation. We note that lessons from the pandemic provide an important opportunity to address pre-existing vulnerabilities in informal settlements to make them more resilient to both health and environmental shocks.

ObjectiveEndoscopic resection (ER) often involves referral to tertiary centres with high volume practices. Lesions can be subject to prior manipulation and mischaracterisation of features required for accurate planning, leading to prolonged or cancelled procedures. As potential solutions, repeating diagnostic procedures is burdensome for services and patients, while even enriched written reports and still images provide insufficient information to plan ER. This project sought to determine the frequency and implications of polyp mischaracterisation and whether the use of telestration might prevent it.Design/methodA retrospective data analysis of ER referrals to four tertiary centres was conducted for the period July–December 2019. Prospective telestration with a novel digital platform was then performed between centres to achieve consensus on polyp features and ER planning.Results163 lesions (163 patients; mean age 67.9±12.2 y; F=62) referred from regional hospitals, were included. Lesion site was mismatched in 11 (6.7%). Size was not mentioned in the referral in 27/163 (16.6%) and incorrect in 81/136 (51.5%), more commonly underestimated by the referring centre (ConclusionsPolyp mischaracterisation is a frequent feature of ER referrals, but could be corrected by the use of telestration between centres. Our study involved expert-to-expert consensus, so extending to ‘real-world’ referring centres would offer additional learning for a digital pathway.

A rapid but intense survey was conducted using visual landmarks in the Point Calimere Wildlife Sanctuary to enumerate the flora and foraging habits of the Blackbuck Antelope cervicapra. The area was divided into various segments such as the sanctuary entrance, Maattu muni kovil, Savukku plot or Casuarina plantation, S-Bend road and the old light house for precise enumeration. A total of 111 plant species that include 50 herbs, 16 climbers/lianas, 30 shrubs and sub-shrubs, and 15 trees belonging to 39 plant families were recorded in this study. Visual observations showed that Blackbucks grazed on grasses such as the Mangrove Grass Aeluropus lagopoides (L.) Thwaites, Dog’s Tooth Grass Cynodon barberi Rang. & Tadul., Indian Durva Grass Cynodon dactylon (L.) Pers., Feather Finger Grass Chloris virgata Sw., and a sedge, the pointed fimbristylis Fimbristylis acuminata Vahl during the day time. They were also observed browsing on the leaves and pods of Algaroba Prosopis juliflora (Sw.) DC. in the evenings. Our observation on the presence of feral horses and stray cattle in the Point Calimere Wildlife Sanctuary shows that they compete for food and water with the Blackbuck. The spread of invasive alien plant species competes with and reduces the space for native species.

Background and Aims There are no agreed-on endoscopic signs for the diagnosis of villous atrophy (VA) in celiac disease (CD), necessitating biopsy sampling for diagnosis. Here we evaluated the role of near-focus narrow-band imaging (NF-NBI) for the assessment of villous architecture in suspected CD with the development and further validation of a novel NF-NBI classification. Methods Patients with a clinical indication for duodenal biopsy sampling were prospectively recruited. Six paired NF white-light endoscopy (NF-WLE) and NF-NBI images with matched duodenal biopsy sampling including the bulb were obtained from each patient. Histopathology grading used the Marsh-Oberhuber classification. A modified Delphi process was performed on 498 images and video recordings by 3 endoscopists to define NF-NBI classifiers, resulting in a 3-descriptor classification: villous shape, vascularity, and crypt phenotype. Thirteen blinded endoscopists (5 expert, 8 nonexpert) then undertook a short training module on the proposed classification and evaluated paired NF-WLE–NF-NBI images. Results One hundred consecutive patients were enrolled (97 completed the study; 66 women; mean age, 51.2 ± 17.3 years). Thirteen endoscopists evaluated 50 paired NF-WLE and NF-NBI images each (24 biopsy-proven VAs). Interobserver agreement among all validators for the diagnosis of villous morphology using the NF-NBI classification was substantial (κ = .71) and moderate (κ = .46) with NF-WLE. Substantial agreement was observed between all 3 NF-NBI classification descriptors and histology (weighted κ = 0.72-.75) compared with NF-WLE to histology (κ = .34). A higher degree of confidence using NF-NBI was observed when assessing the duodenal bulb. Conclusions We developed and validated a novel NF-NBI classification to reliably diagnose VA in suspected CD. There was utility for expert and nonexpert endoscopists alike, using readily available equipment and requiring minimal training. (Clinical trial registration number: NCT04349904.)

Background and Aims EMR of large (≥2 cm) nonpedunculated colorectal polyps (LNPCPs) is associated with high rates of recurrent/residual adenoma, possibly because of microadenoma left at the margin of resection. Data supporting this mechanism are required. We aimed to determine the incidence of residual microadenoma at the defect margin and base after EMR. Methods We performed a retrospective observational study of patients undergoing EMR of large LNPCPs with the lateral defect margin further resected using the EndoRotor device (Interscope Medical, Inc, Worcester, Mass, USA) after confirming no visible residual adenomatous tissue. Aspects of the defect base were also resected in selected patients. Patients underwent surveillance at 3 to 6 months. Results Resection of the normal defect margin was performed in 41 patients and of aspects of the base in 21 patients. Mean lesion size was 43.0 mm (range, 20-130). Microscopic residual lesion was detected in the margin of apparently normal mucosa in 8 cases (19%). In 7 cases this was an adenoma, and in 1 case a serrated lesion was found at the margin of a resected tubular adenoma. Microscopic residual lesion was detected at the base in 5 of 21 cases. Residual/recurrent adenoma was detected in 2 patients. Neither had residual microadenoma at the lateral margin or base detected after the primary resection. Conclusions Microscopic residual adenoma after wide-field EMR was detected in 19% of cases at the apparently normal defect margin and at the resection base in 5 of 21 cases. This study confirms the presence of residual microadenoma after resection of LNPCPs, providing evidence for the mechanism of recurrence.

This dissertation is a collection of three papers, “Why undermining evolutionary debunkers is not enough,” “Absence of evidence against belief as credence one,” and “Suspending belief in credal accounts.” The role of suspension—the agnostic’s attitude that sits between belief and disbelief—is central in each paper. The first paper demonstrates that though mere undermining of the evolutionary debunker is a tempting response to their argument, it requires suspension on a premise. That is incoherent with belief in the other premise and disbelief in the conclusion. Therefore, mere undermining does not make believing we have moral knowledge epistemically permissible. The second paper demonstrates that Jane Friedman’s objection to an account of suspension as credence between 0 and 1 relies on equivocation or a false premise. Friedman’s objection entails that suspension on p is rationally permissible while one is maximally confident that not-p. I argue that these two attitudes are incoherent and so her objection fails. The third paper demonstrates that suspension should not be thought of as a credence of any kind whether precise or imprecise. Unique problems are associated with every possible credal account of suspension. This means that a traditional picture of belief, suspension, and disbelief cannot be reduced to a credal picture. Suspension is either fundamental or should be eliminated.

Background There is a trend toward organ conservation in the management of rectal tumors. However, there is no consensus on standardized investigations to guide treatment. Objective We report the value of multimodal endoscopic assessment (white light, magnification chromoendoscopy and narrow band imaging, selected colonoscopic ultrasound) for rectal early neoplastic tumors to inform treatment decisions. Design This was a retrospective study. Setting The study was conducted in a tertiary referral unit for interventional endoscopy and early colorectal cancer. Patients A total of 296 patients referred with rectal early neoplastic tumors were assessed using standardized multimodal endoscopic assessment and classified according to risk of harboring invasive cancer. Main outcome measures Sensitivity, specificity, positive and negative predictive values of multimodal endoscopic assessment, and previous biopsy to predict invasive cancer were calculated and treatment outcomes reported. Results After multimodal endoscopic assessment, lesions were classified as invasive cancer, at least deep submucosal invasion (n = 65); invasive cancer, superficial submucosal invasion or high risk of covert cancer (n = 119); or low risk of covert cancer (n = 112). Sensitivity, specificity, positive predictive values, and negative predictive values of multimodal endoscopic assessment for diagnosing invasive cancer, deep submucosal invasion, were 77%, 98%, 93%, and 93%. The combined classification of all lesions with invasive cancer or high risk of covert cancer had a negative predictive value of 96% for invasive cancer on final histopathology. Sensitivity of previous biopsy was 37%. A total of 47 patients underwent radical surgery and 33 transanal endoscopic microsurgery. No patients without invasive cancer were subjected to radical surgery; 222 patients initially underwent endoscopic resection. Of the 203 without deep submucosal invasion, 95% avoided surgery and were free from recurrence at last follow-up. Limitations This was a retrospective study from a tertiary referral unit. Conclusions Standardized multimodal endoscopic assessment guides rational treatment decisions for rectal tumors resulting in organ-conserving treatment for all patients without deep submucosal invasive cancer. See Video Abstract at http://links.lww.com/DCR/B133. LA EVALUACION ENDOSCOPICA MULTIMODAL COMO GUIA DE DECISIONES EN EL TRATAMIENTO DE TUMORES RECTALES NEOPLASICOS PRECOCES: La tendencia actual es la preservacion del organo en el manejo de los tumores de rectao. Sin embargo, no hay consenso sobre las investigaciones estandar para guiar dicho tratamiento.Presentamos los valores de la evaluacion endoscopica multimodal (luz blanca, cromoendoscopia de aumento, imagen de banda estrecha y ecografia colonoscopica seleccionada) para tumores rectales neoplasicos tempranos y asi notificar las decisiones sobre el tratamiento.Estudio retrospectivo.El estudio se realizo en una unidad de referencia terciaria para endoscopia intervencionista y cancer colorrectal temprano.Se evaluaron 296 pacientes referidos con tumores neoplasicos precoces de recto mediante una evaluacion endoscopica multimodal estandarizada y se clasificaron de acuerdo al riesgo de albergar un cancer invasivo.Se calcularon la sensibilidad, la especificidad, los valores predictivos positivos y negativos de la evaluacion endoscopica multimodal y la biopsia previa para predecir el cancer invasivo y se notificaron los resultados para el tratamiento.Despues de la evaluacion endoscopica multimodal, las lesiones se clasificaron como: cancer invasive (al menos invasion submucosa profunda n = 65); cancer invasive (invasion submucosa superficial o alto riesgo de cancer encubierto n = 119) y finalmente aquellos de bajo riesgo de cancer encubierto (n = 112). La sensibilidad, la especificidad, los valores predictivos positivos y negativos de la evaluacion endoscopica multimodal para el diagnostico de cancer invasivo, la invasion submucosa profunda fueron 77%, 98%, 93% y 93% respectivamente. La clasificacion combinada de todas las lesiones con cancer invasivo o de alto riesgo de cancer encubierto tuvo un VPN del 96% para el cancer invasivo en la histopatologia final. La sensibilidad fue de 37% en todas las biopsias previas. 47 pacientes fueron sometidos a cirugia radical, 33 por microcirugia endoscopica transanal. Ningun paciente sin cancer invasivo fue sometido a cirugia radical. Inicialmente, 222 pacientes fueron sometidos a reseccion endoscopica. De los 203 sin invasion submucosa profunda, el 95% evito la cirugia y no tuvieron recurrencia en el ultimo seguimiento.Estudio retrospectivo de una unidad de referencia terciaria.La evaluacion endoscopica multimodal estandarizada guia las decisiones racionales de tratamiento para los tumores rectales que resultan en un tratamiento conservador de organos para todos los pacientes sin cancer invasivo submucoso profundo. Consulte Video Resumen en http://links.lww.com/DCR/B133.

Objective: To investigate the Phytochemical screening, antioxidant and antimicrobial activities of the essential oil and ethanol extract of Psidium guajava. Methods: The leaf of Psidium guajavabelongs to the myrtle family (Myrtacease) which is used as herbal remedies for the cure of many ailments by natives in northern part of Nigeria, was collected in June, 2018 from the Professor’s Quarters of Modibbo Adama University of Technology (MAUTECH) Yola. The leaf was air dried, pulverized and extracted by simple overnight maceration technique and then analyzed. Fresh leaf of the aforementioned was extracted using modified steam distillation. The phytochemical screening of the ethanol extract was carried out using standard method. Results: The result revealed the present of Tannin, Flavanoid, Alkaloid, Volatile oil, Triterpene, Saponin, Glycoside while phenolic compound was absent in the ethanol extract of Psidium guajava. The result of the antioxidant activity of the essential oil was screened using DPPH method and the IC25 values of ascorbic acid (standard drug) was 57.92 µl/m and Psidium guajava of the essential oil was 46.55 µl/ml respectively. Antibacterial activity was carried out using dics diffusion method and the results showed reasonable zone of inhibition against tasted organisms, with Staphylococcus epidemidis being the most inhibited (23 mm) and Proteus vulgari being the least inhibited (2 mm) with the ethanol extract of Psidium guajava. In contrast, Staphylococcus aureus was the most inhibited (13 mm) and Salmonella typhi showed the least inhibition (9mm) in the essential oil of Psidium guajava. Conclusion: The result, thus support the use of the plants traditionally to treat chronic diarrhea, fever, diabetes, malaria and suggest its usage in the formulation of new antioxidant and antibacterial drugs.

The latest state of the art technological innovations have led to a palpable progression in endoscopic imaging and may facilitate standardisation of practice. One of the most rapidly evolving modalities is artificial intelligence with recent studies providing real-time diagnoses and encouraging results in the first randomised trials to conventional endoscopic imaging. Advances in functional hypoxia imaging offer novel opportunities to be used to detect neoplasia and the assessment of colitis. Three-dimensional volumetric imaging provides spatial information and has shown promise in the increased detection of small polyps. Studies to date of self-propelling colonoscopes demonstrate an increased caecal intubation rate and possibly offer patients a more comfortable procedure. Further development in robotic technology has introduced ex vivo automated locomotor upper gastrointestinal and small bowel capsule devices. Eye-tracking has the potential to revolutionise endoscopic training through the identification of differences in experts and non-expert endoscopist as trainable parameters. In this review, we discuss the latest innovations of all these technologies and provide perspective into the exciting future of diagnostic luminal endoscopy.

Almost any colorectal superficial neoplastic lesion can be treated by endoscopic resection (ER) but very little is known about outcomes of ER leaving circumferential or near-circumferential mucosal defects. We report the outcomes of ER leaving ≥ 75% circumferential mucosal defects performed in a western expert centre. Five hundred eighty-seven ERs of large colorectal lesions ≥ 20 mm were grouped according to the extent of the mucosal defect and comparisons made between those with