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Curriculum for safe and effective use of artificial intelligence in endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
No full textThe European Society of Gastrointestinal Endoscopy (ESGE) has identified a critical need to establish structured training for safe and effective use of artificial intelligence (AI) in endoscopy. This manuscript presents the results of a formal Delphi consensus process and outlines the official ESGE position, offering a comprehensive curriculum for acquiring and maintaining the competence needed to exploit the benefit of using AI tools in endoscopy. The proposed framework defines the prerequisites in the preadoption phase, core training components, and requirements to maintain optimal implementation. Key recommendations include: (1) ensuring basic competency in standard endoscopy procedures; (2) acquiring foundational knowledge of AI principles; (3) implementing educational programs to enhance AI literacy; (4) recognizing and mitigating cognitive biases in human–AI interaction; (5) avoiding over-reliance on AI in clinical decision-making; and (6) continuous monitoring of key performance indicators throughout AI system integration
Soil formation and weathering over the past 60 kyr reconstructed using lithium isotopes from Maar records
No full textChemical weathering of silicate rocks is a fundamental control on the carbon cycle, although on timescales shorter than a few tens of kyr, transient carbon storage becomes more important. However, weathering can still act as an amplifier or inhibitor of the carbon cycle on these timescales. Further, weathering produces soils, a storage reservoir of carbon, although the rate at which soils can be produced is likely highly variable, and remains uncertain. Here, we use lithium isotopes in laminated maar sediments from western Germany to examine weathering and soil formation rates, principally across the rapid warming transitions of Greenland Interstadials (GI), also known as Dansgaard Oeschger (D/O) events, and rapid cooling of Greenland Stadials (GS). Our principal finding is that Li isotope ratios are higher during cooler periods, both on glacial-interglacial and GI-GS event scales. Thus, δ7Li values average −2.5 ± 1.6‰ during GI events, and −1.5 ± 1.5‰ in the intervening colder stadial events. Based on the evolution of Li isotopes with weathering, this suggests that there was more soil formation relative to primary mineral dissolution during cooler compared to warmer events. That is not to say that weathering rates were higher, but that clay formation was amplified relative to a given weathering rate when it was cooler, due to the combination of lower erosion rates, thermodynamically favoured conditions for clay formation, and enhanced water–rock contact times, promoting secondary mineral formation. Overall, the data show that soil formation responds even through rapid (∼100 years) climate change events
On the general linear group over polynomial rings
No full textWithin algebraic K-theory, when A ↠ B is a ring homomorphism it is frequently
important to determine the image of the induced homomorphism GLk(A) → GLk(B).
We show that, if A = A[t, t
−1
, x] is a ring of mixed polynomials and Laurent polynomials over a commutative ring A of Krull dimension 1 and B = F[t, t
−1
, x] is
the corresponding ring over a finite quotient ring F of A then, SLk(A) → SLk(B) is
surjective for all k ≥ 2, provided every stably free A-module is free
Operational efficiencies reduce emission intensity of online shopping in China by one-third between 2000 and 2023
No full textHeart failure in patients with acute myeloid leukemia (AML) treated with anthracycline agents during remission induction therapy: a systematic review and meta-analysis
No full textPatients with acute myeloid leukemia (AML) are at increased risk of cardiovascular disease, particularly heart failure. Anthracyclines are integral to remission induction therapy in patients eligible for intensive treatment and well-known for their association with cardiotoxicity. However, the incidence of heart failure and other cardiovascular adverse events (CVAEs), as well as differences across various anthracycline agents, has not been comprehensively assessed. We systematically searched PubMed and EMBASE for studies conducted in AML patients treated with anthracyclines during remission induction. Forty-one studies (5995 patients), primarily clinical trials, published between February 1991 and March 2024 were included. The pooled proportion of heart failure was 3.2% (95% CI 1.0–6.2) overall and 2.3% (95% CI 1.4–3.3), 5.0% (95% CI 0.3–14.1) and 10.2% (95% CI 2.4–21.7) for patients treated with daunorubicin, idarubicin or mitoxantrone respectively. Cardiac function was infrequently monitored, and CVAE reporting was generally poor. Since current adverse event grading systems primarily rely on clinical symptoms to assign severity, significant asymptomatic declines in cardiac function will remain undetected. Enhanced CVAE monitoring and reporting, along with revisions to established grading systems, is needed to better identify subclinical cardiotoxicity in AML patients, enabling timely intervention to prevent progression to more advanced heart failure stages. (Figure presented.
‘It is not a topic that should be assessed by a test’: Understanding teachers' assessment literacy in the teaching of ‘difficult histories’ such as the Holocaust
No full textThis paper explores how history teachers in secondary education in England (a) see their role as assessors and (b) how they make decisions about assessing a difficult history: learning about the Holocaust. Assessment literacy (AL) is recognised as a potentially valuable aspect of good teaching and central to supporting students' learning, enabling them to be reflective learners. This paper argues that not only is the task of choosing appropriate assessments demanding for ‘difficult histories’ such as in this instance the Holocaust, but there are inherent tensions relating to the idea of assessing such learning at all. Using data from a national survey with secondary history teachers, we were able to explore practice and beliefs about the nature of assessing learning about the Holocaust, and these responses suggested some characteristics of teachers' AL. We found that ‘traditional’ forms of assessment still predominate, but that the subject matter in Holocaust education opens a space for more ‘non-traditional’ approaches that are not normally so apparent, in particular discursive and creative forms. Teachers demonstrate a significant amount of uncertainty, ambiguity and anxiety over what appropriate assessment might look like, and for some, whether topics such as the Holocaust should be assessed at all. Assessment plays a vital role in supporting effective students’ learning, and our findings suggest there is a need for further research into teachers' AL and how their practice might be better supported in the teaching and assessing of ‘difficult histories’
Open Fetal Versus Postnatal Repair of Spina Bifida Aperta-A Comparison of Neonatal Outcomes
No full textOBJECTIVES: To compare the 30-day outcomes of infants undergoing fetal versus postnatal repair of open spina bifida (OSB) who met the equivalent eligibility criteria. METHOD: A retrospective study of consecutive patients who underwent OSB repair (2018-2022) by a consistent pediatric neurosurgical team. All met the MOMS trial fetal surgery criteria. Primary outcomes included cerebrospinal fluid (CSF) complications, motor function, wound complications and non-neurosurgical neonatal complications within 30 days of birth. RESULTS: Among 109 myelomeningocele repairs (82 fetal and 27 postnatal), postnatal repairs had higher mean birthweight (3116.8 vs. 2477.8 g; p < 0.01) and gestational age at delivery (38 + 1 vs. 34 + 4 weeks + days; p < 0.01). Neonates with fetal repair were less likely to require hydrocephalus treatment (9% vs. 56%, p < 0.01) or have CSF leak (1% vs. 19%, p < 0.01). Wound infection (5.2% vs. 14.8%; p = 0.10) and dehiscence (2.6% vs. 14.8%; p = 0.09) rates were comparable. Respiratory distress syndrome was more frequent with fetal surgery (43% vs. 4%; p < 0.004), although neonatal intensive care (NICU) admission (34% vs. 26%) and neonatal hospital stay were comparable (fetal repair: 15.2 days ± 2.1 vs. postnatal repair: 14.8 days ± 3.1, p = 0.91). CONCLUSIONS: Open fetal repair was associated with earlier delivery but with comparable NICU and hospital stay and lower hydrocephalus treatment rate at 1 month of age
UAV-RHS-Enabled Full-Duplex ISAC Covert System: Robust Beamforming and Trajectory Optimization
No full textThis paper proposes a novel covert transmission framework for an uncrewed aerial vehicle (UAV)-reconfigurable holographic surface (RHS)-aided full-duplex (FD) integrated sensing and communication (ISAC) system, where the aerial access point (AP) simultaneously performs target sensing and downlink covert communication. We jointly design the AP’s downlink transmit signal and uplink receive beamformers, the RHS weights, the users’ uplink transmit powers, and the UAV’s trajectory, considering imperfect knowledge of the warden’s channel state information (CSI). An optimization problem is formulated to maximize the minimum covert transmission rate (CTR) among all downlink covert users (DCUs), subject to constraints on required sensing and uplink transmission capabilities, covertness, and total power budget. To tackle the intractable non-convex problem, we leverage the Bernstein-type inequality, majorization-minimization (MM), and successive convex approximation (SCA), and propose a secure optimization framework that efficiently updates all variables using convex optimization techniques. To further understand the proposed algorithm, its convergence behavior and computational complexity are discussed. Simulation results demonstrate that integrating RHS and UAV techniques into the optimization design enhances the covert transmission performance of FD-ISAC systems while ensuring a certain level of sensing capability
Equitable and culturally sensitive perinatal mental health screening and referral for all: experiences and needs from primary care and community-based healthcare providers
No full textMETHODS: A qualitative study design was employed, conducting focus groups with primary care and community-based healthcare providers. Participants were recruited through a purposive sampling strategy using newsletters, social media, and email. Discussions were recorded, verbatim transcribed, and analysed using inductive framework analysis. To ensure credibility, a member check survey was conducted. RESULTS: Based on the analysis of five heterogeneous focus groups (n = 20 in total), four themes and seven subthemes were identified: (1) complexity of interactions between healthcare providers and migrant women: underscoring (a) the impact of cultural and language barriers and (b) the importance of a trusting relationship; (2) screening in its context: highlighting (c) the ambivalence around screening and (d) the impact of organisational and financial factors on implementation; (3) accessible referral: stressing (e) the importance of person-centred, culturally and linguistically appropriate services; and (4) PMH in its proper context: addressing (f) the role of stigma, taboo, PMH literacy, and understanding, and (g) the involvement of women’s partner, family and broader network. CONCLUSIONS: These findings underscore the complexity of screening and referral practices among all (expectant) mothers, particularly among women from migrant communities, and simultaneously offer a foundation to develop and implement screening and referral protocols. Ideally, these protocols should be co-designed with perinatal service users to ensure equitable practices for all
Coordinated pathways to a low-carbon, healthy, and equitable food system in China
No full textTackling the ongoing challenges of food insecurity and nutritional deficiencies may complicate efforts to reduce carbon emissions within the food system, a critical component of meeting the climate target. Spatial disparities in food distribution further intensify existing inequalities. This study enhances a widely used regional integrated assessment model by incorporating a novel bottom-up lifecycle assessment framework for China’s food system at the provincial level. It evaluates trade-offs and explores synergies across strategies aimed at balancing healthy diets, low carbon emissions, and reduced inequalities through 2060. The results indicate that implementing single mitigation measures may increase food costs and exacerbate inequality without achieving the target carbon emission mitigation goal. However, a coordinated approach integrating actions across the supply chain, consumer demand, and land management transformation could reduce greenhouse gas emissions by 41.7%, improve nutritional quality by 24.4%, and decrease inequality by 21.9% by 2060. This study highlights the need for a cross-sectoral and regionally coordinated food system framework to achieve the climate target, ensure adequate nutrition, and foster an affordable, equitable food system