Accuracy and Inter-observer Agreement Among Endoscopists for Visual Identification of Colorectal Polyps Using Endoscopy Images.

BACKGROUND: It is essential to accurately distinguish small benign hyperplastic colon polyps (HP) from sessile serrated lesions (SSL) or adenomatous polyps (TA) based on endoscopic appearances. Our objective was to determine the accuracy and inter-observer agreements for the endoscopic diagnosis of small polyps. METHODS: High-quality endoscopic images of 30 small HPs, SSLs, and TAs were used randomly to create two-timed PowerPoint slide sets-one with and another one without information on polyp size and location. Seven endoscopists viewed the slides on two separate occasions 90 days apart, identified the polyp type, and graded their confidence level. Overall and polyp-specific accuracies were assessed for the group and individual endoscopists. Chi-square tests and Kappa (κ) statistics were used to compare differences as appropriate. RESULTS: When polyp size and location were provided, overall accuracy was 67.1% for TAs, 50.0% for SSLs, and 41.4% for HPs; the corresponding accuracies were 60%, 44.3%, and 34.3% when polyp size and location were withheld (p < .001). Inter-observer agreement was moderate for TAs (κ = 0.50) and fair for SSLs (κ = 0.26) and HPs (κ = 0.29); the corresponding inter-observer agreements were 0.44, 0.31, and 0.17 with polyp size and location withheld. Accuracy was not affected by knowledge of polyp size, location, or confidence level. Endoscopists with ≥ 10 years (vs. < 10 years) of colonoscopy experience had marginally higher (56% vs. 40%, p = 0.05) accuracy for SSL diagnosis. CONCLUSIONS: The ability to distinguish between small TAs, SSLs, and HPs on their endoscopic appearance is poor regardless of the endoscopists' knowledge of polyp size and location.

Medial prefrontal cortex neuronal activation and synaptic alterations after stress-induced reinstatement of palatable food seeking: a study using c-fos-GFP transgenic female rats.

Relapse to maladaptive eating habits during dieting is often provoked by stress and there is evidence for a role of ovarian hormones in stress responses and feeding. We studied the role of these hormones in stress-induced reinstatement of food seeking and medial prefrontal cortex (mPFC) neuronal activation in c-fos-GFP transgenic female rats, which express GFP in strongly activated neurons. Food-restricted ovariectomized or sham-operated c-fos-GFP rats were trained to lever-press for palatable food pellets. Subsequently, lever-pressing was extinguished and reinstatement of food seeking and mPFC neuronal activation was assessed after injections of the pharmacological stressor yohimbine (0.5-2 mg/kg) or pellet priming (1-4 noncontingent pellets). Estrous cycle effects on reinstatement were also assessed in wild-type rats. Yohimbine- and pellet-priming-induced reinstatement was associated with Fos and GFP induction in mPFC; both reinstatement and neuronal activation were minimally affected by ovarian hormones in both c-fos-GFP and wild-type rats. c-fos-GFP transgenic rats were then used to assess glutamatergic synaptic alterations within activated GFP-positive and nonactivated GFP-negative mPFC neurons following yohimbine-induced reinstatement of food seeking. This reinstatement was associated with reduced AMPA receptor/NMDA receptor current ratios and increased paired-pulse facilitation in activated GFP-positive but not GFP-negative neurons. While ovarian hormones do not appear to play a role in stress-induced relapse of food seeking in our rat model, this reinstatement was associated with unique synaptic alterations in strongly activated mPFC neurons. Our paper introduces the c-fos-GFP transgenic rat as a new tool to study unique synaptic changes in activated neurons during behavior.

Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries.

BACKGROUND: The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). METHODS: In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. FINDINGS: Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. INTERPRETATION: Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. FUNDING: Bill & Melinda Gates Foundation.

Effect of adaptation strategies when feeding fresh cassava foliage on intake and physiological responses of lambs.

The objective of the experiment was to study different adaptation strategies to avoid HCN intoxication when feeding fresh cassava foliage to sheep. Twenty-four Phan Rang lambs (initial weight = 19.6 kg at 5.5 months of age) were used in the study. The four experimental diets contained guinea grass (Panicum maximum) supplemented with concentrate at 1.5% of body weight (BW) as dry matter (DM) (control) or supplemented with fresh cassava foliage (FCF) that was introduced into the diet with an adaptation period of 0 (FCF-0), 7 (FCF-7) or 21 (FCF-21) days before reaching the target feeding level of 2% of BW. The average intake of FCF expressed as DM was not different amongst the supplemented treatments and ranged from 1.4 to 1.5% of BW but gradually increased during the first 7 days without any adaptation. The hydrogen cyanide consumed varied from 5.1 to 5.4 mg/kg BW and no difference between treatments with cassava foliage in the diet was found. The live weight gain was significantly higher in the treatments control and FCF-7 compared to FCF-21. No significant differences in heart rate, respiration rate and rumen movement were found between diets. The thiocyanate concentration in the urine of the lambs increased concomitantly with the increase in fresh cassava foliage offered during the first part of the experiment. In conclusion, an adaptation period of approximately 7 days seems to be favourable in combined diets where cassava foliage is offered in quantities up to 2% of BW. This level of intake could enhance the intake and LWG of the lambs without any documented effects on heart rate, respiration rate or rumen movements.

Effect of harvesting frequency, variety and leaf maturity on nutrient composition, hydrogen cyanide content and cassava foliage yield.

The experiment studied the effect of harvesting frequencies and varieties on yield, chemical composition and hydrogen cyanide content in cassava foliage. Foliage from three cassava varieties, K94 (very bitter), K98-7 (medium bitter) and a local (sweet), were harvested in three different cutting cycles, at 3, 6 and 9 months; 6 and 9 months and 9 months after planting, in a 2-yr experiment carried out in Hanoi, Vietnam. Increasing the harvesting frequency increased dry matter (DM) and crude protein (CP) production in cassava foliage. The K94 variety produced higher foliage yields than the other two varieties. Dry matter, neutral detergent fibre (NDF), acid detergent fibre (ADF) and total tannin content increased with months to the first harvest, whereas CP content decreased. Hydrogen cyanide (HCN) content was lower at the first harvest than at later harvests for all cutting cycles. At subsequent harvests the content of total tannins tended to decline, while HCN content increased (p<0.05). Chemical composition differed somewhat across varieties except for total tannins and ash. Dry matter, NDF, ADF and total tannins were higher in fully matured leaves, while CP and HCN were lower in developing leaves.

Trauma Care Training in Vietnam: Narrative Scoping Review.

BACKGROUND: The model of trauma in Vietnam has changed significantly over the last decade and requires reforming medical education to deal with new circumstances. Our aim is to evaluate this transition regarding the new target by analyzing trauma and the medical training system as a whole. OBJECTIVE: This study aimed to establish if medical training in the developing country of Vietnam has adapted to the new disease pattern of road trauma emerging in its economy. METHODS: A review was performed of Vietnamese medical school, Ministry of Health, and Ministry of Education and Training literature on trauma education. The review process and final review paper were prepared following the guidelines on scoping reviews and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. RESULTS: The current trauma training at the undergraduate level is minimal and involves less than 5% of the total credit. At the postgraduate level, only the specialties of surgery and anesthesia have a significant and increasing trauma training component ranging from 8% to 22% in the content. Trauma training, which focuses on practical skills, accounts for 31% and 32% of the training time of orientation courses for young doctors in "basic surgery" and "basic anesthesia," respectively. Other relevant short course trainings, such as continuing medical education, in trauma are available, but they vary in topics, facilitators, participants, and formats. CONCLUSIONS: Medical training in Vietnam has not adapted to the new emerging disease pattern of road trauma. In the interim, the implementation of short courses, such as basic trauma life support and primary trauma care, can be considered as an appropriate method to compensate for the insufficient competency-related trauma care among health care workers while waiting for the effectiveness of medical training reformation.

Quality of Life and Activities of Daily Living among Patients with Complete Cervical Spinal Cord Injury and Surgical Treatment in Vietnam.

Spinal cord injury (SCI) is defined as temporary or permanent changes in spinal cord function and reflex activity. The objective of this study is to evaluate health-related quality of life (HRQoL) and activities of daily living (ADL) among postoperative surgery patients with complete cervical SCI in Vietnam and to explore the factors associated with these indices. A cross-sectional study was conducted on 88 adults in Vietnam from June 2018 to June 2019. The EQ-5D-5L, ADL, and instrumental activities of daily living (IADL) were applied. Multivariate Tobit regression was adopted to determine factors that were associated with HRQOL, ADL, and IADL. Results: Participants who were in American Spinal Cord Injury Association (ASIA) scale group A (ASIA-A) had the lowest ADL, IADL index, and HRQOL score (p < 0.001). HRQoL and ADL were affected by health insurance coverage, occupation, type of fracture, and IADL. Meanwhile, IADL was significantly associated with living areas and ASIA. Low HRQoL among patients suffering from SCI was observed. Attention should be given to outcomes related to a disability during clinical treatment and should be treated effectively in the recovery.

Context-induced relapse to alcohol seeking after punishment in a rat model.

BACKGROUND: Rat studies have demonstrated that exposure to environments associated with alcohol intake reinstates alcohol seeking after extinction of alcohol-reinforced responding in a different context. However, extinction is limited as an abstinence model, because humans typically abstain because of negative consequences associated with excessive drinking. It is currently unknown whether alcohol-associated contexts can provoke relapse to alcohol seeking after alcohol-taking behavior is suppressed by adverse consequences in a different context. METHODS: Alcohol-preferring P rats were first given home-cage access to 20% ethanol. Next, they were trained to self-administer 20% ethanol in one context (context A). Subsequently, all rats continued to self-administer alcohol in a different context (context B). For one group, 50% of alcohol-reinforced responses were punished by mild footshock; two other groups either received noncontingent shocks or no shock. A fourth group was given extinction training in context B. All rats were then tested for relapse to alcohol seeking under extinction conditions in contexts A and B. RESULTS: In Context B, alcohol-taking behavior was suppressed by contingent shock (punishment) and extinction training but not by noncontingent shock. In Context A, relapse to alcohol seeking was reliably observed in the punished and extinction groups; a context switch had no effect on alcohol seeking in the no-shock or noncontingent shock groups. CONCLUSIONS: Our data indicate that punishment-induced suppression of alcohol-taking behavior is context-dependent. We propose that our procedure can be used to explore mechanisms of context-induced relapse to alcohol seeking after alcohol-taking behavior is suppressed by adverse consequences.

High accuracy mass spectrometry comparison of Conus bandanus and Conus marmoreus venoms from the South Central Coast of Vietnam.

Cone snail (genus Conus) venoms provide a rich source of small bioactive peptides known as conopeptides or conotoxins, which are highly interesting in pharmacological studies for new drug discovery. Conus species have evolved expressing a variety of conopeptides, adapted to the biological targets of their own specific preys at their living environments. Therefore, the potential proteomic evaluation of Conus venom components, poorly studied, is of great interest. Early studies supposed about 5% overlap in venom peptides from different Conus species. In this study, we compare using nano-liquid chromatography coupled with electrospray ionisation-mass spectrometry and bioinformatics, the molluscivorous Conus bandanus venom to that of its close-relative Conus marmoreus of the South Central Coast of Vietnam. With this approach, we demonstrate with high precision that 92 common conopeptides are present in the venom of the two mollusc-hunting cone snails, representing 24.4% (out of 376 peptides) and 18.4% (out of 499 peptides) of C. bandanus and C. marmoreus components, respectively. The proteomic comparison of the two close-relative interspecies suggests both common and different strategies for mature conopeptide production in the two species. The overall estimation of putative conopeptide disulphide bridges reveals 75% and 61% of "disulphide-rich" peptides in C. bandanus and C. marmoreus venom components, respectively. The same amino acid sequence for Bn1.1 and Mr1.1, determined at the genomic level, was also found in the two venoms, besides other common conopeptides. Confidently, the broader distribution of C. bandanus compared to C. marmoreus guarantee new opportunities for discovering conopeptides with original pharmacological properties.