Description: The upper Texas coast is an ideal location to examine coastal response to global change over geologic and historic time. Here we quantify the long-term sequestration for sand eroded from an island into two main sinks, offshore Galveston Island and San Luis Pass Tidal Delta, in order to compare long-term and short-term erosion. We determine the average storm-related offshore sand flux for the middle part of the Holocene (ca. 5240–5040 [2] cal yr B.P. to present) to be ~4200–4400 ± 670 m 3 /yr, with a decrease in the offshore sand flux to ~920–970 ± 270 m 3 /yr during the latter part of the Holocene (ca. 2730–2610 [2] cal yr B.P. to present). The tidal delta initially formed ca. 2100 (1 median) cal yr B.P., when the rate of sea-level rise slowed from 2.0 mm/yr to 0.60 mm/yr. We calculate the sand flux from Galveston Island into San Luis Pass from ca. 2100 (1 median) cal yr B.P. to 200 yr ago to be ~4700 m 3 /yr. Evidence from navigational charts and sediment cores suggests this flux has increased to ~10,000 m 3 /yr over the past ~200 yr. Coupling these data with recently published long-term sand fluxes to the shoreface of Galveston Island yields a total of only ~130,000 ± 28,000 m 3 /yr, i.e., significantly less than the ~240,000 ± 49,000 m 3 /yr estimated to have been eroded during historic time using the measured erosion rates. While some of this increased erosion can be attributed to anthropogenic influences, the magnitude of change requires additional forcing, specifically, the recent acceleration in relative sea-level rise punctuated by storm impacts during historic time.

Description: John Patrick Anderson’s father and brother were both general practitioners in Stockton. After professional house jobs at the Royal Victoria Infirmary, Newcastle upon Tyne, John served with Airborne...

Description: Objective Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial. Design 40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders’ ADR. Mixed effect models using ORs and 95% CIs were computed. Results The study included 24 582 colonoscopies performed by 38 leaders and 56 617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p〈0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017). Conclusions Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy. Trial registration number NCT01667198.

Description: We use extensive sedimentary and marine geophysical data to derive sediment volume–based millennial time-scale glacial erosion rates ( Ē ) from glacially influenced fjords and bays across a broad latitudinal transect, from central Patagonia (46°S) to the Antarctic Peninsula (65°S), and to determine how glacial erosion rates change with increasing latitude and decreasing atmospheric temperatures. We also calculate million-year time-scale erosion rates for the western Antarctic Peninsula cordillera and inner continental shelf from seismic stratigraphic analysis of the continental margin. These results are complemented by erosion rates derived from existing thermochronology data sets (apatite fission-track and apatite [U-Th]/He) for both Patagonia and the Antarctic Peninsula regions. Despite considerable regional variability, our results show a clear trend of decreasing Ē with increasing latitude. Millennial Ē values span two orders of magnitude, from 0.02 mm/yr for Illiad glacier on Anvers Island, Antarctica (~64.5°S), to 0.83 mm/yr for San Rafael glacier in northern Patagonia (~46.5°S). Regional averages are three times higher for the Patagonian areas than the Antarctic Peninsula areas. This trend is interpreted to result from a general decrease in temperature and water availability at the ice-bedrock interface. For the Antarctic Peninsula study sites, erosion rates are highly clustered around 0.1 mm/yr, with the exception of Maxwell Bay, for which the Ē value is 0.36 mm/yr. In Patagonia, erosion rates are more variable than in the Antarctic Peninsula, with Ē ranging between 0.14 mm/yr (Europa glacier area) and 0.83 mm/yr (San Rafael glacier area). This regional variability in Ē is interpreted as due to differences in hypsometry and bedrock resistance to erosion. Million-year time-scale Ē values derived from thermochronology ages also decrease with latitude, with maximum values decreasing from ~0.9–1.1 mm/yr north of 46°S to ~0.1–0.2 mm/yr south of 48°S in Patagonia, and reaching ~0.2–0.3 mm/yr in the Antarctic Peninsula. The sediment-based million-year time-scale Ē estimates for the western Antarctic Peninsula cordillera indicate that glacial erosion rates increased by 25%–30% after 5.3 Ma, from ~0.09 mm/yr (5.3–9.5 Ma) to ~0.11–0.12 mm/yr (〈5.3 Ma). For Patagonia, the decrease in long-term erosion rates south of ~46°S is interpreted to result from relatively long periods of slow glacial erosion associated with the ice masses having been colder (subpolar) on the southern Patagonian cordillera, and having eroded at rates comparable to those we obtained for the Antarctic Peninsula. These long-term erosion rates are 1–2 orders of magnitude lower than estimates based on recent sediment yields, highlighting the transient nature of high-sediment-flux events. However, our sediment volume–derived millennial time-scale Ē closely approximates the maximum values of tectonic time-scale Ē values derived from thermochronology ages. Our combined millennial and million-year time-scale glacial erosion data quantify the significant decrease in rates of glacially driven denudation at geological (tectonic) and millennial time scales with increasing latitude from Patagonia to the Antarctic Peninsula, highlighting the influence of climate on mountain denudation.

Description: This document represents the first position statement produced by the British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, setting out the minimum expected standards in diagnostic upper gastrointestinal endoscopy. The need for this statement has arisen from the recognition that while technical competence can be rapidly acquired, in practice the performance of a high-quality examination is variable, with an unacceptably high rate of failure to diagnose cancer at endoscopy. The importance of detecting early neoplasia has taken on greater significance in this era of minimally invasive, organ-preserving endoscopic therapy. In this position statement we describe 38 recommendations to improve diagnostic endoscopy quality. Our goal is to emphasise practices that encourage mucosal inspection and lesion recognition, with the aim of optimising the early diagnosis of upper gastrointestinal disease and improving patient outcomes.

Description: Objective To perform a comprehensive audit of all colonoscopy undertaken in the UK over a 2-week period. Design Multi-centre survey. All adult (≥16 years of age) colonoscopies that took place in participating National Health Service hospitals between 28 February 2011 and 11 March 2011 were included. Results Data on 20 085 colonoscopies and 2681 colonoscopists were collected from 302 units. A validation exercise indicated that data were collected on over 94% of all procedures performed nationally. The unadjusted caecal intubation rate (CIR) was 92.3%. When adjusted for impassable strictures and poor bowel preparation the CIR was 95.8%. The polyp detection rate was 32.1%. The polyp detection rate for larger polyps (≥10mm diameter) was 11.7%. 92.3% of resected polyps were retrieved. 90.2% of procedures achieved acceptable levels of patient comfort. A total of eight perforations and 52 significant haemorrhages were reported. Eight patients underwent surgery as a consequence of a complication. Conclusions This is the first national audit of colonoscopy that has successfully captured the majority of adult colonoscopies performed across an entire nation during a defined time period. The data confirm that there has been a significant improvement in the performance of colonoscopy in the UK since the last study reported seven years ago (CIR 76.9%) and that performance is above the required national standards.

Description: Objectives To examine mortality patterns and dose-response relations between ionising radiation and mortality outcomes of a priori interest in 6409 uranium workers employed for at least 30 days (1951–1985), and followed through 2004. Methods Cohort mortality was evaluated through standardised mortality ratios (SMR). Linear excess relative risk (ERR) regression models examined associations between cause-specific mortality and exposures to internal ionising radiation from uranium deposition, external gamma and x-ray radiation, and radon decay products, while adjusting for non-radiologic covariates. Results Person-years at risk totalled 236 568 (mean follow-up 37 years), and 43% of the cohort had died. All-cause mortality was below expectation only in salaried workers. Cancer mortality was significantly elevated in hourly males, primarily from excess lung cancer (SMR=1.25, 95% CI 1.09 to 1.42). Cancer mortality in salaried males was near expectation, but lymphohaematopoietic malignancies were significantly elevated (SMR=1.52, 95% CI 1.06 to 2.12). A positive dose-response relation was observed for intestinal cancer, with a significant elevation in the highest internal organ dose category and a significant dose-response with organ dose from internal uranium deposition (ERR=1.5 per 100 μGy, 95% CI 0.12 to 4.1). Conclusions A healthy worker effect was observed only in salaried workers. Hourly workers had excess cancer mortality compared with the US population, although there was little evidence of a dose-response trend for any cancer evaluated except intestinal cancer. The association between non-malignant respiratory disease and radiation dose observed in previous studies was not apparent, possibly due to improved exposure assessment, different outcome groupings, and extended follow-up.

Description: Laurence Dopson, who has died at the age of 88, enjoyed a career in medical and nursing journalism over 65 years, and was still writing on the contemporary NHS until shortly before his...

Description: In this study, structures in plutons and host rocks are coupled with geochronology to track paleodeformation fields from the late Paleozoic to Late Cretaceous in the central Sierra Nevada. Regional NW-striking host-rock foliation, NE- or SW-vergent thrust faults, and associated folds developed from the early Mesozoic to Early Cretaceous. Dextral transpressional shear zones developed in the Late Cretaceous. Strikes of steep-dipping magmatic foliations in Mesozoic plutons temporally vary from approximately NW (Triassic–Jurassic) to WNW (Late Cretaceous), displaying a progressive counterclockwise rotation. Joint interpretation based on combining host-rock and magmatic structures suggests that intra-arc paleodeformation fields were dominated by coaxial and arc-perpendicular contraction from the early Mesozoic to Early Cretaceous, becoming increasingly dextral transpressive in the Late Cretaceous. The switch from contraction to transpression was likely caused by oblique convergence between the Farallon and North American plates. Based on observations in the study area and other host-rock pendants in the central Sierra Nevada, we propose that the intensity of intra-arc deformation is cyclic. To some extent, it mimics the episodic pattern of arc magmatism: Stronger deformation coincides with magmatic flare-ups. Magmatism promotes intra-arc deformation, which in turn causes crustal thickening during transfer of materials downward to the magma source regions, potentially fertilizing source regions with supracrustal materials and resulting in increased magma generation. Thus, models addressing continental arc tempos should include intra-arc processes. Evolution of continental arcs may be influenced by linked cyclic processes within the arcs accompanied by noncyclic processes driven by events external to the arcs.

Description: These guidelines provide an evidence-based framework for the management of patients with large non-pedunculated colorectal polyps (LNPCPs), in addition to identifying key performance indicators (KPIs) that permit the audit of quality outcomes. These are areas not previously covered by British Society of Gastroenterology (BSG) Guidelines. A National Institute of Health and Care Excellence (NICE) compliant BSG guideline development process was used throughout and the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to structure the guideline development process. A systematic review of literature was conducted for English language articles up to May 2014 concerning the assessment and management of LNPCPs. Quality of evaluated studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist System. Proposed recommendation statements were evaluated by each member of the Guideline Development Group (GDG) on a scale from 1 (strongly agree) to 5 (strongly disagree) with 〉80% agreement required for consensus to be reached. Where consensus was not reached a modified Delphi process was used to re-evaluate and modify proposed statements until consensus was reached or the statement discarded. A round table meeting was subsequently held to finalise recommendations and to evaluate the strength of evidence discussed. The GRADE tool was used to assess the strength of evidence and strength of recommendation for finalised statements. KPIs, a training framework and potential research questions for the management of LNPCPs were also developed. It is hoped that these guidelines will improve the assessment and management of LNPCPs.