Standardised training for endoscopic mucosal resection of large non-pedunculated colorectal polyps to reduce recurrence (*STAR-LNPCP study): a multicentre cluster randomised trial.

OBJECTIVE: Endoscopic mucosal resection (EMR) is the preferred treatment for non-invasive large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) but is associated with an early recurrence rate of up to 30%. We evaluated whether standardised EMR training could reduce recurrence rates in Dutch community hospitals. DESIGN: In this multicentre cluster randomised trial, 59 endoscopists from 30 hospitals were randomly assigned to the intervention group (e-learning and 2-day training including hands-on session) or control group. From April 2019 to August 2021, all consecutive EMR-treated LNPCPs were included. Primary endpoint was recurrence rate after 6 months. RESULTS: A total of 1412 LNPCPs were included; 699 in the intervention group and 713 in the control group (median size 30 mm vs 30 mm, 45% vs 52% size, morphology, site and access (SMSA) score IV, 64% vs 64% proximal location). Recurrence rates were lower in the intervention group compared with controls (13% vs 25%, OR 0.43; 95% CI 0.23 to 0.78; p=0.005) with similar complication rates (8% vs 9%, OR 0.93; 95% CI 0.64 to 1.36; p=0.720). Recurrences were more often unifocal in the intervention group (92% vs 76%; p=0.006). In sensitivity analysis, the benefit of the intervention on recurrence rate was only observed in the 20-40 mm LNPCPs (5% vs 20% in 20-29 mm, p=0.001; 10% vs 21% in 30-39 mm, p=0.013) but less evident in ≥40 mm LNPCPs (24% vs 31%; p=0.151). In a post hoc analysis, the training effect was maintained in the study group, while in the control group the recurrence rate remained high. CONCLUSION: A compact standardised EMR training for LNPCPs significantly reduced recurrences in community hospitals. This strongly argues for a national dedicated training programme for endoscopists performing EMR of ≥20 mm LNPCPs. Interestingly, in sensitivity analysis, this benefit was limited for LNPCPs ≥40 mm. TRIAL REGISTRATION NUMBER: NTR7477.

A Health Crisis in the Age of Misinformation: How Social Media and Mass Media Influenced Misperceptions about COVID-19 and Compliance Behavior.

The media are important information disseminators in society. Particularly in uncertain times, such as the COVID-19 pandemic, citizens are very "media dependent." The way in which people are informed about the coronavirus heavily depends on the type of media they use. Especially on social media, the share of misinformation is considerable, which might impact the way in which people comply with preventive measures. Our study investigates how media use affects misperceptions about the coronavirus and whether this influences important behavioral determinants as well as compliance behavior itself. The results of a unique 5-wave panel survey (N = 1,741) conducted between April 2020 and October 2020 show that the use of mass media reduces misperceptions. The same was found for Twitter users, whereas Facebook and Instagram users have more misperceptions about the coronavirus. Misperceptions negatively influence the perceived severity, susceptibility and efficacy of preventive measures taken by governments, which may ultimately result in decreased compliance. Our findings underline the important role of media consumption and misperceptions in shaping citizens' beliefs and behavior regarding COVID-19. They re-emphasize the importance of mass media, such as newspapers, television broadcasts or reliable news websites, to inform the public about current affairs. They also imply that platform media might be more heterogeneous in their effects than mass media.

Start Spreading the News: A Comparative Experiment on the Effects of Populist Communication on Political Engagement in Sixteen European Countries.

Although populist communication has become pervasive throughout Europe, many important questions on its political consequences remain unanswered. First, previous research has neglected the differential effects of populist communication on the Left and Right. Second, internationally comparative studies are missing. Finally, previous research mostly studied attitudinal outcomes, neglecting behavioral effects. To address these key issues, this paper draws on a unique, extensive, and comparative experiment in sixteen European countries (N = 15,412) to test the effects of populist communication on political engagement. The findings show that anti-elitist populism has the strongest mobilizing effects, and anti-immigrant messages have the strongest demobilizing effects. Moreover, national conditions such as the level of unemployment and the electoral success of the populist Left and Right condition the impact of populist communication. These findings provide important insights into the persuasiveness of populist messages spread throughout the European continent.

Nation Binding: How Public Service Broadcasting Mitigates Political Selective Exposure.

Recent research suggests that more and more citizens select news and information that is congruent with their existing political preferences. This increase in political selective exposure (PSE) has allegedly led to an increase in polarization. The vast majority of studies stem from the US case with a particular media and political system. We contend that there are good reasons to believe PSE is less prevalent in other systems. We test this using latent profile analysis with national survey data from the Netherlands (n = 2,833). We identify four types of media use profiles and indeed only find partial evidence of PSE. In particular, we find that public broadcasting news cross-cuts all cleavages. This research note offers an important antidote in what is considered a universal phenomenon. We do find, however, a relatively large segment of citizens opting out of news consumption despite the readily available news in today's media landscape.

A single amino acid substitution in the MurF UDP-MurNAc-pentapeptide synthetase renders Streptococcus pneumoniae dependent on CO2 and temperature.

The respiratory tract pathogen Streptococcus pneumoniae encounters different levels of environmental CO2 during transmission, host colonization and disease. About 8% of all pneumococcal isolates are capnophiles that require CO2 -enriched growth conditions. The underlying molecular mechanism for caphnophilic behaviour, as well as its biological function is unknown. Here, we found that capnophilic S. pneumoniae isolates from clonal complex (CC) 156 (i.e. Spain(9V) -3 ancestry) and CC344 (i.e. Norway(NT) -42 ancestry) have a valine at position 179 in the MurF UDP-MurNAc-pentapeptide synthetase. At ≤ 30°C, the growth characteristics of capnophilic and non-capnophilic CC156 strains were equal, but at > 30°C growth and survival of MurF(V) (179) strains was dependent on > 0.1% CO2 -enriched conditions. Expression of MurF(V) (179) in S. pneumoniae R6 and G54 rendered these, otherwise non-capnophilic strains, capnophilic. Time-lapse microscopy revealed that a capnophilic CC156 strain undergoes rapid autolysis upon exposure to CO2 -poor conditions at 37°C, and staining with fluorescently labelled vancomycin showed a defect in de novo cell wall synthesis. In summary, in capnophilic S. pneumoniae strains from CC156 and CC344 cell wall synthesis is placed under control of environmental CO2 levels and temperature. This mechanism might represent a novel strategy of the pneumococcus to rapidly adapt and colonize its host under changing environmental conditions.

Primary care patients' recognition of their own risk for cardiovascular disease: implications for risk communication in practice.

PURPOSE OF REVIEW: Guidelines on primary prevention of cardiovascular disease emphasize identifying high-risk patients for intensive risk-reducing management. These guidelines recommend the identification of individuals with high risk using risk score sheets or risk tables. Patients' misperceptions of risk seem to hamper implementation of the high-risk approach. How appropriate are the risk perceptions of patients? What is known about effective ways of risk communication? RECENT FINDINGS: Cardiovascular risk is often perceived inappropriately in primary care populations; by nearly four in five high-risk patients (incorrect optimism), and by one in five low-risk patients (incorrect pessimism). Communicating cardiovascular risk by means of natural frequencies seems effective to correct inappropriate risk perception, though effects are small. SUMMARY: In communicating cardiovascular disease risk, primary care physicians must be aware that they mostly encounter low-risk patients and that the perceived risk does not necessarily correspond with the actual risk. Professionals should be skilled in the use of effective formats for risk communication that are ideally integrated within patient decision aids for cardiovascular risk management.