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Evaluation of activity indices and inter-observer variation is another focus of interest, especially in how it affects clinical trials and practice. This includes evaluating the outcome of different definitions of remission in ulcerative colitis and evaluating the Pediatric Ulcerative Colitis Activity Index (PUCAI) in adults, in collaboration with Dan Turner (Jerusalem). Oxford has lead the development of the first internationally validated endoscopic scoring system in UC, the Ulcerative Colitis Endoscopic Index of Severity (UCEIS, see publications). There are now opportunities to develop it as a training tool. Oxford is contributing to the development of the cumulative damage index in Crohn’s disease (Lémann score, through IPNIC) and the international definition of Early Crohn’s Disease.