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tTasmanian early childhood services (ECS) are attempting to improve their engagement with vulnera-ble families and increase the uptake of universal health and education services in this population. Thispaper presents qualitative findings from the [name] Study, focusing on the scope and role of outreachin supporting family engagement in the Tasmanian ECS. Using an ethnographic study design, over 100naturalistic observations were recorded in health and education ECS settings in Tasmanian communitiesbetween April 2017 and February 2018. In addition, 42 ECS providers and 32 parents/guardians withpre-school aged children participated in semi-structured interviews. Interview transcripts and obser-vation field notes were analysed thematically, focusing on family engagement and the role of outreachacross three key universal ECS. Outreach was undertaken by all services involved in this study, but var-ied in practice and scope. Outreach was not directed at specific population groups, but was instigatedin response to an identified need with more vulnerable families to address issues of inequity in serviceaccess. Policies and strategic frameworks within services provided little or no guidance about outreachbeyond procedures for conducting home visits. Attending specialised services alongside parents, a strat-egy adopted by one service, was particularly effective for facilitating connection to services for vulnerablefamilies. The capacity of services to offer outreach was constrained by structured service systems, indi-vidual providers’ skills and capability, resource limitations and lack of clarity with respect to policiesand procedures. Outreach activities are occurring within the universal ECS system in Tasmania, facilitat-ing engagement with vulnerable Tasmanian families and children. Flexible service systems, building theskills and capacities of service providers and clearer policies and procedures would enable services tomore fully embed outreach practices within existing ECS.

Background: Increased inflammation is a hallmark of COVID-19, with pulmonary and systemic inflammation identified in multiple cohorts of patients. Definitive cellular and molecular pathways driving severe forms of this disease remain uncertain. Neutrophils, the most numerous leukocytes in blood circulation, can contribute to immunopathology in infections, inflammatory diseases and acute respiratory distress syndrome (ARDS), a primary cause of morbidity and mortality in COVID-19. Neutrophilia, elevated neutrophil:lymphocyte ratios, and elevated neutrophil-associated cytokines are present in COVID-19, but changes in neutrophil functions have not been characterized. Here we analyzed the functional state of circulating neutrophils in COVID-19. Methods: Blood was obtained from critically ill COVID-19 patients over two weeks and healthy controls across multiple timepoints. Plasma cytokine profiles were assessed by bead array. Neutrophils were isolated and tested ex vivo for oxidative burst, neutrophil extracellular trap formation (NETosis) and phagocytosis. Lung tissue was obtained immediately post-mortem from COVID-19 patients for immunostaining. Results: Elevations in neutrophil-associated cytokines IL-8 and IL-6 were identified in COVID-19 plasma both at the first measurement and across their hospitalization (p < 0.0001). Elevations in cytokines IP-10, GM-CSF, IL-1b, IL-10 and TNF were also present at the first measurement and across hospital stays. Functionally, circulating neutrophils from COVID-19 patients had exaggerated oxidative burst (p < 0.0001), NETosis (p < 0.0001) and phagocytosis (p < 0.0001) relative to controls. Increased NETosis was found to be correlated with both leukocytosis and neutrophilia in COVID-19 patients. Neutrophils and NETs were identified within airways and alveoli in lung parenchyma. While elevations in IL-8 and ANC correlated to COVID-19 disease severity, plasma IL-8 levels alone correlated with death. Conclusions: Circulating neutrophils in COVID-19 exhibit an activated phenotype with increased oxidative burst, NETosis and phagocytosis. Readily accessible and dynamic, plasma IL-8 and circulating neutrophil function can be explored as potential COVID-19 disease biomarkers. Funding Statement: This work was supported by the Department of Veterans Affairs (salary support and VA Merit Award, PI Crotty Alexander) and NIH NHLBI (PI Crotty Alexander). Declaration of Interests: The authors report no conflicts of interest. Ethics Approval Statement: The research protocol was approved by the UCSD, VASDHS and Rady Children’s Hospital institutional review boards (IRBs) and all participants or designated family member gave written informed consent.

We present the largest exome sequencing study of autism spectrum disorder (ASD) to date (n=35,584 total samples, 11,986 with ASD). Using an enhanced Bayesian framework to integrate de novo and case-control rare variation, we identify 102 risk genes at a false discovery rate ≤ 0.1. Of these genes, 49 show higher frequencies of disruptive de novo variants in individuals ascertained for severe neurodevelopmental delay, while 53 show higher frequencies in individuals ascertained for ASD; comparing ASD cases with mutations in these groups reveals phenotypic differences. Expressed early in brain development, most of the risk genes have roles in regulation of gene expression or neuronal communication (i.e., mutations effect neurodevelopmental and neurophysiological changes), and 13 fall within loci recurrently hit by copy number variants. In human cortex single-cell gene expression data, expression of risk genes is enriched in both excitatory and inhibitory neuronal lineages, consistent with multiple paths to an excitatory/inhibitory imbalance underlying ASD.

State of the art Engineering Education is crucial for Research and Innovation according to the European Union's growth strategy. This paper contributes with more knowledge of how Universities and Industry can facilitate collaborative learning environments and create efficient working methods. A group of students accepted the challenge from an industrial company to examine robotic assembly of their products. The students built a robot cell prototype in the company's design department, to promote knowledge about design for robot manufacturing. The setting of this learning environment enabled knowledge creation with significant learning outcomes for the university, the Industrial Company and other partners. The project motivated the teachers to collaborate across Faculties at the University, and gave new insight in formulation of objectives for this type of projects.

Summary Background Chronic obstructive pulmonary disease (COPD) is under-diagnosed and diagnosis often occurs late thereby reducing opportunities to prevent deterioration. Investigation of causes has focused on the use of spirometry but the role of attitudes of doctors and patients has not been directly investigated. Methods A cross-sectional study of patients diagnosed with COPD and their general practitioners in two general practices in Tasmania who participated in semi-structured interviews and focus groups. Practice records were examined and patients underwent spirometry, quality of life and symptom assessment. Iterative content analysis identified themes that were compared with quantitative data. Findings For the 32 participating patients, mean recorded duration of COPD was 8.0 (SD 6.8) years and mean FEV 1 % predicted 38.4% (SD 19.8). Qualitative data were obtained from 14 (44%) of patients with COPD (5M/9F) and 16 general practitioners (GPs) (10M/6F). We identified three themes around the diagnosis of COPD in primary care: patients' labels, acquiring and communicating a diagnosis and consequences of delaying or withholding diagnosis. Doctors correctly recognised that patients were unfamiliar with COPD. They intentionally avoided early diagnosis as a result of nihilism and misperception of patients' attitudes. Patients often received the diagnosis from other sources and found delayed diagnosis frustrating. Interpretation Nihilistic attitudes to COPD may explain the disappointing results from promotion of spirometry in primary care. Education about COPD for doctors in primary care is needed and action to increase awareness and understanding of COPD in the community.