Search

Abstract Background National institutes and education initiatives emphasize the need to prepare future biologists to apply discoveries in science towards solving problems that are both social and scientific in nature. Research from socio-scientific, design-based, and problem-based learning demonstrates that contextualized, real-world tasks can improve students’ ability to apply their scientific knowledge in practical ways to navigate social problems. Biomimicry Design is an interdisciplinary field requiring biology and design skills; it informs the creation of sustainable designs through emulation of biological structures and functions that arise as a result of natural selection. Notably, engaging in biomimicry design targets an important biology and engineering learning outcome: understanding of how structure influences function. This study leveraged the practices of biomimicry along with those of design-based learning (DBL) to improve student outcomes in an evolutionary biology undergraduate course. Through DBL, the authors aimed to (1) ignite deeper understanding of how structure determines function in nature (a cross-disciplinary concept) and (2) help students to consider new ways this concept can benefit society (a science process skill). Results We randomly assigned two sections of an upper-division evolutionary biology course to either a biomimicry DBL (DBL group) or species comparison (comparison group) curricular design. Students in the course were exposed to a 1-day lesson, then 1-weeklong case study, and then a final project focused on either biomimicry species-to-human design comparisons (DBL condition) or species-to-species comparisons (comparison condition). To assess the targeted outcomes, we analyzed students’ responses from a pre-post assessment. Students in the biomimicry section were more likely to apply their biological structure–function knowledge to societal benefits when leaving the course. Students in both sections showed comparable gains in structure–function understanding, but there was no change in the number of students who used misconception language in their post-course compared to pre-course responses. Conclusions We conclude that our DBL curriculum, above and beyond the comparison curriculum, may support students’ ability to apply biological concepts to societal benefits without compromising structure–function understanding. Overall, these results provide rationale for incorporating tasks situated in DBL to address socio-scientific issues in biology courses.

Abstract Background We meta‐analyzed the efficacy and safety of catheter (CA) vs thoracoscopic (TA) ablation for atrial fibrillation (AF). Methods PubMed, Embase, and Cochrane databases were searched until 31/12/2019 for relevant randomized trials and subsequent pooled analyses. Results In six trials totaling 465 patients (254 CA/211 TA), 1‐year AF recurrences were higher for CA (46% vs 26%, odds ratio 2.90 [95% CI 1.32‐6.38]), whereas total adverse events were lower (10% vs 25%, 0.35 [0.14‐0.86], respectively). Conclusion CA has lower efficacy but higher safety than TA. CA should remain the first‐line AF ablation strategy, and TA reserved for selected CA‐resistant patients where rhythm control is clinically necessary.

Abstract Background In Canada alone, almost 3000 VLBW infants are born and treated annually with almost 1200 going onto death or survival with severe brain injury, chronic lung disorders, aggressive retinopathy of prematurity, late-onset sepsis, or significant necrotizing enterocolitis. Lactoferrin is an antimicrobial, antioxidant, anti-inflammatory iron-carrying, bifidogenic glycoprotein found in all vertebrates and in mammalian milk, leukocytes and exocrine secretions. Lactoferrin aids in creating an environment for growth of beneficial bacteria in the gut, thus reducing colonization with pathogenic bacteria. It is hypothesized that oral bovine lactoferrin (bLF), through its antimicrobial, antioxidant and anti-inflammatory properties, will reduce the rate of mortality or major morbidity in very low birth weight preterm infants. Method Lactoferrin Infant Feeding Trial_Canada (LIFT_Canada) is a multi-centre, double-masked, randomized controlled trial with the aim to enroll 500 infants whose data will be combined with the data of the 1542 infants enrolled from Lactoferrin Infant Feeding Trial_Australia/New Zealand (LIFT_ANZ) in a pooled intention-to-treat analysis. Eligible infants will be randomized and allocated to one of two treatment groups: 1) a daily dose of 200 mg/kg bLF in breast/donor human milk or formula milk until 34 weeks corrected gestation or for a minimum of 2 weeks, whichever is longer, or until discharge home or transfer, if earlier; 2) no bLF with daily feeds. The primary outcome will be determined at 36 weeks corrected gestation for the presence of neonatal morbidity and at discharge for survival and treated retinopathy of prematurity. The duration of the trial is expected to be 36 months. Discussion Currently, there continues to be no clear answer related to the benefit of bLF in reducing mortality or any or all of the significant neonatal morbidities in very low birth weight infants. LIFT_Canada is designed with the hope that the pooled results from Australia, New Zealand, and Canada may help to clarify the situation. Trial registration Clinical Trials.Gov, Identifier: NCT03367013, Registered December 8, 2017.

Abstract Background Vascular complications are common during invasive cardiac electrophysiology procedures. This meta‐analysis compares outcomes following ultrasound and nonultrasound‐guided vascular access for these procedures. Methods PubMed, Embase and Cochrane 01/01/1980‐30/09/2018 were searched for relevant studies to meta‐analyse. Results Seven studies (6269 patients) were included. Pooled rates and odds ratio(95% confidence interval) for ultrasound and nonultrasound subgroups were 1.2% vs 3.0%, 0.32 (0.21‐0.49) for all vascular complications, with less hematomas and arterial punctures but similar arteriovenous fistulas, pseudoaneurysms or retroperitoneal bleeds. Conclusion Ultrasound guidance had less complications due to less hematoma and arterial puncture, and is generally recommended for electrophysiology procedures.

Biomass-based, small-scale Combined Cooling, Heating and Power (CCHP) systems can increase the energy autonomy of building complexes while reducing their Greenhouse Gases (GHG) emissions. In combination with air-to-water Heat Pumps (HP), highly efficient energy systems can be designed, which allow for high flexibility in serving thermal and electric demands. This study presents an exergy evaluation of such a small-scale CCHP/HP system using a dynamic modelling approach based on gasification of various types of woody biomass. The transient model takes into account the effects of the biomass chemical composition as well as of ambient temperatures on the exergy performance of all key components for various CCHP system sizes supporting an HP system. The model has been applied in a case study for a historic building complex, where the CCHP sub-system would support an HP-subsystem allowing for downsizing the latter. The results show that smaller CCHP systems operate with higher exergy efficiency, because for larger systems the heat transfer from the engine and the operation of the absorption chiller are less exergy efficient. The electric load-following CCHP subsystem reaches exergy efficiencies of up to 13.3%, indicating huge improvement potential for system and sub-system design. It was also found that the biomass composition heavily influences the exergy efficiency of the gasifier and in turn changes the exergy efficiency of the syngas engine and the entire CCHP sub-system.

The use of waste incineration with energy recovery is a matured waste-to-energy (WtE) technology. Waste incineration can reduce the volume and mass of municipal solid waste significantly. However, the generation of high volumes of polluting flue gases is one of the major drawbacks of this technology. Acidic gases are constituents in the flue gas stream which are deemed detrimental to the environment. The wet flue gas desulphurization (FGD) method is widely employed to clean acidic gases from flue gas streams, due to its high efficiency. A major setback of the wet FGD technology is the production of wastewater, which must be treated before reuse or release into the environment. Treating the wastewater from the wet FGD presents challenges owing to the high level of contamination of heavy metals and other constituents. Membrane distillation (MD) offers several advantages in this regard, owing to the capture of low-grade heat to drive the process. In this study the wet FGD method is adopted for use in a proposed waste incineration plant located in Ghana. Through a mass and energy flow analysis it was found that MD was well matched to treat the 20 m3/h of wastewater generated during operation. Thermal performance of the MD system was assessed together with two parametric studies. The thermal efficiency, gained output ratio, and specific energy consumption for the optimized MD system simulated was found to be 64.9%, 2.34 and 966 kWh/m3, respectively, with a total thermal energy demand of 978.6 kW.

This study investigates the value of community experience for mediating linguistic practice and cultural learning. Learners of English as an Additional Language (EAL), both immigrants and international students, frequently report difficulties in practicing English outside the classroom (Wright, 2006). Grounded in poststructuralist social identity theory (Norton, 2000, 2009), social constructivism (Lave & Wenger, 1991; Wenger, 1998) and imbued by insights into language socialization (Duff, 2007; Duff & Hornberger, 2008), this project identifies what students gain linguistically, culturally, and ontologically from prolonged interaction within a nursing home (known as a "rest home" in New Zealand). Four Chinese women who had undertaken a 10-hour community placement as part of a B.A. program in Auckland were asked to live on-site as caregivers. This project uses students' reflective diaries and transcripts of a focus group interview to address key questions about how the context of the rest home and the experience of volunteering impact actuating communicative practice into social learning. I conclude that authentic practice allowed the four women to apply linguistic strategies taught in the classroom, observe aspects of culture firsthand, report on language used in the homes and for what purposes, and realise they could "make a difference."

The purpose of this article is to describe the sociocultural learning of 40 second-year students in a Bachelor of Arts in English-as-an-additional-language (EAL) program in Auckland, New Zealand. These learners participated in a teaching and learning intervention involving journalized community placement. The study illustrates how reflective journals can be used as a vibrant teaching, learning, and assessment tool, enabling students to make connections with the culture of their host country, to reflect on their experiences of language socialization, and to become aware of their own investments. Students from the four categories of EAL learner (immigrants, international students, study-abroad students, and refugees) participated in a real-world community/workplace writing reflective diaries recording their observations and interactions. Qualitative analysis using discourse positioning reveals students describing themselves in relation to themes of changing perceptions of English abilities, changing identities relative to the host culture, and participation as socialization. The article concludes that writing reflective journals helps learners to evaluate how far they have come as learners and citizens and to find spaces for the enhancement of human possibility (Norton, 2000). The practical pedagogical implication of the study is that combined with journaling, community placements contribute to a positive, future-focused "pedagogy for authentic being" (Barnett, 2004).

Carlos II of Spain (1661–1700), last of the Spanish Habsburgs, was known as The ‘Bewitched’ due to his multiple medical issues and feeble nature. He suffered from a range of ailments extending beyond the well-known Habsburg jaw, including developmental delay, intellectual disability, dysarthria, skeletal deformity, recurrent infections, epilepsy and infertility, among others. The Habsburg dynasty of Spain was characterised by marked inbreeding, and the male line died out with Carlos II. Various diagnoses have been proffered to explain Carlos II’s infirmity, though none have been full satisfactory to explain the full breadth of his ailments. As illustrated here, it may be that aspartylglucosaminuria, an autosomal recessively inherited lysosomal storage disorder, can account for both the characteristic facial features and the wide variety of other features exhibited by Carlos II.

Background: Teaching is a core activity for universities, and pedagogic research is essential for improving student experience, staff satisfaction, and research and teaching quality. Pedagogic research is often performed as a secondary research area or by part-time staff, requiring good collaboration. Existing research structures in universities often result in pedagogic research falling through the gaps and for quality work and pedagogic improvements to be missed. Aim: The aim was to develop a clear and flexible structure to improve participation and output of pedagogic research in the School of Pharmacy and Biomedical Sciences at the University of Central Lancashire. Method: A collaborative adhocracy called the Pedagogic Interest Group (PIG) was created in January 2020. It was designed to allow collaborative, flexible research projects to be easily set up by any staff member. The group supervises and organises a bespoke team of people for each project, drawing on all previously involved staff's expertise and contacts through an initial project meeting organised by an independent group chair. Each project group runs independently, with further help available from the group chairs. Results: Under the PIG structure, seven projects have been undertaken in less than one year. Two papers were published, one under review, two in preparation, one abstract accepted at an international conference, and fifteen funded undergraduate research projects completed. Part-time teaching staff are more involved in the research. Internally, three departments and externally, three other UK universities have been collaboratively involved in research projects. Conclusion: The PIG structure works and depends on staff's continued engagement and at least two independent chairs for impartiality and transparency.

Abstract Many applications are built upon private algorithms, and executing them in untrusted, remote environments poses confidentiality issues. To some extent, these problems can be addressed by ensuring the use of secure hardware in the execution environment; however, an insecure software-stack can only provide limited algorithm secrecy. This paper aims to address this problem, by exploring the components of the Trusted Computing Base (TCB) in hardware-supported enclaves. First, we provide a taxonomy and give an extensive understanding of trade-offs during secure enclave development. Next, we present a case study on existing secret-code execution frameworks; which have bad TCB design due to processing secrets with commodity software in enclaves. This increased attack surface introduces additional footprints on memory that breaks the confidentiality guarantees; as a result, the private algorithms are leaked. Finally, we propose an alternative approach for remote secret-code execution of private algorithms. Our solution removes the potentially untrusted commodity software from the TCB and provides a minimal loader for secret-code execution. Based on our new enclave development paradigm, we demonstrate three industrial templates for cloud applications: ① computational power as a service, ② algorithm querying as a service, and ③ data querying as a service.

Abstract Background Differentiating bacterial from viral pneumonia is important for guiding targeted management and judicious use of antibiotics. We assessed if clinical characteristics and blood inflammatory biomarkers could be used to distinguish bacterial from viral pneumonia. Methods Western Australian children (≤17 years) hospitalized with radiologically-confirmed community-acquired pneumonia were recruited and clinical symptoms and management data were collected. C-reactive protein (CRP), white cell counts (WCC) and absolute neutrophil counts (ANC) were measured as part of routine care. Clinical characteristics and biomarker levels were compared between cases with definite bacterial pneumonia (clinical empyema and/or bacteria detected in blood or pleural fluid), presumed viral pneumonia (presence of ≥1 virus in nasopharyngeal swab without criteria for definite bacterial pneumonia), and other pneumonia cases (pneumonia in the absence of criteria for either definite bacterial or presumed viral pneumonia). The area-under-curve (AUC) of the receiver operating characteristic (ROC) curve for varying biomarker levels were used to characterise their utility for discriminating definite bacterial from presumed viral pneumonia. For biomarkers with AUC > 0.8 (fair discriminator), Youden index was measured to determine the optimal cut-off threshold, and sensitivity, specificity, predictive values (positive and negative) were calculated. We investigated whether better discrimination could be achieved by combining biomarker values with the presence/absence of symptoms. Results From May 2015 to October 2017, 230 pneumonia cases were enrolled: 30 with definite bacterial pneumonia, 118 with presumed viral pneumonia and 82 other pneumonia cases. Differences in clinical signs and symptoms across the groups were noted; more definite bacterial pneumonia cases required intravenous fluid and oxygen supplementation than presumed viral or other pneumonia cases. CRP, WCC and ANC were substantially higher in definite bacterial cases. For a CRP threshold of 72 mg/L, the AUC of ROC was 0.82 for discriminating definite bacterial pneumonia from presumed viral pneumonia. Combining the CRP with either the presence of fever (≥38οC) or the absence of rhinorrhea improved the discrimination. Conclusions Combining elevated CRP with the presence or absence of clinical signs/ symptoms differentiates definite bacterial from presumed viral pneumonia better than CRP alone. Further studies are required to explore combination of biomarkers and symptoms for use as definitive diagnostic tool.

The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated the knowledge and health service experiences of users and providers to generate new hypotheses and scientific investigations that would contribute to improvement in health care for autistic adults. An online survey designed for autistic adults, carers of autistic adults, and professionals in adult services was translated into 11 languages and distributed electronically by organizations and in-country adult service facilities in 2017; 522 autistic adults, 442 carers, and 113 professionals provided answers to the health questions. Professionals, the majority in non-medical services, appeared to be poorly informed about whether certain co-occurring conditions were more frequent in autistic adults than typical adults—especially some medical conditions, suicide attempts, accidents, and pain. A minority of autistic adults reported preventive health behaviors such as routine health check-ups. The majority of users and providers expressed the desire to make health care services more user-friendly for autistic adults. Among the three groups,

The chronically increased blood pressure characteristic of essential hypertension represents an insidious and cumulative risk for cardiovascular disease. Essential hypertension is a multifactorial condition, with no known specific aetiology but a strong genetic component. The Spontaneously Hypertensive rat (SHR) shares many characteristics of human essential hypertension, and as such is a commonly used experimental model. The mammalian hypothalamo-neurohypophyseal system (HNS) plays a pivotal role in the regulation of blood pressure, volume and osmolality. In order to better understand the possible role of the HNS in hypertension, we have used microarray analysis to reveal differential regulation of genes in the HNS of the SHR compared to a control normotensive strain, the Wistar Kyoto rat (WKY). These results were validated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). One of the genes identified and validated as being downregulated in SHR compared to WKY was that encoding the neuropeptide urocortin (Ucn). Immunohistochemical analyses revealed Ucn to be highly expressed within magnocellular neurons of the PVN and SON, with pronounced localisation in dendritic projections containing oxytocin and vasopressin. When Ucn was overexpressed in the PVN of the SHR by in vivo lentiviral mediated gene transfer, blood pressure was unaffected but there were significant, transient reductions in the VLF spectra of systolic blood pressure consistent with an action on autonomic balance. We suggest that Ucn may act, possibly via dendritic release, to subtly regulate neurohumoral aspects of arterial pressure control.

The purpose of this multi-study article was to investigate the roles of adaptability and social support in predicting a variety of psychological outcomes. Data were collected from Year 12 college students (N = 73; Study 1), university students (N = 102; Study 2), and non-studying members of the general public (N = 141; Study 3). Findings showed that, beyond variance attributable to social support, adaptability made a significant independent contribution to psychological wellbeing (life satisfaction, psychological wellbeing, flourishing, and general affect) and psychological distress across all studies. Beyond the effects of adaptability, social support was found to make a significant independent contribution to most wellbeing outcomes (but not psychological distress in university students). In a multi-group analysis comparing predictors of psychological wellbeing in university students and non-studying adults, where the same outcome measures were used (Study 4; N = 243), it was found that adaptability played a stronger role (relative to social support) for university students, whereas social support played a stronger role for non-studying adults. Finally, (contrary to expectations) there was no evidence of an interaction between adaptability and social support predicting psychological outcomes—adaptability and social support operated as independent main effects. These findings demonstrate the importance of adaptability and social support in uniquely predicting psychological wellbeing in different sample groups. It is argued here that these two factors, should be given greater consideration in discussions of psychological wellbeing, and are relevant to psychological wellbeing at different major developmental life stages.

The regolith environment and associated organic material on Ceres is analogous to environments that existed on Earth 3–4 billion years ago. This has implications not only for abiogenesis and the theory of transpermia, but it provides context for developing a framework to contrast the limits of Earth’s biosphere with extraterrestrial environments of interest. In this study, substrate utilisation by the ice-associated bacterium Colwellia hornerae was examined with respect to three aliphatic organic hydrocarbons that may be present on Ceres: dodecane, isobutyronitrile, and dioctyl-sulphide. Following inoculation into a phyllosilicate regolith spiked with a hydrocarbon (1% or 20% organic concentration wt%), cell density, electron transport activity, oxygen consumption, and the production of ATP, NADPH, and protein in C. hornerae was monitored for a period of 32 days. Microbial growth kinetics were correlated with changes in bioavailable carbon, nitrogen, and sulphur. We provide compelling evidence that C. hornerae can survive and grow by utilising isobutyronitrile and, in particular, dodecane. Cellular growth, electron transport activity, and oxygen consumption increased significantly in dodecane at 20 wt% compared to only minor growth at 1 wt%. Importantly, the reduction in total carbon, nitrogen, and sulphur observed at 20 wt% is attributed to biotic, rather than abiotic, processes. This study illustrates that short-term bacterial incubation studies using exotic substrates provide a useful indicator of habitability. We suggest that replicating the regolith environment of Ceres warrants further study and that this dwarf planet could be a valid target for future exploratory missions.

Sea ice supports a unique assemblage of microorganisms that underpin Antarctic coastal food-webs, but reduced ice thickness coupled with increased snow cover will modify energy flow and could lead to photodamage in ice-associated microalgae. In this study, microsensors were used to examine the influence of rapid shifts in irradiance on extracellular oxidative free radicals produced by sea-ice algae. Bottom-ice algal communities were exposed to one of three levels of incident light for 10 days: low (0.5 μmol photons m−2 s−1, 30 cm snow cover), mid-range (5 μmol photons m−2 s−1, 10 cm snow), or high light (13 μmol photons m−2 s−1, no snow). After 10 days, the snow cover was reversed (either removed or added), resulting in a rapid change in irradiance at the ice-water interface. In treatments acclimated to low light, the subsequent exposure to high irradiance resulted in a ~400× increase in the production of hydrogen peroxide (H2O2) and a 10× increase in nitric oxide (NO) concentration after 24 h. The observed increase in oxidative free radicals also resulted in significant changes in photosynthetic electron flow, RNA-oxidative damage, and community structural dynamics. In contrast, there was no significant response in sea-ice algae acclimated to high light and then exposed to a significantly lower irradiance at either 24 or 72 h. Our results demonstrate that microsensors can be used to track real-time in-situ stress in sea-ice microbial communities. Extrapolating to ecologically relevant spatiotemporal scales remains a significant challenge, but this approach offers a fundamentally enhanced level of resolution for quantifying the microbial response to global change.

Purpose This study aimed to evaluate the impact of Patient as teacher (PAT) sessions on the knowledge, communication skills, and participation of pharmacy students in the United Kingdom. Methods During the academic year 2019–2020, year 1 and 2 pharmacy students at the University of Central Lancashire were invited to complete a questionnaire following PAT sessions. Data were analyzed by means of descriptive statistics, including mean and standard deviation for: continuous variables and reliability analysis. Pearson’s chi-square or Fisher exact test, odds ratio, and phi were used for analyzing dichotomous variables. Thematic analysis was used for free text comments. Results Sixty eight of 228 students participated (response rate of 29.8%). No statistical difference was found between gender (P=0.090); a statistically significant difference was found between year (P=0.008). Cronbach’s α (0.809) confirmed a good internal consistency. Ninety-seven percent of the students learned a lot, and 85.3% appreciated and valued the PAT sessions; 89.7% wanted more sessions. Ninety-two point seven percent perceived the sessions to contextualize their learning. Five questions were dichotomized by grouping the responses into negative and positive; 90.3% of responses were positive and did not show statistically significant differences in gender and year of study. Overall students’ free text comments were positive, but active listening and consultation appeared in the positive and negative domains, highlighting the need for more student engagement. Conclusion PAT sessions had a positive impact on students’ knowledge, communication skills and participation, and contextualized learning. They provide a valuable contribution to the pharmacy students’ experience in the United Kingdom.

The main challenge for implementing an industrial-scale membrane distillation (MD) system is its associated thermal power demand and resulting operational cost, which hinders the commercialization of the technology, even after forty years of its evolution and development. Nevertheless, an enormous amount of waste heat releasing from the nano-electronics facilities provides MD an opportunity to showcase its potential for treating industrial wastewater discharging from the facilities. In this work, a waste heat driven MD system for a plant capacity of 15 m3/h was analyzed in terms of its thermal power demand and unit wastewater treatment cost. The economic analysis was performed using the factored estimate method. The results show that the thermal power requirement of the industrial-scale MD system was 12.38 MW, and the unit water treatment cost can vary between 3-23 $/m3, based on plant type (i.e., retrofitted facility or new wastewater treatment facility). • Determination of various industrial waste heat sources in typical nano-electronics fabrication facilities via interviews of related professionals, and designed industrial-scale waste heat integrated MD system for nano-electronics industries • Mass and energy balances around the industrial-scale MD system for wastewater treatment in nano-electronics industries • Equipment design for the purpose and performed economic evaluation of the MD system by customizing factored estimate method

Three cationic tracers, Sr2+, Co2+ and Cs+ were tested with a modified electromigration device by applying 2V, 3V and 4V voltage gradients over an intact Grimsel granodiorite rock sample. An ideal plug-flow model and an advection-dispersion model were applied to analyze the breakthrough curves. Matrix characterization by C-14-PMMA autoradiography and scanning electron microscopy showed that in the centimeter scale of Grimsel granodiorite rock, the interconnected matrix porosity forms a well-connected network for diffusion. Micrometer-scale fissures are transecting biotite and chlorite minerals, indicating sorption of the studied cations. The ideal plug-flow model indicated that the effective diffusion coefficients (De values) for Sr2+, Co2+ and Cs+ tracer ions within the Grimsel granodiorite rock were 3.20 × 10−13 m2/s, 1.23 × 10−13 m2/s and 2.25 × 10−12 m2/s, respectively. De values were also derived from the advection-dispersion model, from which 2.86 × 10−13 m2/s, 1.35 × 10−13 m2/s and 2.26 × 10−12 m2/s were calculated. The diffusion speed for the tracers was in the sequence of Cs+ > Sr2+ > Co2+ that is in the same sequence as their diffusion in diluted water. The distribution coefficients (Kd values) calculated from the models covered the range of two magnitudes (from 10−7 m3/kg to 10−5 m3/kg). The result indicated that the sorption process of the studied elements did not reach equilibrium during the electromigration process, mainly due to the too much acceleration of the migration speed by the voltage gradients applied over the rock sample.

Abstract Background Bleomycin, etoposide, and cisplatin (BEP) chemotherapy administered every 3 weeks for 4 cycles remains the standard first line treatment for patients with intermediate- and poor-risk metastatic germ cell tumours (GCTs). Administering standard chemotherapy 2-weekly rather than 3-weekly, so-called ‘accelerating chemotherapy’, has improved cure rates in other cancers. An Australian multicentre phase 2 trial demonstrated this regimen is feasible and tolerable with efficacy data that appears promising. The aim of this trial is to determine if accelerated BEP is superior to standard BEP as first line chemotherapy for adult and paediatric male and female participants with intermediate and poor risk metastatic GCTs. Methods This is an open label, randomised, stratified, 2-arm, international multicentre, 2 stage, phase 3 clinical trial. Participants are randomised 1:1 to receive accelerated BEP or standard BEP chemotherapy. Eligible male or female participants, aged between 11 and 45 years with intermediate or poor-risk metastatic GCTs for first line chemotherapy will be enrolled from Australia, the United Kingdom and the United States. Participants will have regular follow up for at least 5 years. The primary endpoint for stage 1 of the trial (n = 150) is complete response rate and for the entire trial (n = 500) is progression free survival. Secondary endpoints include response following treatment completion (by a protocol-specific response criteria), adverse events, health-related quality of life, treatment preference, delivered dose-intensity of chemotherapy (relative to standard BEP), overall survival and associations between biomarkers (to be specified) and their correlations with clinical outcomes. Discussion This is the first international randomised clinical trial for intermediate and poor-risk metastatic extra-cranial GCTs involving both adult and pediatric age groups open to both males and females. It is also the largest, current randomised trial for germ cell tumours in the world. Positive results for this affordable intervention could change the global standard of care for intermediate and poor risk germ cell tumours, improve cure rates, avoid the need for toxic and costly salvage treatment, and return young adults to long, healthy and productive lives. Trial registration ACTRN 12613000496718 on 3rd May 2013 and Clinicaltrials.gov NCT02582697 on 21st October 2015.

Abstract Background Falls are a common cause of hospitalization, morbidity, and mortality among the elderly in the United States. Evidence-based imaging recommendations for evaluation of delayed intracranial hemorrhage (DICH) are not generally agreed upon. The purpose of this project was to evaluate the incidence of DICH detected by head computer tomography (CT) among an elderly population on pre-injury anticoagulant or antiplatelet (ACAP) therapy. Methods Data from a Level 1 Trauma Center trauma registry was used to assess the incidence of DICH in an elderly population of patients (≥65 years) who sustained a minor fall while on pre-injury ACAP medications. Counts and percentages are reported. Results Data on 1076 elderly trauma patients were downloaded, of which 838 sustained a minor fall and 513 were found to be using a pre-injury ACAP medication. One patient (0.46%) with a DICH was identified out of 218 patients who received a routine repeat head CT. Aspirin and warfarin were the most common pre-injury ACAP medications and 19.27% (42/218) of patients were found to be using multiple ACAP medications. Conclusions Universal screening protocols promote immediate-term patient safety, but do so at a great expense with respect to health expenditures and increased radiation exposure. This analysis highlights the need for an effective risk assessment tool for DICH that would reduce the burden of unnecessary screenings while still identifying life-threatening intracranial hemorrhages in affected patients.

Abstract Background Lung cancer is the leading cause of cancer mortality worldwide. Early diagnosis and treatment is a key factor in reducing mortality and improving patient outcomes. To achieve this, it is important to understand the diagnostic pathways of cancer patients. Patients from Culturally and Linguistically Diverse (CALD) are a vulnerable group for lung cancer with higher mortality rates than Caucasian patients. The aim of this study is to explore differences in the lung cancer diagnostic pathways between CALD and Anglo-Australian patients and factors underlying these differences. Methods This is a prospective, observational cohort study using a mixed-method approach. Quantitative data regarding time intervals in the lung cancer diagnostic pathways will be gathered via patient surveys, General practitioner (GP) review of general practice records, and case-note analysis of hospital records. Qualitative data will be gathered via structured interviews with lung cancer patients, GPs, and hospital specialists. The study will be conducted in five study sites across three states in Australia. Anglo-Australian patients and patients from five CALD groups (i.e., Arabic, Chinese, Greek, Italian and Vietnamese communities) will mainly be identified through the list of new cases presented at lung multidisciplinary team meetings. For the quantitative component, it is anticipated that 724 patients (362 Anglo-Australian and 362 CALD patients) will be recruited to obtain a final sample of 290 (145 per group) assuming a 50% patient survey completion rate and a 80% GP record review completion rate. For the qualitative component, 60 interviews with lung cancer patients (10 Anglo-Australian and 10 patients per CALD group), 20 interviews with GPs, and 20 interviews with specialists will be conducted. Discussion This is the first Australian study to compare the time intervals along the lung cancer diagnostic pathway between CALD and Anglo-Australian patients. The study will also explore the underlying patient, healthcare provider, and health system factors that influence the time intervals in the two groups. This information will improve our understanding of the effect of ethnicity on health outcomes among lung cancer patients and will inform future interventions aimed at early diagnosis and treatment for lung cancer, particularly patients from CALD backgrounds. Trial registration The project was retrospectively registered with Australian New Zealand Clinical Trials Registry (registration number: ACTRN12617000957392, date registered: 4th July 2017).