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Abstract Background Therapeutic options for early-stage hepatocellular carcinoma (HCC) in individual patients can be limited by tumor and location, liver dysfunction and comorbidities. Many patients with early-stage HCC do not receive curative-intent therapies. Stereotactic ablative body radiotherapy (SABR) has emerged as an effective, non-invasive HCC treatment option, however, randomized evidence for SABR in the first line setting is lacking. Methods Trans-Tasman Radiation Oncology Group (TROG) 21.07 SOCRATES-HCC is a phase II, prospective, randomised trial comparing SABR to other current standard of care therapies for patients with a solitary HCC ≤ 8 cm, ineligible for surgical resection or transplantation. The study is divided into 2 cohorts. Cohort 1 will compromise 118 patients with tumors ≤ 3 cm eligible for thermal ablation randomly assigned (1:1 ratio) to thermal ablation or SABR. Cohort 2 will comprise 100 patients with tumors > 3 cm up to 8 cm in size, or tumors ≤ 3 cm ineligible for thermal ablation, randomly assigned (1:1 ratio) to SABR or best other standard of care therapy including transarterial therapies. The primary objective is to determine whether SABR results in superior freedom from local progression (FFLP) at 2 years compared to thermal ablation in cohort 1 and compared to best standard of care therapy in cohort 2. Secondary endpoints include progression free survival, overall survival, adverse events, patient reported outcomes and health economic analyses. Discussion The SOCRATES-HCC study will provide the first randomized, multicentre evaluation of the efficacy, safety and cost effectiveness of SABR versus other standard of care therapies in the first line treatment of unresectable, early-stage HCC. It is a broad, multicentre collaboration between hepatology, interventional radiology and radiation oncology groups around Australia, coordinated by TROG Cancer Research. Trial registration anzctr.org.au, ACTRN12621001444875, registered 21 October 2021.

The surge in digital platforms has revolutionized how consumers purchase, favoring online shopping. Despite its popularity, customer loyalty in this sphere requires enhancement. Companies are striving to augment loyalty and repurchase intention among consumers. However, the factors driving repurchase intention through shopping well-being in the online context, particularly in Vietnam, remain incompletely understood. This study examines shopping value components, including utilitarian and hedonic values, while exploring their relationships with customer trust and impulsive buying, influencing repurchase intention through customer’s shopping well-being on digital platforms. Employing a mixed-method approach, the study conducts qualitative interviews with online shoppers, marketers, and researchers to refine assessment scales for the Vietnamese context. A quantitative survey will gather data and use Covariance-based Structural Equation Modeling (CB-SEM) to test proposed hypotheses. In addition, the PRISMA model is applied in the systematic evaluation of literature reviews. This research offers a theoretical model for understanding consumer behavior in the Vietnamese online shopping landscape. Additionally, it furnishes valuable insights for digital platform sellers aiming to improve customers’ repurchase intention by refining the shopping experience and well-being.

This dataset explores the perception of happiness and job satisfaction among Vietnamese general school teachers and administrators (principals and vice-principles) in implementing a new curriculum. This study uses SPSS Statistics 26.0 and Exel to analyze data on the opinions of 782 general school teachers and administrators (principles and vice-principles) about satisfaction and happiness at work and influencing factors such as gender, age, experience, income, and workplace, workplaces, difficulties, sources of support when implementing new programs. This dataset contributes to a better understanding of the factors influencing educators' well-being and job satisfaction in the context of curriculum change, providing insights into educational policy and practice in Vietnam and beyond.

Abstract Introduction Travelling for cancer treatment comes with unique challenges, particularly for a young patient and his or her family. The aims of this study were to (1) gain an understanding of the experiences of families and patients who travelled overseas (OS) from Australia for proton beam therapy (PBT) and (2) identify the supportive care needs patients and their families require when living away from home, while having PBT. Methods This was a retrospective, qualitative study using semi‐structured interviews, conducted with participants aged under 25 years and their families who travelled OS for PBT between 2017 and 2020. Data were analysed using Microsoft Excel Software, where key themes were identified and coded based on their responses. A total of 17 participants were included in interviews from seven Australian families who travelled to America or Europe for PBT. Results The majority of participants reported a lack of coordination with travel and treatment arrangements prior to arrival OS. Families who stayed in hotel accommodation while OS reported greater feelings of isolation compared with those who stayed in share house‐style accommodation. The acuity of cancer diagnosis played a significant part in patient experience, with those patients requiring the greatest amount of supportive care and availability of service provision at stand‐alone centres reporting a lack of appropriate care provision. Conclusions This study has identified services, accommodation provisions and care coordination requirements that are largely missing from the travel and treatment experience in patients travelling OS for PBT. Future use of consumer‐led working groups or committees in creating models of care for families travelling for PBT treatment could be advantageous, with many families willing to share their experiences and provide support to others who are travelling for PBT.

Abstract This scoping review aimed to determine whether the COVID‐19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy (PT) centres. This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines. A literature search was performed in Medline, Embase, Web of Science and Scopus, as well as grey literature. Keywords such as “COVID‐19” and “Proton Therapy” were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 11 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Six of 11 articles included statements regarding treatment of COVID‐19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of unconventional therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment target volumes and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Few publications detailed changes to patient selection or workflow methods during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in PT, collecting this data could aid in future planning for PT in Australia.

Abstract With the anticipated launch of the Australian Bragg Centre for Proton Therapy and Research (ABCPTR) in Adelaide, Australia, proton therapy will become a significant addition to existing cancer treatment options for Australians. The anticipated benefits will be particularly evident in rare cancers such as clival chordomas, a challenging tumour entity due to the anatomical relationship with critical structures, and proven radio‐resistance to conventional radiation therapy. The article synthesises key findings from major studies and evaluates the current evidence supporting various management strategies for clival chordomas. It also considers the influence of institutional volume and multidisciplinary team management on patient outcomes and outlines how high‐quality care can be effectively delivered within the Australian healthcare system, emphasising the potential impact of proton therapy on the treatment paradigm of clival chordomas in Australia.

Transmission of extended-spectrum β-lactamase (ESBL) genes has increased the global prevalence of ESBL-producing bacteria, especially in developing countries. Human infection with these bacteria may be food-mediated but has not been fully elucidated. Therefore, we aimed to examine ESBL-producing bacteria in edible river fish and elucidate their potential for horizontal gene transfer. A total of 173 ESBL-producing Enterobacterales were isolated (Escherichia coli [n = 87], Klebsiella pneumoniae [n = 52], Enterobacter cloacae complex [n = 18], Citrobacter freundii complex [n = 14], Atlantibacter hermannii [n = 1] and Serratia fonticola [n = 1]) from 56 of 80 fish intestinal contents sampled. Among the bacterial blaCTX-M genotypes, blaCTX-M-55 was the most predominant, followed by blaCTX-M-15, blaCTX-M-27, and blaCTX-M-65. Furthermore, we found that ESBL-producing Enterobacterales were able to transfer their blaCTX-M genes to E. coli. In summary, our results suggest that ESBL-producing Enterobacterales transfer blaCTX-M to indigenous gut E. coli in humans, following the consumption of contaminated fish.

This study presents a sediment rating curve (SRC), multiple regression (MR), and long short-term memory (LSTM) model for estimating daily suspended sediment concentration (SSC). The data of daily SSC at Yen Thuong and daily flow at five locations in the Ca River Basin, Vietnam are used to demonstrate multiple approaches. Using the daily flow and SSC data in the period from 2009 to 2019, appropriate coefficients in each method are identified carefully using five popular criteria. The results showed that SRC and MR approaches reproduced acceptably the observed values, with the values of RMSE, MAE, and ME of daily SSC being less than 5% of daily SSC magnitude observed at the station, while NSE ranges from 0.47 to 0.63 and r coefficient varies between 0.69 and 0.80. The LSTM model represented the observed values of daily SSC very well. The values of two dimensionless criteria are greater than 0.94 and its values of three-dimensional criteria are smaller than 2.0% of the observed magnitude of daily SSC in both training and validation steps. The LSTM model is found to be the best among the three investigated approaches. Then, the model is applied to estimate daily SSC values for the period from 1969 to 2008 and the year 2020. HIGHLIGHTS Multiple approaches were implemented for estimating daily suspended sediment concentration.; Sediment rating curve and multiple regression reproduced acceptably the observed values of daily SSC.; A very good reproduction of the observed values of daily SSC was obtained when using the LSTM model.;

Background: Plagiarism by researchers and college students in Vietnam has become a major concern for publishers. Many cases of master’s theses of graduate students in Vietnam being cancelled or their diplomas being revoked for plagiarism are recorded, and some scientists also have been warned or criticized for plagiarism or self-plagiarism.Objectives: The purpose of this study was to analyse the use in educational research of 13 popular text-matching software packages at universities in Vietnam.Methods: The study was based on semistructured interviews of 104 researchers from 18 universities in Vietnam with reference to the use of text-matching software by the researchers.Results: The three most commonly used text-matching software packages were Turnitin, DoIT, and iThenticate. Three-fourths of the 18 universities employ text-matching software and although 17 out of 104 researchers were unfamiliar with such software. Universities in Vietnam primarily require plagiarism checks for master’s theses (79 out of 104 responses) and doctoral dissertations (72 out of 104 responses). Out of 104 participants, 32 use them for graduate theses or project reports, and 45 use them for research papers and project reports.Conclusions: Many universities in Vietnam are yet to specify the requirements for use of text-matching software, and most researchers and students use it only when prompted by publishers or institutions. Researchers in educational science typically lack the financial resources and the requisite skills for using text-matching software.

Background and purpose: The [18]F-fluoroethyl-l-tyrosine (FET) PET in Glioblastoma (FIG) study is an Australian prospective, multi-centre trial evaluating FET PET for newly diagnosed glioblastoma management. The Radiation Oncology credentialing program aimed to assess the feasibility in Radiation Oncologist (RO) derivation of standard-of-care target volumes (TVMR) and hybrid target volumes (TVMR+FET) incorporating pre-defined FET PET biological tumour volumes (BTVs). Materials and methods: Central review and analysis of TVMR and TVMR+FET was undertaken across three benchmarking cases. BTVs were pre-defined by a sole nuclear medicine expert. Intraclass correlation coefficient (ICC) confidence intervals (CIs) evaluated volume agreement. RO contour spatial and boundary agreement were evaluated (Dice similarity coefficient [DSC], Jaccard index [JAC], overlap volume [OV], Hausdorff distance [HD] and mean absolute surface distance [MASD]). Dose plan generation (one case per site) was assessed. Results: Data from 19 ROs across 10 trial sites (54 initial submissions, 8 resubmissions requested, 4 conditional passes) was assessed with an initial pass rate of 77.8 %; all resubmissions passed. TVMR+FET were significantly larger than TVMR (p

Abstract Background Isolated pulmonary oligometastases as the first site of dissemination after initial resection of pancreatic ductal adenocarcinoma (PC) is a rare event, and the treatment in this subgroup is challenging. Recurrence in the lung after initial primary tumour resection is associated with the most long-term survivors of patients with metastatic PC. Stereotactic ablative body radiation therapy (SABR) or metastectomy for pulmonary oligometastases from PC is becoming more common. However, patients with close or positive margins after metastectomy for isolated pulmonary metastatic PC are at high risk for recurrence. This requires a treatment capable of achieving high rates of local control and improved quality of life by delaying the need for systemic chemotherapy. In other settings, SABR has been shown to achieve these goals, allowing safe dose escalation with excellent conformity and short duration of treatment. Case presentation We report the case of a 48-year old Caucasian man with a history of locally advanced PC initially treated with neoadjuvant chemotherapy followed by Whipple’s resection in August 2016. After a disease-free interval of 3 years, he developed three isolated pulmonary metastases which were treated with local resection. In the setting of microscopically positive resection margins (R1), adjuvant lung SABR was delivered to all three sites. His treated lung disease remained radiologically stable for up to twenty months after SABR. Treatment was well tolerated. In January 2021, he developed a malignant pre-tracheal node which was treated with conventionally fractionated radiotherapy and remained controlled for the duration of follow-up. A year later, he developed widespread metastatic disease including pleura, bone and adrenal gland, together with presumed progression in one of the original lung lesions, receiving palliative radiotherapy for right chest wall pain. He was later found to have an intracranial metastasis and died in February 2022, 5½ years after initial treatment. Conclusion We present the case of a patient treated with SABR after R1 resection of 3 isolated pulmonary metastases from PC, with no treatment toxicities and durable local control. For well-selected patients in this setting, adjuvant lung SABR may be a safe and effective treatment option.

Abstract Introduction Stereotactic ablative radiotherapy (SABR) can be a curative option for non‐small cell lung cancer (NSCLC) and oligometastatic lung disease. Volumetric modulated arc therapy (VMAT) has offered further advancements in terms of radiation dose shaping without compromising treatment times however there is potential for greater low‐dose exposure to the lung. This study was to assess whether VMAT lung SABR would result in any increase to the dosimetry parameters compared with three‐dimensional conformal radiotherapy (3D‐CRT) that could confer increased risk of radiation pneumonitis. Methods A total of 53 and 30 3D‐CRT treatment plans of patients treated with 48 Gy in 4 fractions were compared. Results No statistically significant difference in planning target volumes between the VMAT 29.9 cc (range 12.4–58.5 cc) and 3D‐CRT 31.2 cc (range 12.3–58.3 cc) P = 0.79. The mean of total lung V5, ipsilateral lung V5 and contralateral lung V5 all showed a trend of being smaller in the VMAT treatment group‐ 14% versus 15.8%, 25.6% versus 30.4% and 1.6% versus 2.2%, respectively, but all were not statistically significant differences. Mean of the mean lung dose MLD, again showed a trend of being lower in the VMAT treatments but was also non‐significant, 2.6 Gy versus 3.0 Gy, P = 1.0. Mean V20 was the same in both cohorts, 3.3%. Conclusions The dosimetry for 3D‐CRT and VMAT plans were not significantly different including V5, and therefore we conclude that VMAT treatment is unlikely to be associated with an increased risk of radiation pneumonitis.

Accurately characterizing DNA double-stranded breaks (DSBs) and understanding the DNA damage response (DDR) is crucial for assessing cellular genotoxicity, maintaining genomic integrity, and advancing gene editing technologies. Immunofluorescence-based techniques have proven to be invaluable for quantifying and visualizing DSB repair, providing valuable insights into cellular repair processes. However, the selection of appropriate markers for analysis can be challenging due to the intricate nature of DSB repair mechanisms, often leading to ambiguous interpretations. This comprehensively summarizes the significance of immunofluorescence-based techniques, with their capacity for spatiotemporal visualization, in elucidating complex DDR processes. By evaluating the strengths and limitations of different markers, we identify where they are most relevant chronologically from DSB detection to repair, better contextualizing what each assay represents at a molecular level. This is valuable for identifying biases associated with each assay and facilitates accurate data interpretation. This review aims to improve the precision of DSB quantification, deepen the understanding of DDR processes, assay biases, and pathway choices, and provide practical guidance on marker selection. Each assay offers a unique perspective of the underlying processes, underscoring the need to select markers that are best suited to specific research objectives.

Life-prolonging central nervous system active systemic therapies for metastatic NSCLC have increased the complexity of managing brain metastases (BMs). Australian medical oncologists, radiation oncologists, and neurosurgeons discussed the evidence guiding the diverse clinical approaches to the management of BM in NSCLC. The Australian context is broadly applicable to other jurisdictions; therefore, we have documented these discussions as principles with broader applications. Patient management was stratified according to clinical and radiologic factors under two broad classifications of newly diagnosed BMs: symptomatic and asymptomatic. Other important considerations include the number and location of metastases, tumor histotypes, molecular subtype, and treatment purpose. Careful consideration of the pace and burden of symptoms, risk of worsening neurologic function at a short interval, and extracranial disease burden should determine whether central nervous system active systemic therapies are used alone or in combination with local therapies (surgery with or without radiation therapy). Most clinical trial evidence currently focuses on historical treatment options or a single treatment modality rather than the optimal sequencing of multiple modern therapies; therefore, an individualized approach is key in a rapidly changing therapeutic landscape.

This paper presents the long short-term memory (LSTM), rating curve (RC), and rainfall–runoff model that can be used for estimating the daily flow at the outlet of river basins. The Hieu river basin in Vietnam is selected as an example for demonstrating the ability of multiple approaches. Hydro-meteorological data at the Quy Chau station are collected over a long period from 1/1/1991 to 31/12/2020. Multiple approaches mentioned above are implemented and used for calculating the daily flow in the studied river basin. The coefficients and modeling parameters in each approach are then carefully determined based on five statistical error indexes. The results revealed that the RC using either one or two segments and the LSTM model using water elevation as input data represented the observed daily flow very well, with the values of dimensional errors (i.e. mean error, mean absolute error and root mean square error) equal only to about of 1% of the observed magnitude of the flow in the studied river basin, while Nash–Sutcliffe efficiency and correlation coefficients are greater than 0.95. Impacts of different types of input datasets on estimated values of the daily flow are also presented when the LSTM model is applied. HIGHLIGHTS Long short-term memory, rating curve, and rainfall–runoff model are implemented for estimating the daily flow in river basins.; Long short-term memory and rating curve using either one or two segments represented the observed daily flow very well in the studied river basin.; Using the long short-term memory model, input datasets affected significantly estimated values of the daily flow.;

Abstract Hypertension prevalence in Vietnam is high, but few people are aware of their disease status. Detection, diagnosis, and treatment are limited, so new approaches are needed to improve awareness and manage the condition, especially at the primary health care level. The Communities for Healthy Hearts programme operated in four districts of Ho Chi Minh City, with the aim of increasing awareness and ensuring linkage to care. Interventions focused on extending services beyond health facilities to convenient community locations; training cadres of community volunteers to screen, refer, and follow up with clients; training health workers in facilities to diagnose, educate, and manage patients referred from the community; and supporting the process with digital case tracking. Community-based blood pressure screenings took place in client homes, commune health stations, and non-traditional sites such as coffee shops, dentists’ offices, marketplaces, neighbourhood watch/security posts, and tailor shops. In total, 121,273 adults aged 40 and older were screened. Of these, 25.1% had elevated blood pressure or a previous hypertension diagnosis and were referred to health facilities. Of those referred, 56.2% were confirmed to have hypertension, and of those confirmed, 75.2% were treated. Of those treated, 51.0% achieved blood pressure control, a favourable outcome over past programmes.

Abstract Introduction Telemedicine consultations can be a cost‐effective and convenient method of communication, particularly with patients living in remote areas. Given the dearth of patient‐reported satisfaction data with this form of consultation in Radiation Oncology, we surveyed patients to assess this in our department. Methods The study recruited patients who had experienced both a Telemedicine consultation and an in‐person consultation with the same radiation oncologist at our tertiary centre in South Australia. Eligible patients were identified from the Royal Adelaide Hospital oncology information system. The patient satisfaction questionnaire was sent via registered post with a reply‐paid envelope. The questionnaire consisted of 38 questions divided into four major categories, focusing on communication, medical care, privacy/confidentiality and convenience. Results of the survey were tabulated in an excel spreadsheet. Results Between 1 January 2018 and 1 January 2019, 130 eligible patients were identified. One hundred and nine patients were alive and contactable of whom 37 responded (34%). Two surveys were returned incomplete resulting in 35 patient responses available for analysis. The median age was 70 years (range 35–87); 74% were male. There was no statistically significant difference between the satisfaction scores for Telemedicine and in‐person consultations with regards to communication, privacy/confidentiality or overall satisfaction. The respondent felt it was more important to be examined when the consultation was conducted in‐person and found Telemedicine consultations more convenient in terms of cost and time. Conclusion Telemedicine used in Radiation Oncology is an effective form of consultation that is convenient, provides a similar level of patient satisfaction and maintains patient confidentiality. Telemedicine consultations should therefore be considered for all rural and remote cancer patients where feasible.

Abstract Background and Aim The rate of contraindications to percutaneous ablation (PA) for inoperable early hepatocellular carcinoma (HCC) and subsequent outcomes is not well described. We investigated the prevalence and outcomes of inoperable early HCC patients with contraindications to PA, resulting in treatment stage migration (TSM). Methods Barcelona Clinic Liver Cancer (BCLC) 0/A patients diagnosed between September 2013 and September 2019 across five hospitals were identified. Primary endpoint was proportion of BCLC 0/A HCCs with contraindications to PA. Secondary endpoints included overall survival (OS), local tumor control (LTC), and recurrence‐free survival (RFS). The causal effects of PA versus TSM were assessed using a potential outcome means (POM) framework in which the average treatment effects (ATEs) of PA were estimated after accounting for potential selection bias and confounding. Results Two hundred twenty patients with inoperable BCLC 0/A HCC were identified. One hundred twenty‐two patients (55.5%) had contraindications to PA and received TSM therapy, 98 patients (44.5%) received PA. The main contraindication to PA was difficult tumor location (51%). Patients who received TSM therapy had lower median OS (2.4 vs 5.3 years), LTC (1.0 vs 4.8 years), and RFS (0.8 vs 2.9 years); P

Background and Aims: Frozen embryo transfer is a current trend in practice worldwide. Modified Natural Cycle, Hormone Replacement Therapy are common endometrial preparation protocols in Vietnam. The aim of this study was to compare the outcomes of a Modified Natural Cycle vs Hormone Replacement Therapy for Endometrial Preparation for Frozen Embryo Transfer. Method: This was a single center randomized clinical trial. It was conducted in the period between August 2022 and March 2023 in Andrology and Fertility Hospital of Hanoi. A total of 166 patients were randomly allocated to two groups, either the hormone replacement cycle (83 patients) (HRT group) or the modified natural cycle (83 patients) (mNC group). Results: The mean age was 31 vs 30 years in mNC and HRT. The endometrial thickness on the day of Progesterone administration in mNC was higher than HRT (10.99±1.46 và 10.70±1.06 mm), p>0.05. There was no significant difference between mNC group and HRT group regarding implantation rate, clinical pregnancy rate, on-going rate. After adjusting for age, BMI, duration of infertility, type of infertility, history of miscarriage, number of failed embryo transfers, endometrial thickness on the day of Progesterone administration, number of good-quality embryos transferred showed that the clinical pregnancy rate in the HRT was higher than that mNC, but the relationship was not statistically significant with p>0.05. Conclusion: The selection of regimen to use for endometrial preparation for frozen embryo transfer depends on individualized patient treatment, particularly with respect to the selection of the endometrial preparation method particularly with respect to the selection of the endometrial preparation method.

Abstract The aim was to explore various national and international clinical decision‐making tools and dose comparison methods used for selecting cancer patients for proton versus X‐ray radiation therapy. To address this aim, a literature search using defined scoping review methods was performed in Medline and Embase databases as well as grey literature. Articles published between 1 January 2015 and 4 August 2020 and those that clearly stated methods of proton versus X‐ray therapy patient selection and those published in English were eligible for inclusion. In total, 321 studies were identified of which 49 articles met the study’s inclusion criteria representing 13 countries. Six different clinical decision‐making tools and 14 dose comparison methods were identified, demonstrating variability within countries and internationally. Proton therapy was indicated for all paediatric patients except those with lymphoma and re‐irradiation where individualised model‐based selection was required. The most commonly reported patient selection tools included the Normal Tissue Complication Probability model, followed by cost‐effectiveness modelling and dosimetry comparison. Model‐based selection methods were most commonly applied for head and neck clinical indications in adult cohorts (48% of studies). While no ‘Gold Standard’ currently exists for proton therapy patient selection with variations evidenced globally, some of the patient selection methods identified in this review can be used to inform future practice in Australia. As literature was not identified from all countries where proton therapy centres are available, further research is needed to evaluate patient selection methods in these jurisdictions for a comprehensive overview.

Abstract Background Among patients with non-metastatic pancreatic cancer, 80% have high-risk, borderline resectable or locally advanced cancer, with a 5-year overall survival of 12%. MASTERPLAN evaluates the safety and activity of stereotactic body radiotherapy (SBRT) in addition to chemotherapy in these patients. Methods and design MASTERPLAN is a multi-centre randomised phase II trial of 120 patients with histologically confirmed potentially operable pancreatic cancer (POPC) or inoperable pancreatic cancer (IPC). POPC includes patients with borderline resectable or high-risk tumours; IPC is defined as locally advanced or medically inoperable pancreatic cancer. Randomisation is 2:1 to chemotherapy + SBRT (investigational arm) or chemotherapy alone (control arm) by minimisation and stratified by patient cohort (POPC v IPC), planned induction chemotherapy and institution. Chemotherapy can have been commenced ≤28 days prior to randomisation. Both arms receive 6 × 2 weekly cycles of modified FOLFIRINOX (oxaliplatin (85 mg/m2 IV), irinotecan (150 mg/m2), 5-fluorouracil (2400 mg/m2 CIV), leucovorin (50 mg IV bolus)) plus SBRT in the investigational arm. Gemcitabine+nab-paclitaxel is permitted for patients unsuitable for mFOLFIRINOX. SBRT is 40Gy in five fractions with planning quality assurance to occur in real time. Following initial chemotherapy ± SBRT, resectability will be evaluated. For resected patients, adjuvant chemotherapy is six cycles of mFOLFIRINOX. Where gemcitabine+nab-paclitaxel was used initially, the adjuvant treatment is 12 weeks of gemcitabine and capecitabine or mFOLFIRINOX. Unresectable or medically inoperable patients with stable/responding disease will continue with a further six cycles of mFOLFIRINOX or three cycles of gemcitabine+nab-paclitaxel, whatever was used initially. The primary endpoint is 12-month locoregional control. Secondary endpoints are safety, surgical morbidity and mortality, radiological response rates, progression-free survival, pathological response rates, surgical resection rates, R0 resection rate, quality of life, deterioration-free survival and overall survival. Tertiary/correlative objectives are radiological measures of nutrition and sarcopenia, and serial tissue, blood and microbiome samples to be assessed for associations between clinical endpoints and potential predictive/prognostic biomarkers. Interim analysis will review rates of locoregional recurrence, distant failure and death after 40 patients complete 12 months follow-up. Fifteen Australian and New Zealand sites will recruit over a 4-year period, with minimum follow-up period of 12 months. Discussion MASTERPLAN evaluates SBRT in both resectable and unresectable patients with pancreatic ductal adenocarcinoma. Trial registration Australia New Zealand Clinical Trials Registry ACTRN12619000409178 , 13/03/2019. Protocol version: 2.0, 19 May 2019

Abstract Introduction The significantly greater cost of proton therapy compared with X‐ray therapy is frequently justified by the expected reduction in normal tissue toxicity. This is often true for indications such as paediatric and skull base cancers. However, the benefit is less clear for other more common indications such as breast cancer, and it is possible that the degree of benefit may vary widely between these patients. The aim of this work was to demonstrate a method of individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness of treatment. Methods 16 left‐sided breast cancer patients had a treatment plan generated for the delivery of intensity‐modulated proton therapy (IMPT) and of intensity‐modulated photon therapy (IMRT) with the deep inspiration breath‐hold (DIBH) technique. The resulting dosimetric data was used to predict probabilities of tumour control and toxicities for each patient. These probabilities were used in a Markov model to predict costs and the number of quality‐adjusted life years expected as a result of each of the two treatments. Results IMPT was not cost‐effective for the majority of patients but was cost‐effective where there was a greater risk reduction of second malignancies with IMPT. Conclusion The Markov model predicted that IMPT with DIBH was only cost‐effective for selected left‐sided breast cancer patients where IMRT resulted in a significantly greater dose to normal tissue. The presented model may serve as a means of evaluating the cost‐effectiveness of IMPT on an individual patient basis.

Chlorophyll-a (Chl-a) concentration, a crucial indicator of phytoplankton biomass, is sensitive to seasonality. The variations in trophic states regarding seasonality and the changes of spectral properties of water bodies pose uncertainties to the accuracy of remote sensing semiempirical models. In particular, lakes in subtropical regions generally experience different trophic states in dry and wet seasons. In this study, a season-insensitive Chl-a retrieval model using multitask convolution neural network with multiple output layers (MCNN) is proposed. A layer-sharing network combined with data augmentation is adopted to alleviate the issue of insufficient quantity of in situ samples. In addition, a hyperparameter optimization is performed to automatically refine the MCNN architecture. To evaluate the accuracy of proposed method, Laguna Lake, one of the largest lakes in Southeast Asia, is selected as the validation target. The lake is characterized by oligotrophic and mesotrophic states in wet season, whereas the states change to mesotrophic and low-level eutrophic states in dry season. A collection of Sentinel-3 Ocean and Land Colour Instrument Level-2 images and 409 in situ samples with the Chl-a concentration range 1.24–22.30 mg$\cdot$m$^{-3}$ were used for model calibration and evaluation. Experimental results showed that MCNN with the performance of average $\boldsymbol{R^{2}}$ = 0.74, RMSE = 2.06 mg$\cdot$m$^{-3}$, Pearson's $\boldsymbol {r}$ = 0.86 outperforms related semiempirical models, including normalized difference chlorophyll index, two-band and three-band models, and WaterNet. The Chl-a prediction accuracy was improved by 7.19–14.6%, in terms of RMSE, compared with WaterNet.

Abstract Background Patients with human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPC) have substantially better treatment response and overall survival (OS) than patients with HPV-negative disease. Treatment options for HPV+ OPC can involve either a primary radiotherapy (RT) approach (± concomitant chemotherapy) or a primary surgical approach (± adjuvant radiation) with transoral surgery (TOS). These two treatment paradigms have different spectrums of toxicity. The goals of this study are to assess the OS of two de-escalation approaches (primary radiotherapy and primary TOS) compared to historical control, and to compare survival, toxicity and quality of life (QOL) profiles between the two approaches. Methods This is a multicenter phase II study randomizing one hundred and forty patients with T1–2 N0–2 HPV+ OPC in a 1:1 ratio between de-escalated primary radiotherapy (60 Gy) ± concomitant chemotherapy and TOS ± de-escalated adjuvant radiotherapy (50–60 Gy based on risk factors). Patients will be stratified based on smoking status (

Background Of the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB.Methods A cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs’ referral.Results In total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan.Conclusions Few SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings.

On inland waterways the ship resistance and propulsive characteristics are strictly related to the depth of the waterway, thus it is important to have an understanding of the influence of water depth on ship hydrodynamic characteristics. Therefore, accurate predictions of hydrodynamic forces in restricted waterways are required and important. The aim of this paper is investigating the capability of the commercial unsteady Reynolds–Averaged Navier–Stokes (RANS) solver to predict the influence of water depth on ship resistance. The volume of fluid method (VOF) is applied to simulate the free surface flow around the ship. The hull resistance in shallow and deep water is compared. The obtained numerical results are validated against related experimental studies available in the literature.

Abstract Introduction The majority of pancreatic cancers present locally advanced and carry a high mortality rate. Treatment is challenging, with mixed data suggesting use of chemotherapy alone or in combination with radiotherapy. The use of radiotherapy has previously been limited due to lack of ability to deliver radiation to the tumour mass without causing significant toxicity to surrounding organs. Stereotactic body radiotherapy (SBRT) allows delivery of higher biologically equivalent dose in a shorter treatment duration. We sought to investigate the safety and application of this technique in our centre. Method We enrolled 27 patients from 2015, identified as locally advanced unresectable with histologically confirmed, non‐metastatic, pancreatic adenocarcinoma. All patients had endoscopically inserted fiducial markers and where possible concurrent chemotherapy was administered. Dose schedules ranged from 25 to 42 Gy in 5 or 3 fractions. Results With an overall median follow up of 9 months (range, 3–32.7), the median survival was 11.6 months. Of those alive at 1 year, the local control rate was 67%. Six patients had Grade 3 toxicity, and other six had Grade 2 toxicity. None had Grade 4 or above toxicity. The most common symptom recorded was fatigue. Conclusion SBRT for locally advanced pancreatic cancer is technically complex but feasible in a high volume centre. SBRT is unique, allowing safe delivery of high radiation dose resulting in good local control and decreases treatment time making it an attractive option for patients with unresectable pancreatic cancer.

The effects of Chinese pine (Pinus tabuliformis) on soil variables after afforestation have been established, but microbial community changes still need to be explored. Using high-throughput sequencing technology, we analyzed bacterial and fungal community composition and diversity in soils from three stands of different-aged, designated 12-year-old (PF1), 29-year-old (PF2), and 53-year-old (PF3), on a Chinese pine plantation and from a natural secondary forest (NSF) stand that was almost 80 years old. Abandoned farmland (BL) was also analyzed. Shannon index values of both bacterial and fungal community in PF1 were greater than those in PF2, PF3 and NSF. Proteobacteria had the lowest abundance in BL, and the abundance increased with stand age. The abundance of Actinobacteria was greater in BL and PF1 soils than those in other sites. Among fungal communities, the dominant taxa were Ascomycota in BL and PF1 and Basidiomycota in PF2, PF3 and NSF, which reflected the successional patterns of fungal communities during the development of Chinese pine plantations. Therefore, the diversity and dominant taxa of soil microbial community in stands 12 and 29 years of age appear to have undergone significant changes; afterward, the soil microbial community achieved a relatively stable state. Furthermore, the abundances of the most dominant bacterial and fungal communities correlated significantly with organic C, total N, C:N, available N, and available P, indicating the dependence of these microbes on soil nutrients. Overall, our findings suggest that the large changes in the soil microbial community structure of Chinese pine plantation forests may be attributed to the phyla present (e.g., Proteobacteria, Actinobacteria, Ascomycota and Basidiomycota) which were affected by soil carbon and nutrients in the Loess Plateau.

In neurons, specific RNAs are assembled into granules, which are translated in dendrites, however the functional consequences of granule assembly are not known. Tumor overexpressed gene (TOG) is a granule-associated protein containing multiple binding sites for heterogeneous nuclear ribonucleoprotein (hnRNP) A2, another granule component that recognizes cis-acting sequences called hnRNP A2 response elements (A2REs) present in several granule RNAs. Translation in granules is sporadic, which is believed to reflect monosomal translation, with occasional bursts, which are believed to reflect polysomal translation. In this study, TOG expression was conditionally knocked out (TOG cKO) in mouse hippocampal neurons using cre/lox technology. In TOG cKO cultured neurons granule assembly and bursty translation of activity-regulated cytoskeletal associated (ARC) mRNA, an A2RE RNA, are disrupted. In TOG cKO brain slices synaptic sensitivity and long term potentiation (LTP) are reduced. TOG cKO mice exhibit hyperactivity, perseveration and impaired short term habituation. These results suggest that in hippocampal neurons TOG is required for granule assembly, granule translation and synaptic plasticity, and affects behavior.

This study makes use of recent evidence from developing countries by which to evaluate the effectiveness of private higher education institutions (HEIs), comparing them with public HEIs. In this way, it contributes to the literature by providing the first evaluation of productivity and its components in Vietnamese HEIs. The study uses the Färe-Primont index together with a meta-frontier approach. The research results indicate that the higher education system in Vietnam is powerfully driven by the large-scale public sector coupled with the long-term plans of Vietnamese state HEIs. Public HEIs have also been a major contributor to domestic research, and although there has been an increase in total factor productivity (TFP) throughout the research period, the private sector's TFP was 30% higher than that of the public sector. Moreover, the higher technology gap rate (TGR) of private HEIs shows the potential for greater development in the future.