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Introduction: Smoking is a major risk factor for both chronic obstructive pulmonary disease (COPD) and myocardial infarction (MI). Systemic inflammation also contributes to both diseases and has been suggested as a potential target for intervention. Prevalence of COPD in those with a significant smoking history hospitalised for MI has not been well-characterised. We sought to obtain an accurate estimate of COPD burden in this group and characterise the population. Methods: Two consecutive cohorts of patients hospitalised for MI with a smoking history of ≥10 pack-years were recruited in Sweden and the United Kingdom (UK). Baseline characteristics were recorded, including treatment with inhaled corticosteroids (ICS) and eosinophil count in blood. Microspirometry was performed using the Vitalograph COPD-6 device and symptom burden assessed using the COPD Assessment Test (CAT). The primary outcome was the prevalence of a preliminary diagnosis of clinically-significant COPD, here defined as a ratio of forced expiratory volume in 1 and 6 seconds (FEV1/FEV6) <0.7 and with FEV1 <80% of predicted value. Results: In the UK cohort, 216 participants with MI (26% female, median age 60 (IQR 53–67) years, smoking history 32 (23–45) pack-years) were recruited. The proportion with any COPD was 36%. Clinically-significant COPD was found in 30 participants (13.9%, 95% CI 9.5–19.2). Of these, 43% had a prior COPD diagnosis, 20% had an eosinophil count ≥300 cells/mm3, mean CAT score was 14.4 ± 9.3), 80% had high symptom burden (CAT score >10) and 23% were receiving ICS. The Swedish cohort included 302 participants with MI (24% female, median age 68 (IQR 61–76) years, 26 (15–38) pack years), and clinically-significant COPD was found in 52 (17.2%; 12.9–21.5). In these 52 participants, 17% had a prior COPD diagnosis, 20% had an eosinophil count ≥300 cells/mm3, mean CAT score was 12.9 ± 7.2, 63% had CAT score ≥10 and 15% had treatment with ICS. Conclusions: The prevalence of prelim

Zinc inhibits replication of the SARS-CoV virus. We aimed to evaluate the safety, feasibility, and biological effect of administering high-dose intravenous zinc (HDIVZn) to patients with COVID-19. We performed a Phase IIa double-blind, randomized controlled trial to compare HDIVZn to placebo in hospitalized patients with COVID-19. We administered trial treatment per day for a maximum of 7 days until either death or hospital discharge. We measured zinc concentration at baseline and during treatment and observed patients for any significant side effects. For eligible patients, we randomized and administered treatment to 33 adult participants to either HDIVZn (n = 15) or placebo (n = 18). We observed no serious adverse events throughout the study for a total of 94 HDIVZn administrations. However, three participants in the HDIVZn group reported infusion site irritation. Mean serum zinc on Day 1 in the placebo, and the HDIVZn group was 6.9 ± 1.1 and 7.7 ± 1.6 µmol/l, respectively, consistent with zinc deficiency. HDIVZn, but not placebo, increased serum zinc levels above the deficiency cutoff of 10.7 µmol/l (p < .001) on Day 6. Our study did not reach its target enrollment because stringent public health measures markedly reduced patient hospitalizations. Hospitalized COVID-19 patients demonstrated zinc deficiency. This can be corrected with HDIVZn. Such treatment appears safe, feasible, and only associated with minimal peripheral infusion site irritation. This pilot study justifies further investigation of this treatment in COVID-19 patients.

An outbreak of a novel coronavirus (COVID-19 or 2019-CoV) infection has posed significant threats to international health and the economy. Patients with COVID-19 are at risk of cytokine storm, acute respiratory distress syndrome (ARDS), reduced blood oxygenation, mechanical ventilation, and a high death rate. Although recent studies have shown remdesivir and dexamethasone as treatment options, there is an urgent need to find a treatment to inhibit virus replication and to control the progression of the disease. Essential biometal zinc has generated a lot of excitement as one of the promising candidates to reduce the severity of COVID-19 infection. Several published observations outlined in the review are the reasons why there is a global enthusiasm that zinc therapy could be a possible therapeutic option. However, the biggest challenge in realising the therapeutic value of zinc is lack of optimal treatment modalities such as dose, duration of zinc supplementation and the mode of delivery. In this review, we discuss the regulatory mechanism that hinges upon the bioavailability of zinc. Finally, we propose that intravenous zinc could circumvent the confounding factors affecting the bioavailability of zinc and allow zinc to achieve its therapeutic potential. If successful, due to advantages such as lack of toxicity, low cost and ease of availability, intravenous zinc could be rapidly implemented clinically.

INTRODUCTION: SARS-CoV-2 (COVID-19) has caused an international pandemic of respiratory illness, resulting in significant healthcare and economic turmoil. To date, no robust vaccine or treatment has been identified. Elemental zinc has previously been demonstrated to have beneficial effects on coronaviruses and other viral respiratory infections due to its effect on RNA polymerase. Additionally, zinc has well-demonstrated protective effects against hypoxic injury-a clear mechanism of end-organ injury in respiratory distress syndrome. We aimed to assess the effect of high-dose intravenous zinc (HDIVZn) on SARS-CoV-2 infection. The end of study analyses will evaluate the reduction of impact of oxygen saturations or requirement of oxygen supplementation. METHODS AND ANALYSIS: We designed a double-blind randomised controlled trial of daily HDIVZn (0.5 mg/kg) versus placebo. Primary outcome measures are lowest oxygen saturation (or greatest level of supplemental oxygenation) for non-ventilated patients and worst PaO2/FiO2 for ventilated patients. Following power calculations, 60 hospitalised patients and 100 ventilated patients will be recruited to demonstrate a 20% difference. The duration of follow-up is up to the point of discharge. ETHICS AND DISSEMINATION: Ethical approval was obtained through the independent Human Research Ethics Committee. Participant recruitment will commence in May 2020. Results will be published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER: ACTRN126200000454976.

Background and objectives The majority of bladder cancers diagnosed in Australia are non-muscle invasive bladder cancers (NMIBC). We recently established a dedicated haematuria and postoperative bladder oncology clinics with the aim to fast track diagnosis and treatment for newly diagnosed bladder cancers. In this study, we have assessed whether the new service was adhering to the European Association of Urology (EAU) guidelines for the management of NMIBC. Materials and methods Retrospective data collection for patients with primary NMIBC diagnosed between the 1st of July 2015 till 30th of June 2017 at our Victorian Public hospital. All recurrent tumours were excluded. We utilized all patient files and our hospital pathology database. Results 349 patients were diagnosed with primary NMIBC (265 males, 84 females, mean age 54). 177 (51%) patients were diagnosed with Ta tumours, 118 (34%) with T1 tumours and 54 (15%) patients with carcinoma in situ (CIS). 7 (4%) patients with Ta disease received a single immediate post-operative instillation of MMC. All patients with Ta disease were referred to a flexible cystoscopy surveillance program, 3 (0.86%) were lost to follow-up. 140 (81.4%) High Grade disease patients were referred to our BCG clinic, 2 (1.2%) were referred directly for a radical cystectomy, 30 (17.4%) were deemed inappropriate for BCG therapy and referred for surveillance. Of the 140 who were referred for BCG, 130 (92.9%) patients received full induction course. Only 49 (35.0%) patients went on to receive the full maintenance course. Conclusion Our study has illustrated that the majority of our highgrade disease patients received induction BCG, however few progressed to have the recommended maintenance course. Reasons included patient, clinician, and hospital factors. The vast majority of our low-grade tumour patients did not receive the recommended immediate intravesical chemotherapy. This demonstrates that we are not currently adhering to the current level

Introduction & Objectives: The majority of bladder cancers diagnosed in Australia are non-muscle invasive bladder cancers (NMIBC). We recently established a dedicated haematuria and post-operative bladder oncology clinics with the aim to fast track diagnosis and treatment for newly diagnosed bladder cancers. In this study, we have assessed whether the new service was adhering to the European Association of urology (EAU) guidelines for the management of NMIBC. Method(s): Retrospective data collection for patients with primary NMIBC diagnosed between the 1st of July 2015 till 30th of June 2017 at our Victorian Public hospital. All recurrent tumours were excluded. We utilized all patient files and our hospital pathology database. Result(s): 349 patients were diagnosed with primary NMIBC (265 males, 84 females, mean age 54). 177 (51%) patients were diagnosed with Ta tumours, 118 (34%) with T1 tumours and 54 (15%) patients with carcinoma in situ (CIS). 7 (4%) patients with Ta disease received a single immediate post-operative instillation of MMC. All patients with Ta disease were referred to a flexible cystoscopy surveillance program, 3 (0.86%) were lost to follow-up. 140 (81.4%) High Grade disease patients were referred to our BCG clinic, 2 (1.2%) were referred directly for a radical cystectomy, 30 (17.4%) were deemed inappropriate for BCG therapy and referred for surveillance. Of the 140 who were referred for BCG, 130 (92.9%) patients received full induction course. Only 49 (35.0%) patients went on to receive the full maintenance course. Conclusion(s): Our study has illustrated that the majority of our High-grade disease patients received induction BCG, however few progressed to have the recommended maintenance course. Reasons included patient, clinician, and hospital factors. The vast majority of our Low-grade tumour patients did not receive the recommended immediate intravesical chemotherapy. This demonstrates that we are not currently adhering to the current Level 1

Introduction & Objectives: Ureteric stents are a commonly indicated in the treatment of ureteric and renal stones. Routinely they are inserted pre-stone treatment in either an emergency or elective setting. Occasionally they are also inserted post-operatively after the treatment of ureteric and renal stones. In the public system the ureteric stents may be left in-situ anywhere between two to six weeks. Often our patients experience a range of stent symptoms, from mild haematuria to debilitating stent colic. Generally, patients are educated pre-operatively regarding these symptoms, but often patients return complaining that they were never made aware of the side-effects. These patients may return to our emergency departments and admitted to the hospital for several days placing unnecessary burden on the public system. In this study we aim to evaluate the use of patient education pamphlets and whether they increase patient satisfaction by decreasing ureteric stent symptoms and re-admission rates. Method(s): We conducted a single surgeon prospective randomised control trial, in which we recruited patients who were stented for ureteric or renal stones, either as an elective or emergency procedure. Patients were excluded if they had previously had ureteric stents. Patients were randomised into two arms, some were given an education pamphlet on ureteric stents prior to their operation, while the control group was educated on ureteric stents in the usual manner by the same surgeon. Patient satisfaction was measured utilising a questionnaire (using a scale 1-10) upon their routine follow-up and readmission rates for both arms were recorded from our patient scanned medical records. Result(s): A total 51 patients were recruited that met the inclusion criteria (30 men, 21 women). 25 patients were randomised into the experimental group (14 men, 11 women). There was a total of six (24%) emergency department representations in the control group, with three (12%) having to be read

Introduction & Objectives: A full bladder is required for adequate assessment on bladder ultrasound. However, over-distension may lead to impaired detrusor contraction and bladder emptying. Our departmental uroflowmetry requires patients to abstain from voiding for 2 h, compared to 1 h with bladder ultrasound. We aim to evaluate and assess the relationship between duration of voiding abstinence and bladder emptying. Method(s): Retrospective data collection for patients who presented to our Victorian metropolitan hospital for a uroflowmetry assessment between January 2016 and January 2017 was performed. Patients are included in the study if a bladder ultrasound was performed within 6 months of uroflowmetry. Voided volume (VV) and post-void residuals (PVR) between the 2 modalities were compared, while prostate size was also recorded for all men included in the study. Result(s): 59 patients who met inclusion criteria were included in this study (58 males, 1 female). The mean age was 65 years of age (range 20-88). The mean prostate volume was 51.3 ml. The mean Qmax for the uroflow was 11.8 ml/s. The mean initial bladder volume with uroflowmetry was 220.5 ml, compared to 237 ml with ultrasound. PVR with uroflowmetry was 86.4 ml compared to 76.7 ml with ultrasound. T-test did not reveal any statistical significance between the 2 modalities. Conclusion(s): Our study did not demonstrate any effect of duration of voiding abstinence on bladder emptying. There was also no difference in the mean initial volume between the two different modalities. This seems to correlate well with the PVR volumes, which indicates that even 2 h of voiding abstinence is probably not enough to cause over-distention and impaired detrusor contraction. From our study, we conclude that it is not necessary to ask patients to abstain from voiding for 2 h for all bladder ultrasounds. Further prospective studies should be performed however to determine whether this finding can be extrapolated to include a

This book chapter is adapted from [1] and it is closely linked to work published in [2] and [3]. Reducing power consumption of network equipment has been both driven by a need to reduce the ecological footprint of the cloud as well as the im-mense power costs of data centers. As data centers, core networks and conse-quently, the cloud, constantly increase in size, their power consumption should be mitigated. Ethernet, the most widely used access network still remains the biggest communication technology used in core networks and cloud infrastructures. The Energy-Efficient Ethernet or EEE standard introduced by IEEE in 2010, aims to reduce the power consumption of EEE ports by transitioning Ethernet ports into a low power mode when traffic is not present. As statistics show that the average utilization rate of ethernet links is 5 percent on desktops and 30 percent in data centers, the power saving potential of EEE could be immense. This research aims to assess the benefits of deploying EEE and create a power consumption model for network switches with and without EEE. Our measurements show that an EEE port runs at 12-15% of its total power when in low power mode. Therefore, the power savings can exceed 80% when there is no traffic. However, our measure-ments equally show that the power consumption of a single port represents less than 1% of the total power consumption of the switch. The base power consumed by the switch without any port is still significantly high and is not affected by EEE. Experiment results also show that the base power consumption of switches does not significantly increase with the size of the switches. Doubling the size of the switch between 24 and 48 ports increases power consumption by 35.39%. EEE has a greater effect on bigger switches, with a power (or energy) gain on the EEE-enabled 48-port switch compared to 2 x EEE-enabled 24-port switch. On the other hand, it seems to be more energy efficient to use 2 separate 24-port switches (NO EEE)

Introduction and Objectives: Renal colic secondary to ureteric stones is a major emergency department presentation in Australia. Emergency in-situ extracorporeal shock wave lithotripsy (SWL) has been reported as an alternative to stenting with subsequent ureteroscopy but is rarely performed in Australia.1 We acquired a new lithotripter in late 2014 and based it in the radiology department to enable theatre and anaesthetic free easy access with a view to treat as many patients with colic as possible. We hoped to reduce demand on theatre waiting lists and improve patient satisfaction with significant cost savings for our organisation. Method(s): All SWL data has been prospectively recorded since the start of our service in December 2014. Where possible patients requiring treatment for ureteric colic were offered emergency SWL. The procedure was considered successful if patients at 3-month follow-up were asymptomatic and radiologically stone free. Patients that did not meet the above criteria or needed ureteroscopy/ureteric stent were deemed to have failed SWL treatment. We used a previously validated model to calculate individual case costs and compared them to the costs for the traditional urgent treatment.+ Results: Between December 2014 and September 2015 45 patients underwent insitu lithotripsy for acute ureteric stones (38 males, 8 females, mean age 46, range 20-83). Mean stone size was 7 mm (range 4-12 mm). 57.8% were proximal ureteric, 6.6% mid ureteric and 35.6% were distal ureteric. 35 patients (77.8%) were stone free after a single treatment at 3-month follow up. Failure was associated with stones >1 cm maximum measurement or with stones that were impacted at pelviureteric junction and vesico-ureteric junction. We calculated standard stent, ureteroscopy and stent, and stent removal as A$4025/patient. Our in-situ SWL cost A $764/treatment. Conclusion(s): SWL is underutilised in the treatment of ureteric stones. We have shown that the majority of ureteric ston