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• First seizure patients face delays to assessment with epilepsy specialists. • A sizeable proportion awaiting first appointment experience seizure recurrence. • There is variability in the documented care of suspected first seizure patients. • National variability suggests underlying systematic and organisational barriers. Current guidelines set clinical standards for the management of suspected first seizures and epilepsy. We aimed to assess if these standards are being met across first seizure clinics nationally, to describe variations in care and identify opportunities for service delivery improvement. Multicentre audit assessing the care of adults (≥16 years) referred to first seizure clinics from 31st December 2019 going backwards (30 consecutive patients per centre). Patients with pre-existing diagnosis of epilepsy were excluded. Anonymised referral, clinic, and follow-up data are reported with descriptive statistics. Data provided for 727 patients from 25 hospitals in the UK and Ireland (median age 41 years [IQR 26–59], 52% males). Median time to review was 48 days (IQR 26–86), with 13.8% (IQR 3.3%–24.0%) of patients assessed within 2 weeks. Seizure recurrence was seen in 12.7% (IQR 6.6%–17.4%) of patients awaiting first appointment. Documentation for witness accounts and driving advice was evident in 85.0% (IQR 74.0%–100%) and 79.7% (IQR 71.2%–96.4%) of first seizure/epilepsy patients, respectively. At first appointment, discussion of sudden unexpected death in epilepsy was documented in 30.1% (IQR 0%–42.5%) of patients diagnosed with epilepsy. In epilepsy patients, median time to MRI neuroimaging was 37 days [IQR 22–56] and EEG was 30 days [IQR 19–47]. 30.4% ([IQR 0%–59.5%]) of epilepsy patients were referred to epilepsy nurse specialists. There is variability nationally in the documented care of patients referred to first seizure clinics. Many patients are facing delays to assessment with epilepsy specialists with likely subsequent impact on further management. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effectiveness and tolerability of micafungin versus posaconazole during chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome (MDS).Methods: Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin 100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance, adverse event, or death). Time to failure and survival were calculated by Kaplan-Meier analysis.Results: From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis were analyzed (58 patients randomized to micafungin and 55 to posaconazole). Prophylaxis failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively (P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR) 12-20] for micafungin and 13 [IQR 6-16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence and survival were similar between study arms.Conclusions: Our data support micafungin as alternative antifungal prophylaxis in patients with AL and MDS. [ABSTRACT FROM AUTHOR]

Submicron scale titanium carbide–carbon (TiC–C) hybrid nanofibers have been synthesized from electrospinning of titania (TiO 2 ) nanoparticle and polyacrylonitrile (PAN) in dimethyl formaldehyde (DMF) solution, followed by carbothermal reduction of TiO 2 with carbon at high temperature. Scanning Electron Microscope (SEM) images of TiC–C nanofibers show the conservation of fiber morphology after the carbothermal reduction reaction. XRD study demonstrates that the thermal treatment of TiO 2 –carbon fibers results in the formation of titanium oxycarbide (TiC x O y ) crystals and the reduction in the titania phase, and the oxygen content in TiC x O y and the fraction of titania phase decreases with increasing reaction temperature. Transmission Electron Microscope (TEM) images show the loss of the titania phase after the carbothermal reduction. The surface area of TiC–C nanofibers drastically decreases at high reaction temperatures. Finally, it is observed that the electrical conductivity of TiC–C nanofiber mats is higher than that of neat carbon nanofiber mats, and it increases with raising carbothermal reduction temperature. [ABSTRACT FROM AUTHOR]

We have incorporated graphene nanoribbons (GNRs) which are unzipped from multi-wall carbon nanotubes (MWCNT) into silicon–carbon (Si/C) nanofibers, not only to reinforce hybrid Si/C fibers, but also to increase the electrical conductivity and charge transport capability of fibers. We demonstrated that GNRs are promising components for improving the rechargeable Li-ion battery performance due to their unique nanostructures and properties. Water based electrospinning, an easily scalable and environmentally benign process, was utilized to fabricate GNR/Si/C fibers. The resulting fibers exhibited a high reversible capacity of more than 1800 mA h/g at 0.5 C, and an excellent performance of 1400 mA h/g with no capacity fading at a charge/discharge rate of 1 C. This outstanding performance should be attributed to the enhanced charge and mass transfer ability of fibers by incorporation of ultrathin, flexible, conductive, and high aspect ratio GNRs. Electrodes made with GNR/Si/C fibers are more durable than ones with Si/C fibers, and do not exhibit dramatic volume and morphology changes after cycling. Moreover, GNR/Si/C fiber anodes were tested in a full-cell configuration where they displayed a steady gravimetric capacity of ca. 1400 mA h/g anode for 25 cycles. [ABSTRACT FROM AUTHOR]

With billions of dollars in research and development (R&D) funding continuing to be invested, the novel coronavirus disease 2019 (COVID-19) has become into a singular focus for the scientific community. However, the collective response from the scientific communities have seen poor return on investment, particularly for therapeutic research for COVID-19, revealing the existing weaknesses and inefficiencies of the clinical trial enterprise. In this article, we argue for the importance of structural changes to existing research programs for clinical trials in light of the lessons learned from COVID-19. [ABSTRACT FROM AUTHOR]

The novel coronavirus 2019 (COVID-19) pandemic has mobilized global research at an unprecedented scale. While challenges associated with the COVID-19 trial landscape have been discussed previously, no comprehensive reviews have been conducted to assess the reporting, design, and data sharing practices of randomized controlled trials (RCTs). The purpose of this review was to gain insight into the current landscape of reporting, methodological design, and data sharing practices for COVID-19 RCTs. We conducted three searches to identify registered clinical trials, peer-reviewed publications, and pre-print publications. After screening eight major trial registries and 7844 records, we identified 178 registered trials and 38 publications describing 35 trials, including 25 peer-reviewed publications and 13 pre-prints. Trial ID, registry, location, population, intervention, control, study design, recruitment target, actual recruitment, outcomes, data sharing statement, and time of data sharing were extracted. Of 178 registered trials, 112 (62.92%) were in hospital settings, median planned recruitment was 100 participants (IQR: 60, 168), and the majority (n = 166, 93.26%) did not report results in their respective registries. Of 35 published trials, 31 (88.57%) were in hospital settings, median actual recruitment was 86 participants (IQR: 55.5, 218), 10 (28.57%) did not reach recruitment targets, and 27 trials (77.14%) reported plans to share data. The findings of our study highlight limitations in the design and reporting practices of COVID-19 RCTs and provide guidance towards more efficient reporting of trial results, greater diversity in patient settings, and more robust data sharing. [ABSTRACT FROM AUTHOR]

This study aimed to upcycle a byproduct of the edible oil industry, cold-pressed nettle seed meal (CPNSM), into a plant-based emulsifier, thereby increasing the sustainability of the food system. The protein content of the nettle seed protein (NSP) powder was 48.3% with glutamic acid (16.6%), asparagine (10.7%), and arginine (9.7%) being the major amino acids. NSPs had a denaturation temperature of 66.6 °C and an isoelectric point of pH 4.3. They could be used as emulsifiers to form highly viscous coarse corn oil-in-water emulsions (10% oil, 4% NSP). Nevertheless, 10-fold diluted emulsions exhibited rapid creaming under different pH (2–9), salt (0–500 mM NaCl) and temperature (>40 °C) conditions, but they were relatively stable to aggregation. Our findings suggest that NSPs could be used as emulsifiers in highly viscous or gelled foods, like dressings, sauces, egg, cheese, or meat analogs. [Display omitted] • Nettle seed protein (NSP) powder was isolated from cold-pressed nettle seed meal. • NSPs remained in their native state due to the mild extraction conditions used. • NSPs could be used as a plant-based emulsifiers to form oil-in-water emulsions. • NSP-coated oil droplets were stable to coalescence, but not creaming (due to large size). • NSPs may be useful emulsifiers in plant-based foods, like dairy, egg, and meat analogs. [ABSTRACT FROM AUTHOR]

Improving the targeted use of drug regimens requires robust real-world evidence (RWE) to address the uncertainties that remain regarding their real-world performance following market entry. However, challenges in the current state of RWE production limit its impact on clinical decisions, as well as its operational scalability and sustainability. We propose an adaptive point-of-care (APoC) platform trial as an approach to RWE production that improves both clinical and operational efficiencies. We explored design innovations, operational challenges, and infrastructure needs within a multi-stakeholder consortium to evaluate the potential of an APoC platform trial for studying chronic disease treatment regimens using rheumatoid arthritis as a case study. The concept integrates elements from adaptive clinical trials (dynamic treatment regimen strategies) and point-of-care trials (research embedded into routine clinical care) under a perpetual platform infrastructure. The necessary components to implement an APoC platform trial within outpatient settings exist, and present an opportunity for a cross-disciplinary, multi-stakeholder approach. Effective engagement of key stakeholders involved in and impacted by the platform is critical to success. Our collaborative design process identified three high-impact stakeholder-engagement areas: (1) focus on research question(s), (2) design and implementation planning such that it is feasible and fit-for-purpose, and (3) measurement , or meaningful metrics for both clinical (patient outcomes) and system (operational efficiencies) impact. An APoC platform trial for rheumatoid arthritis integrating innovative design elements in a scalable infrastructure has the potential to reduce important uncertainties about the real-world performance of biomedical innovations and improve clinical decisions. • Real-world evidence is critical to optimize use of new drugs in routine practice. • The current paradigm of randomized real-world trials is costly and inefficient. • We propose an agile, efficient approach to study chronic disease treatment regimens. • We combine point-of-care trial, adaptive design, and platform infrastructure. • Our multi-stakeholder consortium identified key areas for successful implementation. [ABSTRACT FROM AUTHOR]