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Abstract Introduction Due to a lack of robust population denominators, Australia is unable to accurately monitor changes in the HIV epidemic for some populations. The ratio of HIV transmission relative to the number of people with HIV (an incidence prevalence ratio, or IPR) can measure such changes. The IPR is measured against an IPR benchmark derived from post‐HIV acquisition life expectancy, to indicate whether an HIV epidemic is shrinking or growing. Using IPRs and Australia‐specific IPR benchmarks, this study aims to describe the Australian HIV epidemic among three groups: men with HIV attributed to male‐to‐male sex, women with HIV and people with HIV attributed to injection drug use. Methods Using mathematical modelling derived from HIV notifications, cohort and administrative data, IPRs were generated for each of the three groups. These IPRs were compared with IPR benchmarks derived from post‐HIV acquisition mortality estimates using abridged life tables for men, women and people who inject drugs. The IPR benchmark for men was applied to people with HIV attributed to male‐to‐male sex. Trends in the IPR over time were described for each reported population from 2015 to 2022. Results Overall, the IPR fell by 80%, from 0.040 (range: 0.034−0.045) in 2015 to 0.008 (range: 0.003−0.013) in 2022 and fell below the benchmark (0.022) in 2020. Among people with HIV attributed to male‐to‐male sex, the IPR fell by 85%, from 0.041 (range: 0.034−0.047) in 2015 to 0.006 (range: 0.003−0.024) in 2022 and fell below the benchmark (0.022) in 2020. Among women with HIV, the IPR fell by 56%, from 0.032 (range: 0.026−0.039) in 2015 to 0.014 (range: 0.003−0.029) in 2022 and fell below the benchmark (0.022) in 2019. Among people with HIV attributed to injection drug use, the IPR fell by 61%, from 0.036 (range: 0.022−0.047) in 2015 to 0.014 (range: 0.002−0.057) in 2022 and fell below the benchmark (0.028) in 2019. Conclusions Australian IPRs in all populations examined have dropped below the level required to sustain the HIV epidemic at current levels. By applying this method in other contexts, the changing scale of HIV epidemics may be better described for populations lacking robust population denominators.

Abstract Aims The prevalence of advanced heart failure (HF) is increasing due to the growing number of patients with HF and their better treatment and survival. There is a scarcity of data on the accuracy of HF web‐based risk scores in this selected population. This study aimed to assess mortality prediction performance of the Meta‐Analysis Global Group in Chronic HF (MAGGIC‐HF) risk score and the model of the Barcelona Bio‐HF Risk Calculator (BCN‐Bio‐HF) containing N terminal pro brain natriuretic peptide in HF patients receiving intermittent inotropic support with levosimendan as destination therapy. Methods and results Four hundred and three advanced HF patients from 23 tertiary hospitals in Spain receiving intermittent inotropic support with levosimendan as destination therapy were included. Discrimination for all‐cause mortality was compared by area under the curve (AUC) and Harrell's C‐statistic at 1 year. Calibration was assessed by calibration plots comparing observed versus expected events based on estimated risk by each calculator. The included patients were predominantly men, aged 71.5 [interquartile range 64–78] years, with reduced left ventricular ejection fraction (27.5 ± 9.4%); ischaemic heart disease was the most prevalent aetiology (52.5%). Death rate at 1 year was 26.8%, while the predicted 1‐year mortality by BCN‐Bio‐HF and MAGGIC‐HF was 17.0% and 22.1%, respectively. BCN‐Bio‐HF AUC was 0.66 (Harrell's C‐statistic 0.64), and MAGGIC‐HF AUC was 0.62 (Harrell's C‐statistic 0.61). Conclusions The two evaluated risk scores showed suboptimal discrimination and calibration with an underestimation of risk in advanced HF patients receiving levosimendan as destination therapy. There is a need for specific scores for advanced HF.

Abstract Aim Patients with advanced heart failure (AHF) who are not candidates to advanced therapies have poor prognosis. Some trials have shown that intermittent levosimendan can reduce HF hospitalizations in AHF in the short term. In this real‐life registry, we describe the patterns of use, safety and factors related to the response to intermittent levosimendan infusions in AHF patients not candidates to advanced therapies. Methods and results Multicentre retrospective study of patients diagnosed with advanced heart failure, not HT or LVAD candidates. Patients needed to be on the optimal medical therapy according to their treating physician. Patients with de novo heart failure or who underwent any procedure that could improve prognosis were not included in the registry. Four hundred three patients were included; 77.9% needed at least one admission the year before levosimendan was first administered because of heart failure. Death rate at 1 year was 26.8% and median survival was 24.7 [95% CI: 20.4–26.9] months, and 43.7% of patients fulfilled the criteria for being considered a responder lo levosimendan (no death, heart failure admission or unplanned HF visit at 1 year after first levosimendan administration). Compared with the year before there was a significant reduction in HF admissions (38.7% vs. 77.9%; P 12 g/dL (+1.5), amiodarone use (−1.5) HF visit 1 year before levosimendan (−1.5) and heart rate >70 b.p.m. (−2). Patients with a score less than −1 had a very low probability of response (21.5% free of death or HF event at 1 year) meanwhile those with a score over 1.5 had the better chance of response (68.4% free of death or HF event at 1 year). LEVO‐D score performed well in the ROC analysis. Conclusion In this large real‐life series of AHF patients treated with levosimendan as destination therapy, we show a significant decrease of heart failure events during the year after the first administration. The simple LEVO‐D Score could be of help when deciding about futile therapy in this population.

Abstract Background and Aim This study evaluates whether a stool donor program to supply fecal microbiota transplantation (FMT) product is feasible in the Australian regulatory environment. The primary outcome was capacity to supply FMT product. The secondary outcomes were donor eligibility, retention, and output. Methods Prospective observational cohort study using data collected from the stool donor and FMT production records from BiomeBank, South Australia. Participants were people who engaged with BiomeBank's donor screening and FMT manufacturing process between 01 January 2021 and 31 December 2021. Results In total 176 people registered interest in the program, 74 of 176 (42.0%) proceeded to written questionnaire, 14 of 176 (8.0%) underwent clinical assessment, and 8 of 176 (4.5%) enrolled in the program. Two people were ineligible based on laboratory tests: both had an extended spectrum beta‐lactamase producing organism in stool and one also tested positive for hepatitis B core antibody. Two donors remained eligible from 2020, resulting in 10 enrolled donors in 2021; 5 of 10 (50%) male with a median age of 36.9 years (interquartile range, 30.3–42.7 years). All donors were ineligible to donate at some time point. There were 144 stool donations processed into 1480 50 mL FMT; 413 FMT were shipped to 33 Australian hospitals for treatment, 470 for clinical trials, and 89 were destroyed prior to release from quarantine. Conclusion Recruitment into the program, retention, and maximizing the yield from a donation period was challenging. Despite this, BiomeBank was able to produce and supply FMT to Australian hospitals under the TGA‐regulated Class 2 Biologicals framework.

Abstract Salinization and eutrophication are nearly ubiquitous in watersheds with human activity. Despite the known impacts of the freshwater salinization syndrome (FSS) to organisms, we demonstrate a pronounced knowledge gap on how FSS alters wetland biogeochemistry. Most experiments assessing FSS and biogeochemistry pertain to coastal saltwater intrusion. The few inland wetland studies mostly add salt as sodium chloride. Sodium chloride alone does not reflect the ionic composition of inland salinization, which derives from heterogeneous sources, producing spatially and temporally variable ionic mixtures. We develop mechanistic hypotheses for how elevated ionic strength and changing ionic composition alter urban wetland sediment biogeochemistry, with the prediction that FSS diminishes nutrient removal capacity via a suite of related direct and indirect processes. We propose that future efforts specifically investigate inland urban wetlands, a category of wetland heavily relied on for its biogeochemical processing ability that is likely to be among the most impacted by salinization.

Objective Some patients with rheumatic diseases might be at higher risk for coronavirus disease 2019 (COVID‐19) acute respiratory distress syndrome (ARDS). We aimed to develop a prediction model for COVID‐19 ARDS in this population and to create a simple risk score calculator for use in clinical settings. Methods Data were derived from the COVID‐19 Global Rheumatology Alliance Registry from March 24, 2020, to May 12, 2021. Seven machine learning classifiers were trained on ARDS outcomes using 83 variables obtained at COVID‐19 diagnosis. Predictive performance was assessed in a US test set and was validated in patients from four countries with independent registries using area under the curve (AUC), accuracy, sensitivity, and specificity. A simple risk score calculator was developed using a regression model incorporating the most influential predictors from the best performing classifier. Results The study included 8633 patients from 74 countries, of whom 523 (6%) had ARDS. Gradient boosting had the highest mean AUC (0.78; 95% confidence interval [CI]: 0.67‐0.88) and was considered the top performing classifier. Ten predictors were identified as key risk factors and were included in a regression model. The regression model that predicted ARDS with 71% (95% CI: 61%‐83%) sensitivity in the test set, and with sensitivities ranging from 61% to 80% in countries with independent registries, was used to develop the risk score calculator. Conclusion We were able to predict ARDS with good sensitivity using information readily available at COVID‐19 diagnosis. The proposed risk score calculator has the potential to guide risk stratification for treatments, such as monoclonal antibodies, that have potential to reduce COVID‐19 disease progression.

Abstract Aims To describe logistics and outcomes of the accreditation program of centres of excellence in heart failure (HF) developed in Spain by the Spanish Society of Cardiology (SEC) between 2016 and 2021. Methods and results A scientific committee created by the SEC defined three types of HF units (community, specialized, and advanced), depending on the characteristics of the hospital and their portfolio of services and equipment, as well as the quality standards required for the accreditation of excellence. The units were required to submit to the SEC a document certifying compliance with the requirements and quality standards. Once verified these, the unit received accreditation of excellence from the SEC. Between 2017 and October 2021, 78 HF units spread throughout Spain applied for accreditation. This represents 50.6% of all Spanish national health system centres with cardiology departments. Accreditation was definitive in 56.4% of the applicant centres and provisional in the remaining 43.6%. Of the 78 units, 19 were community units, 44 specialized, and 15 advanced. Of the 34 units that received provisional accreditation for failure to meet any of the required quality standards, all resolved these deficits within 6 months of the initial evaluation, subsequently receiving definitive accreditation. Conclusions Our experience indicates that implementation of an accreditation programme for excellence and quality of care of HF units at the national level by a scientific society is feasible and sustainable over time, leading the majority of HF units in the country to apply for accreditation and to meet the required quality standards.

Objective To evaluate the impact of telemedicine use during the coronavirus disease 2019 (COVID‐19) pandemic on rheumatology trainees. Methods A voluntary, anonymous, web‐based survey was administered in English, Spanish, or French from August 19 to October 5, 2020. Adult and pediatric rheumatology trainees were invited to participate via social media and email. Using multiple‐choice questions and Likert scales, the survey assessed prior and current telemedicine use, impact on training, and supervision after COVID‐19 prompted rapid telemedicine implementation. Results Surveys were received from 302 trainees from 33 countries, with 83% in adult rheumatology training programs. Reported telemedicine use increased from 13% before the pandemic to 82% during the pandemic. United States trainees predominantly used video visits, whereas outside the United States telemedicine was predominantly audio only. Most (65%) evaluated new patients using telemedicine. More respondents were comfortable using telemedicine for follow‐up patients (69%) than for new patients (25%). Only 39% of respondents reported receiving telemedicine‐focused training, including instruction on software, clinical skills, and billing, whereas more than half of United States trainees (59%) had training. Postconsultation verbal discussion was the most frequent form of supervision; 24% reported no supervision. Trainees found that telemedicine negatively impacted supervision (50%) and the quality of clinical teaching received (70%), with only 9% reporting a positive impact. Conclusions Despite widespread uptake of telemedicine, a low proportion of trainees received telemedicine training, and many lacked comfort in evaluating patients, particularly new patients. Inadequate supervision and clinical teaching were areas of concern. If telemedicine remains in widespread use, ensuring appropriate trainee supervision and teaching should be prioritized.

Abstract Coexistence between large carnivores and humans is a global conservation concern. Montana (USA) is home to recovering grizzly bear (Ursus arctos) populations and increasing human–grizzly interactions. In 2019, we administered a survey of Montanans to investigate factors influencing normative beliefs about grizzly bear population sizes and quantify the relationship between these beliefs and satisfaction with grizzly management in the state. Using a linear regression (r2 = .61), we found that residents with positive attitudes and emotional dispositions toward grizzlies or who trusted the agency were more likely to believe grizzly populations were too low. Residents who believed hunting should be used to manage conflict, were themselves hunters, had vicarious wildlife experience with property damage, believed grizzly populations were expanding, or were older were more likely to believe populations were too high. We found a negative quadratic relationship between normative grizzly bear population size beliefs and satisfaction with management, suggesting an optimal “Goldilocks” zone where coexistence is most possible. In practice, if observed Goldilocks zones are incompatible with population numbers required to meet conservation goals, considering factors influencing these beliefs may help bolster acceptance of larger population sizes.

Abstract Human skin equivalents (HSEs) are a popular technology due to limitations in animal testing, particularly as they recapitulate aspects of structure and function of human skin. Many HSEs contain two basic cell types to model dermal and epidermal compartments, however this limits their application, particularly when investigating the effect of exogenous stressors on skin health. We describe the development of a novel platform technology that accurately replicates skin pigmentation in vitro. Through incorporation of melanocytes, specialized pigment producing cells, into the basal layer of the epidermis we are able to re‐create skin pigmentation in vitro. We observe apical distribution of melanin within keratinocytes and formation of supranuclear caps (SPNCs), only when the epidermal compartment is co‐cultured with a dermal compartment, leading to the conclusion that fibroblast support is essential for correct pigment organization. We also evaluate the commonly observed phenomenon that pigmentation darkens with time in vitro, which we further explore through mechanical exfoliation to remove a build‐up of melanin deposits in the stratum corneum. Finally, we demonstrate the application of a pigmented HSE to investigate drug modulation of skin tone and protection from UV‐induced damage, highlighting the importance of such a model in the wider context of skin biology.

Abstract Stream fishes are restricted to specific environments with appropriate habitats for feeding and reproduction. Interactions between streams and surrounding landscapes influence the availability and type of fish habitat, nutrient concentrations, suspended solids, and substrate composition. Valley width and gradient are geomorphological variables that influence the frequency and intensity that a stream interacts with the surrounding landscape. For example, in constrained valleys, canyon walls are steeply sloped and valleys are narrow, limiting the movement of water into riparian zones. Wide valleys have long, flat floodplains that are inundated with high discharge. We tested for differences in fish assemblages with geomorphology variation among stream sites. We selected rivers in similar forested and endorheic ecoregion types of the United States and Mongolia. Sites where we collected were defined as geomorphologically unique river segments (i.e., functional process zones; FPZs) using an automated ArcGIS‐based tool. This tool extracts geomorphic variables at the valley and catchment scales and uses them to cluster stream segments based on their similarity. We collected a representative fish sample from replicates of FPZs. Then, we used constrained ordinations to determine whether river geomorphology could predict fish assemblage variation. Our constrained ordination approach using geomorphology to predict fish assemblages resulted in significance using fish taxonomy and traits in several watersheds. The watersheds where constrained ordinations were not successful were next analyzed with unconstrained ordinations to examine patterns among fish taxonomy and traits with geomorphology variables. Common geomorphology variables as predictors for taxonomic fish assemblages were river gradient, valley width, and valley slope. Significant geomorphology predictors of functional traits were valley width‐to‐floor width ratio, elevation, gradient, and channel sinuosity. These results provide evidence that fish assemblages respond similarly and strongly to geomorphic variables on two continents.

Objective Although gait analysis provides an estimate of joint loading magnitude and patterns during a typical step, accelerometry provides information about loading frequency. Understanding the relationships between these components of loading and knee osteoarthritis (OA) progression may improve conservative management, as gait interventions may need to account for physical activity levels or vice versa. The primary objective was to examine relationships between gait patterns that have previously been associated with OA progression and accelerometer‐derived metrics of loading frequency. The secondary objective examined the association of accelerometer‐derived metrics and total knee arthroplasty (TKA) at a mean follow‐up of 3.5 years. Methods Fifty‐seven individuals with knee OA underwent gait analysis and 1 week of accelerometer wear. Spearman correlations were calculated between accelerometer‐derived metrics and gait patterns. Differences across quartiles of step count were examined with Jonckheere‐Terpstra tests. In a subsample, baseline differences between TKA and no TKA groups were examined with Mann‐Whitney U‐tests. Results Gait variables previously related to progression were correlated to both step count and moderate‐ to vigorous‐intensity, but not lower‐intensity, physical activity. Individuals in the lowest quartile (~4000 steps/day) exhibited gait patterns previously related to progression. There were no differences in any baseline accelerometer‐derived metrics between those that did and did not undergo TKA at follow‐up. Conclusion Complex relationships exist between gait, physical activity, and OA progression. Accelerometer‐derived metrics may contribute unique information about overall loading for individuals above a certain activity threshold, but for those with lower activity levels, gait may be sufficient to predict clinical progression risk, at least over the short term.

Abstract Objectives To investigate the utility of Magnetic Resonance Imaging (MRI) for prostate cancer diagnosis in the Australian setting. Patients and methods All consecutive men who underwent a prostate biopsy (transperineal or transrectal) at Royal Melbourne Hospital between July 2017 to June 2019 were included, totalling 332 patients. Data were retrospectively collected from patient records. For each individual patient, the risk of prostate cancer diagnosis at biopsy based on clinical findings was determined using the European Randomized study of Screening for Prostate Cancer (ERSPC) risk calculator, with and without incorporation of MRI findings. Results MRI has good diagnostic accuracy for clinically significant prostate cancer. A PI‐RADS 2 or lower finding has a negative predictive value of 96% for clinically significant cancer, and a PI‐RADS 3, 4 or 5 MRI scan has a sensitivity of 93%. However, MRI has a false negative rate of 6.5% overall for clinically significant prostate cancers. Pre‐ biopsy MRI may reduce the number of unnecessary biopsies, as up to 50.0% of negative or ISUP1 biopsies have MRI PI‐RADS 2 or lower. Incorporation of MRI findings into the ERSPC calculator improved predictive performance for all prostate cancer diagnoses (AUC 0.77 vs 0.71, P = .04), but not for clinically significant cancer (AUC 0.89 vs 0.87, P = .37). Conclusion MRI has good sensitivity and negative predictive value for clinically significant prostate cancers. It is useful as a pre‐biopsy tool and can be used to significantly reduce the number of unnecessary prostate biopsies. However, MRI does not significantly improve risk predictions for clinically significant cancers when incorporated into the ERSPC risk calculator.

Abstract Objectives The objective of this study is to demonstrate that computational finite element models can be used to reliably simulate dynamic interaction between a pacifier, the palate, and the tongue during nonnutritive sucking (NNS). The interactions can be quantified by the results of finite element analyses which include deformation, strain, stress, contact force, and contact area. Materials and Methods A finite element model was created based upon CAD solid models of an infant pacifier and palate. The silicone pacifier bulb is represented by a hyperelastic constitutive law. Contact surfaces are defined between the pacifier and palate. A time and spatially varying pressure load is applied to the bulb representing peristaltic interaction with the tongue. A second time‐varying, periodic pressure representing NNS is applied to the model simultaneously. A large displacement, nonlinear transient dynamic analysis is run over two NNS cycles. Results Results from the finite element analysis show the deformed shape of the bulb with maximum principal elastic strain of 0.23 and a range of maximum principal stress on the palate from 0.60 MPa (tensile) to −0.27 MPa (compressive) over the NNS cycles. The areas of contact between the pacifier and the palate are shown in surface contour plots. Conclusions A nonlinear transient dynamic finite element model can simulate the mechanical behavior of a pacifier and its interaction with the tongue and contact with the palate subject to NNS. Quantitative results predicting deformation, strain, stress, contact force, and contact area can be used in comparative studies to provide insight on how pacifiers cause changes in dental, orthognathic, and facial development.

Abstract Fecal microbiota transplantation (FMT) is effective for induction of remission in ulcerative colitis (UC). Diet has potential to augment the efficacy and durability of FMT by encouraging engraftment of transplanted microorganisms. A trial of FMT combined with a defined diet was undertaken as salvage therapy for a 71‐year‐old woman with active steroid‐refractory extensive UC. A multidimensional sulfide‐reducing diet (4‐SURE diet) was commenced followed by single‐donor FMT administered by colonoscopy and then enemas over 7 days. Dietary adherence, clinical evaluation, and stool samples for metagenomic profiling were undertaken at weeks 0, 4, 8, and 24. Colonoscopy was performed 8 weeks post‐FMT. Shotgun metagenomic profiling of the donor fecal suspension was also performed. A rapid clinical response to FMT and 4‐SURE diet was observed with normalization of stool frequency (≤2 motions/day) and resolution of rectal bleeding within 2 weeks. Dietary adherence was excellent. Colonoscopy at week 8 revealed no evidence of active colitis (Mayo endoscopic sub‐score 0) with histology showing no evidence of acute or chronic lamina propria inflammatory cell infiltrate. Sustained clinical and endoscopic remission out to 24 weeks was observed. Metagenomic sequencing confirmed sustained engraftment of beneficial donor microbiota with increased alpha‐diversity and capacity for short‐chain fatty acid production, including Faecalibacterium prauznitzii and Eubacterium hallii. This case report supports the rationale of prescribed diet therapy to support engraftment of donor microbiota following FMT for UC. Further large trials with a diet‐arm control group are needed to evaluate FMT augmented by a defined diet in UC.

Background A run‐in period may increase adherence to intervention and reduce loss to follow‐up. Whether use of a run‐in period affects the magnitude of treatment effects is unknown. Methods and Results We conducted a meta‐analysis comparing treatment effects from 11 systematic reviews of cardiovascular prevention trials using a run‐in period with matched trials not using a run‐in period. We matched run‐in with non–run‐in trials by population, intervention, control, and outcome. We calculated a ratio of relative risks (RRRs) using a random‐effects meta‐analysis. Our primary outcome was a composite of cardiovascular events, and the primary analysis was a matched comparison of clinical trials using a run‐in period versus without a run‐in period. We identified 66 run‐in trials and 111 non–run‐in trials (n=668 901). On meta‐analysis there was no statistically significant difference in the magnitude of treatment effect between run‐in trials (relative risk [RR], 0.83 [95% CI, 0.80–0.87]) compared with non–run‐in trials (RR, 0.88 [95% CI, 0.84–0.91]; RRR, 0.95 [95% CI, 0.90–1.01]). There was no significant difference in the RRR for secondary outcomes of all‐cause mortality (RRR, 0.97 [95% CI, 0.91–1.03]) or medication discontinuation because of adverse events (RRR, 1.05 [95% CI, 0.85–1.21]). Post hoc exploratory univariate meta‐regression showed that on average a run‐in period is associated with a statistically significant difference in treatment effect (RRR, 0.94 [95% CI, 0.90–0.99]) for cardiovascular composite outcome, but this was not statistically significant on multivariable meta‐regression analysis (RRR, 0.95 [95% CI, 0.90–1.0]). Conclusions The use of a run‐in period was not associated with a difference in the magnitude of treatment effect among cardiovascular prevention trials.

Abstract River hydrogeomorphology is a major driver shaping biodiversity and community composition. Here, we examine how hydrogeomorphic heterogeneity expressed by Functional Process Zones (FPZs) in river networks is associated with fish assemblage variation. We examined this association in two distinct ecoregions in Mongolia expected to display different gradients of river network hydrogeomorphic heterogeneity. We delineated FPZs by extracting valley‐scale hydrogeomorphic variables at 10 km sample intervals in forest steppe (FS) and in grassland (G) river networks. We sampled fish assemblages and examined variation associated with changes in gradients of hydrogeomorphology as expressed by the FPZs. Thus, we examined assemblage variation as patterns of occurrence‐ and abundance‐based beta diversities for the taxonomic composition of assemblages and as functional beta diversity. Overall, we delineated 5 and 6 FPZs in river networks of the FS and G, respectively. Eight fish species were found in the FS river network and seventeen in the G, four of them common to both ecoregions. Functional richness was correspondingly higher in the G river network. Variation in the taxonomic composition of assemblages was driven by species turnover and was only significant in the G river network. Abundance‐based taxonomic variation was significant in river networks of both ecoregions, while the functional beta diversity results were inconclusive. We show that valley‐scale hydrogeomorphology is a significant driver of variation in fish assemblages at a macrosystem scale. Both changes in the composition of fish assemblages and the carrying capacity of the river network were driven by valley‐scale hydrogeomorphic variables. River network hydrogeomorphology as accounted for in the study has, therefore, the potential to inform macrosystem scale community ecology research and conservation efforts.

Abstract Objective To evaluate local clinical outcomes of sliding clip renorrhaphy, from inception to current utilization for open, laparoscopic, and robotically assisted partial nephrectomy. Methods We reviewed prospectively maintained databases of three surgeons performing partial nephrectomies with the sliding‐clip technique at teaching hospitals between 2005 and 2019. Baseline characteristics, operative parameters, including surgical approach, RENAL Nephrometry Score, and post‐operative outcomes, including Clavien‐Dindo classification of complications, were recorded for 76 consecutive cases. We compared perioperative and 90‐day events with patient and tumor characteristics, stratified by operative approach and case complexity, using Wilcoxon rank‐sum test for continuous variables and the Chi‐squared or Fisher's exact test, for binary and categorical variables, respectively. Results Open surgery (n = 15) reduced ischemia time and operative time, but increased hospital admission time. Pre‐ and post‐operative estimated glomerular filtration rates did not change significantly by operative approach. Older patients (P = .007) and open surgery (P = .003) were associated with a higher rate of complications (any‐grade). Six grade ≥3 complications occurred: these were associated with higher RENAL Nephrometry Score (P = .016) and higher pathological tumor stage (P = .045). Limits include smaller case volumes which incorporate the learning curve cases; therefore, these data are most applicable to lower volume teaching hospitals. Conclusion The sliding‐clip technique for partial nephrectomy was first described by Agarwal et al and has low complication rates, acceptable operative time, and preserves renal function across open and minimally invasive surgeries. This series encompasses the initial learning curve with developing the technique through to present‐day emergence as a routine standard of practice.

Abstract Digitalisation is seen to have contributed to the demise of 50% of the Fortune 500 companies since 2000. The large electric motor segment is not immune to this changing business landscape and must evolve to survive. This sector is experiencing declining revenues as traditional hardware‐sales‐focused business models have proved inadequate to address a reduction in profitability. New business models that exploit new digital value streams are to leverage the value from emerging technologies of the Industrial Internet of Things, Big Data and the associated emerging predictive analytics. These can be optimised via Cloud Computing and delivered utilising Platform as a Service software solutions to reduce cost and support scalability. The missing link in the justification chain for the installation of digitalisation packages on large electric motors is a model to determine if and which package sections return the most customer value and, therefore, sales opportunities for the supplier. In this context, this paper introduces the concept of the smart electric motor. The focus is on the oil and gas industry, where digitalisation is already deeply engrained in practice and shows how risk‐based decisions can deliver a profitable project through new business models and digitalised solutions to reinvigorate this traditional industry.

Abstract Background and Aim Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent or refractory Clostridioides difficile infection (rCDI). Despite inclusion in society guidelines, the uptake of FMT therapy has been variable. Physician and patient attitudes may be a barrier to evidence‐based uptake of therapies; however, data assessing attitudes regarding FMT for rCDI are limited. Methods The South Australian FMT for CDI database prospectively recorded patient outcomes of FMT for CDI from August 2013 to January 2019. A total of 93 consecutive patients who underwent FMT for rCDI in South Australia were invited to participate in a 20‐question survey regarding the patient experience of FMT. All gastroenterologists and infectious disease physicians practicing in South Australia were invited to participate in an online survey comprised of 22 questions that addressed referral experience, indications for referral, perceived risks, and regulation and funding. Results Fifty‐four patients (54/93, 58%) returned the survey, of whom 52 (96%) would recommend FMT to others, and 51 (94%) were satisfied with treatment outcome. Fifty physicians returned the online survey (50/100, 50%), of whom 23 (46%) were concerned about disease transmission risk, and 15 (30%) believed that the risk of FMT would outweigh the benefit. Infectious diseases physicians and advanced trainees had significantly greater concern regarding the potential alteration of the microbiome than gastroenterology physicians and advanced trainees (8/17 (47%) vs 6/33 (18%); P = 0.047). Conclusion Despite high levels of patient‐reported satisfaction following FMT, physician‐reported reservations exist and may present a barrier to uptake of this therapy.

Abstract Background and Aim Point‐of‐care ultrasound (POCUS) is a noninvasive alternative to ileocolonoscopy for monitoring disease activity in inflammatory bowel disease (IBD) but is underutilized in practice. Accuracy data are needed to engender clinician confidence in POCUS and increase uptake. The aim of this study was to evaluate the accuracy of POCUS compared to ileocolonoscopy in detecting active disease and extent in patients with IBD. Methods A prospective, blinded study was performed at a single tertiary center in South Australia between May 2017 and May 2018. Consecutive patients with a formal diagnosis of IBD who underwent both POCUS and ileocolonoscopy within 30 days of one another, performed to evaluate IBD disease activity, were eligible for participation. The accuracy of POCUS compared to ileocolonoscopy was assessed using sensitivity, specificity, and Cohen's kappa coefficient analyses. Results A total of 74 patients were included in the final analysis, 35 (47%) of whom had Crohn's disease and 39 (53%) ulcerative colitis; 37 subjects (50%) underwent a POCUS and ileocolonoscopy on the same day. POCUS demonstrated 91% sensitivity and 83% specificity for detecting endoscopically active IBD, correlating with a positive predictive value (PPV) of 89%, a negative predictive value (NPV) of 86%, and a kappa coefficient of 0.74 (88%). POCUS defined disease extent with 87% sensitivity and 81% specificity, correlating with a PPV of 85% and NPV of 83% and a kappa coefficient of 0.70 (85%). Conclusion POCUS is accurate in defining disease activity and extent in IBD compared to ileocolonoscopy. POCUS represents an appealing, noninvasive alternative to ileocolonoscopy for monitoring disease activity in IBD.

Abstract Background and Aim Objective monitoring of disease activity is integral to therapeutic decision‐making in inflammatory bowel disease (IBD). Data are sparse on patients' perspectives of tools used to monitor disease activity in IBD. To evaluate patients' perspectives of gastrointestinal ultrasound (GIUS) performed during routine IBD clinical care, along with its impact on IBD‐specific knowledge. Methods Patients with a formal diagnosis of IBD who underwent GIUS at two tertiary IBD services between March 2017 and January 2019 participated in this prospective study. Participants completed a questionnaire measuring the acceptability, tolerability, and usefulness of GIUS using a visual analogue scale (VAS) from 0 (disagree) to 10 (strongly agree). Comparative acceptability of IBD monitoring tools and the impact of GIUS on IBD‐specific knowledge was measured. Results A total of 121 participants completed the questionnaire, with a mean age of 42 years (range 17–78), 54 (45%) males, and 79 (65%) Crohn's disease patients. In the overall population, GIUS was scored as highly acceptable for monitoring IBD (mean 9.20 ± 1.37) compared to colonoscopy (7.94 ± 2.30), stool sampling (8.17 ± 1.96), blood sampling (8.87 ± 1.62), and imaging (8.67 ± 1.60); P

Abstract Context Public and patient involvement is increasingly becoming an expectation of research funders and policy makers. Not all areas of health research are public‐facing. Here, we outline an approach for building the skills and developing the relationships required for downstream public and patient involvement in pre‐clinical adolescent rheumatology research. Objective To design a methodology for improving researcher‐adolescent communications specifically aimed at mutual relationship building for PPI. Deliberate and effective preparation in advance of research involvement to improve the downstream success of that involvement. Design A research seminar and research skills workshop conducted entirely in ‘plain English’ for adolescents and their siblings aged 10‐20. Upskilling of pre‐clinical researchers for effective public involvement. Setting and participants Study co‐design between the voluntary charity Irish Children's Arthritis Network and the academic research centre UCD Centre for Arthritis Research. Fifteen adolescents aged 10‐20 years old living with arthritis, four pre‐clinical researchers and one qualitative researcher investigating adolescent or paediatric arthritis. Main variables studied Relationship building and communications for effective downstream public involvement in pre‐clinical and laboratory research. Results The methodology outlined here was received extremely positively. Both researchers and adolescents living with arthritis felt more comfortable communicating, more knowledgeable about juvenile arthritis and research, and more able to engage in co‐operative dialogue. Discussion Engaging early, considering the needs of the community and developing appropriate involvement methodology can enable involvement in pre‐clinical research. Conclusions Dedicating resources to building relationships and skills necessary for co‐operative research involvement can overcome some of the barriers to public involvement in pre‐clinical and laboratory‐based research.

Abstract The southern sea otter (Enhydra lutris nereis) is a threatened sub‐species in coastal ecosystems. To understand better the role of diet, monitor health, and enhance management of this and other marine mammal species, we characterized the oral (gingival) and distal gut (rectal and fecal) microbiota of 158 wild southern sea otters living off the coast of central California, USA, and 12 captive sea otters, some of which were included in a diet shift experiment. We found that the sea otter fecal microbiota was distinct from that of three other otter species, and that captivity does not significantly alter the community structure of the sea otter gingival or distal gut microbiota. Metagenomic analysis unexpectedly revealed that the majority of sea otter fecal DNA is derived from prey, rather than from indigenous bacteria or host cells as with most other mammals. We speculate that a reduced bacterial biomass in the sea otter gut reflects rapid gut transit time and a particular strategy for foraging and energy harvest. This study establishes a reference for the healthy sea otter microbiota, highlights how a marine lifestyle may shape the mammalian microbiota, and may inform future health assessments and conservation management of sea otter populations.

Abstract In rural Bangladesh, intake of nutrient‐rich foods, such as animal source foods (ASFs), is generally suboptimal. Diets low in nutrients and lacking in diversity put women of reproductive age (WRA) at risk of malnutrition as well as adverse birth outcomes. The objective of this study was to assess the relationship between maternal dietary diversity, consumption of specific food groups and markers of nutritional status, including underweight [body mass index (BMI)

Abstract Background Individuals with chronic obstructive pulmonary disease (COPD) commonly experience exacerbations, which may require hospital admission. Early detection of exacerbations, and therefore early treatment, could be crucial in preventing admission and improving outcomes. Our previous research has demonstrated that the pattern analysis of peripheral oxygen saturation (SpO2) fluctuations provides novel insights into the engagement of the respiratory control system in response to physiological stress (hypoxia). Therefore, this pilot study tested the hypothesis that the pattern of SpO2 variations in overnight recordings of individuals with COPD would distinguish between stable and exacerbation phases of the disease. Methods Overnight pulse oximetry data from 11 individuals with COPD, who exhibited exacerbation after a period of stable disease, were examined. Stable phase recordings were conducted overnight and one night prior to exacerbation recordings were also analyzed. Pattern analysis of SpO2 variations was carried examined using sample entropy (for assessment of irregularity), the multiscale entropy (complexity), and detrended fluctuation analysis (self‐similarity). Results SpO2 variations displayed a complex pattern in both stable and exacerbation phases of COPD. During an exacerbation, SpO2 entropy increased (p = 0.029) and long‐term fractal‐like exponent (α2) decreased (p = 0.002) while the mean and standard deviation of SpO2 time series remained unchanged. Through ROC analyses, SpO2 entropy and α2 were both able to classify the COPD phases into either stable or exacerbation phase. With the best positive predictor value (PPV) for sample entropy (PPV = 70%) and a cut‐off value of 0.454. While the best negative predictor value (NPV) was α2 (NPV = 78%) with a cut‐off value of 1.00. Conclusion Alterations in SpO2 entropy and the fractal‐like exponent have the potential to detect exacerbations in COPD. Further research is warranted to examine if SpO2 variability analysis could be used as a novel objective method of detecting exacerbations.

Abstract Aims This study aims to determine if traditional markers of disadvantage [female sex, low socio‐economic status (SES), and remoteness] are associated with lower prescription of evidence‐based therapy and higher mortality among patients with moderate–severe heart failure with reduced ejection fraction. Methods and results We recruited 452 consecutive class II–III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence‐based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow‐up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74–1.92, 0.48). There was no difference in prescription of beta‐blockers [χ2(1) = 0.91, 0.66], angiotensin‐converting enzyme inhibitors [χ2(1) = 0.001, 0.97], nor aldosterone antagonists [χ2(1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter‐defibrillator implantation in men compared with women [χ2(1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit. Conclusions In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.