Effectiveness of biomarker-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection : the BATCH RCT

Background Procalcitonin is a biomarker specific for bacterial infection, with a more rapid response than other commonly used biomarkers, such as C-reactive protein, but it is not routinely used in the National Health Service. Objective To determine if using a procalcitonin-guided algorithm may safely reduce duration of antibiotic therapy compared to standard of care in hospitalised children with suspected or confirmed infection. Design A pragmatic, multicentre, open-label, parallel two-arm, individually randomised controlled trial with internal pilot phase, qualitative study and health economic evaluations. Setting Paediatric wards or paediatric intensive care units within children’s hospitals (n = 6) and district general hospitals (n = 9) in the United Kingdom. Participants Children aged between 72 hours and 18 years admitted to hospital and being treated with intravenous antibiotics for suspected or confirmed bacterial infection. Interventions Procalcitonin-guided algorithm versus usual standard care alone. Main outcome measures Coprimary outcomes were duration of intravenous antibiotic use and a composite safety measure. Results Between 11 June 2018 and 12 October 2022, 1949 children were recruited: 977 to the procalcitonin group [427 female (43.7%), 550 male (56.3%)], and 972 to the usual care group [478 female (49.2%), 494 male (50.8%)]. Duration of intravenous antibiotics was not significantly different between the procalcitonin group (median 96.0 hours) and the usual care group (median 99.7 hours) [hazard ratio = 0.96 (0.87, 1.05)], and the procalcitonin-guided algorithm was non-inferior to usual care [risk difference = −0.81% (95% confidence interval upper bound 1.11%)]. At clinical review, a procalcitonin result was available for 81.8% of the time, which was considered as part of clinical decision-making 66.6% of the time, and the algorithm was adhered to 57.2% of the time. Incremental cost-effectiveness ratio per duration of intravenous antibiotics hour avoided from bootstrapped samples was £467.62 per intravenous antibiotic hour avoided. Cost analysis of complete cases was also higher in the procalcitonin arm for all age groups, and for children aged 5 years and over. The intervention is not cost-effective as it is more expensive with no significant improvement in intravenous antibiotic duration. Limitations Robust antimicrobial stewardship programmes were already implemented in the lead recruiting sites, and adherence to the algorithm was poor. Clinicians may be reluctant to adhere to biomarker-guided algorithms, due to unfamiliarity with interpreting the test result. Conclusions In children hospitalised with confirmed or suspected bacterial infection, the addition of a procalcitonin-guided algorithm to usual care is non-inferior in terms of safety, but does not reduce duration of intravenous antibiotics, and is not cost-effective. In the presence of robust antimicrobial stewardship programmes to reduce antibiotic use, a procalcitonin-guided algorithm may offer little added value. Future work Future trials must include an implementation framework to improve trial intervention fidelity, and repeated cycles of education and training to facilitate implementation of biomarker-guided algorithms into routine clinical care. Trial registration This trial is registered as ISRCTN11369832. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/188/42) and is published in full in Health Technology Assessment; Vol. 29, No. 16. See the NIHR Funding and Awards website for further award information

The case of AT2022wtn : a tidal disruption event in an interacting galaxy

We present the results from our multiwavelength monitoring campaign of the transient AT 2022wtn, discovered by the Zwicky Transient Facility in the nucleus of SDSS J232323.79 + 104107.7, the less-massive galaxy in an active merging pair with a mass ratio of 10:1. AT 2022wtn shows spectroscopic and photometric properties consistent with a X-ray faint N-strong TDE-H + He with a number of peculiarities. Specifically, a 30-d long plateau at maximum luminosity, a corresponding dip in temperature and the development of a double-horned N iii + He ii line profile. Strong and time-evolving velocity offsets in the tidal disruption event (TDE) broad emission lines and the detection of a transient radio emission, indicate the presence of outflows. Overall, the observed properties are consistent with the full disruption of a low-mass star by a M supermassive black hole followed by an efficient disc formation and the launch of a quasi-spherical reprocessing envelope of fast expanding outflowing material. The observed differences between the He ii and the Hydrogen and N iii lines can be explained either with a spatial separation of the lines emitting region or with a late-time reveal of shocks from the returning debris streams, as the photosphere recedes. Finally, we present an extensive analysis of the hosting environment and discuss the implications for the discovery of two TDEs in interacting galaxy pairs, finding indication for an over-representation of TDEs in these systems. The AT 2022wtn host galaxy properties suggest that it is in the early stages of the merger, therefore we may be witnessing the initial enhanced rate of TDEs in interacting galaxies before the post-starburst phase

Salivary Testosterone, Androstenedione and 11‐Oxygenated 19‐Carbon Concentrations Differ by Age and Sex in Children

Background: The diagnosis and management of childhood adrenal disorders is challenging. Clinical markers of hormone excess or deficiency may take months to manifest, and traditional biomarkers correlate only partially with clinical outcomes. Recent work has indicated that 11 oxygenated 19‐carbon (11oxC19) steroids may be useful in the assessment of adrenal function. 11oxC19 steroids, testosterone (T) and androstenedione (A4), can be measured in saliva, but very little is known about these hormones in healthy children. Methods: Participants collected saliva samples 30 min after waking and every 2 h until bedtime. Samples were analysed for T, A4, 11 ketotestosterone (11KT) and 11βhydroxyandrostenedione (11OHA4) by liquid chromatography tandem mass spectrometry. Results: Fifty‐two (30 male) healthy children aged 10.4 ± 3.9 (5.0–17.5) participated. Median height SDS was 0.4 (IQR −0.3 to 1.01) and median BMI SDS was 0.3 (IQR −0.2 to 1.3). All steroids showed a diurnal rhythm, with all hormones decreasing in measured concentration at time points that are 30 min after waking. Salivary T was higher in postpubertal children, particularly boys (p < 0.001). Salivary A4 was lower in boys compared to girls (p = 0.009) and did not differ with pubertal development. 11KT increased with age (p < 0.001) and concentrations were similar between boys and girls. 11OHA4 reduced in concentration with age (p = 0.03) and was below detectable limits after the early morning peak in both sexes. Conclusion: For the first time we describe the physiological profile of 11KT and 11OHA4 in children. Further data are required to establish reference ranges, which should consider age, sex, pubertal status and time of sampling

Measuring the impact of SoTL in research-intensive business schools : Developing an institutional framework for innovation

This workshop addresses the critical need for integrating the Scholarship of Teaching and Learning (SoTL) within research-intensive business schools, focusing particularly on developing frameworks to assess the impact of teaching innovations on student learning and institutional growth. Drawing on insights from Lancaster’s Centre for Scholarship and Innovation in Management Education (SIME) and King’s Business School’s Centre for Innovation, Leadership, Education and Development (ILEAD), as well as initial findings from research, this session invites participants to explore strategies for effectively embedding and measuring the value of SoTL in management education contexts. Research-intensive business schools are uniquely poised to adopt SoTL principles due to their focus on reflective practices, experiential learning and critical thinking. Yet, SoTL remains underutilised within these institutions, often sidelined by traditional reward structures that prioritize discipline-based research over teaching scholarship. Despite studies illustrating SoTL’s positive impact, including through cross-disciplinary collaborations, many institutions face cultural and systemic barriers in fostering widespread SoTL engagement. In addition, business and management education faces broader existential challenges related to the values in the context of global polycrises. To counter these, we propose applying a Theory of Change (ToC) framework, recognising that institutional transformation requires strategic steps: defining conditions for change, enabling collaboration, and establishing robust measures of impact

Smooth Brain Society Podcast Episode #65: Mainstreaming of the Far-Right – Dr. Aaron Winter

In this powerful episode, we sit down with Dr. Aaron Winter, senior lecturer in sociology at Lancaster University and Director of the Centre for Alternatives to Social and Economic Inequalities (CASEI), to unpack the complex rise and normalization of far-right ideologies. From his personal roots in anti-racist activism to his research on racism, terrorism, and structural inequality, Dr. Winter explores how mainstream institutions, media, and political parties have helped legitimize far-right narratives. We discuss the myth of the “white working class” grievance, how race and class are falsely divided, the political misuse of populism, and the dangers of platforming hate under the guise of public discourse. An essential listen for anyone concerned about democracy, justice, and the future of inclusive politics

Iso-electronic Sb impurities in GaAs studied by cross-sectional scanning tunneling microscopy

Highly mismatched III/V alloys, such as GaAsN and GaAsSb, are known to suffer from segregation and clustering effects, which often limit their application in devices. In this cross-sectional scanning tunneling microscopy (X-STM) study, we explore the atomic-scale behavior of iso-electronic Sb doping atoms in MBE-grown dilute GaAs1-xSbx (0.01 < x < 0.03). We found that Sb atoms up to four layers below the cleavage surface can be identified in filled-state X-STM images. They appear with diverse anisotropic contrasts, depending on the depth of the Sb atom. These features are classified and are related to their depth below the cleavage surface through careful symmetry considerations. We show that the depth-dependent contrast of Sb atoms in filled-state imaging is determined by both topographic effects (lattice deformation due to the large Sb atom) and electronic effects (resonances of Sb atoms in the valence band). This study shows that in MBE-grown GaAsSb alloys, the Sb atoms can be rapidly incorporated, in which case the GaAsSb layers suffer little from segregation and sharp interfaces can be obtained. Additionally, short-range ordering of Sb, which can be uniquely studied by X-STM, has been analyzed in terms of nearest-neighbor-pair formation, and we find that in MBE-grown GaAsSb materials, a tendency to form Sb pairs or clusters can be suppressed. This opens the route to create high-quality devices based on the highly mismatched GaAsSb alloy

Integration of coarser images in subpixel mapping

The mixed pixel problem impacts significantly the accuracy of land cover land use (LCLU) mapping, particularly in heterogeneous scenes. Subpixel mapping (SPM) addresses this by predicting LCLU distributions at a finer spatial resolution than the input image. However, as an ill-posed problem, SPM faces inevitable uncertainties of prediction. Existing SPM methods commonly rely on auxiliary data at the target fine spatial resolution, which are generally scarce. To address this issue, this paper proposes a novel SPM approach called Coarser-SPM, which integrates information from images that are coarser than the original input coarse image. These coarser images, can include those with spatial resolutions that follow a non-pyramid (i.e., intersecting) relationship with the original coarse image, can provide complementary spatial information and serve as additional constraints for SPM. To integrate the information from both the original coarse image and the coarser images, Coarser-SPM conducts a joint optimization strategy that optimizes class probabilities at the subpixel scale. Experimental results show that with the integration of the coarser images, Coarser-SPM produces more accurate SPM results, revealing more satisfactory details of the LCLU distributions compared to conventional SPM methods. Moreover, the accuracy of subpixels in the intersection area between the coarser and original coarse scales increases significantly, highlighting the effectiveness of using coarser images to enhance SPM

Understanding disinformation : definitions, discussions, and discourses

Disinformation is an online harm that has affected billions of people worldwide. It has become the focus of political figures, government legislation, educational initiatives, and even an array of television specials and documentaries. Despite its prevalence as a cultural issue, disinformation is not necessarily a well understood phenomenon. The use of other terms such as ‘misinformation’ and ‘fake news’ alongside the many associated, subjective concepts such as propaganda, clickbait, and trolling mean it is a topic characterised by conceptual murkiness. Disinformation is mediated semiotically. Whether through text, audio, video, or other means, disinformation must be mediated through some communicative mode in order to be disseminated and consumed. Consequently, linguistics has a lot to offer disinformation studies. There is an ever growing body of research that explores how disinformation spreads, the content of disinforming articles, and the actors responsible for its production. A great deal of this research focuses on so-called ‘fake news’. However, to date there have been no studies that explore how the terms ‘disinformation’ and ‘misinformation’ are themselves used in computer-mediated communication. This thesis seeks to redress this foundational gap in the literature by examining the use of ‘disinformation’, ‘misinformation’, and other terms for false content in naturalistically occurring discourse to inform theory surrounding disinformation. Using an approach grounded in critical corpus assisted discourse studies, this thesis examined two time periods: a historical study ranging from 1470-1690 using the pre-existing Early English Books Online (EEBO) corpus, and a contemporary study from a ten-year period spanning 2012-2021 using custom-made Twitter corpora. Corpus tools such as concordancing, word lists, and keyword lists are used to explore how discourses are constructed surrounding these terms and to analyse them drawing on contextual factors. The purpose of this is to understand firstly how disinformation evolved over the centuries and secondly to understand whether public representations of disinformation as mediated through discourse on social media can add additional insights to dictionary definitions of terms such as ‘disinformation and ‘misinformation’. The historical analysis, in tandem with an analysis of definitions of disinformation, found that several competing terms have been used over centuries but that one of the core components of defining disinformation is intentionality and blame. This analysis led to tangible recommendations for both disinformation scholars and counter-disinformation practitioners for how we should refer to disinformation, and the issues with over-extending terminology. The contemporary social media analysis shows that intentionality manifests itself in many explainable, but not previously reported, ways. Chief among these is that discourses of the term ‘misinformation’ focus heavily on matters related to health, medicine, and science, while discourses of the term ‘disinformation’ focus on disinformation actors and hostile-state information operations. I consistently draw on real-world examples of disinformation to ensure the thesis is grounded in actual examples of disinformation, and not hypothetical scenarios. I conclude by noting that we need to bear in mind how people represent disinformation and misinformation when we discuss it so that we are not at odds with public understandings of these concepts. Throughout the thesis I provide examples where we can update our current understandings of disinformation using evidence-based analysis from naturalistically occurring discourse and highlight potential policy and educational interventions that could help mitigate the impacts of disinformation