Development of mathematical pathways for vet students to articulate to related higher education courses

Australia needs more qualified professionals in the areas of engineering, education, health and other sciences. The national focus on widening participation in higher education (HE) includes strengthening pathways from vocational education and training (VET). VET students often lack the mathematics skills necessary to articulate successfully to their chosen degrees. Current approaches such as bridging and foundation mathematics programs, and university in-degree support, are fragmented and not tailored or sufficiently contextualised for VET articulants. Flexible approaches are needed that enable institutions to assess the numeracy skills of VET articulants and provide resources and support to build their mathematical skills and confidence. This project is developing a series of mathematics pathways designed to improve the readiness of VET qualified students for higher education study in the areas of engineering, education and health science. Year 1 of this project focuses on engineering and education. The main VET qualifications and HE education courses have been identified and mapping the mathematical gap in knowledge between the two is underway. Mathematical pathways will be delivered as Open Education Resources and designed to be delivered flexibly. This presentation will review the progress on the mathematical pathway development and review the gaps that exist between the two sectors

Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JADAS without inclusion of the ESR. Disclosure statement: All authors have declared no conflicts of interest. Table 1Spearman's correlation between JADAS 71 and single markers DA by ILAR subtype ILAR Subtype Systemic onset JIA Persistent oligo JIA Extended oligo JIA Rheumatoid factor neg JIA Rheumatoid factor pos JIA Enthesitis related JIA Psoriatic JIA Undifferentiated JIA Unknown subtype Total cohort Number of children 23 111 12 57 7 9 19 7 17 262 AJC 0.54 0.67 0.53 0.75 0.53 0.34 0.59 0.81 0.37 0.59 PGA 0.63 0.69 0.25 0.73 0.14 0.05 0.50 0.83 0.56 0.64 PGE 0.51 0.68 0.83 0.61 0.41 0.69 0.71 0.9 0.48 0.61 ESR 0.28 0.31 0.35 0.4 0.6 0.85 0.43 0.7 0.5 0.53 Limited 71 JC 0.29 0.51 0.23 0.37 0.14 -0.12 0.4 0.81 0.45 0.41 Parental pain 0.23 0.62 0.03 0.57 0.41 0.69 0.7 0.79 0.42 0.53 Childhood health assessment questionnaire 0.25 0.57 -0.07 0.36 -0.47 0.84 0.37 0.8 0.66 0.4

Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit

Background: Endoscopy within 24 hours of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between Nov-Dec 2017. Analyses were performed to identify factorsassociated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0- 35.7), comprising median admission to referral and referral to endoscopy times of 8.1h (IQR 3.7- 18.1) and 6.7h (IQR 3.0-23.1) respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7am-7pm or via the Emergency Department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1d; p= 0.004), but not 30-day mortality (p=0.344).Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Writing Orkney’s Future: Minority Language and Speculative Poetics

This creative and critical doctoral dissertation engages contemporary Scots language writing and theory, developing an antinational approach to European minority languages. In a double methodology, creative practice informs and develops critical research, and critical research shapes and directs creative practice. Part One, Deep Wheel Orcadia, is an Orcadian science fiction verse novel. Written in the Orkney language, a form of Scots, the poetry imagines a future space station as a utopian reflection of zero-world Orkney. The central characters, Astrid and Darling, offer diverging perspectives on language and belonging against a backdrop of escalating ecological and economic crisis. The language used is a synthetic, vernacularly-rooted approach to Orkney, using orthographical techniques of coherence and fluidity to construct a literary register that is neither a universalising standard nor a particularising dialect: a science fiction Orkney. Part Two, Writing Orkney’s Future: Minority Language and Speculative Poetics, critically investigates theoretical and creative approaches to the Scots language in specific and European minority language in general. Chapter 1 reads Edwin Morgan’s and Rachel Plummer’s science fiction poetry as scoping the colonised-and-colonising double bind facing Scottish writing and language. Chapter 2 argues that Scots itself is a science fiction project, using postcolonial theory to critique linguistic and narrative temporality in James Leslie Mitchell and Wulf Kurtoglu. Arguing that national approaches to Scots have trapped the language in a colonial position outside of time, this chapter advocates for porous boundaries and utopian entanglement, deploying language against the coherence of the nation. In Chapter 3, a critical history of Orkney language literature contextualises an account of minority language practice from the vowel to the plot, writing towards antinational approaches. Chapter 4 deploys Yasemin Yildiz’s “postmonolingual paradigm” to critique existing Scots language advocacy, arguing in conclusion for “difficult utopia now”

IDENTIFICADOS TRES TIPOS DE RESPUESTAS INMUNOLÓGICAS EN PACIENTES DE COVID-19

Muchos pacientes con enfermedad por COVID-19, causada por una infecci&oacute;n por coronavirus 2 (SARS-CoV-2) del s&iacute;ndrome respiratorio agudo severo, presentan una enfermedad respiratoria grave que requiere hospitalizaci&oacute;n y ventilaci&oacute;n mec&aacute;nica. Aunque la mayor&iacute;a de los pacientes se recuperan, la enfermedad es compleja y la letalidad puede llegar al 10%. Actualmente, no se comprende bien c&oacute;mo las respuestas inmunitarias humanas controlan o exacerban el COVID-19, y definir la naturaleza de las respuestas inmunitarias durante el COVID-19 agudo podr&iacute;a ayudar a identificar terapias y vacunas eficaces. Con este objetivo, se public&oacute; un estudio en Science prominentes y distintos de pacientes COVID-19 hospitalizados, los cuales est&aacute;n asociados con trayectorias cl&iacute;nicas deficientes frente a la mejora de la salud. Estos inmunotipos pueden tener implicaciones para el dise&ntilde;o de terapias y vacunas para COVID-19

Autoreactive helper T cells alleviate the need for intrinsic TLR signaling in autoreactive B cell activation

T cells play a significant role in the pathogenesis of systemic autoimmune diseases, including systemic lupus erythematosus; however, there is relatively little information on the nature and specificity of autoreactive T cells. Identifying such cells has been technically difficult because they are likely to be rare and low affinity. Here, we report a method for identifying autoreactive T cell clones that recognize proteins contained in autoantibody immune complexes, providing direct evidence that functional autoreactive helper T cells exist in the periphery of normal mice. These T cells significantly enhanced autoreactive B cell proliferation and altered B cell differentiation in vivo. Most importantly, these autoreactive T cells were able to rescue many aspects of the TLR-deficient AM14 (anti-IgG2a rheumatoid factor) B cell response, suggesting that TLR requirements can be bypassed. This result has implications for the efficacy of TLR-targeted therapy in the treatment of ongoing disease