Australian water consumer outlook 2015

Executive Summary Do we think and talk about water only when we are in drought? Do we complain about the price of water, but are happy to pay $3 a bottle for it at the shop? Do urban residents think differently about water to people living in rural and regional areas? Do consumers know enough about our water resources to understand if governments and industry are protecting our water supply in the future? These questions and more are explored in the Australian Water Consumer Outlook. As the driest inhabited continent on earth, it’s critical we engage with and understand the attitudes of water consumers, water industry and government, and make water policy a priority. Although many utilities undertake customer satisfaction surveys they often don’t ask broader questions to gain an understanding of the consumer make-up and leadership of the industry. Further, each of these surveys is conducted independently of each other, making it difficult to identify trends and variances of perceptions nationally. The Australian Water Consumer Outlook presents the findings of the Australian Water Consumer Survey. The Survey was conducted online between 27 July and 3 September 2015 and received 3948 responses. The data gathered for the Australian Water Consumer Outlook provides a basis for further community-informed policy debate. • State based reports are also available at AWA\u27s websit

Unselected brain imaging in suspected meningitis delays lumbar puncture, can prolong hospitalisation and may increase antibiotic costs - a pilot study

Background: Antibiotics reduce mortality in bacterial meningitis; a lumbar puncture (LP) will demonstrate that many patients with suspected meningitis do not need them; but delays reduce chances of culture, particularly if N8 h. Guidelines advise a LP without brain imaging unless specific features are present. Objective: We assessed the duration of hospitalisation and inpatient costs incurred with delays in LP in a Northwest of England teaching hospital. Methods: We screened the cerebrospinal fluid (CSF) database to identify patients with suspected meningitis over 3 months (07–09/ 2010). Data were recorded from clinical case notes; costs were calculated with established datasets and the British national formulary. Results: 142 patients were screened; 35 had a suspected CNS infection; 10 had a CNS infection proven: 3 bacterial meningitis; 4 aseptic meningitis and 3 viral encephalitis. Brain imaging delayed the LP for 19 (54%), (11.08 vs 5.29 hrs, p= 0.10); ten (53%) did not need imaging. 11 (42%) of those given antibiotics before the LP were delayed N8 h. For patients with aseptic meningitis and those who had a CNS infection excluded, without prior antibiotics, the delay in LP increased duration of hospitalisation (r=0.94, p=0.02 and r=0.96, p=0.01 respectively). Overall there was no trend with LP delays and antibiotic cost. However, 4 patients had antibiotics continued despite negative cultures; 2 of whom had the LP delayed N8 h, with an antibiotic cost of £215.96. Conclusion: Inappropriate brain imaging often delayed the LP; in patients who did not need antibiotics this led to longer hospitalisation

Exploring the effectiveness of a novel teaching approach for information and academic literacies in a first year engineering unit

First year Engineering students tend to lack key information and academic literacy skills, which results in poor writing and language use, the use of a limited range of sources and poor referencing in their assignments. In the 2014 graduate outlook survey, 48% of graduate employers ranked communication skills as the most important selection criterion when recruiting graduates. Transferable skills are becoming increasingly important, not just to produce a more adaptable work force, but to inspire lifelong students who will continuously learn and improve. In the Macquarie University Engineering Program these transferable skills are introduced early in the degree using enquiry based methodology in a core first year Engineering unit. Tutors play a pivotal role in this process, facilitating repeated practice and acting as mentors for the students. To emphasise the importance of information and academic literacy as the first step in educating Engineering students, librarians developed a series of ‘research studios’ based on Baratta, Chong and Foster’s work (2011) which were run during tutorial sessions in week 4 of session 1. As Engineering students typically have active, sensing, inductive and visual learning styles (Young, 2012, p. 22) an activity based approach was used to help students self-discover and practice. This was supplemented with an online language activity created by the learning skills department. The following learning outcomes were addressed: recognising when information is needed appreciating the relevance of different types of resources for their field identifying the most efficient search strategy to locate relevant information of a high standard critically evaluating information sources using appropriate academic language using the correct format of reporting referencing correctly and ethically Over 300 students attended tutorials held in library classrooms. Each ‘research studio’ was held in a different room and facilitated by a different library staff member, with groups of students moving from room to room at the conclusion of each 40 minute session. Library staff members provided short instruction, with most of the tutorial time devoted to hands-on activities, small group work and discussion. A large first year core unit was chosen to pilot this approach in order to be representative of the Engineering student population. Evaluation data shows that all of the activities had positive effects on student learning. The online language activity recorded a high number of hits. Student feedback indicated that the activity-based approach to developing information skills helped to consolidate understanding. Tutor feedback indicated that the quality of assignments submitted following the program was improved over previous sessions. To facilitate integrating these literacies into the unit, tutors will provide input into reviewing the exercises and will be trained to facilitate the learning activities co-designed by librarians and learning skills specialists in a blended learning format. As there was some feedback that exercises were too easy, the input from tutors will help pitch the training at the appropriate level and also provide valuable subject specific context. This presentation shares the results of this unique collaboration and its impact on student test results. It will address the information and academic literacy skills that Engineering students require to succeed in their academic and professional endeavours. REFERENCES Ali, R., Abu Hassan, N., Daud, M. Y. M., & Jusoff, K. (2010). Information literacy skills of engineering students. International Journal of Research and Reviews in Applied Sciences, 5(3), 264-270. http://eprints.utm.my/37881/2/IJRRAS_5_3_08.pdf Baratta, M., Chong, A & Foster, J.A. (2011). The research studio: integrating information literacy into a first year engineering science course. American Society for Engineering Education Conference, Vancouver, Canada. file:///C:/Users/mariette.leroux/Downloads/ASEE2011TheResearchStudioFinal%20(2).pdf Fosmire, M & Radcliffe, D. (2013). Integrating information into the Engineering design process. West Lafayette, IN.: Perdue University Press. http://docs.lib.purdue.edu/cgi/viewcontent.cgi?article=1030&context=purduepress_ebooks Lindsay, E. (2015). Graduate outlook 2014: employer’s perspectives on graduate recruitment in Australia. Melbourne, Vic.: Graduate Careers Australia. http://www.graduatecareers.com.au/wp-content/uploads/2015/06/Graduate_Outlook_2014.pdf Young, S.J. (2012). Engineering. in O’Clair and Davidson, J. (eds) The busy librarian’s guide to information literacy in science and engineering. Chicago, IL: Association of College and Research Libraries Proceedings of the Australian Conference on Science and Mathematics Education, Curtin University, Sept 30th to Oct 1st, 2015, page X, ISBN Number 978-0-9871834-4-6

A comparison of HMGB1 concentrations between cerebrospinal fluid and blood in patients with neurological disease

AIMS: To determine whether a correlation exists between paired cerebrospinal fluid (CSF) and serum levels of a novel inflammatory biomarker, high-mobility group box 1 (HMGB1), in different neurological conditions. METHODS: HMGB1 was measured in the serum and CSF of 46 neurological patients (18 idiopathic intracranial hypertension [IIH], 18 neurological infection/inflammation [NII] and 10 Rasmussen's encephalitis [RE]). RESULTS: Mean serum (± SD) HMGB1 levels were 1.43 ± 0.54, 25.28 ± 27.9 and 1.89 ± 1.49 ng/ml for the patients with IIH, NII and RE, respectively. Corresponding mean (± SD) CSF levels were 0.35 ± 0.22, 4.48 ± 6.56 and 2.24 ± 2.35 ng/ml. Both CSF and serum HMGB1 was elevated in NII. Elevated CSF HMGB1 was demonstrated in RE. There was no direct correlation between CSF and serum levels of HMGB1. CONCLUSION: Serum HMGB1 cannot be used as a surrogate measure for CSF levels. CSF HMGB1 was elevated in NII and RE, its role as a prognostic/stratification biomarker needs further study

A survey of UK healthcare workers' attitudes on volunteering to help with the Ebola outbreak in West Africa

Objective To understand the barriers and enablers for UK healthcare workers who are considering going to work in the current Ebola outbreak in West Africa, but have not yet volunteered. Design After focus group discussions, and a pilot questionnaire, an anonymous survey was conducted using SurveyMonkey to determine whether people had considered going to West Africa, what factors might make them more or less likely to volunteer, and whether any of these were modifiable factors. Participants The survey was publicised among doctors, nurses, laboratory staff and allied health professionals. 3109 people answered the survey, of whom 472 (15%) were considering going to work in the epidemic but had not yet volunteered. 1791 (57.6%) had not considered going, 704 (22.6%) had considered going but decided not to, 53 (1.7%) had volunteered to go and 14 (0.45%) had already been and worked in the epidemic. Results For those considering going to West Africa, the most important factor preventing them from volunteering was a lack of information to help them decide; fear of getting Ebola and partners’ concerns came next. Uncertainty about their potential role, current work commitments and inability to get agreement from their employer were also important barriers, whereas clarity over training would be an important enabler. In contrast, for those who were not considering going, or who had decided against going, family considerations and partner concerns were the most important factors. Conclusions More UK healthcare workers would volunteer to help tackle Ebola in West Africa if there was better information available, including clarity about roles, cover arrangements, and training. This could be achieved with a well-publicised high quality portal of reliable information

High Viral Diversity and Mixed Infections in Cerebral Spinal Fluid From Cases of Varicella Zoster Virus Encephalitis.

BACKGROUND: Varicella zoster virus (VZV) may cause encephalitis, both with and without rash. Here we investigate whether viruses recovered from the central nervous system (CNS; encephalitis or meningitis) differ genetically from those recovered from non-CNS samples. METHODS: Enrichment-based deep sequencing of 45 VZV genomes from cerebral spinal fluid (CSF), plasma, bronchoalveolar lavage (BAL), and vesicles was carried out with samples collected from 34 patients with and without VZV infection of the CNS. RESULTS: Viral sequences from multiple sites in the same patient were identical at the consensus level. Virus from vesicle fluid and CSF in cases of meningitis showed low-level diversity. By contrast, plasma, BAL, and encephalitis had higher numbers of variant alleles. Two CSF-encephalitis samples had high genetic diversity, with variant frequency patterns typical of mixed infections with different clades. CONCLUSIONS: Low viral genetic diversity in vesicle fluid is compatible with previous observations that VZV skin lesions arise from single or low numbers of virions. A similar result was observed in VZV from cases of VZV meningitis, a generally self-limiting infection. CSF from cases of encephalitis had higher diversity with evidence for mixed clade infections in 2 cases. We hypothesize that reactivation from multiple neurons may contribute to the pathogenesis of VZV encephalitis.Action Medical research GN2424 This work was supported by a UK MRC New Investigator Award to D. P. D; UCL/UCLH BRC (J. B.); Action Medical Research (grant number GN2424 to C. J. H); Swedish Research Council (P. N. and T. B.). The work was also support by an NIHR Fellowship (grant number DRF-2013-06-168 to F. M.), the Meningitis Research Foundation (grant number 0904.0), an NIHR Programme Grant in Applied Research (grant number RP-PG-0108-10048 to T. S.), and the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool

An RCT of a decision aid to support informed choices about taking aspirin to prevent colorectal cancer and other chronic diseases: a study protocol for the SITA (Should I Take Aspirin?) trial.

BACKGROUND: Australian guidelines recommend that all people aged 50-70 years old actively consider taking daily low-dose aspirin (100-300 mg per day) for 2.5 to 5 years to reduce their risk of colorectal cancer (CRC). Despite the change of national CRC prevention guidelines, there has been no active implementation of the guidelines into clinical practice. We aim to test the efficacy of a health consultation and decision aid, using a novel expected frequency tree (EFT) to present the benefits and harms of low dose aspirin prior to a general practice consultation with patients aged 50-70 years, on informed decision-making and uptake of aspirin. METHODS: Approximately five to seven general practices in Victoria, Australia, will be recruited to participate. Patients 50-70 years old, attending an appointment with their general practitioner (GP) for any reason, will be invited to participate in the trial. Two hundred fifty-eight eligible participants will be randomly allocated 1:1 to intervention or active control arms using a computer-generated allocation sequence stratified by general practice, sex, and mode of trial delivery (face-to-face or teletrial). There are two co-primary outcomes: informed decision-making at 1-month post randomisation, measured by the Multi-dimensional Measure of Informed Choice (MMIC), and self-reported daily use of aspirin at 6 months. Secondary outcomes include decisional conflict at 1-month and other behavioural changes to reduce CRC risk at both time points. DISCUSSION: This trial will test the efficacy of novel methods for implementing national guidelines to support informed decision-making about taking aspirin in 50-70-year-olds to reduce the risk of CRC and other chronic diseases. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001003965 . Registered on 10 October 2020

The predictive role of symptoms in COVID-19 diagnostic models : A longitudinal insight

Acknowledgements 2019nCoV-302 Study Group Members: The NVX-CoV2373-2019nCoV-302 clinical trial was a collective group effort across multiple institutions and locations. Below is a list of sites and staff that significantly contributed to the implementation and conduct of the NVX-CoV2373-2019nCoV-302 clinical trial.Peer reviewe

Safety and efficacy of the NVX-CoV2373 coronavirus disease 2019 vaccine at completion of the placebo-controlled phase of a randomized controlled trial

Background: The recombinant protein-based vaccine, NVX-CoV2373, demonstrated 89.7% efficacy against coronavirus disease 2019 (COVID-19) in a phase 3, randomized, observer-blinded, placebo-controlled trial in the United Kingdom. The protocol was amended to include a blinded crossover. Data to the end of the placebo-controlled phase are reported. Methods: Adults aged 18–84 years received 2 doses of NVX-CoV2373 or placebo (1:1) and were monitored for virologically confirmed mild, moderate, or severe COVID-19 (onset from 7 days after second vaccination). Participants who developed immunoglobulin G (IgG) against nucleocapsid protein but did not show symptomatic COVID-19 were considered asymptomatic. Secondary outcomes included anti-spike (S) IgG responses, wild-type virus neutralization, and T-cell responses. Results: Of 15 185 participants, 13 989 remained in the per-protocol efficacy population (6989 NVX-CoV2373, 7000 placebo). At a maximum of 7.5 months (median, 4.5) postvaccination, there were 24 cases of COVID-19 among NVX-CoV2373 recipients and 134 cases among placebo recipients, a vaccine efficacy of 82.7% (95% confidence interval [CI], 73.3%–88.8%). Vaccine efficacy was 100% (95% CI, 17.9%–100.0%) against severe disease and 76.3% (95% CI, 57.4%–86.8%) against asymptomatic disease. High anti-S and neutralization responses to vaccination were evident, together with S-protein–specific induction of interferon-γ secretion in peripheral blood T cells. Incidence of serious adverse events and adverse events of special interest were similar between groups. Conclusions: A 2-dose regimen of NVX-CoV2373 conferred a high level of ongoing protection against asymptomatic, symptomatic, and severe COVID-19 through >6 months postvaccination. A gradual decrease of protection suggests that a booster may be indicated. Clinical Trials Registration: EudraCT, 2020-004123-16