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Lesion Delivery and Scar Formation in Catheter Ablation for Atrial Fibrillation The DECAAF II Trial
No full textBackground: The Efficacy of Delayed Enhancement MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation of Atrial Fibrillation randomized trial showed no difference in atrial fibrillation (AF) recurrence with additional delayed enhancement magnetic resonance imaging (DE-MRI) fibrosis-targeted ablation to pulmonary vein isolation (PVI) in persistent AF. Objective: We evaluated the effect of lesion delivery on ablation-induced scarring and AF recurrence. Methods: Lesions delivered, targeting fibrotic and nonfibrotic areas identified from preablation DE-MRI, were studied in relation to ablation-induced scarring on 3-month DE-MRI, including their association with arrhythmia recurrence. Results: A total of 593 patients treated with radiofrequency were analyzed: 293 (49.4%) underwent PVI and 300 (50.6%) underwent additional fibrosis-guided ablation. Lesion analysis showed that 80.9% in the MRI fibrosis-guided group vs 16.5% in the PVI group (P < .001) had ≥40% of baseline fibrosis targeted. MRI assessment of ablation-induced scar showed that 44.8% of fibrosis-guided ablation and 15.5% of PVI had ≥40% of their fibrosis covered by scar (P < .001), demonstrating significant attenuation from lesions delivered to scar formed. In the overall population, fibrosis coverage with scar was not associated with recurrence (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.80–1.01; P 5 .08 per 20% increase). In patients with baseline fibrosis < 20%, fibrosis coverage with scar was associated with lower recurrence than PVI (HR 0.85; 95% CI 0.73–0.97; P 5 .03), whereas the association was not significant when baseline fibrosis ≥ 20% (HR 0.97; 95% CI 0.80–1.17; P 5 .77). Significant center variation was observed in fibrosis targeting and coverage with scarring. Conclusion: Radiofrequency ablation lesions do not uniformly result in scar formation. A post hoc analysis suggests reduced arrhythmia recurrence when ablation-induced scarring covers fibrotic regions in patients with low baseline fibrosis.Nazem Akoum, Mario Mekhael, Felipe Bisbal, Oussama Wazni, Christopher McGann, Hyejung Lee, Tyler Bardsley, Tom Greene, J. Michael Dean, Lilas Dagher, Eugene Kholmovski, Moussa Mansour, Francis Marchlinski, David Wilber, Gerhard Hindricks, Christian Mahnkopf, Darryl Wells, Pierre Jaïs, Prashanthan Sanders, Johannes Brachmann, Jeroen J. Bax, Leonie Morrison-de Boer, Thomas Deneke, Hugh Calkins, Christian Sohns, Nassir Marrouche, for the DECAAF II investigator
Effects of pre- and post-surgery physical activity interventions on physical activity and sedentary behaviour levels following knee and hip arthroplasty: a systematic review and meta-analysis of randomised controlled trials
No full textData source: Supplementary material, https://doi.org/10.1016/j.joca.2025.07.003Objective To evaluate general exercise and behavioural interventions designed to improve physical activity (PA) or reduce sedentary behaviour in total knee or hip arthroplasty (TKA/THA) patients. Design A systematic review and meta-analysis were conducted on randomised controlled trials reporting PA or sedentary behaviour changes in TKA/THA patients, with effects calculated using standardised mean differences (SMD). Subgroup analyses assessed whether effects differed based on intervention characteristics, arthroplasty timing, outcome type, and follow-up duration. Risk of bias and certainty of evidence were assessed using the PEDro scale and GRADE, respectively. Results Twenty-three trials were included, with meta-analyses including 1265 and 270 participants for PA and sedentary behaviour outcomes, respectively. PA interventions did not decrease sedentary behaviour (SMD=−0.19; 95% CI: −0.66 to 0.29; very low certainty of evidence), but did improve PA (SMD=0.16; 95% CI: 0.01 to 0.30; high certainty of evidence). This included improvements in step count (SMD=0.22; 95% CI: 0.05 to 0.40), but not moderate-to-vigorous PA (SMD=−0.01, 95% CI: −0.33 to 0.30). Interventions were most effective when they integrated wearable activity trackers (e.g., Fitbits; SMD=0.38; 95% CI: 0.18 to 0.57), behaviour change techniques (SMD=0.20, 95% CI: 0.01 to 0.39), and began less than two weeks after surgery (SMD=0.32, 95% CI: 0.14 to 0.50). Conclusion PA interventions, particularly those integrating behavioural strategies and wearable technology, promote PA in arthroplasty patients, but their effects on sedentary behaviour are unclear. These findings suggest that implementing evidence-based PA interventions be considered an essential component of acute arthroplasty care to enhance overall patient health.Noah d'Unienville, Ben Singh, Bethany Gower, Kimberley Szeto, Heather Badger, Matilda Krywanio, Carol Maher, Dominic Thewli
From Misunderstandings to Learning Opportunities: Leveraging Generative AI in Discussion Forums to Support Student Learning
No full textIn the contemporary educational landscape, particularly in large classroom settings, discussion forums have become a crucial tool for promoting interaction and addressing student queries. These forums foster a collaborative learning environment where students engage with both the teaching team and their peers. However, the sheer volume of content generated in these forums poses two significant interconnected challenges: How can we effectively identify common misunderstandings that arise in student discussions? And once identified, how can instructors use these insights to address them effectively? This paper explores the approach to integrating large language models (LLMs) and Retrieval-Augmented Generation (RAG) to tackle these challenges. We then demonstrate the approach Misunderstanding to Mastery (M2M) with authentic data from three computer science courses, involving 1355 students with 2878 unique posts, followed by an evaluation with five instructors teaching these courses. Results show that instructors found the approach promising and valuable for teaching, effectively identifying misunderstandings and generating actionable insights. Instructors highlighted the need for more fine-grained groupings, clearer metrics, validation of the created resources, and ethical considerations around data anonymity
Scoping review of adult NCD-relevant phenotypes measured in today's large child cohort studies
No full textData source: Supplementary Information, https://doi.org/10.1038/s41390-025-04056-3Background: Child cohort studies are important resources that can inform strategies to prevent adult noncommunicable diseases (NCDs). Technological advances now enable direct measurement of NCD-relevant phenotypes at large scale. Across contemporary large child cohorts, we aimed to provide the first comprehensive map of NCD-relevant phenotype measurement and gaps.
Methods: We included cohorts with >8000 child participants that were recruiting in whole or part after 2010 and measuring phenotypes relevant to ten high-burden NCDs. Our database and gray literature search identified 15 cohort studies for inclusion. Details on phenotype measurement (methods, age, location) are presented in an online, searchable inventory.
Results: All 15 cohorts measure body size or composition. Most cohorts measure aspects of cardiovascular health (n = 10) and neurocognition (n = 9). Fewer measure musculoskeletal phenotypes (n = 6), pulmonary function (n = 6), vision (n = 6) and glucose (n = 4). Only two cohorts measure hearing or kidney function.
Conclusions: Today's childhood cohorts are not measuring some phenotypes important to global burden of disease, notably kidney function and hearing. Given the rarity of very large contemporary child cohorts, cross-cohort coordination will be required if all major NCD precursors are to be adequately represented for future benefit
Teaching the laboratory assessment of neutrophil chemotaxis: a simulation-based approach for undergraduate immunology
No full textNeutrophils are essential cellular components of innate immunity. After injury, they migrate into tissues following chemotactic gradients to phagocytose pathogens or respond to tissue damage. This multistep process is tightly regulated, and defects at any stage can lead to increased bacterial infections. Identifying specific defects requires specialized assays, yet teaching the assessment of these functions in a laboratory setting presents challenges. At the University of South Australia, undergraduate immunology is taught to students training as laboratory medicine scientists, who must understand how to assess neutrophil function. However, demonstrating chemotaxis in the laboratory is not possible due to a lack of inverted microscopes, restricted laboratory time, and lack of patient samples with defined neutrophil defects. To address this, we developed a computer simulation replicating the under-agarose method of quantifying neutrophil chemotaxis. In the simulation, students load both "control" and "patient" samples and measure both random and directed migration toward 5 common chemoattractants. Using an in-house-defined reference range, they determine the immunological status of each sample. The simulation's impact was evaluated using a mixed-methods approach, incorporating Likert-scale questionnaires, free-text feedback, and scores from laboratory reports. Student feedback was overwhelmingly positive, with the simulation significantly enhancing their understanding of neutrophil function. All students successfully completed the report, typically achieving high grades. These findings support the use of authentic computer-based simulations as effective alternatives for teaching complex immunological techniques in resource-limited settings, offering a practical and engaging solution to challenges in traditional laboratory instruction
From vulnerable to valuable: a strengths based approach to international student teaching placements
No full textAustralia is experiencing a significant teacher workforce shortage, particularly in the field of early childhood. International students, who reflect the diversity of Australian early childhood classrooms, have the potential to provide rich, cultural strengths to the early childhood workforce. However, international preservice teachers (IPSTs) experience unique challenges during their initial teacher education training. This paper reports on an action research project that engaged with twenty-nine IPSTs to co-construct a series of workshops, underpinned by culturally responsive pedagogies to support them to complete their first teaching placement. The research aimed to develop the IPST’s knowledge of the Australian teaching context and make explicit the cultural strengths IPSTs bring to teaching. The findings of this study evidenced the coupling of university and school-based workshops as significant in supporting IPSTs to not only familiarise themselves with the Australian teaching context, but also maintain a positive cultural identity and view this as an asset within their developing pedagogy. This research is important in developing approaches to enable IPSTs to shift from being vulnerable to valuable cultural assets to the Australian teaching workforce.Susan Raymond, Martyn Mills-Bayne, Penelope Batema
Influence of fragment and roadside vegetation on canola (Brassica napus) and faba bean (Vicia faba) pollination in South Australia
No full textData source: Supplementary material, https://doi.org/10.1016/j.agee.2025.109481Native vegetation remnants within agricultural landscapes play a crucial role in supporting biodiversity and ecosystem services such as pollination; however, their benefits are not always recognised by farmers. We investigated the influence of native vegetation remnants, both in fragment and linear forms, on pollination of Brassica napus (canola or oilseed rape) and Vicia faba (faba beans) in South Australia. We used the difference in the number of seeds per pod between open-pollinated (unbagged) plants and those unpollinated by animals (bagged) as pollination success.
We found a positive relationship between seed set (and total crop yield) and the area of fragment and linear vegetation within 200 m for both crop species, with linear vegetation showing a stronger influence on both crop species possibly because of its use by exotic honeybees. Increasing distance to the closest vegetation had a significant negative effect on seed set. Sandy soils diminished the positive effects of native vegetation on bean seed set. Of the pods sampled from beans and canola, 12.2 % and 2.4 % respectively achieved maximum pollination; all were unbagged.
Area of fragment and linear vegetation within 200 m of plants exerted a greater effect on maximum pollination than proximity to vegetation for canola. Only distance to vegetation was a significant predictor of bean maximum pollination. These results demonstrate the positive effects of non-crop vegetation with configurational heterogeneity on crop pollination. Given the common practice of crop rotation on commercial farms, the impact of various vegetation types fluctuates across cropping cycles. To ensure the continuity of pollination services over time, conserving and restoring fragment and linear vegetation in agricultural regions are imperative
Aircraft lavatory wastewater surveillance for movement of antimicrobial resistance genes: a proof-of-concept study
No full textData source: supplementary material, https://doi.org/10.1128/spectrum.00569-25Long-haul flight aircraft wastewater may serve as a representative microbial footprint, often of mixed country origin, offering valuable insight into the movement of pathogens and antimicrobial resistance (AMR) on a global scale. Herein, we present a proof-of-concept for aircraft-based surveillance of AMR by investigating lavatory wastewater samples from 44 repatriation flights to Australia departing from nine countries. Profiles of pathogens including ESKAPE pathogens (Salmonella spp., Mycobacterium spp., Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) and antibiotic resistance genes (ARGs) (aph(3’)-IIIa, blaNDM-1, blaCTX_M-1, blaKPC, ermB, qnrS, sul1, tetM, and vanA) were investigated along with traditional fecal indicator bacteria (Escherichia coli and Enterococcus spp.) and fecal/urine marker genes (Bacteroides HF183, Carjivirus, human polyomavirus, and a cryptic plasmid pBI143) using quantitative PCR (qPCR). Two fecal indicator bacteria (FIB) and four human fecal/urine marker genes were detected in all aircraft wastewater samples. Detection rates for ESKAPE pathogens ranged from 6.8% (S. aureus) to 84.1% (K. pneumoniae). Of all ARG targets, aph(3’)-IIIa, ermB, qnrS, sul1, and tetM were detected in all wastewater samples, whereas blaKPC and vanA were not detected in any of the samples. Results reflected geographic differences in ARG abundance originating from departure countries/continents and suggested a potential risk of importing ARGs that might be rare in local wastewater systems. The loss of nucleic acid targets was less than 10% over a 24 h incubation in the presence of disinfectants, suggesting that nucleic acids are resilient enough to persist in aircraft wastewater over the maximum duration of a flight
Mass spectrometric detection of neutrophil elastase cleaved corticosteroid binding globulin and its association with Asn347 site glycosylation, in septic shock patients
No full textData source: Supplementary data, https://doi.org/10.1016/j.cca.2024.120108Background: Corticosteroid-binding globulin (CBG) modulates tissue cortisol availability via modification of cortisol:CBG binding affinity in response to multiple factors, including neutrophil elastase (NE) cleavage of the reactive centre loop (RCL), converting high affinity CBG (haCBG) to low affinity CBG (laCBG). In vitro, glycosylation of the RCL at Asn347 affects NE cleavage susceptibility. To date, no direct measurement of laCBG, which would verify NE cleavage, has been reported.
Objective: To measure serum laCBG in septic shock patients by mass spectrometry to confirm NE cleavage in vivo, with Asn347 site glycosylation profiling to determine its impact on NE cleavage, and determine effect of %laCBG on septic shock clinical outcome.
Methods: Serum from septic shock patients from a tertiary hospital intensive care unit was analysed by mass spectrometry for CBG affinity forms and Asn347 glycosylation profile, following CBG immunoprecipitation. Data was correlated with septic shock clinical outcome.
Results: N-terminal peptide of NE cleaved RCL (AVLQLNEEGVDTAGSTGV) was consistently detected in patient serum, although at low concentrations. Mean %laCBG/total CBG was 0.23 % in septic shock (range = 0.07–0.74 %, SD = 0.12 %); in comparison healthy controls mean %laCBG was 0.04 % (range 0.02–0.08 %, SD = 0.03 %). There was a negative correlation between %laCBG and serum concentrations of CBG with triantennary Asn347 glycans; TS3 (r = -0.190, p = 0.040) and TS3F (r = -0.252, p = 0.006).
Conclusions: NE cleaved CBG (laCBG) is present in septic shock patient serum, and %laCBG correlates with Asn347 glycosylation occupancy and composition. However, serum %laCBG did not correlate with septic shock clinical outcome