Bias intervention messaging in student evaluations of teaching: The role of gendered perceptions of bias.

Many studies have documented discrepancies in student evaluation of teaching ratings between male and female instructors and between ethnic majority and minority instructors. Given the importance of such ratings to academic careers and the likelihood of potential intergroup bias, it is crucial that institutions consider approaches to mitigate such biases. Several recent studies have found that simple bias mitigation messaging can be effective in reducing gender and other biases. In the present research, students enrolled in several large Faculty of Science undergraduate courses at an Australian university were recruited on a volunteer basis via the course learning management system. Half of the participants were randomly assigned an intervention message highlighting potential biases relating to gender and language background. Data from 185 respondents were analysed using Bayesian ordinal regression models assessing the impact of message exposure on evaluation scores. Reading a bias intervention message caused students to significantly adjust their scores, with the nature of that change dependent on student and instructor characteristics. Among male students, the bias intervention message significantly increased scores for all except male instructors with English speaking backgrounds, for whom there was no significant impact of the message. In contrast, among female students, the bias intervention message significantly decreased scores for male instructors with English speaking backgrounds only. The sample showed an overall decrease in scores in the intervention group relative to the control group. This is the first study to detect a negative impact of bias intervention messaging on SET scores. Our results suggest students may not acknowledge their own potential bias towards instructors with whom they share similar demographic backgrounds. In conclusion, bias intervention messaging may be a simple method of mitigating bias, but it may lead to consequences in which one or more groups receive lower ratings as a result of the correction.

Variation in Successional Dynamics Shape Biodiversity Patterns over a Tropical-Temperate Latitudinal Gradient.

AbstractSuccessional dynamics can vary because of a range of ecological and environmental factors, but our understanding of biogeographic variation in succession, and the processes contributing to community development across ecosystems, is limited. The pattern and rate of recruitment of dispersive propagules likely differs over large spatial scales and can be an important predictor of successional trajectory. Over a 20° tropical-temperate latitudinal gradient, we measured sessile invertebrates over 12 months of community development and successive 3-month recruitment windows to understand succession and how it is influenced by recruitment. Succession and recruitment patterns varied over latitude. In the tropics, fast temporal turnover, fluctuating abundances, and lack of successional progression suggest that the contribution of stochastic processes was high. As latitude increased, successional progression became more apparent, characterized by increasing species richness and community cover and a shift to more competitive taxa over time. At temperate locations, species identities were similar between older communities and recruiting assemblages; however, community composition became more variable across space over time. Such divergence suggests an important role of early colonizers and species interactions on community structure. These findings demonstrate differences in the processes contributing to community development and biodiversity patterns over latitude. Understanding such biogeographic variation in community dynamics and identifying the prevalence of different processes can provide insights into how communities assemble and persist in response to environmental variability.

Investigating the interactive effects of habitat type and light intensity on rocky shores.

Light availability and habitat complexity are two key drivers of community assembly. Urbanisation has been shown to affect both, with important consequences to ecological communities. On the intertidal, for instance, studies have shown that light intensity is greater on natural rocky shores than on less complex artificial habitats (seawalls), though different habitats can also experience similar light intensities, for example when shaded by urban structures. Understanding therefore how these factors individually, and combined, affect communities is important to understand the mechanisms driving changes in community structure, and consequently provide solutions to tackle the increasing homogenisation of habitats and lightscapes in urbanised spaces through smart infrastructure designs. Here, we assessed how different light levels affect the recruitment of communities in rock pools and on emergent rock on an intertidal rocky shore. We cleared 30 patches of emergent rock and 30 rock pools and manipulated light using shades with different light transmissions (full light, procedural control, 75%, 35%, and 15% light transmission, full shade) and assessed mobile and sessile communities monthly for 6 months. Effects of reducing light levels were generally stronger on rock than in pools. Fully shaded plots supported double the amount of mobile organisms than plots in full sunlight, in both habitats. Algal cover was higher in pools compared to rock, and at intermediate light levels, but effects varied with site. This study highlights the importance of variable light conditions and different habitats for rocky shore communities, which should be considered in future coastal developments to retain natural biodiversity.

Identifying research priorities for improving information and support for patients undergoing breast cancer surgery: a UK patient-centred priority setting project.

PURPOSE: To use robust consensus methods with individuals with lived breast cancer experience to agree the top 10 research priorities to improve information and support for patients undergoing breast cancer surgery in the UK. METHODS: Research uncertainties related to information and support for breast cancer surgery submitted by patients and carers were analysed thematically to generate summary questions for inclusion in an online Delphi survey. Individuals with lived breast cancer experience completed two Delphi rounds including feedback in which they selected their top 10 research priorities from the list provided. The most highly ranked priorities from the survey were discussed at an in-person prioritisation workshop at which the final top 10 was agreed. RESULTS: The 543 uncertainties submitted by 156 patients/carers were categorised into 63 summary questions for inclusion in the Delphi survey. Of the 237 individuals completing Round 1, 190 (80.2%) participated in Round 2. The top 25 survey questions were carried forward for discussion at the in-person prioritisation workshop at which 17 participants from across the UK agreed the final top 10 research priorities. Key themes included ensuring patients were fully informed about all treatment options and given balanced, tailored information to support informed decision-making and empower their recovery. Equity of access to treatments including contralateral mastectomy for symmetry was also considered a research priority. CONCLUSION: This process has identified the top 10 research priorities to improve information and support for patients undergoing breast cancer surgery. Work is now needed to develop studies to address these important questions.

Failure to rescue following oesophagectomy in Australia: a multi-site retrospective study using American College of Surgeons National Surgical Quality Improvement Program.

BACKGROUND: Failure to rescue (FTR), defined as death after a major complication, is increasingly being used as a surrogate for assessing quality of care following major cancer resection. The aim of this paper is to determine the failure to rescue (FTR) rate after oesophagectomy and explore factors that may contribute to FTR within Australia. METHODS: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015 to 2023 at five Australian hospitals was conducted to identify patients who underwent an oesophagectomy. The primary outcome was FTR rate. Perioperative parameters were examined to evaluate predictive factors for FTR. Secondary outcomes include major complications, overall morbidity, mortality, length of stay and 30-day readmissions. RESULTS: A total of 155 patients were included with a median age of 65.2 years, 74.8% being male. The FTR rate was 6.3%. In total, 50.3% of patients (n = 78) developed at least one postoperative complication with the most common complication being pneumonia (20.6%) followed by prolonged intubation (12.9%) and organ space SSI/anastomotic leak (11.0%). Multivariate logistic regression analysis was performed to determine any factors that were predictive for FTR however none reached statistical significance. CONCLUSION: This study is the first to evaluate the FTR rates following oesophagectomy within Australia, with FTR rates and complication profile comparable to international benchmarks. Integration of multi-institutional national databases such as ACS NSQIP into units is essential to monitor and compare patient outcomes following major cancer surgery, especially in low to moderate volume centres.

The long-lived deep-sea bivalve Acesta excavata is sensitive to the dual stressors of sediment and warming.

Human influence in the deep-sea is increasing as mining and drilling operations expand, and waters warm because of climate change. Here, we investigate how the long-lived deep-sea bivalve, Acesta excavata responds to sediment pollution and/or acute elevated temperatures. A. excavata were exposed to suspended sediment, acute warming, and a combination of the two treatments for 40 days. We measured O2 consumption, NH4+ release, Total Organic Carbon (TOC), and lysosomal membrane stability (LMS). We found suspended sediment and warming interacted to decrease O:N ratios, while sediment as a single stressor increased the release of TOC and warming increased NH4+ release in A. excavata. Warming also increased levels of LMS. We found A. excavata used protein catabolism to meet elevated energetic demands indicating a low tolerance to stress. A. excavata has limited capacity for physiological responses to the stressors of warming and sediment which may lead to decreased fitness of A. excavata.

Organic enrichment reduces sediment bacterial and archaeal diversity, composition, and functional profile independent of bioturbator activity.

Eutrophication is a worldwide issue that can disrupt ecosystem processes in sediments. Studies have shown that macrofauna influences sediment processes by engineering environments that constrain microbial communities. Here, we explored the effect of different sizes of the Sydney cockle (Anadara trapezia), on bacterial and archaeal communities in natural and experimentally enriched sediments. A mesocosm experiment was conducted with two enrichment conditions (natural or enriched) and 5 cockle treatments (small, medium, large, mixed sizes and a control). This study was unable to detect A. trapezia effects on microbial communities irrespective of body size. However, a substantial decrease of bacterial richness, diversity, and structural and functional shifts, were seen with organic enrichment of sediments. Archaea were similarly changed although the magnitude of effect was less than for bacteria. Overall, we found evidence to suggest that A. trapezia had limited capacity to affect sediment microbial communities and mitigate the effects of organic enrichment.

Evolution of laparoscopic pancreaticoduodenectomy at Westmead Hospital.

BACKGROUND: Despite its proposed benefits, laparoscopic pancreaticoduodenectomy (LPD) has not been widely adopted due to its technical complexity and steep learning curve. The aim of this study was to report a single surgeon's experience in the stepwise implementation of LPD and evolution of technique over a nine-year period in a moderate-high volume unit. METHODS: Carefully selected patients underwent LPD initially by hybrid approach (laparoscopic resection and open reconstruction), which evolved into a total LPD (laparoscopic resection and reconstruction). Data was prospectively collected to include patient characteristics, intraoperative data, evolution of technique and postoperative outcomes. RESULTS: A total of 25 patients underwent hybrid LPD (HLPD) and 20 patients underwent total LPD (TLPD). There was no 90-day mortality. Three patients developed a postoperative pancreatic fistula (POPF), all of which occurred in patients undergoing HLPD. There was no POPF in 20 consecutive TLPD. There was no evidence of anastomotic strictures in the hepaticojejunostomy in patients undergoing TLPD at long term follow up. CONCLUSION: A gradual and cautious progression from HLPD to TLPD is essential to ensure safe implementation into a unit. LPD should only be considered in carefully selected patients, with outcomes subjected to regular and rigorous independent audit.

Assessing human and physical drivers of macro-plastic debris spatially across Queensland, Australia.

Plastic pollution poses environmental and socio-economic risks, requiring policy and management interventions. The evidence-base for informing management and evaluation of their effectiveness is limited. Partnerships with citizen scientists provide opportunities to increase the spatio-temporal scale of monitoring programs, where training and standardised protocols provides opportunities for the use of data in addressing multiple hypotheses. Here, we provide a baseline of debris trends and infer debris drivers of abundance across 18° of latitude, using 168 surveys from 17 beaches across Queensland, Australia through the ReefClean project. Plastics were the dominant material (87% of total debris, with hard, soft and foam plastics aggregated), although linking recovered debris to sources was limited, as 67% of items were fragmented. We tested potential drivers of specific debris types (i.e., plastics, commercial fishing items, items dumped at-sea, and single-use items) and identified significant relationships between debris accumulation with distance from the nearest population centre and site characteristics (modal beach state, beach orientation and across-beach section). Management efforts should consider beach type and orientation within site selection, as an opportunity to maximise the amount recovered, alongside other criteria such as the risks posed by debris on environmental, economic, and social values. This study demonstrates the utility of citizen science to provide baselines and infer drivers of debris, through data gathered at scales that are infeasible to most formal monitoring programs. The identified drivers of debris may also differ from regional and global studies, where monitoring at relevant scales is needed for effective management.

Exploring narcissism and human- and animal-centered empathy in pet owners.

Having empathy for others is typically generalized to having empathy for animals. However, empathy for humans and for animals are only weakly correlated. Thus, some individuals may have low human-centered empathy but have high animal-centered empathy. Here, we explore whether pet owners who are high in narcissism display empathy towards animals despite their low human-centered empathy. We assessed pet owners' (N = 259) three components of trait narcissism (Agentic Extraversion, Antagonism, and Narcissistic Neuroticism), human- and animal-centered empathy, attitudes towards animals, and their pet attachment. We found that Agentic Extraversion was unrelated to both human- and animal-centered empathy. We also found that Antagonism was related to less empathy for both humans and animals, as well as more negative attitudes towards animals. Lastly, we found that Narcissistic Neuroticism was unrelated to human-centered empathy and positively related to animal-centered empathy and attitudes towards animals. This research furthers our understanding of the relation between empathy towards humans and animals and provides insight into whether animal-assisted approaches may be useful for empathy training in those with narcissistic characteristics.

National priority setting partnership using a Delphi consensus process to develop neonatal research questions suitable for practice-changing randomised trials in the UK.

BACKGROUND: The provision of neonatal care is variable and commonly lacks adequate evidence base; strategic development of methodologically robust clinical trials is needed to improve outcomes and maximise research resources. Historically, neonatal research topics have been selected by researchers; prioritisation processes involving wider stakeholder groups have generally identified research themes rather than specific questions amenable to interventional trials. OBJECTIVE: To involve stakeholders including parents, healthcare professionals and researchers to identify and prioritise research questions suitable for answering in neonatal interventional trials in the UK. DESIGN: Research questions were submitted by stakeholders in population, intervention, comparison, outcome format through an online platform. Questions were reviewed by a representative steering group; duplicates and previously answered questions were removed. Eligible questions were entered into a three-round online Delphi survey for prioritisation by all stakeholder groups. PARTICIPANTS: One hundred and eight respondents submitted research questions for consideration; 144 participants completed round one of the Delphi survey, 106 completed all three rounds. RESULTS: Two hundred and sixty-five research questions were submitted and after steering group review, 186 entered into the Delphi survey. The top five ranked research questions related to breast milk fortification, intact cord resuscitation, timing of surgical intervention in necrotising enterocolitis, therapeutic hypothermia for mild hypoxic ischaemic encephalopathy and non-invasive respiratory support. CONCLUSIONS: We have identified and prioritised research questions suitable for practice-changing interventional trials in neonatal medicine in the UK at the present time. Trials targeting these uncertainties have potential to reduce research waste and improve neonatal care.

Land use and COVID-19 lockdowns influence debris composition and abundance in stormwater drains.

Stormwater drains act as a pathway for anthropogenic debris from land to sea, particularly in urbanised estuaries where impervious surfaces expedite the process. Debris type and abundance in stormwater drains may vary due to land use and human activity, and knowledge of this variation is necessary to manage the growing threat of debris. Surveys of stormwater debris can inform targeted reduction and remediation efforts by intercepting and identifying pollutants near their source. We surveyed replicate stormwater gross pollutant traps across four land use zones (city centre, shopping centre, transportation hub, industrial precinct) before and during COVID-19 measures to assess the effects of changing human activities. Gross pollutant traps were installed in 120 drains in Greater Melbourne, Australia, and citizen scientists trained by Tangaroa Blue Foundation weighed and classified debris at 6-week intervals between October 2019 and October 2020. Four survey cycles were conducted before lockdowns were implemented, then another four during lockdowns. COVID-19 lockdowns and patterns of debris type and abundance across land use revealed how changes in human activity might impact the flow of debris. Cigarette butts were the most abundant macro debris (>5 mm) item in every survey cycle, regardless of lockdowns. Industrial land use zones had the lowest macro debris counts but contained over 90 % of the micro debris (1-5 mm). The amount of total macro debris decreased during lockdowns, however the most abundant and problematic debris items such as cigarettes and single-use plastics did not decrease as much as might be expected from the concomitant reductions in human activity. Occupational health and safety items, such as masks and gloves, increased (144 %) during COVID-19 lockdowns. Micro debris counts did not change in industrial zones during lockdowns, suggesting that workplace interventions may be necessary to reduce this debris leakage. Tracing the pathway of debris from source to sea can inform reduction and long-term management strategies.

Contaminant pulse following wildfire is associated with shifts in estuarine benthic communities.

Novel combinations of climatic conditions due to climate change and prolonged fire seasons have contributed to an increased occurrence of "megafires". Such large-scale fires pose an unknown threat to biodiversity due to the increased extent and severity of burn. Assessments of wildfires often focus on terrestrial ecosystems and effects on aquatic habitats are less documented, particularly in coastal environments. In a novel application of eDNA techniques, we assessed the impacts of the 2019-2020 Australian wildfires on the diversity of estuarine benthic sediment communities in six estuaries in NSW, Australia, before and after the fires. Estuaries differed in area of catchment burnt (0-92%) and amount of vegetative buffer that remained post-fire between burnt areas and waterways. We found greater dissimilarities in the composition and abundance of eukaryotic and bacterial sediment communities in estuaries from burnt catchments with no buffer compared to those with an intact buffer or from unburnt catchments. Shifts in composition in highly burnt catchments were associated with increased concentrations of nutrients, carbon, including fire-derived pyrogenic carbon, and copper, which was representative of multiple highly correlated trace metals. Changes in the relative abundances of certain taxonomic groups, such as sulfate-reducing and nitrifying bacterial groups, in the most impacted estuaries indicate potential consequences for the functioning of sediment communities. These results provide a unique demonstration of the use of eDNA to identify wildfire impacts on ecological communities and emphasize the importance of vegetative buffers in limiting wildfire-associated impacts.

Reducing unplanned general surgical readmissions: a review of the Australian and New Zealand National Surgical Quality Improvement Program Database.

BACKGROUND: Unplanned surgical readmissions are an important indicator of quality care and are a key focus of improvement programs. The aims of this study were to evaluate the factors that lead to unplanned hospital readmissions in patients undergoing general surgical procedures and to identify preventable readmissions. METHODS: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database from 2016 to 2020 at a tertiary hospital was conducted to identify patients undergoing a general surgical procedure. Various perioperative parameters were studied to identify risk factors and reasons for unplanned readmission. Preventable readmissions were identified. RESULTS: A total of 3069 patients underwent a general surgical procedure. Of these, the overall unplanned readmission rate was 8.8% (n = 247). The most common reason for readmission was associated with surgical site infections (n = 112, 44.3%) followed by pain (n = 50, 20.2%), with over 45% deemed as preventable readmissions. Factors associated with increased risk of readmission included older age, longer index length of stay, prolonged operative time, elective procedures, higher ASA score and contaminated procedures. CONCLUSION: Unplanned readmissions are more likely to occur in patients who develop postoperative complications. Understanding factors associated with readmissions may facilitate targeted quality improvement projects that reduce hospital readmission after surgery.

Piers are hotspots for benthic marine debris in an urbanised estuary.

Records of anthropogenic marine debris and the threats it poses are increasing worldwide, yet we know relatively little about the distribution of benthic debris. The seafloor is the final destination for a large proportion of debris due to the degradation and sinking of items. A more detailed understanding of debris distributions in hotspots such as urbanised estuaries can help decision makers target management and remediation activities. We selected sites frequented by fishers and boaters in Sydney Harbour, an urbanised estuary, to investigate the impacts of recreational activities on debris abundance. The aim of this study was to examine variation in macro debris (>5mm in diameter) type and abundance at two habitat types (piers and non-piers). We chose five locations at various distances from the estuary mouth. In each location SCUBA teams performed fixed transects at two sites, one under a pier and one over nearby soft-sediment habitat. Debris was recovered by the divers and brought to the surface for classification and disposal. Surveys were repeated multiple times at each location between November 2019 and February 2020, recording a total of 2803 debris items over 36 survey events. Overall, piers had more than ten times the debris abundance of soft-sediment sites, and much higher proportion of debris types related to recreational fishing. Over half of the debris items in this study were plastic (65%), and approximately 70% of the total debris was classified as related to recreational fishing. This trait was most prominent in debris at sites closest to the estuary mouth, likely reflecting increased fishing activity in this area. This study indicates that policy makers and community groups in urbanised estuaries should focus monitoring, reduction, and remediation efforts near artificial structures such as piers, and that public awareness campaigns should target the behaviour of recreational users of these structures.

Vedolizumab: what is the benefit from increasing the dose frequency?

Vedolizumab was introduced in 2014 as a therapy for Inflammatory Bowel Disease (IBD). Although recommendations from the National Institute for Health and Care Excellence were based on a maintenance dose of 300 mg administered intravenously every 8 weeks, the Summary of Product Characteristics includes an option of increasing the frequency of dosing for patients who initially respond but later experience a decrease in response. In this literature review of the evidence for a shorter duration between doses we identified seven studies which report that dose interval shortening recaptures response in around 50% of cases with remission rates of 11% to 34% between 4 and 52 weeks. A sustained response was seen in the majority of patients for up to 1 year, however, patients continued to receive escalated dosing for up to 100 weeks, which does not reflect clinical practice where short-term escalation is usually prescribed. There is a lack of randomised controlled trials and a lack of trials reporting endoscopic remission, which is the goal of care in IBD. The use of therapeutic drug monitoring (TDM) to guide dose escalation is uncertain and further studies are required to help clarify the role of TDM.

Computational Modeling of Virally-encoded Ion Channel Structure.

Viroporins are ion channels encoded within a virus's genome, that facilitate a range of devastating infectious diseases such as COVID-19, HIV, and rotavirus. The non-structural protein 4 (NSP4) from rotavirus includes a viroporin domain that disrupts cellular Ca2+ homeostasis, initiating viral replication, and leading to life-threatening vomiting and diarrhea. Though the structure of soluble segments of NSP4 has been determined, membrane-associated regions, including the viroporin domain, remain elusive when utilizing well-established available experimental methods such as x-ray crystallography. However, two recently published protein folding algorithms, AlphaFold2 and trRosetta, demonstrated a high degree of accuracy, when determining the structure of membrane proteins from their primary amino acid sequences, though their training datasets are known to exclude proteins from viral systems. We tested the ability of these non-viral algorithms to predict functional molecular structures of the full-length NSP4 from SA11 rotavirus. We also compared the accuracy of these structures to predictions of other experimental structures of eukaryotic proteins from the Protein Data Banks (PDB), and show that the algorithms predict models more similar to corresponding experimental data than what we saw for the viroporin structure. Our data suggest that while AlphaFold2 and trRosetta each produced distinct NSP4 models, constructs based on either model showed viroporin activity when expressed in E. coli, consistent with that seen from other historical NSP4 sequences.

Comparative effectiveness of a second-line biologic in patients with ulcerative colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab.

Background: Sequential drug treatment with biological agents in ulcerative colitis (UC) is becoming increasingly complex. There are few studies comparing head-to-head outcomes in second-line treatments. The study assesses whether using anti-tumour necrosis factor (anti-TNF)-α therapy following the α4ß7 integrin blocker vedolizumab (VDZ) or VDZ after an anti-TNF has more favourable clinical outcomes in UC in a real-world outpatient setting. Methods: Patients with UC who were exposed to first-line anti-TNF (adalimumab or infliximab) or VDZ who subsequently switched to the alternate class between May 2013 and August 2020 were identified by reviewing patient databases at 10 hospitals. Data were collected retrospectively using patient records. Baseline demographics, disease activity indices, biochemical markers, endoscopic Mayo score, colectomy rates, treatment persistence and urgent hospital utilisation composite endpoint (UHUC) rates were examined over a 52-week period. Results: Second-line week 52 treatment persistence was higher in the VDZ group (71/81, 89%) versus the anti-TNF group (15/34, 44%; p=0.0001), as were week 52 colectomy-free survival (VDZ: 77/80, 96%, vs anti-TNF: 26/32, 81%; p=0.009), week 52 UHUC survival (VDZ: 68/84, 81%, vs anti-TNF: 20/34, 59%; p=0.002) and week 52 corticosteroid-free clinical remission (CFCR) rates (VDZ: 22/34, 65%, vs anti-TNF: 4/20, 20%; p=0.001). Conclusion: Compared with second-line anti TNF usage, the VDZ second-line cohort had significantly higher 52-week treatment persistence, UHUC survival, higher colectomy-free survival rates and higher week 52 CFCR. These data suggest that VDZ is an effective biologic in UC as a second-line therapy after anti-TNF exposure. It highlights the effect of biological order on clinically important outcomes.

National priority setting partnership using a Delphi consensus process to develop neonatal research questions suitable for practice-changing randomised trials in the United Kingdom.

INTRODUCTION: Methodologically robust clinical trials are required to improve neonatal care and reduce unwanted variations in practice. Previous neonatal research prioritisation processes have identified important research themes rather than specific research questions amenable to clinical trials. Practice-changing trials require well-defined research questions, commonly organised using the Population, Intervention, Comparison, Outcome (PICO) structure. By narrowing the scope of research priorities to those which can be answered in clinical trials and by involving a wide range of different stakeholders, we aim to provide a robust and transparent process to identify and prioritise research questions answerable within the National Healthcare System to inform future practice-changing clinical trials. METHODS AND ANALYSIS: A steering group comprising parents, doctors, nurses, allied health professionals, researchers and representatives from key organisations (Neonatal Society, British Association of Perinatal Medicine, Neonatal Nurses Association and Royal College of Paediatrics and Child Health) was identified to oversee this project. We will invite submissions of research questions formatted using the PICO structure from the following stakeholder groups using an online questionnaire: parents, patients, healthcare professionals and academic researchers. Unanswered, non-duplicate research questions will be entered into a three-round eDelphi survey of all stakeholder groups. Research questions will be ranked by mean aggregate scores. ETHICS AND DISSEMINATION: The final list of prioritised research questions will be disseminated through traditional academic channels, directly to key stakeholder groups through representative organisations and on social media. The outcome of the project will be shared with key research organisations such as the National Institute for Health Research. Research ethics committee approval is not required.

A global horizon scan of issues impacting marine and coastal biodiversity conservation.

The biodiversity of marine and coastal habitats is experiencing unprecedented change. While there are well-known drivers of these changes, such as overexploitation, climate change and pollution, there are also relatively unknown emerging issues that are poorly understood or recognized that have potentially positive or negative impacts on marine and coastal ecosystems. In this inaugural Marine and Coastal Horizon Scan, we brought together 30 scientists, policymakers and practitioners with transdisciplinary expertise in marine and coastal systems to identify new issues that are likely to have a significant impact on the functioning and conservation of marine and coastal biodiversity over the next 5-10 years. Based on a modified Delphi voting process, the final 15 issues presented were distilled from a list of 75 submitted by participants at the start of the process. These issues are grouped into three categories: ecosystem impacts, for example the impact of wildfires and the effect of poleward migration on equatorial biodiversity; resource exploitation, including an increase in the trade of fish swim bladders and increased exploitation of marine collagens; and new technologies, such as soft robotics and new biodegradable products. Our early identification of these issues and their potential impacts on marine and coastal biodiversity will support scientists, conservationists, resource managers and policymakers to address the challenges facing marine ecosystems.