Abstract Museums and Science Centres are informal education environments that intend to engage the visitors with their exhibitions. The installation ‘The Highway of the Seas’ in the exhibition Norway is the Sea is a game that teaches players the roles of people employed in shipping and tasks related to shipping from the perspective of a ship operator. We investigate the narrative elements of this installation, how to characterise these, and their impact on engagement. Using such characteristics, informed modifications that increase engagement can be made. Further, we compare aspects of ‘The Highway of the Seas’ with two other installations in a study and find that ‘The Highway of the Seas’ is the most engaging serious game of these three.

Staging the extent and location of prostate cancer in biochemical relapse (BR) is critical to informing further management of both post-surgical and post-radiation patients with focal or systemic therapies. This retrospective, observational study hypothesized that the investigational amino acid PET tracer fluciclovine F18 could effectively detect disease recurrence in this patient group and would be well tolerated. Diagnostic performance of fluciclovine F18, as compared to histopathology and clinical follow-up, was determined in a patient cohort with sufficient data for truth determination. The safety profile and imaging positivity rate relative to PSA level were evaluated in the larger cohort. Overall, 714 cancer patients underwent fluciclovine F18 PET-CT scanning at 4 sites in Norway, Italy and USA, including 596 patients who presented with BR of prostate cancer. Imaging positivity or detection rate (DR) was determined according to PSA quartile. To determine diagnostic performance in prostate cancer BR, fluciclovine F18 PET-CT results were compared to available histopathological findings (n = 143) and to histopathology plus clinical follow-up (n = 125). Determination of DR, sensitivity and specificity, positive and negative predictive value (PPV, NPV) were made, as applicable, at lesion, regional and subject level (prostate/prostate bed (P/B) or extra-prostatic (E/P)). Fluciclovine F18 was very well tolerated: adverse events possibly related to fluciclovine were reported by 0.6% of patients; no significant treatment-related effects on laboratory values or ECG variables were noted. Risk factors for the prostate cancer BR cohort included: Gleason score ≥7 (80%); intermediate/high risk by D’Amico criteria at initial treatment (65%); median PSA before imaging: 2.03 ng/mL. For diagnostic performance vs. histopathology (n = 143) the sensitivity for detection of P/B disease was 88.1%, with specificity of 32.6% and PPV of 71.8%. The PPV for E/P disease was higher at 92.3%. For diagnostic performance vs pathology plus clinical follow up (n = 125), sensitivity, specificity, PPV, and NPV for the regions P/B and E/P were: P/B: 95.1%, 48.8%, 78%, and 84%, and E/P: 84.2%, 89.7%, 78.0%, and 92.9%. Analysis of patient level DR (%) by PSA quartile (ng/mL) in the full BR cohort (n = 596) was: ≤0.79: 41%; >0.79 to ≤2.03: 59%; >2.03 to ≤ 6.0: 75%; >6.0: 86%. Fluciclovine (18F) PET-CT scanning is well tolerated and able to sensitively detect recurrent prostate cancer, even at PSA levels below 1ng/mL, potentially facilitating the optimization of subsequent patient management, including the scope and dose of radiotherapy.

Purpose: Sensitive detection of cancer foci in men experiencing biochemical recurrence following initial treatment of prostate cancer is of great clinical significance with a possible impact on subsequent treatment choice. We describe a multisite experience of the efficacy and safety of the positron emission tomography/computerized tomography agent fluciclovine (F-18) after biochemical recurrence.Materials and Methods: A total of 596 patients underwent fluciclovine (F-18) positron emission tomography/computerized tomography at 4 clinical sites. Detection rate determinations were stratified by the baseline prostate specific antigen value. Diagnostic performance was assessed against a histological reference standard in 143 scans.Results: The subject level fluciclovine (18 F) positron emission tomography/computer tomography detection rate was 67.7% (403 of 595 scans). Positive findings were detected in the prostate/bed and pelvic lymph node regions in 38.7% (232 of 599) and 32.6% of scans (194 of 596), respectively. Metastatic involvement outside the pelvis was detected in 26.2% of scans (155 of 591). The subject level detection rate in patients in the lowest quartile for baseline prostate specific antigen (0.79 ng/ml or less) was 41.4% (53 of 128). Of these patients 13 had involvement in the prostate/bed only, 16 had pelvic lymph node involvement without distant disease and 24 had distant metastases. The positive predictive value of fluciclovine (18 F) positron emission tomography/computerized tomography scanning for all sampled lesions was 62.2%, and it was 92.3% and 71.8% for extraprostatic and prostate/bed involvement, respectively. Fluciclovine (F-18) was well tolerated and the safety profile was not altered following repeat administration.Conclusions: Fluciclovine (F-18) is well tolerated and able to detect local and distant prostate cancer recurrence across a wide range of prostate specific antigen values.