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BACKGROUND: Temperate grass (eg, ryegrass) pollen is a major driver of seasonal allergic rhinitis (SAR) and asthma risks, including thunderstorm asthma. Data for the effectiveness of temperate grass pollen allergen immunotherapy (AIT) in SAR patients from the southern hemisphere, who are frequently polysensitized to subtropical grass pollens, are limited. The 300 IR 5-grass pollen sublingual immunotherapy tablet (300 IR 5-grass SLIT) is known to be effective in polysensitized SAR patients with primary allergy to temperate grasses, however, the influence of polysensitization to subtropical grass pollen on treatment responses has yet to be specifically addressed. Key aims of this study were to measure patient treatment satisfaction during 300 IR 5-grass SLIT treatment and evaluate how polysensitization to subtropical grass pollens affects treatment responses. METHODS: A prospective observational study was conducted in 63 patients (aged ≥5 years) in several temperate regions of Australia prescribed 300 IR 5-grass SLIT for SAR over 3 consecutive grass pollen seasons. Ambient levels of pollen were measured at representative sites. Patient treatment satisfaction was assessed using a QUARTIS questionnaire. Rhinoconjunctivitis Total Symptom Score (RTSS) and a Hodges-Lehmann Estimator analysis was performed to evaluate if polysensitization to subtropical grass pollen affected SAR symptom intensity changes during SLIT. RESULTS: A diagnosis of ryegrass pollen allergy was nearly universal. There were 74.6% (47/63) polysensitized to subtropical and temperate grass pollens. There were 23.8% (15/63) monosensitized to temperate grass pollens. From the first pollen season, statistically significant improvements occurred in SAR symptoms compared with baseline in both monosensitized and polysensitized patients, particularly in those polysensitized (P = 0.0297). Improvements in SAR symptoms were sustained and similar in both groups in the second and third pollen seasons, reaching 70-85

Passive acoustic detectors are increasingly used for monitoring biodiversity, particularly for echolocating bat species (Microchiroptera). However, identification of calls collected at large scales is hindered by substantial variation within and between species, and the considerable time investment needed to manually identify acoustic data. We use acoustic data from 14 species of echolocating bats, occurring in temperate forests and woodlands of southeastern Australia to build a supervised classification model that identifies species from large acoustic datasets. Acoustic data from hand‐release (39,567) and free‐flying (8851) bat calls were used to build a predictive model, which was then validated using field‐collected calls (149,097) from the same region. We maximized the model fit per species by validating the associated confidence scores against manually identified presence and absence values. This allowed us to model the identification success of each species as a function of the confidence score. From this relationship, we set specific thresholds for accepting species identification, enabling more accurate classification of calls and identification of multiple bat species within a single acoustic recording. Including calls from manually identified free‐flying bats improved overall identification accuracy, including a 60% improvement for bats that navigate in open spaces. Assigning species‐specific thresholds achieved substantial improvements in overall model confidence, with functionally meaningful changes in the identification of species exhibiting considerable acoustic overlap in time and frequency measures. Research into the ecological requirements of species is hampered by problems with identification. Our research illustrates that internal train–test validation overestimates model accuracy particularly for species that were in low abundance or for uncommon species, which are acoustically similar to more common ones. Recognizing this, we set speci

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA

Introduction: Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Consensus Study (VICCCS) to agree on principles (VICCCS-1) and protocols (VICCCS-2) for diagnosis of VCI. We present VICCCS-2. Methods: We used VICCCS-1 principles and published diagnostic guidelines as points of reference for an online Delphi survey aimed at achieving consensus on clinical diagnosis of VCI. Results: Six survey rounds comprising 65–79 participants agreed guidelines for diagnosis of VICCCS-revised mild and major forms of VCI and endorsed the National Institute of Neurological Disorders–Canadian Stroke Network neuropsychological assessment protocols and recommendations for imaging. Discussion: The VICCCS-2 suggests standardized use of the National Institute of Neurological Disorders–Canadian Stroke Network recommendations on neuropsychological and imaging assessment for diagnosis of VCI so as to promote research collaboration.

BACKGROUND AND OBJECTIVES:: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. PROTOCOL DESIGN:: The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3×2 factorial design comparing: three different SBP targets (1, <145-135; 2, <135-125; 3, <125mmHg); two different LDL-C targets (target A, 2.8-1.8; target B, <1.8mmol/l). The trial is to be conducted on 7500 patients aged at least 65 years (2500 in Europe, 5000 in China) with hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly. OUTCOMES:: Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment

BACKGROUND AND OBJECTIVES:: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke. RESULTS:: A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak. CONCLUSION:: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.

The Moidart earthquake of 4 August 2017 (4.0 ML) was the largest earthquake in Scotland for 18 years. The earthquake was felt widely across the west of Scotland. Only five other earthquakes of this size or greater have been observed in the period of instrumental recording from 1970 to present. Historical observations and instrumental recordings have been used to estimate that an earthquake of 4.0 ML or greater occurs somewhere in Scotland roughly every 8-9 years on average. The earthquake hypocentre was calculated using an iterative linearized method. The results suggest that the earthquake occurred in the mid-Crust at a depth of approximately 12 km. This is largely consistent with observed focal depths for other earthquakes in the region, which are distributed throughout the upper 20 km of the Crust. The strong similarity between the recorded ground motions from the mainshock and the four recorded aftershocks suggests that they all occurred within a small source volume, of the order of a few hundred metres in extent and had similar source mechanisms. The modelled source displacement spectra provide a good fit for the observed displacement spectra and suggest a moment magnitude (Mw) of 3.6 ± 0.1. This is slightly less than that expected for an earthquake with a local magnitude of 4.0 ML using commonly used empirical relationships relating local and moment magnitude, which gives an expected moment magnitude of 3.7. The calculated focal mechanism suggests that the earthquake resulted from strike-slip faulting on a fault plane that strikes either SW-NE or NW-SE and dips steeply, although the dip of both fault planes is rather poorly constrained. This is in good agreement with focal mechanisms calculated for other earthquakes across the region, which all show similar solutions. Seismicity in northwest Scotland is clustered around a number of large, steeply dipping major faults that strike either NE-SW or NW-SE suggesting that earthquake activity across the region is dri

© 2016 Ecological Society of Australia Microbats perform important ecological services in agro-ecosystems, but several species are globally threatened by loss of roosting and breeding habitats. The successful conservation of bats in agricultural land requires adequate knowledge of their ecology. Using ultrasonic recorders, we studied the activity of insectivorous bats in areas of macadamia production in eastern Australia at two spatial scales: across woodland-orchard transects at the local scale and across three levels of fragmentation at the landscape scale. At the local scale, activity patterns of ‘clutter’ and ‘edge’ specialists were consistently higher in woodland patches, gradually decreasing towards isolated orchards, where only a few ‘open’ specialists were active. At the landscape scale, bat community activity was affected by the level of fragmentation, partly because three of the most recorded taxa (Austronomus australis, Saccolaimus flaviventris and Miniopterus australis) had their highest activity in less-fragmented areas. A distance-based model explained 24% of the bat community activity based on a combination of six environmental variables. Canonical correspondence analysis showed that a number of bat taxa were associated with open areas of macadamia, whereas other taxa were associated with increasing values of landscape composition, and arthropod and water availability. In addition, total bat activity was highly correlated with foraging rate. These results suggest that most bat taxa were influenced by proximity to woodland and the degree of fragmentation, and only few taxa were able to exploit isolated orchards. Environmental factors that promote bat activity could be exploited to strengthen conservation efforts. Preserving remnant woodland and promoting habitat heterogeneity will benefit several bat species. In particular, the foraging activity of ‘edge’ specialists could be fostered by increasing landscape connectivity and maintaining unobstructed wa

The Moidart earthquake of 4 August 2017 (4.0 ML) was the largest earthquake in Scotland for 18 years. The earthquake was felt widely across the west of Scotland. Only five other earthquakes of this size or greater have been observed in the period of instrumental recording from 1970 to present. Historical observations and instrumental recordings have been used to estimate that an earthquake of 4.0 ML or greater occurs somewhere in Scotland roughly every 8-9 years on average. The earthquake hypocentre was calculated using an iterative linearized method. The results suggest that the earthquake occurred in the mid-Crust at a depth of approximately 12 km. This is largely consistent with observed focal depths for other earthquakes in the region, which are distributed throughout the upper 20 km of the Crust. The strong similarity between the recorded ground motions from the mainshock and the four recorded aftershocks suggests that they all occurred within a small source volume, of the order of a few hundred metres in extent and had similar source mechanisms. The modelled source displacement spectra provide a good fit for the observed displacement spectra and suggest a moment magnitude (Mw) of 3.6 ± 0.1. This is slightly less than that expected for an earthquake with a local magnitude of 4.0 ML using commonly used empirical relationships relating local and moment magnitude, which gives an expected moment magnitude of 3.7. The calculated focal mechanism suggests that the earthquake resulted from strike-slip faulting on a fault plane that strikes either SW-NE or NW-SE and dips steeply, although the dip of both fault planes is rather poorly constrained. This is in good agreement with focal mechanisms calculated for other earthquakes across the region, which all show similar solutions. Seismicity in northwest Scotland is clustered around a number of large, steeply dipping major faults that strike either NE-SW or NW-SE suggesting that earthquake activity across the region is dri

Introduction Numerous diagnostic criteria have tried to tackle the variability in clinical manifestations and problematic diagnosis of vascular cognitive impairment (VCI) but none have been universally accepted. These criteria have not been readily comparable, impacting on clinical diagnosis rates and in turn prevalence estimates, research, and treatment. Methods The Vascular Impairment of Cognition Classification Consensus Study (VICCCS) involved participants (81% academic researchers) from 27 countries in an online Delphi consensus study. Participants reviewed previously proposed concepts to develop new guidelines. Results VICCCS had a mean of 122 (98–153) respondents across the study and a 67% threshold to represent consensus. VICCCS redefined VCI including classification of mild and major forms of VCI and subtypes. It proposes new standardized VCI-associated terminology and future research priorities to address gaps in current knowledge. Discussion VICCCS proposes a consensus-based updated conceptualization of VCI intended to facilitate standardization in research.

© 2016 Ecological Society of Australia Microbats perform important ecological services in agro-ecosystems, but several species are globally threatened by loss of roosting and breeding habitats. The successful conservation of bats in agricultural land requires adequate knowledge of their ecology. Using ultrasonic recorders, we studied the activity of insectivorous bats in areas of macadamia production in eastern Australia at two spatial scales: across woodland-orchard transects at the local scale and across three levels of fragmentation at the landscape scale. At the local scale, activity patterns of ‘clutter’ and ‘edge’ specialists were consistently higher in woodland patches, gradually decreasing towards isolated orchards, where only a few ‘open’ specialists were active. At the landscape scale, bat community activity was affected by the level of fragmentation, partly because three of the most recorded taxa (Austronomus australis, Saccolaimus flaviventris and Miniopterus australis) had their highest activity in less-fragmented areas. A distance-based model explained 24% of the bat community activity based on a combination of six environmental variables. Canonical correspondence analysis showed that a number of bat taxa were associated with open areas of macadamia, whereas other taxa were associated with increasing values of landscape composition, and arthropod and water availability. In addition, total bat activity was highly correlated with foraging rate. These results suggest that most bat taxa were influenced by proximity to woodland and the degree of fragmentation, and only few taxa were able to exploit isolated orchards. Environmental factors that promote bat activity could be exploited to strengthen conservation efforts. Preserving remnant woodland and promoting habitat heterogeneity will benefit several bat species. In particular, the foraging activity of ‘edge’ specialists could be fostered by increasing landscape connectivity and maintaining unobstructed wa

Background: Telemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients’ and carers’ views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health care staff. Method: We recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semistructured interviews were conducted using an interview guide based on normalisation process theory (NPT). Thematic analysis was undertaken. Results: We conducted 24 interviews with 29 participants (16 patients; 13 carers). 11 interviews pertained to ‘live’ telemedicine assessments (at time of admission); 9 had mockup telemedicine assessments (within 48 hours of admission); 4 had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sensemaking) included people’s knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. Conclusion: Although telemedicine was well-accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The ‘remote’ nature of the consultation posed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking.

Background: Telemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients’ and carers’ views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health care staff. Method: We recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semistructured interviews were conducted using an interview guide based on normalisation process theory (NPT). Thematic analysis was undertaken. Results: We conducted 24 interviews with 29 participants (16 patients; 13 carers). 11 interviews pertained to ‘live’ telemedicine assessments (at time of admission); 9 had mockup telemedicine assessments (within 48 hours of admission); 4 had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sensemaking) included people’s knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. Conclusion: Although telemedicine was well-accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The ‘remote’ nature of the consultation posed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking.

Background: Telemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients’ and carers’ views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health care staff. Method: We recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semistructured interviews were conducted using an interview guide based on normalisation process theory (NPT). Thematic analysis was undertaken. Results: We conducted 24 interviews with 29 participants (16 patients; 13 carers). 11 interviews pertained to ‘live’ telemedicine assessments (at time of admission); 9 had mockup telemedicine assessments (within 48 hours of admission); 4 had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sensemaking) included people’s knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. Conclusion: Although telemedicine was well-accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The ‘remote’ nature of the consultation posed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking.

Background: Telemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients’ and carers’ views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health care staff. Method: We recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semistructured interviews were conducted using an interview guide based on normalisation process theory (NPT). Thematic analysis was undertaken. Results: We conducted 24 interviews with 29 participants (16 patients; 13 carers). 11 interviews pertained to ‘live’ telemedicine assessments (at time of admission); 9 had mockup telemedicine assessments (within 48 hours of admission); 4 had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sensemaking) included people’s knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. Conclusion: Although telemedicine was well-accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The ‘remote’ nature of the consultation posed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking.

In this paper we present a catalog of Giant Molecular Clouds (GMCs) in the An- dromeda (M31) galaxy extracted from the Herschel Exploitation of Local Galaxy An- dromeda (HELGA) dataset. GMCs are identified from the Herschel maps using a hierarchical source extraction algorithm. We present the results of this new catalog and characterise the spatial distribution and spectral energy properties of its clouds based on the radial dust/gas properties found by Smith et al (2012). 326 GMCs in the mass range 104 − 107 M⊙ are identified, their cumulative mass distribution is found to be proportional to M −2.34 in agreement with earlier studies. The GMCs appear to follow the same cloud mass to LCO correlation observed in the Milky Way. However, comparison between this catalog and interferometry studies also shows that the GMCs are substructured below the Herschel resolution limit suggesting that we are observing associations of GMCs. Following Gordon et al. (2006), we study the spatial structure of M31 by splitting the observed structure into a set of spiral arms and offset rings. We fit radii of 10.3 and 15.5 kpc to the two most prominent rings. We then fit a logarithmic spiral with a pitch angle of 8fdg9 to the GMCs not associated with either ring. Last, we comment on the effects of deprojection on our results and investigate the effect different models for M31's inclination will have on the projection of an unperturbed spiral arm system.

In this paper we present a catalog of Giant Molecular Clouds (GMCs) in the An- dromeda (M31) galaxy extracted from the Herschel Exploitation of Local Galaxy An- dromeda (HELGA) dataset. GMCs are identified from the Herschel maps using a hierarchical source extraction algorithm. We present the results of this new catalog and characterise the spatial distribution and spectral energy properties of its clouds based on the radial dust/gas properties found by Smith et al (2012). 326 GMCs in the mass range 104 − 107 M⊙ are identified, their cumulative mass distribution is found to be proportional to M −2.34 in agreement with earlier studies. The GMCs appear to follow the same cloud mass to LCO correlation observed in the Milky Way. However, comparison between this catalog and interferometry studies also shows that the GMCs are substructured below the Herschel resolution limit suggesting that we are observing associations of GMCs. Following Gordon et al. (2006), we study the spatial structure of M31 by splitting the observed structure into a set of spiral arms and offset rings. We fit radii of 10.3 and 15.5 kpc to the two most prominent rings. We then fit a logarithmic spiral with a pitch angle of 8fdg9 to the GMCs not associated with either ring. Last, we comment on the effects of deprojection on our results and investigate the effect different models for M31's inclination will have on the projection of an unperturbed spiral arm system.

In this paper we present a catalog of Giant Molecular Clouds (GMCs) in the An- dromeda (M31) galaxy extracted from the Herschel Exploitation of Local Galaxy An- dromeda (HELGA) dataset. GMCs are identified from the Herschel maps using a hierarchical source extraction algorithm. We present the results of this new catalog and characterise the spatial distribution and spectral energy properties of its clouds based on the radial dust/gas properties found by Smith et al (2012). 326 GMCs in the mass range 104 − 107 M⊙ are identified, their cumulative mass distribution is found to be proportional to M −2.34 in agreement with earlier studies. The GMCs appear to follow the same cloud mass to LCO correlation observed in the Milky Way. However, comparison between this catalog and interferometry studies also shows that the GMCs are substructured below the Herschel resolution limit suggesting that we are observing associations of GMCs. Following Gordon et al. (2006), we study the spatial structure of M31 by splitting the observed structure into a set of spiral arms and offset rings. We fit radii of 10.3 and 15.5 kpc to the two most prominent rings. We then fit a logarithmic spiral with a pitch angle of 8fdg9 to the GMCs not associated with either ring. Last, we comment on the effects of deprojection on our results and investigate the effect different models for M31's inclination will have on the projection of an unperturbed spiral arm system.

In this paper we present a catalog of Giant Molecular Clouds (GMCs) in the An- dromeda (M31) galaxy extracted from the Herschel Exploitation of Local Galaxy An- dromeda (HELGA) dataset. GMCs are identified from the Herschel maps using a hierarchical source extraction algorithm. We present the results of this new catalog and characterise the spatial distribution and spectral energy properties of its clouds based on the radial dust/gas properties found by Smith et al (2012). 326 GMCs in the mass range 104 − 107 M⊙ are identified, their cumulative mass distribution is found to be proportional to M −2.34 in agreement with earlier studies. The GMCs appear to follow the same cloud mass to LCO correlation observed in the Milky Way. However, comparison between this catalog and interferometry studies also shows that the GMCs are substructured below the Herschel resolution limit suggesting that we are observing associations of GMCs. Following Gordon et al. (2006), we study the spatial structure of M31 by splitting the observed structure into a set of spiral arms and offset rings. We fit radii of 10.3 and 15.5 kpc to the two most prominent rings. We then fit a logarithmic spiral with a pitch angle of 8fdg9 to the GMCs not associated with either ring. Last, we comment on the effects of deprojection on our results and investigate the effect different models for M31's inclination will have on the projection of an unperturbed spiral arm system.

In this paper we present a catalog of Giant Molecular Clouds (GMCs) in the An- dromeda (M31) galaxy extracted from the Herschel Exploitation of Local Galaxy An- dromeda (HELGA) dataset. GMCs are identified from the Herschel maps using a hierarchical source extraction algorithm. We present the results of this new catalog and characterise the spatial distribution and spectral energy properties of its clouds based on the radial dust/gas properties found by Smith et al (2012). 326 GMCs in the mass range 104 − 107 M⊙ are identified, their cumulative mass distribution is found to be proportional to M −2.34 in agreement with earlier studies. The GMCs appear to follow the same cloud mass to LCO correlation observed in the Milky Way. However, comparison between this catalog and interferometry studies also shows that the GMCs are substructured below the Herschel resolution limit suggesting that we are observing associations of GMCs. Following Gordon et al. (2006), we study the spatial structure of M31 by splitting the observed structure into a set of spiral arms and offset rings. We fit radii of 10.3 and 15.5 kpc to the two most prominent rings. We then fit a logarithmic spiral with a pitch angle of 8fdg9 to the GMCs not associated with either ring. Last, we comment on the effects of deprojection on our results and investigate the effect different models for M31's inclination will have on the projection of an unperturbed spiral arm system.

In this paper we present a catalog of Giant Molecular Clouds (GMCs) in the An- dromeda (M31) galaxy extracted from the Herschel Exploitation of Local Galaxy An- dromeda (HELGA) dataset. GMCs are identified from the Herschel maps using a hierarchical source extraction algorithm. We present the results of this new catalog and characterise the spatial distribution and spectral energy properties of its clouds based on the radial dust/gas properties found by Smith et al (2012). 326 GMCs in the mass range 104 − 107 M⊙ are identified, their cumulative mass distribution is found to be proportional to M −2.34 in agreement with earlier studies. The GMCs appear to follow the same cloud mass to LCO correlation observed in the Milky Way. However, comparison between this catalog and interferometry studies also shows that the GMCs are substructured below the Herschel resolution limit suggesting that we are observing associations of GMCs. Following Gordon et al. (2006), we study the spatial structure of M31 by splitting the observed structure into a set of spiral arms and offset rings. We fit radii of 10.3 and 15.5 kpc to the two most prominent rings. We then fit a logarithmic spiral with a pitch angle of 8fdg9 to the GMCs not associated with either ring. Last, we comment on the effects of deprojection on our results and investigate the effect different models for M31's inclination will have on the projection of an unperturbed spiral arm system.

The response to mechanical stimuli, i.e., tensegrity, plays an important role in regulating cell physiological and pathophysiological function and the mechanical silencing observed in intensive care unit (ICU) patients leads to a severe and specific muscle wasting condition. This study aims at unravelling the underlying mechanisms and the effects of passive mechanical loading on skeletal muscle mass and function at the gene, protein and cellular levels. A unique experimental rat ICU model has been used allowing long-term (weeks) time-resolved analyses of the effects of standardized unilateral passive mechanical loading on skeletal muscle size and function and underlying mechanisms. Results show that passive mechanical loading alleviated the muscle wasting and the loss of force-generation associated with the ICU intervention, resulting in a doubling of the functional capacity of the loaded vs. the unloaded muscles after a 2-week ICU intervention. We demonstrated that the improved maintenance of muscle mass and function is likely a consequence of a reduced oxidative stress revealed by lower levels of carbonylated proteins, and a reduced loss of the molecular motor protein myosin. A complex temporal gene expression pattern, delineated by microarray analysis, was observed with loading-induced changes in transcript levels of sarcomeric proteins, muscle developmental processes, stress response, ECM/cell adhesion proteins and metabolism. Thus, the results from this study show that passive mechanical loading alleviates the severe negative consequences on muscle size and function associated with the mechanical silencing in ICU patients, strongly supporting early and intense physical therapy in immobilized ICU patients.

The response to mechanical stimuli, i.e. tensegrity, plays an important role in regulating cell physiological and pathophysiological function, and the mechanical silencing observed in intensive care unit (ICU) patients leads to a severe and specific muscle wasting condition. This study aims to unravel the underlying mechanisms and the effects of passive mechanical loading on skeletal muscle mass and function at the gene, protein and cellular levels. A unique experimental rat ICU model has been used allowing long-term (weeks) time-resolved analyses of the effects of standardized unilateral passive mechanical loading on skeletal muscle size and function and underlying mechanisms. Results show that passive mechanical loading alleviated the muscle wasting and the loss of force-generation associated with the ICU intervention, resulting in a doubling of the functional capacity of the loaded versus the unloaded muscles after a 2-week ICU intervention. We demonstrate that the improved maintenance of muscle mass and function is probably a consequence of a reduced oxidative stress revealed by lower levels of carbonylated proteins, and a reduced loss of the molecular motor protein myosin. A complex temporal gene expression pattern, delineated by microarray analysis, was observed with loading-induced changes in transcript levels of sarcomeric proteins, muscle developmental processes, stress response, extracellular matrix/cell adhesion proteins and metabolism. Thus, the results from this study show that passive mechanical loading alleviates the severe negative consequences on muscle size and function associated with the mechanical silencing in ICU patients, strongly supporting early and intense physical therapy in immobilized ICU patients.

The response to mechanical stimuli, i.e. tensegrity, plays an important role in regulating cell physiological and pathophysiological function, and the mechanical silencing observed in intensive care unit (ICU) patients leads to a severe and specific muscle wasting condition. This study aims to unravel the underlying mechanisms and the effects of passive mechanical loading on skeletal muscle mass and function at the gene, protein and cellular levels. A unique experimental rat ICU model has been used allowing long-term (weeks) time-resolved analyses of the effects of standardized unilateral passive mechanical loading on skeletal muscle size and function and underlying mechanisms. Results show that passive mechanical loading alleviated the muscle wasting and the loss of force-generation associated with the ICU intervention, resulting in a doubling of the functional capacity of the loaded versus the unloaded muscles after a 2-week ICU intervention. We demonstrate that the improved maintenance of muscle mass and function is probably a consequence of a reduced oxidative stress revealed by lower levels of carbonylated proteins, and a reduced loss of the molecular motor protein myosin. A complex temporal gene expression pattern, delineated by microarray analysis, was observed with loading-induced changes in transcript levels of sarcomeric proteins, muscle developmental processes, stress response, extracellular matrix/cell adhesion proteins and metabolism. Thus, the results from this study show that passive mechanical loading alleviates the severe negative consequences on muscle size and function associated with the mechanical silencing in ICU patients, strongly supporting early and intense physical therapy in immobilized ICU patients.

OBJECTIVE. Low-dose dexamethasone facilitates extubation in chronically ventilator-dependent infants with no obvious short-term complications. The objective of this study was to determine the long-term effects of low-dose dexamethasone. METHODS. Very preterm (<28 weeks' gestation) or extremely low birth weight (birth weight <1000 g) infants who were ventilator dependent after the first week of life for whom clinicians considered corticosteroids were indicated were eligible. After informed consent, infants were randomly assigned to masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Survivors were assessed at 2 years' corrected age by staff blinded to treatment group allocation to determine neurosensory outcome, growth, and health. RESULTS. The trial was abandoned well short of its target sample size because of recruitment difficulties. Seventy infants were recruited from 11 centers, 35 in each group: 59 survived to 2 years of age, and 58 (98%) were assessed at follow-up, but data for cerebral palsy were available for only 56 survivors. There was little evidence for a difference in the major end point, the rate of the combined outcome of death, or major disability at 2 years of age (dexamethasone group: 46%; controls: 43%). Rates of mortality before follow-up (11% vs 20%), major disability (41% vs 31%), cerebral palsy (14% vs 22%), or of the combined outcomes of death or cerebral palsy (23% vs 37%) were not substantially different between the groups. There were no obvious effects of low-dose dexamethasone on growth or readmissions to hospital after discharge. CONCLUSIONS. Although this trial was not able to provide definitive evidence on the long-term effects of low-dose dexamethasone after the first week of life in chronically ventilator-dependent infants, our data indicate no strong association with long-term morbidity. Copyright © 2007 by the American Academy of Pediatrics.

Context. Although the increasing effectiveness of neonatal programs for extremely low birth weight (ELBW, birth weight <1000 g) infants has been established from cohort studies, there is a paucity of data on the relationship between the costs and the consequences of neonatal intensive care. Objective. To determine the changes in the efficiency of neonatal intensive care for ELBW infants in Victoria, Australia over 2 decades. Design. Economic evaluation (cost-effectiveness and cost-utility analyses) in a population-based cohort study of consecutive ELBW infants born during 4 distinct eras (1979-1980, 1985-1987, 1991-1992, and 1997) followed to at least 2 years of age. Setting. The state of Victoria. Patients. All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979-1980: n = 351; 1985-1987: n = 560; 1991-1992: n = 429; 1997: n = 233). Main Outcome Measures. Costs were assessed primarily by the consumption of hospital resources. The consequences included survival and quality-adjusted survival rates at 2 years of age. Results. The cost-effectiveness ratios (expressed in Australian dollars for 1997) were similar between successive eras at $5270, $3130, and $4050 per life-year gained, respectively. The cost-utility ratios were similar between successive eras at $5270, $3690, and $5850 per quality-adjusted life-year gained, respectively, and were similar to the cost-effectiveness ratios. The cost-effectiveness and cost-utility ratios were generally higher in lower birth-weight subgroups, but there were consistent gains in efficiency over time in infants of lower birth weight. Conclusions. As there have been large increases in effectiveness from the late 1970s to the late 1990s, the efficiency of neonatal intensive care for ELBW infants in Victoria has remained relatively stable.

The aim of this study of extremely low birth-weight (ELBW, birth-weight 500-999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979-80, 1985-87, and 1991-92, in the proportions who were born outside level 3 perinatal centres (outborn), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn:fell significantly over successive eras, from 30.2% (106 of 351) in 1979-80, to 23.0% (129 of 560)in 1985-87, and to 15.6% (67 of 429) in 1991-92. Between 1979-80 and 1985-87, the proportions who were outborn fell predominantly in those of birth-weight from 800-999 g, whereas between 1985-87 and 1991-92 the proportions who were outborn fell predominantly in those of birth-weight 500-799 g, The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in the 3 eras, at 49.1%, 38.0% and 41.2%, respectively. The survival rates for outborn infants were lower in each era than for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level-3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 1991-92 (34.6%, 36.7% and 60.7%, respectively),The rates of sensorineural impairments and disabilities in survivors fell significantly between the first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high-risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres.

Context. Although individual components of neonatal intensive care have proven efficacy, doubts remain about its overall effectiveness. Objective. To determine the changes in effectiveness of neonatal intensive care for extremely low birth weight (ELBW) infants over 2 decades. Design. Population-based cohort study of consecutive ELBW infants born during 4 distinct eras: 1979-1980, 1985-1987, 1991-1992, and 1997, all followed to at least 2 years of age. Setting. The state of Victoria, Australia. Patients. All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979-1980 In = 351]; 1985-1987 In = 560]; 1991-1992 In = 429]; 1997 In = 233]). Survivors were assessed at 2 years of age by pediatricians and psychologists blinded to perinatal details. The follow-up rates were high for each ELBW cohort (1979-1980: 100% [89 of 89]; 1985-1987: 100% [212 of 212]; 1991-1992: 98% [237 of 241]; 1997: 99% [168 of 1701). Main Outcome Measures. Survival and quality-adjusted survival rates at 2 years of age. Results. The survival rate to 2 years of age improved significantly between successive eras (absolute increase and 95% confidence interval: 1985-1987 vs 1979-1980, 12.5% and 6.3%-18.4%; 1991-1992 vs 1985-1987, 18.3% and 12.1%-24.4%; 1997 vs 1991-1992, 16.8% and 9.2%-23.9%), as did the quality-adjusted survival rate (absolute increase: 1985-1987 vs 1979-1980, 12.4%; 1991-1992 vs 1985-1987, 13.8%; 1997 vs 1991-1992, 13.2%). Overall, the survival rate increased from ~1 in 4 (25%) in 1979-1980 to 3 in 4 (73%) in 1997, and the quality-adjusted survival rate also increased threefold, from 19% in 1979-1980 to 59% in 1997. The biggest gains in survival and quality-adjusted survival in the most recent era were in infants in lighter birth-weight subgroups. Conclusion. The effectiveness of neonatal intensive care for ELBW infants in Victoria improved progressively from the late 1970s to the late 1990s.

Aims - To compare the survival and sensorineural disability rates in extremely low birthweight (ELBW) (500-999 g) infants born in 1991-2 with ELBW babies born in 1979-80 and 1985-7, and with normal birthweight infants born in the same time periods. Methods - ELBW infants born in Victoria in 1991-2 were compared with regional cohorts of ELBW infants born in 1979-80 and 1985- 7, and with contemporaneous normal birthweight (>2499 g) controls, and those of birthweight 500-749 g with those of birthweight 750-999 g. Results - In 1979-80, 25.4% (89/351) ELBW live births survived to 2 years of age, increasing significantly to 37.9% (212/560) in 1985-7, and to 56.2% (241/429) in 1991-2. The rates of severe disability in survivors assessed were 12.4%, 6.6%, and 6.8% in the 1979-80, 1985-7, and 1991-2 ELBW cohorts, respectively. The rate of disability, overall, was significantly lower in the 1985-7 and 1991-2 ELBW cohorts compared with the 1979-80 ELBW cohort, but was significantly higher in 1991-2 ELBW infants than normal birthweight controls. Surviving children with birthweights <750 g had significantly higher rates of sensorineural disability compared with those of birthweight 750-999 g in 1979-80, but not in 1985-7 or 1991-2. Conclusions - Survival rates for ELBW babies in Victoria have progressively improved since the late 1970s. Sensorineural outcome for survivors born in 1985-7 has also improved compared with those born in 1979-80. However, there is no evidence that further reductions in adverse sensorineural outcomes into the 1990s, and these, as well as disabilities remain higher in ELBW than in normal birthweight babies.

Background: Postnatal corticosteroids reduce ventilator dependence in preterm infants, but possible long-term benefits for either survival or sensorineural morbidity are not proved. Aim(s): The aim of this study was to determine the association between corticosteroid therapy given postnatally and sensorineural outcome in childhood. Subjects: The subjects comprised 346 consecutive livebirths either of birthweight < 1000 g or with gestational age < 28 weeks born in the state of Victoria during 1991 and 1992, and who survived the first week after birth; 120 (34.7%) were given corticosteroids postnatally. Result(s): Of the 120 children who received corticosteroids, 98 (81.7%) survived to 5 years of age, compared with 200 (88.5%) of the 226 children who did not receive corticosteroids. At 5 years of age, survivors treated with corticosteroids postnatally had significantly higher rates of cerebral palsy (corticosteroids 23%, no corticosteroids 4%), blindness (corticosteroids 4%, no corticosteroids 1%) or an intelligence quotient more than one standard deviation below the mean (corticosteroids 54%, no corticosteroids 32%) compared with children not treated with corticosteroids. The rate of sensorineural disabilities imposed by these impairments was significantly higher in children treated with postnatal corticosteroids, and the association between adverse sensorineural outcome and postnatal corticosteroids remained after adjustments for potentially confounding variables. In a separate case-control analysis of 60 children in each group, the rate of cerebral palsy remained significantly elevated (corticosteroids 22%, no corticosteroids 5%). Conclusion(s): Postnatal corticosteroid therapy is associated with substantial adverse sensorineural outcomes at 5 years of age.

We present an analysis of the dust and gas in Andromeda, using Herschel images sampling the entire far-infrared peak. We fit a modified-blackbody model to ~4000 quasi-independent pixels with spatial resolution of ~140pc and find that a variable dust-emissivity index (beta) is required to fit the data. We find no significant long-wavelength excess above this model suggesting there is no cold dust component. We show that the gas-to-dust ratio varies radially, increasing from ~20 in the center to ~70 in the star-forming ring at 10kpc, consistent with the metallicity gradient. In the 10kpc ring the average beta is ~1.9, in good agreement with values determined for the Milky Way (MW). However, in contrast to the MW, we find significant radial variations in beta, which increases from 1.9 at 10kpc to ~2.5 at a radius of 3.1kpc and then decreases to 1.7 in the center. The dust temperature is fairly constant in the 10kpc ring (ranging from 17-20K), but increases strongly in the bulge to ~30K. Within 3.1kpc we find the dust temperature is highly correlated with the 3.6 micron flux, suggesting the general stellar population in the bulge is the dominant source of dust heating there. At larger radii, there is a weak correlation between the star formation rate and dust temperature. We find no evidence for 'dark gas' in M31 in contrast to recent results for the MW. Finally, we obtained an estimate of the CO X-factor by minimising the dispersion in the gas-to-dust ratio, obtaining a value of (1.9+/-0.4)x10^20 cm^-2 [K kms^-1]^-1., Comment: 19 pages, 18 figures. Submitted to ApJ April 2012; Accepted July 2012

OBJECTIVE. Low-dose dexamethasone facilitates extubation in chronically ventilator-dependent infants with no obvious short-term complications. The objective of this study was to determine the long-term effects of low-dose dexamethasone. METHODS. Very preterm (<28 weeks' gestation) or extremely low birth weight (birth weight <1000 g) infants who were ventilator dependent after the first week of life for whom clinicians considered corticosteroids were indicated were eligible. After informed consent, infants were randomly assigned to masked dexamethasone (0.89 mg/kg over 10 days) or saline placebo. Survivors were assessed at 2 years' corrected age by staff blinded to treatment group allocation to determine neurosensory outcome, growth, and health. RESULTS. The trial was abandoned well short of its target sample size because of recruitment difficulties. Seventy infants were recruited from 11 centers, 35 in each group: 59 survived to 2 years of age, and 58 (98%) were assessed at follow-up, but data for cerebral palsy were available for only 56 survivors. There was little evidence for a difference in the major end point, the rate of the combined outcome of death, or major disability at 2 years of age (dexamethasone group: 46%; controls: 43%). Rates of mortality before follow-up (11% vs 20%), major disability (41% vs 31%), cerebral palsy (14% vs 22%), or of the combined outcomes of death or cerebral palsy (23% vs 37%) were not substantially different between the groups. There were no obvious effects of low-dose dexamethasone on growth or readmissions to hospital after discharge. CONCLUSIONS. Although this trial was not able to provide definitive evidence on the long-term effects of low-dose dexamethasone after the first week of life in chronically ventilator-dependent infants, our data indicate no strong association with long-term morbidity. Copyright © 2007 by the American Academy of Pediatrics.

Context. Although the increasing effectiveness of neonatal programs for extremely low birth weight (ELBW, birth weight <1000 g) infants has been established from cohort studies, there is a paucity of data on the relationship between the costs and the consequences of neonatal intensive care. Objective. To determine the changes in the efficiency of neonatal intensive care for ELBW infants in Victoria, Australia over 2 decades. Design. Economic evaluation (cost-effectiveness and cost-utility analyses) in a population-based cohort study of consecutive ELBW infants born during 4 distinct eras (1979-1980, 1985-1987, 1991-1992, and 1997) followed to at least 2 years of age. Setting. The state of Victoria. Patients. All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979-1980: n = 351; 1985-1987: n = 560; 1991-1992: n = 429; 1997: n = 233). Main Outcome Measures. Costs were assessed primarily by the consumption of hospital resources. The consequences included survival and quality-adjusted survival rates at 2 years of age. Results. The cost-effectiveness ratios (expressed in Australian dollars for 1997) were similar between successive eras at $5270, $3130, and $4050 per life-year gained, respectively. The cost-utility ratios were similar between successive eras at $5270, $3690, and $5850 per quality-adjusted life-year gained, respectively, and were similar to the cost-effectiveness ratios. The cost-effectiveness and cost-utility ratios were generally higher in lower birth-weight subgroups, but there were consistent gains in efficiency over time in infants of lower birth weight. Conclusions. As there have been large increases in effectiveness from the late 1970s to the late 1990s, the efficiency of neonatal intensive care for ELBW infants in Victoria has remained relatively stable.

The aim of this study of extremely low birth-weight (ELBW, birth-weight 500-999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979-80, 1985-87, and 1991-92, in the proportions who were born outside level 3 perinatal centres (outborn), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn:fell significantly over successive eras, from 30.2% (106 of 351) in 1979-80, to 23.0% (129 of 560)in 1985-87, and to 15.6% (67 of 429) in 1991-92. Between 1979-80 and 1985-87, the proportions who were outborn fell predominantly in those of birth-weight from 800-999 g, whereas between 1985-87 and 1991-92 the proportions who were outborn fell predominantly in those of birth-weight 500-799 g, The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in the 3 eras, at 49.1%, 38.0% and 41.2%, respectively. The survival rates for outborn infants were lower in each era than for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level-3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 1991-92 (34.6%, 36.7% and 60.7%, respectively),The rates of sensorineural impairments and disabilities in survivors fell significantly between the first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high-risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres.

Context. Although individual components of neonatal intensive care have proven efficacy, doubts remain about its overall effectiveness. Objective. To determine the changes in effectiveness of neonatal intensive care for extremely low birth weight (ELBW) infants over 2 decades. Design. Population-based cohort study of consecutive ELBW infants born during 4 distinct eras: 1979-1980, 1985-1987, 1991-1992, and 1997, all followed to at least 2 years of age. Setting. The state of Victoria, Australia. Patients. All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979-1980 In = 351]; 1985-1987 In = 560]; 1991-1992 In = 429]; 1997 In = 233]). Survivors were assessed at 2 years of age by pediatricians and psychologists blinded to perinatal details. The follow-up rates were high for each ELBW cohort (1979-1980: 100% [89 of 89]; 1985-1987: 100% [212 of 212]; 1991-1992: 98% [237 of 241]; 1997: 99% [168 of 1701). Main Outcome Measures. Survival and quality-adjusted survival rates at 2 years of age. Results. The survival rate to 2 years of age improved significantly between successive eras (absolute increase and 95% confidence interval: 1985-1987 vs 1979-1980, 12.5% and 6.3%-18.4%; 1991-1992 vs 1985-1987, 18.3% and 12.1%-24.4%; 1997 vs 1991-1992, 16.8% and 9.2%-23.9%), as did the quality-adjusted survival rate (absolute increase: 1985-1987 vs 1979-1980, 12.4%; 1991-1992 vs 1985-1987, 13.8%; 1997 vs 1991-1992, 13.2%). Overall, the survival rate increased from ~1 in 4 (25%) in 1979-1980 to 3 in 4 (73%) in 1997, and the quality-adjusted survival rate also increased threefold, from 19% in 1979-1980 to 59% in 1997. The biggest gains in survival and quality-adjusted survival in the most recent era were in infants in lighter birth-weight subgroups. Conclusion. The effectiveness of neonatal intensive care for ELBW infants in Victoria improved progressively from the late 1970s to the late 1990s.

Aims - To compare the survival and sensorineural disability rates in extremely low birthweight (ELBW) (500-999 g) infants born in 1991-2 with ELBW babies born in 1979-80 and 1985-7, and with normal birthweight infants born in the same time periods. Methods - ELBW infants born in Victoria in 1991-2 were compared with regional cohorts of ELBW infants born in 1979-80 and 1985- 7, and with contemporaneous normal birthweight (>2499 g) controls, and those of birthweight 500-749 g with those of birthweight 750-999 g. Results - In 1979-80, 25.4% (89/351) ELBW live births survived to 2 years of age, increasing significantly to 37.9% (212/560) in 1985-7, and to 56.2% (241/429) in 1991-2. The rates of severe disability in survivors assessed were 12.4%, 6.6%, and 6.8% in the 1979-80, 1985-7, and 1991-2 ELBW cohorts, respectively. The rate of disability, overall, was significantly lower in the 1985-7 and 1991-2 ELBW cohorts compared with the 1979-80 ELBW cohort, but was significantly higher in 1991-2 ELBW infants than normal birthweight controls. Surviving children with birthweights <750 g had significantly higher rates of sensorineural disability compared with those of birthweight 750-999 g in 1979-80, but not in 1985-7 or 1991-2. Conclusions - Survival rates for ELBW babies in Victoria have progressively improved since the late 1970s. Sensorineural outcome for survivors born in 1985-7 has also improved compared with those born in 1979-80. However, there is no evidence that further reductions in adverse sensorineural outcomes into the 1990s, and these, as well as disabilities remain higher in ELBW than in normal birthweight babies.

Background: Postnatal corticosteroids reduce ventilator dependence in preterm infants, but possible long-term benefits for either survival or sensorineural morbidity are not proved. Aim(s): The aim of this study was to determine the association between corticosteroid therapy given postnatally and sensorineural outcome in childhood. Subjects: The subjects comprised 346 consecutive livebirths either of birthweight < 1000 g or with gestational age < 28 weeks born in the state of Victoria during 1991 and 1992, and who survived the first week after birth; 120 (34.7%) were given corticosteroids postnatally. Result(s): Of the 120 children who received corticosteroids, 98 (81.7%) survived to 5 years of age, compared with 200 (88.5%) of the 226 children who did not receive corticosteroids. At 5 years of age, survivors treated with corticosteroids postnatally had significantly higher rates of cerebral palsy (corticosteroids 23%, no corticosteroids 4%), blindness (corticosteroids 4%, no corticosteroids 1%) or an intelligence quotient more than one standard deviation below the mean (corticosteroids 54%, no corticosteroids 32%) compared with children not treated with corticosteroids. The rate of sensorineural disabilities imposed by these impairments was significantly higher in children treated with postnatal corticosteroids, and the association between adverse sensorineural outcome and postnatal corticosteroids remained after adjustments for potentially confounding variables. In a separate case-control analysis of 60 children in each group, the rate of cerebral palsy remained significantly elevated (corticosteroids 22%, no corticosteroids 5%). Conclusion(s): Postnatal corticosteroid therapy is associated with substantial adverse sensorineural outcomes at 5 years of age.

Background Rapid access to emergency medical services (EMS) is essential at the onset of acute stroke, but significant delays in contacting EMS often occur. Objective To explore factors that influence the caller's decision to contact EMS at the onset of stroke, and the caller's experiences of the call. Methods Participants were identified through a purposive sample of admissions to two hospitals via ambulance with suspected stroke. Participants were interviewed using open-ended questions and content analysis was undertaken. Results 50 participants were recruited (median age 62 years, 68% female). Only one of the callers (2%) was the patient. Two themes were identified that influenced the initial decision to contact EMS at the onset of stroke: perceived seriousness, and receipt of lay or professional advice. Two themes were identified in relation to the communication between the caller and the call handler: symptom description by the caller, and emotional response to onset of stroke symptoms. Conclusions Many callers seek lay or professional advice prior to contacting EMS and some believe that the onset of acute stroke symptoms does not warrant an immediate 999 call. More public education is needed to improve awareness of stroke and the need for an urgent response.

Background Rapid access to emergency medical services (EMS) is essential at the onset of acute stroke, but significant delays in contacting EMS often occur. Objective To explore factors that influence the caller's decision to contact EMS at the onset of stroke, and the caller's experiences of the call. Methods Participants were identified through a purposive sample of admissions to two hospitals via ambulance with suspected stroke. Participants were interviewed using open-ended questions and content analysis was undertaken. Results 50 participants were recruited (median age 62 years, 68% female). Only one of the callers (2%) was the patient. Two themes were identified that influenced the initial decision to contact EMS at the onset of stroke: perceived seriousness, and receipt of lay or professional advice. Two themes were identified in relation to the communication between the caller and the call handler: symptom description by the caller, and emotional response to onset of stroke symptoms. Conclusions Many callers seek lay or professional advice prior to contacting EMS and some believe that the onset of acute stroke symptoms does not warrant an immediate 999 call. More public education is needed to improve awareness of stroke and the need for an urgent response.

Background Rapid access to emergency medical services (EMS) is essential at the onset of acute stroke, but significant delays in contacting EMS often occur. Objective To explore factors that influence the caller's decision to contact EMS at the onset of stroke, and the caller's experiences of the call. Methods Participants were identified through a purposive sample of admissions to two hospitals via ambulance with suspected stroke. Participants were interviewed using open-ended questions and content analysis was undertaken. Results 50 participants were recruited (median age 62 years, 68% female). Only one of the callers (2%) was the patient. Two themes were identified that influenced the initial decision to contact EMS at the onset of stroke: perceived seriousness, and receipt of lay or professional advice. Two themes were identified in relation to the communication between the caller and the call handler: symptom description by the caller, and emotional response to onset of stroke symptoms. Conclusions Many callers seek lay or professional advice prior to contacting EMS and some believe that the onset of acute stroke symptoms does not warrant an immediate 999 call. More public education is needed to improve awareness of stroke and the need for an urgent response.

We present an analysis of the dust and gas in Andromeda, using Herschel images sampling the entire far-infrared peak. We fit a modified-blackbody model to ~4000 quasi-independent pixels with spatial resolution of ~140pc and find that a variable dust-emissivity index (beta) is required to fit the data. We find no significant long-wavelength excess above this model suggesting there is no cold dust component. We show that the gas-to-dust ratio varies radially, increasing from ~20 in the center to ~70 in the star-forming ring at 10kpc, consistent with the metallicity gradient. In the 10kpc ring the average beta is ~1.9, in good agreement with values determined for the Milky Way (MW). However, in contrast to the MW, we find significant radial variations in beta, which increases from 1.9 at 10kpc to ~2.5 at a radius of 3.1kpc and then decreases to 1.7 in the center. The dust temperature is fairly constant in the 10kpc ring (ranging from 17-20K), but increases strongly in the bulge to ~30K. Within 3.1kpc we find the dust temperature is highly correlated with the 3.6 micron flux, suggesting the general stellar population in the bulge is the dominant source of dust heating there. At larger radii, there is a weak correlation between the star formation rate and dust temperature. We find no evidence for 'dark gas' in M31 in contrast to recent results for the MW. Finally, we obtained an estimate of the CO X-factor by minimising the dispersion in the gas-to-dust ratio, obtaining a value of (1.9+/-0.4)x10^20 cm^-2 [K kms^-1]^-1., Comment: 19 pages, 18 figures. Submitted to ApJ April 2012; Accepted July 2012

Background Rapid access to emergency medical services (EMS) is essential at the onset of acute stroke, but significant delays in contacting EMS often occur. Objective To explore factors that influence the caller's decision to contact EMS at the onset of stroke, and the caller's experiences of the call. Methods Participants were identified through a purposive sample of admissions to two hospitals via ambulance with suspected stroke. Participants were interviewed using open-ended questions and content analysis was undertaken. Results 50 participants were recruited (median age 62 years, 68% female). Only one of the callers (2%) was the patient. Two themes were identified that influenced the initial decision to contact EMS at the onset of stroke: perceived seriousness, and receipt of lay or professional advice. Two themes were identified in relation to the communication between the caller and the call handler: symptom description by the caller, and emotional response to onset of stroke symptoms. Conclusions Many callers seek lay or professional advice prior to contacting EMS and some believe that the onset of acute stroke symptoms does not warrant an immediate 999 call. More public education is needed to improve awareness of stroke and the need for an urgent response.

The Abraham-Lorentz-Dirac equation for a point electron, while suffering from runaway solutions and an acausal response to external forces, is compatible with the optical theorem. We show that a theory of radiative reaction that allows for a finite charge distribution is not only causal and free of runaway solutions, but is also consistent with the optical theorem and the standard formula for the Rayleigh scattering cross section., Comment: 4 pages, 2 figures

Non-technical summary Wasting and severely impaired function of skeletal muscle is frequently observed in critically ill intensive care unit (ICU) patients, with negative consequences for recovery and quality of life. An experimental rat ICU model has been used to study the mechanisms underlying this unique wasting condition in neuromuscularly blocked and mechanically ventilated animals at durations varying between 6 h and 2 weeks. The complete 'mechanical silencing' of skeletal muscle (removal of both weight bearing and activation) resulted in a specific myopathy frequently observed in ICU patients and characterized by a preferential loss of the motor protein myosin. A highly complex and coordinated protein synthesis and degradation system was observed in the time-resolved analyses. It is suggested the 'mechanical silencing' of skeletal muscle is a dominating factor triggering the specific myopathy associated with the ICU intervention, and strongly supporting the importance of interventions counteracting the complete unloading in ICU patients.The muscle wasting and impaired muscle function in critically ill intensive care unit (ICU) patients delay recovery from the primary disease, and have debilitating consequences that can persist for years after hospital discharge. It is likely that, in addition to pernicious effects of the primary disease, the basic life support procedures of long-term ICU treatment contribute directly to the progressive impairment of muscle function. This study aims at improving our understanding of the mechanisms underlying muscle wasting in ICU patients by using a unique experimental rat ICU model where animals are mechanically ventilated, sedated and pharmacologically paralysed for duration varying between 6 h and 14 days. Results show that the ICU intervention induces a phenotype resembling the severe muscle wasting and paralysis associated with the acute quadriplegic myopathy (AQM) observed in ICU patients, i.e. a preferential loss of myo

We have obtained Herschel images at five wavelengths from 100 to 500 micron of a ~5.5x2.5 degree area centred on the local galaxy M31 (Andromeda), our nearest neighbour spiral galaxy, as part of the Herschel guaranteed time project "HELGA". The main goals of HELGA are to study the characteristics of the extended dust emission, focusing on larger scales than studied in previous observations of Andromeda at an increased spatial resolution, and the obscured star formation. In this paper we present data reduction and Herschel maps, and provide a description of the far-infrared morphology, comparing it with features seen at other wavelengths. We use high--resolution maps of the atomic hydrogen, fully covering our fields, to identify dust emission features that can be associated to M31 with confidence, distinguishing them from emission coming from the foreground Galactic cirrus. Thanks to the very large extension of our maps we detect, for the first time at far-infrared wavelengths, three arc-like structures extending out to ~21, ~26 and ~31 kpc respectively, in the south-western part of M31. The presence of these features, hosting ~2.2e6 Msol of dust, is safely confirmed by their detection in HI maps. Overall, we estimate a total dust mass of ~5.8e7 Msol, about 78% of which is contained in the two main ring-like structures at 10 and 15 kpc, at an average temperature of 16.5 K. We find that the gas-to-dust ratio declines exponentially as a function of the galacto-centric distance, in agreement with the known metallicity gradient, with values ranging from 66 in the nucleus to ~275 in the outermost region. [Abridged], Comment: 15 Pages, 9 Figures. Accepted for publication in Astronomy and Astrophysics. A high resolution version of the paper can be found at http://wazn.ugent.be/jfritz/HelgaI_final.pdf

The Abraham-Lorentz-Dirac equation for a point electron, while suffering from runaway solutions and an acausal response to external forces, is compatible with the optical theorem. We show that a theory of radiative reaction that allows for a finite charge distribution is not only causal and free of runaway solutions, but is also consistent with the optical theorem and the standard formula for the Rayleigh scattering cross section., Comment: 4 pages, 2 figures

The muscle wasting and impaired muscle function in critically ill intensive care unit (ICU) patients delay recovery from the primary disease, and have debilitating consequences that can persist for years after hospital discharge. It is likely that, in addition to pernicious effects of the primary disease, the basic life support procedures of long-term ICU treatment contribute directly to the progressive impairment of muscle function. This study aims at improving our understanding of the mechanisms underlying muscle wasting in ICU patients by using a unique experimental rat ICU model where animals are mechanically ventilated, sedated and pharmacologically paralysed for duration varying between 6 h and 14 days. Results show that the ICU intervention induces a phenotype resembling the severe muscle wasting and paralysis associated with the acute quadriplegic myopathy (AQM) observed in ICU patients, i.e. a preferential loss of myosin, transcriptional down-regulation of myosin synthesis, muscle atrophy and a dramatic decrease in muscle fibre force generation capacity. Detailed analyses of protein degradation pathways show that the ubiquitin proteasome pathway is highly involved in this process. A sequential change in localisation of muscle-specific RING finger proteins 1/2 (MuRF1/2) observed during the experimental period is suggested to play an instrumental role in both transcriptional regulation and protein degradation. We propose that, for those critically ill patients who develop AQM, complete mechanical silencing, due to pharmacological paralysis or sedation, is a critical factor underlying the preferential loss of the molecular motor protein myosin that leads to impaired muscle function or persisting paralysis.

The muscle wasting and impaired muscle function in critically ill intensive care unit (ICU) patients delay recovery from the primary disease, and have debilitating consequences that can persist for years after hospital discharge. It is likely that, in addition to pernicious effects of the primary disease, the basic life support procedures of long-term ICU treatment contribute directly to the progressive impairment of muscle function. This study aims at improving our understanding of the mechanisms underlying muscle wasting in ICU patients by using a unique experimental rat ICU model where animals are mechanically ventilated, sedated and pharmacologically paralysed for duration varying between 6 h and 14 days. Results show that the ICU intervention induces a phenotype resembling the severe muscle wasting and paralysis associated with the acute quadriplegic myopathy (AQM) observed in ICU patients, i.e. a preferential loss of myosin, transcriptional down-regulation of myosin synthesis, muscle atrophy and a dramatic decrease in muscle fibre force generation capacity. Detailed analyses of protein degradation pathways show that the ubiquitin proteasome pathway is highly involved in this process. A sequential change in localisation of muscle-specific RING finger proteins 1/2 (MuRF1/2) observed during the experimental period is suggested to play an instrumental role in both transcriptional regulation and protein degradation. We propose that, for those critically ill patients who develop AQM, complete mechanical silencing, due to pharmacological paralysis or sedation, is a critical factor underlying the preferential loss of the molecular motor protein myosin that leads to impaired muscle function or persisting paralysis.