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The nearby radio galaxy M87 is a prime target for studying black hole accretion and jet formation^{1,2}. Event Horizon Telescope observations of M87 in 2017, at a wavelength of 1.3 mm, revealed a ring-like structure, which was interpreted as gravitationally lensed emission around a central black hole^3. Here we report images of M87 obtained in 2018, at a wavelength of 3.5 mm, showing that the compact radio core is spatially resolved. High-resolution imaging shows a ring-like structure of 8.4_{-1.1}^{+0.5} Schwarzschild radii in diameter, approximately 50% larger than that seen at 1.3 mm. The outer edge at 3.5 mm is also larger than that at 1.3 mm. This larger and thicker ring indicates a substantial contribution from the accretion flow with absorption effects in addition to the gravitationally lensed ring-like emission. The images show that the edge-brightened jet connects to the accretion flow of the black hole. Close to the black hole, the emission profile of the jet-launching region is wider than the expected profile of a black-hole-driven jet, suggesting the possible presence of a wind associated with the accretion flow., 50 pages, 18 figures, 3 tables, author's version of the paper published in Nature

Purpose: To report the 12-month safety and efficacy outcomes of the investigational device exemption trial evaluating an implantable below-the-knee (BTK) dissection repair device. Materials and Methods: The prospective, multicenter, single-arm Tack-Optimized Balloon Angioplasty (TOBA) II BTK study ( ClinicalTrials.gov identifier NCT02942966) evaluated the Tack Endovascular System in the BTK arteries vs objective performance goals derived from a systematic review of BTK angioplasty literature. Patients presenting with Rutherford category 3–5 ischemia were eligible and were enrolled during the procedure if angioplasty resulted in dissection(s) of the BTK arteries. Between February 2017 and December 2018, the study enrolled 233 patients (mean age 74.4±10.0 years; 157 men). Most lesions (93.8%) were de novo; almost half (118/248, 47.6%) were total occlusions. Mean target lesion length was 80±49 mm. Moderate to severe calcium was present in 89 (35.8%) lesions. The 30-day primary safety endpoint was a composite of major adverse limb events (MALE) and all-cause perioperative death (POD). The primary efficacy endpoint was a composite of MALE at 6 months and 30-day POD. These safety and efficacy endpoints were assessed at 12 months as observational endpoints along with amputation-free survival (AFS), freedom from clinically-driven target lesion revascularization (CD-TLR), vessel patency, and changes from baseline in clinical and quality of life measures. Results: All patients had post-PTA dissection and received at least 1 Tack implant (range 1 to 16). The angiographic core laboratory noted successful resolution of 100% of the 341 treated dissections. At 12 months, 93.4% (170/182) of patients remained free of the composite endpoint of MALE + POD. Tacked segment patency was 81.3% and limb salvage was 96.8% at 12 months; freedom from CD-TLR and AFS were 83.1% and 89.3%, respectively. Sustained Rutherford category improvement was reported in 82.4% of evaluated patients, with 62.4% improving ≥3 categories (p

Nonurban residential living is associated with adverse outcomes for a number of chronic health conditions. However, it is unclear what effect it has amongst survivors of critical illness.The purpose of this study is to determine whether patients living greater than 50 km from the treating intensive care unit (ICU) have disability outcomes at 6 months that differ from people living within 50 km.This was a multicentre, prospective cohort study conducted in five metropolitan ICUs. Participants were adults admitted to the ICU, who received24 h of mechanical ventilation and survived to hospital discharge. In a secondary analysis of these data, the cohort was dichotomised based on residential distance from the treating ICU:50 km and ≥50 km. The primary outcome was patient-reported disability using the 12-item World Health Organization's Disability Assessment Schedule (WHODAS 2.0). This was recorded at 6 months after ICU admission by telephone interview. Secondary outcomes included health status as measured by EQ-5D-5L return to work and psychological function as measured by the Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression was used to assess the association between distance from the ICU and moderate to severe disability, adjusted for potential confounders. Variables included in the multivariable model were deemed to be clinically relevant and had baseline imbalance between groups (p0.10). These included marital status and hours of mechanical ventilation. Sensitivity analysis was also conducted using distance in kilometres as a continuous variable.A total of 262 patients were enrolled, and 169 (65%) lived within 50 km of the treating ICU and 93 (35%) lived ≥50 km from the treating ICU (interquartile range [IQR] 10-664 km). There was no difference in patient-reported disability at 6 months between patients living50 km and those living ≥50 km (WHODAS total disability % [IQR] 10.4 [2.08-25] v 14.6 [2.08-20.8], P = 0.74). There was also no difference between groups for the six major life domains of the WHODAS. There was no difference in rates of anxiety or depression as measured by HADS score (HADS anxiety median [IQR] 4 [1-7] v 3 [1-7], P = 0.60) (HADS depression median [IQR] 3 [1-6] v 3 [1-6], P = 0.62); health status as measured by EQ-5D (mean [SD] 66.7 [20] v 69.8 [22.2], P = 0.24); or health-related unemployment (% (N) 39 [26] v 25 [29.1], P = 0.61). After adjusting for confounders, living ≥50 km from the treating ICU was not associated with increased disability (odds ratio 0.61, 95% confidence interval: 0.33-1.16; P = 0.13) CONCLUSIONS: Survivors of intensive care in Victoria, Australia, who live at least 50 km from the treating ICU did not have greater disability than people living less than 50 km at 6 months after discharge. Living 50 km or more from the treating ICU was not associated with disability, nor was it associated with anxiety or depression, health status, or unemployment due to health.

Algae-based products have applications in the food and pharmaceutical industries, bioremediation of waste streams and biofuel production. Drying has been recognised to constitute the largest energy cost in algae processing, yet there is limited data or modelling characterising the drying kinetics of macroalgae. This research modelled the equilibrium moisture content of two macroalgae species, Ulva ohnoi, a saltwater alga and Oedogonium intermedium, a freshwater alga. The Guggenheim&ndash, Anderson&ndash, de Boer model was found to best represent experimental equilibrium moisture contents. Drying rate curves obtained under both convective and radiative conditions were fitted to an analytical solution of Fick&rsquo, s second law, including the modelled equilibrium moisture values. Effective diffusivity values for the two species are presented.

With recent downsizing of talented professionals and the power of globalization to provide opportunities for more underdeveloped countries, the gig economy is a source of influence in today�s generation of professionals. Online outsourcing media have shown to be valuable resources for companies who need a specific set of skills for a limited period. This case study evaluates Upwork.com, one of the leading freelance websites in the gig economy; this article provides insights on how others should evaluate the power of this new economy in terms of opportunities for small businesses, entrepreneurs, and freelancers. Upwork has led the pack by providing a flexible platform for freelancers worldwide, including coders, writers, and web developers, putting businesses in touch with reasonably priced workers. The study begins by exploring the attributes of the gig economy. Data collection is achieved through qualitative analysis. The application of these conclusions could increase the survival rate of new freelancers on Upwork.com and in the gig economy. The study is significant because this research widens contemporary assumptions about strategic thinking for individuals engaged in e-commerce.

To determine predictors of inability to return to work due to health six-months after intensive care admission; and compare functional recovery between patients who had not returned to work and employed patients.Participants were working adults admitted to ICU who received24 h of mechanical ventilation. Outcomes included inability to return to work due to health at six-months post-ICU admission, disability, health status, anxiety, depression and post-traumatic stress.Of 107 patients, 31 (29%) were unable to return to work due to health at six-months after ICU admission. Predictors of inability to return to work included longer hospital stay (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.08; P = .004); lower Glasgow Coma Scale (GCS) at admission (OR, 0.86; CI, 0.75-0.99; P = .03); and admission due to major trauma (OR, 8.83; CI, 2.57-30.38; P .001). Compared to employed patients, those who had not returned to work reported higher levels of disability and psychological distress, and poorer health-related quality of life.Major trauma, lower GCS and increased hospital length of stay predicted inability to return to work due to health at six-months post-ICU admission. Compared to employed patients, those who had not returned to work reported poorer functional recovery.

M87 is the best source in which to study a jet at high resolution in gravitational units because it has a very high mass black hole and is nearby. The angular size of the black hole is second only to Sgr A*, which does not have a strong jet. The jet structure is edge brightened with a wide opening angle base and a weak counterjet. We have roughly annual observations for 17 years plus intensive monitoring at three week intervals for a year and five day intervals for 2.5 months made with the Very Long Baseline Array (VLBA) at 43 GHz. The inner jet shows very complex dynamics, with apparent motions both along and across the jet. Speeds from zero to over 2c are seen, with acceleration observed over the first 3 milli-arcseconds. The counterjet decreases in brightness much more rapidly than the main jet, as is expected from relativistic beaming in an accelerating jet oriented near the line-of-sight. Details of the structure and dynamics are discussed. The roughly annual observations show side-to-side motion of the whole jet with a characteristic time scale of about 9 years., 11 pages, 7 figures. Published in a special issue of Galaxies which is the proceedings of "Blazars through Sharp Multi-Wavelength Eyes" edited by J. L. Gomez, A. P. Marscher, and S. G. Jorstad

In the Results section, under the subheading “Return to work or usual activities”, the second sentence should read.

With an emphasis on reducing fossil fuel consumption and emissions, major delivery service corporations have begun deploying and operating Class 6 zero emissions delivery vans. Battery electric delivery vans are currently available, but their range is a limitation and doesn't offer flexibility in assigning vehicles to delivery routes. Fuel cell hybrid delivery vans offer a zero emissions solution with extended range and route planning flexibility. In a competitive market, a delivery van design that trades the fuel cell and battery size, performance, and cost is critical to the success and adoption of these zero emissions trucks. This paper outlines a systematic approach using real world operational data and duty cycles to properly size the fuel cell and battery for a zero emissions hybrid delivery van. The approach uses real world GPS data to define routes and duty cycles, along with vehicle powertrain models to assess performance capabilities. The study suggests that a 32 kW fuel cell power system paired with a 49 kWh battery energy storage system and 15 kg of hydrogen storage is a desired option to complete the most demanding parcel and delivery duty cycles.

To use the World Health Organisation’s International Classification of Functioning to measure disability following critical illness using patient-reported outcomes. A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been admitted to the ICU, received more than 24 h of mechanical ventilation and survived to hospital discharge. The primary outcome was measurement of disability using the World Health Organisation’s Disability Assessment Schedule 2.0. The secondary outcomes included the limitation of activities and changes to health-related quality of life comparing survivors with and without disability at 6 months after ICU. We followed 262 patients to 6 months, with a mean age of 59 ± 16 years, and of whom 175 (67%) were men. Moderate or severe disability was reported in 65 of 262 (25%). Predictors of disability included a history of anxiety/depression [odds ratio (OR) 1.65 (95% confidence interval (CI) 1.22, 2.23), P = 0.001]; being separated or divorced [OR 2.87 (CI 1.35, 6.08), P = 0.006]; increased duration of mechanical ventilation [OR 1.04 (CI 1.01, 1.08), P = 0.03 per day]; and not being discharged to home from the acute hospital [OR 1.96 (CI 1.01, 3.70) P = 0.04]. Moderate or severe disability at 6 months was associated with limitation in activities, e.g. not returning to work or studies due to health (P

V. Pettilä on työryhmän ARISE Investigators jäsen. Study objective: The influence of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) on the conduct of future sepsis research is unknown. We seek to examine the potential effect of the new definitions on the identification and outcomes of patients enrolled in a sepsis trial. Methods: This was a post hoc analysis of the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial of early goal-directed therapy that recruited 1,591 adult patients presenting to the emergency department (ED) with early septic shock diagnosed by greater than or equal to 2 systemic inflammatory response syndrome criteria and either refractory hypotension or hyperlactatemia. The proportion of participants who would have met the Sepsis-3 criteria for quick Sequential Organ Failure Assessment (qS0FA) score, sepsis (an increased Sequential Organ Failure Assessment score >= 2 because of infection) and septic shock before randomization, their baseline characteristics, interventions delivered, and mortality were determined. Results: There were 1,139 participants who had a qSOFA score of greater than or equal to 2 at baseline (71.6% [95% confidence interval [Cl) 69.4% to 73.8%]). In contrast, 1,347 participants (84.7% [95% CI 82.9% to 86.4%]) met the Sepsis-3 criteria for sepsis. Only 1,010 participants were both qSOFA positive and met the Sepsis-3 criteria for sepsis (63.5% [95% CI 61.1% to 65.8%]). The Sepsis-3 definition for septic shock was met at baseline by 203 participants (12.8% [95% CI 11.2% to 14.5%]), of whom 175 (86.2% [95% CI 81.5% to 91.0%]) were also qSOFA positive. Ninety-day mortality for participants fulfilling the Sepsis-3 criteria for sepsis and septic shock was 20.4% (95% CI 18.2% to 22.5%) (274/1,344) and 29.6% (95% CI 23.3% to 35.8% [60/203]) versus 9.4% (95% CI 5.8% to 13.1%) (23/244) and 17.1% (95% CI 15.1% to 19.1% [237/1,388]), respectively, for participants not meeting the criteria (risk differences 11.0% [95% CI 6.2% to 14.8%] and 12.5% [95% CI 6.3% to 19.4%], respectively). Conclusion: Most ARISE participants did not meet the Sepsis-3 definition for septic shock at baseline. However, the majority fulfilled the new sepsis definition and mortality was higher than for participants not fulfilling the criteria. A quarter of participants meeting the new sepsis definition did not fulfill the qSOFA screening criteria, potentially limiting its utility as a screening tool for sepsis trials with patients with suspected infection in the ED. The implications of the new definitions for patients not eligible for recruitment into the ARISE trial are unknown.

The central radio source in M87 provides the best opportunity to study jet formation because it has a large angular size for the gravitational radius of the black hole and has a bright jet that is well resolved by VLBI observations. We present intensive monitoring observations from 2007 and 2008, plus roughly annual observations that span 17 years, all made with the the Very Long Baseline Array at 43 GHz with a resolution of about 30 by 60 Rs. Our high-dynamic-range images clearly show the wide-opening-angle structure and the counter-jet. The jet and counter-jet are nearly symmetric in the inner 1.5 milli-arcseconds (mas; 0.12 pc in projection) with both being edge brightened. Both show deviations from parabolic shape in the form of an initial rapid expansion and subsequent contraction followed by further rapid expansion and, beyond the visible counter-jet, subsequent collimation. Proper motions and counter-jet/jet intensity ratios both indicate acceleration from apparent speeds of $\lesssim 0.5c$ to $\gtrsim 2c$ in the inner about 2 mas and suggest a helical flow. The jet displays a sideways shift with an approximately 8 to 10 year quasi-periodicity. The shift propagates outwards non-ballistically and significantly more slowly than the flow speed revealed by the fastest moving components. Polarization data show a systematic structure with magnetic field vectors that suggest a toroidal field close to the core., 49 pages, 25 figures (one double). 4 tables, 3 animations. Accepted for publication in the Astrophysical Journal. The animations are provided in the ancillary files

Introduction Despite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in this study was to test the safety and feasibility of mobilization in this population. Methods A total of 33 patients undergoing continuous renal replacement therapy via femoral, subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled. Patients underwent one of three levels of mobilization intervention as appropriate: (1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching. Catheter dislodgement, haematoma and bleeding during and following interventions were evaluated. Filter pressure parameters and lifespan (hours), nursing workload and concern were also measured. Results No episodes of filter occlusion or failure occurred during any of the interventions. No adverse events were detected. The intervention filters lasted longer than the nonintervention filters (regression coefficient = 13.8 (robust 95% confidence interval (CI) = 5.0 to 22.6), P = 0.003). In sensitivity analyses, we found that filter life was longer in patients who had more position changes (regression coefficient = 2.0 (robust 95% CI = 0.6 to 3.5), P = 0.007). The nursing workloads between the intervention shift and the following shift were similar. Conclusions Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life. These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011) Electronic supplementary material The online version of this article (doi:10.1186/cc14001) contains supplementary material, which is available to authorized users.

Objective/Scope In Q4 2012, the 8” Teal dynamic riser required replacement. A project team was assembled to remove the existing riser and install a replacement. The riser was originally installed in the 1990's by divers based on the Anasuria Floating Production Storage Offloading (FPSO). The FPSO facilities that were used to provide diver access into the chain table area to secure the bend restrictor were no longer operational. Previous diver intervention at the chain table had experienced high levels of non-productive time, so a remote removal method to cut and lower the riser and bend restrictor to the seabed was pursued. Methods, Procedures, Process The project team initiated a concept study to set the challenge to release the riser from the FPSO remotely to a) reduce HSE risk; b) de-risk project by separating release campaign from recovery campaign and c) perform the work offshore using a very small team (FPSO bedding constraints was one of the reasons the team didn't use an air dive team to do it from the FPSO). The concept selected was largely based on a method used for removal of other similar risers in 1999 albeit that all that remained from that campaign was a PowerPoint presentation. The majority of engineering calculations and drawings could not be located. Results, Observations, Conclusions The tooling was designed, fabricated and tested in less than 6 months from award of contract to offshore operations. During the offshore campaign, various issues were encountered (e.g. incorrect ‘as built‘ documentation) but the remote removal campaign was a success with both the riser and its bend restrictor being removed from the FPSO without requiring any diver intervention, thus reducing the project costs and HSE exposure. Novel/Additive Information Lessons learned from the offshore campaign are being captured with the concept being further refined to allow the removal of the riser and bend restrictor without first having to cut and remove the topside riser end fitting. This should reduce the offshore operational time for any future riser removals and remove the risks associated with unknown internal condition of the riser.