The most intensively star-forming galaxies are extremely luminous at far-infrared (FIR) wavelengths, highly obscured at optical and ultraviolet wavelengths, and lie at z ≥ 1-3. We present a programme ...of FIR spectroscopic observations with the SPIRE FTS, as well as photometric observations with PACS, both on board Herschel, towards a sample of 45 gravitationally lensed, dusty starbursts across z ∼ 1-3.6. In total, we detected 27 individual lines down to 3 σ, including nine C II 158 μm lines with confirmed spectroscopic redshifts, five possible C II lines consistent with their FIR photometric redshifts, and in some individual sources a few O III 88 μm, O III 52 μm, O I 145 μm, O I 63 μm, N II 122 μm and OH 119 μm (in absorption) lines. To derive the typical physical properties of the gas in the sample, we stack all spectra weighted by their intrinsic luminosity and by their 500μm flux densities, with the spectra scaled to a common redshift. In the stacked spectra, we detect emission lines of C II 158 μm, N II 122 μm, O III 88 μm, O III 52 μm, O I 63 μm and the absorption doublet of OH at 119 μm, at high fidelity. We find that the average electron densities traced by the N II and O III lines are higher than the average values in local star-forming galaxies and ULIRGs, using the same tracers. From the N II/C II and O I/C II ratios, we find that the C II emission is likely dominated by the photodominated regions (PDR), instead of by ionized gas or large-scale shocks.
The Herschel Spectral and Photometric REceiver (SPIRE) instrument consists of an imaging photometric camera and an imaging Fourier Transform Spectrometer (FTS), both operating over a frequency range ...of ∼450–1550 GHz. In this paper, we briefly review the FTS design, operation, and data reduction, and describe in detail the approach taken to relative calibration (removal of instrument signatures) and absolute calibration against standard astronomical sources. The calibration scheme assumes a spatially extended source and uses the Herschel telescope as primary calibrator. Conversion from extended to point-source calibration is carried out using observations of the planet Uranus. The model of the telescope emission is shown to be accurate to within 6 per cent and repeatable to better than 0.06 per cent and, by comparison with models of Mars and Neptune, the Uranus model is shown to be accurate to within 3 per cent. Multiple observations of a number of point-like sources show that the repeatability of the calibration is better than 1 per cent, if the effects of the satellite absolute pointing error (APE) are corrected. The satellite APE leads to a decrement in the derived flux, which can be up to ∼10 per cent (1 σ) at the high-frequency end of the SPIRE range in the first part of the mission, and ∼4 per cent after Herschel operational day 1011. The lower frequency range of the SPIRE band is unaffected by this pointing error due to the larger beam size. Overall, for well-pointed, point-like sources, the absolute flux calibration is better than 6 per cent, and for extended sources where mapping is required it is better than 7 per cent.
Universal health care systems have been organized in most industrialized nations with a view to ensuring equitable access to medical services and improving health status for all citizens. Canada's ...federal–provincial Medicare plan covers all medically necessary services provided by hospitals and physicians without any user fees and is based on the principle of access according to need rather than income.
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Considerable evidence suggests that Medicare has improved access to health services for poorer Canadians,
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but some studies have found that those of low socioeconomic status remain less likely to receive specific services than wealthier patients.
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Guidelines recommend that patients suffering an ischaemic transient ischaemic attack (TIA) or stroke caused by carotid artery stenosis should undergo carotid endarterectomy (CEA) within 14 days.
The ...degree to which UK vascular units met this standard was examined and whether rapid interventions were associated with procedural risks. The study analysed patients undergoing CEA between January 2009 and December 2014 from 100 UK NHS hospitals. Data were collected on patient characteristics, intervals of time from symptoms to surgery, and 30-day postoperative outcomes. The relationship between outcomes and time from symptom to surgery was evaluated using multilevel multivariable logistic regression.
In 23,235 patients, the median time from TIA/stroke to CEA decreased over time, from 22 days (IQR 10–56) in 2009 to 12 days (IQR 7–26) in 2014. The proportion of patients treated within 14 days increased from 37% to 58%. This improvement was produced by shorter times across the care pathway: symptoms to referral, from medical review to being seen by a vascular surgeon, and then to surgery. The spread of the median time from symptom to surgery among NHS hospitals shrank between 2009 and 2013 but then grew slightly. Low-, medium-, and high-volume NHS hospitals all improved their performance similarly. Performing CEA within 48 h of symptom onset was associated with a small increase in the 30-day stroke and death rate: 3.1% (0–2 days) compared with 2.0% (3–7 days); adjusted odds ratio 1.64 (95% CI 1.04–2.59) but not with longer delays.
The delay from symptom to CEA in symptomatic patients with ipsilateral 50–99% carotid stenoses has reduced substantially, although 42% of patients underwent CEA after the recommended 14 days. The risk of stroke after CEA was low, but there may be a small increase in risk during the first 48 h after symptoms.
Advances in antiemetic therapy for chemotherapy-induced emesis have resulted in improved protection against symptoms occurring within 24 h of chemotherapy. However, the vomiting which tends to occur ...beyond 24 h after chemotherapy (delayed-phase vomiting) is still relatively poorly controlled by the currently available drugs, suggesting that more than one mechanism may mediate these symptoms. The standard antiemetic regimen currently recommended for prevention of chemotherapy-induced emesis includes a serotonin (5-HT3) antagonist and a corticosteroid. The neurokinin-1 (NK1) antagonist aprepitant represents a new class of antiemetic currently in clinical development. Using data obtained in 2 Phase II clinical trials of aprepitant in patients receiving chemotherapy based on the highly emetogenic chemotherapeutic agent cisplatin, we compared the time course of antiemetic effect of aprepitant, a 5-HT3 antagonist, or a combination of both. Over the entire observation period (up to 7 days post-cisplatin), patients who received the NK1 antagonist had a superior prevention of emesis. However, in the first 24 h after cisplatin, emesis occurred in fewer patients who received the 5-HT3 antagonist than in patients who did not receive this class of drug. Furthermore, the majority of treatment failures in patients who received the NK1 antagonist occurred within the first 8–12 h of chemotherapy, whereas the treatment failures in patients who received a 5-HT3 antagonist were more evenly distributed over time. Patients who received both drugs had superior control of symptoms compared with patients who received one or the other. The difference in the time course of emesis blockade observed with two different classes of receptor antagonists provides substantial evidence for involvement of separate pathophysiological mechanisms in chemotherapy-induced vomiting. Serotonin mediates the early vomiting process that occurs within 8–12 h following cisplatin-based chemotherapy, after which time substance P acting at NK1 receptors becomes the dominant mediator of vomiting
Background
Subclinical hyperthyroidism (SHyper) has been associated with increased risk of hip and other fractures, but the linking mechanisms remain unclear.
Objective
To investigate the association ...between subclinical thyroid dysfunction and bone loss.
Methods
Individual participant data analysis was performed after a systematic literature search in MEDLINE/EMBASE (1946–2016). Two reviewers independently screened and selected prospective cohorts providing baseline thyroid status and serial bone mineral density (BMD) measurements. We classified thyroid status as euthyroidism (thyroid‐stimulating hormone TSH 0.45–4.49 mIU/L), SHyper (TSH < 0.45 mIU/L) and subclinical hypothyroidism (SHypo, TSH ≥ 4.50–19.99 mIU/L) both with normal free thyroxine levels. Our primary outcome was annualized percentage BMD change (%ΔBMD) from serial dual X‐ray absorptiometry scans of the femoral neck, total hip and lumbar spine, obtained from multivariable regression in a random‐effects two‐step approach.
Results
Amongst 5458 individuals (median age 72 years, 49.1% women) from six prospective cohorts, 451 (8.3%) had SHypo and 284 (5.2%) had SHyper. During 36 569 person‐years of follow‐up, those with SHyper had a greater annual bone loss at the femoral neck versus euthyroidism: %ΔBMD = −0.18 (95% CI: −0.34, −0.02; I2 = 0%), with a nonstatistically significant pattern at the total hip: %ΔBMD = −0.14 (95% CI: −0.38, 0.10; I2 = 53%), but not at the lumbar spine: %ΔBMD = 0.03 (95% CI: −0.30, 0.36; I2 = 25%); especially participants with TSH < 0.10 mIU/L showed an increased bone loss in the femoral neck (%Δ BMD = −0.59; 95% CI: −0.99, −0.19) and total hip region (%ΔBMD = −0.46 95% CI: −1.05, −0.13). In contrast, SHypo was not associated with bone loss at any site.
Conclusion
Amongst adults, SHyper was associated with increased femoral neck bone loss, potentially contributing to the increased fracture risk.
The HER2 (ERBB2) and MYC genes are commonly amplified in breast cancer, yet little is known about their molecular and clinical interaction. Using a novel chimeric mammary transgenic approach and in ...vitro models, we demonstrate markedly increased self-renewal and tumour-propagating capability of cells transformed with Her2 and c-Myc. Coexpression of both oncoproteins in cultured cells led to the activation of a c-Myc transcriptional signature and acquisition of a self-renewing phenotype independent of an epithelial-mesenchymal transition programme or regulation of conventional cancer stem cell markers. Instead, Her2 and c-Myc cooperated to induce the expression of lipoprotein lipase, which was required for proliferation and self-renewal in vitro. HER2 and MYC were frequently coamplified in breast cancer, associated with aggressive clinical behaviour and poor outcome. Lastly, we show that in HER2(+) breast cancer patients receiving adjuvant chemotherapy (but not targeted anti-Her2 therapy), MYC amplification is associated with a poor outcome. These findings demonstrate the importance of molecular and cellular context in oncogenic transformation and acquisition of a malignant stem-like phenotype and have diagnostic and therapeutic consequences for the clinical management of HER2(+) breast cancer.
We present a power spectrum analysis of the Herschel-SPIRE observations of the Polaris flare, a high Galactic latitude cirrus cloud midway between the diffuse and molecular phases. The SPIRE images ...of the Polaris flare reveal for the first time the structure of the diffuse interstellar medium down to 0.01 parsec over a 10 square degrees region. These exceptional observations highlight the highly filamentary and clumpy structure of the interstellar medium even in diffuse regions of the map. The power spectrum analysis shows that the structure of the interstellar medium is well described by a single power law with an exponent of -2.7±0.1 at all scales from 30” to 8°. That the power spectrum slope of the dust emission is constant down to the SPIRE angular resolution is an indication that the inertial range of turbulence extends down to the 0.01 pc scale. The power spectrum analysis also allows the identification of a Poissonian component at sub-arcminute scales in agreement with predictions of the cosmic infrared background level at SPIRE wavelengths. Finally, the comparison of the SPIRE and IRAS 100 μm data of the Polaris flare clearly assesses the capability of SPIRE in maping diffuse emission over large areas.
Context. Fomalhaut is a young (2 +/- 1 x 10(8) years), nearby (7.7 pc), 2 M-circle dot star that is suspected to harbor an infant planetary system, interspersed with one or more belts of dusty ...debris. Aims. We present far-infrared images obtained with the Herschel Space Observatory with an angular resolution between 5.7 '' and 36.7 '' at wavelengths between 70 mu m and 500 mu m. The images show the main debris belt in great detail. Even at high spatial resolution, the belt appears smooth. The region in between the belt and the central star is not devoid of material; thermal emission is observed here as well. Also at the location of the star, excess emission is detected. We aim to construct a consistent image of the Fomalhaut system. Methods. We use a dynamical model together with radiative-transfer tools to derive the parameters of the debris disk. We include detailed models of the interaction of the dust grains with radiation, for both the radiation pressure and the temperature determination. Comparing these models to the spatially resolved temperature information contained in the images allows us to place strong constraints on the presence of grains that will be blown out of the system by radiation pressure. We use this to derive the dynamical parameters of the system. Results. The appearance of the belt points toward a remarkably active system in which dust grains are produced at a very high rate by a collisional cascade in a narrow region filled with dynamically excited planetesimals. Dust particles with sizes below the blow-out size are abundantly present. The equivalent of 2000 one-km-sized comets are destroyed every day, out of a cometary reservoir amounting to 110 Earth masses. From comparison of their scattering and thermal properties, we find evidence that the dust grains are fluffy aggregates, which indicates a cometary origin. The excess emission at the location of the star may be produced by hot dust with a range of temperatures, but may also be due to gaseous free-free emission from a stellar wind.
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