Background: Despite significant advances in the treatment of neurological disorders, many conditions remain palliative. Neurologists are in a unique position as they are integral in providing patient centered care, understanding neurologic disease and illness trajectory, and how disease can affect patients’ sense of self and values. Currently, little is known about neurologists’ perceptions and challenges in care planning and palliative care for their patients. Methods: A qualitative approach was utilized with semi-structured interviews of ten neurologists. Data was analyzed using a constant comparative method (constructivist grounded theory). Results: Participants represented a broad spectrum of neurologist experience and subspecialties. Four theories were identified: (1) care planning and palliative care are high priorities, (2) neurologic diseases uniquely affect patients and require a dynamic, patient-centered care plan, (3) a care gap exists in providing palliative care for neurologic patients with multifactorial barriers, and (4) opportunities to improve care exist with continuing education, collaboration, and health system support. Conclusions: Neurologists have a key role in care planning and palliative care for patients with chronic neurological diseases. Our findings show that there is a gap in the provision of palliative care. Future directions may include exploring educational opportunities and dedicated health systems to improve care management.

Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.

Yukon Territory (YT) is a remote region in northern Canada with ongoing spread of tuberculosis (TB). To explore the utility of whole genome sequencing (WGS) for TB surveillance and monitoring in a setting with detailed contact tracing and interview data, we used a mixed-methods approach. Our analysis included all culture-confirmed cases in YT (2005–2014) and incorporated data from 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) genotyping, WGS and contact tracing. We compared field-based (contact investigation (CI) data + MIRU-VNTR) and genomic-based (WGS + MIRU-VNTR + basic case data) investigations to identify the most likely source of each person's TB and assessed the knowledge, attitudes and practices of programme personnel around genotyping and genomics using online, multiple-choice surveys (n = 4) and an in-person group interview (n = 5). Field- and genomics-based approaches agreed for 26 of 32 (81%) cases on likely location of TB acquisition. There was less agreement in the identification of specific source cases (13/22 or 59% of cases). Single-locus MIRU-VNTR variants and limited genetic diversity complicated the analysis. Qualitative data indicated that participants viewed genomic epidemiology as a useful tool to streamline investigations, particularly in differentiating latent TB reactivation from the recent transmission. Based on this, genomic data could be used to enhance CIs, focus resources, target interventions and aid in TB programme evaluation.

Few studies have used genomic epidemiology to understand tuberculosis (TB) transmission in rural and remote settings – regions often unique in history, geography and demographics. To improve our understanding of TB transmission dynamics in Yukon Territory (YT), a circumpolar Canadian territory, we conducted a retrospective analysis in which we combined epidemiological data collected through routine contact investigations with clinical and laboratory results. Mycobacterium tuberculosis isolates from all culture-confirmed TB cases in YT (2005–2014) were genotyped using 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) and compared to each other and to those from the neighbouring province of British Columbia (BC). Whole genome sequencing (WGS) of genotypically clustered isolates revealed three sustained transmission networks within YT, two of which also involved BC isolates. While each network had distinct characteristics, all had at least one individual acting as the probable source of three or more culture-positive cases. Overall, WGS revealed that TB transmission dynamics in YT are distinct from patterns of spread in other, more remote Northern Canadian regions, and that the combination of WGS and epidemiological data can provide actionable information to local public health teams.

Clostridium difficile, the most common cause of hospital-associated diarrhoea in developed countries, presents major public health challenges. The high clinical and economic burden from C. difficile infection (CDI) relates to the high frequency of recurrent infections caused by either the same or different strains of C. difficile. An interval of 8 weeks after index infection is commonly used to classify recurrent CDI episodes. We assessed strains of C. difficile in a sample of patients with recurrent CDI in Western Australia from October 2011 to July 2017. The performance of different intervals between initial and subsequent episodes of CDI was investigated. Of 4612 patients with CDI, 1471 (32%) were identified with recurrence. PCR ribotyping data were available for initial and recurrent episodes for 551 patients. Relapse (recurrence with same ribotype (RT) as index episode) was found in 350 (64%) patients and reinfection (recurrence with new RT) in 201 (36%) patients. Our analysis indicates that 8- and 20-week intervals failed to adequately distinguish reinfection from relapse. In addition, living in a non-metropolitan area modified the effect of age on the risk of relapse. Where molecular epidemiological data are not available, we suggest that applying an 8-week interval to define recurrent CDI requires more consideration.

Excitable temperament disrupts physiological events required for reproductive development in cattle, but no research has investigated the impacts of temperament on growth and puberty attainment in Bos indicus females. Hence, this experiment evaluated the effects of temperament on growth, plasma cortisol concentrations and puberty attainment in B. indicus heifers. A total of 170 Nelore heifers, weaned 4 months before the beginning of this experiment (days 0 to 91), were managed in two groups of 82 and 88 heifers each (mean ± SE; initial BW=238±2 kg, initial age=369±1 days across groups). Heifer temperament was evaluated via exit velocity on day 0. Individual exit score was calculated within each group by dividing exit velocity into quintiles and assigning heifers with a score from 1 to 5 (1=slowest; 5=fastest heifer). Heifers were classified according to exit score as adequate (ADQ, n=96; exit score⩽3) or excitable temperament (EXC, n=74; exit score>3). Heifer BW, body condition score (BCS) and blood samples were obtained on days 0, 31, 60 and 91. Heifer exit velocity and score were recorded again on days 31, 60 and 91. Ovarian transrectal ultrasonography was performed on days 0 and 10, 31 and 41, 60 and 70, 81 and 91 for puberty evaluation. Heifer was declared pubertal at the first 10-day interval in which a corpus luteum was detected. Exit velocity and exit score obtained on day 0 were correlated (r⩾0.64, P<0.01) with evaluations on days 31, 60 and 91. During the experiment, ADQ had greater (P<0.01) mean BCS and BW gain, and less (P<0.01) mean plasma cortisol concentration compared with EXC heifers. Temperament × time interactions were detected (P<0.01) for exit velocity and exit score, which were always greater (P<0.01) in EXC v. ADQ heifers. A temperament × time interaction was also detected (P=0.03) for puberty attainment, which was delayed in EXC v. ADQ heifers. At the end of the experiment, a greater (P<0.01) proportion of ADQ were pubertal compared with EXC heifers. In summary, B. indicus heifers classified as EXC had reduced growth, increased plasma cortisol concentrations and hindered puberty attainment compared to ADQ heifers. Moreover, exit velocity may serve as temperament selection criteria to optimize development of B. indicus replacement heifers.

To evaluate the effects of a polyunsaturated fatty acids (PUFA) supplement on reproductive parameters of suckled beef cows, two experiments were conducted. In Experiment (Exp.) 1, 60 primiparous cows were randomly assigned to one of two treatments: CTRL – 1.36 kg/day of corn gluten feed (CGF) and MEGR – 1.36 kg/day of CGF and 0.23 kg/day of calcium salts of soybean oil. Supplementation occurred from 30 days before fixed-time artificial insemination (TAI) until 7 days post-TAI. The expression of interferon-stimulated genes (ISG) was measured on days 18 and 21. Pregnancy rates were diagnosed on days 30 and 100. Treatment altered plasma fatty acid profile (P<0.05), however, did not change cow BW (P=0.52) or body condition score (BCS) (P=0.52). Treatment did not alter (P=0.12) pregnancy rates to TAI or final pregnancy rates (P=0.56). Treatments did not impact messenger RNA (mRNA) expression of the ISG OAS1 or MX2 on days 18 (P=0.67; P=0.96, respectively) or 21 (P=0.72; P=0.17, respectively). Length of gestation was greater (P=0.02) for MEGR, however, treatments did not alter calf birth weight (P=0.20). In Exp. two, 66 multiparous cows were assigned to one of two treatments: MEG – 0.65 kg/day of CGF+0.23 kg/day of calcium salts of palm oil and MEGR – 0.65 kg/day of CGF+0.23 kg/day of Ca salts of soybean oil. Cows were supplemented from 30 days prepartum to 30 days postpartum. On day 35 after TAI, pregnancy status, embryo crown-to-rump length (CRL), and plasma concentrations of pregnancy-specific protein-B (PSPB) were evaluated. Treatment altered plasma fatty acid profile (P<0.05). In addition, cows from the MEG treatment had greater BW (P<0.01) and BCS (P<0.01) than those in the MEGR treatment, as well as heavier calves at weaning (P=0.03). Treatment did not affect resumption of estrous cycle (P=0.29). There were no differences in pregnancy rates to TAI (P=0.87) or final pregnancy rates (P=0.29). No differences between treatments were detected on CRL (P=0.24) and plasma concentrations of PSPB (P=0.46). Birth weight (P=0.12) and calving distribution (P=0.52) were not altered. We concluded that PUFA supplementation altered plasma fatty acid profile, however, did not impact the remaining reproductive parameters evaluated.

The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.

Introduction: 2.6% of emergency department (ED) syncope patients will have underlying cardiac serious conditions (e.g. arrhythmia, serious structural heart disease) identified within 30-days of disposition. If those at risk are discharged home, outpatient cardiac testing can detect underlying arrhythmias and structural heart disease, and thereby improve patient safety. We describe the frequency of outpatient referrals for cardiac testing and the proportion of cardiac serious adverse events (SAE) among high risk and non-high (low and medium) risk ED syncope patients, as defined by the Canadian Syncope Risk Score (CSRS). Methods: We conducted a multicenter prospective cohort study to enroll adult syncope patients across five large tertiary care EDs. We collected demographics, medical history, disposition, CSRS value, outpatient referrals and testing results (holter, echocardiography), and cardiac SAE. Adjudicated 30-day SAE included death due to unknown cause, myocardial infarction, arrhythmia, and structural heart disease. We used descriptive analysis. Results: Of 4,064 enrolled patients, a total of 955 patients (23%) received an outpatient referral (mean age 57.7 years, 52.1% female). Of the 299 patients (7%) hospitalized, 154 received outpatient cardiac testing after discharge. Among the 3,765 patients discharged home from the ED, 40% of the non-high risk patients (305/756) and 56% of the high risk patients (25/45) received outpatient cardiac testing. Of all patients who received outpatient cardiac testing, 4 patients (0.8%) had serious cardiac conditions identified and all were arrhythmias. Among those with no cardiac testing, 5 patients (0.9%) suffered cardiac SAE (80% arrhythmias) outside the hospital. Of the 20 (44%) high risk patients who did not receive outpatient cardiac testing, 2 (10%) patients suffered arrhythmias outside the hospital. While among the 451 non-high risk patients, only 0.8% suffered arrhythmia outside the hospital. Conclusion: Outpatient cardiac testing among ED syncope patients is largely underutilized, especially among high risk patients. Better guidelines for outpatient cardiac testing are needed, as current practice is highly variable and mismatched with patient risk.

Introduction: Syncope is a common emergency department (ED) presentation and constitutes 1% of all ED visits, approximately 160,000 visits annually across Canada. Lack of standardized syncope care has economic and cost implications. Currently, emergency medical services (EMS) is over utilized, variations in ED management exist and a substantial proportion (46.5%) are hospitalized for cardiac monitoring. Our previous studies have proposed ways to reduce health care utilization through development of EMS clinical decision tool, ED risk scores and remote cardiac monitoring. We sought to: 1) Estimate costs associated with syncope care in the pre-hospital, ED and inpatient settings; and 2) Determine potential cost savings if the proposed alternate strategies were adopted. Methods: A prospective cohort study was conducted in five Canadian EDs from 2010-2014. We enrolled adult (≥16 years) syncope patients and excluded those with prolonged loss of consciousness, mental status changes, seizure, significant trauma, or alcohol/illicit drug abuse. Demographics, medical history, mode of arrival, EMS time points, reasons for hospitalization, ED and inpatient length of stay, final ED diagnosis and any serious adverse event within 30 days of index visit were collected. Descriptive and inferential statistics were used. Results: Out of 4,064 patients enrolled, 67.3% were transported to the ED by EMS and the average cost per event was $262.78 (range at study sites: $156.43-$553.03). The average cost per ED visit was $267.98 (range: $174.66-$374.95). 12.9% of the patients were admitted and the average of cost per admission was $9,886.15 (range: $9,715.23-$10,277.98). Syncope is associated with an estimated total annual cost of $257 million. In Canada, we estimate that diverting low-risk patients will save $5 million in the pre-hospital setting and $15 million in the ED annually, and implementing a remote cardiac monitoring strategy will save $50 million annually. Conclusion: It is estimated that the proposed strategies will save $70 million annually. This is likely an underestimation as cost savings due to reduction in investigations related to diversion of ED patients, reduction in ED length of stay and hospitalization are unaccounted. Adoption of similar strategies will likely lead to significantly higher cost savings in countries with higher resource utilization for syncope management.

The established control anticipation parameter longitudinal handling qualities criterion is based on the assumption that the short term dynamic response of the aeroplane is classical, or second-order-like. Modern fly-by-wire aircraft often have longitudinal short term dynamics which are not second-order-like and to which it is difficult to apply the criterion. This paper presents a proposed generic control anticipation parameter which is a modified version of the control anticipation parameter and which may be applicable to both unaugmented and augmented aircraft of all types. The appropriateness of the modified criterion was illustrated by designing a number of command and stability augmentation control laws, constrained to meet the criterion, for application to a medium weight fly-by-wire civil transport aircraft. The handling characteristics conferred by the control laws were assessed in a series of flight simulator trials, the results of which are briefly presented.

This paper describes and compares various analyses leading to the development of approximate models for the linear stability modes of the non-rigid airship. The progress of the analyses was variously dependent on assumptions made from the detailed scrutiny of linear numerical models for three airships. For each airship studied, the linear models were obtained from non-linear simulation models by linearising about a number of chosen trim speeds representative of a typical speed envelope. The decoupled linear models comprised the longitudinal and lateral-directional state equations of the neutrally buoyant airship, for speeds from the hover to 30m/sec. Since the fidelity of the earliest airship models was not known, the principal purpose of this paper is to re-visit the original analysis using a later airship model of known excellent fidelity.

The longitudinal modes of the airship comprise the surge mode, the heave-pitch subsidence mode and the oscillatory pitch-incidence mode. The lateral-directional modes of the airship comprise the sideslip subsidence mode, the yaw subsidence mode and the oscillatory roll pendulum mode. Approximate models for these modes are derived and expressed in terms of concise aerodynamic stability derivatives. The mode characteristics are discussed, and the approximate models are compared with the actual airship modes over the typical airspeed envelope.

This paper describes a comparative evaluation of two data smoothing algorithms for use in a two step estimation-beforemodelling procedure for aircraft parameter identification. A simple fixed lag smoother is compared with the usual, and more complex, modified-Bryson-Frazier smoother in the first, state estimation, step of the aircraft parameter identification procedure. The comparison is illustrated by application to the analysis of the Dutch Roll motion of the Embraer EMB-312 Tucano. Both algorithms were found to give results of comparable accuracy although the fixed lag smoother is computationally more efficient. It was concluded that the fixed lag smoother algorithm is an acceptable alternative to the modified-Bryson-Frazier algorithm in aircraft parameter identification applications.

This paper relates to a recent project in which the aim was to devise a procedure that could be used to identify the linearised transfer functions of the longitudinal motion of the solar powered airship Lotte from flight test data.

Using a non-linear mathematical model of the Airship, a linearised state space model was derived numerically and this was used to derive the response transfer functions, which formed the theoretical results. A test procedure was then developed to identify the transfer functions experimentally from frequency response data obtained in simulated flight tests. Initially, the linearised model was used and the test procedure was refined until a suitable level of coherence between the experimental and theoretical results was observed. The test procedure was then applied to simulated flight test data from the non-linear model, and finally sensor noise was added in order to represent actual flight test conditions as closely as possible. Unfortunately, the results were inaccurate and in some cases, they were unacceptable. When the test procedure was applied to the non-linear model, significant errors were seen in all the results. The addition of sensor noise led to heavily distorted results and a further degradation of the resulting transfer function estimates.

It was concluded that meaningful results could not be achieved unless frequency response data with a higher resolution could be obtained and the effects of sensor noise could be reduced. Presently, no test procedure has been developed that would be of any use in a practical situation. However, a number of ways of possibly improving the test procedure or otherwise improving the quality of the results were conceived near the end of the project. It is therefore the purpose of this paper to account for the shortcomings that were encountered in the project and to introduce briefly the unexplored remedies, in the hope that these may be of some benefit to future identification studies.

A future advanced supersonic transport aircraft (AST) has fundamental characteristics and problems inherent to supersonic cruise aircraft with corresponding unique control and handling characteristics.

In order to optimise the aerodynamic performance across the full flight envelope a fully integrated flight and propulsion control system will be required. However, this will need to be designed from the outset within clearly defined flight control and performance guidelines.

Relevant existing and AST specific handling qualities criteria will need to be developed if a successful commercial transport aircraft is to be produced.

This paper begins by presenting an overview of existing supersonic transport (SST) aircraft operations and current second generation SST research activities and design considerations. This is followed by an analysis of the principal aerodynamic, dynamic and control characteristics of SST and AST aircraft and their effect on the aircraft’s handling qualities. Finally, some possible solutions to the control and handling issues are investigated, assessed and presented.

This paper describes the development of a simple theory of the longitudinal static stability of the hang-glider. The classical theory, as developed for the conventional aeroplane, is modified to accommodate the particular features of the hang-glider. When the appropriate assumptions are made, the theory provides simple insight into the controls fixed and controls free stability and control characteristics of the hang-glider. The validity of the theoretical models is successfully demonstrated by application to a typical fifth generation hang-glider wing for which good quality aerodynamic data were available.

Introduction: Syncope can be caused by serious life-threatening conditions not obvious during the initial ED assessment leading to wide variations in management. We aimed to identify the reasons for consultations and hospitalizations, outcomes, and the potential cost savings if an outpatient cardiac monitoring strategy were developed. Methods: We conducted a prospective cohort study of adult syncope patients at 5 academic EDs over 41 months. We collected baseline characteristics, reasons for consultation and hospitalization, hospital length of stay and average total inpatient cost. Adjudicated 30-day serious adverse events (SAEs) included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage and procedural intervention. We used descriptive statistics with 95% CI. Results: Of the 4,064 patients enrolled (mean age 53.1 years, 55.9% female), 3,255 (80.1%) were discharged from the ED, 209 (5.2%) had a SAE identified in the ED, 600 (14.8%) with no SAE were referred for consultation in the ED and 299 (7.4%) were hospitalized: 55.5% of referrals and 55.2% of hospitalizations were for suspected cardiac syncope (46.5% admitted for cardiac monitoring of whom 71.2% had no cause identified). SAE among groups were 9.7% in total; 2.5% discharged by ED physician; 3.4% discharged by consultant from ED; 21.7% as inpatient and 4.8% following discharge from hospital. The mean hospital length of stay for cardiac syncope was 6.7 (95%CI 5.8, 7.7) days with total estimated costs of $7,925 per patient (95% CI: 7434, 8417). Conclusion: Suspected cardiac syncope, particularly arrhythmia, was the major reason for ED referral and hospitalization. The majority of patients hospitalized for cardiac monitoring had no identified cause. An important number of patients suffered SAE, particularly arrhythmias outside the hospital. These findings highlight the need to develop a robust syncope prediction tool and a remote cardiac monitoring strategy to improve patient safety while saving substantial health care resources.