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Summary Background Antenatal corticosteroids given to women before preterm birth improve infant survival and health. However, whether dexamethasone or betamethasone have better maternal, neonatal, and childhood health outcomes remains unclear. We therefore aimed to assess whether administration of antenatal dexamethasone to women at risk of preterm birth reduced the risk of death or neurosensory disability in their children at age 2 years compared with betamethasone. We also aimed to assess whether dexamethasone reduced neonatal morbidity, had benefits for the mother, or affected childhood body size, blood pressure, behaviour, or general health compared with betamethasone. Methods In this multicentre, double-blind, randomised controlled trial, we recruited pregnant women from 14 maternity hospitals in Australia and New Zealand that could provide care to preterm babies. Women were eligible for study inclusion if they were at risk of preterm birth before 34 weeks of gestation, had a singleton or twin pregnancy, and had no contraindications to antenatal corticosteroids. We randomly assigned women (1:1) to receive two intramuscular injections of either 12 mg dexamethasone (dexamethasone sodium phosphate) or 11·4 mg betamethasone (Celestone Chronodose), 24 h apart. The randomisation schedule used balanced, variable blocks that were stratified by hospital, gestational age, and number of fetuses (singleton or twins). We masked all participants, staff, and assessors to treatment groups. Analyses were by intention to treat. The primary outcome was death or neurosensory disability at age 2 years (corrected for prematurity). This study is registered with ANZCTR, ACTRN12608000631303. Findings Between Jan 28, 2009, and Feb 1, 2013, we randomly assigned 1346 (78%) women who were pregnant with 1509 fetuses to groups: 679 (50%) women were assigned to receive dexamethasone and 667 (50%) women were assigned to receive betamethasone. 27 (4%) fetuses, infants, or children in the dexamethasone group and 28 (4%) fetuses, infants, or children in the betamethasone group died before age 2 years. The primary outcome of death or neurosensory disability at age 2 years was determined for 603 (79%) of 763 fetuses whose mothers received dexamethasone and 591 (79%) of 746 fetuses whose mothers received betamethasone. We found a similar incidence of death or neurosensory disability in the dexamethasone (198 [33%] of 603 infants) and betamethasone groups (192 [32%] of 591 infants; adjusted relative risk [adjRR] 0·97, 95% CI 0·83 to 1·13; p=0·66). 18 (3%) of 679 women in the dexamethasone group and 28 of 667 (4%) women in the betamethasone group reported side-effects. Discomfort at the injection site, the most frequent side-effect, was less likely in the dexamethasone group than in the betamethasone group (six [1%] women vs 17 [3%] women; p=0·02). Interpretation The incidence of survival without neurosensory disability at age 2 years did not differ between dexamethasone and betamethasone treatment. Our findings indicate that either antenatal corticosteroid can be given to women before preterm birth to improve infant and child health. Funding National Health and Medical Research Council (Australia).

Background Exosomes arise from viable cancer cells and may reflect a different biology than circulating cell-free DNA (cfDNA) shed from dying tissues. We compare exosome-derived DNA (exoDNA) to cfDNA in liquid biopsies of patients with pancreatic ductal adenocarcinoma (PDAC). Patients and methods Patient samples were obtained between 2003 and 2010, with clinically annotated follow up to 2015. Droplet digital PCR was performed on exoDNA and cfDNA for sensitive detection ofKRAS mutants at codons 12/13. A cumulative series of 263 individuals were studied, including a discovery cohort of 142 individuals: 68 PDAC patients of all stages; 20 PDAC patients initially staged with localized disease, with blood drawnafter resection for curative intent; and 54 age-matched healthy controls. A validation cohort of 121 individuals (39 cancer patients and 82 healthy controls) was studied to validateKRAS detection rates in early-stage PDAC patients. Primary outcome was circulatingKRAS status as detected by droplet digital PCR. Secondary outcomes were disease-free and overall survival. Results KRAS mutations in exoDNA, were identified in 7.4%, 66.7%, 80%, and 85% of age-matched controls, localized, locally advanced, and metastatic PDAC patients, respectively. Comparatively, mutantKRAS cfDNA was detected in 14.8%, 45.5%, 30.8%, and 57.9% of these individuals. Higher exoKRAS MAFs were associated with decreased disease-free survival in patients with localized disease. In the validation cohort, mutantKRAS exoDNA was detected in 43.6% of early-stage PDAC patients and 20% of healthy controls. Conclusions Exosomes are a distinct source of tumor DNA that may be complementary to other liquid biopsy DNA sources. A higher percentage of patients with localized PDAC exhibited detectableKRAS mutations in exoDNA than previously reported for cfDNA. A substantial minority of healthy samples demonstrated mutantKRAS in circulation, dictating careful consideration and application of liquid biopsy findings, which may limit its utility as a broad cancer-screening method.

Introduction: Pregnancy and childbirth can be a source of anxiety and worry for women. This is probably more so for women with a complicated pregnancy. Anxiety and worry may contribute to, or exacerbate, mental health disorders including depression and post-traumatic stress disorder (PTSD). Mental health is an integral part of health and well-being and poor mental health can be detrimental to the woman's welfare and her infant's behavior and cognitive development. It may be undetected, potentially leading to a burden on the woman, her family, the health system, and society. Women with complicated pregnancies, such as those with hypertensive disorders of pregnancy (HDP), may be at greater risk of poor mental health. The aim of this review was to examine whether there is an association between depression, anxiety, and PTSD in postpartum women with a history of HDP. Methods: A narrative literature review was undertaken. Using the key search terms: preeclampsia, gestational hypertension, hypertensive disorders, pregnancy complications, depression, anxiety, and post-traumatic stress disorder; electronic databases were searched to determine what is known about depression, anxiety, and PTSD after HDP. Results: In total, 17 publications were included. The relationship between HDP and depression, anxiety, and PTSD was variable between studies and inconsistent. Although some studies reported no significant association, there is a trend for increased prevalence and symptom severity of depression, anxiety, and PTSD following HDP. This trend was particularly evident following the more severe presentations of HDP. It was uncertain whether this association was due to the hypertensive disorder itself, the sequelae of the HDP, such as giving birth to a preterm baby, or it predated the pregnancy. Conclusions: Women who experience HDP may be at increased risk of developing postpartum depression, anxiety, and PTSD. Awareness of, and screening for, these mental health disorders in the postpartum period will alert clinicians to the need for additional follow-up and referral for women following HDP. More research on the benefits and risks of such an approach is needed.

The world is currently in a pandemic of COVID-19 (Coronavirus disease-2019) caused by a novel positive-sense, single-stranded RNA β-coronavirus referred to as SARS-CoV-2. Fortunately, most infected individuals recover and are then resistant to re-infection for a period, indicating that a vaccination approach can be successful. Elucidation of rates of past SARS-CoV-2 infection within select regions across the United States of America (USA) will help direct vaccination efforts and together will inform our approach towards achieving herd immunity. Here we investigated rates of SARS-CoV-2 infection in the greater Cincinnati, Ohio, USA metropolitan area from August to December 2020, just prior to initiation of the national vaccination program. Examination of 9,550 adult blood donor volunteers for serum IgG antibody positivity against the SARS-CoV-2 Spike protein showed an overall prevalence of 8.40%, measured as 7.56% in the first 58 days of this time frame, versus a significant increase to 9.24% in the last 58 days, and a final rate of 12.86% in December 2020. Approximately 56% of Spike seropositive individuals also had immunoreactivity against the receptor binding domain (RBD) within the Spike protein, which is associated with viral neutralization. Males and females in the Cincinnati area showed nearly identical rates of past infection, and rates among Hispanics, African Americans and Caucasians were not significantly different. Interestingly, donors under 30 years of age had the highest rates of past infection, while those over 60 had the lowest. Geographic analysis showed that the West side of Cincinnati had a rate of 9.63% versus 8.13% on the East side (demarcated by Interstate-75), while the adjoining area of Kentucky was 7.04% (as demarcated by the Ohio River). These results among healthy blood donors will be critical in calculating the time needed to achieve regional herd immunity in conjunction with the national vaccination campaign.

Background Caesarean section rates in Australia have risen to >30%, with repeat caesarean delivery the most common indication. One method of reducing caesarean delivery rates is to increase rates of vaginal birth after caesarean section (VBAC). Aims To determine the combined effect of two management strategies on the rates of successful VBAC in women experiencing their first pregnancy following primary caesarean section. Methods Prospective cohort study from May 2009 to October 2010 at a metropolitan Australian teaching hospital. The strategies studied were (i) allocating responsibility for VBAC candidates attempting labour to the hospital's three high-risk obstetric consultants and (ii) implementing a next birth after caesarean (NBAC) antenatal clinic designed to counsel and support women deciding on mode of birth for their next pregnancy after a primary caesarean section. Data were collected from Obstetrix, a NBAC logbook and medical records of 396 eligible women who gave birth during the study period. Results Overall VBAC rates improved from 17.2% in 2006 prior to implementation of the combined strategies, to 27.0% over the studied period (P Conclusions A dedicated NBAC clinic and more consistent approach to labour management can help improve VBAC rates. Further targeted counselling towards women with previous malpresentation and/or East Asian descent may further improve VBAC attempt rates.

Introduction Women who have had pre-eclampsia (PE) have increased risk for future hypertension and cardiovascular disease; however, what defines normal blood pressure (BP) for healthy young non-pregnant women is unclear. Objective To determine: a) the normal BP range for healthy young women who have had a normal pregnancy (NP); b) the percentage of women with prior PE with BPs above this range. Methods The prospective P4 study examines BP, cardiovascular function and risk, mental health and paediatric assessment following PE and NP at 6 months, 2 yrs. and 5 yrs. post-partum. We measured routine sphygmomanometry BP, central BP (CBP) with applanation tonometry, and 24 h. ambulatory BP (ABPM) at 6 months (NP = 245, PE = 76) and, in the same women, at 2 years (NP = 66, PE = 27) post-partum. Results At 6 months PE women had higher: 1) routine BP (112/71 vs. 104/66 mmHg, p 0.001); 2) central BP (105/74 vs. 97/68 mmHg, p = 0.002); 3) ABPM (114/71 vs. 107/67 mmHg, p 0.001) than NP women. The upper normal BP at 6 months was 122/79 mmHg for routine BP (‘traditional’ = 140/90 mmHg), 115/81 mmHg for central BP (‘traditional’ = 120 mmHg systolic) and 120/77 mmHg for ABPM (‘traditional’ = 130/80 mmHg). Between group differences persisted at 2 years post-partum; there were no changes in any BP parameter within groups between 6 months and 2 years. Clinicians using traditional values would have considered up to 3% as hypertensive by routine BP, 8% by Central BP and 17% by ABPM; using these new limits hypertension detection rates were 15,13 and 20% respectively at 6 months and 22, 32 and 17% at 2 years. Discussion These new normal BP limits for defining hypertension in young women are lower than those used in the general community; using these values defines more formerly PE women as hypertensive than using traditional cut-off BP levels.

Background: Widespread use of antiplatelet and anticoagulation medications (APACs) can be a difficult challenge in the presence of a neurosurgical emergency. Premorbid use of APACs, particularly clopidogrel, has been shown to affect outcomes in patients with stroke and traumatic brain injury. Objective: We hypothesized that pre-morbid clopidogrel use in patients with intracranial hemorrhage necessitating surgical intervention would lead to a greater risk of death and need for re-operation than those taking other APACs. Methods: Retrospective single institution review was conducted from January, 2010 through November, 2012 for intracranial hemorrhages necessitating surgical evacuation. Acute, subacute and chronic subdural, epidural and intraparenchymal hemorrhages were included. Results: 185 of 410 patients that required surgery for intracranial hemorrhage were on APACs. Overall mortality rate was 33%, with a 37% mortality rate in the APAC group. Overall reoperation rate was 7.5%, and 13% in the APAC group. Chi-square testing demonstrated significance between mortality and clopidogrel use (p = 0.0038), but not in APAC, warfarin or aspirin groups. There was statistical significance between the need for reoperation and APAC use (p = 0.002), aspirin use (p = 0.0097), and clopidogrel use (p = 0.0152), but not warfarin. Multivariate regression demonstrated only clopidogrel use is associated with higher mortality (p = 0.05) and need for reoperation (p = 0.0206). Conclusion: APAC use in the setting of intracranial hemorrhage necessitating surgical evacuation have higher intraoperative blood loss, need for transfusion and risk for adverse cardiac events. Premorbid clopidogrel use is associated with an increased risk in mortality and need for reoperation.

PurposeThe purpose of the paper is to present the results of a content analysis of Canadian corporate sustainable development reports.Design/methodology/approachA comparison of existing content analyses of corporate sustainable development reports was conducted. Based on the comparison, eight key areas were identified for further research in the content analysis of Canadian corporate reports. A total of 89 reports were reviewed in the content analysis.FindingsThe content analysis highlighted several interesting trends in Canadian reporting. For example, the analysis highlighted that relatively few corporations explicitly identify the audience for the report, include an endorsement from the board chair, provide details on specific standards used for managing the supply chain, discuss linkages to public policy, or use third‐party assurance. The analysis also highlighted the wide variety in report structure.Research limitations/implicationsThe content analysis did not address all issues related to corporate sustainable development reporting. Numerous areas for further research were identified, such as focusing on how companies decide on what to include in the reports, how the reports are used, the accommodations made for specific audiences, challenges in auditing the reports, and future directions of company reporting.Originality/valueThe content analysis focused on several areas that have been highlighted in previous studies as well as areas that have not previously been investigated. The analysis is based on a larger sample size than the most recent Canadian studies. The research will be of interest to both research and practitioners in corporate sustainable development reporting.

Subitization, the rapid enumeration of small numbers of objects, is often held to reflect a general ability to process three or four items simultaneously. However, questions as to which types of visual representations count as items for subitization have, thus far, received relatively little attention. In several new experiments, we instructed participants to enumerate three or four colored regions in a display. In some trials, all of these regions belonged to separate visual objects, whereas in others, two or more belonged to the same object(s). We found far slower enumeration in the latter case than in the former case, a result that cannot be attributed to Stroop interference from the number of attended objects in a display. We conclude that subitization mechanisms cannot operate on small fragments of shape and color alone, even when such fragments are easily individuated from one another. Rather, such mechanisms are compelled to operate on object representations.

In divided-attention tasks, observers must make speeded (or near threshold accuracy) judgements concerning two target features in a display. Typically, when the two features belong to the same object they are more rapidly judged than when they belong to separate objects, a pattern of findings referred to here as a “same-object benefit”. However, we note here that many of these studies share common features, in particular the use of pre-exposed, outline, and/or overlapping objects, and their findings may not generalize to other types of display. Building substantially on previous work by Davis, Welch, Holmes, and Shepherd (2001), we show in four new studies that once these features are not present in a divided-attention task, no same-object benefits are reported. Rather we now find “same-object costs”, where features belonging to a single object are less rapidly judged than features belonging to separate objects.

Background Women who have hypertension in pregnancy are routinely treated with antihypertensive medication and the recent CHIPS study has recommended tighter blood pressure control, requiring greater use of medication [1]. While the perinatal outcomes of babies after treatment of mild to moderate hypertension in pregnancy with medication are no different [2], the longer term effects on infants are not well described. Aims To compare the physical health and development of the infants at six months after birth of women who were normotensive in pregnancy and: (1) those who had gestational hypertension (GH) or preeclampsia (PE); (2) those requiring antihypertensive medication. Methods Infants are recruited as part of the Postpartum Physiology, Psychology and Paediatric Study (P4 Study) – a longitudinal follow up study of normotensive and hypertensive women and their babies. It is planned to recruit 300 women who were normotensive, 100 who had GH and 100 who had PE and their babies. Women and their babies are assessed at six months, two and five years after birth. Mother-infant bonding is assessed with a validated self-report questionnaire completed by the mother. The infants are examined by a paediatrician and their behavioural development is assessed with an age appropriate Ages and Stages Questionnaire completed by their mother. Results Recruitment began in July 2013 and by the end of 2015, 210 women completed their six month assessments. Of the 210 women assessed, 161 were normotensive in pregnancy and 49 hypertensive (40 PE, 9 GH). As expected, women with hypertension gave birth earlier and had smaller babies. Conclusions References 1. L.A. Magee, P. von Dadelszen, E. Rey, et al., Less-tight versus tight control of hypertension in pregnancy, New Engl. J. Med. 372 (2015) 407–417. 2. E. Abalos, L. Duley, D.W. Steyn, Antihypertensive drug therapy for mild to moderate hypertension during pregnancy, Cochrane Database Syst. Rev. 2 (2014) CD002252.

Background Women who have had hypertension in pregnancy are at greater risk of future cardiovascular disease. Little is known about their cardiovascular risk postpartum or the effects of hypertensive pregnancy on a woman’s mental health and the outcomes of her infant. Aims In this project we are studying the physiological and psychological health of women and the physical health and development of their infants six months, two years and five years after birth. We will establish normal ranges for women who were normotensive in pregnancy and compare these in women who had gestational hypertension (GH) or preeclampsia (PE). Methods Women are asked to participate if they have given birth in the preceding six months. Exclusion criteria include diabetes mellitus, chronic hypertension, renal or other serious maternal disease prior to pregnancy or congenital anomaly in the pregnancy. Recruitment has commenced for 300 women with prior normotensive pregnancy, 100 who had PE and 100 who had GH, and their babies. They are assessed at six months, two and five years after birth. At each assessment, women have their blood pressure (BP) assessed peripherally with a manual liquid crystal sphygmomanometer and 24 h ambulatory blood pressure monitoring, and centrally with non-invasive applanation tonometry. Additional physiological testing includes: body composition; energy balance; vascular compliance; cardiac function; liver and renal function, lipids and biochemistry; glucose and insulin; and urinalysis. Psychological status is assessed using validated self-report questionnaires for depression, anxiety, posttraumatic stress disorder and mother-infant bonding. The babies are examined by a paediatrician at each assessment. Their behavioural development is assessed with an age appropriate Ages and Stages Questionnaire completed by their mother at each assessment and a developmental assessment by a child psychologist at two and five years. Results Recruitment began in July 2013 and by the end of 2015, 210 women completed their six month assessments. Of the 210 women assessed, 161 were normotensive in pregnancy and 49 hypertensive (40 PE, 9 GH). Both groups were similar in age, ethnicity, level of education and body mass index (BMI). A number of abstracts will be presented at this meeting with progress results in more detail. Conclusions When complete, this study will re-define normal BP and other physiological parameters for young parous women thereby permitting a more sensitive assessment of post-partum BP and other cardiovascular risk markers in women who have had GH or PE. It will also determine the extent, if any, of psychological disorders in these women and developmental or other concerns in their babies.

Many previous studies have found that we can attend pairs of visual features (e.g., colour, orientation) more efficiently when they belong to the same “object” compared to when they belong to separate, neighbouring objects (e.g., Behrmann, Zemel, & Mozer, 1998; Egly, Rafal, & Driver, 1994). This advantage for attending features from the same object may reflect stronger binding between these features than arises for pairs of features belonging to separate objects. However, recent findings described by Davis, Welch, Holmes, and Shepherd (in press) suggest that under specific conditions this same-object advantage can be reversed, such that attention now spreads more readily between features belonging to separate neighbouring objects than between features of the same object. In such cases it would appear that features belonging to separate visual objects are more strongly bound than features of the same object. Here I review these findings and present the results of a new study. Together these data suggest th...

Four experiments examined whether Kanizsa subjective figures can induce amodal completion of a notched circle at parallel stages of visual search. Search for the notched circle among full circles was slow and inefficient when the notched circle appeared stereoscopically behind an abutting subjective surface, as if occluded by it. However, search became efficient and parallel when the notched and completed circles appeared nearer so that the subjective figures could not act as occluders. Control studies ruled out explanations in terms of low spatial frequencies, grouping of aligned edges, or the depth of the circles per se. Multiple Kanizsa subjective figures can be coded in parallel as occluding surfaces; such coding is obligatory because it arises even when highly detrimental to performance.

Regions of objects that are partially obscured in the current retinal image are often perceptually filled in by the visual system (Kantzsa, 1979) In some cases (modal completion), this causes the filled-in region to appear tinged with the color and brightness of unobscured parts of that object, but in other cases (amodal completion), it does not (Michotte & Burke, 1951) It has recently been argued that modal and amodal completion both arise in preattentive vision, and may operate equivalently at that level (Davis & Driver, 1994, He & Nakayama, 1992, Shipley & Kellman, 1992) In this article, we show that they have different effects on attentive vision, with attention tending to spread to (and from) modally completed regions and their visible inducers, but not to (or from) comparable amodally completed regions and their inducers This finding is consistent with visual attention operating on surfaces (eg, He & Nakayama, 1995) in a viewer-centered representation of the scene, after the operation of filling-in processes.

Background Pregnancy and childbirth are usually joyful experiences. However, when medical complications occur, these experiences can be more traumatic, leading to depression, anxiety and posttraumatic stress disorder (PTSD). The most common complication in pregnancy is hypertension, but the literature around the psychological consequences of this is limited and inconsistent. There is also a scarcity of research reporting on the woman’s perspective of her experience and whether the care she received influenced her experience. Objective To compare the level of depression, anxiety and PTSD symptoms amongst women who were normotensive and hypertensive in pregnancy, at six months postpartum and to gain insight into women’s experiences of hypertension in pregnancy (HIP). Methods A mixed methods study was undertaken using prospective observational and qualitative descriptive methods. Eligible women who were normotensive or hypertensive (gestational hypertension or preeclampsia) in pregnancy completed the Edinburgh Postnatal Depression Scale (EPDS), General Anxiety Disorder (GAD) scale and Posttraumatic Stress Diagnostic Scale six months postpartum. Questionnaire scores from each group were compared using an independent t-test, with additional chi squared tests to compare levels in each group reaching thresholds for caseness. 20 women who experienced hypertension in their pregnancy were interviewed 10–12 months postpartum. Thematic analysis was used to analyse interview data. Results A total of 210 women participated in this study, of which 49 had HIP. The mean EPDS score was 4 in both groups (p = 0.7); 6% of the HIP group scored above the established threshold for postnatal depression (EPDS ⩾ 12) compared to 4% in the normal (p = 0.47). The mean GAD score was 2 in both groups (p = 0.3) with moderate or high anxiety reported by 4% in the HIP group versus 3% (p = 0.74). 10% of the HIP group reported their birth experience as a traumatic event, compared to 1% of the normotensive group (p = 0.003). In spite of this difference, the mean PTSD symptom scores were low and not significantly different between the two groups (3 in the HIP group, 4 in the normal, p = 0.7). The themes identified from the interviews were reacting to the diagnosis, being a mother in adversity, processing the situation and ‘moving on’ from the experience. Factors that helped improve the woman’s experience were feeling safe and trusting the care providers, continuity of care and having social support. Conclusions The study shows that women who experience HIP are more likely to report their birthing experience as traumatic. Despite this, by six months postpartum, levels of psychological morbidity are reassuringly low and not significantly different from women who were normotensive during pregnancy. Women who experienced HIP reported that with time, they could process the experience and move on with being a mother. The care of women with HIP often focusses on the immediate physical health issues, but their care should also include emotional and social support. Trust and continuity of care are important mediating factors for improving the woman’s birth experience.

Objectives To examine the frequency with which the most accepted indicators for delivery in pre-eclampsia (term gestation, inability to control blood pressure, progressive maternal end-organ dysfunction, fetal compromise) are used in a population with predominantly late-onset (birth >34 weeks) pre-eclampsia (PE). Methods Retrospective cohort study using the St George Public Hospital (SGH) Hypertension in Pregnancy database (Metropolitan Australia). Demographic, pregnancy, and outcome details were extracted and verified by comparison with data collection sheets. Results From 2001 to 2011, 817 women with PE cared for at SGH were included. Mean maternal age was 30.2 ± 5.6 years, mean gestation (GA) at time of consultation was 34.8 weeks, and at delivery 37.5 ± 2.5 weeks (65% GA 37+weeks at delivery). 93% had proteinuria ⩾30 mg/mmol, 7% liver involvement, and 3.5% platelets ⩽100. 172 women had data sheets with delivery triggers available. In this group, the most common maternal trigger for delivery (all gestations) was uncontrolled/severe hypertension (105 cases, 61.0%) and most common fetal trigger intrauterine growth restriction (IUGR: 12 cases, 7.0%). 35 (29%) of term women had no specific delivery trigger. Detailed results are displayed in Table 1. Presence of a fetal or combined maternal/fetal trigger as the final indication for delivery was significantly more common in women delivering at p Conclusions In our population of predominantly late-onset PE, maternal triggers for delivery (predominantly severe hypertension) far outweigh fetal triggers (predominantly IUGR). Fetal and mixed indicators for delivery were relatively more common in women delivering preterm, possibly reflecting the severity of placental dysfunction in this subgroup. Disclosures N.A. Varnier: None. M. Brown: None. G. Davis: None. F. Pettit: None. G. Mangos: None. A. Henry: None.

Unconscious stimuli activate task sets, mental programs that orchestrate performance of complex tasks, but the role of attention in such effects has not been addressed. In previous studies, unconscious prime stimuli appeared at attended locations and were explicitly specified in the task instructions; spatial attention to the prime and/or a specific conscious attentional set may thus be required for such unconscious activation to arise. In the present experiments, a learning phase established associations between unconscious prime stimuli and performance of two tasks. These associations influenced task performance in a subsequent test phase, even though the primes were not specified in current task instructions. This is the first demonstration that unconscious stimuli can prime task sets independently of a current attentional set that specifies stimulus-task mappings. Such priming was not influenced by spatial attention cues, in contrast to clear attention influences in comparison trials that mimicked conditions employed by previous studies.

In contrast to standard search templates that specify a target object's expected features, templates for rejection (TFR) may specify features of nontargets, biasing attention away from irrelevant objects. Little is known about TFR, and virtually nothing is known about their role in guiding search across natural scenes. In such scenes, targets and nontargets may not be easily distinguished on the basis of their visual features; it has been claimed that standard search templates may therefore specify target objects' semantic features to guide attention. Here, we ask whether TFR can do so. Noting a limitation of previous procedures used to study standard search templates, we trialed an alternative method to examine semantic templates for nontarget exclusion in natural scene search. We found that when nontargets belonged unpredictably to either of two physically distinct categories, search was less efficient than when targets belonged to one known category. This two-category cost, attributed to inefficient application of search templates, was absent for two physically dissimilar but semantically related categories. Adding a training phase to highlight semantic distinctiveness of two object categories reinstated the two-category cost, precluding stimulus-based accounts of the effect. These patterns were not observed for one-image displays or when observers searched for object categories rather than ignoring them, demonstrating their specificity to TFR, the inadequacy of search-and-destroy models to account for them, and likely basis in attentional guidance. TFR can specify semantic information to guide attention away from nontargets.

In 1990, Whitehill Manufacturing produced one of the earliest mooring ropes made with Spectrareg fiber for a Jones Act tanker operator. The lines were tested aboard a 60 k dwt tanker dedicated in ship-to-ship lightering service in San Francisco Bay since this vessel docked and undocked 3 to 5 times more frequently than a typical tanker. Therefore, it provided an ideal accelerated test case to evaluate the endurance of synthetic lines in a pier-side mooring application. Initial test results reflecting 8 years of service were presented at the 1998 DOT MTS conference. The breaking strength was determined to be excellent and the lines remained in service. In May 2003, these same lines were retired after 13 years of service. One of the retired lines was returned to Whitehill in its entirety. Sample sections were removed and tested to determine residual breaking strength characteristics as a function of position on the winch drum. Spectrareg fiber was removed from positions between each of the test samples and sent to Honeywell for microscopic analysis. Results on retained breaking strength are presented as well as a discussion of the mechanisms affecting the long term life of mooring lines containing fiber made from high modulus polyethylene (HMPE)

Luck and Vogel (1997) have reported several striking results in support of the view that visual short-term memory (VSTM) has a fixed capacity of four objects, irrespective of how many relevant features those objects comprise. However, more recent studies have challenged this account, indicating only a weak effect of the number of objects once other factors are more evenly equated across conditions. Here, we employed a symmetry manipulation to verify object segmentation in our displays, to demonstrate that when spatial and masking factors are held constant, the number of objects per se has no effect on VSTM. Instead, VSTM capacity may reflect the number of object "parts" or feature conjunctions in a given display.

Objective White coat hypertension (WCH) is a common phenomenon with a long term prognosis intermediatebetween those with true hypertension and true normotension. The natural history of this phenomenonthroughout pregnancy remains unknown. We assessed the likelihood of women with an initial diagnosis ofWCH developing pre-eclampsia (PE) as their pregnancy progressed.Design Prospective observational study.Setting St George Hospital, a teaching and University hospital.Population Two hundred and forty-one pregnant women with an early pregnancy diagnosis of essentialhypertension (EH).Methods Eighty-six women had this diagnosis (EH) confirmed pre-pregnancy by 24-hour ambulatory bloodpressure monitoring (ABPM) or repeated automated home blood pressure (BP) self-measurement. Theremaining 155 underwent 24-hour ABPM in early pregnancy to establish their diagnosis. Women found tohave WCH did not receive antihypertensives during their pregnancy, whereas those with confirmed EHreceived oxprenolol or methyldopa. Women with WCH had repeated 24-hour ABPM and/or BP assessmentsin a pregnancy day assessment unit until delivery.Main outcome measure The development of PE in women with WCH or EH.Results The overall prevalence of WCH was 32%. Half retained this phenomenon throughout pregnancy andhad good pregnancy outcomes. Forty percent developed (benign) gestational hypertension and also had goodpregnancy outcomes while 8% developed proteinuric PE, significantly fewer than in women with confirmedEH (22%), P ¼ 0.008. No BP parameter at study entry permitted discrimination between those women withWCH who retained this phenomenon and those who developed GH or PE.Conclusion WCH is a common phenomenon in pregnant women who appear to have EH according to routineBP measurement early in pregnancy. Antihypertensives may be withheld from this group initially and theycan be advised they will have better pregnancy outcomes than women with true EH. However, continuedmonitoring throughout pregnancy remains important to detect the small group of white coat hypertensiveswho develop PE.INTRODUCTIONThe advent of 24-hour ambulatory blood pressure mon-itoring (ABPM) and automated self-initiated home bloodpressure (BP) monitoring has led to the recognition of thephenomenon ‘white coat hypertension’ (WCH), also called‘office hypertension’. These terms define a group ofpatients with elevated BP in the presence of their medicalcarer, usually a doctor, whose BPs are normal in their usualwork or home environment. The currently accepted defi-nition of WCH is a conventional office or clinic systolicBP > 140 mmHg or a diastolic BP > 90 mmHg with anABPM average awake systolic BP < 135 mmHg anddiastolic BP < 85 mmHg.

A 65-year-old woman presented with an 8-year history of progressive frontotemporal alopecia and hirsutism. She had elevated serum levels of testosterone, androstenedione and estradiol. Ultrasound and computed tomography imaging suggested a right ovarian mass, while bilateral ovarian venous sampling demonstrated increased testosterone levels originating from both ovarian veins. Histology obtained following bilateral oophorectomy demonstrated bilateral ovarian hyperthecosis. Six months after surgery, the patient remains well with no progression of the alopecia. Ovarian hyperthecosis is a rare cause of androgenetic alopecia in postmenopausal women. The role of hyperthecosis and its relationship to androgenetic alopecia is reviewed.

Summary Background There is debate about whether diastolic blood pressure should be recorded as the fourth (muffling, K4) or fifth (disappearance, K5) Korotkoff sound in pregnancy. We compared maternal and fetal outcomes and the likelihood that episodes of severe hypertension would be recorded when hypertensive pregnancies were managed according to either K4 or K5. Methods 220 pregnant women with diastolic hypertension (K4 ≥90 mm Hg) after the 20th week of gestation were enrolled in a prospective randomised study at two obstetric units in Australia; they were randomly assigned management with K4 (n=103) or K5 (n=117) for the remainder of the pregnancy. Clinical management was according to a uniform department protocol. Analysis was by intention to treat. All the women completed the trial. Findings An episode of severe hypertension (systolic ≥170 mm Hg, diastolic ≥110 mm Hg, or both) was more likely to be recorded with use of K4 than with use of K5 (39 [38%] VS 30 [26%] women, p=0·051), mainly because of a greater likelihood that severe diastolic hypertension would be recorded (34 [33%] VS 20 [17%], p=0·006). The frequency of severe systolic hypertension and simultaneous severe systolic and diastolic hypertension did not differ between groups. Pregnancy was prolonged by an average of 2 weeks in both groups, and there were no significant differences between the groups in laboratory data, requirements for antihypertensive treatment, birthweight, fetal growth retardation, or perinatal mortality. There was no eclampsia or significant maternal morbidity in either group. Interpretation A change from use of K4 to K5 would mean that one fewer case of severe diastolic hypertension would be recorded for every six hypertensive pregnancies, but all other episodes of severe hypertension would be recorded with similar frequency. Since the K4/ K5 difference is smaller in hypertensive than in normotensive pregnant women and since K5 is closer to the actual intra-arterial pressure and more reliably detected, universal adoption of K5 to record diastolic blood pressure in hypertensive pregnancy should be considered.

The complex relationship between attention and STM forms a core issue in the study of human cognition, and Cowan's target article attempts, quite successfully, to elucidate an important part of this relationship. However, while I agree that aspects of STM performance may reflect the action mechanisms that we normally consider to subserve “attention” I shall argue here that attention is not subject to a fixed four-object capacity limit as Cowan suggests. Rather, performance in attention tasks as well as STM may be best accounted for in terms of decay and interference.

Support for object-based accounts of visual attention has been drawn from several different types of effect. One effect is found when observers try to restrict their attention to a particular region of a display. Other regions belonging to the same object are often selected as well, suggesting that attention spreads spatially over entire objects. Another effect is found when judging two visual attributes; performance is often less efficient when the attributes belong to separate objects rather than both belonging to a single object. This latter effect has been taken to imply that only one segmented object can be attended at a time. However, it may instead merely be a variant of the first effect. If, as we assume here, attention spreads to task-irrelevant regions of relevant objects, it will encompass a larger spatial region and more information when judging attributes of two objects rather than one. Here we compared judging one versus two objects, while manipulating whether the two objects occupied a wider extent than the single object condition (as in previous work), or not. Costs were found for judging two objects versus one only when together they occupied a wider spatial extent. We conclude that reported difficulties in attending two objects may be due to attention spreading across the entire spatial extent of objects when judging their parts, rather than a fixed inability to process more than object at a time.