Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: the French EPIPAGE-2 cohort study

OBJECTIVES: To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes. DESIGN: Prospective cohort study, EPIPAGE-2. SETTING: France, 2011. PARTICIPANTS: 53 (NICUs); 2135 VP neonates born at 27 to 31 weeks. OUTCOME MEASURES: Clusters of units, defined by the association of practices in five neonatal care domains - respiratory, cardiovascular, nutrition, pain management and neurodevelopmental care. Mortality at 2 years corrected age (CA) or severe/moderate neuro-motor or sensory disabilities and proportion of children with scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ). METHODS: Hierarchical cluster analysis to identify clusters of units. Comparison of outcomes between clusters, after adjustment for potential cofounders. RESULTS: Three clusters were identified: Cluster 1 with higher proportions of neonates free of mechanical ventilation at 24 hours of life, receiving early enteral feeding, and neurodevelopmental care practices (26 units; n=1118 babies); Cluster 2 with higher levels of patent ductus arteriosus and pain screening (11 units; n=398 babies); Cluster 3 with higher use of respiratory, cardiovascular and pain treatments (16 units; n=619 babies). No difference was observed between clusters for the baseline maternal and babies' characteristics. No differences in outcomes were observed between Clusters 1 and 3. Compared with Cluster 1, mortality at 2 years CA or severe/moderate neuro-motor or sensory disabilities was lower in Cluster 2 (adjusted OR 0.46, 95% CI 0.25 to 0.84) but with higher proportion of children with an ASQ below threshold (adjusted OR 1.49, 95% CI 1.07 to 2.08). CONCLUSION: In French NICUs, care practices for VP babies were non-randomly associated. Differences between clusters were poorly explained by unit or population differences, but were associated with mortality and development at 2 years. Better understanding these variations may help to improve outcomes for VPT babies, as it is likely that some of these discrepancies are unwarranted

The circumstellar envelope of the C-rich post-AGB star HD 56126

We present a detailed study of the circumstellar envelope of the post-asymptotic giant branch ``21 micron object'' HD 56126. We build a detailed dust radiative transfer model of the circumstellar envelope in order to derive the dust composition and mass, and the mass-loss history of the star. To model the emission of the dust we use amorphous carbon, hydrogenated amorphous carbon, magnesium sulfide and titanium carbide. We present a detailed parametrisation of the optical properties of hydrogenated amorphous carbon as a function of H/C content. The mid-infrared imaging and spectroscopy is best reproduced by a single dust shell from 1.2 to 2.6 arcsec radius around the central star. This shell originates from a short period during which the mass-loss rate exceeded 10^(-4) M_sun/yr. We find that the strength of the ``21'' micron feature poses a problem for the TiC identification. The low abundance of Ti requires very high absorption cross-sections in the ultraviolet and visible wavelength range to explain the strength of the feature. Other nano-crystalline metal carbides should be considered as well. We find that hydrogenated amorphous carbon in radiative equilibrium with the local radiation field does not reach a high enough temperature to explain the strength of the 3.3-3.4 and 6-9 micron hydrocarbon features relative to the 11-17 micron hydrocarbon features. We propose that the carriers of these hydrocarbon features are not in radiative equilibrium but are transiently heated to high temperature. We find that 2 per cent of the dust mass is required to explain the strength of the ``30'' micron feature, which fits well within the measured atmospheric abundance of Mg and S. This further strengthens the MgS identification of the ``30'' micron feature.Comment: 20 Pages, 10 Figures, accepted for publication in Astronomy and Astrophysic

The carrier of the "30" micron emission feature in evolved stars. A simple model using magnesium sulfide

We present 2-45 micron spectra of a large sample of carbon-rich evolved stars in order to study the ``30'' micron feature. We find the ``30'' micron feature in sources in a wide range of sources: low mass loss carbon stars, extreme carbon-stars, post-AGB objects and planetary nebulae. We extract the profiles from the sources by using a simple systematic approach to model the continuum. We find large variations in the wavelength and width of the extracted profiles of the ``30'' micron feature. We modelled the whole range of profiles in a simple way by using magnesium sulfide (MgS) dust grains with a MgS grain temperature different from the continuum temperature. The systematic change in peak positions can be explained by cooling of MgS grains as the star evolves off the AGB. In several sources we find that a residual emission excess at ~26 micron can also be fitted using MgS grains but with a different grains shape distribution. The profiles of the ``30'' micron feature in planetary nebulae are narrower than our simple MgS model predicts. We discuss the possible reasons for this difference. We find a sample of warm carbon-stars with very cold MgS grains. We discuss possible causes for this phenomenon. We find no evidence for rapid destruction of MgS during the planetary nebula phase and conclude that the MgS may survive to be incorporated in the ISM.Comment: 31 pages, accepted for publication in Astronomy and Astrophysics. Full resolution version can be obtained by contacting [email protected]

The rich 6 to 9 um spectrum of interstellar PAHs

Here, we present 6-9 um spectra of a sample of RNe, HII regions, YSOs, evolved stars and galaxies that show strong unidentified infrared bands, obtained with the ISO-SWS. The IR emission features show pronounced variations. 1) The 6.2 um feature shifts and clearly shows profile variations. 2) The 7.7 um complex is comprised of at least two subpeaks peaking at 7.6 and one longwards of 7.7 um. In some cases the main peak can apparently shift up to 8 um. Two sources do not exhibit a 7.7 um complex but instead show a broad emission feature at 8.22 um. 3) The 8.6 um feature has a symmetric profile in all sources and some sources exhibit this band at slightly longer wavelengths. For the 6.2, 7.7 and 8.6 um features, the sources have been classified independently based on their profile and peak position. The classes derived for these features are directly linked with each other. Furthermore, the observed 6--9 um spectrum depends on the type of object. We attribute the observed 6.2 um profile and peak position to the combined effect of a PAH family and anharmonicity with pure PAHs representing the 6.3 um component and substituted/complexed PAHs representing the 6.2 um component. The 7.6 um component is well reproduced by both pure and substituted/complexed PAHs but the 7.8 um component remains an enigma. In addition, the exact identification of the 8.22 um feature remains unknown. The observed variations in the characteristics of the IR emission bands are linked to the local physical conditions. Possible formation and evolution processes that may influence the interstellar PAH class are highlighted.Comment: 26 pages, 25 figures, 3 tables accepted by A&

Light-emitting silicon nanocrystals from laser pyrolysis

Crystalline Si nanoparticles with diameters between 2.5 and 20 nm are prepared by CO2-laser-induced decomposition of silane in a gas flow reactor. A small portion of the products created in the reaction zone is extracted through a nozzle into a high- acuum apparatus to form a freely propagating molecular beam of clusters and nanoparticles that can be deposited on suitable substrates. The strong visible photoluminescence (PL) of the Si nanocrystals is studied as a function of their size, and as a function of the time for which they are exposed to air. All observations can be explained on the basis of quantum confinement as the only origin of the PL. Chemical methods are exploited to modify the surface of the Si, nanoparticles and to reduce their size, thus shifting their PL to shorter wavelengths. With this technique, the Si nanoparticles, collected in much larger quantities in the filter of the flow reactor, can be made strongly luminescent so that they may be used for various applications