We describe the sample design for the SDSS-IV MaNGA survey and present the final properties of the main samples along with important considerations for using these samples for science. Our target ...selection criteria were developed while simultaneously optimizing the size distribution of the MaNGA integral field units (IFUs), the IFU allocation strategy, and the target density to produce a survey defined in terms of maximizing signal-to-noise ratio, spatial resolution, and sample size. Our selection strategy makes use of redshift limits that only depend on i-band absolute magnitude (Mi), or, for a small subset of our sample, Mi and color (NUV − i). Such a strategy ensures that all galaxies span the same range in angular size irrespective of luminosity and are therefore covered evenly by the adopted range of IFU sizes. We define three samples: the Primary and Secondary samples are selected to have a flat number density with respect to Mi and are targeted to have spectroscopic coverage to 1.5 and 2.5 effective radii (Re), respectively. The Color-Enhanced supplement increases the number of galaxies in the low-density regions of color-magnitude space by extending the redshift limits of the Primary sample in the appropriate color bins. The samples cover the stellar mass range and are sampled at median physical resolutions of 1.37 and 2.5 kpc for the Primary and Secondary samples, respectively. We provide weights that will statistically correct for our luminosity and color-dependent selection function and IFU allocation strategy, thus correcting the observed sample to a volume-limited sample.
ABSTRACT Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) is an optical fiber-bundle integral-field unit (IFU) spectroscopic survey that is one of three core programs in the ...fourth-generation Sloan Digital Sky Survey (SDSS-IV). With a spectral coverage of 3622-10354 and an average footprint of ∼500 arcsec2 per IFU the scientific data products derived from MaNGA will permit exploration of the internal structure of a statistically large sample of 10,000 low-redshift galaxies in unprecedented detail. Comprising 174 individually pluggable science and calibration IFUs with a near-constant data stream, MaNGA is expected to obtain ∼100 million raw-frame spectra and ∼10 million reduced galaxy spectra over the six-year lifetime of the survey. In this contribution, we describe the MaNGA Data Reduction Pipeline algorithms and centralized metadata framework that produce sky-subtracted spectrophotometrically calibrated spectra and rectified three-dimensional data cubes that combine individual dithered observations. For the 1390 galaxy data cubes released in Summer 2016 as part of SDSS-IV Data Release 13, we demonstrate that the MaNGA data have nearly Poisson-limited sky subtraction shortward of ∼8500 and reach a typical 10 limiting continuum surface brightness = 23.5 AB arcsec−2 in a five-arcsecond-diameter aperture in the g-band. The wavelength calibration of the MaNGA data is accurate to 5 km s−1 rms, with a median spatial resolution of 2.54 arcsec FWHM (1.8 kpc at the median redshift of 0.037) and a median spectral resolution of = 72 km s−1.
Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that ...cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteenfold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting.
Antibiotic use is a modifiable driver of antibiotic resistance. In many circumstances, antibiotic use is overly broad or unnecessary. We systematically assessed factors associated with antibiotic ...prescribing for respiratory tract infections (RTI). Studies were included if they used actual (not self-reported or intended) prescribing data, assessed factors associated with antibiotic prescribing for RTIs, and performed multivariable analysis of associations. We searched Medline, Embase, and International Pharmaceutical Abstracts using keyword and MeSH (medical subject headings) search terms. Two authors reviewed each abstract and independently appraised all included texts. Data on factors affecting antibiotic prescribing were extracted. Our searches retrieved a total of 2,848 abstracts, with 97 included in full-text review and 28 meeting full inclusion criteria. Compared to other factors, diagnosis of acute bronchitis was associated with increased antibiotic prescribing (range of adjusted odds ratios aOR, 1.56 to 15.9). Features on physical exam, such as fever, purulent sputum, abnormal respiratory exam, and tonsillar exudate, were also associated with higher odds of antibiotic prescribing. Patient desire for an antibiotic was not associated or was modestly associated with prescription (range of aORs, 0.61 to 9.87), in contrast to physician perception of patient desire for antibiotics, which showed a stronger association (range of aORs, 2.11 to 23.3). Physician's perception of patient desire for antibiotics was strongly associated with antibiotic prescribing. Antimicrobial stewardship programs should continue to expand in the outpatient setting and should emphasize clear and direct communication between patients and physicians, as well as signs and symptoms that do and do not predict bacterial etiology of upper respiratory tract infections.
ABSTRACT Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) is an integral-field spectroscopic survey that is one of three core programs in the fourth-generation Sloan Digital Sky Survey ...(SDSS-IV). MaNGA's 17 pluggable optical fiber-bundle integral field units (IFUs) will observe a sample of 10,000 nearby galaxies distributed throughout the SDSS imaging footprint (focusing particularly on the North Galactic Cap). In each pointing these IFUs are deployed across a 3° field; they yield spectral coverage 3600−10300 at a typical resolution R ∼ 2000, and sample the sky with 2″ diameter fiber apertures with a total bundle fill factor of 56%. Observing over such a large field and range of wavelengths is particularly challenging for obtaining uniform and integral spatial coverage and resolution at all wavelengths and across each entire fiber array. Data quality is affected by the IFU construction technique, chromatic and field differential refraction, the adopted dithering strategy, and many other effects. We use numerical simulations to constrain the hardware design and observing strategy for the survey with the aim of ensuring consistent data quality that meets the survey science requirements while permitting maximum observational flexibility. We find that MaNGA science goals are best achieved with IFUs composed of a regular hexagonal grid of optical fibers with rms displacement of 5 m or less from their nominal packing position; this goal is met by the MaNGA hardware, which achieves 3 m rms fiber placement. We further show that MaNGA observations are best obtained in sets of three 15 minute exposures dithered along the vertices of a 1.44 arcsec equilateral triangle; these sets form the minimum observational unit, and are repeated as needed to achieve a combined signal-to-noise ratio of 5 −1 per fiber in the r-band continuum at a surface brightness of 23 AB arcsec−2. In order to ensure uniform coverage and delivered image quality, we require that the exposures in a given set be obtained within a 60 minute interval of each other in hour angle, and that all exposures be obtained at airmass (i.e., within 1-3 hr of transit depending on the declination of a given field).
ABSTRACT Mapping Nearby Galaxies at Apache Point Observatory (MaNGA), one of three core programs in the Sloan Digital Sky Survey-IV, is an integral-field spectroscopic survey of roughly 10,000 nearby ...galaxies. It employs dithered observations using 17 hexagonal bundles of 2″ fibers to obtain resolved spectroscopy over a wide wavelength range of 3600-10300 . To map the internal variations within each galaxy, we need to perform accurate spectral surface photometry, which is to calibrate the specific intensity at every spatial location sampled by each individual aperture element of the integral field unit. The calibration must correct only for the flux loss due to atmospheric throughput and the instrument response, but not for losses due to the finite geometry of the fiber aperture. This requires the use of standard star measurements to strictly separate these two flux loss factors (throughput versus geometry), a difficult challenge with standard single-fiber spectroscopy techniques due to various practical limitations. Therefore, we developed a technique for spectral surface photometry using multiple small fiber-bundles targeting standard stars simultaneously with galaxy observations. We discuss the principles of our approach and how they compare to previous efforts, and we demonstrate the precision and accuracy achieved. MaNGA's relative calibration between the wavelengths of H and Hβ has an rms of 1.7%, while that between N ii λ6583 and O ii λ3727 has an rms of 4.7%. Using extinction-corrected star formation rates and gas-phase metallicities as an illustration, this level of precision guarantees that flux calibration errors will be sub-dominant when estimating these quantities. The absolute calibration is better than 5% for more than 89% of MaNGA's wavelength range.
In all Canadian provinces, physicians can decide to either bill the provincial public system (opt in) or work privately and bill patients directly (opt out). We hypothesized that 2 policy events were ...associated with an increase in physicians opting out in Quebec.
The 2 policy events of interest were the 2005 Supreme Court of Canada ruling on
v.
and a regulatory clampdown forbidding double billing that was implemented by Quebec's government in 2017. We used interrupted time-series analyses of the Quebec government's yearly list of physicians who chose to opt out from 1994 to 2019 to analyze the relation between these events and physician billing status.
The number of family physicians who opted out increased from 9 in 1994 to 347 in 2019. Opting out increased after the Chaoulli ruling, and our analysis suggested that between 2005 and 2019, 284 more family physicians opted out than if pre-Chaoulli trends had continued. The number of specialist physicians who opted out rose from 23 in 1994 to 150 in 2019. Our analysis suggested that an additional 69 specialist physicians opted out after the 2017 clampdown on double billing than previous trends would have predicted.
We found that the number of physicians who opted out increased in Quebec, and increases after 2 policy actions suggest an association with these policy interventions. Opting out decisions are likely important inputs into decision-making by physicians, which, in turn may influence the provision of publicly funded health care.
Routine health information systems (RHISs) support resource allocation and management decisions at all levels of the health system, as well as strategy development and policy-making in many low- and ...middle-income countries (LMICs). Although RHIS data represent a rich source of information, such data are currently underused for research purposes, largely due to concerns over data quality. Given that substantial investments have been made in strengthening RHISs in LMICs in recent years, and that there is a growing demand for more real-time data from researchers, this systematic review builds upon the existing literature to summarize the extent to which RHIS data have been used in peer-reviewed research publications.
Using terms 'routine health information system', 'health information system', or 'health management information system' and a list of LMICs, four electronic peer-review literature databases were searched from inception to February 202,019: PubMed, Scopus, EMBASE, and EconLit. Articles were assessed for inclusion based on pre-determined eligibility criteria and study characteristics were extracted from included articles using a piloted data extraction form.
We identified 132 studies that met our inclusion criteria, originating in 37 different countries. Overall, the majority of the studies identified were from Sub-Saharan Africa and were published within the last 5 years. Malaria and maternal health were the most commonly studied health conditions, although a number of other health conditions and health services were also explored.
Our study identified an increasing use of RHIS data for research purposes, with many studies applying rigorous study designs and analytic methods to advance program evaluation, monitoring and assessing services, and epidemiological studies in LMICs. RHIS data represent an underused source of data and should be made more available and further embraced by the research community in LMIC health systems.
Objective
This study was undertaken to evaluate the impact of a Multidisciplinary Care Assessment (MCA) billing code on health system costs and access to care in British Columbia (BC).
Methods
Data ...on all people treated by rheumatologists in BC were obtained from five linked health administrative databases held by Population Data BC from April 1, 2006, to March 31, 2020. Rheumatologists were allocated to either the intervention (ever‐billers) or control groups (never‐billers). For the intervention group, the index date was the month of the first MCA code billing. For the control group the index dates were imputed from intervention index dates. Our analysis focused on a 48‐month period (24 months before and after the index date). We evaluated the impact on two cost (costs related to rheumatoid arthritis RA; total health care costs) and access outcomes (rheumatology‐related visits per rheumatologist; days between rheumatology visits for patients with RA) using an interrupted time series analysis.
Results
A total of 46 rheumatologists (31 intervention and 15 control) met our inclusion criteria. Introduction of the MCA was associated with a small but significant increase in RA‐related costs that, at 2 years, translates to a net absolute change of $9.66 per patient per month, but no statistically significant changes in total health care costs. There was no statistically significant change in the number of rheumatology‐related visits, but at 2 years there was a net absolute reduction in the median days between rheumatologist visits for patients with RA (6.3 days).
Conclusion
The introduction of the MCA code was associated with a negligible increase in the RA‐related costs and an improvement in access to ongoing care for patients.
Unbiased genetic studies have uncovered surprising molecular mechanisms in human cellular immunity and autoimmunity. We performed whole-exome sequencing and targeted sequencing in five families with ...an apparent mendelian syndrome of autoimmunity characterized by high-titer autoantibodies, inflammatory arthritis and interstitial lung disease. We identified four unique deleterious variants in the COPA gene (encoding coatomer subunit α) affecting the same functional domain. Hypothesizing that mutant COPA leads to defective intracellular transport via coat protein complex I (COPI), we show that COPA variants impair binding to proteins targeted for retrograde Golgi-to-ER transport. Additionally, expression of mutant COPA results in ER stress and the upregulation of cytokines priming for a T helper type 17 (TH17) response. Patient-derived CD4(+) T cells also demonstrate significant skewing toward a TH17 phenotype that is implicated in autoimmunity. Our findings uncover an unexpected molecular link between a vesicular transport protein and a syndrome of autoimmunity manifested by lung and joint disease.
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