The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) collects detailed clinical data from participating hospitals using standardized data definitions, analyzes ...these data, and provides participating hospitals with reports that permit risk-adjusted comparisons with a surgical quality standard. Since its inception, the ACS NSQIP has worked to refine surgical outcomes measurements and enhance statistical methods to improve the reliability and validity of this hospital profiling. From an original focus on controlling for between-hospital differences in patient risk factors with logistic regression, ACS NSQIP has added a variable to better adjust for the complexity and risk profile of surgical procedures (procedure mix adjustment) and stabilized estimates derived from small samples by using a hierarchical model with shrinkage adjustment. New models have been developed focusing on specific surgical procedures (eg, “Procedure Targeted” models), which provide opportunities to incorporate indication and other procedure-specific variables and outcomes to improve risk adjustment. In addition, comparative benchmark reports given to participating hospitals have been expanded considerably to allow more detailed evaluations of performance. Finally, procedures have been developed to estimate surgical risk for individual patients. This article describes the development of, and justification for, these new statistical methods and reporting strategies in ACS NSQIP.
Abstract
We analyse the velocity dispersion properties of 472 z ∼ 0.9 star-forming galaxies observed as part of the KMOS Redshift One Spectroscopic Survey (KROSS). The majority of this sample is ...rotationally dominated (83 ± 5 per cent with vC/σ0 > 1) but also dynamically hot and highly turbulent. After correcting for beam smearing effects, the median intrinsic velocity dispersion for the final sample is σ0 = 43.2 ± 0.8 km s−1 with a rotational velocity to dispersion ratio of vC/σ0 = 2.6 ± 0.1. To explore the relationship between velocity dispersion, stellar mass, star formation rate, and redshift, we combine KROSS with data from the SAMI survey (z ∼ 0.05) and an intermediate redshift MUSE sample (z ∼ 0.5). Whilst there is, at most, a weak trend between velocity dispersion and stellar mass, at fixed mass there is a strong increase with redshift. At all redshifts, galaxies appear to follow the same weak trend of increasing velocity dispersion with star formation rate. Our results are consistent with an evolution of galaxy dynamics driven by discs that are more gas rich, and increasingly gravitationally unstable, as a function of increasing redshift. Finally, we test two analytic models that predict turbulence is driven by either gravitational instabilities or stellar feedback. Both provide an adequate description of the data, and further observations are required to rule out either model.
We investigate the relationship between stellar and gas specific angular momentum j, stellar mass M
* and optical morphology for a sample of 488 galaxies extracted from the Sydney-AAO Multi-object ...Integral field Galaxy Survey. We find that j, measured within one effective radius, monotonically increases with M
* and that, for M
* > 109.5 M⊙, the scatter in this relation strongly correlates with optical morphology (i.e. visual classification and Sérsic index). These findings confirm that massive galaxies of all types lie on a plane relating mass, angular momentum and stellar-light distribution, and suggest that the large-scale morphology of a galaxy is regulated by its mass and dynamical state. We show that the significant scatter in the M
*-j relation is accounted for by the fact that, at fixed stellar mass, the contribution of ordered motions to the dynamical support of galaxies varies by at least a factor of 3. Indeed, the stellar spin parameter (quantified via λ
R
) correlates strongly with Sérsic and concentration indices. This correlation is particularly strong once slow rotators are removed from the sample, showing that late-type galaxies and early-type fast rotators form a continuous class of objects in terms of their kinematic properties.
Desmoplasia and hypovascularity are thought to impede drug delivery in pancreatic ductal adenocarcinoma (PDAC). However, stromal depletion approaches have failed to show clinical responses in ...patients. Here, we aimed to revisit the role of the tumour microenvironment as a physical barrier for gemcitabine delivery.
Gemcitabine metabolites were analysed in
;
;
(KPC) murine tumours and matched liver metastases, primary tumour cell lines, cancer-associated fibroblasts (CAFs) and pancreatic stellate cells (PSCs) by liquid chromatography-mass spectrometry/mass spectrometry. Functional and preclinical experiments, as well as expression analysis of stromal markers and gemcitabine metabolism pathways were performed in murine and human specimen to investigate the preclinical implications and the mechanism of gemcitabine accumulation.
Gemcitabine accumulation was significantly enhanced in fibroblast-rich tumours compared with liver metastases and normal liver. In vitro, significantly increased concentrations of activated 2',2'-difluorodeoxycytidine-5'-triphosphate (dFdCTP) and greatly reduced amounts of the inactive gemcitabine metabolite 2',2'-difluorodeoxyuridine were detected in PSCs and CAFs. Mechanistically, key metabolic enzymes involved in gemcitabine inactivation such as hydrolytic cytosolic 5'-nucleotidases (Nt5c1A, Nt5c3) were expressed at low levels in CAFs in vitro and in vivo, and recombinant expression of Nt5c1A resulted in decreased intracellular dFdCTP concentrations in vitro. Moreover, gemcitabine treatment in KPC mice reduced the number of liver metastases by >50%.
Our findings suggest that fibroblast drug scavenging may contribute to the clinical failure of gemcitabine in desmoplastic PDAC. Metabolic targeting of CAFs may thus be a promising strategy to enhance the antiproliferative effects of gemcitabine.
ABSTRACT
We present a detailed exploration of the stellar mass versus gas-phase metallicity relation (MZR) using integral field spectroscopy data obtained from ∼1000 galaxies observed by the SAMI ...galaxy survey. These spatially resolved spectroscopic data allow us to determine the metallicity within the same physical scale (Reff) for different calibrators. The shape of the MZ relations is very similar between the different calibrators, while there are large offsets in the absolute values of the abundances. We confirm our previous results derived using the spatially resolved data provided by the CALIFA and MaNGA surveys: (1) we do not find any significant secondary relation of the MZR with either the star formation rate (SFR) or the specific SFR (SFR/M*) for any of the calibrators used in this study, based on the analysis of the individual residuals; (2) if there is a dependence with the SFR, it is weaker than the reported one (rc ∼ −0.3), it is confined to the low-mass regime (M* < 109 M⊙) or high-SFR regimes, and it does not produce any significant improvement in the description of the average population of galaxies. The aparent disagreement with published results based on single-fibre spectroscopic data could be due to (i) the interpretation of the secondary relation itself; (ii) the lower number of objects sampled at the low-mass regime by the current study; or (iii) the presence of extreme star-forming galaxies that drive the secondary relation in previous results.
The SAMI Galaxy Survey will observe 3400 galaxies with the Sydney-AAO Multi-object Integral-field spectrograph (SAMI) on the Anglo-Australian Telescope in a 3-yr survey which began in 2013. We ...present the throughput of the SAMI system, the science basis and specifications for the target selection, the survey observation plan and the combined properties of the selected galaxies. The survey includes four volume-limited galaxy samples based on cuts in a proxy for stellar mass, along with low-stellar-mass dwarf galaxies all selected from the Galaxy And Mass Assembly (GAMA) survey. The GAMA regions were selected because of the vast array of ancillary data available, including ultraviolet through to radio bands. These fields are on the celestial equator at 9, 12 and 14.5 h, and cover a total of 144 deg2 (in GAMA-I). Higher density environments are also included with the addition of eight clusters. The clusters have spectroscopy from 2-degree Field Galaxy Redshift Survey (2dFGRS) and Sloan Digital Sky Survey (SDSS) and photometry in regions covered by the SDSS and/or VLT Survey Telescope/ATLAS. The aim is to cover a broad range in stellar mass and environment, and therefore the primary survey targets cover redshifts 0.004 ... 0.095, magnitudes ... 19.4, stellar masses ..., and environments from isolated field galaxies through groups to clusters of ... (ProQuest: ... denotes formulae/symbols omitted.)
We present the results of models that were designed to study all possible water maser transitions in the frequency range 0–1.91 THz, with particular emphasis on maser transitions that may be ...generated in evolved-star envelopes and observed with the ALMA and SOFIA telescopes. We used tens of thousands of radiative transfer models of both spin-species of H2O, spanning a considerable parameter space in number density, kinetic temperature and dust temperature. Results, in the form of maser optical depths, have been summarized in a master table. Maser transitions identified in these models were grouped according to loci of inverted regions in the density/kinetic temperature plane, a property clearly related to the dominant mode of pumping. A more detailed study of the effect of dust temperature on maser optical depth enabled us to divide the maser transitions into three groups: those with both collisional and radiative pumping schemes (22, 96, 209, 321, 325, 395, 941 and 1486 GHz), a much larger set that are predominantly radiatively pumped, and another large group with a predominantly collisional pump. The effect of accelerative and decelerative velocity shifts of up to 5 km s−1 was found to be generally modest, with the primary effect of reducing computed maser optical depths. More subtle asymmetric effects, dependent on line overlap, include maximum gains offset from zero shift by >1 km s−1, but these effects were predominantly found under conditions of weak amplification. These models will allow astronomers to use multitransition water maser observations to constrain physical conditions down to the size of individual masing clouds (size of a few astronomical units).
We use data from the Sydney-AAO Multi-Object Integral Field Spectrograph Galaxy Survey and the Galaxy And Mass Assembly (GAMA) survey to investigate the spatially resolved signatures of the ...environmental quenching of star formation in galaxies. Using dust-corrected measurements of the distribution of H... emission, we measure the radial profiles of star formation in a sample of 201 star-forming galaxies covering three orders of magnitude in stellar mass (M*; 10 super( 8.1)-10 super( 10.95) M...) and in fifth nearest neighbour local environment density (...; 10 super( -1.3)-10 super( 2.1) Mpc super( -2)). We show that star formation rate gradients in galaxies are steeper in dense (log sub( 10)(.../Mpc super( 2)) > 0.5) environments by 0.58 plus or minus 0.29dexr sub( e) super( -1) in galaxies with stellar masses in the range 10 super( 10)<M*/M...<10 super( 11) and that this steepening is accompanied by a reduction in the integrated star formation rate. However, for any given stellar mass or environment density, the star formation morphology of galaxies shows large scatter. We also measure the degree to which the star formation is centrally concentrated using the unitless scale-radius ratio (r sub( 50,H...)/r sub( 50,cont)), which compares the extent of ongoing star formation to previous star formation. With this metric, we find that the fraction of galaxies with centrally concentrated star formation increases with environment density, from ~5 plus or minus 4 per cent in low-density environments (log sub( 10)(.../Mpc super( 2)) < 0.0) to 30 plus or minus 15 per cent in the highest density environments (log sub( 10)(.../Mpc super( 2)) > 1.0). These lines of evidence strongly suggest that with increasing local environment density, the star formation in galaxies is suppressed, and that this starts in their outskirts such that quenching occurs in an outside-in fashion in dense environments and is not instantaneous. (ProQuest: ... denotes formulae/symbols omitted.)
Background Data used for evaluating quality of medical care need to be of high reliability to ensure valid quality assessment and benchmarking. The American College of Surgeons National Surgical ...Quality Improvement Program (ACS NSQIP) has continually emphasized the collection of highly reliable clinical data through its program infrastructure. Study Design We provide a detailed description of the various mechanisms used in ACS NSQIP to assure collection of high quality data, including training of data collectors (surgical clinical reviewers) and ongoing audits of data reliability. For the 2005 through 2008 calendar years, inter-rater reliability was calculated overall and for individual variables using percentages of agreement between the data collector and the auditor. Variables with > 5% disagreement are flagged for educational efforts to improve accurate collection. Cohen's kappa was estimated for selected variables from the 2007 audit year. Results Inter-rater reliability audits show that overall disagreement rates on variables have fallen from 3.15% in 2005 (the first year of public enrollment in ACS NSQIP) to 1.56% in 2008. In addition, disagreement levels for individual variables have continually improved, with 26 individual variables demonstrating > 5% disagreement in 2005, to only 2 such variables in 2008. Estimated kappa values suggest substantial or almost perfect agreement for most variables. Conclusions The ACS NSQIP has implemented training and audit procedures for its hospital participants that are highly effective in collecting robust data. Audit results show that data have been reliable since the program's inception and that reliability has improved every year.
ABSTRACT
We present the first detection of mass-dependent galactic spin alignments with local cosmic filaments with >2σ confidence using IFS kinematics. The 3D network of cosmic filaments is ...reconstructed on Mpc scales across GAlaxy and Mass Assembly fields using the cosmic web extractor DisPerSe. We assign field galaxies from the SAMI survey to their nearest filament segment in 3D and estimate the degree of alignment between SAMI galaxies’ kinematic spin axis and their nearest filament in projection. Low-mass galaxies align their spin with their nearest filament while higher mass counterparts are more likely to display an orthogonal orientation. The stellar transition mass from the first trend to the second is bracketed between $10^{10.4}$ and $10^{10.9}\, \mathrm{ M}_{\odot }$, with hints of an increase with filament scale. Consistent signals are found in the Horizon-AGN cosmological hydrodynamic simulation. This supports a scenario of early angular momentum build-up in vorticity rich quadrants around filaments at low stellar mass followed by progressive flip of spins orthogonal to the cosmic filaments through mergers at high stellar mass. Conversely, we show that dark matter only simulations post-processed with a semi-analytical model treatment of galaxy formation struggles to reproduce this alignment signal. This suggests that gas physics is key in enhancing the galaxy-filament alignment.
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