Diffuse X-ray emission in spiral galaxies

We compare the soft diffuse X-ray emission from Chandra images of 12 nearby intermediate inclination spiral galaxies to the morphology seen in Halpha, molecular gas, and mid-infrared emission. We find that diffuse X-ray emission is often located along spiral arms in the outer parts of spiral galaxies but tends to be distributed in a rounder morphology in the center. The X-ray morphology in the spiral arms matches that seen in the mid-infrared or Halpha and so implies that the X-ray emission is associated with recent active star formation. We see no strong evidence for X-ray emission trailing the location of high mass star formation in spiral arms. However, population synthesis models predict a high mechanical energy output rate from supernovae for a time period that is about 10 times longer than the lifetime of massive ionizing stars, conflicting with the narrow appearance of the arms in X-rays. The fraction of supernova energy that goes into heating the ISM must depend on environment and is probably higher near sites of active star formation. The X-ray estimated emission measures suggest that the volume filling factors and scale heights are high in the galaxy centers but low in the outer parts of these galaxies. The differences between the X-ray properties and morphology in the centers and outer parts of these galaxies suggest that galactic fountains operate in outer galaxy disks but that winds are primarily driven from galaxy centers.Comment: 28 pages, 4 figures, to be submitted to Ap

DIFFUSE X-RAY EMISSION IN SPIRAL GALAXIES

ABSTRACT We compare the soft diffuse X-ray emission from Chandra images of 12 nearby intermediate-inclination spiral galaxies to the morphology seen in H, molecular gas, and mid-infrared emission. We find that diffuse X-ray emission is often located along spiral arms in the outer parts of spiral galaxies but tends to be distributed in a more nearly radially symmetric morphology in the center. The X-ray morphology in the spiral arms matches that seen in the mid-infrared or H and thus implies that the X-ray emission is associated with recent active star formation. In the spiral arms there is a good correlation between the level of diffuse X-ray emission and that in the mid-infrared in different regions. The correlation between X-ray and mid-IR flux in the galaxy centers is less strong. We also find that the central X-ray emission tends to be more luminous in galaxies with brighter bulges, suggesting that more than one process is contributing to the level of central diffuse X-ray emission. We see no strong evidence for X-ray emission trailing the location of high-mass star formation in spiral arms. However, population synthesis models predict a high mechanical energy output rate from supernovae for a time period that is about 10 times longer than the lifetime of massive ionizing stars, conflicting with the narrow appearance of the arms in X-rays. The fraction of supernova energy that goes into heating the interstellar medium must depend on environment and is probably higher near sites of active star formation. The X-ray estimated emission measures suggest that the volume filling factors and scale heights are low in the outer parts of these galaxies but higher in the galaxy centers. The differences between the X-ray properties and morphology in the centers and outer parts of these galaxies suggest that galactic fountains operate in outer galaxy disks but that winds are primarily driven from galaxy centers

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London