Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia

IMPORTANCE: Febrile neutropenia (FN) is the most common oncologic emergency and is among the most deadly. Guidelines recommend risk stratification and outpatient management of both pediatric and adult FN patients deemed to be at low risk of complications or mortality, but our prior single-center research demonstrated that the vast majority (95%) are hospitalized. OBJECTIVE: From a nationwide perspective, to determine the proportion of cancer patients of all ages hospitalized after an emergency department (ED) visit for FN, and to analyze variability in hospitalization rates. Our a priori hypothesis was that >90% of US cancer-associated ED FN visits would end in hospitalization. DESIGN: Analysis of data from the Nationwide Emergency Department Sample, 2006-2014. SETTING: Stratified probability sample of all US ED visits. PARTICIPANTS: Inclusion criteria were: (1) Clinical Classification Software code indicating cancer, (2) diagnostic code indicating fever, and (3) diagnostic code indicating neutropenia. We excluded visits ending in transfer. EXPOSURE: The hospital at which the visit took place. MAIN OUTCOMES AND MEASURES: Our main outcome is the proportion of ED FN visits ending in hospitalization, with an a priori hypothesis of >90%. Our secondary outcomes are: (a) hospitalization rates among subsets, and (b) proportion of variability in the hospitalization rate attributable to which hospital the patient visited, as measured by the intra-class correlation coefficient (ICC). RESULTS: Of 348,868 visits selected to be representative of all US ED visits, 94% ended in hospitalization (95% Confidence Interval [CI] 93-94%). Each additional decade of age conferred 1.23x increased odds of hospitalization. Those with private (92%), self-pay (92%), and other (93%) insurance were less likely to be hospitalized than those with public insurance (95%, odds ratios [OR] 0.74-0.76). Hospitalization was least likely at non-metropolitan hospitals (84%, OR 0.15 relative to metropolitan teaching hospitals), and was also less likely at metropolitan non-teaching hospitals (94%, OR 0.64 relative to metropolitan teaching hospitals). The ICC adjusted for hospital random effects and patient and hospital characteristics was 26% (95%CI 23-29%), indicating that 26% of the variability in hospitalization rate was attributable to which hospital the patient visited. CONCLUSIONS AND RELEVANCE: Nearly all cancer-associated ED FN visits in the US end in hospitalization. Inter-hospital variation in hospitalization practices explains 26% of the limited variability in hospitalization decisions. Simple, objective tools are needed to improve risk stratification for ED FN patients

The Galaxy Angular Correlation Functions and Power Spectrum from the Two Micron All Sky Survey

We calculate the angular correlation function of galaxies in the Two Micron All Sky Survey. We minimize the possible contamination by stars, dust, seeing and sky brightness by studying their cross correlation with galaxy density, and limiting the galaxy sample accordingly. We measure the correlation function at scales between 1-18 arcdegs using a half million galaxies. We find a best fit power law to the correlation function has a slope of 0.76 and an amplitude of 0.11. However, there are statistically significant oscillations around this power law. The largest oscillation occurs at about 0.8 degrees, corresponding to 2.8 h^{-1} Mpc at the median redshift of our survey, as expected in halo occupation distribution descriptions of galaxy clustering. We invert the angular correlation function using Singular Value Decomposition to measure the three-dimensional power spectrum and find that it too is in good agreement with previous measurements. A dip seen in the power spectrum at small wavenumber k is statistically consistent with CDM-type power spectra. A fit of CDM-type power spectra to k < 0.2 h Mpc^{-1} give constraints of \Gamma_{eff}=0.116 and \sigma_8=0.96. This suggest a K_s-band linear bias of 1.1+/-0.2. This \Gamma_{eff} is different from the WMAP CMB derived value. On small scales the power-law shape of our power spectrum is shallower than that derived for the SDSS. These facts together imply a biasing of these different galaxies that might be nonlinear, that might be either waveband or luminosity dependent, and that might have a nonlocal origin.Comment: 14 pages, 20 figures, to be published in ApJ January 20th, revision included two new figures, version with high resolution figures can be found here http::ww

Can Baryonic Features Produce the Observed 100 Mpc Clustering?

We assess the possibility that baryonic acoustic oscillations in adiabatic models may explain the observations of excess power in large-scale structure on 100h^-1 Mpc scales. The observed location restricts models to two extreme areas of parameter space. In either case, the baryon fraction must be large (Omega_b/Omega_0 > 0.3) to yield significant features. The first region requires Omega_0 < 0.2h to match the location, implying large blue tilts (n>1.4) to satisfy cluster abundance constraints. The power spectrum also continues to rise toward larger scales in these models. The second region requires Omega_0 near 1, implying Omega_b well out of the range of big bang nucleosynthesis constraints; moreover, the peak is noticeably wider than the observations suggest. Testable features of both solutions are that they require moderate reionization and thereby generate potentially observable (about 1 uK) large-angle polarization, as well as sub-arc-minute temperature fluctuations. In short, baryonic features in adiabatic models may explain the observed excess only if currently favored determinations of cosmological parameters are in substantial error or if present surveys do not represent a fair sample of 100h^-1 Mpc structures.Comment: LaTeX, 7 pages, 5 Postscript figures, submitted to ApJ Letter

Probing Dark Energy with Baryonic Acoustic Oscillations from Future Large Galaxy Redshift Surveys

We show that the measurement of the baryonic acoustic oscillations in large high redshift galaxy surveys offers a precision route to the measurement of dark energy. The cosmic microwave background provides the scale of the oscillations as a standard ruler that can be measured in the clustering of galaxies, thereby yielding the Hubble parameter and angular diameter distance as a function of redshift. This, in turn, enables one to probe dark energy. We use a Fisher matrix formalism to study the statistical errors for redshift surveys up to z=3 and report errors on cosmography while marginalizing over a large number of cosmological parameters including a time-dependent equation of state. With redshifts surveys combined with cosmic microwave background satellite data, we achieve errors of 0.037 on Omega_x, 0.10 on w(z=0.8), and 0.28 on dw(z)/dz for cosmological constant model. Models with less negative w(z) permit tighter constraints. We test and discuss the dependence of performance on redshift, survey conditions, and fiducial model. We find results that are competitive with the performance of future supernovae Ia surveys. We conclude that redshift surveys offer a promising independent route to the measurement of dark energy.Comment: submitted to ApJ, 24 pages, LaTe

First Measurement of the Clustering Evolution of Photometrically-Classified Quasars

We present new measurements of the quasar autocorrelation from a sample of \~80,000 photometrically-classified quasars taken from SDSS DR1. We find a best-fit model of $\omega(\theta) = (0.066\pm^{0.026}_{0.024})\theta^{-(0.98\pm0.15)}$ for the angular autocorrelation, consistent with estimates from spectroscopic quasar surveys. We show that only models with little or no evolution in the clustering of quasars in comoving coordinates since z~1.4 can recover a scale-length consistent with local galaxies and Active Galactic Nuclei (AGNs). A model with little evolution of quasar clustering in comoving coordinates is best explained in the current cosmological paradigm by rapid evolution in quasar bias. We show that quasar biasing must have changed from b_Q~3 at a (photometric) redshift of z=2.2 to b_Q~1.2-1.3 by z=0.75. Such a rapid increase with redshift in biasing implies that quasars at z~2 cannot be the progenitors of modern L* objects, rather they must now reside in dense environments, such as clusters. Similarly, the duration of the UVX quasar phase must be short enough to explain why local UVX quasars reside in essentially unbiased structures. Our estimates of b_Q are in good agreement with recent spectroscopic results, which demonstrate the implied evolution in b_Q is consistent with quasars inhabiting halos of similar mass at every redshift. Treating quasar clustering as a function of both redshift and luminosity, we find no evidence for luminosity dependence in quasar clustering, and that redshift evolution thus affects quasar clustering more than changes in quasars' luminosity. We provide a new method for quantifying stellar contamination in photometrically-classified quasar catalogs via the correlation function.Comment: 34 pages, 10 figures, 1 table, Accepted to ApJ after: (i) Minor textual changes; (ii) extra points added to Fig.