Propensity score matching for surgical outcomes with observational data.

Because of limitations in randomized controlled trials, medical researchers are often forced to rely upon studies of observational data. Confounding is a major difficulty encountered in such studies that can create considerable bias in estimates of treatment effects. Propensity score analysis was developed by Rosenbaum & Rubin in 1983 to overcome these difficulties. In essence, a propensity score allows balance to be achieved on confounding covariates in treatment and control groups, thus creating a \u27quasi-randomized\u27 trial from observational data. In this study, I illustrate the use of propensity matching to demonstrate that African American race is a significant risk factor for receiving a lower quality donor kidney using a national database on transplantation. I then use propensity matching to demonstrate the benefits of laparoscopic resection for hepatic colorectal metastases. In doing so, the great value of propensity matching in reducing bias in observational studies is demonstrated

Surgical resection for hilar cholangiocarcinoma: experience improves resectability

AbstractObjectivesIn hilar cholangiocarcinoma, resection provides the only opportunity for longterm survival. A US experience of hilar cholangiocarcinoma was examined to determine the effect of clinical experience on negative margin (R0) resection rates.MethodsWe conducted a retrospective analysis of 110 consecutive hilar cholangiocarcinoma patients presenting over an 18-year period. Analyses were performed using chi-squared, Wilcoxon rank sum and Kaplan–Meier methods, and multivariable Cox and logistic regression modelling.ResultsOf the 110 patients in the cohort, 59.1% were male and 90.9% were White. The median patient age was 64 years. A total of 59 (53.6%) patients underwent resection; 37 of these demonstrated R0. The 30-day mortality rate was 5.1%; the complication rate was 39.0%. The rate of resectability increased over time (36.4% vs. 70.9%; P= 0.001), as did the percentage of R0 resections (10.9% vs. 56.5%; P < 0.001). Of the 59 patients who underwent resection, 23 (39.0%) experienced recurrence. Multivariable Cox regression analysis identified resection margins [hazard ratio (HR) = 4.124 for positive vs. negative; P= 0.002] and type of operation (HR = 5.075 for exploration vs. resection; P= 0.001) as significant to survival.ConclusionsAlthough R0 resection can be achieved in only a minority of patients, these patients have a reasonable chance of longterm survival. The last decade has seen a significant rise in rates of resectability of Klatskin's tumour at specialty centres

A Novel Classification System to Address Financial Impact and Referral Decisions for Bile Duct Injury in Laparoscopic Cholecystectomy

Purpose. The study was undertaken to evaluate a novel classification system developed to estimate financial cost of bile duct injury (BDI) and to aid in decision making for referral. Study Design. A retrospective review of patients referred for BDI was performed. Grade I injuries involve the duct of Luschka or accessory right hepatic ducts, grade II includes all other biliary injuries, and grade III includes all vasculobiliary injuries. Groups were compared using standard statistical methods. Results. There were 14 grade I, 74 grade II, and 20 grade III injuries. There was a significant difference in the cost and mortality of grade I ($12,457, 0$46,481, 1.4%), and grade III ($69,368, 15%, P = 0.002 and P = 0.030, resp.) injuries. Grade II and III injuries were significantly more likely to require surgical repair (OR 27.7, P < 0.001). Conclusion. We have presented a simple classification system that is able to accurately predict cost and need for surgical repair

Spatially Resolved PAH Emission Features in Nearby, Low Metallicity, Star-Forming Galaxies

Low-resolution, mid-infrared Spitzer/IRS spectral maps are presented for three nearby, low-metallicity dwarf galaxies (NGC 55, NGC 3109 and IC 5152) for the purpose of examining the spatial distribution and variation of polycyclic aromatic hydrocarbon (PAH) emission. The sample straddles a metallicity of 12+log(O/H)~8.0, a transition point below which PAH intensity empirically drops and the character of the interstellar medium changes. We derive quantitative radiances of PAH features and atomic lines on both global and spatially-resolved scales. The Spitzer spectra, combined with extensive ancillary data from the UV through the mid-infrared, allow us to examine changes in the physical environments and in PAH feature radiances down to a physical scale of 50 pc. We discuss correlations between various PAH emission feature and atomic line radiances. The (6.2 micron)/(11.3 micron), (7.7 micron)/(11.3 micron), (8.6 micron)/(11.3 micron), (7.7 micron)/(6.2 micron), and (8.6 micron)/(6.2 micron) PAH radiance ratios are found to be independent of position across all three galaxies, although the ratios do vary from galaxy to galaxy. As seen in other galaxies, we find no variation in the grain size distribution as a function of local radiation field strength. Absolute PAH feature intensities as measured by a ratio of PAH/(24 micron) radiances are seen to vary both positionally within a given galaxy, and from one galaxy to another when integrated over the full observed extent of each system. We examine direct comparisons of CC mode PAH ratios (7.7 micron)/(6.2 micron) and (8.6 micron)/(6.2 micron) to the mixed (CC/CH) mode PAH ratio (7.7 micron)/(11.3 micron). We find little variation in either mode, and no difference in trends between modes. While the local conditions change markedly over the observed regions of these galaxies, the properties of PAH emission show a remarkable degree of uniformity.Comment: Astrophysical Journal, in pres

Sodium naphthalene-2,6-dicarboxylate : an anode for sodium batteries

We thank the EPSRC (EP/K025112/1) and the Leverhulme Trust (RPG-2016-323) for funding and Diamond Light Source for rapid access to synchrotron radiation facilities.The conjugated dicarboxylate, sodium naphthalene-2,6-dicarboxylate (Na2NDC), has been prepared by a low energy consumption reflux method and its performance as a negative electrode for sodium-ion batteries evaluated in electrochemical cells. The structure of Na2NDC was solved for the first time (monoclinic P21/c) from powder X-ray diffraction data and consists of π-stacked naphthalene units separated by sodium-oxygen layers. Through an appropriate choice of binder and conducting carbon additive Na2NDC exhibits a reversible two electron sodium insertion at around 0.4 V vs. Na+/Na with remarkably stable capacities of ca. 200 mA h g-1 at a rate of C/2 and good rate capability (~133 mA h g-1 at 5C). In parallel the high thermal stability of the material is demonstrated by HT-X-ray diffraction, the framework remaining intact to above 500 °C.PostprintPeer reviewe

The M81 Group Dwarf Irregular Galaxy DDO 165. I. High Velocity Neutral Gas in a Post-Starburst System

We present new multi-configuration VLA HI spectral line observations of the M81 group dIrr post-starburst galaxy DDO 165. The HI morphology is complex, with multiple column density peaks surrounding a large region of very low HI surface density that is offset from the center of the stellar distribution. The bulk of the neutral gas is associated with the southern section of the galaxy; a secondary peak in the north contains ~15% of the total HI mass. These components appear to be kinematically distinct, suggesting that either tidal processes or large-scale blowout have recently shaped the ISM of DDO 165. Using spatially-resolved position-velocity maps, we find multiple localized high-velocity gas features. Cross-correlating with radius-velocity analyses, we identify eight shell/hole structures in the ISM with a range of sizes (~400-900 pc) and expansion velocities (~7-11 km/s). These structures are compared with narrow- and broad-band imaging from KPNO and HST. Using the latter data, recent works have shown that DDO 165's previous "burst" phase was extended temporally (>1 Gyr). We thus interpret the high-velocity gas features, HI holes, and kinematically distinct components of the galaxy in the context of the immediate effects of "feedback" from recent star formation. In addition to creating HI holes and shells, extended star formation events are capable of creating localized high velocity motion of the surrounding interstellar material. A companion paper connects the energetics from the HI and HST data.Comment: The Astrophysical Journal, in press. Full-resolution version available on request from the first autho

The Formation of Kiloparsec-scale HI Holes in Dwarf Galaxies

The origin of kpc-scale holes in the atomic hydrogen (H i) distributions of some nearby dwarf irregular galaxies presents an intriguing problem. Star formation histories (SFHs) derived from resolved stars give us the unique opportunity to study past star-forming events that may have helped shape the currently visible Hi distribution. Our sample of five nearby dwarf irregular galaxies spans over an order of magnitude in both total Hi mass and absolute B-band magnitude and is at the low-mass end of previously studied systems. We use Very Large Array Hi line data to estimate the energy required to create the centrally dominant hole in each galaxy. We compare this energy estimate to the past energy released by the underlying stellar populations computed from SFHs derived from data taken with the Hubble Space Telescope. The inferred integrated stellar energy released within the characteristic ages exceeds our energy estimates for creating the holes in all cases, assuming expected efficiencies. Therefore, it appears that stellar feedback provides sufficient energy to produce the observed holes. However, we find no obvious signature of single star-forming events responsible for the observed structures when comparing the global SFHs of each galaxy in our sample to each other or to those of dwarf irregular galaxies reported in the literature. We also fail to find evidence of a central star cluster in FUV or Hα imaging. We conclude that large Hi holes are likely formed from multiple generations of star formation and only under suitable interstellar medium conditions