Seeing statistics at the upgraded 3.8m UK infrared telescope (UKIRT)

From 1991 until 1997, the 3.8m UK Infrared Telescope (UKIRT) underwent a programme of upgrades aimed at improving its intrinsic optical performance. This resulted in images with a FWHM of 0."17 at 2.2 um in September 1998. To understand and maintain the improvements to the delivered image quality since the completion of the upgrades programme, we have regularly monitored the overall atmospheric seeing, as measured by radial displacements of subaperture images (i.e. seeing-generated focus fluctuations), and the delivered image diameters. The latter have been measured and recorded automatically since the beginning of 2001 whenever the facility imager UFTI (UKIRT Fast Track Imager) has been in use. In this paper we report the results of these measurements. We investigate the relation between the delivered image diameter and the RMS atmospheric seeing (as measured by focus fluctuations, mentioned above). We find that the best seeing occurs in the second half of the night, generally after 2am HST and that the best seeing occurs in the summer between the months of July and September. We also find that the relationship between Zrms and delivered image diameter is uncertain. As a result Zrms frequently predicts a larger FWHM than that measured in the images. Finally, we show that there is no correlation between near-infrared seeing measured at UKIRT and sub-mm seeing measured at the Caltech Submillimetre Observatory (CSO).Comment: 10 pages to appear in the SPIE proceeding vol. 4484 on Observatory Operations to Maximize Scientific Retur

Evidence for a correlation between the sizes of quiescent galaxies and local environment to z ~ 2

We present evidence for a strong relationship between galaxy size and environment for the quiescent population in the redshift range 1 < z < 2. Environments were measured using projected galaxy overdensities on a scale of 400 kpc, as determined from ~ 96,000 K-band selected galaxies from the UKIDSS Ultra Deep Survey (UDS). Sizes were determined from ground-based K-band imaging, calibrated using space-based CANDELS HST observations in the centre of the UDS field, with photometric redshifts and stellar masses derived from 11-band photometric fitting. From the resulting size-mass relation, we confirm that quiescent galaxies at a given stellar mass were typically ~ 50 % smaller at z ~ 1.4 compared to the present day. At a given epoch, however, we find that passive galaxies in denser environments are on average significantly larger at a given stellar mass. The most massive quiescent galaxies (M_stellar > 2 x 10^11 M_sun) at z > 1 are typically 50 % larger in the highest density environments compared to those in the lowest density environments. Using Monte Carlo simulations, we reject the null hypothesis that the size-mass relation is independent of environment at a significance > 4.8 sigma for the redshift range 1 < z < 2. In contrast, the evidence for a relationship between size and environment is much weaker for star-forming galaxies.Comment: Accepted for publication in MNRAS. 16 pages, 11 figures, 6 table

Systemic inflammation, coagulopathy, and acute renal insufficiency following endovascular thoracoabdominal aortic aneurysm repair

ObjectiveTo characterize the inflammatory and coagulopathic response after endovascular thoracoabdominal aortic aneurysm (TAAA) repair and to evaluate the effect of the response on postoperative renal function.MethodsFrom July 2005 to June 2008, 42 patients underwent elective endovascular repair of a TAAA using custom designed multi-branched stent-grafts at a single academic institution. Four patients were excluded from the analysis. White blood cell count (WBC), platelet count, prothrombin time (PT), and creatinine were measured in all patients. In the last nine patients, interleukin-6 (IL-6), protein C, Factor V, d-dimers, cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL) levels were also measured. Change in lab values were expressed as a percentage of baseline values.ResultsThe 30-day mortality rate was 5% (2/38). All patients (n = 38) had a higher WBC (mean ± SD: 139 ± 80%, P < .0001), lower platelet count (56 ± 15%, P < .0001), and higher PT (median: 17%, Interquartile range (IQR) 12%-22%, P < .0001) after stent-graft insertion. Twelve of 38 patients (32%) developed postoperative acute renal insufficiency (>50% rise in creatinine). Patients with renal insufficiency had significantly larger changes in WBC (178 ± 100% vs 121 ± 64%, P = .04) and platelet count (64 ± 17% vs 52 ± 12%, P = .02) compared with those without renal insufficiency. All patients (n = 9) had significant increases in NGAL (182 ± 115%, P = .008) after stent-graft insertion. Six of nine patients (67%) had increased cystatin C (35 ± 43%, P = .04) after stent-graft insertion, with a greater rise in those with postoperative renal insufficiency (87 ± 32% vs 8 ± 13%, P = .02). IL-6 levels were markedly increased in all patients (n = 9) after repair (9840 ± 6160%, P = .008). Protein C (35 ± 10%, P = .008) and Factor V levels (28 ± 20%, P = .008) were uniformly decreased, while d-dimers were elevated after repair in all patients (310 ± 213%, P = .008).ConclusionsLeukocytosis and thrombocytopenia were uniform following endovascular TAAA repair, and the severity of the response correlated with post-operative renal dysfunction. Elevation of a sensitive marker of renal injury (NGAL) suggests that renal injury may occur in all patients after stent-graft insertion

‘New Medicine Service’: supporting adherence in people starting a new medication for a long-term condition: 26-week follow-up of a pragmatic randomised controlled trial

OBJECTIVE: To examine the effectiveness and cost-effectiveness of the community pharmacy New Medicine Service (NMS) at 26 weeks. METHODS: Pragmatic patient-level parallel randomised controlled trial in 46 English community pharmacies. 504 participants aged ≥14, identified in the pharmacy when presenting a prescription for a new medicine for predefined long-term conditions, randomised to receive NMS (n=251) or normal practice (n=253) (NMS intervention: 2 consultations 1 and 2 weeks after prescription presentation). Adherence assessed through patient self-report at 26-week follow-up. Intention-to-treat analysis employed. National Health Service (NHS) costs calculated. Disease-specific Markov models estimating impact of non-adherence combined with clinical trial data to calculate costs per extra quality-adjusted life-year (QALY; NHS England perspective). RESULTS: Unadjusted analysis: of 327 patients still taking the initial medicine, 97/170 (57.1%) and 103/157 (65.6%) (p=0.113) patients were adherent in normal practice and NMS arms, respectively. Adjusted intention-to-treat analysis: adherence OR 1.50 (95% CI 0.93 to 2.44, p=0.095), in favour of NMS. There was a non-significant reduction in 26-week NHS costs for NMS: -£104 (95% CI -£37 to £257, p=0.168) per patient. NMS generated a mean of 0.04 (95% CI -0.01 to 0.13) more QALYs per patient, with mean reduction in lifetime cost of -£113.9 (-1159.4, 683.7). The incremental cost-effectiveness ratio was -£2758/QALY (2.5% and 97.5%: -38 739.5, 34 024.2. NMS has an 89% probability of cost-effectiveness at a willingness to pay of £20 000 per QALY. CONCLUSIONS: At 26-week follow-up, NMS was unable to demonstrate a statistically significant increase in adherence or reduction in NHS costs, which may be attributable to patient attrition from the study. Long-term economic evaluation suggested NMS may deliver better patient outcomes and reduced overall healthcare costs than normal practice, but uncertainty around this finding is high. TRIAL REGISTRATION NUMBER: NCT01635361, ISRCTN23560818, ISRCTN23560818, UKCRN12494

Abdominal aortic aneurysm repair with the Zenith stent graft: Short to midterm results

AbstractPurpose: The purpose of this study was to assess the short-term and mid-term results of endovascular aneurysm repair with the Zenith stent graft in a single-center prospective study. Method: Between October 1998 and July 2001, we used the Zenith stent graft for elective endovascular aneurysm repair in 116 patients, six of whom were women. The mean age was 75 years, and the mean aneurysm diameter was 60.3 ± 8.8 mm. Stent grafts were oversized 10% to 20% relative to computed tomographic (CT) scan-based diameter measurements. All repairs were performed in the operating room through surgically exposed femoral arteries. The results were assessed before discharge with three-phase, contrast-enhanced CT scan and plain abdominal radiograph. These studies were repeated at 1, 6, 12, and 24 months after operation. Follow-up periods ranged from 1 to 34 months. Results: No failed insertions and no conversions to open surgery occurred. The diameter of the main body of the stent graft was 28 mm or more in 73 patients (63%). Additional stents were inserted during surgery to treat kinking in eight patients (6.9%) and renal artery encroachment in two patients (1.7%). Mean fluoroscopy time was 35.1 ± 18.3 minutes, contrast load was 146 ± 53 mL (350 mg/mL), and estimated blood loss was 249 ± 407 mL. The major complication rate was 9.5%, and the minor complication rate was 10.3%. The perioperative complications were myocardial infarction in four patients, arrythmia in four patients, and pulmonary embolism, renal failure, stroke, small bowel obstruction, femoral stenosis, digital embolism, and graft limb thrombosis in one patient each. All 116 patients went home from the hospital, but one patient died 2 weeks later of a combination of pulmonary embolism and myocardial infarction. Endoleak was seen on the first CT scan in 16 patients (15%); 15 were type II, and one was type III. No endoleaks of type I or IV were seen. Additional interventions were performed for each of the following conditions: type II endoleak (n = 4), type III endoleak (n = 1), femoral clamp injury (n = 1), renal artery stenosis (n = 1), and graft limb occlusion (n = 1). One patient had acute aneurysm dilatation and rupture caused by a type II endoleak through the inferior mesenteric artery 6 months after stent graft implantation. No cases were seen of late graft occlusion, stent graft migration, stent fracture, barb fracture, or secondary endoleak. Conclusion: The Zenith device is safe, versatile, and effective in the short to medium term. Most patients need wide stent grafts (≥28 mm proximally and ≥16 mm distally) to achieve 10% to 20% oversizing to prevent type I endoleak. (J Vasc Surg 2002;36:217-25.

The sizes, masses and specific star formation rates of massive galaxies at 1.3 &lt; z &lt; 1.5: strong evidence in favour of evolution via minor mergers

We report the results of a comprehensive study of the relationship between galaxy size, stellar mass and specific star-formation rate (sSFR) at redshifts 1.3= 6x10^10 Msun), spectroscopic sample from the UKIDSS Ultra-deep Survey (UDS), with accurate stellar-mass measurements derived from spectro photometric fitting, we find that at z~1.4 the location of massive galaxies on the size-mass plane is determined primarily by their sSFR. At this epoch we find that massive galaxies which are passive (sSFR <= 0.1 Gyr^-1) follow a tight size-mass relation, with half-light radii a factor f=2.4+/-0.2 smaller than their local counterparts. Moreover, amongst the passive sub-sample we find no evidence that the off-set from the local size-mass relation is a function of stellar population age. Based on a sub-sample with dynamical mass estimates we also derive an independent estimate of f=2.3+/-0.3 for the typical growth in half-light radius between z~1.4 and the present day. Focusing on the passive sub-sample, we conclude that to produce the necessary evolution predominantly via major mergers would require an unfeasible number of merger events and over populate the high-mass end of the local stellar mass function. In contrast, we find that a scenario in which mass accretion is dominated by minor mergers can produce the necessary evolution, whereby an increase in stellar mass by a factor of ~2, accompanied by an increase in size by a factor of ~3.5, is sufficient to reconcile the size-mass relation at z~1.4 with that observed locally. Finally, we note that a significant fraction (44+/-12%) of the passive galaxies in our sample have a disk-like morphology, providing additional evidence that separate physical processes are responsible for the quenching of star-formation and the morphological transformation of massive galaxies (abridged).Comment: 21 pages, 11 figures, accepted for publication in MNRAS. Replaced to match accepted versio

A patient safety toolkit for family practices

Objectives: Major gaps remain in our understanding of primary care patient safety. We describe a toolkit for measuring patient safety in family practices. Methods: Six tools were used in 46 practices. These tools were: NHS Education for Scotland Trigger Tool, NHS Education for Scotland Medicines Reconciliation Tool, Primary Care Safequest, Prescribing Safety Indicators, PREOS-PC, and Concise Safe Systems Checklist. Results: PC-Safequest showed that most practices had a well-developed safety climate. However, the Trigger Tool revealed that a quarter of events identified were associated with moderate or substantial harm, with a third originating in primary care and avoidable. Although medicines reconciliation was undertaken within 2 days in >70% of cases, necessary discussions with a patient/carer did not always occur. The prescribing safety indicators identified 1,435 instances of potentially hazardous prescribing or lack of recommended monitoring (from 92,649 patients). The Concise Safe Systems Checklist found that 25% of staff thought their practice provided inadequate follow-up for vulnerable patients discharged from hospital and inadequate monitoring of non-collection of prescriptions. Most patients had a positive perception of the safety of their practice although 45% identified at least one safety problem in the past year. Conclusions: Patient safety is complex and multidimensional. The Patient Safety Toolkit is easy to use and hosted on a single platform with a collection of tools generating practical and actionable information. It enables family practices to identify safety deficits that they can review and change procedures to improve their patient safety across a key sets of patient safety issues