Using geographical information systems and cartograms as a health service quality improvement tool

Introduction: Disease prevalence can be spatially analysed to provide support for service implementation and health care planning, these analyses often display geographic variation. A key challenge is to communicate these results to decision makers, with variable levels of Geographic Information Systems (GIS) knowledge, in a way that represents the data and allows for comprehension. The present research describes the combination of established GIS methods and software tools to produce a novel technique of visualising disease admissions and to help prevent misinterpretation of data and less optimal decision making. The aim of this paper is to provide a tool that supports the ability of decision makers and service teams within health care settings to develop services more efficiently and better cater to the population; this tool has the advantage of information on the position of populations, the size of populations and the severity of disease. Methods: A standard choropleth of the study region, London, is used to visualise total emergency admission values for Chronic Obstructive Pulmonary Disease and bronchiectasis using ESRI's ArcGIS software. Population estimates of the Lower Super Output Areas (LSOAs) are then used with the ScapeToad cartogram software tool, with the aim of visualising geography at uniform population density. An interpolation surface, in this case ArcGIS' spline tool, allows the creation of a smooth surface over the LSOA centroids for admission values on both standard and cartogram geographies. The final product of this research is the novel Cartogram Interpolation Surface (CartIS). Results: The method provides a series of outputs culminating in the CartIS, applying an interpolation surface to a uniform population density. The cartogram effectively equalises the population density to remove visual bias from areas with a smaller population, while maintaining contiguous borders. CartIS decreases the number of extreme positive values not present in the underlying data as can be found in interpolation surfaces. Discussion: This methodology provides a technique for combining simple GIS tools to create a novel output, CartIS, in a health service context with the key aim of improving visualisation communication techniques which highlight variation in small scale geographies across large regions. CartIS more faithfully represents the data than interpolation, and visually highlights areas of extreme value more than cartograms, when either is used in isolation. © 2014 The Authors

The Herschel Exploitation of Local Galaxy Andromeda (HELGA) II: Dust and Gas in Andromeda

We present an analysis of the dust and gas in Andromeda, using Herschel images sampling the entire far-infrared peak. We fit a modified-blackbody model to ~4000 quasi-independent pixels with spatial resolution of ~140pc and find that a variable dust-emissivity index (beta) is required to fit the data. We find no significant long-wavelength excess above this model suggesting there is no cold dust component. We show that the gas-to-dust ratio varies radially, increasing from ~20 in the center to ~70 in the star-forming ring at 10kpc, consistent with the metallicity gradient. In the 10kpc ring the average beta is ~1.9, in good agreement with values determined for the Milky Way (MW). However, in contrast to the MW, we find significant radial variations in beta, which increases from 1.9 at 10kpc to ~2.5 at a radius of 3.1kpc and then decreases to 1.7 in the center. The dust temperature is fairly constant in the 10kpc ring (ranging from 17-20K), but increases strongly in the bulge to ~30K. Within 3.1kpc we find the dust temperature is highly correlated with the 3.6 micron flux, suggesting the general stellar population in the bulge is the dominant source of dust heating there. At larger radii, there is a weak correlation between the star formation rate and dust temperature. We find no evidence for 'dark gas' in M31 in contrast to recent results for the MW. Finally, we obtained an estimate of the CO X-factor by minimising the dispersion in the gas-to-dust ratio, obtaining a value of (1.9+/-0.4)x10^20 cm^-2 [K kms^-1]^-1.Comment: 19 pages, 18 figures. Submitted to ApJ April 2012; Accepted July 201

The ISM properties and gas kinematics of a redshift 3 massive dusty star-forming galaxy

We present CO (J = 1 → 0; 3 → 2; 5 → 4; 10 → 9) and 1.2 kpc resolution [C II] line observations of the dusty star-forming galaxy (SFG) HXMM05—carried out with the Karl G. Jansky Very Large Array, the Combined Array for Research in Millimeter-wave Astronomy, the Plateau de Bure Interferometer, and the Atacama Large Millimeter/submillimeter Array, measuring an unambiguous redshift of z = 2.9850 ± 0.0009. We find that HXMM05 is a hyperluminous infrared galaxy (LIR = (4 ± 1) × 1013 Le) with a total molecular gas mass of (2.1 ± 0.7) × 1011(aCO/0.8) Me. The CO (J = 1 → 0) and [C II] emission are extended over ∼9 kpc in diameter, and the CO line FWHM exceeds 1100 km s−1 . The [C II] emission shows a monotonic velocity gradient consistent with a disk, with a maximum rotation velocity of vc = 616 ± 100 km s−1 and a dynamical mass of (7.7 ± 3.1) × 1011 Me. We find a star formation rate of 2900- + 595 750 Me yr−1 . HXMM05 is thus among the most intensely SFGs known at high redshift. Photodissociation region modeling suggests physical conditions similar to nearby SFGs, showing extended star formation, which is consistent with our finding that the gas emission and dust emission are cospatial. Its molecular gas excitation resembles the local major merger Arp 220. The broad CO and [C II] lines and a pair of compact dust nuclei suggest the presence of a late-stage major merger at the center of the extended disk, again reminiscent of Arp 220. The observed gas kinematics and conditions, together with the presence of a companion and the pair of nuclei, suggest that HXMM05 is experiencing multiple mergers as a part of the evolution

Low genetic variability, female-biased dispersal and high movement rates in an urban population of Eurasian badgersMeles meles

1. Urban and rural populations of animals can differ in their behaviour, both in order to meet their ecological requirements and due to the constraints imposed by different environments. The study of urban populations can therefore offer useful insights into the behavioural flexibility of a species as a whole, as well as indicating how the species in question adapts to a specifically urban environment. 2. The genetic structure of a population can provide information about social structure and movement patterns that is difficult to obtain by other means. Using non-invasively collected hair samples, we estimated the population size of Eurasian badgers Meles meles in the city of Brighton, England, and calculated population-specific parameters of genetic variability and sex-specific rates of outbreeding and dispersal. 3. Population density was high in the context of badger densities reported throughout their range. This was due to a high density of social groups rather than large numbers of individuals per group. 4. The allelic richness of the population was low compared with other British populations. However, the rate of extra-group paternity and the relatively frequent (mainly temporary) intergroup movements suggest that, on a local scale, the population was outbred. Although members of both sexes visited other groups, there was a trend for more females to make intergroup movements. 5. The results reveal that urban badgers can achieve high densities and suggest that while some population parameters are similar between urban and rural populations, the frequency of intergroup movements is higher among urban badgers. In a wider context, these results demonstrate the ability of non-invasive genetic sampling to provide information about the population density, social structure and behaviour of urban wildlife

Surgical decisions in older women with early breast cancer: patient and disease factors.

BACKGROUND: Studies reporting lower rates of surgery for older women with early invasive breast cancer have focused on women with oestrogen receptor (ER)-positive tumours. This study examined the factors that influence receipt of breast surgery in older women with ER-positive and ER-negative early invasive breast cancer . METHODS: Women aged 50 years or above with unilateral stage 1-3A early invasive breast cancer diagnosed in 2014-2017 were identified from linked English and Welsh cancer registration and routine hospital data sets. Logistic regression analysis was used to evaluate the influence of tumour and patient factors on receipt of surgery. RESULTS: Among 83 188 women, 86.8 per cent had ER-positive and 13.2 per cent had ER-negative early invasive breast cancer. These proportions were unaffected by age at diagnosis. Compared with women with ER-negative breast cancer, a higher proportion of women with ER-positive breast cancer presented with low risk tumour characteristics: G1 (20.0 versus 1.5 per cent), T1 (60.8 versus 44.2 per cent) and N0 (73.9 versus 68.8 per cent). The proportions of women with any recorded co-morbidity (13.7 versus 14.3 per cent) or degree of frailty (25 versus 25.8 per cent) were similar among women with ER-positive and ER-negative disease respectively. In women with ER-positive early invasive breast cancer aged 70-74, 75-79 and 80 years or above, the rate of no surgery was 5.6, 11.0 and 41.9 per cent respectively. Among women with ER-negative early invasive breast cancer, the corresponding rates were 3.8, 3.7 and 12.3 per cent. The relatively lower rate of surgery for ER-positive breast cancer persisted in women with good fitness. CONCLUSION: The reasons for the observer differences should be further explored to ensure consistency in treatment decisions

Galaxy Evolution and Star Formation Efficiency at 0.2 < z < 0.6

We present the results of a CO line survey of 30 galaxies at moderate redshift (z \sim 0.2-0.6), with the IRAM 30m telescope, with the goal to follow galaxy evolution and in particular the star formation efficiency (SFE) as defined by the ratio between far-infrared luminosity and molecular gas mass (LFIR/M(H2)). The sources are selected to be ultra-luminous infrared galaxies (ULIRGs), with LFIR larger than 2.8 10^{12} Lsol, experiencing starbursts; adopting a low ULIRG CO-to-H2 conversion factor, their gas consumption time-scale is lower than 10^8 yr. To date only very few CO observations exist in this redshift range that spans nearly 25% of the universe's age. Considerable evolution of the star formation rate is already observed during this period. 18 galaxies out of our sample of 30 are detected (of which 16 are new detections), corresponding to a detection rate of 60%. The average CO luminosity for the 18 galaxies detected is L'CO = 2 10^{10} K km/s pc^2, corresponding to an average H2 mass of 1.6 10^{10} Msol. The FIR luminosity correlates well with the CO luminosity, in agreement with the correlation found for low and high redshift ULIRGs. Although the conversion factor between CO luminosity and H2 mass is uncertain, we find that the maximum amount of gas available for a single galaxy is quickly increasing as a function of redshift. Using the same conversion factor, the SFEs for z\sim 0.2-0.6 ULIRGs are found to be significantly higher, by a factor 3, than for local ULIRGs, and are comparable to high redshift ones. We compare this evolution to the expected cosmic H2 abundance and the cosmic star formation history.Comment: 11 pages, 13 figures, accepted in A&

Herschel-ATLAS: Multi-wavelength SEDs and physical properties of 250 micron-selected galaxies at z < 0.5

We present a pan-chromatic analysis of an unprecedented sample of 1402 250 micron-selected galaxies at z < 0.5 (mean z = 0.24) from the Herschel-ATLAS survey. We complement our Herschel 100-500 micron data with UV-K-band photometry from the Galaxy And Mass Assembly (GAMA) survey and apply the MAGPHYS energy-balance technique to produce pan-chromatic SEDs for a representative sample of 250 micron selected galaxies spanning the most recent 5 Gyr of cosmic history. We derive estimates of physical parameters, including star formation rates, stellar masses, dust masses and infrared luminosities. The typical H-ATLAS galaxy at z < 0.5 has a far-infrared luminosity in the range 10^10 - 10^12 Lsolar (SFR: 1-50 Msolar/yr) thus is broadly representative of normal star forming galaxies over this redshift range. We show that 250 micron-selected galaxies contain a larger mass of dust at a given infra-red luminosity or star formation rate than previous samples selected at 60 micron from IRAS. We derive typical SEDs for H-ATLAS galaxies, and show that the emergent SED shape is most sensitive to specific star formation rate. The optical-UV SEDs also become more reddened due to dust at higher redshifts. Our template SEDs are significantly cooler than existing infra-red templates. They may therefore be most appropriate for inferring total IR luminosities from moderate redshift submillimetre selected samples and for inclusion in models of the lower redshift submillimetre galaxy populations.Comment: 26 pages, 24 figures, Accepted by MNRA

The pre-launch Planck Sky Model: a model of sky emission at submillimetre to centimetre wavelengths

We present the Planck Sky Model (PSM), a parametric model for the generation of all-sky, few arcminute resolution maps of sky emission at submillimetre to centimetre wavelengths, in both intensity and polarisation. Several options are implemented to model the cosmic microwave background, Galactic diffuse emission (synchrotron, free-free, thermal and spinning dust, CO lines), Galactic H-II regions, extragalactic radio sources, dusty galaxies, and thermal and kinetic Sunyaev-Zeldovich signals from clusters of galaxies. Each component is simulated by means of educated interpolations/extrapolations of data sets available at the time of the launch of the Planck mission, complemented by state-of-the-art models of the emission. Distinctive features of the simulations are: spatially varying spectral properties of synchrotron and dust; different spectral parameters for each point source; modeling of the clustering properties of extragalactic sources and of the power spectrum of fluctuations in the cosmic infrared background. The PSM enables the production of random realizations of the sky emission, constrained to match observational data within their uncertainties, and is implemented in a software package that is regularly updated with incoming information from observations. The model is expected to serve as a useful tool for optimizing planned microwave and sub-millimetre surveys and to test data processing and analysis pipelines. It is, in particular, used for the development and validation of data analysis pipelines within the planck collaboration. A version of the software that can be used for simulating the observations for a variety of experiments is made available on a dedicated website.Comment: 35 pages, 31 figure

Change in the Use of Fractionation in Radiotherapy Used for Early Breast Cancer at the Start of the COVID-19 Pandemic: A Population-Based Cohort Study of Older Women in England and Wales.

AIMS: Adjuvant radiotherapy is recommended for most patients with early breast cancer (EBC) receiving breast-conserving surgery and those at moderate/high risk of recurrence treated by mastectomy. During the first wave of COVID-19 in England and Wales, there was rapid dissemination of randomised controlled trial-based evidence showing non-inferiority for five-fraction ultra-hypofractionated radiotherapy (HFRT) regimens compared with standard moderate-HFRT, with guidance recommending the use of five-fraction HFRT for eligible patients. We evaluated the uptake of this recommendation in clinical practice as part of the National Audit of Breast Cancer in Older Patients (NABCOP). MATERIALS AND METHODS: Women aged ≥50 years who underwent surgery for EBC from January 2019 to July 2020 were identified from the Rapid Cancer Registration Dataset for England and from Wales Cancer Network data. Radiotherapy details were from linked national Radiotherapy Datasets. Multivariate mixed-effects logistic regression models were used to assess characteristics influential in the use of ultra-HFRT. RESULTS: Among 35 561 women having surgery for EBC, 71% received postoperative radiotherapy. Receipt of 26 Gy in five fractions (26Gy5F) increased from <1% in February 2020 to 70% in April 2020. Regional variation in the use of 26Gy5F during April to July 2020 was similar by age, ranging from 49 to 87% among women aged ≥70 years. Use of 26Gy5F was characterised by no known nodal involvement, no comorbidities and initial breast-conserving surgery. Of those patients receiving radiotherapy to the breast/chest wall, 85% had 26Gy5F; 23% had 26Gy5F if radiotherapy included regional nodes. Among 5139 women receiving postoperative radiotherapy from April to July 2020, nodal involvement, overall stage, type of surgery, time from diagnosis to start of radiotherapy were independently associated with fractionation choice. CONCLUSIONS: There was a striking increase in the use of 26Gy5F dose fractionation regimens for EBC, among women aged ≥50 years, within a month of guidance published at the start of the COVID-19 pandemic in England and Wales