COVID-19 model-based practice changes in managing a large prostate cancer practice: following the trends during a month-long ordeal

Coronavirus (COVID-19) has been a life-changing experience for both individuals and institutions. We describe changes in our practice based on real-time assessment of various national and international trends of COVID-19 and its effectiveness in the management of our resources. Initial risk assessment and peak resource requirement using the COVID-19 Hospital Impact Model for Epidemics (CHIME) and McKinsey models. Strengths, weaknesses, opportunities, and threats (SWOT) analysis of our practice\u2019s approach during the pandemic. Based on CHIME the community followed 60% social distancing, the number of expected new patients hospitalized at maximum surge would be 401, with 100 patients requiring ventilator support. In contrast, when the community followed 15% social distancing, the maximum surge of hospitalized new patients would be 1823 and 455 patients would require a ventilator. on April 15, the expected May requirement of ICU beds at peak would be 68, with 61 patients needing ventilators. The estimated surge numbers improved throughout April, and on April 22 the expected ICU bed peak in May would be 11.7, and those requiring ventilator would be 10.5. Simultaneously, within a month, our surgical waitlist grew from 585 to over 723 patients. Our SWOT analysis revealed our internal strengths and inherent weakness, relevant to the pandemic. A graded and a guarded response to this type of situation is crucial in managing patients in a large practice

On the structure of the transition disk around TW Hya

For over a decade, the structure of the inner cavity in the transition disk of TW Hydrae has been a subject of debate. Modeling the disk with data obtained at different wavelengths has led to a variety of proposed disk structures. Rather than being inconsistent, the individual models might point to the different faces of physical processes going on in disks, such as dust growth and planet formation. Our aim is to investigate the structure of the transition disk again and to find to what extent we can reconcile apparent model differences. A large set of high-angular-resolution data was collected from near-infrared to centimeter wavelengths. We investigated the existing disk models and established a new self-consistent radiative-transfer model. A genetic fitting algorithm was used to automatize the parameter fitting. Simple disk models with a vertical inner rim and a radially homogeneous dust composition from small to large grains cannot reproduce the combined data set. Two modifications are applied to this simple disk model: (1) the inner rim is smoothed by exponentially decreasing the surface density in the inner ~3 AU, and (2) the largest grains (>100 um) are concentrated towards the inner disk region. Both properties can be linked to fundamental processes that determine the evolution of protoplanetary disks: the shaping by a possible companion and the different regimes of dust-grain growth, respectively. The full interferometric data set from near-infrared to centimeter wavelengths requires a revision of existing models for the TW Hya disk. We present a new model that incorporates the characteristic structures of previous models but deviates in two key aspects: it does not have a sharp edge at 4 AU, and the surface density of large grains differs from that of smaller grains. This is the first successful radiative-transfer-based model for a full set of interferometric data.Comment: 22 pages, 12 figures, accepted for publication in Astronomy & Astrophysic

Cardiorespiratory fitness is associated with hard and light intensity physical activity but not time spent sedentary in 10–14 year old schoolchildren: the HAPPY study

Sedentary behaviour is a major risk factor for developing chronic diseases and is associated with low cardiorespiratory fitness in adults. It remains unclear how sedentary behaviour and different physical activity subcomponents are related to cardiorespiratory fitness in children. The purpose of this study was to assess how sedentary behaviour and different physical activity subcomponents are associated with 10–14 year-old schoolchildren's cardiorespiratory fitness

Age-related patterns of vigorous-intensity physical activity in youth:the International Children’s Accelerometry Database

Abstract Physical activity declines during youth but most evidence reports on combined moderate and vigorous-intensity physical activity. We investigated how vigorous-intensity activity varies with age. Cross-sectional data from 24,025 participants (5.0–18.0 y; from 20 studies in 10 countries obtained 2008–2010) providing ≥ 1 day accelerometer data (International Children's Accelerometry Database (ICAD)). Linear regression was used to investigate age-related patterns in vigorous-intensity activity; models included age (exposure), adjustments for monitor wear-time and study. Moderate-intensity activity was examined for comparison. Interactions were used to investigate whether the age/vigorous-activity association differed by sex, weight status, ethnicity, maternal education and region. A 6.9% (95% CI 6.2, 7.5) relative reduction in mean vigorous-intensity activity with every year of age was observed; for moderate activity the relative reduction was 6.0% (5.6%, 6.4%). The age-related decrease in vigorous-intensity activity remained after adjustment for moderate activity. A larger age-related decrease in vigorous activity was observed for girls (− 10.7%) versus boys (− 2.9%), non-white (− 12.9% to − 9.4%) versus white individuals (− 6.1%), lowest maternal education (high school (− 2.0%)) versus college/university (ns) and for overweight/obese (− 6.1%) versus healthy-weight participants (− 8.1%). In addition to larger annual decreases in vigorous-intensity activity, overweight/obese individuals, girls and North Americans had comparatively lower average vigorous-intensity activity at 5.0–5.9 y. Age-related declines in vigorous-intensity activity during youth appear relatively greater than those of moderate activity. However, due to a higher baseline, absolute moderate-intensity activity decreases more than vigorous. Overweight/obese individuals, girls, and North Americans appear especially in need of vigorous-intensity activity promotion due to low levels at 5.0–5.9 y and larger negative annual differences

Molecular Gas Clumps from the Destruction of Icy Bodies in the β\beta Pictoris Debris Disk

Many stars are surrounded by disks of dusty debris formed in the collisions of asteroids, comets and dwarf planets. But is gas also released in such events? Observations at submm wavelengths of the archetypal debris disk around $\beta$ Pictoris show that 0.3% of a Moon mass of carbon monoxide orbits in its debris belt. The gas distribution is highly asymmetric, with 30% found in a single clump 85AU from the star, in a plane closely aligned with the orbit of the inner planet, $\beta$ Pic b. This gas clump delineates a region of enhanced collisions, either from a mean motion resonance with an unseen giant planet, or from the remnants of a collision of Mars-mass planets

ALMA High-frequency Long Baseline Campaign in 2017:Band-to-band Phase Referencing in Submillimeter Waves

In 2017, an Atacama Large Millimeter/submillimeter Array (ALMA) high-frequency long baseline campaign was organized to test image capabilities with baselines up to 16 km at submillimeter (submm) wavelengths. We investigated image qualities using ALMA receiver Bands 7, 8, 9, and 10 (285-875 GHz) by adopting band-to-band (B2B) phase referencing in which a phase calibrator is tracked at a lower frequency. For B2B phase referencing, it is expected that a closer phase calibrator to a target can be used, comparing to standard in-band phase referencing. In the first step, it is ensured that an instrumental phase offset difference between low- and high-frequency Bands can be removed using a differential gain calibration in which a phase calibrator is certainly detected while frequency switching. In the next step, comparative experiments are arranged to investigate the image quality between B2B and in-band phase referencing with phase calibrators at various separation angles. In the final step, we conducted long baseline imaging tests for a quasar at 289 GHz in Band 7 and 405 GHz in Band 8 and complex structure sources of HL Tau and VY CMa at ~670 GHz in Band 9. The B2B phase referencing was successfully applied, allowing us to achieve an angular resolution of 14x11 and 10x8 mas for HL Tau and VY CMa, respectively. There is a high probability of finding a low-frequency calibrator within 5.4 deg in B2B phase referencing, bright enough to use an 8 s scan length combined with a 7.5 GHz bandwidth.Comment: 61 pages, 17 figures, 8 table

First Results from High Angular Resolution ALMA Observations Toward the HL Tau Region

We present Atacama Large Millimeter/submillimeter Array (ALMA) observations from the 2014 Long Baseline Campaign in dust continuum and spectral line emission from the HL Tau region. The continuum images at wavelengths of 2.9, 1.3, and 0.87 mm have unprecedented angular resolutions of 0.075 arcseconds (10 AU) to 0.025 arcseconds (3.5 AU), revealing an astonishing level of detail in the circumstellar disk surrounding the young solar analogue HL Tau, with a pattern of bright and dark rings observed at all wavelengths. By fitting ellipses to the most distinct rings, we measure precise values for the disk inclination (46.72pm0.05 degrees) and position angle (+138.02pm0.07 degrees). We obtain a high-fidelity image of the 1.0 mm spectral index ($\alpha$), which ranges from $\alpha\sim2.0$ in the optically-thick central peak and two brightest rings, increasing to 2.3-3.0 in the dark rings. The dark rings are not devoid of emission, we estimate a grain emissivity index of 0.8 for the innermost dark ring and lower for subsequent dark rings, consistent with some degree of grain growth and evolution. Additional clues that the rings arise from planet formation include an increase in their central offsets with radius and the presence of numerous orbital resonances. At a resolution of 35 AU, we resolve the molecular component of the disk in HCO+ (1-0) which exhibits a pattern over LSR velocities from 2-12 km/s consistent with Keplerian motion around a ~1.3 solar mass star, although complicated by absorption at low blue-shifted velocities. We also serendipitously detect and resolve the nearby protostars XZ Tau (A/B) and LkHa358 at 2.9 mm.Comment: 11 pages, 5 figures, 2 tables, accepted for publication in the Astrophysical Journal Letter

Influence of Guideline Operationalization on Youth Activity Prevalence in the International Children's Accelerometry Database

Introduction The United Kingdom and World Health Organization recently changed their youth physical activity (PA) guidelines from 60 min of moderate- to vigorous-intensity PA (MVPA) every day, to an average of 60 min of MVPA per day, over a week. The changes are based on expert opinion due to insufficient evidence comparing health outcomes associated with different guideline definitions. This study used the International Children’s Accelerometry Database to compare approaches to calculating youth PA compliance and associations with health indicators. Methods Cross-sectional accelerometer data (n = 21,612, 5–18 yr) were used to examine compliance with four guideline definitions: daily method (DM; ≥60 min MVPA every day), average method (AM; average of ≥60 min MVPA per day), AM5 (AM compliance and ≥5 min of vigorous PA [VPA] on ≥3 d), and AM15 (AM compliance and ≥15 min VPA on ≥3 d). Associations between compliance and health indicators were examined for all definitions. Results Compliance varied from 5.3% (DM) to 29.9% (AM). Associations between compliance and health indicators were similar for AM, AM5, and AM15. For example, compliance with AM, AM5, and AM15 was associated with a lower BMI z-score (statistics are coefficient [95% CI]): AM (−0.28 [−0.33 to −0.23]), AM5 (−0.28 [−0.33 to −0.23], and AM15 (−0.30 [−0.35 to −0.25]). Associations between compliance and health indicators for DM were similar/weaker, possibly reflecting fewer DM-compliant participants with health data and lower variability in exposure/outcome data. Conclusions Youth completing 60 min of MVPA every day do not experience superior health benefits to youth completing an average of 60 min of MVPA per day. Guidelines should encourage youth to achieve an average of 60 min of MVPA per day. Different guideline definitions affect inactivity prevalence estimates; this must be considered when analyzing data and comparing studies.publishedVersionPaid open acces