Social Deprivation, Political Alienation and Community Empowerment. The geography of voter turnout in Ireland,1997-2002, and its Association with Social Deprivation.

The Irish political system has become increasingly characterised by declining turnout rates in the past few decades, with this accompanied by very low turnouts in a number of areas and for certain elections types. This thesis addresses this context through analysing turnout variations in recent election using a spatial framework and focussing particularly on how these spatial patterns in turnout are associated with levels of social well being. Other factors were also analysed in terms of their impacts on turnout variations, namely a range of social and political factors. Constituency level and sub-constituency level analyses are used to analyse the extent to which deprivation may influence turnout levels and to determine whether this relationship is stronger in urban or rural areas or for different types of elections. The use of marked register turnout data allows this relationship to be tested using very detailed data for small geographical areas. The ecological modelling of turnout variance is upheld by the use of individual level analyses (through the use of questionnaires and interviews). Strong associations between turnout and social well-being for urban areas were uncovered in the Dublin study area, with turnouts generally lower in the more deprived areas. There was no evidence of such a relationship in the rural areas for local elections, although there was a pattern in which turnouts were lower in the more deprived areas in general elections and, especially, referenda. Election-specific influences on the relationship between turnout and deprivation were uncovered, with class influences being more pertinent in relation to referendum turnouts. Other socio-economic and demographic influences were shown to have a bearing on spatial variations in Irish turnouts, such as age and residential mobility, with the effect of such influences being particularly pronounced in certain geographical contexts. Political mobilisation factors were also shown to have a bearing on Irish turnout variations, with local election turnouts in areas being especially determined by the presence, or nonpresence, of candidates local to the area in the contest

Social Deprivation, Political Alienation and Community Empowerment. The geography of voter turnout in Ireland,1997-2002, and its Association with Social Deprivation.

The Irish political system has become increasingly characterised by declining turnout rates in the past few decades, with this accompanied by very low turnouts in a number of areas and for certain elections types. This thesis addresses this context through analysing turnout variations in recent election using a spatial framework and focussing particularly on how these spatial patterns in turnout are associated with levels of social well being. Other factors were also analysed in terms of their impacts on turnout variations, namely a range of social and political factors. Constituency level and sub-constituency level analyses are used to analyse the extent to which deprivation may influence turnout levels and to determine whether this relationship is stronger in urban or rural areas or for different types of elections. The use of marked register turnout data allows this relationship to be tested using very detailed data for small geographical areas. The ecological modelling of turnout variance is upheld by the use of individual level analyses (through the use of questionnaires and interviews). Strong associations between turnout and social well-being for urban areas were uncovered in the Dublin study area, with turnouts generally lower in the more deprived areas. There was no evidence of such a relationship in the rural areas for local elections, although there was a pattern in which turnouts were lower in the more deprived areas in general elections and, especially, referenda. Election-specific influences on the relationship between turnout and deprivation were uncovered, with class influences being more pertinent in relation to referendum turnouts. Other socio-economic and demographic influences were shown to have a bearing on spatial variations in Irish turnouts, such as age and residential mobility, with the effect of such influences being particularly pronounced in certain geographical contexts. Political mobilisation factors were also shown to have a bearing on Irish turnout variations, with local election turnouts in areas being especially determined by the presence, or nonpresence, of candidates local to the area in the contest

The nature of point source fringes in mid-infrared spectra acquired with the James Webb Space Telescope

The constructive and destructive interference in different layers of the James Webb Space Telescope (JWST) Mid-Infrared Instrument (MIRI) detector arrays modulate the detected signal as a function of wavelength. Additionally, sources of different spatial profiles show different fringe patterns. Dividing by a static fringe flat could hamper the scientific interpretation of sources whose fringes do not match that of the fringe flat. We find point source fringes measured by the MIRI Medium-Resolution Spectrometer (MRS) to be reproducible under similar observing conditions. We want, thus, to identify the variables, if they exist, that would allow for a parametrization of the signal variations induced by point source fringe modulations. We do this by analyzing MRS detector plane images acquired on the ground. We extracted the fringe profile of multiple point source observations and studied the amplitude and phase of the fringes as a function of field position and pixel sampling of the point spread function of the optical chain. A systematic variation in the amplitude and phase of the point source fringes is found over the wavelength range covered by the test sources (4.9-5.8 $\mu$m). The variation depends on the fraction of the point spread function seen by the detector pixel. We identify the non-uniform pixel illumination as the root cause of the reported systematic variation. We report an improvement after correction of 50% on the 1$\sigma$ standard deviation of the spectral continuum. A 50% improvement is also reported in line sensitivity for a benchmark test with a spectral continuum of 100 mJy. The improvement in the shape of weak lines is illustrated using a T Tauri model spectrum. Consequently, we verify that fringes of extended sources and potentially semi-extended sources and crowded fields can be simulated by combining multiple point source fringe transmissions.Comment: 17 pages, 31 figure

JWST MIRI flight performance: The Medium-Resolution Spectrometer

The Medium-Resolution Spectrometer (MRS) provides one of the four operating modes of the Mid-Infrared Instrument (MIRI) on board the James Webb Space Telescope (JWST). The MRS is an integral field spectrometer, measuring the spatial and spectral distributions of light across the 5-28 $\mu m$ wavelength range with a spectral resolving power between 3700-1300. We present the MRS's optical, spectral, and spectro-photometric performance, as achieved in flight, and we report on the effects that limit the instrument's ultimate sensitivity. The MRS flight performance has been quantified using observations of stars, planetary nebulae, and planets in our Solar System. The precision and accuracy of this calibration was checked against celestial calibrators with well-known flux levels and spectral features. We find that the MRS geometric calibration has a distortion solution accuracy relative to the commanded position of 8 mas at 5 $\mu m$ and 23 mas at 28 $\mu m$. The wavelength calibration is accurate to within 9 km/sec at 5 $\mu m$ and 27 km/sec at 28 $\mu m$. The uncertainty in the absolute spectro-photometric calibration accuracy was estimated at 5.6 +- 0.7 %. The MIRI calibration pipeline is able to suppress the amplitude of spectral fringes to below 1.5 % for both extended and point sources across the entire wavelength range. The MRS point spread function (PSF) is 60 % broader than the diffraction limit along its long axis at 5 $\mu m$ and is 15 % broader at 28 $\mu m$. The MRS flight performance is found to be better than prelaunch expectations. The MRS is one of the most subscribed observing modes of JWST and is yielding many high-profile publications. It is currently humanity's most powerful instrument for measuring the mid-infrared spectra of celestial sources and is expected to continue as such for many years to come.Comment: 16 pages, 21 figure

The Mid-infrared Instrument for JWST and Its In-flight Performance

The Mid-Infrared Instrument (MIRI) extends the reach of the James Webb Space Telescope (JWST) to 28.5 μm. It provides subarcsecond-resolution imaging, high sensitivity coronagraphy, and spectroscopy at resolutions of λ/Δλ ∼ 100-3500, with the high-resolution mode employing an integral field unit to provide spatial data cubes. The resulting broad suite of capabilities will enable huge advances in studies over this wavelength range. This overview describes the history of acquiring this capability for JWST. It discusses the basic attributes of the instrument optics, the detector arrays, and the cryocooler that keeps everything at approximately 7 K. It gives a short description of the data pipeline and of the instrument performance demonstrated during JWST commissioning. The bottom line is that the telescope and MIRI are both operating to the standards set by pre-launch predictions, and all of the MIRI capabilities are operating at, or even a bit better than, the level that had been expected. The paper is also designed to act as a roadmap to more detailed papers on different aspects of MIRI

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries