Uncertainty as a Key Influence in the Decision To Admit Patients with Transient Ischemic Attack

Background Patients with transient ischemic attacks (TIA) are at high risk of subsequent vascular events. Hospitalization improves quality of care, yet admission rates for TIA patients vary considerably. Objectives We sought to identify factors associated with the decision to admit patents with TIA. Design We conducted a secondary analysis of a prior study’s data including semi-structured interviews, administrative data, and chart review. Participants We interviewed multidisciplinary clinical staff involved with TIA care. Administrative data included information for TIA patients in emergency departments or inpatient settings at VA medical centers (VAMCs) for fiscal years (FY) 2011 and 2014. Chart reviews were conducted on a subset of patients from 12 VAMCs in FY 2011. Approach For the qualitative data, we focused on interviewees’ responses to the prompt: “Tell me what influences you in the decision to or not to admit TIA patients.” We used administrative data to identify admission rates and chart review data to identify ABCD2 scores (a tool to classify stroke risk after TIA). Key Results Providers’ decisions to admit TIA patients were related to uncertainty in several domains: lack of a facility TIA-specific policy, inconsistent use of ABCD2 score, and concerns about facilities’ ability to complete a timely workup. There was a disconnect between staff perceptions about TIA admission and facility admission rates. According to chart review data, staff at facilities with higher admission rates in FY 2011 reported consistent reliance on ABCD2 scores and related guidelines in admission decision-making. Conclusions Many factors contributed to decisions regarding admitting a patient with TIA; however, clinicians’ uncertainty appeared to be a key driver. Further quality improvement interventions for TIA care should focus on facility adoption of TIA protocols to address uncertainty in TIA admission decision-making and to standardize timely evaluation of TIA patients and delivery of secondary prevention strategies

Inferring pandemic growth rates from sequence data

Using sequence data to infer population dynamics is playing an increasing role in the analysis of outbreaks. The most common methods in use, based on coalescent inference, have been widely used but not extensively tested against simulated epidemics. Here, we use simulated data to test the ability of both parametric and non-parametric methods for inference of effective population size (coded in the popular BEAST package) to reconstruct epidemic dynamics. We consider a range of simulations centred on scenarios considered plausible for pandemic influenza, but our conclusions are generic for any exponentially growing epidemic. We highlight systematic biases in non-parametric effective population size estimation. The most prominent such bias leads to the false inference of slowing of epidemic spread in the recent past even when the real epidemic is growing exponentially. We suggest some sampling strategies that could reduce (but not eliminate) some of the biases. Parametric methods can correct for these biases if the infected population size is large. We also explore how some poor sampling strategies (e.g. that over-represent epidemiologically linked clusters of cases) could dramatically exacerbate bias in an uncontrolled manner. Finally, we present a simple diagnostic indicator, based on coalescent density and which can easily be applied to reconstructed phylogenies, that identifies time-periods for which effective population size estimates are less likely to be biased. We illustrate this with an application to the 2009 H1N1 pandemic

CANDELS: The correlation between galaxy morphology and star formation activity at z~2

We discuss the state of the assembly of the Hubble Sequence in the mix of bright galaxies at redshift 1.4< z \le 2.5 with a large sample of 1,671 galaxies down to H_{AB}~26, selected from the HST/ACS and WFC3 images of the GOODS--South field obtained as part of the GOODS and CANDELS observations. We investigate the relationship between the star formation properties and morphology using various parametric diagnostics, such as the Sersic light profile, Gini (G), M_{20}, Concentration (C), Asymmetry (A) and multiplicity parameters. Our sample clearly separates into massive, red and passive galaxies versus less massive, blue and star forming ones, and this dichotomy correlates very well with the galaxies' morphological properties. Star--forming galaxies show a broad variety of morphological features, including clumpy structures and bulges mixed with faint low surface brightness features, generally characterized by disky-type light profiles. Passively evolving galaxies, on the other hand, very often have compact light distribution and morphology typical of today's spheroidal systems. We also find that artificially redshifted local galaxies have a similar distribution with z~2galaxies in a G-M_{20} plane. Visual inspection between the rest-frame optical and UV images show that there is a generally weak morphological k-correction for galaxies at z~2, but the comparison with non-parametric measures show that galaxies in the rest-frame UV are somewhat clumpier than rest-frame optical. Similar general trends are observed in the local universe among massive galaxies, suggesting that the backbone of the Hubble sequence was already in place at z~2.Comment: 22 pages, 19 figures, ApJ accepted (added 3 references

Clumpy Galaxies in CANDELS. I. The Definition of UV Clumps and the Fraction of Clumpy Galaxies at 0.5<z<3

Although giant clumps of stars are crucial to galaxy formation and evolution, the most basic demographics of clumps are still uncertain, mainly because the definition of clumps has not been thoroughly discussed. In this paper, we study the basic demographics of clumps in star-forming galaxies (SFGs) at 0.5<z<3, using our proposed physical definition that UV-bright clumps are discrete star-forming regions that individually contribute more than 8% of the rest-frame UV light of their galaxies. Clumps defined this way are significantly brighter than the HII regions of nearby large spiral galaxies, either individually or blended, when physical spatial resolution and cosmological dimming are considered. Under this definition, we measure the fraction of SFGs that contain at least one off-center clump (Fclumpy) and the contributions of clumps to the rest-frame UV light and star formation rate of SFGs in the CANDELS/GOODS-S and UDS fields, where our mass-complete sample consists of 3239 galaxies with axial ratio q>0.5. The redshift evolution of Fclumpy changes with the stellar mass (M*) of the galaxies. Low-mass (log(M*/Msun)<9.8) galaxies keep an almost constant Fclumpy of about 60% from z~3.0 to z~0.5. Intermediate-mass and massive galaxies drop their Fclumpy from 55% at z~3.0 to 40% and 15%, respectively, at z~0.5. We find that (1) the trend of disk stabilization predicted by violent disk instability matches the Fclumpy trend of massive galaxies; (2) minor mergers are a viable explanation of the Fclumpy trend of intermediate-mass galaxies at z<1.5, given a realistic observability timescale; and (3) major mergers are unlikely responsible for the Fclumpy trend in all masses at z<1.5. The clump contribution to the rest-frame UV light of SFGs shows a broad peak around galaxies with log(M*/Msun)~10.5 at all redshifts, possibly linked to the molecular gas fraction of the galaxies. (Abridged)Comment: 22 pages, 15 figures. Appeared in ApJ (2015, 800, 39). A few typos correcte

CANDELS Sheds Light on the Environmental Quenching of Low-mass Galaxies

We investigate the environmental quenching of galaxies, especially those with stellar masses (M*)$<10^{9.5} M_\odot$, beyond the local universe. Essentially all local low-mass quenched galaxies (QGs) are believed to live close to massive central galaxies, which is a demonstration of environmental quenching. We use CANDELS data to test {\it whether or not} such a dwarf QG--massive central galaxy connection exists beyond the local universe. To this purpose, we only need a statistically representative, rather than a complete, sample of low-mass galaxies, which enables our study to $z\gtrsim1.5$. For each low-mass galaxy, we measure the projected distance ($d_{proj}$) to its nearest massive neighbor (M*$>10^{10.5} M_\odot$) within a redshift range. At a given redshift and M*, the environmental quenching effect is considered to be observed if the $d_{proj}$ distribution of QGs ($d_{proj}^Q$) is significantly skewed toward lower values than that of star-forming galaxies ($d_{proj}^{SF}$). For galaxies with $10^{8} M_\odot < M* < 10^{10} M_\odot$, such a difference between $d_{proj}^Q$ and $d_{proj}^{SF}$ is detected up to $z\sim1$. Also, about 10\% of the quenched galaxies in our sample are located between two and four virial radii ($R_{Vir}$) of the massive halos. The median projected distance from low-mass QGs to their massive neighbors, $d_{proj}^Q / R_{Vir}$, decreases with satellite M* at $M* \lesssim 10^{9.5} M_\odot$, but increases with satellite M* at $M* \gtrsim 10^{9.5} M_\odot$. This trend suggests a smooth, if any, transition of the quenching timescale around $M* \sim 10^{9.5} M_\odot$ at $0.5<z<1.0$.Comment: 8 pages, 5 figures. ApJL accepted. Typos correcte

Structural Evolution of Early-type Galaxies to z=2.5 in CANDELS

Projected axis ratio measurements of 880 early-type galaxies at redshifts 1<z<2.5 selected from CANDELS are used to reconstruct and model their intrinsic shapes. The sample is selected on the basis of multiple rest-frame colors to reflect low star-formation activity. We demonstrate that these galaxies as an ensemble are dust-poor and transparent and therefore likely have smooth light profiles, similar to visually classified early-type galaxies. Similar to their present-day counterparts, the z>1 early-type galaxies show a variety of intrinsic shapes; even at a fixed mass, the projected axis ratio distributions cannot be explained by the random projection of a set of galaxies with very similar intrinsic shapes. However, a two-population model for the intrinsic shapes, consisting of a triaxial, fairly round population, combined with a flat (c/a~0.3) oblate population, adequately describes the projected axis ratio distributions of both present-day and z>1 early-type galaxies. We find that the proportion of oblate versus triaxial galaxies depends both on the galaxies' stellar mass, and - at a given mass - on redshift. For present-day and z<1 early-type galaxies the oblate fraction strongly depends on galaxy mass. At z>1 this trend is much weaker over the mass range explored here (10^10<M*/M_sun<10^11), because the oblate fraction among massive (M*~10^11 M_sun) was much higher in the past: 0.59+-0.10 at z>1, compared to 0.20+-0.02 at z~0.1. In contrast, the oblate fraction among low-mass early-type galaxies (log(M*/M_sun)1 to 0.72+-0.06 at z=0. [Abridged]Comment: accepted for publication in ApJ; 14 pages; 10 figures; 4 table