Variations in hospital standardised mortality ratios (HSMR) as a result of frequent readmissions

BACKGROUND: We investigated the impact that variations in the frequency of readmissions had upon a hospital's standardised mortality ratio (HSMR). An adapted HSMR model was used in the study. Our calculations were based on the admissions of 70 hospitals in The Netherlands during the years 2005 to 2009. METHODS: Through a retrospective analysis of routinely collected hospital data, we calculated standardised in-hospital mortality ratios both by hospital and by diagnostic group (H/SMRs) using two different models. The first was the Dutch 2010 model while the second was the same model but with an additional adjustment for the readmission frequency. We compared H/SMR outcomes and the corresponding quality metrics in order to test discrimination (c-statistics), calibration (Hosmer-Lemeshow) and explanatory power (pseudo-R2 statistic) for both models. RESULTS: The SMR outcomes for model 2 compared to model 1, varied between -39% and +110%. On the HSMR level these variations ranged from -12% to +11%. There was a substantial disagreement between the models with respect to significant death on the SMR level as well as the HSMR level (~ 20%). All quality metrics comparing both models were in favour of model 2. The susceptibility to adjustment for readmission increased for longer review periods. CONCLUSIONS: The 2010 HSMR model for the Netherlands was sensitive to adjustment for the frequency of readmissions. A model without this adjustment, as opposed to a model with the adjustment, produced substantially different HSMR outcomes. The uncertainty introduced by these differences exceeded the uncertainty indicated by the 95% confidence intervals. Therefore an adjustment for the frequency of readmissions should be considered in The Netherlands, since such a model showed more favourable quality metric characteristics compared to a model without such an adjustment. Other countries could well benefit from a similar adjustment to their models. A review period of the data collected over the last three years, at least, is advisable. (aut.ref.

An Over-Massive Black Hole in the Compact Lenticular Galaxy NGC1277

All massive galaxies likely have supermassive black holes at their centers, and the masses of the black holes are known to correlate with properties of the host galaxy bulge component. Several explanations have been proposed for the existence of these locally-established empirical relationships; they include the non-causal, statistical process of galaxy-galaxy merging, direct feedback between the black hole and its host galaxy, or galaxy-galaxy merging and the subsequent violent relaxation and dissipation. The empirical scaling relations are thus important for distinguishing between various theoretical models of galaxy evolution, and they further form the basis for all black hole mass measurements at large distances. In particular, observations have shown that the mass of the black hole is typically 0.1% of the stellar bulge mass of the galaxy. The small galaxy NGC4486B currently has the largest published fraction of its mass in a black hole at 11%. Here we report observations of the stellar kinematics of NGC 1277, which is a compact, disky galaxy with a mass of 1.2 x 10^11 Msun. From the data, we determine that the mass of the central black hole is 1.7 x 10^10 Msun, or 59% its bulge mass. Five other compact galaxies have properties similar to NGC 1277 and therefore may also contain over-sized black holes. It is not yet known if these galaxies represent a tail of a distribution, or if disk-dominated galaxies fail to follow the normal black hole mass scaling relations.Comment: 7 pages. 6 figures. Nature. Animation at http://www.mpia.de/~bosch/blackholes.htm

Galaxy Clustering & Galaxy-Galaxy Lensing: A Promising Union to Constrain Cosmological Parameters

Galaxy clustering and galaxy-galaxy lensing probe the connection between galaxies and their dark matter haloes in complementary ways. On one hand, the halo occupation statistics inferred from the observed clustering properties of galaxies are degenerate with the adopted cosmology. Consequently, different cosmologies imply different mass-to-light ratios for dark matter haloes. On the other hand, galaxy-galaxy lensing yields direct constraints on the actual mass-to-light ratios and it can be used to break this degeneracy, and thus to constrain cosmological parameters. In this paper we establish the link between galaxy luminosity and dark matter halo mass using the conditional luminosity function (CLF). We constrain the CLF parameters using the galaxy luminosity function and the luminosity dependence of the correlation lengths of galaxies. The resulting CLF models are used to predict the galaxy-galaxy lensing signal. For a cosmology with $(\Omega_{\rm m},\sigma_8)=(0.238,0.734)$, the model accurately fits the galaxy-galaxy lensing data obtained from the SDSS. For a comparison cosmology with $(\Omega_{\rm m},\sigma_8)=(0.3,0.9)$, however, we can accurately fit the luminosity function and clustering properties of the galaxy population, but the model predicts mass-to-light ratios that are too high, resulting in a strong overprediction of the galaxy-galaxy lensing signal. We conclude that the combination of galaxy clustering and galaxy-galaxy lensing is a powerful probe of the galaxy-dark matter connection, with the potential to yield tight constraints on cosmological parameters. Since this method mainly probes the mass distribution on non-linear scales, it is complementary to constraints obtained from the galaxy power-spectrum, which mainly probes the large-scale (linear) matter distribution.Comment: 20 pages, 11 figures, submitted to MNRA

Cosmological Constraints from a Combination of Galaxy Clustering and Lensing -- III. Application to SDSS Data

We simultaneously constrain cosmology and galaxy bias using measurements of galaxy abundances, galaxy clustering and galaxy-galaxy lensing taken from the Sloan Digital Sky Survey. We use the conditional luminosity function (which describes the halo occupation statistics as function of galaxy luminosity) combined with the halo model (which describes the non-linear matter field in terms of its halo building blocks) to describe the galaxy-dark matter connection. We explicitly account for residual redshift space distortions in the projected galaxy-galaxy correlation functions, and marginalize over uncertainties in the scale dependence of the halo bias and the detailed structure of dark matter haloes. Under the assumption of a spatially flat, vanilla {\Lambda}CDM cosmology, we focus on constraining the matter density, {\Omega}m, and the normalization of the matter power spectrum, {\sigma}8, and we adopt WMAP7 priors for the spectral index, the Hubble parameter, and the baryon density. We obtain that \Omegam = 0.278_{-0.026}^{+0.023} and {\sigma}8 = 0.763_{-0.049}^{+0.064} (95% CL). These results are robust to uncertainties in the radial number density distribution of satellite galaxies, while allowing for non-Poisson satellite occupation distributions results in a slightly lower value for {\sigma}8 (0.744_{-0.047}^{+0.056}). These constraints are in excellent agreement (at the 1{\sigma} level) with the cosmic microwave background constraints from WMAP. This demonstrates that the use of a realistic and accurate model for galaxy bias, down to the smallest non-linear scales currently observed in galaxy surveys, leads to results perfectly consistent with the vanilla {\Lambda}CDM cosmology.Comment: 21 pages, 9 figures, 5 tables, submitted to MNRA

Cosmological Constraints from a Combination of Galaxy Clustering and Lensing -- I. Theoretical Framework

We present a new method that simultaneously solves for cosmology and galaxy bias on non-linear scales. The method uses the halo model to analytically describe the (non-linear) matter distribution, and the conditional luminosity function (CLF) to specify the halo occupation statistics. For a given choice of cosmological parameters, this model can be used to predict the galaxy luminosity function, as well as the two-point correlation functions of galaxies, and the galaxy-galaxy lensing signal, both as function of scale and luminosity. In this paper, the first in a series, we present the detailed, analytical model, which we test against mock galaxy redshift surveys constructed from high-resolution numerical $N$-body simulations. We demonstrate that our model, which includes scale-dependence of the halo bias and a proper treatment of halo exclusion, reproduces the 3-dimensional galaxy-galaxy correlation and the galaxy-matter cross-correlation (which can be projected to predict the observables) with an accuracy better than 10 (in most cases 5) percent. Ignoring either of these effects, as is often done, results in systematic errors that easily exceed 40 percent on scales of \sim 1 h^{-1}\Mpc, where the data is typically most accurate. Finally, since the projected correlation functions of galaxies are never obtained by integrating the redshift space correlation function along the line-of-sight out to infinity, simply because the data only cover a finite volume, they are still affected by residual redshift space distortions (RRSDs). Ignoring these, as done in numerous studies in the past, results in systematic errors that easily exceed 20 perent on large scales (r_\rmp \gta 10 h^{-1}\Mpc). We show that it is fairly straightforward to correct for these RRSDs, to an accuracy better than $\sim 2$ percent, using a mildly modified version of the linear Kaiser formalism

The Merger Rates and Mass Assembly Histories of Dark Matter Haloes in the Two Millennium Simulations

We construct merger trees of dark matter haloes and quantify their merger rates and mass growth rates using the joint dataset from the Millennium and Millennium-II simulations. The finer resolution of the Millennium-II Simulation has allowed us to extend our earlier analysis of halo merger statistics to an unprecedentedly wide range of descendant halo mass (10^10 < M0 < 10^15 Msun), progenitor mass ratio (10^-5 < xi < 1), and redshift (0 < z < 15). We update our earlier fitting form for the mean merger rate per halo as a function of M_0, xi, and z. The overall behavior of this quantity is unchanged: the rate per unit redshift is nearly independent of z out to z~15; the dependence on halo mass is weak (M0^0.13); and it is nearly a power law in the progenitor mass ratio (xi^-2). We also present a simple and accurate fitting formula for the mean mass growth rate of haloes as a function of mass and redshift. This mean rate is 46 Msun/yr for 10^12 Msun haloes at z=0, and it increases with mass as M^{1.1} and with redshift as (1+z)^2.5 (for z > 1). When the fit for the mean mass growth rate is integrated over a halo's history, we find excellent match to the mean mass assembly histories of the simulated haloes. By combining merger rates and mass assembly histories, we present results for the number of mergers over a halo's history and the statistics of the redshift of the last major merger.Comment: 12 pages, 9 figures, accepted in MNRA

The Evolution of the Dark Halo Spin Parameters lambda and lambda' in a LCDM Universe: The Role of Minor and Major Mergers

The evolution of the spin parameter of dark halos and the dependence on the halo merging history in a set of dissipationless cosmological LCDM simulations is investigated. Special focus is placed on the differences of the two commonly used versions of the spin parameter, namely lambda=J*E^1/2/(G*M^5/2) (Peebles 80) and lambda'=J/(sqrt(2)*M_vir*R_vir*V_vir) (Bullock et al. 01). Though the distribution of the spin transfer rate defined as the ratio of the spin parameters after and prior to a merger is similar to a high degree for both, lambda and lambda', we find considerable differences in the time evolution: while lambda' is roughly independent of redshift, lambda turns out to increase significantly with decreasing redshift. This distinct behaviour arises from small differences in the spin transfer during accretion events. The evolution of the spin parameter is strongly coupled with the virial ratio eta:=2*E_kin/|E_pot| of dark halos. Major mergers disturb halos and increase both their virial ratio and spin parameter for 1-2 Gyrs. At high redshifts (z=2-3) many halos are disturbed with an average virial ratio of eta = 1.3 which approaches unity until z=0. We find that the redshift evolution of the spin parameters is dominated by the huge number of minor mergers rather than the rare major merger events.Comment: 10 pages, 11 figures, submitted to MNRA

Subjective cognitive decline and self-reported sleep problems: The SCIENCe project

We aim to investigate the frequency and type of sleep problems in memory clinic patients with subjective cognitive decline (SCD) and their association with cognition, mental health, brain magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) biomarkers. Three hundred eight subjects (65 ± 8 years, 44% female) were selected from the Subjective Cognitive Impairment Cohort (SCIENCe) project. All subjects answered two sleep questionnaires, Berlin Questionnaire (sleep apnea) and Pittsburgh Sleep Quality Index (sleep quality) and underwent a standardized memory clinic work-up. One hundred ninety-eight (64%) subjects reported sleep problems, based on 107 (35%) positive screenings on sleep apnea and 162 (53%) on poor sleep quality. Subjects with sleep problems reported more severe depressive symptoms, more anxiety, and more severe SCD. Cognitive tests, MRI, and CSF biomarkers did not differ between groups. Our results suggest that improvement of sleep quality and behaviors are potential leads for treatment in many subjects with SCD to relieve the experienced cognitive complaints

Detection of IMBHs from microlensing in globular clusters

Globular clusters have been alternatively predicted to host intermediate-mass black holes (IMBHs) or nearly impossible to form and retain them in their centres. Over the last decade enough theoretical and observational evidence have accumulated to believe that many galactic globular clusters may host IMBHs in their centres, just like galaxies do. The well-established correlations between the supermassive black holes and their host galaxies do suggest that, in extrapolation, globular clusters (GCs) follow the same relations. Most of the attempts in search of the central black holes (BHs) are not direct and present enormous observational difficulties due to the crowding of stars in the GC cores. Here we propose a new method of detection of the central BH -- the microlensing of the cluster stars by the central BH. If the core of the cluster is resolved, the direct determination of the lensing curve and lensing system parameters are possible; if unresolved, the differential imaging technique can be applied. We calculate the optical depth to central BH microlensing for a selected list of Galactic GCs and estimate the average time duration of the events. We present the observational strategy and discuss the detectability of microlensing events using a 2-m class telescope.Comment: 10 pages, 11 figures, accepted in New Astronom