The impact of private sector provision on equitable provision of coronary revascularisation

Objective: To investigate the impact of including private sector data on assessments of equity of coronary revascularisation provision using NHS data only. Design: Analyses of Hospital Episodes Statistics and private sector data by age, sex, and PCT of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. GINI coefficients were derived to provide an index of inequality across sub-populations, with parametric bootstrapping to estimate confidence intervals. Setting: London Participants London residents undergoing coronary revascularisation April 2001 - December 2003. Intervention Coronary artery bypass graft or angioplasty Main outcome measures: Directly-standardised revascularisation rates, GINI coefficients. Results: NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100,000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p=0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately-funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS funded care alone. Conclusion: Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place

Search for L5 Earth Trojans with DECam

Most of the major planets in the Solar system support populations of co-orbiting bodies, known as Trojans, at their L4 and L5 Lagrange points. In contrast, Earth has only one known co-orbiting companion. This paper presents the results from a search for Earth Trojans (ETs) using the DECam instrument on the Blanco Telescope at CTIO. This search found no additional Trojans in spite of greater coverage compared to previous surveys of the L5 point. Therefore, the main result of this work is to place the most stringent constraints to date on the population of ETs. These constraints depend on assumptions regarding the underlying population properties, especially the slope of the magnitude distribution (which in turn depends on the size and albedo distributions of the objects). For standard assumptions, we calculate upper limits to a 90 per cent confidence limit on the L5 population of N_(ET) < 1 for magnitude H < 15.5, N_(ET) = 60–85 for H < 19.7, and N_(ET) = 97 for H = 20.4. This latter magnitude limit corresponds to Trojans ∼300 m in size for albedo 0.15. At H = 19.7, these upper limits are consistent with previous L4 ET constraints and significantly improve L5 constraints

Behaviour of Boron Trichloride & Tribromide, Boric Anhydride & Boric Acid in Disulphuric Acid

384-38

Increasing compliance with low tidal volume ventilation in the ICU with two nudge-based interventions: evaluation through intervention time-series analyses

Objectives: Low tidal volume (TVe) ventilation improves outcomes for ventilated patients, and the majority of clinicians state they implement it. Unfortunately, most patients never receive low TVes. ‘Nudges’ influence decision-making with subtle cognitive mechanisms and are effective in many contexts. There have been few studies examining their impact on clinical decision-making. We investigated the impact of 2 interventions designed using principles from behavioural science on the deployment of low TVe ventilation in the intensive care unit (ICU). Setting: University Hospitals Bristol, a tertiary, mixed medical and surgical ICU with 20 beds, admitting over 1300 patients per year. Participants: Data were collected from 2144 consecutive patients receiving controlled mechanical ventilation for more than 1 hour between October 2010 and September 2014. Patients on controlled mechanical ventilation for more than 20 hours were included in the final analysis. Interventions: (1) Default ventilator settings were adjusted to comply with low TVe targets from the initiation of ventilation unless actively changed by a clinician. (2) A large dashboard was deployed displaying TVes in the format mL/kg ideal body weight (IBW) with alerts when TVes were excessive. Primary outcome measure: TVe in mL/kg IBW. Findings: TVe was significantly lower in the defaults group. In the dashboard intervention, TVe fell more quickly and by a greater amount after a TVe of 8 mL/kg IBW was breached when compared with controls. This effect improved in each subsequent year for 3 years. Conclusions: This study has demonstrated that adjustment of default ventilator settings and a dashboard with alerts for excessive TVe can significantly influence clinical decision-making. This offers a promising strategy to improve compliance with low TVe ventilation, and suggests that using insights from behavioural science has potential to improve the translation of evidence into practice

Chandra X-ray Sources in the LALA Cetus Field

The 174 ks Chandra Advanced CCD Imaging Spectrometer exposure of the Large Area Lyman Alpha Survey (LALA) Cetus field is the second of the two deep Chandra images on LALA fields. In this paper we present the Chandra X-ray sources detected in the Cetus field, along with an analysis of X-ray source counts, stacked X-ray spectrum, and optical identifications. A total of 188 X-ray sources were detected: 174 in the 0.5-7.0 keV band, 154 in the 0.5-2.0 keV band, and 113 in the 2.0-7.0 keV band. The X-ray source counts were derived and compared with LALA Bootes field (172 ks exposure). Interestingly, we find consistent hard band X-ray source density, but 36+-12% higher soft band X-ray source density in Cetus field. The weighted stacked spectrum of the detected X-ray sources can be fitted by a powerlaw with photon index Gamma = 1.55. Based on the weighted stacked spectrum, we find that the resolved fraction of the X-ray background drops from 72+-1% at 0.5-1.0 keV to 63+-4% at 6.0-8.0 keV. The unresolved spectrum can be fitted by a powerlaw over the range 0.5-7 keV, with a photon index Gamma = 1.22. We also present optical counterparts for 154 of the X-ray sources, down to a limiting magnitude of r' = 25.9 (Vega), using a deep r' band image obtained with the MMT.Comment: 21 pages, including 6 figures, 1 table, ApJ accepte

Search for z~6.96 Ly-alpha emitters with Magellan/IMACS in the COSMOS field

We report a search for z~6.96 Ly-alpha emitters (LAEs) using a Narrow-Band filter, centered at 9680 Angstroms, with the IMACS instrument on the Magellan telescope at Las Campanas Observatory. We obtain a sample of 6 Ly-alpha emitter candidates of luminosity ~10^42 erg/s in a total area of 465 square arcmin corresponding to a comoving volume of ~ 72000 Mpc^3. From this result, we derive a Ly-alpha luminosity function (LF) at z~6.96 and compare our sample with the only z~6.96 Ly-alpha emitter spectroscopically confirmed to date (Iye et al. 2006). We find no evolution between the z=5.7 and z~7 Ly-alpha luminosity functions, if a majority of our candidates are confirmed. Spectroscopic confirmation for this sample will enable more robust conclusions.Comment: Accepted to Ap

Morphology and evolution of emission line galaxies in the Hubble Ultra Deep Field

We investigate the properties and evolution of a sample of galaxies selected to have prominent emission lines in low-resolution grism spectra of the Hubble Ultra Deep Field (HUDF). These objects, eGRAPES, are late type blue galaxies, characterized by small proper sizes (R_50 < 2 kpc) in the 4350A rest-frame, low masses (5x10^9 M_sun), and a wide range of luminosities and surface brightnesses. The masses, sizes and volume densities of these objects appear to change very little up to a redshift of z=1.5. On the other hand, their surface brightness decreases significantly from z=1.5 to z=0 while their mass-to-light ratio increases two-folds. This could be a sign that most of low redshift eGRAPES have an older stellar population than high redshift eGRAPES and hence that most eGRAPES formed at higher redshifts. The average volume density of eGRAPES is (1.8 \pm 0.3)x10^{-3} Mpc^{-3} between 0.3 < z < 1.5. Many eGRAPES would formally have been classified as Luminous Compact Blue Galaxies (LCBGs) if these had been selected based on small physical size, blue intrinsic color, and high surface brightness, while the remainder of the sample discussed in this paper forms an extension of LCBGs towards fainter luminosities.Comment: Accepted, to appear in Ap

[CII] line emission in BRI1335-0417 at z=4.4

Using the 12m APEX telescope, we have detected redshifted emission from the 157.74micron [CII] line in the z=4.4074 quasar BRI1335-0417. The linewidth and redshift are in good agreement with previous observations of high-J CO line emission. We measure a [CII] line luminosity, L_[CII] = (16.4 +/- 2.6)x10^9 Lsun, making BRI~1335-0417 the most luminous, unlensed [CII] line emitter known at high-redshift. The [CII]-to-FIR luminosity ratio of (5.3+/-0.8)x10^-4 is ~3x higher than expected for an average object with a FIR luminosity L_FIR = 3.1x10^13 Lsun, if this ratio were to follow the trend observed in other FIR-bright galaxies that have been detected in [CII] line emission. These new data suggest that the scatter in the [CII]-to-FIR luminosity ratio could be larger than previously expected for high luminosity objects. BR1335-0417 has a similar FIR luminosity and [CII]/CO luminosity compared to local ULIRGS and appears to be a gas-rich merger forming stars at a rate of a few thousand solar masses per year.Comment: A&A accepte