Age and Prostate-Specific Antigen Level Prior to Diagnosis Predict Risk of Death from Prostate Cancer.

A single early prostate-specific antigen (PSA) level has been correlated with a higher likelihood of prostate cancer diagnosis and death in younger men. PSA testing in older men has been considered of limited utility. We evaluated prostate cancer death in relation to age and PSA level immediately prior to prostate cancer diagnosis. Using the Veterans Affairs database, we identified 230,081 men aged 50-89 years diagnosed with prostate cancer and at least one prior PSA test between 1999 and 2009. Prostate cancer-specific death over time was calculated for patients stratified by age group (e.g., 50-59 years, through 80-89 years) and PSA range at diagnosis (10 ranges) using Kaplan-Meier methods. Risk of 10-year prostate cancer mortality across age and PSA was compared using log-rank tests with a Bonferroni adjustment for multiple testing. 10.5% of men diagnosed with prostate cancer died of cancer during the 10-year study period (mean follow-up = 3.7 years). Higher PSA values prior to diagnosis predict a higher risk of death in all age groups (p < 0.0001). Within the same PSA range, older age groups are at increased risk for death from prostate cancer (p < 0.0001). For PSA of 7-10 ng/mL, cancer-specific death, 10 years after diagnosis, increased from 7% for age 50-59 years to 51% for age 80-89 years. Men older than 70 years are more likely to die of prostate cancer at any PSA level than younger men, suggesting prostate cancer remains a significant problem among older men (even those aged 80+) and deserves additional study

The Galactic O-Star Spectroscopic Survey (GOSSS). II. Bright Southern Stars

We present the second installment of GOSSS, a massive spectroscopic survey of Galactic O stars, based on new homogeneous, high signal-to-noise ratio, R ~ 2500 digital observations from both hemispheres selected from the Galactic O-Star Catalog (GOSC). In this paper we include bright stars and other objects drawn mostly from the first version of GOSC, all of them south of delta = -20 degrees, for a total number of 258 O stars. We also revise the northern sample of paper I to provide the full list of spectroscopically classified Galactic O stars complete to B = 8, bringing the total number of published GOSSS stars to 448. Extensive sequences of exceptional objects are given, including the early Of/WN, O Iafpe, Ofc, ON/OC, Onfp, Of?p, and Oe types, as well as double/triple-lined spectroscopic binaries. The new spectral subtype O9.2 is also discussed. The magnitude and spatial distributions of the observed sample are analyzed. We also present new results from OWN, a multi-epoch high-resolution spectroscopic survey coordinated with GOSSS that is assembling the largest sample of Galactic spectroscopic massive binaries ever attained. The OWN data combined with additional information on spectroscopic and visual binaries from the literature indicate that only a very small fraction (if any) of the stars with masses above 15-20 M_Sol are born as single systems. In the future we will publish the rest of the GOSSS survey, which is expected to include over 1000 Galactic O stars.Comment: 110 pages, 16 figures, accepted for publication in ApJS. Some figures have low quality due to arXiv file size limitations, alternative version available at http://jmaiz.iaa.es/files/Sotaetal14.pd

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study

© 2018, The Author(s). Abstract: To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients. Methods: Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy. Results: 2493 patients, with median age 78–80 years (DK–Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7–8.6 vs. 5.8 95% CI 5.6–5.9) and Danish mean 7.1 (95% CI 6.6–7.5 vs. 5.5 95% CI 5.4–5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL’s accuracy was only modest for in-hospital death prediction in either setting. Conclusions: The modified CriSTAL tool (with CFS instead of Fried’s frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician’s confidence in initiating earlier end-of-life discussions

Spectroscopic and photometric analysis of the early-type spectroscopic binary HD 161853 in the centre of an H II region

We study the O-type star HD 161853, which has been noted as a probable double-lined spectroscopic binary system. We secured high-resolution spectra of HD 161853 during the past nine years. We separated the two components in the system and measured their respective radial velocities for the first time. We confirm that HD 161853 is an $\sim$1 Ma old binary system consisting of an O8 V star ($M_{\rm A,RV} \geq 22$ M$_\odot$) and a B1--3 V star ($M_{\rm B,RV} \geq 7.2$ M$_\odot$) at about 1.3 kpc. From the radial velocity curve, we measure an orbital period $P$ = 2.66765$\pm$0.00001 d and an eccentricity $e$ = 0.121$\pm$0.007. Its $V$-band light curve is constant within 0.014 mag and does not display eclipses, from which we impose a maximum orbital inclination $i=54$ deg. HD 161853 is probably associated with an H II region and a poorly investigated very young open cluster. In addition, we detect a compact emission region at 50 arcsec to HD 161853 in 22$\mu$m-WISE and 24$\mu$m-Spitzer images, which may be identified as a dust wave piled up by the radiation pressure of the massive binary system.Comment: 5 pages, 4 figures, to appear in A&

On the multiplicity of the zero-age main-sequence O star Herschel 36

We present the analysis of high-resolution optical spectroscopic observations of the zero-age main-sequence O star Herschel 36 spanning six years. This star is definitely a multiple system, with at least three components detected in its spectrum. Based on our radial-velocity (RV) study, we propose a picture of a close massive binary and a more distant companion, most probably in wide orbit about each other. The orbital solution for the binary, whose components we identify as O9 V and B0.5 V, is characterized by a period of 1.5415 +/- 0.0006 days. With a spectral type O7.5 V, the third body is the most luminous component of the system and also presents RV variations with a period close to 498 days. Some possible hypotheses to explain the variability are briefly addressed and further observations are suggested.Comment: 6 pages, 2 figure