Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: A multicenter comparative trial

ObjectiveResults are presented from the first completed multicenter trial directed at gaining approval from the US Food and Drug Administration of endovascular versus open surgical repair of descending thoracic aortic aneurysms.MethodsBetween September 1999 and May 2001, 140 patients with descending thoracic aneurysms were enrolled at 17 sites and evaluated for a Gore TAG Thoracic Endograft. An open surgical control cohort of 94 patients was identified by enrolling historical and concurrent subjects. Patients were assessed before treatment, at treatment, and at hospital discharge and returned for follow-up visits at 1 month, 6 months, and annually thereafter.ResultsOne hundred thirty-seven of 140 patients had successful implantation of the endograft. Perioperative mortality in the endograft versus open surgical control cohort was 2.1% (n = 3) versus 11.7% (n = 11, P < .001). Thirty-day analysis revealed a statistically significant lower incidence of the following complications in the endovascular cohort versus the surgical cohort: spinal cord ischemia (3% vs 14%), respiratory failure (4% vs 20%), and renal insufficiency (1% vs 13%). The endovascular group had a higher incidence of peripheral vascular complications (14% vs 4%). The mean lengths of intensive care unit stay (2.6 ± 14.6 vs 5.2 ± 7.2 days) and hospital stay (7.4 ± 17.7 vs 14.4 ± 12.8 days) were significantly shorter in the endovascular cohort. At 1 and 2 years’ follow-up, the incidence of endoleaks was 6% and 9%, respectively. Through 2 years of follow-up, there were 3 reinterventions in the endograft cohort and none in the open surgical control cohort. Kaplan–Meier analysis revealed no difference in overall mortality at 2 years.ConclusionsIn this multicenter study early outcomes with descending aortic endovascular stent grafting were very encouraging when compared with those of a well-matched surgical cohort. However, at 2 years’ follow-up, there is an incidence of endoleaks and reinterventions associated with endovascular versus open surgical repair. Continued vigilant surveillance of patients treated with an endograft is important

Oxygen and nitrogen abundances in Virgo and field spirals

The oxygen and nitrogen abundances in the HII regions of the nine Virgo spirals of the sample from Skillman et al (1996) and in nine field spiral galaxies are re-determined with the recently suggested P - method. We confirm that there is an abundance segregation in the sample of Virgo spirals in the sense that the HI deficient Virgo spirals near the core of the cluster have higher oxygen abundances in comparison to the spirals at the periphery of the Virgo cluster. At the same time both the Virgo periphery and core spirals have counterparts among field spirals. We conclude that if there is a difference in the abundance properties of the Virgo and field spirals, this difference appears to be small and masked by the observational errors.Comment: 16 pages, 10 figures, accepted for publication in Astronomy and Astrophysic

COLD GASS, an IRAM legacy survey of molecular gas in massive galaxies: I. Relations between H2, HI, stellar content and structural properties

We are conducting COLD GASS, a legacy survey for molecular gas in nearby galaxies. Using the IRAM 30m telescope, we measure the CO(1-0) line in a sample of ~350 nearby (D=100-200 Mpc), massive galaxies (log(M*/Msun)>10.0). The sample is selected purely according to stellar mass, and therefore provides an unbiased view of molecular gas in these systems. By combining the IRAM data with SDSS photometry and spectroscopy, GALEX imaging and high-quality Arecibo HI data, we investigate the partition of condensed baryons between stars, atomic gas and molecular gas in 0.1-10L* galaxies. In this paper, we present CO luminosities and molecular hydrogen masses for the first 222 galaxies. The overall CO detection rate is 54%, but our survey also uncovers the existence of sharp thresholds in galaxy structural parameters such as stellar mass surface density and concentration index, below which all galaxies have a measurable cold gas component but above which the detection rate of the CO line drops suddenly. The mean molecular gas fraction MH2/M* of the CO detections is 0.066+/-0.039, and this fraction does not depend on stellar mass, but is a strong function of NUV-r colour. Through stacking, we set a firm upper limit of MH2/M*=0.0016+/-0.0005 for red galaxies with NUV-r>5.0. The average molecular-to-atomic hydrogen ratio in present-day galaxies is 0.3, with significant scatter from one galaxy to the next. The existence of strong detection thresholds in both the HI and CO lines suggests that "quenching" processes have occurred in these systems. Intriguingly, atomic gas strongly dominates in the minority of galaxies with significant cold gas that lie above these thresholds. This suggests that some re-accretion of gas may still be possible following the quenching event.Comment: Accepted for publications in MNRAS. 32 pages, 25 figure

Kinematics of the dwarf irregular galaxy GR8

We present deep, high velocity resolution (~1.6 km/s) Giant Meterwave Radio Telescope HI 21cm synthesis images for the faint (M_B ~ -12.1) dwarf irregular galaxy GR8. We find that the velocity field of the galaxy shows a clear systematic large scale pattern, with a maximum amplitude ~10 km/s. Neither pure rotation, nor pure radial motion alone can fit the observed velocity field; however a combination of radial and circular motions can provide a reasonable fit. The most natural interpretation is that the neutral ISM, in addition to rotating about the center, is also expanding outwards, as a result of energy input from the ongoing star formation in the galaxy. Support for this interpretation comes from the fact that the pressure in the HII regions in the galaxy is known to be substantially (~55 times) more than the average pressure in the gas disk. It is, however, also possible that the velocity field is the result of the gas swirling inwards, in which case GR8 could be in the process of formation via the merger of subgalactic clumps.Comment: 9 pages, 5 figures. Accepted for publication in Astronomy and astrophysic

Incorporating concepts of inequality and inequity into health benefits analysis

BACKGROUND: Although environmental policy decisions are often based in part on both risk assessment information and environmental justice concerns, formalized approaches for addressing inequality or inequity when estimating the health benefits of pollution control have been lacking. Inequality indicators that fulfill basic axioms and agree with relevant definitions and concepts in health benefits analysis and environmental justice analysis can allow for quantitative examination of efficiency-equality tradeoffs in pollution control policies. METHODS: To develop appropriate inequality indicators for health benefits analysis, we provide relevant definitions from the fields of risk assessment and environmental justice and consider the implications. We evaluate axioms proposed in past studies of inequality indicators and develop additional axioms relevant to this context. We survey the literature on previous applications of inequality indicators and evaluate five candidate indicators in reference to our proposed axioms. We present an illustrative pollution control example to determine whether our selected indicators provide interpretable information. RESULTS AND CONCLUSIONS: We conclude that an inequality indicator for health benefits analysis should not decrease when risk is transferred from a low-risk to high-risk person, and that it should decrease when risk is transferred from a high-risk to low-risk person (Pigou-Dalton transfer principle), and that it should be able to have total inequality divided into its constituent parts (subgroup decomposability). We additionally propose that an ideal indicator should avoid value judgments about the relative importance of transfers at different percentiles of the risk distribution, incorporate health risk with evidence about differential susceptibility, include baseline distributions of risk, use appropriate geographic resolution and scope, and consider multiple competing policy alternatives. Given these criteria, we select the Atkinson index as the single indicator most appropriate for health benefits analysis, with other indicators useful for sensitivity analysis. Our illustrative pollution control example demonstrates how these indices can help a policy maker determine control strategies that are dominated from an efficiency and equality standpoint, those that are dominated for some but not all societal viewpoints on inequality averseness, and those that are on the optimal efficiency-equality frontier, allowing for more informed pollution control policies

Stakeholder collaboration in climate-smart agricultural production innovations: insights from the Cocoa industry in Ghana

Although collaboration is vital in addressing global environmental sustainability challenges, research understanding on stakeholder engagement in climate-smart production innovation adoption and implementation, remains limited. In this paper, we advance knowledge about stakeholder collaboration by examining the roles played by stakeholders in scaling up ecological sustainability innovations. Using the illustrative context and case of green cocoa industry in Ghana, the analysis identified three distinctive phases of stakeholder engagement in ecological sustainability innovations implemented from 1960-2017. We highlight defining periods of ecological challenges encompassing the production recovery sustainability initiative phase solely driven by the Ghana Cocoa Board (COCOBOD)–a governmental body responsible for production, processing and marketing of cocoa, coffee and sheanut. During the period, major initiatives were driven by non-governmental organisations in collaboration with COCOBOD to implement the Climate-Smart agriculture scheme in the cocoa sector. The findings have implications for cocoa production research and stakeholder collaboration in environmental innovations adoption