Constraining the Size of the Dusty Torus in Active Galactic Nuclei: An Optical/Infrared Reverberation Lag Study

The dusty torus is the key component in the Active Galactic Nuclei (AGN) Unification Scheme that explains the spectroscopic differences between Seyfert galaxies of types 1 and 2. The torus dust is heated by the nuclear source and emits the absorbed energy in the infrared (IR); but because of light travel times, the torus IR emission responds to variations of the nuclear ultraviolet/optical continuum with a delay that corresponds to the size of the emitting region. The results from a mid-infrared (MIR) monitoring campaign using the Spitzer Space Telescope and optical ground-based telescopes (B and V band imaging), which spanned over 2 years and covered a sample of 12 Seyfert galaxies, are presented. The aim was to constrain the distances from the nucleus to the regions in the torus emitting at wavelengths of 3.6 μm and 4.5 μm. MIR light curves showing the variability characteristics of these AGN are presented and the effects of photometric uncertainties on the time-series analysis of the light curves are discussed. Significant variability was observed in the IR light curves of 10 of 12 objects, with relative amplitudes ranging from ∼10% to ∼100% from their mean flux. The “reverberation lags” between the 3.6 μm and 4.5 μm IR bands were determined for the entire sample and between the optical and MIR bands for NGC6418. In NGC6418, the 3.6 μm and 4.5 μm fluxes lagged behind those of the optical continuum by 47.5 (+2.0,-1.9) days and 62.5 (+2.5,−2.9) days, respectively. This is consistent with the inferred lower limit to the sublimation radius for pure graphite grains at T=1800 K but smaller by a factor of 2 than the lower limit for dust grains with a “standard” interstellar medium (ISM) composition. There is evidence that the lags increased following approximately by a factor of 2 increase in luminosity, consistent with an increase in the sublimation radius

Spitzer Space Telescope Measurements of Dust Reverberation Lags in the Seyfert 1 Galaxy NGC 6418

We present results from a fifteen-month campaign of high-cadence (~ 3 days) mid-infrared Spitzer and optical (B and V ) monitoring of the Seyfert 1 galaxy NGC 6418, with the objective of determining the characteristic size of the dusty torus in this active galactic nucleus (AGN). We find that the 3.6 $\mu$m and 4.5 $\mu$m flux variations lag behind those of the optical continuum by $37.2^{+2.4}_{-2.2}$ days and $47.1^{+3.1}_{-3.1}$ days, respectively. We report a cross-correlation time lag between the 4.5 $\mu$m and 3.6 $\mu$m flux of $13.9^{+0.5}_{-0.1}$ days. The lags indicate that the dust emitting at 3.6 $\mu$m and 4.5 $\mu$m is located at a distance of approximately 1 light-month (~ 0.03 pc) from the source of the AGN UV-optical continuum. The reverberation radii are consistent with the inferred lower limit to the sublimation radius for pure graphite grains at 1800 K, but smaller by a factor of ~ 2 than the corresponding lower limit for silicate grains; this is similar to what has been found for near-infrared (K-band) lags in other AGN. The 3.6 and 4.5 $\mu$m reverberation radii fall above the K-band $\tau \propto L^{0.5}$ size-luminosity relationship by factors $\lesssim 2.7$ and $\lesssim 3.4$, respectively, while the 4.5 $\mu$m reverberation radius is only 27% larger than the 3.6 $\mu$m radius. This is broadly consistent with clumpy torus models, in which individual optically thick clouds emit strongly over a broad wavelength range.Comment: 13 pages, 9 figure

\u3cem\u3eSpitzer Space Telescope\u3c/em\u3e Measurements of Dust Reverberation Lags in the Seyfert 1 Galaxy NGC 6418

We present results from a 15 month campaign of high-cadence (~3 days) mid-infrared Spitzer and optical (B and V) monitoring of the Seyfert 1 galaxy NGC 6418, with the objective of determining the characteristic size of the dusty torus in this active galactic nucleus (AGN). . . . For the remainder of the abstract, please visit: http://dx.doi.org/10.1088/0004-637X/801/2/12

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Predictable modulation of cancer treatment outcomes by the gut microbiota

The gut microbiota has the potential to influence the efficacy of cancer therapy. Here, we investigated the contribution of the intestinal microbiome on treatment outcomes in a heterogeneous cohort that included multiple cancer types to identify microbes with a global impact on immune response. Human gut metagenomic analysis revealed that responder patients had significantly higher microbial diversity and different microbiota compositions compared to non-responders. A machine-learning model was developed and validated in an independent cohort to predict treatment outcomes based on gut microbiota composition and functional repertoires of responders and non-responders. Specific species, Bacteroides ovatus and Bacteroides xylanisolvens, were positively correlated with treatment outcomes. Oral gavage of these responder bacteria significantly increased the efficacy of erlotinib and induced the expression of CXCL9 and IFN-gamma in a murine lung cancer model. These data suggest a predictable impact of specific constituents of the microbiota on tumor growth and cancer treatment outcomes with implications for both prognosis and therapy.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]