526 research outputs found

    The ALMA Survey of 70 ÎŒm Dark High-mass Clumps in Early Stages (ASHES). IX. Physical Properties and Spatial Distribution of Cores in IRDCs

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    The initial conditions found in infrared dark clouds (IRDCs) provide insights on how high-mass stars and stellar clusters form. We have conducted high-angular resolution and high-sensitivity observations toward thirty-nine massive IRDC clumps, which have been mosaicked using the 12 and 7 m arrays from the Atacama Large Millimeter/submillimeter Array. The targets are 70 ÎŒ m dark massive (220–4900 M _⊙ ), dense (>10 ^4 cm ^−3 ), and cold (∌10–20 K) clumps located at distances between 2 and 6 kpc. We identify an unprecedented number of 839 cores, with masses between 0.05 and 81 M _⊙ using 1.3 mm dust continuum emission. About 55% of the cores are low-mass (<1 M _⊙ ), whereas â‰Č1% (7/839) are high-mass (≳27 M _⊙ ). We detect no high-mass prestellar cores. The most massive cores (MMC) identified within individual clumps lack sufficient mass to form high-mass stars without additional mass feeding. We find that the mass of the MMCs is correlated with the clump surface density, implying denser clumps produce more massive cores. There is no significant mass segregation except for a few tentative detections. In contrast, most clumps show segregation once the clump density is considered instead of mass. Although the dust continuum emission resolves clumps in a network of filaments, some of which consist of hub-filament systems, the majority of the MMCs are not found in the hubs. Our analysis shows that high-mass cores and MMCs have no preferred location with respect to low-mass cores at the earliest stages of high-mass star formation

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

    Phylogenomic tree of the 85 <i>Mtb</i> clinical isolates from Mexico.

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    (A) The phylogeny was reconstructed with 11,150 SNPs, the GTR+FO+G4m substitution model, and a bootstrap cutoff of 0.03. Color strip indicates the classification by sublineage, followed by the phenotypic DST and the comorbidities T2DM (black star) and HIV (blue star) associated with each sample. Colored clades (light blue and pink) indicate transmission groups. (B) Geographical distribution of Mtb samples, colored by sublineage and (C) drug-resistant classification.</p

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries