Federalism and the Constitutional Right to Keep and Bear Arms
In: Publius: the journal of federalism, Band 33, Heft 3, S. 63-82
ISSN: 1747-7107
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In: Publius: the journal of federalism, Band 33, Heft 3, S. 63-82
ISSN: 1747-7107
Orhan, Zeynep Celik/0000-0002-9424-2339; Serenelli, Aldo/0000-0001-6359-2769; Monteiro, Mario J. P. F. G./0000-0003-0513-8116; Huber, Daniel/0000-0001-8832-4488; Adibekyan, Vardan/0000-0002-0601-6199; Reffert, Sabine/0000-0002-0460-8289; Stock, Stephan/0000-0002-1166-9338; Stassun, Keivan/0000-0002-3481-9052; Cunha, Margarida/0000-0001-8237-7343; Kuszlewicz, James/0000-0002-3322-5279; Lund, Mikkel Norup/0000-0001-9214-5642; Mathur, Savita/0000-0002-0129-0316; Nielsen, Martin Bo/0000-0001-9169-2599; Mosser, Benoit/0000-0002-7547-1208; Pereira, Filipe/0000-0002-2157-7146; Lucas, Miles/0000-0001-6341-310X; miglio, andrea/0000-0001-5998-8533; Ball, Warrick/0000-0002-4773-1017; Basu, Sarbani/0000-0002-6163-3472; Veras, Dimitri/0000-0001-8014-6162; Handberg, Rasmus/0000-0001-8725-4502; Christensen-Dalsgaard, Jorgen/0000-0001-5137-0966; Delgado Mena, Elisa/0000-0003-4434-2195 ; WOS: 000498546800001 ; The Transiting Exoplanet Survey Satellite (TESS) is performing a near all-sky survey for planets that transit bright stars. in addition, its excellent photometric precision enables asteroseismology of solar-type and red-giant stars, which exhibit convection-driven, solar-like oscillations. Simulations predict that TESS will detect solar-like oscillations in nearly 100 stars already known to host planets. in this paper, we present an asteroseismic analysis of the known red-giant host stars HD;212771 and HD;203949, both systems having a long-period planet detected through radial velocities. These are the first detections of oscillations in previously known exoplanet-host stars by TESS, further showcasing the mission?s potential to conduct asteroseismology of red-giant stars. We estimate the fundamental properties of both stars through a grid-based modeling approach that uses global asteroseismic parameters as input. We discuss the evolutionary state of HD;203949 in depth and note the large discrepancy between its asteroseismic mass (M-* = 1.23 0.15 MM* = 1.00 0.16 M if in the clump) and the mass quoted in the discovery paper (M-* = 2.1 0.1 M), implying a change >30% in the planet?s mass. Assuming HD;203949 to be in the clump, we investigate the planet?s past orbital evolution and discuss how it could have avoided engulfment at the tip of the red-giant branch. Finally, HD;212771 was observed by K2 during its Campaign 3, thus allowing for a preliminary comparison of the asteroseismic performances of TESS and K2. We estimate the ratio of the observed oscillation amplitudes for this star to be
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Monteiro, Mario J. P. F. G./0000-0003-0513-8116; Suarez, Juan Carlos/0000-0003-3649-8384; Serenelli, Aldo/0000-0001-6359-2769; Jiang, Chen/0000-0002-7614-1665; Slumstrup, Ditte/0000-0003-4538-9518; Mathur, Savita/0000-0002-0129-0316; Christensen-Dalsgaard, Jorgen/0000-0001-5137-0966; Bodi, Attila/0000-0002-8585-4544; Pereira, Filipe/0000-0002-2157-7146; YILDIZ, Mutlu/0000-0002-7772-7641; Di Mauro, Maria Pia/0000-0001-7801-7484; Ball, Warrick/0000-0002-4773-1017; Spitoni, Emanuele/0000-0001-9715-5727; Handberg, Rasmus/0000-0001-8725-4502; Lustosa de Moura, Bruno/0000-0001-6295-3526; Lund, Mikkel Norup/0000-0001-9214-5642; Rodriguez Diaz, Luisa Fernanda/0000-0002-0588-1375; Basu, Sarbani/0000-0002-6163-3472; Stokholm, Amalie/0000-0002-5496-365X; Cunha, Margarida/0000-0001-8237-7343; miglio, andrea/0000-0001-5998-8533; BUGNET, Lisa/0000-0003-0142-4000; Buzasi, Derek/0000-0002-1988-143X; Van Eylen, Vincent/0000-0001-5542-8870; Stello, Dennis/0000-0002-4879-3519; Lysgaard Rorsted, Jakob/0000-0001-9234-430X; Angelou, George/0000-0003-4463-1907; Mosser, Benoit/0000-0002-7547-1208; Verma, Kuldeep/0000-0003-0970-6440; Kuszlewicz, James/0000-0002-3322-5279; Bell, Keaton/0000-0002-0656-032X; Huber, Daniel/0000-0001-8832-4488; Lundkvist, Mia Sloth/0000-0002-8661-2571 ; WOS: 000520956000001 ; Since the onset of the "space revolution" of high-precision high-cadence photometry, asteroseismology has been demonstrated as a powerful tool for informing Galactic archeology investigations. the launch of the NASA Transiting Exoplanet Survey Satellite (TESS) mission has enabled seismic-based inferences to go full sky-providing a clear advantage for large ensemble studies of the different Milky Way components. Here we demonstrate its potential for investigating the Galaxy by carrying out the first asteroseismic ensemble study of red giant stars observed by TESS. We use a sample of 25 stars for which we measure their global asteroseimic observables and estimate their fundamental stellar properties, such as radius, mass, and age. Significant improvements are seen in the uncertainties of our estimates when combining seismic observables from TESS with astrometric measurements from the Gaia mission compared to when the seismology and astrometry are applied separately. Specifically, when combined we show that stellar radii can be determined to a precision of a few percent, masses to 5%-10%, and ages to the 20% level. This is comparable to the precision typically obtained using end-of-mission Kepler data. ; NASA's Science Mission directorate; Danish National Research FoundationDanmarks Grundforskningsfond [DNRF106]; ESA PRODEXEuropean Space Agency [PEA 4000119301]; Stellar Astrophysics Centre (SAC) at Aarhus University; Independent Research Fund Denmark [7027-00096B]; FCT/MCTESPortuguese Foundation for Science and Technology [UID/FIS/04434/2019, PTDC/FIS-AST/30389/2017, POCI-01-0145-FEDER-030389, CEECIND/02619/2017]; FEDER through COMPETE2020 [UID/FIS/04434/2019, PTDC/FIS-AST/30389/2017, POCI-01-0145-FEDER-030389, CEECIND/02619/2017]; CNES/PLATO grant; NASANational Aeronautics & Space Administration (NASA) [NNX16AB76G]; European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreementEuropean Union (EU) [792848, 664931]; ESA PRODEX programme; Premiale 2015 MITiC; National Science FoundationNational Science Foundation (NSF) [AST-1903828]; Carlsberg FoundationCarlsberg Foundation [CF17-0760]; European Research Council under the European Community's Seventh Framework Programme (FP7/2007-2013)/ERC grant [338251]; European Research CouncilEuropean Research Council (ERC) [772293]; MINECO [ESP2017-82674R]; Spanish public funds for research [ESP2017-87676-2-2]; Spanish Ministry of Science and EducationSpanish Government [RYC-2012-09913] ; This Letter includes data collected by the TESS mission, which are publicly available from the Mikulski Archive for Space Telescopes (MAST). Funding for the TESS mission is provided by NASA's Science Mission directorate. Funding for the TESS Asteroseismic Science Operations Centre is provided by the Danish National Research Foundation (grant agreement No. DNRF106), ESA PRODEX (PEA 4000119301), and Stellar Astrophysics Centre (SAC) at Aarhus University. V.S. A. acknowledges support from the Independent Research Fund Denmark (Research grant 7027-00096B). D.B. is supported in the form of work contract FCT/MCTES through national funds and by FEDER through COMPETE2020 in connection to these grants: UID/FIS/04434/2019; PTDC/FIS-AST/30389/2017 & POCI-01-0145-FEDER-030389. L.B., R.A.G., and B.M. acknowledge the support from the CNES/PLATO grant. D.B. acknowledges NASA grant NNX16AB76G. T.L.C. acknowledges support from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No.792848 (PULSATION). This work was supported by FCT/MCTES through national funds (UID/FIS/04434/2019). E.C. is funded by the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 664931. R.H. and M.N.L. acknowledge the support of the ESA PRODEX programme. T.S.R. acknowledges financial support from Premiale 2015 MITiC (PI B. Garilli). K.J.B. is supported by the National Science Foundation under Award AST-1903828. M. S.L. is supported by the Carlsberg Foundation (grant agreement No. CF17-0760). M.C. is funded by FCT//MCTES through national funds and by FEDER through COMPETE2020 through these grants: UID/FIS/04434/2019, PTDC/FIS-AST/30389/2017 & POCI-01-0145-FEDER-030389, CEECIND/02619/2017. the research leading to the presented results has received funding from the European Research Council under the European Community's Seventh Framework Programme (FP7/2007-2013)/ERC grant agreement no 338251 (StellarAges). A.M. acknowledges support from the European Research Council Consolidator Grant funding scheme (project ASTEROCHRONOMETRY, grant agreement No. 772293,.http://www.asterochronometry.eu).A.M.S.is partially supported by MINECO grant ESP2017-82674R. J.C.S. acknowledges funding support from Spanish public funds for research under projects ESP2017-87676-2-2, and from project RYC-2012-09913 under the `Ramon y Cajal' program of the Spanish Ministry of Science and Education. Resources supporting this work were provided by the NASA High-End Computing (HEC) Program through the NASA Advanced Supercomputing (NAS) Division at Ames Research Center for the production of the SPOC data products.
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BACKGROUND: Acute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK). METHODS: Patients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up. RESULTS: The patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26–49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1–4] days vs. 3 [2–4], p < 0.001). At 30 days, complications were significantly higher in the operative group (p < 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive. CONCLUSION: COVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond.
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BackgroundAcute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK).MethodsPatients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up.ResultsThe patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26–49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1–4] days vs. 3 [2–4], p [less than] 0.001). At 30 days, complications were significantly higher in the operative group (p [less than] 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive. ConclusionCOVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond.
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We present the discovery and characterization of a new transiting planet from Campaign 17 of the Kepler extended mission K2. The planet K2-292 b is a warm sub-Neptune on a 17 day orbit around a bright (V = 9.9 mag) solar-like G3 V star with a mass and radius of M∗ = 1.00 ± 0.03 MȮ and R∗ = 1.09 ± 0.03 RȮ, respectively. We modeled simultaneously the K2 photometry and CARMENES spectroscopic data and derived a radius of Rp=2.63-0.10+0.12 RȮ and mass of Mp=24.5-4.4+4.4 MȮ, yielding a mean density of ρp=7.4-1.5+1.6 g cm-3, which makes it one of the densest sub-Neptunian planets known to date. We also detected a linear trend in the radial velocities of K2-292 (γRV =-0.40-0.07+0.07 m s-1 d-1) that suggests a long-period companion with a minimum mass on the order of 33 MȮ. If confirmed, it would support a formation scenario of K2-292 b by migration caused by Kozai-Lidov oscillations. © 2019 ESO. ; Funding for the K2 mission is provided by the NASA Science Mission directorate. This work has made use of data from the European Space Agency (ESA) mission Gaia (https://www.cosmos.esa.int/gaia), processed by the Gaia Data Processing and Analysis Consortium (DPAC; https://www.cosmos.esa.int/web/gaia/dpac/consortium). Funding for the DPAC has been provided by national institutions, in particular the institutions participating in the Gaia Multilateral Agreement. CARMENES is an instrument for the Centro Astronomico Hispano-Aleman de Calar Alto (CAHA, Almeria, Spain) funded by the German Max-Planck-Gesellschaft (MPG), the Spanish Consejo Superior de Investigaciones Cientificas (CSIC), the European Union through FEDER/ERF FICTS-2011-02 funds, and the members of the CARMENES Consortium. R.L. has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 713673 and financial support through the >la Caixa> INPhINIT Fellowship Grant for Doctoral studies at Spanish Research Centres of Excellence, >la Caixa> Banking Foundation, Barcelona, Spain. This work is partly financed by the Spanish Ministry of Economics and Competitiveness through grants ESP2013-48391-C4-2-R and AYA2016-79425-C3, and supported by the Japan Society for Promotion of Science (JSPS) KAKENHI Grant Number JP16K17660, JP18H01265 and JP18H05439, and JST PRESTO Grant Number JPMJPR1775. Funding for the Stellar Astrophysics Centre is provided by The Danish National Research Foundation (Grant agreement no.: DNRF106). K.W.F.L acknowledges the support of the DFG priority program SPP 1992 >Exploring the Diversity of Exoplanets in the Mass-Density Diagram> (RA 714/14-1). M.F. and C.M.P. gratefully acknowledge the support of the Swedish National Space Agency. ; Peer Reviewed
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WOS: 000469975500005 ; We present the discovery of HD 221416 b, the first transiting planet identified by the Transiting Exoplanet Survey Satellite (TESS) for which asteroseismology of the host star is possible. HD 221416 b (HIP 116158, TOI-197) is a bright (V = 8.2 mag), spectroscopically classified subgiant that oscillates with an average frequency of about 430 mu Hz and displays a clear signature of mixed modes. The oscillation amplitude confirms that the redder TESS bandpass compared to Kepler has a small effect on the oscillations, supporting the expected yield of thousands of solar-like oscillators with TESS 2 minute cadence observations. Asteroseismic modeling yields a robust determination of the host star radius (R-* = 2.943 +/- 0.064 R-circle dot), mass (M-* = 1.212 +/- 0.074 M-circle dot), and age (4.9 +/- 1.1 Gyr), and demonstrates that it has just started ascending the red-giant branch. Combining asteroseismology with transit modeling and radial-velocity observations, we show that the planet is a "hot Saturn" (R-p = 9.17 +/- 0.33 R-circle plus) with an orbital period of similar to 14.3 days, irradiance of F = 343 +/- 24 F-circle plus, and moderate mass (M-p = 60.5 +/- 5.7 M-circle plus) and density (rho(p) = 0.431 +/- 0.062 g cm(-3)). The properties of HD 221416 b show that the host-star metallicity-planet mass correlation found in sub-Saturns (4-8 R-circle plus) does not extend to larger radii, indicating that planets in the transition between sub-Saturns and Jupiters follow a relatively narrow range of densities. With a density measured to similar to 15%, HD 221416 b is one of the best characterized Saturn-size planets to date, augmenting the small number of known transiting planets around evolved stars and demonstrating the power of TESS to characterize exoplanets and their host stars using asteroseismology. ; National Aeronautics and Space Administration through the TESS Guest Investigator Program [80NSSC18K1585]; National Science FoundationNational Science Foundation (NSF) [AST-1717000]; Science and Technology Facilities CouncilScience & Technology Facilities Council (STFC); UK Space Agency; European Social Fund via the Lithuanian Science Council [09.3.3-LMT-K-712-01-0103]; Danish National Research FoundationDanmarks Grundforskningsfond [DNRF106]; FONDECYT projectComision Nacional de Investigacion Cientifica y Tecnologica (CONICYT)CONICYT FONDECYT [1171208]; CONICYT projectComision Nacional de Investigacion Cientifica y Tecnologica (CONICYT) [BASAL AFB-170002]; Ministry for the Economy, Development, and Tourism's Programa Iniciativa Cientifica Milenio [IC 120009]; FONDECYTComision Nacional de Investigacion Cientifica y Tecnologica (CONICYT)CONICYT FONDECYT [3180246]; Millennium Institute of Astrophysics (MAS); MINECOSpanish Ministry of Economy & Competitiveness [ESP2017-82674-R]; AGAURAgencia de Gestio D'Ajuts Universitaris de Recerca Agaur (AGUAR) [SGR2017-1131]; PLATO grant from the CNES; European Research Council under the European Community's Seventh Framework Programme (FP72007-2013) ERC grant [338251]; European Research Council through the SPIRE grant [647383]; FCT (Portugal); FEDER through COMPETE2020 [UID/FIS/04434/2013, POCI-01-0145-FEDER-007672, PTDC/FIS-AST/30389/2017, POCI-01-0145-FEDER-030389]; European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grantEuropean Union (EU) [792848]; European UnionEuropean Union (EU) [664931]; Independent Research Fund Denmark [7027-00096B]; Australian Research CouncilAustralian Research Council; NASANational Aeronautics & Space Administration (NASA) [NNX16AI09G, AS5-26555]; NSFNational Science Foundation (NSF) [AST-1514676]; Australian Research CouncilAustralian Research Council [DP150100250]; ERCEuropean Research Council (ERC) [772293]; Ramon y Cajal fellowshipMinistry of Education and Science, Spain [RYC-2015-17697]; Carlsberg FoundationCarlsberg Foundation [CF17-0760]; HBCSE-NIUS programme; NASA through Hubble Fellowship grants - Space Telescope Science Institute [HST-HF2-51399.001, HST-HF2-51424.001]; Premiale 2015 MITiC; NKFIH [K-115709]; Lendulet Program of the Hungarian Academy of Sciences [LP2018-7/2018]; NASA's Science Mission directorate ; The authors wish to recognize and acknowledge the very significant cultural role and reverence that the summit of Maunakea has always had within the indigenous Hawai'ian community. We are most fortunate to have the opportunity to conduct observations from this mountain. We thank Andrei Tokovinin for helpful information on the Speckle observations obtained with SOAR. D.H. acknowledges support by the National Aeronautics and Space Administration through the TESS Guest Investigator Program (80NSSC18K1585) and by the National Science Foundation (AST-1717000). A.C. acknowledges support by the National Science Foundation under the Graduate Research Fellowship Program. W.J.C., W.H.B., A.M., O.J.H., and G.R.D. acknowledge support from the Science and Technology Facilities Council and UK Space Agency. H.K. and F.G. acknowledge support from the European Social Fund via the Lithuanian Science Council grant No. 09.3.3-LMT-K-712-01-0103. Funding for the Stellar Astrophysics Centre is provided by The Danish National Research Foundation (grant DNRF106). A.J. acknowledges support from FONDECYT project 1171208, CONICYT project BASAL AFB-170002, and by the Ministry for the Economy, Development, and Tourism's Programa Iniciativa Cientifica Milenio through grant IC 120009, awarded to the Millennium Institute of Astrophysics (MAS). R.B. acknowledges support from FONDECYT Post-doctoral Fellowship Project 3180246, and from the Millennium Institute of Astrophysics (MAS). A.M.S. is supported by grants ESP2017-82674-R (MINECO) and SGR2017-1131 (AGAUR). R.A.G. and L.B. acknowledge the support of the PLATO grant from the CNES. The research leading to the presented results has received funding from the European Research Council under the European Community's Seventh Framework Programme (FP72007-2013) ERC grant agreement No. 338251 (StellarAges). S.M. acknowledges support from the European Research Council through the SPIRE grant 647383. This work was also supported by FCT (Portugal) through national funds and by FEDER through COMPETE2020 by these grants: UID/FIS/04434/2013 and POCI-01-0145-FEDER-007672, PTDC/FIS-AST/30389/2017, and POCI-01-0145-FEDER-030389. T.L.C. acknowledges support from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No. 792848 (PULSATION). E.C. is funded by the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 664931. V.S.A. acknowledges support from the Independent Research Fund Denmark (Research grant 7027-00096B). D.S. acknowledges support from the Australian Research Council. S.B. acknowledges NASA grant NNX16AI09G and NSF grant AST-1514676. T.R.W. acknowledges support from the Australian Research Council through grant DP150100250. A.M. acknowledges support from the ERC Consolidator Grant funding scheme (project ASTEROCHRONOMETRY, G.A. n. 772293). S.M. acknowledges support from the Ramon y Cajal fellowship number RYC-2015-17697. M.S.L. is supported by the Carlsberg Foundation (grant agreement No. CF17-0760). A.M. and P.R. acknowledge support from the HBCSE-NIUS programme. J.K.T. and J.T. acknowledge that support for this work was provided by NASA through Hubble Fellowship grants HST-HF2-51399.001 and HST-HF2-51424.001 awarded by the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., for NASA, under contract AS5-26555. T.S.R. acknowledges financial support from Premiale 2015 MITiC (PI B. Garilli).; This project has been supported by the NKFIH K-115709 grant and the Lendulet Program of the Hungarian Academy of Sciences, project No. LP2018-7/2018.; Based on observations made with the Hertzsprung SONG telescope operated on the Spanish Observatorio del Teide on the island of Tenerife by the Aarhus and Copenhagen Universities and by the Instituto de Astrofisica de Canarias. Funding for the TESS mission is provided by NASA's Science Mission directorate. We acknowledge the use of public TESS Alert data from pipelines at the TESS Science Office and at the TESS Science Processing Operations Center. This research has made use of the Exoplanet Follow-up Observation Program website, which is operated by the California Institute of Technology, under contract with the National Aeronautics and Space Administration under the Exoplanet Exploration Program. This paper includes data collected by the TESS mission, which are publicly available from the Mikulski Archive for Space Telescopes (MAST).
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Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
BASE
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
BASE