| 1. |
- Forouzanfar, Mohammad H, et al.
(författare)
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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013.
- 2015
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 386:10010, s. 2287-2323
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.FUNDING: Bill & Melinda Gates Foundation.
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| 2. |
- Wang, Haidong, et al.
(författare)
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Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015
- 2016
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1459-1544
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.
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| 3. |
- Wang, Haidong, et al.
(författare)
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Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015.
- 2016
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Ingår i: The lancet. HIV. - : Elsevier. - 2352-3018. ; 3:8, s. e361-e387
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.
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| 4. |
- Davis, Timothy A., et al.
(författare)
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Revealing the intermediate-mass black hole at the heart of the dwarf galaxy NGC404 with sub-parsec resolution ALMA observations
- 2020
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Ingår i: Monthly Notices of the Royal Astronomical Society. - : Oxford University Press (OUP). - 0035-8711 .- 1365-2966. ; 496:4, s. 4061-4078
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Tidskriftsartikel (refereegranskat)abstract
- We estimate the mass of the intermediate-mass black hole at the heart of the dwarf elliptical galaxy NGC 404 using Atacama Large Millimetre/submillimetre Array (ALMA) observations of the molecular interstellar medium at an unprecedented linear resolution of approximate to 0.5 pc, in combination with existing stellar kinematic information. These ALMA observations reveal a central disc/torus of molecular gas clearly rotating around the black hole. This disc is surrounded by a morphologically and kinematically complex flocculent distribution of molecular clouds, that we resolve in detail. Continuum emission is detected from the central parts of NGC 404, likely arising from the Rayleigh-Jeans tail of emission from dust around the nucleus, and potentially from dusty massive star-forming clumps at discrete locations in the disc. Several dynamical measurements of the black hole mass in this system have been made in the past, but they do not agree. We show here that both the observed molecular gas and stellar kinematics independently require a approximate to 5 x 10(5) M-circle dot black hole once we include the contribution of the molecular gas to the potential. Our best estimate comes from the high-resolution molecular gas kinematics, suggesting the black hole mass of this system is 5.5(-3.8)(+4.1) x 10(5) M-circle dot (at the 99 per cent confidence level), in good agreement with our revised stellar kinematic measurement and broadly consistent with extrapolations from the black hole mass-velocity dispersion and black hole massbulge mass relations. This highlights the need to accurately determine the mass and distribution of each dynamically important component around intermediate-mass black holes when attempting to estimate their masses.
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| 5. |
- Imanishi, Masatoshi, et al.
(författare)
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ALMA 002 Resolution Observations Reveal HCN-abundance-enhanced Counter-rotating and Outflowing Dense Molecular Gas at the NGC 1068 Nucleus
- 2020
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Ingår i: Astrophysical Journal. - : American Astronomical Society. - 1538-4357 .- 0004-637X. ; 902:2
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Tidskriftsartikel (refereegranskat)abstract
- We present ALMA similar to 002 resolution observations of the nucleus of the nearby (similar to 14 Mpc) type 2 active galactic nucleus NGC 1068 at HCN/HCO+/HNCJ = 3-2 lines, as well as at their(13)C isotopologue and vibrationally excited lines, to scrutinize the morphological, dynamical, chemical, and physical properties of dense molecular gas in the putative dusty molecular torus around a mass-accreting supermassive black hole. We confirm almost east-west-oriented dense molecular gas emission both morphologically and dynamically, which we regard as coming from the torus. Bright emission is compact (less than or similar to 3 pc), and low-surface-brightness emission extends out to 5-7 pc. These dense molecular gas properties are not symmetric between the eastern and western torus. The HCNJ = 3-2 emission is stronger than the HCO(+)J = 3-2 emission within the similar to 7 pc torus region, with an estimated dense molecular mass of (0.4-1.0) x 10(6)M. We interpret that HCN abundance is enhanced in the torus. We detect signatures of outflowing dense molecular gas and a vibrationally excited HCNJ = 3-2 line. Finally, we find that in the innermost (less than or similar to 1 pc) part of the torus, the dense molecular line rotation velocity, relative to the systemic velocity, is the opposite of that in the outer (greater than or similar to 2 pc) part, in both the eastern and western torus. We prefer a scenario of counter-rotating dense molecular gas with innermost almost Keplerian rotation and outer slowly rotating (far below Keplerian) components. Our high-spatial-resolution dense molecular line data reveal that torus properties of NGC 1068 are much more complicated than the simple axisymmetrically rotating torus picture in the classical active galactic nucleus unification paradigm.
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| 6. |
- Kawamuro, Taiki, et al.
(författare)
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AGN X-Ray Irradiation of CO Gas in NGC 2110 Revealed by Chandra and ALMA
- 2020
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Ingår i: Astrophysical Journal. - : American Astronomical Society. - 1538-4357 .- 0004-637X. ; 895:2
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Tidskriftsartikel (refereegranskat)abstract
- We report spatial distributions of the Fe-K alpha line at 6.4 keV and the CO(J = 2-1) line at 230.538 GHz in NGC 2110, which are, respectively, revealed by Chandra and Atacama Large Millimeter/submillimeter Array (ALMA) at 05. A Chandra 6.2-6.5 keV to 3.0-6.0 keV image suggests that the Fe-K alpha emission extends preferentially in a northwest to southeast direction out to 3 '', or similar to 500 pc, on each side. Spatially resolved spectral analyses support this by finding significant Fe-K alpha emission lines only in the northwest and southeast regions. Moreover, their equivalent widths are found to be similar to 1.5 keV, indicative for the fluorescence by nuclear X-ray irradiation as the physical origin. By contrast, CO(J = 2-1) emission is weak therein. For quantitative discussion, we derive ionization parameters by following an X-ray dominated region (XDR) model. We then find them high enough to interpret the weakness as the result of X-ray dissociation of CO and/or H-2. Another possibility also remains that CO molecules follow a superthermal distribution, resulting in brighter emission in higher-J lines. Further follow-up observations are encouraged to draw a conclusion on what predominantly changes the interstellar matter properties and whether the X-ray irradiation eventually affects the surrounding star formation as active galactic nucleus (AGN) feedback.
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| 7. |
- Kawamuro, Taiki, et al.
(författare)
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Hard X-Ray Irradiation Potentially Drives Negative AGN Feedback by Altering Molecular Gas Properties
- 2021
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Ingår i: Astrophysical Journal, Supplement Series. - : American Astronomical Society. - 1538-4365 .- 0067-0049. ; 257:2
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the role of active galactic nucleus (AGN) X-ray irradiation on the interstellar medium (ISM), we systematically analyzed Chandra and Atacama Large Millimeter/submillimeter Array CO (J = 2-1) data for 26 hard X-ray (>10 keV) selected AGNs at redshifts below 0.05. While Chandra unveils the distribution of X-ray-irradiated gas via Fe-K alpha emission, the CO (J = 2-1) observations reveal that of cold molecular gas. At high resolutions less than or similar to 1 '', we derive Fe-K alpha and CO (J = 2-1) maps for the nuclear 2 '' region and for the external annular region of 2 ''-4 '', where 2 '' is similar to 100-600 pc for most of our AGNs. First, focusing on the external regions, we find the Fe-K alpha emission for six AGNs above 2 sigma. Their large equivalent widths (greater than or similar to 1 keV) suggest a fluorescent process as their origin. Moreover, by comparing the 6-7 keV/3-6 keV ratio, as a proxy of Fe-K alpha, and CO (J = 2-1) images for three AGNs with the highest significant Fe-K alpha detections, we find a possible spatial separation. These suggest the presence of X-ray-irradiated ISM and the change in the ISM properties. Next, examining the nuclear regions, we find that (1) the 20-50 keV luminosity increases with the CO (J = 2-1) luminosity; (2) the ratio of CO (J = 2-1)/HCN (J = 1-0) luminosities increases with 20-50 keV luminosity, suggesting a decrease in the dense gas fraction with X-ray luminosity; and (3) the Fe-K alpha-to-X-ray continuum luminosity ratio decreases with the molecular gas mass. This may be explained by a negative AGN feedback scenario: the mass accretion rate increases with gas mass, and simultaneously, the AGN evaporates a portion of the gas, which possibly affects star formation.
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| 8. |
- Thater, Sabine, et al.
(författare)
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Cross-checking SMBH mass estimates in NGC 6958-I. Stellar dynamics from adaptive optics-assisted MUSE observations
- 2022
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Ingår i: Monthly Notices of the Royal Astronomical Society. - : Oxford University Press (OUP). - 0035-8711 .- 1365-2966. ; 509:4, s. 5416-5436
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Tidskriftsartikel (refereegranskat)abstract
- Supermassive black hole masses (M (BH)) can dynamically be estimated with various methods and using different kinematic tracers. Different methods have only been cross-checked for a small number of galaxies and often show discrepancies. To understand these discrepancies, detailed cross-comparisons of additional galaxies are needed. We present the first part of our cross-comparison between stellar- and gas-based M-BH estimates in the nearby fast-rotating early-type galaxy NGC 6958. The measurements presented here are based on ground-layer adaptive optics-assisted Multi-Unit Spectroscopic Explorer (MUSE) science verification data at around 0."6 spatial resolution. The spatial resolution is a key ingredient for the measurement and we provide a Gaussian parametrization of the adaptive optics-assisted point spread function for various wavelengths. From the MUSE data, we extracted the stellar kinematics and constructed dynamical models. Using an axisymmetric Schwarzschild technique, we measured an M-BH of (3.6(-2.4)(+2.7)) x10(8) M-circle dot at 3 sigma significance taking kinematical and dynamical systematics (e.g. radially varying mass-to-light ratio) into account. We also added a dark halo, but our data do not allow us to constrain the dark matter fraction. Adding dark matter with an abundance matching prior results in a 25 per cent more massive black hole. Jeans anisotropic models return M-BH of (4.6(-2.7)(+2.5)) x10(8) and (8.6(-0.8)(+0.8)) x10(8) M-circle dot at 3 sigma confidence for spherical and cylindrical alignments of the velocity ellipsoid, respectively. In a follow-up study, we will compare the stellar-based M (BH) with those from cold and warm gas tracers, which will provide additional constraints for the M-BH for NGC 6958, and insights into assumptions that lead to potential systematic uncertainty.
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