Signature of a massive rotating metal-poor star imprinted in the Phoenix stellar stream*

The Phoenix stellar stream has a low intrinsic dispersion in velocity and metallicity that implies the progenitor was probably a low mass globular cluster. In this work we use Magellan/MIKE high-dispersion spectroscopy of eight Phoenix stream red giants to confirm this scenario. In particular, we find negligible intrinsic scatter in metallicity ($\sigma(\mathrm{[Fe~II/H]}) = 0.04^{+0.11}_{-0.03}$) and a large peak-to-peak range in [Na/Fe] and [Al/Fe] abundance ratios, consistent with the light element abundance patterns seen in the most metal-poor globular clusters. However, unlike any other globular cluster, we also find an intrinsic spread in [Sr II/Fe] spanning $\sim$1 dex, while [Ba II/Fe] shows nearly no intrinsic spread ($\sigma(\mathrm{[Ba~II/H]}) = {0.03}^{+0.10}_{-0.02}$). This abundance signature is best interpreted as slow neutron capture element production from a massive fast-rotating metal-poor star ($15-20 \mathrm{M}_\odot$, $v_\mathrm{ini}/v_\mathrm{crit} = 0.4$, $[\mathrm{Fe/H}] = -3.8$). The low inferred cluster mass suggests the system would have been unable to retain supernovae ejecta, implying that any massive fast-rotating metal-poor star that enriched the interstellar medium must have formed and evolved before the globular cluster formed. Neutron capture element production from asymptotic giant branch stars or magneto-rotational instabilities in core-collapse supernovae provide poor fits to the observations. We also report one Phoenix stream star to be a lithium-rich giant ($A(\mathrm{Li}) = 3.1 \pm 0.1$). At $[\mathrm{Fe/H}] = -2.93$ it is among the most metal-poor lithium-rich giants known.Comment: Accepted to ApJ 2021-07-0

S5S^5: Probing the Milky Way and Magellanic Clouds potentials with the 6-D map of the Orphan-Chenab stream

We present a 6-D map of the Orphan-Chenab (OC) stream by combining the data from 5 years of Southern Stellar Stream Spectroscopic Survey $S^5$ observations with Gaia EDR3 data. We reconstruct the proper motion, radial velocity, distance and on-sky track of stream stars with spline models and extract the stellar density along the stream. The stream has a total luminosity of $M_V=-8.2$ and an average metallicity of $[Fe/H]=-1.9$, similar to classical MW satellites like Draco. The stream shows drastic changes in its physical width varying from 200 pc to 1 kpc, a constant line of sight velocity dispersion of 5 km/s, but an increase in the velocity dispersion along the stream near pericenter to $\sim$ 10 km/s. Despite the large apparent variation in the stellar number density along the stream, the flow rate of stars along the stream is remarkably constant. We model the 6-D stream track by a Lagrange-point stripping method with a flexible MW potential in the presence of a moving extended LMC potential. This allows us to constrain the mass profile of the MW within the distance range 15.6 < r < 55.5 kpc, with the best measured enclosed mass of $(2.85\pm 0.1)\times10^{11}\,M_\odot$ within 32.4 kpc. With the OC stream's closest approach distance to the LMC of $\sim 21$ kpc, our stream measurements are highly sensitive to the LMC mass profile with the most precise measurement of the LMC's enclosed mass being at 32.8 kpc with $M=(7.02\pm 0.9)\times10^{10}\, {M}_\odot$. We confidently detect that the LMC DM halo extends to at least 53 kpc. The fitting of the OC stream allows us to constrain the past LMC trajectory and the degree of dynamical friction it experienced. We demonstrate that the stars on the OC stream show large energy and angular momentum spreads caused by the LMC perturbation and revealing the limitations of orbital invariants for substructure identification in the MW halo.Comment: submitted to MNRAS; comments welcome; data released with the paper is available on Zenodo https://zenodo.org/record/722265

The Southern Stellar Stream Spectroscopic Survey (S5): Chemical Abundances of Seven Stellar Streams

We present high-resolution Magellan/MIKE spectroscopy of 42 red giant stars in seven stellar streams confirmed by the Southern Stellar Stream Spectroscopic Survey (S5): ATLAS, Aliqa Uma, Chenab, Elqui, Indus, Jhelum, and Phoenix. Abundances of 30 elements have been derived from over 10,000 individual line measurements or upper limits using photometric stellar parameters and a standard LTE analysis. This is currently the most extensive set of element abundances for stars in stellar streams. Three streams (ATLAS, Aliqa Uma, and Phoenix) are disrupted metal-poor globular clusters, although only weak evidence is seen for the light-element anticorrelations commonly observed in globular clusters. Four streams (Chenab, Elqui, Indus, and Jhelum) are disrupted dwarf galaxies, and their stars display abundance signatures that suggest progenitors with stellar masses ranging from 106 to 107 M⊙. Extensive description is provided for the analysis methods, including the derivation of a new method for including the effect of stellar parameter correlations on each star's abundance and uncertainty.A.R.C. is supported in part by the Australian Research Council through a Discovery Early Career Researcher Award (DE190100656). Parts of this research were supported by the Australian Research Council Centre of Excellence for All Sky Astrophysics in 3 Dimensions (ASTRO 3D) through project No. CE170100013. A.B.P. acknowledges support from NSF grant AST-1813881. S.K. is partially supported by NSF grants AST-1813881 and AST-1909584 and HeisingSimons foundation grant 2018-1030. S.L.M. and J.D.S. acknowledge support from the Australian Research Council through Discovery Project grant DP180101791

Broken into Pieces::ATLAS and Aliqa Uma as One Single Stream

We present the first spectroscopic measurements of the ATLAS and Aliqa Uma streams from the Southern Stellar Stream Spectroscopic Survey ($S^5$), in combination with the photometric data from the Dark Energy Survey and astrometric data from $Gaia$. From the coherence of spectroscopic members in radial velocity and proper motion, we find out that these two systems are extremely likely to be one stream with discontinuity in morphology and density on the sky (the "kink" feature). We refer to this entire stream as the ATLAS-Aliqa Uma stream, or the AAU stream. We perform a comprehensive exploration of the effect of baryonic substructures and find that only an encounter with the Sagittarius dwarf $\sim 0.5$ Gyr ago can create a feature similar to the observed "kink". In addition, we also identify two gaps in the ATLAS component associated with the broadening in the stream width (the "broadening" feature). These gaps have likely been created by small mass perturbers, such as dark matter halos, as the AAU stream is the most distant cold stream known with severe variations in both the stream surface density and the stream track on the sky. With the stream track, stream distance and kinematic information, we determine the orbit of the AAU stream and find that it has been affected by the Large Magellanic Cloud, resulting in a misalignment between the proper motion and stream track. Together with the Orphan-Chenab Stream, AAU is the second stream pair that has been found to be a single stream separated into two segments by external perturbation.Comment: 33 pages, 22 figures (including 1 movie), 3 tables. Accepted for publication in Ap

Pelvic trauma : WSES classification and guidelines

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.Peer reviewe

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial

Background Some high-income countries have deployed fourth doses of COVID-19 vaccines, but the clinical need, effectiveness, timing, and dose of a fourth dose remain uncertain. We aimed to investigate the safety, reactogenicity, and immunogenicity of fourth-dose boosters against COVID-19.Methods The COV-BOOST trial is a multicentre, blinded, phase 2, randomised controlled trial of seven COVID-19 vaccines given as third-dose boosters at 18 sites in the UK. This sub-study enrolled participants who had received BNT162b2 (Pfizer-BioNTech) as their third dose in COV-BOOST and randomly assigned them (1:1) to receive a fourth dose of either BNT162b2 (30 µg in 0·30 mL; full dose) or mRNA-1273 (Moderna; 50 µg in 0·25 mL; half dose) via intramuscular injection into the upper arm. The computer-generated randomisation list was created by the study statisticians with random block sizes of two or four. Participants and all study staff not delivering the vaccines were masked to treatment allocation. The coprimary outcomes were safety and reactogenicity, and immunogenicity (antispike protein IgG titres by ELISA and cellular immune response by ELISpot). We compared immunogenicity at 28 days after the third dose versus 14 days after the fourth dose and at day 0 versus day 14 relative to the fourth dose. Safety and reactogenicity were assessed in the per-protocol population, which comprised all participants who received a fourth-dose booster regardless of their SARS-CoV-2 serostatus. Immunogenicity was primarily analysed in a modified intention-to-treat population comprising seronegative participants who had received a fourth-dose booster and had available endpoint data. This trial is registered with ISRCTN, 73765130, and is ongoing.Findings Between Jan 11 and Jan 25, 2022, 166 participants were screened, randomly assigned, and received either full-dose BNT162b2 (n=83) or half-dose mRNA-1273 (n=83) as a fourth dose. The median age of these participants was 70·1 years (IQR 51·6–77·5) and 86 (52%) of 166 participants were female and 80 (48%) were male. The median interval between the third and fourth doses was 208·5 days (IQR 203·3–214·8). Pain was the most common local solicited adverse event and fatigue was the most common systemic solicited adverse event after BNT162b2 or mRNA-1273 booster doses. None of three serious adverse events reported after a fourth dose with BNT162b2 were related to the study vaccine. In the BNT162b2 group, geometric mean anti-spike protein IgG concentration at day 28 after the third dose was 23 325 ELISA laboratory units (ELU)/mL (95% CI 20 030–27 162), which increased to 37 460 ELU/mL (31 996–43 857) at day 14 after the fourth dose, representing a significant fold change (geometric mean 1·59, 95% CI 1·41–1·78). There was a significant increase in geometric mean anti-spike protein IgG concentration from 28 days after the third dose (25 317 ELU/mL, 95% CI 20 996–30 528) to 14 days after a fourth dose of mRNA-1273 (54 936 ELU/mL, 46 826–64 452), with a geometric mean fold change of 2·19 (1·90–2·52). The fold changes in anti-spike protein IgG titres from before (day 0) to after (day 14) the fourth dose were 12·19 (95% CI 10·37–14·32) and 15·90 (12·92–19·58) in the BNT162b2 and mRNA-1273 groups, respectively. T-cell responses were also boosted after the fourth dose (eg, the fold changes for the wild-type variant from before to after the fourth dose were 7·32 [95% CI 3·24–16·54] in the BNT162b2 group and 6·22 [3·90–9·92] in the mRNA-1273 group).Interpretation Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose

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

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries