The total mass of the Large Magellanic Cloud from its perturbation on the Orphan stream

In a companion paper by Koposov et al., RR Lyrae from \textit{Gaia} Data Release 2 are used to demonstrate that stars in the Orphan stream have velocity vectors significantly misaligned with the stream track, suggesting that it has received a large gravitational perturbation from a satellite of the Milky Way. We argue that such a mismatch cannot arise due to any realistic static Milky Way potential and then explore the perturbative effects of the Large Magellanic Cloud (LMC). We find that the LMC can produce precisely the observed motion-track mismatch and we therefore use the Orphan stream to measure the mass of the Cloud. We simultaneously fit the Milky Way and LMC potentials and infer that a total LMC mass of $1.38^{+0.27}_{-0.24} \times10^{11}\,\rm{M_\odot}$ is required to bend the Orphan Stream, showing for the first time that the LMC has a large and measurable effect on structures orbiting the Milky Way. This has far-reaching consequences for any technique which assumes that tracers are orbiting a static Milky Way. Furthermore, we measure the Milky Way mass within 50 kpc to be $3.80^{+0.14}_{-0.11}\times10^{11} M_\odot$. Finally, we use these results to predict that, due to the reflex motion of the Milky Way in response to the LMC, the outskirts of the Milky Way's stellar halo should exhibit a bulk, upwards motion.Comment: 17 pages, 11 figures. Updated to version accepted to MNRAS after minor revisio

INSPIRE: INvestigating Stellar Population In RElics -- V. Final Data Release: the first catalogue of relics outside the local Universe

This paper presents the final sample and data release of the INvestigating Stellar Population In RElics (INSPIRE) project, comprising 52 ultra-compact massive galaxies (UCMGs) observed with the ESO-VLT X-Shooter spectrograph. We measure integrated stellar velocity dispersion, [Mg/Fe] abundances, ages, and metallicities for all the INSPIRE objects. We thus infer star formation histories and confirm the existence of a degree of relicness (DoR), defined in terms of the fraction of stellar mass formed by $z=2$, the cosmic time at which a galaxy has assembled 75% of its mass and the final assembly time. Objects with a high DoR assembled their stellar mass at early epochs, while low-DoR objects show a non-negligible fraction of later-formed populations and hence a spread in ages and metallicities. A higher DoR correlates with larger [Mg/Fe], super-solar metallicity, and larger velocity dispersion values. The 52 UMCGs span a large range of DoR from 0.83 to 0.06, with 38 of them having formed more than 75% of their mass by $z=2$, which translates in a lower limit to the number density of relics at $z\sim0.3$ of $\log \rho \approx 2.8 \times 10^{-7} \text{Mpc}^{-3}$.. Nine relics are extreme (DoR$>0.7$), since they formed almost the totality ($>98\%$) of their stellar mass by redshift $z=2$. With INSPIRE, we have increased the number of fully confirmed relics by more than a factor of 10, also pushing the redshift boundaries, hence building the first sizeable sample of relics outside the local Universe, opening up an important window to explain the mass assembly of massive galaxies in the high-z Universe.Comment: submitted to MNRAS, 20 pages, 16 figures, 3 table

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

CALYPSO 2019 Cruise Report: field campaign in the Mediterranean

This cruise aimed to identify transport pathways from the surface into the interior ocean during the late winter in the Alborán sea between the Strait of Gibraltar (5°40’W) and the prime meridian. Theory and previous observations indicated that these pathways likely originated at strong fronts, such as the one that separates salty Mediterranean water and the fresher water in owing from the Atlantic. Our goal was to map such pathways and quantify their transport. Since the outcropping isopycnals at the front extend to the deepest depths during the late winter, we planned the cruise at the end of the Spring, prior to the onset of thermal stratification of the surface mixed layer.Funding was provided by the Office of Naval Research under Contract No. N000141613130

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)