Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

AGNs on the Move: A Search for Off-nuclear AGNs from Recoiling Supermassive Black Holes and Ongoing Galaxy Mergers with the Zwicky Transient Facility

A supermassive black hole (SMBH) ejected from the potential well of its host galaxy via gravitational wave recoil carries important information about the mass ratio and spin alignment of the pre-merger SMBH binary. Such a recoiling SMBH may be detectable as an active galactic nucleus (AGN) broad-line region offset by up to 10 kpc from a disturbed host galaxy. We describe a novel methodology using forward modeling with The Tractor to search for such offset AGNs in a sample of 5493 optically variable AGNs detected with the Zwicky Transient Facility (ZTF). We present the discovery of nine AGNs that may be spatially offset from their host galaxies and are candidates for recoiling SMBHs. Five of these offset AGNs exhibit double-peaked broad Balmer lines, which may have arisen from unobscured accretion disk emission, and four show radio emission indicative of a relativistic jet. The fraction of double-peaked emitters in our spatially offset AGN sample is significantly larger than the 16% double-peaked emitter fraction observed for ZTF AGNs overall. In our sample of variable AGNs we also identified 52 merging galaxies, including a new spectroscopically confirmed dual AGN. Finally, we detected the dramatic rebrightening of SDSS 1133, a previously discovered variable object and recoiling SMBH candidate, in ZTF. The flare was accompanied by the reemergence of strong P Cygni line features, indicating that SDSS 1133 may be an outbursting luminous blue variable star

AGN on the move: A search for off-nuclear AGN from recoiling SMBHs and ongoing galaxy mergers with the Zwicky Transient Facility

A supermassive black hole (SMBH) ejected from the potential well of its host galaxy via gravitational wave recoil carries important information about the mass ratio and spin alignment of the pre-merger SMBH binary. Such a recoiling SMBH may be detectable as an active galactic nucleus (AGN) broad line region offset by up to 10\,kpc from a disturbed host galaxy. We describe a novel methodology using forward modeling with \texttt{The Tractor} to search for such offset AGN in a sample of 5493 optically variable AGN detected with the Zwicky Transient Facility (ZTF). We present the discovery of 9 AGN which may be spatially offset from their host galaxies and are candidates for recoiling SMBHs. Five of these offset AGN exhibit double-peaked broad Balmer lines which may arise from unobscured accretion disk emission and four show radio emission indicative of a relativistic jet. The fraction of double-peaked emitters in our spatially offset AGN sample is significantly larger than the 16\% double-peaked emitter fraction observed for ZTF AGN overall. In our sample of variable AGN we also identified 52 merging galaxies, including a new spectroscopically confirmed dual AGN. Finally, we detected the dramatic rebrightening of SDSS1133, a previously discovered variable object and recoiling SMBH candidate, in ZTF. The flare was accompanied by the re-emergence of strong P-Cygni line features indicating that it may be an outbursting luminous blue variable star.Comment: Accepted by ApJ. 31 pages, 16 figure

Earth's Alfv\'en wings driven by the April 2023 Coronal Mass Ejection

We report a rare regime of Earth's magnetosphere interaction with sub-Alfv\'enic solar wind in which the windsock-like magnetosphere transforms into one with Alfv\'en wings. In the magnetic cloud of a Coronal Mass Ejection (CME) on April 24, 2023, NASA's Magnetospheric Multiscale mission distinguishes the following features: (1) unshocked and accelerated cold CME plasma coming directly against Earth's dayside magnetosphere; (2) dynamical wing filaments representing new channels of magnetic connection between the magnetosphere and foot points of the Sun's erupted flux rope; (3) cold CME ions observed with energized counter-streaming electrons, evidence of CME plasma captured due to reconnection between magnetic-cloud and Alfv\'en-wing field lines. The reported measurements advance our knowledge of CME interaction with planetary magnetospheres, and open new opportunities to understand how sub-Alfv\'enic plasma flows impact astrophysical bodies such as Mercury, moons of Jupiter, and exoplanets close to their host stars.Comment: 14 pages, including 4 figures, Under review in Geophys. Res. Let

Lawson criterion for ignition exceeded in an inertial fusion experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion