Observation of inverse Compton emission from a long γ-ray burst.

Long-duration γ-ray bursts (GRBs) originate from ultra-relativistic jets launched from the collapsing cores of dying massive stars. They are characterized by an initial phase of bright and highly variable radiation in the kiloelectronvolt-to-megaelectronvolt band, which is probably produced within the jet and lasts from milliseconds to minutes, known as the prompt emission1,2. Subsequently, the interaction of the jet with the surrounding medium generates shock waves that are responsible for the afterglow emission, which lasts from days to months and occurs over a broad energy range from the radio to the gigaelectronvolt bands1-6. The afterglow emission is generally well explained as synchrotron radiation emitted by electrons accelerated by the external shock7-9. Recently, intense long-lasting emission between 0.2 and 1 teraelectronvolts was observed from GRB 190114C10,11. Here we report multi-frequency observations of GRB 190114C, and study the evolution in time of the GRB emission across 17 orders of magnitude in energy, from 5 × 10-6 to 1012 electronvolts. We find that the broadband spectral energy distribution is double-peaked, with the teraelectronvolt emission constituting a distinct spectral component with power comparable to the synchrotron component. This component is associated with the afterglow and is satisfactorily explained by inverse Compton up-scattering of synchrotron photons by high-energy electrons. We find that the conditions required to account for the observed teraelectronvolt component are typical for GRBs, supporting the possibility that inverse Compton emission is commonly produced in GRBs

Registro Español de Trasplante Cardiaco. XXXI Informe Oficial de la Asociación de Insuficiencia Cardiaca de la Sociedad Española de Cardiología

Introducción y objetivos Se presentan las características clínicas y los resultados de los trasplantes cardiacos realizados en España con la actualización correspondiente a 2019. Métodos Se describen las características clínicas y los resultados de los trasplantes cardiacos realizados en 2019, así como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a años previos, los cambios más llamativos son el descenso hasta el 38% de los trasplantes realizados en código urgente, y la consolidación en el cambio de asistencia circulatoria pretrasplante, con la práctica desaparición del balón de contrapulsación (0, 7%), la estabilización del uso del oxigenador extracorpóreo de membrana (9, 6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0, 34), y ambas mejores que la del trienio 2010-2012 (p = 0, 002 y p = 0, 01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en España como los resultados en supervivencia en los últimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoría con dispositivos de asistencia ventricular. Introduction and objectives: The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. Methods: We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. Results: In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P = .34). Survival in both these periods was better than that from 2010 to 2012 (P = .002 and P = .01, respectively). Conclusions: Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant

Insights into the high-energy γ-ray emission of Markarian 501 from extensive multifrequency observations in the Fermi era

We report on the γ-ray activity of the blazar Mrk 501 during the first 480 days of Fermi operation. We find that the average Large Area Telescope (LAT) γ-ray spectrum of Mrk 501 can be well described by a single power-law function with a photon index of 1.78 ± 0.03. While we observe relatively mild flux variations with the Fermi-LAT (within less than a factor of two), we detect remarkable spectral variability where the hardest observed spectral index within the LAT energy range is 1.52 ± 0.14, and the softest one is 2.51 ± 0.20. These unexpected spectral changes do not correlate with the measured flux variations above 0.3 GeV. In this paper, we also present the first results from the 4.5 month long multifrequency campaign (2009 March 15-August 1) on Mrk 501, which included the Very Long Baseline Array (VLBA), Swift, RXTE, MAGIC, and VERITAS, the F-GAMMA, GASP-WEBT, and other collaborations and instruments which provided excellent temporal and energy coverage of the source throughout the entire campaign. The extensive radio to TeV data set from this campaign provides us with the most detailed spectral energy distribution yet collected for this source during its relatively low activity. The average spectral energy distribution of Mrk 501 is well described by the standard one-zone synchrotron self-Compton (SSC) model. In the framework of this model, we find that the dominant emission region is characterized by a size ≲0.1 pc (comparable within a factor of few to the size of the partially resolved VLBA core at 15-43 GHz), and that the total jet power (≃1044 erg s-1) constitutes only a small fraction (∼10-3) of the Eddington luminosity. The energy distribution of the freshly accelerated radiating electrons required to fit the time-averaged data has a broken power-law form in the energy range 0.3 GeV-10 TeV, with spectral indices 2.2 and 2.7 below and above the break energy of 20 GeV. We argue that such a form is consistent with a scenario in which the bulk of the energy dissipation within the dominant emission zone of Mrk 501 is due to relativistic, proton-mediated shocks. We find that the ultrarelativistic electrons and mildly relativistic protons within the blazar zone, if comparable in number, are in approximate energy equipartition, with their energy dominating the jet magnetic field energy by about two orders of magnitude. © 2011. The American Astronomical Society

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

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

Characterization of dark-matter-induced anisotropies in the diffuse gamma-ray background

The Fermi-LAT collaboration has recently reported the detection of angular power above the photon noise level in the diffuse gamma-ray background between 1 and 50 GeV. Such signal can be used to constrain a possible contribution from dark matter (DM) induced photons. We estimate the intensity and features of the angular power spectrum (APS) of this potential DM signal, for both decaying and annihilating DM candidates, by constructing template all-sky gamma-ray maps for the emission produced in the galactic halo and its substructures, as well as in extragalactic (sub)haloes. The DM distribution is given by state-of-the-art N-body simulations of cosmic structure formation, namely Millennium-II for extragalactic (sub)haloes, and Aquarius for the galactic halo and its subhaloes. We use a hybrid method of extrapolation to account for (sub)structures that are below the resolution limit of the simulations, allowing us to estimate the total emission all the way down to the minimal self-bound halo mass. We describe in detail the features appearing in the APS of our template maps and we estimate the effect of various uncertainties such as the value of the minimal halo mass, the fraction of substructures hosted in a halo and the shape of the DM density profile. Our results indicate that the fluctuation APS of the DM-induced emission is of the same order as the Fermi-LAT APS, suggesting that one can constrain this hypothetical emission from the comparison with the measured anisotropy. We also quantify the uncertainties affecting our results, finding ‘theoretical error bands’ spanning more than two orders of magnitude and dominated (for a given particle physics model) by our lack of knowledge of the abundance of low-mass (sub)haloes

Angular power spectrum of the diffuse gamma-ray emission as measured by the Fermi Large Area Telescope and constraints on its dark matter interpretation

The isotropic gamma-ray background arises from the contribution of unresolved sources, including members of confirmed source classes and proposed gamma-ray emitters such as the radiation induced by dark matter annihilation and decay. Clues about the properties of the contributing sources are imprinted in the anisotropy characteristics of the gamma-ray background. We use 81 months of Pass 7 Reprocessed data from the Fermi Large Area Telescope to perform a measurement of the anisotropy angular power spectrum of the gamma-ray background. We analyze energies between 0.5 and 500 GeV, extending the range considered in the previous measurement based on 22 months of data. We also compute, for the first time, the cross-correlation angular power spectrum between different energy bins. We find that the derived angular spectra are compatible with being Poissonian, i.e. constant in multipole. Moreover, the energy dependence of the anisotropy suggests that the signal is due to two populations of sources, contributing, respectively, below and above 2 GeV. Finally, using data from state-of-the-art numerical simulations to model the dark matter distribution, we constrain the contribution from dark matter annihilation and decay in Galactic and extragalactic structures to the measured anisotropy. These constraints are competitive with those that can be derived from the average intensity of the isotropic gamma-ray background. Data are available at https://www-glast.stanford.edu/pub_data/552.Comment: 51 pages, 39 figures. Data are available at https://www-glast.stanford.edu/pub_data/55

The clustering of the SDSS-IV extended Baryon Oscillation Spectroscopic Survey DR14 quasar sample: Measurement of the growth rate of structure from the anisotropic correlation function between redshift 0.8 and 2.2

We present the clustering measurements of quasars in configuration space based on the Data Release 14 (DR14) of the Sloan Digital Sky Survey IV extended Baryon Oscillation Spectroscopic Survey (eBOSS). This data set includes 148 659 quasars spread over the redshift range 0.8 ≤ z ≤ 2.2 and spanning 2112.9 deg2. We use the Convolution Lagrangian Perturbation Theory approach with a Gaussian Streaming model for the redshift space distortions of the correlation function and demonstrate its applicability for dark matter haloes hosting eBOSS quasar tracers. At the effective redshift zeff = 1.52, we measure the linear growth rate of structure fσ8(zeff) = 0.426 ± 0.077, the expansion rate H(zeff) = 159 -13 +12(r s fid/rs) kms-1Mpc-1, and the angular diameter distance DA(zeff) = 1850 -115 +90 (rs/r s fid) Mpc, where rs is the sound horizon at the end of the baryon drag epoch and r s fid is its value in the fiducial cosmology. The quoted uncertainties include both systematic and statistical contributions. The results on the evolution of distances are consistent with the predictions of flat Λ-cold dark matter cosmology with Planck parameters, and the measurement of fσ8 extends the validity of General Relativity to higher redshifts (z > 1). This paper is released with companion papers using the same sample. The results on the cosmological parameters of the studies are found to be in very good agreement, providing clear evidence of the complementarity and of the robustness of the first full-shape clustering measurements with the eBOSS DR14 quasar sample. © 2017 The Authors.PZ and EB acknowledge support from the P2IO LabEx (reference ANR-10-LABX-0038). HGM acknowledges support from the Labex ILP (reference ANR-10-LABX-63) part of the Idex SUPER, and received financial state aid managed by the Agence Nationalede la Recherche, as part of the programme Investissements d'avenir under the reference ANR-11-IDEX-0004-02. AJR is grateful for support from the Ohio State University Center for Cosmology and ParticlePhysics. GBZ is supported by NSFC Grants 1171001024 and 11673025. GBZ is also supported by a Royal Society Newton Advanced Fellowship, hosted by University of Portsmouth. SH's and KH's work was supported under the U.S. Department of Energy contract DE-AC02-06CH11357. GBZ is supported by NSFC Grant No. 11673025, and by a Royal Society Newton Advanced Fellowship. GR acknowledges support from the National Research Foundation of Korea (NRF) through Grant No. 2017077508 funded by the Korean Ministry of Education, Science and Technology (MoEST), and from the faculty research fund of Sejong University in 2018. Funding for SDSS-III and SDSS-IV has been provided by the Alfred P. Sloan Foundation and Participating Institutions. Additional funding for SDSS-III comes from the National Science Foundation and the U.S. Department of Energy Office of Science. Further information about both projects is available at www.sdss.org. SDSS is managed by the Astrophysical Research Consortium for the Participating Institutions in both collaborations. In SDSS-III, these include the University of Arizona, the Brazilian Participation Group, Brookhaven National Laboratory, Carnegie Mellon University, University of Florida, the French Participation Group, the German Participation Group, Harvard University, the Instituto de Astrofisica de Canarias, the Michigan State/Notre Dame/JINA Participation Group, Johns Hopkins University, Lawrence Berkeley National Laboratory, Max Planck Institute for Astrophysics, Max Planck Institute for Extraterrestrial Physics, New Mexico State University, New York University, Ohio State University, Pennsylvania State University, University of Portsmouth, Princeton University, the Spanish Participation Group, University of Tokyo, University of Utah, Vanderbilt University, University of Virginia, University of Washington, and Yale University. The Participating Institutions in SDSS-IV are CarnegieMellon University, Colorado University, Boulder, Harvard-Smithsonian Center for Astrophysics Participation Group, Johns Hopkins University, Kavli Institute for the Physics and Mathematics of the Universe Max-Planck-Institut fuer Astrophysik (MPA Garching), Max-Planck-Institut fuer Extraterrestrische Physik (MPE), Max-Planck-Institut fuer Astronomie (MPIA Heidelberg), National Astronomical Observatories of China, New Mexico State University, New York University, The Ohio State University, Penn State University, Shanghai Astronomical Observatory, United Kingdom Participation Group, University of Portsmouth, University of Utah, University of Wisconsin, and Yale University. This research used resources of the Argonne Leadership Computing Facility, which is a DOE Office of Science User Facility supported under contract DE-AC02-06CH11357. This work made use of the facilities and staff of the UK Sciama High Performance Computing cluster supported by the ICG, SEPNet, and the University of Portsmouth. This research used resources of the National Energy Research Scientific Computing Center, a DOE Office of Science User Facility supported by the Office of Science of the U.S. Department of Energy under Contract No.r DE-AC02-05CH11231

Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice : A multicentre cohort study

Background: The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods: Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014-2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen). Results: We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. Conclusions: EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads