A new probe of the small-scale primordial power spectrum: astrometric microlensing by ultracompact minihalos

The dark matter enclosed in a density perturbation with a large initial amplitude (delta-rho/rho > 1e-3) collapses shortly after recombination and forms an ultracompact minihalo (UCMH). Their high central densities make UCMHs especially suitable for detection via astrometric microlensing: as the UCMH moves, it changes the apparent position of background stars. A UCMH with a mass larger than a few solar masses can produce a distinctive astrometric microlensing signal that is detectable by the space astrometry mission Gaia. If Gaia does not detect gravitational lensing by any UCMHs, then it establishes an upper limit on their abundance and constrains the amplitude of the primordial power spectrum for k~2700 Mpc^{-1}. These constraints complement the upper bound on the amplitude of the primordial power spectrum derived from limits on gamma-ray emission from UCMHs because the astrometric microlensing signal produced by an UCMH is maximized if the dark-matter annihilation rate is too low to affect the UCMH's density profile. If dark matter annihilation within UCMHs is not detectable, a search for UCMHs by Gaia could constrain the amplitude of the primordial power spectrum to be less than 1e-5; this bound is three orders of magnitude stronger than the bound derived from the absence of primordial black holes.Comment: 17 pages, 6 figures, references added and minor changes made to match version published in PR

The Structure of RdDddP from Roseobacter denitrificans Reveals That DMSP Lyases in the DddP-Family Are Metalloenzymes

Marine microbes degrade dimethylsulfoniopropionate (DMSP), which is produced in large quantities by marine algae and plants, with DMSP lyases into acrylate and the gas dimethyl sulfide (DMS). Approximately 10% of the DMS vents from the sea into the atmosphere and this emission returns sulfur, which arrives in the sea through rivers and runoff, back to terrestrial systems via clouds and rain. Despite their key role in this sulfur cycle DMSP lyases are poorly understood at the molecular level. Here we report the first X-ray crystal structure of the putative DMSP lyase RdDddP from Roseobacter denitrificans, which belongs to the abundant DddP family. This structure, determined to 2.15 Å resolution, shows that RdDddP is a homodimeric metalloprotein with a binuclear center of two metal ions located 2.7 Å apart in the active site of the enzyme. Consistent with the crystallographic data, inductively coupled plasma mass spectrometry (ICP-MS) and total reflection X-ray fluorescence (TRXF) revealed the bound metal species to be primarily iron. A 3D structure guided analysis of environmental DddP lyase sequences elucidated the critical residues for metal binding are invariant, suggesting all proteins in the DddP family are metalloenzymes

Physical Activity of Osteopathic Medical Students

Context: Physical inactivity has been identified as one of the greatest current health burdens worldwide. In addition to physical activity’s primary, secondary, and tertiary prevention benefits related to many diseases, physical activity has been shown to be associated with improvements in concentration, memory, and performance on standardized tests. Studies on physical activity and medical education have suggested that given the scholastic demands required to become a physician, medical trainees may find it challenging to meet the recommended amounts of physical activity. Objective: To determine the extent to which osteopathic medical students (OMS) in the United States are meeting minimum recommendations for physical activity. Methods: Utilizing a cross-sectional design, in partnership with the Student Osteopathic Medical Association (SOMA) and Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), we conducted an online survey of third and fourth year OMS across USA, from August through December 2015. The survey collected self-reported data on frequency and duration of vigorous and moderate physical activity per week. Results: Most participants (60.7%) met or exceeded the American College of Sports Medicine (ACSM) physical activity guidelines of at least 150 minutes of moderate intensity aerobic activity per week. The OMS respondents’ mean of 215 minutes of physical activity per week significantly exceeded the ACSM recommendation ('p' = .000). Conclusions: OMS are well positioned to become physically active physicians and, in turn, promote physical activity in their patients. Future studies may look at barriers to physical activity in medical students and attempt to increase participation in active lifestyles in this population

Astrometric Microlensing by Local Dark Matter Subhalos

High-resolution N-body simulations of dark matter halos indicate that the Milky Way contains numerous subhalos. When a dark matter subhalo passes in front of a star, the light from that star will be deflected by gravitational lensing, leading to a small change in the star's apparent position. This astrometric microlensing signal depends on the inner density profile of the subhalo and can be greater than a few microarcseconds for an intermediate-mass subhalo (Mvir > 10000 solar masses) passing within arcseconds of a star. Current and near-future instruments could detect this signal, and we evaluate SIM's, Gaia's, and ground-based telescopes' potential as subhalo detectors. We develop a general formalism to calculate a subhalo's astrometric lensing cross section over a wide range of masses and density profiles, and we calculate the lensing event rate by extrapolating the subhalo mass function predicted by simulations down to the subhalo masses potentially detectable with this technique. We find that, although the detectable event rates are predicted to be low on the basis of current simulations, lensing events may be observed if the central regions of dark matter subhalos are more dense than current models predict (>1 solar mass within 0.1 pc of the subhalo center). Furthermore, targeted astrometric observations can be used to confirm the presence of a nearby subhalo detected by gamma-ray emission. We show that, for sufficiently steep density profiles, ground-based adaptive optics astrometric techniques could be capable of detecting intermediate-mass subhalos at distances of hundreds of parsecs, while SIM could detect smaller and more distant subhalos.Comment: 18 pages, 8 figures, minor revisions made to match version to appear in Ap

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

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

Like gold dust these days’: domestic violence fact-finding hearings in child contact cases

Fact-finding hearings may be held to determine disputed allegations of domestic violence in child contact cases in England and Wales, and can play a vital role for mothers seeking protection and autonomy from violent fathers. Drawing on the author’s empirical study, this article examines the implications for the holding of fact-finding hearings of judges’ and professionals’ understandings of domestic violence and the extent to which they perceive it to be relevant to contact. While more judges and professionals are developing their understanding of domestic violence, the ambit of when and how it is considered relevant to contact has grown increasingly narrow, which suggests that many disputed allegations of domestic violence are disregarded and women and children continue to be put at risk from violent fathers. This bifurcated approach is likely to have significant implications for recent developments in this area of family law which are considered in this article

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

PHYSICAL ACTIVITY LEVELS OF OSTEOPATHIC MEDICAL STUDENTS AND PERFORMANCE ON THE COMPREHENSIVE OSTEOPATHIC MEDICAL LICENSING EXAMINATION

Objective. 1) determine if osteopathic medical students are meeting The American College of Sports Medicine’s (ACSM) recommendations of physical activity levels 2) identify the barriers that the osteopathic medical student may have to meeting these recommendations 3) test for a correlation between physical activity and Comprehensive Osteopathic Medical Licensing Examination of The United States (COMLEX) Level 1 scores. Background. Despite the known health benefits associated with physical activity, the positive impacts a physically active physician can have on patients, and the existence of recommended guidelines for physical activity, a variety of barriers exist that can pose a significant hindrance to meeting recommended physical activity levels in medical students. Although extensively studied in other populations, factors influencing physical activity in osteopathic medical students have not been investigated. This study will determine if osteopathic medical students are meeting minimum requirements to physical activity, the barriers that they may have to meeting these requirements, and test for a relationship, if any, between physical activity and medical school performance. Methods. We have obtained IRB approval and are currently collecting data until November 30, 2015. A survey tool is being used to gather data to support or refute the hypotheses of this study. We are specifically interested in identifying the relationship between the physical activity levels, barriers to physical activity, and COMLEX Level 1 scores of osteopathic medical students currently in their third and fourth year (the class of 2017 and 2016 respectively). The questionnaire is being sent out through Student Osteopathic Medical Association (SOMA), Student Government Association (SGA), and other associated online social networks. OMS-IIIs and OMS-IVs across the country are filling out these online questionnaires, which take less than 5 minutes to complete. As of now, we have 718 submitted responses and will close the survey on November 30, 2015. Results. Results and conclusions from this research will be presented. Conclusion. Results and conclusions from this research will be presented. Grants. Burnell Award application submitted on September 21, 2015. Outcome pending