First results from the JWST Early Release Science Program Q3D: Ionization cone, clumpy star formation and shocks in a z=3z=3 extremely red quasar host

Massive galaxies formed most actively at redshifts $z=1-3$ during the period known as `cosmic noon.' Here we present an emission-line study of an extremely red quasar SDSSJ165202.64+172852.3 host galaxy at $z=2.94$, based on observations with the Near Infrared Spectrograph (NIRSpec) integral field unit (IFU) on board JWST. We use standard emission-line diagnostic ratios to map the sources of gas ionization across the host and a swarm of companion galaxies. The quasar dominates the photoionization, but we also discover shock-excited regions orthogonal to the ionization cone and the quasar-driven outflow. These shocks could be merger-induced or -- more likely, given the presence of a powerful galactic-scale quasar outflow -- these are signatures of wide-angle outflows that can reach parts of the galaxy that are not directly illuminated by the quasar. Finally, the kinematically narrow emission associated with the host galaxy presents as a collection of 1 kpc-scale clumps forming stars at a rate of at least 200 $M_{\odot}$ yr$^{-1}$. The ISM within these clumps shows high electron densities, reaching up to 3,000 cm$^{-3}$ with metallicities ranging from half to a third solar with a positive metallicity gradient and V band extinctions up to 3 magnitudes. The star formation conditions are far more extreme in these regions than in local star-forming galaxies but consistent with that of massive galaxies at cosmic noon. JWST observations reveal an archetypical rapidly forming massive galaxy undergoing a merger, a clumpy starburst, an episode of obscured near-Eddington quasar activity, and an extremely powerful quasar outflow simultaneously.Comment: 19 pages, 8 figures. Accepted for publication in Ap

First results from the JWST Early Release Science Program Q3D: The Warm Ionized Gas Outflow in z ~ 1.6 Quasar XID 2028 and its Impact on the Host Galaxy

Quasar feedback may regulate the growth of supermassive black holes, quench coeval star formation, and impact galaxy morphology and the circumgalactic medium. However, direct evidence for quasar feedback in action at the epoch of peak black hole accretion at z ~ 2 remains elusive. A good case in point is the z = 1.6 quasar WISEA J100211.29+013706.7 (XID 2028) where past analyses of the same ground-based data have come to different conclusions. Here we revisit this object with the integral field unit of the Near Infrared Spectrograph (NIRSpec) on board the James Webb Space Telescope (JWST) as part of Early Release Science program Q3D. The excellent angular resolution and sensitivity of the JWST data reveal new morphological and kinematic sub-structures in the outflowing gas plume. An analysis of the emission line ratios indicates that photoionization by the central quasar dominates the ionization state of the gas with no obvious sign for a major contribution from hot young stars anywhere in the host galaxy. Rest-frame near-ultraviolet emission aligned along the wide-angle cone of outflowing gas is interpreted as a scattering cone. The outflow has cleared a channel in the dusty host galaxy through which some of the quasar ionizing radiation is able to escape and heat the surrounding interstellar and circumgalactic media. The warm ionized outflow is not powerful enough to impact the host galaxy via mechanical feedback, but radiative feedback by the AGN, aided by the outflow, may help explain the unusually small molecular gas mass fraction in the galaxy host.Comment: 17 pages, 9 figures, accepted for publication in The Astrophysical Journa

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

First results from the JWST Early Release Science Program Q3D: The Warm Ionized Gas Outflow in z ~ 1.6 Quasar XID 2028 and its Impact on the Host Galaxy

International audienceQuasar feedback may regulate the growth of supermassive black holes, quench coeval star formation, and impact galaxy morphology and the circumgalactic medium. However, direct evidence for quasar feedback in action at the epoch of peak black hole accretion at z ~ 2 remains elusive. A good case in point is the z = 1.6 quasar WISEA J100211.29+013706.7 (XID 2028) where past analyses of the same ground-based data have come to different conclusions. Here we revisit this object with the integral field unit of the Near Infrared Spectrograph (NIRSpec) on board the James Webb Space Telescope (JWST) as part of Early Release Science program Q3D. The excellent angular resolution and sensitivity of the JWST data reveal new morphological and kinematic sub-structures in the outflowing gas plume. An analysis of the emission line ratios indicates that photoionization by the central quasar dominates the ionization state of the gas with no obvious sign for a major contribution from hot young stars anywhere in the host galaxy. Rest-frame near-ultraviolet emission aligned along the wide-angle cone of outflowing gas is interpreted as a scattering cone. The outflow has cleared a channel in the dusty host galaxy through which some of the quasar ionizing radiation is able to escape and heat the surrounding interstellar and circumgalactic media. The warm ionized outflow is not powerful enough to impact the host galaxy via mechanical feedback, but radiative feedback by the AGN, aided by the outflow, may help explain the unusually small molecular gas mass fraction in the galaxy host

First Results from the JWST Early Release Science Program Q3D: Benchmark Comparison of Optical and Mid-infrared Tracers of a Dusty, Ionized Red Quasar Wind at z = 0.435

The [O iii ] 5007 Å emission line is the most common tracer of warm, ionized outflows in active galactic nuclei across cosmic time. JWST newly allows us to use mid-IR spectral features at both high spatial and spectral resolution to probe these same winds. Here we present a comparison of ground-based, seeing-limited [O iii ] and space-based, diffraction-limited [S iv ] 10.51 μ m maps of the powerful, kiloparsec-scale outflow in the Type 1 red quasar SDSS J110648.32+480712.3. The JWST data are from the Mid-InfraRed Instrument. There is a close match in resolution between the data sets (∼0.″6), in ionization potential of the O ^+2 and S ^+3 ions (35 eV) and in line sensitivity (1–2 × 10 ^−17 erg s ^−1 cm ^−2 arcsec ^−2 ). The [O iii ] and [S iv ] line shapes match in velocity and line width over much of the 20 kpc outflowing nebula, and [S iv ] is the brightest line in the rest-frame 3.5–19.5 μ m range, demonstrating its usefulness as a mid-IR probe of quasar outflows. [O iii ] is nevertheless intrinsically brighter and provides better contrast with the point-source continuum, which is strong in the mid-IR. There is a strong anticorrelation of [O iii ]/[S iv ] with average velocity, which is consistent with a scenario of differential obscuration between the approaching (blueshifted) and receding (redshifted) sides of the flow. The dust in the wind may also obscure the central quasar, consistent with models that attribute red quasar extinction to dusty winds

Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore : A 6-month multi-centre prospective study

Aim The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. Method A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale). Results The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout. Conclusions Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs.publishedVersionPeer reviewe

Analysis of clinically relevant variants from ancestrally diverse Asian genomes

Asian populations are under-represented in human genomics research. Here, we characterize clinically significant genetic variation in 9051 genomes representing East Asian, South Asian, and severely under-represented Austronesian-speaking Southeast Asian ancestries. We observe disparate genetic risk burden attributable to ancestry-specific recurrent variants and identify individuals with variants specific to ancestries discordant to their self-reported ethnicity, mostly due to cryptic admixture. About 27% of severe recessive disorder genes with appreciable carrier frequencies in Asians are missed by carrier screening panels, and we estimate 0.5% Asian couples at-risk of having an affected child. Prevalence of medically-actionable variant carriers is 3.4% and a further 1.6% harbour variants with potential for pathogenic classification upon additional clinical/experimental evidence. We profile 23 pharmacogenes with high-confidence gene-drug associations and find 22.4% of Asians at-risk of Centers for Disease Control and Prevention Tier 1 genetic conditions concurrently harbour pharmacogenetic variants with actionable phenotypes, highlighting the benefits of pre-emptive pharmacogenomics. Our findings illuminate the diversity in genetic disease epidemiology and opportunities for precision medicine for a large, diverse Asian population.</p

Large-Scale Whole-Genome Sequencing of Three Diverse Asian Populations in Singapore

Because of Singapore's unique history of immigration, whole-genome sequence analysis of 4,810 Singaporeans provides a snapshot of the genetic diversity across East, Southeast, and South Asia.</p

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe