Incidence and Risk Factors for Clinically Confirmed secondary bacterial infections in patients hospitalized for coronavirus disease 2019 (COVID-19)

Objective: The true incidence and risk factors for secondary bacterial infections in coronavirus disease 2019 (COVID-19) remains poorly understood. Knowledge of risk factors for secondary infections in hospitalized patients with COVID-19 is necessary to optimally guide selective use of empiric antimicrobial therapy. Design: Single-center retrospective cohort study of symptomatic inpatients admitted for COVID-19 from April 15, 2020, through June 30, 2021. Setting: Academic quaternary-care referral center in Portland, Oregon. Patients: The study included patients who were 18 years or older with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR test up to 10 days prior to admission. Methods: Secondary infections were identified based on clinical, radiographic, and microbiologic data. Logistic regression was used to identify risk factors for secondary infection. We also assessed mortality, length of stay, and empiric antibiotics among those with and without secondary infections. Results: We identified 118 patients for inclusion; 31 (26.3%) had either culture-proven or possible secondary infections among hospitalized patients with COVID-19. Mortality was higher among patients with secondary infections (35.5%) compared to those without secondary infection (4.6%). Empiric antibiotic use on admission was high in both the secondary and no secondary infection groups at 71.0% and 48.3%, respectively. Conclusions: The incidence of secondary bacterial infection was moderate among hospitalized patients with COVID-19. However, a higher proportion of patients received empiric antibiotics regardless of an identifiable secondary infection. Transfer from an outside hospital, baseline immunosuppressant use, and corticosteroid treatment were independent risk factors for secondary infection. Additional studies are needed to validate risk factors and best guide antimicrobial stewardship efforts

Influence of Antibiotic Exposure Intensity on the Risk of Clostridioides Difficile Infection

Antibiotics are a strong risk factor for Clostridioides difficile infection (CDI), and CDI incidence is often measured as an important outcome metric for antimicrobial stewardship interventions aiming to reduce antibiotic use. However, risk of CDI from antibiotics varies by agent and dependent on the intensity (i.e., spectrum and duration) of antibiotic therapy. Thus, the impact of stewardship interventions on CDI incidence is variable, and understanding this risk requires a more granular measure of intensity of therapy than traditionally used measures like days of therapy (DOT)

Self-Reported Cognitive Function and Mental Health Diagnoses among Former Professional American-Style Football Players

Clinical practice strongly relies on patients' self-report. Former professional American-style football players are hesitant to seek help for mental health problems, but may be more willing to report cognitive symptoms. We sought to assess the association between cognitive symptoms and diagnosed mental health problems and quality of life among a cohort of former professional players. In a cross-sectional design, we assessed self-reported cognitive function using items from the Quality of Life in Neurological Disorders (Neuro-QOL) Item Bank. We then compared mental health diagnoses and quality of life, assessed by items from the Patient-Reported Outcome Measurement Information System (PROMIS ®), between former professional players reporting daily problems in cognitive function and former players not reporting daily cognitive problems. Of the 3758 former professional players included in the analysis, 40.0% reported daily problems due to cognitive dysfunction. Former players who reported daily cognitive problems were more likely to also report depression (18.0% vs. 3.3%, odds ratio [OR] = 6.42, 95% confidence interval [CI] [4.90-8.40]) and anxiety (19.1% vs. 4.3%, OR = 5.29, 95% CI [4.14-6.75]) than those without daily cognitive problems. Further, former players reporting daily cognitive problems were more likely to report memory loss and attention deficit(/hyperactivity) disorder and poorer general mental health, lower quality of life, less satisfaction with social activities and relationships, and more emotional problems. These findings highlight the potential of an assessment of cognitive symptoms for identifying former players with mental health, social, and emotional problems

An ALMA survey of submillimetre galaxies in the COSMOS field: The extent of the radio-emitting region revealed by 3 GHz imaging with the Very Large Array

We determine the radio size distribution of a large sample of 152 SMGs in COSMOS that were detected with ALMA at 1.3 mm. For this purpose, we used the observations taken by the VLA-COSMOS 3 GHz Large Project. One hundred and fifteen of the 152 target SMGs were found to have a 3 GHz counterpart. The median value of the major axis FWHM at 3 GHz is derived to be $4.6\pm0.4$ kpc. The radio sizes show no evolutionary trend with redshift, or difference between different galaxy morphologies. We also derived the spectral indices between 1.4 and 3 GHz, and 3 GHz brightness temperatures for the sources, and the median values were found to be $\alpha=-0.67$ and $T_{\rm B}=12.6\pm2$ K. Three of the target SMGs, which are also detected with the VLBA, show clearly higher brightness temperatures than the typical values. Although the observed radio emission appears to be predominantly powered by star formation and supernova activity, our results provide a strong indication of the presence of an AGN in the VLBA and X-ray-detected SMG AzTEC/C61. The median radio-emitting size we have derived is 1.5-3 times larger than the typical FIR dust-emitting sizes of SMGs, but similar to that of the SMGs' molecular gas component traced through mid-$J$ line emission of CO. The physical conditions of SMGs probably render the diffusion of cosmic-ray electrons inefficient, and hence an unlikely process to lead to the observed extended radio sizes. Instead, our results point towards a scenario where SMGs are driven by galaxy interactions and mergers. Besides triggering vigorous starbursts, galaxy collisions can also pull out the magnetised fluids from the interacting disks, and give rise to a taffy-like synchrotron-emitting bridge. This provides an explanation for the spatially extended radio emission of SMGs, and can also cause a deviation from the well-known IR-radio correlation.Comment: 32 pages (incl. 5 appendices), 17 figures, 7 tables; accepted for publication in A&A; abstract abridged for arXi

DEIMOS spectroscopy of z=6z=6 protocluster candidate in COSMOS -- A massive protocluster embedded in a large scale structure?

We present the results of our Keck/DEIMOS spectroscopic follow-up of candidate galaxies of i-band-dropout protocluster candidate galaxies at $z\sim6$ in the COSMOS field. We securely detect Lyman-$\alpha$ emission lines in 14 of the 30 objects targeted, 10 of them being at $z=6$ with a signal-to-noise ratio of $5-20$, the remaining galaxies are either non-detections or interlopers with redshift too different from $z=6$ to be part of the protocluster. The 10 galaxies at $z\approx6$ make the protocluster one of the riches at $z>5$. The emission lines exhibit asymmetric profiles with high skewness values ranging from 2.87 to 31.75, with a median of 7.37. This asymmetry is consistent with them being Ly$\alpha$, resulting in a redshift range of $z=5.85-6.08$. Using the spectroscopic redshifts, we re-calculate the overdensity map for the COSMOS field and find the galaxies to be in a significant overdensity at the $4\sigma$ level, with a peak overdensity of $\delta=11.8$ (compared to the previous value of $\delta=9.2$). The protocluster galaxies have stellar masses derived from Bagpipes SED fits of $10^{8.29}-10^{10.28} \rm \,M_{\rm \odot}$ and star formation rates of $2-39\,\rm M_{\rm \odot}\rm\,yr^{-1}$, placing them on the main sequence at this epoch. Using a stellar-to-halo-mass relationship, we estimate the dark matter halo mass of the most massive halo in the protocluster to be $\sim 10^{12}\rm M_{\rm \odot}$. By comparison with halo mass evolution tracks from simulations, the protocluster is expected to evolve into a Virgo- or Coma-like cluster in the present day.Comment: 26 pages, 14 figues, 5 tables, main text is 16 pages, appendix is 10 pages, published in MNRA

COSMOS2020: Identification of High-z Protocluster Candidates in COSMOS

We conduct a systematic search for protocluster candidates at $z \geq 6$ in the COSMOS field using the recently released COSMOS2020 source catalog. We select galaxies using a number of selection criteria to obtain a sample of galaxies that have a high probability of being inside a given redshift bin. We then apply overdensity analysis to the bins using two density estimators, a Weighted Adaptive Kernel Estimator and a Weighted Voronoi Tessellation Estimator. We have found 15 significant ($>4\sigma$) candidate galaxy overdensities across the redshift range $6\le z\le7.7$. The majority of the galaxies appear to be on the galaxy main sequence at their respective epochs. We use multiple stellar-mass-to-halo-mass conversion methods to obtain a range of dark matter halo mass estimates for the overdensities in the range of $\sim10^{11-13}\,M_{\rm \odot}$, at the respective redshifts of the overdensities. The number and the masses of the halos associated with our protocluster candidates are consistent with what is expected from the area of a COSMOS-like survey in a standard $\Lambda$CDM cosmology. Through comparison with simulation, we expect that all the overdensities at $z\simeq6$ will evolve into a Virgo-/Coma-like clusters at present (i.e., with masses $\sim 10^{14}-10^{15}\,M_{\rm \odot}$). Compared to other overdensities identified at $z \geq 6$ via narrow-band selection techniques, the overdensities presented appear to have $\sim10\times$ higher stellar masses and star-formation rates. We compare the evolution in the total star-formation rate and stellar mass content of the protocluster candidates across the redshift range $6\le z\le7.7$ and find agreement with the total average star-formation rate from simulations.Comment: 52 pages, 32 figues, 18 tables, main text is 30 pages, appendix is 22 pages, to be published in Ap

JWST and ALMA discern the assembly of structural and obscured components in a high-redshift starburst galaxy

We present observations and analysis of the starburst, PACS-819, at z=1.45 ($M_*=10^{10.7}$ M$_{ \odot}$), using high-resolution ($0^{\prime \prime}.1$; 0.8 kpc) ALMA and multi-wavelength JWST images from the COSMOS-Web program. Dissimilar to HST/ACS images in the rest-frame UV, the redder NIRCam and MIRI images reveal a smooth central mass concentration and spiral-like features, atypical for such an intense starburst. Through dynamical modeling of the CO J=5--4 emission with ALMA, PACS-819 is rotation-dominated thus has a disk-like nature. However, kinematic anomalies in CO and asymmetric features in the bluer JWST bands (e.g., F150W) support a more disturbed nature likely due to interactions. The JWST imaging further enables us to map the distribution of stellar mass and dust attenuation, thus clarifying the relationships between different structural components, not discernable in the previous HST images. The CO J = 5 -- 4 and FIR dust continuum emission are co-spatial with a heavily-obscured starbursting core (<1 kpc) which is partially surrounded by much less obscured star-forming structures including a prominent arc, possibly a tidally-distorted dwarf galaxy, and a clump, either a sign of an ongoing violent disk instability or a recently accreted low-mass satellite. With spatially-resolved maps, we find a high molecular gas fraction in the central area reaching $\sim3$ ($M_{\text{gas}}$/$M_*$) and short depletion times ($M_{\text{gas}}/SFR\sim$ 120 Myrs) across the entire system. These observations provide insights into the complex nature of starbursts in the distant universe and underscore the wealth of complementary information from high-resolution observations with both ALMA and JWST.Comment: 18 pages, 12 figures, Submitted to Ap

COSMOS-Web: Intrinsically Luminous z≳\gtrsim10 Galaxy Candidates Test Early Stellar Mass Assembly

We report the discovery of 15 exceptionally luminous $10\lesssim z\lesssim14$ candidate galaxies discovered in the first 0.28 deg$^2$ of JWST/NIRCam imaging from the COSMOS-Web Survey. These sources span rest-frame UV magnitudes of $-20.5>M_{\rm UV}>-22$, and thus constitute the most intrinsically luminous $z\gtrsim10$ candidates identified by JWST to-date. Selected via NIRCam imaging with Hubble ACS/F814W, deep ground-based observations corroborate their detection and help significantly constrain their photometric redshifts. We analyze their spectral energy distributions using multiple open-source codes and evaluate the probability of low-redshift solutions; we conclude that 12/15 (80%) are likely genuine $z\gtrsim10$ sources and 3/15 (20%) likely low-redshift contaminants. Three of our $z\sim12$ candidates push the limits of early stellar mass assembly: they have estimated stellar masses $\sim5\times10^{9}\,M_\odot$, implying an effective stellar baryon fraction of $\epsilon_{\star}\sim0.2-0.5$, where $\epsilon_{\star}\equiv M_{\star}/(f_{b}M_{halo})$. The assembly of such stellar reservoirs is made possible due to rapid, burst-driven star formation on timescales $<$100\,Myr where the star-formation rate may far outpace the growth of the underlying dark matter halos. This is supported by the similar volume densities inferred for $M_\star\sim10^{10}\,M_\odot$ galaxies relative to $M_\star\sim10^{9}\,M_\odot$ -- both about $10^{-6}$ Mpc$^{-3}$ -- implying they live in halos of comparable mass. At such high redshifts, the duty cycle for starbursts would be of order unity, which could cause the observed change in the shape of the UVLF from a double powerlaw to Schechter at $z\approx8$. Spectroscopic redshift confirmation and ensuing constraints of their masses will be critical to understanding how, and if, such early massive galaxies push the limits of galaxy formation in $\Lambda$CDM.Comment: 30 pages, 9 figures; ApJ submitte

Uncovering a Massive z~7.65 Galaxy Hosting a Heavily Obscured Radio-Loud QSO Candidate in COSMOS-Web

In this letter, we report the discovery of the highest redshift, heavily obscured, radio-loud QSO candidate selected using JWST NIRCam/MIRI, mid-IR, sub-mm, and radio imaging in the COSMOS-Web field. Using multi-frequency radio observations and mid-IR photometry, we identify a powerful, radio-loud (RL), growing supermassive black hole (SMBH) with significant spectral steepening of the radio SED ($f_{1.32 \mathrm{GHz}} \sim 2$ mJy, $q_{24\mu m} = -1.1$, $\alpha_{1.32-3\mathrm{GHz}}=-1.2$, $\Delta \alpha = -0.4$). In conjunction with ALMA, deep ground-based observations, ancillary space-based data, and the unprecedented resolution and sensitivity of JWST, we find no evidence of QSO contribution to the UV/optical/NIR data and thus infer heavy amounts of obscuration (N$_{\mathrm{H}} > 10^{23}$ cm$^{-2}$). Using the wealth of deep UV to sub-mm photometric data, we report a singular solution photo-z of $z_\mathrm{phot}$ = 7.65$^{+0.4}_{-0.3}$ and estimate an extremely massive host-galaxy ($\log M_{\star} = 11.92 \pm 0.06\,\mathrm{M}_{\odot}$). This source represents the furthest known obscured RL QSO candidate, and its level of obscuration aligns with the most representative but observationally scarce population of QSOs at these epochs.Comment: Submitted to ApJL, Comments welcom

Unveiling the distant Universe: Characterizing z≥9z\ge9 Galaxies in the first epoch of COSMOS-Web

We report the identification of 15 galaxy candidates at $z\ge9$ using the initial COSMOS-Web JWST observations over 77 arcmin$^2$ through four NIRCam filters (F115W, F150W, F277W, F444W) with an overlap with MIRI (F770W) of 8.7 arcmin$^2$. We fit the sample using several publicly-available SED fitting and photometric redshift codes and determine their redshifts between $z=9.3$ and $z=10.9$ ($\langle z\rangle=10.0$), UV-magnitudes between M$_{\rm UV}$ = $-$21.2 and $-$19.5 (with $\langle$M$_{\rm UV}\rangle=-20.2$) and rest-frame UV slopes ($\langle \beta\rangle=-2.4$). These galaxies are, on average, more luminous than most $z\ge9$ candidates discovered by JWST so far in the literature, while exhibiting similar blue colors in their rest-frame UV. The rest-frame UV slopes derived from SED-fitting are blue ($\beta\sim$[$-$2.0, $-$2.7]) without reaching extremely blue values as reported in other recent studies at these redshifts. The blue color is consistent with models that suggest the underlying stellar population is not yet fully enriched in metals like similarly luminous galaxies in the lower redshift Universe. The derived stellar masses with $\langle \log_{\rm 10} ($M$_\star/$M$_\odot)\rangle\approx8-9$ are not in tension with the standard $\Lambda$CDM model and our measurement of the volume density of such UV luminous galaxies aligns well with previously measured values presented in the literature at $z\sim9-10$. Our sample of galaxies, although compact, are significantly resolved.Comment: Submitted to Ap