Modeling the Extragalactic Background Light and the Cosmic Star Formation History

We present an updated model for the extragalactic background light (EBL) from stars and dust, over wavelengths approximately 0.1 to 1000 $\mu$m. This model uses accurate theoretical stellar spectra, and tracks the evolution of star formation, stellar mass density, metallicity, and interstellar dust extinction and emission in the universe with redshift. Dust emission components are treated self-consistently, with stellar light absorbed by dust reradiated in the infrared as three blackbody components. We fit our model, with free parameters associated with star formation rate and dust extinction and emission, to a wide variety of data: luminosity density, stellar mass density, and dust extinction data from galaxy surveys; and $\gamma$-ray absorption optical depth data from $\gamma$-ray telescopes. Our results strongly constraint the star formation rate density and dust photon escape fraction of the universe out to redshift $z=10$, about 90% of the history of the universe. We find our model result is, in some cases, below lower limits on the $z=0$ EBL intensity, and below some low-$z$ $\gamma$-ray absorption measurements.Comment: 23 pages, 12 figures, 3 tables. Accepted for publication in AAS journal

Reionization with star-forming galaxies: insights from the Low-z Lyman Continuum Survey

The fraction of ionizing photons escaping from galaxies, $f_{esc}$, is at the same time a crucial parameter in modelling reionization and a very poorly known quantity, especially at high redshift. Recent observations are starting to constrain the values of $f_{esc}$ in low-z star-forming galaxies, but the validity of this comparison remains to be verified. Applying at high-z the empirical relation between $f_{esc}$ and the UV slope trends derived from the Low-z Lyman Continuum Survey, we use the DELPHI semi-analytical galaxy formation model to estimate the global ionizing emissivity of high-z galaxies, which we use to compute the resulting reionization history. We find that both the global ionizing emissivity and reionization history match the observational constraints. Assuming that the low-z correlations hold during the epoch of reionization, we find that galaxies with $-16 \lesssim M_{UV} \lesssim -13.5$ are the main drivers of reionization. We derive a population-averaged $\langle f_{esc} \rangle \simeq 8\%, 10\%, 20\%$ at z=4.5, 6, 8.Comment: 5+1 page, 3 figures, submitted to A&

The Low-redshift Lyman Continuum Survey: Radio continuum properties of low-zz Lyman continuum emitters

The sources that leak Lyman-continuum (LyC) photons and lead to the reionisation of the universe are intensely studied using multiple observing facilities. Recently, the Low-redshift LyC Survey (LzLCS) has found the first large sample of LyC emitting galaxies at low redshift ($z\sim 0.3$) with the Hubble Space Telescope/Cosmic Origins Spectrograph. The LzLCS sample contains a robust estimate of the LyC escape fraction ($f_\mathrm{esc}^\mathrm{LyC}$) for 66 galaxies spanning a wide range of $f_\mathrm{esc}^\mathrm{LyC}$. Here we, for the first time, aim to study the radio continuum (RC) properties of LzLCS sources and their dependence on $f_\mathrm{esc}^\mathrm{LyC}$. We present Karl G. Jansky Very Large Array RC observations at C (4-8 GHz), S (2-4 GHz) and L (1-2 GHz) bands for a sub-sample of the LzLCS sources. The radio spectral index ($\alpha^{\mathrm{3GHz}}_\mathrm{6GHz}$) spans a wide range from being flat ( $\geq -0.1$) to very steep ($\leq -1.0$). We find that the strongest leakers in our sample show flat $\alpha^{\mathrm{3GHz}}_\mathrm{6GHz}$, weak leakers have $\alpha^{\mathrm{3GHz}}_\mathrm{6GHz}$ close to normal star-forming galaxies, and non-leakers are characterized by steep $\alpha^{\mathrm{3GHz}}_\mathrm{6GHz}$. We argue that a combination of young ages, free-free absorption, and a flat cosmic-ray energy spectrum can altogether lead to a flat $\alpha^{\mathrm{3GHz}}_\mathrm{6GHz}$ for strong leakers. Non-leakers are characterized by steep spectra which can arise due to break/cutoff at high frequencies. Such a cutoff in the spectrum can arise in a single injection model of CRs characteristic of galaxies which have recently stopped star formation. Such a relation between $\alpha^{\mathrm{3GHz}}_\mathrm{6GHz}$ and $f_\mathrm{esc}^\mathrm{LyC}$ hints at the interesting role of supernovae, CRs, and magnetic fields in facilitating the escape (and/or the lack) of LyC photons.Comment: 25 pages, 14 figures, 3 tables, Submitted to Astronomy & Astrophysic

HETDEX Public Source Catalog 1 -- Stacking 50K Lyman Alpha Emitters

We describe the ensemble properties of the $1.9 < z < 3.5$ Lyman Alpha Emitters (LAEs) found in the HETDEX survey's first public data release, HETDEX Public Source Catalog 1 (Mentuch Cooper et al. 2023). Stacking the low-resolution ($R \sim$ 800) spectra greatly increases the signal-to-noise ratio, revealing spectral features otherwise hidden by noise, and we show that the stacked spectrum is representative of an average member of the set. The flux limited, Ly$\alpha$ signal-to-noise ratio restricted stack of 50K HETDEX LAEs shows the ensemble biweight ``average" $z \sim 2.6$ LAE to be a blue (UV continuum slope $\sim -2.4$ and E(B-V) $< 0.1$), moderately bright (M$_{\text{UV}} \sim -19.7$) star forming galaxy with strong Ly$\alpha$ emission (log $L_{Ly\alpha}$ $\sim$ 42.8 and $W_{\lambda}$(Ly$\alpha$) $\sim$ 114\AA), and potentially significant leakage of ionizing radiation. The restframe UV light is dominated by a young, metal poor stellar population with an average age 5-15 Myr and metallicity of 0.2-0.3 Z$_{\odot}$.Comment: 17 pages, 11 figures, 2 data files (ApJ Accepted

The Low-Redshift Lyman Continuum Survey. Unveiling the ISM properties of low-zz Lyman continuum emitters

Combining 66 ultraviolet (UV) spectra and ancillary data from the Low-Redshift Lyman Continuum Survey (LzLCS) and 23 LyC observations by earlier studies, we form a statistical sample of star-forming galaxies at $z \sim 0.3$ to study the role of the cold interstellar medium (ISM) gas in the leakage of ionizing radiation. We first constrain the massive star content (ages and metallicities) and UV attenuation, by fitting the stellar continuum with a combination of simple stellar population models. The models, together with accurate LyC flux measurements, allow to determine the absolute LyC photon escape fraction for each galaxy ($f_{\rm esc}^{\rm abs}$). We measure the equivalent widths and residual fluxes of multiple HI and low-ionization state (LIS) lines, and the geometrical covering fraction adopting the picket-fence model. The $f_{\rm esc}^{\rm abs}$ spans a wide range, with a median (0.16, 0.84 quantiles) of 0.04 (0.02, 0.20), and 50 out of the 89 galaxies detected in the LyC. The HI and LIS line equivalent widths scale with the UV luminosity and attenuation, and inversely with the residual flux of the lines. The HI and LIS residual fluxes are correlated, indicating that the neutral gas is spatially traced by the LIS transitions. We find the observed trends of the absorption lines and the UV attenuation are primarily driven by the covering fraction. The non-uniform gas coverage demonstrates that LyC photons escape through low-column density channels in the ISM. The equivalent widths and residual fluxes of the UV lines strongly correlate with $f_{\rm esc}^{\rm abs}$: strong LyC leakers show weak absorption lines, low UV attenuation, and large Ly$\alpha$ equivalent widths. We finally show that simultaneous UV absorption line and dust attenuation measurements can predict, on average, the escape fraction of galaxies and the method can be applied to galaxies across a wide redshift range.Comment: 30 pages, 16 figures, 3 tables; accepted for publication in Astronomy and Astrophysics on December 16, 2021. Tables A1 to A4 are part of the LzLCS science products and will be publicly available in a dedicated websit

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

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline