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Background:
COVID-19 has infected millions of people worldwide and is responsible for several hundred thousand fatalities. The COVID-19 pandemic has necessitated thoughtful resource allocation and early identification of high-risk patients. However, effective methods to meet these needs are lacking.
Objective:
The aims of this study were to analyze the electronic health records (EHRs) of patients who tested positive for COVID-19 and were admitted to hospitals in the Mount Sinai Health System in New York City; to develop machine learning models for making predictions about the hospital course of the patients over clinically meaningful time horizons based on patient characteristics at admission; and to assess the performance of these models at multiple hospitals and time points.
Methods:
We used Extreme Gradient Boosting (XGBoost) and baseline comparator models to predict in-hospital mortality and critical events at time windows of 3, 5, 7, and 10 days from admission. Our study population included harmonized EHR data from five hospitals in New York City for 4098 COVID-19-positive patients admitted from March 15 to May 22, 2020. The models were first trained on patients from a single hospital (n=1514) before or on May 1, externally validated on patients from four other hospitals (n=2201) before or on May 1, and prospectively validated on all patients after May 1 (n=383). Finally, we established model interpretability to identify and rank variables that drive model predictions.
Results:
Upon cross-validation, the XGBoost classifier outperformed baseline models, with an area under the receiver operating characteristic curve (AUC-ROC) for mortality of 0.89 at 3 days, 0.85 at 5 and 7 days, and 0.84 at 10 days. XGBoost also performed well for critical event prediction, with an AUC-ROC of 0.80 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. In external validation, XGBoost achieved an AUC-ROC of 0.88 at 3 days, 0.86 at 5 days, 0.86 at 7 days, and 0.84 at 10 days for mortality prediction. Similarly, the unimputed XGBoost model achieved an AUC-ROC of 0.78 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. Trends in performance on prospective validation sets were similar. At 7 days, acute kidney injury on admission, elevated LDH, tachypnea, and hyperglycemia were the strongest drivers of critical event prediction, while higher age, anion gap, and C-reactive protein were the strongest drivers of mortality prediction.
Conclusions:
We externally and prospectively trained and validated machine learning models for mortality and critical events for patients with COVID-19 at different time horizons. These models identified at-risk patients and uncovered underlying relationships that predicted outcomes.
This paper presents a study of the galactic environment of a chemically pristine (<0.6 per cent solar metallicity) Lyman Limit system (LLS) discovered along the sightline towards QSO SDSSJ 135726.27+043541.4 (Z(QSO) = 1.233) at projected distance d = 126 physical kpc (pkpc) from a luminous red galaxy (LRG) at z = 0.33. Combining deep Hubble Space Telescope images, MUSE integral field spectroscopic data, and wide-field redshift survey data has enabled an unprecedented, ultradeep view of the environment around this LRG-LLS pair. A total of 12 galaxies, including the LRG, are found at d less than or similar to 400 pkpc and line-of-sight velocity Delta v < 600 km S-1 of the LLS, with intrinsic luminosity ranging from 0.001 L-* to 2 L-* and a corresponding stellar mass range of M-star approximate to 10(7-11) M-circle dot. All 12 galaxies contribute to a total mass of M-star = 1.6 x 10(11) M-circle dot with approximate to 80 per cent contained in the LRG. The line-of-sight velocity dispersion of these galaxies is found to be sigma (group) = 230 km s(-1) with the centre of mass at d(group) = 118 pkpc and line-of-sight velocity offset of Delta v(group) = 181 km s(-1) from the LLS. Three of these are located at d less than or similar to 100 pkpc from the LLS, and they are all faint with intrinsic luminosity less than or similar to 0.02 L-* and gas-phase metallicity of approximate to 10 per cent solar in their interstellar medium. The disparity in the chemical enrichment level between the LLS and the group members suggests that the LLS originates in infalling intergalactic medium and that parts of the intergalactic gas near old and massive galaxies can still remain chemically pristine through the not too distant past.
The extragalactic background light (EBL), a diffuse photon field in the optical and infrared range, is a record of radiative processes over the universe?s history. Spectral measurements of blazars at very high energies (>100 GeV) enable the reconstruction of the spectral energy distribution (SED) of the EBL, as the blazar spectra are modified by redshift- and energy-dependent interactions of the gamma-ray photons with the EBL. The spectra of 14 VERITAS-detected blazars are included in a new measurement of the EBL SED that is independent of EBL SED models. The resulting SED covers an EBL wavelength range of 0.56?56 ?m, and is in good agreement with lower limits obtained by assuming that the EBL is entirely due to radiation from cataloged galaxies.
A Search for Pulsed Very High-energy Gamma-Rays from 13 Young Pulsars in Archival VERITAS Data
(2019)
We conduct a search for periodic emission in the very high-energy (VHE) gamma-ray band (E > 100 GeV) from a total of 13 pulsars in an archival VERITAS data set with a total exposure of over 450 hr. The set of pulsars includes many of the brightest young gamma-ray pulsars visible in the Northern Hemisphere. The data analysis resulted in nondetections of pulsed VHE gamma-rays from each pulsar. Upper limits on a potential VHE gamma-ray flux are derived at the 95% confidence level above three energy thresholds using two methods. These are the first such searches for pulsed VHE emission from each of the pulsars, and the obtained limits constrain a possible flux component manifesting at VHEs as is seen for the Crab pulsar.
Cosmic-ray electrons and positrons (CREs) at GeV-TeV energies are a unique probe of our local Galactic neighborhood. CREs lose energy rapidly via synchrotron radiation and inverse-Compton scattering processes while propagating within the Galaxy, and these losses limit their propagation distance. For electrons with TeV energies, the limit is on the order of a kiloparsec. Within that distance, there are only a few known astrophysical objects capable of accelerating electrons to such high energies. It is also possible that the CREs are the products of the annihilation or decay of heavy dark matter (DM) particles. VERITAS, an array of imaging air Cherenkov telescopes in southern Arizona, is primarily utilized for gamma-ray astronomy but also simultaneously collects CREs during all observations. We describe our methods of identifying CREs in VERITAS data and present an energy spectrum, extending from 300 GeV to 5 TeV, obtained from approximately 300 hours of observations. A single power-law fit is ruled out in VERITAS data. We find that the spectrum of CREs is consistent with a broken power law, with a break energy at 710 +/- 40(stat) +/- 140(syst) GeV.
We report the discovery of six spatially extended (10-100 kpc) line-emitting nebulae in the z approximate to 0.57 galaxy group hosting PKS 0405-123, one of the most luminous quasars at z < 1. The discovery is enabled by the Multi Unit Spectroscopic Explorer and provides tantalizing evidence connecting large-scale gas streams with nuclear activity on scales of <10 proper kpc (pkpc). One of the nebulae exhibits a narrow, filamentary morphology extending over 50 pkpc toward the quasar with narrow internal velocity dispersion (50 km s(-1)) and is not associated with any detected galaxies, consistent with a cool intragroup medium filament. Two of the nebulae are 10 pkpc north and south of the quasar with tidal-arm-like morphologies. These two nebulae, along with a continuum-emitting arm extending 60 pkpc from the quasar, are signatures of interactions that are expected to redistribute angular momentum in the host interstellar medium (ISM) to facilitate star formation and quasar fueling in the nucleus. The three remaining nebulae are among the largest and most luminous [O III] emitting "blobs" known (1400-2400 pkpc(2)) and correspond both kinematically and morphologically to interacting galaxy pairs in the quasar host group, consistent with arising from stripped ISM rather than large-scale quasar outflows. The presence of these large- and small-scale nebulae in the vicinity of a luminous quasar bears significantly on the effect of large-scale environment on galaxy and black hole fueling, providing a natural explanation for the previously known correlation between quasar luminosity and cool circumgalactic medium.
We present a new measurement of the energy spectrum of iron nuclei in cosmic rays from 20 TeV to 500 TeV; The measurement makes use of a template-based analysis method, which, for the first time, is applied to the energy reconstruction of iron-induced air showers recorded by the VERITAS array of imaging atmospheric Cherenkov telescopes. The event selection makes use of the direct Cherenkov light which is emitted by charged particles before the first interaction, as well as other parameters related to the shape of the recorded air shower images. The measured spectrum is well described by a power law dF/dE = f(0) center dot (E/E-0)(-gamma) over the full energy range, with gamma = 2.82 +/- 0.30(stat)(-0.27)(+0.24)(syst) and f(0) = (4.82 +/- 0.98(stat)(-2.70)(+2.12)(syst)) x 10(-7) m(-2) s(-1) TeV-1 sr(-1) at E-0 = 50 TeV, with no indication of a cutoff or spectral break. The measured differential flux is compatible with previous results, with improved statistical uncertainty at the highest energies.
VERITAS and Fermi-LAT Observations of TeV Gamma-Ray Sources Discovered by HAWC in the 2HWC Catalog
(2018)
The High Altitude Water Cherenkov (HAWC) collaboration recently published their 2HWC catalog, listing 39 very high energy (VHE; >100 GeV) gamma-ray sources based on 507 days of observation. Among these, 19 sources are not associated with previously known teraelectronvolt (TeV) gamma-ray sources. We have studied 14 of these sources without known counterparts with VERITAS and Fermi-LAT. VERITAS detected weak gamma-ray emission in the 1 TeV-30 TeV band in the region of DA 495, a pulsar wind nebula coinciding with 2HWC J1953+294, confirming the discovery of the source by HAWC. We did not find any counterpart for the selected 14 new HAWC sources from our analysis of Fermi-LAT data for energies higher than 10 GeV. During the search, we detected gigaelectronvolt (GeV) gamma-ray emission coincident with a known TeV pulsar wind nebula, SNR G54.1+0.3 (VER J1930+188), and a 2HWC source, 2HWC J1930+188. The fluxes for isolated, steady sources in the 2HWC catalog are generally in good agreement with those measured by imaging atmospheric Cherenkov telescopes. However, the VERITAS fluxes for SNR G54.1+0.3, DA 495, and TeV J2032+4130 are lower than those measured by HAWC, and several new HAWC sources are not detected by VERITAS. This is likely due to a change in spectral shape, source extension, or the influence of diffuse emission in the source region.
Aims. We aim to characterize the multiwavelength emission from Markarian 501 (Mrk 501), quantify the energy-dependent variability, study the potential multiband correlations, and describe the temporal evolution of the broadband emission within leptonic theoretical scenarios. Methods. We organized a multiwavelength campaign to take place between March and July of 2012. Excellent temporal coverage was obtained with more than 25 instruments, including the MAGIC, FACT and VERITAS Cherenkov telescopes, the instruments on board the Swift and Fermi spacecraft, and the telescopes operated by the GASP-WEBT collaboration. Results. Mrk 501 showed a very high energy (VHE) gamma-ray flux above 0.2 TeV of similar to 0.5 times the Crab Nebula flux (CU) for most of the campaign. The highest activity occurred on 2012 June 9, when the VHE flux was similar to 3 CU, and the peak of the high-energy spectral component was found to be at similar to 2 TeV. Both the X-ray and VHE gamma-ray spectral slopes were measured to be extremely hard, with spectral indices <2 during most of the observing campaign, regardless of the X-ray and VHE flux. This study reports the hardest Mrk 501 VHE spectra measured to date. The fractional variability was found to increase with energy, with the highest variability occurring at VHE. Using the complete data set, we found correlation between the X-ray and VHE bands; however, if the June 9 flare is excluded, the correlation disappears (significance <3 sigma) despite the existence of substantial variability in the X-ray and VHE bands throughout the campaign. Conclusions. The unprecedentedly hard X-ray and VHE spectra measured imply that their low- and high-energy components peaked above 5 keV and 0.5 TeV, respectively, during a large fraction of the observing campaign, and hence that Mrk 501 behaved like an extreme high-frequency-peaked blazar (EHBL) throughout the 2012 observing season. This suggests that being an EHBL may not be a permanent characteristic of a blazar, but rather a state which may change over time. The data set acquired shows that the broadband spectral energy distribution (SED) of Mrk 501, and its transient evolution, is very complex, requiring, within the framework of synchrotron self-Compton (SSC) models, various emission regions for a satisfactory description. Nevertheless the one-zone SSC scenario can successfully describe the segments of the SED where most energy is emitted, with a significant correlation between the electron energy density and the VHE gamma-ray activity, suggesting that most of the variability may be explained by the injection of high-energy electrons. The one-zone SSC scenario used reproduces the behavior seen between the measured X-ray and VHE gamma-ray fluxes, and predicts that the correlation becomes stronger with increasing energy of the X-rays.
We present results from deep observations toward the Cygnus region using 300 hr of very high energy (VHE)gamma-ray data taken with the VERITAS Cerenkov telescope array and over 7 yr of high-energy.-ray data taken with the Fermi satellite at an energy above 1 GeV. As the brightest region of diffuse gamma-ray emission in the northern sky, the Cygnus region provides a promising area to probe the origins of cosmic rays. We report the identification of a potential Fermi-LAT counterpart to VER J2031+415 (TeV J2032+4130) and resolve the extended VHE source VER J2019+368 into two source candidates (VER J2018+367* and VER J2020+368*) and characterize their energy spectra. The Fermi-LAT morphology of 3FGL J2021.0+4031e (the Gamma Cygni supernova remnant) was examined, and a region of enhanced emission coincident with VER J2019+407 was identified and jointly fit with the VERITAS data. By modeling 3FGL J2015.6+3709 as two sources, one located at the location of the pulsar wind nebula CTB 87 and one at the quasar QSO J2015+371, a continuous spectrum from 1 GeV to 10 TeV was extracted for VER J2016+371 (CTB 87). An additional 71 locations coincident with Fermi-LAT sources and other potential objects of interest were tested for VHE gamma-ray emission, with no emission detected and upper limits on the differential flux placed at an average of 2.3% of the Crab Nebula flux. We interpret these observations in a multiwavelength context and present the most detailed gamma-ray view of the region to date.