Eastern Arctic Ocean Diapycnal Heat Fluxes through Large Double-Diffusive Steps

The diffusive layering (DL) form of double-diffusive convection cools the Atlantic Water (AW) as it circulates around the Arctic Ocean. Large DL steps, with heights of homogeneous layers often greater than 10 m, have been found above the AW core in the Eurasian Basin (EB) of the eastern Arctic. Within these DL staircases, heat and salt fluxes are determined by the mechanisms for vertical transport through the high-gradient regions (HGRs) between the homogeneous layers. These HGRs can be thick (up to 5 m and more) and are frequently complex, being composed of multiple small steps or continuous stratification. Microstructure data collected in the EB in 2007 and 2008 are used to estimate heat fluxes through large steps in three ways: using the measured dissipation rate in the large homogeneous layers; utilizing empirical flux laws based on the density ratio and temperature step across HGRs after scaling to account for the presence of multiple small DL interfaces within each HGR; and averaging estimates of heat fluxes computed separately for individual small interfaces (as laminar conductive fluxes), small convective layers (via dissipation rates within small DL layers), and turbulent patches (using dissipation rate and buoyancy) within each HGR. Diapycnal heat fluxes through HGRs evaluated by each method agree with each other and range from ~2 to ~8 W m−2, with an average flux of ~3–4 W m−2. These large fluxes confirm a critical role for the DL instability in cooling and thickening the AW layer as it circulates around the eastern Arctic Ocean

Universal Magnetic Properties of La2−δSrδCuO4La_{2-\delta} Sr_{\delta} Cu O_4 at Intermediate Temperatures

We present the theory of two-dimensional, clean quantum antiferromagnets with a small, positive, zero temperature ($T$) stiffness $\rho_s$, but with the ratio $k_B T / \rho_s$ arbitrary. Universal scaling forms for the uniform susceptibility ($\chi_u$), correlation length($\xi$), and NMR relaxation rate ($1/T_1$) are proposed and computed in a $1/N$ expansion and by Mont\'{e}-Carlo simulations. For large $k_B T/\rho_s$, $\chi_u (T)/T$ and $T\xi(T)$ asymptote to universal values, while $1/T_{1}(T)$ is nearly $T$-independent. We find good quantitative agreement with experiments and some numerical studies on $La_{2-\delta} Sr_{\delta} Cu O_4$.Comment: 14 pages, REVTEX, 1 postscript figure appende

Theory of Two-Dimensional Quantum Heisenberg Antiferromagnets with a Nearly Critical Ground State

We present the general theory of clean, two-dimensional, quantum Heisenberg antiferromagnets which are close to the zero-temperature quantum transition between ground states with and without long-range N\'{e}el order. For N\'{e}el-ordered states, `nearly-critical' means that the ground state spin-stiffness, $\rho_s$, satisfies $\rho_s \ll J$, where $J$ is the nearest-neighbor exchange constant, while `nearly-critical' quantum-disordered ground states have a energy-gap, $\Delta$, towards excitations with spin-1, which satisfies $\Delta \ll J$. Under these circumstances, we show that the wavevector/frequency-dependent uniform and staggered spin susceptibilities, and the specific heat, are completely universal functions of just three thermodynamic parameters. Explicit results for the universal scaling functions are obtained by a $1/N$ expansion on the $O(N)$ quantum non-linear sigma model, and by Monte Carlo simulations. These calculations lead to a variety of testable predictions for neutron scattering, NMR, and magnetization measurements. Our results are in good agreement with a number of numerical simulations and experiments on undoped and lightly-doped $La_{2-\delta} Sr_{\delta}Cu O_4$.Comment: 81 pages, REVTEX 3.0, smaller updated version, YCTP-xxx

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Collins and Sivers asymmetries in muonproduction of pions and kaons off transversely polarised protons

Measurements of the Collins and Sivers asymmetries for charged pions and charged and neutral kaons produced in semi-inclusive deep-inelastic scattering of high energy muons off transversely polarised protons are presented. The results were obtained using all the available COMPASS proton data, which were taken in the years 2007 and 2010. The Collins asymmetries exhibit in the valence region a non-zero signal for pions and there are hints of non-zero signal also for kaons. The Sivers asymmetries are found to be positive for positive pions and kaons and compatible with zero otherwise. © 2015

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt