Extragalactic magnetism with SOFIA (SALSA Legacy Program). VI. The magnetic fields in the multi-phase interstellar medium of the Antennae galaxies

Mergers are thought to be a fundamental channel for galaxy growth, perturbing the gas dynamics and the magnetic fields (B-fields) in the interstellar medium (ISM). However, the mechanisms that amplify and dissipate B-fields during a merger remain unclear. We characterize the morphology of the ordered B-fields in the multi-phase ISM of the closest merger of two spiral galaxies, the Antennae galaxies. We compare the inferred B-fields using $154~\mu$m thermal dust and $11$ cm radio synchrotron emission polarimetric observations. We find that the $154~\mu$m B-fields are more ordered across the Antennae galaxies than the $11$ cm B-fields. The turbulent-to-ordered $154~\mu$m B-field increases at the galaxy cores and star-forming regions. The relic spiral arm has an ordered spiral $154~\mu$m B-field, while the $11$ cm B-field is radial. The $154~\mu$m B-field may be dominated by turbulent dynamos with high $^{12}$CO(1-0) velocity dispersion driven by star-forming regions, while the $11$ cm B-field is cospatial with high HI velocity dispersion driven by galaxy interaction. This result shows the dissociation between the warm gas mainly disturbed by the merger, and the dense gas still following the dynamics of the relic spiral arm. We find a $\sim8.9$ kpc scale ordered B-field connecting the two galaxies. The base of the tidal tail is cospatial with the HI and $^{12}$CO(1-0) emission and has compressed and/or sheared $154~\mu$m and $11$ cm B-fields driven by the merger. We suggest that amplify B-fields, with respect to the rest of the system and other spiral galaxies, may be supporting the gas flow between both galaxies and the tidal tail.Comment: 11 pages, 5 figures, Accepted for publication in ApJ Letter

Extragalactic magnetism with SOFIA (SALSA Legacy Program) -- V: First results on the magnetic field orientation of galaxies

We present the analysis of the magnetic field ($B$-field) structure of galaxies measured with far-infrared (FIR) and radio (3 and 6 cm) polarimetric observations. We use the first data release of the Survey on extragALactic magnetiSm with SOFIA (SALSA) of 14 nearby ($<20$ Mpc) galaxies with resolved (5 arcsec-18 arcsec; $90$ pc--$1$ kpc) imaging polarimetric observations using HAWC+/SOFIA from $53$ to $214$ \um. We compute the magnetic pitch angle ($\Psi_{B}$) profiles as a function of the galactrocentric radius. We introduce a new magnetic alignment parameter ($\zeta$) to estimate the disordered-to-ordered $B$-field ratio in spiral $B$-fields. We find FIR and radio wavelengths to not generally trace the same $B$-field morphology in galaxies. The $\Psi_{B}$ profiles tend to be more ordered with galactocentric radius in radio ($\zeta_{\rm{6cm}} = 0.93\pm0.03$) than in FIR ($\zeta_{\rm{154\mu m}} = 0.84\pm0.14$). For spiral galaxies, FIR $B$-fields are $2-75$\% more turbulent than the radio $B$-fields. For starburst galaxies, we find that FIR polarization is a better tracer of the $B$-fields along the galactic outflows than radio polarization. Our results suggest that the $B$-fields associated with dense, dusty, turbulent star-forming regions, those traced at FIR, are less ordered than warmer, less-dense regions, those traced at radio, of the interstellar medium. The FIR $B$-fields seem to be more sensitive to the activity of the star-forming regions and the morphology of the molecular clouds within a vertical height of few hundred pc in the disk of spiral galaxies than the radio $B$-fields.Comment: 26 pages, 13 figure

Extragalactic Magnetism with SOFIA (SALSA Legacy Program). VII. A tomographic view of far infrared and radio polarimetric observations through MHD simulations of galaxies

The structure of magnetic fields in galaxies remains poorly constrained, despite the importance of magnetism in the evolution of galaxies. Radio synchrotron and far-infrared dust polarization (FIR) polarimetric observations are the best methods to measure galactic scale properties of magnetic fields in galaxies beyond the Milky Way. We use synthetic polarimetric observations of a simulated galaxy to identify and quantify the regions, scales, and interstellar medium (ISM) phases probed at FIR and radio wavelengths. Our studied suite of magnetohydrodynamical cosmological zoom-in simulations features high-resolutions (10 pc full-cell size) and multiple magnetization models. Our synthetic observations have a striking resemblance to those of observed galaxies. We find that the total and polarized radio emission extends to approximately double the altitude above the galactic disk (half-intensity disk thickness of $h_\text{I radio} \sim h_\text{PI radio} = 0.23 \pm 0.03$ kpc) relative to the FIR total and polarized emission that are concentrated in the disk midplane ($h_\text{I FIR} \sim h_\text{PI FIR} = 0.11 \pm 0.01$ kpc). Radio emission traces magnetic fields at scales of $\gtrsim 300$ pc, whereas FIR emission probes magnetic fields at the smallest scales of our simulations. These scales are comparable to our spatial resolution and well below the spatial resolution ($<300$ pc) of existing FIR polarimetric measurements. Finally, we confirm that synchrotron emission traces a combination of the warm neutral and cold neutral gas phases, whereas FIR emission follows the densest gas in the cold neutral phase in the simulation. These results are independent of the ISM magnetic field strength. The complementarity we measure between radio and FIR wavelengths motivates future multiwavelength polarimetric observations to advance our knowledge of extragalactic magnetism.Comment: Submitted to ApJ. 32 pages, 15 figure

Clinical guide of the Spanish Society of Nephrology on the prevention and treatment of peritoneal infection in peritoneal dialysis

[Resumen] Las infecciones peritoneales siguen constituyendo una complicación muy relevante de la diálisis peritoneal, por su incidencia todavía elevada y por sus importantes consecuencias clínicas, en términos de mortalidad, fracaso de la técnica y costes para el sistema sanitario. Las prácticas de prevención y tratamiento de esta complicación muestran una notable heterogeneidad derivada, entre otros factores, de la complejidad del problema y de la escasez de evidencia clínica que permitan responder de manera clara a muchas de las dudas planteadas. El propósito de este documento es proporcionar una revisión completa y actualizada de los métodos de diagnóstico, prevención y tratamiento de estas infecciones. El documento se ha elaborado tomando como referencia de partida la guía más reciente de la Sociedad Internacional de Diálisis Peritoneal (2016). Mientras que para el capítulo diagnóstico se ha adoptado una estructura más narrativa, el análisis de las medidas de prevención y tratamiento ha seguido una metodología sistemática (Grading of Recommendations, Assessment, Development and Evaluation [GRADE]), que especifica el nivel de evidencia y la fuerza de las sugerencias y recomendaciones propuestas, y facilita actualizaciones futuras de la guía. La gran extensión y numerosas recomendaciones o sugerencias emanadas de la revisión ponen de manifiesto la complejidad y gran número de facetas a tener en cuenta para un adecuado abordaje de esta importante complicación de la diálisis peritoneal.[Abstract] Peritoneal infections still represent a most feared complication of chronic peritoneal dialysis, due to their high incidence and relevant clinical consequences, including direct mortality, technique failure and a significant burden for the health system. The practices for prevention and treatment of this complication show a remarkable heterogeneity emerging, among other factors, from the complexity of the problem and from a paucity of quality evidence which could permit to respond clearly to many of the raised questions. The purpose of this document is to provide a complete and updated review of the main methods of diagnosis, prevention and treatment of these infections. The document has been elaborated taking as a reference the most recent guidelines of the International Society of Peritoneal Dialysis (2016). The diagnostic considerations are presented in a narrative style while, for prevention and therapy, we have used a systematic methodology (Grading of Recommendations, Assessment, Development and Evaluation [GRADE]), which specifies the level of evidence and the strength of the proposed suggestions and recommendations and facilitates future updates of the document. The length of the document and the many suggestions and recommendations coming out of the review underline the large number and the complexity of the factors to be taken into consideration for an adequate approach to this complication of peritoneal dialysis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake