Plasma exchange in the intensive care unit: a narrative review

In this narrative review, we discuss the relevant issues of therapeutic plasma exchange (TPE) in critically ill patients. For many conditions, the optimal indication, device type, frequency, duration, type of replacement fluid and criteria for stopping TPE are uncertain. TPE is a potentially lifesaving but also invasive procedure with risk of adverse events and complications and requires close monitoring by experienced teams. In the intensive care unit (ICU), the indications for TPE can be divided into (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy, (2) relative, for which TPE is a recognized second-line treatment (alone or combined) and (3) rescue therapy, where TPE is used with a limited or theoretical evidence base. New indications are emerging and ongoing knowledge gaps, notably regarding the use of TPE during critical illness, support the establishment of a TPE registry dedicated to intensive care medicine

Observation of inclined EeV air showers with the radio detector of the Pierre Auger Observatory

With the Auger Engineering Radio Array (AERA) of the Pierre Auger Observatory, we have observed the radio emission from 561 extensive air showers with zenith angles between 60 and 84. In contrast to air showers with more vertical incidence, these inclined air showers illuminate large ground areas of several km2 with radio signals detectable in the 30 to 80 MHz band. A comparison of the measured radio-signal amplitudes with Monte Carlo simulations of a subset of 50 events for which we reconstruct the energy using the Auger surface detector shows agreement within the uncertainties of the current analysis. As expected for forward-beamed radio emission undergoing no significant absorption or scattering in the atmosphere, the area illuminated by radio signals grows with the zenith angle of the air shower. Inclined air showers with EeV energies are thus measurable with sparse radio-antenna arrays with grid sizes of a km or more. This is particularly attractive as radio detection provides direct access to the energy in the electromagnetic cascade of an air shower, which in case of inclined air showers is not accessible by arrays of particle detectors on the ground

Data-driven estimation of the invisible energy of cosmic ray showers with the Pierre Auger Observatory

The determination of the primary energy of extensive air showers using the fluorescence detection technique requires an estimation of the energy carried away by particles that do not deposit all their energy in the atmosphere. This estimation is typically made using Monte Carlo simulations and thus depends on the assumed primary particle mass and on model predictions for neutrino and muon production. In this work we present a new method to obtain the invisible energy from events detected by the Pierre Auger Observatory. The method uses measurements of the muon number at ground level, and it allows us to reduce significantly the systematic uncertainties related to the mass composition and the high energy hadronic interaction models, and consequently to improve the estimation of the energy scale of the Observatory.Comment: Published version, 18 pages, 10 figures, 4 table

A 3-Year Sample of Almost 1,600 Elves Recorded Above South America by the Pierre Auger Cosmic-Ray Observatory

Elves are a class of transient luminous events, with a radial extent typically greater than 250 km, that occur in the lower ionosphere above strong electrical storms. We report the observation of 1,598 elves, from 2014 to 2016, recorded with unprecedented time resolution (100 ns) using the fluorescence detector (FD) of the Pierre Auger Cosmic-Ray Observatory. The Auger Observatory is located in the Mendoza province of Argentina with a viewing footprint for elve observations of 3.106 km2, reaching areas above the Pacific and Atlantic Oceans, as well as the Córdoba region, which is known for severe convective thunderstorms. Primarily designed for ultrahigh energy cosmic-ray observations, the Auger FD turns out to be very sensitive to the ultraviolet emission in elves. The detector features modified Schmidt optics with large apertures resulting in a field of view that spans the horizon, and year-round operation on dark nights with low moonlight background, when the local weather is favorable. The measured light profiles of 18% of the elve events have more than one peak, compatible with intracloud activity. Within the 3-year sample, 72% of the elves correlate with the far-field radiation measurements of the World Wide Lightning Location Network. The Auger Observatory plans to continue operations until at least 2025, including elve observations and analysis. To the best of our knowledge, this observatory is the only facility on Earth that measures elves with year-round operation and full horizon coverage. ©2020. The Authors

Limits on point-like sources of ultra-high-energy neutrinos with the Pierre Auger Observatory

International audienceWith the Surface Detector array (SD) of the Pierre Auger Observatory we can detect neutrinos with energy between 1017 eV and 1020 eV from point-like sources across the sky, from close to the Southern Celestial Pole up to 60ˆ in declination, with peak sensitivities at declinations around ∼ −53ˆ and ∼+55ˆ, and an unmatched sensitivity for arrival directions in the Northern hemisphere. A search has been performed for highly-inclined air showers induced by neutrinos of all flavours with no candidate events found in data taken between 1 Jan 2004 and 31 Aug 2018. Upper limits on the neutrino flux from point-like steady sources have been derived as a function of source declination. An unrivaled sensitivity is achieved in searches for transient sources with emission lasting over an hour or less, if they occur within the field of view corresponding to the zenith angle range between 60ˆ and  95ˆ where the SD of the Pierre Auger Observatory is most sensitive to neutrinos