Plasma Turbulence in the Local Bubble

Turbulence in the Local Bubble could play an important role in the thermodynamics of the gas that is there. The best astronomical technique for measuring turbulence in astrophysical plasmas is radio scintillation. Measurements of the level of scattering to the nearby pulsar B0950+08 by Philips and Clegg in 1992 showed a markedly lower value for the line-of-sight averaged turbulent intensity parameter $$than is observed for other pulsars, consistent with radio wave propagation through a highly rarefied plasma. In this paper, we discuss the observational progress that has been made since that time. At present, there are four pulsars (B0950+08, B1133+16, J0437-4715, and B0809+74) whose lines of sight seem to lie mainly within the local bubble. The mean densities and line of sight components of the interstellar magnetic field along these lines of sight are smaller than nominal values for pulsars, but not by as much expected. Three of the four pulsars also have measurements of interstellar scintillation. The value of the parameter$$ is smaller than normal for two of them, but is completely nominal for the third. This inconclusive status of affairs could be improved by measurements and analysis of ``arcs'' in ``secondary spectra'' of pulsars.Comment: Submitted to Space Science Reviews as contribution to Proceedings of ISSI (International Space Science Institute) workshop "From the Heliosphere to the Local Bubble". Refereed version accepted for publicatio

Exotic clouds in the local interstellar medium

The neutral interstellar medium (ISM) inside the Local Bubble (LB) has been known to have properties typical of the warm neutral medium (WNM). However, several recent neutral hydrogen (HI) absorption experiments show evidence for the existence of at least several cold diffuse clouds inside or at the boundary of the LB, with properties highly unusual relative to the traditional cold neutral medium. These cold clouds have a low HI column density, and AU-scale sizes. As the kinematics of cold and warm gas inside the LB are similar, this suggests a possibility of all these different flavors of the local ISM belonging to the same interstellar flow. The co-existence of warm and cold phases inside the LB is exciting as it can be used to probe the thermal pressure inside the LB. In addition to cold clouds, several discrete screens of ionized scattering material are clearly located inside the LB. The cold exotic clouds inside the LB are most likely long-lived, and we expect many more clouds with similar properties to be discovered in the future with more sensitive radio observations. While physical mechanisms responsible for the production of such clouds are still poorly understood, dynamical triggering of phase conversion and/or interstellar turbulence are likely to play an important role.Comment: 10 pages, refereed, accepted for publication in the proceedings of the "From the Outer Heliosphere to the Local Bubble: Comparisons of New Observations with Theory" conference, Space Science Review

International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

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. © 2020 American Medical Association. All rights reserved