Preparing for pandemic influenza: the need for enhanced surveillance.

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Search for Interstellar Water in the Translucent Molecular Cloud toward HD 154368

We report an upper limit of 9 x 10^{12} cm-2 on the column density of water in the translucent cloud along the line of sight toward HD 154368. This result is based upon a search for the C-X band of water near 1240 \AA carried out using the Goddard High Resolution Spectrograph of the Hubble Space Telescope. Our observational limit on the water abundance together with detailed chemical models of translucent clouds and previous measurements of OH along the line of sight constrain the branching ratio in the dissociative recombination of H_3O+ to form water. We find at the $3\sigma$ level that no more than 30% of dissociative recombinations of H_3O+ can lead to H_2O. The observed spectrum also yielded high-resolution observations of the Mg II doublet at 1239.9 \AA and 1240.4 \AA, allowing the velocity structure of the dominant ionization state of magnesium to be studied along the line of sight. The Mg II spectrum is consistent with GHRS observations at lower spectral resolution that were obtained previously but allow an additional velocity component to be identified.Comment: Accepted by ApJ, uses aasp

Subarcsecond resolution observations of warm water towards three deeply embedded low-mass protostars

Water is present during all stages of star formation: as ice in the cold outer parts of protostellar envelopes and dense inner regions of circumstellar disks, and as gas in the envelopes close to the protostars, in the upper layers of circumstellar disks and in regions of powerful outflows and shocks. In this paper we probe the mechanism regulating the warm gas-phase water abundance in the innermost hundred AU of deeply embedded (Class~0) low-mass protostars, and investigate its chemical relationship to other molecular species during these stages. Millimeter wavelength thermal emission from the para-H2-18O 3(1,3)-2(2,0) (Eu=203.7 K) line is imaged at high angular resolution (0.75"; 190 AU) with the IRAM Plateau de Bure Interferometer towards the deeply embedded low-mass protostars NGC 1333-IRAS2A and NGC 1333-IRAS4A. Compact H2-18O emission is detected towards IRAS2A and one of the components in the IRAS4A binary; in addition CH3OCH3, C2H5CN, and SO2 are detected. Extended water emission is seen towards IRAS2A, possibly associated with the outflow. The detections in all systems suggests that the presence of water on <100 AU scales is a common phenomenon in embedded protostars. We present a scenario in which the origin of the emission from warm water is in a flattened disk-like structure dominated by inward motions rather than rotation. The gas-phase water abundance varies between the sources, but is generally much lower than a canonical abundance of 10^-4, suggesting that most water (>96 %) is frozen out on dust grains at these scales. The derived abundances of CH3OCH3 and SO2 relative to H2-18O are comparable for all sources pointing towards similar chemical processes at work. In contrast, the C2H5CN abundance relative to H2-18O is significantly lower in IRAS2A, which could be due to different chemistry in the sources.Comment: 12 pages, 9 figure

Herschel observations of deuterated water towards Sgr B2(M)

Observations of HDO are an important complement for studies of water, because they give strong constraints on the formation processes -- grain surfaces versus energetic process in the gas phase, e.g. in shocks. The HIFI observations of multiple transitions of HDO in Sgr~B2(M) presented here allow the determination of the HDO abundance throughout the envelope, which has not been possible before with ground-based observations only. The abundance structure has been modeled with the spherical Monte Carlo radiative transfer code RATRAN, which also takes radiative pumping by continuum emission from dust into account. The modeling reveals that the abundance of HDO rises steeply with temperature from a low abundance ($2.5\times 10^{-11}$) in the outer envelope at temperatures below 100~K through a medium abundance ($1.5\times 10^{-9}$) in the inner envelope/outer core, at temperatures between 100 and 200~K, and finally a high abundance ($3.5\times 10^{-9}$) at temperatures above 200~K in the hot core.Comment: A&A HIFI special issue, accepte

Modeling water emission from low-mass protostellar envelopes

Within low-mass star formation, water vapor plays a key role in the chemistry and energy balance of the circumstellar material. The Herschel Space Observatory will open up the possibility to observe water lines originating from a wide range of excitation energies.Our aim is to simulate the emission of rotational water lines from envelopes characteristic of embedded low-mass protostars. A large number of parameters that influence the water line emission are explored: luminosity, density,density slope and water abundances.Both dust and water emission are modelled using full radiative transfer in spherical symmetry. The temperature profile is calculated for a given density profile. The H2O level populations and emission profiles are in turn computed with a non-LTE line code. The results are analyzed to determine the diagnostic value of different lines, and are compared with existing observations. Lines can be categorized in: (i) optically thick lines, including ground-state lines, mostly sensitive to the cold outer part; (ii) highly excited (E_u>200-250 K) optically thin lines sensitive to the abundance in the hot inner part; and (iii) lines which vary from optically thick to thin depending on the abundances. Dust influences the emission of water significantly by becoming optically thick at the higher frequencies, and by pumping optically thin lines. A good physical model of a source, including a correct treatment of dust, is a prerequisite to infer the water abundance structure and possible jumps at the evaporation temperature from observations. The inner warm (T>100 K) envelope can be probed byhighly-excited lines, while a combination of excited and spectrally resolved ground state lines probes the outer envelope. Observations of H218O lines, although weak, provide even stronger constraints on abundances.Comment: 17 pages with an online appendix of 6 pages. Accepted by A&A. Several figures are too large for astro-ph. These can be downloaded from http://www.strw.leidenuniv.nl/~kempen/water.ph

Safety of Nivolumab Added to Chemoradiation Therapy Platforms for Intermediate and High-Risk Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: RTOG Foundation 3504

PURPOSE: Programmed death-1 immune checkpoint blockade improves survival of patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC), but the benefits of addition to (chemo)radiation for newly diagnosed patients with HNSCC remain unknown. METHODS AND MATERIALS: We evaluated the safety of nivolumab concomitant with 70 Gy intensity modulated radiation therapy and weekly cisplatin (arm 1), every 3-week cisplatin (arm 2), cetuximab (arm 3), or alone for platinum-ineligible patients (arm 4) in newly diagnosed intermediate- or high-risk locoregionally advanced HNSCC. Patients received nivolumab from 2 weeks prior to radiation therapy until 3 months post-radiation therapy. The primary endpoint was dose-limiting toxicity (DLT). If ≤2 of the first 8 evaluable patients experienced a DLT, an arm was considered safe. Secondary endpoints included toxicity and feasibility of adjuvant nivolumab to 1 year, defined as all 7 additional doses received by ≥4 of the first 8 evaluable patients across arms. RESULTS: Of 39 patients (10 in arms 1, 3, 4 and 9 in arm 2), 72% had T3-4 tumors, 85% had N2-3 nodal disease, and 67% had \u3e10 pack-years of smoking. There were no DLTs in arms 1 and 2, 1 in arm 3 (mucositis), and 2 in arm 4 (lipase elevation and mucositis in 1 and fatigue in another). The most common grade ≥3 nivolumab-related adverse events were lipase increase, mucositis, diarrhea, lymphopenia, hyponatremia, leukopenia, fatigue, and serum amylase increase. Adjuvant nivolumab was feasible as defined in the protocol. CONCLUSIONS: Concomitant nivolumab with the 4 tested regimens was safe for patients with intermediate- and high-risk HNSCC, and subsequent adjuvant nivolumab was feasible as defined (NCT02764593)

The Use of Preoperative Prophylactic Systemic Antibiotics for the Prevention of Endopthalmitis in Open Globe Injuries:A Meta-Analysis

Topic:This study reports the effect of systemic prophylactic antibiotics (and their route) on the risk of endophthalmitis after open globe injury. Clinical relevance:Endophthalmitis is a major complication of open globe injury, it can lead to rapid sight loss in the affected eye. The administration of systemic antibiotic prophylaxis is common practice in some health care systems, although there is no consensus on their use. PubMed, CENTRAL, Web of Science, CINAHL and Embase were searched. This was completed 6th July 2021 and updated 10th Dec 2022. We included randomised and non-randomised prospective studies which reported the rate of post-open globe injury endophthalmitis, when systemic pre-operative antibiotic prophylaxis (via the oral or intravenous route) was given. The Cochrane Risk of Bias tool and ROBINS-I tool were used for assessing the risk of bias. Where meta-analysis was performed results were reported as odds ratio. PROSPERO registration: CRD42021271271. Three studies were included. One prospective observational study compared outcomes of patients who had received systemic or no systemic pre-operative antibiotics. The endophthalmitis rates reported were 3.75% and 4.91% in the systemic and no systemic pre-operative antibiotics groups, a non-significant difference (p = 0.68). Two randomised controlled trials were included (1,555 patients). The rates of endophthalmitis were 17 events in 751 patients (2.26%) and 17 events in 804 patients (2.11%) in the oral antibiotics and intravenous (+/- oral) antibiotics groups, respectively. Meta-analysis demonstrated no significant differences between groups (OR 1.07 [95% confidence interval 0.54 – 2.12]). The incidences of endophthalmitis after open globe injury were low with and without systemic antibiotic prophylaxis, although high risk cases were excluded in the included studies. When antibiotic prophylaxis is considered, there is moderate evidence that oral antibiotic administration is non-inferior to intravenous

The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies:A Meta-analysis

Topic: Sympathetic ophthalmia (SO) is a sight-threatening granulomatous panuveitis caused by a sensitizing event. Primary enucleation or primary evisceration, versus primary repair, as a risk management strategy after open-globe injury (OGI) remains controversial.Clinical Relevance: This systematic review was conducted to report the incidence of SO after primary repair compared with that of after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat.Methods: Five journal databases were searched. This review was registered with International Prospective Register of Systematic Reviews (identifier, CRD42021262616). Searches were carried out on June 29, 2021, and were updated on December 10, 2022. Prospective or retrospective studies that reported outcomes (including SO or lack of SO) in a patient population who underwent either primary repair and primary enucleation or primary evisceration were included. A systematic review and meta-analysis were carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effects modelling was used to estimate pooled SO rates and absolute risk reduction (ARR).Results: Eight studies reporting SO as an outcome were included in total. The included studies contained 7500 patients and 7635 OGIs. In total, 7620 OGIs met the criteria for inclusion in this analysis; SO developed in 21 patients with OGI. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval [CI], 0.00%–0.25%) after OGI. Of 779 patients who underwent primary enucleation or primary evisceration, no SO cases were reported, resulting in a pooled SO estimate of 0.05% (95% CI, 0.00%–0.21%). For primary repair, the pooled estimate of SO rate was 0.15% (95% CI, 0.00%–0.33%). The ARR using a random effects model was −0.0010 (in favour of eye removal; 95% CI, −0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). Grading of Recommendations, Assessment, Development, and Evaluations analysis highlighted a low certainty of evidence because the included studies were observational, and a risk of bias resulted from missing data.Discussion: Based on the available data, no evidence exists that primary enucleation or primary evisceration reduce the risk of secondary SO.Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article