HH 1158: The lowest luminosity externally irradiated Herbig-Haro jet

We have identified a new externally irradiated Herbig-Haro (HH) jet, HH 1158, within ~2 pc of the massive OB type stars in the sigma Orionis cluster. At an Lbol ~ 0.1 Lsun, HH 1158 is the lowest luminosity irradiated HH jet identified to date in any cluster. Results from the analysis of high-resolution optical spectra indicate asymmetries in the brightness, morphology, electron density, velocity, and the mass outflow rates for the blue and red-shifted lobes. We constrain the position angle of the HH 1158 jet at 102+/-5 degree. The mass outflow rate and the mean accretion rate for HH 1158 using multiple diagnostics are estimated to be (5.2 +/- 2.6) x 10^(-10) Msun/yr and (3.0 +/- 1.0) x 10^(-10) Msun/yr, respectively. The properties for HH 1158 are notably similar to the externally irradiated HH 444 -- HH 447 jets previously identified in sigma Orionis. In particular, the morphology is such that the weaker jet beam is tilted towards the massive stars, indicating a higher extent of photo-evaporation. The high value for the Halpha/[SII] ratio is also consistent with the ratios measured in other irradiated jets, including HH 444 -- HH 447. The presence of an extended collimated jet that is bipolar and the evidence of shocked emission knots make HH 1158 the first unique case of irradiated HH jets at the very low-luminosity end, and provides an opportunity to learn the physical properties of very faint HH jet sources.Comment: Accepted in ApJ Letter

Delayed surgical debridement in pediatric open fractures: a systematic review and meta-analysis.

Purpose: Open fractures are considered orthopedic emergencies that are traditionally treated with surgical debridement within 6 h of injury to prevent infection. However, this proclaimed “6-h rule” is arbitrary and not based on rigorous scientific evidence. The aim of our study was to systematically review the literature that compares late (>6 h from the time of injury) to early (<6 h from the time of injury) surgical debridement of pediatric open fractures. Methods: We searched several databases from 1946 to 2013 for any observational or experimental studies that evaluated late and early surgical debridement of pediatric open fractures. We performed a meta-analysis using a random effects model to pool odds ratios for a comparison of infection rates between children undergoing late versus early surgical debridement. We also investigated the infection rates in upper- and lower-limb pediatric open fractures. Descriptive, quantitative, and qualitative data were extracted. Results: Of the 12 articles identified, three studies (retrospective cohort studies) were eligible for the meta-analysis, encompassing a total of 714 open fractures. The pooled odds ratio (OR = 0.79) for infection between late and early surgical debridement was in favor of late surgical debridement but was not statistically significant (95 % CI 0.32, 1.99; p = 0.38, I 2 = 0 %). No significant difference in infection rate was detected between pediatric open fractures in the upper and lower limbs according to the time threshold in the included studies (OR = 0.72, 95 % CI 0.29, 1.82; p = 0.40, I 2 = 0 %). Conclusions: The cumulative evidence does not, at present, indicate an association between late surgical debridement and higher infection rates in pediatric open fractures. However, initial expedient surgical debridement of open fractures in children should always remain the rule. Thus, multi-center randomized controlled trials or prospective cohort studies will be able to answer this question with more certainty and a higher level of evidence

Market Access Analysis of Biologics and Small-Molecule Inhibitors for Inflammatory Bowel Disease Among US Health Insurance Policies.

BACKGROUND AND AIMS:Treatment pathways for ulcerative colitis (UC) and Crohn's disease (CD) are shifting to a more individualized, risk-stratified approach. The perception is that insurance policies may not have implemented this paradigm shift, particularly regarding access to newer agents. We evaluated patient access to advanced therapies by analyzing policy information from the Managed Markets Insight and Technology database. METHODS:Coverage status as of December 2018 for all US lives was queried for adalimumab, infliximab, infliximab-dyyb, tofacitinib, ustekinumab, and vedolizumab by indication (UC and/or CD) and medical or pharmacy coverage benefit. Coverage status was classified by the number of biologic steps before access to specified drug as "No Biologic," "1 Prior Biologic," "2+ Prior Biologics," "Not Covered." Unknown lives were excluded from the analyses. RESULTS:Coverage analysis was available for approximately 302 million lives under each medical and pharmacy benefit. Our analysis indicates that approximately half of covered lives had access to all agents (except tofacitinib) as first-line therapy; two-thirds had access after one biologic exposure. Among newer agents, vedolizumab had the widest coverage. For indications of UC and CD, 81% of known lives had access to vedolizumab with no prior biologic exposure required ("No Biologic"), 95% after "No Biologic" + "1 prior Biologic." Geographic variations were identified for coverage patterns. CONCLUSIONS:This US-based healthcare policy analysis points to an increased access to advanced therapies for UC and CD. An individualized, risk-stratified treatment approach integrating advanced therapies, including those recently approved, into treatment pathways for UC and CD is feasible

First Confirmed Detection of a Bipolar Molecular Outflow from a Young Brown Dwarf

Studying the earliest stages in the birth of stars is crucial for understanding how they form. Brown dwarfs with masses between that of stars and planets are not massive enough to maintain stable hydrogen-burning fusion reactions during most of their lifetime. Their origins are subject to much debate in recent literature because their masses are far below the typical mass where core collapse is expected to occur. We present the first confirmed evidence that brown dwarfs undergo a phase of molecular outflow that is typical of young stars. Using the Submillimeter Array, we have obtained a map of a bipolar molecular outflow from a young brown dwarf. We estimate an outflow mass of 1.6 x 10^-4 M_Sun and a mass-loss rate of 1.4 x 10^-9 M_Sun. These values are over two orders of magnitude smaller than the typical ones for T Tauri stars. From our millimiter continuum data and our own analysis of Spitzer infrared photometry, we estimate that the brown dwarf has a disk with a mass of 8 x 10^-3 M_Sun and an outer disk radius of 80 AU. Our results demonstrate that the bipolar molecular outflow operates down to planetary masses, occurring in brown dwarfs as a scaled-down version of the universal process seen in young stars.Comment: accepted by ApJ Letter

Tissue material properties and computational modelling of the human tibiofemoral joint: a critical review

Understanding how structural and functional alterations of individual tissues impact on whole-joint function is challenging, particularly in humans where direct invasive experimentation is difficult. Finite element (FE) computational models produce quantitative predictions of the mechanical and physiological behaviour of multiple tissues simultaneously, thereby providing a means to study changes that occur through healthy ageing and disease such as osteoarthritis (OA). As a result, significant research investment has been placed in developing such models of the human knee. Previous work has highlighted that model predictions are highly sensitive to the various inputs used to build them, particularly the mathematical definition of material properties of biological tissues. The goal of this systematic review is two-fold. First, we provide a comprehensive summation and evaluation of existing linear elastic material property data for human tibiofemoral joint tissues, tabulating numerical values as a reference resource for future studies. Second, we review efforts to model tibiofemoral joint mechanical behaviour through FE modelling with particular focus on how studies have sourced tissue material properties. The last decade has seen a renaissance in material testing fuelled by development of a variety of new engineering techniques that allow the mechanical behaviour of both soft and hard tissues to be characterised at a spectrum of scales from nano- to bulk tissue level. As a result, there now exists an extremely broad range of published values for human tibiofemoral joint tissues. However, our systematic review highlights gaps and ambiguities that mean quantitative understanding of how tissue material properties alter with age and OA is limited. It is therefore currently challenging to construct FE models of the knee that are truly representative of a specific age or disease-state. Consequently, recent tibiofemoral joint FE models have been highly generic in terms of material properties even relying on non-human data from multiple species. We highlight this by critically evaluating current ability to quantitatively compare and model (1) young and old and (2) healthy and OA human tibiofemoral joints. We suggest that future research into both healthy and diseased knee function will benefit greatly from a subject- or cohort-specific approach in which FE models are constructed using material properties, medical imagery and loading data from cohorts with consistent demographics and/or disease states

Bacterial ventriculoperitoneal shunt infections: changing trends in antimicrobial susceptibility, a 7-year retrospective study from Pakistan

BACKGROUND: Ventriculoperitoneal (VP) shunt infections in adults represent a severe complication and make treatment more challenging. Therefore, drug susceptibility patterns are crucial for therapeutic decisions and infection control in neurosurgical centers. This 7-year retrospective study aimed to identify the bacteria responsible for adult VP shunt infections and determine their drug susceptibility patterns. METHODS: This single-center study was performed from 2015 to 2021 in Lahore, Pakistan, and included CSF cultures from VP shunt infections. Demographic data, causative organisms, and antimicrobial susceptibility testing results were collected. Multivariate analysis of variance (MANOVA) and two-sample t-tests were used to analyze and compare the antibiotic sensitivity trends over the study period. RESULTS: 14,473 isolates recovered from 13,937 CSF samples of VP shunt infections were identified and analyzed for their susceptibility patterns to antimicrobials. The proportion of Gram-negative and Gram-positive bacteria were 11,030 (76%) and 3443 (24)%, respectively. The predominant bacteria were Acinetobacter species (n = 5898, 41%), followed by Pseudomonas species (n = 2368, 16%) and coagulase-negative Staphylococcus (CoNS) (n = 1880, 13%). 100% of Staphylococcus aureus (S.aureus) and CoNS were sensitive to vancomycin and linezolid (n = 2580). However, 52% of S. aureus (719/1,343) were methicillin-resistant Staphylococcus aureus (MRSA). Acinetobacter showed maximum sensitivity to meropenem at 69% (2759/4768). Pseudomonas was 80% (1385/1863 sensitive to piperacillin-tazobactam, Escherichia coli (E. coli) showed 72% to amikacin (748/1055), while Klebsiella spp. was 57% (574/1170) sensitive to piperacillin-tazobactam. The sensitivity of piperacillin-tazobactam and meropenem for Gram-negative bacteria decreased significantly (p < 0.05) over 7 years, with 92.2% and 88.91% sensitive in 2015 and 66.7% and 62.8% sensitive in 2021, respectively. CONCLUSION: The significant decrease in the effectiveness of carbapenem and beta-lactam/beta-lactamase inhibitor combination drugs for the common Gram-negative causative agents of VP shunt infections suggests that alternative antibiotics such as colistin, fosfomycin, ceftazidime/avibactam, ceftolozane/tazobactam, and tigecycline should be considered and in consequence included in testing panels. Additionally, it is recommended to adopt care bundles for the prevention of VP shunt infection

Kinetic and equilibrium modeling of Cu(II) and Ni(II) sorption onto physically pretreated Rosa centifolia distillation waste biomass

The removal of Cu(II) and Ni(II) from aqueous solution by physically pretreated (boiled, heated and autoclaved) Rosa centifolia distillation waste biomass was conducted in batch conditions. The obtained results revealed that initial metal ion concentration, kinetics, and temperature affected the adsorption capacity of the physically pretreated R. centifolia distillation waste biomass. The Cu(II) and Ni(II) equilibrium sorption data agreed well to Langmuir isotherm model and the sorption kinetics were accurately described by pseudo second order kinetic model. The Cu(II) and Ni(II) uptake capacities (mg g-1) of physical pretreated R. centifolia distillation waste biomass were in following order: boiled (66.91) &gt; heated (52.51) &gt; autoclaved (49.82) &gt; native (42.68) and boiled (67.55) &gt; heated (65.19) &gt; autoclaved (58.09) &gt; native (45.19), respectively. The nature of R. centifolia distillation waste biomass surface functionalities was analyzed by FTIR spectroscopy.Keywords: Cu(II), Ni(II), isotherms, kinetics, pretreatment, Rosa centifolia