We present ALMA observations of the CO(1–0) and CO(3–2) line emission tracing filaments of cold molecular gas in the central galaxy of the cluster PKS 0745−191. The total molecular gas mass of
...$4.6\pm 0.3\times 10^{9} {\rm \, M_{{\odot}}}$
, assuming a Galactic X
CO factor, is divided roughly equally between three filaments each extending radially 3-5 kpc from the galaxy centre. The emission peak is located in the SE filament ∼ 1 arcsec (2 kpc) from the nucleus. The velocities of the molecular clouds in the filaments are low, lying within
$\pm 100 {\rm \, km \rm \, s^{-1}}$
of the galaxy's systemic velocity. Their full width at half-maximum (FWHM) are less than
$150 {\rm \, km \rm \, s^{-1},}$
which is significantly below the stellar velocity dispersion. Although the molecular mass of each filament is comparable to a rich spiral galaxy, such low velocities show that the filaments are transient and the clouds would disperse on < 107 yr time-scales unless supported, likely by the indirect effect of magnetic fields. The velocity structure is inconsistent with a merger origin or gravitational free-fall of cooling gas in this massive central galaxy. If the molecular clouds originated in gas cooling even a few kpc from their current locations their velocities would exceed those observed. Instead, the projection of the N and SE filaments underneath X-ray cavities suggests they formed in the updraft behind bubbles buoyantly rising through the cluster atmosphere. Direct uplift of the dense gas by the radio bubbles appears to require an implausibly high coupling efficiency. The filaments are coincident with low temperature X-ray gas, bright optical line emission and dust lanes indicating that the molecular gas could have formed from lifted warmer gas that cooled in situ.
Clostridium difficile-associated diarrhea (CDAD) is a major cause of morbidity and increasing health-care costs among hospitalized patients. Although exposure to antibiotics remains the most ...documented risk factor for CDAD, attention has recently been directed toward a plausible link with proton pump inhibitors (PPIs). However, the results of studies on the association between CDAD and PPIs remain controversial. We have conducted a meta-analysis to summarize the association between PPIs and CDAD among hospitalized patients.
A systematic search of published literature on studies that investigated the association between PPIs and CDAD from 1990 to 2010 was conducted on Medline and PubMed. The identified articles were reviewed for additional references. The most adjusted risk estimates were extracted by two authors and summarized using random effects meta-analysis. We also conducted a subgroup analysis by study design. Publication bias was evaluated using the Begg and Egger tests. A sensitivity analysis using the Duval and Tweedie "trim-and-fill" method has also been performed.
Twenty-three studies including close to 300,000 patients met the inclusion criteria. There was a 65% (summary risk estimate 1.69 with a 95% confidence interval (CI) from 1.395 to 1.974; P<0.000) increase in the incidence of CDAD among patients on PPIs. By study design, whether case-control study (17) or cohort study (6), there was still a significant increase in the incidence of CDAD among PPI users. The risk estimates were 2.31 (95% CI from 1.72 to 3.10; P<0.001) and 1.48 (95% CI from 1.25 to 1.75; P<0.001) for cohort and case-control studies, respectively.
There is sufficient evidence to suggest that PPIs increase the incidence of CDAD. Our meta-analysis shows a 65% increase in the incidence of CDAD among PPI users. We recommend that the routine use of PPIs for gastric ulcer prophylaxis should be more prudent. Establishing a guideline for the use of PPI may help in the future with the judicious use of PPIs. Further studies, preferably prospective, are needed to fully explore the association between PPIs and CDAD.
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•Lake Erie is heavily impacted by urban and agricultural nutrient loading.•The timing and bioavailability of these nutrient inputs favour toxic cyanobacteria.•High organic production ...exacerbates bottom hypoxia and sediment release of phosphorus, which will delay the lake's response to nutrient management.•Modelling has generated soluble and total P reduction targets for Lake Erie.•Many best management options were identified; their performance should be verified on a watershed basis.
Lake Erie supplies drinking water to more than 11 million consumers, processes millions of gallons of wastewater, provides important species habitat and supports a substantial industrial sector, with >$50 billion annual income to tourism, recreational boating, shipping, fisheries, and other industries. These and other key ecosystem services are currently threatened by an excess supply of nutrients, manifested in particular by increases in the magnitude and extent of harmful planktonic and benthic algal blooms (HABs) and hypoxia. Widespread concern for this important international waterbody has been manifested in a strong focus of scientific and public material on the subject, and commitments for Canada-US remedial actions in recent agreements among Federal, Provincial and State agencies. This review provides a retrospective synthesis of past and current nutrient inputs, impairments by planktonic and benthic HABs and hypoxia, modelling and Best Management Practices in the Lake Erie basin. The results demonstrate that phosphorus reduction is of primary importance, but the effects of climate, nitrogen and other factors should also be considered in the context of adaptive management. Actions to reduce nutrient levels by targeted Best Management Practices will likely need to be tailored for soil types, topography, and farming practices.
The conversion of gas into stars is a fundamental process in astrophysics and cosmology. Stars are known to form from the gravitational collapse of dense clumps in interstellar molecular clouds, and ...it has been proposed that the resulting star formation rate is proportional to either the amount of mass above a threshold gas surface density, or the gas volume density. These star formation prescriptions appear to hold in nearby molecular clouds in our Milky Way Galaxy's disc as well as in distant galaxies where the star formation rates are often much larger. The inner 500 pc of our Galaxy, the Central Molecular Zone (CMZ), contains the largest concentration of dense, high-surface density molecular gas in the Milky Way, providing an environment where the validity of star formation prescriptions can be tested. Here, we show that by several measures, the current star formation rate in the CMZ is an order-of-magnitude lower than the rates predicted by the currently accepted prescriptions. In particular, the region 1° < l < 3°.5, |b| < 0°.5 contains ∼107 M of dense (> several 103 cm−3) molecular gas - enough to form 1000 Orion-like clusters - but the present-day star formation rate within this gas is only equivalent to that in Orion. In addition to density, another property of molecular clouds must be included in the star formation prescription to predict the star formation rate in a given mass of molecular gas. We discuss which physical mechanisms might be responsible for suppressing star formation in the CMZ.
Many global environmental agendas, including halting biodiversity loss, reversing land degradation, and limiting climate change, depend upon retaining forests with high ecological integrity, yet the ...scale and degree of forest modification remain poorly quantified and mapped. By integrating data on observed and inferred human pressures and an index of lost connectivity, we generate a globally consistent, continuous index of forest condition as determined by the degree of anthropogenic modification. Globally, only 17.4 million km
of forest (40.5%) has high landscape-level integrity (mostly found in Canada, Russia, the Amazon, Central Africa, and New Guinea) and only 27% of this area is found in nationally designated protected areas. Of the forest inside protected areas, only 56% has high landscape-level integrity. Ambitious policies that prioritize the retention of forest integrity, especially in the most intact areas, are now urgently needed alongside current efforts aimed at halting deforestation and restoring the integrity of forests globally.
ABSTRACT Recent first detections of the cross-correlation of the thermal Sunyaev-Zel'dovich (tSZ) signal in Planck cosmic microwave background (CMB) temperature maps with gravitational lensing maps ...inferred from the Planck CMB data and the CFHTLenS galaxy survey provide new probes of the relationship between baryons and dark matter. Using cosmological hydrodynamics simulations, we show that these cross-correlation signals are dominated by contributions from hot gas in the intracluster medium (ICM), rather than diffuse, unbound gas located beyond the virial radius (the "missing baryons"). Thus, these cross-correlations offer a tool with which to study the ICM over a wide range of halo masses and redshifts. In particular, we show that the tSZ-CMB lensing cross-correlation is more sensitive to gas in lower-mass, higher-redshift halos and gas at larger cluster-centric radii than the tSZ-galaxy lensing cross-correlation. Combining these measurements with primary CMB data will constrain feedback models through their signatures in the ICM pressure profile. We forecast the ability of ongoing and future experiments to constrain the parameters of a phenomenological ICM model, including the mean amplitude of the pressure-mass relation, the redshift evolution of this amplitude, and the mean outer logarithmic slope of the pressure profile. The results are promising, with 5%-20% precision constraints achievable with upcoming experiments, even after marginalizing over cosmological parameters.
Hospital acquired infections stemming from contaminated reusable medical devices are of increasing concern. This issue is exaggerated with the introduction of complex medical devices like endoscopes ...and robotic instrumentation. Although medical device manufacturers validate their cleaning instructions for use, evidence in the literature demonstrates that effective device processing is not being performed consistently within sterile processing departments in clinical settings. The result is increased risks to patient safety. As a solution to this problem, focused one-on-one training increases compliance to the medical device manufacturer's processing instruction. However, often this is not a practical solution for the volume of healthcare staff responsible for device processing activities. This constitutes the first paper to address the blended use of educational and digital technologies to address these challenges and as a result inform safety and sustainability for the medical device sector. Cognitive learning theory is an evidence-based framework for learning. It supports the use of immersive educational experiences using emerging extended reality technologies (e.g., virtual or augmented reality) to increase learning comprehension. The delivery of educational content via these technologies provides an innovative option for repeatable leaning and training outcomes. The motivation is to decrease patient risk of contaminated reusable medical devices. The proposed approach while primary motivated by safety can also enhance sustainability and efficiency enabled by artificial intelligence and robotic instrumentation.
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We report the direct observation of resistive flow through a weak link in a weakly interacting atomic Bose-Einstein condensate. Two weak links separate our ring-shaped superfluid atomtronic circuit ...into two distinct regions, a source and a drain. Motion of these weak links allows for creation of controlled flow between the source and the drain. At a critical value of the weak link velocity, we observe a transition from superfluid flow to superfluid plus resistive flow. Working in the hydrodynamic limit, we observe a conductivity that is 4 orders of magnitude larger than previously reported conductivities for a Bose-Einstein condensate with a tunnel junction. Good agreement with zero-temperature Gross-Pitaevskii simulations and a phenomenological model based on phase slips indicate that the creation of excitations plays an important role in the resulting conductivity. Our measurements of resistive flow elucidate the microscopic origin of the dissipation and pave the way for more complex atomtronic devices.
Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy ...given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials.
We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality).
Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5–14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 81% of 4756 women). More than two thirds (1349 69% of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 65% of 2320 treated with NACT vs 1135 49% of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase 95% CI 2·4–8·6; rate ratio 1·37 95% CI 1·17–1·61; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 95% CI 0·92–1·14; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 0·95–1·18; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 0·94–1·15; p=0·45).
Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered—eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy.
Cancer Research UK, British Heart Foundation, UK Medical Research Council, and UK Department of Health.
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