Successful Utilization of High-Flux Hemodialysis for Treatment of Vancomycin Toxicity in a Child

Vancomycin is routinely used for empiric antibiotic therapy in children. Higher-serum-concentration targets for serious infections are now being recommended. This recommendation may result in aggressive dosing with increased potential for toxicity. We report a case of a pediatric patient who developed vancomycin toxicity and associated oliguric renal failure who was treated effectively with high-flux hemodialysis for vancomycin toxicity, clearing serum concentrations of vancomycin by over 75% in only 6 hours (213.2 mcg/mL to 51.8 mcg/mL) with subsequent return to baseline renal function and without adverse sequelae. While not historically considered a viable option for drug removal in cases of toxicity, new high-flux hemodialysis techniques can remove significant percentages of vancomycin in short periods of time

A probable Keplerian disk feeding an optically revealed massive young star.

The canonical picture of star formation involves disk-mediated accretion, with Keplerian accretion disks and associated bipolar jets primarily observed in nearby, low-mass young stellar objects (YSOs). Recently, rotating gaseous structures and Keplerian disks have been detected around several massive (M > 8 M ) YSOs (MYSOs) , including several disk-jet systems . All the known MYSO systems are in the Milky Way, and all are embedded in their natal material. Here we report the detection of a rotating gaseous structure around an extragalactic MYSO in the Large Magellanic Cloud. The gas motion indicates that there is a radial flow of material falling from larger scales onto a central disk-like structure. The latter exhibits signs of Keplerian rotation, so that there is a rotating toroid feeding an accretion disk and thus the growth of the central star. The system is in almost all aspects comparable to Milky Way high-mass YSOs accreting gas from a Keplerian disk. The key difference between this source and its Galactic counterparts is that it is optically revealed rather than being deeply embedded in its natal material as is expected of such a massive young star. We suggest that this is the consequence of the star having formed in a low-metallicity and low-dust content environment. Thus, these results provide important constraints for models of the formation and evolution of massive stars and their circumstellar disks

A probable Keplerian disk feeding an optically revealed massive young star

The canonical picture of star formation involves disk-mediated accretion, with Keplerian accretion disks and associated bipolar jets primarily observed in nearby, low-mass young stellar objects (YSOs). Recently, rotating gaseous structures and Keplerian disks have been detected around a number of massive (M > 8 solar masses) YSOs (MYSOs) including several disk-jet systems. All of the known MYSO systems are located in the Milky Way, and all are embedded in their natal material. Here we report the detection of a rotating gaseous structure around an extragalactic MYSO in the Large Magellanic Cloud. The gas motions show radial flow of material falling from larger scales onto a central disk-like structure, the latter exhibiting signs of Keplerian rotation, i.e., a rotating toroid feeding an accretion disk and thus the growth of the central star. The system is in almost all aspects comparable to Milky Way high-mass young stellar objects accreting gas via a Keplerian disk. The key difference between this source and its Galactic counterparts is that it is optically revealed, rather than being deeply embedded in its natal material as is expected of such a young massive star. We suggest that this is the consequence of the star having formed in a low-metallicity and low-dust content environment, thus providing important constraints for models of the formation and evolution of massive stars and their circumstellar disks.Comment: 20 pages, 9 page

Into the Mystic: the MUSE view of the ionized gas in the Mystic Mountains in Carina

We present optical integral field unit observations of the Mystic Mountains, a dust pillar complex in the centre of the Carina Nebula that is heavily irradiated by the nearby young massive cluster Trumpler 14. With the continuous spatial and spectral coverage of data from the Multi-Unit Spectroscopic Explorer (MUSE), we measure the physical properties in the ionized gas including the electron density and temperature, excitation, and ionization. MUSE also provides an excellent view of the famous jets HH 901, 902, and 1066, revealing them to be high-density, low-ionization outflows despite the harsh environment. HH 901 shows spatially extended [C i] emission tracing the rapid dissociation of the photoevaporating molecular outflow in this highly irradiated source. We compute the photoevaporation rate of the Mystic Mountains and combine it with recent Atacama Large Millimeter Array observations of the cold molecular gas to estimate the remaining lifetime of the Mystic Mountains and the corresponding shielding time for the embedded protostars. The longest remaining lifetimes are for the smallest structures, suggesting that they have been compressed by ionizing feedback. Our data do not suggest that star formation in the Mystic Mountains has been triggered but it does point to the role that ionization-driven compression may play in enhancing the shielding of embedded stars and discs. Planet formation models suggest that the shielding time is a strong determinant of the mass and orbital architecture of planets, making it important to quantify in high-mass regions like Carina that represent the type of environment where most stars form

Illuminating evaporating protostellar outflows: ERIS/SPIFFIER reveals the dissociation and ionization of HH 900

Protostellar jets and outflows are signposts of active star formation. In H II regions, molecular tracers like CO only reveal embedded portions of the outflow. Outside the natal cloud, outflows are dissociated, ionized, and eventually completely ablated, leaving behind only the high-density jet core. Before this process is complete, there should be a phase where the outflow is partially molecular and partially ionized. In this paper, we capture the HH 900 outflow while this process is in action. New observations from the ERIS/SPIFFIER near-IR integral field unit (IFU) spectrograph using the K-middle filter ($\lambda$=2.06-2.34 $\mu$m) reveal H$_2$ emission from the dissociating outflow and Br-$\gamma$ tracing its ionized skin. Both lines trace the wide-angle outflow morphology but H$_2$ only extends $\sim$5000 au into the H II region while Br-$\gamma$ extends the full length of the outflow ($\sim$12,650 au), indicating rapid dissociation of the molecules. H$_2$ has higher velocities further from the driving source, consistent with a jet-driven outflow. Diagnostic line ratios indicate that photoexcitation, not just shocks, contributes to the excitation in the outflow. We argue that HH 900 is the first clear example of an evaporating molecular outflow and predict that a large column of neutral material that may be detectable with ALMA accompanies the dissociating molecules. Results from this study will help guide the interpretation of near-IR images of externally irradiated jets and outflows such as those obtained with the James Webb Space Telescope (JWST) in high-mass star-forming regions where these conditions may be common.Comment: MNRAS, accepte

Illuminating evaporating protostellar outflows: ERIS/SPIFFIER reveals the dissociation and ionization of HH 900

Protostellar jets and outflows are signposts of active star formation. In H II regions, molecular tracers like CO only reveal embedded portions of the outflow. Outside the natal cloud, outflows are dissociated, ionized, and eventually completely ablated, leaving behind only the high-density jet core. Before this process is complete, there should be a phase where the outflow is partially molecular and partially ionized. In this paper, we capture the HH 900 outflow while this process is in action. New observations from the Enhanced Resolution Imager and Spectrograph/SPIFFIER near-infrared (IR) integral field unit spectrograph using the K-middle filter (λ = 2.06–2.34 μm) reveal H2 emission from the dissociating outflow and Br-γ tracing its ionized skin. Both lines trace the wide-angle outflow morphology but H2 only extends ∼5000 au into the H II region while Br-γ extends the full length of the outflow (∼12 650 au), indicating rapid dissociation of the molecules. H2 has higher velocities further from the driving source, consistent with a jet-driven outflow. Diagnostic line ratios indicate that photoexcitation, not just shocks, contributes to the excitation in the outflow. We argue that HH 900 is the first clear example of an evaporating molecular outflow and predict that a large column of neutral material that may be detectable with Atacama Large Millimeter Array accompanies the dissociating molecules. Results from this study will help guide the interpretation of near-IR images of externally irradiated jets and outflows such as those obtained with the JWST in high-mass star-forming regions where these conditions may be common

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR