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BackgroundCOVID-19 is associated with acute risk of major adverse cardiac events (MACE), including myocardial infarction, stroke, and mortality (all-cause). However, the duration and underlying determinants of heightened risk of cardiovascular disease and MACE post-COVID-19 are not known.MethodsData from the UK Biobank was used to identify COVID-19 cases (n=10 005) who were positive for polymerase chain reaction (PCR+)-based tests for SARS-CoV-2 infection (n=8062) or received hospital-based International Classification of Diseases version-10 (ICD-10) codes for COVID-19 (n=1943) between February 1, 2020 and December 31, 2020. Population controls (n=217 730) and propensity score-matched controls (n=38 860) were also drawn from the UK Biobank during the same period. Proportional hazard models were used to evaluate COVID-19 for association with long-term (>1000 days) risk of MACE and as a coronary artery disease risk equivalent. Additional analyses examined whether COVID-19 interacted with genetic determinants to affect the risk of MACE and its components.ResultsThe risk of MACE was elevated in COVID-19 cases at all levels of severity (HR, 2.09 [95% CI, 1.94-2.25]; P

Abstract. Introduction:. Central neuropathic pain (CNP) commonly develops in patients after spinal cord injury (SCI), causing debilitating symptoms and sensory abnormalities to mechanical and thermal stimuli. The biological variability of pain phenotypes in individuals has limited the number of positive outcomes. Thus, it is necessary to investigate the physiological processes contributing to sensory changes that develop over time. Objective:. To investigate the physiological processes contributing to neuropathic pain sensory changes and locomotor impairments with sensory phenotypes that develop over time. Methods:. Using the tail flick and von Frey tests, we performed hierarchical clustering to determine the subpopulation of rats that developed thermal and mechanical sensory abnormalities. To measure inflammation as a potential mediator of CNP phenotypes, we used flow cytometry and immunohistochemistry. Finally, to assess the secondary effects on locomotor recovery, up to 8 weeks after injury, we used the CatWalk test to assess multiple parameters of gait. Results:. The von Frey test showed a subpopulation of SCI rats that were hyposensitive to mechanical stimuli from 6 to 8 weeks after injury. The tail flick test showed a subpopulation of SCI rats that were hypersensitive to thermal stimuli at 1 week and 3 to 8 weeks after injury. Although there were no differences in inflammatory cells between subpopulations, we did see significant changes in locomotor recovery between rats with and without sensory abnormalities. Conclusion:. The myeloid cell population at large is not affected by mechanical or thermal phenotypes of pain in this model; however, locomotor recovery is impaired depending on the pain phenotype present. Further investigation into acute inflammatory cells may be insightful for predicting the development of pain phenotypes.

In this paper, we explore what it means to be Black researchers exploring racial battle fatigue while simultaneously navigating our own racial battle fatigue. We undertook a photo-elicitation project to investigate racial battle fatigue among Black undergraduate and graduate students. Amid doing this work, we wrestled with how to responsibly complete this research while treating participants with care who had full lives, histories, and stories. Using scholarly personal narrative methodology, we make sense of our research process as a research team of five Black people (two faculty members and three graduate students). We share journal entries to underscore the questions with which we were grappling in the research process, ultimately, to help readers understand our answer to the question: What does it mean to center racial battle fatigue in educational research when Black researchers are navigating their own racial battle fatigue? We close the article with lessons learned from our process to leave readers with ideas to consider as they embark on their own journeys of researching a topic with which they are also experiencing.

ABSTRACT Importance Critically ill children with pre‐existing mental health conditions may have an increased risk of poor health outcomes. Objective We aimed to evaluate if pre‐existing mental health conditions in critically ill pediatric patients would be associated with worse clinical outcomes, compared to children with no documented mental health conditions. Methods This retrospective observational cohort study utilized the TriNetX electronic health record database of critically ill subjects aged 12–18 years. Data were analyzed for demographics, pre‐existing conditions, diagnostic, medication, procedural codes, and mortality. Results From a dataset of 102 027 critically ill children, we analyzed 1999 subjects (284 [14.2%] with a pre‐existing mental health condition and 1715 [85.8%] with no pre‐existing mental health condition). Multivariable analysis demonstrated that death within one year was associated with the presence of pre‐existing mental health conditions (odds ratio 8.97 [3.48–23.15], P < 0.001), even after controlling for the presence of a complex chronic condition. Interpretation The present study demonstrates that the presence of pre‐existing mental health conditions was associated with higher odds of death within 1 year after receiving critical care. However, the confidence interval was wide and hence, the findings are inconclusive. Future studies with a larger sample size may be necessary to evaluate the true long‐term impact of children with pre‐existing mental health conditions who require critical care services.

Abstract Climate change, with warming and drying weather conditions, is reducing the growth, seed production, and survival of fire‐adapted plants in fire‐prone regions such as Mediterranean‐type ecosystems. These effects of climate change on local plant demographics have recently been shown to reduce the persistence time of local populations of the fire‐killed shrub Banksia hookeriana dramatically. In principle, extinctions of local populations may be partly compensated by recolonization events through long‐distance dispersal mechanisms of seeds, such as post‐fire wind and bird‐mediated dispersal, facilitating persistence in spatially structured metapopulations. However, to what degree and under which assumptions metapopulation dynamics might compensate for the drastically increased local extinction risk remains to be explored. Given the long timespans involved and the complexity of interwoven local and regional processes, mechanistic, process‐based models are one of the most suitable approaches to systematically explore the potential role of metapopulation dynamics and its underlying ecological assumptions for fire‐prone ecosystems. Here we extend a recent mechanistic, process‐based, spatially implicit population model for the well‐studied fire‐killed and serotinous shrub species B. hookeriana to a spatially explicit metapopulation model. We systematically tested the effects of different ecological processes and assumptions on metapopulation dynamics under past (1988–2002) and current (2003–2017) climatic conditions, including (i) effects of different spatio‐temporal fires, (ii) effects of (likely) reduced intraspecific plant competition under current conditions and (iii) effects of variation in plant performance among and within patches. In general, metapopulation dynamics had the potential to increase the overall regional persistence of B. hookeriana. However, increased population persistence only occurred under specific optimistic assumptions. In both climate scenarios, the highest persistence occurred with larger fires and intermediate to long inter‐fire intervals. The assumption of lower intraspecific plant competition caused by lower densities under current conditions alone was not sufficient to increase persistence significantly. To achieve long‐term persistence (defined as >400 years) it was necessary to additionally consider empirically observed variation in plant performance among and within patches, that is, improved habitat quality in some large habitat patches (≥7) that could function as source patches and a higher survival rate and seed production for a subset of plants, specifically the top 25% of flower producers based on current climate conditions monitoring data. Our model results demonstrate that the impacts of ongoing climate change on plant demographics are so severe that even under optimistic assumptions, the existing metapopulation dynamics shift to an unstable source‐sink dynamic state. Based on our findings, we recommend increased research efforts to understand the consequences of intraspecific trait variation on plant demographics, emphasizing the variation of individual traits both among and within populations. From a conservation perspective, we encourage fire and land managers to revise their prescribed fire plans, which are typically short interval, small fires, as they conflict with the ecologically appropriate spatio‐temporal fire regime for B. hookeriana, and likely as well for many other fire‐killed species.

There is a growing awareness that the condition of the built environment has a substantial impact on health. Systematic housing conditions surveys are a method for developing information about the physical condition of housing. This paper introduces the Center for Economic Information’s (CEI) Neighborhood Housing Conditions Survey (NHCS). We discuss the history and implementation of the NHCS in light of other academic and civic housing conditions surveys. The paper also reviews the history and method of the NHCS. We find that housing conditions surveys are generally designed from scratch for each new research program, translating survey results into policy remains underdeveloped in the scholarly literature, and heterogeneity between surveys reduces the ability to compare observations across space and time. The NHCS may address some of these issues, suitable as an “off the shelf” template, adjustable to suit programmatic needs, and providing a baseline consistency across space and time.

Abstract Background Sepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key drivers of SA-AKI. We sought to measure differences between endothelial dysfunction markers among children with and without SA-AKI, test whether this association varied across inflammatory biomarker-based risk strata, and develop prediction models to identify those at highest risk of SA-AKI. Methods Secondary analyses of prospective observational cohort of pediatric septic shock. Primary outcome of interest was the presence of ≥ Stage II KDIGO SA-AKI on day 3 based on serum creatinine (D3 SA-AKI SCr). Biomarkers including those prospectively validated to predict pediatric sepsis mortality (PERSEVERE-II) were measured in Day 1 (D1) serum. Multivariable regression was used to test the independent association between endothelial markers and D3 SA-AKI SCr. We conducted risk-stratified analyses and developed prediction models using Classification and Regression Tree (CART), to estimate risk of D3 SA-AKI among prespecified subgroups based on PERSEVERE-II risk. Results A total of 414 patients were included in the derivation cohort. Patients with D3 SA-AKI SCr had worse clinical outcomes including 28-day mortality and need for CRRT. Serum soluble thrombomodulin (sTM), Angiopoietin-2 (Angpt-2), and Tie-2 were independently associated with D3 SA-AKI SCr. Further, Tie-2 and Angpt-2/Tie-2 ratios were influenced by the interaction between D3 SA-AKI SCr and risk strata. Logistic regression demonstrated models predictive of D3 SA-AKI risk performed optimally among patients with high- or intermediate-PERSEVERE-II risk strata. A 6 terminal node CART model restricted to this subgroup of patients had an area under the receiver operating characteristic curve (AUROC) 0.90 and 0.77 upon tenfold cross-validation in the derivation cohort to distinguish those with and without D3 SA-AKI SCr and high specificity. The newly derived model performed modestly in a unique set of patients (n = 224), 84 of whom were deemed high- or intermediate-PERSEVERE-II risk, to distinguish those patients with high versus low risk of D3 SA-AKI SCr. Conclusions Endothelial dysfunction biomarkers are independently associated with risk of severe SA-AKI. Pending validation, incorporation of endothelial biomarkers may facilitate prognostic and predictive enrichment for selection of therapeutics in future clinical trials among critically ill children. Graphical abstract

Summary: Background: Multiple organ dysfunction syndrome (MODS) disproportionately drives morbidity and mortality among critically ill patients. However, we lack a comprehensive understanding of its pathobiology. Identification of genes associated with a persistent MODS trajectory may shed light on underlying biology and allow for accurate prediction of those at-risk. Methods: Secondary analyses of publicly available gene-expression datasets. Supervised machine learning (ML) was used to identify a parsimonious set of genes associated with a persistent MODS trajectory in a training set of pediatric septic shock. We optimized model parameters and tested risk-prediction capabilities in independent validation and test datasets, respectively. We compared model performance relative to an established gene-set predictive of sepsis mortality. Findings: Patients with a persistent MODS trajectory had 568 differentially expressed genes and characterized by a dysregulated innate immune response. Supervised ML identified 111 genes associated with the outcome of interest on repeated cross-validation, with an AUROC of 0.87 (95% CI: 0.85–0.88) in the training set. The optimized model, limited to 20 genes, achieved AUROCs ranging from 0.74 to 0.79 in the validation and test sets to predict those with persistent MODS, regardless of host age and cause of organ dysfunction. Our classifier demonstrated reproducibility in identifying those with persistent MODS in comparison with a published gene-set predictive of sepsis mortality. Interpretation: We demonstrate the utility of supervised ML driven identification of the genes associated with persistent MODS. Pending validation in enriched cohorts with a high burden of organ dysfunction, such an approach may inform targeted delivery of interventions among at-risk patients. Funding: H.R.W.′s NIH R35GM126943 award supported the work detailed in this manuscript. Upon his death, the award was transferred to M.N.A. M.R.A., N.S.P, and R.K were supported by NIH R21GM151703. R.K. was supported by R01GM139967.

Using the MIRI medium-resolution spectrometer on JWST, we have detected pure rotational, suprathermal OH emissions from the vicinity of the intermediate-mass protostar HOPS 370 (OMC2/FIR3). These emissions are observed from shocked knots in a jet/outflow and originate in states of rotational quantum number as high as 46 that possess excitation energies as large as E _U / k = 4.65 × 10 ^4 K. The relative strengths of the observed OH lines provide a powerful diagnostic of the ultraviolet radiation field in a heavily extinguished region ( A _V ∼ 10–20) where direct UV observations are impossible. To high precision, the OH line strengths are consistent with a picture in which the suprathermal OH states are populated following the photodissociation of water in its $\tilde{B}-X$ band by ultraviolet radiation produced by fast (∼80 km s ^−1 ) shocks along the jet. The observed dominance of emission from symmetric ( $A^{\prime} $ ) OH states over that from antisymmetric ( A ″) states provides a distinctive signature of this particular population mechanism. Moreover, the variation of intensity with rotational quantum number suggests specifically that Ly α radiation is responsible for the photodissociation of water, an alternative model with photodissociation by a 10 ^4 K blackbody being disfavored at a high level of significance. Using measurements of the Br α flux to estimate the Ly α production rate, we find that ∼4% of the Ly α photons are absorbed by water. Combined with direct measurements of water emissions in the ν _2 = 1 − 0 band, the OH observations promise to provide key constraints on future models for the diffusion of Ly α photons in the vicinity of a shock front.

Background and objectiveAcute kidney injury (AKI) is a common complication in hospitalized pediatric patients. Previous studies focused on adults found that proteinuria detected during an admission urinalysis is fit to serve as an indicator for AKI and associated clinical outcomes. The objective of this study is to evaluate if proteinuria on the first day of hospital services in hospitalized children is associated with AKI, need for renal replacement therapy, shock and/or antibiotic use, critical care services, and all-cause mortality at 30 days, hypothesizing that it is associated with these outcomes.MethodsThis is a retrospective cohort study using TriNetX electronic health record data of patients 2 to 18 years of age who underwent urinalysis laboratory testing on hospital admission, had three subsequent days of hospital or critical care services billing codes and creatinine laboratory values, and no pre-existing renal-related complex chronic condition. This study evaluated for the frequency, odds, and severity of AKI as defined by Kidney Disease: Improving Global Outcomes modified criteria and assessed for associated clinical outcomes.ResultsThis study included 971 pediatric subjects [435 (44.7%) with proteinuria]. Proteinuria on the first day of hospital services was associated with an increased odds for higher severity AKI on any day of hospitalization (odds ratio [OR] 2.41, CI 1.8-3.23, pConclusionChildren with proteinuria on the first day of hospital care services may have an increased odds of higher severity AKI, need for renal replacement therapy, shock and/or antibiotic use, and all-cause mortality at 30 days post-admission, with no significant association found for critical care services, mechanical intubation, or inotrope or vasopressor use.

Investigating Protostellar Accretion (IPA) is a JWST Cycle 1 GO program that uses NIRSpec integral field units and MIRI Medium Resolution Spectrograph to obtain 2.9–28 μ m spectral cubes of young, deeply embedded protostars with luminosities of 0.2–10,000 L _⊙ and central masses of 0.15–12 M _⊙ . In this Letter, we report the discovery of a highly collimated atomic jet from the Class 0 protostar IRAS 16253−2429, the lowest-luminosity source ( L _bol = 0.2 L _⊙ ) in the IPA program. The collimated jet is detected in multiple [Fe ii ] lines and [Ne ii ], [Ni ii ], and H i lines but not in molecular emission. The atomic jet has a velocity of about 169 ± 15 km s ^−1 , after correcting for inclination. The width of the jet increases with distance from the central protostar from 23 to 60 au, corresponding to an opening angle of 2.°6 ± 0.°5. By comparing the measured flux ratios of various fine-structure lines to those predicted by simple shock models, we derive a shock speed of 54 km s ^−1 and a preshock density of 2.0 × 10 ^3 cm ^−3 at the base of the jet. From these quantities and using a suite of jet models and extinction laws, we compute a mass-loss rate between 0.4 and 1.1 ×10 ^−10 M _⊙ yr ^−1 . The low mass-loss rate is consistent with simultaneous measurements of low mass accretion rate (2.4 ± 0.8 × 10 ^−9 M _⊙ yr ^−1 ) for IRAS 16253−2429 from JWST observations, indicating that the protostar is in a quiescent accretion phase. Our results demonstrate that very low-mass protostars can drive highly collimated, atomic jets, even during the quiescent phase.

OBJECTIVES:. Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk varied across biomarker-based risk strata upon adjusting for illness severity, presence of severe acute kidney injury (acute kidney injury), and use of continuous renal replacement therapy (CRRT) in pediatric septic shock. DESIGN:. Ongoing multicenter prospective observational cohort. SETTING:. Thirteen PICUs in the United States (2003–2023). PATIENTS:. Six hundred and eighty-one children with septic shock. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Cumulative percent PFB between days 1 and 7 (days 1–7 %PFB) was determined. Primary outcome of interest was complicated course defined as death or persistence of greater than or equal to two organ dysfunctions by day 7. Pediatric Sepsis Biomarker Risk Model (PERSEVERE)-II biomarkers were used to assign mortality probability and categorize patients into high mortality (n = 91), intermediate mortality (n = 134), and low mortality (n = 456) risk strata. Cox proportional hazard regression models with adjustment for PERSEVERE-II mortality probability, presence of sepsis-associated acute kidney injury on day 3, and use of CRRT, demonstrated that time-dependent variable days 1–7%PFB was independently associated with an increased hazard of complicated course. Risk-stratified analyses revealed that each 10% increase in days 1–7 %PFB was associated with increased hazard of complicated course only among patients with high mortality risk strata (adjusted hazard ratio 1.24 (95% CI, 1.08–1.43), p = 0.003). However, this association was not causally mediated by PERSEVERE-II biomarkers. CONCLUSIONS:. Our data demonstrate the influence of cumulative %PFB on the risk of complicated course in pediatric septic shock. Contrary to our previous report, this risk was largely driven by patients categorized as having a high mortality risk based on PERSEVERE-II biomarkers. Incorporation of such prognostic enrichment tools in randomized trials of restrictive fluid management or early initiation of de-escalation strategies may inform targeted application of such interventions among at-risk patients.

Abstract Background Sepsis is associated with significant mortality. Yet, there are no efficacious therapies beyond antibiotics. PCSK9 loss-of-function (LOF) and inhibition, through enhanced low-density lipoprotein receptor (LDLR) mediated endotoxin clearance, holds promise as a potential therapeutic approach among adults. In contrast, we have previously demonstrated higher mortality in the juvenile host. Given the potential pleiotropic effects of PCSK9 on the endothelium, beyond canonical effects on serum lipoproteins, both of which may influence sepsis outcomes, we sought to test the influence of PCSK9 LOF genotype on endothelial dysfunction. Methods Secondary analyses of a prospective observational cohort of pediatric septic shock. Genetic variants of PCSK9 and LDLR genes, serum PCSK9, and lipoprotein concentrations were determined previously. Endothelial dysfunction markers were measured in day 1 serum. We conducted multivariable linear regression to test the influence of PCSK9 LOF genotype on endothelial markers, adjusted for age, complicated course, and low- and high-density lipoproteins (LDL and HDL). Causal mediation analyses to test impact of select endothelial markers on the association between PCSK9 LOF genotype and mortality. Juvenile Pcsk9 null and wildtype mice were subject to cecal slurry sepsis and endothelial markers were quantified. Results A total of 474 patients were included. PCSK9 LOF was associated with several markers of endothelial dysfunction, with strengthening of associations after exclusion of those homozygous for the rs688 LDLR variant that renders it insensitive to PCSK9. Serum PCSK9 was not correlated with endothelial dysfunction. PCSK9 LOF influenced concentrations of Angiopoietin-1 (Angpt-1) upon adjusting for potential confounders including lipoprotein concentrations, with false discovery adjusted p value of 0.042 and 0.013 for models that included LDL and HDL, respectively. Causal mediation analysis demonstrated that the effect of PCSK9 LOF on mortality was mediated by Angpt-1 (p = 0.0008). Murine data corroborated these results with lower Angpt-1 and higher soluble thrombomodulin among knockout mice with sepsis relative to the wildtype. Conclusions We present genetic and biomarker association data that suggest a potential direct role of the PCSK9-LDLR pathway on Angpt-1 in the developing host with septic shock and warrant external validation. Further, mechanistic studies on the role of PCSK9-LDLR pathway on vascular homeostasis may lead to the development of pediatric-specific sepsis therapies. Graphical abstract

Abstract Background Intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation may result in Takotsubo syndrome (TS), but the frequency, predisposing factors (age, sex, mental health disorders), and outcomes are currently unknown. This study sought to assess the frequency, predisposing factors, and outcomes of subjects who underwent intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation and were diagnosed with TS. Methods This was a retrospective observational cohort study utilizing TriNetX® electronic health record (EHR) data. We included subjects aged older than 18 years who underwent intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation. The study population was divided into two groups (no TS diagnostic code presence and TS diagnostic code presence). We analyzed the distributions of age, sex, race, diagnostic codes, common terminology procedures (CPT), and vasoactive medication codes and examined mortality rate within 30 days. Results We included 69,116 subjects. Of these, 27 (0.04%) had a TS diagnostic code, the cohort was comprised mostly of females [17 (63.0%)], and 1 (3.7%) death within 30 days was reported. There were no significant differences in age and frequency of mental health disorders between those patients in TS and non‐TS cohorts. Adjusting for age, sex, race, ethnicity, patient regionality, and mental health disorder diagnostic code, those patients who developed TS had a significantly higher odds of dying in 30 days after catheter ablation compared to those without TS (OR = 15.97, 95% CI: 2.10–121.55, p = .007). Conclusions Approximately 0.04% of subjects who underwent intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation had a subsequent diagnostic code of TS. Further study is needed to determine whether there are predisposing factors associated with the development of TS in subjects who undergo catheter ablation of atrial fibrillation by pulmonary vein isolation.

Relational memory improves during middle childhood and adolescence, yet the neural correlates underlying those improvements are debated. Although memory for spatial, temporal, and other associative relations requires the hippocampus, it is not established whether within-individual changes in hippocampal structure contribute to memory improvements from middle childhood into adolescence. Here, we investigated how structural changes in hippocampal head, body, and tail subregions predict improvements in the capacity to remember item-space, item-time, and item-item relations. Memory for each relation and volumes of hippocampal subregions were assessed longitudinally in 171 participants across 3 time points (Mage at T1 = 9.45 years; Mage at T2 = 10.86 years, Mage at T3 = 12.12 years; comprising 393 behavioral assessments and 362 structural scans). Among older children, volumetric growth in: (a) head and body predicted improvements in item-time memory, (b) head predicted improvements in item-item memory; and (c) right tail predicted improvements in item-space memory. The present research establishes that changes in hippocampal structure are related to improvements in relational memory, and that sub-regional changes in hippocampal volume differentially predict changes in different aspects of relational memory. These findings underscore a division of labor along the anterior-posterior axis of the hippocampus during child development.

Abstract Background When central or peripheral intravenous access cannot be achieved in a timely manner, intraosseous (IO) access is recommended as a safe and equally effective alternative for pediatric resuscitation. IO usage and its complications in the pediatric population have been primarily studied in the setting of cardiac arrest. However, population-based studies identifying noncardiac indications and complications associated with different age groups are sparse. Results This was a retrospective observational cohort study utilizing the TriNetX® electronic health record data. Thirty-seven hospitals were included in the data set with 1012 patients where an IO procedure code was reported in the emergency department or inpatient setting. The cohort was split into two groups, pediatric subjects < 1 year of age and those ≥ 1 year of age. A total incidence of IO line placement of 18 per 100,000 pediatric encounters was reported. Total mortality was 31.8%, with a higher rate of mortality seen in subjects < 1 year of age (39.2% vs 29.0%; p = 0.0028). A diagnosis of cardiac arrest was more frequent in subjects < 1 year of age (51.5% vs 38.0%; p = 0.002), and a diagnosis of convulsions was more frequent in those ≥ 1 of age (28.0% vs 13.8%; p

BackgroundInfluenza virus is responsible for a large global burden of disease, especially in children. Multiple Organ Dysfunction Syndrome (MODS) is a life-threatening and fatal complication of severe influenza infection.MethodsWe measured RNA expression of 469 biologically plausible candidate genes in children admitted to North American pediatric intensive care units with severe influenza virus infection with and without MODS. Whole blood samples from 191 influenza-infected children (median age 6.4 years, IQR: 2.2, 11) were collected a median of 27 hours following admission; for 45 children a second blood sample was collected approximately seven days later. Extracted RNA was hybridized to NanoString mRNA probes, counts normalized, and analyzed using linear models controlling for age and bacterial co-infections (FDR q

Ultraviolet flare emission can drive photochemistry in exoplanet atmospheres and even serve as the primary source of uncertainty in atmospheric retrievals. Additionally, flare energy budgets are not well understood due to a paucity of simultaneous observations. We present new near-UV (NUV) and optical observations of flares from three M dwarfs obtained at 20 s cadence with Swift and the Transiting Exoplanet Survey Satellite (TESS), along with a reanalysis of flares from two M dwarfs in order to explore the energy budget and timing of flares at NUV-optical wavelengths. We find a 9000 K blackbody underestimates the NUV flux by ≥2× for 54 ± 14% of flares and 14.8× for one flare. We report time lags between the bands of 0.5–6.6 minutes and develop a method to predict the qualitative flare shape and time lag to 36% ± 30% accuracy. The scatter present in optical-NUV relations is reduced by a factor of 2.0 ± 0.6 when comparing the total NUV energy with the TESS energy during the FWHM duration due to the exclusion of the T _eff ≈ 5000 K tail. We show the NUV light curve can be used to remove flares from the optical light curve and consistently detect planets with 20% smaller transits than is possible without flare detrending. Finally, we demonstrate a 10× increase in the literature number of multiwavelength flares with the Early eVolution Explorer (EVE), an astrophysics Small Explorer concept to observe young clusters with simultaneous NUV and optical bands in order to detect young planets, assess their photochemical radiation environments, and observe accretion.

HOPS 87 is a Class 0 protostellar core known to harbor an extremely young bipolar outflow and a hot corino. We report the discovery of localized, chemically rich regions near the bases of the two-lobe bipolar molecular outflow in HOPS 87 containing molecules such as H _2 CO, ^13 CS, H _2 S, OCS, and CH _3 OH, the simplest complex organic molecule (COM). The locations and kinematics suggest that these localized features are due to jet-driven shocks rather than being part of the hot-corino region encasing the protostar. The COM compositions of the molecular gas in these jet-localized regions are relatively simpler than those in the hot-corino zone. We speculate that this simplicity is due to either the liberation of ice with a less complex chemical history or the effects of shock chemistry. Our study highlights the dynamic interplay between the protostellar bipolar outflow, disk, inner-core environment, and the surrounding medium, contributing to our understanding of molecular complexity in solar-like young stellar objects.

Molecular hydrogen (H _2 ) formation and dissociation are key processes that drive the gas life cycle in galaxies. Using the SImulating the LifeCycle of Molecular Clouds zoom-in simulation suite, we explore the utility of future observations of H _2 dissociation and formation for tracking the life cycle of molecular clouds. The simulations used in this work include nonequilibrium H _2 formation, stellar radiation, sink particles, and turbulence. We find that at early times in the cloud evolution H _2 formation rapidly outpaces dissociation and molecular clouds build their mass from the atomic reservoir in their environment. Rapid H _2 formation is also associated with a higher early star formation rate. For the clouds studied here, H _2 is strongly out of chemical equilibrium during the early stages of cloud formation but settles into a bursty chemical steady state about 2 Myr after the first stars form. At the latest stage of cloud evolution, dissociation outweighs formation and the clouds enter a dispersal phase. We discuss how theories of the molecular cloud life cycle and star formation efficiency may be distinguished with observational measurements of H _2 fluorescence with a space-based high-resolution far-UV spectrometer, such as the proposed Hyperion and Eos NASA Explorer missions. Such missions would enable measurements of the H _2 dissociation and formation rates, which we demonstrate can be connected to different phases in a molecular cloud’s star-forming life, including cloud building, rapidly star forming, H _2 chemical equilibrium, and cloud destruction.

2MASS J16075796-2040087 is an ∼5 Myr young star in Upper Sco with evidence for accretion bursts on a timescale of about 15 days and, uncommonly for its age, outflows traced by multicomponent forbidden emission lines (FELs). The accretion bursts may be triggered by a companion at ∼4.6 au. We analyze HIRES spectra optimised for spectro-astrometry to better understand the origin of the several FEL velocity components and determine whether a magnetohydrodynamic (MHD) disk wind is present. The FEL high-velocity component (HVC) traces an asymmetric, bipolar jet ∼700 au long. The jet’s position angle ∼ 277° is not perpendicular to the disk. The lower-velocity emission, classified previously as a disk wind low-velocity component, is found to have more in common with the HVC and overall it is not possible to identify an MHD disk wind component. The spectro-astrometric signal of the low-velocity emission resembles those of jets and its density and ionisation fraction fall into the range of HVCs. We suggest a scenario where the accretion bursts due to the close companion power the jets past the age where such activity ends around most stars. The low-velocity emission here could come from a slow jet launched near the close companion and this emission would be blended with emission from the MHD wind.

Photoevaporation driven by hydrogen-ionizing extreme-ultraviolet (EUV) radiation profoundly shapes the lives of diverse astrophysical objects. We construct an analytical model accounting for the finite timescales of photoheating and photoionization and apply it to the dispersal of protoplanetary disks. The model yields improved estimates for the ionization, temperature, and velocity versus distance from the central source when compared to the classical picture of fully ionized and isothermal winds with temperatures ≈10 ^4 K and speeds ≈10 km s ^−1 . In contrast to the classical picture, the photoevaporative winds take on several distinct hydrodynamical and thermochemical states depending on the central star’s EUV emission rate and spectral hardness: T Tauri stars with EUV luminosities around 10 ^30 erg s ^−1 drive nonisothermal ionized disk winds at lower temperatures than the classical value if the spectrum is soft, with an average deposited energy per photoionization less than about 3.7 eV. If, however, the spectrum is hard, the winds tend to be atomic and isothermal at most disk radii. For lower EUV intensities, even with soft spectra, atomic winds can emerge beyond ∼10 au through advection. We show that these predictions are in general agreement with detailed radiation hydrodynamics calculations. The model furthermore illustrates how the energy efficiency of photoevaporation varies with the intensity and spectral hardness of the EUV illumination, as well as addressing discrepancies in the literature around the effectiveness of X-ray photoevaporation. The findings highlight the importance of the photoheating and photoionization timescales both for modeling and for understanding winds’ observed behavior.