Eddington limited starbursts in the central 10pc of AGN, and the Torus in NGC1068

We present results from a survey of nearby AGN using the near infrared adaptive optics integral field spectrograph SINFONI. These data enable us to probe the distribution and kinematics of the gas and stars at spatial resolutions as small as 0.085arcsec. We find strong evidence for recent but short lived starbursts residing in very dense nuclear disks. On scales of less than 10pc these would have reached Eddington-limited luminosities when active, perhaps accounting for their short duration. In addition, for NGC1068 at a resolution of 6pc, we present direct observations of molecular gas close around the AGN which we identify with the obscuring torus.Comment: Conference proceedings to appear in "The Central Engine of Active Galactic Nuclei", ed. L. C. Ho and J.-M. Wang (San Francisco: ASP

[The Impact of Nuclear Star Formation on Gas Inflow to AGN

Our adaptive optics observations of nearby AGN at spatial resolutions as small as 0.085arcsec show strong evidence for recent, but no longer active, nuclear star formation. We begin by describing observations that highlight two contrasting methods by which gas can flow into the central tens of parsecs. Gas accumulation in this region will inevitably lead to a starburst, and we discuss the evidence for such events. We then turn to the impact of stellar evolution on the further inflow of gas by combining a phenomenological approach with analytical modelling and hydrodynamic simulations. These complementary perspectives paint a picture in which all the processes are ultimately regulated by the mass accretion rate into the central hundred parsecs, and the ensuing starburst that occurs there. The resulting supernovae delay accretion by generating a starburst wind, which leaves behind a clumpy interstellar medium. This provides an ideal environment for slower stellar outflows to accrete inwards and form a dense turbulent disk on scales of a few parsecs. Such a scenario may resolve the discrepancy between the larger scale structure seen with adaptive optics and the small scale structure seen with VLTI.Comment: to appear in: Co-Evolution of Central Black Holes and Galaxies; 7 page

Evaluation of patients treated with natalizumab for progressive multifocal leukoencephalopathy

Background: Progressive multifocal leukoencephalopathy (PML) was reported to have developed in three patients treated with natalizumab. We conducted an evaluation to determine whether PML had developed in any other treated patients. Methods: We invited patients who had participated in clinical trials in which they received recent or long-term treatment with natalizumab for multiple sclerosis, Crohn's disease, or rheumatoid arthritis to participate. The clinical history, physical examination, brain magnetic resonance imaging (MRI), and testing of cerebrospinal fluid for JC virus DNA were used by an expert panel to evaluate patients for PML. We estimated the risk of PML in patients who completed at least a clinical examination for PML or had an MRI. Results: Of 3417 patients who had recently received natalizumab while participating in clinical trials, 3116 (91 percent) who were exposed to a mean of 17.9 monthly doses underwent evaluation for PML. Of these, 44 patients were referred to the expert panel because of clinical findings of possible PML, abnormalities on MRI, or a high plasma viral load of JC virus. No patient had detectable JC virus DNA in the cerebrospinal fluid. PML was ruled out in 43 of the 44 patients, but it could not be ruled out in one patient who had multiple sclerosis and progression of neurologic disease because data on cerebrospinal fluid testing and follow-up MRI were not available. Only the three previously reported cases of PML were confirmed (1.0 per 1000 treated patients; 95 percent confidence interval, 0.2 to 2.8 per 1000). Conclusions: A detailed review of possible cases of PML in patients exposed to natalizumab found no new cases and suggested a risk of PML of roughly 1 in 1000 patients treated with natalizumab for a mean of 17.9 months. The risk associated with longer treatment is not known

A Close Look at Star Formation around Active Galactic Nuclei

We analyse star formation in the nuclei of 9 Seyfert galaxies at spatial resolutions down to 0.085arcsec, corresponding to length scales of less than 10pc in some objects. Our data were taken mostly with the near infrared adaptive optics integral field spectrograph SINFONI. The stellar light profiles typically have size scales of a few tens of parsecs. In two cases there is unambiguous kinematic evidence for stellar disks on these scales. In the nuclear regions there appear to have been recent - but no longer active - starbursts in the last 10-300Myr. The stellar luminosity is less than a few percent of the AGN in the central 10pc, whereas on kiloparsec scales the luminosities are comparable. The surface stellar luminosity density follows a similar trend in all the objects, increasing steadily at smaller radii up to 10^{13}L_sun/kpc^2 in the central few parsecs, where the mass surface density exceeds 10^4M_sun/pc^2. The intense starbursts were probably Eddington limited and hence inevitably short-lived, implying that the starbursts occur in multiple short bursts. The data hint at a delay of 50--100Myr between the onset of star formation and subsequent fuelling of the black hole. We discuss whether this may be a consequence of the role that stellar ejecta could play in fuelling the black hole. While a significant mass is ejected by OB winds and supernovae, their high velocity means that very little of it can be accreted. On the other hand winds from AGB stars ultimately dominate the total mass loss, and they can also be accreted very efficiently because of their slow speeds.Comment: 51 pages, including 27 figures; accepted by ApJ (paper reorganised, but results & conclusions the same

Indications and practical approach to non-invasive ventilation in acute heart failure

In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique

Prohormones in the early diagnosis of cardiac syncope

Background--The early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional-pro-A-type natriuretic peptide (MRproANP), C-terminal proendothelin 1, copeptin, and midregionalproadrenomedullin. Methods and Results--We prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study. ED probability of cardiac syncope was quantified by the treating ED physician using a visual analogue scale. Prohormones were measured in a blinded manner. Two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information, including 1-year follow-up. Among 689 patients, cardiac syncope was the adjudicated final diagnosis in 125 (18%). Plasma concentrations of MRproANP, C-terminal proendothelin 1, copeptin, and midregional-proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (P < 0.001). The diagnostic accuracies for cardiac syncope, as quantified by the area under the curve, were 0.80 (95% confidence interval [CI], 0.76-0.84), 0.69 (95% CI, 0.64-0.74), 0.58 (95% CI, 0.52-0.63), and 0.68 (95% CI, 0.63-0.73), respectively. In conjunction with the ED probability (0.86; 95% CI, 0.82-0.90), MRproANP, but not the other prohormone, improved the area under the curve to 0.90 (95% CI, 0.87-0.93), which was significantly higher than for the ED probability alone (P=0.003). An algorithm to rule out cardiac syncope combining an MRproANP level of < 77 pmol/L and an ED probability of < 20% had a sensitivity and a negative predictive value of 99%. Conclusions--The use of MRproANP significantly improves the early detection of cardiac syncope among unselected patients presenting to the ED with syncope

Electrically Tunable Excitonic Light Emitting Diodes based on Monolayer WSe2 p-n Junctions

Light-emitting diodes are of importance for lighting, displays, optical interconnects, logic and sensors. Hence the development of new systems that allow improvements in their efficiency, spectral properties, compactness and integrability could have significant ramifications. Monolayer transition metal dichalcogenides have recently emerged as interesting candidates for optoelectronic applications due to their unique optical properties. Electroluminescence has already been observed from monolayer MoS2 devices. However, the electroluminescence efficiency was low and the linewidth broad due both to the poor optical quality of MoS2 and to ineffective contacts. Here, we report electroluminescence from lateral p-n junctions in monolayer WSe2 induced electrostatically using a thin boron nitride support as a dielectric layer with multiple metal gates beneath. This structure allows effective injection of electrons and holes, and combined with the high optical quality of WSe2 it yields bright electroluminescence with 1000 times smaller injection current and 10 times smaller linewidth than in MoS2. Furthermore, by increasing the injection bias we can tune the electroluminescence between regimes of impurity-bound, charged, and neutral excitons. This system has the required ingredients for new kinds of optoelectronic devices such as spin- and valley-polarized light-emitting diodes, on-chip lasers, and two-dimensional electro-optic modulators.Comment: 13 pages main text with 4 figures + 4 pages upplemental material

Treatment of distal humeral fractures using conventional implants. Biomechanical evaluation of a new implant configuration

<p>Abstract</p> <p>Background</p> <p>In the face of costly fixation hardware with varying performance for treatment of distal humeral fractures, a novel technique (U-Frame) is proposed using conventional implants in a 180° plate arrangement. In this in-vitro study the biomechanical stability of this method was compared with the established technique which utilizes angular stable locking compression plates (LCP) in a 90° configuration.</p> <p>Methods</p> <p>An unstable distal 3-part fracture (AO 13-C2.3) was created in eight pairs of human cadaveric humeri. All bone pairs were operated with either the "Frame" technique, where two parallel plates are distally interconnected, or with the LCP technique. The specimens were cyclically loaded in simulated flexion and extension of the arm until failure of the construct occurred. Motion of all fragments was tracked by means of optical motion capturing. Construct stiffness and cycles to failure were identified for all specimens.</p> <p>Results</p> <p>Compared to the LCP constructs, the "Frame" technique revealed significant higher construct stiffness in extension of the arm (P = 0.01). The stiffness in flexion was not significantly different (P = 0.16). Number of cycles to failure was found significantly larger for the "Frame" technique (P = 0.01).</p> <p>Conclusions</p> <p>In an in-vitro context the proposed method offers enhanced biomechanical stability and at the same time significantly reduces implant costs.</p

The Star-Forming Torus and Stellar Dynamical Black Hole Mass in the Seyfert 1 Nucleus of NGC3227

We report R~4300 VLT SINFONI adaptive optics integral field K-band spectroscopy of the nucleus of the Seyfert 1 galaxy NGC3227 at a spatial resolution of 0.085" (7pc). We present the morphologies and kinematics of emission lines and absorption features, and give the first derivation of a black hole mass in a Seyfert 1 nucleus from spatially resolved stellar dynamics. We show that the gas in the nucleus has a mean column density of order 10^{24}-10^{25}cm^{-2} and that it is geometrically thick, in agreement with the standard `molecular torus' scenario. We discuss which heating processes may be responsible for maintaining the vertical height of the torus. We have also resolved the nuclear stellar distribution, and find that within a few parsecs of the AGN there has been an intense starburst, the most recent episode of which began ~40Myr ago but has now ceased. The current luminosity of stars within 30pc of the AGN, ~3x10^9L_sun, is comparable to that of the AGN. Based on a comparison of the respective size scales, we argue that the star formation has been occuring in the obscuring torus. Finally, we present the first derivation of a black hole mass in a Seyfert 1 nucleus from stellar dynamics which marginally spatially resolve the black hole's sphere of influence. We apply Schwarzschild orbit superposition models to our full 2-dimensional data and derive the mass of the black hole, paying careful attention to the input parameters which are often uncertain: the contribution of the large scale bulge and its mass-to-light ratio; the recent star formation in the nucleus and its mass-to-light ratio; the contribution of the gas mass to the potential; and the inclination. Our models yield a 1sigma range for the black hole mass of M_{BH} = 7x10^6-2x10^7M_sun.Comment: Accepted by ApJ, 42 pages with 20 figure