MUSE-inspired view of the quasar Q2059-360, its Lyman alpha blob, and its neighborhood

The radio-quiet quasar Q2059-360 at redshift $z=3.08$ is known to be close to a small Lyman $\alpha$ blob (LAB) and to be absorbed by a proximate damped Ly$\alpha$ (PDLA) system. Here, we present the Multi Unit Spectroscopic Explorer (MUSE) integral field spectroscopy follow-up of this quasi-stellar object (QSO). Our primary goal is to characterize this LAB in detail by mapping it both spatially and spectrally using the Ly$\alpha$ line, and by looking for high-ionization lines to constrain the emission mechanism. Combining the high sensitivity of the MUSE integral field spectrograph mounted on the Yepun telescope at ESO-VLT with the natural coronagraph provided by the PDLA, we map the LAB down to the QSO position, after robust subtraction of QSO light in the spectral domain. In addition to confirming earlier results for the small bright component of the LAB, we unveil a faint filamentary emission protruding to the south over about 80 pkpc (physical kpc); this results in a total size of about 120 pkpc. We derive the velocity field of the LAB (assuming no transfer effects) and map the Ly$\alpha$ line width. Upper limits are set to the flux of the N V $\lambda 1238-1242$, C IV $\lambda 1548-1551$, He II $\lambda 1640$, and C III] $\lambda 1548-1551$ lines. We have discovered two probable Ly$\alpha$ emitters at the same redshift as the LAB and at projected distances of 265 kpc and 207 kpc from the QSO; their Ly$\alpha$ luminosities might well be enhanced by the QSO radiation. We also find an emission line galaxy at $z=0.33$ near the line of sight to the QSO. This LAB shares the same general characteristics as the 17 others surrounding radio-quiet QSOs presented previously. However, there are indications that it may be centered on the PDLA galaxy rather than on the QSO.Comment: Accepted for publication in Astronomy & Astrophysics; 16 pages, 19 figure

Calibrating Galaxy Redshifts Using Absorption by the Surrounding Intergalactic Medium

Rest-frame UV spectral lines of star-forming galaxies are systematically offset from the galaxies' systemic redshifts, probably because of large-scale outflows. We calibrate galaxy redshifts measured from rest-frame UV lines by utilizing the fact that the mean HI Ly-alpha absorption profiles around the galaxies, as seen in spectra of background objects, must be symmetric with respect to the true galaxy redshifts if the galaxies are oriented randomly with respect to the lines of sight to the background objects. We use 15 QSOs at z~2.5-3 and more than 600 foreground galaxies with spectroscopic redshifts at z~1.9-2.5. All galaxies are within 2 Mpc proper from the lines of sight to the background QSOs. We find that LyA emission and ISM absorption redshifts require systematic shifts of v_LyA=-295(+35)(-35) km/s and v_ISM=145(+70)(-35) km/s. Assuming a Gaussian distribution, we put 1-sigma upper limits on possible random redshift offsets of <220 km/s for LyA and <420 km/s for ISM redshifts. For the small subset (<10%) of galaxies for which near-IR spectra have been obtained, we can compare our results to direct measurements based on nebular emission lines which we confirm to mark the systemic redshifts. While our v_ISM agrees with the direct measurements, our v_LyA is significantly smaller. However, when we apply our method to the near-IR subsample which is characterized by slightly different selection effects, the best-fit velocity offset comes into agreement with the direct measurement. This confirms the validity of our approach, and implies that no single number appropriately describes the whole population of galaxies, in line with the observation that the line offset depends on galaxy spectral morphology. This method provides accurate redshift calibrations and will enable studies of circumgalactic matter around galaxies for which rest-frame optical observations are not available.Comment: 7 pages, 3 figures, accepted for publication in MNRA

Brand and generic use of inhalation medication and frequency of switching in children and adults : a population-based cohort study

BACKGROUND: The expiration of patents of brand inhalation medications and the ongoing pressure on healthcare budgets resulted in a growing market for generics. AIM: To study the use of brand and generic inhalation medication and the frequency of switching between brand and generic and between devices. In addition, we investigated whether switching affected adherence. METHODS: From dispensing data from the Dutch PHARMO Database Network a cohort aged ≥ 5 years, using ≥ 1 year of inhalation medication between 2003 and 2012 was selected. Switching was defined as changing from brand to generic or vice versa. In addition, we studied change in aerosol delivery device type (e.g., DPI, pMDI, and nebulizers). Adherence was calculated using the medication possession ratio (MPR). RESULTS: The total cohort comprised 70,053 patients with 1,604,488 dispensations. Per calendar year, 5% switched between brand and generic inhalation medication and 5% switched between devices. Median MPRs over the first 12 months ranged between 33 and 55%. Median MPR over the total period was lower after switch from brand to generic and vice versa for formoterol (44.5 vs. 42.1 and 63.5 vs. 53.8) and beclomethasone (93.8 vs. 59.8 and 81.3 vs. 55.9). CONCLUSION: Per year, switching between brand and generic inhalation medication was limited to 5% of the patients, switching between device types was observed in 5% as well. Adherence to both generic and brand inhalation medication was low. Effect of switching on adherence was contradictory; depending on time period, medication and type, and direction of switching. Further research on reasons for switching and potential impact on clinical outcomes is warranted

Hypertension in older patients, a retrospective cohort study

Background: It is unknown to what extent General Practitioners (GPs) manage hypertension (HT) differently in older patients, as compared to younger age groups. The purpose of our study was to compare HT management in older patients to younger age groups. Methods: We performed a retrospective cohort study of patients of 159 GP's practices in the Integrated Primary Care Information (IPCI) database. The study period lasted from September 2010 through December 2012. The study population consisted of all patients aged 60 years or older with at least one blood pressure (BP) measurement during the inclusion period, without pre-existent HT, diabetes mellitus (DM) or atherosclerotic cardiovascular disease at time of study start. Study outcomes were a diagnosis of HT within one month after cohort entry and the use of antihypertensive medication within 4 months after cohort entry in HT diagnosed patients. We compared the incidence of outcomes between the age groups, stratified by systolic blood pressure (SBP). Logistic regression analysis was used to assess the influence of age-adjusted SBP Z-scores, age and gender on the outcomes. Results: We included 19,500 patients from 159 GP's practices of whom 1,181 (6.1 %) were newly diagnosed with HT. Corrected for age-adjusted SBP, older patients were less likely to be diagnosed with HT (odds ratio per year age increase 0.98, p < 0.001). Corrected for age-adjusted SBP, no significant effect of age on the probability of treatment in newly diagnosed HT patients was observed (p = 0.82). Conclusions: This study showed that GPs are less inclined to diagnose HT with increasing patient age, but do not withhold treatment when they diagnose HT in older patients

The properties of the brightest Lyα emitters at z ∼ 5.7

We use deep Very Large Telescope (VLT) optical and near-infrared spectroscopy and deep Spitzer/IRAC imaging to examine the properties of two of the most luminous Lyα emitters at z= 5.7. The continuum redward of the Lyα line is clearly detected in both objects, thus facilitating a relatively accurate measurement (10-20 per cent uncertainties) of the observed rest-frame equivalent widths, which are around 160 Å for both objects. Through detailed modelling of the profile of the Lyα line with a 3D Monte Carlo radiative transfer code, we estimate the intrinsic rest-frame equivalent width of Lyα and find values that are around 300 Å, which is at the upper end of the range allowed for very young, moderately metal-poor star-forming galaxies. However, the uncertainties are large and values as high as 700 Å are permitted by the data. Both Lyα emitters are detected at 3.6 m in deep images taken with the Spitzer Space Telescope. We use these measurements, the measurement of the continuum redward of Lyα and other photometry to constrain the spectral energy distributions of these very luminous Lyα emitters and to compare them with three similar Lyα emitters from the literature. The contribution from nebular emission is included in our models: excluding it results in significantly higher masses. Four of the five Lyα emitters have masses of the order of ∼109 M⊙ and fairly high specific star formation rates (≳10-100 Gyr−1). While our two Lyα emitters appear similar in terms of the observed Lyα rest-frame equivalent width, they are quite distinct from each other in terms of age, mass and star formation history. Evidence for dust is found in all objects, and emission from nebular lines often makes a dominant contribution to the rest-frame 3.6 m flux. Rich in emission lines, these objects are prime targets for the next generation of extremely large telescopes, the James Webb Space Telescope (JWST) and the Atacama Large Millimeter Array (ALMA

Diagnostic challenges in chronic inflammatory demyelinating polyradiculoneuropathy

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) consists of a spectrum of autoimmune diseases of the peripheral nerves, causing weakness and sensory symptoms. Diagnosis often is challenging, because of the heterogeneous presentation and both mis- and underdiagnosis are common. Nerve conduction study (NCS) abnormalities suggestive of demyelination are mandatory to fulfil the diagnostic criteria. On the one hand, performance and interpretation of NCS can be difficult and none of these demyelinating findings are specific for CIDP. On the other hand, not all patients will be detected despite the relatively high sensitivity of NCS abnormalities. The electrodiagnostic criteria can be supplemented with additional diagnostic tests such as CSF examination, MRI, nerve biopsy, and somatosensory evoked potentials. However, the evidence for each of these additional diagnostic tests is limited. Studies are often small without the use of a clinically relevant control group. None of the findings are specific for CIDP, meaning that the results of the diagnostic tests should be carefully interpreted. In this update we will discuss the pitfalls in diagnosing CIDP and the value of newly introduced diagnostic tests such as nerve ultrasound and testing for autoantibodies, which are not yet part of the guidelines

Epidemiology of chronic inflammatory demyelinating polyradiculoneuropathy in The Netherlands

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare but disabling disorder that often requires long‐term immunomodulatory treatment. Background incidence rates and prevalence and risk factors for developing CIDP are still poorly defined. In the current study, we used a longitudinal population‐based cohort study in The Netherlands to assess these rates and demographic factors and comorbidity associated with CIDP. We determined the incidence rate and prevalence of CIDP between 2008 and 2017 and the occurrence of potential risk factors in a retrospective Dutch cohort study using the Integrated Primary Care Information (IPCI) database. Cases were defined as CIDP if the diagnosis of CIDP was described in the electronic medical file. In a source population of 928 030 persons with a contributing follow‐up of 3 525 686 person‐years, we identified 65 patients diagnosed with CIDP. The overall incidence rate was 0.68 per 100 000 person‐years (95% CI 0.45‐0.99). The overall prevalence was 7.00 per 100 000 individuals (95% CI 5.41‐8.93). The overall incidence rate was higher in men compared to woman (IRR 3.00, 95% CI 1.27‐7.11), and higher in elderly of 50 years or older compared with people <50 years of age (IRR 17 95% CI 4‐73). Twenty percent of CIDP cases had DM and 9% a co‐existing other auto‐immune disease. These background rates are important to monitor changes in the frequency of CIDP following infectious disease outbreaks, identify potential risk factors, and to estimate the social and economic burden of CIDP

Ubiquitous giant Ly α\alpha nebulae around the brightest quasars at z∼3.5z\sim3.5 revealed with MUSE

Direct Ly $\alpha$ imaging of intergalactic gas at $z\sim2$ has recently revealed giant cosmological structures around quasars, e.g. the Slug Nebula (Cantalupo et al. 2014). Despite their high luminosity, the detection rate of such systems in narrow-band and spectroscopic surveys is less than 10%, possibly encoding crucial information on the distribution of gas around quasars and the quasar emission properties. In this study, we use the MUSE integral-field instrument to perform a blind survey for giant Ly $\alpha$ nebulae around 17 bright radio-quiet quasars at $3<z<4$ that does not suffer from most of the limitations of previous surveys. After data reduction and analysis performed with specifically developed tools, we found that each quasar is surrounded by giant Ly $\alpha$ nebulae with projected sizes larger than 100 physical kpc and, in some cases, extending up to 320 kpc. The circularly averaged surface brightness profiles of the nebulae appear very similar to each other despite their different morphologies and are consistent with power laws with slopes $\approx-1.8$. The similarity between the properties of all these nebulae and the Slug Nebula suggests a similar origin for all systems and that a large fraction of gas around bright quasars could be in a relatively "cold" (T$\sim$10$^4$K) and dense phase. In addition, our results imply that such gas is ubiquitous within at least 50 kpc from bright quasars at $3<z<4$ independently of the quasar emission opening angle, or extending up to 200 kpc for quasar isotropic emission.Comment: 19 pages, 9 figures, 3 Tables, accepted to Ap

An extreme [OIII] emitter at z=3.2z=3.2: a low metallicity Lyman continuum source

[Abridged] We investigate the physical properties of a Lyman continuum emitter candidate at $z=3.212$ with photometric coverage from $U$ to MIPS 24$\mu$m band and VIMOS/VLT and MOSFIRE/Keck spectroscopy. Investigation of the UV spectrum confirms a direct spectroscopic detection of the Lyman continuum emission with $S/N>5$. Non-zero Ly$\alpha$ flux at the systemic redshift and high Lyman-$\alpha$ escape fraction suggest a low HI column density. The weak C and Si low-ionization absorption lines are also consistent with a low covering fraction along the line of sight. The [OIII]$\lambda\lambda4959,5007+\mathrm{H}\beta$ equivalent width is one of the largest reported for a galaxy at $z>3$ ($\mathrm{EW}([\mathrm{OIII}]\lambda\lambda4959,5007+\mathrm{H}\beta) \simeq 1600\AA$, rest-frame) and the NIR spectrum shows that this is mainly due to an extremely strong [OIII] emission. The large observed [OIII]/[OII] ratio ($>10$) and high ionization parameter are consistent with prediction from photoionization models in case of a density-bounded nebula scenario. Furthermore, the $\mathrm{EW}([\mathrm{OIII}]\lambda\lambda4959,5007+\mathrm{H}\beta)$ is comparable to recent measurements reported at $z\sim7-9$, in the reionization epoch. We also investigate the possibility of an AGN contribution to explain the ionizing emission but most of the AGN identification diagnostics suggest that stellar emission dominates instead. This source is currently the first high-$z$ example of a Lyman continuum emitter exhibiting indirect and direct evidences of a Lyman continuum leakage and having physical properties consistent with theoretical expectation from Lyman continuum emission from a density-bounded nebula.Comment: 14 pages, 11 figures, accepted for publication in A&A. Minor modifications, Figure 2 updated, Figure 9 adde