Pregnant women with type 1 diabetes strive for tight glucose targets (3.5-7.8 mmol/L) to minimise the risks of obstetric and neonatal complications. Despite using diabetes technologies including ...continuous glucose monitoring (CGM), insulin pumps and contemporary insulin analogues, most women struggle to achieve and maintain the recommended pregnancy glucose targets. This study aims to evaluate whether the use of automated closed-loop insulin delivery improves antenatal glucose levels in pregnant women with type 1 diabetes.
A multicentre, open label, randomized, controlled trial of pregnant women with type 1 diabetes and a HbA1c of ≥48 mmol/mol (6.5%) at pregnancy confirmation and ≤ 86 mmol/mol (10%) at randomization. Participants who provide written informed consent before 13 weeks 6 days gestation will be entered into a run-in phase to collect 96 h (24 h overnight) of CGM glucose values. Eligible participants will be randomized on a 1:1 basis to CGM (Dexcom G6) with usual insulin delivery (control) or closed-loop (intervention). The closed-loop system includes a model predictive control algorithm (CamAPS FX application), hosted on an android smartphone that communicates wirelessly with the insulin pump (Dana Diabecare RS) and CGM transmitter. Research visits and device training will be provided virtually or face-to-face in conjunction with 4-weekly antenatal clinic visits where possible. Randomization will stratify for clinic site. One hundred twenty-four participants will be recruited. This takes into account 10% attrition and 10% who experience miscarriage or pregnancy loss. Analyses will be performed according to intention to treat. The primary analysis will evaluate the change in the time spent in the target glucose range (3.5-7.8 mmol/l) between the intervention and control group from 16 weeks gestation until delivery. Secondary outcomes include overnight time in target, time above target (> 7.8 mmol/l), standard CGM metrics, HbA1c and psychosocial functioning and health economic measures. Safety outcomes include the number and severity of ketoacidosis, severe hypoglycaemia and adverse device events.
This will be the largest randomized controlled trial to evaluate the impact of closed-loop insulin delivery during type 1 diabetes pregnancy.
ISRCTN 56898625 Registration Date: 10 April, 2018.
We present the first European network of tree ring δ13C and δ18O, containing 23 sites from Finland to Morocco. Common climate signals are found over broad climatic‐ecological ranges. In temperate ...regions we find positive correlations with summer maximum temperatures and negative correlations with summer precipitation and Palmer Drought Severity Indices (PDSI) with no obvious species‐specific differences. Regional δ13C and δ18O chronologies share high common variance in year‐to‐year variations. Long‐term variations, however, exhibit differences that may reflect spatial variability in environmental forcings, age trends and/or plant physiological responses to increasing atmospheric CO2 concentration. Rotated principal component analysis (RPCA) and climate field correlations enable the identification of four sub‐regions in the δ18O network ‐ northern and eastern Central Europe, Scandinavia and the western Mediterranean. Regional patterns in the δ13C network are less clear and are timescale dependent. Our results indicate that future reconstruction efforts should concentrate on δ18O data in the identified European regions.
Abstract
We present ultraviolet (UV), optical and infrared photometry and optical spectroscopy of the type Ic superluminous supernova (SLSN) Gaia16apd (=SN 2016eay), covering its evolution from 26 d ...before the g-band peak to 234.1 d after the peak. Gaia16apd was followed as a part of the NOT Unbiased Transient Survey (NUTS). It is one of the closest SLSNe known (z = 0.102 ± 0.001), with detailed optical and UV observations covering the peak. Gaia16apd is a spectroscopically typical type Ic SLSN, exhibiting the characteristic blue early spectra with O ii absorption, and reaches a peak Mg = −21.8 ± 0.1 mag. However, photometrically it exhibits an evolution intermediate between the fast and slowly declining type Ic SLSNe, with an early evolution closer to the fast-declining events. Together with LSQ12dlf, another SLSN with similar properties, it demonstrates a possible continuum between fast and slowly declining events. It is unusually UV-bright even for an SLSN, reaching a non-K-corrected Muvm2 ≃ −23.3 mag, the only other type Ic SLSN with similar UV brightness being SN 2010gx. Assuming that Gaia16apd was powered by magnetar spin-down, we derive a period of P = 1.9 ± 0.2 ms and a magnetic field of B = 1.9 ± 0.2 × 1014 G for the magnetar. The estimated ejecta mass is between 8 and 16 M⊙, and the kinetic energy between 1.3 and 2.5 × 1052 erg, depending on opacity and assuming that the entire ejecta is swept up into a thin shell. Despite the early photometric differences, the spectra at late times are similar to slowly declining type Ic SLSNe, implying that the two subclasses originate from similar progenitors.
ABSTRACT
We present the results from a dense multwavelength optical/UV, near-infrared (IR), and X-ray follow-up campaign of the nuclear transient AT 2017gge, covering a total of 1698 d from the ...transient’s discovery. The bolometric light curve, the blackbody temperature and radius, the broad H and He i λ5876 emission lines and their evolution with time, are all consistent with a tidal disruption event (TDE) nature. A soft X-ray flare is detected with a delay of ∼200 d with respect to the optical/UV peak and it is rapidly followed by the emergence of a broad He ii λ4686 and by a number of long-lasting high ionization coronal emission lines. This indicate a clear connection between a TDE flare and the appearance of extreme coronal line emission (ECLEs). An IR echo, resulting from dust re-radiation of the optical/UV TDE light is observed after the X-ray flare and the associated near-IR spectra show a transient broad feature in correspondence of the He i λ10830 and, for the first time in a TDE, a transient high-ionization coronal NIR line (the Fe xiii λ10798) is also detected. The data are well explained by a scenario in which a TDE occurs in a gas-and-dust rich environment and its optical/UV, soft X-ray, and IR emission have different origins and locations. The optical emission may be produced by stellar debris stream collisions prior to the accretion disc formation, which is instead responsible for the soft X-ray flare, emitted after the end of the circularization process.
ABSTRACT
Tidal disruption events (TDEs) occur when a star gets torn apart by a supermassive black hole as it crosses its tidal radius. We present late-time optical and X-ray observations of the ...nuclear transient AT2019qiz, which showed the typical signs of an optical-UV transient class commonly believed to be TDEs. Optical spectra were obtained 428, 481, and 828 rest-frame days after optical light-curve peak, and a UV/X-ray observation coincided with the later spectrum. The optical spectra show strong coronal emission lines, including Fe vii, Fe x, Fe xi, and Fe xiv. The Fe lines rise and then fall, except Fe xiv that appears late and rises. We observe increasing flux of narrow H α and H β and a decrease in broad H α flux. The coronal lines have full width at half-maximum ranging from ∼150−300 km s−1, suggesting they originate from a region between the broad- and narrow-line emitting gas. Between the optical flare and late-time observation, the X-ray spectrum softens dramatically. The 0.3–1 keV X-ray flux increases by a factor of ∼50, while the hard X-ray flux decreases by a factor of ∼6. Wide-field Infrared Survey Explorer fluxes also rose over the same period, indicating the presence of an infrared echo. With AT2017gge, AT2019qiz is one of two examples of a spectroscopically confirmed optical-UV TDE showing delayed coronal line emission, supporting speculations that Extreme Coronal Line Emitters in quiescent galaxies can be echos of unobserved past TDEs. We argue that the coronal lines, narrow lines, and infrared emission arise from the illumination of pre-existing material likely related to either a previous TDE or active galactic nucleus activity.
Soft, potentially thermal spectral components observed in some ultra-luminous X-ray sources (ULXs) can be fit with models for emission from cool, optically thick accretion disks. If that description ...is correct, the low temperatures that are observed imply accretion onto "intermediate-mass" black holes. Subsequent work has found that these components may follow an inverse relationship between luminosity and temperature, implying a non-blackbody origin for this emission. We have re-analyzed numerous XMM-Newton spectra of extreme ULXs. Crucially, observations wherein the source fell on a chip gap were excluded owing to their uncertain flux calibration, and the neutral column density along the line of sight to a given source was jointly determined by multiple spectra. The luminosity of the soft component is found to be positively correlated with temperature, and to be broadly consistent with L proportional, variant T super(4) in the measured band pass, as per blackbody emission from a standard thin disk. These results are nominally consistent with accretion onto black holes with masses above the range currently known in Galactic X-ray binaries, though there are important caveats. Emission from inhomogeneous or super-Eddington disks may also be consistent with the data.
Abstract
Accretion disks and coronae around massive black holes have been studied extensively, and they are known to be coupled. Over a period of 30 yr, however, the X-ray (coronal) flux of Mrk 817 ...increased by a factor of 40 while its UV (disk) flux remained relatively steady. Recent high-cadence monitoring finds that the X-ray and UV continua in Mrk 817 are also decoupled on timescales of weeks and months. These findings could require mechanical beaming of the innermost accretion flow, and/or an absorber that shields the disk and/or broad line region (BLR) from the X-ray corona. Herein, we report on a 135 ks observation of Mrk 817 obtained with NuSTAR, complemented by simultaneous X-ray coverage via the Neil Gehrels Swift Observatory. The X-ray data strongly prefer a standard relativistic disk reflection model over plausible alternatives. Comparable fits with related models constrain the spin to lie in the range of 0.5 ≤
a
≤ 1, and the viewing angle to lie between 10° ≤
θ
≤ 22° (including 1
σ
statistical errors and small systematic errors related to differences between the models). The spectra also reveal strong evidence of moderately ionized absorption, similar to but likely less extreme than obscuring events in NGC 5548 and NGC 3783. Archival Swift data suggest that the absorption may be variable. Particularly if the column density of this absorber is higher along the plane of the disk, it may intermittently mask or prevent coupling between the central engine, disk, and BLR in Mrk 817.
Individuals born from pregnancies complicated by preeclampsia have an elevated risk for cognitive impairment. Deviations in maternal plasma angiokines occur for prolonged intervals before clinical ...signs of preeclampsia. We hypothesized that fetal brain vascular and nervous tissue development become deviated during maternal progression toward preeclampsia and that such deviations would be detectable by MR imaging.
In this pilot study, 10 matched (gestational and current ages) pairs (5 boys/5 girls, 7-10 years of age) from preeclampsia or control pregnancies were examined by using diffusion tensor MR imaging. An unbiased voxel-based analysis was conducted on fractional anisotropy and mean diffusivity parametric maps. Six brain ROIs were identified for subsequent analysis by tractography (middle occipital gyrus, caudate nucleus and precuneus, cerebellum, superior longitudinal fasciculus, and cingulate gyrus).
Statistical differences were present between groups for fractional anisotropy in the caudate nucleus (offspring from preeclamptic gestation > controls), volume of the tract for the superior longitudinal fasciculus (offspring from preeclamptic gestation > controls) and the caudate nucleus (offspring from preeclamptic gestation > controls), and for parallel diffusivity of the cingulate gyrus (offspring from preeclamptic gestation > controls).
These novel preliminary results along with previous results from the same children that identified altered cerebral vessel calibers and increased regional brain volumes justify fully powered MR imaging studies to address the impact of preeclampsia on human fetal brain development.
ABSTRACT
We present observations of the unusually luminous Type II supernova (SN) 2016gsd. With a peak absolute magnitude of V = −19.95 ± 0.08, this object is one of the brightest Type II SNe, and ...lies in the gap of magnitudes between the majority of Type II SNe and the superluminous SNe. Its light curve shows little evidence of the expected drop from the optically thick phase to the radioactively powered tail. The velocities derived from the absorption in H α are also unusually high with the blue edge tracing the fastest moving gas initially at 20 000 km s−1, and then declining approximately linearly to 15 000 km s−1 over ∼100 d. The dwarf host galaxy of the SN indicates a low-metallicity progenitor which may also contribute to the weakness of the metal lines in its spectra. We examine SN 2016gsd with reference to similarly luminous, linear Type II SNe such as SNe 1979C and 1998S, and discuss the interpretation of its observational characteristics. We compare the observations with a model produced by the jekyll code and find that a massive star with a depleted and inflated hydrogen envelope struggles to reproduce the high luminosity and extreme linearity of SN 2016gsd. Instead, we suggest that the influence of interaction between the SN ejecta and circumstellar material can explain the majority of the observed properties of the SN. The high velocities and strong H α absorption present throughout the evolution of the SN may imply a circumstellar medium configured in an asymmetric geometry.
Abstract
When discovered, SN 2017egm was the closest (redshift
z
= 0.03) hydrogen-poor superluminous supernova (SLSN-I) and a rare case that exploded in a massive and metal-rich galaxy. Thus, it has ...since been extensively observed and studied. We report spectroscopic data showing strong emission at around He
i
λ
10830 and four He
i
absorption lines in the optical. Consequently, we classify SN 2017egm as a member of an emerging population of helium-rich SLSNe-I (i.e., SLSNe-Ib). We also present our late-time photometric observations. By combining them with archival data, we analyze high-cadence ultraviolet, optical, and near-infrared light curves spanning from early pre-peak (∼−20 days) to late phases (∼+300 days). We obtain its most complete bolometric light curve, in which multiple bumps are identified. None of the previously proposed models can satisfactorily explain all main light-curve features, while multiple interactions between the ejecta and circumstellar material (CSM) may explain the undulating features. The prominent infrared excess with a blackbody luminosity of 10
7
–10
8
L
⊙
detected in SN 2017egm could originate from the emission of either an echo of a pre-existing dust shell or newly formed dust, offering an additional piece of evidence supporting the ejecta–CSM interaction model. Moreover, our analysis of deep Chandra observations yields the tightest-ever constraint on the X-ray emission of an SLSN-I, amounting to an X-ray-to-optical luminosity ratio ≲10
−3
at late phases (∼100–200 days), which could help explore its close environment and central engine.
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