From X-ray dips to eclipse: Witnessing disk reformation in the recurrent nova USco

The 10th recorded outburst of the recurrent eclipsing nova USco was observed simultaneously in X-ray, UV, and optical by XMM-Newton on days 22.9 and 34.9 after outburst. Two full passages of the companion in front of the nova ejecta were observed, witnessing the reformation of the accretion disk. On day 22.9, we observed smooth eclipses in UV and optical but deep dips in the X-ray light curve which disappeared by day 34.9, then yielding clean eclipses in all bands. X-ray dips can be caused by clumpy absorbing material that intersects the line of sight while moving along highly elliptical trajectories. Cold material from the companion could explain the absence of dips in UV and optical light. The disappearance of X-ray dips before day 34.9 implies significant progress in the formation of the disk. The X-ray spectra contain photospheric continuum emission plus strong emission lines, but no clear absorption lines. Both continuum and emission lines in the X-ray spectra indicate a temperature increase from day 22.9 to day 34.9. We find clear evidence in the spectra and light curves for Thompson scattering of the photospheric emission from the white dwarf. Photospheric absorption lines can be smeared out during scattering in a plasma of fast electrons. We also find spectral signatures of resonant line scattering that lead to the observation of the strong emission lines. Their dominance could be a general phenomenon in high-inclination systems such as Cal87.Comment: Submitted to ApJ. 16 pages, 16 figure

A public at risk: Personal fitness trainers without a standard of care

In 2002, an overweight, sedentary, and middle-aged man suffered a heart attack during his first workout with his “certified” personal trainer. During the workout, the man repeatedly asked to stop because he was experiencing fatigue, heat, thirst, breathlessness, and chest pain. The trainer responded to requests to stop and complaints of fatigue by questioning his client’s masculinity and by continuing the workout. In the lawsuit that followed (Rostai v. Neste Enterprises, 2006), the court did not have the option to consider a statutorily defined standard of care since no licensing requirements existed for those who design and/or lead fitness programs. The court examined the facts and law as presented including the trainer’s conduct, expert testimony, as well as a doctrine known as “primary assumption of risk.” In the end, the court held that under this doctrine, the trainer owed no duty to protect a client from the risks inherent with exercise or to avoid challenging him beyond his current capacity during an initial training session. Simply put, the client assumed the risks associated with exercise, including a risk as serious as a heart attack [1, 2]

An Empirical Method of Detecting Time-Dependent Confounding: An Observational Study of Next Day Delirium in a Medical ICU

Longitudinal research on older persons in the medical intensive care unit (MICU) is often complicated by the time-dependent confounding of concurrently administered interventions such as medications and intubation. Such temporal confounding can bias the respective longitudinal associations between concurrently administered treatments and a longitudinal outcome such as delirium. Although marginal structural models address time-dependent confounding, their application is non-trivial and preferably justified by empirical evidence. Using data from a longitudinal study of older persons in the MICU, we constructed a plausibility score from 0 - 10 where higher values indicate higher plausibility of time-dependent confounding of the association between a time-varying explanatory variable and an outcome. Based on longitudinal plots, measures of correlation, and longitudinal regression, the plausibility scores were compared to the differences in estimates obtained with non-weighted and marginal structural models of next day delirium. The plausibility scores of the three possible pairings of daily doses of fentanyl, haloperidol, and intubation indicated the following: low plausibility for haloperidol and intubation, moderate plausibility for fentanyl and haloperidol, and high plausibility for fentanyl and intubation. Comparing multivariable models of next day delirium with and without adjustment for time-dependent confounding, only intubation's association changed substantively. In our observational study of older persons in the MICU, the plausibility scores were generally reflective of the observed differences between coefficients estimated from non-weighted and marginal structural models

Collimation and asymmetry of the hot blast wave from the recurrent nova V745 Scorpii

The recurrent symbiotic nova V745 Sco exploded on 2014 February 6 and was observed on February 22 and 23 by the Chandra X-ray Observatory Transmission Grating Spectrometers. By that time the supersoft source phase had already ended and Chandra spectra are consistent with emission from a hot, shock-heated circumstellar medium with temperatures exceeding 10^7K. X-ray line profiles are more sharply peaked than expected for a spherically-symmetric blast wave, with a full width at zero intensity of approximately 2400 km/s, a full width at half maximum of 1200 +/- 30 km/s and an average net blueshift of 165 +/- 10 km/s. The red wings of lines are increasingly absorbed toward longer wavelengths by material within the remnant. We conclude that the blast wave was sculpted by an aspherical circumstellar medium in which an equatorial density enhancement plays a role, as in earlier symbiotic nova explosions. Expansion of the dominant X-ray emitting material is aligned close to the plane of the sky and most consistent with an orbit seen close to face-on. Comparison of an analytical blast wave model with the X-ray spectra, Swift observations and near-infrared line widths indicates the explosion energy was approximately 10^43 erg, and confirms an ejected mass of approximately 10^-7 Msun. The total mass lost is an order of magnitude lower than the accreted mass required to have initiated the explosion, indicating the white dwarf is gaining mass and is a supernova Type 1a progenitor candidate.Comment: To appear in the Astrophysical Journa

Does Gender Impact Intensity of Care Provided to Older Medical Intensive Care Unit Patients?

Introduction. Women receive less aggressive critical care than men based on prior studies. No documented studies evaluate whether men and women are treated equally in the medical intensive care unit (MICU). The Therapeutic Intervention Scoring System-28 (TISS-28) has been used to examine gender differences in mixed ICU studies. However, it has not been used to evaluate equivalence of care in older MICU patients. We hypothesize that given nonsignificant, baseline health differences between genders at MICU admission, the level of care provided would be equivalent. Methods. Prospective cohort of 309 patients ≥60 years old in the MICU of an urban university teaching hospital. Explanatory variables were demographic data and baseline measures. Primary outcomes were TISS-28 scores and MICU interventions. We compare TISS-28 scores by gender using a statistical test of equivalence. Results. Women were older and had more chronic respiratory failure at MICU admission. Using equivalence limits of ±15% on gender-based scores of TISS-28, MICU interventions were equivalent. Supplementary analysis showed no statistically significant association between gender and mortality. Conclusions. In contrast with other reports from the cardiac critical care literature, as measured by the TISS-28, gender-based care delivered to older MICU patients in this cohort was equivalent

Swift X-ray Observations of Classical Novae

The new gamma-ray burst mission Swift has obtained pointed observations of several classical novae in outburst. We analyzed all the observations of classical novae from the Swift archive up to 30 June, 2006. We analyzed usable observations of 12 classical novae and found 4 non-detections, 3 weak sources and 5 strong sources. This includes detections of 2 novae exhibiting spectra resembling those of Super Soft X-ray binary Source spectra (SSS) implying ongoing nuclear burning on the white dwarf surface. With these new Swift data, we add to the growing statistics of the X-ray duration and characteristics of classical novae.Comment: Accepted for ApJ; this version contains additional material: 18 pages, 16 figure

Pan-chromatic observations of the remarkable nova LMC 2012

We present the results of an intensive multiwavelength campaign on nova LMC 2012. This nova evolved very rapidly in all observed wavelengths. The time to fall two magnitudes in the V band was only 2 days. In X-rays the super soft phase began 13$\pm$5 days after discovery and ended around day 50 after discovery. During the super soft phase, the \Swift/XRT and \Chandra\ spectra were consistent with the underlying white dwarf being very hot, $\sim$ 1 MK, and luminous, $\sim$ 10$^{38}$ erg s$^{-1}$. The UV, optical, and near-IR photometry showed a periodic variation after the initial and rapid fading had ended. Timing analysis revealed a consistent 19.24$\pm$0.03 hr period in all UV, optical, and near-IR bands with amplitudes of $\sim$ 0.3 magnitudes which we associate with the orbital period of the central binary. No periods were detected in the corresponding X-ray data sets. A moderately high inclination system, $i$ = 60$\pm$10^{\arcdeg}, was inferred from the early optical emission lines. The {\it HST}/STIS UV spectra were highly unusual with only the \ion{N}{5} (1240\AA) line present and superposed on a blue continuum. The lack of emission lines and the observed UV and optical continua from four epochs can be fit with a low mass ejection event, $\sim$ 10$^{-6}$ M$_{\odot}$, from a hot and massive white dwarf near the Chandrasekhar limit. The white dwarf, in turn, significantly illuminated its subgiant companion which provided the bulk of the observed UV/optical continuum emission at the later dates. The inferred extreme white dwarf characteristics and low mass ejection event favor nova LMC 2012 being a recurrent nova of the U Sco subclass.Comment: 18 figures, 6 tables (one online only containing all the photometry

A research algorithm to improve detection of delirium in the intensive care unit

INTRODUCTION: Delirium is a serious and prevalent problem in intensive care units (ICUs). The purpose of this study was to develop a research algorithm to enhance detection of delirium in critically ill ICU patients using chart review to complement a validated clinical delirium instrument. METHODS: A prospective cohort study was conducted in 178 patients aged 60 years and older who were admitted to the medical ICU. The Confusion Assessment Method for the ICU (CAM-ICU) and a validated chart review method for detecting delirium were performed daily. We assessed the diagnostic accuracy of the chart-based delirium method using the CAM-ICU as the 'gold standard'. We then used an algorithm to detect delirium first using the CAM-ICU ratings and then chart review when the CAM-ICU was unavailable. RESULTS: When using both the CAM-ICU and the chart-based review, the prevalence of delirium was found to be 80% of patients (143 out of 178) or 64% of patient-days (929 out of 1,457). Of these patient-days, 292 were classified as delirium by the CAM-ICU. The remainder (637 patient-days) were classified as delirium by the validated chart review method when CAM-ICU was missing because the assessment was conducted for weekends or holidays (404 patient-days), when CAM-ICU was not performed because of stupor or coma (205 patient-days), and when the CAM-ICU was negative (28 patient-days). Sensitivity of the chart-based method was 64% and specificity was 85%. Overall agreement between chart and the CAM-ICU was 72%. CONCLUSION: Eight out of 10 patients in this cohort study developed delirium in the ICU. Although use of a validated delirium instrument with frequent direct observations is recommended for clinical care, this approach may not always be feasible, especially in a research setting. The algorithm proposed here comprises a more comprehensive method for detecting delirium in a research setting, taking into account the fluctuation that occurs with delirium, which is a key component of accurate determination of delirium status. Improving detection of delirium is of paramount importance both to advance delirium research and to enhance clinical care and patient safety