Informing the design of ‘lifestyle monitoring’ technology for the detection of health deterioration in long-term conditions: a qualitative study of people living with heart failure

Background Health technologies are being developed to help people living at home manage long-term conditions. One such technology is “lifestyle monitoring” (LM) a telecare technology based on the idea that home activities may be monitored unobtrusively via sensors to give an indication of changes in health-state. However questions remain about LM technology: how home activities change when participants experience differing health-states; and how sensors might capture clinically important changes to inform timely interventions. Objective This paper reports the findings of a study aiming to identify changes in activity indicative of important changes in health in people with long-term conditions, particularly those changes indicative of exacerbation - by exploring the relationship between home activities and health amongst people with heart failure (HF). We aim to add to the knowledge base informing the development of home monitoring technologies designed to detect health deterioration in order to facilitate early intervention and avoid hospital admissions. Method This qualitative study utilised semi-structured interviews to explore everyday activities undertaken during the three health-states of HF: normal days, bad days, and exacerbations. Potential recruits were identified by specialist nurses and from attendees at a HF support group. The sample was purposively selected to include a range of experience of living with HF. Results The sample comprised twenty people with HF aged fifty years and older, and eleven spouses/partners of the individuals with HF. All resided in Northern England. Participant accounts revealed that home activities are in-part shaped by the degree of intrusion from HF symptoms. During an exacerbation participants undertook activities specifically to ease symptoms, and detailed activity changes were identified. Everyday activity was also influenced by a range of factors other than health. Conclusion The study highlights the importance of careful development of lifestyle monitoring technology if it is to identify changes in activity that occur during clinically important changes in health. These detailed activity changes need to be considered by developers of LM sensors, platforms, and algorithms intended to detect early signs of deterioration. Results suggest that for LM to move forward sensor set-up should be personalised both to individual circumstances and targeted at individual health conditions. LM needs to take account of the uncertainties that arise from placing technology within the home, in order to inform sensor set-up and data interpretation. This more targeted approach is likely to yield more clinically meaningful data, and in addition addresses some of the ethical issues of remote monitoring

Towards a New Standard Model for Black Hole Accretion

We briefly review recent developments in black hole accretion disk theory, emphasizing the vital role played by magnetohydrodynamic (MHD) stresses in transporting angular momentum. The apparent universality of accretion-related outflow phenomena is a strong indicator that large-scale MHD torques facilitate vertical transport of angular momentum. This leads to an enhanced overall rate of angular momentum transport and allows accretion of matter to proceed at an interesting rate. Furthermore, we argue that when vertical transport is important, the radial structure of the accretion disk is modified at small radii and this affects the disk emission spectrum. We present a simple model demonstrating how energetic, magnetically-driven outflows modify the emergent disk emission spectrum with respect to that predicted by standard accretion disk theory. A comparison of the predicted spectra against observations of quasar spectral energy distributions suggests that mass accretion rates inferred using the standard disk model may severely underestimate their true values.Comment: To appear in the Fifth Stromlo Symposium Proceedings special issue of ApS

Evolution of Magnetic Fields around a Kerr Black Hole

The evolution of magnetic fields frozen to a perfectly conducting plasma fluid around a Kerr black hole is investigated. We focus on the plunging region between the black hole horizon and the marginally stable circular orbit in the equatorial plane. Adopting the kinematic approximation where the dynamical effects of magnetic fields are ignored, we exactly solve Maxwell's equations with the assumptions that the geodesic motion of the fluid is stationary and axisymmetric, the magnetic field has only radial and azimuthal components and depends only on time and radial coordinates. We show that the stationary state of the magnetic field in the plunging region is uniquely determined by the boundary conditions at the marginally stable circular orbit. If the magnetic field at the marginally stable circular orbit is in a stationary state, the magnetic field in the plunging region will quickly settle into a stationary state if it is not so initially, in a time determined by the dynamical time scale. The radial component of the magnetic field at the marginally stable circular orbit is more important than the toroidal component in determining the structure and evolution of the magnetic field in the plunging region. Even if at the marginally stable circular orbit the toroidal component is zero, in the plunging region a toroidal component is quickly generated from the radial component by the shear motion of the fluid. Finally, we show that the dynamical effects of magnetic fields are unimportant in the plunging region if they are negligible on the marginally stable circular orbit. This supports the ``no-torque inner boundary condition'' of thin disks, contrary to the claim in the recent literature.Comment: 48 pages, including 13 figures; version with full resolution Figs at http://cfa-www.harvard.edu/~lli/astro-ph/mag_evol.p

Resistive and magnetized accretion flows with convection

We considered the effects of convection on the radiatively inefficient accretion flows (RIAF) in the presence of resistivity and toroidal magnetic field. We discussed the effects of convection on transports of angular momentum and energy. We established two cases for the resistive and magnetized RIAFs with convection: assuming the convection parameter as a free parameter and using mixing-length theory to calculate convection parameter. A self-similar method was used to solve the integrated equations that govern the behavior of the presented model. The solutions showed that the accretion and rotational velocities decrease by adding the convection parameter, while the sound speed increases. Moreover, by using mixing-length theory to calculate convection parameter, we found that the convection can be important in RIAFs with magnetic field and resistivity.Comment: 7 pages, 3 figures, accepted by Ap&S

Bondian frames to couple matter with radiation

A study is presented for the non linear evolution of a self gravitating distribution of matter coupled to a massless scalar field. The characteristic formulation for numerical relativity is used to follow the evolution by a sequence of light cones open to the future. Bondian frames are used to endow physical meaning to the matter variables and to the massless scalar field. Asymptotic approaches to the origin and to infinity are achieved; at the boundary surface interior and exterior solutions are matched guaranteeing the Darmois--Lichnerowicz conditions. To show how the scheme works some numerical models are discussed. We exemplify evolving scalar waves on the following fixed backgrounds: A) an atmosphere between the boundary surface of an incompressible mixtured fluid and infinity; B) a polytropic distribution matched to a Schwarzschild exterior; C) a Schwarzschild- Schwarzschild spacetime. The conservation of energy, the Newman--Penrose constant preservation and other expected features are observed.Comment: 20 pages, 6 figures; to appear in General Relativity and Gravitatio

Radial and vertical angular momentum transport in protostellar discs

Angular momentum in protostellar discs can be transported either radially, through turbulence induced by the magnetorotational instability (MRI), or vertically, through the torque exerted by a large-scale magnetic field. We present a model of steady-state discs where these two mechanisms operate at the same radius and derive approximate criteria for their occurrence in an ambipolar diffusion dominated disc. We obtain "weak field'' solutions - which we associate with the MRI channel modes in a stratified disc - and transform them into accretion solutions with predominantly radial angular-momentum transport by implementing a turbulent-stress prescription based on published results of numerical simulations. We also analyze "intermediate field strength'' solutions in which both radial and vertical transport operate at the same radial location. Our results suggest, however, that this overlap is unlikely to occur in real discs.Comment: 5 pages, 2 figures, 1 table, aastex.cls. Accepted for publication in Astrophysics & Space Scienc

New Insights into White-Light Flare Emission from Radiative-Hydrodynamic Modeling of a Chromospheric Condensation

(abridged) The heating mechanism at high densities during M dwarf flares is poorly understood. Spectra of M dwarf flares in the optical and near-ultraviolet wavelength regimes have revealed three continuum components during the impulsive phase: 1) an energetically dominant blackbody component with a color temperature of T $\sim$ 10,000 K in the blue-optical, 2) a smaller amount of Balmer continuum emission in the near-ultraviolet at lambda $<$ 3646 Angstroms and 3) an apparent pseudo-continuum of blended high-order Balmer lines. These properties are not reproduced by models that employ a typical "solar-type" flare heating level in nonthermal electrons, and therefore our understanding of these spectra is limited to a phenomenological interpretation. We present a new 1D radiative-hydrodynamic model of an M dwarf flare from precipitating nonthermal electrons with a large energy flux of $10^{13}$ erg cm$^{-2}$ s$^{-1}$. The simulation produces bright continuum emission from a dense, hot chromospheric condensation. For the first time, the observed color temperature and Balmer jump ratio are produced self-consistently in a radiative-hydrodynamic flare model. We find that a T $\sim$ 10,000 K blackbody-like continuum component and a small Balmer jump ratio result from optically thick Balmer and Paschen recombination radiation, and thus the properties of the flux spectrum are caused by blue light escaping over a larger physical depth range compared to red and near-ultraviolet light. To model the near-ultraviolet pseudo-continuum previously attributed to overlapping Balmer lines, we include the extra Balmer continuum opacity from Landau-Zener transitions that result from merged, high order energy levels of hydrogen in a dense, partially ionized atmosphere. This reveals a new diagnostic of ambient charge density in the densest regions of the atmosphere that are heated during dMe and solar flares.Comment: 50 pages, 2 tables, 13 figures. Accepted for publication in the Solar Physics Topical Issue, "Solar and Stellar Flares". Version 2 (June 22, 2015): updated to include comments by Guest Editor. The final publication is available at Springer via http://dx.doi.org/10.1007/s11207-015-0708-

Current status of turbulent dynamo theory: From large-scale to small-scale dynamos

Several recent advances in turbulent dynamo theory are reviewed. High resolution simulations of small-scale and large-scale dynamo action in periodic domains are compared with each other and contrasted with similar results at low magnetic Prandtl numbers. It is argued that all the different cases show similarities at intermediate length scales. On the other hand, in the presence of helicity of the turbulence, power develops on large scales, which is not present in non-helical small-scale turbulent dynamos. At small length scales, differences occur in connection with the dissipation cutoff scales associated with the respective value of the magnetic Prandtl number. These differences are found to be independent of whether or not there is large-scale dynamo action. However, large-scale dynamos in homogeneous systems are shown to suffer from resistive slow-down even at intermediate length scales. The results from simulations are connected to mean field theory and its applications. Recent work on helicity fluxes to alleviate large-scale dynamo quenching, shear dynamos, nonlocal effects and magnetic structures from strong density stratification are highlighted. Several insights which arise from analytic considerations of small-scale dynamos are discussed.Comment: 36 pages, 11 figures, Spa. Sci. Rev., submitted to the special issue "Magnetism in the Universe" (ed. A. Balogh

General Overview of Black Hole Accretion Theory

I provide a broad overview of the basic theoretical paradigms of black hole accretion flows. Models that make contact with observations continue to be mostly based on the four decade old alpha stress prescription of Shakura & Sunyaev (1973), and I discuss the properties of both radiatively efficient and inefficient models, including their local properties, their expected stability to secular perturbations, and how they might be tied together in global flow geometries. The alpha stress is a prescription for turbulence, for which the only existing plausible candidate is that which develops from the magnetorotational instability (MRI). I therefore also review what is currently known about the local properties of such turbulence, and the physical issues that have been elucidated and that remain uncertain that are relevant for the various alpha-based black hole accretion flow models.Comment: To be published in Space Science Reviews and as hard cover in the Space Sciences Series of ISSI: The Physics of Accretion on to Black Holes (Springer Publisher

Accretion, Outflows, and Winds of Magnetized Stars

Many types of stars have strong magnetic fields that can dynamically influence the flow of circumstellar matter. In stars with accretion disks, the stellar magnetic field can truncate the inner disk and determine the paths that matter can take to flow onto the star. These paths are different in stars with different magnetospheres and periods of rotation. External field lines of the magnetosphere may inflate and produce favorable conditions for outflows from the disk-magnetosphere boundary. Outflows can be particularly strong in the propeller regime, wherein a star rotates more rapidly than the inner disk. Outflows may also form at the disk-magnetosphere boundary of slowly rotating stars, if the magnetosphere is compressed by the accreting matter. In isolated, strongly magnetized stars, the magnetic field can influence formation and/or propagation of stellar wind outflows. Winds from low-mass, solar-type stars may be either thermally or magnetically driven, while winds from massive, luminous O and B type stars are radiatively driven. In all of these cases, the magnetic field influences matter flow from the stars and determines many observational properties. In this chapter we review recent studies of accretion, outflows, and winds of magnetized stars with a focus on three main topics: (1) accretion onto magnetized stars; (2) outflows from the disk-magnetosphere boundary; and (3) winds from isolated massive magnetized stars. We show results obtained from global magnetohydrodynamic simulations and, in a number of cases compare global simulations with observations.Comment: 60 pages, 44 figure