An eccentric wave in the circumstellar disc of the Be/X-ray binary X Persei

We present spectroscopic observations of the Be/X-ray binary X Per obtained during the period 2017 December-2020 January (MJD 58095-58865). In 2017 December, the H α, H β, and He I 6678 emission lines were symmetric with violet-to-red peak ratio V/R ≈ 1. During the first part of the period (2017 December-2018 August), the V/R ratio decreased to 0.5 and the asymmetry developed simultaneously in all three lines. In 2018 September, a third component with velocity ≈250 km s−1 appeared on the red side of the He I line profile. Later, this component emerged in H β, accompanied by the appearance of a red shoulder in H α. Assuming that it is due to an eccentric wave in the circumstellar disc, we find that the eccentric wave appeared first in the innermost part of the disc, it spreads out with outflowing velocity vwave ≈ 1.1 ± 0.2 km s−1, and the eccentricity of the eccentric wave is ewave ≈ 0.29 ± 0.07. A detailed understanding of the origin of such eccentricities would have applications to a wide range of systems from planetary rings to AGNs

Discovery of optical flickering from the symbiotic star EF Aquilae

We report optical charge-coupled device (CCD) photometry of the recently identified symbiotic star EF Aquilae (EF Aql). Our observations in the Johnson V and B bands clearly show the presence of stochastic light variations with an amplitude of about 0.2 mag on a time scale of minutes. The observations point toward a white dwarf (WD) as the hot component in the system. It is the 11th object among more than 200 symbiotic stars known with detected optical flickering. Estimates of the mass accretion rate onto the WD and the mass loss rate in the wind of the Mira secondary star lead to the conclusion that less than 1% of the wind is captured by the WD. Eight further candidates for the detection of flickering in similar systems are suggested

Learners in a Changing Learning Landscape: Reflections from an Instructional Design Perspective

Van Merriënboer, J. J. G., & Stoyanov, S. (2008). Learners in a changing learning landscape: Reflections from an instructional design perspective. In J. Visser & M. Visser-Valfrey (Eds.), Learners in a changing learning landscape: Reflections from a dialogue on new roles and expectations (pp. 69-90). Dordrecht, The Netherlands: Springer.Both learners and teachers find themselves in a learning landscape that is rapidly changing, along with fast societal and technological developments. This paper discusses the new learning landscape from an instructional design perspective. First, with regard to what is learned, people more than ever need flexible problem-solving and reasoning skills allowing them to deal with new, unfamiliar problem situations in their professional and everyday life. Second, with regard to the context in which learning takes place, learning in technology-rich, informal and professional 24/7 settings is becoming general practice. And third, with regard to the learners themselves, they can more often be characterized as lifelong learners who are mature, bring relevant prior knowledge, and have very heterogeneous expectations and perceptions of learning. High-quality instructional design research should focus on the question which instructional methods and media-method combinations are effective, efficient and appealing in this new learning landscape. Some innovative instructional methods that meet this requirement are discussed

The hidden symbiotic star SU Lyn-detection of flickering in U band

We report photometric observations of the hidden symbiotic star SU Lyn in the optical bands. In four nights we detect a weak flickering in U band with amplitude of about 0.05 magnitudes. No intranight variations are found in B, V, g’ and r’ bands. This is one more indication that the secondary component is a white dwarf accreting at a low accretion rate Ẇe also searched for intranight variability of a dozen related objects-RR Boo, RT Boo, AM Cyg, AG Peg, BF Cyg, NQ Gem, StHa190, V627 Cas, XX Oph, FS Cet and Y Gem-however no variability above the observational errors is detected

Integration of P2Y receptor-activated signal transduction pathways in G protein-dependent signalling networks

The role of nucleotides in intracellular energy provision and nucleic acid synthesis has been known for a long time. In the past decade, evidence has been presented that, in addition to these functions, nucleotides are also autocrine and paracrine messenger molecules that initiate and regulate a large number of biological processes. The actions of extracellular nucleotides are mediated by ionotropic P2X and metabotropic P2Y receptors, while hydrolysis by ecto-enzymes modulates the initial signal. An increasing number of studies have been performed to obtain information on the signal transduction pathways activated by nucleotide receptors. The development of specific and stable purinergic receptor agonists and antagonists with therapeutical potential largely contributed to the identification of receptors responsible for nucleotide-activated pathways. This article reviews the signal transduction pathways activated by P2Y receptors, the involved second messenger systems, GTPases and protein kinases, as well as recent findings concerning P2Y receptor signalling in C6 glioma cells. Besides vertical signal transduction, lateral cross-talks with pathways activated by other G protein-coupled receptors and growth factor receptors are discussed

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Cardiopoietic cell therapy for advanced ischemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial

Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Optical spectroscopy of the Be/black hole binary MWC 656 - interaction of a black hole with a circumstellar disc

We present new spectroscopic observations of the Be/black hole binary MWC 656 obtained during the period 2015–2021. We measure the equivalent width of Hα (EWα), Hβ ((Formula presented.)), and the distance between the peaks of Hα ((Formula presented.)), Hβ ((Formula presented.)), and FeII ((Formula presented.)) lines. Combining new and old data, we find that: (1) the density of the circumstellar disc of MWC 656 ((Formula presented.) versus (Formula presented.) diagram) is similar to the Be stars. For the Be stars, we find the relation (Formula presented.) km s−1, and the position of MWC 656 corresponds to the average behavior of the Be stars. This means that the presence of the black hole does not change the overall structure of the circumstellar disc; (2) the periodogram analysis indicates modulation of (Formula presented.) with a period (Formula presented.) days, which is identical to the binary orbital period. The maxima of (Formula presented.) and (Formula presented.) are around periastron (phase zero); (3) around orbital phase zero, (Formula presented.) and (Formula presented.) decrease by about (Formula presented.) km s−1. This suggests that we observe an increase of the circumstellar disc size induced by the periastron passage of the black hole and that the entire circumstellar disc pulsates with the orbital period with relative amplitude of 10–20%. The observations also indicate, that the reason for the black hole in MWC 656 to be in deep quiescence is a very low efficiency of accretion ((Formula presented.))