A physically based 3-D model of ice cliff evolution over debris-covered glaciers

We use high-resolution digital elevation models (DEMs) from unmanned aerial vehicle (UAV) surveys to document the evolution of four ice cliffs on the debris-covered tongue of Lirung Glacier, Nepal, over one ablation season. Observations show that out of four cliffs, three different patterns of evolution emerge: (i) reclining cliffs that flatten during the ablation season; (ii) stable cliffs that maintain a self-similar geometry; and (iii) growing cliffs, expanding laterally. We use the insights from this unique data set to develop a 3-D model of cliff backwasting and evolution that is validated against observations and an independent data set of volume losses. The model includes ablation at the cliff surface driven by energy exchange with the atmosphere, reburial of cliff cells by surrounding debris, and the effect of adjacent ponds. The cliff geometry is updated monthly to account for the modifications induced by each of those processes. Model results indicate that a major factor affecting the survival of steep cliffs is the coupling with ponded water at its base, which prevents progressive flattening and possible disappearance of a cliff. The radial growth observed at one cliff is explained by higher receipts of longwave and shortwave radiation, calculated taking into account atmospheric fluxes, shading, and the emission of longwave radiation from debris surfaces. The model is a clear step forward compared to existing static approaches that calculate atmospheric melt over an invariant cliff geometry and can be used for long-term simulations of cliff evolution and to test existing hypotheses about cliffs' survival

A three dimensional model of the photosynthetic membranes of Ectothiorhodospira halochloris

The three dimensional organization of the complete photosynthetic apparatus of the extremely halophilic, bacteriochlorophyll b containing Ectothiorhodospira halochloris has been elaborated by several techniques of electron microscopy. Essentially all thylakoidal sacs are disc shaped and connected to the cytoplasmic membrane by small membraneous ldquobridgesrdquo. In sum, the lumina of all thylakoids (intrathylakoidal space) form one common periplasmic space. Thin sections confirm a paracrystalline arrangement of the photosynthetic complexes in situ. The ontogenic development of the photosynthetic apparatus is discussed based on a structural model derived from serial thin sections

Accreting Black Holes

This chapter provides a general overview of the theory and observations of black holes in the Universe and on their interpretation. We briefly review the black hole classes, accretion disk models, spectral state classification, the AGN classification, and the leading techniques for measuring black hole spins. We also introduce quasi-periodic oscillations, the shadow of black holes, and the observations and the theoretical models of jets.Comment: 41 pages, 18 figures. To appear in "Tutorial Guide to X-ray and Gamma-ray Astronomy: Data Reduction and Analysis" (Ed. C. Bambi, Springer Singapore, 2020). v3: fixed some typos and updated some parts. arXiv admin note: substantial text overlap with arXiv:1711.1025

Optimal search strategies for identifying sound clinical prediction studies in EMBASE

BACKGROUND: Clinical prediction guides assist clinicians by pointing to specific elements of the patient's clinical presentation that should be considered when forming a diagnosis, prognosis or judgment regarding treatment outcome. The numbers of validated clinical prediction guides are growing in the medical literature, but their retrieval from large biomedical databases remains problematic and this presents a barrier to their uptake in medical practice. We undertook the systematic development of search strategies ("hedges") for retrieval of empirically tested clinical prediction guides from EMBASE. METHODS: An analytic survey was conducted, testing the retrieval performance of search strategies run in EMBASE against the gold standard of hand searching, using a sample of all 27,769 articles identified in 55 journals for the 2000 publishing year. All articles were categorized as original studies, review articles, general papers, or case reports. The original and review articles were then tagged as 'pass' or 'fail' for methodologic rigor in the areas of clinical prediction guides and other clinical topics. Search terms that depicted clinical prediction guides were selected from a pool of index terms and text words gathered in house and through request to clinicians, librarians and professional searchers. A total of 36,232 search strategies composed of single and multiple term phrases were trialed for retrieval of clinical prediction studies. The sensitivity, specificity, precision, and accuracy of search strategies were calculated to identify which were the best. RESULTS: 163 clinical prediction studies were identified, of which 69 (42.3%) passed criteria for scientific merit. A 3-term strategy optimized sensitivity at 91.3% and specificity at 90.2%. Higher sensitivity (97.1%) was reached with a different 3-term strategy, but with a 16% drop in specificity. The best measure of specificity (98.8%) was found in a 2-term strategy, but with a considerable fall in sensitivity to 60.9%. All single term strategies performed less well than 2- and 3-term strategies. CONCLUSION: The retrieval of sound clinical prediction studies from EMBASE is supported by several search strategies

Adherence with statins in a real-life setting is better when associated cardiovascular risk factors increase: a cohort study

<p>Abstract</p> <p>Background</p> <p>While the factors for poor adherence for treatment with statins have been highlighted, the impact of their combination on adherence is not clear.</p> <p>Aims</p> <p>To estimate adherence for statins and whether it differs according to the number of cardiovascular risk factors.</p> <p>Methods</p> <p>A cohort study was conducted using data from the main French national health insurance system reimbursement database. Newly treated patients with statins between September 1 and December 31, 2004 were included. Patients were followed up 15 months. The cohort was split into three groups according to their number of additional cardiovascular risk factors that included age and gender, diabetes mellitus and cardiovascular disease (using co-medications as a <it>proxy</it>). Adherence was assessed for each group by using four parameters: <it>(i) </it>proportion of days covered by statins, <it>(ii) </it>regularity of the treatment over time, <it>(iii) </it>persistence, and <it>(iv) </it>the refill delay.</p> <p>Results</p> <p>16,397 newly treated patients were identified. Of these statin users, 21.7% did not have additional cardiovascular risk factors. Thirty-one percent had two cardiovascular risk factors and 47% had at least three risk factors. All the parameters showed a sub-optimal adherence whatever the group: days covered ranged from 56% to 72%, regularity ranged from 23% to 33% and persistence ranged from 44% to 59%, but adherence was better for those with a higher number of cardiovascular risk factors.</p> <p>Conclusions</p> <p>The results confirm that long-term drug treatments are a difficult challenge, particularly in patients at lower risk and invite to the development of therapeutic education.</p

The effects of high density on the X-ray spectrum reflected from accretion discs around black holes

Current models of the spectrum of X-rays reflected from accretion discs around black holes and other compact objects are commonly calculated assuming that the density of the disc atmosphere is constant within several Thomson depths from the irradiated surface. An important simplifying assumption of these models is that the ionization structure of the gas is completely specified by a single, fixed value of the ionization parameter $\xi$, which is the ratio of the incident flux to the gas density. The density is typically fixed at $n_\text{e}$ = 10$^{15}$ cm$^{−3}$. Motivated by observations, we consider higher densities in the calculation of the reflected spectrum. We show by computing model spectra for $n_\text{e}$ $\gtrsim$ 10$^{17}$ cm$^{−3}$ that high-density effects significantly modify reflection spectra. The main effect is to boost the thermal continuum at energies $\lesssim$2 keV. We discuss the implications of these results for interpreting observations of both active galactic nuclei and black hole binaries. We also discuss the limitations of our models imposed by the quality of the atomic data currently available.JG and JEM acknowledge the support of a CGPS grant from the Smithsonian Institution. ACF acknowledges ERC Advanced Grant 340442 Feedback. JFS has been supported by the Einstein Fellowship grant PF5-160144

Highly Coherent Quasiperiodic Oscillations in the “Heartbeat” Black Hole X-Ray Binary IGR J17091-3624

\ua9 2024. The Author(s). Published by the American Astronomical Society.IGR J17091-3624 is a black hole X-ray binary (BHXB), often referred to as the “twin” of GRS 1915+105 because it is the only other known BHXB that can show exotic “heartbeat”-like variability that is highly structured and repeated. Here, we report on observations of IGR J17091-3624 from its 2022 outburst, where we detect an unusually coherent quasiperiodic oscillation (QPO) when the broadband variability is low (total fractional rms ≲6%) and the spectrum is dominated by the accretion disk. Such spectral and variability behavior is characteristic of the soft state of typical BHXBs (i.e., those that do not show heartbeats), but we also find that this QPO is strongest when there is some exotic heartbeat-like variability (so-called Class V variability). This QPO is detected at frequencies between 5 and 8 Hz and has Q factors (defined as the QPO frequency divided by the width) ≳50, making it one of the most highly coherent low-frequency QPOs ever seen in a BHXB. The extremely high Q factor makes this QPO distinct from typical low-frequency QPOs that are conventionally classified into type-A/B/C QPOs. Instead, we find evidence that archival observations of GRS 1915+105 also showed a similarly high-coherence QPO in the same frequency range, suggesting that this unusually coherent and strong QPO may be unique to BHXBs that can exhibit “heartbeat”-like variability

The 2022 Outburst of IGR J17091-3624: Connecting the Exotic GRS 1915+105 to Standard Black Hole X-Ray Binaries

\ua9 2024. The Author(s). Published by the American Astronomical Society.While the standard X-ray variability of black hole X-ray binaries (BHXBs) is stochastic and noisy, there are two known BHXBs that exhibit exotic “heartbeat”-like variability in their lightcurves: GRS 1915+105 and IGR J17091-3624. In 2022, IGR J17091-3624 went into outburst for the first time in the NICER/NuSTAR era. These exquisite data allow us to simultaneously track the exotic variability and the corresponding spectral features with unprecedented detail. We find that as in typical BHXBs, the outburst began in the hard state, then continued in the intermediate state, but then transitioned to an exotic soft state, where we identify two types of heartbeat-like variability (Class V and a new Class X). The flux energy spectra show a broad iron emission line due to relativistic reflection when there is no exotic variability, and absorption features from highly ionized iron when the source exhibits exotic variability. Whether absorption lines from highly ionized iron are detected in IGR J17091-3624 is not determined by the spectral state alone, but rather is determined by the presence of exotic variability; in a soft spectral state, absorption lines are only detected along with exotic variability. Our finding indicates that IGR J17091-3624 can be seen as a bridge between the most peculiar BHXB GRS 1915+105 and “normal” BHXBs, because it alternates between the conventional and exotic behaviors of BHXBs. We discuss the physical nature of the absorbing material and exotic variability in light of this new legacy data set

Foundations of Black Hole Accretion Disk Theory

This review covers the main aspects of black hole accretion disk theory. We begin with the view that one of the main goals of the theory is to better understand the nature of black holes themselves. In this light we discuss how accretion disks might reveal some of the unique signatures of strong gravity: the event horizon, the innermost stable circular orbit, and the ergosphere. We then review, from a first-principles perspective, the physical processes at play in accretion disks. This leads us to the four primary accretion disk models that we review: Polish doughnuts (thick disks), Shakura-Sunyaev (thin) disks, slim disks, and advection-dominated accretion flows (ADAFs). After presenting the models we discuss issues of stability, oscillations, and jets. Following our review of the analytic work, we take a parallel approach in reviewing numerical studies of black hole accretion disks. We finish with a few select applications that highlight particular astrophysical applications: measurements of black hole mass and spin, black hole vs. neutron star accretion disks, black hole accretion disk spectral states, and quasi-periodic oscillations (QPOs).Comment: 91 pages, 23 figures, final published version available at http://www.livingreviews.org/lrr-2013-

Primary care follow up of patients discharged from the emergency department: a retrospective study

BACKGROUND: The visit to the emergency department (ED) constitutes a brief, yet an important point in the continuum of medical care. The aim of our study was to evaluate the continuity of care of adult ED visitors. METHODS: We retrospectively reviewed all ED discharge summaries for over a month 's period. The ED chart, referral letter and the patient's primary care file were reviewed. Data collected included: age, gender, date and hour of ED visit, documentation of ED referral and ED discharge letter in the primary care file. RESULTS: 359 visits were eligible for the study. 192 (53.5%) of the patients were women, average age 54.1 ± 18.7 years (mean ± SD). 214 (59.6%) of the visits were during working hours of primary care clinics ("working hours"), while the rest were "out of hours" visits. Only 196 (54.6%) of patients had a referral letter, usually from their family physician. A third (71/214) of "working hours" visits were self referrals, the rate rose to 63.5% (92/145) of "out of hours" visits (p < 0.0001). The ED discharge letter was found in 50% (179/359) of the primary care files. A follow-up visit was documented in only 31% (111/359). Neither follow up visit nor discharge letter were found in 43% of the files (153/359). CONCLUSIONS: We have found a high rate of ED self referrals throughout the day together with low documentation rates of ED visits in the primary care charts. Our findings point to a poor continuity of care of ED attendees