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Quasi-periodic eruptions (QPEs) are luminous bursts of soft X-rays from the nuclei of galaxies, repeating on timescales of hours to weeks 1-5 . The mechanism behind these rare systems is uncertain, but most theories involve accretion disks around supermassive black holes (SMBHs) undergoing instabilities 6-8 or interacting with a stellar object in a close orbit 9-11 . It has been suggested that this disk could be created when the SMBH disrupts a passing star 8,11 , implying that many QPEs should be preceded by observable tidal disruption events (TDEs). Two known QPE sources show long-term decays in quiescent luminosity consistent with TDEs 4,12 and two observed TDEs have exhibited X-ray flares consistent with individual eruptions 13,14 . TDEs and QPEs also occur preferentially in similar galaxies 15 . However, no confirmed repeating QPEs have been associated with a spectroscopically confirmed TDE or an optical TDE observed at peak brightness. Here we report the detection of nine X-ray QPEs with a mean recurrence time of approximately 48 h from AT2019qiz, a nearby and extensively studied optically selected TDE 16 . We detect and model the X-ray, ultraviolet (UV) and optical emission from the accretion disk and show that an orbiting body colliding with this disk provides a plausible explanation for the QPEs., (© 2024. The Author(s).)

As a highly deployed field instrument for the detection of narcotics, explosives, and chemical warfare agents, drift tube ion mobility spectrometry relies heavily upon the performance of the ionization source and mechanism of ion beam modulation. For this instrumental platform, ion chemistry plays a critical role in the performance of the instrument from a sensitivity and selectivity perspective; however, a range of instrumental components also occupy pivotal roles. Most notably, the mechanism of ion modulation or ion gating is a primary contributor to peak width in a drift tube ion mobility experiment. Unfortunately, physical ion gates rarely perform perfectly, and in addition to serving as physical impediments to ion transmission, their modulation also has undesirable field effects. Using a recently developed modulated, non-radioactive X-ray source, we detail the performance of an ion mobility spectrometry (IMS) system that is free of a gating structure and utilizes the pulsed nature of the modulated X-ray source (MXS) for both ion generation and initiation of the IMS experiment. After investigating the influence of pulse duration and spatial X-ray beam width on the analytical performance of the instrument, the possibility of using multiplexing with a shutterless system is explored. By increasing ion throughput, the observed multiplexing gain compared to a signal-averaged spectrum approaches the theoretical maximum and illustrates the capability of the MXS-IMS system to realize significant signal to noise improvements.

Introduction: Communication impairment during mechanical ventilation and prolonged critical illness is extremely frustrating and frightening for patients and increases the risk for miscommunication, misinterpretation, and poor outcomes. The COVID-19 pandemic amplified patient communication impairment in intensive care units. This article presents 3 case examples from the experience of a team of hospital-based speech-language pathologists providing augmentative and alternative communication support resources and services to intensive care unit patients treated for COVID-19 during the first wave of the pandemic. Cases were selected to illustrate the protracted and complex in-hospital and rehabilitative recovery of critically ill patients with COVID-19, necessitating creative problem-solving and nursing collaborations with speech-language pathologists to support patient-provider communication., Clinical Findings: The cases demonstrate (1) increased need for bilingual communication resources, (2) impaired cognitive and motor function associated with a variety of post-COVID-19 sequelae including severe critical illness myopathy, and (3) delayed transition to a speaking valve due to the secretion burden., Diagnoses: COVID-19 and acute respiratory distress syndrome (all), cerebral microhemorrhage, multi-system organ failure, hypoxic brain injury, altered mental status, seizure, stroke., Interventions: Multimodal and progressive augmentative and alternative communication interventions included low-technology strategies and simple communication boards, video language interpretation, tracheostomy speaking strategies, and a video intercom system., Outcomes: All patients made progressive gains in communication ability., Conclusion: Evaluation by augmentative and alternative communication specialists and progressive intervention from speech-language pathologists in collaboration with intensive care unit nurses can greatly improve patient-provider communication during treatment for and recovery from COVID-19 and other prolonged critical illnesses., (©2022 American Association of Critical-Care Nurses.)

Quasi-periodic eruptions (QPEs) are very-high-amplitude bursts of X-ray radiation recurring every few hours and originating near the central supermassive black holes of galactic nuclei 1,2 . It is currently unknown what triggers these events, how long they last and how they are connected to the physical properties of the inner accretion flows. Previously, only two such sources were known, found either serendipitously or in archival data 1,2 , with emission lines in their optical spectra classifying their nuclei as hosting an actively accreting supermassive black hole 3,4 . Here we report observations of QPEs in two further galaxies, obtained with a blind and systematic search of half of the X-ray sky. The optical spectra of these galaxies show no signature of black hole activity, indicating that a pre-existing accretion flow that is typical of active galactic nuclei is not required to trigger these events. Indeed, the periods, amplitudes and profiles of the QPEs reported here are inconsistent with current models that invoke radiation-pressure-driven instabilities in the accretion disk 5-9 . Instead, QPEs might be driven by an orbiting compact object. Furthermore, their observed properties require the mass of the secondary object to be much smaller than that of the main body 10 , and future X-ray observations may constrain possible changes in their period owing to orbital evolution. This model could make QPEs a viable candidate for the electromagnetic counterparts of so-called extreme-mass-ratio inspirals 11-13 , with considerable implications for multi-messenger astrophysics and cosmology 14,15 .

Computed tomography (CT) is used to diagnose many emergent medical conditions, including stroke and traumatic brain injuries. Unfortunately, the size, weight, and expense of CT systems make them largely inaccessible for patients outside of major hospitals. We have designed a module containing multiple miniature x-ray sources that could allow for CT systems to be significantly lighter, smaller, and cheaper, and to operate without any moving parts. We have developed a novel photocathode-based x-ray source, created by depositing a thin film of magnesium on an electron multiplier. When illuminated by a UV LED, this photocathode emits a beam of electrons, with a beam current of up to 1 mA. The produced electrons are accelerated through a high voltage to a tungsten target. These sources are individually addressable and can be pulsed rapidly, through electronic control of the LEDs. Seven of these sources are housed together in a 17.5 degree arc within a custom vacuum manifold. A full ring of these modules could be used for CT imaging. By pulsing the sources in series, we are able to demonstrate x-ray tomosynthesis without any moving parts. With a clinical flat-panel detector, we demonstrate 3D acquisition and reconstructions of a cadaver swine lung.

The role of dietary carbohydrates in weight loss has received considerable attention in light of the current obesity epidemic. The authors investigated the association of body mass index (weight (kg)/height (m)(2)) with dietary intake of carbohydrates and with measures of the induced glycemic response, using data from an observational study of 572 healthy adults in central Massachusetts. Anthropometric measurements, 7-day dietary recalls, and physical activity recalls were collected quarterly from each subject throughout a 1-year study period. Data were collected between 1994 and 1998. Longitudinal analyses were conducted, and results were adjusted for other factors related to body habitus. Average body mass index was 27.4 kg/m(2) (standard deviation, 5.5), while the average percentage of calories from carbohydrates was 44.9 (standard deviation, 9.6). Mean daily dietary glycemic index was 81.7 (standard deviation, 5.5), and glycemic load was 197.8 (standard deviation, 105.2). Body mass index was found to be positively associated with glycemic index, a measure of the glycemic response associated with ingesting different types of carbohydrates, but not with daily carbohydrate intake, percentage of calories from carbohydrates, or glycemic load. Results suggest that the type of carbohydrate may be related to body weight. However, further research is required to elucidate this association and its implications for weight management.

A guinea pig model to assess the immunogenicity of a combination vaccine containing diphtheria, tetanus and acellular pertussis (DTaP) vaccine and Haemophilus influenzae type b (Hib) capsular polysaccharide conjugated to tetanus toxoid (HibT) was evaluated comparatively with the mouse immunogenicity test to study the effect of combining these antigens on the immunogenicity of various components. The immunogenicity test in mice was performed by subcutaneous injection of groups of 10 animals twice at an interval of four weeks with 1/10 of a single human dose of various formulations of combination vaccines, DTaP or HibT vaccine. The animals were bled at 4 and 6 weeks and IgG or total antibodies to various components were determined by ELISA or RIA. The guinea pig immunogenicity model included groups of animals injected subcutaneously twice at an interval of six weeks with 1.5 times the single human dose of various formulations. The animals were bled at 4, 6 and 8 weeks and serum samples were tested for antibodies to various components by ELISA, RIA and/or neutralization tests. Additionally, potency of tetanus and diphtheria components was assessed as per the US Food and Drug Administration's regulations. Aluminium phosphate (AIPO(4)) adsorbed HibT vaccine or HibT as a combination with AIPO(4)adsorbed DTaP vaccine showed significant increases in IgG antibodies to tetanus toxin in mice as well increased tetanus antitoxin levels in guinea pigs as compared to soluble HibT vaccine. In general, combining DTaP and HibT vaccines did not affect the antibody levels to tetanus and diphtheria toxoids whereas DTaP-HibT combination vaccine elicited significantly lower IgG antibodies to pertussis toxin and filamentous haemagglutinin than DTaP vaccine alone, particularly after first injection. Mice showed similar Hib antibody responses for the combination and HibT alone whereas guinea pigs consistently showed lower anamnestic responses to Hib for combination formulations than for HibT alone. Reducing the amount of HibT and/or tetanus toxoid in the combination formulations reduced this suppression of Hib antibody response in guinea pigs. Suppression of Hib antibody response in combination vaccines has also been reported from recent clinical trials. Based on the results from this study, it appears that the guinea pig model may be able to predict the human response to various components of combination vaccines., (Copyright 1999 The International Association for Biologicals.)