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Ever since the discovery of the first active galactic nuclei (AGN), substantial observational and theoretical effort has been invested into understanding how massive black holes have evolved across cosmic time. Circum-nuclear obscuration is now established as a crucial component, with almost every AGN observed known to display signatures of some level of obscuration in their X-ray spectra. However, despite more than six decades of effort, substantial open questions remain: how does the accretion power impact the structure of the circum-nuclear obscurer? What are the dynamical properties of the obscurer? Can dense circum-nuclear obscuration exist around intrinsically weak AGN? How many intermediate mass black holes occupy the centers of dwarf galaxies? In this paper, we showcase a number of next-generation prospects attainable with the High-Energy X-ray Probe (HEX-P1) to contribute toward solving these questions in the 2030s. The uniquely broad (0.2–80 keV) and strictly simultaneous X-ray passband of HEX-P makes it ideally suited for studying the temporal co-evolution between the central engine and circum-nuclear obscurer. Improved sensitivities and reduced background will enable the development of spectroscopic models complemented by current and future multi-wavelength observations. We show that the angular resolution of HEX-P both below and above 10 keV will enable the discovery and confirmation of accreting massive black holes at both low accretion power and low black hole masses even when concealed by thick obscuration. In combination with other next-generation observations of the dusty hearts of nearby galaxies, HEX-P will be pivotal in paving the way toward a complete picture of black hole growth and galaxy co-evolution.

Since the discovery of the cosmic X-ray background (CXB), astronomers have strived to understand the accreting supermassive black holes (SMBHs) contributing to its peak in the 10–40 keV band. Existing soft X-ray telescopes could study this population up to only 10 keV, and, while NuSTAR (focusing on 3–24 keV) made great progress, it also left significant uncertainties in characterizing the hard X-ray population, crucial for calibrating current population synthesis models. This paper presents an in-depth analysis of simulations of two extragalactic surveys (deep and wide) with the High-Energy X-ray Probe (HEX-P), each observed for 2 Ms. Applying established source detection techniques, we show that HEX-P surveys will reach a flux of ∼10−15 erg s−1 cm−2 in the 10–40 keV band, an order of magnitude fainter than current NuSTAR surveys. With the large sample of new hard X-ray detected sources (∼2000), we showcase HEX-P’s ability to resolve more than 80% of the CXB up to 40 keV into individual sources. The expected precision of HEX-P’s resolved background measurement will allow us to distinguish between population synthesis models of SMBH growth. HEX-P will leverage accurate broadband (0.5–40 keV) spectral analysis and the combination of soft and hard X-ray colors to provide obscuration constraints even for the fainter sources, with the overall objective of measuring the Compton-thick fraction. With unprecedented sensitivity in the 10–40 keV band, HEX-P will explore the hard X-ray emission from AGN to flux limits never reached before, thus expanding the parameter space for serendipitous discoveries. Consequently, it is plausible that new models will be needed to capture the population HEX-P will unveil.

Constraining the primary growth channel of supermassive black holes (SMBHs) remains one the most actively debated questions in the context of cosmological structure formation. Owing to the expected connection between SMBH spin parameter evolution and the accretion and merger history of individual black holes, population spin measurements offer a rare observational window into the cosmic growth of SMBHs. As of today, the most common method for estimating SMBH spin relies on modeling the relativistically broaden atomic profiles in the reflection spectrum observed in X-rays. In this paper, we study the observational requirements needed to confidently distinguish between the primary SMBH growth channels based on their distinct spin-mass distributions predicted by the Horizon-AGN cosmological simulation. Indoing so, we characterize outstanding limitations associated with the existing measurements and discuss the landscape of future observational campaigns which could be planned and executed with future X-ray observatories. We focus our attention on the High-Energy X-ray Probe (HEX-P), a proposed probe-class mission designed to serve the high-energy community in the 2030s.

Accreting neutron stars (NSs) represent a unique laboratory for probing the physics of accretion in the presence of strong magnetic fields (B ≳ 108 G). Additionally, the matter inside the NS itself exists in an ultra-dense, cold state that cannot be reproduced in Earth-based laboratories. Hence, observational studies of these objects are a way to probe the most extreme physical regimes. Here we present an overview of the field and discuss the most important outstanding problems related to NS accretion. We show how these open questions regarding accreting NSs in both low-mass and high-mass X-ray binary systems can be addressed with the High-Energy X-ray Probe (HEX-P) via simulated data. In particular, with the broad X-ray passband and improved sensitivity afforded by a low X-ray background, HEX-P will be able to 1) distinguish between competing continuum emission models; 2) provide tighter upper limits on NS radii via reflection modeling techniques that are independent and complementary to other existing methods; 3) constrain magnetic field geometry, plasma parameters, and accretion column emission patterns by characterizing fundamental and harmonic cyclotron lines and exploring their behavior with pulse phase; 4) directly measure the surface magnetic field strength of highly magnetized NSs at the lowest accretion luminosities; as well as 5) detect cyclotron line features in extragalactic sources and probe their dependence on luminosity in the super-Eddington regime in order to distinguish between geometrical evolution and accretion-induced decay of the magnetic field. In these ways HEX-P will provide an essential new tool for exploring the physics of NSs, their magnetic fields, and the physics of extreme accretion.

There are a large number of geophysical processes affecting sea level dynamics and coastal erosion in the Baltic Sea region. These processes operate on a large range of spatial and temporal scales and are observed in many other coastal regions worldwide. This, along with the outstanding number of long data records, makes the Baltic Sea a unique laboratory for advancing our knowledge on interactions between processes steering sea level and erosion in a climate change context. Processes contributing to sea level dynamics and coastal erosion in the Baltic Sea include the still ongoing viscoelastic response of the Earth to the last deglaciation, contributions from global and North Atlantic mean sea level changes, or contributions from wind waves affecting erosion and sediment transport along the subsiding southern Baltic Sea coast. Other examples are storm surges, seiches, or meteotsunamis which primarily contribute to sea level extremes. Such processes have undergone considerable variation and change in the past. For example, over approximately the past 50 years, the Baltic absolute (geocentric) mean sea level has risen at a rate slightly larger than the global average. In the northern parts of the Baltic Sea, due to vertical land movements, relative mean sea level has decreased. Sea level extremes are strongly linked to variability and changes in large-scale atmospheric circulation. The patterns and mechanisms contributing to erosion and accretion strongly depend on hydrodynamic conditions and their variability. For large parts of the sedimentary shores of the Baltic Sea, the wave climate and the angle at which the waves approach the nearshore region are the dominant factors, and coastline changes are highly sensitive to even small variations in these driving forces. Consequently, processes contributing to Baltic sea level dynamics and coastline change are expected to vary and to change in the future, leaving their imprint on future Baltic sea level and coastline change and variability. Because of the large number of contributing processes, their relevance for understanding global figures, and the outstanding data availability, global sea level research and research on coastline changes may greatly benefit from research undertaken in the Baltic Sea.

Metanephric Adenoma (MA) is a rare and unclassifiable renal tumour with sparse reported clinical and morphological features. Generally MA's have a benign course without recurrence after nephrectomy, however a few cases received oncological treatment due to malignant progression.We present a 42-year-old woman who years after an initial nephrectomy developed several processes and biopsy confirmed recurrence of MA. Sunitinib was given for only two weeks, as she developed side-effects and currently the patient undergoes control scans with only minimal growth of the processes.This is the first case of MA treated with Tyrosin-Kinase-Inhibitor.

Making Sense of Nonsense: Readings of Children’s Poetry as Play and Creative Thinking Abstract: Nonsense and meaning are not necessarily conflicting concepts, but can be conceived of as a hendiadys, that is, not opposites, the one or the other, but as one and the other. The idea that meaning and nonsense are related and coexist is a premise for this article, which describes different structures of meaning in the nonsense poetry of Birgitte Krogsbøll and Kamilla Wichmann’s picture book Funkelgnister: Rim, råb og remser (2015, Glittersparks: Rhymes, Roars and Rigmaroles). By linking our analysis of Funkelgnister to Johan Huizinga’s theory of play as a prerequisite for culture, we reveal how the specific structures and logics of the poems generate meaning and thereby we disclose how children’s nonsense poetry is simultaneously meaningful and nonsensical, as a creative thinking akin to culture developed through play and playfulness. We describe how meaning can be sought in three directions, suggested by Gilles Deleuze: above, below and on the surface. In the first case, we consider nonsense as a seductive acoustic phenomenon. In the second, we focus on nonsense poetry as subversive. And finally, in the third case, we show how it is an event. In all, these different aspects demonstrate how nonsense poetry functions as play and challenges our understanding of what it means to read. Following Jurij Lotman’s understanding of pictorial language as creative thinking, we show how nonsense in Funkelgnister opens up a free space by utilizing an in-between, where meaning takes on different forms as signs and sounds, and how the inherent rejection of normative rules of reading in such a venture, initiates a production of meaning as metonymic activity. We thereby highlight how nonsense generates a ground for a creative development of meaning.

Differences in fundamental frequency (F0) or pitch between competing voices facilitate our ability to segregate a target voice from interferers, thereby enhancing speech intelligibility. Although lower-numbered harmonics elicit a stronger and more accurate pitch sensation than higher-numbered harmonics, it is unclear whether the stronger pitch leads to an increased benefit of pitch differences when segregating competing talkers. To answer this question, sentence recognition was tested in young normal-hearing listeners in the presence of a single competing talker. The stimuli were presented in a broadband condition or were highpass or lowpass filtered to manipulate the pitch accuracy of the voicing, while maintaining roughly equal speech intelligibility in the highpass and lowpass regions. Performance was measured with average F0 differences (ΔF0) between the target and single-talker masker of 0, 2, and 4 semitones. Pitch discrimination abilities were also measured to confirm that the lowpass-filtered stimuli elicited greater pitch accuracy than the highpass-filtered stimuli. No interaction was found between filter type and ΔF0 in the sentence recognition task, suggesting little or no effect of harmonic rank or pitch accuracy on the ability to use F0 to segregate natural voices, even when the average ΔF0 is relatively small. The results suggest that listeners are able to obtain some benefit of pitch differences between competing voices, even when pitch salience and accuracy is low.

Objectives The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients.Setting University-initiated international survey.Participants The expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers.Procedures The initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache. Suggested outcome measures were rated by each expert, blinded towards the other members of the panel, for its usefulness on a 5-point Likert scale ranging from definitely not useful to extremely useful. Results were combined using median values and IQRs. Tools rated overall as definitely or probably not useful were excluded from subsequent rounds. Experts further suggested additional outcome measures that were presented to the panel in subsequent rounds. Additionally, experts were asked to rank the most useful tools and provide information on feasible cut-off levels for effectiveness for the three highest ranked tools.Results Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks.Conclusions Recommendations are for the use of the MIDAS, the HIT-6 and headache frequency, in combination with an outcome measure for quality of life. Associated symptoms and fear of attacks should also be considered as secondary outcomes, if relevant for the individual target population. The cut-off level for effectiveness should be lower for non-pharmacological interventions, especially when used as an adjunct to medication.Trial registration number German Register of Clinical Trials (DRKS00011777)

Abstract The purpose of this study was to compare the effect of a 6‐week period of knee flexion strength training at either optimal or short muscle length, on length‐specific muscle strength and fatigue. Twelve healthy volunteers performed dynamic (isokinetic concentric) training with one leg at short and the contralateral leg at optimal muscle length for 6 weeks. Knee flexor muscle strength was assessed before and after training, comprising maximal voluntary isometric and dynamic contractions at short, intermediate and near optimal muscle length and electrically evoked, contractions at near optimal length only. Fatigability was tested by performing 60 maximal concentric contractions at either short or optimal muscle length. Isometric torque at all muscle lengths improved equally by training at short and optimal muscle length, for example, tested at short 18 (17) versus 21 (17) % (CI) and at optimal 14 (8) versus 17 (16) % muscle length, respectively. Likewise, equal improvements were observed for dynamic contractions in both groups. Prior to training, fatigue induced at optimal muscle length tended to be more pronounced than at short muscle length (fatigue‐indexes −41 (6) vs. −34 (7) %, respectively, P = 0.05). However, training at either length did not reduce fatigability. Training with maximal concentric contractions at either short or optimal muscle length for 6 weeks improved isometric and dynamic muscle strength in the entire range of motion without inducing any discernible length‐specific adaptations. However, strength training at restricted muscle length did not reduce relative fatigue when induced at either short or optimal muscle length.