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We study 4-dimensional homology cobordisms without 3-handles, showing that they interact nicely with Thurston geometries, character varieties, and instanton and Heegaard Floer homologies. Using these, we derive obstructions to such cobordisms. As one example of these obstructions, we generalize other recent results on the behavior of knot Floer homology under ribbon concordances. Finally, we provide topological applications, including to Dehn surgery problems.
preprint / 2022