Preventative tele-health supported services for early stage chronic obstructive pulmonary disease: a protocol for a pragmatic randomized controlled trial pilot

Background Chronic Obstructive Pulmonary Disease (COPD) is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care. Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life. Methods/Design We describe a pilot study for a two arm, one site randomized controlled trial (RCT) to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a) Tele-health supported Community COPD Service; or (b) Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist) then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service. Discussion The tele-health service under study is a complex service delivered through a collaboration between local authority and health care partners. The implementation of this service demanded significant changes to established working patterns and has been a challenging process requiring considerable planning - a challenge that many providers are likely to face in the future. Trial registration Current Controlled Trials ISRCTN6885601

A high-order Godunov scheme for global 3D MHD accretion disks simulations. I. The linear growth regime of the magneto-rotational instability

We employ the PLUTO code for computational astrophysics to assess and compare the validity of different numerical algorithms on simulations of the magneto-rotational instability in 3D accretion disks. In particular we stress on the importance of using a consistent upwind reconstruction of the electro-motive force (EMF) when using the constrained transport (CT) method to avoid the onset of numerical instabilities. We show that the electro-motive force (EMF) reconstruction in the classical constrained transport (CT) method for Godunov schemes drives a numerical instability. The well-studied linear growth of magneto-rotational instability (MRI) is used as a benchmark for an inter-code comparison of PLUTO and ZeusMP. We reproduce the analytical results for linear MRI growth in 3D global MHD simulations and present a robust and accurate Godunov code which can be used for 3D accretion disk simulations in curvilinear coordinate systems

Accretion of low angular momentum material onto black holes: 2D magnetohydrodynamical case

We report on the second phase of our study of slightly rotating accretion flows onto black holes. We consider magnetohydrodynamical (MHD) accretion flows with a spherically symmetric density distribution at the outer boundary, but with spherical symmetry broken by the introduction of a small, latitude-dependent angular momentum and a weak radial magnetic field. We study accretion flows by means of numerical 2D, axisymmetric, MHD simulations with and without resistive heating. Our main result is that the properties of the accretion flow depend mostly on an equatorial accretion torus which is made of the material that has too much angular momentum to be accreted directly. The torus accretes, however, because of the transport of angular momentum due to the magnetorotational instability (MRI). Initially, accretion is dominated by the polar funnel, as in the hydrodynamic inviscid case, where material has zero or very low angular momentum. At the later phase of the evolution, the torus thickens towards the poles and develops a corona or an outflow or both. Consequently, the mass accretion through the funnel is stopped. The accretion of rotating gas through the torus is significantly reduced compared to the accretion of non-rotating gas (i.e., the Bondi rate). It is also much smaller than the accretion rate in the inviscid, weakly rotating case.Our results do not change if we switch on or off resistive heating. Overall our simulations are very similar to those presented by Stone, Pringle, Hawley and Balbus despite different initial and outer boundary conditions. Thus, we confirm that MRI is very robust and controls the nature of radiatively inefficient accretion flows.Comment: submitted in Ap

Towards a New Standard Model for Black Hole Accretion

We briefly review recent developments in black hole accretion disk theory, emphasizing the vital role played by magnetohydrodynamic (MHD) stresses in transporting angular momentum. The apparent universality of accretion-related outflow phenomena is a strong indicator that large-scale MHD torques facilitate vertical transport of angular momentum. This leads to an enhanced overall rate of angular momentum transport and allows accretion of matter to proceed at an interesting rate. Furthermore, we argue that when vertical transport is important, the radial structure of the accretion disk is modified at small radii and this affects the disk emission spectrum. We present a simple model demonstrating how energetic, magnetically-driven outflows modify the emergent disk emission spectrum with respect to that predicted by standard accretion disk theory. A comparison of the predicted spectra against observations of quasar spectral energy distributions suggests that mass accretion rates inferred using the standard disk model may severely underestimate their true values.Comment: To appear in the Fifth Stromlo Symposium Proceedings special issue of ApS

Multiwavelength observations of a giant flare on CN Leonis I. The chromosphere as seen in the optical spectra

Flares on dM stars contain plasmas at very different temperatures and thus affect a wide wavelength range in the electromagnetic spectrum. While the coronal properties of flares are studied best in X-rays, the chromosphere of the star is observed best in the optical and ultraviolet ranges. Therefore, multiwavelength observations are essential to study flare properties throughout the atmosphere of a star. We analysed simultaneous observations with UVES/VLT and XMM-Newton of the active M5.5 dwarf CN Leo (Gl 406) exhibiting a major flare. The optical data cover the wavelength range from 3000 to 10000 Angstrom. From our optical data, we find an enormous wealth of chromospheric emission lines occurring throughout the spectrum. We identify a total of 1143 emission lines, out of which 154 are located in the red arm, increasing the number of observed emission lines in this red wavelength range by about a factor of 10. Here we present an emission line list and a spectral atlas. We also find line asymmetries for H I, He I, and Ca II lines. For the last, this is the first observation of asymmetries due to a stellar flare. During the flare onset, there is additional flux found in the blue wing, while in the decay phase, additional flux is found in the red wing. We interpret both features as caused by mass motions. In addition to the lines, the flare manifests itself in the enhancement of the continuum throughout the whole spectrum, inverting the normal slope for the net flare spectrum.Comment: 15 pages, accepted by A&

The Chromospheric Activity and Ages of M Dwarf Stars in Wide Binary Systems

We investigate the relationship between age and chromospheric activity for 139 M dwarf stars in wide binary systems with white dwarf companions. The age of each system is determined from the cooling age of its white dwarf component. The current limit for activity-age relations found for M dwarfs in open clusters is 4 Gyr. Our unique approach to finding ages for M stars allows for the exploration of this relationship at ages older than 4 Gyr. The general trend of stars remaining active for a longer time at later spectral type is confirmed. However, our larger sample and greater age range reveals additional complexity in assigning age based on activity alone. We find that M dwarfs in wide binaries older than 4 Gyr depart from the log-linear relation for clusters and are found to have activity at magnitudes, colors and masses which are brighter, bluer and more massive than predicted by the cluster relation. In addition to our activity-age results, we present the measured radial velocities and complete space motions for 161 white dwarf stars in wide binaries.Comment: 22 pages including 9 figures and 5 tables. Accepted for publication in The Astronomical Journa

Vortex Glass and Vortex Liquid in Oscillatory Media

We study the disordered, multi-spiral solutions of two-dimensional homogeneous oscillatory media for parameter values at which the single spiral/vortex solution is fully stable. In the framework of the complex Ginzburg-Landau (CGLE) equation, we show that these states, heretofore believed to be static, actually evolve on ultra-slow timescales. This is achieved via a reduction of the CGLE to the evolution of the sole vortex position and phase coordinates. This true defect-mediated turbulence occurs in two distinct phases, a vortex liquid characterized by normal diffusion of individual spirals, and a slowly relaxing, intermittent, ``vortex glass''.Comment: 4 pages, 2 figures, submitted to Physical Review Letter