A Far-Ultraviolet Spectroscopic Survey of Luminous Cool Stars

FUSE ultraviolet spectra of 8 giant and supergiant stars reveal that high temperature (3 X 10^5 K) atmospheres are common in luminous cool stars and extend across the color-magnitude diagram from Alpha Car (F0 II) to the cool giant Alpha Tau (K5 III). Emission present in these spectra includes chromospheric H-Lyman Beta, Fe II, C I, and transition region lines of C III, O VI, Si III, Si IV. Emission lines of Fe XVIII and Fe XIX signaling temperatures of ~10^7 K and coronal material are found in the most active stars, Beta Cet and 31 Com. A short-term flux variation, perhaps a flare, was detected in Beta Cet during our observation. Stellar surface fluxes of the emission of C III and O VI are correlated and decrease rapidly towards the cooler stars, reminiscent of the decay of magnetically-heated atmospheres. Profiles of the C III (977A) lines suggest that mass outflow is underway at T~80,000 K, and the winds are warm. Indications of outflow at higher temperatures (3 X 10^5K) are revealed by O VI asymmetries and the line widths themselves. High temperature species are absent in the M-supergiant Alpha Ori. Narrow fluorescent lines of Fe II appear in the spectra of many giants and supergiants, apparently pumped by H Lyman Alpha, and formed in extended atmospheres. Instrumental characteristics that affect cool star spectra are discussed.Comment: Accept for publication in The Astrophysical Journal; 22 pages of text, 23 figures and 8 table

GJ 900: A new hierarchical system with low-mass components

Speckle interferometric observations made with the 6 m telescope of the Special Astrophysical Observatory of the Russian Academy of Sciences in 2000 revealed the triple nature of the nearby ($\pi_{Hip}=51.80\pm1.74$ mas) low-mass young ($\approx200$ Myr) star GJ 900. The configuration of the triple system allowed it to be dynamically unstable. Differential photometry performed from 2000 through 2004 yielded $I$- and $K$-band absolute magnitudes and spectral types for the components to be $I_{A}$=6.66$\pm$0.08, $I_{B}$=9.15$\pm$0.11, $I_{C}$=10.08$\pm$0.26, $K_{A}$=4.84$\pm$0.08, $K_{B}$=6.76$\pm$0.20, $K_{C}$=7.39$\pm$0.31, $Sp_{A}$$\approx$K5--K7, $Sp_{B}$$\approx$M3--M4, $Sp_{C}$$\approx$M5--M6. The ``mass--luminosity'' relation is used to estimate the individual masses of the components: $\mathcal{M}_{A}$$\approx0.64\mathcal{M}_{\odot}$, $\mathcal{M}_{B}$$\approx0.21\mathcal{M}_{\odot}$, $\mathcal{M}_{C}$$\approx0.13\mathcal{M}_{\odot}$. From the observations of the components relative motion in the period 2000--2006, we conclude that GJ 900 is a hierarchical triple star with the possible orbital periods P$_{A-BC}$$\approx$80 yrs and P$_{BC}$$\approx$20 yrs. An analysis of the 2MASS images of the region around GJ 900 leads us to suggest that the system can include other very-low-mass components.Comment: 7 pages, 5 figure

HST Observations of Chromospheres in Metal Deficient Field Giants

HST high resolution spectra of metal-deficient field giants more than double the stars in previous studies, span about 3 magnitudes on the red giant branch, and sample an abundance range [Fe/H]= -1 to -3. These stars, in spite of their age and low metallicity, possess chromospheric fluxes of Mg II (2800 Angstrom) that are within a factor of 4 of Population I stars, and give signs of a dependence on the metal abundance at the lowest metallicities. The Mg II k-line widths depend on luminosity and correlate with metallicity. Line profile asymmetries reveal outflows that occur at lower luminosities (M_V = -0.8) than detected in Ca K and H-alpha lines in metal-poor giants, suggesting mass outflow occurs over a larger span of the red giant branch than previously thought, and confirming that the Mg II lines are good wind diagnostics. These results do not support a magnetically dominated chromosphere, but appear more consistent with some sort of hydrodynamic, or acoustic heating of the outer atmospheres.Comment: 36 pages, 12 figures, 7 tables, and accepted for publication in The Astronomical Journa

On a mechanism for enhancing magnetic activity in tidally interacting binaries

We suggest a mechanism for enhancing magnetic activity in tidally interacting binaries. We suppose that the deviation of the primary star from spherical symmetry due to the tidal influence of the companion leads to stellar pulsation in its fundamental mode. It is shown that stellar radial pulsation amplifies torsional Alfv{\'e}n waves in a dipole-like magnetic field, buried in the interior, according to the recently proposed swing wave-wave interaction (Zaqarashvili 2001). Then amplified Alfv{\'e}n waves lead to the onset of large-scale torsional oscillations, and magnetic flux tubes arising towards the surface owing to magnetic buoyancy diffuse into the atmosphere producing enhanced chromospheric and coronal emission.Comment: Accepted in Ap

Opportunistic screening versus usual care for diagnosing atrial fibrillation in general practice:a cluster randomised controlled trial

Background Atrial fibrillation [AF] increases the risk of stroke, heart failure, and all-cause mortality. AF may be asymptomatic and therefore remain undiagnosed. Devices such as single-lead electrocardiographs [ECGs] may help GPs to diagnose AF. Aim To investigate the yield of opportunistic screening for AF in usual primary care using a single-lead ECG device. Design and setting A clustered, randomised controlled trial among patients aged >= 65 years with no recorded AF status in the Netherlands from October 2014 to March 2016. Method Fifteen intervention general practices used a single-lead ECG device at their discretion and 16 control practices offered usual care. The follow-up period was 1 year, and the primary outcome was the proportion of newly diagnosed cases of AF. Results In total. 17 107 older people with no recorded AF status were eligible to participate in the study. In the intervention arm. 10.7% of eligible patients [n = 919] were screened over the duration of the study year. The rate of newly diagnosed AF was similar in the intervention and control practices [1.43% versus 1.37%, P= 0.73]. Screened patients were more likely to have comorbidities, such as hypertension [60.0% versus 48.7%], type 2 diabetes [24.3% versus 18.6%], and chronic obstructive pulmonary disease [11.3% versus 7.4%], than eligible patients not screened in the intervention arm. Among patients with newly diagnosed AF in intervention practices. 27% were detected by screening, 23% by usual primary care. and 50% by a medical specialist or after stroke/transient ischaemic attack. Conclusion Opportunistic screening with a single-lead ECG at the discretion of the GP did not result in a higher yield of newly detected cases of AF in patients aged >= 65 years in the community than usual care. For higher participation rates in future studies, more rigorous screening methods are needed

Population-based screen-detected type 2 diabetes mellitus is associated with less need for insulin therapy after 10 years

INTRODUCTION: With increased duration of type 2 diabetes, most people have a growing need of glucose-lowering medication and eventually might require insulin. Presumptive evidence is reported that early detection (eg, by population-based screening) and treatment of hyperglycemia will postpone the indication for insulin treatment. A treatment legacy effect of population-based screening for type 2 diabetes of about 3 years is estimated. Therefore, we aim to compare insulin prescription and glycemic control in people with screen-detected type 2 diabetes after 10 years with data from people diagnosed with type 2 diabetes seven (treatment legacy effect) and 10 years before during care-as-usual. RESEARCH DESIGN AND METHODS: Three cohorts were compared: one screen-detected cohort with 10 years diabetes duration (Anglo-Danish-Dutch study of Intensive Treatment in People with Screen-Detected Diabetes in Primary care (ADDITION-NL): n=391) and two care-as-usual cohorts, one with 7-year diabetes duration (Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) and Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC): n=4473) and one with 10-year diabetes duration (GIANTT and ZODIAC: n=2660). Insulin prescription (primary outcome) and hemoglobin A1c (HbA1c) of people with a known diabetes duration of 7 years or 10 years at the index year 2014 were compared using regression analyses. RESULTS: Insulin was prescribed in 10.5% (10-year screen detection), 14.7% (7-year care-as-usual) and 19.0% (10-year care-as-usual). People in the 7-year and 10-year care-as-usual groups had a 1.5 (95% CI 1.0 to 2.1) and 1.8 (95% CI 1.3 to 2.7) higher adjusted odds for getting insulin prescribed than those after screen detection. Lower HbA1c values were found 10 years after screen detection (mean 50.1 mmol/mol (6.7%) vs 51.8 mmol/mol (6.9%) and 52.8 mmol/mol (7.0%)), compared with 7 years and 10 years after care-as-usual (MDadjusted: 1.6 mmol/mol (95% CI 0.6 to 2.6); 0.1% (95% CI 0.1 to 0.2) and 1.8 mmol/mol (95% CI 0.7 to 2.9); and 0.2% (95% CI 0.1 to 0.3)). CONCLUSION: Population-based screen-detected type 2 diabetes is associated with less need for insulin after 10 years compared with people diagnosed during care-as-usual. Glycemic control was better after screen detection but on average good in all groups

Diagnostic value of a heart-type fatty acid-binding protein (H-FABP) bedside test in suspected acute coronary syndrome in primary care

AbstractBackgroundTo determine the diagnostic accuracy of a rapid heart-type fatty acid-binding protein (H-FABP) test in patients suspected of acute coronary syndrome (ACS) in primary care.MethodsGeneral practitioners included 298 patients suspected of ACS. In all patients, whether referred to hospital or not, ECG and cardiac biomarker testing was performed. ACS was determined in accordance with international guidelines. Multivariate analysis was used to determine the value of H-FABP in addition to clinical findings.ResultsMean patient age was 66years (SD 14), 52% was female and 66 patients (22%) were diagnosed with ACS. The H-FABP bedside test was performed within 24h (median 3.1, IQR 1.5 to 7.1) after symptom onset. The positive predictive value (PPV) of H-FABP was 65% (95% confidence interval (CI) 50–78). The negative predictive value (NPV) was 85% (95% CI 80–88). Sensitivity was 39% (29–51%) and specificity 94% (90–96%). Within 6h after symptom onset, the PPV was 72% (55–84) and the NPV was 83% (77–88), sensitivity 43% (31–57%) and specificity 94% (89–97%). Adding the H-FABP test to a diagnostic model for ACS led to an increase in the area under the receiver operating curve from 0.66 (95% CI 0.58–0.73) to 0.75 (95% CI 0.68–0.82).ConclusionThe H-FABP rapid test provides modest additional diagnostic certainty in primary care. It cannot be used to safely exclude rule out ACS. The test can only be used safely in patients otherwise NOT referred to hospital by the GP, as an extra precaution not to miss ACS (‘rule in’)

Magnetic Flux Cancellation in Ellerman Bombs

Ellerman Bombs (EBs) are often found to be co-spatial with bipolar photospheric magnetic fields. We use Hα imaging spectroscopy along with Fe I 6302.5 Å spectropolarimetry from the Swedish 1 m Solar Telescope (SST), combined with data from the Solar Dynamic Observatory, to study EBs and the evolution of the local magnetic fields at EB locations. EBs are found via an EB detection and tracking algorithm. Using NICOLE inversions of the spectropolarimetric data, we find that, on average, (3.43 ± 0.49) × 1024 erg of stored magnetic energy disappears from the bipolar region during EB burning. The inversions also show flux cancellation rates of 1014–1015 Mx s−1 and temperature enhancements of 200 K at the detection footpoints. We investigate the near-simultaneous flaring of EBs due to co-temporal flux emergence from a sunspot, which shows a decrease in transverse velocity when interacting with an existing, stationary area of opposite polarity magnetic flux, resulting in the formation of the EBs. We also show that these EBs can be fueled further by additional, faster moving, negative magnetic flux regions

Stellar Iron Abundances: non-LTE Effects

We report new statistical equilibrium calculations for Fe I and Fe II in the atmosphere of Late-Type stars. We used atomic models for Fe I and Fe II having respectively 256 and 190 levels, as well as 2117 and 3443 radiative transitions. Photoionization cross-sections are from the Iron Project. These atomic models were used to investigate non-LTE effects in iron abundances of Late-Type stars with different atmospheric parameters. We found that most Fe I lines in metal-poor stars are formed in conditions far from LTE. We derived metallicity corrections of about 0.3 dex with respect to LTE values, for the case of stars with [Fe/H] ~ -3.0. Fe II is found not to be affected by significant non-LTE effects. The main non-LTE effect invoked in the case of Fe I is overionization by ultraviolet radiation, thus classical ionization equilibrium is far to be satisfied. An important consequence is that surface gravities derived by LTE analysis are in error and should be corrected before final abundances corrections. This apparently solves the observed discrepancy between spectroscopic surface gravities derived by LTE analyses and those derived from Hipparcos parallaxes. A table of non-LTE [Fe/H] and log g values for a sample of metal-poor late-type stars is given.Comment: 22 pages, 9 figures, 1 table, ApJ style, accepte

Patient‐reported outcomes after 10‐year follow‐up of intensive, multifactorial treatment in individuals with screen‐detected type 2 diabetes: the ADDITION‐Europe trial

AimsTo present the longer‐term impact of multifactorial treatment of type 2 diabetes on self‐reported health status, diabetes‐specific quality of life, and diabetes treatment satisfaction at 10‐year follow up of the ADDITION‐Europe trial.MethodsThe ADDITION‐Europe trial enrolled 3057 individuals with screen‐detected type 2 diabetes from four centres [Denmark, the UK (Cambridge and Leicester) and the Netherlands], between 2001 and 2006. Participants were randomized at general practice level to intensive treatment or to routine care . The trial ended in 2009 and a 10‐year follow‐up was performed at the end of 2014. We measured self‐reported health status (36‐item Short‐Form Health Survey and EQ‐5D), diabetes‐specific quality of life (Audit of Diabetes‐Dependent Quality of Life questionnaire), and diabetes treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire) at different time points during the study period. A mixed‐effects model was applied to estimate the effect of intensive treatment (intention‐to‐treat analyses) on patient‐reported outcome measures for each centre. Centre‐specific estimates were pooled using a fixed effects meta‐analysis.ResultsThere was no difference in patient‐reported outcome measures between the routine care and intensive treatment arms in this 10‐year follow‐up study [EQ‐5D: –0.01 (95% CI –0.03, 0.01); Physical Composite Score (36‐item Short‐Form Health Survey): –0.27 (95% CI –1.11, 0.57), Audit of Diabetes‐Dependent Quality of Life questionnaire: –0.01 (95% CI –0.11, 0.10); and Diabetes Treatment Satisfaction Questionnaire: –0.20 (95% CI –0.70, 0.29)].ConclusionsIntensive, multifactorial treatment of individuals with screen‐detected type 2 diabetes did not affect self‐reported health status, diabetes‐specific quality of life, or diabetes treatment satisfaction at 10‐year follow‐up compared to routine care.</div