Oral healthcare access and adequacy in alternative long-term care facilities

This study was undertaken to determine practices and perceived barriers to access related to oral health by surveying administrators in Michigan alternative long-term care facilities (ALTCF). A 24-item questionnaire was mailed to all 2,275 Michigan ALTCF serving residents aged 60+. Facility response rate was 22% (n = 508). Eleven percent of facilities had a written dental care plan; 18% stated a dentist examined new residents; and 19% of facilities had an agreement with a dentist to come to the facility, with 52% of those being for emergency care only. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or private offices as well as financial concerns. Substantial barriers to care were uniformly perceived.Oral health policies and practices within Michigan ALTCF vary, as measured by resources, attitudes, and the availability of professional care. There is limited involvement by dental professionals in creating policy and providing consultation and service.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79086/1/j.1754-4505.2010.00132.x.pd

The VLT-FLAMES Tarantula Survey. VII. A low velocity dispersion for the young massive cluster R136

Detailed studies of resolved young massive star clusters are necessary to determine their dynamical state and evaluate the importance of gas expulsion and early cluster evolution. In an effort to gain insight into the dynamical state of the young massive cluster R136 and obtain the first measurement of its velocity dispersion, we analyse multi-epoch spectroscopic data of the inner regions of 30 Doradus in the Large Magellanic Cloud (LMC) obtained as part of the VLT-FLAMES Tarantula Survey. Following a quantitative assessment of the variability, we use the radial velocities of non-variable sources to place an upper limit of 6 km/s on the line-of-sight velocity dispersion of stars within a projected distance of 5 pc from the centre of the cluster. After accounting for the contributions of undetected binaries and measurement errors through Monte Carlo simulations, we conclude that the true velocity dispersion is likely between 4 and 5 km/s given a range of standard assumptions about the binary distribution. This result is consistent with what is expected if the cluster is in virial equilibrium, suggesting that gas expulsion has not altered its dynamics. We find that the velocity dispersion would be ~25 km/s if binaries were not identified and rejected, confirming the importance of the multi-epoch strategy and the risk of interpreting velocity dispersion measurements of unresolved extragalactic young massive clusters.Comment: 18 pages, 7 figures, accepted by A&

Collective pulsational velocity broadening due to gravity modes as a physical explanation for macroturbulence in hot massive stars

We aimed at finding a physical explanation for the occurrence of macroturbulence in the atmospheres of hot massive stars, a phenomenon found in observations since more than a decade but yet unexplained. We computed time series of line profiles for evolved massive stars broadened by rotation and by hundreds of low-amplitude nonradial gravity-mode pulsations which are predicted to be excited for evolved massive stars. In general, line profiles based on macrotubulent broadening can mimic those subject to pulsational broadening. In several cases, though, good fits require macroturbulent velocities that pass the speed of sound for realistic pulsation amplitudes. Moreover, we find that the rotation velocity can be seriously underestimated by using a simple parameter description for macroturbulence rather than an appropriate pulsational model description to fit the line profiles. We conclude that macroturbulence is a likely signature of the collective effect of pulsations. We provide line diagnostics and their typical values to decide whether or not pulsational broadening is present in observed line profiles, as well as a procedure to avoid an inaccurate estimation of the rotation velocity.Comment: 12 pages, 9 figures, accepted for publication by Astronomy and Astrophysic

N-3 fatty acids and cardiovascular outcomes in patients with dysglycemia

Publisher Copyright: Copyright © 2012 Massachusetts Medical Society.Background: The use of n-3 fatty acids may prevent cardiovascular events in patients with recent myocardial infarction or heart failure. Their effects in patients with (or at risk for) type 2 diabetes mellitus are unknown. Methods: In this double-blind study with a 2-by-2 factorial design, we randomly assigned 12,536 patients who were at high risk for cardiovascular events and had impaired fasting glucose, impaired glucose tolerance, or diabetes to receive a 1-g capsule containing at least 900 mg (90% or more) of ethyl esters of n-3 fatty acids or placebo daily and to receive either insulin glargine or standard care. The primary outcome was death from cardiovascular causes. The results of the comparison between n-3 fatty acids and placebo are reported here. Results: During a median follow up of 6.2 years, the incidence of the primary outcome was not significantly decreased among patients receiving n-3 fatty acids, as compared with those receiving placebo (574 patients [9.1%] vs. 581 patients [9.3%]; hazard ratio, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P = 0.72). The use of n-3 fatty acids also had no significant effect on the rates of major vascular events (1034 patients [16.5%] vs. 1017 patients [16.3%]; hazard ratio, 1.01; 95% CI, 0.93 to 1.10; P = 0.81), death from any cause (951 [15.1%] vs. 964 [15.4%]; hazard ratio, 0.98; 95% CI, 0.89 to 1.07; P = 0.63), or death from arrhythmia (288 [4.6%] vs. 259 [4.1%]; hazard ratio, 1.10; 95% CI, 0.93 to 1.30; P = 0.26). Triglyceride levels were reduced by 14.5 mg per deciliter (0.16 mmol per liter) more among patients receiving n-3 fatty acids than among those receiving placebo (P<0.001), without a significant effect on other lipids. Adverse effects were similar in the two groups. Conclusions: Daily supplementation with 1 g of n-3 fatty acids did not reduce the rate of cardiovascular events in patients at high risk for cardiovascular events. (Funded by Sanofi; ORIGIN ClinicalTrials.gov number, NCT00069784.).Peer reviewe

Rotational properties of the O-type star population in the Tarantula region

The 30 Doradus (30\,Dor) region in the Large Magellanic Cloud (also known as the Tarantula Nebula) is the nearest massive starburst region, containing the richest sample of massive stars in the Local Group. It is the best possible laboratory to investigate aspects of the formation and evolution of massive stars. Here, we focus on rotation which is a key parameter in the evolution of these objects. We establish the projected rotational velocity, $v_{e}\sin i$, distribution of an unprecedented sample of 216 radial velocity constant ($\rm{\Delta RV\, \leq\, 20 \,km s^{-1}}$) O-type stars in 30\,Dor observed in the framework of the VLT-FLAMES Tarantula Survey (VFTS). The distribution of $v_{e}\sin i$ shows a two-component structure: a peak around 80 $\rm{km s^{-1}}$ and a high-velocity tail extending up to $\sim$600 $\rm{km s^{-1}}$. Around 75% of the sample has 0 $\leq\, v_{e}\sin i \leq$ 200 $\rm{km s^{-1}}$ with the other 25% distributed in the high-velocity tail. The presence of the low-velocity peak is consistent with that found in other studies of late-O and early-B stars. The high-velocity tail is compatible with expectations from binary interaction synthesis models and may be predominantly populated by post-binary interaction, spun-up, objects and mergers. This may have important implications for the nature of progenitors of long-duration gamma ray bursts.Comment: 4 pages, 1 figure. Conference proceedings article: Massive stars: from alpha to Omega, 10-14 June 2013, Rhodes, Greec

The VLT-FLAMES Tarantula Survey XVIII. Classifications and radial velocities of the B-type stars

We present spectral classifications for 438 B-type stars observed as part of the VLT-FLAMES Tarantula Survey (VFTS) in the 30 Doradus region of the Large Magellanic Cloud. Radial velocities are provided for 307 apparently single stars, and for 99 targets with radial-velocity variations which are consistent with them being spectroscopic binaries. We investigate the spatial distribution of the radial velocities across the 30 Dor region, and use the results to identify candidate runaway stars. Excluding potential runaways and members of two older clusters in the survey region (SL 639 and Hodge 301), we determine a systemic velocity for 30 Dor of 271.6 ± 12.2 kms-1 from 273 presumed single stars. Employing a 3σ criterion we identify nine candidate runaway stars (2.9% of the single stars with radial-velocity estimates). The projected rotational velocities of the candidate runaways appear to be significantly different to those of the full B-type sample, with a strong preference for either large (≥345 kms-1) or small (≤65 kms-1) rotational velocities. Of the candidate runaways, VFTS 358 (classified B0.5: V) has the largest differential radial velocity (−106.9 ± 16.2 kms-1), and a preliminary atmospheric analysis finds a significantly enriched nitrogen abundance of 12 + log (N/H) ≳ 8.5. Combined with a large rotational velocity (ve sin i = 345 ± 22 kms-1), this is suggestive of past binary interaction for this star

The VLT-FLAMES Tarantula Survey XIX. B-type Supergiants - Atmospheric parameters and nitrogen abundances to investigate the role of binarity and the width of the main sequence

TLUSTY non-LTE model atmosphere calculations have been used to determine atmospheric parameters and nitrogen (N) abundances for 34 single and 18 binary B-type supergiants (BSGs). The effects of flux contribution from an unseen secondary were considered for the binary sample. We present the first systematic study of the incidence of binarity for a sample of BSGs across the theoretical terminal age main sequence (TAMS). To account for the distribution of effective temperatures of the BSGs it may be necessary to extend the TAMS to lower temperatures. This is consistent with the derived distribution of mass discrepancies, projected rotational velocities (vsini) and N abundances, provided that stars cooler than this temperature are post RSG objects. For the BSGs in the Tarantula and previous FLAMES surveys, most have small vsini. About 10% have larger vsini (>100 km/s) but surprisingly these show little or no N enhancement. All the cooler BSGs have low vsini of <70km/s and high N abundance estimates, implying that either bi-stability braking or evolution on a blue loop may be important. A lack of cool binaries, possibly reflects the small sample size. Single star evolutionary models, which include rotation, can account for the N enhancement in both the single and binary samples. The detailed distribution of N abundances in the single and binary samples may be different, possibly reflecting differences in their evolutionary history. The first comparative study of single and binary BSGs has revealed that the main sequence may be significantly wider than previously assumed, extending to Teff=20000K. Some marginal differences in single and binary atmospheric parameters and abundances have been identified, possibly implying non-standard evolution for some of the sample. This sample as a whole has implications for several aspects of our understanding of the evolution of BSGs. Full abstract in paperComment: 21 pages, 15 figures, 11 table

Rotational velocities of single and binary O-type stars in the Tarantula Nebula

Rotation is a key parameter in the evolution of massive stars, affecting their evolution, chemical yields, ionizing photon budget, and final fate. We determined the projected rotational velocity, $v_e\sin i$, of $\sim$330 O-type objects, i.e. $\sim$210 spectroscopic single stars and $\sim$110 primaries in binary systems, in the Tarantula nebula or 30 Doradus (30\,Dor) region. The observations were taken using VLT/FLAMES and constitute the largest homogeneous dataset of multi-epoch spectroscopy of O-type stars currently available. The most distinctive feature of the $v_e\sin i$ distributions of the presumed-single stars and primaries in 30 Dor is a low-velocity peak at around 100\,$\rm{km s^{-1}}$. Stellar winds are not expected to have spun-down the bulk of the stars significantly since their arrival on the main sequence and therefore the peak in the single star sample is likely to represent the outcome of the formation process. Whereas the spin distribution of presumed-single stars shows a well developed tail of stars rotating more rapidly than 300\,$\rm{km s^{-1}}$, the sample of primaries does not feature such a high-velocity tail. The tail of the presumed-single star distribution is attributed for the most part -- and could potentially be completely due -- to spun-up binary products that appear as single stars or that have merged. This would be consistent with the lack of such post-interaction products in the binary sample, that is expected to be dominated by pre-interaction systems. The peak in this distribution is broader and is shifted toward somewhat higher spin rates compared to the distribution of presumed-single stars. Systems displaying large radial velocity variations, typical for short period systems, appear mostly responsible for these differences.Comment: 6 pages, 3 figures, Proceedings IAU Symposium No. 307, 2014, 'New windows on massive stars: asteroseismology, interferometry, and spectropolarimetry

VLBI study of maser kinematics in high-mass SFRs. II. G23.01-0.41

The present paper focuses on the high-mass star-forming region G23.01-0.41. Methods: Using the VLBA and the EVN arrays, we conducted phase-referenced observations of the three most powerful maser species in G23.01-0.41: H2O at 22.2 GHz (4 epochs), CH3OH at 6.7 GHz (3 epochs), and OH at 1.665 GHz (1 epoch). In addition, we performed high-resolution (> 0".1), high-sensitivity (< 0.1 mJy) VLA observations of the radio continuum emission from the HMC at 1.3 and 3.6 cm. Results: We have detected H2O, CH3OH, and OH maser emission clustered within 2000 AU from the center of a flattened HMC, oriented SE-NW, from which emerges a massive 12CO outflow, elongated NE-SW, extended up to the pc-scale. Although the three maser species show a clearly different spatial and velocity distribution and sample distinct environments around the massive YSO, the spatial symmetry and velocity field of each maser specie can be explained in terms of expansion from a common center, which possibly denotes the position of the YSO driving the maser motion. Water masers trace both a fast shock (up to 50 km/s) closer to the YSO, powered by a wide-angle wind, and a slower (20 km/s) bipolar jet, at the base of the large-scale outflow. Since the compact free-free emission is found offset from the putative location of the YSO along a direction consistent with that of the maser jet axis, we interpret the radio continuum in terms of a thermal jet. The velocity field of methanol masers can be explained in terms of a composition of slow (4 km/s in amplitude) motions of radial expansion and rotation about an axis approximately parallel to the maser jet. Finally, the distribution of line of sight velocities of the hydroxyl masers suggests that they can trace gas less dense (n(H2) < 10^6 cm^-3) and more distant from the YSO than that traced by the water and methanol masers, which is expanding toward the observer. (Abridged)Comment: 23 pages, 8 figures, 4 tables, accepted by Astronomy and Astrophysic

Statistical properties of a sample of periodically variable B-type supergiants - Evidence for opacity-driven gravity-mode oscillations

We have studied a sample of 28 periodically variable B-type supergiants selected from the HIPPARCOS mission and 12 comparison stars covering the whole B-type spectral range. Our goal is to test if their variability is compatible with opacity-driven non-radial oscillations. We have used the NLTE atmosphere code FASTWIND to derive the atmospheric and wind parameters of the complete sample through line profile fitting. We applied the method to selected H, He and Si line profiles, measured with the high resolution CES spectrograph attached to the ESO CAT telescope in La Silla, Chile. From the location of the stars in the (log Teff, log g) diagram, we suggest that variability of our sample supergiants is indeed due to the gravity modes resulting from the opacity mechanism. We find nine of the comparison stars to be periodically variable as well, and suggest them to be new alpha Cyg variables. We find marginal evidence of a correlation between the amplitude of the photometric variability and the wind density. We investigate the Wind Momentum Luminosity Relation for the whole range of B spectral type supergiants, and find that the later types (> B5) perfectly follow the relation for A supergiants. Additionally, we provide a new spectral type - Teff calibration for B supergiants. Our results imply the possibility to probe internal structure models of massive stars of spectral type B through seismic tuning of gravity modes.Comment: 33 pages (including 14 pages online material). Accepted for publication in Astronomy & Astrophysic