The Digital House of Care: information solutions for integrated care

Purpose – The purpose of this paper is to describe the development of a digital tool in an English county striving towards a vision of integrated information that is used to underpin an increasingly integrated future of health and social care delivery. Design/methodology/approach – It discusses the policy context nationally, the origins and implementation of the initiative, the authors’ experiences and viewpoint highlighting key challenges and learning, as well as examples of new work undertaken. Findings – In all, 12 health and care organisations have participated in this project. The ability for local commissioners and providers of services to now understand “flow” both between and within services at a granular level is unique. Costs are modest, and the opportunities for refining and better targeting as well as validating services are significant, thus demonstrating a return on investment. Key learning includes how organisational development was equally as important as the implementation of innovative new software, that change management from grass roots to strategic leaders is vital, and that the whole system is greater than the sum of its otherwise in-silo parts. Practical implications – Data linkage initiatives, whether local, regional or national in scale, need to be programme managed. A robust governance and accountability framework must be in place to realise the benefits of such as a solution, and IT infrastructure is paramount. Social implications – Organisational development, collaborative as well as distributed leadership, and managing a change in culture towards health and care information is critical in order to create a supportive environment that fosters learning across organisational boundaries. Originality/value – This paper draws on the recent experience of achieving large-scale data integration across the boundaries of health and social care, to help plan and commission services more effectively. This rich, multi-agency intelligence has already begun to change the way in which the system considers service planning, and learning from this county’s approach may assist others considering similar initiatives.N/

Magnetic inflation and stellar mass. V. Intensification and saturation of M-dwarf absorption lines with Rossby number

In young Sun-like stars and field M-dwarf stars, chromospheric and coronal magnetic activity indicators such as Hα, X-ray, and radio emission are known to saturate with low Rossby number (Ro lesssim 0.1), defined as the ratio of rotation period to convective turnover time. The mechanism for the saturation is unclear. In this paper, we use photospheric Ti i and Ca i absorption lines in the Y band to investigate magnetic field strength in M dwarfs for Rossby numbers between 0.01 and 1.0. The equivalent widths of the lines are magnetically enhanced by photospheric spots, a global field, or a combination of the two. The equivalent widths behave qualitatively similar to the chromospheric and coronal indicators: we see increasing equivalent widths (increasing absorption) with decreasing Ro and saturation of the equivalent widths for Ro lesssim 0.1. The majority of M dwarfs in this study are fully convective. The results add to mounting evidence that the magnetic saturation mechanism occurs at or beneath the stellar photosphere.Published versio

A physically motivated and empirically calibrated method to measure effective temperature, metallicity, and Ti abundance of M dwarfs

The ability to perform detailed chemical analysis of Sun-like F-, G-, and K-type stars is a powerful tool with many applications including studying the chemical evolution of the Galaxy and constraining planet formation theories. Unfortunately, complications in modeling cooler stellar atmospheres hinders similar analysis of M-dwarf stars. Empirically-calibrated methods to measure M dwarf metallicity from moderate-resolution spectra are currently limited to measuring overall metallicity and rely on astrophysical abundance correlations in stellar populations. We present a new, empirical calibration of synthetic M dwarf spectra that can be used to infer effective temperature, Fe abundance, and Ti abundance. We obtained high-resolution (R~25,000), Y-band (~1 micron) spectra of 29 M dwarfs with NIRSPEC on Keck II. Using the PHOENIX stellar atmosphere modeling code (version 15.5), we generated a grid of synthetic spectra covering a range of temperatures, metallicities, and alpha-enhancements. From our observed and synthetic spectra, we measured the equivalent widths of multiple Fe I and Ti I lines and a temperature-sensitive index based on the FeH bandhead. We used abundances measured from widely-separated solar-type companions to empirically calibrate transformations to the observed indices and equivalent widths that force agreement with the models. Our calibration achieves precisions in Teff, [Fe/H], and [Ti/Fe] of 60 K, 0.1 dex, and 0.05 dex, respectively and is calibrated for 3200 K < Teff < 4100 K, -0.7 < [Fe/H] < +0.3, and -0.05 < [Ti/Fe] < +0.3. This work is a step toward detailed chemical analysis of M dwarfs at a similar precision achieved for FGK stars.Comment: accepted for publication in ApJ, all synthetic spectra available at http://people.bu.edu/mveyette/phoenix

Kepler-445, Kepler-446 And The Occurrence Of Compact Multiples Orbiting Mid-M Dwarf Stars

We confirm and characterize the exoplanetary systems Kepler-445 and Kepler-446: two mid-M dwarf stars, each with multiple, small, short-period transiting planets. Kepler-445 is a metal-rich ([ Fe/H] = + 0.25 0.10) M4 dwarf with three transiting planets, and Kepler-446 is a metal-poor ([ Fe/H] = -0.30 0.10) M4 dwarf also with three transiting planets. Kepler-445c is similar toGJ 1214b: both in planetary radius and the properties of the host star. The Kepler-446 system is similar to the Kepler-42 system: both are metal-poor with large galactic space velocities and three short-period, likely rocky transiting planets that were initially assigned erroneously large planet-to-star radius ratios. We independently determined stellar parameters from spectroscopy and searched for and fitted the transit light curves for the planets, imposing a strict prior on stellar density in order to remove correlations between the fitted impact parameter and planet-to-star radius ratio for short-duration transits. Combining Kepler-445, Kepler-446, and Kepler-42, and isolating all mid-M dwarf stars observed by Kepler with the precision necessary to detect similar systems, we calculate that 21+ 7 -5 % of mid-M dwarf stars host compact multiples ( multiple planets with periods of less than 10 days) for a wide range of metallicities. We suggest that the inferred planet masses for these systems support highly efficient accretion of protoplanetary disk metals by mid-M dwarf protoplanets.NSF DGE1144152, AST-1005313NASA NAS5-26555NASA Office of Space Science NNX13AC07GAstronom

A Catalog of Cool Dwarf Targets for the Transiting Exoplanet Survey Satellite

We present a catalog of cool dwarf targets ($V-J>2.7$, $T_{\rm eff} \lesssim 4000 K$) and their stellar properties for the upcoming Transiting Exoplanet Survey Satellite (TESS), for the purpose of determining which cool dwarfs should be observed using two-minute observations. TESS has the opportunity to search tens of thousands of nearby, cool, late K and M-type dwarfs for transiting exoplanets, an order of magnitude more than current or previous transiting exoplanet surveys, such as {\it Kepler}, K2 and ground-based programs. This necessitates a new approach to choosing cool dwarf targets. Cool dwarfs were chosen by collating parallax and proper motion catalogs from the literature and subjecting them to a variety of selection criteria. We calculate stellar parameters and TESS magnitudes using the best possible relations from the literature while maintaining uniformity of methods for the sake of reproducibility. We estimate the expected planet yield from TESS observations using statistical results from the Kepler Mission, and use these results to choose the best targets for two-minute observations, optimizing for small planets for which masses can conceivably be measured using follow up Doppler spectroscopy by current and future Doppler spectrometers. The catalog is incorporated into the TESS Input Catalog and TESS Candidate Target List until a more complete and accurate cool dwarf catalog identified by ESA's Gaia Mission can be incorporated.Comment: Accepted to The Astronomical Journal. For the full catalog, please contact the corresponding autho

Multiwavelength transit observations of the candidate disintegrating planetesimals orbiting WD 1145+017

We present multiwavelength, ground-based follow-up photometry of the white dwarf WD 1145+017, which has recently been suggested to be orbited by up to six or more short-period, low-mass, disintegrating planetesimals. We detect nine significant dips in flux of between 10% and 30% of the stellar flux in our ~32 hr of photometry, suggesting that WD 1145+017 is indeed being orbited by multiple, short-period objects. Through fits to the asymmetric transits that we observe, we confirm that the transit egress is usually longer than the ingress, and that the transit duration is longer than expected for a solid body at these short periods, all suggesting that these objects have cometary tails streaming behind them. The precise orbital periods of the planetesimals are unclear, but at least one object, and likely more, have orbital periods of ~4.5 hr. We are otherwise unable to confirm the specific periods that have been reported, bringing into question the long-term stability of these periods. Our high-precision photometry also displays low-amplitude variations, suggesting that dusty material is consistently passing in front of the white dwarf, either from discarded material from these disintegrating planetesimals or from the detected dusty debris disk. We compare the transit depths in the V- and R-bands of our multiwavelength photometry, and find no significant difference; therefore, for likely compositions, the radius of single-size particles in the cometary tails streaming behind the planetesimals must be ~0.15 μm or larger, or ~0.06 μm or smaller, with 2σ confidence

Friends of Hot Jupiters II: No Correspondence Between Hot-Jupiter Spin-Orbit Misalignment and the Incidence of Directly Imaged Stellar Companions

Multi-star systems are common, yet little is known about a stellar companion's influence on the formation and evolution of planetary systems. For instance, stellar companions may have facilitated the inward migration of hot Jupiters towards to their present day positions. Many observed short period gas giant planets also have orbits that are misaligned with respect to their star's spin axis, which has also been attributed to the presence of a massive outer companion on a non-coplanar orbit. We present the results of a multi-band direct imaging survey using Keck NIRC2 to measure the fraction of short period gas giant planets found in multi-star systems. Over three years, we completed a survey of 50 targets ("Friends of Hot Jupiters") with 27 targets showing some signature of multi-body interaction (misaligned or eccentric orbits) and 23 targets in a control sample (well-aligned and circular orbits). We report the masses, projected separations, and confirmed common proper motion for the 19 stellar companions found around 17 stars. Correcting for survey incompleteness, we report companion fractions of $48\%\pm9\%$, $47\%\pm12\%$, and $51\%\pm13\%$ in our total, misaligned/eccentric, and control samples, respectively. This total stellar companion fraction is $2.8\,\sigma$ larger than the fraction of field stars with companions approximately $50-2000\,$AU. We observe no correlation between misaligned/eccentric hot Jupiter systems and the incidence of stellar companions. Combining this result with our previous radial velocity survey, we determine that $72\% \pm 16\%$ of hot Jupiters are part of multi-planet and/or multi-star systems.Comment: typos and references updated; 25 pages, 7 figures and 10 tables, accepted for publication in Ap

A Gyrochronology and Microvariability Survey of the Milky Way's Older Stars Using Kepler's Two-Wheels Program

Even with the diminished precision possible with only two reaction wheels, the Kepler spacecraft can obtain mmag level, time-resolved photometry of tens of thousands of sources. The presence of such a rich, large data set could be transformative for stellar astronomy. In this white paper, we discuss how rotation periods for a large ensemble of single and binary main- sequence dwarfs can yield a quantitative understanding of the evolution of stellar spin-down over time. This will allow us to calibrate rotation-based ages beyond ~1 Gyr, which is the oldest benchmark that exists today apart from the Sun. Measurement of rotation periods of M dwarfs past the fully-convective boundary will enable extension of gyrochronology to the end of the stellar main-sequence, yielding precise ages ({\sigma} ~10%) for the vast majority of nearby stars. It will also help set constraints on the angular momentum evolution and magnetic field generation in these stars. Our Kepler-based study would be supported by a suite of ongoing and future ground-based observations. Finally, we briefly discuss two ancillary science cases, detection of long-period low-mass eclipsing binaries and microvariability in white dwarfs and hot subdwarf B stars that the Kepler Two-Wheels Program would facilitate.Comment: Kepler white pape

The gold standard: accurate stellar and planetary parameters for eight Kepler M dwarf systems enabled by parallaxes

We report parallaxes and proper motions from the Hawaii Infrared Parallax Program for eight nearby M dwarf stars with transiting exoplanets discovered by Kepler. We combine our directly measured distances with mass-luminosity and radius–luminosity relationships to significantly improve constraints on the host stars’ properties. Our astrometry enables the identification of wide stellar companions to the planet hosts. Within our limited sample, all the multi-transiting planet hosts (three of three) appear to be single stars, while nearly all (four of five) of the systems with a single detected planet have wide stellar companions. By applying strict priors on average stellar density from our updated radius and mass in our transit fitting analysis, we measure the eccentricity probability distributions for each transiting planet. Planets in single-star systems tend to have smaller eccentricities than those in binaries, although this difference is not significant in our small sample. In the case of Kepler-42bcd, where the eccentricities are known to be ≃0, we demonstrate that such systems can serve as powerful tests of M dwarf evolutionary models by working in L⋆ − ρ⋆ space. The transit-fit density for Kepler- 42bcd is inconsistent with model predictions at 2.1σ (22%), but matches more empirical estimates at 0.2σ (2%), consistent with earlier results showing model radii of M dwarfs are underinflated. Gaia will provide high-precision parallaxes for the entire Kepler M dwarf sample, and TESS will identify more planets transiting nearby, late-type stars, enabling significant improvements in our understanding of the eccentricity distribution of small planets and the parameters of late-type dwarfs.Support for Program number HST-HF2-51364.001-A was provided by NASA through a grant from the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Incorporated, under NASA contract NAS5-26555.Some of the data presented in this paper were obtained from the Mikulski Archive for Space Telescopes (MAST). STScI is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS5-26555. Support for MAST for non-HST data is provided by the NASA Office of Space Science via grant NNX09AF08G and by other grants and contracts. This paper includes data collected by the Kepler mission. Funding for the Kepler mission is provided by the NASA Science Mission directorate. The authors acknowledge the Texas Advanced Computing Center (TACC) at The University of Texas at Austin for providing HPC resources that have contributed to the research results reported within this paper. URL: http://www.tacc.utexas.edu. (HST-HF2-51364.001-A - NASA through Space Telescope Science Institute; NAS5-26555 - NASA; NNX09AF08G - NASA Office of Space Science; NASA Science Mission directorate

A qualitative exploration of the barriers to healthy physical activity and diet in young adults with intellectual disabilities transitioning to adulthood

[Abstract unavailable