Screening of community-dwelling older patients by the emergency medical services : An observational retrospective registry study

Background: Inadequate nutrition, falls, and cognitive impairment are common problems among acutely ill older people and are associated with complicated and prolonged health problems and mortality. Objectives: To assess if the emergency medical services can identify patients with nutritional risk, falls risk, and cognitive impairment by using simple screening tools and to assess the prevalence of risks and rate they are reported to the emergency department. Setting: The study was carried out in Espoo, Finland to patients over the age of 70 requiring non-urgent ambulance transfer to the emergency department. Outcome measures: A set of validated electronic screening tools was used to identify patients at nutritional risk, risk of falling and having cognitive impairment. Main results: A total of 488 (8%) out of 5792 patients were screened. Of the patients 60%, (n = 292) had at least one risk: 17% (n = 81) had nutritional risk, 43% (n = 209) falls risk, and 28% (n = 137) cognitive impairment. Twenty-two (5%) were screened positive in all three categories. The observed risk was reported to the emergency department staff in 59% (n = 173) of the patients. Conclusion: The emergency medical services can be used in preventive health care to identify patients having nutritional risk, falls risk, or cognitive impairment.Peer reviewe

SN 2015bn: A DETAILED MULTI-WAVELENGTH VIEW of A NEARBY SUPERLUMINOUS SUPERNOVA

We present observations of SN 2015bn (=PS15ae = CSS141223-113342+004332 = MLS150211-113342+004333), a Type I superluminous supernova (SLSN) at redshift z = 0.1136. As well as being one of the closest SLSNe I yet discovered, it is intrinsically brighter (${M}_{U}\approx -23.1$) and in a fainter galaxy (${M}_{B}\approx -16.0$) than other SLSNe at $z\sim 0.1$. We used this opportunity to collect the most extensive data set for any SLSN I to date, including densely sampled spectroscopy and photometry, from the UV to the NIR, spanning −50 to +250 days from optical maximum. SN 2015bn fades slowly, but exhibits surprising undulations in the light curve on a timescale of 30–50 days, especially in the UV. The spectrum shows extraordinarily slow evolution except for a rapid transformation between +7 and +20–30 days. No narrow emission lines from slow-moving material are observed at any phase. We derive physical properties including the bolometric luminosity, and find slow velocity evolution and non-monotonic temperature and radial evolution. A deep radio limit rules out a healthy off-axis gamma-ray burst, and places constraints on the pre-explosion mass loss. The data can be consistently explained by a $\gtrsim 10$ M ${}_{\odot }$ stripped progenitor exploding with $\sim {10}^{51}$ erg kinetic energy, forming a magnetar with a spin-down timescale of ~20 days (thus avoiding a gamma-ray burst) that reheats the ejecta and drives ionization fronts. The most likely alternative scenario—interaction with ~20 M ${}_{\odot }$ of dense, inhomogeneous circumstellar material—can be tested with continuing radio follow-up.S.J.S. acknowledges funding from the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013)/ERC Grant agreement no [291222] and STFC grants ST/I001123/1 and ST/L000709/1. This work is based (in part) on observations collected at the European Organisation for Astronomical Research in the Southern Hemisphere, Chile as part of PESSTO, (the Public ESO Spectroscopic Survey for Transient Objects Survey) ESO program 188.D-3003, 191.D-0935. The Pan-STARRS1 Surveys (PS1) have been made possible through contributions of the Institute for Astronomy, the University of Hawaii, the Pan-STARRS Project Office, the Max-Planck Society and its participating institutes, the Max Planck Institute for Astronomy, Heidelberg and the Max Planck Institute for Extraterrestrial Physics, Garching, The Johns Hopkins University, Durham University, the University of Edinburgh, Queen's University Belfast, the Harvard-Smithsonian Center for Astrophysics, the Las Cumbres Observatory Global Telescope Network Incorporated, the National Central University of Taiwan, the Space Telescope Science Institute, the National Aeronautics and Space Administration under Grant No. NNX08AR22G issued through the Planetary Science Division of the NASA Science Mission Directorate, the National Science Foundation under Grant No. AST-1238877, the University of Maryland, and Eotvos Lorand University (ELTE). Operation of the Pan-STARRS1 telescope is supported by the National Aeronautics and Space Administration under Grant No. NNX12AR65G and Grant No. NNX14AM74G issued through the NEO Observation Program. Based on observations made with the Nordic Optical Telescope, operated by the Nordic Optical Telescope Scientific Association at the Observatorio del Roque de los Muchachos, La Palma, Spain, of the Instituto de Astrofisica de Canarias. A.G.-Y. is supported by the EU/FP7 via ERC grant No. 307260, the Quantum universe I-Core programme by the Israeli Committee for Planning and Budgeting and the ISF; by Minerva and ISF grants; by the Weizmann-UK "making connections" programme; and by the Kimmel and YeS awards. B.D.M. is supported by NSF grant AST-1410950 and the Alfred P. Sloan Foundation. Support for L.G. is provided by the Ministry of Economy, Development, and Tourism's Millennium Science Initiative through grant IC120009 awarded to The Millennium Institute of Astrophysics (MAS), and CONICYT through FONDECYT grant 3140566. This work was partly supported by the European Union FP7 programme through ERC grant number 320360. K.M. acknowledges support from the STFC through an Ernest Rutherford Fellowship. A.M. acknowledges funding from CNRS. Development of ASAS-SN has been supported by NSF grant AST-0908816 and CCAPP at the Ohio State University. ASAS-SN is supported by NSF grant AST-1515927, the Center for Cosmology and AstroParticle Physics (CCAPP) at OSU, the Mt. Cuba Astronomical Foundation, George Skestos, and the Robert Martin Ayers Sciences Fund. B.S. is supported by NASA through Hubble Fellowship grant HF-51348.001 awarded by the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., for NASA, under contract NAS 5-26555. C.S.K. is supported by NSF grants AST-1515876 and AST-1515927. T.W.-S.H. is supported by the DOE Computational Science Graduate Fellowship, grant number DE-FG02-97ER25308. V.A.V. is supported by a NSF Graduate Research Fellowship. P.S.C. is grateful for support provided by the NSF through the Graduate Research Fellowship Program, grant DGE1144152. P.B. is supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. DGE1144152. D.A.H., C.M., and G.H. are supported by NSF grant 1313484.This is the author accepted manuscript. The final version is available from the Institute of Physics via http://dx.doi.org/10.3847/0004-637X/826/1/3

Primary Black Hole Spin in OJ 287 as Determined by the General Relativity Centenary Flare

OJ 287 is a quasi-periodic quasar with roughly 12 year optical cycles. It displays prominent outbursts that are predictable in a binary black hole model. The model predicted a major optical outburst in 2015 December. We found that the outburst did occur within the expected time range, peaking on 2015 December 5 at magnitude 12.9 in the optical R -band. Based on Swift /XRT satellite measurements and optical polarization data, we find that it included a major thermal component. Its timing provides an accurate estimate for the spin of the primary black hole, ##IMG## [http://ej.iop.org/images/2041-8205/819/2/L37/apjl523055ieqn1.gif] $i =0.313pm 0.01$ . The present outburst also confirms the established general relativistic properties of the system such as the loss of orbital energy to gravitational radiation at the 2% accuracy level, and it opens up the possibility of testing the black hole no-hair theorem with 10% accuracy during the present decade.Peer reviewe

A Search for QPOs in the Blazar OJ287: Preliminary Results from the 2015/2016 Observing Campaign

We analyse the light curve in the R band of the blazar OJ287, gathered during the 2015/2016 observing season. We did a search for quasi-periodic oscillations (QPOs) using several methods over a wide range of timescales. No statistically significant periods were found in the high-frequency domain both in the ground-based data and in Kepler observations. In the longer-period domain, the Lomb–Scargle periodogram revealed several peaks above the 99% significance level. The longest one—about 95 days—corresponds to the innermost stable circular orbit (ISCO) period of the more massive black hole. The 43-day period could be an alias, or it can be attributed to accretion in the form of a two-armed spiral wave.Peer reviewe

Authenticating the Presence of a Relativistic Massive Black Hole Binary in OJ 287 Using Its General Relativity Centenary Flare : Improved Orbital Parameters

Results from regular monitoring of relativistic compact binaries like PSR 1913+16 are consistent with the dominant (quadrupole) order emission of gravitational waves (GWs). We show that observations associated with the binary black hole (BBH) central engine of blazar OJ 287 demand the inclusion of gravitational radiation reaction effects beyond the quadrupolar order. It turns out that even the effects of certain hereditary contributions to GW emission are required to predict impact flare timings of OJ 287. We develop an approach that incorporates this effect into the BBH model for OJ 287. This allows us to demonstrate an excellent agreement between the observed impact flare timings and those predicted from ten orbital cycles of the BBH central engine model. The deduced rate of orbital period decay is nine orders of magnitude higher than the observed rate in PSR 1913+16, demonstrating again the relativistic nature of OJ 287's central engine. Finally, we argue that precise timing of the predicted 2019 impact flare should allow a test of the celebrated black hole "no-hair theorem" at the 10% level.Peer reviewe

The First Post-Kepler Brightness Dips of KIC 8462852

We present a photometric detection of the first brightness dips of the unique variable star KIC 8462852 since the end of the Kepler space mission in 2013 May. Our regular photometric surveillance started in October 2015, and a sequence of dipping began in 2017 May continuing on through the end of 2017, when the star was no longer visible from Earth. We distinguish four main 1-2.5% dips, named "Elsie," "Celeste," "Skara Brae," and "Angkor", which persist on timescales from several days to weeks. Our main results so far are: (i) there are no apparent changes of the stellar spectrum or polarization during the dips; (ii) the multiband photometry of the dips shows differential reddening favoring non-grey extinction. Therefore, our data are inconsistent with dip models that invoke optically thick material, but rather they are in-line with predictions for an occulter consisting primarily of ordinary dust, where much of the material must be optically thin with a size scale <<1um, and may also be consistent with models invoking variations intrinsic to the stellar photosphere. Notably, our data do not place constraints on the color of the longer-term "secular" dimming, which may be caused by independent processes, or probe different regimes of a single process

Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Purpose Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. Methods We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. Results We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Non-AIDS-, non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Conclusion Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.publishedVersio

Authenticating the Presence of a Relativistic Massive Black Hole Binary in OJ 287 Using Its General Relativity Centenary Flare: Improved Orbital Parameters

© 2018. The American Astronomical Society. All rights reserved. Results from regular monitoring of relativistic compact binaries like PSR 1913+16 are consistent with the dominant (quadrupole) order emission of gravitational waves (GWs). We show that observations associated with the binary black hole (BBH) central engine of blazar OJ 287 demand the inclusion of gravitational radiation reaction effects beyond the quadrupolar order. It turns out that even the effects of certain hereditary contributions to GW emission are required to predict impact flare timings of OJ 287. We develop an approach that incorporates this effect into the BBH model for OJ 287. This allows us to demonstrate an excellent agreement between the observed impact flare timings and those predicted from ten orbital cycles of the BBH central engine model. The deduced rate of orbital period decay is nine orders of magnitude higher than the observed rate in PSR 1913+16, demonstrating again the relativistic nature of OJ 287's central engine. Finally, we argue that precise timing of the predicted 2019 impact flare should allow a test of the celebrated black hole "no-hair theorem" at the 10% level