Where do the elderly die? The impact of nursing home utilisation on the place of death. Observations from a mortality cohort study in Flanders

BACKGROUND: Most of the research concerning place of death focuses on terminally ill patients (cancer patients) while the determinants of place of death of the elderly of the general population are not intensively studied. Studies showed the influence of gender, age, social-economical status and living arrangements on the place of death, but a facet not taken into account so far is the influence of the availability of nursing homes. METHODS: We conducted a survey of deaths, between January 1999 and December 2000 in a small densely populated area in Belgium, with a high availability of nursing homes (within 5 to 10 km of the place of residence of every elderly). We determined the incidence of total mortality (of subjects >60 years) from local official death registers that we consulted via the priest or the mortician of the local parish, to ask where the decedent had died and whether the deceased had lived in a nursing home. We compared the distribution of the places of death between parishes with a nursing home and with parishes without nursing home. RESULTS: 240 women and 217 men died during the two years study period. Only 22% died at home, while the majority (78%) died in an institutional setting, either a hospital (50%) or a nursing home (28%). Place of death was influenced by individual factors (age and gender) and the availability of a nursing home in the 'own' parish. The chance of in-hospital death was 65% higher for men (95% Confidence Interval [CI]: 14 to 138%; p = 0.008) and decreased by 4% (CI: -5.1% to -2.5%; p < 0.0001) for each year increase in age. Independent of gender and age, the chance of in-hospital death was 41% (CI: -60% to -13%; p = 0.008) lower in locations with a nursing home. CONCLUSION: Demographic, but especially social-contextual factors determine where elderly will end their life. The majority of elderly in Flanders die in an institution. Age, gender and living situation are predictors of the place of death but the embedment of a nursing home in the local community seems to be a key predictor

A detailed X-ray investigation of zeta Puppis I. The dataset and some preliminary results

Aims: zeta Puppis, one of the closest and brightest massive stars, was the first early-type object observed by the current generation of X-ray observatories. These data provided some surprising results, confirming partly the theoretical predictions while simultaneously unveiling some problematic mismatches with expectations. In this series of papers, we perform a thorough study of zeta Puppis in X-rays, using a decade of XMM observations. Methods: zeta Puppis was observed 18 times by XMM, totaling 1Ms in exposure. This provides the highest-quality high-resolution X-ray spectrum of a massive star to date, as well as a perfect dataset for studying X-ray variability in an "archetype" object. Results: This first paper reports on the data reduction of this unique dataset and provides a few preliminary results. On the one hand, the analysis of EPIC low-resolution spectra shows the star to have a remarkably stable X-ray emission from one observation to the next. On the other hand, the fitting by a wind model of individual line profiles recorded by RGS confirms the wavelength dependence of the line morphology.Comment: 9 pages, 3 figures, accepted for publication by A&

Massive binaries and the enrichment of the interstellar medium in globular clusters

Abundance anomalies observed in globular cluster stars indicate pollution with material processed by hydrogen burning. Two main sources have been suggested: asymptotic giant branch stars and massive stars rotating near the break-up limit. We discuss the potential of massive binaries as an interesting alternative source of processed material. We discuss observational evidence for mass shedding from interacting binaries. In contrast to the fast, radiatively driven winds of massive stars, this material is typically ejected with low velocity. We expect that it remains inside the potential well of a globular cluster and becomes available for the formation or pollution of a second generation of stars. We estimate that the amount of processed low-velocity material that can be ejected by massive binaries is larger than the contribution of two previously suggested sources combined.Comment: 6 pages, 2 figures, to appear in the proceedings of IAU Symposium 266, "Star Clusters - Basic Galactic Building Blocks throughout Time and Space", 10-14 August 2009, at the general assembly in Rio de Janeiro, Brazi

The origin of runaway stars

Milli-arcsecond astrometry provided by Hipparcos and by radio observations makes it possible to retrace the orbits of some of the nearest runaway stars and pulsars to determine their site of origin. The orbits of the runaways AE Aurigae and mu Columbae and of the eccentric binary iota Orionis intersect each other about 2.5 Myr ago in the nascent Trapezium cluster, confirming that these runaways were formed in a binary-binary encounter. The path of the runaway star zeta Ophiuchi intersects that of the nearby pulsar PSR J1932+1059, about 1 Myr ago, in the young stellar group Upper Scorpius. We propose that this neutron star is the remnant of a supernova that occurred in a binary system which also contained zeta Oph, and deduce that the pulsar received a kick velocity of about 350 km/s in the explosion. These two cases provide the first specific kinematic evidence that both mechanisms proposed for the production of runaway stars, the dynamical ejection scenario and the binary-supernova scenario, operate in nature.Comment: 5 pages, including 2 eps-figures and 1 table, submitted to the ApJ Letters. The manuscript was typeset using aaste

The origin of the runaway high-mass X-ray binary HD153919/4U1700-37

Based on its Hipparcos proper motion, we propose that the high-mass X-ray binary HD153919/4U1700-37 originates in the OB association Sco OB1. At a distance of 1.9 kpc the space velocity of 4U1700-37 with respect to Sco OB1 is 75 km/s. This runaway velocity indicates that the progenitor of the compact X-ray source lost about 7 Msun during the (assumed symmetric) supernova explosion. The system's kinematical age is about 2 +/- 0.5 million years which marks the date of the supernova explosion forming the compact object. The present age of Sco OB1 is <8 Myr; its suggested core, NGC 6231, seems to be somewhat younger (~5 Myr). If HD153919/4U1700-37 was born as a member of Sco OB1, this implies that the initially most massive star in the system terminated its evolution within 30 Msun. With these parameters the evolution of the binary system can be constrained.Comment: 6 pages, latex, 3 embedded ps figures, to appear in A&

Which activities threaten independent living of elderly when becoming problematic : inspiration for meaningful service robot functionality

Purpose: In light of the increasing elderly population and the growing demand for home care, the potential of robot support is given increasing attention. In this paper, an inventory of activities was made that threaten independent living of elderly when becoming problematic. Results will guide the further development of an existing service robot, the Care-O-bot®. Method: A systematic literature search of PubMed was performed, focused on the risk factors for institutionalization. Additionally, focus group sessions were conducted in the Netherlands, United Kingdom and France. In these focus group sessions, problematic activities threatening the independence of elderly people were discussed. Three separate target groups were included in the focus group sessions: (1) elderly persons (n = 41), (2) formal caregivers (n = 40) and (3) informal caregivers (n = 32). Results: Activities within the International Classification of Functioning domains mobility, self-care, and interpersonal interaction and relationships were found to be the most problematic. Conclusions: A distinct set of daily activities was identified that may threaten independent living, but no single activity could be selected as the main activity causing a loss of independence as it is often a combination of problematic activities that is person-specific. Supporting the problematic activities need not involve a robotic solution Read More: http://informahealthcare.com/doi/abs/10.3109/17483107.2013.840861Peer reviewe

A cyclic bipolar wind in the interacting binary V393 Scorpii

V393 Scorpii is a Double Periodic Variable characterized by a relatively stable non-orbital photometric cycle of 253 days. Mennickent et al. argue for the presence of a massive optically thick disc around the more massive B-type component and describe the evolutionary stage of the system. In this paper we analyze the behavior of the main spectroscopic optical lines during the long non-orbital photometric cycle. We study the radial velocity of the donor determining their orbital elements and find a small but significant orbital eccentricity (e = 0.04). The donor spectral features are modeled and removed from the spectrum at every observing epoch using the light-curve model given by Mennickent et al. We find that the line emission is larger during eclipses and mostly comes from a bipolar wind. We find that the long cycle is explained in terms of a modulation of the wind strength; the wind has a larger line and continuum emissivity on the high state. We report the discovery of highly variable chromospheric emission in the donor, as revealed by Doppler maps of the emission lines MgII 4481 and CI 6588. We discuss notable and some novel spectroscopic features like discrete absorption components, especially visible at blue-depressed OI 7773 absorption wings during the second half-cycle, Balmer double emission with V/R-curves showing "Z-type" and "S-type" excursions around secondary and main eclipse, respectively, and H_beta emission wings extending up to +- 2000 km/s. We discuss possible causes for these phenomena and for their modulations with the long cycle.Comment: 19 pages, 22 figures, accepted for publication in MNRA

Fundamental stellar parameters of zeta Pup and gamma^2 Vel from HIPPARCOS data

We report parallax measurements by the HIPPARCOS satellite of zeta Puppis and gamma^2 Velorum. The distance of zeta Pup is d=429 (+120/ -77) pc, in agreement with the commonly adopted value to Vela OB2. However, a significantly smaller distance is found for the gamma^2 Vel system: d=258 (+41/-31) pc. The total mass of gamma^2 Vel derived from its parallax, the angular size of the semi-major axis as measured with intensity interferometry, and the period is M(WR+O)=29.5 (+/-15.9) Msun. This result favors the orbital solution of Pike et al. (1983) over that of Moffat et al. (1986). The stellar parameters for the O star companion derived from line blanketed non-LTE atmosphere models are: Teff=34000 (+/-1500) K, log L/Lsun=5.3 (+/-0.15) from which an evolutionary mass of M=29 (+/-4) Msun and an age of 4.0 (+0.8/-0.5) Myr is obtained from single star evolutionary models. With non-LTE model calculations including He and C we derive a luminosity log L/Lsun~4.7 (+/-0.2) for the WR star. The mass-luminosity relation of hydrogen-free WR stars implies a mass of M(WR)~5 (+/-1.5) Msun. From our data we favor an age of ~10 Myr for the bulk of the Vela OB2 stars. Evolutionary scenarios for zeta Pup and gamma^2 Vel are discussed in the light of our results.Comment: Submitted to ApJ Letters (misprints corrected

Discovery of a bow shock around Vela X-1

We report the discovery of a symmetric bow shock around the well-known high-mass X-ray binary (HMXB) Vela X-1. Wind bow shocks are a ubiquitous phenomenon around OB-runaway stars, but now such a structure is found around a HMXB. The presence of a bow shock indicates that the system has a high (supersonic) velocity with respect to the interstellar medium. From the symmetry of the bow shock, the direction of motion and, moreover, the origin and age of the system can be derived. Our observation supports Blaauw's scenario for the formation of an OB-runaway star by the supernova explosion of the binary companion.Comment: 14 pages, latex (including style file), 3 postscript figures, ApJ Letters, in pres

Orbital period changes and the higher-order multiplicity fraction amongst SuperWASP eclipsing binaries

Orbital period changes of binary stars may be caused by the presence of a third massive body in the system. Here we have searched the archive of the Wide Angle Search for Planets (SuperWASP) project for evidence of period variations in 13 927 eclipsing binary candidates. Sinusoidal period changes, strongly suggestive of third bodies, were detected in 2% of cases; however, linear period changes were observed in a further 22% of systems. We argue on distributional grounds that the majority of these apparently linear changes are likely to reflect longer-term sinusoidal period variations caused by third bodies, and thus estimate a higher-order multiplicity fraction of 24% for SuperWASP binaries, in good agreement with other recent figures for the fraction of triple systems amongst binary stars in general