EUPRON: nurses’ practice in interprofessional pharmaceutical care in Europe. A cross-sectional survey in 17 countries

Abstract Objectives Safe pharmaceutical care (PC) requires an interprofessional team approach, involving physicians, nurses and pharmacists. Nurses’ roles however, are not always explicit and clear, complicating interprofessional collaboration. The aim of this study is to describe nurses’ practice and interprofessional collaboration in PC, from the viewpoint of nurses, physicians and pharmacists. Design A cross-sectional survey. Setting The study was conducted in 17 European countries, each with their own health systems. Participants Pharmacists, physicians and nurses with an active role in PC were surveyed. Main outcome measures Nurses’ involvement in PC, experiences of interprofessional collaboration and communication and views on nurses’ competences. Results A total of 4888 nurses, 974 physicians and 857 pharmacists from 17 European countries responded. Providing patient education and information (PEI), monitoring medicines adherence (MMA), monitoring adverse/therapeutic effects (ME) and prescribing medicines were considered integral to nursing practice by 78%, 73%, 69% and 15% of nurses, respectively. Most respondents were convinced that quality of PC would be improved by increasing nurses’ involvement in ME (95%), MMA (95%), PEI (91%) and prescribing (53%). Mean scores for the reported quality of collaboration between nurses and physicians, collaboration between nurses and pharmacists and interprofessional communication were respectively <7/10, ≤4/10, <6/10 for all four aspects of PC. Conclusions ME, MMA, PEI and prescribing are part of nurses’ activities, and most healthcare professionals felt their involvement should be extended. Collaboration between nurses and physicians on PC is limited and between nurses and pharmacists even more

Photochemically produced SO2 in the atmosphere of WASP-39b

S.-M.T. is supported by the European Research Council advanced grant EXOCONDENSE (no. 740963; principal investigator: R. T. Pierrehumbert). E.K.H.L. is supported by the SNSF Ambizione Fellowship grant (no. 193448). X.Z. is supported by NASA Exoplanet Research grant 80NSSC22K0236. O.V. acknowledges funding from the ANR project ‘EXACT’ (ANR-21-CE49-0008-01), from the Centre National d’Études Spatiales (CNES) and from the CNRS/INSU Programme National de Planétologie (PNP). L.D. acknowledges support from the European Union H2020-MSCA-ITN-2109 under grant no. 860470 (CHAMELEON) and the KU Leuven IDN/19/028 grant Escher. This work benefited from the 2022 Exoplanet Summer Program at the Other Worlds Laboratory (OWL) at the University of California, Santa Cruz, a programme financed by the Heising-Simons Foundation. T.D. is an LSSTC Catalyst Fellow. J.K. is an Imperial College Research Fellow. B.V.R. is a 51 Pegasi b Fellow. L.W. is an NHFP Sagan Fellow. A.D.F. is an NSF Graduate Research Fellow.Photochemistry is a fundamental process of planetary atmospheres that regulates the atmospheric composition and stability1. However, no unambiguous photochemical products have been detected in exoplanet atmospheres so far. Recent observations from the JWST Transiting Exoplanet Community Early Release Science Program2,3 found a spectral absorption feature at 4.05 μm arising from sulfur dioxide (SO2) in the atmosphere of WASP-39b. WASP-39b is a 1.27-Jupiter-radii, Saturn-mass (0.28 MJ) gas giant exoplanet orbiting a Sun-like star with an equilibrium temperature of around 1,100 K (ref. 4). The most plausible way of generating SO2 in such an atmosphere is through photochemical processes5,6. Here we show that the SO2 distribution computed by a suite of photochemical models robustly explains the 4.05-μm spectral feature identified by JWST transmission observations7 with NIRSpec PRISM (2.7σ)8 and G395H (4.5σ)9. SO2 is produced by successive oxidation of sulfur radicals freed when hydrogen sulfide (H2S) is destroyed. The sensitivity of the SO2 feature to the enrichment of the atmosphere by heavy elements (metallicity) suggests that it can be used as a tracer of atmospheric properties, with WASP-39b exhibiting an inferred metallicity of about 10× solar. We further point out that SO2 also shows observable features at ultraviolet and thermal infrared wavelengths not available from the existing observations.Publisher PDFPeer reviewe

Revisiting the HD 21749 planetary system with stellar activity modelling

HD 21749 is a bright (V = 8.1 mag) K dwarf at 16 pc known to host an inner terrestrial planet HD 21749c as well as an outer sub-Neptune HD 21749b, both delivered by Transiting Exoplanet Survey Satellite (TESS). Follow-up spectroscopic observations measured the mass of HD 21749b to be 22.7 ± 2.2 M with a density of 7.0^{+1.6}_{-1.3} g cm-3, making it one of the densest sub-Neptunes. However, the mass measurement was suspected to be influenced by stellar rotation. Here, we present new high-cadence PFS RV data to disentangle the stellar activity signal from the planetary signal. We find that HD 21749 has a similar rotational time-scale as the planet's orbital period, and the amplitude of the planetary orbital RV signal is estimated to be similar to that of the stellar activity signal. We perform Gaussian process regression on the photometry and RVs from HARPS and PFS to model the stellar activity signal. Our new models reveal that HD 21749b has a radius of 2.86 ± 0.20 R, an orbital period of 35.6133 ± 0.0005 d with a mass of Mb = 20.0 ± 2.7 M and a density of 4.8^{+2.0}_{-1.4} g cm-3 on an eccentric orbit with e = 0.16 ± 0.06, which is consistent with the most recent values published for this system. HD 21749c has an orbital period of 7.7902 ± 0.0006 d, a radius of 1.13 ± 0.10 R, and a 3σ mass upper limit of 3.5 M. Our Monte Carlo simulations confirm that without properly taking stellar activity signals into account, the mass measurement of HD 21749b is likely to arrive at a significantly underestimated error bar

The NUPHAC-EU Framework for Nurses' Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe.

Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses' responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses' level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86-97%), patient education (85-96%), medication safety (83-95%), monitoring adherence (82-97%), care coordination (82-95%), and drug monitoring (78-96%). The most prevalent level of responsibility was 'with shared responsibility'. Prescription management tasks were considered to be nurses' responsibility by 48-81% of the professionals. All contextual factors were indicated as being relevant for nurses' role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks

The L 98-59 System: Three Transiting, Terrestrial-Size Planets Orbiting A Nearby M Dwarf

We report the Transiting Exoplanet Survey Satellite (TESS) discovery of three terrestrial-size planets transiting L 98-59 (TOI-175, TIC 307210830)—a bright M dwarf at a distance of 10.6 pc. Using the Gaia-measured distance and broadband photometry, we find that the host star is an M3 dwarf. Combined with the TESS transits from three sectors, the corresponding stellar parameters yield planet radii ranging from 0.8 R⊕ to 1.6 R⊕. All three planets have short orbital periods, ranging from 2.25 to 7.45 days with the outer pair just wide of a 2:1 period resonance. Diagnostic tests produced by the TESS Data Validation Report and the vetting package DAVE rule out common false-positive sources. These analyses, along with dedicated follow-up and the multiplicity of the system, lend confidence that the observed signals are caused by planets transiting L 98-59 and are not associated with other sources in the field. The L 98-59 system is interesting for a number of reasons: the host star is bright (V = 11.7 mag, K = 7.1 mag) and the planets are prime targets for further follow-up observations including precision radial-velocity mass measurements and future transit spectroscopy with the James Webb Space Telescope; the near-resonant configuration makes the system a laboratory to study planetary system dynamical evolution; and three planets of relatively similar size in the same system present an opportunity to study terrestrial planets where other variables (age, metallicity, etc.) can be held constant. L 98-59 will be observed in four more TESS sectors, which will provide a wealth of information on the three currently known planets and have the potential to reveal additional planets in the system

A New Sedimentation Model for Greater Cloud Diversity in Giant Exoplanets and Brown Dwarfs

The observed atmospheric spectrum of exoplanets and brown dwarfs depends critically on the presence and distribution of atmospheric condensates. The Ackerman and Marley methodology for predicting the vertical distribution of condensate particles is widely used to study cloudy atmospheres and has recently been implemented in an open-source python package, Virga. The model relies upon input parameter f sed, the sedimentation efficiency, which until now has been held constant. The relative simplicity of this model renders it useful for retrieval studies due to its rapidly attainable solutions. However, comparisons with more complex microphysical models such as CARMA have highlighted inconsistencies between the two approaches, namely that the cloud parameters needed for radiative transfer produced by Virga are dissimilar to those produced by CARMA. To address these discrepancies, we have extended the original Ackerman and Marley methodology in Virga to allow for non-constant f sed values, in particular, those that vary with altitude. We discuss one such parameterization and compare the cloud mass mixing ratio produced by Virga with constant and variable f sed profiles to that produced by CARMA. We find that the variable f sed formulation better captures the profile produced by CARMA with heterogeneous nucleation, yet performs comparatively to constant f sed for homogeneous nucleation. In general, Virga has the capacity to handle any f sed with an explicit anti-derivative, permitting a plethora of alternative cloud profiles that are otherwise unattainable by constant f sed values. The ensuing flexibility has the potential to better agree with increasingly complex models and observed data. © 2022. The Author(s). Published by the American Astronomical Society.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Modeling Polarization Signals from Cloudy Brown Dwarfs Luhman 16 A and B in Three Dimensions

The detection of disk-integrated polarization from Luhman 16 A and B in the H band, and subsequent modeling, has been interpreted in the framework of zonal cloud bands on these bodies. Recently, Tan and Showman investigated the 3D atmospheric circulation and cloud structures of brown dwarfs with general circulation models (GCMs), and their simulations yielded complex cloud distributions showing some aspects of zonal jets, but also complex vortices that cannot be captured by a simple model. Here we use these 3D GCMs specific to Luhman 16 A and B, along with the 3D Monte Carlo radiative transfer code ARTES, to calculate their polarization signals. We adopt the 3D temperature-pressure and cloud profiles from the GCMs as our input atmospheric structures. Our polarization calculations at 1.6 μm agree well with the measured degree of linear polarization from both Luhman 16 A and B. Our calculations reproduce the measured polarization for both objects with cloud particle sizes between 0.5 and 1 μm for Luhman 16 A and of 5 μm for Luhman 16 B. We find that the degree of linear polarization can vary on hour-long timescales over the course of a rotation period. We also show that models with azimuthally symmetric band-like cloud geometries, typically used for interpreting polarimetry observations of brown dwarfs, overpredict the polarization signal if the cloud patterns do not include complex vortices within these bands. This exploratory work shows that GCMs are promising for modeling and interpreting polarization signals of brown dwarfs. © 2021. The American Astronomical Society. All rights reserved..Immediate accessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Impact of Water-latent Heat on the Thermal Structure of Ultra-cool Objects: Brown Dwarfs and Free-floating Planets

Brown dwarfs are essential targets for understanding planetary and sub-stellar atmospheres across a wide range of thermal and chemical conditions. As surveys continue to probe ever deeper and as observing capabilities continue to improve, the number of known Y dwarfs - the coldest class of sub-stellar objects, with effective temperatures below about 600 K - is rapidly growing. Critically, this class of ultra-cool objects has atmospheric conditions that overlap with solar-system worlds and, as a result, tools and ideas developed from studying Earth, Jupiter, Saturn, and other nearby worlds are well suited for application to sub-stellar atmospheres. To that end, we developed a one-dimensional (vertical) atmospheric structure model for ultra-cool objects that includes moist adiabatic convection, as this is an important process for many solar-system planets. Application of this model across a range of effective temperatures (350, 300, 250, 200 K), metallicities ([M/H] of 0.0, 0.5, 0.7, 1.5), and gravities (log g of 4.0, 4.5, 4.7, 5.0) demonstrates strong impact of water-latent heat release on simulated temperature-pressure profiles. At the highest metallicities, water-vapor mixing ratios reach an Earth-like 3% with associated major alterations to the thermal structure in the atmospheric regions where water condenses. Spectroscopic and photometric signatures of metallicity and moist convection should be readily detectable at near- and mid-infrared wavelengths, especially with James Webb Space Telescope observations, and can help indicate the formation history of an object. © 2021. The American Astronomical Society. All rights reserved.Immediate accessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Following the Lithium: Tracing li-bearing molecules across age, mass, and gravity in brown dwarfs

Lithium is an important element for the understanding of ultracool dwarfs because it is lost to fusion at masses above ~68MJ. Hence, the presence of atomic Li has served as an indicator of the nearby H-burning boundary at about 75MJ between brown dwarfs and very low mass stars. Historically, the "lithium test,"a search for the presence of the Li line at 670.8 nm, has been a marker if an object has a substellar mass. While the Li test could, in principle, be used to distinguish masses of later-type L-T dwarfs, Li is predominantly no longer found as an atomic gas but rather a molecular species such as LiH, LiF, LiOH, and LiCl in cooler atmospheres. The L- and T-type dwarfs are quite faint at 670 nm and thus challenging targets for high-resolution spectroscopy. But only recently have experimental molecular line lists become available for the molecular Li species, allowing molecular Li mass discrimination. Here we generated the latest opacity of these Li-bearing molecules and performed a thermochemical equilibrium atmospheric composition calculation of their abundances. Finally, we computed thermal emission spectra for a series of radiative-convective equilibrium models of cloudy and cloudless brown dwarf atmospheres (with Teff = 500-2400 K and log g = 4.0-5.0) to understand where the presence of atmospheric lithium-bearing species is most easily detected as a function of brown dwarf mass and age. After atomic Li, the best spectral signatures were found to be LiF at 10.5-12.5 μm and LiCl at 14.5-18.5 μm. Also, LiH shows a narrow feature at ~9.38 μm. © 2021. The American Astronomical Society. All rights reserved.Immediate accessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Double Trouble: Two Transits of the Super-Earth GJ 1132 b Observed with JWST NIRSpec G395H

The search for rocky planet atmospheres with JWST has focused on planets transiting M dwarfs. Such planets have favorable planet-to-star size ratios, enhancing the amplitude of atmospheric features. Since the expected signal strength of atmospheric features is similar to the single-transit performance of JWST, multiple observations are required to confirm any detection. Here, we present two transit observations of the rocky planet GJ 1132 b with JWST NIRSpec G395H, covering 2.8-5.2 μm. Previous Hubble Space Telescope WFC3 observations of GJ 1132 b were inconclusive, with evidence reported for either an atmosphere or a featureless spectrum based on analyses of the same data set. Our JWST data exhibit substantial differences between the two visits. One transit is consistent with either an H2O-dominated atmosphere containing ∼1% CH4 and trace N2O ( χ ν 2 = 1.13 ) or stellar contamination from unocculted starspots ( χ ν 2 = 1.36 ). However, the second transit is consistent with a featureless spectrum. Neither visit is consistent with a previous report of HCN. Atmospheric variability is unlikely to explain the scale of the observed differences between the visits. Similarly, our out-of-transit stellar spectra show no evidence of changing stellar inhomogeneity between the two visits—observed 8 days apart, only 6.5% of the stellar rotation rate. We further find no evidence of differing instrumental systematic effects between visits. The most plausible explanation is an unlucky random noise draw leading to two significantly discrepant transmission spectra. Our results highlight the importance of multivisit repeatability with JWST prior to claiming atmospheric detections for these small, enigmatic planets. © 2023. The Author(s). Published by the American Astronomical Society.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]