New Insights on Planet Formation in WASP-47 from a Simultaneous Analysis of Radial Velocities and Transit Timing Variations

Measuring precise planet masses, densities, and orbital dynamics in individual planetary systems is an important pathway toward understanding planet formation. The WASP-47 system has an unusual architecture that motivates a complex formation theory. The system includes a hot Jupiter ("b") neighbored by interior ("e") and exterior ("d") sub-Neptunes, and a long-period eccentric giant planet ("c"). We simultaneously modeled transit times from the Kepler K2 mission and 118 radial velocities to determine the precise masses, densities, and Keplerian orbital elements of the WASP-47 planets. Combining RVs and TTVs provides a better estimate of the mass of planet d () than that obtained with only RVs () or TTVs (). Planets e and d have high densities for their size, consistent with a history of photoevaporation and/or formation in a volatile-poor environment. Through our RV and TTV analysis, we find that the planetary orbits have eccentricities similar to the solar system planets. The WASP-47 system has three similarities to our own solar system: (1) the planetary orbits are nearly circular and coplanar, (2) the planets are not trapped in mean motion resonances, and (3) the planets have diverse compositions. None of the current single-process exoplanet formation theories adequately reproduce these three characteristics of the WASP-47 system (or our solar system). We propose that WASP-47, like the solar system, formed in two stages: first, the giant planets formed in a gas-rich disk and migrated to their present locations, and second, the high-density sub-Neptunes formed in situ in a gas-poor environment

Implementation of patient-reported outcome measures for gender-affirming care worldwide

Importance Gender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy. Objective To identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation. Evidence Review In this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080). Findings In total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate. Conclusions and Relevance In this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs

Two transiting low density sub-Saturns from K2

We report the discovery and confirmation of K2-24 b and c, two sub-Saturn planets orbiting a bright (V = 11.3), metal-rich ([Fe/H] = 0.42 ± 0.04 dex) G3 dwarf in the K2 Campaign 2 field. The planets are 5.68 ± 0.56 R⊕ and 7.82 ± 0.72 R⊕ and have orbital periods of 20.8851 ± 0.0003 days and 42.3633 ± 0.0006 days, near the 2:1 mean-motion resonance. We obtained 32 radial velocities with Keck/HIRES and detected the reflex motion due to K2-24 b and c. These planets have masses of 21.0 ± 5.4 M⊕ and 27.0 ± 6.9 M⊕, respectively. With low densities of 0.63 ± 0.25 g cm-3 and 0.31 ± 0.12 g cm-3, respectively, the planets require thick envelopes of H/He to explain their large sizes and low masses. Interior structure models predict that the planets have fairly massive cores of 17.6 ± 4.3 M⊕ and 16.1, ± 4.2 M⊕, respectively. They may have formed exterior to their present locations, accreted their H/He envelopes at large orbital distances, and migrated in as a resonant pair. The proximity to resonance, large transit depths, and host star brightness offers rich opportunities for TTV follow-up. Finally, the low surface gravities of the K2-24 planets make them favorable targets for transmission spectroscopy by Hubble Space Telescope, Spitzer, and James Webb Space Telescope

New Insights on Planet Formation in WASP-47 from a Simultaneous Analysis of Radial Velocities and Transit Timing Variations

Measuring precise planet masses, densities, and orbital dynamics in individual planetary systems is an important pathway toward understanding planet formation. The WASP-47 system has an unusual architecture that motivates a complex formation theory. The system includes a hot Jupiter ("b") neighbored by interior ("e") and exterior ("d") sub-Neptunes, and a long-period eccentric giant planet ("c"). We simultaneously modeled transit times from the Kepler K2 mission and 118 radial velocities to determine the precise masses, densities, and Keplerian orbital elements of the WASP-47 planets. Combining RVs and TTVs provides a better estimate of the mass of planet d (13.6 ± 2.0,M_⊕) than that obtained with only RVs (12.75 ± 2.70,M_⊕) or TTVs (16.1 3.8, M_⊕). Planets e and d have high densities for their size, consistent with a history of photoevaporation and/or formation in a volatile-poor environment. Through our RV and TTV analysis, we find that the planetary orbits have eccentricities similar to the solar system planets. The WASP-47 system has three similarities to our own solar system: (1) the planetary orbits are nearly circular and coplanar, (2) the planets are not trapped in mean motion resonances, and (3) the planets have diverse compositions. None of the current single-process exoplanet formation theories adequately reproduce these three characteristics of the WASP-47 system (or our solar system). We propose that WASP-47, like the solar system, formed in two stages: first, the giant planets formed in a gas-rich disk and migrated to their present locations, and second, the high-density sub-Neptunes formed in situ in a gas-poor environment

New Insights on Planet Formation in WASP-47 from a Simultaneous Analysis of Radial Velocities and Transit Timing Variations

Measuring precise planet masses, densities, and orbital dynamics in individual planetary systems is an important pathway toward understanding planet formation. The WASP-47 system has an unusual architecture that motivates a complex formation theory. The system includes a hot Jupiter ("b") neighbored by interior ("e") and exterior ("d") sub-Neptunes, and a long-period eccentric giant planet ("c"). We simultaneously modeled transit times from the Kepler K2 mission and 118 radial velocities to determine the precise masses, densities, and Keplerian orbital elements of the WASP-47 planets. Combining RVs and TTVs provides a better estimate of the mass of planet d (13.6 ± 2.0,M_⊕) than that obtained with only RVs (12.75 ± 2.70,M_⊕) or TTVs (16.1 3.8, M_⊕). Planets e and d have high densities for their size, consistent with a history of photoevaporation and/or formation in a volatile-poor environment. Through our RV and TTV analysis, we find that the planetary orbits have eccentricities similar to the solar system planets. The WASP-47 system has three similarities to our own solar system: (1) the planetary orbits are nearly circular and coplanar, (2) the planets are not trapped in mean motion resonances, and (3) the planets have diverse compositions. None of the current single-process exoplanet formation theories adequately reproduce these three characteristics of the WASP-47 system (or our solar system). We propose that WASP-47, like the solar system, formed in two stages: first, the giant planets formed in a gas-rich disk and migrated to their present locations, and second, the high-density sub-Neptunes formed in situ in a gas-poor environment

Assessing fragility of statistically significant findings from randomized controlled trials assessing pharmacological therapies for opioid use disorders: a systematic review

Abstract Background The fragility index is a statistical measure of the robustness or “stability” of a statistically significant result. It has been adapted to assess the robustness of statistically significant outcomes from randomized controlled trials. By hypothetically switching some non-responders to responders, for instance, this metric measures how many individuals would need to have responded for a statistically significant finding to become non-statistically significant. The purpose of this study is to assess the fragility index of randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder. This will provide an indication as to the robustness of trials in the field and the confidence that should be placed in the trials’ outcomes, potentially identifying ways to improve clinical research in the field. This is especially important as opioid use disorder has become a global epidemic, and the incidence of opioid related fatalities have climbed 500% in the past two decades. Methods Six databases were searched from inception to September 25, 2021, for randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder, and meeting the necessary requirements for fragility index calculation. Specifically, we included all parallel arm or two-by-two factorial design RCTs that assessed the effectiveness of any opioid substitution and antagonist therapies using a binary primary outcome and reported a statistically significant result. The fragility index of each study was calculated using methods described by Walsh and colleagues. The risk of bias of included studies was assessed using the Revised Cochrane Risk of Bias tool for randomized trials. Results Ten studies with a median sample size of 82.5 (interquartile range (IQR) 58, 179, range 52–226) were eligible for inclusion. Overall risk of bias was deemed to be low in seven studies, have some concerns in two studies, and be high in one study. The median fragility index was 7.5 (IQR 4, 12, range 1–26). Conclusions Our results suggest that approximately eight participants are needed to overturn the conclusions of the majority of trials in opioid use disorder. Future work should focus on maximizing transparency in reporting of study results, by reporting confidence intervals, fragility indexes, and emphasizing the clinical relevance of findings. Trial registration PROSPERO CRD42013006507. Registered on November 25, 2013

The First Habitable-zone Earth-sized Planet from TESS. I. Validation of the TOI-700 System

We present the discovery and validation of a three-planet system orbiting the nearby (31.1 pc) M2 dwarf star TOI-700 (TIC 150428135). TOI-700 lies in the TESS continuous viewing zone in the Southern Ecliptic Hemisphere; observations spanning 11 sectors reveal three planets with radii ranging from 1 R⊕ to 2.6 R⊕ and orbital periods ranging from 9.98 to 37.43 days. Ground-based follow-up combined with diagnostic vetting and validation tests enables us to rule out common astrophysical false-positive scenarios and validate the system of planets. The outermost planet, TOI-700 d, has a radius of 1.19 ± 0.11 R⊕ and resides within a conservative estimate of the host star's habitable zone, where it receives a flux from its star that is approximately 86% of Earth's insolation. In contrast to some other low-mass stars that host Earth-sized planets in their habitable zones, TOI-700 exhibits low levels of stellar activity, presenting a valuable opportunity to study potentially rocky planets over a wide range of conditions affecting atmospheric escape. While atmospheric characterization of TOI-700 d with the James Webb Space Telescope (JWST) will be challenging, the larger sub-Neptune, TOI-700 c (R = 2.63 R⊕), will be an excellent target for JWST and future space-based observatories. TESS is scheduled to once again observe the Southern Hemisphere, and it will monitor TOI-700 for an additional 11 sectors in its extended mission. These observations should allow further constraints on the known planet parameters and searches for additional planets and transit timing variations in the system