Patient handover in a European border region: Cross-sectional survey study among healthcare workers to explore the status quo, potential risks, and solutions

Introduction: While the popularity of international care is rising, the complexity of international care compromises patient safety. To identify risks and propose solutions to improve international care, this study explores experiences of healthcare workers with international handovers in a European border region.Methods: A cross-sectional survey design was used to reach out to 3000 healthcare workers, working for hospitals or emergency services in three neighboring countries in the Meuse-Rhine Euregion. In total, 846 healthcare workers completed the survey with 35 closed- and open-ended questions about experiences with international patient handover.Results: One-third of respondents had been involved in international handover in the previous month. The handovers occurred in planned and acute care settings and were supported by numerous, yet varying standardized procedures. Healthcare workers were trained for this in some, but not all settings. Respondents mentioned 408 risks and proposed 373 solutions, which were inductively analyzed. Six identified themes classify the level on which risks and accompanying solutions can be found: awareness, professional competencies, communication between professionals, loss of information, facilities and support, and organizational structure.Discussion: This study gives insight in international patient handovers in a European border region. Among the biggest risks experienced are procedural differences, sharing patient information, unfamiliarity with foreign healthcare systems, and not knowing roles and responsibilities of peers working across the border. Standardization of procedures, harmonization of systems, and the possibility for healthcare workers to get to know each other will contribute to reach common ground and move towards optimized and patient-safer cross-border care

Strong dust processing in circumstellar discs around 6 RV Tauri stars. Are dusty RV Tauri stars all binaries?

We present extended Spectral Energy Distributions (SEDs) of seven classical RV Tauri stars, using newly obtained submillimetre continuum measurements and Geneva optical photometry supplemented with literature data. The broad-band SEDs show a large IR excess with a black-body slope at long wavelengths in six of the seven stars, R Sct being the noticeable exception. This long wavelength slope is best explained assuming the presence of a dust component of large grains in the circumstellar material. We show that the most likely distribution of the circumstellar dust around the six systems is that the dust resides in a disc. Moreover, very small outflow velocities are needed to explain the presence of dust near the sublimation temperature and we speculate that the discs are Keplerian. The structure and evolution of these compact discs are as yet not understood but a likely prerequisite for their formation is that the dusty RV Tauri stars are binaries.Comment: 10 pages, will be published in A&

A multi-transition submillimeter water maser study of evolved stars - detection of a new line near 475 GHz

Context: Maser emission from the H2O molecule probes the warm, inner circumstellar envelopes of oxygen-rich red giant and supergiant stars. Multi-maser transition studies can be used to put constraints on the density and temperature of the emission regions. Aims: A number of known H2O maser lines were observed toward the long period variables R Leo and W Hya and the red supergiant VY CMa. A search for a new, not yet detected line near 475 GHz was conducted toward these stars. Methods: The Atacama Pathfinder Experiment telescope was used for a multi-transition observational study of submillimeter H2O lines. Results: The 5_33-4_40 transition near 475 GHz was clearly detected toward VY CMa and W Hya. Many other H2O lines were detected toward all three target stars. Relative line intensity ratios and velocity widths were found to vary significantly from star to star. Conclusions: Maser action is observed in all but one line for which it was theoretically predicted. In contrast, one of the strongest maser lines, in R Leo by far the strongest, the 437 GHz 7_53-6_60 transition, is not predicted to be inverted. Some other qualitative predictions of the model calculations are at variance with our observations. Plausible reasons for this are discussed. Based on our findings for W Hya and VY CMa, we find evidence that the H2O masers in the AGB star W Hya arise from the regular circumstellar outflow, while shock excitation in a high velocity flow seems to be required to excite masers far from the red supergiant VY CMa.Comment: 9 pages, 4 figures, Astronomy and Astrophyics (in press

The variable mass loss of the AGB star WX Psc as traced by the CO J=1-0 through 7-6 lines and the dust emission

Low and intermediate mass stars lose a significant fraction of their mass through a dust-driven wind during the Asymptotic Giant Branch (AGB) phase. Recent studies show that winds from late-type stars are far from being smooth. Mass-loss variations occur on different time scales, from years to tens of thousands of years. The variations appear to be particularly prominent towards the end of the AGB evolution. The occurrence, amplitude and time scale of these variations are still not well understood. The goal of our study is to gain insight into the structure of the circumstellar envelope (CSE) of WX Psc and map the possible variability of the late-AGB mass-loss phenomenon. We have performed an in-depth analysis of the extreme infrared AGB star WX Psc by modeling (1) the CO J=1-0 through 7-6 rotational line profiles and the full spectral energy distribution (SED) ranging from 0.7 to 1300 micron. We hence are able to trace a geometrically extended region of the CSE. Both mass-loss diagnostics bear evidence of the occurrence of mass-loss modulations during the last ~2000 yr. In particular, WX Psc went through a high mass-loss phase (Mdot~5e-5 Msun/yr) some 800 yr ago. This phase lasted about 600 yr and was followed by a long period of low mass loss (Mdot~5e-8 Msun/yr). The present day mass-loss rate is estimated to be ~6e-6 Msun/yr. The AGB star WX Psc has undergone strong mass-loss rate variability on a time scale of several hundred years during the last few thousand years. These variations are traced in the strength and profile of the CO rotational lines and in the SED. We have consistently simulated the behaviour of both tracers using radiative transfer codes that allow for non-constant mass-loss rates.Comment: 12 pages, accepted for publication in A&

Near-infrared polarimetric study of the bipolar nebula IRAS 19312+1950

We obtained H-band polarimetric data of IRAS 19312+1950 using the near-infrared camera (CIAO) on the 8 m Subaru telescope. In order to investigate the physical properties of the central star and the nebula, we performed dust radiative transfer modeling and compared the model results with the observed spectral energy distributions (SEDs), the radial profiles of the total intensity image, and the fraction of linear polarization map. The total intensity image shows a nearly spherical core with ~3" radius, an S-shaped arm extending ~10" in the northwest to southeast direction, and an extended lobe towards the southwest. The polarization map shows a centro-symmetric vector alignment in almost the entire nebula and low polarizations along the S-shaped arm. These results suggest that the nebula is accompanied by a central star, and the S-shaped arm has a physically ring-like structure. From our radiative transfer modeling, we estimated the stellar temperature, the bolometric luminosity, and the current mass-loss rate to be 2800 K, 7000 L_sun, and 5.3x10^{-6} M_sun yr^{-1}, respectively. Taking into account previous observational results, such as the detection of SiO maser emissions and silicate absorption feature in the 10 $\mu$m spectrum, our dust radiative transfer analysis based on our NIR imaging polarimetry suggests that (1) the central star of IRAS 19312+1950 is likely to be an oxygen-rich, dust-enshrouded AGB star and (2) most of the circumstellar material originates from other sources (e.g. ambient dark clouds) rather than as a result of mass loss from the central star.Comment: 8 pages with 4 figure

Mapping the submillimeter spiral wave in NGC 6946

We have analysed SCUBA 850\mum images of the (near) face-on spiral galaxy NGC 6946, and found a tight correlation between dust thermal emission and molecular gas. The map of visual optical depth relates well to the distribution of neutral gas (HI+H2) and implies a global gas-to-dust ratio of 90. There is no significant radial variation of this ratio: this can be understood, since the gas content is dominated by far by the molecular gas. The latter is estimated through the CO emission tracer, which is itself dependent on metallicity, similarly to dust emission. By comparing the radial profile of our visual optical depth map with that of the SCUBA image, we infer an emissivity (dust absorption coefficient) at 850\mum that is 3 times lower than the value measured by COBE in the Milky Way, and 9 times lower than in NGC 891. A decomposition of the spiral structure half way out along the disk of NGC 6946 suggests an interarm optical depth of between 1 and 2. These surprisingly high values represent 40-80% of the visual opacity that we measure for the arm region (abridged).Comment: 12 pages, 9 figures, accepted in A&

Circumstellar molecular composition of the oxygen-rich AGB star IK~Tau: II. In-depth non-LTE chemical abundance analysis

Aims: Little information exists on the circumstellar molecular abundance stratifications of many molecules. The aim is to study the circumstellar chemical abundance pattern of 11 molecules and isotopologs ($^{12}$CO, $^{13}$CO, SiS, $^{28}$SiO, $^{29}$SiO, $^{30}$SiO, HCN, CN, CS, SO, SO$_2$) in the oxygen-rich evolved star IK~Tau. Methods: We have performed an in-depth analysis of a large number of molecular emission lines excited in the circumstellar envelope around IK~Tau. The analysis is done based on a non-local thermodynamic equilibrium (non-LTE) radiative transfer analysis, which calculates the temperature and velocity structure in a self-consistent way. The chemical abundance pattern is coupled to theoretical outer wind model predictions including photodestruction and cosmic ray ionization. Not only the integrated line intensities, but also the line shapes, are used as diagnostic tool to study the envelope structure. Results: The deduced wind acceleration is much slower than predicted from classical theories. SiO and SiS are depleted in the envelope, possibly due to the adsorption onto dust grains. For HCN and CS a clear difference with respect to inner wind non-equilibrium predictions is found, either indicating uncertainties in the inner wind theoretical modeling or the possibility that HCN and CS (or the radical CN) participate in the dust formation. The low signal-to-noise profiles of SO and CN prohibit an accurate abundance determination; the modeling of high-excitation SO$_2$ lines is cumbersome, possibly related to line misidentifications or problems with the collisional rates. The SiO isotopic ratios ($^{29}$SiO/$^{28}$SiO and $^{30}$SiO/$^{28}$SiO) point toward an enhancement in $^{28}$SiO compared to results of classical stellar evolution codes. Predictions for H$_2$O lines in the spectral range of the Herschel/HIFI mission are performed. [abbreviated]Comment: 24 pagees, accepted for publication in Astronomy & Astrophysic

On the reliability of mass-loss-rate estimates for AGB stars

In the recent literature there has been some doubt as to the reliability of CO multi-transitional line observations as a mass-loss-rate estimator for AGB stars. Mass-loss rates for 10 intermediate- to high-mass-loss-rate AGB stars are derived using a detailed non-LTE, non-local radiative transfer code based on the Monte-Carlo method to model the CO radio line intensities. The circumstellar envelopes are assumed to be spherically symmetric and formed by constant mass-loss rates. The energy balance is solved self-consistently and the effects of dust on the radiation field and thermal balance are included. An independent estimate of the mass-loss rate is also obtained from the combination of dust radiative transfer modelling with a dynamical model of the gas and dust particles. We find that the CO radio line intensities and shapes are successfully reproduced for the majority of our objects assuming a constant mass-loss rate. Moreover, the CO line intensities are only weakly dependent on the adopted micro-turbulent velocity, in contrast to recent claims in the literature. The two methods used in the present work to derive mass-loss-rates are consistent within a factor of ~3 for intermediate- to high-mass-loss-rate objects, indicating that this is a lower limit to the uncertainty in present mass-loss-rate estimates. We find a tentative trend with chemistry. Mass-loss rates from the dust/dynamical model are systematically higher than those from the CO model for the carbon stars and vice versa for the M-type stars. This could be ascribed to a discrepancy in the adopted CO/H_2-abundance ratio, but we caution that the sample is small and systematic errors cannot be excluded.Comment: 18 pages, 17 figures, accepted for publication in A&

The close circumstellar environment of the semi-regular S-type star Pi^1 Gruis

We study the close circumstellar environment of the nearby S-type star Pi^1 Gruis using high spatial-resolution, mid-infrared observations from the ESO/VLTI. Spectra and visibilities were obtained with the MIDI interferometer on the VLT Auxiliary Telescopes. The cool M5III giant Beta Gruis was used as bright primary calibrator, and a dedicated spectro-interferometric study was undertaken to determine its angular diameter accurately. The MIDI measurements were fitted with the 1D numerical radiative transfer code DUSTY to determine the dust shell parameters of Pi^1 Gruis. Taking into account the low spatial extension of the model in the 8-9 $\mu$m spectral band for the smallest projected baselines, we consider the possibility of a supplementary molecular shell. The MIDI visibility and phase data are mostly dominated by the spherical 21 mas (694 Rsol) central star, while the extended dusty environment is over-resolved even with the shortest baselines. No obvious departure from spherical symmetry is found on the milliarcsecond scale. The spectro-interferometric observations are well-fitted by an optically thin (tau(dust)<0.01 in the band) dust shell that is located at about 14 stellar radii with a typical temperature of 700 K and composed of 70% silicate and 30% of amorphous alumina grains. An optically thin (tau(mol)<0.1 in the N band) H2O+SiO molecular shell extending from the photosphere of the star up to 4.4 stellar radii with a typical temperature of 1000 K is added to the model to improve the fit in the 8-9 $\mu$m spectral band. We discuss the probable binary origin of asymmetries as revealed by millimetric observations