The implementation evaluation of primary care groups of practice: a focus on organizational identity

<p>Abstract</p> <p>Background</p> <p>Since 2002 the Health Ministry of Québec (Canada) has been implementing a primary care organizational innovation called 'family medicine groups'. This is occurring in a political context in which the reorganization of primary care is considered necessary to improve health care system performance. More specifically, the purpose of this reform has been to overcome systemic deficiencies in terms of accessibility and continuity of care. This paper examines the first years of implementation of the family medicine group program, with a focus on the emergence of the organizational identity of one of the pilot groups located in the urban area of Montreal.</p> <p>Methods</p> <p>An in-depth longitudinal case study was conducted over two and a half years. Face to face individual interviews with key informants from the family medicine group under study were conducted over the research period considered. Data was gathered throuhg observations and documentary analysis. The data was analyzed using temporal bracketing and Fairclough's three-dimensional critical discourse analytical techniques.</p> <p>Results</p> <p>Three different phases were identified over the period under study. During the first phase, which corresponded to the official start-up of the family medicine group program, new resources and staff were only available at the end of the period, and no changes occurred in medical practices. Power struggles between physicians and nurses characterized the second phase, resulting in a very difficult integration of advanced nurse practitioners into the group. Indeed, the last phase was portrayed by initial collaborative practices associated with a sensegiving process prompted by a new family medicine group director.</p> <p>Conclusions</p> <p>The creation of a primary care team is a very challenging process that goes beyond the normative policy definitions of who is on the team or what the team has to do. To fulfil expectations of quality improvement through team-based care, health care professionals who are required to work together need shared time/space contexts to communicate; to overcome interprofessional and interpersonal conflicts; and to make sense of and define who they collectively are and what they do as a clinical team.</p

Etude de la variabilite de Macrophomina phaseolina (Tassi) Goid. au Burkina Faso

CNRS T Bordereau / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc

Impact of infralimbic inputs on intercalated amygdala neurons: A biophysical modeling study

Intercalated (ITC) amygdala neurons regulate fear expression by controlling impulse traffic between the input (basolateral amygdala; BLA) and output (central nucleus; Ce) stations of the amygdala for conditioned fear responses. Previously, stimulation of the infralimbic (IL) cortex was found to reduce fear expression and the responsiveness of Ce neurons to BLA inputs. These effects were hypothesized to result from the activation of ITC cells projecting to Ce. However, ITC cells inhibit each other, leading to the question of how IL inputs could overcome the inter-ITC inhibition to regulate the responses of Ce neurons to aversive conditioned stimuli (CSs). To investigate this, we first developed a compartmental model of a single ITC cell that could reproduce their bistable electroresponsive properties, as observed experimentally. Next, we generated an ITC network that implemented the experimentally observed short-term synaptic plasticity of inhibitory inter-ITC connections. Model experiments showed that strongly adaptive CS-related BLA inputs elicited persistent responses in ITC cells despite the presence of inhibitory interconnections. The sustained CS-evoked activity of ITC cells resulted from an unusual slowly deinactivating K+ current. Finally, over a wide range of stimulation strengths, brief IL activation caused a marked increase in the firing rate of ITC neurons, leading to a persistent decrease in Ce output, despite inter-ITC inhibition. Simulations revealed that this effect depended on the bistable properties and synaptic heterogeneity of ITC neurons. These results support the notion that IL inputs are in a strategic position to control extinction of conditioned fear via the activation of ITC neurons

Black Spruce Soils Accumulate More Uncomplexed Organic Matter than Aspen Soils

Improving knowledge on the dynamics and maintenance of the boreal soil’s C pool is of particular importance in response to climate change concerns. We hypothesized that different forest types (black spruce, trembling aspen, and mixedwood) found on a similar site type differentially affect soil organic carbon (SOC) distribution among physical fractions. The surface mineral soil (0–15 cm) of 24 plots differing in forest composition was sampled in forested Hapludalfs of the Abitibi-James Bay region, Canada. The soil was first separated into three water-stable aggregate size fractions (\u3e1000, 1000–250, and \u3c250 μm) by wet sieving, followed by a density flotation (NaI: 1.7 g cm−3) and a dispersion (with glass beads) to isolate the free light fraction (LF), the intraaggregate particulate organic matter (iPOM) and the silt plus clay fraction (S&C). According to mixed linear models, whole SOC contents (in Mg C ha−1) decreased in the following order: black spruce (46.3) \u3e mixedwood (41.9) \u3e trembling aspen (34.7). While similar amounts of SOC (~30 Mg C ha−1) were found in the S&C, more SOC was found in the less protected fractions (i.e., uncomplexed organic matter, UOM: LF and iPOM) under black spruce than under trembling aspen, the mixedwood being intermediate. This higher accumulation of UOM under black spruce suggests a slower C turnover that is probably induced by the low-quality C inputs and environmental constraints to decomposition found in these forests. These differences in the amounts of SOC stored within soil physical fractions might have strong repercussions on the SOC budget of the boreal forest of eastern Canada under climate change