Protocol for an implementation and realist evaluation of a new organisational model for primary care practices in the canton of Vaud, Switzerland.

Continuity of care, especially for patients with complex needs, is a major challenge for healthcare systems in many high-income countries, including Switzerland. Since 2015, a collaborative project between Unisanté-Department of Family Medicine (DMF), some general practitioners (GPs) and canton of Vaud's public health authorities has sought to develop a new organisational model for the provision of primary care to ensure better care coordination and to provide adapted care deliveries to patients' healthcare needs. The model's main component is the addition of a primary care nurse to GPs practices. Three additional tools are individualised patient care plans, electronic medical records and patient empanelment. To assess this model, a 2-year pilot study has begun in nine GPs' practices in the canton. This paper presents the protocol for an evaluation of the implementation and effectiveness of the new organisational model. We will conduct a before-and-after study using a mixed-methods and a realist approach. First, we will use quantitative and qualitative data to assess the new organisational model's implementation (feasibility, fidelity, acceptability and costs) and effectiveness (healthcare services use, patient experience, staff experience and patient-level costs). Combining this data with focus group data will enable a realist evaluation of the pilot project, which will help understand the elements of context and mechanism that affect implementation. The evaluation will inform the canton of Vaud's health authorities about the limits of and perspectives for this organisational model. All results will also be made available to the practices and the patients involved. At the end of the project, we will propose organisational adaptations and a sustainable financial model for extending the model to other practices in the canton and potentially to the national level.The canton of Vaud's Human Research Ethics Committee approved the study, and Data Protection and Information Law Authority gave a favourable opinion concerning data processing procedures

Experimental conditions for suppressing Edge Localised Modes by magnetic perturbations in ASDEX Upgrade

EUROfusion Consortium 63305

Isotopic signals in an agricultural watershed suggest denitrification is locally intensive in riparian areas but extensive in upland soils

© The Author(s), 2022. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Sigler, W. A., Ewing, S. A., Wankel, S. D., Jones, C. A., Leuthold, S., Brookshire, E. N. J., & Payn, R. A. Isotopic signals in an agricultural watershed suggest denitrification is locally intensive in riparian areas but extensive in upland soils. Biogeochemistry, 158, (2022): 251–268, https://doi.org/10.1007/s10533-022-00898-9.Nitrogen loss from cultivated soils threatens the economic and environmental sustainability of agriculture. Nitrate (NO3−) derived from nitrification of nitrogen fertilizer and ammonified soil organic nitrogen may be lost from soils via denitrification, producing dinitrogen gas (N2) or the greenhouse gas nitrous oxide (N2O). Nitrate that accumulates in soils is also subject to leaching loss, which can degrade water quality and make NO3− available for downstream denitrification. Here we use patterns in the isotopic composition of NO3− observed from 2012 to 2017 to characterize N loss to denitrification within soils, groundwater, and stream riparian corridors of a non-irrigated agroecosystem in the northern Great Plains (Judith River Watershed, Montana, USA). We find evidence for denitrification across these domains, expressed as a positive linear relationship between δ15N and δ18O values of NO3−, as well as increasing δ15N values with decreasing NO3− concentration. In soils, isotopic evidence of denitrification was present during fallow periods (no crop growing), despite net accumulation of NO3− from the nitrification of ammonified soil organic nitrogen. We combine previous results for soil NO3− mass balance with δ15N mass balance to estimate denitrification rates in soil relative to groundwater and streams. Substantial denitrification from soils during fallow periods may be masked by nitrification of ammonified soil organic nitrogen, representing a hidden loss of soil organic nitrogen and an under-quantified flux of N to the atmosphere. Globally, cultivated land spends ca. 50% of time in a fallow condition; denitrification in fallow soils may be an overlooked but globally significant source of agricultural N2O emissions, which must be reduced along-side other emissions to meet Paris Agreement goals for slowing global temperature increase.National Institute of Food and Agriculture, 2011–51130-31121, S. A. Ewing, 2011, S. A. Ewing, 2016–67026-25067, S. A. Ewing, Montana State University Extension, Montana Fertilizer Advisory Committee, Montana Agricultural Experiment Station, Montana State University Vice President of Research, Montana State University College of Agriculture, Montana Institute on Ecosystems, NSF EPSCoR, OIA-1757351, S. A. Ewing, OIA-1443108, S. A. Ewing, EPS-110134, S. A. Ewing

Robust avoidance of edge-localized modes alongside gradient formation in the negative triangularity tokamak edge

In a series of high performance diverted discharges on DIII-D, we demonstrate that strong negative triangularity (NT) shaping robustly suppresses all edge-localized mode (ELM) activity over a wide range of plasma conditions: $\langle n\rangle=0.1-1.5\times10^{20}$m$^{-3}$, $P_\mathrm{aux}=0-15$MW and $|B_\mathrm{t}|=1-2.2$T, corresponding to $P_\mathrm{loss}/P_\mathrm{LH08}\sim8$. The full dataset is consistent with the theoretical prediction that magnetic shear in the NT edge inhibits access to ELMing H-mode regimes; all experimental pressure profiles are found to be at or below the infinite-$n$ ballooning stability limit. Importantly, we also report enhanced edge pressure gradients at strong NT that are significantly steeper than in traditional ELM-free L-mode plasmas and provide significant promise for NT reactor integration.Comment: 5 pages, 5 figure

Cross-polarized photon-pair generation and bi-chromatically pumped optical parametric oscillation on a chip

Nonlinear optical processes are one of the most important tools in modern optics with a broad spectrum of applications in, for example, frequency conversion, spectroscopy, signal processing and quantum optics. For practical and ultimately widespread implementation, on-chip devices compatible with electronic integrated circuit technology offer great advantages in terms of low cost, small footprint, high performance and low energy consumption. While many on-chip key components have been realized, to date polarization has not been fully exploited as a degree of freedom for integrated nonlinear devices. In particular, frequency conversion based on orthogonally polarized beams has not yet been demonstrated on chip. Here we show frequency mixing between orthogonal polarization modes in a compact integrated microring resonator and demonstrate a bi-chromatically pumped optical parametric oscillator. Operating the device above and below threshold, we directly generate orthogonally polarized beams, as well as photon pairs, respectively, that can find applications, for example, in optical communication and quantum optics

Ready ... Go: Amplitude of the fMRI Signal Encodes Expectation of Cue Arrival Time

What happens when the brain awaits a signal of uncertain arrival time, as when a sprinter waits for the starting pistol? And what happens just after the starting pistol fires? Using functional magnetic resonance imaging (fMRI), we have discovered a novel correlate of temporal expectations in several brain regions, most prominently in the supplementary motor area (SMA). Contrary to expectations, we found little fMRI activity during the waiting period; however, a large signal appears after the “go” signal, the amplitude of which reflects learned expectations about the distribution of possible waiting times. Specifically, the amplitude of the fMRI signal appears to encode a cumulative conditional probability, also known as the cumulative hazard function. The fMRI signal loses its dependence on waiting time in a “countdown” condition in which the arrival time of the go cue is known in advance, suggesting that the signal encodes temporal probabilities rather than simply elapsed time. The dependence of the signal on temporal expectation is present in “no-go” conditions, demonstrating that the effect is not a consequence of motor output. Finally, the encoding is not dependent on modality, operating in the same manner with auditory or visual signals. This finding extends our understanding of the relationship between temporal expectancy and measurable neural signals