Evidence and modeling of turbulence bifurcation in L-mode confinement transitions on Alcator C-Mod

© 2020 Author(s). Analysis and modeling of rotation reversal hysteresis experiments show that a single turbulent bifurcation is responsible for the Linear to Saturated Ohmic Confinement (LOC/SOC) transition and concomitant intrinsic rotation reversal on Alcator C-Mod. Plasmas on either side of the reversal exhibit different toroidal rotation profiles and therefore different turbulence characteristics despite the profiles of density and temperature, which are indistinguishable within measurement uncertainty. Elements of this bifurcation are also shown to persist for auxiliary heated L-modes. The deactivation of subdominant (in the linear growth rate and contribution to heat transport) ion temperature gradient and trapped electron mode instabilities is identified as the only possible change in turbulence within a reduced quasilinear transport model across the reversal, which is consistent with the measured profiles and inferred heat and particle fluxes. Experimental constraints on a possible change from strong to weak turbulence, outside the description of the quasilinear model, are also discussed. These results indicate an explanation for the LOC/SOC transition that provides a mechanism for the hysteresis through the dynamics of subdominant modes and changes in their relative populations and does not involve a change in the most linearly unstable ion-scale drift-wave instability

Continuity of care with doctors - A matter of life and death? A systematic review of continuity of care and mortality

 This is the final version. Available from BMJ Publishing Group via the DOI in this record. Objective Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality. Design Systematic review without meta-analysis. Data sources MEDLINE, Embase and the Web of Science, from 1996 to 2017. Eligibility criteria for selecting studies Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients. Results Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors. Conclusions This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important. PROSPERO registration number CRD42016042091

Envelope structure of deeply embedded young stellar objects in the Serpens Molecular Cloud

Aperture synthesis and single-dish (sub) millimeter molecular lines and continuum observations reveal in great detail the envelope structure of deeply embedded young stellar objects (SMM1, SMM2, SMM3, SMM4) in the densely star-forming Serpens Molecular Cloud. Resolved millimeter continuum emission constrains the density structure to a radial power law with index -2.0 +/- 0.5, and envelope masses of 8.7, 3.0, and 5.3 M_sol for SMM1, SMM3, and SMM4. The core SMM2 does not seem to have a central condensation and may not have formed a star yet. The molecular line observations can be described by the same envelope model, if an additional, small amount of warm (100 K) material is included. This probably corresponds to the inner few hundred AU of the envelope were the temperature is high. In the interferometer beam, the molecular lines reveal the inner regions of the envelopes, as well as interaction of the outflow with the surrounding envelope. Bright HCO+ and HCN emission outlines the cavities, while SiO and SO trace the direct impact of the outflow on ambient gas. Taken together, these observations provide a first comprehensive view of the physical and chemical structure of the envelopes of deeply embedded young stellar objects in a clustered environment on scales between 1000 and 10,000 AU.Comment: 46 pages, incl. 12 postscript figures, uses ApJ latex and psfig macro

Provider reimbursement following the Affordable Care Act

Decreasing healthcare expenditure has been one of the main objectives of the Affordable Care Act (ACA). To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was to study the effects of the ACA on physician reimbursement rates from CMS to determine the most cost effective method of delivering healthcare services. CMS has experimented with payment methods in an attempt to increase cost effectiveness. Medicare has offered shared cost savings incentives to reward quality care to both primary care providers and preventative services. CMS has determined fee-for- service payments obsolete, opting instead for a Value Based Purchasing (VBP) method of payment. Although a universal payment method has yet to be adopted, it has been evident that a VBP model and preventative care can be used to decrease healthcare expenditure

Cooling flow bulk motion corrections to the Sunyaev Zel'dovich effect

We study the influence of converging cooling flow bulk motions on the Sunyaev-Zel'dovich (SZ) effect. To that purpose we derive a modified Kompaneets equation which takes into account the contribution of the accelerated electron media of the cooling flow inside the cluster frame. The additional term is different from the usual kinematic SZ-effect, which depends linearly on the velocity, whereas the contribution described here is quadratic in the macroscopic electron fluid velocity, as measured in the cluster frame. For clusters with a large cooling flow mass deposition rate and/or a small central electron density, it turns out that this effect becomes relevant.Comment: accepted for publication in New Astronom

Birthweight and risk markers for type 2 diabetes and cardiovascular disease in childhood: the Child Heart and Health Study in England (CHASE).

AIMS/HYPOTHESIS: Lower birthweight (a marker of fetal undernutrition) is associated with higher risks of type 2 diabetes and cardiovascular disease (CVD) and could explain ethnic differences in these diseases. We examined associations between birthweight and risk markers for diabetes and CVD in UK-resident white European, South Asian and black African-Caribbean children. METHODS: In a cross-sectional study of risk markers for diabetes and CVD in 9- to 10-year-old children of different ethnic origins, birthweight was obtained from health records and/or parental recall. Associations between birthweight and risk markers were estimated using multilevel linear regression to account for clustering in children from the same school. RESULTS: Key data were available for 3,744 (66%) singleton study participants. In analyses adjusted for age, sex and ethnicity, birthweight was inversely associated with serum urate and positively associated with systolic BP. After additional height adjustment, lower birthweight (per 100 g) was associated with higher serum urate (0.52%; 95% CI 0.38, 0.66), fasting serum insulin (0.41%; 95% CI 0.08, 0.74), HbA1c (0.04%; 95% CI 0.00, 0.08), plasma glucose (0.06%; 95% CI 0.02, 0.10) and serum triacylglycerol (0.30%; 95% CI 0.09, 0.51) but not with BP or blood cholesterol. Birthweight was lower among children of South Asian (231 g lower; 95% CI 183, 280) and black African-Caribbean origin (81 g lower; 95% CI 30, 132). However, adjustment for birthweight had no effect on ethnic differences in risk markers. CONCLUSIONS/INTERPRETATION: Birthweight was inversely associated with urate and with insulin and glycaemia after adjustment for current height. Lower birthweight does not appear to explain emerging ethnic difference in risk markers for diabetes

Carbon Nanotubes Band Assignation, Topology, Bloch States and Selection Rules

Various properties of the energy band structures (electronic, phonon, etc.), including systematic band degeneracy, sticking and extremes, following from the full line group symmetry of the single-wall carbon nanotubes are established. The complete set of quantum numbers consists of quasi momenta (angular and linear or helical) and parities with respect to the z-reversal symmetries and, for achiral tubes, the vertical plane. The assignation of the electronic bands is performed, and the generalized Bloch symmetry adapted eigen functions are derived. The most important physical tensors are characterized by the same set of quantum numbers. All this enables application of the presented exhaustive selection rules. The results are discussed by some examples, e.g. allowed interband transitions, conductivity, Raman tensor, etc.Comment: 11 pages, 2 figures, 2 tables; pdf available from: http://www.ff.bg.ac.yu/qmf/qsg_e.ht

What determines the density structure of molecular clouds? A case study of Orion B with <i>Herschel</i>

A key parameter to the description of all star formation processes is the density structure of the gas. In this Letter, we make use of probability distribution functions (PDFs) of Herschel column density maps of Orion B, Aquila, and Polaris, obtained with the Herschel Gould Belt survey (HGBS). We aim to understand which physical processes influence the PDF shape, and with which signatures. The PDFs of Orion B (Aquila) show a lognormal distribution for low column densities until AV ~ 3 (6), and a power-law tail for high column densities, consistent with a ρα r-2 profile for the equivalent spherical density distribution. The PDF of Orion B is broadened by external compression due to the nearby OB stellar aggregates. The PDF of a quiescent subregion of the non-star-forming Polaris cloud is nearly lognormal, indicating that supersonic turbulence governs the density distribution. But we also observe a deviation from the lognormal shape at AV > 1 for a subregion in Polaris that includes a prominent filament. We conclude that (1) the point where the PDF deviates from the lognormal form does not trace a universal AV -threshold for star formation, (2) statistical density fluctuations, intermittency, and magnetic fields can cause excess from the lognormal PDF at an early cloud formation stage, (3) core formation and/or global collapse of filaments and a non-isothermal gas distribution lead to a power-law tail, and (4) external compression broadens the column density PDF, consistent with numerical simulations

Effect of nearest neighbor repulsion on the low frequency phase diagram of a quarter-filled Hubbard-Holstein chain

We have studied the influence of nearest-neighbor (NN) repulsion on the low frequency phase diagram of a quarter-filled Hubbard-Holstein chain. The NN repulsion term induces the apparition of two new long range ordered phases (one $4k_F$ CDW for positive $U_{eff} = U-2g^2/\omega$ and one $2k_F$ CDW for negative $U_{eff}$) that did not exist in the V=0 phase diagram. These results are put into perspective with the newly observed charge ordered phases in organic conductors and an interpretation of their origin in terms of electron-molecular vibration coupling is suggested.Comment: 10 pages, 10 figure