Magnetic reconnection is a fundamental physical process in plasmas whereby stored 40 magnetic energy is converted into heat and kinetic energy of charged particles. 41Reconnection occurs in many astrophysical plasma environments and in laboratory 42 plasmas. Using very high time resolution measurements, NASA's Magnetospheric 43 2 Multiscale Mission (MMS) has found direct evidence for electron demagnetization and 44 acceleration at sites along the sunward boundary of Earth's magnetosphere where the 45 interplanetary magnetic field reconnects with the terrestrial magnetic field. We have (i) 46 observed the conversion of magnetic energy to particle energy, (ii) measured the electric 47 field and current, which together cause the dissipation of magnetic energy, and (iii) 48identified the electron population that carries the current as a result of demagnetization 49 and acceleration within the reconnection diffusion/dissipation region. 50 51 Introduction 52

IMPORTANCE Medicare payment initiatives are spurring efforts to reduce potentially avoidable hospitalizations. OBJECTIVE To determine whether training and support for implementation of a nursing home (NH) quality improvement program (Interventions to Reduce Acute Care Transfers [INTERACT]) reduced hospital admissions and emergency department (ED) visits. DESIGN, SETTING, AND PARTICIPANTS This analysis compared changes in hospitalization and ED visit rates between the preintervention and postintervention periods for NHs randomly assigned to receive training and implementation support on INTERACT to changes in control NHs. The analysis focused on 85 NHs (36 717 NH residents) that reported no use of INTERACT during the preintervention period. INTERVENTIONS The study team provided training and support for implementing INTERACT, which included tools that help NH staff identify and evaluate acute changes in NH resident condition and document communication between physicians; care paths to avoid hospitalization when safe and feasible; and advance care planning and quality improvement tools.MAIN OUTCOMES AND MEASURES All-cause hospitalizations, hospitalizations considered potentially avoidable, 30-day hospital readmissions, and ED visits without admission. All-cause hospitalization rates were calculated for all resident-days, high-risk days (0-30 days after NH admission), and lower-risk days (Ն31 days after NH admission). RESULTSWe found that of 85 NHs, those that received implementation training and support exhibited statistically nonsignificant reductions in hospitalization rates compared with control NHs (net difference, −0.13 per 1000 resident-days; P = .25), hospitalizations during the first 30 days after NH admission (net difference, −0.37 per 1000 resident-days; P = .48), hospitalizations during periods more than 30 days after NH admission (net difference, −0.09 per 1000 resident-days; P = .39), 30-day readmission rates (net change in rate among hospital discharges, −0.01; P = .36), and ED visits without admission (net difference, 0.02 per 1000 resident-days; P = .83). Intervention NHs exhibited a reduction in potentially avoidable hospitalizations overall (net difference, −0.18 per 1000 resident-days, P = .01); however, this effect was not robust to a Bonferroni correction for multiple comparisons. CONCLUSIONS AND RELEVANCETraining and support for INTERACT implementation as carried out in this study had no effect on hospitalization or ED visit rates in the overall population of residents in participating NHs. The results have several important implications for implementing quality improvement initiatives in NHs. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02177058

Kinetic 1D simulations reveal that a weak density depression in a current-carrying plasma can lead to the formation of a strong potential ramp (double layer). The ramp and plasma turbulence it creates share many features with recent particle and field measurements in the auroral ionosphere. An electron beam accelerated by the ramp produces a series of propagating electron phase-space holes via a spatial two-stream instability. Electron heating associated with the formation and merging of these holes is found to influence the subsequent evolution of the potential ramp.

Abstract.The evolution of two counter-streaming electron beams is shown by means of 2-D kinetic simulations to lead to electron distributions and coherent localized bipolar plasma wave structures with features similar to those measured by the FAST satellite in the auroral ionosphere. Electrostatic whistler waves are generated at later times when the bipolar structures begin to lose coherence and break up in the dimension transverse to the geomagnetic field.

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