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Coronal mass ejections (CMEs), often associated with flares1–3, are the most powerful magnetic phenomena occurring on the Sun. Stars show magnetic activity levels up to ten thousand times higher4, and CME effects on stellar physics and circumstellar environments are predicted to be substantial5–9. However, stellar CMEs remain observationally unexplored. Using time-resolved high-resolution X-ray spectroscopy of a stellar flare on the active star HR 9024 observed with the High Energy Transmission Grating Spectrometer onboard the Chandra X-ray Observatory space telescope, we distinctly detected Doppler shifts in S xvi, Si xiv and Mg xii lines that indicate upward and downward motions of hot plasmas (around 10–25 MK) within the flaring loop, with velocities of 100–400 km s−1, in agreement with a model of a flaring magnetic tube. Most notably, we also detected a later blueshift in the O viii line that reveals an upward motion, with velocity 90 ± 30 km s−1, of cool plasma (about 4 MK), that we ascribe to a CME coupled to the flare. From this evidence we were able to derive a CME mass of 1.2-0.8+2.6×1021 g and a CME kinetic energy of 5.2-3.6+27.7×1034 erg. These values provide clues in the extrapolation of the solar case to higher activity levels in other stars, suggesting that CMEs could indeed be a major cause of mass and angular momentum loss.Chandra X-ray Observatory spectral observations of the active star HR 9024 provide evidence of plasma motions that indicate a stellar flare and subsequent coronal mass ejection. This event provides critical information on non-solar coronal mass ejections and a point of comparison to the Sun, a much less active star.

The shaping of astrophysical outflows into bright, dense, and collimated jets due to magnetic pressure is here investigated using laboratory experiments. Here we look at the impact on jet collimation of a misalignment between the outflow, as it stems from the source, and the magnetic field. For small misalignments, a magnetic nozzle forms and redirects the outflow in a collimated jet. For growing misalignments, this nozzle becomes increasingly asymmetric, disrupting jet formation. Our results thus suggest outflow/magnetic field misalignment to be a plausible key process regulating jet collimation in a variety of objects from our Sun’s outflows to extragalatic jets. Furthermore, they provide a possible interpretation for the observed structuring of astrophysical jets. Jet modulation could be interpreted as the signature of changes over time in the outflow/ambient field angle, and the change in the direction of the jet could be the signature of changes in the direction of the ambient field. Mass outflow is a common process in astrophysical objects. Here the authors investigate in which conditions an astrophysically-scaled laser-produced plasma flow can be collimated and evolves in the presence of a misaligned external magnetic field.

The objective of this study was to evaluate the efficacy of an in-service, short-term training program in improving the attitudes toward, and readiness and activities for collaboration among community health workers (CHWs) in a primary care setting in the Philippines. A randomized controlled trial was adopted dividing participants into an intervention (n = 42) and a control group (n = 39). Attitudes toward, and readiness and activities for collaboration were measured using three standardized scales before and at 6 months after the training. A significant difference (p < 0.001) was observed in the Attitudes Toward Health Care Teams Scale (ATHCTS) scores between pre- and post-test in the intervention (6.3 ± 8.3 [Mean ± SD]) and control groups (0.7 ± 8.2). Multivariate linear regression analysis showed an independent positive association between the intervention and greater improvement in the ATHCTS score (Coefficient β = 6.17; 95% CI = 0.82, 11.53; p = 0.03) at follow-up, after adjustment for age, years in current occupation, and social support role of participants. The results demonstrated the efficacy of the intervention for improving the attitudes of CHWs toward collaborative practice in the care of older adults.

Background A growing number of older adults require complex care, but coordination among professionals to provide comprehensive and high-quality care is perceived to be inadequate. Opportunities to gain the knowledge and skills important for interprofessional collaboration in the context of geriatric care are limited, particularly for those already in the workforce. A short-term training programme in interprofessional collaboration for health and social care workers in the Philippines was designed and pilot tested. The programme was devised following a review of the literature about geriatric care education and group interviews about training needs. The objectives of this paper are to introduce the training programme and to evaluate its influence on attitudes and readiness to collaborate among participants using both quantitative and qualitative methodologies. Methods A total of 42 community health workers and 40 health institution workers participated in the training in July 2019. Quantitative indicators were used to evaluate attitudes towards and readiness for collaboration before and after the training. Content analysis was performed of responses to open-ended questions asking participants to evaluate the training. A convergent parallel mixed-methods design was applied to determine the patterns of similarities or differences between the quantitative and qualitative data. Results Significant improvements were seen in scores on the Attitudes Towards Health Care Teams Scale among community health ( P  < 0.001) and health institution ( P  < 0.001) staff after the training. Scenario-based case studies allowed participants to work in groups to practise collaboration across professional and institutional boundaries; the case studies fostered greater collaboration and continuity of care. Exposure to other professionals during the training led to a deeper understanding of current practices among health and social care workers. Use of the scenario-based case studies followed by task-based discussion in groups was successful in engaging care professionals to provide patient-centred care. Conclusions This pilot test of in-service training in interprofessional collaboration in geriatric care improved community and health institution workers’ attitudes towards such collaboration. A 3-day training attended by health and social care workers from diverse healthcare settings resulted in recommendations to enhance collaboration when caring for older adults in their current work settings.

Background Childhood disability remains a lowly prioritized and funded international health concern in the world today. Exacerbated by poverty, a lack of bureaucratic support, and societal discrimination, rehabilitation services are not readily accessible for Filipino families who happen to have a child with disability. This article intends to determine the perceived barriers of Filipino service users when it comes to accessing rehabilitation services for children with special needs in Cagayan de Oro City and to propose suggestions to improve the access to rehabilitation services from an international health perspective. Methods The study utilized the four‐phased Q methodology, a mixed‐method research design with an exploratory sequential approach: (1) creating and validating the Q‐sort statements, (2) Q‐sorting administration, (3) factor analysis, and (4) interpreting factors. Results After going through the four phases of Q methodology, the following factors, called “viewpoints” emerged: systemic discrimination based on differences in culture and ethnicity (Viewpoint 1), socioeconomic factors such as affordability and accessibility (Viewpoint 2), and predisposed health beliefs and lack of trust to health professionals (Viewpoint 3). Discussion Barriers to accessing rehabilitation services in the Philippines go beyond the lack of individual resources. These perceived barriers can be mitigated by employing participatory and collaborative approaches in developing rehabilitation programs for children and their families, viable strategies such as integrating telehealth in the rehabilitation process, and cultural competence in recognizing folkloric beliefs as a way to build trust toward health‐care professionals. Conclusion This article determined contextualized barriers when accessing health and rehabilitation services based on service users themselves, which in turn hopes to promote inclusive, justice‐oriented, and culturally focused rehabilitation services underpinned by international health principles. Children with special needs and their access to rehabilitation services in the Philippines: A Q methodology study on perceived barriers by family members.

In order to evaluate the impact of atmospheric pollutants emitted by the industrial settlement of Milazzo (Italy) on agriculture, sulphur dioxide and ozone levels in air were monitored and the data were used to estimate yield losses of the most widespread cultures. Trace element concentrations in crops and soils were also detected and metabolic profiles of soil microbial communities were considered. Vibrio fischeri test was used to appraise airborne pollutant ecotoxicity and epidemiological studies on causes of death distribution were carried out to characterize health state of people living in the area. All the sampling points were selected in farms on the basis of a theoretical meteo-diffusive model of industrial air pollutants. Experimental SO₂ and O₃ values mainly exceeded the threshold established by Italian and EU regulations to protect vegetation and they correspond to estimated significant crop losses. Conversely toxic element residues in soils and in agroalimentary products were generally lower than the fixed values. SO₂ and O₃ concentrations, toxic element contents and ecotoxicity levels of airborne pollutants were not related only to industrial site emissions, while the fluctuations on metabolic profiles of soil microbial communities seem to agree with the predicted deposition of xenobiotic compounds from the industrial plants. The epidemiological study evidenced a better health state of populations living in the investigated area than in the Messina province and the Sicily region but, inside the area, males living in the municipalities closest to the industrial settlement exhibited a worst health state than those in the very far ones.

Although bipolar jets are seen emerging from a wide variety of astrophysical systems, the issue of their formation and morphology beyond their launching is still under study. Our scaled laboratory experiments, representative of young stellar object outflows, reveal that stable and narrow collimation of the entire flow can result from the presence of a poloidal magnetic field whose strength is consistent with observations. The laboratory plasma becomes focused with an interior cavity. This gives rise to a standing conical shock from which the jet emerges. Following simulations of the process at the full astrophysical scale, we conclude that it can also explain recently discovered x-ray emission features observed in low-density regions at the base of protostellar jets, such as the well-studied jet HH 154.

The structure and dynamics of young stellar object (YSO) accretion shocks depend strongly on the local magnetic field strength and configuration, as well as on the radiative transfer effects responsible for the energy losses. We present the first 3D YSO shock simulations of the interior of the stream, assuming a uniform background magnetic field, a clumpy infalling gas, and an acoustic energy flux flowing at the base of the chromosphere. We study the dynamical evolution and the post-shock structure as a function of the plasma-beta (thermal pressure over magnetic pressure). We find that a strong magnetic field (~hundreds of Gauss) leads to the formation of fibrils in the shocked gas due to the plasma confinement within flux tubes. The corresponding emission is smooth and fully distinguishable from the case of a weak magnetic field (~tenths of Gauss) where the hot slab demonstrates chaotic motion and oscillates periodically.

In classical T Tauri stars (CTTS) strong shocks are formed where the accretion funnel impacts with the denser stellar chromosphere. Although current models of accretion provide a plausible global picture of this process, some fundamental aspects are still unclear: the observed X-ray luminosity in accretion shocks is order of magnitudes lower than predicted; the observed density and temperature structures of the hot post-shock region are puzzling and still unexplained by models. To address these issues we performed 2D MHD simulations describing an accretion stream impacting onto the chromosphere of a CTTS, exploring different configurations and strengths of the magnetic field. From the model results we then synthesized the X-ray emission emerging from the hot post-shock, taking into account the local absorption due to the pre-shock stream and surrounding atmosphere. We find that the different configurations and strengths of the magnetic field profoundly affect the hot post-shock properties. Moreover the emerging X-ray emission strongly depends also on the viewing angle under which accretion is observed. Some of the explored configuration are able to reproduce the observed features of X-ray spectra of CTTS.