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Multi-spacecraft observations of solar energetic particle (SEP) events not only enable a deeper understanding and development of particle acceleration and transport theories but also provide important constraints for model validation efforts. However, because of computational limitations, a given physics-based SEP model is usually best suited to capture a particular phase of an SEP event, rather than its whole development from onset through decay. For example, magnetohydrodynamic (MHD) models of the heliosphere often incorporate solar transients only at the outer boundary of their so-called coronal domain – usually set at a heliocentric distance of 20–30 R⊙. This means that particle acceleration at coronal mass ejection (CME)-driven shocks is also computed from this boundary onwards, leading to simulated SEP event onsets that can be many hours later than observed, since shock waves can form much lower in the solar corona. In this work, we aim to improve the modelled onset of SEP events by inserting a “fixed source” of particle injection at the outer boundary of the coronal domain of the coupled WSA–Enlil 3D MHD model of the heliosphere. The SEP model that we employ for this effort is Solar Energetic Particle MODel (SEPMOD), a physics-based test-particle code based on a field line tracer and adiabatic invariant conservation. We apply our initial tests and results of SEPMOD’s fixed-source option to the 2021 October 9 SEP event, which was detected at five well-separated locations in the inner heliosphere – Parker Solar Probe, STEREO-A, Solar Orbiter, BepiColombo, and near-Earth spacecraft.

The dynamics of vortex ring pairs in the homogeneous nonlinear Schrödinger equation is studied. The generation of numerically exact solutions of traveling vortex rings is described and their translational velocity compared to revised analytic approximations. The scattering behavior of co-axial vortex rings with opposite charge undergoing collision is numerically investigated for different scattering angles yielding a surprisingly simple result for its dependence as a function of the initial vortex ring parameters. We also study the leapfrogging behavior of co-axial rings with equal charge and compare it with the dynamics stemming from a modified version of the reduced equations of motion from a classical fluid model derived using the Biot-Savart law. [ABSTRACT FROM AUTHOR]

Is a permanent injury more likely to elicit a rating of inappropriate care than a temporary injury? To explore this question, we asked 112 practicing anesthesiologists to judge the appropriateness of care in 21 cases involving adverse anesthetic outcomes. The original outcome in each case was classified as either temporary or permanent. The authors then generated a matching alternate case identical to the original in every respect except that a plausible outcome of opposite severity was substituted. The original and alternate cases were randomly divided into two sets and assigned to reviewers who were blind to the intent of the study. The reviewers were asked to rate independently the care in each case as appropriate, less than appropriate, or impossible to judge, based on their personal (implicit) judgment of reasonable and prudent practice. A significant inverse relationship between severity of outcome and judgments of appropriateness of care was observed in 15 (71%) of the 21 matched pairs of cases. Overall, the proportion of ratings for appropriate care decreased by 31 percentage points when the outcome was changed from temporary to permanent and increased by 28 percentage points when the outcome was changed from permanent to temporary. We conclude that knowledge of the severity of outcome can influence a reviewer's judgment of the appropriateness of care. [ABSTRACT FROM AUTHOR]

A double-blind, placebo-controlled, randomized design was used to evaluate the safety and efficacy of transdermal fentanyl citrate for postoperative pain management in 42 healthy adult patients undergoing major shoulder surgery. Transdermal systems rated to deliver fentanyl citrate at a rate of 75 micrograms/h were applied to the skin immediately prior to surgery and worn for 24 hours. Patients in the active group required significantly less morphine than the placebo group during the 24-hour period that systems were in place (0.8 +/- 0.61 vs 1.3 +/- 0.64 mg/h) and for the first 12 hours after removal (0.3 +/- 0.36 vs 0.5 +/- 0.32 mg/h). The incidence of vomiting was more frequent in the active group than in the placebo group (73% vs 30%), and respiratory rate in the active group was lower than in the placebo group during the 13- to 24-hour interval of system application (14 +/- 3 vs 16 +/- 2 breaths per minute). Nevertheless, transdermal fentanyl appears to be safe and effective after orthopedic surgery in healthy adult patients. [ABSTRACT FROM AUTHOR]

The independent prognostic factors affecting survival were assessed in 240 men undergoing treatment for metastatic prostate cancer as part of a randomized clinical trial comparing the gonadotropin releasing hormone analogue Zoladex (goserelin acetate implant) with castration. In a multivariate analysis, the most highly significant predictors were the presence or absence of bone pain, serum testosterone levels, serum alkaline phosphatase levels, and performance status. Patients with all four factors favorable for survival had a 2-year survival rate of 84% as compared with only 8% for patients with none of the four factors favorable for survival. No other factors were significant. A separate analysis of serum testosterone levels revealed that the higher the pretreatment serum testosterone level, the greater the survival rate. Compared with patients with serum testosterone levels less than 6.9 nmol/L, significant differences in survival were observed for patients with serum testosterone levels of 10.4 to 13.9, 13.9 to 17.3, and over 17.3 nmol/L. These results have important implications for the design and analysis of future clinical trials of hormone therapy and for counseling patients regarding the short-term prognosis of their disease. [ABSTRACT FROM AUTHOR]

For the past 3 years, the Committee on Professional Liability of the American Society of Anesthesiologists has been studying records of closed malpractice claims files for anesthesia-related patient injuries. The database of 1004 lawsuits was examined to define the impact of the "standard of care," as judged by a practicing group of anesthesiologists, on the likelihood and amount of financial recovery. We found that payment was made in more than 80% of claims made by patients who were judged to have received substandard anesthetic care. Payment also was made in more than 40% of claims when the anesthesia care was judged to be appropriate. We conclude that in the tort-based system of compensation for anesthesia-related injury, the patient has a high probability of financial recovery for injury caused by substandard care. However, if the anesthesiologist provides appropriate care there is still a greater than 40% chance that payment will be made for the claim of malpractice. [ABSTRACT FROM AUTHOR]

We describe a woman who developed adrenal insufficiency after removal of an apparently nonfunctional adrenal adenoma. She displayed no stigmata of Cushing's syndrome and had normal plasma and urinary cortisol levels. A second patient without clinical findings of Cushing's syndrome also had normal basal steroid levels. This patient displayed partial suppressibility with dexamethasone, had low-normal levels of serum corticotropin, and excreted a low concentration of urinary 17-ketosteroids. She also developed mild adrenal insufficiency after the operation. We believe the adrenal adenomas in these patients secreted enough cortisol to suppress the contralateral adrenal gland but not enough hormone to elevate basal steroid levels. Therefore, we suggest that all patients with adrenal masses be studied with the overnight dexamethasone suppression test rather than basal steroid hormone measurements to detect low levels of autonomous cortisol secretion. In addition, patients with adrenal masses that are not removed surgically should have serial adrenal function tests performed. [ABSTRACT FROM AUTHOR]

Background: The possibility that treatment with tricyclic antidepressants, in the form of dothiepin, might attenuate benzodiazepine withdrawal symptoms was investigated in a double-blind trial.Method: Eighty-seven non-depressed psychiatric out-patients with putative normal dose benzodiazepine dependence had their benzodiazepines reduced in stepwise amounts of 20% of the original dose for eight weeks. The patients were randomised to receive dothiepin (with dosage increasing to 150 mg/day) or placebo as an aid to withdrawal before benzodiazepine reduction and these drugs were taken for four further weeks before being stopped.Results: Fewer patients entered and completed the study than expected and a Type II error was possible in the results. Although there was some evidence of withdrawal symptoms being less marked in those patients allocated to dothiepin this was independent of any antidepressant effect as depression scores were lower in the placebo group in the early phase of withdrawal (P < 0.01). Of those completing the study, greater satisfaction (P = 0.03) was recorded by those who had received dothiepin; no other differences reached statistical significance.Conclusions: Dothiepin (and by implication other tricyclic antidepressants) might have some value in reducing benzodiazepine withdrawal symptoms but does not aid drug withdrawal. [ABSTRACT FROM AUTHOR]

A national task force consisting of members from the American College of Radiology, the American College of Surgeons, and the College of American Pathologists examined the issues surrounding stereotactic core-needle biopsy for occult breast lesions. Their report includes indications and contraindications, informed consent, specimen handling, and management of indeterminate, atypical, or discordant lesions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the tolerance and effectiveness of transdermal estrogen for women with established postmenopausal osteoporosis and vertebral fractures.Design: Double-blind, randomized, placebo-controlled clinical trial lasting 1 year.Setting: Referral-based outpatient clinic.Patients: Seventy-five postmenopausal women, 47 to 75 years of age, with one or more vertebral fractures due to osteoporosis.Interventions: Thirty-nine women received dermal patches delivering 0.1 mg of 17 beta-estradiol for days 1 to 21 and oral medroxyprogesterone acetate for days 11 to 21 of a 28-day cycle. Another 39 women received placebo.Measurements: Bone turnover assessed by biochemical markers and iliac bone histomorphometry; bone loss assessed by serial measurement of bone density; and vertebral fracture rate.Results: Compared with the placebo group, the median annual percentage change in bone mineral density in the estrogen group reflected increased or steady-state bone mineral density at the lumbar spine (5.3 compared with 0.2; P = 0.007), femoral trochanter (7.6 compared with 2.1; P = 0.03), and midradius (1.0 compared with -2.6, P less than 0.001) but showed no significant difference at the femoral neck (2.6 compared with 1.4; P = 0.17). Estrogen treatment uniformly decreased bone turnover as assessed by several methods including serum osteocalcin concentration (median change, -0.35 compared with 0.02 nmol/L; P less than 0.001). Histomorphometric evaluation of iliac biopsy samples confirmed the effect of estrogen on bone formation rate per bone volume (median change, -12.9 compared with -6.2% per year; P = 0.004). Also, 8 new fractures occurred in 7 women in the estrogen group, whereas 20 occurred in 12 women in the placebo group, yielding a lower vertebral fracture rate in the estrogen group (relative risk, 0.39; 95% CI, 0.16 to 0.95).Conclusions: Transdermal estradiol treatment is effective in postmenopausal women with established osteoporosis. [ABSTRACT FROM AUTHOR]

A randomized controlled trial was done to assess the ability of continuing medical education to change physicians' knowledge and behavior in the care of patients with acute myocardial infarction. Patient care practices on eight objectives were audited 6 months before and after physicians completed a 2-hour educational program. Sixty-three physicians from eight randomly selected communities constituted the experimental group and 40 physicians from four similar communities served as controls. The average score for desired care practices over all objectives increased from 48.5% to 60% (p less than 0.001). Three objectives showed significantly greater gains for physicians in the experimental group. The generalizability of these effects was also studied in two additional educational contexts: a multitopic and a unitopic university-based continuing medical education program. Similar significant changes in behavior resulted in both contexts. Significant overall increases in knowledge occurred and persisted for all groups. Continuing medical education can effect changes in physicians' knowledge and care practices that can persist for at least 6 months. [ABSTRACT FROM AUTHOR]

Post Cold War has seen new shifts in security and humanitarian concerns as the vast majority of armed conflicts become internal and ethnic in nature. These have extended the mandate of the United Nations and other multilateral organizations to deal with the international administration of war-torn territories. Third party initiatives to broker and manage peace have played an important role in Bosnia- Herzegovina, Eastern Slovania, Kosovo and East Timor. This book explores the mandates, structure and powers of the international administration of war-torn societies and discusses their effectiveness and the operational, political and normative challenges that arise in the context of these experiences. It reflects on the policy implications of humanitarian interventions and examines recent initiatives taken by states and multinational organizations to enhance the effectiveness and challenges of international administration. This study is divided in two parts. Part 1 examines the conduct of international administration in each of the five principal functional areas: public order and internal security, the resettlement of refugees and internally displaced persons, civil administration, the building of local political institutions, and economic reconstruction and development. Part 2 looks at the major operational, political and normative challenges of territorial administration. [ABSTRACT FROM AUTHOR]

Background: A case is presented describing an association between obsessive-compulsive disorder, tattooing and unusual sexual practices.Method: A single case report.Conclusions: Tattooing and unusual sexual practices are compulsive behaviours associated with the subject's obsessive-compulsive disorder. Such associations have not previously been described in the literature. [ABSTRACT FROM AUTHOR]

Objective: This study compared thought disorder and associated cognitive variables in attention-deficit hyperactivity disorder (ADHD) and schizophrenia.Method: Speech samples of 115 ADHD, 88 schizophrenic, and 190 normal children, aged 8 to 15 years, were coded for thought disorder. A structured psychiatric interview, the WISC-R, the Continuous Performance Test, and the Span of Apprehension task were administered to each child.Results: The ADHD and schizophrenic groups had thought disorder compared with the normal children. However, the subjects with ADHD had a narrower range of less severe thought disorder than did the schizophrenic subjects. The younger children with ADHD and schizophrenia had significantly more thought disorder than did the older children with these diagnoses. IQ, attention, and working memory were associated with thought disorder in the ADHD but not the schizophrenic group.Conclusions: Thought disorder in childhood is not specific to schizophrenia and reflects impaired development of children's communication skills. [ABSTRACT FROM AUTHOR]