Search

Electromagnetic ion cyclotron (EMIC) waves play important roles in particle loss processes in the magnetosphere. Determining the evolution of EMIC waves as they propagate and how this evolution affects wave-particle interactions requires accurate knowledge of the wave vector, k. We present a technique using the curl of the wave magnetic field to determine k observationally, enabled by the unique configuration and instrumentation of the Magnetospheric MultiScale (MMS) spacecraft. The wave curl analysis is demonstrated for synthetic arbitrary electromagnetic waves with varying properties typical of observed EMIC waves. The method is also applied to an EMIC wave interval observed by MMS on October 28, 2015. The derived wave properties and k from the wave curl analysis for the observed EMIC wave are compared with the Waves in Homogenous, Anisotropic, Multi-component Plasma (WHAMP) wave dispersion solution and with results from other single- and multi-spacecraft techniques. We find good agreement between k from the wave curl analysis, k determined from other observational techniques, and k determined from WHAMP. Additionally, the variation of k due to the time and frequency intervals used in the wave curl analysis is explored. This exploration demonstrates that the method is robust when applied to a wave containing at least 3-4 wave periods and over a rather wide frequency range encompassing the peak wave emission. These results provide confidence that we are able to directly determine the wave vector properties using this multi-spacecraft method implementation, enabling systematic studies of EMIC wave k properties with MMS.

AimTo assess the associations between demographic and clinical characteristics and sensor glucose metrics in young children with type 1 diabetes, using masked, continuous glucose monitoring data from children aged 2 to < 8 years.Research design and methodsThe analysis included 143 children across 14 sites in the USA, enrolled in a separate clinical trial. Eligibility criteria were: age 2 to 10.0 mmol/l) and a median of ~1 h/day in hypoglycaemia (

Electromagnetic ion cyclotron (EMIC) waves at large L shells were observed away from the magnetic equator by the Magnetospheric MultiScale (MMS) mission nearly continuously for over four hours on 28 October 2015. During this event, the wave Poynting vector direction systematically changed from parallel to the magnetic field (toward the equator), to bidirectional, to antiparallel (away from the equator). These changes coincide with the shift in the location of the minimum in the magnetic field in the southern hemisphere from poleward to equatorward of MMS. The local plasma conditions measured with the EMIC waves also suggest that the outer magnetospheric region sampled during this event was generally unstable to EMIC wave growth. Together, these observations indicate that the bidirectionally propagating wave packets were not a result of reflection at high latitudes but that MMS passed through an off-equator EMIC wave source region associated with the local minimum in the magnetic field.

We report global observations of high-m poloidal waves during the recovery phase of the 22 June 2015 magnetic storm from a constellation of widely spaced satellites of five missions including Magnetospheric Multiscale (MMS), Van Allen Probes, Time History of Events and Macroscale Interactions during Substorm (THEMIS), Cluster, and Geostationary Operational Environmental Satellites (GOES). The combined observations demonstrate the global spatial extent of storm time poloidal waves. MMS observations confirm high azimuthal wave numbers (m ~ 100). Mode identification indicates the waves are associated with the second harmonic of field line resonances. The wave frequencies exhibit a decreasing trend as L increases, distinguishing them from the single-frequency global poloidal modes normally observed during quiet times. Detailed examination of the instantaneous frequency reveals discrete spatial structures with step-like frequency changes along L. Each discrete L shell has a steady wave frequency and spans about 1 RE , suggesting that there exist a discrete number of drift-bounce resonance regions across L shells during storm times.

We present a statistical study of dipolarization fronts (DFs), using magnetic field data from MMS and Cluster, at radial distances below 12 RE and 20 RE , respectively. Assuming that the DFs have a semicircular cross section and are propelled by the magnetic tension force, we used multispacecraft observations to determine the DF velocities. About three quarters of the DFs propagate earthward and about one quarter tailward. Generally, MMS is in a more dipolar magnetic field region and observes larger-amplitude DFs than Cluster. The major findings obtained in this study are as follows: (1) At MMS ∼57 % of the DFs move faster than 150 km/s, while at Cluster only ∼35 %, indicating a variable flux transport rate inside the flow-braking region. (2) Larger DF velocities correspond to higher Bz  values directly ahead of the DFs. We interpret this as a snow plow-like phenomenon, resulting from a higher magnetic flux pileup ahead of DFs with higher velocities.

We report on field-aligned current observations by the four Magnetospheric Multiscale (MMS) spacecraft near the plasma sheet boundary layer (PSBL) during two major substorms on 23 June 2015. Small-scale field-aligned currents were found embedded in fluctuating PSBL flux tubes near the separatrix region. We resolve, for the first time, short-lived earthward (downward) intense field-aligned current sheets with thicknesses of a few tens of kilometers, which are well below the ion scale, on flux tubes moving equatorward/earthward during outward plasma sheet expansion. They coincide with upward field-aligned electron beams with energies of a few hundred eV. These electrons are most likely due to acceleration associated with a reconnection jet or high-energy ion beam-produced disturbances. The observations highlight coupling of multiscale processes in PSBL as a consequence of magnetotail reconnection.

The ionosphere is the only region of the terrestrial magnetosphere-ionosphere system where in situ observations with high temporal resolution and approaching global spatial scale are possible. Ionospheric measurements of magnetic fields with such spatiotemporal coverage have become available from the Active Magnetosphere and Planetary Electrodynamics Response Experiment, combining data from the Iridium® satellites. Motivated by the emergence of this data set, we report here on the first results of assimilation of low-altitude ionospheric magnetic perturbations into the Lyon-Fedder-Mobarry (LFM) global magnetospheric model coupled with the Rice Convection Model (RCM). Our assimilation approach relies on the assumption of a quasi-steady, linear approximate relation between equatorial magnetospheric pressure and ionospheric Region 2 field-aligned currents. This approximation is implemented numerically by perturbing large-scale modes from the Fourier decomposition of equatorial magnetospheric pressures and computing responses of the corresponding modes in the ionospheric magnetic field. This methodology was validated by using model-based assimilation tests of the so-called "fraternal twins" type. In this approach, the LFM-RCM model with one set of parameters is used to generate synthetic observations, while a model version with different parameters is used to assimilate the ionospheric observations and calculate the magnetospheric pressure corrections which are then applied to reproduce the synthetic observations. The model with assimilated synthetic data responded correctly by modifying ionospheric currents and magnetic perturbations in the expected way. We thus found the approach proposed herein to be promising for future assimilation of real data.

Objective: The study objective was to evaluate how the use of a pervasive blood glucose monitoring (BGM) technology relates to glycemic control, report of self-care behavior, and emotional response to BGM of children with type 1 diabetes and their parents.Research Design and Methods: Forty-eight children aged less than 12 years (mean 8.8 years) with type 1 diabetes were randomly assigned to one of two study groups, a control group (conventional care without technology) or an experimental group (conventional care with technology), and followed for 12 months. Families in the experimental group were given the Automated Diabetes Management System (ADMS), which automatically collects blood glucose (BG) values and sends to parent(s) a 21-day BG trending report via e-mail each night. Measures of glycemic control (HbA(1c)) were collected at baseline and at quarterly diabetes clinic visits; BGM effect and diabetes self-care behavior measures were obtained at the baseline, 6-month, and 12-month visits.Results: Children in the experimental group had significantly (P = 0.01) lower HbA(1c) at 12 months (7.44 ± 0.94, -0.35 from baseline) than controls (8.31 ± 1.24, +0.15 from baseline). Improvement in HbA(1c) was more profound in families using the ADMS more frequently. In addition, in these families, parents showed a significant improvement in BGM effect (P = 0.03) and children became more meticulous in diabetes self-care (P = 0.04). Children in both experimental and control groups experienced no change in their emotional response to BGM.Conclusions: Using the ADMS 1-3 times/week may help children with type 1 diabetes improve glycemic control and gain diabetes self-management skills, as well as improve the BGM effect of parents. [ABSTRACT FROM AUTHOR]

OBJECTIVE To update and validate a diabetes-specific screening tool for disordered eating (the Diabetes Eating Problem Survey [DEPS]) in contemporary youth with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 112 youth with type 1 diabetes, ages 13-19 years, completed the DEPS. Higher scores on the DEPS indicate more disordered eating behaviors. Youth and their parents also completed additional surveys to examine diabetes-specific family conflict, negative affect related to blood glucose monitoring, youth quality of life, and diabetes burden. Clinicians provided data on height, weight, A1C, and insulin dosing. The DEPS was revised into a shorter, updated measure and validated. RESULTS The revised 16-item DEPS (DEPS-R) displayed excellent internal consistency (Cronbach's alpha = 0.86). Construct validity was demonstrated by positive correlations with zBMI (P = 0.01), A1C (P = 0.001), diabetes-specific family conflict (P < 0.005), youth negative affect around blood glucose monitoring (P = 0.001), parental diabetes-specific burden (P = 0.0005), and negative correlations with frequency of blood glucose monitoring (P = 0.03) and quality of life (P < or = 0.002). External validity was confirmed against clinician report of insulin restriction. CONCLUSIONS The DEPS-R is a 16-item diabetes-specific self-report measure of disordered eating that can be completed in <10 min. It demonstrated excellent internal consistency, construct validity, and external validity in this contemporary sample of youth with type 1 diabetes. Future studies should focus on using the DEPS-R to identify high-risk populations for prevention of and early intervention for disordered eating behaviors. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a review to assess clinical studies comparing the effectiveness of different means of maintaining central venous catheter patency. Background. Flushing with heparin is a routine part of central venous catheter maintenance, but it presents risks, including heparin-induced thrombocytopenia. Other techniques used to prevent occlusion of catheters include saline flushes, heparin-bonded catheters and pressure caps. Data sources. A search was conducted using the MEDLINE, CINAHL, EMBASE, Cochrane, National Guideline Clearinghouse and University Healthsystem Consortium databases. Methods. A systematic review of effectiveness was conducted, using GRADE criteria to assess the strength of evidence for each intervention. The review period covered 1982 or earlier to January 2008. Results. There is weak evidence that heparin flushing reduces occlusion of catheters, but no evidence that it reduces bloodstream infections. Results from clinical trials of pressure caps are inconsistent regarding their ability to maintain catheter patency, but provide moderate evidence that at least some varieties of caps are associated with increased bloodstream infections. Conclusion. The evidence base on heparin flushing and other interventions to prevent catheter occlusion is small, and published studies are of low quality. There is insufficient evidence on which to conclude that flushing catheters with heparin is more effective than flushing with saline solution. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine social phobia, alcohol use, and drug use in a methadone-maintained (MM) population. We predicted that individuals with social phobia would demonstrate significantly higher rates of drug and alcohol use. The 383 participants were recruited from five MM programs and completed a structured interview that included the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and a 30-day report of substance use.Participants were 53% male, 78.3% Caucasian, with a mean MMTP duration of 153 weeks and 35% of participants met screening criteria for social phobia. Adjusting for possible confounding variables, SP + participants were estimated to be 2.80 (95% CI 1.42-5.52) times more likely to drink at hazardous levels and were also 1.85 (95%CI 1.10-3.12) times more likely to report use of cannabis than SP--participants. Methadone-maintained persons may be using marijuana and/or alcohol to self-medicate social phobia symptoms. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To provide an overview of the use of acupuncture as an adjunct therapy for in vitro fertilization (IVF), including an evidence-based evaluation of its efficacy and safety and an examination of possible mechanisms of action. DESIGN: Literature review using PubMed, the Science Citation Index, The Cochrane Library (Database of Systematic Reviews and Central Register of Controlled Trials), the New England School of Acupuncture library databases, and a cross-referencing of published data, personal libraries, and Chinese medicine textbooks. RESULTS: Limited but supportive evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy. However, this conclusion should be interpreted with caution because most studies reviewed had design limitations, and the acupuncture interventions employed often were not consistent with traditional Chinese medical principles. The reviewed literature suggests 4 possible mechanisms by which acupuncture could improve the outcome of IVF: modulating neuroendocrinological factors; increasing blood flow to the uterus and ovaries; modulating cytokines; and reducing stress, anxiety, and depression. CONCLUSIONS: More high-quality randomized, controlled trials incorporating placebo acupuncture controls, authentic acupuncture interventions, and a range of outcome measures representative of both clinical outcomes and putative mechanistic processes are required to better assess the efficacy of acupuncture as an adjunct for IVF. [ABSTRACT FROM AUTHOR]

The association of depression and successful smoking cessation efforts is inconsistent. We test the hypothesis that higher levels of depression complicate efforts to quit smoking in a methadone-maintained (MM) population offered nicotine replacement and a brief behavioral intervention. We recruited 383 participants from 2/02 to 5/04; 340 (88.8%) were assessed at follow- up. Current depressive symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ). Participants were 53% male, 78% Caucasian, with a mean MM duration of 153 weeks. Twenty-seven percent met PDSQ screening criteria for Major Depressive Disorder (MDD). Participants with higher levels of depressive symptoms were significantly less likely to set a quit date (p = .02) but depression was not associated significantly with motivation to quit smoking at baseline, time to first cigarette, or any behavioral indicator of smoking during the follow-up period. Depressive symptoms have little influence on smoking cessation outcomes in this population. [ABSTRACT FROM AUTHOR]

Active surveillance for laboratory-confirmed Salmonella serotype Enteritidis (SE) infection revealed a decline in incidence in the 1990s, followed by an increase starting in 2000. We sought to determine if the fluctuation in SE incidence could be explained by changes in foodborne sources of infection. We conducted a population-based case-control study of sporadic SE infection in five of the Foodborne Diseases Active Surveillance Network (FoodNet) sites during a 12-month period in 2002-2003. A total of 218 cases and 742 controls were enrolled. Sixty-seven (31%) of the 218 case-patients and six (1%) of the 742 controls reported travel outside the United States during the 5 days before the case's illness onset (OR 53, 95% CI 23-125). Eighty-one percent of cases with SE phage type 4 travelled internationally. Among persons who did not travel internationally, eating chicken prepared outside the home and undercooked eggs inside the home were associated with SE infections. Contact with birds and reptiles was also associated with SE infections. This study supports the findings of previous case-control studies and identifies risk factors associated with specific phage types and molecular subtypes. [ABSTRACT FROM AUTHOR]

Self-care behavior is the foundation of diabetes treatment, and much diabetes self-care behavior takes place within the family system. Moreover, family relationships both affect and are affected by the self-care behavior of the adult member with diabetes. Researchers need to focus on how transitions in adult development impact the self-care behavior of patients and the coping of family members. In addition, illness-specific measures of family interactions related to self-care behaviors are needed in the study of adults with diabetes. [ABSTRACT FROM AUTHOR]

PURPOSE OF REVIEW: This review explores progress in developmental pharmacokinetics, pharmacogenomics and formulations of analgesic agents, and discusses potential implications for pain therapy. RECENT FINDINGS: Characterization of the developmental pharmacokinetics of morphine, tramadol, paracetamol and nonsteroidal anti-inflammatory drugs has improved dosing in children. Oral sugar solutions have replaced the brandy/sugar pacifier and are effective for single painful events in neonates. Intravenous paracetamol offers increased dosing accuracy, and avoids absorption and bioavailability variability. New nitric-oxide-releasing versions of paracetamol and nonsteroidal anti-inflammatory drugs offer safer alternatives to their parent drugs with enhanced potency. Ketamine has come under a cloud for its possible effects on the neonatal developing brain, but it is being used increasingly in children to supplement opioids for pain after major surgery. Hopes that morphine analgesia may improve neurological outcome in premature babies have not materialized. Reports concerning chronic pain are generally case series and controlled trials are rare and nearly nonexistent in children. SUMMARY: Unlicensed drug use in the very young will increase as familiarity increases. Pharmacogenomic studies have the potential to tailor drug therapy to the individual and decrease between-patient variability. Unfortunately, the pharmacodynamic knowledge in children of analgesic agents remains neglected and is usually extrapolated from adult data. [ABSTRACT FROM AUTHOR]

Despite a growing body of literature on the causes of heavy episodic drinking, little attention has been paid to this phenomenon in the sociological and criminological literature. This research assesses the extent to which a popular theory of crime and deviance, control theory, can explain heavy episodic drinking. Analysis of data collected from a convenience sample of 938 9th, 10th, and 11th grade students shows that attachment to parents, belief in the law, commitment to school, and self-control are all strong predictors of adolescent heavy episodic drinking. Thus, control theory contributes to a more comprehensive understanding of adolescent heavy episodic drinking. The implications of the control theory notion that social integration is a deterrent to heavy episodic drinking are discussed. [ABSTRACT FROM AUTHOR]

This retrospective descriptive study was done to determine if the Geriatric Functional Rating Scale (GFRS) can be used as an objective measure of a resident's need for a higher level of care in a continuing care retirement community (CCRC). A total of 290 of the 300 available independent living residents in a CCRC underwent assessment with the GFRS. At the end of the study period (February 2000 through December 2003), 84% of those who initially had a score of >/=40 were still living independently (alone or with a spouse), of those scoring 20 to <40, 11% were living independently, 40% required some assistance, and 20% entered a Long-Term Care Facility (LTC). Of those scoring <20 initially, none were living independently at the end of the study period. GFRS scores of >/=40 seemed to correlate with continued independence and <40 with an increasing need for assistance. The GFRS provides a functional database on each resident and may be a good objective predictor of future level of care. The sensitivity and specificity of GFRS scores <40 were 42% and 96%, respectively, for either admission to a facility or death. The positive predictive value was 87% and the negative predictive value was 72%. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study was undertaken to determine if alcohol use is associated with sexual risk taking among human immunodeficiency virus (HIV)-infected persons. METHODS: Cross-sectional interviews of 262 HIV-infected patients in the Brown University AIDS Program were performed. Factors associated with any sexual activity, unsafe sexual activity, and a 4-fold typology of sexual risk were examined. Alcohol measures included drinking days, drinks per drinking day, binge drinking, and hazardous alcohol use. RESULTS: The sample was 58% male and 40% white; 67% of patients were self-identified as heterosexual, and 48% drank alcohol. Nearly two thirds of patients reported sexual activity in the past 6 months, with 38% reporting unprotected sex during that period. All measures of alcohol use were significantly associated with any sexual activity and with unsafe sexual behavior. As an example, controlling for age, HIV transmission risk, marital status, and HIV clinical indicators, hazardous drinkers were 5.64 times more likely to report unprotected sex and have multiple partners (p < 0.01) than were those not drinking at hazardous levels. CONCLUSIONS: A high proportion of HIV-infected persons were sexually active and having unsafe sex. Alcohol, at all levels of use, was associated with increased sexual risk taking. [ABSTRACT FROM AUTHOR]

Despite the well-established health hazards associated with cigarette smoking, research indicates that many smokers underestimate their personal susceptibility to these health risks. Previous studies have examined this discrepancy, but validation of measures is lacking. The purpose of this investigation was to develop and validate a measure of smokers' perceptions of their own smoking-related health consequences. The Smokers' Perceived Health Risk Evaluation (SPHERE) was administered at baseline to 255 smokers recruited for a cessation trial at two methadone maintenance treatment programs in Providence, Rhode Island. The scale consisted of two 3-item subscales each demonstrating good to excellent internal consistency reliability: Smoking-Related Health (alpha = .66) and Smoking-Related Risk (alpha = .87). The subscales correlated with common smoking-related pulmonary symptoms, previous treatment for smoking-related illnesses, the physical health functioning scale of the SF-12, and participants' perceived importance of a cessation intervention. The SPHERE is a reliable instrument that captures unique dimensions of smokers' health expectancy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to present the psychometric properties of a new tool for evaluating affective response to blood glucose monitoring (BGM) in youths with type 1 diabetes and their parents.Research Design and Methods: Study participants included 153 youths with type 1 diabetes and their parents. Each youth and parent completed the Blood Glucose Monitoring Communication (BGMC) questionnaire, Diabetes Family Conflict Scale, and Pediatric Quality of Life Inventory. Statistical analyses evaluated the psychometric properties of the BGMC questionnaires and their association with glycemic outcomes.Results: Youth and parent BGMC questionnaires had acceptable internal consistency (youth, alpha = 0.77; parent, alpha = 0.82) and 1-year test-retest reliability (youth, r = 0.60; parent, r = 0.80). Higher BGMC questionnaire scores (indicating more negative affect) showed a strong association with higher levels of diabetes-specific family conflict (youth, r = 0.33; parent, r = 0.44) and poorer health-related psychosocial quality of life (youth, r = -0.50; parent, r = -0.42). Higher BGMC questionnaire scores were also associated with poorer glycemic control (youth, r = 0.28; parent, r = 0.20), even when the effects of diabetes-specific family conflict and psychosocial quality of life were controlled. Youths with BGMC questionnaire scores in the upper quartile had A1c values 1 percentage point higher (9.1%) than youths with scores in the lowest quartile (8.0%).Conclusions: The BGMC questionnaires have strong psychometric properties and are convenient measures of affect specific to BGM. Further, BGM affect is associated with glycemic outcomes and may provide a unique contribution to factors associated with glycemic control in youths. [ABSTRACT FROM AUTHOR]

PURPOSE The purpose of this analysis was to determine whether present National Federation of State High School Associations (NFHS) guidelines adequately prevent and control outbreaks of primary herpes gladiatorum (HG) in high-school wrestlers. METHODS: Using telephone interviews, direct physical examinations, and review of medical charts, data were collected on HG outbreaks among participating teams in the 1999 Minnesota State High School League (MSHSL) wrestling season and on HG outbreaks for 3 yr at a 28-d summer wrestling camp. RESULTS: The outbreak during the 1999 MSHSL wrestling season involved 61 wrestlers and three coaches on 19 teams over 42 d, with a 32.7% probability of transmission to sparring partners. Typical length of time from exposure to outbreak varied from 4 to 11 d with an average of 6.80 +/- 1.70 d. Analysis of data from three outbreaks at a 28-d wrestling camp showed that most outbreaks (96%) occurred on the ventral surface of the body, with 71.9% on the head, face, and neck, areas in direct contact when wrestlers are engaged in the lock-up position. Analysis of data from the 2001 camp outbreak showed that the locations of the lesions reflected the handedness of the wrestler. CONCLUSION: The NFHS guidelines are inadequate to prevent and control outbreaks of HG. The focus of preventive efforts needs to change from mat cleanliness to more rapid detection of outbreaks by requiring culture results and appropriate therapy for all suspected bacterial and herpes lesions before allowing return to contact. To minimize and control spread of HG, treatment and isolation should be implemented based not only on vesicle formation but also on systemic signs and symptoms. [ABSTRACT FROM AUTHOR]

Objective: To evaluate self-report and parent proxy report of child/teen general quality of life in youth with type 1 diabetes, compare their responses with those of a general pediatric population, and identify relationships between diabetes management, diabetes-related family behavior, and diabetes-specific family conflict with quality of life in youth with type 1 diabetes.Research Design and Methods: Study participants included 100 children, 8-17 years of age (12.1 +/- 2.3), with type 1 diabetes for 0.5-6 years (2.7 +/- 1.6). Each child and a parent completed the Pediatric Quality of Life Inventory (PedsQL), completed the Diabetes Family Conflict Scale, and provided data on parent involvement in diabetes management. An independent measure of adherence to treatment assessed by the patient's clinician and a measure of glycemic control (HbA(1c)) were also collected.Results: PedsQL responses from youth with type 1 diabetes were stable over 1 year and similar to norms from a healthy standardization sample for all three scales of the PedsQL: total, physical, and psychosocial quality of life. After controlling for age, duration of diabetes, sex, HbA(1c), and family involvement, child report of diabetes-specific family conflict (P < 0.01) was the only significant predictor of child report of quality of life (model R(2) = 0.21, P < 0.02).Conclusions: Youth with type 1 diabetes report remarkably similar quality of life to a nondiabetic youth population. Greater endorsement of diabetes-specific family conflict predicted diminished quality of life for the child. As treatment programs focus on intensifying glycemic control in youth with type 1 diabetes, interventions should include efforts to reduce diabetes-specific family conflict in order to preserve the child's overall quality of life. [ABSTRACT FROM AUTHOR]