Performance of Major Flare Watches from the Max Millennium Program (2001-2010)

The physical processes that trigger solar flares are not well understood and significant debate remains around processes governing particle acceleration, energy partition, and particle and energy transport. Observations at high resolution in energy, time, and space are required in multiple energy ranges over the whole course of many flares in order to build an understanding of these processes. Obtaining high-quality, co-temporal data from ground- and space- based instruments is crucial to achieving this goal and was the primary motivation for starting the Max Millennium program and Major Flare Watch (MFW) alerts, aimed at coordinating observations of all flares >X1 GOES X-ray classification (including those partially occulted by the limb). We present a review of the performance of MFWs from 1 February 2001 to 31 May 2010, inclusive, that finds: (1) 220 MFWs were issued in 3,407 days considered (6.5% duty cycle), with these occurring in 32 uninterrupted periods that typically last 2-8 days; (2) 56% of flares >X1 were caught, occurring in 19% of MFW days; (3) MFW periods ended at suitable times, but substantial gain could have been achieved in percentage of flares caught if periods had started 24 h earlier; (4) MFWs successfully forecast X-class flares with a true skill statistic (TSS) verification metric score of 0.500, that is comparable to a categorical flare/no-flare interpretation of the NOAA Space Weather Prediction Centre probabilistic forecasts (TSS = 0.488).Comment: 19 pages, 2 figures, accepted for publication in Solar Physic

Storing high moisture crops, including silage in plastic bags

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Performance of Major Flare Watches from the Max Millennium Program (2001 – 2010)

The physical processes that trigger solar flares are not well understood and significant debate remains around processes governing particle acceleration, energy partition, and particle and energy transport. Observations at high resolution in energy, time, and space are required in multiple energy ranges over the whole course of many flares in order to build an understanding of these processes. Obtaining high-quality, co-temporal data from ground- and space- based instruments is crucial to achieving this goal and was the primary motivation for starting the Max Millennium program and Major Flare Watch (MFW) alerts, aimed at coordinating observations of all flares ≥X1 GOES X-ray classification (including those partially occulted by the limb). We present a review of the performance of MFWs from 1 February 2001 to 31 May 2010, inclusive, that finds: (1) 220 MFWs were issued in 3,407 days considered (6.5% duty cycle), with these occurring in 32 uninterrupted periods that typically last 2-8 days; (2) 56% of flares ≥X1 were caught, occurring in 19% of MFW days; (3) MFW periods ended at suitable times, but substantial gain could have been achieved in percentage of flares caught if periods had started 24 h earlier; (4) MFWs successfully forecast X-class flares with a true skill statistic (TSS) verification metric score of 0.500, that is comparable to a categorical flare/no-flare interpretation of the NOAA Space Weather Prediction Centre probabilistic forecasts (TSS = 0.488)

How Do Practitioners Perceive Assurance Cases in Safety-Critical Software Systems?

Safety-critical software systems are those whose failure or malfunction could result in casualty and/or serious financial loss. In such systems, safety assurance cases (SACs) are an emerging approach that adopts a proactive strategy to produce structuralized safety justifications and arguments. While SACs are recommended in many software-intensive safety-critical domains, the lack of knowledge regarding the practitioners' perspectives on using SACs hinders effective adoption of this approach. To gain such knowledge, we interviewed nine practitioners and safety experts who focused on safety-critical software systems. In general, our participants found the SAC approach beneficial for communication of safety arguments and management of safety issues in a multidisciplinary setting. The challenges they faced when using SACs were primarily associated with (1) a lack of tool support, (2) insufficient process integration, and (3) scarcity of experienced personnel. To overcome those challenges, our participants suggested tactics that focused on creating direct safety arguments. Process and organizational adjustments are also needed to streamline SAC analysis and creation. Finally, our participants emphasized the importance of knowledge sharing about SACs across software-intensive safety-critical domains

The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis

Background : Healthcare workers (HCWs) are considered at elevated risk of experiencing mental health disorders in working with patients with COVID-19. Objective : To estimate the prevalence of common mental health disorders in HCWs based in hospitals where pandemic-affected patients were treated. Method : Databases were searched for studies published before 30 March 2020. Quantitative synthesis was used to obtain estimates of the prevalence of mental health disorders in four time windows, determined a priori (the acute phase, i.e. during and up to 1.5 months post-pandemic; 1.5–5.9 months; 6–11.9 months; 12 months and later). Results : Nineteen studies met the review criteria. They predominantly addressed the acute phase of the SARS outbreak in Asia. The most studied outcomes were clinically significant post-traumatic stress symptoms (PTSS) and general psychiatric caseness. For clinically significant PTSS in the acute phase, the prevalence estimate was 23.4% (95% CI 16.3, 31.2; N = 4147; I2 = 96.2%); in the 12 months plus window, the estimate was 11.9% (8.4, 15.8; N = 1136; I2 = 74.3%). For general psychiatric caseness, prevalence estimates were acute phase, 34.1% (18.7, 51.4; N = 3971; I2 = 99.1%); 6–12 months, 17.9% (13.1, 23.2; N = 223; I2 = 0.0%); 12 months plus, 29.3% (6.0, 61.0; N = 710; I2 = 97.8%). No differences between doctors and nurses with respective to PTSS and general psychiatric caseness were apparent in the acute phase. Conclusions : Mental health disorders are particularly common in HCWs working with pandemic-afflicted patients immediately following a pandemic, but the course of disorders following this period is poorly understood. There was considerable heterogeneity between studies, likely linked to methodological differences. More extended follow up of HCWs is needed

Hydrological summary for the United Kingdom: November 2023

The monthly summary of hydrological conditions in the United Kingdom is compiled as part of the National Hydrological Monitoring Programme (a joint UKCEH and BGS enterprise). The report features contemporary data for rainfall, river flow, reservoir and groundwater levels in the form of maps and graphs. A commentary is provided on the status of the nation’s water resources and any notable hydrological events during the month. The National River Flow and National Groundwater Level Archives help provide an historical context for these contemporary assessments. Financial support for the production of the Hydrological Summaries is provided by Defra, the Environment Agency, the Scottish Environment Protection Agency, the Rivers Agency in Northern Ireland and the Office of Water Services

Evidence regarding clinical use of microvolt T-wave alternans

Background: Microvolt T-wave alternans (MTWA) testing in many studies has proven to be a highly accurate predictor of ventricular tachyarrhythmic events (VTEs) in patients with risk factors for sudden cardiac death (SCD) but without a prior history of sustained VTEs (primary prevention patients). In some recent studies involving primary prevention patients with prophylactically implanted cardioverter-defibrillators (ICDs), MTWA has not performed as well. Objective: This study examined the hypothesis that MTWA is an accurate predictor of VTEs in primary prevention patients without implanted ICDs, but not of appropriate ICD therapy in such patients with implanted ICDs. Methods: This study identified prospective clinical trials evaluating MTWA measured using the spectral analytic method in primary prevention populations and analyzed studies in which: (1) few patients had implanted ICDs and as a result none or a small fraction (≤15%) of the reported end point VTEs were appropriate ICD therapies (low ICD group), or (2) many of the patients had implanted ICDs and the majority of the reported end point VTEs were appropriate ICD therapies (high ICD group). Results: In the low ICD group comprising 3,682 patients, the hazard ratio associated with a nonnegative versus negative MTWA test was 13.6 (95% confidence interval [CI] 8.5 to 30.4) and the annual event rate among the MTWA-negative patients was 0.3% (95% CI: 0.1% to 0.5%). In contrast, in the high ICD group comprising 2,234 patients, the hazard ratio was only 1.6 (95% CI: 1.2 to 2.1) and the annual event rate among the MTWA-negative patients was elevated to 5.4% (95% CI: 4.1% to 6.7%). In support of these findings, we analyzed published data from the Multicenter Automatic Defibrillator Trial II (MADIT II) and Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) trials and determined that in those trials only 32% of patients who received appropriate ICD therapy averted an SCD. Conclusion: This study found that MTWA testing using the spectral analytic method provides an accurate means of predicting VTEs in primary prevention patients without implanted ICDs; in particular, the event rate is very low among such patients with a negative MTWA test. In prospective trials of ICD therapy, the number of patients receiving appropriate ICD therapy greatly exceeds the number of patients who avert SCD as a result of ICD therapy. In trials involving patients with implanted ICDs, these excess appropriate ICD therapies seem to distribute randomly between MTWA-negative and MTWA-nonnegative patients, obscuring the predictive accuracy of MTWA for SCD. Appropriate ICD therapy is an unreliable surrogate end point for SCD

Efficacy of lisdexamfetamine dimesylate throughout the day in children and adolescents with attention-deficit/hyperactivity disorder:results from a randomized, controlled trial

Lisdexamfetamine dimesylate (LDX) is a long-acting, prodrug stimulant therapy for patients with attention-deficit/hyperactivity disorder (ADHD). This randomized placebo-controlled trial of an optimized daily dose of LDX (30, 50 or 70 mg) was conducted in children and adolescents (aged 6–17 years) with ADHD. To evaluate the efficacy of LDX throughout the day, symptoms and behaviors of ADHD were evaluated using an abbreviated version of the Conners’ Parent Rating Scale-Revised (CPRS-R) at 1000, 1400 and 1800 hours following early morning dosing (0700 hours). Osmotic-release oral system methylphenidate (OROS-MPH) was included as a reference treatment, but the study was not designed to support a statistical comparison between LDX and OROS-MPH. The full analysis set comprised 317 patients (LDX, n = 104; placebo, n = 106; OROS-MPH, n = 107). At baseline, CPRS-R total scores were similar across treatment groups. At endpoint, differences (active treatment − placebo) in least squares (LS) mean change from baseline CPRS-R total scores were statistically significant (P < 0.001) throughout the day for LDX (effect sizes: 1000 hours, 1.42; 1400 hours, 1.41; 1800 hours, 1.30) and OROS-MPH (effect sizes: 1000 hours, 1.04; 1400 hours, 0.98; 1800 hours, 0.92). Differences in LS mean change from baseline to endpoint were statistically significant (P < 0.001) for both active treatments in all four subscales of the CPRS-R (ADHD index, oppositional, hyperactivity and cognitive). In conclusion, improvements relative to placebo in ADHD-related symptoms and behaviors in children and adolescents receiving a single morning dose of LDX or OROS-MPH were maintained throughout the day and were ongoing at the last measurement in the evening (1800 hours)

Microvolt T-Wave Alternans and the Risk of Death or Sustained Ventricular Arrhythmias in Patients With Left Ventricular Dysfunction

ObjectivesThis study hypothesized that microvolt T-wave alternans (MTWA) improves selection of patients for implantable cardioverter-defibrillator (ICD) prophylaxis, especially by identifying patients who are not likely to benefit.BackgroundMany patients with left ventricular dysfunction are now eligible for prophylactic ICDs, but most eligible patients do not benefit; MTWA testing has been proposed to improve patient selection.MethodsOur study was conducted at 11 clinical centers in the U.S. Patients were eligible if they had a left ventricular ejection fraction (LVEF) ≤0.40 and lacked a history of sustained ventricular arrhythmias; patients were excluded for atrial fibrillation, unstable coronary artery disease, or New York Heart Association functional class IV heart failure. Participants underwent an MTWA test and then were followed for about two years. The primary outcome was all-cause mortality or non-fatal sustained ventricular arrhythmias.ResultsIschemic heart disease was present in 49%, mean LVEF was 0.25, and 66% had an abnormal MTWA test. During 20 ± 6 months of follow-up, 51 end points (40 deaths and 11 non-fatal sustained ventricular arrhythmias) occurred. Comparing patients with normal and abnormal MTWA tests, the hazard ratio for the primary end point was 6.5 at two years (95% confidence interval 2.4 to 18.1, p < 0.001). Survival of patients with normal MTWA tests was 97.5% at two years. The strong association between MTWA and the primary end point was similar in all subgroups tested.ConclusionsAmong patients with heart disease and LVEF ≤0.40, MTWA can identify not only a high-risk group, but also a low-risk group unlikely to benefit from ICD prophylaxis