RAM-SCB simulations of electron transport and plasma wave scattering during the October 2012 "double-dip" storm.

Mechanisms for electron injection, trapping, and loss in the near-Earth space environment are investigated during the October 2012 "double-dip" storm using our ring current-atmosphere interactions model with self-consistent magnetic field (RAM-SCB). Pitch angle and energy scattering are included for the first time in RAM-SCB using L and magnetic local time (MLT)-dependent event-specific chorus wave models inferred from NOAA Polar-orbiting Operational Environmental Satellites (POES) and Van Allen Probes Electric and Magnetic Field Instrument Suite and Integrated Science observations. The dynamics of the source (approximately tens of keV) and seed (approximately hundreds of keV) populations of the radiation belts simulated with RAM-SCB is compared with Van Allen Probes Magnetic Electron Ion Spectrometer observations in the morning sector and with measurements from NOAA 15 satellite in the predawn and afternoon MLT sectors. We find that although the low-energy (E< 100 keV) electron fluxes are in good agreement with observations, increasing significantly by magnetospheric convection during both SYM-H dips while decreasing during the intermediate recovery phase, the injection of high-energy electrons is underestimated by this mechanism throughout the storm. Local acceleration by chorus waves intensifies the electron fluxes at E≥50 keV considerably, and RAM-SCB simulations overestimate the observed trapped fluxes by more than an order of magnitude; the precipitating fluxes simulated with RAM-SCB are weaker, and their temporal and spatial evolutions agree well with POES/Medium Energy Proton and Electron Detectors data.

Prescribing practices in psychiatric hospitals in Eastern Europe.

BACKGROUND: There has been no evidence about the prescribing practices in psychiatric care in Eastern Europe. AIMS: To examine the patterns of psychotropic prescribing in five countries of Eastern Europe. METHOD: We conducted a one-day census of psychiatric treatments used in eight psychiatric hospitals in Albania, Croatia, Macedonia, Serbia and Romania. We examined clinical records and medication charts of 1304 patients. RESULTS: The use of polypharmacy was frequent across all diagnostic groups. Only 6.8% of patients were on monotherapy. The mean number of prescribed drugs was 2.8 (SD 0.97) with 26.5% receiving two drugs, 42.1% receiving three drugs and 22.1% being prescribed four or more psychotropic drugs. Typical antipsychotics were prescribed to 63% and atypical antipsychotics to 40% of patients with psychosis. Older generations of antidepressants were prescribed to 29% of patients with depression. Anxiolitic drugs were prescribed to 20.4% and benzodiazepines to 68.5% of patients. One third of patients received an anticholinergic drug on a regular basis. CONCLUSIONS: Older generation antipsychotics and antidepressants were used more frequently than in the countries of Western Europe. Psychotropic polypharmacy is a common practice. There is a need for adopting more evidence-based practice in psychiatric care in these countries.

Validation of two survey diagnostic interviews among primary care attendees: a comparison of CIS-R and CIDI with SCAN ICD-10 diagnostic categories.

BACKGROUND: The most widely used survey measures in psychiatry, the Composite International Diagnostic Interview (CIDI) and the Clinical Interview Schedule-Revised (CIS-R) have generated estimates of psychiatric morbidity that show considerable variation. Doubts have been raised regarding the validity of these structured lay interviewer assessments. There have been no direct comparisons of the performances of these instruments against a common, established criterion. METHOD: A total of 105 unselected primary care attendees were each interviewed with CIDI, CIS-R and SCAN in a single sitting with random order of administration. SCAN was administered by a SCAN trained psychiatrist, and CIDI and CIS-R by a public health doctor. Concordance was estimated for all ICD-10 neurotic disorders. We assessed the overall discriminability of the CIS-R morbidity scale using a receiver operating characteristic (ROC) analysis. RESULTS: The concordance for CIDI for ICD-10 diagnoses was moderate to excellent (kappa= 0.58-0.97). Concordance for CIS-R ranged between poor and moderate (kappa = 0.10-0.65). The area under the ROC curve for the CIS-R morbidity scale with respect to any ICD-10 disorder [0.87 (95% CI 0.79-0-95)] indicated good overall discriminability, but poor sensitivity (44%) and high specificity (97%) at the usual CIS-R cut-point of 11/12. CONCLUSION: Among primary care attendees the CIDI is a highly valid assessment of common mental disorders, and the CIS-R is moderately valid. Previous studies may have underestimated validity. Against the criteria of all ICD-10 diagnoses (including less severe depressive and anxiety disorders) a much lower CIS-R cut-point is required than that which is usually advocated.