Subpacket structure in strong VLF chorus rising tones: characteristics and consequences for relativistic electron acceleration.

Van Allen Probes in situ observations are used to examine detailed subpacket structure observed in strong VLF (very low frequency) rising-tone chorus elements observed at the time of a rapid MeV electron energization in the inner magnetosphere. Analysis of the frequency gap between lower and upper chorus-band waves identifies f ceEQ, the electron gyrofrequency in the equatorial wave generation region. Initial subpackets in these strong chorus rising-tone elements begin at a frequency near 1/4 f ceEQ and exhibit smooth gradual frequency increase across their > 10 ms temporal duration. A second much stronger subpacket is seen at frequencies around the local value of 1/4 f ce with small wave normal angle (< 10°) and steeply rising df/dt. Smooth frequency and phase variation across and between the initial subpackets support continuous phase trapping of resonant electrons and increased potential for MeV electron acceleration. The total energy gain for individual seed electrons with energies between 100 keV and 3 MeV ranges between 2 and 15%, in their nonlinear interaction with a single chorus element.

Initiation and Termination of Massive Transfusion Protocols: Current Strategies and Future Prospects.

The advent of massive transfusion protocols (MTP) has had a significant positive impact on hemorrhaging trauma patient morbidity and mortality. Nevertheless, societal MTP guidelines and individual MTPs at academic institutions continue to circulate opposing recommendations on topics critical to MTPs. This narrative review discusses up-to-date information on 2 such topics, the initiation and termination of an MTP. The discussion for each begins with a review of the recommendations and supporting literature presented by MTP guidelines from 3 prominent societies, the American Society of Anesthesiologists, the American College of Surgeons, and the task force for Advanced Bleeding Care in Trauma. This is followed by an in-depth analysis of the main components within those recommendations. Societal recommendations on MTP initiation in hemorrhaging trauma patients emphasize the use of retrospectively validated massive transfusion (MT) prediction score, specifically, the Assessment of Blood Consumption and Trauma-Associated Severe Hemorrhage scores. Validation studies have shown that both scoring systems perform similarly. Both scores reliably identify patients that will not require an MT, while simultaneously overpredicting MT requirements. However, each scoring system has its unique advantages and disadvantages, and this review discusses how specific aspects of each scoring system can affect widespread applicability and statistical performance. In addition, we discuss the often overlooked topic of initiating MT in nontrauma patients and the specific tools physicians have to guide the MT initiation decision in this unique setting. Despite the serious complications that can arise with transfusion of large volumes of blood products, there is considerably less research pertinent to the topic of MTP termination. Societal recommendations on MTP termination emphasize applying clinical reasoning to identify patients who have bleeding source control and are adequately resuscitated. This review, however, focuses primarily on the recommendations presented by the Advanced Bleeding Care in Trauma's MTP guidelines that call for prompt termination of the algorithm-guided model of resuscitation and rapidly transitioning into a resuscitation model guided by laboratory test results. We also discuss the evidence in support of laboratory result-guided resuscitation and how recent literature on viscoelastic hemostatic assays, although limited, highlights the potential to achieve additional benefits from this method of resuscitation.

Observations of the step-like accelerating processes of cold ions in the reconnection layer at the dayside magnetopause.

Cold ions of plasmaspheric origin have been observed to abundantly appear in the magnetospheric side of the Earth's magnetopause. These cold ions could affect the magnetic reconnection processes at the magnetopause by changing the Alfvén velocity and the reconnection rate, while they could also be heated in the reconnection layer during the ongoing reconnections. We report in situ observations from a partially crossing of a reconnection layer near the subsolar magnetopause. During this crossing, step-like accelerating processes of the cold ions were clearly observed, suggesting that the inflow cold ions may be separately accelerated by the rotation discontinuity and slow shock inside the reconnection layer.