The diversity of collimated outflows in post-asymptotic-giant-branch stars and their planetary nebula progeny are often explained by a combination of close binary interactions and accretion. The viability of such scenarios can be tested by comparing kinematic outflow data to determine minimum accretion rates necessary to power observed outflows. While many binary channels have been ruled out with this technique, common envelope interactions can accommodate the current observational constraints, are potentially common, lead to a diverse array of planetary-nebula shapes, and naturally produce period gaps for companions to white dwarfs.

The diversity of collimated outflows in post-asymptotic-giant-branch stars and their planetary nebula progeny are often explained by a combination of close binary interactions and accretion. The viability of such scenarios can be tested by comparing kinematic outflow data to determine minimum accretion rates necessary to power observed outflows. While many binary channels have been ruled out with this technique, common envelope interactions can accommodate the current observational constraints, are potentially common, lead to a diverse array of planetary-nebula shapes, and naturally produce period gaps for companions to white dwarfs.

This article reports on the planning, development, and implementation of a large national Internet-based panel study of how Americans are coping with the terrorist attacks of September 11, 2001. The study was designed to determine predictors and correlates of risk and resilience, both cross-sectionally and longitudinally. In order to acquire timely and meaningful data, we developed/adapted an extensive set of measures, obtained human subjects approval, and posted a research Web site just 17 days after the attacks. This article describes the major hurdles we confronted and the guidelines we recommend regarding these topics, including the methodological trade-offs inherent in Internet-based research, information technology requirements and tribulations, human subjects issues, selection of measures and securing permission for their use, and the challenges of participant recruitment. We also discuss issues that we did not anticipate, including the survey intervention. We focus not on findings, but on the concrete procedural, administrative, technical, and scientific challenges we encountered and the solutions we devised under considerable time and resource pressures.

We report on direct numerical simulations of two-dimensional, horizontally periodic Rayleigh–Bénard convection between free-slip boundaries. We focus on the ability of the convection to drive large-scale horizontal flow that is vertically sheared. For the Prandtl numbers ($\mathit{Pr}$) between 1 and 10 simulated here, this large-scale shear can be induced by raising the Rayleigh number ($\mathit{Ra}$) sufficiently, and we explore the resulting convection for $\mathit{Ra}$ up to $10^{10}$. When present in our simulations, the sheared mean flow accounts for a large fraction of the total kinetic energy, and this fraction tends towards unity as $\mathit{Ra}\rightarrow \infty$. The shear helps disperse convective structures, and it reduces vertical heat flux; in parameter regimes where one state with large-scale shear and one without are both stable, the Nusselt number of the state with shear is smaller and grows more slowly with $\mathit{Ra}$. When the large-scale shear is present with $\mathit{Pr}\lesssim 2$, the convection undergoes strong global oscillations on long timescales, and heat transport occurs in bursts. Nusselt numbers, time-averaged over these bursts, vary non-monotonically with $\mathit{Ra}$ for $\mathit{Pr}=1$. When the shear is present with $\mathit{Pr}\gtrsim 3$, the flow does not burst, and convective heat transport is sustained at all times. Nusselt numbers then grow roughly as powers of $\mathit{Ra}$, but the growth rates are slower than any previously reported for Rayleigh–Bénard convection without large-scale shear. We find that the Nusselt numbers grow proportionally to $\mathit{Ra}^{0.077}$ when $\mathit{Pr}=3$ and to $\mathit{Ra}^{0.19}$ when $\mathit{Pr}=10$. Analogies with tokamak plasmas are described.

Objective: To determine how home hospice patients deal with their impending death and whether there is a need for greater involvement of mental health professionals in the care of patients dying at home.

Method: In a pilot study, 12 female home hospice patients with advanced cancer and a median survival time of 42 days were assessed using structured interviews and brief questionnaires. Topics of inquiry included facing death, fear of death, pain, fatigue, depression, and anxiety. Three key themes were extracted from the information reported by the women: (1) confronting the issue of death, (2) fear of dying and death and its correlates, and (3) spirituality/religious faith and its role in mitigating fear of death.

Results: First, all subjects reported thinking about their approaching death. For half of them, this thought was bothersome and these women were frequently troubled by unresolved issues and higher anxiety, pain, and fatigue. The majority of the subjects expressed a desire to actively discuss their impending death. Second, more than half of the patients reported being afraid of death and high death anxiety was associated with fear of dying in pain, high peak or usual pain, unresolved issues, and difficulty in parting with family in death. Third, most subjects experienced their religious faith as an important source of comfort and strength.

Significance of results: A substantial subgroup of home hospice patients expressed problems dealing with their approaching death. These problems are amenable to psychological treatment, such as fear of death, unresolved issues, parting with family, and pain. The findings, thus, highlight the need for close collaboration of mental health professionals with home hospice institutions.

Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.

The study reported by Marks et al is of considerable importance, since it is the largest clinical trial to date comparing the combination of a benzodiazepine and behaviour therapy to either component alone, and the first combined treatment trial to use alprazolam as the pharmacological agent. It was an ambitious project that was apparently well run, and the findings should be of wide interest. However, the potential value of the study is limited by the method, the patient sample, and the analysis and presentation of the data.